Unintended Consequenses

Unintended consequenses are inevitable when making global decisions in a system as complex as medical care. Unfortunately doctors have ceded too much ground to the bureaucrats and it may be too late to save the system without a complete collapse. Over the past two decades the number of doctors in this country has grown with the population. The number of medical administrators, however, has exploded, and these people now consume a large portion of the health care dollar. The administrators and non-practicing physicians spend a lot of time NOT caring for patients but telling the rest of us what we are supposed to be doing with our time and talents. We now have a number of very entrenched special interests that dominate medicine (i.e. Pharma, device/medical equipment companies, hospital corporations, and the government) with little to no input from physicians and with little thought to the consequences for individual patients.

I could give hundreds of examples of the insanity of the current system, but in the interest of time I will give one: a single example of the mind-numbingly idiotic machinations of “the system” is the fact that inhalers are quite expensive for my patients to the point that people are going without medicine and dying. Why? Global warming!

What? you ask? Now we can argue all day about the amount of climate change going on and how much humans have to do with it, but I doubt that anyone would argue that asthma and COPD sufferers are big contributors to climate change. But that does not matter in today’s insanity. Because of “climate change” big Pharma can lobby to make the propellant gases used in inhalers illegal, so that the reformulations – now required by law – can allow them to extend patents for another decade or so. So the old MDIs are out. Now people have to use these “respi-click” inhalers which are difficult for elderly patients with arthritis. And Pharma gets to charge hundreds of dollars for these new inhalers for medicines that should be dirt cheap.

People get hurt. And I would be willing to bet that if you calculated the carbon effects of creating the new manufacturing plants for the new inhalers the overall balance in the carbon calculations would be a wash, if you even believe the carbon dioxide hypothesis of climate change to begin with.

This is just one small insanity in the sea of insanities that is modern medicine. It is no wonder that good people are leaving the occupation in droves. Why would anyone want to be a doctor today? The prestige is gone. The money is gone. The work is shit and we have to listen to the ‘C’ students who are now hospital administrators telling us what to do. Bad EHRs are just adding insult to injury.

I did see a sign posted in one doctor’s office that I think should be a standard sign posted in all doctor’s offices. “Don’t mistake your Google search for my medical degree”

Liberty Under (Friendly?) Fire

Filkins-Do-Not-Resist

After a recent assault on a New Jersey beach, it is becoming even more clear that we have too many police in this country. A well-known fact is that we lock up more people in the United States than any other country, but the reasons why have not been entirely clear. One of the main reasons has been the failed war on drugs, a nearly fifty year debacle that has led to a near police state and the jailing of countless numbers of people whose only crime has been to seek an escape from the tedium of daily life.

Under multiple administrations, local police in this country have become increasingly militarized, using surplus military equipment donated or provided with generous subsidies to local police by the Department of Defense. This has led to deadly SWAT team raids, often on innocent bystanders, leading to increased tensions between the populace and the police, particularly in minority communities, which are disproportionally targeted by these police raids.

Misunderstanding of the origins of this problem has led many people to believe that the motivation behind these police activities is racism, but as can be seen by the assault on the beach above, white people are caught up by these Gestapo tactics as well. Assault by police on white victims does not play into the national media’s narrative of widespread racism and so often goes ignored. The alleged victimhood of minorities in this country is also one of the few remaining sources of power for the Democratic party, which is otherwise bereft of ideas, as the Dems must keep large portions of the population dependent on government in order to stay in office. The combined propaganda power of the mainstream media and Democrats keeps nearly half of the population of this country entranced by outdated and misguided ideas.

This is not a recent problem, although it has certainly worsened over the past fifty years. I recently watched the movie Vanishing Point, in which the protagonist, a car delivery man named Kowalski, is targeted by police for attempting to run a car from Colorado to California in record time. His only crime at the start of the film is speeding, which given his history as a race car driver was not likely endangering anyone. In general, speeding is a victimless crime, only becoming dangerous when combined with distraction for the driver. Unfortunately, speeding is something that is quite easy for police to measure and prove in court, in contrast to driver distraction due to cell phones, eating, or putting on makeup. Anyone who spends any significant time driving will know that driver distraction is much more dangerous on our roads than speeding, yet it largely goes unpoliced and unpunished because doing so is challenging, and our police generally do not like challenges, only going after ‘low-hanging fruit’.

