Archive for the ‘personal’ Category

A Preview of Coming Attractions.

Sunday, April 5th, 2015

alton-nolen-mugshot

A significant number of Somali immigrants’ children have traveled to the middle east as jihadis.

ISIS has been luring thousands of Westerners to the battlefields of Syria and Iraq. The number of Americans who have traveled to Syria is still relatively small — in the neighborhood of 150 people — and a thin slice of that group, perhaps as many as two dozen Americans, are thought to have joined ISIS.

In the discussions at the White House this week, one city has focused minds: Minneapolis-St Paul. It had been ground zero for terrorist recruiters in the past, and is fast becoming the center of ISIS’ recruitment effort in the United States.

This is a growing problem with the emergence of “lone wolf” attacks by jihadis.

The young man pictured above is one of many young black men, many recruited in prison, who have committed these actions.

Over the weekend, the FBI announced that it would treat Islamist Alton Nolan’s alleged beheading of Colleen Hufford, 54, as a case of workplace violence. That despite the fact that Nolan’s Facebook page contains a picture of Nolan giving the ISIS salute, multiple pictures of Osama Bin Laden, a screenshot of the 9/11 attack on the World Trade Center, and a quote reading, “I will instill terror into the hearts of the unbelievers: smile ye above their necks and smite all their fingertips off them.”

Then, of course, we have another example of “workplace violence” courtesy of Major Hassan.

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Western Civilization.

Saturday, January 24th, 2015

When I was a college freshman, back when dinosaurs roamed the earth in 1956, we had a class called “Man and Civilization.” That class is no longer taught, of course, just as “World History” is no longer taught in high school.

There is a good post on Ace of Spades today.

The first leg of the three legged stool that supports Western civilization came from the Jews, and it’s monotheism. The idea of one God as opposed to many different gods begats the concept of absolute right and wrong, which is necessary in order to have the concept of morality. Morality is what takes humans away from a world where might makes right.

The second leg came from the Greeks and Romans, and that’s the idea that the world has certain natural laws, that these laws are universal, and that they can be studied and understood and even manipulated. From this comes science, of course, but a better term for this would be reason.

Finally, from the Anglo-Saxons we got the concept of rule of law. Just as there are universal natural laws that govern nature, so too must man’s laws for governing man must be universal. Nobody is above the law, thus everyone is treated equally. Equality is the third leg.

I agree with this and a corollary from Robert Heinlein, the science fiction writer. In fact, it is #1 on my list of favorite quotes.

Throughout history, poverty is the normal condition of man. Advances which permit this norm to be exceeded—here and there, now and then—are the work of an extremely small minority, frequently despised, often condemned, and almost always opposed by all right-thinking people. Whenever this tiny minority is kept from creating, or (as sometimes happens) is driven out of a society, the people then slip back into abject poverty.
This is known as ‘bad luck’.”

– Robert A. Heinlein

Another bit from the Ace post.

Western culture is the only place that all three have gained equal ascendancy, and that brings us back to where we started, because leftist political ideology is dedicated to destroying all three of the legs upon which our society rests.

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More Biology

Saturday, December 20th, 2014

I have been posting some long comments at at Chicagoboyz, and decided to do them as post here. The topic is the future of technology.

I am pessimistic on molecular medicine for several reasons. I have gotten into two nasty debates on evolution at conservative web sites. One was at Ricochet and was nasty enough that I quit going there. There were something like 250 comments, of which about four were friendly. At Althouse, it was a bit better but still very negative, about 4 to 1. I let my membership at Ricochet expire and so can’t find the thread.

Found it with Google.

A sample of comments is here.

No disrespect Mike but I think you are suffering from the same problem that a lot of people suffer from. The inability to factor faith into the intellectual equation. It is possible to understand and embrace the science of evolution and apply the knowledge gleaned from it even if you aren’t 100% sure we have the story right.

I 100% believe the story of creation in the Bible, but I have no problem understand the evolution of the sickle cell trait. In the same way I have no problem believing Jesus brought Lazarus back from the dead or healed the server of a Roman centurion from miles away even though these things seen completely at odds with medical science.

That doesn’t even take into account the anti-GMO lefties who seem to be more accepting of human modification than with plants.

In both cases, I got into it by commenting that I would not write a letter of recommendation for a student applying to medical school who did not believe in evolution. I tried to make the point that I am not the king of medical school admissions but it was no help.

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Reduced blogging.

Wednesday, October 29th, 2014

For a while I have noticed that comments dropped way off and I attributed this to the fact that I had some health issues a couple of years ago and slowed down blogging considerably. I have also been invited to blog at Chicagoboyz and did not always post the same things here. I do often write the first draft here so I can see it, or, if the topic seems more local to my own community or interests like Mission Hospital, I only posted the item here. If anyone is interested in my posts over there, they are Here although most are at both sites.

