Happy Holidays

I often have a discussion with a friend of mine about religion and specifically he questions the rationality of my recognition and praying to an entity up there somewhere who is watching what I am doing, what I am eating and even what I am thinking. Of course this is a very difficult challenge to answer and ultimately comes down to faith. Our relationship with god, or lack thereof, is one aspect of religion but I think the equally or more important aspect of religion is the improvement/perfection of one's self and one's relations to others. One should come away from a house of worship with introspection. How can one be a better spouse, parent, or child? How can one improve in their place of business with honesty and integrity? How can one improve in their community by donating their time, visiting the sick or by giving charity? There is no doubt that we all have room to improve in at least one of these area and spending time in a house of worship challenges each one of us to ponder where we stand as individuals and how we can improve.

By being a part of a faith based community, the individual should be constantly challenged to improve him or herself. In doing this, as each member perfects themselves, the community as a whole strengthens, a bottoms-up individualistic approach. This stands in stark contrast to government's top-down approach of imposed behaviors. Religion targets the individual to effect change within himself while government uses a one size fits all approach to effect behavior in the population. Certainly, the individualistic approach is ultimately more effective.

A corollary to this individualistic approach is that the faith based leader should be challenging his/ her congregants to change themselves as individuals in order to improve their communities and strive for perfection. They should not be proposing to change others to effect change within their community. Additionally, they should put the blame of any shortcomings on the members of the community not to blame outsiders for what is lacking. If the faith based leader is blaming others for whatever deficiencies may exist then this is a poisonous endeavor and leads to destruction rather than perfection. If the sermon is not about how you can improve yourself but about how you can improve by changing someone else you should get up, walk out, and find a different house of worship.

So my friend would respond that he doesn't need a preacher to instruct him on how to behave, he does the right thing anyway, and he may be correct. But the vast majority of us need to be challenged to constantly improve our behaviors towards others. Very few of us are perfect and we often behave badly to our loved ones, or justify our cheating on an exam or in business, or only think about ourselves and not those less fortunate. Religion comes to challenge each one of us as individuals that we can be better to our fellow man. Not only because there is some entity up there keeping score but because our survival with our soaring population depends on us always challenging ourselves to improve our attitudes towards others.

Government and Fairness

As most are aware BO is turning to class warfare as his primary tactic in his re-election campaign. He claims the source for America's economic malaise is due to the rich and the business community who do not pay their fair share and do not play by the rules. Astonishing, when the top 5% of wage earners pay 60% of the federal income tax yet earn only 35% of the total national gross income. But in actuality it is the perfect strategy and one that will be very hard to beat since every individual has one vote and there are many more people on the bottom than the top. As I have mentioned in previous blogs this is an inherent defect in our democratic system and will necessarily lead to its undoing. The founding fathers likely foresaw this and is why voting was initially not a right granted just because one existed but only to land owners.

The Republican party will have a difficult time overcoming this demographic trend. Generally speaking, the poor will vote for BO to keep their checks and benefits coming and the rich will vote for the opposition to limit government's redistribution agenda. The question remains what happens to the vast middle? Will they support BO to take from the rich and give it to them? Or, do they want a system where one can strive to achieve wealth and keep it even though they may not be there yet. Perhaps, there are enough of those middle people that yearn for themselves or for their children to become future high wage earners and do not want the government to confiscate their hard work's rewards in their redistribution scheme. I am pessimistic and believe human nature would dictate people would rather sit at home and get a check from Uncle Sam rather than busting their butt.

BO talks of economic fairness constantly and he is right. But, the role of government is to make it fair for everyone to compete and achieve based on their abilities. Their should be a fair playing field where everyone can compete equally. No one should have an unfair advantage (bail outs, etc.) or an unfair disadvantage (discrimination based on race, sex, religion, etc.) and this is the exclusive yet limited role of government. But government should not be used to ensure equal outcomes and this where government oversteps its role. BO equates fairness with equal outcomes and this is his fallacy since if equal outcomes are predetermined or if success is blunted to redistribute to the losers then what is the reason to put in the effort to outcompete others. Hence, productivity falls as people feel its not worth the effort to take risks and compete. The fairness comes at the outset where everybody must compete on a level playing field, not at the backend when the results are tallied.

We are in a period in human history where competition for goods and services is international. The lower and middle class compete against workers from all over the world and our workers are entirely noncompetitive. They have priced themselves out of the competition and government has over regulated US industry to be noncompetitive worldwide. Thus jobs are on the decline and will continue to be for the foreseeable future. As the number of people in the bottom of society swell they will vote in candidates who cater to their redistribution desires. As redistribution tactics expand productivity slows, jobs decrease, total wealth decreases, and more people are on the bottom of the ladder demanding more from the government. The vicious cycle keeps going. Eventually society disintegrates (see Greece).

BO's tactics are highly effective and likely successful in the short term but long term will lead to disaster for the entire country.

A somewhat disjointed blog but I can sum it up with a quote from Margaret Thatcher, "The trouble with Socialism is that eventually you run out of other people's money."

Pedophilia

As the situation from Penn State unfolds with this coach being accused of sexual assault against young boys, I hear a lot of people out there stating their disgust at this behavior. People are screaming that this guy is a pervert, sick in the head, human disgrace, etc., and I do not necesarily disagree. But the thought that keeps coming back into my head is that this guy is wired to be attracted sexually to boys. It is completely involuntary and he cannot control these most basic animalistic urges. We all have these sexual atttractions but most are wired in a "societally acceptable" manner. We accept urges between men and women and even between same sexes but involuntary sexual urges between a man and a boy in our society cannot be acted upon, predominantly because of the inability of the minor to consent to the behavior. But what of this man who hasn't voluntarily decided to be attracted to boys, but is just pre-wired that way.

Why would some of us be created hard wired to be attracted to children? If we are created in the image of god and by god why would he create some of us to have one of our most powerful animalistic urges, the urge to be sexual, targeted towards children? You can answer that we all are created with certain desires that are off limits and it is our mission to overcome these desires with our gift of free choice. Married men are attracted sexually to other women. A man may be attracted sexually to a cousin or other relative in his family that is off limits. But, we control these involuntary urges, these animalistic desires of our hard wiring because we know that although the attraction can be all consuming we must supress acting on them. But why be created with such a strong sexual urge yet one that cannot be acted upon? It is truly a curse.

On a similar, but contrary note, we may be entirely repulsed by certain realtions. For instance, the idea of a homosexual relationship to me is repulsive and for the homosexual a man-woman relationship may be similarly repulsive. Certainly, sexual realtions with a young boy to me is repulsive whereas to another may be all consuming. Why would I be repulsed by sexual relations with a sister or mother even though she is more attractive than someone else who I cannot get out of my mind? There is something hard wired into us that controls to whom we are attracted and to whom we are not attracted and this cannot be modified. Why would god do that? It seems to be an almost impossible test for human beings. When we are sexually attracted to someone it can entirely consume our thoughts yet we are charged with self-control of these most powerful desires.

In no way do I condone the behavior of this presumed pedophile but in some way I think that his behaviors are generated by a faulty hard wiring in his brain that promotes an attraction to young boys that he cannot control. He does not have the strength to overcome these involuntary urges that he must know are damaging yet justifies their implementation. He is born with a curse that he must curb this desire throughout his life. I suppose we are all born with certain animalistic, involuntary urges that test us daily our ability to overcome them. Some are tested more than others and I think this attraction to young boys is an almost unfair test for many to endure.

C'mon People

Why I have no patience for some patients.

The patient who comes in repeatedly for sore throat and smokes two packs of cigarettes per day. They complain that I am not helping them even though the source for their problem is those damn cigarettes and refuses to stop.

The patient who leaves a message for me to call them back on their cell phone and when I do has a five minute musical introduction before I can get them. I don't have the time and i don't want to hear your rendition of music.

The patient who weighs over three hundred pounds and comes in and complains of difficulty swallowing. Hello?

The patient who has chronic nasal congestion, went for allergy testing and was found to be allergic to cats. I ask if they have a cat and they respond absolutely. What do you want from me? Ditch the cat.

The patient who has an ear full of wax and swears either that they don't use q-tips or barely put them in their ears. The only way the wax can get so impacted is by jamming those suckers so it almost comes out the other side.

The parent who comes in with a morbidly obese child and complains the child cannot breath at night. Try losing a couple of those chins and maybe they will breath better.

If the doctor asks you how long a symptom has been present do not answer "for a while". I don't know if that is five minutes or five years.

If you are coming to see the doctor for an abnormality on a test or imaging study ordered by another doctor, bring the result or study with you. My crystal ball is malfunctioning.

If you do not speak English, bring a translator with you. Otherwise, it is as if the doc is a veterinarian.

Do not feed your child immediately prior coming to see the doctor for a throat problem (guaranteed to vomit it all over the floor). Especially colored candy which causes the entire mouth to turn red or purple.

Don't come to the doctors office two hours before your appointment and then complain that you have to wait. It is not fair to see you early and then make everyone after you wait.

