My Ten American Holiday Wishes

It is juvenile to make wishes and even more so to believe they might come true. It is especially puerile for me to hope that my particular list of holiday wishes will actually come to fruition. But it is that time of year when we permit ourselves a degree of fantastical thinking and a smidgen of youthful optimism. So here are my dreams:

1.  I want to see the return of honesty. I await the day when people will be truthful in their deeds and words. This requires deep self-reflection on all our parts so when we say or do something we come from a place of hard-earned sincerity. An example would be the current protests of “rampant police racism” culminating in the execution style murder of two innocent officers. Did rampant racism really cause the two recent incidents that have ignited the fury of those promulgating the racism story? No: No evidence supports that thesis. The police have done far more to protect blacks than to harm them. Thus, the recent riots and murders are the result of some other underlying frustration. It is that hidden root of this discord that must be revealed. Those involved in the frays are the only ones with the capacity to acknowledge the misplaced anger of rioters and murderers. My hope is that prominent and powerful leaders will help, not hinder the process of revelation.
2.  I want to watch an unbiased mainstream news report. An old-fashioned report sans biases and fears of reprisal; emphasizing primary sources – not speculative and oftentimes-mindless meanderings – would provide the people of our nation with what we deserve. The media owes it to Americans to find and share the facts. A healthy dose of truth would be most welcome.
3.  I’d love to see the recent surge in racism quelled, not fueled. Since the 60s we have made monumental strides in eradicating bigotry and advancing the opportunities available to African Americans. Just look at our current political landscape – a Black President and Attorney General along with 10% of the House of Representatives. Such a landscape would have been unimaginable 40 years ago. We have surely come a long way. Black doctors, lawyers, business people, and newscasters are no longer an anomaly. They are very much the norm. So why now do we suddenly all feel so racially divided? I want an end to the divisiveness. As an aside I can safely say that almost all Americans have experienced the sting of prejudice. As a Jew I have. The way to conquer such antiquated beliefs is by succeeding. Becoming successful and productive, and contributing meaningfully to society goes a long way to eradicating misconceptions that are the root of prejudice.
4.  I pray for unity in thought and action among those of us who treasure individual rights and freedoms above all else. Let’s end the politically correct attempt to establish moral equivalency among nations and individuals embroiled in battles for survival. With regard to the Israeli/Palestinian conflict let’s not equate accidental deaths of children from Israeli strikes needed to dismantle hostile and active missile launch sites with intentional Hamas attacks on innocent women and children. The same holds true for mass murders of children in Pakistan and other nations. There is absolutely no excuse or rationale for intentionally killing children. We must put aside our political positions on this and similar issues. We must remember that right and wrong do exist. As a world we must condemn wrong actions, regardless of our particular political views.
5.  I yearn for unity in condemning the brutality of Muslim extremists. That means Muslim non-extremists, Christians, and Jews must stand as one and fight our anachronistic and growing foe. This requires real and continual action on the parts of individuals, groups, and Nations. Beheadings, limb amputations, rapes, kidnappings, forced conversions to Islam, public assassinations, and crucifixions have no place in the 21st century. They should be snuffed out with the same vehemence from whence they sprung.
6.  I pray for a way to aid less fortunate Americans: To help the poor and disadvantaged rise and succeed without diminishing the positions of those who have already struggled for success. Leveling the playing field should not require damaging those who have already succeeded. It should be done by enabling those who wish to succeed find a means to do so.
7.  I’d like to see an end to ad hominem attacks on politicians during political campaigns. Let’s hear what politicians truly believe; let’s have the opportunity to understand their visions and plans for implementation. Let’s avoid bringing them down through false character assassinations and the like.
8.  I’d like to see a functional government; one that values its constituents more than it does itself. This would be a government run by people who remain honest, support the views of Americans, build America up, think toward the future, and leave office when they can no longer help those whom they represent.
9.  I pray for America to regain its position as the world leader. We led not only as an economic force, but also a consistent moral compass. We have relinquished that role and now a void has formed. Voids these days tend to be filled by those who do not share our evolved values and beliefs. Let’s regain our primary position in the world before another less enlightened entity takes the world’s reins.
10.  Finally I hope for the day when we will unify under an American leader who delivers a President Kennedy type message that resonates with all Americans, “Ask not what your country can do for you, but what you can do for your country.”  We all need to hear and feel that again.

