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Master Your Financial Destiny with Financial Literacy

John Bechtel- Entrepreneur and Financial Literacy Advocate

John Bechtel- Entrepreneur and Financial Literacy Advocate

This blog is for people, like myself, who are driven by an intense desire to be financially literate.  In this Information Age in which we live, products and seductive promises come at us at warp speed.  Not only is education essential, it has to be education based on a philosophy and principles firmly connected to reality, to what IS.  All of us need to realize that no one is coming to save us, and our survival depends on our being willing and ready to be responsible for ourselves.  Regardless of what ideological temple we choose to worship in, none of us can afford to check our critical thinking at the door.  No matter what any government, political party, sales rep, friend, shaman or crackpot tells us, each of us personally pays the price for our choices.

In case you haven’t noticed, the paradox of poverty is that it is very expensive to be poor.  The poor pay more for everything, both in higher prices and missed opportunities.  Those that choose to remain financially ignorant today are destined to pay a King’s ransom for what they failed to learn.  If you are not personally alarmed at the decisions currently being made in your name, or supposedly for your benefit, then you need to become better informed.  Because one way or another you are going to pay.  And pay.  And pay.

Clearly the stewards of our nation’s economic destiny are hellbent on shipwreck. It is our commitment to be a beacon in this economic storm for those individuals that are dedicated to steering their own course.

John Bechtel, an entrepreneur since 1977, has employed over 5,000 people and is a passionate advocate for self empowerment and freedom.

The Poetry of Sidewalk Construction

Do you ever find the internet to be overwhelming, emotionally exhausting, even toxic?  Not only is there far more than anyone can absorb, it seems everyone has become obsessed with broadcasting every thought that enters their head, everyone yelling “See me!  See me!”  It is as if the human race has been in the isolation ward for thousands of years and has just been released and the result is billions of voices trying to outshout each other for your and my attention.  It is like a communications gold rush, an explosion of individual and corporate narcissism.  Understatement is a thing of the past as everyone gushes how wonderful they are, how uber-successful they are, and how much they want to help us.  Opening our Inbox is like attending a rock concert and the star of the show comes out to thunderous applause and tells us, his fans, how much he loves us.  Each and every nameless one of us.  Only the internet raises the bar because it remembers and auto-inserts our names so we can better feel the love.

Maybe this is why I have to tell you about a small band of strangers that invaded my neighborhood this week and left an indelible footprint on our small community.  There was no announcement, no hype, no advance billing.  No one wanted my email address.  They did what they came to do, and left as stealthily as they had arrived.

Four days ago a low-boy truck arrived with several Bob-Cats on the back, and within another 24 hours a group of about a dozen workers descended on the front lawn of the apartment complex where I live and began the construction of a 10 foot wide sidewalk that will, when completed, circumnavigate a significant portion of the city.  We didn’t know the sidewalk was coming to town, and these surprise intruders quietly fanned out with shovels, picks, and BobCats and began tearing up the lawn.

Their teamwork and coordination were worthy of the NBA playoffs.  They were not only expert at what they did, they seemed to wordlessly anticipate each other’s moves and needs. Their handoffs were so smooth you almost didn’t notice.   There was no one running around shouting orders, no slackers, no one waiting to be told what to do.  There was no way for an outsider to even figure out who the boss was.  I know.  My wife and I watched them from our balcony and tried to single him out from the others.  We couldn’t.  Eventually I went down and asked.  Quiet, unassuming, polite and clearly focused on the work at hand, Tom Farley had to go to his truck to find a business card to give me.  He appeared to be slightly relieved when this minor interruption was over and he could get back on task.  Wet concrete waits for no one.

I am a freelance writer and the sidewalk was being constructed directly underneath my balcony.  I am accustomed to neighborhood noises, dogs barking, occasional yelling, even kids running in the hallway.  Things like that don’t interrupt my workflow; I have learned to block them out.  But for the next three days I found it difficult to concentrate, not because of the human noise below, but because of the lack of it.  From those wielding picks and shovels to others directing the flow of concrete, everyone seemed to know exactly what to do and the precise time to do it, without getting in each other’s way.  I’ve never thought of construction and construction workers as poetry in motion, but watching this team of deeply bronzed workers, from young bucks to late middle aged machinery operators, was mesmerizing.  In three days they transformed lawn and mosquito pits into a beautiful sidewalk a quarter mile long, with the topsoil raked and restored to the edge of the new sidewalk as if it had always been there.

With almost no internet footprint, Ti-Zack Concrete out of the small town of LeCenter, MN is a study in understatement; a flawlessly orchestrated production without aggrandizement of the conductor.  No one was bragging, no one was trying desperately to stand out in a crowd, to be seen.  They were so ridiculously out of fashion.  They paid attention to the smallest details as if they really mattered, when no one was watching (except me).  They were so self-effacing I felt it incumbent upon me to tell somebody about them, because I think they would almost be embarrassed to talk about themselves.    If you are in the center of the nation, from the Great Plains states south to the Mexican border,  I hope you need a sidewalk because theirs is a show not to be missed.  Tom’s card says you can reach them at 507-357-6463.

To use an internet metaphor, Tom’s sidewalks are his product, his content, if you will.  The power of his message was in the people who delivered it, his team.  No megaphone required.

Ti-Zack Concrete Inc Reviews in Le Center



How I Lost 47 Pounds Without Trying (very hard)

Seven weeks ago I weighed 239 lbs.  I am 6’1” tall, and I had just crossed over into clinically obese category.  My weight has ranged from 232 to 245 pounds for the last fifteen years or so.  During that time I have tried any number of diets with the usual erratic results and recidivism: I would lose the weight and add it back on in endless seesaw fashion with the resulting disappointment and loss of self-respect.

I never really thought of myself as obese until I obtained a copy of my medical record and one of the doctor’s notes referred to me as “sort of obese.”  That hit me right between the eyes.  I knew I was overweight, but obese was a word you used for fat people.  People with no self-control.  People with emotional problems.  People whose lives had spun out of control.  I was just a happy gourmand.  I just really liked food.

Okay, that’s not entirely honest.  I knew that I was a binge eater.  Eating was part of my coping mechanism to deal with anxiety.  I knew this because I often found myself not even realizing that I was eating, and sometimes couldn’t remember having eaten or what I had eaten.  I was just putting food in my mouth.  And I had grown comfortable with that leaden feeling in the center of my torso.  In a moment of horrible truth I realized that I wasn’t really even tasting my food most of the time; I was satisfying a craving.  But a craving for what, if I wasn’t tasting my food?  I was putting food in my mouth to make something go away, something that refused to go away, or that always came right back after the briefest recess.

There are several things I had learned along the way to my failures:

1.  If you don’t want to eat it, don’t bring it in the house.

2.  Your stomach and digestive system adapts to too much food, and adds capacity to accommodate increased craving. No matter what you ate, the rate of craving was a constant.

3.  The rate of weight loss was not rapid enough to provide quick and essential positive reinforcement.  Losing weight was like timing a caterpillar with a stopwatch.

4.  All paths lead to the kitchen.  Houses should be designed with the kitchen and pantry on the far side of the garage.  No matter what you’re doing or where you’re going, you always have to go through the kitchen.

5.  Losing weight requires way too many decisions.  Suddenly my hunger hits and I have to answer twenty questions before I can put any food in my mouth.  How many calories, how many carbs, how big a helping, etc.  I can’t make all those decisions when I am hungry.  I want to eat.  NOW.

That’s where I was seven weeks ago.  I called an old friend and he told me he had lost a lot of weight about a year ago and kept it off.  He said it was quick and the weight “just fell off.”  That’s what I needed, something where the weight would just “fall off”.  Something simple.  Not too many decisions.

Without my asking, my friend sent me a link to a video that had motivated him to get started.  The video lasted almost an hour.  It had nothing to sell.  There was no contact information, nothing to buy.  No books, pamphlets, or potions.  Just this Australian guy who decides to take 60 days traveling across the U.S. interviewing people about being fat.  And during his sojourn he carried a juicer in the back of his vehicle and he juiced only fruits and vegetables.  That’s it.  Honest.  That’s the whole story.

I have lost 47 pounds in six weeks.  Three bowling balls.  Oh, a couple other things.  Before I began, I had my wife photograph me from the side, almost naked.  I did not suck my belly in.  I wanted to be photographed in all my grossness.  I wanted to be disgusted.  And I was.  I printed out the photo.  It helped.  Using self-loathing to overcome self-loathing.

It took me about a week to figure out what vegetables and fruits to commingle.  I used a food processor because I didn’t have a juicer.  A juicer separates the juice from the pulp.  A food processor doesn’t.  So I drank a lot of very thick “juice” which was more pulp than anything else.   So I kept adding water to my concoctions because otherwise it was way too thick, almost beyond pouring.

Some of those really dark vegetables that are supposed to be so healthy for you taste unbelievably gross when reduced to mush.  Here’s a few suggestions that the video doesn’t include:

1.  Pears and bananas can mask the bad taste of almost anything.  After that, apples are best.  Mangos and raspberries have too delicate a flavor to mask anything.  They are better eaten and savored than processed.

2. Take a sharp knife and cut the stems of the dark leafy vegetables away from the leaves, and discard them.  Only juice the leaves.  The woody stems add a lot of bitterness to the taste.

3.  I would make up an 8-cup container of juice the night before and put it in the refrigerator.  I couldn’t bear to do all the processing when I was hungry the next morning, so I did my preparations the night before.  I covered the container tightly.  I didn’t want the nutrients to get away during the night (to wherever nutrients go when you’re not looking).

4.  I cheated.  About twice a week I would reward myself and eat an avocado, which I love.  About twice a week I would eat a package of a really tasty fruit like kiwi or raspberries or a couple handfuls of mixed nuts.  Even radishes if I craved something crunchy.

5.  I was never HUNGRY, but I was always hungry, if you know what I mean.  By the seventh week my menu was getting boring.

6.  My wife ate whatever she wanted whenever she wanted, and made no effort to make it easier for me.  I didn’t want her to.  I needed to know I could do this without trying to change the world around me.  It wasn’t a problem.  Sometimes her food looked really good, but I never wavered.  I guess it was just time.

I am doing a lot of thinking about what I’m going to do when I come off this diet.  The best I have come up with is that I am going to continue using the food processor, but I will eat one small meal each day in addition to my “juice.”  I will eat fish about twice a week, and incorporate beans into my diet, and about once a month I will treat myself to a steak dinner.  I get enough natural sugar from the fruit in my diet, so I have lost my taste for artificial sweets, and I have never been a carbonated beverage person.  I have been without coffee and alcohol for the last seven weeks, and I will add red wine back into my diet a few times a week.

I believe it will take me another six months of constant vigilance to maintain my minimalist eating habits.  The fat cells in your body never go away; they sit there empty, and like the plant in The Little Shop Of Horrors, plead with you for the rest of your life “Feed me Seymour, feed me!”

