Reading Between The Lines

As I was returning to Miami on a long flight from Boston, I found myself ruminating on my professional trajectory so far. I realized that a career, any career, is like a plane ride. You get on the plane at one place, take off and fly over a time to another place, rise to a maximum altitude during flight, make connections, then approach your destination for a safe landing. But the most difficult and perhaps even perilous portions of a flight are taking off and landing, especially the landing. Take off requires reaching a critical speed to allow lift. A successful landing, however, is more complicated because it requires a keen sense of timing.

While you are busy flying you may experience turbulence, sudden air pockets — downdrafts and updrafts. On occasion there are headwinds that hinder your forward progress and tail winds that ease it. We are always grateful for the tailwinds, those are the helpers along the way. When approaching your destination you begin a gradual descent and a final approach into the airport, hoping for an uneventful landing.

There are other perils in-flight. There is a sudden loss of pressure or a mechanical mishap or human error, you may not reach your maximum altitude due to unexpected weather, or worse, you may run out of fuel before reaching your destination, requiring an emergency landing, which should be set in advance.

On final approach to your desired destination communicate with the Tower to be mindful of airport traffic to avoid a collision — you must secure the runway at the precise altitude, velocity and location, touching down gently and on time while dealing with weather and wind conditions.

How do you execute a safe and timely landing? First, you must know when you are approaching the end of the journey, preferably according to a preconceived flight plan. You must check the fuel gauge often to know how much time you have left before running out of fuel, for when you are suddenly diverted to another airport and need to continue flying? Timing is everything.

Finally, you will know when its time to hit the hangar for good. But its important to listen to that inner voice. Remember, the end of one journey can be the beginning of another, one you may never have imagined.

Sometimes our careers get in the way of what we are really meant to do in this life. But we can’t know that for sure until we land.

The CDC projects we will have 500,000 overdose deaths within the next decade. We are now at nearly 100 deaths 24/7/365. Do the math.

The Trump administration has declared the epidemic of opioid overdose deaths a public health emergency. This is an important first step.

STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade

Trump has appointed New Jersey Governor Chris Christie to lead the effort. However, Christie may still face impeachment proceedings resulting from ‘BridgeGate’. The Department of Health and Human Services (HHS), the lead agency in this National Emergency, has yet to publish a strategy and a plan with a budget that could realistically stem the exponential tide of deaths. In the meantime, Congress has been preoccupied with crippling Obamacare, that will markedly reduce access to and increase the cost of healthcare for average Americans, which makes absolutely no sense in the midst of this unprecedented public health emergency.

Although I have not been a supporter of decriminalization, the prospect of 500,000 deaths of primarily young people in a decade is terrifying and warrants extreme counter measures. Such a level of excess mortality is not sustainable and inevitably will have major repercussions on the future of the United States.

There is no mystery about what must be done. The challenge will be the rapidity with which we can carry out intervention and treatment. We must start from the perspective that drug addiction is a public health issue, not a legal matter for the courts. If you recall the early days of the HIV epidemic we were also hung up on the notion that the victims’ behaviors somehow justified their fate, significantly delaying much-needed government intervention. It appears we are at the same crossroads with this epidemic.

In 2001 Portugal instituted a national plan to deal with their drug overdose epidemic. The drugs remained illegal. But drug addicts caught with them meant a small fine and a referral to a treatment program — not a criminal hearing leading to jail time and a criminal record. It has been successful in reducing addiction, overdose deaths, and co-morbidities, such as HIV and other infectious diseases. Despite these radical changes it took almost 10 years before the tide turned.

However, Portugal had a head start — universal health care.

#overdosedeaths
#opioidepidemic
#drugaddiction
#chrischristie

The murders of innocent children in Syria have been going on since the Syrian people rose up against Assad more than 5 years ago. The Syrian conflict was the Obama administration’s biggest failure. If you recall, Obama drew a red line after a similar chemical attack then opted to negotiate a deal brokered by Putin, who promised to pressure Assad to give up and destroy his chemical weapons stockpile. I guess Assad and Putin lied.