Do come in 15 minutes before your appointment, especially if you are a new patient to fill out the necessary papers.

I understand for some retired folk the visit to the doc is their one activity for the day. Do not expect the doc to spend additional time with you just to make that singular activity make the day pass.

If you are coming in for a problem in the neck, do not wear a turtle neck.

Medicine is not like the show Grey's Anatomy. I do not live in the hospital. I do not have sexual relations with residents and nurses. I have a family just like you and I don't like to be called in the middle of the night.

If you have a medical problem do not wait until a holiday to call the doctor. Take care of it during normal business hours. I have received too many calls on holidays with medical problems that were existing for days prior which could have and should have been addressed earlier.

Don't call me for a refill of your pain meds on nights and weekends. I will not fill them and any doc that does is inviting trouble. Btw, we have caught on to the trick of calling for medications after hours so you can avoid paying the copay.

I realize that a similar list could probably be constructed about patient complaints against doctors. But c'mon people, get real.

TEOTWAWKI

One night a few weeks ago I couldn't sleep so I started listening to the radio show coast to coast which is on every night from about 1 am to 5 am. Since I have sleeping issues I often find myself listening to the show until I fall back asleep but this particular night the interview was fascinating. The host, George Noory, was interviewing a man named Jim Rawles who was answering questions regarding preparation for TEOTWAWKI, acronym for the end of the world as we know it. What struck me was how ill prepared I was for any potential interruption in my life. We have become so dependent and complacent. We assume the supermarket will always have stocked shelves, the electricity and gas/oil that power our homes and the police that provide security will always be there. But what if it's not? We have become so narrow in our fields of expertise that we have no clue how to provide the basic necessities for ourselves in case we need to. It may not be the extreme of TEOTWAWKI but it is certainly possible for interruptions in supply chains to be prolonged. Terrorists, who by the government's own admission, are already in this country, can cause enough damage to instigate a prolonged interruption of what we take for granted will always be present.

So many of our resources are completely dependent on technology for their production as well as delivery that if this was ever compromised food and fuel delivery would be cut off. What would we do then? Do I have any clue as to how to maintain warmth, obtain and purify water, get food once the pantry goes dry or how to defend my family against looters? Do I gave any of the skills necessary for survival in these circumstances? Now that I am in my fourth day of a blackout and forced to live in someone else's house I think I need to be more concerned about being self-sufficient. What if someone else's house wasn't available or the blackout was regional and not limited to several blocks.

How long would it take for people to loot, steal or worse to obtain food, water or shelter? Mr Rawles suggested we live in a society with a very thin veneer of civility. After missing two or three meals that veneer would disappear and it would be every man for themselves. It seems extremely scary but preparation could put one way ahead of the game. What seems simple and inexpensive to obtain now could be a commodity later. Skills that one could master now would go a long way at TEOTWAWKI. I try to talk to some neighbors about this and most think I'm nuts. If this make any sense to you I suggest you go to Mr Rawles web site at survivalblog.com and start doing the research. Start making the right purchases and obtain the appropriate skills. Plan ahead for a situation where you may need to protect yourself and your family. There is a ton of information on the web to get you started. I know after these several days with no power or warmth, forced to live in small room in a friend's house, I will be doing more to prepare for the next time. I believe this was a wake up call for me.

Bad Medical Decisions

Thought I would share a patient story to illustrate a point. I had seen a five year old child last year with recurrent ear infections and after failing numerous courses of antibiotic therapy the recommendation was to insert tubes in the child's ears. The child was covered by medicaid, the health insurance for the poor. The patient was scheduled for surgery but for whatever reason failed to show for the appointment. I am not sure why the child didn't show up but it was never re-scheduled. About one year later the child shows up with the parent and it appears that permanent damage ensued since the problem was never dealt with and the parent didn't pursue the appropriate treatment. What was an easy problem to fix last year has become a much more difficult problem and perhaps not fixable with a permanent deficit.

My initial reaction was that the nanny state can give the poor all the benefits they want but ultimately an individual or parent still needs to take some individual responsibility for their health care. I blamed the parent for stupid decision making which results in their child having a more serious problem. But after watching 60 minutes last week regarding Steve Jobs it seems that stupid decisions regarding ones health are not limited to a certain segment of the population or income level. It seems there was a chance had he taken care of his tumor when it was initially found he could have beaten the disease. Probably out of fear, he decided to wait and try alternative treatment and that may have cost him his life.

Why do people fail to pursue the recommendations of their doctors? Is it just fear or is there something else that influences their decisions? I put part of the blame on the media. There is so much negative media attention paid to the medical profession that people question the recommendations of their doctors. You hear so many times on the TV the vast number of deaths that are caused by medical errors. You hear how American health care is rated low compared to other nations (totally ridiculous, just look at cancer survival in the US vs. anywhere else). Even BO promotes this skepticism towards doctors when he questions doctors/surgeons motivations when they perform operations. Specifically he questioned the motivations of doctors who perform tonsillectomy in children as well as the greed of doctors who perform amputations only to line their pockets (as if this community organizer has a clue about the indications for such surgery). This environment of suspicion regarding the motivations of doctors has an adverse effect by allowing patients with serious problems to justify putting off needed interventions. On a similar note, there are so many false claims by alternative treatments (which are legally permitted) that the public buys into it. People don't realize that medical treatments go through rigorous trials to ensure efficacy and safety whereas alternative treatments do not.

In no way am I advocating for people to blindly follow any doctor's recommendations as I have encountered many a patient who I believe were advised incorrectly. Similarly, I am sure I have had patients who have seen me and then went elsewhere for another opinion that was different and may have been correct when I was wrong. Doctors are human and can make mistakes or overlook something which is why I always encourage second opinions in my own patients. I never look at it as a threat to my abilities but rather what is in the general welfare of the patient which is the ultimate goal. I believe most physicians feel similarly.

Whatever one may think of a doctor it is imperative that if an individual does not believe or trust the recommendations of a specific doctor that he/she seek another medical opinion.

Herman Cain's Appeal

The reason Herman Cain has such appeal to the republican party (btw, I thought the GOP was a racist institution) is that he does not define himself by his blackness. He is a post racial politician that looks past the color of his own skin and rather defines himself as an American who worked hard his entire life, achieved to the best of his abilities and succeeded and just so happens to be black. He bought into the greatness of this country which is to work hard using your innate and learned abilities to compete on a level playing field and succeed and/or fail in the marketplace. He didn't rely on his blackness as a source for entitlement or as a reason to provide an advantage over non-blacks. He didn't claim to be a victim and use that as an excuse for failure or to not even try. He personifies an America where you can go as far as your abilities take you and what makes this country great. This message needs to be taken to the entire black population and to all segments in this country that race to be the most victimized and in need of a handout.

This message stands in stark contrast to BO whose message is that your failure or inability is not due to you but to the rich guy on the other side of town who doesn't pay his fair share of taxes. He encourages scapegoating another group for one's own shortcomings. The OWS ( occupy wall street) rally is a perfect example of this by blaming wall street bankers (?code name for Jews?) for the lack of jobs and unavailability of opportunities. BO's only chance is to continue his lies that the reason for this country's economic malaise is due to group x and not due to his own political and ideological failures. He is the scapegoater in chief and nobody does it better. The problem is the masses will believe his lies since it is easier and more comfortable to blame someone else for your misfortune then to look inside of yourself and admit to your own failures and lack of success.

These two figures, Cain and BO, have as their only similarity the color of their skin. On everything else they stand in stark opposition. Two black men, two disparate ideologies, two visions for what America is and what it should be. The only way this country can survive and thrive is for the Cain mentality to succeed over BO's.

It seems as though my prayers from my last post were answered (Gilad Shalit) but I never would have imagined they would be answered so quickly . So I am now going to turn my prayers to the downfall of the Iranian regime and support for the suppressed population in that country. As the main source of exported terror to the entire world and instability around the globe as well as the oppression of the Iranian people I hope this prayer gets answered as timely as my last.

5772

One of the nice things about being Jewish in America is the reaction of non-Jews to the celebration of our holy days which we are presently enjoying. There are those who say that spending the holidays in Israel is the only place to be because the entire country revolves around those holy days. But I think that there is something truly special in observing the holidays in America and portraying as a living example to the general population our ancient customs and our dedication to the service of the Almighty. It also demonstrates the religious tolerance of this nation and the respect we all have for each other's religious practice.

The number of people who convey to me new year's wishes this time of year amazes me and they are from all different walks of life. Their wishes seem to be with true sincerity and I think it comes with a deep respect for our religion. The cleaning lady in my house, the loan officer at the bank where I am applying for a mortgage, the stranger on the street who sees me walking to synagogue all wish me well. Additionally, it is nice to hear from so many of my patients who wish me a happy new year. I sincerely appreciate their New Year's wishes.

