Matthew’s book brings to mind a brief section of a lengthy, episodically-written essay of mine (“1 in 3”) cobbled together during my late elder Daughter’s 1996–1998 metastatic cancer ordeal in Los Angeles. I’d been living in Las Vegas since 1992, and was attending grad school at UNLV when Sissy was diagnosed. I subsequently spent most of two years sleeping on a cot in a corner of her small Hollywood apartment as her affliction worsened. As time permitted, I worked on my Master’s thesis (chaotically graduating—quickly up-I-15-and-back—6 weeks before Sissy died), and the weirdly “cathartic” essay excerpted below for its resonance with Matthew’s book. to wit:
_____

Arrogant, narrow-minded, greedy, and indifferent?

Is science the enemy? To the extremist “alternative healing” advocate, the answer is a resounding ‘yes’! A disturbing refrain common to much of the radical “alternative” camp is that medical science is “just another belief system,” one beholden to the economic and political powers of establishment institutions that dole out the research grants and control careers, one that actively suppresses simpler healing truths in the pursuit of profit, one committed to the belittlement and ostracism of any discerning practitioner willing to venture “outside the box” of orthodox medical and scientific paradigms.

One e-mail correspondent, a participant in the internet newsgroup alt.support.cancer, vented splenetic at length recently regarding U.S. authorities’ alleged hounding, arrest, and imprisonment of alternative healers. He railed that law enforcement, at the behest of the AMA/FDA Conspiracy (a.k.a. the “corrupt AMA/FDA/NCI/ACS cartel”), had made the practice of alternative medicine illegal in the U.S. Moreover, he considered the fact that medical science can only claim “cures” for approximately 10% of the roughly 10,000 classified human diseases an a priori indictment of the mainstream profession.

I know: this is akin to the U.N. Black Helicopters/One-World-Government Conspiracy stuff of the not-too-tightly-wrapped. Still, I couldn’t resist — pointing out in (no doubt futile) reply that no one came with guns drawn and cuffs at the ready the night at Brotman Rehab when “Healing Angelite Crystals” practitioners — devotees of India’s Sai Baba — came from Topanga Canyon to hover for hours in ceremony over Sissy (to the curious and wary befuddlement of the night shift nurses); neither did Security nor the medical staff at Brotman confiscate the goopy-looking herbal tonic we brought in, an elixir prescribed for Sissy by a Chinese herbal pharmacist doing business quite openly in Chinatown near downtown L.A.; nor would SWAT teams pounce on the backyard in the Valley where we took part in evening-long Lakota Souix “healing sweat lodge” ceremonies conducted by the venerable Wallace Black Elk; and finally, Wyndie, one of Sissy’s highly skilled and effective physical therapists at Brotman did not have her certification revoked for counseling my daughter on the Hindu principles of the Chakras and efficacy of aromatherapy.

Moreover, I had to respond, the fact that we can only cure 10% of known diseases implies nothing regarding the quality of mainstream medical research and practice, unless the alternatives industry can provide hard, “case-mix adjusted,” scientifically valid data showing their methods to effect consistently and significantly better outcomes — which they cannot (a dearth of peer — reviewed studies being a central characteristic of “alternative” practice). Additionally, I asked, can anyone even cite historical curative percentages from 30, 50, or perhaps 100 years ago? Indeed, even such statistics would prove problematic — “shooting at a moving target,” as it were — in that more subtle and clinically unresponsive maladies continue to be discovered and classified while the easier to treat are dealt with more readily. And, classificatory observation is easy compared to the work and resources required to effect cures; we should expect that identification will outpace remedy. Finally, 50 years ago death certificates listing demise from “natural causes” would today likely have identifiable diseases recorded as the cause of death.

Purveyors of medical quackery should fear the hot breath and hard heel of competent authority, but I see no evidence of suppression of alternative therapy methods that are not certifiably fraudulent. All manner of “unproven” substances are sold quite openly at retail, both in the health food stores and in the national chain outlets; all that need accompany the product is the legal boilerplate disclaimer acknowledging an absence of FDA blessing, along with the inoculating phrase ‘dietary supplement.’…

…Every discipline has its share of the “arrogant and narrow-minded,” but I have mostly found mainstream health care professionals to be a dedicated, unpretentious, and self-deprecating lot quite aware of the limits of their knowledge and the risks of presumption. Once, during a series of health care quality improvement seminars I attended at Intermountain Health Care in Salt Lake City during my Medicare Peer Review tenure, a speaker — himself a noted pediatric surgeon — wryly observed that “the best place to hide a hundred dollar bill from a doctor is inside a book.” The Director of the seminar series, Dr. Brent James of IHC (and a Fellow of the Harvard School of Public Health), noted in our opening session that physicians would probably admit — off the record, of course — that perhaps only 10% of their clinical decisions made during daily practice could be traced to the peer-reviewed scientific literature. Dr. James also made the droll observation that, were you to walk into the typical medical adminstrator’s office, “you’d be much more likely to see copies of the Wall Street Journal rather than the New England Journal strewn about.”

What can one take away from such remarks? First, the many physicians I have come to know in the past few years are in the main acutely sensitive to the problems of clinical conceit and “paradigm blinders.” Indeed, the Utah pediatrician’s”$100 bill” wisecrack was offered to an audience of doctors and their allied health personnel during quality improvement training. Second, the body of peer-reviewed medical literature does not constitute a clinical cookbook; even “proven” therapies — particularly those employed against cancers — are generally incremental in effect and sometimes maddeningly transitory in nature. The sheer numbers of often fleeting causal variables to be accounted for in bioscience make the applied Newtonian physics that safely lifts and lands the 747 and the space shuttle seem child’s play by comparison. Astute clinical intuition is a necessary component of a medical art that must, after all, act and act quickly — so often in the face of indeterminate, inapplicable, or contradictory research findings.

Finally, with respect to Dr. James’ Wall Street Journal quip, the capitalist imperatives within which health care clinicians must operate are, in the aggregate, neither of their making nor under their control. Moreover, blanket indictment of the profit motive as necessarily inimical to optimum medical care and research is a rather simplistic notion. Strategies aimed at maximizing investors’ net returns probably spur at least as many medical advances as they inhibit.

