Let’s Take A Closer Look

One evening in 1978, when I was in medical school, I described to a few dinner companions a fantasy/sci-fi machine for diagnosing illnesses.  CT scanners (which provide multiple computer-generated cross-sectional views, or tomographs, of the body using x-rays) had only recently been invented, and MRI (using NMR technology taught to us in physical chemistry classes at the time) was still a few years away.

My dream machine, I explained to my dinner mates– whose eyes I could see were beginning to glaze over– would compile all the tissue cross-sections to generate a 3-D picture, a hologram.  At that time, CT’s limited resolution showed us the organs and tissues, but what if we could greatly increase the resolution with a different type of energy beam, something other than x-rays?  Radar?  Microwaves?  Cosmic rays?  Who knew?  We would see not only tissues but cells, then drill down to the level of cell nuclei, mitochondria, chromosomes, even individual genes.  The resolution of the imaging technique was the rate-limiting step.

With my dream machine, abnormal cells would stand out right away; combine that information with indicators of tissue metabolism (PET scanners would come along later) and even images of gene sequences, and before you knew it, surgical biopsies of live tissue– for example, to diagnose cancer– would no longer be needed.  “You could examine the hologram from all different angles, then perform a virtual biopsy!” I exclaimed (stimulated by the excellent wine we had with dinner).  The computer, having obtained all necessary data from the high-resolution scan, could “biopsy” pieces of the 3-D image, then project them on a screen for the pathologist:  this could be repeated over and over, without any pain to the patient.

Well, the dream machine is one step closer.  This week– only 36 years later– a newsletter from the dean of Yale Medical School announced the arrival of a high-resolution cryoelectron microscope with tomographic capabilities, enabling researchers to view specimens in 3-D from multiple angles (unfortunately you still have obtain a specimen, as nobody has figured out how to put a whole patient into the machine).  It can tell us the atomic structures of membrane proteins– now that is small!  By the way, the three scientists most responsible for developing cryo-EM received the Nobel Prize in Chemistry this month.

(Not making any claims to the Nobel Prize– just saying).  Here’s an excerpt from my science fiction novel, Fourth World:

Lora stepped out of the Pan-Bio Analyzer, commonly known as the Probot, and reached for her paper robe.  Her skin was flushed and tingling- it felt like a Sonicspray, she thought, only without the blowing sensation.  The Probot scan, which produced a detailed analysis of anatomy and organ function- it would have detected a gastric ulcer, sinus infection or brain tumor, for example- was the final part of the physical evaluation required of all students, and she had passed without a hitch.  So had Benn and Sool, who were already on their way to the first formal lecture for the incoming class of interns, scheduled to begin in Cushing Hall in just a few minutes.  After a week of organizational meetings and introductory talks, it was a much-anticipated moment.

Lora nodded to the technician seated at a control panel, hurriedly crossed the cold Probot Chamber to the adjacent dressing room, and exchanged the robe for her standard-issue orange bodysuit.  Almost everyone attending YaleConn Med- not only the lowly interns- wore those bodysuits to class, so Lora shrugged off their resemblance to the prison uniforms worn by PsySoc reformees back at Tharsis One.  In a way, Lora was disappointed that the computer hadn’t found anything wrong with her:  no explanation for the distracting noise, that persistent insect buzz that had kept her up for part of the night.  It was faint, but intermittently took on a pronounced throbbing pattern- quite annoying.  Neither Benn nor Sool seemed to hear that noise, whatever it was:  A blood clot?  Eustachian tube dysfunction?  Seizure activity?  The Probot said no, no and no.  Meaning that there wouldn’t be an easy remedy.

 

 

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Ejection for Personal Fouls

A political football is a topic or issue that is seized on by opposing political parties or factions and made a more political issue than it might initially seem to be. “To make a political football” [out of something] is defined in William Safire‘s Safire’s Political Dictionary as “To thrust a social, national security, or otherwise ostensibly non-political matter into partisan politics”  — Wikipedia

Implicit in the term “political football” is the back-and-forth, unresolved nature of an issue from which both sides seek an advantage, and yet for which neither side accepts responsibility.

