Friday, November 11, 2011

Demons in our midst

There are two things, which cannot be attacked in front: ignorance and narrow-mindedness. They can only be shaken by the simple development of the contrary qualities. They will not bear discussion. Lord Acton
Warning: This post has charged particles in it that might disassemble your thoughts and reassemble them into new ideas. The comfortable cocoon of status quo is a prison for all fertile minds.

I got into a quandary the other day. It was tantamount to weighing differences between two philosophical outposts. You know, those irritating stigmata inured into some crystallized substance that prick and prod the conscience from time to time. Yes those very ones!

Anyway, off I went into that dark tunnel of thought with Justitia’s balance in hand, facts of logic and with a hope of some certainty. Ok, maybe a dialog. Or… and hopefully not, inviting disdain.

The word that arrested the moment was this ugly, insincere and very provocative word, Demonization.

Don’t you feel like quitting right now? Oh but you will miss out on all the rants and raves that are to follow. Be a good soldier, and soldier on here with me on this short interlude of purposeful enterprise.

Back in those classic days of yore the word demon was descriptive of the devil. If you did not belong to this or that kind of religion well, then you were in the roaring-fire class of hot trident-carrying demons. Thus proselytizers and their ilk were born to rid you of these horns on your head and the arrowhead tail stuck to your back. No, really! The ancients whispered that in my ear the other day.


As stories go here is one that surfaces quickly with a purpose. As the old Virginia Slim cigarette advertising campaign once said, “We have come a long way baby.”  Oh indeed we have! Thank goodness for the smarts of our most beautiful halves in the gender society, they realized that they were duped by an idea of equality for the wrong reasons. Their cognizance raised fears and with the deluge of reasoned thought, action flowed. And what followed was stemming the rising tide of health risks and lung cancer and determined as a result of the declining use of tobacco by women, and by the way is in tandem with the graphs and numbers found in they’re opposite sex.

As plain as daylight it is comforting to know that people understand that there is, what we euphemistically call an “alpha-particle emission” from a glowing cigarette that is caused by the polonium-210 imbedded in the tobacco leaf and that is part of the cancer-genic potential of the cigarette, not to mention the ketamines etc. but we will leave that for another day. 

Ok maybe they really didn’t know that minor detail about Polonium-210, but they knew something was “rotten in the State of Denmark.” And they took action. Women are wise in general. They do understand concepts faster with their analytical minds! We’ll come back to the ending of this short blurb because we have a few more paragraphs to go before that answer, baby!

In the grunt and sweat of our daily lives, headlines abound on newsstands; newspaper, magazines and they have only one purpose, to get you to pay attention. So when you see a barrage of words against some entity there is some personal, philosophical or political motive behind it. Oh yes the news media wants your eyeballs. They embellish the advertisements to entice you to buy a product that the advertiser wants to sell. Nothing wrong with that, that is the “barter-market” way of life. You pay for the paper and the newspaper people are happy, you pay for the advertised product, when you buy it and the advertisers are happy with the paper for promoting their wares. Neat concept!

But then going back to the headlines that got your attention in the first place, what do we do with them? Those large fonts designed to remain resident in the memory are what provoke and agitate you throughout the day. Those words originate from the nefarious creations of the pundits sitting in the Editor chair and churning out opinions! Words are troubling, when they keep you in a state of discombobulation, kind of like a toothache. Clever and discreetly manipulative, don’t you think?

Why, the other day, words splashed across the newswire proclaiming the ills of the “Big Pharma.” The words themselves appear derogatory, just enough to get your goat, slide under your skin like the “Alien,” and pop into your head creating a colossal headache, or maybe just tickle the alert of your common sense dander. Pharmaceutical Companies are in the game for enriching lives of sick people mostly and also themselves and their shareholders in the process. If their product does not have merit it is not used. To offset the cost of a drug production they have to charge the customer or his/her insurance company the amount they deem right based on their R & D. If they charge too much and the value of the product is limited the doctors refuse to use it.

Case in point is a product called “Provenge” the concept so titillating and juicy of scientific fervor that a scientist would at first blush say, “Wow.” Only as the dust settles and the facts become known, the truth wins. Provenge costs $93,000 per treatment for a four-month extension of survival in a patient with metastatic prostate cancer. Unfortunately the cost/benefit ratio just doesn’t fit today’s fiscal reality. Ok so the company is facing an uncertain future at present. But to cast a wide net and demonize the entire industry is tantamount to crying “fire” in a room full of people to incite fear.