A Healing Burger

Or, the “healing pizza/chocolate shake/fries?” One day not long ago, after we’d visited with a pleasant, seemingly intelligent woman of recent acquaintance who had also endured a long struggle with cancer and was committed to a “holistic healing” regimen, I ribbed Sissy that we ought cruise down Sunset for lunch, specifically to order some “healing burgers,” — my facetious reaction to having been cut off mid-sentence the prior evening after uttering the phrase “fruit juice” in the course of responding to a query concerning Sissy’s daily diet. “Oh, no! No fruit juice!” “No sugar!” “No fat!” “No meat!”

The magical quality that “holistic” evangelists impute to various vitamins, herbs, and certain foods (the latter for both good and ill), frequently shouts down the more circumspect and common-sense notion of an adequate and balanced diet. In my mind I parry their personal anecdotes with the equally anecdotal evidence of the long and mostly healthy lives of the large extended family comprising my in-laws. Most of these rural northern Alabama farmers manage somehow to live into their 90’s despite life-long daily breakfast doses of sausage and eggs with biscuits and gravy — along the rest of the typical meat-laden, putatively carcinogenic and arteriosclerotic farm fare that would make a brown rice zealot shrink in horror.

Most of these dietary-herbal and related recuperative obsessions ring resonant with the “bargaining” stage of Elizabeth Kubler-Ross’s dying process model. Please, Lord, I’ll change my indulgent, unhealthy ways, please — just spare my life! See, I’m doing my herbal/ carrot juice/ seaweed/ colonic/ aromatic/ crystalite/ meditative/ mega-vitamin/ macrobiotic/ psycho-spritual penance; please, please spare my life!…
_____

Still seems like last week, residually. And, then, 20 years later, we would lose Sissy’s younger sister Danielle to an unrelated cancer. That still feels like yesterday.

But, those were then, this is now. Dr. Motta’s book is a timely, highly recommended read. Among other bozo assertions, Donald Trump promises to put anti-vaxxer RFK Jr “in charge of public health” should he be re-elected. “He knows more about it than anyone else,” Trump recently preposterously claimed during a campaign rally.

We are frequently admonished to abstain from provoking a large, panicked Cornered Rat. Sharp teeth and claws; a reflexively furious disposition when confronted; possibly afflicted with disease(s)…

Yeah, a lot of truth in that admonition generally. But, sometimes you may have no rational alternative choice.

1979, Knoxville, Tennessee

We lived in a ramshackle rental house on the edge of a meadow in South Knoxville. Heated the place with two wood fire stoves. Stored some of our firewood on the back porch aside a chest freezer and a washer and dryer.

The porch firewood stash eventually attracted a large rat. Failing to trap him, I finally had to confront him directly.

Pulling the wood piles quickly out, I literally cornered him. He hissed and lashed out.

And promptly and terminally encountered the wrong end of my Sears dirt shovel.

I took no pleasure is that lethal remediation. But, beyond my own safety considerations, I had two young daughters romping in and out all the time, blissfully unaware.

May 2024

Former President Trump loves to xenophobically call disfavored others “vermin” (among his numerous other crass epithets).

TO BE PERFECTLY CLEAR: I do not wish this Dangerous Cornered Rat any physical harm. Nothwithstanding, shrinking from the threat he clearly continues to pose to our Democracy will only serve to make matters significantly worse. The fact that he appears now to be finally judicially cornered is a matter entirely of his own doing. His record of culpability is voluminous and dispositive. We must see through all legally available processes to ensure he is appropriately politically neutralized and held to final lawful account.

TO THOSE COMPELLED TO CRACK ON ME:

My paternal Grandfather. Franklin J. Gladd of Floral Park NY, was known to us kids as “Pop.” He was awesome, stinky stogie and all.

Now, I am “Pop” to my 4 yr old Grandson Calvin. (No stogie.)

I’m retired and now live in Baltimore (since 2019), where my son Nick lives with his wife Eileen and Calvin. We pick Calvin up from pre-school most days so the kids can finish out their workdays. Other than that, I just continue to read several books a week (life-long unlearner) and my numerous periodicals, and continue to write my KHIT.org blog, given that people seem to keep reading it. I’m now 78, and lucky to still be alive. Had my aortic valve replaced in 2018. Spent most of 2015 fighting off prostate cancer (capped off by 2 months of daily “Calypso” radiation tx).

Now I wrassle with Parkinson’s. Whatever. Yeah, it sux, but, hey,

Everyone should have this Pop’s problems.

315 days out (as of 12/26) from the November 5th, 2024 U.S. national elections, and counting down. “A republic, if you can keep it.”

What if Trump “wins?”

Well, the Heritage Foundation has some 900 pages of ideas.

I am the victim of a corrupt legal system that is being used by those surrounding Crooked Joe Biden, with his full knowledge & consent, to hurt, demean, and damage his Political Opponent, ME. A terrible precedent is being set, but so far, despite the vulgarity & viciousness of it all, it has driven my poll numbers to record numbers. You see, the American people are MUCH smarter than Crooked Joe! They see what is going on with a Corrupt & Racist New York State A.G., and a Trump Hating Puppet Judge willing to do her dirty work, even as it takes him, and his reputation, to new levels of low. They fully understand the Obama appointed, Radical Left D.C. Federal Judge, who refused to recuse, fully “gagged” me, and set a trial date THE DAY BEFORE “Super Tuesday,” the biggest & most powerful day in the Primaries. They get the fact that A.G. Garland and his boss, Lisa Monaco, sent their TOP DOJ lawyer to Manhattan to run the District Attorney’s “case” on me…And Much More. BUT WE WILL WIN!!!

[NY Times] Former President Donald J. Trump is planning an extreme expansion of his first-term crackdown on immigration if he returns to power in 2025 — including preparing to round up undocumented people already in the United States on a vast scale and detain them in sprawling camps while they wait to be expelled.

The plans would sharply restrict both legal and illegal immigration in a multitude of ways.