The New Year reminds me though of Gilad Shalit who is spending yet another year as a prisoner in a Hamas dungeon. No contact with the outside. No red cross visits. No knowledge of his health. My prayers go out to him and his family who have had to endure this torture of being used as a pawn by the Pals. It wouldn't surprise me if the Israelis had intelligence on his location and may even have a plan in place to extract him. It is a risky undertaking but a point may be reached where there is no alternative. The parents may get desperate as they realize the longer he stays there the higher his mortality. The family and the government may soon reach a conclusion that an attempted rescue is the only option. I pray that next year the Shalit family will be celebrating Rosh Hashanna together with Gilad.

Turkey Out, Greece In

Here we go again with another leader of an Islamic country shooting of his mouth against Israel for the sole purpose of garnering support amongst the masses in their countries. Instead of telling their citizens the truth, they tell lies to their people and attribute all that is wrong in their societies on Israel. Turkey's leader has unilaterally transformed his nation from a peace partner with the West and Israel to just another loser society that will continue to be left behind as the rest of the world advances. All in an attempt to amass personal power and inflate his ego. Antisemitism is always an incredibly forceful rallying cry even as his nations falls farther and farther behind the rest of the world. The citizens will mind-numbingly tolerate any destruction of their own countries as long as they are fed a constant stream of antisemitism.

Erdogan wants to inflate his chest and act like a big bully while picking on Israel as so many other neighboring states are doing. He thinks he's got nothing to lose by tormenting and threatening Israel but I think Israel's big brother needs to step in and put this power hungry Ottoman in his place. The US needs to send warships to the area and demonstrate it's support of Israel and its intolerance of Turkey's provocations.

The Turkish leadership is threatening Israel's exploration and exploitation of energy finds in the Eastern Mediterranean. Here's the deal. For a 10% cut of the mined gas, the US will provide protection for the extraction of the fuel in that area. This way the US gets reimbursed for its expense and maintains a military presence in that region. The US citizens will be thrilled that they will be getting an economic return on their military investment and exerting a presence in the region.

I remind these leaders to look at their bibles, specifically Genesis 12:3. Those who bless Israel will be blessed and those who curse Israel will be cursed. Turkey is definitely being led down the wrong road but ironically Greece may be the beneficiary. It appears that Greece is in dire straits of its own as insolvency is being considered but it is establishing closer military ties with Israel. As they help and support Israel I believe they will be helped with their economic problems.
In a strange quirk of history even as Greece looked to destroy Israel and the Jews two thousand years ago it may be that they will now assist each other in their current existential challenges.

My Dietary Transformation

My wife has been after me for some time to read a book that she read about six months ago called The China Study. So I finally read it while on the Bermuda cruise through Hurricane Irene. I must say it is very compelling and has transformed the way I eat. Essentially, it makes the case for a plant based diet as opposed to an animal based diet. It looks at demographic trends of heart disease and certain cancers in various countries and within countries and correlates it with dietary habits. It is nearly a direct correlation between increased animal protein intake and the rates of heart disease and certain cancers. Conversely, it directly correlates a plant based diet with a decreased incidence of heart disease and certain cancers.

Of course reading this on the cruise wasn't the best place to be exposed to this enlightening information as there was so much food to eat and especially delicious looking desserts. But the truth is there were so many choices on the cruise to eat a plant based (vegan) diet. For the past four or five years I was petty good being on an Atkins type diet, limiting my carbohydrates. I was able to keep my weight in check but as it turns out I was eating so much animal protein and dairy. Eggs, cheese, milk, and butter for breakfast. Tuna for lunch and chicken or beef for dinner. This is exactly the opposite of the diet I should have been consuming per The China Study.

I decided I would try and change my diet. For the last two or three weeks I have been consuming mostly a vegan diet. Whole wheat toast with almond butter, black coffee, and a fruit for breakfast. Large salad and fruit for lunch. Nuts to snack on midday with tea in the late afternoon For dinner vegan chili with a whole grain (brown rice, quinoa, kashe, etc.), a large salad and some veggies. I can say that I do not feel much different but I have lost weight and I do not miss meat or dairy. I do miss milk chocolate and I have cheated on some oreos as there are some things I just cannot give up. I don't know if I will keep it up but for sure I will continue to limit my intake of animal based foods.

While reading the book the question I wanted answered was do vegans live longer than non-vegans. That should be a fairly easy study to do. So when I arrived home I googled vegan longevity study and the results are inconclusive. One may argue they may live a more disease free life and not a longer life but a disease free life should translate into longevity. Even if it has a disease minimizing effect and not a longevity effect I think it is worth the effort. I think a little meat and/or dairy is fine in moderation but no doubt Americans need to cut back on their animal based food choices and spend more time in the produce section.

My teenage children have also adjusted their eating habits and are eating more of a veganish diet. I give my wife a lot of credit for opening my eyes to this way of eating and I should have listened to her a while ago and read this book earlier. I guess it's never too late. I suspect I will read a different book in a few years that will completely refute all the conclusions of The China Study and convince me to change my diet again. Anyway, I highly recommend reading the book. It's worth a look.

A Few Steps to Jumpstart the Economy

I am in the process of trying to refinance my mortgage at these historically low rates and it seems to me there are a few fairly easy steps that can be taken to make the process easier. This would be a tremendous boost to the economy and the housing market as more money would be freed up for people to spend as their interest rates and mortgage payments are lowered. The main problem is that even though rates are very low it is very difficult to qualify for a mortgage or a refinance. The banks have overcompensated for their previous laxity by creating an environment where getting approved for a loan is near impossible. Even a person with excellent credit who has been paying the mortgage bill on time for years has difficulty getting approved. How ridiculous is that? The refinanced mortgage will result in a lower payment and the individual has already demonstrated the ability to pay on time for years at a higher level. Isn't it less risky he/she will default at a lower mortgage payment. This is where government can step in and do something useful for the homeowner and the economy. There should be a national program to be able to refinance your home loan at current interest rates with very few qualifications and no cash out.

My next gripe is title insurance. The entire concept is ridiculous. In order to refinance I am required to have a title search on my property that only I have owned for the last 13 years. The title search is basically a few clicks on the Internet to look to see if there are any liens on the property. To make it worse if the "person" doing the title search is in error I have to pay title insurance to cover for his error. This is parallel to me charging a person my fee for a doctors visit and then charging an additional fee to pay for my malpractice insurance. Additionally title insurance fees are set by regulators when it should be market based and allowed to float like other insurance products. This entire industry of title search/insurance is a hindrance to refinancing property and needs to be adjusted. The problem is they are typically owned by lawyers. Need I say more.

Another innovation could be that a person could take out a mortgage at theses low rates with the condition that he could later sell the property with the mortgage as a package. In other words, the buyer would assume the mortgage of the seller. Locking in a low rate would significantly increase the value of the property to a potential buyer. This simple innovation would trigger rapid investment in the overhanging supply of houses as investors would predict a gain not only in the underlying property but also the increased value of a low interest rate mortgage which they could pass on to the buyer. Of course the buyer would have to qualify with the bank prior to the transition.

These three steps would dramatically spur the real estate market. They would also free up much needed cash flow in people's pockets to be able to spend more and invigorate the economy. It would also trigger job creation within the mortgage and construction industries. The only losers are the lawyers and therefore a perfect plan.

Voting Present on Libya

So let the truth be told. So far things have worked out pretty well for BO in Libya. The removal of Kadaffi seems to be at hand and this was done at a reasonable cost with regards to the financial investment and without the cost of US servicemen's lives. Most importantly, it was done by the citizens of the country who sacrificed their own lives for a future that they will orchestrate and not by a foreign entity. The people have sacrificed their own blood and appear to be winning and have too much skin in the game to let things slip away. A superior formula compared to Iraq where the US changes the regime and is stuck planning the Iraqi people's future. So kudos to BO.

But not so fast. Lets not forget that Iraq was looking real good until the destruction stopped and the construction was to begin. The real test in Libya is what happens now. I suspect it will be as much of a quagmire as Iraq and Afghanistan are presently. Whether it be Islamic fundamentalists, Kadaffi loyalists, this tribe or that tribe, violence will be a mainstay of all of these dictatorless territories. In that area of the world, in that culture, disputes are resolve by violence NOT by discussions. When will we finally learn this and stop transposing our values on other cultures. Additionally, who knows if and when Kadaffi will be caught. I wouldn't be surprised if he has a few tricks up his sleeve for just this occasion. As a result, as quick as Bo was willing to accept credit for the initial triumphs in Libya he will be just as quick to blame someone else for the inevitable future quagmire that will be Libya.

On this Libyan episode BO as usual voted present. He wanted to be in on the success but he also wanted an out if and when things turned badly. This again demonstrates his personality perfectly. He will not commit to anything without the possibility of blaming others if his plan fails. So he opts not to have plans or lead in any specific direction. He calculates his language in such a way that he can later deny having said certain things or claim he was misinterpreted or taken out of context. He plans in advance his escape plan.