I began this journey  in the late third trimester of my “pregnancy” and I have worked my way backwards almost to the orgasm that began it all sometime in the distant and obscure past.  I don’t remember when the bad habits began, but I know this is where they have to end.

Here’s the link:  http://www.hulu.com/watch/289122

Feel free to send me any questions or comments you have.  I would be interested to know how it works out for you.

BOOK REVIEW: The Black Count by Tom Reiss

This is a fabulous  non-fiction narrative that rivals many of the best novels ever written.  Even the fact that it made the New York Times bestseller list and also won the Pulitzer Prize hardly does it justice.  Tom Reiss obviously spent many months, even years, doing very original research on at least two continents and as many languages.  But let’s begin at the beginning

If you have ever read the novel The Count of Monte Cristo by Alexandre Dumas, and you liked it, or like me, loved it, Reiss’ book is a must-read for you.  Dumas also wrote The Three Musketeers and The Man in the Iron Mask, as well as dozens of other fiction and non-fiction books and articles.  The Count of Monte Cristo is a story of revenge; the story of a man imprisoned for life on unknown charges as the result of a conspiracy of three enemies he didn’t know he had.  He is condemned to a medieval prison, whose castle walls are several feet thick.  He makes a daring and miraculous escape aided by another prisoner, an aging abbe, who reveals to him the location of great treasure.  The hero becomes fabulously wealthy and the rest of the book is about how he wreaks revenge on those who had condemned and then forgotten him.  The Hollywood movie version in my opinion ruined the story by changing the ending.

What I didn’t know is that the author of these sagas, Alexandre Dumas, was a mulatto, and his father, Alex Dumas was a very dark black man from the island of Haiti who intermarried with a white French woman.  Through the real story of this man, Reiss takes us on a global panoramic tour of the institution of slavery itself, with many surprises along the way.

Slavery of course, has been around since the beginning of man’s recorded history, and obviously predated that history.  All acquisition of property and power throughout the ages was through conquest, and the victor took all, including the vanquished as slaves.  Slavery was not racially tinged until the 18th century.  Before then, anyone anywhere was at risk of becoming a slave if a predator group won the battle.  For example, when Alexander the Great conquered Egypt, he made slaves of the Egyptians, but he also imported lots of white slaves from what are now eastern European nations populated by ethnic Slavs, which is where we got the word slave.  Christians during this time period thought slavery was fine as long as the slaves weren’t other Christians.  So making slaves of non-Christians and especially the Moors, was acceptable.    In time these ethnic Slavs, who became known as Mamelukes,  revolted against their Egyptian masters, and the Egyptians became their slaves–until Napoleon came along and drove off the Mamelukes. Read more..

In the western hemisphere, there were large population centers located among the Mayans, the Aztecs, and the Incas.  One of the Incan cities had a larger population at the time than the European city of Lisbon, the capital of Portugal. Each of these south and central American civilizations had slave populations themselves.   When the Spanish conquistadors invaded they absorbed the existing slave populations and also made slaves of the former masters.   Those  who didn’t die of the white man’s diseases were turned into slaves and were sent to die in brutal, murderous silver and gold mines.  None of this was race related.

When other imperial explorers reached the islands of the Caribbean, they didn’t find precious metals as they had hoped, but instead found sugar cane, which they learned how to refine into sugar.  The sugar capital of the world became the island of Haiti, then known as Saint Domingue.  Growing sugar cane was labor intensive, and unlike in central and south America, there were no large concentrations of population that could easily be enslaved.  The African slave trade in the 18th century was largely concentrated around the sugar plantations of Saint Domingue.  There were few African women imported to Saint Domingue, and the men were treated so brutally they died quickly of starvation and beatings.  This rapid turnover further exacerbated the labor shortage, requiring more and more slaves.

Reiss traces how the imperial expansion into the western hemisphere took place concurrent with the philosophical movement of The Enlightenment with its special emphasis on liberty and individual rights.  The French were the first to attempt to come to grips with the contradictions between slavery and liberty.  The French were intrigued by the American experiment and the principles embodied in our Declaration of Independence and Constitution, and of course our revolution only came to a successful conclusion due to the assistance of the French navy.  As a matter of fact, the French involvement in our revolution drove their nation into bankruptcy, and precipitated food riots and their own Revolution.  The French Revolution championed the rights of man at the same time that it engaged in a Reign of Terror against its own citizens, sending thousands of innocent people to the guillotine.

The French resolved the slavery/liberty debate at first by declaring that any black man who made it to the shores of France proper was a free man, and the French sort of washed their hands, Pontius Pilate-like,  of what happened in the slave-holding colonies such as Saint Domingue.  Activists pressed the issue however, and within a short time freedom was being promised to slaves in the colonial territories, which of course enraged the plantation owners, who withdrew their support from the French Revolution.   This facilitated Napoleon’s rise to power, culminating in his naming himself emperor of France and ending the centuries-old monarchy.

Alex Dumas, the father of Alexandre, came to France as a young man and entered the military, and quickly distinguished himself.  For a while he actually outranked Napoleon, but in time came to report to him.  He was captured in what is today Italy, and spent several short years in a medieval prison, held without charges.  His prison experience broke his spirit and his health.  Napoleon meanwhile, in an effort to placate the very wealthy plantation owners of the French Caribbean colonies, rescinded many of the freedoms that the Revolution had instituted for blacks.

After many years of valiant service to the Revolution in which he devoutly believed, Alex Dumas found himself without a pension, without a home, and with no means of support.    Napoleon, who knew him well and personally, ignored his requests and his lieutenants ignored the requests and pleas of his widow after Alex died, still fairly young and impoverished.

This is broad brushing this delightful narrative, which holds many insights you’re not going to find in a history book.  Reiss approaches his topic without bias or political correctness, and what I came away with was that the lot of the common man of any race, color, or origin from time immemorial has been to serve as the cannon fodder of the ruling class of every nation, and that the golden rule prevailed:  he who had the gold ruled.

Reiss is quick to point out many of history’s ironies:

Napoleon and Alex Dumas fought against the Spanish in southern Italy.  This is the same Spain that was colonizing the central and southern Americas.  And that is how the South American tomato made it’s way to southern Italy, which of course made it famous. or was it the tomato that made Italian cuisine famous?

The French continued to refer to black and mixed race people in France as “Americans”, in America members of its Congress would not permit blacks into their presence except to serve refreshments or sweep up. Says Reiss: “But having enjoyed prestige as “Americans” during the[French] Revolution, black and mixed-race soldiers now found themselves denigrated as “Africans.”

The French helped us achieve the rights to life, liberty, and pursuit of happiness, and were also the first to give blacks freedom, at a time when  General George Washington said he didn’t think Virginians were ready for that step yet.   French  General Lafayette of Yorktown fame had to flee for his  life from his own Revolution.  He was captured by the Prussians and spent the next five years in prison.  His friend George Washington was powerless to help him because Prussia [parts of what is now Germany] and Austria at the time refused to recognize the new United States.

Miscegenation , or racial intermarriage, was common until it too was outlawed.  Haiti, the sugar capital of the world and probably the richest island on the planet, experienced the first successful major slave rebellion. The slaves fought 80,000 of Napoleon’s troops to a standstill; the French left, the plantations closed, and today Haiti is quite possibly the poorest island on the planet.  Today Haiti has experienced something of a brain drain as their best and brightest have abandoned her to seek their fortunes in the United States and elsewhere.

New post-revolutionary France decided to deflect attention away from their internal problems by invading most of their neighbors, which is how Napoleon and Alex Dumas came to know each other and fight almost literally side by side.  As always, the government attempted to finance their wars with debt, in the form of bonds backed by property–that had been seized from the Church.  These bonds were on pieces of paper called assignats, which were used as money,  and of course they printed more assignats than there was real estate collateral, which resulted in devaluing the assignats and creating massive inflation.  Eventually the floor under the assignats gave out–literally.  At the Paris printing house someone piled up too much of the worthless paper in one place and the floor of the building collapsed under the weight.  Their real-estate secured bonds were worthless.  Nothing familiar here, is there?

Reiss peppers his story with personal vignettes such as this description of one French revolutionary:  “. . . his main character flaw was that of so many French revolutionaries: a zeal for human rights so self-righteous that it translated into intolerance for the actual human beings around him.”  I’ve often thought the same of the purported champions of the war on poverty; their concerns are usually self-serving and they wouldn’t want to get too up close and personal with real poverty.  They preach humanity but don’t like poor people moving into their neighborhood.

Reiss weaves a wonderful and complex tapestry of events that spans the globe and leads to even more questions.  Life is never quite what it appears to be, and the more it seems to change the more it stays the same.  If you have strong opinions about modern race relations in the U.S., read Reiss’ book for a more global perspective.  Without our Constitution and limited government, there is nothing left but the governments guns, the moneyed powers behind the throne, and the ragtag mob.  Without individual freedom that cannot be voted away by any block of voters of any color for any reason, there is no freedom except by permission, and that is not freedom at all.

For author Alexandre Dumas, his novel The Count of Monte Cristo was the fantasy version of his father’s life.  Indeed part of the story begins in an obscure little village in Haiti (Saint Domingue) near the border with the Dominican Republic (Santo Domingo) called Monte Cristo.

Many parts of this biography of Alex Dumas, and his legendary fictional counterpart, the Count of Monte Cristo, read like a Kafkaesque novel.    Until we figure out a way to change human DNA, the possibility of a return to this world should never be dismissed lightly.  Liberty is and always will  be under siege.

The Cat and the Alligators: How Perception Becomes Reality

by on February 2, 2014
in Uncategorized

This post is not about a fable.  It’s real.  See for yourself:


How does a 15-pound cat intimidate an alligator, that weighs up to 800 lbs.?  What is going on in that tiny cat brain?  What is going on in the alligator’s brain?  Obviously the cat has no comprehension of how hopeless his cause is, and how incredibly mismatched he is against the scaly leviathan.  He knows instinctively to avoid the snapping gator jaws, but he doesn’t flee.  Does he see the alligator as an outsized and ugly cat?  Or is he just instinctively being territorial and protecting his turf?  Would he be afraid of anything?

On the other hand, what about the alligator?  Is he so accustomed to prey desperately fleeing his approach that the cat, by virtue of his fearlessness and aggression must not be prey at all, but a new kind of competition in the food chain?  The alligators clearly seem to reevaluate their assessment of the cat and apparently reach the conclusion that anything that fearless constitutes a danger best left alone.  Apparently even in the rest of nature, the best defense against a bully is to stand up to him.

To me this video, while hilarious in its own right, is an excellent metaphor for life.  It has been said that one man with courage constitutes a majority.  There is physical courage, which for the purposes of this discussion we could attribute to this cat, and there is moral courage, the willingness to stand up and be heard when the outcome cannot be assured.  At the very least one risks ostracism from the group, loss of friendship,  love, approval, and resources.

