Maggie's Farm

Our corner of Maine, where we try to spend much of August boating, blueberrying, catching up on reading, playing tennis and golf and socializing over cocktails has broadband now, astonishingly. Re cars: Right now, I drive an oldish Lexus sedan, hubbie drives a fairly new F-250. Spare car? A 2002 Suburban for when needed, which we are considering replacing with a Toyota minivan.  I'll begin with this minor rant -

I hear that Cash for Clunkers - a wonderful subsidy for the Japanese auto makers - has had to extend their time frame for reimbursement from the government. Today is the latest deadline, but who knows?

The car dealers need the money to pay their bills.

It's the amount of paperwork, plus government computers crashing and making terrible errors. And most car dealers do not have, and cannot afford, the staff to get the government forms entered properly. Why would they? They are in the private sector...

That's why I refuse to get involved in government medicine. I don't have the time, and I cannot afford the staff to do their paperwork. And these bozos think they can run American medical care? They do not have a clue.

Errors on government paperwork are potential felonies. Who needs the hassle? Not me. I just want to be a simple doctor, and I would rather be paid with a bushel of potatoes from your garden than with a puny and way-overdue government check.

The "health care" war - and it is a war - attests to the extent to which Americans are divided on the proper role of government in their lives, not to mention in the most personal and sensitive areas of their lives.

For example, Coyote in a piece titled US Medicine - The best in the world, he said this:

I had a professor that used to poll his class — he would ask them if they would prefer a society where the gap between rich and poor was narrower but where the poor were, on an absolute basis, worse off than in the less equal society.  He reported the vote almost always split about 50/50.  (of course the is a purely utilitarian formulation of the question.  Adding in individual liberties issues makes the question far more stark, as to achieve an egalitarian society one must give up both wealth and liberty.)

As a more-or-less Conservative person who was raised in the heart of the American Revolution, my instincts are to distrust centralized power (power is a zero-sum game, unlike money and wealth) and the wisdom and trustworthiness of politicians - and to trust the people to figure out their own lives as best they can (while providing the abundant safety nets we have now for those who stumble and fall).

I know that Lyndon Johnson's Medicaid and Medicare (for the poor, the chronically disabled and the old - imagine considering 65 to be old!), were viewed as first steps towards universal government medical care. Those measure took care of those people that everybody felt badly about.

The Left, which pretends to see "market failures" everywhere as an excuse to place as much as possible under the control of the State (see Dr. Clouthier: Simply put, the government needs to relearn its place, who notes the Left's tendency to promise the sun, moon and stars for free, for all.)

Does Government Know Best? I doubt it very much. There are few people in government, I believe, who are as educated, honest, informed, or thoughtful as I am (and that's not saying much). Regan at American Thinker asks Does Government Know Best?. One quote:

Frighteningly, team Obama and the Democratically-controlled Congress -- who have taken on the role of the prudent parents of juvenile Americans -- have proven to be more than occasionally wrong for the country. In their desire to completely control American lives, they have progressed from losing their tempers to losing their way. Americans are now living in a nanny state in which the Democrats in power are implementing policy after policy designed to reduce freedom of choice and increase government control. Big government, socialized institutions, and sharing the wealth are policies supported by the Democrats - the party whose membership includes academics, Hollywood pseudo-intellectuals, and community organizers. The members of the Democratic Party are those who believe that they are smarter and wiser than the average American and that government intervention in all aspects of our lives is necessary in order to prevent social and economic catastrophe.