I think this exemplifies why we have too many lawyer politicians. I think they learn in law school the power and calculation of language, how to pick words and formulate their semantics so that they can reverse their positions in the future. Compare the speech of lawyer politicians like BO, Clintonx2, Bachmann to nonlawyer politicians like Ran and Ron Paul ,Howard Dean, Tom Coburn (btw, all MDs). The approach to a problem is completely different and I believe stems from their training in their respective professions. The MDs assess a situation pick the best option/plan and institute that plan of action with conviction. The lawyer, on the other hand, is trained to defend whatever postion he is being paid to defend. He is not trained to pick a position and defend that side with conviction. In fact, he is trained to be able to defend both sides. The doctor puts himself in a postion where he can be wrong but uses his best judgement to present his strongest position (ie. leadership). Whereas the lawyer schemes to create a position or a lack of postition where he can never be wrong or blamed which results in lack of leadership. Perfect case in point, voting present. It is amazing how the different formative training of a physician versus a lawyer translate into distinct leadership qualities and ability, or the lack thereof.

Escape From Reality

I've been a little lazy during these dog days of summer getting the blog out and I am on vacation next week so I wanted to get a few thoughts out before I left. I think the true winner of the Iowa straw polls was BO. If you have stock in Michelle Bachmann I would sell now because this is the peak of her popularity. It is all downhill from here. By the way, which of her advisers tells her to scream a platitude very slowly in a monotone voice to finish off every paragraph of her speeches. She gets a huge applause when she shrills "BO will be a one term president". But seriously lady, you show a lot of enthusiasm but there appears to be a significant intelligence gap between you and the other candidates. Speak to us like we are intelligent and not like we're a bunch of morons. BO is the winner because Bachmann is unelectable.

I seriously fear the entrance of a third party candidate into the race which will certainly favor BO and ensure his re-election. The GOP is going to nominate a conservative right winger who will go up against the far left BO. Someone will come up with the bright idea to split these two extreme positions and go after the huge middle. Maybe it will be Bloomberg or Giulianni or Jeb Bush. But in any case BO has a solid third of the electorate who will vote for him regardless of anything he does. Of the remaining two thirds, this will be split amongst the three contenders almost ensuring BO's re-election. The third party candidate will not care that he/she is ensuring BO's victory only to have his/her ego stroked. If they truly cared about the future of the country they would put their efforts into electing the candidate nominated by the GOP.

Moving to another part of the world, Syria is a powder keg waiting to blow. Bashar Assad is all-in to use a poker terminology. He has gone down the road of no return and he will either survive as a dictator which is unlikely or die. My fear here is as he goes down which is eventual he will take as much as he can with him. This means Israel too and it wouldn't surprise me if he instigates Israel in a last attempt to divert attention away from him and rally the Arabs against Israel. He will use all his fire power in his control and all the fire power given to him by Iran. He will direct it at the protesters in his own country but also at Israel. It is very dangerous when you have a madman with nothing to lose and his finger on the button of scuds with chemical weapons aimed at Israel. It is like cornering a caged animal.

On these uplifting notes I am going to escape reality for a much needed vacation with my family. I am so excited to spend a week together until we all go our separate ways next week. Even as it appears that we are heading into frightful and terrible times all around the globe it is these times with the family that makes life so precious, enjoyable and worth living.

On the Backs of Doctors

Once again we see the deficit will be reduced on the backs of the providers of health care in this country. In the recently passed legislation there will be a super-committee of 6 congressman to agree to 1.2 trillion dollars of cuts by November 23, just three months away. If an agreement is not produced by then there will be automatic cuts to various programs, mostly to defense and medicare. As I have blogged about in other posts, medicare is a failed system of providing health care. All medicare bills that come in get paid promptly without determining the need for the service or investigation for fraud and abuse. It is easier for the feds to borrow or print or tax money than to go after fraud. The government is unable and incapable to monitor for waste and it cannot use the allotted resources effectively and this leads to an enormous amount of funds that go down the toilet. Contrarily, private health care systems are much better at detecting fraud and abuse and are careful with each dollar spent and every test or surgery performed is reviewed prior to being pre-certified. This is in complete distinction to the government who pays now and asks later or usually never.

I have heard of a urologist that used to take a few biopsies when performing prostate examinations. The urologist got smart and decided to open a pathology lab in his office, hire a pathologist to read his biopsies, pay him a salary, and bill medicare directly through his office for pathology services. In essence, he would be taking a cut (no pun intended) for each biopsy performed. Once the pathology lab was up and going the urologist increased his number of biopsies from three or four to over ten. This is so abusive, not to mention how unethical it is for this doctor to puncture and damage a person just for his own financial benefit. But where is the government? Can't they see that the number of biopsies has increased three-fold when the billing was changed to this urologist? A private insurance company would pick this up in a second and question the bill. The government DOES NOT AND CANNOT effectively monitor where it sending its funds. This is just one example of fraud that is rampant in the medicare system.

So what the government will do is to cut fees to all providers across the board. Instead of using the allotted healthcare dollars more effectively they will just lower everyone's fees including the best caregivers as well as the fraudsters and wasters. This is government at its worst and where private companies demonstrate how infinitely more economical they are. I am so pissed off that since I play by the rules I get penalized whereas the unethical fraudsters get off clean and will make up the decreased fees by just taking a few more pieces of their patients prostate.

You will say I should turn these fraudsters in but WHERE IS THE GOVERNMENT? We must turn this function over to private industry to save medicare. It's the only way.

Visiting Day

After a few years off I went to visiting day at my son's sleepaway camp. It was great to see him but I kept thinking about one of my ultimate nightmare events. A terrorist or a group of them come to a remote camp with weapons and starting to wipe out defenseless children. This scenario played out in Norway last week and demonstrates how lacking in security these camps are.

These camps are located in remote regions where hundreds of kids concentrate in a small area. The police forces in these rural towns are probably ill-equipped to handle any attack. There is unlikely any alert system in place to notify the outside world what is happening in these isolated locations so the terrorist would have plenty of time to do his thing before anyone knew. I doubt these camps are armed with any weapons to defend themselves. There is no fence to prevent entry into the camp and there is not even a guard at the front entrance preventing anyone from entering. This is a total recipe and invitation for trouble and is a perfect example of where we need to be proactive and not wait until disaster happens and be reactive.

Solutions include obtaining a security analysis from an expert to determine the best strategy to prevent and combat an attack. There must be a gate for entry not directly in the front of the camp but rather at the entrance to the final dirt road that leads to the camp. The camp must be equipped with alarms and systems to notify the authorities. The local police must be trained in counter-terrorism and be on patrol.

Finally, and most important the kids over a certain age must be trained in security and know what to do in the case of an attack. They must learn how to stand patrol and take shifts through the day and night to protect the camp. They should learn how to use and respect firearms. My son's camp has a paintball course with rifles and learn to use these guns with target practice and competing teams. They learn the critical safety instructions in using these "weapons" and plan strategies to overcome their opponent. I had the opportunity to talk with the head of the paintball activity who is an Israeli who just spent the last three years in an elite fighting force of the Israeli army. What a wonderful opportunity for our children to be instructed by these premier soldiers. Our kids get to have a taste of what it is like to defend themselves and a nation as well as to have exposure to someone who can satisfy their curiosity about the IDF.

If we think we can sit here in the US while our brothers in Israel do all the dirty work to defend the Jewish people and nation we are sadly mistaken and will lead to our peril. Enough with the heavy concentration in sports. We should know it is only a matter of time until the Jews are blamed and rounded up. What will a good jump shot do for us then? We need to be proactive and our children need to grow up in an environment where they feel the threats against them and the absolute need to learn self-defense.

Aryan Nation

I was toward the end of my work week last Friday and as usual the last patient of the week was late. He called to say he was lost so I couldn't leave and was forced to wait for him. Finally, he arrived and I had the intention of spending little time with him since he was delaying the onset of my weekend. As it turned out, I spent a long time with him as he had a very interesting story. It was not his medical condition that intrigued me but his bio. Lets call him Abdul.

Abdul was born in Iran and lived there for the first 17 years of his life. He moved to the US with his family in the late 1970s at the time of the Islamic revolution. He was schooled here, became an engineer and went to work for the State of NJ where he had a solid job as an engineer. Sometime in his 30s he decided to go back to Iran because he thought he could do better there but ultimately returned to the US. He described the situation in Iran but concluded that only by living there can one sense the oppression of the people by the government. He pointed out the growing resistance of the people to the mandatory Islamic laws.

He was going to Iran that evening with a stop in Frankfurt to visit family who moved to Germany from Iran and just had a child. He mentioned to me that these Iranian expat relatives are shying away from giving their kids Islamic names, rejecting the forced dictates of Islam and attempting to be more Western. He went on to say that instead of a Muslim name they were naming their son Aryan and had named their daughter Arya. This blew me away. Here they were rejecting the oppressive forces of Islam only to glorify another oppressive ideology, Nazism. Of course, the common thread of the ideologies is the hatred and annihilation of the Jews. It amazes how intense are peoples passions towards Jew hatred.

The name Iran comes from the word Aryan in Farsi and was changed from Persia to Iran in 1935. This was done to emphasize their connection to Aryan principles (ie. Jew hatred). I wanted to confront Abdul about changing one hateful, antisemitic ideology for another one but I bit my tongue and kept my mouth shut. If he only knew in just a few short hours I would be in a synagogue singing about the arrival of the holy Jewish Shabbat. Of course, I also wanted to finish a long and hard week of work and get the weekend started.