For many years I was in the property management business, and in the early eighties I had the opportunity to take a bid tour of the World Trade Center complex in New York City.  During part of the tour we were traveling through seven or eight stories of underground corridors, walking the equivalent of several city blocks through bleak, isolated and empty concrete hallways with no doors or windows.  The contractor who was then responsible for the cleaning of the mammoth facility employed over a thousand cleaning staff, all members of New York unions, and some of those employees had served hard time in the federal penitentiary for murder one raps.  I asked our tour guide, a bright, energetic young female supervisor for the contractor then cleaning the facility if she wasn’t afraid for her physical safety at times.  What would she do if she happened to come across one of the “tough guys” on their staff in one of these isolated tunnels?  I will never forget her answer:  “The only supervisor who needs to be afraid is the supervisor who is afraid.”

Those who are truly fearless, or who give off the impression of being fearless, give pause to their opponents.  They are so certain of themselves and their ability to handle whatever happens that they cause their adversaries to doubt themselves.  This confidence, this certainty, can be in defiance of all the facts of reality and still carry the day.  Power is as power thinks.  I am speaking here more of the moral variety, the sense of the rightness of the ground we stand on, and the moral indignation that causes us to stand that ground against obviously hopeless odds.  I am not speaking of those with the pseudo-courage of shouting from the center of the pack, mocking the outliers who dare to challenge the conventional wisdom.  I am speaking of individuals who are willing to stand alone and speak alone because of their convictions.

How many of us in a classroom situation will wait to answer a question until we see other hands go up?  How many of us will be whistleblowers when we are witnesses of wrongdoing, gross incompetence, negligence,  or causing harm to others knowing we risk being severely penalized for doing so?  How many of us have worked hard all our lives in order to prove we are just as good as the others in the group whose approval we need?

Acceptance into the group is a lot like peeing in your pants.  At first it is warm and wet and vaguely reminiscent of the comforts of the womb from which we were forcefully expelled long ago.  In time it chafes and demands change.  Unattended to, we can become so inflamed we can no longer stand on our own.

So what am I afraid of?  What does it take to make me tremble?  What keeps me awake at night?  In a world consumed with social media, where we all seek the comforts and reinforcement of our groups, how many of us can still remember who we are as individuals, what our core values are?  More has been given to us than the cat or the alligator, so life demands more of us.  We need to know more than who we are; to stand alone we need to know why.  Are we a cat or an alligator?  You can’t always tell by who or what is around us.

The highest level of courage is to understand the odds, feel the fear, and do the right thing anyway.

It doesn’t happen too often.

10 Rules: How Closed Minds Become Closed Borders

It is my intention to provide my readers with a very valuable and unique service.  I am a voracious reader and it is my special talent to distill complex subjects down to their simplest parts and principles (if indeed such principles exist).  Much of what is written, past and present, is intentionally obfuscated for political purposes or dishonest gain, whether of the material, intellectual, or emotional varieties.  It is designed to misinform or mislead.  Even when the ideas are simply muddle-headed rather than intentionally disingenuous, there is rarely an understanding of where those ideas originated, or historical consequences of their application.   These observations are particularly applicable to political discussions, but are not uncommon in virtually any serious discourse.

I am driven to know what is.  I grew up in an intellectually closed society, as one of Jehovah’s Witnesses.  I left that religious organization in mid-life only to find a whole smorgasbord of other closed societies, whether religious, philosophical, political, or social.  There is a vehemence and even fierceness of advocacy that inhibits civil conversation and betrays intolerance of different life experiences and conclusions.  What is most remarkable about all of these is that either side in any of these debates would passionately agree with my observations herewith stated, but only find them applicable to the attitudes and behavior of those with an opposing viewpoint!

As the polemicists outshout each other in the vain belief that raising the volume of their cranky bombast is the key to recruiting you to the cause or the sale, regard for evidence, logic, scientific method, clarity, and other calm pursuits are left behind like abandoned children.   Defense of our own position usually trumps all other considerations without any awareness whatsoever of the road by which we arrived at our convictions.  My most important takeaway from my own life-altering experience  is that I am the bouncer and doorman to my own mind, and I have sole discretion over what is permitted to enter.  I am the final arbiter of what I accept, because I become what I ingest intellectually.   This is a personal responsibility that I cannot delegate to any other person, institution, or authority. In my opinion, every one of my readers shares this same responsibility for themselves, for the same reasons and with the same rewards. Bitterness and anger about years wasted in misguided belief and defiance of reality are efforts to transfer responsibility for our own past choices onto others, but in every case it was we who negligently invited strangers, in the form of ideas, into our mind unidentified and unchallenged.  Even when we absorb faulty premises in our age of innocence, responsibility to identify and correct these later in life cannot be avoided with impunity.

I frequently include book reviews on this blog, on a broad range of subjects.  All of these book reviews are at least somewhat positive in nature, because I do not waste my readers time on books that are in my opinion without at least some important redeeming values.  I am neither Democrat nor Republican, neither liberal nor conservative, and these days, once you get past the rhetoric, it can be said their distinctions are often without differences.  I have no ideology except the value of the individual human being. Each of us is a minority of one.  Regardless of the comfort we find in each other, there is no collective brain.  Descartes famously said “I think, therefore I am.” What we think determines what we become.

I want to share some rules of the road from my personal experience.

When I was growing up, my parents taught me to eat everything on my plate at meal times.  It was axiomatic that to waste food was wrong, even though our young minds rarely grasped the contradiction in the fact that we didn’t overload the plate with all that food, the grown-ups did.  How could we possibly know that for the rest of our lives other BIG PEOPLE would be filling up our intellectual plates with the impassioned ideas, ephemeral notions, and absolute certainties they insisted we must ingest because it is “good for us.”  As in childhood, we trust the source, the same one we associated with survival itself.

Rule #1 :   The purpose of all propaganda is to become your “trusted source.” Read more..

Everyone, it seems, has the strongest notions of what is best for us, beginning with our immediate families and extending to all the institutions of our culture.  What is accepted and practiced in one generation may be repudiated by future generations.  The philosophy that someone else knows what is best for us is nothing more than delegating to strangers what gets put on our plate.  It makes no difference whether this authority figure or expert comes in the guise of clergy, government, Chairman of the Federal Reserve, media talking heads or television and movie script writers; all of them provide us with generous helpings of their opinions and rules and they expect us to eat it, even if it gives us heartburn.  They do not like to be ignored, and most of them are happy, if given the opportunity, to harness the coercive power of the state to enforce what they know is, if not for our own good, at least for the good of the greatest number.  After all, Daddy knows best.

Everything is based on core premises, and unfortunately these are usually absorbed unconsciously from the Influential People of our childhood and adolescence, parents, teachers, news media, friends, and church.

Rule #2:  At a tender age we are neither equipped nor qualified to evaluate  conceptual content, and we know little or nothing about possible  alternatives. 

Content becomes indelibly associated with the persons and institutions of authority that deliver it.  Because of this early childhood association between content and source, we begin to develop class distinctions based on these associations.  We are more inclined to trust and believe those who dress like we do, worship as we do, get educated where we do, and who earn their living as we do.  At the most mundane level it is often said that the best place for a young man to pick up a date is at a church wedding, because he benefits by association with the joy of the occasion and the trust placed in that institution by its members. A “no” response in a different context might become a “yes” at the wedding.

Rule #3:  As children, content becomes truth when it is delivered by those on whom we depend to survive.

Once imbibed, these childhood-acquired core premises become unchallengeable, eternal truths, the template against which all new information is evaluated.  We quickly learn to block dissonance, any new information that makes us uncomfortable.  As we build the rest of our lives around these core premises, our emotional investment in them becomes such that a challenge to their veracity becomes a challenge to our identity.  There is a crushing need to shut down, shut out, and utterly annihilate such threats, and this need is all the more powerful and insidious because it is experienced subconsciously, as in dis-ease.  We experience anxiety without knowing the cause. 

When you experience something that disturbs you, it may or may not mean it is bad for you.  A bad taste in your mouth may mean a poison mushroom, or it may only mean conflict with the taste of the previous mouthful, in which case you need to cleanse your palate before proceeding.  A mouthful of lemon juice may cure you of scurvy, but it could be intensely unpleasant right after eating a sweet.  Likewise you may have been led to believe that very wise people are looking out for your welfare, and this goes down pleasantly, like a sugar cookie.  You might have had great faith in the honest intentions and competence of Bernie Madoff in handling your life savings, or you may currently be planning an extended retirement on Social Security and Medicare as they currently exist, and it tastes sweet.

Rule #4:  What feels safe and tastes good may be the prelude to the financial equivalent of a diabetic coma.

In every case, we always trusted the source.  The doorman to our mind was sound asleep.  There were red flags about what we believed, but we chose to ignore them.

That’s why I write about labels.  I sit down to lunch with people of all stripes and within minutes I can hear, and feel, the palpable hatred as my temporary companions launch into diatribes about those who think differently than they do.  The emotional intensity and intransigence derives from the speaker’s sense of certainty.  A mere label such as the name of a political party, or particular belief or non-belief excites the passions and invites the derision of the group at the table.  To belong is to share in the laughter.  The opposite is equally true and commonplace; the willingness to blithely accept nonsense if it comes from a trusted source.  We will defend what we have already emotionally invested in.

Rule #5:  It is possible to have a lifetime investment in something that is indefensible by any rational standard.  

How long have we known, and has our government refused to acknowledge, that our Social Security is history’s largest Ponzi scheme ever?

I used to finish reading any book I had started.  Like cleaning my plate at dinner, I felt compelled to finish what I had started.  I don’t always do this anymore.  Life is too short.  I always seek to identify as quickly as possible  authors’ basic premises, and even if I disagree with them, I may continue reading if only because I enjoy the writing style or because an author occasionally drops in a redeeming original thought or new twist on something.  I no longer waste my time filling my mind with garbage, but there is a balance between that and closing one’s mind.  Periodically I have to remind myself to re-evaluate my own core premises to see if they still withstand close scrutiny.  The final questions are always, Who says so? Why?  Based on what?  I am always on the alert for the hidden agenda, the sugar-coated dodge.

If some distinguished authority figure makes claims that appear improbable and  unsubstantiated by the facts as you know them, assuming they know more than you is one possibility.  Another possibility is that they have reasons to be less than truthful on this occasion.

If their explanations more accurately resemble circumlocutions, going round and round in circles and making no particular sense, you could assume that their explanation is too deep for your comprehension, given their special training, or you could also entertain the possibility that their non-answer is because they really don’t have an answer but won’t admit it publicly.