For example, our Chaos President’s rescinding of DACA.  Lawmakers on both sides of the aisle, and a large majority of the population, seem to agree that these young, undocumented immigrants should be given a pathway to citizenship in the only country they have ever known.  It’s the right thing to do, regardless of politics.  But Trump purposely exposed 800,000 young people to deportation, upending their lives, flooding them with fear and anxiety.  Then out of supposed compassion, he struck a deal (minus the Great Wall of Mexico) with Democrats to safeguard the Dreamers, passing the responsibility on to Congress to “fix DACA.”  Now he has reneged by demanding that the Wall be part of the deal.  In this football game of his creation, Trump is wearing the uniforms of both teams.

Another example is Trump’s antipathy toward fighting climate change, a cause which would seem to be a no-brainer (especially in light of this year’s severe hurricanes, floods and droughts).  Economic factors, such as the number of jobs in the methane and CO2-producing industries, do not change the science behind climate change, but they do change the politics.  To tackle this political football, the Administration’s strategy is to remove scientists from the EPA and deny the science altogether, rather than create new industries that don’t generate heat-trapping gases.  Now Scott Pruitt is trying to justify repealing Obama’s Clean Power Plan by lying about its costs and benefits.  As always, Trump is an extremely short-term thinker, and his first priority– even over world survival in the long term– is to pander to his political base.

Healthcare has been (and may still be, despite the apparent demise of Repeal and Replace) another political football.  How did taking away health coverage from millions of lower-income Americans for the benefit of the wealthy even get to a vote, let alone several rushed attempts to get Repeal and Replace passed?  Without considering the greatest good for all of the people, Trump appeals to his base (even though many of them would be among those losing coverage) by trying to fulfill a campaign promise.

But stepping back from each of these issues and looking at the whole of Donald Trump’s presidency, you begin to see a much larger game going on, in which immigrants, global warming and healthcare, along with the upcoming tax reform, threats of nuclear escalation in North Korea and potentially Iran, are all isolated plays called from the bench, with the ultimate goal of exciting Trump’s base and reliving the WIN of the 2016 election.  His support for white supremacists and the NRA, his heartless remarks made in Puerto Rico, and his ceaseless campaign rallies complete the picture for those benighted folks (sometimes spelled with a V).

Voices of dissent coming from within the Chaos President’s own camp are welcome news:  GOP Sen. Bob Corker has taken the biggest step so far by pointing out that Trump tweets lies, is volatile, unstable, incompetent, needs to be contained, and could set the nation “on the path to World War III”– but Rex Tillerson calling Trump a “f___ing moron” isn’t far behind.  It’s time for action:  hopefully more Republicans in Congress will muster up similar courage and not only speak up, but also take care of the Dreamers, rejoin the Paris Accord, stop sabotaging the Affordable Care Act, and pull us back from the brink of nuclear war.  Maybe when Trump calls on his team to throw the final Hail Mary pass, they will eject him from the game, or at least opt to take a knee.

 

 

 

Welcome to Our Planet

Eight months ago, coincident with our Chaos President’s dark and threatening inauguration speech about “American carnage” (see my previous post, Inauguration Blues), six people entered an isolated environment on the Big Island of Hawaii, a NASA-run simulation of life on Mars.  Amazingly, their eight months separated from the world have passed, and yesterday the four men and two women emerged to discover that Donald Trump is still the Chaos President, still denying climate science, still unable to build the Great Wall of Mexico.  They will find the world unsubtly and unsettlingly different, however:  while they were gone, the US has withdrawn from TPP and the Paris Agreement, circling its wagons and surrendering its leadership position worldwide; multiple hurricanes, boosted by warm ocean waters and rising sea levels, have laid waste to the Caribbean and parts of Texas and Florida; DACA has been rescinded, exposing 800,000 young people while 11 million undocumented immigrants continue to live in fear; North Korea has launched missiles over Japan and tested a hydrogen bomb; the President has blustered at the United Nations that we may have no choice but to “totally destroy” North Korea; he has also doubled down on his statement that neo-Nazi white supremacists and those protesting against them are equally to blame for violence; a parade of White House officials have departed in disgrace; a special prosecutor is closing in on the Trump campaign’s collusion with Russia to influence the election; the GOP is cynically trying for the fifth (or is it the sixth) time to bring their cruel and destructive healthcare agenda back from the dead (see my previous posts Vive le Healthcare and Kill Bill 3)– Trump wants this bill, which would result in millions losing healthcare coverage, passed by next week, before the Congressional Budget Office and other expert groups can provide any analysis of its dire consequences.