An Israeli Conundrum

I read a book over the last weekend that I highly recommend called Saving Israel by Daniel Gordis. He addresses a few issues that have bothered me for a long time regarding Israel. I was always perplexed with the question of why would a secular Israeli who has absolutely no ties to the Jewish religion and in fact mocks it would risk his life to defend the Jewish nation. The entire reason for the existence of Israel is to be a JEWISH homeland so why would this secular Israeli defend it if they negate their Jewishness.

Over the years I asked this question to Israelis only to receive answers which were unsatisfactory. They would answer that these secular Israelis are patriotic to their country as a Finn would be patriotic to Finland. Or they would say they have certain ties to the land and therefore risk their lives to defend it. But truthfully, Israel is located at the site of its ancestral birth which unfortunately places it smack in the middle of a terrible neighborhood. If these seculars see no value in Judaism and do not care about the history of the Jewish people then why would they care to live under constant threat to themselves and their families rather than a comfy house in LA with many other Israelis.

Mr. Gordis addresses this point in his book and states that this is in fact a huge problem in Israel. A large percentage of secular Israelis are attempting to dodge the draft as they see no value in risking their lives for a Jewish homeland. These draft aged teenagers cannot explain why they are defending a Jewish homeland. They have received zero education and exposure to the Jewish religion and as such it is not hard to understand why they would see no value in protecting its homeland.

Mr. Gordis goes on to say that the fault lies in the founders of the country. Trying to reverse the image of the Jew for centuries as a defenseless individual, they sought to create the new Jew as a powerful one who could defend himself. Trying to extend this metamorphosis, they also reversed the heavily ritual based religion as practiced in Europe and replace it with a nonreligious secular Jew who is not just apathetic to the religion but is antagonistic towards it. They view the religion as an old country custom which must be discarded. This is the genesis of the problems that Israel is now seeing. Secular Israelis who have no ties to Judaism and thus will question whether to risk their lives for the Jewish nation.

The Jews could not survive being stateless in Europe. Strong religion in the diaspora sustained us as a people for centuries, but without a state we were doomed. Now we have a strong state but with little religion and this may be equally unsustainable.

Universal Suffrage: Fatal Flaw?

Over the past two centuries the United States had amended its constitution and provided the right to vote to all its citizens regardless of color, sex, or religion. Originally, the right to vote was restricted to property owners or based on taxation. So we have gone from a period of severely restricted voting rights to one where there is almost zero limitation on voting rights. One doesn't even have to provide proof of identity to vote. It is clear to me that the pendulum has swung too far and this fact is reshaping the US into a country which was never intended by its founders.

Over half of the US population pay no income taxes, these are the takers. A diminishing percentage of the population pay the majority of the taxes, these are the makers. What incentive do the takers have to vote for representatives that would control the size of government or reduce the deficit or reduce taxation? Their sole motivation is to vote for candidates that will continue to use government as a mechanism to take from the makers and give it to them. What do they care if the government borrows endlessly? The bill will never come to their doorstep.

As the takers exceed half the population, their votes will ensure further government expansion and redistribution of wealth. They will continue to vote only for those candidates that will promise and deliver more and more handouts and that will take/steal from the wealthy to give it to them.

This is a flaw in our current democracy and one that will slowly lead to the continued demise in the economy, national wealth, and world status. This flaw was likely foreseen by the original founders of this country which is why voting rights were restricted to those who had a stake in the economy (land owners). Through amendments to the constitution, progressives have expanded voting rights gradually to all citizens. Although the intention was to be fair and not discriminatory, the unintended consequence results in a fatal flaw for this country.

Should someone who has absolutely no knowledge of politics, cannot read and is unable to even name the current vice president be allowed to vote? Is it fair that the vote of someone who pays no taxes and is completely on government handouts for food, shelter, etc. is exactly equal to someone who pays millions in taxes? Worse though is that there is no way to correct this flaw. It is unimaginable that voting rights would be restricted after having been granted. My only hope is that the takers do not vote in the same proportion as the makers.

Left Wing Dilemma

I had a friend growing up who is a kool aid drinking leftist and also a staunch supporter of the State of Israel. Lets call him DF and he must be going through a gut wrenching period trying to maintain his party loyalty. It seems more and more that support for Israel is reflected predominantly amongst the right wing while the pro-Palestinians view is predominantly a left wing phenomenon. Jewish support of the left wing is becoming problematic for many dems as this administration seems to slant towards the Arab states and away from Israel. This causes an inner conflict amongst dems between democratic left wing ideology and the support for the State of Israel.

I wonder which position is stronger for DF. Does Israel policy trump domestic ideology or vice versa. Would he vote against BO due to his Israel policy or stick with his boy in Washington and throw Israel under the bus? In any case, it pleases me to know the inner turmoil he is probably going through as he tries to reconcile his party loyalty. We argued for many years right versus left policies. There were times during the Bush years that I had a very hard time defending the right wing, specifically regarding entry into Iraq and lack of WMDs. But that is nothing compared to the contortions he must be doing trying to defend BO and his Middle East policy.

As I mentioned, anti-Israel and pro-Palestinian policy seems to be overtaking the democratic party. BO certainly has veered democratic foreign policy in this direction. The comparison between W Bush and BO regarding support of Israel couldn't be more stark. Just look at the approval rating of BO in Israel. The support that Palestinians receive by university professors and their views on Israel as an oppressive society bolsters the left's anti-Israel policy. Look at the Americans who are supporting the flotilla, all left wing characters. Also, the anti-Israel and antisemitic diatribes by Black preachers further push large swaths of democrats into the anti-Israel and pro-Palestinian position. It is becoming increasingly clear that the left wing has very little room for supporters of Israel but unlimited tolerance for Muslims and excuses for their misbehavior.

The next year and a half (hopefully, not five and a half) will be very critical for BO vs. Israel. BO can no longer pass his domestic agenda with a GOP congress and the country strongly opposed to a further left wing push by the administration. BO will concentrate on foreign policy as he can push his ideology without congressional or popular support. Nothing would add to his already bloated ego than to try to put Middle East peace as a feather in his cap. He will demand huge concessions from Israel to obtain this goal all to soothe his ego. Further, Israel's enemies and specifically Iran may feel that it is the perfect time to attack Israel while BO is in power. This is their chance while support from the American president is marginal and he may out of office in 18 months when a strong Israel supporter may come in.

The overwhelming majority of Jews are democrats (for some insane reason) and voted for BO. They now have a huge decision to make. Israel or ideology? I sincerely hope that DF and his nutty left wing buddies decide to sit this one out and give Israel a break. It's the least they can do for the State of Israel.

Operating on the Dead

This past week I was on call for the hospital. Without a doubt, the worst part of my job. I was called to evaluate a seventy something year old male for a tracheostomy. He had a major stroke and was hooked up to a ventilator for a couple of weeks. He had major medical problems and the chances of him surviving this episode was nearly zero. However, his family felt they were doing him a favor by insisting that all measures be taken to keep him alive regardless of the fact that he was suffering needlessly. I felt terribly being asked to put this man through a surgical procedure with its associated postoperative pain. But my hands were tied and I could not go against the wishes of the family. The risk of a complication is great because of his medical condition which places me at risk for potential legal action. For all this stress, time spent in family consultation, time spent performing the surgery, and potential liability for any untoward sequelae I will be paid about 200 dollars. Now you know why I hate taking call at the hospital.

I have written before and I will reiterate that we, as a nation, must have the conversation of end of life care. It is bankrupting us as we spent a fortune in the last two weeks of a person's life. We cannot rely on the patient's family to make the difficult decisions. They are not in a position to rationally decide on their parent's or spouses care. There are too many emotional attachments that distort their decision making. Therefore, it is imperative that every person must have an advanced directive so that their wishes are explicitly laid out prior to their eventual illness. Simply, you will decide if you want heroic efforts taken when the time comes and which will be clearly spelled out. If you have an advanced directive your insurance premiums, ie medicare payments, would be reduced. If you fail to have an advance directive or you want heroic measures to be taken you will pay additional premiums during your lifetime. This makes complete sense.

I was reading an article the other day that was very interesting. It is somewhat counterintuitive but makes sense if you think about it. End of life care is significantly more expensive for a 70 old than a 100 year old. The reason is that the 100 year old is likely to die from a sudden event without time to receive medical care and the family is less likely to pursue heroic measures at that age. Additionally their 70 or 80 year old child who is making their medical decisions understands the need for compassionate end of life care better than a 30 year old would. On the other hand, the seventy year old is more likely to have a chronic illness and will sustain a more drawn out end of life process requiring multiple hospital admissions and large costs. This demonstrates that maintaining a healthy lifestyle not only decreases the burden you place on the health system at a younger age but also the costs you incur at death.

