I am ALL Interventional Radiology AND Diagnostic Radiology.

When I was a teen I recall having a discussion  with my mother. At the time, I had often described my heritage as being "half Jewish and half Italian," since my father hailed from Italian descent while my East European heritage from my mother's side was religiously Jewish. So, correctly, Mom pointed out that I was "all Jewish." I replied, "Ok, well I feel all Italian AND all Jewish."

My goal was not to denigrate or ignore Mom's side of the family. It was to point out that I felt that much of my personality came from having those two strong aspects at play.

Similarly, I am ALL interventional radiology and ALL diagnostic radiology.  From day to day, my practice has me performing numerous interventional radiology procedures and, in between those procedures, I contribute meaningfully to the daily imaging workload.

I am happy in this hybrid world of radiology. I enjoy imaging interpretation while I also relish the chance to make a direct difference in people's lives by helping to fix what ails them. 

So you can imagine why there has been much discussion about a recent decision by the American Board of Radiology to convert all relevant existing Diagnostic Radiology and Interventional Radiology board certificates to a single "IR/DR" designation. 

Why has there been such discussion? Simply because a valiant effort based on a good idea arrived at what many feel is the wrong conclusion. Namely, our existing diagnostic radiology board certification status has been revoked, albeit "temporarily,"  in favor of the issuance of a new certificate designated "IR/DR."

I am neither half IR nor half DR. I am ALL interventional radiology and ALL diagnostic radiology. I studied and trained and won, after great effort, my diagnostic radiology board certification. And subsequently, I did the same for my interventional radiology subspecialty certificate. There are many dual board certifications that exist. The two entities or not  mutually exclusive, although there has been some commentary made to the contrary.  

So the conclusion to issue a combined certificate essentially suggests that those of us intended recipients are half of one and half of the other. But what does that say about the 100% effort I put forth to achieve both certificates?

I remain, therefore, 100% interventional radiologist as well as 100% diagnostic radiologist, facile in both disciplines and utilizing all of my knowledge and skills with every patient encounter and every imaging study interpretation.

_________________________________________

For reference, below is the most recent letter that was sent to many of us by the ABR:

September 1, 2017

Dear Paul J. Dorio MD:

We recently sent you an email concerning the status of your Diagnostic Radiology (DR) lifetime certificate and your Vascular and Interventional Radiology (VIR) subspecialty certificate, which you are maintaining through your participation in MOC. In summary, on October 15, 2017, the ABR will convert your two certificates to one new specialty certificate in Interventional Radiology/Diagnostic Radiology (IR/DR). Your new IR/DR certificate will be maintained by continuing to participate in MOC just as you do today.

Since there has been concern expressed in the IR diplomate community, the purpose of this letter is to inform you that if you opt to convert to an IR/DR certificate, you are not relinquishing any of your rights to regain your lifetime DR certificate at any time in the future.

If you should decide to discontinue your interventional radiology practice and practice diagnostic radiology, simply let us know and we’ll reissue your lifetime certification.

If you practice interventional radiology until you retire, let us know when you retire that you no longer want to maintain your IR/DR certificate and we’ll reissue your lifetime DR certification.

If for medical or other reasons you cannot maintain your IR/DR certificate, let us know and we’ll reissue your lifetime DR certification.

If you change your mind at any point in the future, let us know and we’ll reissue your lifetime DR certification.

The new IR/DR specialty certificate is the result of 15 years of work by the Society for Interventional Radiology (SIR) and the ABR to ensure the strength of the specialty and included a protracted effort for recognition by other medical specialties of the nature of our field. This was a big win for interventional radiologists.

Welcome Genetic Manipulation

The risks far outweigh the benefits in my opinion. Yes, that's right. In my opinion as a physician who sees innumerable congenital abnormalities throughout the day, I am thrilled at the prospect of scientifically modifying the genetic code of a developing embryo in order to prevent the emotional, physical and societal burdens that come with a genetic anomaly.

Let not the religious parochiality continue to stymie scientific progress. But attend to appropriate regulation of said science in order to stave off the inevitable fraud and abuse that comes from human greed.

Scientific progress is the name of the game.