So, this goes back to my hypothesis at the start of this essay, that we have too many police. We are in a situation, and have been for decades, where there are too many police, and for police departments to fund their activities they must target and ticket large numbers of people who are generally minding their own business and not harming anyone. These activities are often defended by people (who do not know any better) under the auspices of the need to reduce crime. The fact that crime rates are at all-time lows goes ignored and underreported. The mainstream media needs stories of crime to generate ratings, and politicians need the illusion of crime to justify passing more and more laws. There are now so many federal laws that they are not countable.

Having an uncountable number of laws had led to a situation where almost anyone in this country has committed a crime at some time or another, usually unwittingly. This means that given enough time and resources, a prosecutor digging through any of our lives could probably find an infraction that could land us in jail. Most people do not have the resources needed to defend themselves when faced with this kind of power of a prosecutor and will take a plea, admitting guilt mainly to make the pressure go away. Western society used to recognize this as a tactic of run-away authoritarianism used in communist countries. The 1970 movie The Confession offers a frightening and thought provoking look at these tactics of the state and remains must-viewing for anyone who wants to understand what is happening in our society today.

The ongoing Russia-collusion probe by Robert Mueller is a good example of the dangers of unfettered prosecutorial power. An even more disturbing example from the UK is the recent arrest and secret prosecution of activist Stephen Yaxley-Lennon, aka Tommy Robinson, in England for attempting to report on an Islamic child molestation (grooming) trial. Not only was he arrested and thrown into prison for 13 months alongside Islamic criminals, almost ensuring his death in prison, but the judge issued a gag order against the media of any reporting about the imprisonment. Multiple web articles about the episode were promptly taken down by the subservient media, under fear that they would similarly be imprisoned for supposed “incitement”.

While I am not here to defend the tactics or opinions of Tommy Robinson, of whose history I am only recently becoming informed, there is a famous quote that I am reminded of: “I disapprove of what you say, but I will defend to the death your right to say it.” This quote has largely been attributed to Voltaire, although the origins appear much more recent. Regardless of the true origins of the quote, it has become a clear and succinct statement of the defense of liberty, one of the cornerstones of the French Enlightenment and of the founding of the United States.

What has happened to liberty in the West? It is a still-revered principle that is under assault by runaway police and prosecutors. These people have been given power by an uninformed populace with the misguided mandate to “reduce crime”. The assault on liberty is cheered on by the mainstream media, in search of ratings, and politicians, in pursuit of more power. Whether or not we will be able to preserve liberty, a cornerstone of Western democracies, is a problem that is increasingly coming into question. Only by becoming more informed and embracing the ideas of our founders will we be able to preserve their legacy for future generations.

STEMI or not STEMI?

I am currently stuck in a medical system that wants to treat all doctors and patients like widgets. The bureaucrats want to categorize all patients into neat boxes.
Tonight I had the perfect example. A patient arrived in the emergency room with an acute myocardial infarction. We categorize myocardial infarctions into ST elevation MIs and non-ST elevation MIs based on criteria seen on the ECG. This patient had borderline findings on her ECG and did not meet strict STEMI criteria. However, she had a good story, and an intelligent doctor who understands the underlying process can recognize that she is having an acute infarction. She should probably be treated like a STEMI, although she does not meet the criteria.
The system times us and grades us on our responses to a STEMI. Our reaction time and delivery of care goes into an algorithm that somehow defines the ‘quality’ of our care.
But this patient was not a clear STEMI. It was fuzzy. And dealing with patients is often fuzzy, due to problems with memory, compliance, etc…
So how do we change the system so that we can deliver the best care?
Asking these kind of system questions makes our administrators very uncomfortable. They want all of the patients to fit into boxes and for medical care to be delivered by flowchart. This is not reality.
It is important for people to recognize that patients are all individuals and medical care cannot be delivered by flowsheet. Good medical care takes thinking and accepting that patients often do not fit into neat categories. I do not have solutions as to how to best measure physician quality. A supreme court justice famously said of obscenity “I know it when I see it.” The same can be said of physician quality. Trying to measure quality through measures across a wide spectrum of patients is a fool’s game.