A large majority of chronic illness is the result of lifestyle choices. Overeating and obesity, sedentary lifestyle and lack of exercise, cigarette smoking and avoiding preventive care all incur tremendous burdens on our health care system. Right up to the last seconds of life the bad choices that people make drain our resources and stick the rest of us with the bill. It is critical this be addressed and remedied. These are difficult decisions and conversations that require leadership by our elected officials. As I wrote last week about adaptive challenges, there is no imposable solution. Our leaders must challenge us to change our thinking about end of life care. To take responsibility for our own health and to have an advanced directive to dictate what we each would want done when we all reach that final stage of life.

A Leader's Challenge

I was reading an article by Rabbi Jonathan Sacks (Covenant and Conversation, Beha'alotecha 5771) where he was describing types of challenges that Moses encountered during the time of the Exodus (highly recommended, link at bottom). He quoted the work of Prof. Ronald Heifetz at the JFK School of Government at Harvard. In that work he describes two types of challenges encountered by a leader, technical and adaptive. Briefly the technical challenge is simply one that requires a response by the leader to a specific problem. For instance, providing aid in an emergency situation or defending the nation in response to an attack.

The other challenge, the adaptive challenge, requires the leader to respond not necessarily with a unilateral action but by changing the mindset or circumstance of the people effected by the challenge. Only by doing so can the challenge be resolved. The solution to the problem lies within the people not by an externally imposed response.

For instance, in the case of our national girth problem, obesity. There is no governmental action that can fix this regardless of the attempts with the soda tax or the manipulation school lunches. The change must come from within the people. The leader must address this challenge by altering the behavior of the population. In the case of the enormous public debt and massive entitlement spending there is no externally imposable solution. The population must change its mindset from one of government dependency to one of self sufficiency. From one of selfishness and the mindset of entitlement to one of self-sufficiency and not rely on government to take from others so they can give it to me. In the case of white-black relations, there is no imposable solution. The leader must lead by altering the mindset of the "victim" that he/she is "oppressed". He must lead by example demonstrating that we are all individuals in this country with equal opportunities. We can all get as far as we can based on our own talents. That we are not victimized by our color, sex or sexual preference.

This is where true leadership lies. Unfortunately BO is incapable or unwilling to rise to the adaptive challenges. He tries to respond to adaptive challenges with technical government imposed solutions. He believes the central government can fix all of our problems and not put any demands on the population to accept changes to their sense of entitlement. We need a leader who believes in the people that we can rise to the occasion to solve our problems. We need a leader who will tell us the truth that the federal government is NOT the answer to our problems and often is the cause and that the solution lies within us.

I was optimistic after watching the republican debate the other night. These are much stronger candidates than I had believed and I think one will emerge who will be a true leader. One who can respond to our challenges and lead our country by transforming us as a nation. One who will not impose ineffective and expensive technical solutions to problems that actually require adaptive responses that require changes within ourselves.

http://www.chiefrabbi.org/ReadArtical.aspx?id=1767

DSK

I keep thinking about the Dominique Strauss-Kahn (DSK) case, the one where the French IMF guy was hauled off a flight and accused of raping a hotel maid. At the end of the day it is nearly impossible to determine who will be telling the truth. It is his word against her word. He will say it was consensual and she will deny it, that he forced himself on her. How is a jury supposed to determine who is right? There is no physical evidence that can be obtained to confirm either one's story (unless there are significant signs of assault).

In my practice, I examine women in an examination room and at times there is no one else in the room. My examination involves fully clothed males and females and is limited to the region above the shoulders. What prevents a woman from making a claim against me that I touched her inappropriately behind the closed doors. What proof do I have that this did not happen? What if it was some poor woman versus me, the rich doctor? Which side do you think the media would take?

In the DSK case the media is certainly taking the side of the maid as is the usual stance by the media. They always take the side of the underdog, the poor over the rich, the female over the male, or the minority over the Caucasian. I would probably be hauled off in handcuffs and sent to prison. My practice would be finished and my life would be shattered. I would have to pay a fortune to be defended by a lawyer that would likely bankrupt me. Then they would haul me in front of a jury who would have to decide if I was guilty based on my word versus her word. Based on my appearance, my demeanor, my testimony. And then maybe serve jail time for a crime that never happened.

Am I supposed to hire a person to be with me at all times in the office? Should I have video cameras going in my office at all times to protect me from false accusations? Is that even legal? One thing is for sure, if a woman comes to see me above 18 years old and below say 65 by herself I will try to remember to bring a staff member into the examination room with me. But I am not sure if even that completely protects me.

This is really scary stuff.

Berlin

I just returned from a trip to Berlin and I wanted to mention a few things on the blog. The reason I went was last summer my Dad said he wanted to see Berlin so we decided to go for several days over Memorial Day weekend. It is a beautifully diverse city with much history to explore, both recent history and earlier. My Dad was most interested in the Jewish sites such as the holocaust memorial and the Jewish Museum which were both very well done.

The Berliners we contacted were very pleasant and elicited mixed emotions from me. On the one hand these are the decendents of perpetrators of the worst crime ever commited in the history of humanity yet on the other hand I had empathy that they had to suffer the stigma of sins commited by others. What should be the realtionship between son of perpetrator and son of victim? I do not think there is a resolution to this conflict.

The next to last day we took a walking tour of Sachsenhausen, a concentration camp, located twenty minutes outside of Berlin. It was a very emotional visit especially since my wife's grandfather had been a victim of the Nazis in that particular camp. The tour guide was excellent as he tried to bring the site to life. He tried to have us picture in our minds the sufferring of the victims as individuals and the evil of the Nazis also as individual monsters.

I asked the guide if many Muslims come to visit the site as Berlin has a sizeable Muslim/Turkish population. I was curious because of the holocaust denial that seems prevalent amongst the Muslims as spearheaded by the modern day Hitler, Ahmadinejad. He said not many Muslims come but tried to put a spin on my question by relating a story that there was one Muslim victim of the camp during WWII. Not a satisfactory response. Although he did say that school children, including the Muslim school children come to the site as part of their curriulum.

Of course, holocaust denial is not a purely Muslim phenomenon. But my sense is if you polled Americans or Europeans the percentage of deniers would be under 5% while the same poll amongst Middle Eastern Muslims would be 20% at the minimum. I do not have hard data to support thiese numbers, just my suspicion. The horriffic fact is that the current response by Muslims is not the denial of holocaust but the desire to recreate it in the name of "the prophet". Check out the link below.

The one thought I kept coming back to was the importance of the State of Israel to the Jewish people. It is absolutely critical for our ability to defend ourselves and we must only depend on ourselves for our future. Next time we are not going down without a fight. AM YISROEL CHAI!!

http://www.youtube.com/watch?v=h0qkUB_SHQE&feature=player_embedded

Failure of USA Health Care

I saw a patient this week that exemplifies one of the many problems we are facing in the health care delivery system. The patient was a 30ish year old obese female with medicaid insurance who was told she has cancer of the thyroid and was referred for surgery to remove her thyroid. I was the fourth surgeon she was consulting because all the other doctors declined to operate on her. I like the others also declined to operate on her. Let me explain.

Removing the thyroid for thyroid cancer takes at least a few hours at the minimum. It involves extremely delicate structures of the neck putting at risk nerves that course beneath the thyroid gland that enable the vocal cords to move. It is physically demanding for the surgeon, requires great expertise and skill, and is still associated with potential complications even in the best of hands. It involves postoperative care in the hospital which require serial visits as well as follow up in the office. By the way, postoperative visits in the hospital and in the office are not reimbursed as they are considered included in the fee for the surgery. For all this the surgeon may get paid about 500 dollars. And to top it off, if there are any complications the patient can sue you, which will increase your malpractice insurance whether you win or lose.

So you can see why there are no surgeons willing to take on this case. This represents a systemic failure of our health care system and i believe is just the tip of the iceberg. I see patients all the time who cannot find a doctor to take on their cases and it is just going to get worse as reimbursements continue to fall and expenses go up. Doctors will only take on the safest of cases which have minimal risk.

Government bureaucrats think they are doing the population a favor by swelling the medicaid ranks. What use is it to have insurance if nobody accepts it? Medicare is only slightly better and soon I think the same will happen to medicare beneficiaries. They will not find the surgeons to assume their cases for pennies. When I see a patient who I want to refer out I will typically send them to the local teaching hospital. This is an ideal solution for these patient as they get treated for their problems but at the same time they are educating future doctors. Both sides win. The problem is when I send a patient to them they say we have a waiting list of six months. So here again is a failure of the system and similar to other countries with socialized care there are waiting lists to see specialists. The portion of the USA health care that is socialized has waiting lists at best and no care at its worst.

Bottom line: you get what you pay for. If you don't pay up for surgeons who endure long periods of training to attain the expertise to perform delicate operations. If you subject them to lawyers waiting to pounce on them for any negative result regardless of fault. If you treat us like the plumber that fixes your stuffed toilet but pays us less you can say GOODBYE! You will suffer the consequences.

Never Again Rings Hollow

We just celebrated Passover where a main theme is to remember what happened to the Jews thousands of years ago. It extends a transgenerational chain to teach our children and grand children about the exodus of the Jews from slavery into freedom. We also recite at the Seder that it is not just one nation a long time ago that rose up to destroy us but in every generation there will be an entity bent on our destruction. We relive our past to teach us and awaken us to our future.