The above commentary is based on news excerpted below from the AMA: 

Researchers use CRISPR to repair genetic mutation in embryos

On its front page, the New York Times (8/2, A1, Belluck, Subscription Publication) reports that for the first time, scientists “successfully edited genes in human embryos to repair a” disease-causing mutation, according to a study published in Nature. The study “marks a major milestone and...raises the prospect that gene editing may one day protect babies from a variety of hereditary conditions,” but also raises ethical concerns about human genetic engineering.

        The Washington Post (8/2, A1, Cha) reports in “To Your Health” that researchers injected sperm carrying a mutation that causes hypertrophic cardiomyopathy into eggs without the mutation, and then used CRISPR to remove the mutation from the resulting embryos. The researchers found that the mutation was absent from around 72 percent of the embryos, and the process did not cause any other changes to the cells’ DNA.

        USA Today (8/2, Painter) reports that the research raises the prospect that the single mutations that cause many genetic diseases could be repaired in embryos thereby preventing them from being passed on to future generations. The article points out, however, that the US and many other countries currently prohibit genetic research that could alter germ lines, because of safety and ethical concerns.

Fibroid Embolization is a Better Faster Cheaper Alternative to Hysterectomy

Uterine fibroid embolization is a proven safe and effective treatment for women with uterine fibroids who suffer from heavy menstrual bleeding or pelvic pain. Unfortunately, despite the fact the procedure has been clearly demonstrated to be a viable, appropriate treatment, there remains a gap in information shared by gynecologists, which leaves some patients incompletely informed about all treatment options.

As recently reported in Science Daily:

 "A large nationwide study examining the treatment of uterine fibroids shows that the uterine fibroid embolization (UFE), a minimally invasive, image-guided treatment performed by interventional radiologists, is vastly underutilized, compared to hysterectomies -- especially in rural and smaller hospitals. In fact, there were more than 65 times as many hysterectomies performed than UFEs, despite data showing that UFEs result in substantially lower costs and shorter hospital stays than hysterectomies, according to research presented today at the Society of Interventional Radiology's 2017 Annual Scientific Meeting."

"These findings suggest there is a lack of awareness about this safe, effective and less invasive therapy for uterine fibroids," said Prasoon Mohan, M.D., MRCS, the study's lead author and assistant professor in the department of interventional radiology at the University of Miami Leonard M. Miller School of Medicine. "Interventional radiologists urge health care professionals to present patients with all available treatment options so that the patient can make an informed decision. Patients need to know about the major differences between surgical treatments and UFE, especially that this is a non-surgical treatment that preserves the uterus and has a much faster recovery time compared to hysterectomy."

According to the National Institutes of Health, a majority of women -- almost three out of four -- will develop uterine fibroids by the age of 50. Women are at increased risk for developing fibroids if they are overweight, African-American, over the age of 40, have high blood pressure, have had no children, and have first-degree relatives with fibroids.

Between 25 and 50% of women develop uterine fibroids. Women need to be aware of their treatment options and know that uterine fibroid embolization is an excellent option in appropriate instances. As an example of proper care, Drs John Fischer and Robert Zurawin collaborated on a partnership whereby they describe how gynecologists and interventional radiologists can work together for the benefit of their mutual patients. (Click here for the article)

As discussed in Radiology Today, "The two doctors and their respective partners have found that when gynecologists refer uterine fibroid patients to interventional radiologists and vice versa, everyone benefits—most importantly, the patients....The physicians’ most recent article on the effects of the gynecologist-interventional radiologist relationship on the selection of the treatment for patients with uterine fibroids can be found in the April issue of the Journal of Minimally Invasive Gynecology. The article was based on their study of 226 women seeking UFE for symptomatic fibroids. In it, they concluded that gynecologists’ “fear” of losing uterine fibroid patients to interventional radiologists is groundless and that both specialties get more patients when they each carefully select them."

With uterine fibroid embolization, a small tube (catheter) is guided to the artery supplying the uterus and fibroids. Small particles are then delivered into the arteries, blocking blood flow to the fibroids and causing them to shrink over time. Women undergoing this procedure can anticipate spending the evening overnight in the hospital. Pain and nausea from the procedure can be moderate, but are treated appropriately with several medications. By the morning, nearly all women feel well and are discharged with appropriate followup medications and instructions. Subsequent to the treatment, the fibroids begin to shrink and continue to do so for several months. Typically, an MRI of the pelvis is obtained before the procedure, and six months post-procedure to confirm adequate treatment of the fibroids.