Self-interested in Liberty

For years it has rubbed a raw nerve whenever some pontificating pundit has put forth the idea that red-state individuals vote against their self-interests, but the discussion has been perverted so far that it took Frank Rich’s 4000+ word screed in New York magazine bashing readers about their heads with an almost mechanical redundancy to make me realize precisely where the problem lay. His extended article fired my imagination about what the true self-interests of the voters actually are, for I believe that Trump voters made a statement that does, per se, express their self-interest, but in so doing showed a preference for ideas which fly right over the pointy and outsized heads of the misguided unfortunates on the left.

Rich’s extended naval-gazing exercise regarding the arguments among many ‘progressives’ about the recent election was one of the most depressing pieces about America that I have read in a while (and that is time I will never get back). Not because of his premise, that working-class white Trump voters are all just bigoted rubes too dumb to realize that they need government to help them get ahead in life. No, the depressing part about this article was just how far the left has allowed the frame of the discussion to shift over the past few decades. Milquetoast conservatives of the Bushie brand have certainly contributed to this apocalyptic shift, but the distortion has largely been driven by ‘progressives’ and their toadies in the press, the government bureaucracy, and colleges and universities throughout this land.

So what is this seismic shift that has led to increased partisan divide and an inability of blue-staters to comprehend the thought processes of half of our population? It unfortunately has become part of the accepted narrative of our current politics that people who vote for less government are voting against their own self-interest.

Now this supposition may not seem remarkable to many of you, and in fact this new narrative may seem like just an ‘obvious’ statement – certainly to more ‘progressive’ readers. Many people may even believe that this is just a self-evident ‘fact’ and may even reject my hypothesis that this is a ‘new narrative’. But for those of us in the enlightened ‘traditional liberal’, i.e. conservative, camp this is a point that remains highly in doubt and one that should not be accepted without vigorous opposition.

Rich makes an argument that Trump’s working-class voters are so lost in their own red-state bubble that it may not even be worth the trouble for the Democratic party to try to reach out to them:

The most insistent message of right-wing media hasn’t changed since the Barry Goldwater era: Government is inherently worthless, if not evil, and those who preach government activism, i.e., liberals and Democrats, are subverting America. Facts on the ground...do nothing to counter this bias.

The ‘facts on the ground’ he refers to are the loss of working class jobs (which he attributes to greedy free market corporate robber barons) and the opioid epidemic (undoubtedly the fault of greedy pharmaceutical robber barons). He then goes on to say that:

The notion that they can be won over by some sort of new New Deal — “domestic programs that would benefit everyone (like national health insurance),” as Mark Lilla puts it — is wishful thinking.

But herein lies the fallacy of his thinking: believing that the only thing important in the lives of these people is the number in their bank account, health insurance, and the accumulation of material things around them. He makes the case that great unwashed hordes of hillbillies are really just out-of-work losers who don’t have enough brain cells to realize that the government has freed them from work (via NAFTA) and furnished them with financial aid and cheap imports from China, and that instead of being grateful and taking the blue pill for more of the same, they have opted for OxyContin induced bliss and early death. Only their always benevolent betters in government can save them from themselves.

By voting for Trump, however, they have cried out for a change in the national course. Glenn Reynolds’ article in USA Today makes a strong argument for one of the reasons why they have done so – the abject failure of so-called experts to solve our problems. The people want to be free of their overseers and provide for themselves. And one of the biggest barriers preventing these people from pulling themselves up has been the heavy hand of government, enshrining in regulation a Rube Goldberg apparatus of occupational licenses which purports to ensure competency of virtually every working person but instead offers a government provided protection racket to those lucky enough to already have a job while simultaneously reducing ‘expertise’ to the lowest common denominator.