How do you spot obfuscations, disinformation, and hidden agendas?    For starters, unless you’ve taken a serious course in statistics, distrust all statistics.  Most are not scientifically sound and are intentionally manipulated for uninformed public consumption.  I could say there are a thousand ways to do this, but that would not be a scientifically sound statistic.  So we’ll move on.  In commercial matters, follow the money.  In political and institutional matters, follow the power.  Look past the easy answers.  Look past the obvious beneficiaries of a particular group action.  The secondary beneficiary is always the real beneficiary.  The primary beneficiaries receive very diffused benefits.  They are the poster children of the much ballyhooed political action; the orphans, the poor, the children, the unemployed, the elderly, the American middle class, the racial minorities.   The secondary beneficiary receives very consolidated power;  the power to bestow or withhold.   Daddy isn’t interested in your growing up.  Daddy needs you to need him.  Daddy needs to be in control of permissions, punishments and perks.

Rule #6:  If someone is selling invisible clothes, let them run around naked.  

It is better to be underwhelmed by the titles and decorations and positions of power of the so-called experts.  Who even remembers yesteryear’s Nobel prize winners and Treasury Secretaries or Fed Chairmen?  If anyone makes claims that to your mind seem like the Emperor’s invisible clothes, let them wear them.  Plan your personal life and make your financial choices around your own perceptions, not theirs.  They will usually have agendas you will never know about, and disincentives to provide full disclosure or tell the unvarnished truth.  Do they really know better than you how to direct your life?  Most American households’ finances are looking better than the governments, perhaps for no other reason than we can’t print money like the government  does.  We have been acting to correct our balance sheets, to start saving and stop borrowing.  Does that sound like what they have been doing?  Do they care about you, or are they far more concerned about polishing their credentials to the largest blocks of voters?  This goes for anyone who is offering you advice on any subject.  Would you look to the Dalai Lama for guidance on improving your sex life, knowing he is a celibate monk?

In the end it’s the same.  Money is power.  But government is money plus guns.  By guns I mean the police power of the state.  With guns you can seize other people’s money.  If you get enough people behind you, even in a democracy you can decide whose money you will take, and how much of it.  This is REAL power, and this is why groups will spend a billion dollars to secure a position of power that pays only half a million.  The most expensive seats are reserved for those who hold court, who trade in favors and gifts, and who choose the winners and the losers.  These people are not producers; they are looters who talk as if they understand production.

All ideas have a history, and if you follow the thread of an idea back far enough, there are always surprises.  Every opinion, belief, and conviction—indeed every certainty, was arrived at in a certain historical and social context, and made perfect sense to those persons in their place and time, and was almost invariably the partial result of emotional turmoil in the author’s personal life.  In other words, intellectuals, philosophers, clergymen, or brick layers, we are all made of the same dirt.  Ideas all began with real people and every single one of them had problems, issues, and emotional dilemmas.  Some of them were morons.

Rule #7:  Many of the world’s greatest thinkers would be in therapy today.

Ideological sparks at the intersection of the right time and the right population periodically ignited the imagination of masses.   New truths became eternal truths that have often reversed themselves, sometimes over and over again, everyone so preoccupied with the minutiae of their daily routines they fail to notice the intellectual roundabout on which they have traveled for decades or centuries.    The grand ideas  have all come and gone, or splintered and evolved in almost unrecognizable ways, becoming innumerable dogmas and orthodoxies,  and today they make compelling narrative for the history or philosophy buff.  Those who take the time to look more closely are sobered by the awareness that in every time period of history there were those who were willing and eager to kill or enslave those who disagreed with them.    Our current democratic society provides some cultural and legal protections against this, but a basic meanness still often lurks beneath the surface of many human believers.  I hear it in conversations at lunch.

Rule #8:  There’s a troll under many a believer’s bridge.

When belief devoid of thought is extolled as a virtue, doubt becomes suspect, opposing opinions are demonized, dissenters are criminalized, and definitions of the enemy are crystalized.  Hatred is born and mob action is galvanized.  Ascendant mobs become the state. Other groups see opportunities to advance their respective causes by hitchhiking on the coattails of the rising group, with the idea that they will address their important differences after they achieve a more favorable situation in the power structure.   The state attempts to co-opt and harness culturally powerful forces (the most powerful of which is religion) and then moves to consolidate its power by weakening, neutering,  and eliminating competing groups.  There are no enduring loyalties, just the shifting sands of temporarily overlapping interests.

This is why I champion individual rights in my writing.  The individual is the smallest group in the world.  Protect individual rights and you protect the world.  Democracies are the competition and conflict between groups, but history is replete with the horrors perpetrated by one group (even elected ones) on other groups.  Great evil has been done repeatedly in the name of God or in the name of Society.  Even in a so-called free society there is nothing more fear-inspiring than observing an impassioned closed mind reflected in the eyes of another human being, so certain of his ideas in fact, that he will gladly sacrifice your life to prove it.  On their own, they are dangerous and capable of atrocities; organized into groups with their hands on the levers of power (duly elected or not), no one is safe.  Not even the members of their group.  Every group has its purges.

There IS a problem with championing individual rights.  It puts responsibility on the individual.  There is uncertainty, and results are neither equal nor guaranteed.  What is guaranteed is that no group can by itself or backed by the power of the state, make you do or be what you do not believe in.  And you can’t do that to anyone else either.  Not everyone is comfortable with that.

Individual rights are inalienable, meaning you were born with them and do not acquire them by permission from others–no one and no group can morally take them from you, even when those others are infused with certainty about their better idea.   They may seize your property and take your life by force, but they can never do so morally.  Individual rights mean the right to pursue your own life and happiness as your highest values, and you are free to seek and perform work that sustains those values.  This includes buying and selling from whomever you choose, to your own benefit.  Individual rights means essentially the separation of church and state and the separation of economic activity and state.

Individual rights mean the government is there to protect  individual rights of all, and no one is there to serve the government.  Individual rights in practice, of necessity mean small government because there just isn’t that much the government needs to do.  No modern state, including western democracies, will ever pay more than lip service to government based on the sovereignty of the individual because all governments derive their power from the purse, which includes both confiscatory taxation and gross interference with free trade of its citizens.  The power of government is in granting permissions.  That’s where the money is.

Rule #9:  The government’s favorite childhood game is “Mother, May I?”

You can recognize individual rights in action when your government fears to transgress against its citizens.  

Group rights, on the other hand, are acquired by permission from a majority of others in society, and those permissions can be revoked.  The herd sometimes gives little or no notice of intent to stampede.  The primacy of group rights derives from the belief that your highest value as an individual  is not yourself but your contribution to society as a whole.  Individuals can  expect to be sacrificed to the group when the group calls for it. Every single favor demanded of  government by a group always implies a request for the police power of the state to be used against someone else  who doesn’t want to do the group’s  bidding.  Otherwise, if the group could achieve its ends on a voluntary basis, arrived at through negotiation, documented and signed by the parties, why would they need to involve the state?  Groups only need the state to club minority interests into submission.   I use the word minority here in the very literal sense of anyone who does not have sufficient votes to protect their interests. Group rights are the inevitable political legacy of those obsessed with the certainty of their beliefs, so much so that in their minds the ends justify their means.  Sooner or later the means include the confiscation of human life and property by the state–for the benefit of the greater good, of course.  Group rights degrade into group warfare and lead to an indefinitely expanding state, with eventually the state dwarfing all other groups.

Group rights lead to totalitarianism, which is sanctioned and even welcomed by the public in the name of efficiency.  When the cacophony of bitterly opposed groups gets too rancorous and the machinery of the state grinds down, someone with the necessary stage presence steps forward and suggests temporary consolidation of power to get through the political impasse.  We all know the rest of that story.

You can tell group rights in action when citizens fear their government.

So what is my point?  Am I advocating political activism in favor of limited government and individual rights?  Not really.  You can, of course, if you want to.  All I am encouraging is to become aware of what is happening around you, and to be aware of the ideas behind the events.  Keep your finger on the pulse of the politics in your community, your state, your nation.  Be more careful what you believe in, and scrutinize documentation with a critical eye.  In almost every location it is possible to exercise a great deal of personal freedom as long as you don’t make too much fanfare about it.  Love your life, keep your mind open and your passport current, and

Rule #10:   Know where the border is.

Closed minds eventually become closed borders.


Where Do I Belong?

I grew up as a Jehovah’s Witness. I left that church many, many years ago, but not before I had learned the power of a label. For anyone outside the church, being a JW was associated with the visual of an unwelcome someone knocking at your door, usually on a Sunday morning. Or an association was made with those JW’s who refused blood transfusions and got a lot of unwanted press about it. But very few people really knew anything else about us. Our label was a form of shorthand for the few things anyone knew about us, or most likely, ever wanted to know. Our label was sufficient for others on occasion to be mean to us, especially as children. We knew we were outsiders.

When I left Jehovah’s Witnesses, I lost my lifetime label.  I was now faced with the onerous task of figuring out who I was.  My label had defined my identity up to that point in my life.  I didn’t know anything else.  (For more of this story, go here.)

When Self-Labeling Becomes Self-Destructive

We also label ourselves, sometimes to our own harm. We may develop a certain self-image and then we will live either up to it or down to it. If we see ourselves as a loser,  poor,  fat, sexy, brainy,  pretty, or superior, we often tend to behave in a way that conforms to our self-label, either owning it or over-compensating for it. Labels have power. When we adopt negative labels, we become co-conspirators in our own destruction.

If you want to try an interesting exercise with self-labeling, try to make a summary statement of your own identity in one or two sentences.  Be generous with yourself, but make sure it will pass the snicker test of your best friend or spouse.  Emphasize your core values, what you stand for, what matters, so that someone who just meets you could quickly evaluate whether they would welcome further interaction with you; your signature statement.  This exercise may be more challenging than you expect yet everyone you meet subconsciously performs this exercise and reaches conclusions about you within minutes.  Try doing it for yourself!  It is very difficult to project who you really are if you are confused about the subject yourself. Read more..

Socio-Economic Radar

When we find ourselves among kindred spirits we tend to feel safe and welcome, and when among strangers we turn up the voltage on our social radar, scanning the group for our probable status, the likelihood of acceptance or rejection should these people learn more about us.

When we meet someone new, we ask them what they do for a living. This may be nothing more than an opening line in an attempted conversation, or we may be looking for a label, a shortcut to identify as quickly as possible where this person will most likely fit in our socio-economic hierarchy, so that we can better judge how to interact with him or her. We size them up: are they powerful or weak, rich or poor, well-educated or dropped out of school in fifth grade, doctor or drug dealer, above us or below us, smarter or dumber than us, incredibly attractive or flawed in some important way, a safe companion or a threat to me or my marriage, a benefactor or a competitor for resources?