As repeated in Radiology Today, "UFE has an impressive success rate: 85% to 90% of women who undergo UFE experience relief from their symptoms within a few months and are able to return to their normal routines within seven to 10 days vs. four to six weeks with surgery. Also, with UFE, recurrence of treated fibroids is rare."

 

Radiology Partners Fights For Patient Care

One of the reasons why Columbus Radiology partnered with Radiology Partners is because of patient-focused efforts like Physicians for Fair [Insurance] Coverage. I am proud to be a part of an organization with such a patient-centered, progressive perspective. That focus coupled with the group's size affords us the strength in numbers to make meaningful improvements for the communities we serve.

"Radiology Partners is a board member for a group called the Physicians for Fair Coverage (PFC). The PFC is composed of only hospital based physician groups including those in Emergency Medicine, Anesthesia and Radiology.  In fact, Radiology Partners is the only Radiology Practice on the board for the PFC. The PFC has been advocating to help prevent patients from from receiving surprise gaps in their coverage when they visit an out of network physician at an in network facility, an important problem to solve. Unfortunately, the payers have been trying to solve this problem in a way that is very favorable to the payors."

~Philip Reger

Chief Technology Officer

Radiology Partners

http://www.radpartners.com

Judge Gorsuch Is A Forgone Conclusion

Although I try to keep this blog tilted towards issues of healthcare, I feel the need to opine on a particular issue currently being discussed. The nomination of Judge Gorsuch to the Supreme Court should be a forgone conclusion.

The logic is simple as follows:

Judge Gorsuch is eminently qualified. And he replaces Justice Antonin Scalia, one of the more conservative justices to have served on the court.

The risk, one will rebut, is that the make up of the Supreme Court is being inexorably tilted towards the conservative.

Let's say, for instance, that the Democrats continue on their current path and block the nomination to the best of their ability. It is a temporary measure, as the Republicans have "the nuclear option" at their disposal. Using that option would irrevocably change the landscape going forward. One might think that it would negatively impact the Republicans but nothing would be further from the truth. 

The "nuclear option" would eliminate the need for future nominees to have to reach the 60 vote threshold as well. Hence, future nominees, also likely to be more conservative than the majority might desire, would be easily confirmed, as the Republicans hold a majority in the Senate.

In addition, as the new "Party of No," Democrats, may find their popularity further diminished, making it harder to foresee them adding to, or even keeping, their current number of Senators.

Hence, the logical solution to the current dilemma is to allow the nomination of Judge Gorsuch to proceed and for him to be confirmed forthwith. Hopefully, that would set up a slightly more favorable stance on Capitol Hill for future nominees, should they arise during this presidential term.

If nothing else, one might argue that the Democrats' conciliatory gesture would at the very least not result in diminished popularity for the Democratic Party. 

Why I Choose To Be An Unyielding Optimist

I have been accused of being an unyielding optimist. I see positives when many people see only negatives. No, I am not delusional. But I think that I have a relatively unique ability to objectively view the positive and negative aspects of a situation.

No I do not think I am infallible, nor am I bragging. But I do feel that there are two sides to every story and, seeing and understanding those sides is critical to maintain a healthy emotional balance.

I came across a couple of quotes from "Man's Search for Meaning," by Dr Viktor E Frankl, that I think lend insight into my perspective as follows: 

 "To discover that there was any semblance of art in a concentration camp must be surprise enough for an outsider, but he may be even more astonished to hear that one could find a sense of humor there as well; of course, only the faint trace of one, and then only for a few seconds or minutes. Humor was another of the soul's weapons in the fight for self-preservation. "

and

 "To draw an analogy: a man's suffering is similar to the behavior of gas. If a certain quantity of gas is pumped into an empty chamber, it will fill the chamber completely and evenly, no matter how big the chamber. Thus suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore the 'size' of human suffering is absolutely relative." 

My point is simple:

One can view an adverse situation negatively, wallowing in the pain and suffering and letting it infuse your entire being. 

Or one can choose to stand up against such adversity, find humor in it even where humor seems woefully out of place, and strive to meet its challenges head on in order to turn what seems to be certain failure into a resounding victory. 

I choose the latter. 

Machine Learning is NO Threat to Radiology

Artificial intelligence will replace humans.

We have heard and seen this discussion before.