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Last week’s The Voice brought us a superb rendition of the timeless song Mad World which emotionally depicts collective adolescent angst. Mad World to me however conjures feelings about our modern world, besieged by increasing racial and ethnic strife, both of which are continually fueled by those who should instead be squelching the consuming conflagration. Writing a blog limits my ability to comprehensively analyze this issue so I will mention just two problems that clearly are being fueled by either the ignorant or the malevolent.

The first is racial division. No one can honestly deny the growth of this destructive force. Many examples could be cited and hypotheses rendered but watching the news last evening I was struck by a single worrisome observation. Apparently the upcoming senatorial elections are not only consequential, but also nail-bitingly close. So both sides are doing whatever they can to mobilize their troops to vote. It certainly makes sense to do so. What struck me though was listening to African American Democrats at all levels of power emphasize the need to mobilize the black voters. The black vote they say is nearly uniformly Democrat and therefore they must encourage them to vote. What strikes me is the notion that African Americans are being bundled into a singular stereotyped group by those Blacks currently holding elected office. Are ALL Blacks really the same? Shouldn’t Blacks be recognized to have disparate views independent of their skin color? I know Black doctors, lawyers, engineers, scientists etc. Are we to believe they all hold the same political stance? The answer of course is no; they do not. Imagine if you heard the white politicians calling Whites out to vote – the notion would not only offend Blacks and Whites alike; it would also be terribly misguided. So, how do the African American politicians calling for Blacks to vote not see they are marginalizing the Black Race? If I were Black, I would be appalled by their supplications. I would also recognize their actions to foster, not fix racial divisiveness.

The second issue concerns growing Anti-Semitism. Recently a relative called me to express her concern about a bumper sticker saying “Boycott Israel”. There are so many examples of Anti-Semitism here and abroad, some restricted to verbal abuse, others physical. Let’s just look at the Boycott Israel notion. I would suggest that anyone supporting such a stance should lead by example. That would mean you couldn’t have a colonoscopy as the Israeli’s invented the camera used in that procedure. You couldn’t have a capsule endoscopy – they invented that too. If you have Multiple Sclerosis you’d probably have to abandon your medication and if you were a paraplegic you’d have to abandon your device that helps you walk. Yes, the Israeli’s invented those medical marvels too. If you like your flash drive; oops, that’s got to go; and if you like text messaging, sorry you better stop – Israeli’s again. The list of Israeli inventions is nearly endless and if you add Jewish inventions you might as well stay home and raise your own food and build your own appliances. In fact, you won’t be able to go shopping at all because a Jew invented the barcode. The point is that before you spew racial or ethnic derision, get educated. Know what you’re talking about and if what you’re saying is based solely on bigotry; try staying silent.

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The Joyful Luxury of Bringing Home a Puppy

The world is under siege.  Muslim extremists in Iraq are “cleansing” the hijacked country of the world’s most ancient Christians. Men, women, and children are being slaughtered, after they’ve been tortured and raped. Jewish teenagers are being kidnapped and executed by similar extremists; people are being beheaded in city streets. These are the same missionaries of terror that pierced our false sense of security, destroying our towers and the thousands of innocents within. Our civilized world is unequivocally in peril. A return to the dark ages is at our doorstep.  Some say there is nothing to fear; it’s a minority who are at the source of this evil. Yet a minority can create catastrophic consequences. Witness the horror of Nazi Germany. And, a “minority” in the world of Muslims is likely well upwards of 200 million people. This is a minority in truth, but one demanding our unwavering attention and concern.  So how does a puppy fit in this story?