Sometimes we create the label, and often we buy into pre-existing labels.  Someone who graduated in the bottom 5% of his Harvard class (5% do!) trumps another who graduated summa cum laude from Podunk Community College.  (The person who graduated in the bottom 5% will conceal this—if s/he is even aware of it; the person who graduated with honors may be sure to mention it.)  Someone who showed up in a late model Mercedes outshines the family in a ten-year-old station wagon.   We all bear price tags.  We buff our price tags on the way to our class reunions.  Without our price tags it is very difficult to make snap judgments about others.  I live in North Dakota where there are a lot of very wealthy landowners who confound the labeling process by living in old farm houses.  In the summer they are easily confused with the rednecks because both groups drive dusty pick-up trucks.

The social meaning of a label changes with context. In most places in America, to state publicly that you are an atheist will elicit some type of social opprobrium, the assumption being that an atheist could not be a moral person and therefore is suspect. An atheist may be shunned, or become the object of extended kindness from those who are sure he can be won back to sanity. An atheist in America could never be elected to high office.  The label would defeat him.  Conversely, in many parts of Europe, confessions of atheism would more likely be met with “. . . and your point is???”

“Acceptance Speech”

We may attempt to acquire a label by parroting certain phrases that we think will accelerate our acceptance into a group. We can say inane things like “I’m all for limited government”, whatever that means. That phrase is devoid of meaning because its currency has been, first hijacked, and second, devalued. It is the sort of politically correct thing that can be said at a any party with a reasonable expectation that there will be knowing nods of assent at the shared wisdom. It is a label valued for its emptiness and safety; something each can put their own spin on. Everyone believes in limited government as long as they don’t touch our own particular cherished benefits.

Labels as Closure

Adopting a label can be a form of closure, so that we don’t have to think about a person or topic anymore. Using a previous example, we could justify our cutting off contact with a former friend by using a label, such as “he’s an atheist anyway” or “I can’t believe he’s become a rabid liberal” or “she’s so selfish” or “I’m done with him—he’s gone conservative “. . . We use these labels in much the same way that we would invoke the label “sexual offender”– to end the conversation or close the book on a possible relationship. Once the label has been pronounced, it becomes a judicial sentence, and no further thought or conflict need be entertained.  Everyone to the barricades!

Labels Evolve

We also use labels in a constant effort to determine if we are “normal”. Much of life occurs in a continuum. We live in a world of gray, and we attempt black and white to clarify our sense of identity.  For most of us life refuses to be so tidy. A silly example is our bizarre effort in this country to find the perfect word to describe black people. When I was growing up, first they were Negroes, which was an all-encompassing term. That term was actually the most scientifically correct label, in the same way that Caucasian is. Then we called them colored, which was rather colloquial but acceptable to everyone it seemed. I don’t know who decided they should be called blacks. I suspect that change came from the militant segment of the colored population, when black became an emblem of rebellion against the white man’s aggression, black power type of thing. Black was adopted as an extreme non-white label.  But that’s just a guess.  Where I grew up the most notable characteristic of some in the neighborhood was not their blackness, any more than my defining characteristic was my whiteness.  In our innocence, we saw each other as individuals with personal names and personalities.

I think the label “black” was the black man’s choice as a statement of pride, not a pejorative foisted on him by whites. Then blacks became African-Americans, although most of them had never been anywhere near Africa and maybe had no desire to go there either, at least not to stay. So they emphasized their ethnicity and roots, and indeed there was a bestselling book by that exact name, Roots, by Alex Haley, published in 1976 and aired on television the next year.

Now we are back to “people of color”. Again I am guessing, but perhaps this is an attempt to be more inclusive of many black people who are not all that black. Once again we are back on one of life’s continuums. I know I would rather be referred to as white than Caucasian only because my phylogenetic nomenclature sounds a little pompous and overdone for ordinary conversation.  I am sure blacks must feel the same about being called Negroes.  “People of color?”  I don’t know, will whites become “People without color?”  There is black and there is white, but what do you do when the majority of the population doesn’t really belong to either extreme end of the racial continuum? What will we call each other when we finally realize that our blood all runs red?  How will be label ourselves? And in some cases, how will we know who to hate? How will I know where I fit, if I belong, if I am accepted, if I am normal?  No one wants to be a loner in search of their lost tribe.

Labels and Xenophobia

We cherish our labels because it helps us figure out who we are, a sense of identity that is largely formed through feedback from our community. That community, and therefore our identity, can come as an accident of our birth, or by adoption. We can live our entire life more or less on auto-pilot by the simple expedient of accepting the heritage, and labels, of our forebears. We can be fiercely loyal to our group or faction, religion or political affiliation, and even give our lives to those who neither know nor particularly care about us, except as a means to their ends. And we could hate our neighbor living across the street, who might be the only guy on our block who would pick us up off the street when we fell down. We can miss a lot by limiting ourselves to labels. That is what xenophobia is all about.

Fear of Assimilation

Some folk’s attachment to labels is so intense that their greatest fear is of potential assimilation of their group into another, perhaps larger group. If enough black and white people intermarry, how will we know who is black and who is white anymore? And then who will we have to hate, or to blame our wretchedness on? That is why everywhere in the world, there are very strong taboos about intermarriage between races and ethnicities. Assimilation is the enemy for many, because it dilutes the sense of group identity. And it is always good to have an opposing group, an enemy, a Great Satan, on whom to blame whatever we don’t like about our life or what we see as being wrong with the world. This is also why people everywhere are encouraged to keep a distance from those outside the group, because we can hate or fear them as a group, but when we meet individuals we often form friendships and bonds. That can weaken the cohesiveness of the tribe. Who could forget the Capulets and Montagues?

Survival Advantages to Tribal Identity

Humans are very tribal, and we all draw strength from being “among our own.” We draw comfort from our brand identity. Some tribes, such as the Jews, have apparently drawn great survival advantages from resisting assimilation. When I dated a Jewish girl and we went to Jewish parties, everyone wanted to know right away if I was Jewish or not. They needed to “place” me on their cultural map. They were very welcoming and kind and I knew that I was accepted–on the margins. To be fully accepted I would have had to convert. Otherwise, a goy is still a goy. Some Jews, especially Reform, do intermarry, but overall the tribal or ethnic integrity is considered very important to them. Many of them fear assimilation as a threat to their identity.

Other tribes quite literally died out, became extinct, because of a failure to assimilate. The Vikings who settled in Greenland died out, probably in the 14th century, but the Eskimos survive to this day. Perhaps if the two ethnic groups had intermarried, there would still be Viking blood in the far North. The opposite of assimilation is often war, so perhaps the Eskimos wiped out the Vikings. We don’t know.

Survival Advantages to Mongrelization

When a cross-bred dog loses some of the distinctive characteristics of its forebears, it becomes harder to identify.  It’s size, coloration, and behavior may be different.  We are no longer sure what to expect.  We either don’t know what to call it, or we invent a new breed.  We have label confusion.  Intensive in-breeding, such as what was done to create chocolate labs sometimes produces unanticipated genetic weaknesses.  The same thing happens with too much inbreeding among humans; hence the near universal taboos on incest. Genetic diversity often brings strength and resilience.

America, the melting pot of the world, went on to empire.

The same can be said of the evolution of language itself.  English is a mongrel language; it has borrowed remorselessly and unconscionably from most other languages it has come in contact with.  It has assimilated.  Partly as a result of this, it has become the dominant global language of business and air travel.  There are more people in China learning English than the entire population of the United Kingdom.

Assimilation can convey survival advantages through genetic diversification and intellectual and cultural cross-pollination.  Mutts can be healthier.  Class distinctions and undue emphasis on pedigrees can lead to extinction.  Labels can weaken us.

The Exceptional Individual

At the end of the day, our labels are our instrument for branding ourselves and everyone else, our accounting for differences and similarities. Our heritage may be of the utmost importance to us, or we may be citizens of the world, finding common cause with humanity everywhere. History seems to suggest that belonging to groups strengthens our survivability, but vast populations of groups have repeatedly been victimized and enslaved by their own group leaders. Group identity comes at a price.  It is not always as safe as it appears.

It also seems the world is moved forward periodically by extraordinary individuals, who dare to step away from the group and challenge the status quo, usually at great personal risk. Their courage and originality does not mean necessarily that they were blessed with happy, fulfilled lives. In many cases they paid an awesome price for their uniqueness. We may be grateful to them for their contributions, but make very different choices for ourselves.  Well, enough rambling for one day. I’ve got to get back to my group . . .

BOOK REVIEW: The House of God by Samuel Shem

This book, originally published in 1978, became an almost instant cult classic.  The author Stephen Bergman (pen name Samuel Shem) was a Boomer  child of the fifties and sixties, and he wrote this, his first novel, when he was in residency at Oxford as a Rhodes scholar.  As far as I know he does not claim this, but it appears to me that the book is autobiographical to some degree.  The book is about a year as a medical intern in a Jewish hospital called The House of God.  It is funny, irreverent, occasionally salacious, and was frowned on by the medical establishment when it was first published.  

The book pulls the reader into the lives of the interns serving under intense, almost brutal conditions, and confronting what appears to be the very worst in life, its end and all the degrading things that happen to the human mind and body as they gradually shut down.  It is a revelation for the casual, non-medical reader to learn what  happens in the hospital to real people, the interns, members of the hospital hierarchy, and most of all the patients, most of whom are on the last part of the downhill slide. Read more..

The author doesn’t spare any of the gory details.  He discusses and describes in vivid technicolor many of the most unglamorous tasks undertaken by medical students and the attendant sights, sounds, and smells, work that may make you rethink your desire to go to medical school.  What was of the most interest to me however was what was happening to these young men and women as they struggled with the overwork, the authoritarianism of the hospital regime, and the realities of sickness, disease, and death.

The interns develop their own house rules and vocabulary, the first of which is that gomers don’t die.  A gomer (acronym for Get Out of My Emergency Room) applies to mostly elderly patients who have lost most or all of what makes them a human being.  They are existing and taking up space, but they have no awareness of what is going on around them.  As anyone who has spent time in a nursing home knows, their behavior can be humorous and tragic at the same time.  The patient load at The House of God was mostly gomers, and Rule #1 above means that gomers come in and out of hospitals like a revolving door, but they rarely die.  Their organs seem to function on auto-pilot.  It is mostly the younger patients who die in the hospital.  It’s hard to kill a gomer, and it’s impossible to cure or even save many of the young ones.

Even though this is fiction, there is a lot to be learned from this novel, and I am very glad I have read it.  I am amazed at how well known The House of God is, with over two million copies in print; I mentioned it to two middle-aged doctors just this week and they both immediately confessed to having read it many years ago, and they both broke into a grin when I mentioned the word gomer.

The hero among the interns was a fat black doctor who taught them that the goal of medical care was not to cure anyone, but to buff them and turf  them, which meant to make them look better, and then to transfer them out of the ward, either to another department (surgery, psychiatry, the morgue, or just back out onto the street).  When it came to treatment, they learned that less is better, and Rule # 13 was, heretically :  “The delivery of medical care is to do as much nothing as possible.”  It would appear this is a rule that modern medicine lost and is just now rediscovering–that there is a point of diminishing returns with continually prescribing more, and often unnecessary treatments.  Many of these do more harm than benefit.