William Anderson at Weekly Standard says what I wish to say much better than I can in his Who Owns Your Body? One quote (my bold):

We are berated, ad nauseam, with imprecations that America is the only advanced nation that fails to have universal health care. This statement is often followed by the rueful remark that the debate over government controlled health care has been going on without progress for 60 years and, ipso facto, it is time to settle it. All right, let's do that. Let's look a little deeper. Why is there no settlement of the issue, and why is America unique in its obstinate reluctance to follow the example of our older cultural brothers in Europe? When a debate continues for decades without resolution, it is prudent to consider the deeper underlying assumptions. Principles which underpin the arguments are likely being ignored and marginalized rather than addressed in a forthright manner. America is the only advanced country whose founding assumption is popular sovereignty. This is a proposition that stands with hardly a seconding voice throughout the contemporary international community. Yet it is the taproot of American exceptionalism. Even here, however, the principle of government subordination to the people is by no means universally accepted. It has never been firmly ratified by our political class, those spiritual descendants of Europe's nobility. Our soi-disant elite appear to view with dismay their countrymen's continuing preference for self-rule. Thus arises the question of corporal ownership. For Americans, the answer has been settled. Since the terrible bloodletting of the Civil War, and now excepting military service, ownership of one's body is a matter between the individual and God, with no intermediation by government. Yet assertions are now being made that government should have responsibility for, and thus authority over, the maintenance of our bodies. It necessarily follows that government must have the power to approve or withhold care. This concept collides destructively with the founding principles of individual responsibility and autonomy upon which popular sovereignty depends. This is the reason that the debate never ends. It is also the reason that any resolution of the question will necessarily either confirm or deny the original intent of the Founders.

I have occasionally posted here about the sad, if not pathetic, willingness of some to sell their American birthright of individual sovereignty and freedom for a bowl of lentils. This is especially sad for a shrink because part of our job is to help people emotionally mature. It is no help to a shrink's job for government to be an enabler of perpetual childhood and dependency. Read Anderson's whole good essay (link above).

Obesity is probably decreasing in the USA. What changed (in 1998) was to change the definition of obesity down to 30 lbs. overweight, thus adding millions to the "obese" column.

There's no way somebody 30 lbs overweight (by whatever standard is used) is what people consider obese. 30 lbs overweight is "plump," pudgy," or, as they used to say, "sleek" or "prosperous-looking." In women, "matronly."

In fact, being 30 lbs overweight has no ill medical effects at all. The aesthetics of it are, of course, highly subjective.

Just one humble thought about the government's apparent desire to control the purse-strings of medical care, and then to hire "experts" - our betters, no doubt - to ration it "rationally" (ie on an amoral, communitarian utilitarian basis) to cut costs:

It's our money. All of the government's money is our money. If we didn't make it, they wouldn't have it.

What went wrong in American history such that a government could even imagine making such personal decisions for us, with our own earned dollars?

Yes, I know that I am politically naive. I intend to remain that way.

Bremelanotide. It's a nasal spray, works quickly. Looks like it can be bought online.

Is it a party drug, or a medical drug? I do not know. Haven't tried it yet, personally, but I probably would if only for my educational purposes...

All of the late middle-aged docs I know are "scientifically" curious about it. It is said to be the only true aphrodisiac. If it has no serious side effects, I can see this drug leave Oxycontin in the dust on the black market.

Not everybody, for sure, is fully satisfied with his or her sex life, unless young and in love.

All doctors know this: The "Preventive Care" Myth from Krauthammer.

Preventive care is expensive, and has a very low yield. Things like mammograms do not exist because they are cost-effective: they exist because people want them. 

"A girl should look like a piece of candy."

Former Gucci designer Tom Ford. Might be a paraphrase, but that's how I remember it. This Friday post reminded me of the quote.

A re-post from 2007 -

A brief break from my vacation in Dark Harbor on Islesboro on Penobscot Bay (there is no cable out here, and happily no TV either. Primitive dial-up internet, but once a week is plenty for that hassle) to highlight this piece by Jonah Goldberg at NRO called "Isn't that Special?" 