Mr. Trump wants to revive his first-term border policies, including banning entry by people from certain Muslim-majority nations and reimposing a Covid 19-era policy of refusing asylum claims — though this time he would base that refusal on assertions that migrants carry other infectious diseases like tuberculosis.

He plans to scour the country for unauthorized immigrants and deport people by the millions per year.

To help speed mass deportations, Mr. Trump is preparing an enormous expansion of a form of removal that does not require due process hearings. To help Immigration and Customs Enforcement carry out sweeping raids, he plans to reassign other federal agents and deputize local police officers and National Guard soldiers voluntarily contributed by Republican-run states…

The presumptive 2024 GOP Presidential nominee. We have less than a year to go until November 5th, 2024.

TRANSCRIPT: Donald Trump 2023 CNN Town Hall

Yes, many of these overlap (think Venn diagrams), evincing recursive cause-effect (feedback loop) oscillations. Some may be transient, eventually materially abating with or without concerted mitigation efforts. Others may well worsen irrespective of our countermeasures. I’ve been devoting most of my KHIT.org blog time of late to many of these topics. What among the foregoing might legitimately be characterized as “existential?” Obviously, “Species Extinctions” fits the bill. “Starvation” is certainly existential for those succumbing to it.

I don’t see how anyone can claim to be “bored” these days. I certainly am not. So little time, so much to learn (and unlearn).

(This post will accrue over time, given the breadth of issues and new developments.)

OCTOBER 7TH, 2023: HAMAS STRIKES ISRAEL, SUICIDALLY

JULY 7th, 2023: DAY 498 OF RUSSIA’S 3-DAY CONQUEST OF UKRAINE

Latest projections are that Putin’s aggression against UKR will go on until at least 2024. And, numerous other sociopolitical maladies continue to worsen.

FEBRUARY 24th 2022: RUSSIA INVADES UKRAINE

Buckle up, my friends. This could quickly go all the way bad. Putin quickly hinted at going (literally) nuclear.

LATE DECEMBER UPDATE

This stuff is absurd.

Mike “Wompus” Nieznany is a 73-year-old Vietnam veteran who walks with a cane from the combat wounds he received during his service. That disability doesn’t keep Nieznany from making a living selling custom motorcycle luggage racks from his home in Gainesville, Georgia. Neither will it slow him down when it’s time to visit Washington, D.C. — heavily armed and ready to do his part in overthrowing the U.S. government.

Millions of fellow would-be insurrectionists will be there, too, Nieznany says, “a ticking time-bomb” targeting the Capitol. “There are lots of fully armed people wondering what’s happening to this country,” he says. “Are we going to let Biden keep destroying it? Or do we need to get rid of him? We’re only going to take so much before we fight back.” The 2024 election, he adds, may well be the trigger… [link]

OK, back to where I’d started. I will soon be 76. The U.S. population has doubled across my lifetime. Global population has tripled. What seemed to me—the young kid of his early 1950’s childhood, to be a world of essentially infinite resources there for the opportunistic taking, has revealed itself to be—well—um, otherwise.

Properly, I now have to consider the likely futures of other young kids—both within and beyond my personal orbit. Our offspring will face a world of resource scarcities and maldistributions at every turn, with all of the acute and chronic conflicts such inequities foment.

No, there’s no justification for claiming “boredom.”

to wit,

INTRODUCTION

If all goes well, human history is just beginning. Humanity is about two hundred thousand years old. But the Earth will remain habitable for hundreds of millions more — enough time for millions of future generations; enough to end disease, poverty and injustice forever; enough to create heights of flourishing unimaginable today. And if we could learn to reach out further into the cosmos, we could have more time yet: trillions of years, to explore billions of worlds. Such a lifespan places present-day humanity in its earliest infancy. A vast and extraordinary adulthood awaits.

Our view of this potential is easily obscured. The latest scandal draws our outrage; the latest tragedy, our sympathy. Time and space shrink. We forget the scale of the story in which we take part. But there are moments when we remember — when our vision shifts, and our priorities realign. We see a species precariously close to self-destruction, with a future of immense promise hanging in the balance. And which way that balance tips becomes our most urgent public concern.

This book argues that safeguarding humanity’s future is the defining challenge of our time. For we stand at a crucial moment in the history of our species. Fueled by technological progress, our power has grown so great that for the first time in humanity’s long history, we have the capacity to destroy ourselves — severing our entire future and everything we could become.

Yet humanity’s wisdom has grown only falteringly, if at all, and lags dangerously behind. Humanity lacks the maturity, coordination and foresight necessary to avoid making mistakes from which we could never recover. As the gap between our power and our wisdom grows, our future is subject to an ever-increasing level of risk. This situation is unsustainable. So over the next few centuries, humanity will be tested: it will either act decisively to protect itself and its longterm potential, or, in all likelihood, this will be lost forever.

To survive these challenges and secure our future, we must act now: managing the risks of today, averting those of tomorrow, and becoming the kind of society that will never pose such risks to itself again.

It is only in the last century that humanity’s power to threaten its entire future became apparent…

Ord, Toby. The Precipice (pp. 3–4). Hachette Books. Kindle Edition.

ANTHROPOCENE GLOBAL WARMING, SOME STARTER THOUGHTS:

Perhaps I’m wrong about that.

Beyond direct photovoltaics (PV), wind and wave energies are proxy, non-CO2 solar. Hydroelectric dams are non-CO2 solar, but come with their own environmental footprint baggage. (And fossil fuels are, yeah, technically “solar,” but bound up in the problematic carbon of buried ancient biomass.) We’d have to know the total solar energy striking our planet necessarily consumed by the aggregate contemporary biomass (regarding which, humans reportedly comprise ~0.01%—,0.0001), and what proportion just dissipates entropically, trickling back out to the cold of space.

Nuclear fission is also non-CO2, but requires environmentally onerous mining and the effective “nuclear security state” comprised of often contentious “nuclear club” nations, as well as safe and secure nuke fuel waste disposal. Then there’s stuff like “Three Mile Island,” “Chernobyl,” and “Fukushima.” I started my white collar career in Oak Ridge, working as a programmer and QC analyst in a forensic-level environmental radiation lab. My residual reservations remain. “Bridge Technology?” Dunno. Maybe.

