The Occasional Perspective

Opinions and Reflections 

The Health Of The World – If one listens to the news on a daily basis, one could become increasingly anxious. And, that’s happened to me. Anxious about what? There are so many fronts, it’s hard to ratchet down to just a few items but as I consider what we are facing in the world, I naturally tend to use my “healthcare” lens as a framework for evaluating, considering, and devising solutions. So, bear with me as I try to make sense of my “feelings” on several issues we are facing throughout the world. But, before I provide my outline of issues, just know that I’m quite middle of the road because I sincerely believe that most of our nation's problems have been solved through a compromise where both sides meet in the middle to an acceptable solution. Back in the late ’60s when buildings were being occupied and, in some cases, destroyed – I shared with many of my friends over coffee that “the solution to our problems was not by throwing or breaking down walls but was accomplished by building things one brick at a time.” I still feel that way today.                    

• The Israeli-Palestinian War – First, the slaughter of 2700 innocent civilians on October 7, 2023, just north of Gaza was an abomination!! However, the reciprocal slaughter of over 28,000 Palestinian civilians (as of February 23, 2023) and the push to displace them into Rafa with no resources is causing further widespread illness and death. While we all can abhor the initial incursion into Israel, we should all hold the same consideration for Palestine which is becoming an equivalent abomination!! As we enter the four-year political cycle in the USA, it is clear to me that any way you cut it, the war in Palestine will become a central issue. However, you can do something that will help. Instead of your usual contribution to your favorite charity, consider adding to it or shifting some of it over by contributing to Doctors Without Borders. This is a group that is making a difference and helping people in dire need of medical and health assistance. It’s a small gesture but lots of little small gestures make a difference. Consider it.
• The Rise of Authoritarianism – The move by leaders toward adopting an authoritarian approach to leadership is taking hold throughout the world. If you look at this type of leadership, it tends to evolve during periods when there is broad angst in the populace. Whether it is Brazil, Hungary, China (via “the Party”), Russia, Nicaragua, or the USA – it ultimately is not a viable model for nations. It’s been proven over and over across the centuries. And, the USA is no exception. Forget about all of the lawsuits – a narcissistic, authoritarian approach in our country will not long succeed.
• The Seeming Demise of a Functional National Legislative Body (at least in the USA) – What can I say, I’m disappointed on all sides. Our nation has so many problems that need to be resolved from immigration to infrastructure to education to whatever your favorite issue is – that the he-said-she-said-they-said discourse of the US Congress is more than disconcerting.
• The Boomer Stress on Society – We older folks (my 73^rd birthday is this month) are stressing society. And, it’s a phenomenon that is coming to head throughout the world…now I thank FDR and all who followed him that made Social Security, Medicare, Medicaid, Obamacare, and all of the other programs a reality. For the last bunch of decades, I delivered health care and complained about the insurance companies, drug prices, etc. but went about my business. I never really used health care; however. And, within the last year, I feel like on track to become a super-user 😊. But, I also realize that there are a whole bunch of super-users out there like me who are consuming more and more resources that are slowly eking away resources for younger folks like support for grammar schools, college education, child and daycare, community infrastructure, and a host of other societal demands. So, we need to look at what can done to mitigate the costs so that equity abounds throughout the nation for all generations!
• The Drug Crisis Sweeping Across America – Too many of us live in cocoons where the availability of illicit drugs does not seem to be a problem. Alcohol maybe but, not fentanyl. But, if we go down the street or out into the community or into the rural areas of our nation – it’s a big problem!! It’s a “health” problem. But, it’s not just the illegal and illicit drugs, it’s also the increasing legal drugs (SEE commentary below on “cannabis”) that are of concern – as well as, the cost of pharmaceutical drugs. In some cases, they are not just more costly but “exorbitantly” more costly. This is fueled – in my estimation – by the US Congress’s decision that does not allow for competitive negotiations with the drug companies on behalf of *Care, *Caid, *Veterans Care; and, other federally-managed programs. We – the healthcare people – need to be much more active in working to solve these problems.
• The Meaning of a Professional in an AI/ML Era – And, finally, I come to the question of what does it mean to be a “professional”? I’m an absolute fan of AI, ML, GenAI, whatever NextAI is, and all of the other technology “solutions” that are emanating like rain in a downpour. At the same time, we are NOT training our clinicians on how to effectively evaluate, adopt, train on, implement, utilize, and evaluate again the rapid evolutionary developments within the healthcare field. The healthcare professions – medicine, nursing, pharmacy, physical therapy, social work, laboratory workers, etc. – need to be much more proactively educated, and training on the effective implementation and use of these tools are part of our armamentarium. And, we are not!! For the health of the country, this has got to change AND it will require a wholesale reconsideration of how, what, where and when we provide education on these tools and resources. But, I digress…

