Michael Beckley

I owe an apology.  It has been nearly two weeks since my last posting.  Either time has a way of getting in the middle of commitments, or commitments have a way of stealing time.  By week’s end I will be on another extended journey, one that will likely limit my writing time for a while but surely provide opportunities for new insights and material.  Before I go I am posting one more entry in an effort to redeem myself for short-changing my loyal readers.

Redemption…now there’s a timely topic. We all need redeeming from time to time for any number of reasons, and there are all types of redemptions.  Besides the obvious spiritual and moral redemption celebrated during this season by Christians and Jews, life often calls for redemptions of other kinds: from the physical illness of disease or the fiscal illness of financial calamity, from aimlessly wandering an emotional wasteland devoid of love or hope, from the terror of physical abuse or from the demons of compulsion and addiction.  At some point in our lives nearly all of us need to reclaim that portion of our value, our self worth and dignity forfeited through omission, commission, time or circumstances.  We need to be made whole again; we need a season of re-birth.

Easter, Passover, and coincidentally Spring, combine into a season of multi-layered messages not easily secularized by commercialization.  Chocolate bunnies, colored eggs and bright pastels offer lighthearted alternatives to much deeper messages far too potent and introspective to be avoided, and cycles of life too obvious to be ignored.  Whether we believe in divine intervention or nature’s cyclic perfection this is the season to remember, reflect, and renew…a season for redemption.

It is a time to remember the physical and emotional scars of the past, and wear them without shame as evidence of courage in the face of adversity and reminders of forgiveness.  It is time to reflect on the truths life has taught us: that hatred divides, greed consumes, selfishness isolates, and deceit destroys, and that we must rid ourselves, and our world, of their influence.  It is a time to renew and replenish our supply of faith, hope, trust, love and peace, and freely share these with those who find themselves lacking.   

This is the season of new beginnings, fresh starts and second chances; a time when the wise reject emptiness and choose fulfillment; a time to allow ourselves a moment of redemption.

Russian complaints about US handling of the war in Afghanistan are not well publicized.  Evidently the US has avoided dealing with Afghanistan’s poppy farmers who happen to produce almost 90% of the world’s opium poppies, and therefore almost 90% of the world’s heroin supply.  Because of the war unusually heavy drug traffic is making its way through Russia who claims to have experienced a tremendous upsurge in drug smuggling, drug related crimes and addicts.  The US contends that wiping out the poppy business will turn the farmers into insurgents who will financially support the Taliban, or anyone else who allows them to peacefully ply their trade.  So, for the sake of neutralizing the Taliban the US is turning a blind eye to the drug trade and Russia doesn’t like it.  The result is a complicated moral and ethical dilemma:  end the drug trade and possibly strengthen the Taliban, or win the war and deal with the drug trade later.  Either alternative is costly in terms of lives and resources, and our former arch-enemy appears to me teaching us something about moral high-ground.  How would you resolve the problem?

Support systems that used to provide the moral compass to decide such issues have lost relevance in a world where there are few absolutes.  Churches who for centuries have been the keepers of Western society’s moral and ethical conscience have too often been silenced by scandals of their own or find themselves preaching to declining numbers in societies who have become comfortable with moral relativism.  Universities that once required philosophy courses in ethics and metaphysics of every graduate are now the exception.  The rule of law, underpinned by secular humanism as a philosophical basis for decisions affecting every aspect of life, has replaced any higher accountability.  In short, the “straight and narrow” path of life with deeply rooted guideposts that pointed our way has become a freeway where the drive to get ahead has weakened value systems and lane-changing to suit personal ends is permitted, if not encouraged.  But at this higher speed life’s decisions have become even more complex challenging our values at every turn and testing our moral and ethical reflexes.

As science and technology have gradually unraveled many, but not all of life’s mysteries, polarization on life and death issues has increased.  Research manipulating the very essence of life continues to redefine the boundaries of human existence and dignity.  Business ethics are challenged by unbridled greed that condones the enrichment of the few at the expense of the many, affecting lives in every corner of our planet.  In an age where mind-boggling quantities of information is at our finger tips how do we develop the personal “conscience” that separates good from bad for us, our family, our community or our world?  To whom or what are we ultimataely accountable?  How do we distill the immutable principles that define our character and form our integrity, and what dependable mechanisms teach these values to our children?