Rich laments that Reagan’s dictum “The nine most terrifying words in the English language are: I’m from the government and I’m here to help” ‘remains gospel’ on the right, but it does so because for so many regular people it rings true. The media has repeatedly lambasted Trump and his supporters as anti-immigrant and used the words on the Statue of Liberty “Give me your tired, your poor, Your huddled masses…” to try to rebut his policy proposals but usually stops there without finishing out the phrase. It is instructive that to examine the rest of the poem, “The New Colossus” by Emma Lazarus, to see that Lady Liberty stands in contrast to the fallen Colossus of Rhodes, the “brazen giant of Greek fame, With conquering limbs astride from land to land”. She is not a monument to empire, or to what government has built. The “huddled masses” do not yearn for a handout from some self-titled ‘elite’, but yearn to breathe free: free from tyranny, free from the heavy hand of an unelected bureaucracy, free from self-righteous, patronizing, and smug pronouncements from urban pomposities who know nothing of the way of life or the values of half of their countrymen.

 

A Thought Experiment

A thought experiment: everything about you and everyone else is made public knowledge. Anyone can look in on your life and see everything you do. They can see what you eat, they see all of your interactions with other people, and they even see all of your sexual peccadilloes and when you masturbate. All affairs are revealed and all theft, fraud, and corruption free for anyone to sort through. The only things that you can hold secret are those things you keep in your own brain – never expressed to anyone or written down. Your diary is open.

 

What would you be ashamed about? What would you not want other people to know? This goes straight to what you consider to be right and wrong. This dives deep into religion and even sense of self.

 

This is essentially the state we find ourselves in with the most recent revelations of the extent of the spying ability of the United States government. And with the exponential advancements being made in technology – artificial intelligence, ubiquitous cameras and drones, aerial surveillance, facial recognition software, DNA storage capabilities – it is only a matter of time before all of our activities all of the time from birth to death will be captured in some huge database. Of course the spymasters will say that the only access to that database will be through judicious use of warrants. But if the policeman can get access to the database, certainly hackers will get access to the database, and sooner or later it is going to be fair game for everyone.

 

There are people who say ‘I have nothing to hide. Only people who have done something wrong need to worry.’

 

I fear the implications of this are much more dire. When employers can know all the employees’ medical results, when businesses can pull up the dirty laundry on the executives of their competitors, and when governments can monitor any activity that they may not approve of, where will we be? Forget about negotiations and market tactics – useless. Economies would crumble.

 

There are fundamental questions here. It all has to do with the power some people hold over other people. I wonder whether humans can live and work together without any personal privacy. I don’t know that I would want to live in that type of society. I don’t know that I will have any choice. This may solve the question of why we have not been contacted by other advanced civilizations. This may be why civilizations die.

Old school

A recent post at db’s medical rants addressed the question of whether or not the skills of history taking and physical exam have declined in recent years, and he asked the question ‘What does old school mean to you?

To me ‘old school’ means taking a good history and then performing a focused physical exam. So what exactly does this entail?

History:

Old school:

Questions are asked regarding the patients known medical conditions and the problem at hand. Relevant information is discussed, often but not always including some details about the patient’s occupation and family. If I am sewing up a laceration on someone’s leg from a chainsaw accident, I don’t need a family history, (but I might want to ask if any substances were involved). Treating a swimmer’s ear does not require much history at all, unless this is a recurrent problem or unusual presentation. On the other hand, a patient presenting with heart failure may need an hour’s worth of history, exploring other medical problems, current and past occupations, extensive family history, living conditions, and any history of substance abuse. The history adapts to the situation. I personally do not take notes or use a computer when taking a history – talking with the patient and looking them in the eyes

Modern reality:

In order to bill for the visit you need to make sure that you have checked enough items under the history of present illness, that the past medical history is documented, a social history is documented, a family history is documented, and an extensive review of systems is documented. Most of this is clerical data entry and is done by nurses or medical assistants. If you are very efficient you can click through the boxes to get a level 4 visit paid in a few minutes.

Physical exam:

Old school:

Hands on exam including (for me) listening to the heart and lungs of every patient, and then a focused exam regarding the issues that need to be addressed. In patients with diabetes or hypertension, a (gasp!) fundoscopic exam can be very useful. Looking at a patient’s hands can provide an encyclopedia’s worth of information. When patients complain of gout we actually have them take off their shoes and socks and (double gasp!) touch their feet.