Anyway, those are just a few of the HEALTH CARE ISSUES that we need to be considering – not in the future but, now!! There have been prior revolutions: the Neolithic (which took 5,000 years) and the Industrial (which took two centuries) that caused massive disruptions in society. However, we are now at a pivot point with the latest revolution – the advent of the Digital (which will take only a couple of decades AND, we are only halfway through it). Now is the time to wake up, Consider the healthcare concerns that are embedded in these areas and figure out what we – as committed healthcare professionals – can do to mitigate the problems. Just consider it for a moment at least…

Opinions and Reflections 

Our Ongoing Evolution – I was driving back from Boston recently when I was cogitating about an article I had read in the January 20-26, 2024 issue of New Scientist, a weekly publication on “all things science”. There was this very interesting article on efforts at the Chinese Academy of Sciences in Beijing to clone rhesus monkeys. As you may recall, Dolly – the sheep – was the first announced cloning of a mammalian species in 1996. Subsequently, there have been many efforts in laboratories around the world. In fact, there’s a team in South Korea that has evidently cloned more than 1500 dogs although with a relatively low 4% success rate. When they heard this, my two pups – Toto = (Toren Torme) (age 9) and Lole (= Locklein Leigh) (age 6) expressed some minor degree of concern and but quickly let me know that they wanted to go for a walk…

As for the monkeys, the research started in 1999 with the first success reported in 2022 but the cloned monkey soon died. More recently – through a whole series of refinements in the process – the researchers have been successful in closing a live monkey from “fetal” cells but cloning from “adult” cells has not yet worked (Whew!!). So, are we on the cusp of creating genetic duplicates of ourselves? Not yet, say the scientists. However, when I got home, I read then an article on the use of CRISPR by Vertex Pharmaceutical which has become the first entity to receive regulatory approval in both the US and UK for treating sickle cell anemia – a devastating, genetic disease. So, it appears that we are on the cusp of treating a range of genetic (for beginners) diseases using CRISPR technology for snipping bad genes out and replacing them with good genes to solve a problem.

As I pondered these two developments, it occurred to me that we are on the cusp (not immediate) of potentially developing technology for altering the evolution of our species. The Neanderthal-Sapiens divergence occurred about 650,000 years ago with Neanderthal’s dying out due to their inability to effectively compete. While some of us have some residual Neanderthal genes, the bulk of the human race today is comprised of Homo Sapiens (“Wise Man”) genes. So, the question that evolved in my brain was: What if through genetic manipulation, scientists were able to alter the genetic code of Homo Sapiens to create Novus Sapiens or, “New Man.” Despite all of the assurances by existing scientists that such a move would be “…completely unacceptable…” I strongly suspect – given my knowledge of the human race – that somewhere, sometime, someone of the Homo Sapiens code will step forward and decide it is “completely acceptable”. Hmmm. And, we will go from 650,000 years for the completion of the evolutionary cycle of Homo Sapiens to Novus Sapiens in perhaps a couple of decades. The good part is that I will not be around to try and make it work…

What do you think? Am I simply becoming paranoid? Or rather, senile?

The State of the State – A new report from the Brennan Center for Justice was recently released describing the intimidation – both direct through in-your-face assaults and indirect through online-and-virtual threats – occurring with USA public officials. It is fostering fear and anxiety among those who we have brought on board to manage all of our governmental functions across the board from health care to transportation to enforcement…pick your favorite area!! As a result, the report reveals it is making these leaders and officials less likely to participate in public events that are focused on policy changes where blowback is occurring, in making policy changes, or even in running for office. According to the report, 40% of state legislators surveyed reported being threatened or attacked in the last three years. And, just as importantly, 90% reported suffering from intimidation, harassment, stalking and other forms of abusive behavior. And, it runs all the way to the public officials who are staffing our voting booths this coming November with 1 in 5 new to their position. Who is training the trainer? So, where does this type of behavior emanate from and why are we tolerating it? …Hmmmm – let me guess…

Books and Articles worth a Review…

In keeping with the analysis above, I would also highly recommend that you all listen to Leonard Cohen and his rendition of Anthem. He starts with “…ring the bells that can still ring…forget your perfect offering…there is a crack in everything…that’s how the light gets in. It will make you stop and think…” It will definitely make you stop and think!