In 2003 Bush promised to bring democracy to the Middle East by intervening to remove another mass murderer Saddam Hussein from power in Iraq. He failed miserably to bring democracy, even to Iraq let alone the Middle East at great cost in both American lives and money. In fact, the U.S. failure in Iraq had the complete opposite effect. It destabilized the entire region, thereby ushering in a period of great turmoil that contributed indirectly to the creation of ISIS.

It appears red lines drawn on the sands of the Middle East get blown away very quickly.

Now comes Trump with his faux compassion stating that Assad (but not Putin) has crossed multiple red lines by suffocating to death scores of innocent men, women and children with Sarin gas. This, of course, after trying very hard to block men, women and children escaping Syria from seeking refuge in the United States. And after making it all too clear to Assad (and Putin) that the Trump Administration would allow the Syrian people to decide his fate. This was perhaps the most absurd and cowardly abdication of responsibility in the face of ongoing war crimes since President Roosevelt denied entry to refugees fleeing Nazi Germany.

Despite the many past failures the U.S. has had in this region I am particularly appalled by Trump’s duplicity towards the Syrian people and his refusal to denounce Putin. In my view, the missile attack on an empty military base in Syria without a clearly enunciated long-term strategy to confront Putin who is the 800 lb. gorilla in the room is merely a self-serving effort to draw attention from an administration that is not only failing but under criminal investigation.

In his inaugural speech President Trump said that his was:
“a movement the likes of which had never before been seen on earth”.

I wonder if he considered other ‘movements’, such as the suffragette and women’s rights movement, the Civil rights movement, the anti-Vietnam war movement, among other revolutionary grass roots movements, all of which changed the character of the United States for the better, by helping move our country towards its ultimate goal, ‘a more perfect union’.

The aforementioned movements occurred not only on earth but right here in the the United States. I will not even refer to other grass roots movements that have occurred in other places and times on earth. The hubris that emanates from Trump’s mouth is simply mind boggling. Only a true narcissist and demagogue would completely disregard history so as to portray himself and his puny political efforts as: 1) a movement at all, and; 2) the greatest on earth. Its as though he believes that because he utters something, that utterance automatically becomes reality. Well, it does in a way, it becomes Trump’s own alternate reality and the reality of those who wish to follow blindly.

Yesterday (January 21, 2017) we witnessed another example of Trump’s effort to create an alternate reality. We saw a President of the United States attempt to seduce the CIA through praise and flattery. He did so at its headquarters while standing in front of a wall with 117 stars, representing the ultimate sacrifice made by the same CIA he publicly disparaged only a few weeks earlier. Those stars were there when he called the CIA an incompetent organization. If that was not hypocritical he uses the opportunity to engage in a war of words with the media, of all things, over the size of the inaugural crowd at his inauguration. He calls journalists the most dishonest people on earth. The issue of the size of the inaugural crowd was not even a major story of the day. But out of a sense of false pride he made it the number one issue of his one day old Presidency.

Later in the day Trump sends out his lap dogs Sean Spicer, White House press secretary, and KellyAnne Conway his former campaign manager to continue the feud with the media. They each confront the media about the same petty issue. Sean Spicer dutifully carries out an order by saying that it was the “largest inaugural crowd in history”, a blatant lie, which may cost him his credibility as White House spokesperson.

https://www.washingtonpost.com/news/the-fix/wp/2017/01/21/sean-spicer-held-a-press-conference-he-didnt-take-questions-or-tell-the-whole-truth/?utm_term=.8256f51d6ad3

KellyAnne Conway said about Sean Spicer’s false statement that what he said was ‘alternate facts’.

http://www.nbcnews.com/meet-the-press/wh-spokesman-gave-alternative-facts-inauguration-crowd-n710466

These lies and all the previous bold-faced lies uttered by Trump and his cronies, both in the present and during his campaign are not mere slips of the tongue. I believe they are part of a carefully crafted public relations misinformation campaign aimed at the misinformed citizenry. They are intended to persuade the gullible by creating an alternate reality.