Yesterday my wife fell in love with a nine-week-old puppy. We had recently lost a dog to a sudden splenic rupture from cancer and in truth I believed it would be a long time coming before my wife would open herself up to another similar love. But I was mistaken. She informed me of her find and I immediately knew another dog would be coming home. I was sold on this notion with a simple question, “Isn’t this what life is supposed to be about?” Irrefutable. Life should be about love and puppies and the luxury and freedom to enjoy both. As a Preventive Cardiologist I couldn’t deny both the emotional and physical salutary impact of smiles and laughter engendered by the presence of a simple pup. Then I considered those in other parts of the world; Christians, Jews and non-radicalized Muslims fleeing and dying at the hands of terrorists. These individuals cannot enjoy the American luxuries of which I speak. We are a nation of fortune; but this fortune was built on the selfless sacrifices of our fathers and forefathers. Freedom is not an easy thing to gain but I fear it is quite easy to lose. Understanding this, we must be hyper-vigilant about safeguarding it. Yet its nemesis nips at our heels. Political correctness aside, when critically and honestly examining the world one must acknowledge there is but a single group that seeks to dominate all others. Yes, a minority threatens us, and most of the world abhors the actions of this minority. The minority, however, is fierce, brutal, enormous, powerful, determined, and patient. They will have their way if we do not face and stop them. If we fail, love and puppies, and other often-unappreciated freedoms will become our memories, and the dreams of future generations.

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Sitting on a plane I run through the possible subjects to discuss in this week’s blog post. I consider health related matters but cannot bring myself to settle on a topic. I feel compelled instead to introduce a subject that tortures me far more than do the demigods of media and science. It is the conflagration of Muslim extremism that threatens to engulf our world. Wow, where did that come from you might be wondering. In a word, sadness. I am sad for the young Christian girls of Nigeria who have been stolen from their families, and in a 10th century style forced to convert to Islam and threatened with slavery or marriage to Muslim men. They most likely will never again lay their eyes upon their parents, siblings, and other blood relatives. I am sad for the woman who sits beside her 20-month-old child in a Sudanese prison awaiting a sentence of torture followed by hanging. Her crime: marriage to a Christian. I am sad for all the men and women in other nations forced to follow their religious beliefs in silence, lest they be silenced for good. I am sad that the world watches as so many suffer and I am sad we have lost perspective as we fan the flames of our own relatively petty issues. And finally I am sad for us as we watch a world that will most likely collide with ours, potentially ending the freedoms we now take for granted, ones our ancestors struggled so hard to leave as a legacy for us to enjoy.

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My New Year’s Wish: Disband Debate and Let 2014 be the Year of the Dialectic

Socrates and Plato believed truth to be the highest virtue. In search of absolute truth they employed the dialectic, a discourse between people holding opposing viewpoints. The critical distinction between dialectic and debate is that in dialectic the two individuals (or groups) engaged in a disagreement have no emotional investment in the outcome of their discourse. They both seek the truth; being “right” or “wrong” has no relevance. Victory is achieved if the truth is identified and acknowledged by both parties during their thoughtful interchange. In debate, winning is everything. Emotional appeal, persuasive arguments, and even distorted reasoning can win the day. The truth is not the prize, rather it is victory in argument that opponents seek.

Today we are bombarded by hostile media-reporting. On both “sides of the aisle” respect and honor appear to have vanished. News is rarely if ever reported in an unbiased fashion; there are always elements of editorializing. The right and left are polarized; they report the news to win their “argument.” Though I believe the populace yearns for objective, uncensored reporting, it seems to be a thing of the past. We the people consequently distrust our media. They fail to give us what we need; a window to the truth. Compounding the disillusionment and despair felt by so many Americans is the fact that we have also lost faith in our elected officials. My patients – some nearing one hundred years old – tell me they have never witnessed such discord in our nation. Something must change for us to get back on our prior track. We need to reclaim an America where Kennedy’s inspiring words, “Ask not what your country can do for you, but what you can do for your country” become once again cause for resounding applause.

So my 2014 New Year’s wish is simply this: Let’s reach back through the ages and heed the advice of the fathers of philosophy, Socrates and Plato. United, let’s use dialectic not debate to find our way. No more polarizing-politics, name-calling, character-assassinating, or skirting real issues. Instead let’s try to find the truth where we can, so America can once again become a nation of greatness and an object of emulation.