We must make certain the image facing us in the mirror each morning has 20/20 vision.  If not, turning a blind eye to the challenges facing our world and shaping its future becomes our only recourse.

A snippet in our local newspaper about too many invasive heart tests with two few positive results has given way to a broader A/P piece (Lindsey Tanner) that suggests even President Obama is getting too many diagnostic tests, as evidenced by his recent virtual colonoscopy and prostate cancer screening.  The article highlights unnecessary diagnostic increases created by the “defensive” medicine practiced in America to avoid malpractice suits and the greater appetite for care generated by an informed public seeking the latest in advanced technology.  But as Dr. RIta Redberg, editor of the Archives of Internal Medicine and a cardiologist herself points out, “more care is not necessarily better care”, though “people have come to equate medical tests with good care and prevention”.  The article goes on to say that some doctors and advocacy groups do not subscribe to the “less is more” philosophy and believe that saving even a few lives is worth the cost of screening thousands.  I wonder…

After a lifetime in healthcare I’ve seen a great deal of practice styles and systems.  I’ve seen what defensive care does to medical practice in America, and I’ve also seen practice in countries where the threat of lawsuits is minimal and “negligence” more specifically defined.  Along the way I’ve encountered the “tinkerers” who keep diagnosing until they find a reason to prescribe something, those with “better ideas” who simply can’t abide the treatment prescribed by another physician, and those who seem to think surgery is always the only option.  My own physician ordered a $2200 endoscopy for me because I “should” have it at my age…I respectfully declined and took the cruise instead.

In fairness, I’ve seen all kinds of patients too: those that want a “specialist” for everything, others with prescriptions from every doctor within a ten mile radius, and those who simply have nothing better to do than visit the doctor or their local Emergency Room.  Advocacy groups sometimes encourage decades long diagnostic behaviors, such as routine mammograms, only to later decide the radiation exposure is itself a serious risk.  There’s also “alternative medicine” with everything from aroma-therapy to cupping (similar to the “bleeding” techniques used in previous centuries), not to mention the well-advertised “over-the-counter” trade for every conceivable ache and pain. Where does healthcare begin and where does it end?  Where should it end?  What is enough?  And when it comes to health, where happens to our common sense?

Many of us use medical diagnostics as a gauge.  We want to know if lifestyle elements like smoking, cholesterol, salt, alcohol, sun and a host of other not-so-healthy practices are catching up with us, to see if it’s time to make the lifestyle changes and implement the preventions we know make sense and we know we need.  If the tests come back within reasonable limits we know we can live on the edge just a little longer.  Then one day there’s the chest pain, the lump, or the “spot” on the diagnostic image and suddenly we’ve had our conversion experience.  Then no cost is too great for a medical miracle.

Until a health crisis occurs people tend not to change, but healthcare must change.  While research and technology have made incredible advances in diagnosis and treatment, everything has it’s limits and the limit is cost.  Roughly 40% of an American’s lifetime healthcare expenditure occurs during the last six months of life, most of it spent on “last resort” treatment.  Healthcare does need an overhaul, but it begins with individuals taking responsibility for their own health, facing consequences of lifestyle and behaviors, and adopting realistic expectations for end-of-life care.  At some point it’s up to the individual to say “enough”.

The face is, cost is a healthcare driver that can no longer be ignored.  We cannot make believe there are no limits to the technology a society can afford, and we cannot keep developing solutions with unrealistic price tags.  All the latest, most innovative diagnostics and treatments are to no avail if they are so costly that they are reserved for only the most affluent, those with the best insurance, or those in a privileged society.  True healthcare innovation must be simple, quick and affordable…available to everyone, not just those born within fortunate geopolitical boundaries.  Most important, healthcare innovation must refocus from end-of-life treatment to early prediction and early prevention when counter measures are cheap and effective.

No, more healthcare is not necessarily better healthcare.  There comes a point when enough is enough.

Becoming reacquainted with America after so many years abroad is sometimes a daunting challenge.  Finding ways to bridge a seventeen year time-warp isn’t always easy and frequently results in a certain amount of incredulous head-shaking; that “I can’t believe this is really happening” gesture intended to dispel a dream and verify reality.  Over the past months I’ve had a few of these head-shake moments, most related to television.