In the words of Joseph Goebbels, the Nazi propaganda minister:

“It would not be impossible to prove with sufficient repetition and a psychological understanding of the people concerned that a square is in fact a circle. They are mere words, and words can be molded until they clothe ideas and disguise.”

Goebbels also said:

“There was no point in seeking to convert the intellectuals. For intellectuals would never be converted and would anyway always yield to the sucker, and this will always be “the man in the street.” Arguments must therefore be crude, clear and forcible, and appeal to emotions and instincts, not the intellect. Truth was unimportant and entirely subordinate to tactics and psychology.”

What remains to be seen now is to wait and see whether Trump moves to transform the White House Press Office into a propaganda machine.

With every disaster comes change but also opportunity. Last weeks vote to exit the European Union (EU) by a majority of (misinformed and duped) United Kingdom (UK) citizens was no exception. It hit like an earthquake – sudden and devastating, reverberating with social and political upheaval, as well as unexpected chaos and uncertainty about the future. The decision brought down the British government. Prime Minister Cameron resigned and the British pound dropped significantly against the dollar immediately after votes were counted. The leadership of the two leading parties in Parliament was fractured. Scotland threatened to call for another referendum on Independence so as to remain in the EU, and Northern Ireland (with the only UK border with the EU) was left wondering whether it should join with the Republic of Ireland in order to remain in the EU. To make matters worse British citizens felt betrayed by their leaders who lied to them about the benefits of leaving the EU.

According to the National Foundation for Transplants and the United Network for Organ Sharing (UNOS), the estimated U.S. average in 2011 of billed charges per liver transplant was $577,100.00. The cost of post-transplant medical care, which includes medication to prevent rejection of the organ is estimated at $2,500.00 per month (1). This guarantees the procedure is available almost exclusively to those with some form of health care financing.

During the period 2000-2014 the death rate due to drug overdose in the United States increased by 137%.  In 2014 overdose deaths reached record numbers with 47,055, primarily young people between the ages of 15-24. Furthermore, homicide is the second leading cause of death for young people also between the ages of 15-24.  The victims of preventable drug and homicide deaths are increasingly becoming an important source of organs for transplantation.  A Harvard study published in the International Journal of Health Services reported that 17% of organ donors but less than 1% of organ transplant recipients were uninsured. Americans without health insurance are twenty times more likely to donate a kidney for transplant than to receive one (2). Therefore, the dual epidemics of drug addiction and violent crime and the lack of universal access to health care insurance are creating unintended inequalities in the allocation of organs in the United States.  For this reason it is essential to note the health care insurance gap between organ donors and organ recipients. Because as a society we are confronted with the perverse reality of the uninsured sustaining a health care service they would not be eligible to receive.

A total of 40,000 people die each year for lack of health insurance coverage (3).  We have no data on how many people diagnosed with kidney or liver failure are not referred to a transplant center for evaluation for organ transplantation for lack of health insurance. If they are not evaluated they have no chance to be listed as a candidate for transplantation and their fate is continued reliance on hemodialysis (in some cases covered by Medicare) or in the case of liver failure, death.

Another stark reality is that despite the availability of Medicaid and State Health Insurance for Children (SCHIP) for the non-working poor and Medicare for the older retired population, a substantial portion of minimum or low wage earners either do not qualify for Medicaid or SCHIP and/or cannot afford health care insurance. According to the Center for Studying Health System Change, “significant gaps in access to health care affecting Latinos, Blacks and Whites persist, with Latinos and Blacks consistently reporting lower levels of access than whites” (4). In Florida over 2 million people among the working poor continue to be deprived of health insurance because the Scott administration refuses to expand Medicaid under the affordable care act (ACA). The same is happening in other States with Republican governors that refuse to expand Medicaid under ACA. These governors are playing politics at the expense of peoples’ lives.