We also just passed Yom Hashoah, Holocaust remembrance day where the main slogan is Never Again. We teach our children and the world about our experiences in Nazi Germany. We have ceremonies to pay tribute to those who perished and listen to survivors who give us testimonial to the shocking atrocities they lived through. We remember what man can do to his neighbors given the circumstances. We learn of the few righteous gentiles but also of the many complicit gentiles as well as the majority that remained silent.

After these two important holidays have passed and as powerful as these remembrances are, I feel a certain lacking in our (Jewish) response to these historical events.

We talk, we teach, we sing, we remember, but the glaring deficiency is what are we doing in the area of prevention. Words and memories are important but where is the action taking place to defend against the certain next attack against on the Jews. And I am referring to diaspora Jews, not Israelis. We cannot rely on words alone to prevent the next attack and we Jews should know better than anyone that when the time comes there will be NO ONE to protect us. We only have ourselves to protect us yet we do almost nothing.

How many times do we need to learn the same lessons until we understand that we must prepare ourselves better. Can we rely on the government? our local police? our courts? our non-Jewish neighbors? the constitution? How will the Jews defend themselves? Which Jews will be there when the time comes to defend us? Will the words of Jewish lawyers and Jewish politicians mean anything? The answer is maybe. In any case we must learn to defend ourselves.

We are extremely complacent living in this country (USA). These words seem radical to most Jewish Americans who can never envision attacks against us in the land of liberty. We must learn from our Israeli brothers and sisters that words are important but actions and preparedness are critical parts of the equation.

The Problem With Diaspora Israelis

For some of the Jewish faith the ultimate declaration of their religious devotion is to make aliyah, to move from the the diaspora to the land of Israel. Being Jewish in exile is just too difficult to maintain with so many secular distractions. That along with the desire to fulfill the commandments to the fullest drives some to give up the comforts and safety of America (and other countries) and to move to the hotbed of the Middle East. It is an honorable and admirable move which is very difficult for many reasons including family, finances/employment, and cultural differences. Giving up all the opportunities America has to offer for oneself and for one's children and obligating themselves and their children for Israeli military service is an enormous commitment. Yet the opportunity to move to the land that the Jews have been praying for two thousand years is a powerful force.

What is much less discussed and seemingly purposely silenced is the vast number of Israelis who emigrate from Israel to the diaspora and these Israelis in exile are particularly problematic from a Jewish point of view. Many of them are cultural Israelis but have very little Jewish connection. Israelis in the diaspora are connected by their common language, similar military experiences, common middle Eastern diet and other factors. However these factors are not strong enough to ensure the perpetuation of Judaism. They tend to live amongst themselves apart from American Jews and American Jewish institutions as their language and cultural upbringing is quite different from American Jews. As with many other immigrants to the US, the first or second generation maintain their language and culture but by the third generation the powers of assimilation strongly outweigh the "tired and old world" customs of the grandparents.

American Jews and Israeli Jews are culturally different in many ways and often do not mesh easily. This is evident as Americans who make Aliyah will often live amongst other Anglos and Israelis who move to America will generally live amongst themselves. The problem is the Jews who move to Israel are going for the need to be more religious while the Israelis who move to America are often irreligious and are doomed to assimilation.

Almost every place I go on vacation around the world I hear Hebrew at some point. Israelis are everywhere. I don't blame them for leaving to look for opportunities wherever they may be found but counting on Israeli culture to transmit their heritage to their kids and grandchildren is a recipe for certain assimilation. Only by learning to be Jews in exile will they be able to maintain their heritage.

In Israel many secular people feel they don't have to be religious since they live in the holy land and defend it. Yet in exile Jews have to work harder to maintain their Jewish identity in order to ensure its transmission to future generations. Diaspora Jews know how to propagate their religion in an environment of constant distractions but diaspora Israelis will find that maintaining their Jewishness by being cultural Israelis in the diaspora and not being involved in Synagogue, Jewish schools, Jewish camps, Jewish community centers,etc, will lead ultimately to assimilation of their progeny.

Diaspora Israelis need to learn how to survive as Jews in America. Speaking Hebrew and eating chumus is not enough.

The Power of Fear

I saw a patient this week whom I have been unable to get out of my mind. He is a man in his forties, a smoker, who came in complaining of right ear pain. As soon as I asked him what was wrong with him I could hear in his response that his voice was hoarse. I inquired how long he has been hoarse and he responded about a month. After examining his ear which didn't look too bad I told him that I need to examine his vocal cords. He refused. He said my throat is okay just let me have some antibiotics for my ear.

I asked multiple times to allow me to examine him more thoroughly to determine the source of his hoarseness but he kept refusing. As a last ditch effort I explained to him that he may have a growth or possibly even cancer of the throat. Further, I expanded that if there is something there and it is caught early there is a good chance of cure but if he waits and it gets worse the treatment would be more drastic and the cure rate would decrease. He responded "Doc, my throat is fine, really, just let me have the antibiotics". So he left with his prescriptions and I reiterated if he changes his mind to return.

As I was filling out his chart I was very concerned about the possibility of a lawsuit later on for delay in diagnosis even though he refused a complete examination. I have no doubt he will have no problem getting a lawyer to take his case. So I tried to be as complete as possible documenting the encounter and his refusal even with his knowledge of the potential outcomes. I still felt the only way to protect myself would be for him to sign an affidavit stating that he refuses with full knowledge of the possibilities but I have no expertise in drafting such a document. We often get consents to perform procedures but no formal way to consent to refuse procedures.

What really stuck with me about this case is the fear this man had. He was so terrified of the possible diagnosis that he refused to even allow me to obtain the facts. As a doctor whose goal it is to cure disease it continues to distress me that I can help this man if he could only allow me. I underappreciate the fear that some patients have when they come in. I suppose this is not unreasonable since in a fifteen minute evaluation, a person's life can be turned upside down. This man was more comfortable staying ignorant than risk the possible knowledge of a potentially serious problem. The fear of his life being turned upside down was too much for him to bear.

Often people will come to the office with nonspecific complaints regarding their throats and usually their examinations are negative. I believe that tension and stress will often manifest with symptoms effecting the throat which is why we feel choked up during periods of emotion. The throat, not the heart is truly the organ of emotion. I think many of these people are fearful of a growth and seek comfort and knowledge that there is nothing serious going on in their throats. They are fearful of having a symptom and not knowing if there is an actual problem. So here are two completely opposite patients but both motivated by fear. One is too scared to know and the other is too scared of the unknown.

What If?

What if it became popular to convert to Judaism? What if it became the newest wave and thousands would elect to become Jewish? I do not mean the once a year Yom Kippur Judaism but the all-in Judaism with all its restrictions and lifestyle. Now you will ask me why would anybody want to become Jewish and accept the burden of worldwide hatred against them. Further, why would anyone put upon themselves all the laws and limitations that come with a life of Jewish faith. Let me list a few possible reasons.

Our holidays are a time for commemorating, celebrating and reliving ancient events while your holidays are a time to go the mall and have a barbecue.

Our weekends include a day of rest where we turn off electronics and cannot drive which force us to bond with our families and community while on your weekends each member of the family goes there own way and does his/her own thing.

Our communities are places where families interact and support each other in good times and in bad. In your communities rarely does anyone even know their neighbor.

Charity is an integral part of our lives while amassing possessions is the definition of your lives.

The importance of education is stressed from early in life in our culture while the ability to chase, catch, throw, shoot or hit a ball is paramount in yours.

Our schools teach a balance of secular subjects along with religious texts and culture, while yours reject any mention or demonstration of religion.

We aim to love thy neighbor as thyself and to treat others as you would have them treat you. You look at neighbors with suspicion and distrust and seek personal success at anyone's cost.

We believe in individual responsibility regarding success and failure while so many are quick to blame anyone else but themselves.

We look at the almighty to grant us good health and a sustainable living while too many in society look to government for their sustenance.

We do not look to convert nonbelievers to our faith. In fact we attempt to dissuade those who demonstrate interest. What better way to attract people than to inform them they are not really wanted. Our difficulty is not with non-Jews but with so many born Jews who do not see the value of their own heritage. They follow the path of most in this society and get sucked in to the materialism, desiring wealth, possessions and fame. Ultimately, this path is not a recipe for happiness.

I do not suspect this mass conversion will happen anytime soon and I do not think disconnected Jews will suddenly awaken to their disregarded heritage. Yet it is interesting to note how this ancient culture has so many answers to the problems and shortcomings of modern society.

Support the Syrian Rebels

So how exactly do I contribute and support the rebels in Syria. Out of all the rebellions that are taking place in the Middle East the one I have the greatest stake in at this time is the uprising in Syria (excluding Iran which seems to have been suppressed). Americans and especially American Jews need to show their support for the rebels as they risk their lives to rid themselves of their suppressive dictatorial regime.