Wishing everyone a very happy and healthy New Year!

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Freedom through the Eyes of a Preventive Cardiologist

As an Interventional Cardiologist turned Preventive Cardiologist I understand all too well how much better it is to prevent a disease before it ever has the opportunity to strike. After all, what would you rather experience – a heart attack, angioplasty, stroke, or bypass surgery – or simply a modification of your lifestyle – eating better, exercising regularly and perhaps taking a medicine or two? Most of us would opt for the latter. I’ve yet to meet anyone who has enjoyed the experience of a major cardiac event, but most everyone likes being lean, fit, and energetic. Recently I was struck by the application of “prevention” to politics.

Americans are in the throes of controversy regarding freedom. Daily I listen to my patients as they express their worries that we might be on the road to socialism. Most people would reject such a notion, saying, “it’s impossible; America will always be the land of the free.” Yet, the patients who fret the most are those who actually lived through times of dramatic social change – Cubans, concentration camp survivors, former Eastern Europeans… These individuals have had the misfortune of going from freedom to “captivity”. And what’s truly most terrifying is the unwavering commonality of their views. They all echo the same sentiment declaring, “This is exactly what it looked like before Castro, or Hitler”, or whomever it was that led the movement that ultimately stole their freedom. By “exactly what this looked like “ these patients tell me they mean gun control, governmental intervention in business, loss of certain freedoms of religious expression and the like. They uniformly speak of the insidious nature of freedom’s ebb. Citizens of their former nations had decried the possibility that terrible social change was in the winds believing such a thing could not possibly occur. Listening to them intently I have concluded that freedom is much easier to lose than it is to gain.

Now I understand the need for us all to listen closely to what is happening in Washington as well as wherever we live. We must critically evaluate what we hear on the news, and steadfastly maintain open and circumspect eyes. Everyone would agree our country is in the midst of dramatic change. The question of course remains as to what direction we will take. As in the case of medical prevention it is time for us all to make perhaps our most important decision. Are we willing to do what it takes to prevent the loss of something our forefathers fought so bravely to attain? Will we sit back lazily and let the chips fall where they may? Or, will we get in the game, keep up with national and international events, maintain open but cautious minds, and speak loudly if we believe our freedom to be in jeopardy?  Remember the example of medicine – no one wants a bypass. The best way to avoid a bypass is to be proactive. The same, I believe holds true for remaining free.

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The Fiscal Cliff: Lessons Gleaned from Preventive Cardiology

Cardiovascular prevention requires a team effort with the doctor at the helm but the patient a necessary, eager, and deeply involved participant. The goal of prevention is to identify risks and then diminish them before a crisis ensues. Success demands identification of potential problems followed by a collaborative effort between doctor and patient to minimize those risks. Only through both proper identification and risk reduction can heart attacks and strokes be prevented. As I reflect on what I do for a living I am struck by the similarity we are all experiencing as we walk steadily toward the fiscal cliff. And I find myself perplexed by the fact that although our elected leaders have identified the problems they have been unable to work collaboratively to correct the issues. An analogous scenario would be this. I, the physician, identify a severe cholesterol problem in a patient. I then perform a coronary CT angiogram and demonstrate multiple plaques within the patient’s arteries feeding her heart. I recommend a medication to lower her risk and show her all the copious data supporting my recommendation. She turns to me and replies, “No thank you; I think I’ll just take my chances.” I of course counter with a litany of references to literature and clinical experience. Although I understand this is the best option for her, I fail to offer “lesser” alternatives. I am intransigent. She too is adamant; refuses therapy; and six months later sustains a fatal heart attack. The heart attack could have been avoided, but to do so required the joint efforts of doctor and patient. I should have been more open to “alternative” – albeit probably less successful – possibilities, and she should have been more willing to consider my well-considered recommendation.