Can we get to ~100% direct solar? Are there sufficient PV cell raw materials for the manufacturing? What about the lithium etc necessary for the requisite large capacity batteries?

A lot of experts remain skeptical. But, some substantial fraction less than 100% will benefit us materially nonetheless.

apropos: Read up on Saul Griffith. I just got onto him.

In this book I approach the climate emergency from a new angle. I look for solutions, not barriers. Solving climate change should taste at least as good as carrots, at best ice cream, but it should not be painful. Instead, I’d like to offer a no-regrets pathway to success.

All too many people in climate advocacy or climate work are beginning with the question of “what is politically possible?” That could be a result of the frustration that drives many people, including our children, to march and protest for more rigorous climate action. But aiming only for what is politically possible is the art of limiting ambition before you begin.

This book doesn’t start with the question of what is politically possible, but asks what is technically necessary to reach a climate solution that is also a great economic pathway for a country. After we realize what is technically necessary, America needs nothing short of a concerted mobilization of technology, industry, labor, regulatory reform, and, critically, finance. Every stakeholder needs to coordinate their efforts to create the lowest-cost, zero-carbon energy system for all citizens.

The book provides details about one probable pathway to total decarbonization. Because I am trying to paint a picture of the future that is complete and compelling, some readers might think I am “picking winners” among clean-energy solutions. This book attempts to be technology agnostic — but not at the expense of exploring the likely technological outcomes. Fusion would be great, and nearly free carbon capture would be useful, but I’m not here to champion specific ideas; instead, I support technologies that pass the “Is it ready and does it work?” test.

The pathway that works is best summarized as “electrify everything.”

The book leans on real data, much of which was assembled in an unprecedented analysis of the US energy economy that I undertook under contract with the US Department of Energy. These details provide a story that is less about abstract concepts than about the recognizable technologies that define our world. This book provides a high-resolution picture of the consequences of electrifying everything. Will our lives change? The surprising answer is, not radically. Those things that will change are for the better: cleaner air and water, better health, cheaper energy, and a more robust grid. Our citizens can keep pretty much all of the complexity and variety promised by the American dream, with the same-sized homes and vehicles, while using less than half the energy we currently use. This is a success story that casts aside the 1970s-era narrative of trying to “efficiency” our way to zero emissions. Our country faces a challenge of transformation, not of deprivation.

How do we ensure the lowest cost of energy while electrifying everything? First, policymakers have to rewrite the federal, state, and local rules and regulations that were created for the fossil-fueled world and which prevent the US from having the cheapest electricity ever. Our country needs to massively scale up the industrial production of technological solutions, just as we did to win World War II. We cannot take our foot off the innovation gas — although I’ll argue that we don’t need any major breakthroughs, as thousands of little inventions and cost reductions are the key to achieving our end goal. Finally, we must have cheap financing for our transition to a zero-carbon energy system with low-interest “climate loans.” Climate change will not be solved if only the richest 10% can afford it; we need mechanisms to bring everyone along for the ride. In our nation’s history, there are precedents for doing this: the US pioneered public-private financing in the past. Innovative versions of this can help us get the job done today.

The consequence of getting the technology, financing, and regulations right is that every family in the US can save thousands of dollars each year.

We need to triple the amount of electricity delivered in the US. What is required is a moonshot engineering project to deliver a new energy grid with new rules — a grid that operates more like the internet. To do this, I argue that we must have “grid neutrality.”

The industrial mobilization required to hit the climate targets that our children deserve will require an effort similar to World War II’s “Arsenal of Democracy” in size, speed, and scope.

For a world desperate to rebound from a pandemic and economic crisis, there is no other project that would create this many jobs. I’ve worked with an economist to include an analysis that projects the creation of as many as 25 million good-paying jobs, spread across every zip code, suburb, and rural town in the country, should we choose to address climate aggressively.

This will not be easy, and people will tell you it is politically impossible. But, as I argue in this book, it is still possible. The earth is bigger than politics, and to meet our challenge, politics as usual must change…

Griffith, Saul (2021–10–11T23:58:59.000). Electrify . MIT Press. Kindle Edition.

SOLAR HYDROGEN PRODUCTION?

US Dept of Energy: “Hydrogen can be produced using a number of different processes. Thermochemical processes use heat and chemical reactions to release hydrogen from organic materials, such as fossil fuels and biomass, or from materials like water. Water (H2O) can also be split into hydrogen (H2) and oxygen (O2) using electrolysis or solar energy. Microorganisms such as bacteria and algae can produce hydrogen through biological processes.”

You ignite H2 gas, you get energy and water vapor, full stop. No carbon greenhouse gas compounds. Were you to produce H2 without using fossil fuels and/or biomass, your waste material is nil. Yeah, H2 does not exist on earth in pure molecular form, it has to be produced. Do it.

THREATS TO DEMOCRACIES, RAMPANT CORRUPTION

No shortage of timely reading on these interrelated topics. Below, yet another:

THE BAD GUYS ARE WINNING

If the 20th century was the story of slow, uneven progress toward the victory of liberal democracy over other ideologies — communism, fascism, virulent nationalism — the 21st century is, so far, a story of the reverse…

By Anne Applebaum

…Nowadays, autocracies are run not by one bad guy, but by sophisticated networks composed of kleptocratic financial structures, security services (military, police, paramilitary groups, surveillance), and professional propagandists. The members of these networks are connected not only within a given country, but among many countries. The corrupt, state-controlled companies in one dictatorship do business with corrupt, state-controlled companies in another. The police in one country can arm, equip, and train the police in another. The propagandists share resources — the troll farms that promote one dictator’s propaganda can also be used to promote the propaganda of another — and themes, pounding home the same messages about the weakness of democracy and the evil of America…

This is not to say that there is some supersecret room where bad guys meet, as in a James Bond movie. Nor does the new autocratic alliance have a unifying ideology. Among modern autocrats are people who call themselves communists, nationalists, and theocrats. No one country leads this group. Washington likes to talk about Chinese influence, but what really bonds the members of this club is a common desire to preserve and enhance their personal power and wealth. Unlike military or political alliances from other times and places, the members of this group don’t operate like a bloc, but rather like an agglomeration of companies — call it Autocracy Inc. Their links are cemented not by ideals but by deals — deals designed to take the edge off Western economic boycotts, or to make them personally rich — which is why they can operate across geographical and historical lines…

UPDATE: FINISHED CASEY MICHEL’S BOOK

A great read. I know a good bit about Gresham’s Dynamic financial malfeasance, but Casey’s book illuminates a whole ‘nuther orders-of-magnitude greater level.