In Inauguration Blues, I advised the six Martians-in-training, when they finally came out of isolation, not to utter the classic line, “Take us to your leader.”  But I’ve changed my mind; they should absolutely see our Chaos President, if only to demand of him, “What’s happening to our world?  Why are you doing this?”

Vive Le Healthcare (a.k.a. Kill Bill 3)

Ding dong, the bill is dead!  The “skinny repeal” bill died in a close final vote last night, a surprise attack at 2 AM as Sen. Mitch McConnell tried to ram it through on short notice.  It was killed by unified Democrats and three brave Republicans, to the great relief of nearly everyone, including many Republican senators who had voted to destroy health coverage for millions of their constituents for the sake of party unity.  But is the zombie GOP healthcare bill truly dead (see my post from last week, Vive Le Healthcare II, in which Repeal and Replace first passed the House, morphed and died in the Senate, then came back as Repeal Only, was killed again, then struggled back to life under the guise of Opening Debate on Healthcare).  Well, it soon died again, then- guess what- rose from the dead as Skinny Repeal, which would have deprived 16 million people of health insurance and raised premiums by removing the individual coverage mandate.

And now that, too, has died, and McConnell has finally said it’s time to move on.  Nothing more to see, folks.  I’m reminded of the classic horror movie ending:  ominous music plays as funeral mourners head back to their cars, sniffling with heads bowed under gray skies.  Behind them, the freshly-turned earth on the grave begins to shift.  Terrified movie-goers scream as a claw-like hand suddenly reaches up through the soil!

Just as insurers and exchanges can now look forward to a stabilized market and resume setting rates not artificially raised due to uncertainty (“just in case” the GOP bill had passed), our Chaos President tweets “let Obamacare fail, then deal!”  Even a GOP-owned Congress sees that as a catastrophic option, but Trump wants to win so badly, he’ll force his opponents (and with them, the American people) to their knees.  He’ll “win,” for example, by weakening enforcement of the individual mandate or increasing uncertainty regarding cost-sharing subsidies.  The President will breathe life back into the moribund Repeal and Replace agenda by sabotaging his own nation’s healthcare.  Say… did you see the earth on that grave shifting just now?  No?

In Fourth World Nation, the second novel in my science fiction trilogy, I offer a tongue-in-cheek view of healthcare in a dystopian future.  By the way, I’m doing a final rewrite on the finished book, so you can expect a notice on this blog very soon!  Here’s an excerpt:

True, at each patient’s initial visit, the mobile AI units did all of the diagnostics and prescribed treatments.  And inevitably, some of those treatments would fail; in those cases, according to DOW policy, the second visit would be scheduled with a human provider.  “For the human touch,” said a DOW brochure.  Lora barely felt human at this point, but when the green light flashed above the door, she always took ten seconds to clear her frazzled mind before putting on a smile and heading into the exam room- especially with cases of treatment failure, who tended to be hostile from the outset.  Taking a full ten seconds was actually self-indulgent, comprising over eight percent of the two minutes allotted for the diagnostic phase of each visit.  The patient, seated in a chair which entered the Intake Room through a sliding door on the left and slowly moved along a conveyor belt toward the Probot chamber on the right, had exactly six minutes with the physician before the exit door slid shut.  Yes, spending ten seconds to gather herself was generous, she admitted; but then again, when providing the human touch, good bedside manner was important, wasn’t it?

Six minutes would seem to be plenty of time to take a history, show the appropriate level of concern, perform whatever physical examination was rarely required, assess the psychosocial peculiarities of the patients (“each to be treated respectfully as an individual,” she recalled the admonition from her early days in medical school), and then wish them wellness as they disappeared into the domain of the Probot, where the real work was done.  But those six minutes, Lora had discovered, flew by much faster than expected.  Some patients insisted on elaborating on the history, reporting new symptoms or irrelevant details about family members at the last second:

“Oh, by the way, did I mention that I have triple-vision?  And I can’t feel anything below the waist?  Great-uncle Leo had the same problem when he was my age.  Should I worry?”