Now we find ourselves in an economic and political game of “chicken”. Who will flinch first? Unfortunately the stakes are unbearably high. All our futures hang in the balance. Our president, recently elected by a narrow margin in the most contentious presidential battle many of us have ever witnessed blames the Republican Congress for the standoff. The Republicans blame the President. It appears their current mode of “working together and reaching across the aisle” is at best a pipedream and at worst an impossibility. Surely the Republicans must bend. But so too should the president. He represents the entire country, even the nearly 50% who did not vote for him. He was appalled by Romney’s 47% comment yet he seems to be enacting the very principle he condemned.  And, he is our leader. The buck does stop with him. He must find the way to compromise. And if he does ultimately reach across the aisle the Republicans in turn must be willing to compromise as well. If not, we will like lemmings drop over the fiscal cliff. And we all know how that ends for the lemmings. Let’s hope Congress and our President find the way to diminish the risk that they’ve so clearly identified. Let’s hope we do not experience the unnecessary, potentially fatal, but certainly avoidable “heart attack”.

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Is anyone out there truly “fair”?

2012 is the year of the “fairness debate”. Politicians and laypeople argue daily about what policies are or are not fair. The Merriam Webster Dictionary defines fairness as, “marked by impartiality and honesty: free from self-interest, prejudice, or favoritism”.  Nowadays, “fairness” is tossed about like a football, something concrete, tangible, and easily discernible. The dictionary would support an objective use of the term; yet, in fairness, the term is being used in an entirely subjective manner; what is considered fair to one is often quite unfair to another. It seems our debaters are misusing the word. They are judging fairness to suit their needs, even when aspiring to portray impartiality and generosity. Let’s examine some examples.

Ben Affleck recently told Bill O’Reilly that he wanted to pay “my fair share of taxes”. O’Reilly quickly retorted, “You want to pay 45 or 50%”, to which Affleck stated in an unfiltered fashion, “No, I thought we were going back to the pre-Bush tax level.” Translation, “that’s more than I bargained for. That would not be fair.” But what makes an Affleck tax of 35, 40 or even 60% fair? In fact, as Affleck can earn $10,000,000 for a role in a single movie, why shouldn’t he pay 90% in taxes? That would still leave him with a cool million for simply playing a part in a movie. Most might think that earning well over ten times the annual income of most teachers for a single movie gig is more than fair. Affleck of course would disagree. And so “fairness” should not be part of his vocabulary with regard to his views on tax reform. He is not impartial.

How about the fairness of our current medical system? Would the homeless family struggling to stay together and put food on their makeshift table think it’s fair that our country puts healthcare for all before shelter and food for the needy? Probably not. But most Americans do believe this to be fair. That is why we are in the process of expanding our medical coverage. And so the minority dwellers of the street have their sense of fairness trumped by the majority. It’s not fair, but it is the way our country works.

The football players strike when they earn less than they feel they are entitled to, and yet they make millions… for playing a game. Doctors have had their incomes systematically shredded over the last few years. Cardiologists for example have had their primary sources of income cut 40 to 50%! Fair? Consider what it takes to become a cardiologist. (Full disclosure – I am one). First you have to be a serious junior high school and high school student. That is correct; you must focus at a young age, abandoning the frivolities of normal youth. Then you must attend college, typically an excellent private University to enhance your chances of entry into medical school. I attended Columbia; price tag today, approximately $240,000. Then there’s Medical School. That’s another four years with an additional price tag of about $300,000. Most parents cannot afford these costs and so they spend everything they can and pay the remainder in loans. Consequently students often begin their next phase of medical training already saddled with well over $200,000 of debt. To become a cardiologist you then must complete three years of internal medicine training and an additional 3 years of dedicated cardiology training. That’s six years after medical school and ten years after college! Meanwhile, don’t forget the lost opportunity this student of Medicine has experienced. While he or she has accrued mind-boggling debt, his or her college friends have had ten years in the workforce to climb the ladder, earn money, buy homes, and start families. But that’s not it for our budding cardiologist. Say he wants to specialize further, to become an interventional cardiologist so he can save you when you’re in the throes of a heart attack. That’s another two or even three years. So how much should this super-trained doctor earn? Should it be more than the football player or the actor in a movie? When you are in the midst of a heart attack looking up at him from the gurney, what do you tell yourself he’s worth? What’s fair?