Apparently, such a scary prediction now rears its ugly head in the field of Radiology. Catchphrases include "artificial intelligence" and "machine learning." People are discussing whether machines will replace radiologists. To me, the concept is laughable. It is as laughable as the concept of computers replacing humans once was. While it is undeniable that some jobs have been replaced, think auto assembly lines, there is no doubt in my mind that human adaptability and ingenuity transcends the ability of machines to send humans entirely into obsolescence.

In a recent article in the Journal of the American College of Radiology, December 2016 volume 13, Ezekiel Emanuel, one of the original proponents of and architects of the Affordable Care Act, suggests the following: 

"The human reading a chest radiograph may be inclined to simply interpret the image, determining if it represents someone healthy or sick and, if sick, whether infection, fluid, tumor, or another issue is present. On the other hand, a machine will treat each tiny pixel on the screen as an individual variable and will seek to organize those pixels into shapes and patterns and, from there, make a diagnosis. "

Ridiculous assertion, if I may be so bold.  How will treating each tiny pixel on the screen enable a machine to view the human whose parts are depicted on the image? How will organizing those pixels better evaluate the illnesses that formulate that person's problem list? And how will the machine then guide and assist the referring physicians who desire radiology input as to the next steps in their care paradigms?

I maintain that the exhortation that we radiologists treat the patient not the image is critical. A radiologist's value is not just in identifying abnormalities on images. Our value has long transcended that menial process. Daily, radiologists meaningfully contribute to patient care by identifying abnormalities, making recommendations, and, in the interventionalists' realm, intervening when necessary. 

I do not fear machines. I recognize the value that machines can and will continue to add to our lives. But I am in no way concerned, nor do I think you should be, that machines will create human obsolescence.  

 

A New Year's Wish for Israel and all Jews and Arabs

My hope for the New Year:

Only by forging a new path, one of mutual Arab and Jewish inclusiveness, can peace ever be remotely possible.

I pray that Palestinian leadership decides to acknowledge that Jews and Arabs can and do live and love side by side in harmony.

Peace will not come from elsewhere. All outside parties have vested interests and ulterior motives. My only concern is for the well-being of the Arabs, Jews and Christians living in the region who desire peace, safety and prosperity.

May the New Year bring wisdom and light to the leaders who have fought so long to divide and may they realize the benefits of peace are universal.

Immigration Is Progressive

"Immigration restrictions slow economies, but they don't necessarily prove or portend bigotry or racism. Indeed, it's possible for an American government to restrict immigration and foster national comity at the same time. That's what Presidents Warren Harding and Calvin Coolidge demonstrated in the 1920s." ~Amity Shlaes

"Whether one traces his Americanism back three centuries to the Mayflower, or three years to steerage, is not half so important as whether his Americanism of today is real and genuine. No matter by what various crafts we came here, we are all now in the same boat." ~President Calvin Coolidge

"What Harding and Coolidge sought was a breathing space for all the immigrants to assimilate, time for them to learn English and what people in those days called "Americanism." By Americanism they meant of the familiarity with common law, U.S. civics and adequate workplace English." ~Amity Shlaes

Amity Shlaes points out that immigration restrictions instituted in the 1920s did not result in wage increases as much as "restrictionists had hoped they would. Restriction didn't prevent the Great Depression. When, many decades later, Asians were again allowed to immigrate, they prove their social and economic worth through their contributions many times over."

She then goes on to suggest something that is typically controversial. Read the following passage and think about it. "Defunding the official publicly funded bilingualism of the courts and schools would accelerate Hispanics' move into the professional class. Workers are more flexible and integrate better when there is no language barrier. Official bilingualism directs its own wall, a cultural wall." 

To me, it is clear that this great country is made great by its people and those people come from all corners of the globe. We should celebrate immigration while at the same time acknowledging that free and unfettered entry would carry risks analogous to the Trojan horse.

The Key to Healthy Living is to Rebalance Gut Bacteria

People look for a special magic bullet when it comes to weight loss or healthy living.

There is no single simple solution of course. Even my mantra, "Everything in moderation,"  is incomplete.  Education is key. The more we understand about an issue, the better we can devise solutions.

Much of the healthy living and weight loss discussion has to do with the relative balance of intestinal flora, or the bacteria found in our gut.  If the balance is altered, weight gain, or intestinal symptoms such as bloating, diarrhea or worse, may ensue.