In all fairness it remains to be seen, however, whether the ACA (Obamacare) will ensure that all people who are referred to transplant centers for evaluation will have ‘equal’ access to: 1) receive evaluation and listing, if necessary, and; 2) proceed to receive a donated organ based on need and availability, thereby narrowing unintended disparities that currently exist. Nevertheless, I believe that although more people will be insured under the ACA it is likely that the shortage of organs and not necessarily the lack of health insurance will continue to limit the overall number of future organ transplants.

In conclusion, our first priority must be to address the root causes of the epidemic of violent crime and drug addiction in our communities. In order to do so we must urgently expand access to health care insurance so as to provide on-demand mental health and drug rehabilitation services. This will help to reverse inequities in the access to health care, including organ transplants. Finally, we must redouble our efforts to address the shortage of organs in the U.S. (5).  An opt-out organ donor system as in Europe rather than our opt-in system would be a step in the right direction.

References:
1. (http://www.transplants.org/faq/how-much-does-transplant-cost/ http://www.transplantliving.org/before-the-transplant/financing-a-transplant/the-costs/).

2. Herring AA, Woolhandler S, Himmelstein DU. Insurance status of U.S. organ donors and transplant recipients: the uninsured give, but rarely receive. Int J Health Serv.2008;38(4):641-52.

3. J. Lee Hargraves. Trends in Health Insurance Coverage and Access Among Black, Latino and White Americans, 2001-2003. Tracking report number 11, October 2004. Center for Studying Health System Change. (http://www.hschange.com/CONTENT/713/)

4. Andrew P. Wilper, MD, MPH, Steffie Woolhandler, MD, Karen E. Lasser, MD, MPH, Danny McCormick, MD, MPH, David H. Bor, MD, and David U. Himmelstein, MD . Health Insurance and Mortality in US Adults. Am J Public Health. 2009:99 (12);1-7.

5. United Network for Organ Sharing (UNOS). 2014. United Network for Organ Sharing: Organ donation and transplantation, Richmond, Virginia available at http://www.unos.org

I am not a Catholic nor particularly ‘religious’ in the traditional sense of the word but recently Pope Francis warned mankind that there will be accountability for our destructive individual and collective actions on earth. The Pope’s warning brings to the fore a larger issue; one of the need for universal accountability. This warning raises many questions:

Is a belief in a higher power and arbiter of the actions of human societies necessary for our continued existence on earth?

Can humanity survive without a belief in an afterlife where all accounts will be settled and evil will be punished?

Do our instincts whisper to us that this life is all there is?

Is the concept of immortality (life after death) essential for a fuller and more meaningful understanding of the universe?

Humans have created societies that demand what I would call ‘micro-accountability’. For example, I am accountable to myself, to my family, to my employers. As a citizen I am accountable to my community and my country. Without these spheres of accountability there is chaos and individuals, families and societies suffer break down. In the same vein individuals ultimately are accountable for the actions of the larger global human society. This can be called macro-accountability.

As stated above human societies are structured to demand accountability of its citizens. Accountability encompasses every facet of human life and is the hallmark of a civilized and mature society. The exercise of accountability takes many forms voluntary and involuntary (imposed) by consensus and through the rule of law. We agree to be accountable and to abide by laws. The alternative is a society without accountability resulting in lawlessness, anarchy and chaos. Moreover, there can be no accountability without morality and justice. Morality is the foundation upon which we construct systems of accountability. Justice is the means through which we administer accountability. Therefore, morality is at the root of all human behavior.

Where does our sense of morality come from?

Was it acquired through evolution or was it programmed into us during creation by a higher intelligence?

Morality provides us with a sense of what is right and wrong. Is our sense of love also connected in some way to our sense of morality?

Can an unintelligent evolutionary process such as Darwinian natural selection expressed as ‘survival of the fittest’, account for the emergence of caring, loving, self-sacrificing, intelligent and self-accountable moral human beings?