Modern reality:

Too many doctors do not even examine the patient. They look at the electronic health record and click off the boxes. The entire physical exam section of the clinical note is boilerplate to fulfill billing rules. Patients tell me that they have seen doctors who did not examine them at all but stood by the door and diagnosed them based on what was in the computer. Some doctors seem to think that their patients are ‘icky’ and do not want to touch.

The problem of modern medicine

The problem today is a mentality that the history is all you need and then technology – lab tests and imaging – will make the diagnosis clear. This mentality has been driven by a number of forces. The most important force that drives everything in medicine is money. The way doctors are paid is insane. Take, for example, a challenging patient with a rare medical condition seen by two different doctors:

Doctor #1

Doctor #1 was the top of their class, well educated, sharp, engaged, and takes time to do a thorough history and physical exam on the patient. The doctor comes up with a presumptive diagnosis and sends a lab test to confirm or exclude the condition. After one hour, doctor #1 bills for 1 level 5 visit and a lab test. The insurance company refuses to authorize the lab test because it is for a rare condition and the bean-counter there has never heard of this test. They also question whether doctor #1 is billing too many level 5 visits. The patient then gets a huge bill from the lab company and makes an angry phone call to the doctor. The doctor’s practice goes broke and he burns out.

Doctor #2

Doctor #2 was at the bottom of their class and has no clue as to what could be wrong with the patient. He spends five minutes with the patient, orders 100 lab tests, and refers the patient to a specialist. He then goes on and treats eleven other patients that hour in the same way. After one hour, doctor #2 bills for twelve level 4 patient visits, 1200 lab tests, and laughs all the way to the bank.

 

Which doctor do you want? Doctor #2 may be just fine if you have pink-eye or a stubbed toe, but what if you have amyloidosis and need a heart transplant? Why does the system favor doctor #2 so much?

 

Old school

You must put hands on the patient. There is a tremendous amount of information that is gathered by simply listening to the heart and lungs. Patients often do not tell everything up front. You can take a history that you think was complete and all of a sudden you see a scar and ask about it. A patient will then spill out ‘Oh I had heart surgery as a kid’ or something similar. (it would have been helpful if they had mentioned it before)

Check-boxes and past medical history forms are not sufficient to obtain a medical history –they are only tools to get paid.

What ‘old school’ seems to mean is actually being a doctor. Taking time with patients, touching patients, and examining them is essential to medicine.

Some doctors think that it is OK to not learn about different heart murmurs – just get an echo. What a waste of resources! This is why medical care is so expensive. Yes, an echo can tell you more about the heart, but the way the medical system is now this requires time, money, and lots and lots of paperwork – er, computer data entry.

If we were paid a salary as doctors instead of fee-for-service everything would be much easier. Then we could use echo machines for diagnosis and not worry about what billing code we need to use and making sure that we have a complete study. If our payment system were different we would all be using mini echo devices just as we (well, at least some of us) use a stethoscope today.

This is why doctors switch to concierge practices. Unfortunately this is not an option for most specialists.

Medical Thinking

There are two main ways of thinking in today’s medicine. One is the mentality of Obamacare and the use of business techniques – specifically from manufacturing – to improve throughput of the system and reduce cost. The goal is to improve ‘justice’ in the system by proving care to the most people possible. The quality of the care is measured by population metrics – cost, number of infections, mortality, etc. Doctors and patients are essentially interchangeable widgets in this system, and all medical problems can be reduced to a basic set of algorithms that will dictate care. Actually, because thinking is no longer required in this algorithmic, guideline driven system, the role of the doctor is not that important, and physician ‘extenders’ may be used as interchangeable parts. If some patients fall through the cracks and are misdiagnosed, mismanaged, or ultimately die, that is the cost of increasing ‘justice’ throughout the population.

 

The second way of thinking is ‘old school’. Each patient is considered unique, and every doctor/patient interaction is precious. Time must be taken to get a good history, which will then guide a hands-on physical exam, lab tests, and ultimately diagnoses and a plan of care. The process cannot be rushed, but takes the amount of time needed to come to a good outcome. Extensive training is required to be able to consider the multitude of possible diagnoses. This way of thinking is clearly better for the individual patient (and for the doctors) but is resource intensive.