Probiotics and fermented foods don't work in isolation. There is much more to rebalancing gut bacteria. For more read this excellent essay published by Johns Hopkins Medicine.

CDC Reported A Drop In Average Life Expectancy?!

Huge question mark here and by no means able to be answered at this time. Remember there are 80 million people who were born between 1945-1964 ("Baby Boomers") and the average life expectancy is 76/81 (M/F). So, unfortunately, the numbers of people dying are expected to increase simply because of the numbers of people in each age group.

 

ABC News reported that the CDC revealed a decrease in average life expectancy for the first time since 1993.

"The CDC report is based mainly on 2015 death certificates. There were more than 2.7 million deaths, or about 86,000 more than the previous year. The increase in raw numbers partly reflects the nation's growing and aging population.

It was led by an unusual upturn in the death rate from the nation's leading killer, heart disease. Death rates also increased for chronic lower lung disease, accidental injuries, stroke, Alzheimer's disease, diabetes, kidney disease and suicide.

The only clear drop was in cancer, the nation's No. 2 killer."

I'd like to think interventional radiology had something to do with the decrease in cancer-related deaths. 😉👍🏾

Opioids Are Responsible for More Deaths Than Cars and Guns

"The amount of deaths from overdose was greater than that of car crashes and gun violence."

I'm not sure what the solution is, but this kind of statistic amazes me. I don't see the appeal of brain-cell killing drugs but the temporary euphoria must entice the users tremendously. Research and development of, ironically, new drugs to suppress the brain's response to opioids would be a remarkable development. 

As summarized by the AMA:

CDC Says Opioid-Related Deaths At All-Time High

The Washington Post (12/8, Ingraham) reports data released by the Centers for Disease Control and Prevention on Thursday revealed that “opioid deaths continued to surge in 2015, surpassing 30,000 for the first time in recent history.” The data shows “an increase of nearly 5,000 deaths from 2014.” CDC Director Tom Frieden, MD, said in a statement, “The epidemic of deaths involving opioids continues to worsen.” He added, “Prescription opioid misuse and use of heroin and illicitly manufactured fentanyl are intertwined and deeply troubling problems.”

        The AP (12/8, Stobbe) reports that according to the data, overdose deaths rose “11 percent last year, to 52,404.” The AP specifies that “heroin deaths rose 23 percent in one year,” deaths “from synthetic opioids, including illicit fentanyl, rose 73 percent,” and abuse “of drugs like OxyContin and Vicodin” increased 4 percent. Robert Anderson, “who oversees death statistics at the Centers for Disease Control and Prevention,” said, “I don’t think we’ve ever seen anything like this. Certainly not in modern times.” The amount of deaths from overdose was greater than that of car crashes and gun violence.

Was the Supreme Court conservative in 1973?

The question I posed in my title has been asked before. When I went to google.com and typed in the beginning of that question, the end came up, indicating that others had thought to search for the same thing. So I proceeded to click on a link or two and read other thoughts that had been previously written. This link gives a nice summary of each justice sitting on the Court at the time. And fascinating, but the Supreme Court make up was majority conservative in the early 1970s. This tends to turn on its head the supposition that a conservative Supreme Court might rule in a consistently opposite manner than a court made up of more liberal thinkers.

As Justice Ginsburg noted, "In that year, 1971, the Court turned in a new direction. The Justices begin to respond favorably to the arguments of equal rights advocates who urged a more encompassing interpretation of the equality principle, one that would better serve U.S. society as it had evolved since the founding of the nation in the late 18th century."

My supposition has always been that, once placed on the Court, justices tend to make their own decisions using their vast experiences and knowledge to guide them. Obviously, people are concerned that individual biases might come to play. But nine justices seems to me to be a historically reliable number which, on balance, usually results in the right decisions.

21st Century Cures is President Obama's Last Best Move

The final days of President Obama's presidency are passing before our eyes and much of the world can understandably speak of nothing else but his successor. 

Fortunately, the current president has one final opportunity to put into place lasting legislation that can have a substantial impact. 

As reported by the AMA: 

Senate Passes 21st Century Cures Act

The Los Angeles Times (12/7, Levey) reports that the Senate on Wednesday “easily” passed the 21st Century Cures Act. The $6.3 billion measure “to increase federal support for medical research, mental healthcare and controlling the opioid epidemic,” cleared the Senate and “is headed to President Obama’s desk for his signature, delivering a rare bipartisan breakthrough in the waning days of his presidency.”