Let me digress for a moment as you might be saying to yourself, “but for doctors it shouldn’t be about the money. They should go into medicine to save people’s lives, to help the sick and keep the healthy well.” And you would be correct. Doctors shouldn’t practice medicine for the money. And most of them, myself included, don’t. But there are pragmatic issues. We too have families to support, children to send to college (and hopefully Medical School), houses that develop leaky roofs, and yes, food to put on the table. So early on, when we decide what path to take in life, these practical issues merit consideration. We are not choosing to go into the priesthood as some would suggest; we are truly selecting a career path. And the balance sheet of pros and cons that everyone considers in making important decisions must be looked at with a discerning eye. That is after all the smart way to do it. And believe me; you definitely want your doctors to be smart. So please don’t get hung up on whether or not doctors ought to think about their incomes. They do because they must.

Back to fairness. Whatever side you are on in this highly contentious political and social moment in history I simply want to suggest that the fairness card should not be on the table. “Fair” is intended to be an objective concept, but who among us has the genuine capacity to be completely unbiased? Instead of clothing the debates in false garments, let’s instead examine the real issues. Let’s look at how we see ourselves, our country, and most importantly our children’s country. No one is right or wrong here. It’s simply an issue of divergent visions for our nation. My suggestion to us all is to find a way to be as open and honest with ourselves as possible. We must educate ourselves to the best of our ability, swiping away bias and false information like bothersome gnats on a hot summer’s night. Then we can look at the issues with clarity and on November 6th go to the poll and pull the lever that feels right for us.

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Let Us Be a Nation of the Dialectic not the Debate

It is time to bury the debate and resuscitate the dialectic. Mankind’s greatest thinkers, Greek philosophers such as Plato, Aristotle and Socrates, held the compass to truth. They understood that dialectic, not debate could enable educated and free-thinking people possessing opposing viewpoints to peacefully and congenially work together for the sole purpose of discovering truth. Winning was not the goal.  We have lost their vision. Instead we have become a nation of fighters.  We argue our viewpoints with tenacity and oftentimes utter disrespect for our opponents. The fight has become more valuable than the truth. Consequently we have trapped ourselves in an intellectual whirlpool wherein we desperately tread water, struggling to stay afloat but never making any headway toward the safety of the shore.

I see this in different aspects of our culture. In medicine the alternative practitioners condemn the traditional doctors often claiming money to be their only motivation. They effortlessly and unfoundedly dismiss well-structured clinical trials and large bodies of clinical evidence as “flawed”. In doing this they often dispose of the baby with the bathwater, and steer patients away from potentially life-saving therapies.  The traditional doctors are no better. They misrepresent evidence based medicine as though it were “truth based”.  In so doing they cite an evidentiary void as cause for dissuading patients with chronic and sometimes incurable ailments from seeking alternative and potentially beneficial strategies.  They dismiss anecdotes, clinical intuition, and even well-accepted human physiology as meaningless evidence for shaping health care strategies. In the end, we all suffer. The bilateral intransigence leads to cognitive and creative stagnation, precluding possibilities that might have led to better patient outcomes.

Politics is even worse. Both inter – and intra-party discord reigns king. While everyone would agree that our nation is experiencing desperate times, where do we see our leaders and the public engaging in discourses to find true answers?  How long has it been since we have witnessed a genuinely respectful discourse, its sole intent to discover a solution? Debates abound; gaffs draw more attention than brilliance; solutions to our problems are instantly met with blind criticism, and no one seems to be able to acknowledge a valuable perspective when it is voiced by a member of the “opposing” party. We preach about reaching across the aisle yet there is no evidence of any sincere attempts to do so. Yes, in politics politicians must get elected and then re-elected. But they are charged with expressing their true viewpoints, minus acerbity, and then we the people are supposed to select our representatives, those individuals who will best represent our beliefs and our ideals. We know that our politicians have become far too concerned with their own political well-being. This is why they fail us. This is where we are today.

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