Facts no matter how brazen or how ugly always rear their heads. Truth seeks and finds and supplants the innuendos and falsehoods. Cases like the advent of Adriamycin for Breast cancer, Gleevac for Chronic Myeloid Leukemia, Cisplatin for Lung cancer, Oxaliplatin and Avastin for Ovarian and Colo-rectal cancer are the successes that have transformed medicine against cancer.

Newer techniques of selective antibodies against specific modes of action in cell signaling pathways and targeting specific gene/proteins are presently undergoing trials with hopes riding high. These successes abound in the annals of the “Big Pharma.” but they do not make good fodder for headlines. You would read them on the last column of page 36. (My disclaimer here is that I have no interests to support or vindicate the “Big Pharma.” Only as Joe Friday in Dragnet would say, “Just the facts maam!”). BUT there is a dark side to the Big and Small Pharma too. Really? you ask. Oh yes and here it is. They can and at various points in the cause for promoting a new drug against an old disease, or an old drug against a new "indication," they can and have spruced up, whittled down, amped or simply disregarded the underlying consensus of the real science from the data acquired.

So let me say this with the peaceable conscience that allows comfortable sleep at night and a look at myself in the mirror at daybreak, that corruptive influences do abound in that field too. But you have to look at the real facts, to decipher the real meaning behind the headlines. Are all Pharmas the same, I hope not. One always sets out with the principles of doing good and overtime under some bean-counter, stock price and other pressures take over control. 


And then another flash of photons enters my already narrowed pupils, “Big Oil!” Really? Come on folks. What pray do you fill your station wagons, SUVs or minivans with each morning to get to the other side?  For now there is no other alternative for mass transportation then the use of fossil oil. It is the truth, period! (Disclaimer: Oil companies, and I have no vested interests). Companies such as these serve the people to power their mode of transportation and or heating and air-conditioning etc., for a price of their product usage.

When the day arrives that I can economically, (cheaper and/or more efficient then gas) drive or fly from point A to point B, I will jump at the opportunity. Till then, lets cut this nonsense. Alternate proposed modes of energy don’t have much muscle-power. 

Windmills for instance, harness wind power but only so much, ask T. Boone Pickens who spent $2 billion venturing and lost. A better question is if this is so good, why not each household and every corporation put up a single or a few windmills in their yards and reap free energy from nature? Why not? Besides cost, the problem is none of us really want it in our back yards. As the proposed "Wind Farm" contemplated near the Eastern shore of Nantucket was crushed since it was a distant back yard for a politician.

Even though Cervantes’ Don Quixote would love to lean against those windmills, Sancho Panza would know better, now wouldn’t he? Solar power on the other hand harnesses sun energy but only so much, ask Solyndra a billion dollar enterprise funded by tax-payer money crashed into a rubbled heap of Chapter 7 in less the a year. (King Richard would have cried, “A solar panel, a solar panel, my kingdom for a solar panel”). Well if King Richard would have his way, he could pave his kingdom with solar panels and reap the rewards of free electricity. His subjects would be eternally in his debt. Wouldn't they?

The problem is that they are grossly inefficient at present and the storage process is equally so too. When those processes are improved, the concept can be further developed as long as you and I love the idea of a solar paneled rooftops. Electric cars are another hot item now considered for transportation, a great concept but guess what, to move those turbines that generate the electricity to power that automobile comes from, you guessed it, coal (another fossil fuel). So lets get the facts before we start punching the keyboards and raising our political back hairs to a creepy state of hedgehoginess!

“And each particular hair to stand on end,
Like quills upon the fretful porpentine:” ~Shakespeare


And now of course we have the famed HAI. You know what that is, don’t you? “Hospital Acquired Infection.”  Now, let me get this straight, you think patients actually acquire infections inside the hospital? Right? Well here is the resident truth, infections don’t just blossom, they have an incubation period where they slowly or rapidly insinuate themselves through the body’s defenses. If the patients enter the hospital with a subclinical infection and then that manifests itself during the admission, is that a HAI or not? “Not” you say, because common sense would dictate such a reason, right?

You would be wrong in the eyes of the bean counters. But the bean counters have never figured out that bacteria reside on surfaces of raw vegetables for example Klebsiella on salad surfaces etc. They also have not figured out (or read) medical literature that supports the communal pool of such bugs as MRSA and VRE that exist outside of the hospital environment. (eg. As innocent residents within normally functioning humans – saprophytic alliance between bug and the mucosal membrane) (Or they get buggy from the use of antibiotics used to cure another infection as in Clostridium difficile enterocolitis) It is the weakened immune system or a large enough inoculum that allows the bacteria to proliferate inside the human body.

And yet the stigmata of such a vile occurrence becomes a manifest signal for the payer to deny payments to the hospitals. Is that fair? No, but the issue of fairness in this society, controlled by a federation of dunces,  has long been discarded. As some very self-absorbed individuals would say, “we have determined the cause and we have moved on.”