A couple of commenters seem to be coming back and commenting so I thought an update was in order.

I’m still teaching at Keck (USC) medical school in the same Introduction to Clinical Medicine Program as I have for fourteen years now.

I also spend a day or two examining recruits at the Los Angeles MEPS which allows me more time to visit with young people and I enjoy it.

Maynard Brandsma

Tuesday, September 2nd, 2014

I was just thinking tonight about an amazing character I knew years ago. In 1972, I moved to Mission Viejo and began a surgical practice at Mission Hospital, now known as Mission Medical Center. When I arrived in December of 1972, I met an internist who had an amazing career and personal history. He was born in Holland and during World War II was supposedly a fighter pilot in the Dutch Air Force in what is now Indonesia. At the time it was the Dutch East Indies. He was also a physician at the time and was chief of staff at the hospital in Indonesia where another physician friend, Sergei Lockareff was born.

Maynard practiced as a physician in Santa Monica and was the personal physician for a number of movie stars, including Humphrey Bogart, Greer Garson and Carole Landis.

Life seemed very good indeed. But Bogie came home one day and told me that he’d run into an old co-star, Greer Garson.
Over lunch, she’d announced that she didn’t like the sound of his cough, and dragged him to see her doctor, Maynard Brandsma, at the Beverly Hills Clinic.

I was so used to Bogie’s cough that I never paid too much attention. He’d been off his food a little, but that wasn’t unusual. I should have realised at once that the mere fact that he’d consented to go with Greer to a doctor was indicative of something serious. Any time I’d ever mentioned a doctor to him, Bogie bristled.

Maynard discovered Bogart’s esophageal cancer and cared for him during that illness. Another physician friend, Burt Meyer, was the surgeon who operated on Bogart and who later said that the cancer was so small that he would never operate on another. If he couldn’t cure that one, there was none he could cure. Burt operated on John Wayne for his lung cancer with better luck.

Maynard was the physician who examined and treated the wife of David Niven for her fatal head injury, suffered when she fell down a flight of stairs in the dark at a Hollywood party.

When I came to Mission, Maynard had been there for several years. He had moved to Mission Viejo after marrying his second wife Mickie. He was active in practice and was kind of intimidating to a new surgeon. By that time, he was 65 years old but still very active. I remember that he tried to get me to join the Coto de Caza gun club, which was abruptly closed by the developer in 1991. At the time that Maynard was a member there was good quail shooting there but I couldn’t afford it.

He was quite the character. One night his telephone did not answer and the hospital asked the sheriffs to go to his house and let him know it was pout of order and they were trying to reach him. They knocked on his door at 3 AM and he came to the door with a .45 automatic held behind his back. Things were far less tense with the police in those days and they thought nothing of it.

The hospital was quite small at the time and Maynard was seeking a second career and life with his new wife. His career at St John’s Hospital in Santa Monica was spectacular in that he had been chief of staff and had a Hollywood practice, as well. One of his patients was John Ford and he made the diagnosis of Ford’s colon cancer that ultimately killed him.

Maynard was a good physician and continued to practice for a number of years after my arrival. Eventually, he and Mickie moved away and they are buried in Montana. He was a very colorful character and I remember him fondly.

Medicine is coming to be a government benefit.

Sunday, August 3rd, 2014

Obamacare is having serious trouble as I have discussed. The success stories, like California, are an example of what I have called Medicaid for All.

“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Most of the new enrollees are Medicaid members and those enrolled in “private insurance” learn that they have severely restricted choice of doctor or hospital.

Now we have a new development.

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New developments at the hospital where I used to practice.

Friday, June 27th, 2014

When I moved to Orange County in 1972, I joined a friend from my surgery residency in practice at a new hospital that had opened a year before. It was called “Mission Community Hospital,” and was owned by a group of doctors with one of the partners an owner of the new development of Mission Viejo. His name was Richard O’Neill and his family had developed Mission Viejo from part of their huge ranch.

The hospital was small with 110 beds total and the staff was made up of young doctors who had recently finished their training like me. The owners were mostly older doctors and practiced in another area of the county. Some of them we would not have allowed on the staff if they had applied. They largely left us alone and over a period of a few years we developed what we thought was the best hospital in Orange County.

Mission Hospital in 1975.

Mission Hospital in 1975.

This is what the hospital looked like in 1975. The swallows used to nest in that entry area. To the right of the entry, there was a doctors’ parking lot and, for a while, the hospital paid a kid to wash our cars. Tom and I always tipped him extra. The food in the doctors’ dining room was free and good and I got a bit pudgy. The hospital went to considerable trouble to make it friendly to doctors and we responded.

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Rape Culture

Thursday, March 20th, 2014

trapeculture-thumb-250x219-896

The college scene is all agog about rape culture. How do we know if it is a problem ?