I am always pleased to see folks knock the concept of "self esteem." What we humans need to aspire to is Self Respect. Self respect is hard-earned, or never fully-earned, but a worthy goal. A quote from the Goldberg piece:

These investments in self-esteem paid off royally, according to a report, “Egos Inflating Over Time.” Jean Twenge of San Diego State University and a team of psychologists combed through the answers of 16,475 college students nationwide who took the Narcissistic Personality Inventory survey between 1982 and 2006. Their conclusion: Today’s American youth are the most self-absorbed since we’ve studied the subject. “We need to stop endlessly repeating, ‘You’re special,’ and having children repeat that back,” Twenge told the Associated Press. “Kids are self-centered enough already.”

Read the whole thing - link above.

Meanwhile, we will assemble the routine lobster, corn, potato and steamer clam dinner, but with a giant pot of hand-plucked Maine mussels also, cooked Italian-style in the kitchen, with garlic bread on the side.

We'll do the lobsters, cod, potato and clams on the beach, in a sand hole on hot rocks and coals under a pile of seaweed and sand - a true clambake. We wrap the hunks of cod (salt and pepper first) in rockweed (our main seaweed up here), and it tastes much better than lobster, in my opinion.

Family-picked Blueberry cobbler for dessert. Yes, we did bring a mini wine cellar with us, and plenty of fine champagne too.

The drinks provide that instant and unearned self-esteem; the harvesting of the fine wild foods provides the self respect, Maine-style. Yes, we fished at 4 am this morning, and fetched some fine cod with clam as bait. Saw a whale, too.

Images: Upper photo is of Islesboro. Lower borrowed from our friend neoneo, because I do not do cameras on vacation.

When somebody collapses and stops breathing, make sure you remember how to do CPR. Just make sure you don't do it to some person who simply fainted, because you can be sued if you break a rib. Legal protection for Good Samaritans in the US is fading fast. Still, every citizen ought to know how to do this.

I have had to do it twice, once in a parking lot and once in church. One lived, one died.

"Positive Psychology," an intellectual fad for the masses. These people talk about "happiness interventions." It's nuts, if you ask me, but I guess it attracts research grant money. Nobody has the wisdom to tell anyone else how to be happy, and anyone who purports to do so is a fool. A commenter to that article posted this:

A lifetime of happiness no man alive could bear it, it would be hell on earth. Bernard Shaw.
Happiness is nothing more than good health and bad memory. Albert Schweitzer
To be stupid, selfish and have a good health are three requirements for happiness, though if stupidity is lacking all is lost. Flaubert

I have posted on the subject here and here and also our Do Americans expect too much from marriage? (and I still think happiness is a dumb subject. It's what I call "psycho-utopianism"). 

Funny how disparate posts can seem to come together. Our Sowell quote yesterday captured it: The universe, or reality, was not designed to make people happy. But if you are one of those people who view happiness as a sociological phenomenon, see neoneo today on dystopias.

I am more inclined to the negativity proposed in our link to Nyquist this morning. One quote from him:

Chapter 3 should be titled “The Virtue of Guilt.” If you haven’t done anything bad in recent weeks or months, consider what you presently have in mind. You are wicked by nature, so you are guilty by nature. Therefore, it is appropriate to feel guilty. Don’t let yourself off the hook. Don’t be slipshod and weak. Suck in your gut and make a new start. Guilt is the stick across your back sent to make you better. Is guilt unpleasant? It’s supposed to be, and it better be. Feel guilty often, and have plenty of regrets. People who have no regrets are dangerous. They will suck you in and suck you down.

I do not know much about what Psychologists do or study. I do know what Psychiatrists try to do, which is to relieve disability and unreasonable pain. That can be difficult enough. Worrying about "happiness" isn't my problem. I happen to be reasonably happy right now, but I will not be in ten minutes when I attack my pile of bills and paperwork.

I opted out of being a Medicare "provider" several years ago. It saddened me, because I like working with seasoned citizens. However, they are now so accustomed to Medicare that the expectation that they should personally pay me for my time is anathema to many. Not to all, however. I have never refused to help a patient because of financial limits.

However, entitlements turn otherwise proud grey-haired adults into... what?