        The Washington Times (12/7, Howell) says the measure “provides nearly $5 billion for the National Institutes of Health to accelerate research into major diseases, including $1.8 billion for Vice President Joseph R. Biden’s ‘moonshot’ project on cancer, and $500 million for the Food and Drug Administration to make its approval process more efficient.” In addition, it provides “$1 billion in state grants to combat opioids addiction – a key priority for President Obama – and provides money for mental health treatment and suicide prevention, while establishing a new assistant secretary for mental health at the Department of Health and Human Services.”

        The Wall Street Journal (12/7, Burton, Subscription Publication) predicts the legislation, which will accelerate FDA approvals in combination with President-elect Trump, who has said he will “cut red tape” at the agency will bring about an era of industry-friendly regulation of drugs and medical devices.

What Does It Mean to Be Overweight or Obese?

The Washington Post published an article entitled "Nearly Half of America's Overweight People Don't Realize That They Are Overweight," by Christopher Ingraham. The article prompted me to remind myself on what basis do we evaluate our own weight? So I went to the CDC website and found that the definition of obese and overweight are purely based on one's BMI, which is calculated using only height and weight.

The CDC further states:

BMI is a person's weight in kilograms divided by the square of height in meters. BMI does not measure body fat directly, but research has shown that BMI is moderately correlated with more direct measures of body fat obtained from skinfold thickness measurements, bioelectrical impedance, densitometry (underwater weighing), dual energy x-ray absorptiometry (DXA) and other methods 1,2,3. Furthermore, BMI appears to be as strongly correlated with various metabolic and disease outcome as are these more direct measures of body fatness 4,5,6,7,8,9. In general, BMI is an inexpensive and easy-to-perform method of screening for weight category, for example underweight, normal or healthy weight, overweight, and obesity. 

In my estimation, and using a little common sense, BMI is a reasonable indicator of the health status of a person but it is by no means a complete evaluation of health. Yet, unfortunately, as I know from personal experience, conclusions are made about a person's health based solely on BMI. As a personal anecdote, I once applied for life insurance. I am 6' 200 lbs. I exercise daily and am fairly muscular. My BMI calculation yielded the following from the CDC website:

Height: 6 feet, 0 inches
Weight: 200 pounds
Your BMI is 27.1, indicating your weight is in the Overweight category for adults of your height.
For your height, a normal weight range would be from 136 to 184 pounds.
People who are overweight or obese are at higher risk for chronic conditions such as high blood pressure, diabetes, and high cholesterol.

Now I'd like to lose a few pounds just to really get that six pack going, but I'm not exactly sure how to get down to 184, let alone 136!.

The point is that the public perception of their collective weight may not be so "normalized." It may just be that people see the same things I am seeing, have little or no medical training to help guide them, and end up concluding that it is too challenging a topic to figure out. Couple that with the obvious goal of the original WP article, that people need to pay more attention to their health status, and you see why this subject becomes unwieldy.

Public perception could be helped if health officials, and reporters covering these subjects, used more complete definitions of health based on height, weight and body mass characteristics, taking into consideration muscle mass and fat deposits as well as metabolic considerations and preexisting ailments such as hypertension and diabetes, to name just two. Doing so would go a long way towards improving people's understanding of this complex entity we call "obesity." 

Politics and Values are Not Diametric Opposites

Politics is a complicated entity comprised of infinite shades of gray dotted with infrequent black and white decision points. A good friend recently suggested that politics and values go hand in hand. In a sort of epiphany, I now realize that people who disagree on political views also must fundamentally feel that the other party has differing values.

I believe that nothing could be further from the truth for the vast majority of us. In fact, I think the usual political discussion, pick an issue, revolves around differing ways to solve a problem with the same basic underlying values at play. 

Examples abound but here are a few: 

Abortion: For years I have listened to the debate from the pro-choice and the pro life groups. It amazes me that the views are notoriously rigid and unyielding on both sides. Do their values differ? Or is the debate not even about the same topics? Pro-choice viewpoint is one of freedom. Pro-life viewpoint is one of rights. But to suggest that either group values life more or less would be to lack understanding of the basic underlying values that each group holds.  Both groups value life similarly I would argue.