Admittedly, I’ve never been a television-watcher.  Other than the occasional spectacle such as the Olympic Games, a significant natural disaster or benchmark political upheaval, I’ve never been comfortable idling in front of the TV’s mindless chatter or being absorbed into programming that cues when I’m supposed to laugh.  Television is, however, a reflection of the culture and so I’ve recently watched some in the hope of scaling the years I’ve been away and catching up on my homeland.  The results have been amazing.

I’m not sure television programming merits the time and effort it takes to write a blog, but the commercials certainly do.  While television programming hasn’t dramatically changed over the years advertising has, and it depicts some intriguing cultural shifts.

Local programming remains littered with the amateurish ads for car dealers and furniture stores, but national advertising is pre-occupied with drugs.  Recently, within the course of a one hour program, I viewed no less than five separate ads for five different medications, each admonishing us viewers to “talk to our doctor” and find out if they’re “right for us”.  And these ads aren’t just on certain programs, they’re on every prime-time program and the list of maladies and medications they hawk seems endless.  I quickly forgot about the actual programming because the medication ads had me on the edge of my chair wondering if I needed it or wanted the “better life” it offered.

Each begins the same; a troubled look, anxious demeanor, furrowed brow, deep sighs of concern.  Symptoms flash across the screen in time to a peaceful melody in the background.  Once the stage is set, the important part is next.  A monotone voice suddenly, dramatically drones on at a rapid pace about side-effects, contraindications, possible drug interactions, danger signs and serious warnings, in a manner similar to the interest rate disclaimers at the end of a credit card ad.   Just as I discover I’m holding my breath and I’m about to close my eyes in terror, the soothing voice returns once again.  Now the screen is filled with smiling faces playing in the park, walking hand-in-hand without a care in the world, while in the background a last warm and tender admonition encourages me to “ask my doctor”.  Thus, a better life through chemistry is available to everyone.

Frankly, I’m at a loss for words to describe my utter distaste for such blatant pandering to human emotion and fear.  These despicable vignettes prey upon our worse fears and insecurities, seemingly providing slick and easy answers to serious, and in many cases chronic, health problems.  Some ads unabashedly target the aged who are most susceptible to the subtle fears they raise or the false hope they imply.  Worse, they undermine medical practice by imparting superficial and incomplete knowledge to uninformed patients who then question the competence and integrity of physicians who refuse to prescribe them.  Patient education is a good thing; pharmaceutical salesmanship thinly disguised as valuable health information is not.

Even more disconcerting is the cost of these ads, both the development and airing.  Most are well presented with obviously professional actors and attractive settings, and they run during prime-time in some of the costliest advertising slots.  Perhaps this is one of the reasons medications in the US are dramatically more expensive than just about anywhere else in the world and a primary contributor to our unconscionable healthcare costs.  While pharmaceutical companies justify higher US medication prices with the cost of research and drug approval protocols, I’m not a believer, particularly when I see purposeless, exorbitant advertising solely for the purpose of creating brand recognition.

In my view pharmaceutical commercials for prescription medications should not be permitted on television, at any time under any circumstances as they are not products patients themselves can purchase and they create hidden consumer costs.  If there ever was a contraindication for medications, prime time TV is it.

It appears my recent blog titled “Excess Baggage” (February 18, 2010) concerning the airlines relentless determination to penalize passengers who happen to be outside an industry-imposed physical norm was prophetic.  One line in my posting specifically referred to the plight of tall passengers: “Fortunately, the lofty have yet to be demonized by irritable airline staff, most probably by suffering in silence, but in light of recent events I fear we too are in jeopardy”.  How quickly things change in the airline industry!  Could they have read my blog?

The other day Continental airlines announced that on March 17 they will begin charging a premium of up to $59 per flight segment  for “exit row” seats, with other carriers such as Northwest and U.S. Airways currently implementing similar programs.  According to Jim Compton, Continental’s chief marketing officer, “Seats with additional legroom are higher-value seats, and we want to offer them to customers who recognize that value”.  Translation:  Penalize tall people who can’t fit into the debilitating legroom that has gradually become industry standard.