The reader cringes at the descriptions of what the interns put the sick and dying through in the name of doing something, anything, even if it puts the patient through pointless, agonizing pain.  The concept of modern hospice, i.e. make the patient as comfortable as possible and let them ease into death, was incomprehensible and unacceptable.  You as the reader watch time and again the horrific prolonging of life out of “collective impotence and guilt” — of the interns and the families of the patients.  I cannot imagine anything being more graphic other than  being personally involved in such useless miscarriages of medicine.  I know that such things still happen, because I  remember the final weeks of my sister’s life when she was demented due to brain cancer and procedures for no known purpose were performed on her that obviously caused enormous stress and pain, because she shoved violently at the restraints that kept her bound to the bed.  She did not scream because apparently her brain was not able to transmit or translate the pain signals to other parts that controlled cognition and vocal ability.  It was modern medicine at its best and it was horrible to watch.  The author describes situations that make my sister’s situation pale in comparison, and the reader just prays for the damn interns to let this poor soul die.  And of course they can’t, because their code of ethics requires them to torment their subjects until there is nothing left of them.  That brings us to Rule #8  “”They can always hurt you more.”

I have to believe much of the medical information in the book is based on reality, and the novel is a fun way to explore how young men and women become doctors.  The reader also learns how normal, and sometimes even humble interns gradually evolve into the narcissistic god frame of mind that is partly responsible for the closed society that the medical fraternity has been.

The book is a good read and you will occasionally find yourself laughing out loud, and there will be times when you turn the pages in horrified anticipation of what is done next  in the name of medicine to the defenseless old or dying.

I will leave my readers with a very important question that remains unresolved in my mind:  How many patients have to die, on average, for one medical student to become a doctor?  Students, interns, and residents do practice on, and occasionally kill their patients, and very, very few of these become malpractice lawsuits.  What is the price in human lives and suffering for each apprentice to learn “to do no harm?”

BOOK REVIEW: Hospital Negligence: Legal and Administrative Issues by Arthur S. Shorr, FACHE

Edith Rodriguez entered Martin Luther King Hospital in Los Angeles on May 8, 2007 and was misdiagnosed as suffering from gallstones.  She returned the next day complaining of severe abdominal pain. The triage nurse refused to assess and prioritize her condition, and so Edith could not be placed in line to be examined by a physician.

In an effort at fairness, this could be understandable, don’t you think?  Lots of people use the ER for non-emergency purposes, because they are lonely, hypochondriacs, have mental issues;  or they use the ER as a substitute for seeing a doctor.

But not this time.  The hospital’s surveillance camera shows Edith lying on the floor “writhing and screaming in pain while the janitor mopped around her.” Other patients in the ER asked the nurse to help Edith Rodriguez, but these requests were ignored.  Someone called the police, but even they could not persuade the nurse to triage Mrs. Rodriguez, so the police decided to take her to a police facility where she could be treated.  Unfortunately before that was possible, Edith Rodriguez suffered a cardiac arrest secondary to a perforated colon, and died.

This happened less than five years ago, here in America.  The county settled with Edith’s family for $3 million.  Would you call this a malpractice litigation problem, or a malpractice problem? Read more..

My question is not what is the magic dollar amount of appropriate compensation for Edith’s family, but how can something this barbaric happen?  Can refusing treatment to a patient writhing on the floor in pain be considered just a lapse in judgment?   Can healthcare practitioners become this fatigued, indifferent, or callous to their power of life and death over a suffering patient?  The obvious answer is yes, and not infrequently.  Edith Rodriguez’ case can be found on page 290 of Arthur Shorr’s book Hospital Negligence Legal and Administrative Issues.

If you are interested in a movie developed around this type of flagrant and catastrophic medical malfeasance, watch The Confession, starring Alec Baldwin, Amy Irving, and Ben Kingsley.  If you are interested in an exhaustive (but not exhausting) treatment of current patient care in American hospitals, and the efforts of the courts to establish accountability, read Arthur Shorr’s book.

As those of you who have been faithfully following the thread of this blog over the last few months know, I have been heavily engaged in a research project on the subject of medical malpractice.  Not, mind you, the subject of medical malpractice litigation, but the subject of malpractice itself.  The objective has been to get past the defensiveness, angry bombast, propagandizing, and frequent intellectual dishonesty of vested interests, and discover what is really going on in the arcane, veiled world of healthcare in America.  Admittedly there is a bias to what I report, and that bias is that I am very pro-patient.   I have been a patient  many times, and as I approach the geriatric years, I want to know what to expect, I want to better understand the mysterious inner workings of the healthcare universe and how to survive in it.  Statistically, all of us will spend more time in the hospital during the last year of our life than the total of all our prior hospitalizations combined.  This is even true of doctors and nurses.  We are all going to die, and about half  of us are going to die in a hospital.  Would you like to get better acquainted with the place now, while you are well?  Then take this journey with me through Arthur Shorr’s book.

The 5% Who Maim and Kill

If you have been reading my previous book reviews, you cannot possibly have any doubt that to enter the doors of a hospital in calm confidence that your best interests will be tended to competently and professionally is not only naïve, but to play the part of the fool.  No one disputes the Institute of Medicine’s conclusion that between 100,000-200,000 people are killed in hospitals every year due to preventable error, carelessness, negligence, whatever you want to call it.  What most people don’t know, as Arthur Shorr, the author of Hospital Negligence Legal and Administrative Issues reminds us, is that 5% of all physicians create 54% of all malpractice litigation.  (See National Practitioners Data Bank, 2001 Annual Report: www.npdb-hipdb.com/pubs/stats.2001HIPDB_Annual_Report.pdf )  The National Practitioner’s Data Bank is the central repository for all major physician disciplinary actions, loss of privileges, etc.

You say you didn’t know that such a fount of valuable information existed?    Ever wondered what your doctor’s  cumulative professional history looks like? Would you be interested in knowing if s/he made the honor roll of healthcare practitioners whose  competence is open to question?  Now that you are educating yourself about the very real perils of healthcare  in America that one day could conceivably impact your life or prematurely end it, would you like to take a peek at this repository of reportable events created by the federal HCQIA law?  Well, so sorry, but the same law says you and I  aren’t allowed to see it.  In what is apparently a flagrant and obsequious concession to physician and hospital political lobbies, we, the patient population, are not permitted to identify and avoid the 5%ers.  In the healthcare game, the patient is the patsy, the powerless constituent who continues to have sublime faith that the system is going to take care of him (us).

Clearly, in actual malpractice litigation is the part of the malpractice iceberg that shows above the surface; the vast majority of mistakes go undiscovered, are concealed from patients and their families, or for various reasons never make it to the courtroom.

Where and how do these 5% hide out?  What (and why) hospitals permit them to admit and treat patients within their institutions?  How are doctors screened, or in the argot of the medical world, credentialed and privileged?  How reliable and trustworthy a process is this?  Why is the profession so notoriously lax in disciplining its own members?  When you enter a hospital, it all appears vaguely chaotic, with all these people in uniform running here and there.  Who are they, what are they doing, and who’s in charge here?  How do you know if these people are doing what they are supposed to be doing, especially when it’s your turn?  Mistakes and even negligence are a frequent part of life, in every profession and occupation.  Mistakes and negligence kill 50,000 on the roads of America every year, yet we don’t bat an eye.  But when an accident happens, there is an investigation, there is accountability, there are consequences.  Depending on the circumstances and intent, when a driver kills someone, it may be called accidental death, or involuntary manslaughter, or vehicular homicide.  What happens when a doctor kills someone?  What is it called?  Oops?  (And dispose of the evidence?)

In other words, the issue is medical malpractice or institutional negligence  or both, and this does not mean mistakes, which are inevitable to all aspects of the human experience.  It is important for readers to appreciate that outcomes are not guaranteed, but this should not be confused with medical malpractice or institutional negligence. Malpractice in Shorr’s book means administrative negligence; in other words, outcomes (often catastrophic) that with customary professional care should not have happened.  And so Mr. Shorr wrote a 600+ page tome that takes us on a guided tour into the bowels of the hospital organization, explaining the interrelationships between all levels of the institution, including the responsibilities, conflicts, egos, frustrations, and humanity of all the players, from the governing body to the newest certified nursing assistant.  He elucidates the processes, regulations, policies, and system redundancies that must, or should, be in place to prevent disaster, and what happens when they fail.

Cooking Patients

Considering his subject material and the human carnage involved, the author is remarkably sanguine as he calmly marches through the records and elucidates what actions can and should be taken to improve patient safety.  Take for example his treatment of surgical fires.  I had never even heard of surgical fires, and perhaps, dear reader, you haven’t either.  These occur when something combustible, such as oxygen catches fire on, or even worse, inside the patient on the operating table.  The Joint Commission, the organization that develops minimum safety oriented community standards for hospitals issued a Sentinel event bulletin alerting hospitals to the issue of operating room fires.  Arthur Shorr lists the nine inexpensive  measures recommended by the Joint Commission to take so that a surgical fire never occurs.  Sometimes the fires occur because ointments or gels on the patients face have not fully dried yet, and when an electric tool is used to cauterize, it ignites the ointment.  The solution is very simple; either wait until the ointment thoroughly dries, or make sure you wipe excess ointment that may be hidden in the folds of an obese patient’s skin before you proceed.  Surgeons do not operate alone in the operating room.  They have nurses and assistants and anesthesiologists working with them.  How could all of these people not think of taking simple and necessary precautions to prevent a disaster?  Too often the answer is, they all defer to the surgeon, the commander-in-chief in the operating room.

When a surgical fire occurs, it is usually around the face and neck, and often part of the patient’s face can get severely burned, on the inside as well, including the mouth, airways, esophagus, etc.  The treatment of these burns often causes infections and other complications, leading sometimes to the death of the patient, and most certainly to grotesque scarring.  Imagine going into what you expect to be a routine surgery, and, as reported by MSNBC,  waking up in recovery with ‘your chin gone, your nose deformed, your mouth virtually melted—so damaged that after a dozen reconstructive surgeries, you still have difficulty eating, drinking, and breathing?’

If you are having difficulty imagining this, look at this.

How Many Does It Take?

Now that you’ve looked at some pictures, maybe, like me, you have a problem with comments such as from Karen Weiss, M.D., M.P.H., program director of the Safe Use Initiative in FDA’s Center for Drug Evaluation and Research, that ‘these fires are small in number compared to the millions of surgical procedures performed each year.’  How many is this small number of surgical burn victims?  The same article estimates 550-650 each year!  Entirely preventable except  that the others in the operating room are too intimidated by the surgeon to speak up when the situation is unsafe!  We know this number must be understated because there are many more surgical fires that go unreported or are covered over to preclude malpractice litigation.  As Arthur Shorr reflects, “Both plaintiff and defense attorneys should recognize that the theory of the surgeon as “captain of the ship” has given way to the concept of the surgical team in which everyone  in the operating room has a duty to maximize the patient’s safety.”