The last time I was accepting Medicare, they paid me around $70 for a lengthy office visit, less than my plumber charges me for the same thing. No disrespect for plumbers at all: I respect their skills very much.

But what really put me over the top was their paperwork. Being a sole practioner who donates 1/3 of her time to teaching and a charity clinic, I could never afford a trained "Coder" to do insurance forms for me for $65,000/year (or more).

Yet if I did the Medicare forms myself, I'd end up working for around $20/hr - spending more time on paperwork than seeing patients. Just check out the government manual for Medicare filing for doctors.

Bear in mind that a form-filling error is a potential felony. My plumber has no such problems.

Hanson at Overcoming Bias posts the graph below from the British Medical Journal. It says they looked at 2500 treatments, so I suspect this isn't just medicines. I'd like to see the list to determine whether it only included standard treatments like antibiotics for pneumonia or stents for coronary artery blockages, or whether it includes things like homeopathy and massage therapy.

I don't know what to make of the Terra Incognita of the 46% of "unknown effectiveness." I want to see the details.

Heather MacDonald's fascinating report on American jails (as opposed to prisons) of today, with a cheerful visit to Riker's Island.

One of my life goals is to stay out of jail despite my dark and evil side.

Diagnostic madness in the DMS-5.

I knew they went over the edge when they began talking about Sex Addiction. Who gets to define that? These are the sorts of thing that makes people think shrinks are nuts, and damage their reputations as serious Docs. You cannot pathologize every human idiosyncrasy, desire, hobby, or preoccupation, because these are the things that make people interesting, unique, and colorful.

But for some sanity, making things out of wood leads to happiness. I have no doubt.

No signs of Wood-Working Addiction Disorder yet, but it's probably coming - right after Book-Worm Disorder, TV-Watching Disorder, Stamp Collecting Disorder, Bird Watching Disorder, and Diagnosis-Inventing Disorder.

Dr. Bob has penned a definitive essay on the topic of preventive medicine. It's all true, and all docs know it. One quote:

It looks like we are on the subject of health freedom today. What I have observed over the past ten years is that people increasingly equate insurance coverage with medical care. That's sad.

In my view, it's a pathologically infantile sense of entitlement when people expect others to take care of them. Sad, indeed when Americans can afford their cars and car insurance and computers and iPods and cell phones etc. but expect somebody else to pay their bills if they get sick.

My view is that every responsible adult needs cheap catastrophic medical coverage - what used to be called Major Medical, with the deductible of your choice. Budget into your life the costs of your kid's broken arm and annual $120 camp physical - or don't have kids. If there's a big problem, the Major Medical will cover you. Like if you have a heart attack, break your back falling off a ladder, or if your kid gets shot in the eye with a BB gun.

I want to know what the Dems want to cover with their grand plan to "reduce" medical costs:

Will they cover Reike, massage therapy, homeopathy, acupuncture, chiropractic, crystal therapy, therapeutic touch, late-term abortion, breast enhancement, plastic and cosmetic surgery, hopeless chemotherapy and radiation therapy, eye movement therapy, light therapy, Chinese herbal medicine, hypnosis, social workers, bunion removal, in vitro fertilization, elective Psychoanalysis, alcohol rehab, penile implants, heart transplants, high colonic cleansings, liposuction, ingrown toenails and toenail fungus, Native Indian Soul Renewal, and liver transplants?

And do you want politicians making these decisions for you?

Me? I want the government 100% out of medical care and medical choices, because they have no idea what they are doing. No more of a clue than they know how to run GM - or the corner candy shop. I know what my private family policy covers. I chose it, I pay for it, and it's cheaper than the family's car insurance.

What the heck does the government have to do with these decisions, anyway?