I can remember the whines and grumbles that theme-park ride limitations elicited from my kids when they couldn’t quite measure up to Mickey’s outstretched arm, but the safety implications were clear and the discipline uniform.  Theme parks wouldn’t surcharge kids who didn’t meet the requirements or allow them to ride for an extra few bucks.  Height restrictions have been a strictly enforced practice that made sense and parents complied, often coupling the event with a teachable moment about personal safety and appropriate conduct.  But what are the airlines teaching us?  They’re teaching us that personal safety and comfort aren’t for everyone.

Gradually, airlines are creating new revenue sources by deciding “ideal” physical characteristics and discriminating against passengers who don’t meet them.  Since there is no inherent safety issue involved, airlines are creating new revenue streams on the backs, legs and bottoms of passengers who can’t manage a 3 hour flight in a fetal position.  Carefully positioned as an “offer”, insinuating passengers have a “choice”, airlines carefully deflect potential lawsuits from passengers developing DVT from sitting too long in cramped positions.  In fact their purported “choice” is actually a penalty in disguise; an additional fee for the same range of movement as other passengers the airlines have defined as “normal” are permitted.

I fail to see why airlines are free to implement these “back of the bus” discriminatory tactics based on physical stature, particularly since it is the airlines themselves that have subjectively, arbitrarily and consistently reduced seat and legroom on aircraft over many years.  It is doubtful that any other transportation industry such as railroads, rapid transit, busses, ferries or taxicabs would get away with surcharges based on stature.  Why are airlines exempt?

On the other hand, perhaps the airlines are demonstrating ground breaking vision and initiative by taking the physically “challenged” to task.  Maybe they embody the “one size fits all” culture America has labored so long to achieve, and their exclusionary practices will be trend-setting for a host of other industries that will eventually “right-size” America. 

The airlines have made one point perfectly clear:  size does matter.

The last thing I want to do is write another blog about healthcare.  I’m tired of being asked what I think about the healthcare proposals, the latest inquisition coming from own primary care physician who was less than delighted with my response.  Having visited more hospitals around the world than I care to count, and having investigated many healthcare delivery systems, I can simply state that Americans who think they have the world’s only good healthcare system are deluded…it just isn’t so.  But our healthcare system isn’t the topic of this column.

I wonder how or why President Obama decided to stake the success of his presidency on healthcare.  Whatever his administration has or hasn’t accomplished during the past 13 months is completely obscured by the fruitless and endless debate over healthcare.  Nothing else the president has done, or intends to do, is even on the radar at this point…and the Republicans love it.

For some reason President Obama has chosen to draw his line in the sand with the healthcare bill.  Perhaps Hillary Clinton should have taken the president aside and given him a little free advice.  More than anyone, Mrs. Clinton knows the toxic nature of the healthcare debate.  No topic engenders as much fear, intransigence, and inept grandstanding as healthcare.  A political life can survive lying, cheating, adultery, mismanagement, and just about anything else…but not the healthcare debate.

By failing to dismount what is now a dead horse, President Obama has given the opposition manifold opportunities to entrench healthcare as symbolic of his failed administration, at the distraction of any other initiatives or accomplishments, permitting them to characterize him as a quixotic juggernaut bent on providing health insurance to 30 million Americans while nearly that many are unemployed, the economy is in a shambles, and foreclosures continue at unprecendented rates.

Despite the president’s admirable State of the Union address that prioritized issues of epic consequence and accurately positioned his daunting inheritance from the Bush administration, his follow-up has been to move healthcare back to the front pages, providing yet another opportunity for Republicans to rally.  Whether the president likes it or not, he is polishing the Republican sword that will pierce the heart of his presidency.

If things keep going as they are, the mid-term elections will definitely result in Democratic losses.  Even now it’s obvious that some are already abandoning what they perceive to be a sinking ship, and will continue their flight as the failure of the administration’s key program becomes more and more obvious.

However, the greatest injustice and unfortunate loss in all of this is that the extremist right-wing views and “spoiler” mentality that has come to characterize the Republican party is reaping political gains while they get away with political murder.  Their unabashed antagonism and self-serving cynicism is going unnoticed, if not rewarded, at the expense of the fresh start and new hope that characterized the last election.

Time is running out.  The President has two years before the election process starts all over again.  If he is to deliver any of the hoped-for change he promised, it’s time to fight the battles he can win.  Healthcare legislation may be important to him but it just isn’t resonating with the American people.