ECONOMIC DISRUPTION

“…the hip bone connected to the thigh bone, the thigh bone connected to the knee bone…” So much for the prevailing “Just In Time” global supply chain tight-coupling efficiency. Markets don’t play nice with a serious viral pandemic.

Imagine my surprise.

Moreover, given the worrisome new “Omicron” Cov-2 variant now spreading from South Africa (?), recent tentative economic “recoveries” around the world may well hit more bumps in the roads—with all the political adversity they beget.

There’s plenty of good reading on the ECON repercussions of COVID-19. Here’s a particularly nice book.

Tragedy of the Commons

Government is charged with preventing tragedies of the commons, so to speak. As I write this in August 2020, the immediate responsibility of government is to steer us through and out of the pandemic. I doubt that mission will have changed by the time this book goes to press. The history of missteps and chances lost in this pandemic is depressingly long, but the blame game is for historians, not serious leaders. We are facing an economic catastrophe, and we’ve already wasted the better part of $3 trillion not fixing it.

We need to protect people, not companies. My choice would have been to follow the German model. Under their “Kurzarbeit” program, employers can furlough workers during the pandemic, while the government takes responsibility for two thirds of the worker’s salary. Workers stay technically employed, so they can easily return to their job once there is work to be done, but are under no pressure to work while it is unsafe. In effect, the government says, You don’t need to worry about food. You are in a position where you can distance safely without putting your family at risk. You don’t have to make bad decisions to feed your family. And there’s no fear.43 Happiness is not only a function of what you have, but what you don’t have. Specifically, an absence of fear. Absence from the fear that you won’t be able to feed your family or that serious illness might mean bankruptcy…

Galloway, Scott. Post Corona (pp. 200–201). Penguin Publishing Group. Kindle Edition

And, for a sweeping historical contextual view I could not recommend Kyle Harper’s new book more highly.

MICROORGANISMS AND MACROHISTORY

ONE OF THE CHIEF BLESSINGS of living in the modern world is supposed to be that the risk of dying from an infectious disease has become vanishingly small. The nuisances of modern civilization are a small price to pay for the good fortune of being alive at a time when our germs have been brought to heel. We can grudgingly resign ourselves to the inevitability that cancers, chronic diseases, or degenerative disorders will catch up to us someday. We moderns die of old age, of overabundance, of cellular malfunction … but not plagues and poxes. Until, that is, a new pestilence has the temerity to disrupt our daily lives, here and now. More than we are apt to remember, even in the shadow of a pandemic, the world we inhabit thoroughly presupposes the subjugation of infectious disease…

Harper, Kyle. Plagues upon the Earth (The Princeton Economic History of the Western World) . Princeton University Press. Kindle Edition.

THE EDUCATIONAL SECTOR

Problems in academia long predate the latest pandemic episode. Rampant cost increases, crushing student debt, questionable value propositions, prioritization of the big revenue sports, using non-profit status to venture into real estate and other commercial initiatives (while depriving local governments of tax revenue)…

I was fortunate as a (late bloomer) student. Very little undergrad debt (now long paid off), and I paid cash for my Master’s. I even got to subsequently do an interesting Adjunct stint teaching “Critical Thinking” and “Argument Analysis” at UNLV for a number of years while working as a bank credit risk analyst.

60% of our classroom faculty were adjuncts; the regular faculty mostly hated to teach (particularly undergrads), preferring their research and publication interests. Given that ~60% of our incoming freshmen were really not ready for college, one can perhaps have some sympathy. I recall looking out over a class and thinking “man, 2/3rds of you need to re-take high school.”

Couple of interesting books:

COVID-19 has served to make things acutely worse across the board. The unsustainable “business model” has been laid bare for all to see. We’ll see what shakes out eventually.

January 2022 update. Just saw news reporting that U.S. college admissions declined by nearly a half million students last year. What will be the broad ripple effects of that?

CIVILIAN FIREARMS VIOLENCE?

Not much to say here, other than,

The civil law tort principle of “inherently dangerous instrumentality” is what finally brought Big Tobacco to regulatory and compensatory damages heel. Habitually used as intended, tobacco products disproportionately sicken or kill those who partake of them. They are inherently dangerous, and, as such — while still not outlawed — they are heavily regulated in reflection of the threat they pose (however inadequately).

A firearm, absent its fitted calibre projectile, is just an expensive piece of pipe. The intended function of the bullet, however, is to damage or destroy that which it impacts — be it a beer bottle or can, a paper target, or an animal or human. There is no other purpose.

And yes, firearms can be “used safely.“ That is not in dispute. But neither can there be any rational dispute about the purpose of bullets. People who buy them intend to use them to hit things.

It’s not a perfect analogy. Tobacco products are not protected by the constitution. But it’s damn close enough functionally to justify rational firearms restriction (I am not arguing prohibition here). The relative risk associated with the smoking of a single cigarette pales in comparison with that posed by the firing of a single bullet.

Let’s get real.

I am now 76. I have never owned a firearm.

_____

Troubled reflections on the George Floyd murder and its upshot.

I include myself in that admonition. You’re either doing “justice” or you’re not. We’ve been “talking about race” as long as I can remember. And, justice as a verb extends far beyond race. Think about it.

None of this is exactly news. Uhhh… Aristotle, anyone.

apropos, see my prior post on Tom Price.

Indu Subaiya, to the Senate Finance Committee: Vote “No” on Tom Price: a perspective from the innovation community; January 30, 2017

Honorable members of the Senate Finance committee:

My name is Indu Subaiya, MD MBA and I am Co-Chairman and CEO of Health 2.0, the largest healthcare innovation conference and network in the world. I submit this letter to oppose Tom Price’s nomination for Secretary of Health and Human Services.