It’s a phrase you hear a lot. But, what exactly does it mean? Is there one general definition? Not necessarily. In many ways the phrase evokes the famous Supreme Court comment about obscenity from Potter Stewart, “I know it when I see it.”

And, you don’t have to look far to see examples of rape culture these days. Whether it’s advertising, movies, music videos or social media — images, words, concepts — it’s all out there illustrating men dominating women.

So, now we know the problem. It is men.

Popular movies are strewn with plots of men with the sole purpose of having sex. In the movie “American Pie,” the entire plot of the film revolves around teenage boys wanting to throw a party so they can get girls drunk and have sex with them.

That movie was when ? Well, it was 1999. That was 15 years ago, wasn’t it ? How old were these activists then ?

It’s also been stated by writer Adam Herz that the title also refers to the quest of losing your virginity in high school, which is as “American as apple pie.” So, it wasn’t just about girls losing virginity ?

How about porn star/student, Belle Knox ?

Despite the ordeal, Knox said she plans to continue both her porn work and her classes at Duke. In interviews, she frequently mentions working to increase the rights of sex workers.

“I really want to break down barriers,” Knox said. “I want to change peoples views on sex work. … I mean, I was the first porn star to go on ‘The View.’ This is really exciting for me.

She complains about the publicity and the reaction of others but “This is really exciting for me.” Feminism 2014 version. Another porn star success story.

Ph.D. program in sociology at the University of Nevada, Las Vegas. She does cam work, some porn, stripping, and some fetish work. Unlike Knox and L., Parreira is out about her sex work. “The department seems to be a sort of hub for sex workers and sex work research, so it has been a non-issue,” Well, that’s a relief.

Now, back to rape culture. Maybe it’s a tiny bit exaggerated ?

An early sign of an obsession with “rape culture” on campus occurred at Duke during the lacrosse case. In April 2006, in a 2000-plus word statement that declined to mention the presumption of innocence, Duke president Richard Brodhead created a “Campus Culture Initiative,” to explicate and “confirm [emphasis added] the existence of a dominant culture among Duke undergraduates.” There was, of course, no rape, but the CCI proceeded along as if there were, operating under the Orwellian slogan that “diversity makes a more excellent university.”

The Duke LaCrosse team case is a horrible example of leftist agitation in action. The whole story is here. Briefly, a hysteria descended on the Duke University campus after a stripper, later convicted of murder, accused the La Crosse team of a gang rape. The young men of the team were immediate demonized by the usual suspects of campus radicals. Fortunately, the boys came from families that could afford good lawyers.

The immediate frenzy followed the usual script.

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Where is housing going ?

Sunday, March 9th, 2014

UPDATE: Megan McArdle has some doubts about house prices.

housing

The housing inflation seems to be limited to certain cities. How will this last in the poor (except District of Columbia) economy ?

I live in south Orange County and have noticed a huge amount of rental construction going on. This area has been mostly single family homes and condos since 1972 when I moved here. Now, we see big projects like this and others nearby that I don’t know the name of. These are big projects including hundreds and perhaps thousands of units. The builder is the Irvine Company which, in my previous experience, has built mostly homes and condos. Recently, I began to notice more rental projects in Irvine.

The Irvine Company Apartment Communities is dedicated to making it easy to find a home you’ll love with unsurpassed services meeting your every need. With approximately 122 exceptional apartment communities located throughout the prime California regions of Orange County, West Los Angeles, San Diego and Silicon Valley, we offer choices to fit every lifestyle and budget.

They seem to be going to rental property in a big way. Maybe this is the reason.

From reading the mainstream press all you hear are glorious signs of housing resurrection! Come one come all into the house of real estate where the almighty Fed will allow no harm to occur. Just sign and pray and the next thing you know you’ll be the next Donald Trump. The flipping, rehabbing, and housing shows are once again filling the space on a cable station near you. The perception of the Fed being this almighty protector of housing makes a bit of sense but where was the Fed in 2007?

I see lots of housing flips in southern California, not in Orange County so far.

foreclosure-completions

Even in 2013 we had 1.4 million properties with notice of defaults, scheduled auctions, and full on REOs taken on. Early in the crisis these stories were common since they were a novelty to the press. Now however, many of these properties are shifting over to large investors pushing inventory up. A clear consequence of this is a large pool of potential buyers that are unable to buy.

These may be the renters.

first-time-home-buyer

Yup. The would-be first time buyers have student loans and bad credit. They are renting.

The number of first time buyers is pathetic because household formation is weak and many young Americans are living at home with mom and dad. Forget about buying, they are having a tough time paying higher rents to the new feudal landlords. You would expect with the rapid rise in prices that existing home sales are off the charts but they are not.