Minimum wage: If a politician votes to raise the minimum wage, are his/her fundamental values about helping people in need diametrically opposed to the politician who voted against raising wages? Or is the opposing viewpoint simply a matter of understanding the ramifications of the economic decision? 

Immigration: If one politician votes not to the deport illegal immigrants who have committed crimes and the other politician votes do do so, does that imply that one politician values the safety of Americans more or less than the other? Do their positions imply that one of them is racist while the other is caring?

With each of these examples, and I could go on, I feel strongly that the values underlying each person's decision are not the main focus of disagreements. But what I have also realized just recently, is that perhaps the perception of differing values is exactly why there is so much difficulty discussing politics between people.

Perhaps if we understood and accepted the probability that we each have similar values but differing opinions about how to solve real-world problems then we might better be able to hear one another and solve the issues at hand. 

 

Parts of the ACA will stay, suggests Pres-Elect Trump

As John Belushi said in "Animal House," "Nothing is over until we say it is." 

from the AMA: 

Trump Indicates He May Preserve Some Parts Of ACA

The Wall Street Journal (11/11, A1, Baker, Langley, Subscription Publication) reported that during an interview, President-elect Donald Trump signaled an openness to keeping at least two provisions of the Affordable Care Act intact while repealing other parts of President Obama’s signature healthcare law.

        The New York Times (11/11, Hulse, Davis, Rappeport, Haberman, Subscription Publication) reported that during the Wall Street Journal interview, “Trump said he told the president that he would consider keeping two provisions of the law: the prohibition against insurers denying coverage because of a patient’s pre-existing condition; and the one that allows parents to keep their children on their insurance plans until they turn 26.” But, according to the Times, if the ACA mandate were eliminated, this “could send insurance companies into a tailspin, because their costs would rise with sicker customers, and that would not be offset by healthy consumers forced to buy insurance.”

        The Washington Post (11/11, Goldstein) reported that just a few days after the election, Trump began “to revise his health-care agenda in ways that conform more closely to the heart of Republican thinking in recent decades.”

Election Fever

“The election becomes the greatest and, as it were, the only matter which occupies people’s minds. Then political factions redouble their enthusiasm; every possible phony passion that the imagination can conceive in a contented and peaceful country comes out into the light of day… As the election draws near, intrigues multiply and turmoil spreads. Citizens divide up between several camps each of which adopts the name of its candidate. The whole nation descends into a feverish state; the election becomes the daily theme of newspapers, the subject of private conversations, the object of every maneuver and every thought, the only concern of the present moment. It is true that as soon as the result has been announced, this passion is dispelled, all returns to calm, and the river which momentarily overflowed its banks returns peacefully to its bed.”

Alexis de Tocqueville

I Refuse to Look Backward

I refuse to look backwards to what might have been. I choose to seek the way forward regardless of how dim the view ahead. The world is bright. The earth revolves around the sun. And we are but specks in the universe. How lofty the view that ours is the most awesome plight when in reality it is merely the blink of an eye.

Menschkeit - A Way of Life

The following description of Menschkeit was borrowed with permission from Peter Swank, MBA.

The Definition of a Mensch:

  1. A person having admirable, noble, or dignified characteristics, such as fortitude, responsibility, and firmness of purpose: "He radiates the kind of fundamental decency that has a name in Yiddish; he's a Mensch." (James Atlas).

  2. A person who is admired, respected, and trusted because of a sense of ethics, fairness, and nobility.

Alternate Spellings: Menschlichkeit

The Philosophy of Menschkeit:

Menschkeit is a philosophy... a way of living... a selfless, innate drive for doing the right and decent thing, in every possible situation, according to the foundational ethics and values shared by most people in a society. Below is the philosophy of Menschkeit (including, but not limited to the following principles). No Mensch possesses all these qualities, but he does spend his life trying to attain them. No one knows how many or which of these qualities one must possess to be a Mensch, yet one Mensch knows another when he sees one.

  1. Strength - physical, as well as of conviction

  2. Honor - Every Mensch has a Code of Honor.

  3. Integrity - A Mensch is honest with firm moral principles; his word carries the weight and trustworthiness of an iron vault.