The sad plight of children shot and killed in our schools and malls recently has dominated the attention of the media.  So how is it that five or six hundred patients have been burned on the operating table, and it doesn’t even make the news?  And since this conservative estimate of the number of victims is so small, according to Weiss of the FDA, how many victims do there have to be before it deserves comparable outrage?  The MSNBC article quoted above downplays the severity of the situation, in my opinion, by noting that 500 incidents out of 50 million surgeries per year is not that big a deal (unless it’s you, or a member of your family, of course).  Well, let’s see, 89 million passengers fly out of Atlanta airport every year, so I guess if five or six hundred a year catch fire, are disfigured or killed getting off the ground, that’s not such a big deal, right?

Who Authorized this Doctor to Practice?

Author Shorr divides his time equally between the top and the bottom of the hospital hierarchy, but always his focus is on patient safety.  It is obvious he knows from 40+ years of personal experience where the land mines are.  He gives a superb and constructive critique of the credentialing process, which is how hospital governing boards decide whether to grant hospital privileges to a physician after evaluating his performance record.  He points out the turf wars and ego conflicts that can (and do) occur between the administrator and the powerful, leading figures in the medical hierarchy of the hospital.  The CEO, in the incredibly delicate position of having  nondelegable accountability for whatever occurs in the institution,  also knows that if and when he challenges or countermands the medical leadership, those who recommend clinical practice privileges to the governing body, he places himself at the risk of jeopardizing his own employment and career.  How do you exercise principled leadership in such a situation?  Shorr points out the powerful personal incentives for administrators to avoid confrontation with the medical staff leadership and stick to issues with less personal risks such as the politics of  hospital systems, finance, equipment purchases, etc. and not to push issues that could create unpleasant blowback from the medical hierarchy.  Everyone likes to stay employed.

The Administrator’s Catch-22

The catch-22 for the CEO/administrator is that when malpractice occurs in his hospital by a member of the medical staff, the buck stops with the administrator if the credentialing process was compromised when that negligent physician was screened and accepted.  In other words, if a doctor’s professional history gives reason to doubt his competency and he is credentialed and granted practice privileges at the hospital anyway and then later is found guilty of malpractice, the CEO/administrator and the governing body have a serious problem.  The hospital may likely share liability for negligent credentialing and privilege granting.

Shorr focuses on not only ineffective credentialing and weak peer reviews, but he turns his laser on the opposite: sham peer review; the removal from the medical staff of otherwise qualified clinicians for political or economic reasons.  The most dramatic example might be of powerful physicians basically ganging up on a whistle blower in their midst and maliciously driving him/her out of the hospital:  “One of the most profound unintended consequences of HCQIA (a 1986 law designed to improve accountability of physicians)  is the emergence of “sham peer review,” the willful misapplication of HCQIA’s intended  protections refocused to persecute, punish, and otherwise penalize competent physicians.  This cynical and abusive practice is often employed by politically powerful physicians or groups of physicians to advance their own economic, social, or political agendas in the hospital setting.”  It’s hardly a quantum intellectual leap to go from understanding the existence of sham peer review to a profession that tightly closes ranks around its members and resists efforts at transparency, a threat to their control.

Registered Nurses as the Patient’s Advocate

My favorite part of Hospital Negligence is the section on nursing.  Nurses spend by far the most time in actual patient contact, and it is the nurses who generally define a patient’s experience during a hospital stay.  It is obvious that author Shorr has a special empathy for the nursing constituency.  He emphasizes their unique responsibility as patient advocate:  “Registered nurses are the full-time guardians of the patient, and function as patient advocates as defined by the American Nurses Association (ANA) Code of Ethics and most state licensure laws.  Their role as patient advocates should be recognized in their job descriptions as well.  It is understood that although the nurse will principally discharge physician orders consistent with their professional assessment of patients, professional nurses are also expected to utilize their independent  professional assessment and evaluation skills, and communicate relevant observations and concerns to the physician in a timely manner.”

The ANA Code of Ethics, in application, means that a registered nurse will advocate for the patient, even in the face of incompetent or compromised physician oversight.  This puts the registered nurse in the same precarious employment position as the hospital administrator.  If she advocates for the patient, she may open herself up to retaliation from those higher up on the food chain, but if her failure to act courageously results in harm to the patient, she exposes her hospital to liability and probably the termination of her employment.  I have to wonder how many of either hospital administrators or nurses would pass that test?  In my experience, survival instincts trump all other considerations, including violations of the training manual.  As Shorr points out “The administration must continuously reinforce senior management’s commitment to support nursing advocacy”—but how many of them will do that in actual practice?  To his credit, Shorr gives practical examples of how a nurse can question without seeming to challenge authority.

Following a sub-theme of protecting the patients from the very human natures of their caretakers, Shorr gives examples of patient chart notes appropriately done, but no one reads them, and hospital or nursing home records that are falsified by nursing staff, attesting to their having timely turned their patients to prevent pressure sores, when the patient in question had been transferred or even died, or the individual  who falsified the record was not even at work on the days or shifts indicated on the turning logs.  This would be almost funny were it not for the fact that patients needlessly die because of such negligence.  Shorr says:  “Although turning the patients is highly effective, the unreliability of nursing assistants coupled with inconsistent supervisory follow up can place patients at risk.”

Shorr maintains that while physician negligence is by far the most expensive per case in human suffering, death, and malpractice litigation, the mistakes of nurses and other caregiving hospital staff are greater in number, but generally cost far less per incident.

The New Healthcare–a Different Paradigm

The lesson for the patient:  “Until the 1970s the relationship between doctors and patients was highly paternalistic, based upon the premise that “the doctor knows best.”  Today, the concept of patient rights is based on the principle that patients are self-reliant and should exercise the greatest degree of influence possible on the decisions that impact their health and well-being.  Thus, this principle has re-defined the relationship between the patient and the caregivers.  It is the hospital’s responsibility to ensure that this dynamic is respected.”

To which I would add that it is our individual responsibility as patients to insist on this, or find better  caretakers as soon as the opportunity presents itself.  The paternalistic (and sometimes narcissistic) physician model who dictates rather than invites patient participation is being replaced by a new patient activism aided and abetted by the Information Age.  Our becoming a more-aware consumer of healthcare will raise the bar for our providers, as they realize they have a better educated, more observant and involved patient.  Some of them will become better doctors because of us.  That’s good for everybody.

The 5-percenters?  I can’t help wondering, of the five or six hundred people who are victims of surgical fires each year, what happens to the sloppy surgeons who wreck their lives or kill them? Presumably we only know about these five or six hundred cases each year because the doctors are  sued.  Are they still practicing medicine?  Was there disciplinary action?  Even a slap on the wrist?  How would we even know?  I have to ask you, my reader, if you or one of your children needed surgery, and you saw pictures like these of what your intended surgeon had done to one of his/her previous patients, would it influence your decision to have him operate on you or your child?  Would you be inclined to blow it off with an “Aw shucks, everybody has a bad day?  He deserves another chance.”  How would you feel if you knew, not only that he withheld this information from you, but that his entire profession conspired to prevent it from becoming known in order to protect him, a member of the Hippocratic brotherhood?  With improved and accessible performance metrics and much greater transparency,  dangerous physicians should be encouraged to  find something more suitable to do for a living.

Who Should Read This Book?

Who should read this book?  I did, but I am researching the subject.  But I found myself enjoying it, and I learned a lot.  I feel slightly less like a potential victim, and slightly more empowered knowing how a hospital is organized, the relationships, the conflicts, the dangers, the pressure points.  Just as with prior books where I have learned to pay attention to such things as whether or not my doctors or nurses wash their hands (most don’t), Shorr’s book has helped me learn what I have a right to expect in the hospital, and when I have the right to object or insist, strenuously if necessary.  This book has contributed to my self-confidence when I am in a very intimidating hospital environment where you are vulnerable both mentally and physically, are unceremoniously pushed, pulled, and poked, and I am less inclined to passivity the more I learn.  I think it will be a little bit harder for a careless provider to bluff or blast their way past me.

Besides everybody like me, patients or might-be-patients-someday, who else should read this book?  The first thing that comes to mind is every single Congressman and all their staff assistants.  It is the staff assistants who write healthcare legislation, and no one should be permitted to do that without reading this book first.  If this book has an ideology, it is patient safety.  If the staff aides are only concerned about satisfying their lobbyist campaign donors, they might conclude that this book would be of little practical value to them.  This, in my opinion, would be a mistake.  Health, and healthcare, are the great equalizers of us all.  Sooner or later, with very few exceptions, we are all going to need a hospital, and no matter which side of the ideological aisle we hail from, when that day comes, we are going to be better prepared if we have read Arthur Shorr’s book.  There should be a copy of this book in every Congressional office.

Graduate students enrolled or majoring in hospital administration should read this book, and learn about hospital accountability from someone who knows it from the inside out.

Key hospital administrative, nursing, and physician staffs should read this as a reminder of why they chose their respective professions to begin with, and who have a greater interest in raising the bar of their profession than they do in evading the plaintiff’s bar.  By paying more attention to the former, they can minimize danger from the latter.

Defense attorneys:  This book creates a clear picture of the standards and expectations against which your client will be measured.

Plaintiff attorneys who screen potential clients, to appreciate where the community standards and the bar of accountability  are set in order to assess whether the client’s situation is actually worthy of legal pursuit. Shorr makes it clear that there are no guarantees for outcomes in the practice of medicine or patient care services.  As such, the author makes it clear that less than desirable outcomes aren’t necessarily worthy of lawsuit, and draws a clear line between medical and ministered cases of negligence and bad outcomes.

Anyone involved in the education of future generations of hospital administrators should have this book as a resource.

Patient safety advocates of every stripe need to read this book.  Hospital Negligence Legal and Administrative Issues is an invaluable  desktop encyclopedia of patient safety case law.

Why am I promoting Arthur Shorr’s book?  Because nothing in this world moves unless someone or something is pushing it.  If we want our hospitals to become safer places, we have to participate at some level.  This book is a great combination of academic excellence without being afflicted with ivory tower isolation.  It is reality-based, not rhetoric.  This man obviously didn’t spend his many years of hospital administration hiding in some corner office.  He knows hospitals where it really counts most–at the intersection of the hospital and the patient.

You can reach the author through his website here.