We know that the ACA reduces barriers to health care for millions of Americans, but what many don’t know is that it also fuels a vibrant segment of the private sector, the health technology innovation economy.

In a decade of working alongside thousands of healthcare innovators globally, and in chapters in over 40 US cities from Nashville to Boston, Dallas to Chicago, we have never seen our healthcare system adapt so beautifully to reward private enterprise while saving lives and taking care of our most vulnerable without the heavy hand of government.

Dr. Price appears to be a well-intentioned, educated man, but he has been out of both the practice of medicine and a transforming health care industry for too long to lead us in this dynamic market. Appointing him to architect a replacement plan for the ACA would be like hiring a dinosaur to build a space station.

What healthcare needs today is a pragmatic voice who can put pedal to metal on the progress that’s begun, who can work on reforming the ACA dispassionately with business leaders, entrepreneurs and patients represented in equal proportions, and who understands the healthcare innovation economy.

But Dr. Price is far too polarizing in his politics to be taken seriously by the diverse and moderate mainstream on both sides of the aisle. Those of us fixing healthcare on the ground have blasted silos, left partisanship at the door and figured out how to advance a common interest. Ask Republican Governor Charlie Baker, Republican former Head of the ONC, Dr. David Brailer, Chelsea Clinton of the Clinton Foundation, Mark Bertolini, CEO of Aetna, Bernard Tyson, CEO of Kaiser all of whom we’ve warmly welcomed on stage at Health 2.0 not just as speakers but as partners in the work of transforming health care.

Dr. Price on the other hand has never reached out to our community, and he’s had a decade to do so. Instead he has represented the Association of American Physicians and Surgeons, seen as a fringe group promoting self-interest, technophobia, and a “doctor knows best” philosophy. That era in medicine is over. The era of shared decision making, data transparency, evidence-based medicine and providers as partners in care and innovation is here. Our era needs a Secretary of HHS who will command the respect of the brightest lights in the healthcare innovation economy and Dr. Price is just not that person.

What do I mean by the innovation economy in health care? I am not referring to the old generation of electronic medical record companies (EMR) that indirectly received incentives under the HITECH act. I’m referring to the more than four thousand new companies and many more thousand jobs that were created in response to the ACA’s imperative to make health care more accountable for its outcomes. These companies have applied the best of American business and technological ingenuity to support doctors in their workflow and decision-making, to promote collaboration among caregivers, to avoid redundancy in testing, to improve patient safety and to allow patients to take more responsibility for their health and care.

As a sector, they’ve raised over 19.8 billion dollars in venture capital since 2011 because investors could bet on the momentum of a system aligning around the best interests of patients for the first time in history. What happens when you leave the doctor’s office or hospital has always mattered to individuals and families; but now it made business sense.

All this capital isn’t just lining the pockets of Silicon Valley startups. Economic development corporations in New York City, Massachusetts, Detroit, and Louisiana are making long-term, strategic investments in the health technology innovation economy to attract innovative companies to set up shop in their cities to provide badly needed solutions and to be powerful engines of job growth.

That’s great you say. We’ll keep this thriving and virtuous economy alive, we’re just going to get rid of the individual mandate, some nasty corporate penalties and poorly run exchanges that limit choice and raise premiums for patients and we’ll handle pre-existing conditions with hiving off those patients into separate pools. But that’s a fool’s errand.

It was precisely because the ACA widened the tent of coverage that new private sector markets were created. It was precisely because of exchanges that Americans woke up to the fact that you need to take responsibility for your health and spend your pre-deductible dollars wisely, and private sector businesses rose to the occasion to build tools to educate consumers on managing health care expenses and decision-making.

Overstretched health systems also see innovative technology as a way to do more for patients with less overhead, to reach people in rural areas and at home cheaply and effectively, to refer repeat visitors to the ER to a lower cost option in the community. Hospitals like Massachusetts General in Boston, Cedars Sinai in Los Angeles, Dell Medical Center in Texas, UPMC in Philadelphia and New York Presbyterian in New York City all have either started their own or participated in health technology innovation programs to test new models of care delivery in partnership with the entrepreneurial community in healthcare.

It was the ACA’s imperative to take care of a wider and more diverse population that created demand for new products to address the social determinants of health that are killing our small towns: caregiving burden, mental health, substance abuse, food insecurity, health literacy, social support for the elderly and so much more. These social ills normally depend on inefficient government programs. But thanks to the ACA, for the first time entrepreneurs have paying customers for solutions to these issues. Customers like public health departments, community clinics and hospitals. At the national conference we run on health innovation, the session on “Community Health” normally draws a handful of do-gooders. This past year you couldn’t get in the room if you tried; it was packed with entrepreneurs. The ACA had succeeded in creating a market for doing well by doing good.

The train of progress toward a healthier America and a more efficient health care system has left the station. If confirmed, Dr. Price would waste time trying to run after it only to get run over by it. We have better Republican candidates to choose from who have worked shoulder to shoulder with patients and innovators, who’ve been part of the transformation of American healthcare on the ground, not in DC and not in the ivory tower.

Don’t appoint him because you are comfortable with him as a congressman and a doctor. Neither role prepares him for this job. Don’t appoint him because the AMA endorsed him. The AMA is a friend to the innovation community but it speaks for a minority of physicians. You have already heard from thousands of doctors who aren’t involved in politics who oppose this nomination. Take your time and don’t rush this vote. Let’s fix what’s broken together without taking a wrecking ball to progress. On behalf of those of us with real experience making positive change in the trenches of health care, I ask you to vote “no” on Tom Price.

Thank you for your consideration.

Sincerely,

Indu Subaiya, MD MBA
CEO, Health 2.0

Indu Subaiya, MD, MBA is the Co-Chairman and CEO of Health 2.0, a leading conference series and network for innovation in health care.

Indu is scary smart, and someone I’ve characterized as “the most cheerful person in all of health care.” When she speaks, we do well to listen carefully.

Also relevant to health policy reform, my prior post “Put patients back in control of their health care.”