Housing prices do NOT mean buyers who will be occupants. Look at mortgage applications !

mortgage-apps-for-purchase

Wow ! We are back to levels last seen nearly 20 years ago! Only difference is that we have 50,000,000 more people today walking the streets of the U.S. of A. than we did back then. Since access to middle class living is getting tougher thanks to weak income growth, more people are opting to rent:

rentals-vs-households

This is what I am seeing in Orange County. I have been looking in San Pedro for a small house near the ocean. I can no longer afford Orange County except condos. I sold my house four years ago and bought a house in the mountains. That was a bad move. I found that I could not tolerate the altitude. I had to sell into the bad market of 2012. That cost me a lot. Now, I have to lower my sights and may just stay a renter for a while. At my age, it may make better sense.

Why healthcare is in trouble.

Friday, November 8th, 2013

Our health care system has been built up over the years in a jury-rigged, ramshackle fashion. Before World War II, there was very little health insurance and what there was often was the product of labor union contracts. The early years were concerned with accident insurance and workers compensation laws.

The American life insurance system was established in the mid-1700s. The earliest forms of health insurance, how­ever, did not emerge until 1850, when the Franklin Health Assurance Com­pany of Massachusetts began providing accident insurance, to cover injuries re­lated to railroad and steamboat travel. From this, sickness insurance covering all kinds of illnesses and injuries soon evolved, but the first modern health insurance plans were not formed until 1930.

The Baylor program for school teachers was the first in 1929.

Medical insurance took stride in 1929 when Dr. Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, Texas, realized that many schoolteachers were not paying their medical bills. In response to this problem, he developed the Baylor Plan – teachers were to pay 50 cents per month in exchange for the guarantee that they could receive medical services for up to 21 days of any one year.

In those days, the concern was lost wages more than hospital care.

In 1939, the American Hospital Association (AHA) first used the name Blue Cross to des­ignate health care plans that met their standards. These plans merged to form Blue Cross under the AHA in 1960. Considered nonprofit organizations, the Blue Cross plans were exempted from paying taxes, enabling them to maintain low premiums. Pre-paid plans covering physician and surgeon services, includ­ing the California Physicians’ Service in 1939, also emerged around this time. These physician-sponsored plans com­bined into Blue Shield in 1946 and Blue Cross and Blue Shield merged into one company in 1971.

The modern insurance plans were very recent in origin. I was there for much of it. The commercial insurers fought the status of Blue Cross, which was not required to have reserves. Blue Cross asserted that it promised hospital care, not payment, so reserves were not necessary.

The 1940s and 1950s also saw the proliferation of employee benefit plans, and the included health insurance pack­ages became more and more compre­hensive as strong unions negotiated for additional benefits. During the Second World War, companies competing for labor had limited ability to use wages to attract employees due to wartime wage controls, so they began to compete through health insurance packages. The companies’ healthcare expenses were exempted from income tax, and the resulting trend is largely responsible for the workplace’s present role as the main supplier of health insurance.

The war produced much of this as wage limitations were in force but fringe benefits, like health insurance, were permitted. A lot of this history is contained in Paul Starr’s book The Social Transformation of American Medicine.

From the first, commercial insurers focused on employer plans while Blue Cross and Blue Shield (which was founded by the California Medical Association to pay doctor bills) were individual plans.

In 1954, Social Security coverage included disability benefits for the first time, and in 1965, Medicare and Medicaid pro­grams were introduced, in part because of the Democratic majority in Congress. In the 1970s and 1980s, more expen­sive medical technology and flaws in the health care system led to higher costs for health insurance companies. Responding to higher costs, employee benefit plans changed into managed care plans, and Health Maintenance Organizations (HMOs) emerged. Man­aged care plans are unique in that they involve a particular network of health­care providers that have been verified for healthcare quality and that have agreements with the insurer about price and related issues. HMOs were originally primarily nonprofit, but they were quickly replaced by commercial interests, and managed care only suc­ceeded in temporarily slowing the growth of healthcare costs.

Two major changes came in the 1970s. In 1978, the federal government established what were called Professional Standards Review Organizations or PSRO. All doctors had to receive training in how to do these reviews and it was immediately apparent that cost was the only consideration, not quality of care.

I decided to educate myself and took a course from an organization called “The American Board of Quality Assurance and Utilization Review Physicians. I took the exam and passed, then attended the annual meeting. This was about 1986. People I met at that meeting informed me that the exams were graded by throwing them up in the air. Any that landed balancing on one edge were flunked. Nonetheless, the experience was valuable because I could see what was coming.

I was president of the Orange County Medical Association that year and had served for eight years on the Commission on Legislation of the CMA, now called The Council on Legislation. This gave me an opportunity to meet many legislators, many state level and some federal. The impression they made on me was that few knew anything about medicine and most were not very intelligent.

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