Book Review: The Life You Save . . . Nine Steps to Finding the Best Medical Care—and Avoiding the Worst by Patrick Malone

As my regular subscribers know, I have been involved as a researcher and ghostwriter for a fabulous (of course!) book due to be released in the Spring of 2013 that for the moment we’ll just call Inside Medical Malpractice.  In that role, over the last eight months or so I have become something of an expert on the current literature on the state of American healthcare.  So for my busy readers, let me cut to the chase and simply say, get out your credit card and order The Life You Save . . . from Amazon or Barnes & Noble or your favorite bookseller, but do it now.  Get a copy for yourself, and get a copy for your grown children with a mandate to actually read it.  It will make a superb Christmas gift for anyone you care deeply about, including any who are healthcare practitioners themselves.  And no, I’m not connected to any of the beneficiaries of this enthusiastic endorsement, including the author. Read more..

So what’s this all about?  It is not my nature to gush or engage in hyperbole.  What’s up with my enthusiasm for  The Life You Save . . . ?  The shortest and straightest answer is in the title itself—this book is about saving your own life when it comes your time to enter the healthcare system for anything more serious than the common cold.

A few weeks ago I recommended How We Do Harm—A Doctor Breaks Ranks About Being Sick in America, by Dr. Otis Brawley, Executive Vice President of the American Cancer Society.  In my review of Dr. Brawley’s excellent book (you can read it here: https://www.financialliteracysource.com/money/book-review-how-we-do-harm-a-doctor-breaks-ranks-about-being-sick-in-america-by-otis-webb-brawley-m-d/#more-354) I recommended this book as a wake-up call to naïve Americans who enter the healthcare system with an unwarranted confidence that they will be treated competently and with reasonable expectations of a happy outcome.  Dr. Brawley lays it all out with well-documented information about how broken, chaotic, and fragmented our system is, and how frequently patient safety is the last priority of the stakeholders in the system.

More recently I recommended Unaccountable—What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, by Dr. Marty Makary, a surgeon at Johns Hopkins Hospital.  You can read this review here:  https://www.financialliteracysource.com/book-review/book-review-unaccountable-what-hospitals-wont-tell-you-and-how-transparency-can-revolutionize-health-care/#more-390. Dr. Makary’s book focuses on the culture of cover-up in the medical profession, and the intentional code of silence about mistakes, negligence, and incompetence.  He talks about how difficult it is for a patient to discover the safety track record of any institution or doctor, and Dr. Makary has excellent suggestions and comments about a ground swell of interest inside and outside the profession to clean it up and make it safer and more honest for the patient.  He makes the profound point that meaningful change will not happen unless we demand it, push for it, insist on it.

Then comes The Life You Save:  Nine Steps  to Finding the Best Care—and Avoiding the Worst.  The author, Patrick Malone, is a very successful medical malpractice attorney who has had clients all over the country.  His book, however, is not about medical malpractice, and his book is not some ill-disguised attempt to promote his legal practice.  This book is very simply a down-to-earth and comprehensive Survival Guide to coming out of the healthcare system unharmed and unscathed.  This book has valuable checklists for everything, from things to ask your family doctor; steps to take to find a competent doctor; checklists for safe surgery; the red flags that tell you to run like hell from someone you thought was a competent physician; how to become better informed about your prescription drugs; how to evaluate recommended treatments, procedures, and tests; how to avoid infection in hospitals; and how to evaluate hospitals, departments in hospitals, and the presence or absence of a patient-safety culture within the hospital or department you will be using.

Believe me, this guy knows what he is talking about.  For those who have a false sense of security by relying on federal and state regulatory agencies, Mr. Malone exposes the limitations and conflicts of interest that can cripple the effectiveness of these organizations.  He gets behind the statistics, and explains in simple street language what those horrifying prognoses really mean—and don’t mean, when the doctor tells you what your survival chances are, or how long you have to live.

Author Malone makes the point that we should not, as patients, have to go to such lengths to assure ourselves of being given competent, attentive care, but unfortunately when it comes to patient safety, American healthcare has only moved the space of a few inches on a journey of miles.  We have to become responsible for ourselves, which from my view on the bench, is not such a bad habit to cultivate anyway.  Because when you are sick it is often beyond your capabilities to be alert and assertive, it is essential that every one of us know someone who can go with us to our appointments, stay with us in the hospital, including overnight, and, oh, by the way, our friend needs to have big kahunas.  The healthcare system is not likely to pay much attention to someone without assertiveness, the ability to speak up and be firm.  The hospital is the last place to be intimidated, or in awe, of your healthcare providers.  These people are made of the same dirt as everyone else.  They have bad days, they suffer lapses of attention, they have other things on their mind, they have egos, they have wrong-headed financial incentives, they have attitudes, some of them are substance abusers, and some of them shouldn’t be practicing medicine at all.  With some of them, that is precisely the problem—they are practicing medicine.  As long as they are practicing, you had better be paying attention.  Caveat emptor.  Translation:  If you’re not being treated like a customer (instead of a patient), go somewhere else.

Malone cautions us that we also need to develop our relationship skills.  If we start acting like we know more than our physician, either we are now part of the problem or we need a new doctor (and maybe both).  Mutual respect is important.  And any good doctor will welcome an involved, educated client.  Yes, client.

A few days after I finished reading this book, I had an appointment with a new doctor.  I brought my checklist (borrowed from The Life You Save) with me.  My new doctor did not wash her hands after entering the examination room, and did not put on a clean pair of gloves.  She did not use antiseptic hand wipes, and she did not clean the head of her stethoscope in my presence before examining me with it.  She did have a bright cheerful smile as she shook my hand.  For the first time ever, I wondered, who else had she just treated, what sicknesses did they have, and did she shake their hands as well?

One more thing I loved about Malone’s book.  He lists dozens of websites where the reader can go for further information.  Unless you are a trained researcher, these websites are a fabulous resource.  Buy this book now, and keep it handy as your most valuable resource when the freight train of health issues is headed down your track.  Be prepared.  The Life You Save??  Let’s put it this way:  Like an ice-cold Budweiser, this book’s for you!

Why Voltaire?

If you have been following this blogsite, you are aware that it is in a state of renovation under the theme of The New Voltaire.  The revised graphics and other technical goodies are coming.  But much more importantly, I would like to address the question, why Voltaire?

Growing up, Voltaire was one of my heroes.  He still is.  His real name was Francois Arouet.  Voltaire was his pen name.  He had a very strict religious upbringing.  So did I.  He eventually left the church, and became its outspoken critic.  So have I.  He was a writer, a dramatist, playwright; he wrote biographies, histories, books on science.  While my meager offerings pale in comparison with the productivity of this 18th century prodigy, I also am a writer, including non-fiction books, literary economic commentary, and on matters of financial, historical, social, and political interest for today’s non-aligned and non-ideological seekers.

Most of what Voltaire wrote was banned during his lifetime, and therefore he often wrote anonymously.  I also write some things anonymously, as a ghost writer for others whose names adorn my work as the “authors” of record.  In my case, I do this not as protection from a coercive State (at least not yet), but as an artist whose work is commissioned and paid for by my clients.  In other words, it’s called making a living.

Voltaire evidently did not subscribe to the Platonic split of humans into an upper and lower self, a spiritual and material self, and he saw no reason to eschew the material comforts in life.  He was neither stoic nor monastic in search of his higher self.  He held no highbrow distinctions between the sciences, the arts, and the world of business and trade, and he applied himself equally assiduously and successfully to all of them.  This aspect of his character resonates with me, because all my life I have been a writer, but for 35 of those adult years I was a businessman for the simple reason that it provided for my financial needs and aspirations less tentatively than a writing career might have.  Or so I thought. Read more..

Voltaire wrote 56 plays, as well as countless other stories, novels, epic poetry, and what we would today call scientific “white papers”, book reviews, and over 20,000 letters.   But that didn’t prevent him from becoming a successful investor, bond, commodity, and currency trader, and becoming a millionaire by the time he was 40.  With his books banned, he relied on his business income for his lifestyle.

He was a champion of individual freedom, was imprisoned twice in the infamous Paris prison, La Bastille, and both the government of France and the Church were the targets of his rapier wit and excoriation.  He was beaten in the streets by hired thugs while an aristocrat watched from his coach.  He knew the importance of having cash on hand and living close to the border in the event that a hasty exit became necessary.  Voltaire lived in a time and place where the rule of law was arbitrary and capricious and its implementation often viciously politically motivated by those whose primary preoccupation was with the extension of their privilege and power over the masses.  So many laws were being made that virtually anyone could be construed as guilty, and their property could be confiscated by the State, and their life made forfeit.  Interestingly, the finances of the State were in such chaos, that in 1764 a law was passed forbidding publication of any criticisms of the finances of the State.  My oh my, the more things change, the more they stay the same.

Much of what Voltaire wrote was set in the context of countries other than his native France, making it somewhat more difficult for his censors to claim that he was criticizing his own government.  Most of what he wrote was published and distributed outside of France for the same reason.

Last but not least, I am forever impressed with Voltaire’s taste in women.  He met Emilie, the Marquise du Chatelet,  in 1733, and eventually moved into the Chateau de Cirey owned by the Marquise’s husband, the Marquis du Chatelet.  Emilie’s marriage to the Marquis was one of convenience, and husband and wife led separate lives and each took lovers.  The Marquis was a military man, and a hunter, whereas Emilie was a genius in her own right, an intellectual worthy of the term.  By the age of twelve she could read, write, and speak fluent German, Latin, and Greek (bear in mind that her mother tongue was French) and she continued on to take private lessons in geometry, algebra, calculus, and physics; she spent her fifteen years with Voltaire studying mathematics, the sciences, philosophy, and metaphysics.  Like Voltaire, she was no ascetic seeking absolution or approval by a life of self-denial; she loved her extensive wardrobe, shoes, and diamonds, sang opera and performed as an amateur actress.  With no taste for gossip and small talk, she had few female friends and intimidated most men.  She met her match in Voltaire, and they were together until she died.

Voltaire was one of the intellectual giants of history, one of the few who defied the orthodoxy of his time and moved the world forward.  Voltaire was a contributor to the Encyclopedie, one of the primary French philosophical contributions to the Enlightenment.  He stood head and shoulders with his contemporaries, John Locke and Sir Isaac Newton.  He was a major intellectual influence on the founding fathers of the great American political experiment, the creation of a republic, the first of its kind in the world,  that championed individual rights as inalienable, and therefore not granted by the State. 

Voltaire’s father disapproved of his son’s choice of vocation; he kept telling him he couldn’t earn a living as a writer.

In today’s world where the omnipotent State is on the march as never before and liberty is perpetually in retreat, the voice of Voltaire needs to be heard, revived, and amplified.  This call needs to be taken up by anyone with a voice, a keyboard, and most of all, a good mind and the courage to use it.  But like Voltaire, do not live just to save the world; learn to love your own life and live in this world.  Keep your sense of humor, keep some cash on hand and remember where the border is.

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