Fortunately the patients were belted to their seats for safety’s sake, as a number of them had tried to get up in order to show her some physical finding, such as a fungus on the foot or a growth in the groin.  Completely unnecessary, she would hastily reassure them:  the Probot would diagnose all of these imperfections much better than she could.

To my readers, stay tuned, in good health!

 

 

Vive Le Healthcare II

Maybe I should have titled this post Kill Bill 2.  Just when you thought the GOP healthcare bill was dead, it has begun to exhale sulfurous vapors again, its glowing red eyes blinking open, its sharp claws twitching in anticipation of wreaking more mischief.  It’s as scary as any horror story by Stephen King.

Despite essentially every healthcare organization and the majority of the population coming out against it, the House birthed a malformed Repeal and Replace bill which, you have heard many times, would increase the number of uninsured by 22 million, take away protections for pre-existing conditions, and worse.  After behind-closed-doors tinkering in the Senate, Repeal and Replace emerged more fully developed but equally grotesque.  It would cause 15 million people to lose coverage within a year, and again, 22 million by 2026, as well as water down the quality of health coverage.  When four Republican senators jumped sides and put any hope of passing this horrible bill out of reach, the relieved majority of citizens (remember them?) in this country celebrated.  The bill had been killed- or so we thought.

But then President Trump’s response was to “let Obamacare fail… I won’t own it,” without any regard to the cost to his citizens- he’s only concerned about a “win” for himself, and has been actively sabotaging Obamacare for months.  That would leave no healthcare plan, but who cares?  He, the President, won’t own it, and a win’s a win, never mind where the buck stops.  In a strikingly similar vein, Sen. McConnell- backed by Trump, of course- plotted a move to Repeal And Not Replace, even though 32 million people would be left out in the cold.  So once again, the GOP healthcare agenda stirred ominously back to life.  Do any of these elected officials ever consider the people who voted them in?

Then came another bright spot in the GOP (following Sen. Collins):  when Sen. Capito announced that she had “not come to Washington to hurt people,” I thought that would surely be a stake driven into the heart of the beast.  Congress would come to its senses (unless they had come to Washington to hurt people… )  And when 50% of those polled said they were in favor of Obamacare, versus 24% for the GOP plan, I was sure the struggle was finally over.  But no, no, here it comes again, still staggering among the undead:  McConnell wants to open floor debate on healthcare next week, in the faint hope that the GOP bill can somehow be rewritten on the fly- perhaps garnering just enough votes to squeak by?  Remember, repeal efforts have been going on for seven years, and yet the GOP doesn’t have a realistic plan to offer.  This healthcare zombie won’t go away, no matter how badly scared the people get:  already six long months into the Trump Administration, the battered GOP needs a win at any cost!

If Republicans in the Senate get their way, I might have to make an adjustment to my science fiction novel, Fourth World:  the average life expectancy in 2197, I wrote, is 107.  But now, if access to health insurance dwindles, I might dial that down; it seems that only GOP Repeal and Replace bills can live that long!

 

Vive Le Healthcare!

Start stockpiling those pills.  Republicans in the Senate have just released their latest revised healthcare bill, and it does not look promising.  Despite a few tweaks, for example to planned tax cuts for the rich and lower-cost options for buying insurance (eliminating benefits considered essential under the Affordable Care Act, such as maternity care), several huge, ugly bugs remain in the system:  deep cuts to Medicaid resulting in loss of coverage for millions (the CBO, which predicted a loss of 22 million for the previous version, will weigh in next week- hopefully before the Senate vote), loss of guaranteed protection for pre-existing conditions, etc.  On this eve of Bastille Day, the current political turmoil- including Healthcare, the Trump/Russia investigation, Paris Accord, Muslim travel ban, and so much more- brings to mind the storming of a prison or fortress by a population which has reached the end of its rope.