Can evolution with its fundamental law that determines selection of only the fittest lifeforms produce a human being who would fall on a grenade to save his fellow brothers in arms?

Don’t our consciences, the inner voice in our mind guide us to what is right or wrong irrespective of our upbringing and/or our ‘religious’ affiliation or lack thereof? Isn’t this evidence of creative intent and purpose?

Wherever the source of our sense of what is moral (right) and what is immoral (wrong) it is imperative to structure civil society to conform to the rule of law and moral accountability.

But is there such a thing as absolute morality?

Is morality relative; can it be dictated or imposed upon those who don’t conform to our interpretation of what is moral?

If morality is relative then who is to judge whose code of conduct is ‘more moral’ or immoral?

Increasingly there are human beings in the world whose morality is quite different from the mainstream. If the law of survival of the fittest (social Darwinism) continues to proliferate as the sole explanation for the appearance of mankind on this planet then who will prevent future sociopaths like Hitler from justifying their actions on the basis of assisting nature by proactively and systematically exterminating the weak and the infirm, the mentally handicapped, and those human beings they consider defective?

In conclusion, we live in a finite world within a universe with infinite resources. And yet those infinite resources are located in galaxies, stars and planets whose distances from earth, even at the speed of light, far exceed the lifespan of mere mortals. However, if the distances between galaxies is viewed from the perspective of a future immortal existence then the infinite distances between galaxies becomes less unfathomable.

If we continue to adhere to the notion that this life is the end and that there is no existence beyond death wherein there could be a final accounting for human actions, then this vast universe with all its unexplored potentially habitable planets, each containing untold and unimaginable beauty, has no meaning or purpose and will have existed in vein  —  an immense and colossal wasteland. Without a firm belief in a final arbiter of human affairs and a universal code of morality and justice to both guide and judge human actions in this life, we may never be able to coexist long enough even to attempt to achieve the scientific and technological know-how to perpetuate our own existence let alone attempt to travel within our own solar system so as to populate nearby worlds, perhaps discover new lifeforms, new sources of rich mineral deposits, and new ‘natural’ wonders.

Finally, the gradual abandonment of a belief in a higher power who is the final arbiter of human actions will eventually have irreversible consequences on mankind and the planet.  A perpetuation of current conditions will result in the piecemeal deterioration of human society and the destruction of a once beautiful and precious planet.  At this stage in human history this fate seems inevitable.

In a recent speech President Obama would have us believe that ISIS extremists have no ideology. This statement begs the question: can extremism exist without an ideology to support and sustain it? In my opinion, the President’s argument, however well intentioned it may have been, is a fallacy. There is no question that ISIS adheres to an ideology. Undoubtedly, ISIS and other like-minded organizations have an ideological foundation. That is evident in its writings, language, symbolism, and objectives. If so, the President’s argument is a ‘deductive fallacy’, wherein true premises lead to a false conclusion. It is also politically misguided, insofar as it weakens the effort to permanently defeat ISIS. Why? Because every extremist ideology by definition is embedded within a community of adherents that share elements of the ideology but who are not fanatical or radical in their beliefs. The Islamic ideology that ISIS combatants adhere to transcends the battlefield. It appeals to a much wider cohort of individuals within Islam, who, for whatever reasons, may be undecided, passive or unwilling to advance the cause. One can kill those radicals who have deployed to the battlefield but unless you confront their false ideology with the truth, it will prevail. As such, the effort to defeat ISIS must be two-fold, immediate and protracted, 1) immediate: its armed agents must be defeated militarily on the battlefield, and; 2) protracted: the ideology that provides ISIS its adherents must be unequivocally discredited by thought leaders. In summary, we can and will succeed on the battlefield but ultimately the false ideology must be identified and its lies uncovered for all to see. The naked truth is that the Emperor does not have new clothes and we cannot be a party to a lie, regardless of who it is we are trying to protect by believing the lie.

http://www.miamiherald.com/opini…/op-ed/article10710845.html