  4. Loyalty - fierce, to his fellow Menschs, loved ones, wife, children, mother, and family

  5. Sacrifice - A Mensch's personal desires are subordinate to Menschkeit.

  6. Uncompromising Ethics - A Mensch always strives to do what is right.

  7. Intelligence - not necessarily academic, but raw intelligence

  8. Control - A Mensch has the ability to forge/manhandle/bend a situation towards his will; if not in control, a Mensch will find a way to be in control. Alternatively, a Mensch will relinquish control in order to be in control.

  9. Stoicism and Toughness - high pain tolerance; absence of complaining

  10. Fairness - A Mensch always considers all sides.

  11. Knowledge - may be specific to a particular area, as long as it is at the level of mastery

  12. Killer Instinct - A Mensch goes after what he wants like a bulldozer, makes things happen, gets things done.

  13. Independence - A Mensch draws upon the inner strength of Menschkeit.

  14. Instinct to Protect - a Mensch's loved ones, wife, children, mother, family, and those close

  15. Perseverance - A Mensch never quits until he succeeds, or until his intelligence tells him there is a better path.

  16. Instinct to Survive - "never say die" attitude; A Mensch is reigned by wisdom (knowledge, intelligence, and ethics), but will fight like a cornered animal when necessary.

  17. Open-Mindedness - A Mensch is not so foolish as to be complacent with his ideas.

  18. A Certain Degree of Crudity - A Mensch realizes what is important and what is not; as such he is at ease with himself and not inhibited by meaningless proprieties.

  19. Directness - A Mensch does not mince words; he says what he means and means what he says; "When I use a word, Humpty Dumpty said in rather a scornful tone, it means just what I choose it to mean - neither more nor less." - Lewis Carroll

  20. Discipline - Every Mensch is Master over himself.

  21. Work Ethic - A Mensch spends his life breaking his back; a Mensch enjoys hard labor, and the equivalent in any pursuit.

  22. Self-Sustainability - A Mensch needs very little to survive, and, indeed, be happy; in certain cases, only Menschkeit alone is needed to sustain life.

  23. Perceptiveness - A Mensch has the ability to see in a flash, like an X-ray, the core of a person, situation, and/or place, with 100% accuracy.

  24. Judgment - Because of his perceptiveness, a Mensch possesses the uncanny ability to consistently make the best decisions possible; a Mensch always knows what to do.

  25. Mechanical Inclination- Some of a Mensch's closest friends are his tools.

  26. Camaraderie - Every Mensch possesses an unspoken bond with his loved ones, wife, children, mother, family, and those close.

  27. Vision - A Mensch always has a clear goal in mind, and affects that goal with supreme efficiency through use of his Menschkeit qualities: If a Mensch sees it, it is done.

  28. Absence of Fear - A Mensch knows that his Menschkeit qualities will carry him through to triumph over any situation.

  29. Composure - A Mensch never appears perturbed or shaken, but maintains a mental evenness that allows him to navigate any situation.

  30. Ingenuity - A Mensch has the uncanny ability to find novel and creative solutions, 10 out of 10 times.

  31. Craftsmanship - Nothing satisfies a Mensch more than to have created something from scratch with his bare hands.

  32. Dependability - A Mensch can be counted on as the sun rises.

  33. Fertility of Mind - A Mensch always has some sort of project running on the side to satisfy his creative impulses.

  34. Appreciation of Women- A Mensch appreciates a good woman and the beauty of the female.

  35. Physical Endurance - A Mensch takes a beating and keeps on ticking; in fact, a Mensch welcomes a beating.

  36. Awareness - A Mensch is simultaneously aware of all that is around him, his mind ever present, ever vigilant, his surroundings accounted for, every scenario considered, weighed, and chosen at will.

  37. Quality - The job a Mensch does is the best. No question. Hands down. Finished.

  38. Economy of Speech - A Mensch does not talk much; to those without Menschkeit he may seem reticent, but in reality a Mensch is a master of his spoken language, using as few words as necessary to precisely convey his message. In fact, most Menschs have transcended language. This explains why two Menschs hardly ever talk, yet never miss a step. Whereas the non-Mensch must blather on, a simple nod from a Mensch suffices.

  39. Logic - In any stressful situation, a Mensch always chooses his path by logic; his logic is never swayed by emotion.

  40. Work and live to serve others, to leave the world a little better than you found it, and to garner for yourself as much peace of mind as you can. This is happiness.