Category Archives: People

Football In the Future

Football Hall of Fame Re-opens

Newly remodeled Football Hall of Remembrance opens to celebrate Traumatic Brain Injury.

SATIRE AFFILIATED PRESS
CANTON, OHIO 11 September 2035

Although American style football has been banned, the Football Hall of Remembrance—formerly the Football Hall of Fame—is still a popular tourist attraction. It’s remodeling was recently completed and the familiar football roof is now surmounted by an artist’s conception of traumatic brain injury. Over the front door, the entryway features a bronze relief of a player being carted off the field after, as they used to say, “Having his bell rung.”

While the exhibits still include trophies, helmets, jerseys, and other game paraphernalia, it’s the preserved brain tissue and MRI scans that are today’s favorite. Visitors can view the pathology, then try to guess to which famous player the brain once belonged. Pressing a touch screen, the player’s name, teams, scores, and number of concussions is displayed. Original plans included videos of interviews with former players, but many could no longer communicate, being content to babble incoherently, or stop mid-sentence with, “What did you just ask me?”

Taking a page from big tobacco’s playbook, the industry insisted for years that football was not dangerous; eventually there were too many injuries at the high school, university, and professional levels to ignore. Professional teams found that medical insurance costs exceeded revenues—even if the revenue from sale of team products like hats and jerseys are included. With the profits gone, most owners took their investments elsewhere. Unfortunately, this left many cities with substantial debt for stadiums they built. Many are crumbling and have been condemned because of the degree of deterioration; there’s reason to repair them and no money to tear them down. Universities initially expected a huge financial crisis, but found that the sport had actually not been a money maker, in terms of real cash, but a huge annual loss. Without football many universities were able to improve facilities and pay teachers better.

Football, is gone, but not forgotten—except by those who played the game and had their bells rung too many times.

Newspapers

When I was growing up,  it seemed that every city had several newspapers—often a morning paper and an evening paper. In Toledo, they were owned by the same company, so there was not a lot of divergence of opinion—the biggest diversity was in the comics.

In the 70s and 80s, many cities began to lose newspapers, only offering one. (I remember reading Sherlock Holmes—written during my grandparents’ lifetimes—in which there were multiple editions of multiple newspapers. Wow!)

Over time, in many places, local reporting waned and most of what they printed came from the news services to cut costs. (Sorry Peter Parker and Clark Kent, we’re not hiring.)

The number of news services dwindled as Associated Press overtook and bought part of United Press International. Today, much of what you read in the morning newspaper you already read online.

Newspapers got smaller, and the cycle continues.

Is it better or worse than when I was young? Probably neither—just different. However, I appreciate a well-written article. After it was written, the author probably re-read it and made some changes. An editor tweaked it—or sent it back to the author for another rewrite. Written news is polished, at least a little. It took a significant event to “Stop the presses!” and change the headline—an expensive operation.

A news video, on the other hand, has no style and certainly no cachet. It’s kind of thrown together, with too many stories labeled as “Breaking News.” To add insult to injury, the talking head’s intro, repartee, and smile, of course, is as much a part of the story as the content.

More’s the pity.

I think I’ll go listen to Don Henley’s “Get Over It.”

It’s Good to Be the Tsar!

putin

Vladimir Putin, according to reports, is wealthier than the next two richest people combined with a net worth of $200 billion. Pretty good for someone who grew up as Communist with enough commitment to work for the KGB.

His career with the KGB was unremarkable (his highest rank was lieutenant colonel), but once he got into politics, he found his niche. Trained as a lawyer, he adopted the Don Corleone business model (“One lawyer with a briefcase can steal more money than 100 men with guns.”–The Godfather). When the Soviet Union fell, various Russians began to acquire wealth. Putin apparently made many of them an offer they couldn’t refuse.

It might be good to keep that in mind before considering doing business with Putin.

Only a Loan

Mother Nature loans us many things, but we need to remember that they’re only a loan.

Hurricane-Katrina-FloodingNorfolk, Virginia has much of its downtown built on filled in waterways and swamps. The area already tends to flood with nor’easters, and tropical storms, but with rising sea levels, flooding is expected to happen more often. Since there are people and businesses already established in the area, government officials are exploring possibilities such as levees, flood walls, and whatever the latest technology offers to prevent loss of life and property.

I understand. Where I live used to have a moderate risk of flooding, but as more of the area was developed the waterflow reversed. Low-lying wooded areas were clear-cut, raised five feet, and houses built so that instead of absorbing the rainwater, it now flows into my neighborhood. Bummer. Maybe if I replace my lawn with rice it will work better.

Mother Nature only loans us geography. I used to live in Louisiana. Mother Nature wants to move the Mississippi River west into the Atchafalaya basin. The United States Army, Corps of Engineers have been tasked with keeping the Mississippi River where it is. They’ve been mostly successful, except for the occasional world-class disaster like Katrina. History has shown that if weather doesn’t satisfy Mother Nature’s requirements, the occasional earthquake will. The New Madrid Fault in the early 19th century caused the Mississippi to flow backward for several days and reroute itself.

These issues are not unique to Norfolk and Louisiana. I grew up in Toledo, Ohio, which is built on what was the Black Swamp. Part of Downtown Chicago is built on the rubble from the great Chicago Fire, which was tossed onto the shore of Lake Michigan. Enough of Florida is built on drained swamps, or the equivalent, and so much groundwater is extracted that sinkholes routinely swallow cars or even houses.

Mother Nature loaned us these areas. I hope she doesn’t want them all back too soon.

Oyay! Oyay, ye Rolling Stones!

Who would have guessed that in 1965, the most accurate prognosticators of the twenty-first century would have been the Rolling Stones?

I mean, give me a break!