Similarly, then, with hundreds of millions (Approximately 152,000,000 to be exact) of admissions and treatments rendered in the hospitals all across the United States the powers continue to focus on 85,000 “possible” deaths from mismanagements. That translates to 0.0005%. Not bad odds, Right? (I mean you have a better chance of being maimed or worse killed just driving to the hospital) But no they would have you believe that going to the hospital is like signing your own death certificate.

It is agreed universally that transmission within the hospital inpatients must be kept to a minimum. Expecting a zero occurrence (or zero tolerance as some highly overrated minds might suggest) is expecting too much from the bacteria and viruses that invade humans for their own survival via “touching,” “sneezing” and other assortment of human reflex behaviors. Life forms have a golden predicate in their DNA: To survive! And they will do that under the weakest of all pretexts.

 Adding fuel to this proverbial hospital misdeed fire, listen to this, if you are elderly and have a reason for readmission within a 30-day period or for a similar diagnosis in 90 days then your care would be denied payments for services rendered. How this is portrayed in the drumbeat of the day is that the doctors don’t know what they are doing, or don’t care about the patients, or care only for payments for readmitting.

Really? Ask the poor 80-year old person laden with multiple co-morbidities who is unable to breathe due to his COPD exacerbation or the tired heart that beats slower under duress and starts the cascade of a dammed water load leading to congestive heart failure. Whereas it might take forgetting to take a diuretic one time to an emotionally distraught day the next time to throw the poor heart out of frame. Ask that question at 2 AM on a Saturday morning and then maybe we can talk! Am I bashing concepts here? Yes, with certifiable reason, I hope. Oh, what a web we weave! (Disclaimer: I don’t defend hospitals, doctors, nurses, transporters, housekeeping etc. for any misdeeds).

But if you thought that physicians, the healers, the caregivers, the ones who think and plan against and manage a sick person’s disease are safe from this blossoming art of finger pointing? You would be wrong again. Sorry. There are now people who are trained as professional “patients” to carry out a sting on doctors they deem to be doing wrong things.

Now I do agree that bad people in any walk of life or business, in any profession of any conduct or company must be dealt with strictly. But to make the whole profession quiver under the mighty fist of absolute power is tantamount to subjugation of entire nobility, which seeks only to better and further the cause of human health.

Oh but what do I know? Those with the might and the understanding are all knowing and all purposeful. Indeed that is the lay of today’s landscape. And you might ask, does it not then hurt the patients? Of course it does, the bond and trust between doctor and patient that has been forged, dissipates and in the patient’s eyes his or her doctor is regarded with a narrow-eyed frown of blame and irreverence. Food for thought!

Speaking of food, here is a classic example of fear mongering. Today fish is bad for you because “x” amounts of polynomobolony was found in it, tomorrow however chicken meat has the quadravalent-hypo-banner-crisy in it and therefore not fit for consumption and later of course don’t forget the cows might be prion infested. Sometime in the wake of such generated fear lies the hidden truth of power plays between bigger and mightier players.

The governing bodies have the mandate to determine the source of contamination with alacrity, intellectual prowess and rigid experimentation and recall the offending tainted food to protect the public. But to raise the specter of doom and gloom for all is improper and a disservice. The fish is no different today then it was yesterday and the chicken still tastes good, but the damage is done, to honor a completely different set of reasoning. And lo and behold the industry that produces the product is laid bare to financial destruction, ridicule and ruin. It is also true that sometime a bacterium or virus escapes the hatches in society and finds refuge in humans, animals or plants to survive and flourish.

Assuming causation for the sake of finding fault has its rewards for those seeking it. Thorough and careful investigation, self-critique and preventative measures of such a “jump” are the rightful art and science to pursue and not follow a path to devastate with impunity. In a world populated with 7 billion humans, billions and billions of bacteria and trillions and trillions of viruses, escapes do occur and will occur. Bacteria mutate as do viruses and they do so at a much faster then the semi-plastic thinking of a rigid mind. It takes about 20 minutes for a E Coli bacterium to double in number. 

This growth rate is called the Malthusian Growth model and shows exponential increment based on a binary fission. Thus the rapidly evolving generations will “Evolve” via the DNA guidance for survival by finding mechanisms against them at a much faster rate. Human evolution in self-preservation is slower in spite of the wondrous “Jumping Genes” (Transposons) that we have manifesting within our molecular machinery. But each human generation takes roughly 15-20 years to complete. A much longer time to process and mitigate! Our purpose then must be to find these mutants without assigning some false intangible etiology to them.