Over on my KHIT.org blog I’ve posted a reflection on Ann Neumann’s important book “The Good Death: an exploration of dying in America.”

Two years before he died, Dad mentioned that he was thinking of shooting himself or hanging himself out behind the shop. When things got bad, he hoped to find a painless way out. I was terrified I’d be the one to find him, his body swinging somewhere or bloody and mangled. I told this to a friend who brought me a copy of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, the New York Times best seller first published by Derek Humphry in 1991. Humphry, a brusque and controversial figure, was a principle founder of the Hemlock Society in 1980. Final Exit outlines the ways in which a person can kill himself, without legal ramifications. I read it and read it again, then gave it to my father. I was certain that, if I ever had to make the decision to end my life, I knew exactly how I would do so (sleeping pills, turkey basting bag over the head, loose rubber band around my neck to keep the carbon dioxide in), and my father would find his way, if he wanted to. I wanted him to know that whatever he decided, I supported him. Instead, he found death, good or not, in a hospice facility far from his beloved hollow.

When I finally left Africa for home, I quickly realized that all the hurt I thought I was working out on the road was still there, where I had left it. The divorce papers, the job search, the house that Dad built — my memory’s catalog of images consistently fell open to the same one: my father, almost naked, pale, lean, and contorted. I realize that in many ways, my memory’s recall of this image was my need for what Susan Sontag called, in her 2003 book Regarding the Pain of Others, “the pleasure of flinching.” It’s an easy memory to access because it hurts so much, but also because it made me feel close to him again. Yet it was crowding out all the good memories I had from our life together, like when we’d catch each other’s eye some golden afternoon while cutting wood on the farm. Or the comforting intimacy of his voice when I’d call him out of the blue to talk about the rain. His twisted body, arranged in a way it never would have been had he been alive, was crowding out all the things I loved about him. I replayed the last hospice scenes in my head. Did everyone die this way, fighting with both arms and legs until the needles came? I wanted to know if his had been “a good death.” And if so, might it come for me the same way?

It was clearly time for me to find another way to deal with my grief. Like my decision to get out of the country after he died. But this time, instead of running away from it, I had to get closer to it. I had been unmoored by my own grief for so long that I had no alternative but to finally make sense of it, to wrestle it to the ground and know it. To function in the world again, I’d need to understand what had happened to my father, to my family, to me — to all of us. I didn’t grasp the nature of this work at the time, but I was doing what Peter Trachtenberg describes in The Book of Calamities: I was launching myself into an investigation with all the raw energies and emotions I had put into grieving. “Before suffering people can form a coherent picture of their suffering,” he writes, “they must first ask questions about it, or maybe of it. In doing so, they are performing the work of science and philosophy, interrogating their reality in order to derive a thesis about it.”

Finding a good death seemed about as likely as finding the fountain of youth. What was good about dying? I had no idea where to begin, but since my reality of death began with hospice, I became a hospice volunteer. Most anyone can volunteer, and training is fairly brief, but hospice programs are constantly in need of more willing participants. Volunteers are warmly welcomed. I learned how to sit with other peoples’ dying. And I kept going. I followed my pain-filled curiosity to conferences and clinics, to academic lectures and to grief sessions in church basements, to isolated prison cells and to pale-blue hospital wards where every hushed word could be the last. I didn’t care if it was a morbid inquiry or a vain self-improvement project. I asked questions, yes, but mostly I listened to the stories of others who were close to death, their own or a loved one’s. I pursued an expert’s knowledge of how we human beings, in this time and country, slide into death or thrash at the end, and how those of us left behind stumble around in the absence. I told myself that this investigation was something that my father, who never let a loose chair leg or a broken appliance go unfixed, would have appreciated, if not encouraged. Something was rattling around, and I was going to set it right…

Neumann, Ann (2016–02–16). The Good Death: An Exploration of Dying in America (pp. 17–19). Beacon Press. Kindle Edition.

I subsequently tweeted

…A larger understanding was necessary: of why we die the way we do today; of the development of medicine and concepts of choice, autonomy, informed consent; of how hospice and hospital cultures were formed and perpetuated; and of what our regard for the dying has become in broader society. Too, the laws that regulate what is available to the dying had to be considered, along with their purpose and origin. As well, the financial systems that had locked us into the untenable way we currently die. Religious and other cultural forces also play a role in how we die. I had to ask myself how all of these interactions influenced end-of-life care. By focusing on individual lives and deaths, it became clear to me that changing the way we die would be a project of depth and breadth, one that involved loving care for patients as well as a fearless examination of the social, legal, and institutional systems that governed the end of our lives [ibid, p. 20].

A must-read, IMO.

There is no good death, I now know. It always hurts, both the dying and the left behind. But there is a good enough death. It is possible to look it in the face, to know how it will come, to accept its inevitability. Knowing death makes facing it bearable. There are many kinds of good enough death, each specific to the person dying. As they wish, as best they can. And there is really one kind of bad death, characterized by the same bad facts: pain, denial, prolongation, loneliness [ibid, pg 210].

“I realized that I was [now] in a club: those who knew what it was like to see the death of a loved one up close…I had not imagined what was coming. I had never taken care of a dying person before. I had never even seen someone who was dying.” [ibid, pp 6–7].

Interesting.

On July 1st, 1998, I held my first-born child as she “awoke” briefly from her days-long morphine pump haze “death rattle” and lurched up in her deathbed in Brotman Medical Center in Culver City, the culmination of 26 months of cancer hell. “It’s OK, Sissy, we love you, you can let go…”

There are no words, really.

A decade later, in May of 2008 I raced from a live music photoshoot I was doing at The Palms to the nursing home in Las Vegas shortly after midnight, only to arrive shortly after my dementia-addled 92 year old Dad fizzled out from what the death certificate would subsequently list as “end-stage debility.”

A month later my musician friends and I gathered at the apartment of our dear friend, Cuban-born bassist Adrian Garcia, who was dying of colon cancer that day. I still have his phone number in my iPhone eight years later. Just can’t delete it.

Three years hence, in November of 2011, I placed shavings of my Mom’s beloved dark chocolate on her tongue as she departed after four years in long-term care, just shy of her 90th birthday.