This is what's on my "serious book" pile this summer. A gold star for me if I finish it all:

Telling Lies: Clues to Deceit in the Marketplace, Politics, and Marriage, Third Edition - Paul Ekman

Aristotle's Poetics for Screenwriters: Storytelling Secrets From the Greatest Mind in Western Civilization - Michael Tierno

Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development - Allan N. Schore

From Dawn to Decadence: 500 Years of Western Cultural Life 1500 to the Present - Jacques Barzun. It's like 1/4 of a Columbia undergrad education in one book.

The Lucifer Effect: Understanding How Good People Turn Evil - Philip Zimbardo

Plea For A Measure Of Abnormality - Joyce McDougall

As a seafood lover, I have had 100s of crabmeat salads. Better than Maine lobster, in my opinion - and I eat plenty of lobsters.

When you go to Cooks.com, you can find tons of recipes. I object to all of them, because the meat of the Blue Crab is too special, precious, and too subtle to dilute with other random flavors like red peppers and mayo.

Here's my theory for the perfect crab salad: Finely chop some sweet red onion, mix with the cooked meat, and toss lightly with a regular or balsamic vinaigrette. Chill, and serve on Buttercrunch lettuce.

Ed. note: Get the crabs. I see Brooks Brothers has their crab chinos on sale.

There is no convincing evidence that "healthy eating" - whatever that is (eating "organic" vegetables?) - or a "healthy lifestyle," eg exercising daily or whatever - has any beneficial effect on your long-term medical future. 

Those things might - or will - make you feel better, happier, and more functional, and nobody likes to carry 30 lbs. of unecessary lard around with them, looking like a muffin-top or worse. Nothing to do with health, though. And that is why "Lifestyle Medicine" is quackery which has been foisted on a credulous public.

One quote:

...it’s little wonder, then, that the results of every major randomized, controlled clinical trial of healthy eating and lifestyles to date have been ignored, downplayed, or explained away... or their benefits greatly overstated. As incredible as it seems, they have failed to demonstrate significant benefit in preventing chronic diseases of old age, like the big three diabetes, heart disease or cancers, or in living longer. Nor has any healthy eating intervention been credibly shown to give everyone a government-approved BMI.

Other than avoiding smoking and substance abuse, and taking our medicines, our fates are sadly not in our hands.

Carpe diem: every day could be your last.

From a piece at Junk Science, The Vision of our Healthcare. These are the correct rates for docs as determined by the geniuses at the Center for Medicare and Medicaid:

Emergency medicine is valued at $38.36/hour, while chiropractors are at $65.33/hour (even 31% higher than previously) and osteopathic manipulative therapy is valued at $53.93/hour. Endocrinology (think especially diabetes and obesity) was valued by the PPIS at nearly twice what the CMS had been using to determine physician payments, and is now at $84.39/hour. Family medicine saw a similar increase and is now valued at $90.15/hour. In contrast, for example, Cardiologists’ value was cut nearly in half to $88.04/hour. Allergy and Immunology care was increased to $162.68/hour and Dermatology was increased to $184.62/hour.

When you’re injured or have a real medical emergency, or actually develop a disease, which of the best doctors will you hope are available to care for you: emergency medical physician, cardiologist, family medicine doctor, chiropractor or dermatologist?

News to me that chiropractors are covered by government insurance but, for all I know, they may cover massage too. Anyway, are these numbers insane? No doc could pay his school debt and his malpractice insurance on those fees, plus office and staff overhead.

This is valuing ER docs lower than what I pay my part-time secretary. But my real comparisons are my excellent plumber ($125/hr) and the local electronics repairman ($175/hr).

Read the whole piece. Another interesting bit he has in there is about the quackery of "Lifestyle Medicine." He has it right:

The popular belief, rigorously spread by the growing lifestyle medicine movement, is that chronic diseases of aging; such as cancers, heart disease and diabetes; can be prevented and are to blame on unhealthy diets and lifestyles and failing to control health risk factors. The actual fact is that the best randomized controlled trials (the gold standards of medical evidence) continue to fail to support such premises behind lifestyle medicine, as we’ve seen time and again. The 64 percent drop in age-related deaths from heart disease over the past 50 years, for example, is largely attributed to our modern, advanced medical care and coupled with the survival advantage of a better fed, immunized and overall healthier population. Even mainstream medicine is finally realizing lifestyle medicine is more pseudoscience and ideology than sound, evidence-based science.