 

If I were to devise a health care system for this country, I would take a cue from business and the way technical support is handled. This approach would maximize the benefit of both approaches above. Young and/or generally healthy patients would use a ‘level 1’ system which is the first option above. NPs, PAs, and primary care MDs would handle the vast majority of complaints (URIs, UTIs, minor injuries) in an urgent care type setting. Patients with multiple problems or who have failed treatment at ‘level 1’ would then be elevated to ‘level 2’ where experienced general internists would see the patients, optimally no more than ~8 per day, and take time to go through all of the medical problems, take time to educate, and diagnose more severe problems. ‘Level 2’ internists would then consult specialists as needed.

Anyone concerned about bathrooms is an idiot

I honestly cannot understand what all the fuss about transgender people and bathrooms is all about. It seems to me that common sense should prevail. Tonight on the Tucker Carlson show, Zac Petkanas, a democratic pundit, was interviewed and stated repeatedly that gender is determined by how people self-identify. This is absolutely absurd on it’s face. Tucker then asked him the entirely reasonable question whether race is determined in the same way, but Mr. Petkanas said no. This is clearly incongruous. If we are going to put aside biology and use self-identification to determine gender, then the same logic should be applied to race. And therefore logically any white man should be able to claim to be a black woman for the purposes of, say, getting into a University. This is insanity.

Biology is biology, despite people wanting to deny that. Men are men, and women are women, but I believe that gender biology as well as gender identity exist on a spectrum, and for a very small portion of the population in the middle of this spectrum gender is ambiguous. Still, other than a very tiny fraction of people who are hermaphrodites or have mixed gonads, the biology is clear. The majority of people in the world are men who identify as men or women who identify as women. There are a small number of people for whom this does not apply, but this still does not change biology. A man who identifies as a woman is not a woman, but a man who identifies as a woman, and vice versa. Anyone who says otherwise is a nitwit and a biology denier.

That being said, what any one person wants to call himself or herself makes no difference to me. If a man wants to go around saying he is a woman, or a woman wants to say that she is a man, that is fine with me. All I ask is that if I am going to be accepting of you and be sensitive towards you that you do the same for me. If you appear to be a man and I address you as a man, please do not take offense if you want to be addressed as a woman. I will try to be sensitive, but please do not go out of your way to take offense.

As far as bathrooms are concerned, what I want to know is where are the bathroom police who are checking? If you identify as a woman, use the women’s bathroom. If you identify as a man, use the men’s room. I certainly am not going to check whether you are what you say you are.

People who want to be divisive are ginning this entire issue up, and it serves no one any good. People who are ignorant or bigoted about transgender people may have irrational fears about these people being ‘dangerous’. I think this is a personal problem for the people who are afraid, and education and kindness can overcome this problem. But I believe that there are more people on the left who are just looking for ways to take offense in order to push their agenda.

If everyone would just mind their own business and stop trying to tell other people how to live the world would be a better place.

Climate Shame

Once again we have revelations of data manipulation and false information in the ‘settled’ science of the global climate. This reveals what I have long argued: ‘climate change’ is a scam.

Now before you dismiss me as a ‘climate denier’, please, hear me out. I am an environmentalist and hope that we continue to work to manage our pollution better. But this entire issue really has nothing to do with the environment.

I have a few points to share that may upset the sensibilities of people who are convinced of the coming climate catastrophe:

1) Climate changes, life goes on

The climate of this planet has changed over the eons and will continue to do so in the future. Wishful (magical) thinking on the part of activists will not cause the climate to suddenly stop changing to suit their tastes. Human activity likely is contributing to that change, but how much and what to do about it remain topics of hot debate.

I hate to break it to you bleeding-hearts, but the planet will continue to do just fine for the foreseeable future. One hundred, five hundred, one thousand, or one million years from now there will be life in abundance on this planet, whether human or not. Whether we blow ourselves up with nuclear bombs or trash the planet with poly-cyclo-benzo-whatevers, life will find a way.