Opinions and Reflections

The Health Of The World – As we enter the annual holiday period, it’s always a time of reflection. From my perspective it’s been a rough couple of months. I usually discuss the health of the community and how we can improve it. However, it seems that we also need to consider the health of the world. First, there was the invasion of Ukraine by Russia that started the day after my birthday on February 24, 2022, then there was the Hamas incursion into Israel with the equally aggressive incursion into Gaza as a response of the Israeli military, and then in Maine we had the mass shooting in Lewiston. I then had the opportunity to travel to France for a meeting and we decided to spend a bit of time in Paris. While there, we walked all over the city only to come upon a protest of more than 100,000 people who marched through the city in protest against rising antisemitism that has raised its ugly head in the wake of Israel’s ongoing war against Hamas in Gaza. It was a striking protest because of the nature of it. There were no shouts, there were no chants, there were no signs. It was a protest of more than 100,000 people walking in silence through the main streets of Paris. It evoked considerable emotion as we watched – in silence – as the seemingly endless stream of people walked by…it was attended by representations of multiple parties both left, centrists and conservatives as a call to rise up against “the unbearable resurgence of unbridled antisemitism.” As one 67-year-old man in the march put it, “It's a march against violence, against antisemitism, against all (political extremes) that are infiltrating the society, to show that the silent majority does exist.”

I – like many of you – am increasingly concerned about the state of our country, of all the nations among the nations of the world – and, of the world, more generally. It occurs to me that it is time for “the silent majority” to speak up – for the health of the world!! If we don’t, the extremes on either side of the equation will capture the bullhorn and control the discourse. Then, I listened to a Ted Radio Hour presentation by Barbara Walter, Ph.D, (not the TV personality) a Professor of Political Science at the University of California at San Diego. Her assessment is captured in the following segment that…

All Democracies Are Fragile – The podcast [AN ABSOLUTELY MANDATORY “LISTEN”) starts off with notes on the fact that we are facing more civil wars around the world than at any previous time in the recent history. As a result of this analysis, the USA Central Intelligence Agency (CIA) convened a research group of civil war experts and information analysts to collaborate in identifying the major factors for the preponderance of civil wars throughout the world. Two factors were identified based on the group’s work. The first factor was the formation of an anocracy or, a “partial democracy”. The example given in the Ted Talk was the current Hungarian democracy where elections are held but where the opposition is jailed, the media controlled, and societal information managed by the existing power. The second identified factor was the presence of social conflicts between self-identified groups e.g. Black vs. White, Catholic vs. Protestant, Democrat vs. Republican and the like. It’s where the extremes of both sides are trying to control the social narrative.

But, the analysis showed that there was one country missing from the analysis. Guess which one? Yes, of course – the United States of America.  It was noted that in 2016 there was an economic downgrade by all the major banks in the world due to problems with the election monitors and concerns that the elections were free but not fair. Second, in 2019 the White House refused to hand over information on the election. And, in 2020, the White House actively tried to overturn the results of the elections. These three events would have placed the USA on the watch list; however, the CIA cannot do any work inside the United States so the researchers simply took note of the fact that the USA is at risk but not on the list. Now…that was a disturbing podcast to hear as well.

So, it seems that the health of the nation is in need of preventive maintenance as well. I suspect that the answer lies in the vast majority of silent voters to take note, speak up, and support a different direction. The major looming question is whether or not we will do that…

Where We Get Our Information – A recent report in Axios is also a bit disturbing because it seems – from my perspective – to support the notion that society has experienced a loss in the sense of “community”. The study – conducted at Northeastern University – projects that by the end of 2024 about one-third (1/3) of the 8,891 newspapers in the USA will have been lost. In addition, more than 80% of the newspapers published in the USA are weekly and not daily. The essence of the study is that we are increasingly reliant upon fewer sources of information – especially news about our community, the people and the places we know. So, the question is: Are we losing our sense of community? Couple this question with the above information on the projection of civil wars throughout the world and we have the nidus for a major problem emanating from the embers of discontent that exist throughout the USA…