Fads and quackery have always abounded in Medicine. Who would expect government to be able to tell the difference?

Related, how they keep medical costs down in England

America continues to take the subject of abortion seriously. That's a good thing, because it means we are morally and ethically still alive.

Hard cases make for bad law. Abortion is a mare's nest of conflicing considerations and motives: a Mom's right to control her fate vs. a baby human's right to life; individual freedom vs. group moral norms; a woman's instinctive striving for maternity vs. her wish for "freedom;" the human's (understandable) desire for consequence-free pleasure vs. the human and natural fact of moral limits, and others. 

I don't know about other countries, but I have never seen a woman who did not carry some guilt about her abortion(s). I consider myself lucky in never having had one, because I did some dumb things when I was young.

The pro-abortion movement has done its best, for 30 years, to try to normalize abortion. They have done this with language, by de-humanizing the "fetus" (nobody is "with child" any more); by speaking of "choice," by speaking of a woman's ownership of her womb as if a child were a homeless squatter on her property, by terming it a "d and c," and so forth.

Despite their efforts, the inner voice still speaks: the inner voice of our Judeo-Christian foundation and conscience which considers human life to be the property of God and which deplores the taking of innocent life.

People hate to feel guilt - it's painful. And people hate to feel inner conflict - it's uncomfortably confusing. Our brains struggle to suppress one side of a conflict to relieve us of these discomforts.

I do not really want to tell anybody else that they shouldn't have one done, but I wouldn't perform one (I doubt whether it is consistent with the Hippocratic oath) and I sure wouldn't have one. However, I wouldn't be surprised if I would have if I had gotten myself knocked up at 18 - when I was a selfish and frivolous person.

Thus my views lack moral and intellectual consistency. And that makes for a headache.

This post was prompted by Dr. Clouthier's America's Abortion Headache.

So asks Newsweek. (I resent the "we" in the question, because I hardly ever do those things.)

The article discusses how thin the science is of Evolutionary Psychology. It is. Whenever the issue of nature/nurture comes up, I find people making arguments which ignore two of the most basic aspects of human nature: 1. mankind's ability to adapt to almost anything and to create his own environment, and 2. mankind's obligatory social and culture-creating impulses.

It is innate to man to create cultures which reflect at least some aspects of human nature, but no culture can eliminate the beast in him. Thank goodness for that.

Thanks to Insty for letting me know about my old colleague Dr. Michael Stone's new book, Anatomy of Evil. Quote from the Amazon site:

What do psychology, psychiatry, and neuroscience tell us about the minds of those whose actions could be described as evil? And what will that mean for the rest of us? Stone discusses how an increased understanding of the causes of evil will affect the justice system. He predicts a day when certain persons can safely be declared salvageable and restored to society and when early signs of violence in children may be corrected before potentially dangerous patterns become entrenched.

Pretty to think so, but that day will never come, Dr. Stone.

Revisiting Klavan's brief video message to new college grads from a couple of weeks ago, with the great quote above.

It explains why I believe that any shrink, psychologist (or anyone in the social sciences) should be of a Conservative bent unless they have no faith whatsoever in the human spirit (in which case they should have no faith in their own, either).

It would be stupid of pharma companies not to market their new products. They have bills to pay and investors to pay. You cannot fault them for it.

As a shrink (who does not have a primarily pharmacology practice, but uses meds whenever needed), I never use the newest medicines. I let other docs find out whether they have any advantages first, or any repellent side effects.

For Bipolar, I still think good old Lithium, a salt dug out of the ground which costs pennies, is the best, safest medicine. It works.

From the NYT: New Drugs Have Allure, Not Track Record