“Hey, you get off of my cloud!”

Computer technology—which was quite limited in 1965—has today become so cloud dependent—forty-plus years after their warning.

More importantly, today there are hackers at every turn . . . . It’s almost eerie. How did Keith Richards and Mick Jagger know what was coming? They are the two most unlikely people . . .

Unless you’re a fan of Men in Black, in which case, that explains a lot.

On the other hand, Will Smith and Tommy Lee Jones–as much as I love their acting–have always struck me as just a bit different.

Do you know what I mean?

Fixing Healthcare – Part Three

Physician’s Assistants (PAs) and Advanced Registered Nurse  (ARNPs) are helping lower costs and increase access. While some nurse practitioners, can operate relatively independently; other nurse practitioners and most physicians’ assistants, cannot. Why?

Physicians are adamant that they maintain a high degree of control over these and other healthcare workers. This is a throwback to the nineteenth century—which is kind of interesting in a weird sort of way. The story, and I cannot vouch for its accuracy, although all my research seems to support it, is that the country was besotted with traveling medicine shows hawking patent medicines (You’ve seen it in the movies—“One for a man, two for a horse”). The physician industry supposedly promised to get things under control if they were put in charge of medical practitioners, i.e., physicians and surgeons (MD). It, at best, minimized, if not blackballed, osteopathic physicians (DO), chiropractors (DC) and chiropodists, now known as podiatrists (DPM).

A physician, at the time, could authorize any hireling under his license to perform any duty under the concept that the doctor was “the captain of the ship” and was responsible for everything. Therefore, he had authority to authorize any employee to do anything—hopefully, but not necessarily, after some training.

Today, many non-physician healthcare workers are licensed in their own right; in most states this includes nurses (of all levels), therapists (of all varieties), and technologists (ditto). These people are trained and possess technical skills that physicians do not. Generally speaking, only television doctors leave their practice in order to operating high technology devices. It’s good theater but bad economics.

Many of the other healthcare careers such as nurse practitioners, physicians’ assistants, etc., have made significant advances Unfortunately, old attitudes die hard, and there are too many physicians who try to maintain an inordinate control over everything, including these other professionals. Nurse anesthetists and physicians’ assistance must be “supervised” by a physician, although such supervision does not require actual observation or even the presence of the supervising physician.

Efforts to keep others under control have led to some bizarre arrangements. In radiology, for example I’m told that the technologists are now required to periodically retake the examination that initially proved their competence even though there has been continuing education requirements for 40 years. If true, I believe this is a unique requirement, but a warning to all others. Of all the physicians’ assistants, only those specializing in radiology are not permitted to interpret x-ray or other diagnostic images.

Why?

Some blame the American Medical Association, a very powerful organization with effective lobbyists. However, it apparently speaks for a self-selected group of physicians. Out of 923,308 practicing physicians, the most recent numbers available indicates that only 228,000 belonged to the AMA. If you don’t round, that’s just less than 25 percent.

Nobel Laureate Milton Friedman and his wife, who wrote the book Free to Choose, asserted that the AMA functions more like a guild with the goal of increasing physicians’ wages and fees by limiting both the supply of physicians and the competition from non-physician groups.

This is yet another issue that must be addressed if we are truly interested in fixing healthcare.

Medical School Rationing

Fixing Healthcare – Part 2 — Doctors

I’ve known many intelligent, talented, committed young people who aspired to become doctors, but couldn’t get into medical school. Some were resigned to their fate and used their degree in biochemistry to become medical technologists; others made arrangements to attend medical school outside the United States—primarily in the Caribbean. In one case, in order to study at a school in the Caribbean, the aspiring medical student’s parents sold virtually everything to finance her education. She’s nearly complete with her rotations back here at US hospitals and plans on serving rural or tribal underserved areas.

While we don’t have enough graduates of United States medical schools, we grant 85,000 special visas to foreign medical graduates every year because it’s a “critical shortage.” Today, roughly one quarter of all practicing physicians are foreign medical graduates. I’ve worked with many, and while their initial desire is to return home, after about six months the sports car and the arm-candy significant other appears. When I ask if their plans have changed, I’ve been told, “If I return home, I will be paid in chickens and melons. If I stay here, I will be paid in dollars. I like dollars better than chickens and melons.”

So, we import thousands of non-American doctors every year even though we have many Americans who want to study medicine but are turned away.

A decade or so ago, when more students wanted to study law, the educational industry had no difficulty in adding seats—even if they had to build new schools. Why won’t (not can’t) we do the same for medical schools?

Some claim there wouldn’t be enough residency opportunities if we graduated more doctors from US schools, yet foreign medical graduates can and do get residency positions at US hospitals. In any other industry, this might be viewed as restraint of trade.

I suggest that the goal of US medical schools should be to increase their capacity so that by 2030 ALL US residency openings can be filled with US citizens who graduated from US medical schools.

Next, I would change the entry criteria to include the following:

  1. Accepting students with a commitment to actually practice medicine; better yet a commitment to practice whatever type of medicine is in short supply, wherever needed, for at least three years. After that, every accommodation should be made to place that individual in a residency or fellowship of their choosing for which they have the talent, without a decrease in salary.
  2. While academic achievement is important, the ability to work as a team is critical. History is full of brilliant people who didn’t succeed because they could not work with others, and medicine is now a team sport—whether the person with MD or DO after their name likes it or not, they are teammates with the nurses, technologists, therapists, etc. No one is a superstar.
  3. Children of doctors or other elites should have to prove themselves more—not less—than other medical school candidates. They’ve grown up exposed to the field, often in an environment of privilege, so they should demonstrate their desire to serve, not their pedigree.

In short, we need more doctors, but our current method of selecting them is less than optimal.