The people demand liberty, including freedom of the press, speech and assembly.  To me, liberty also includes- within reasonable limits- freedom from fear:  fear of hunger, oppression, deportation, terrorism, global warming, pollution- and also illness.  Access to healthcare should be part of our daily expectations, but a GOP-controlled Congress doesn’t agree.  As Joel Baden, at the Yale School of Divinity, recently pointed out:  Republicans like to quote from the Book of Proverbs, wherein the righteous are consistently rewarded and the wicked are punished; in this worldview, it follows that the successful (i.e. rich) must be more righteous than those who struggle (the poor).  Mo Brooks (R-Alabama) said the poor should pay more for healthcare, because “those people who live good lives, they’re healthy.”  He must not have read Ecclesiastes 9: 11-12:  “the race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to the skillful; but time and chance happen to them all.”

They demand equality:  equal pay and treatment in the workplace, social and environmental justice, educational and employment opportunity.  And, as you might expect, equal access to healthcare!  The proposed bill would throw millions of people off Medicaid, while providing tax breaks for the wealthy.  Everyone understands that if the entire country had health insurance, pooling the risk would enable equal treatment of the whole spectrum of medical conditions, from the worried-well to the chronically and severely ill.  Not requiring health insurance, Speaker Paul Ryan says, would give people the freedom not to buy something they don’t want.  So he wants to give them freedom, not healthcare.  That has the callous, unthinking feel of “Let them eat cake!”

Although deeply divided, the people need fraternity as well.  Cross the aisle.  End mindless, tribal partisanship.  Talk amongst yourselves.  One bright spot:  Susan Collins (R-Maine), in rejecting the proposed GOP bill, says she is ready to work with Democrats on improving the Affordable Care Act- imagine that!  Improve Obamacare?  Not “repeal and replace?”  Not “lock ‘er up,” “murderers and rapists,” fake news, witch hunts and chaos?  Yes:  a return to sanity, mutual respect and the realization that dominance-based politics destroys fraternity, equality and liberty.

Wishing all of you out there a happy and healthy Bastille Day!

Just Act Natural, If You Can

In my early practice, I used to have a patient- a handsome, urbane Chinese man in his thirties- who had appeared in a number of car commercials.  He seemed successful, and yet at every doctor’s visit, even before mentioning his health, he would complain about the lack of acting roles for Asian actors.  It was more important to him, he said, than his blood pressure!  This turned out to be a widespread frustration which has resulted in activism, educational endeavors, signed petitions and quasi-political gatherings across the country.  George Takei (Mr. Sulu) has been particularly outspoken on the topic.

In the 1930s, the Chinese stereotype depicted in movies ranged from the super-smart, respectful and submissive Charlie Chan to the super-smart, evil and insidious Dr. Fu Manchu.  These were two Chinese extremes, and yet, as Asian activists love to point out, Charlie Chan was played by a Swedish actor, Warner Oland, and Fu Manchu by another Caucasian actor (I forget his name) in yellowface.

Another stereotype is the martial artist, and here at least, we see Bruce Lee, Jet Li, Jackie Chan and other Chinese actors in kung fu movies.  And who can forget Michelle Yeoh and Zhang Ziyi in Crouching Tiger, Hidden Dragon?  All fighting with hands, feet, sticks and swords.  But where is the Asian Meryl Streep, Harrison Ford, Tommy Lee Jones, or even Woody Allen?  Maybe there won’t ever be one.  Does the necessary depth of character and experience lie beyond what Hollywood expects from such actors, based on Asian stereotypes?  Now Daniel Dae Kim and Grace Park are departing from the cast of Hawaii Five-O, allegedly because of unequal treatment and pay.  The show is based in an Asian-dominant environment, and yet the Asian actors are considered secondary.

When I wrote the sci-fi novel Fourth World, I chose a Chinese youth- Benn Marr- as the protagonist, the hero/anti-hero.  True, I was motivated by concern over the exploitation of post-colonial Third World countries; the European nations’ intolerance of their colonial subjects, now transplanted minorities in the homeland; and- part of the autobiographical element in Fourth World- the difficulty finding acceptance when coming in from the outside.  I wanted Benn to wrestle with not-belonging, and to crystallize these types of issues.  But it’s also true that, in thinking about my long-ago former patient, I wanted to create a leading role for a Chinese actor (John Cho?), in case Fourth World ever becomes a movie!  I know, dream on…