Remarkably as concepts of evolution go, the industrial revolution created the new enterprise of productive humans that created cities and roads and homes with air conditioners, refrigerators etc. That lasted a century, ultimately to be replaced by a more modern electronic revolution that limited the foul and thick smoke of yesteryears. This did not happen because of demonizing but steadily by human enterprise and thought.

Just like Marconi’s invention changed the way information traveled from by hand to electrical signals, so to did communication via mails change from a postal service to the ease of free e-mail. This new format now threatens the Postal Service. So the powers that be would love to regulate the free-internet zone so they can reap the fiscal benefits from such a fiat. What Newtonian Physics did for the industrial revolution, the Quantum Physics is poised to do for the electronic revolution.

Oh but I digress. Society is a large component of human intellect and its failing. It receives, processes and determines the rightful action over time without a hammer, a fist or a sickle.



A word about the “Green Revolution.” Everyone seems to be suddenly in love with the color green. Unfortunately the revolution seems to only benefit a select few “Green” people and companies while demonizing the rest of the industrial complex. I believe profligate abuse of litter is reprehensible but forcing shenanigans like “green bulbs,” “green cars” and “green homes” without reference to facts are as much bologna-rich nonsense, don’t you think? The planet from 35,000 feet seems so rich in its foliage and beauty. Interestingly you cannot see a single human down below, or cars for that matter. You do see large industries but without them we would still be rubbing sticks together to forge a fire, now wouldn’t we? Lets think for a moment and make that moment rich with reason.

Preserving nature is a wonderful enterprise without question but a better carefully balanced understanding and explanation will enjoy support rather then brow-beating and demonizing people for barbequing in their backyards on a summer’s Sunday afternoon. Scientists and artists minds both validate truths. Is the green concept then a bad idea. Absolutely not. It is however embedded in dire and consequential fear-mongering that frightens me more.

If "green" is the right thing hen let it stand on its own green legs and it will be a paradigm shifter. The pundits dictate and demonize, but they shy from reverence to facts. Hurling invectives at questioning minds is nothing more than a shrink wrapped, unchanging rigid philosophical construct of little import. I know that if all this goes counter to your imbedded focus that you have probably spit on the computer screen by now and denounced my rants as those of a mad man. But please, just in case there is a kernel of truth, wont you please just give it a thought?

Now we come to the trebuchets being fired at the citizens with high fences. The class warfare is in full force. Why? The rich are demonized for their success in life. That is akin to saying that if a good student got an A in class then everyone else should also get an A, otherwise the results are deemed as skewed and that success should be granted to all. There must be no failures in society. Really? Where oh where is the incentive then to succeed and become that unreasonable person to change the world?

Unfortunately the failings of a few bad people make for a great drama for the media circus to revile the many. And in today’s world we cannot and must not with words or action hurt the fragile senses of any lazy individual. Even with my limited resources, I was able to find some information that is readily available to anyone who can point and click.

2010 facts and figures on taxes paid:

Bottom 20% paid MINUS -3.9% or they received some IRS compensation
Next 20% paid MINUS -4.3% so they too got paid for being poor
Next 20% (average salary $44,000) paid 3.9% or $1 of every $25 they earned.
Next 20% (average salary $58,000-$102,000) paid 15.1% or $1 of every $7 earned.
Last 19.9% (average salary - $1 million) paid 16.4% or $1 of every $6 earned.
And the very ultra last 0.1% (average salary $1.9 million) paid 16.5% or $1 of $6 earned.

 Based on USA Today 70% of all taxes are paid by the top 10% wage earners. Okay simplified enough! So before we go hurling fireballs of venom and vitriol let us keep a cool head filled with the truth and not animus. The rich get rich because of hard work. They create industries out of thin air and employ millions. Should we really make them the evil monsters? Look around, your job depends on one of them. If you work for the Government then, the taxpaying rich or poor, hard working stiff also pays your salary. The Government does not create wealth, now does it? And if it does, it does so by printing money, which really destroys wealth through devaluation of currency and inflation anyway. Oops, sorry, I digressed again.

Getting back to the Virginia Slims cigarettes, they are being sold for cheap over the Internet because the understanding and knowledgeable public knows the addictive risks of cigarette smoking. The makers of these cigarettes might get so deprived of the consumer dollar that they will get starved out of existence and that would be good riddance. No demonizing needed here. Human understanding is a resourceful ingenuity.

In the game of demonization all it takes is a motive and a voice. The rest as they say becomes “history!”
  
Rightly to be great is not to stir without great argument,
But greatly to find quarrel in a straw when honor’s at the stake. ~Shakespeare

by Parvez Dara, MD FACP
Twitter: @JediPD

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