(Of course, there’s also the endless procession of my serial stray magnet pets who don’t live long enough.)

2018 UPDATE: We’ve been struck yet again. See “A tale of two sisters.” Unreal.

__

I’ve never been in the military, nor have I ever been around lethal crimes (with one exception noted below), so my direct experience with the deaths of unrelated others is limited to two incidents. First, in 1963 while in high school, as I was returning home one afternoon on the two-lane Route 206 in Hillsborough NJ with my mother, the driver directly in front of us impatiently and abruptly pulled out to pass the car in front of him, and promptly collided with the rear of a semi tractor truck hurtling up the other way pulling an empty flatbed trailer, knocking the aft wheels array out. The trailer wheels careened down the highway toward us at first, then bounced wildly off into the adjacent field. The victim’s car spun violently and crashed headlong into a ditch on the other side of the road.

I was first to the scene. The engine compartment was fully smashed back to the firewall. I frantically pulled at the crunched driver’s side door. It took several hard pulls to get it to creak open.

This man was obviously dead or shortly to be formally so. Impaled on the steering wheel shaft. Blood and saliva oozing down out of his mouth, unseeing eyes open, “staring” down. Wow.

Then in 1966 in Chicago, where I was playing guitar in a road band during my second year out of high school, we were hanging out sitting at the large second story window of our Near North Side hotel room one afternoon, just watching the day’s random auto and foot traffic.

A scruffy fellow ambled stumblingly across the intersection at the light change — a “drunkard’s walk,” it seemed. A wad of what looked to be crumpled dollar bills in his left hand.

Another man raced up from behind and snatched the money out of his grip. The robbery victim shouted incoherently and gave halting chase. He tripped on the curb and hurtled headlong across the sidewalk, through the plate glass window of the store on the corner.

Yikes! Holy Shit!”

We raced down and ran across the street. A crowd of gawkers quickly assembled. “Damn, man, look at that! Those are his brains, man.”

Indeed. A shard of heavy window glass had pentrated and pried open his skull at his right temple. A river of blood flowed across the sidewalk and into the gutter.

Police and an ambulance arrived forthwith. There would be no saving this hapless fellow. He was quickly loaded up and hauled away. A store employee came out straight away and hosed the blood and brain tissue into the gutter and down the sewer drain as the crowd drifted off.

An hour later you couldn’t tell anything had ever happened, except for the quickly boarded-up storeront window.

That’s it for me. More than enough.

____

Do yourself a favor. Buy and study Ann Neumann’s excellent book.

CODA

Speaking of death…

Some people give the full measure of sacrifice.

In the summer of 1977 we rented a U-Haul truck and summarily up and moved from Tuscaloosa to Knoxville, Tennessee. No job, no nothing. Merely wanted a change, and east Tennessee looked pretty good: beautful country, close to the Smokies, not too far from my in-laws’ NW Alabama farm home, large university (where I would subsequently get my first college degree in 1985 at age 39), decent local music scene (I was a hardscrabble roadhouse bandleader at the time; Cheryl was managing a bar and attending graduate school at Alabama).

We rented a motel room in West Knoxville, bought a paper (no MacAirs and Zillow in those days, lol), and looked in the classifieds for a house to rent. Found a run-down place next to a meadow in South Knoxville (circled in red) up in the woods just below the forested ridge line off West Ford Valley Road (the landlord’s house up on a ridge is noted by the lower right hand rectangle).

Back then there was just a fenced meadow with a small stream running through it and a barn down by the road just across the owner’s driveway where horses were boarded. We would come to call it “Griz Row.” There are a few houses there now in the former meadow down close to West Ford Valley Road.

It was one of three houses the landlord had bought from nearby demolition close to Chapman Highway and moved onto his property to use as rentals. His name was Paul Griz, a local Baptist church music minister. First time I saw him, he was this Elvis big hair pompadour guy wearing polyester slacks, white shoes, and a white patent leather belt.

Lordy.

It was just my bass player Stan and I; we’d left the kids back at the motel with one of the other band guys (Cheryl was still back down in Alabama, working and going to school).

No problem, we quickly did a deal and rented the place. A dump, but cheap, and the bucolic setting was quite nice.

Later, after I brought the kids there and we were moving in, he showed up again, all agitated. Wanted to know “is your wife black?”

My younger daughter is mixed race. “Adopted” at birth. Long story.

“No.” I sort of briefly explained (simplistically and euphemistically) what was none of his business. Hoping I was not about to be evicted on Day One.

He was obviously freaking over what his whitebread redneck neighbors would think. There Goes The Neighborhood.

He left. It was uncomfortable. Swell first day in the new ‘hood. Shit.

A day later he showed back up on the porch. Carrying a large plate of food. His true Christianity had gotten the better of him, and he was chagrined and remorseful and effusively apologetic. Genuinely so.

No Biggie, dude.

We became fast friends.

I subsequently learned he was in remission from melanoma, and could not really work a regular job. He had this rickety-assed, dangerous sawmill up in the woods, where he made locust fence posts and cut lumber on order for other locals, some of whom would drop off big logs hauled in on trucks.

Big, scary 4-foot saw blade powered by an old tractor hooked up to a belt. The u-shaped hinges that held the blade axle down on beams would jerk around loosely. I could just see this thing coming off and cutting someone in half. Like, uh, me…

I’d go up and help him. He would sing church songs in this utterly beautiful baritone voice. He LOVED cutting lumber, and was a great source of conversation. We would talk and laugh for hours. He was a genuinely good man. While he talked of his faith a lot, he never laid any hard-sell preaching on me. Never probed me for my beliefs. Never once pitched me to come to his church.

His melanoma came back eventually and quickly killed him. It was a very sad loss for me. I loved him and his family.

I still shlep around this old 1 x 10 x 4ft cedar board I kept from the stuff we cut. It is a prized possession I will always keep.

I am not “religious” (a Recovered Episcopalian and subsequent Lapsed Unitarian — the ultimate spiritual dilettante). But, I was blessed to come to know someone who exemplified the best of what a “Christian” is supposed to be.

My late friend Paul Griz.