2) Species go extinct

Look at the fossil record and you will see countless species that have developed and then gone extinct over the ages. But now all of a sudden because some econutballs have ‘awareness’ of the environment, everything is supposed to remain static. If I understand the green fringe elements, any species that roams the earth at this moment is sacred and it would be a tragedy if we let any of them die out. This not only goes for the large mammals, but also for the left-handed-green-spotted-wharf-snail in Kalamazoo. I am all for preserving areas where wildlife can live, but I think the way to go about it should be for the environmental groups to buy land and then keep it natural. Bringing government into the equation is only a power play by the weak – they can’t get their way through persuasion so they must hire (elect) people with guns to enforce their way of view. And expecting all living species today to continue on in perpetuity is a pipe dream.

3) Science is messy

Science is never ‘settled’. In fact, the majority of scientific advancement is achieved by disproving previously known ‘truths’. Trying to predict the future is a fool’s errand. Just look at your local weather: models have gotten quite good at predicting the next few hours or even days of weather, but is it going to rain where you are one month from now? Who knows? There are just too many variables for us to be able to comprehend this system entirely.

I know what science is like – I have published a number of papers myself – and anyone else who has published a peer-reviewed scientific paper will know the magic of statistics. You can take raw data and analyze it by many various methods, you can fill in gaps in the data in many different ways, and you can drive the outcome of a study towards a desired goal in the process, if one were so inclined. Every scientist makes personal justifications for these manipulations, and every one will find their position on the spectrum of what is and is not allowable. The more manipulation of the data that takes place, the further from ‘pure’ science we go. And this brings us directly to the next point:

4) Many climate scientists have an agenda clouding their judgment

What are these agendas? They are different for each individual, whether it is a desire for tenure, status, and respect among peers; righteous indignation towards polluters; disdain for American capitalism; or some combination of these, the agendas of the individual may drive them away from ‘pure’ science and allow them to justify data manipulation to the point of a reversal of the true findings of the study.

So deeply ingrained is the ‘global warming’…err ‘climate change’ paradigm that many scientists cannot see their data objectively. They resist change fiercely, and will go to great lengths to defend their theory. As Thomas Kuhn puts it:

The source of resistance is the assurance that the older paradigm will ultimately solve all its problems, that nature can be shoved into the box the paradigm provides. Inevitably, at times of revolution, that assurance seems stubborn and pigheaded as indeed it sometimes becomes.

Kuhn goes on to say that the ‘assurance’ of scientists allows science to proceed, but the resistance to change is often so strong that it takes the dying out of an entire generation for new ideas to take the place of the old way of thinking.

5) It is all about money and power

Most of the powerful players in this game couldn’t care less what the temperature of the planet will be in fifty or one hundred years. What they do care about is money and power and how to manipulate people, governments, and corporations. The only proof you need: were climate activists and government officials so concerned about carbon they would set up internet tele-conferences instead of flying on their private jets to conferences in Paris, Geneva, and Davos. Everyone wants clean air and clean water, so this serves as a useful front for their bait-and-switch game.

that, ladies and gentlemen, is the Inconvenient Truth.

Leeches!

 

In ancient Greece an imbalance in the proportions of the human body’s four “humors” — blood, phlegm, black bile, and yellow bile — was believed to be the cause of ill health. Bloodletting using leeches was one method used by physicians to balance the humors, and this practice continued through the ages.

 

Modern medicine continues to use the leech in a few ways, mostly through the use of hirudin, lepirudin, and bivalirudin, but for most people the lowly leech (Hirudo medicinalis) is viewed with horror and disgust for the blood-sucking parasite that it is.

 

And this brings us to the American Board of Medical Specialties (ABMS) and its ‘Member Boards’ and the Maintenance of Certification (MOC). In ancient times the ABMS had its place, and hopefully we can take the best parts of MOC and use it in new and different ways. But it is time for all doctors to see the ABMS for the blood-sucking parasite that it has become.

 

And it is with horror and disgust that we see all that Westby Fisher and Charles Kroll have uncovered.

•  It is time to pull off the leeches that are sucking us dry!

•  I call for all Board positions to be held by practicing physicians – no ‘professional class’.

•  I call for a federal law to mirror the Oklahoma Law to free all physicians to practice without the dark shadow of MOC looming over them.