Syria is ruled by a double talking manipulative regime that is a proxy for Iran sitting on the border of Israel. It is a constant threat and has shown its desire to procure nuclear weapons. It has never desired peace with Israel and has only talked a good game while its actions demonstrate its true intentions. Hillary Clinton, John Kerry and BO are all fooled by his double talk as they stupidly call him a reformer while behind their back he has only evil intentions. As long as he talks the talk the American fools believe him.

The Syrian regime is also destroying its neighbor Lebanon by its support of Hezbollah and Islamicizing that country. What was once a moderate regime is heading the the way of an Islamic Sharia state a la Iran. Elections are useless once the Islamists get in because they fudge the results. Once they get in its over. The Syrians are certainly supplying Hezbollah with weapons prohibited by the 2006 cease fire which will eventually be used against Israel.

Iran is building a military port on the Mediterranean coast of Syria giving the Islamic state of Iran a strategic military position. When I fly to Israel and watch the flight map on the plane I can see when we get within range of the Mediterranean coast. It will be unnerving knowing that I will be flying nearby this Iran/Syria military port and an Iranian missile can take the plane down.

This is the opportunity to change the regime in Syria. Of course, there is now way to know who will take over but they cannot be any worse and will hopefully be better. It is the chance to counter the expanding Iranian influence in the region. BO helped take down Mubarak and is helping take down Khadaffi, both were suppressing radical Islam. Our national interest is against radical Islam and those states that seek worldwide Sharia. Syria is where we need to be focusing our attention. We must confront the spread of Iranian influence especially where we have proxies willing to fight to promote our interests .

So if anybody knows how I can support the Syrian rebels please let me know. Perhaps we can bypass our government of fools and create a huge wave of support behind the rebels. The rebels make the sacrifice and all we have to do is support them financially and with our voices.

I take solace in the fact that although the US government cannot detect this opportunity, it wouldn't surprise me if the Israelis are secretly supporting the rebels.

Genesis 16:12

I think the overwhelming majority of humanity would find it very difficult to murder another human being. In fact, it is likely difficult for many to murder an animal and even more difficult to murder a newborn animal. What kind of human being would slash the throat of a three month old child? What must go through the mind of a person as he looks at an innocent baby and murders her? What is more peaceful and innocent than a sleeping newborn sucking on their pacifier. Contrarily, what is more heinous an act than to slit the throat and murder an innocent three month old.

There is no rational way to understand how a human being can commit this terrible act but it demonstrates the mindset that is pervasive amongst Arabs. Similar to the Nazis who also carried out such atrocities they are infused with hatred and the dehumanization of the Jews. The degree to which their education and media are filled with anti-Jewish and anti-Israel false rhetoric leads to this type of behavior and thus the Arab leadership is complicit.

I refer you to Genesis chapter 16 verse 12 where Ishmael (and his descendants) is destined by an angel to be the father of a nation and is described as a wild ass of a man. Further it states his hands will be against everyone and everyone's hand against him. As descendants of Ishmael, the Arabs are certainly living up to their biblical inheritance. So is it the divine plan for Israel and the world to be plagued by these wild ass people forever? Is it even possible for Arabs to live peacefully amongst the nations, with the Jews, or even with each other for that matter?

The Arabs desperately need a new leader to step up. Where is this Arab person who can lead this nation and tell the people the truth? The truth that while the world is beginning the 21st century, the Arab nations are being left way behind at the fault of their leaders. The truth that their grievances, poverty and failure to succeed in the world economy is the fault ONLY of themselves and their leaders. This is despite being given a huge head start by their abundant natural resources. The truth that the Jews are a peaceful people who share a forefather, Abraham, and only desire is to live peacefully on a small sliver of land with mutual respect. The truth that the US is only concerned with freedom of all peoples of the world, not imperialists or crusaders as falsely accused.

Where is this leader who can state these truths and transform the Arab world? There must be someone who could fill this tremendous void. You will say they would be killed on the spot but I disagree. They would be protected by the thousands of Arabs whose only desire is to join the world community. They want to be freed to demonstrate their unique talents and compete with the rest of the world. One voice can transform the Arab world or is our destiny to live with these wild asses whose pathetic contribution to the world includes the celebartion of the murder a three month old child.

Multiculturalism

It always amazes me when I occasionally look around my work environment, the variety of people that I work with. The operating room is staffed with people from all backgrounds which represent all areas of the world. Just a couple of generations ago my ancestors were being marched into ovens while others were slaves or living in repressive regimes. Yet, we all assemble here through some fluke of history and migration and arrive at the same work place.

Once in a while I will get an elderly Polish or German patient who has recently immigrated and was certainly in Europe during WWII. I consider what this person was doing when my ancestors were being rounded up into ghettos and later sent off to concentration camps. Here they are coming to me for help with their medical problems while they may have been complicit in murdering my relatives. I remain professional and imagine perhaps they were one of the righteous gentiles that saved Jews and I should not imagine the worst. Through a fluke of history, because of their persecution, my parents arrived in the US well before these immigrants have arrived. This has given me the advantage of having grown up in the US and benefited from an excellent education and opportunities while they are just now reaching the US seeking their opportunities. It's a cruel irony that 65 years ago these same people who may have been contributing to my relative's murder are now coming to me for medical help to save their lives.

On a lighter note, I work with a large group of Korean-Americans and as a Jewish-American I think we work very well together. But there are definitely some distinct cultural differences between us. For one, in our lunch room there has to be two refrigerators. One for the Korean food and the other for typical American fare. The reason for this is the odor from Korean food permeates every other food item in the fridge so that everything ends up smelling like kimchi. Kimchi is a fermented cabbage that is the staple of Korean food and has a very distinct smell that many non-Koreans find offensive. It is supposedly very healthy and was likely used because kimchi can be preserved without refrigeration. This is similar to Jewish pickling of vegetables, fish, and meats for preservation.

Kimchi can be found in many products like kimchi soda, kimchi candy, and kimchi ice cream. But I was talking to one of the staff who is Korean and worked in the past in a Kosher deli. She was talking to me about Jewish food and I was making fun of kimchi and we thought about a combination of the two. So we thought of a few ideas like kimchi latkes or kimchi kugel but in honor of the upcoming Purim holiday I think kimchi hamantaschen was the best idea. Hamantaschen are cookies folded into a triangular shape and filled with jam that represent the ears of Haman, the villain of the Purim story.

We decided we would create the first kimchi hamantaschen and test market the cookie. It would be a huge success and we would each be able to retire and reap the rewards of our intercultural creation. The only problem is I find the idea of a kimchi cookie to be extremely distasteful. But what better way to remember Haman then to fill his cookie with gross fermented cabbage.

The Perfect Sunrise

I wrote this last week while I was sitting on the porch of my hotel at 6am listening to to the church bells mingling with the sounds of the birds as I watched the sun rise over the the old city walls of Jerusalem. It was the final morning of my trip to Israel and as I sat there alone in tranquility I thought to myself how lucky I was to be able to be sitting at this spot overlooking the old city walls. I thought of how many Jews have died for the sake of the Jewish people and the Jewish state so that I am able to be sitting here. How many of my forefathers have prayed for a return to Jerusalem over the last two thousand years yet I am the one that fulfills their prayers.

The morning started out chilly yet as the sun peaked out above the walls it gradually warmed me. The sun rise lit up the Jerusalem stone on the Eastern face of the hotel bringing about an abundance of beautiful colors within the stone. It was a beautifully clear day with only a few clouds and I could clearly see the building and minarets in the old city rising above the city walls.

The birds were busy picking up scraps from a nearby table that went uncleaned from the night before. A large hawk like bird would fly down to the table pick up the morsel of food and quickly fly away to the date palm tree where the nest is located. They would fly to the top of the hotel and gawk proclaiming their territory. A smaller finch bird would fly in and quickly grab a scrap while the hawk was not nearby. All the time the songs of the birds were beautifully filling the auditory void.

Every five minutes the church bells would ring for about fifteen seconds until seven o'clock when they rang for about two minutes getting progressively louder then fading away. I suspect this was an alarm clock for the Monks to come for prayer. About every thirty minutes I could see a helicopter travelling from North to South. It was travelling East of the old city likely patrolling the West Bank region.

I was very sad sitting there on that last day as I enjoyed the beauty of that morning. I wondered when would be the next time I will be able to return. Will there be a next time? I became jealous of the Arab waiter who was cleaning the tables and gets to experience this sunrise every morning. I was jealous of the doorman who although doesn't have the view from the porch can listen to the beautiful songs of the birds and talks to them with his bird calls.

Gradually, human activity began competing with the tranquility of the morning. The sounds of traffic and construction, voices from the hotel, cigarette smoke from a person who came outside to smoke start interfering with my perfect sunrise. Only a few precious minutes are left to listen to the birds and watch the sunrise and I try to concentrate to slow down time.

At about eight O'clock my daughter finds me sitting on the porch and asks if I want to go exercise with her. I am torn between the beauty of the morning and the request of my daughter. The last hours in Jerusalem with my daughter will transpire quickly and I thoroughly enjoyed my trip with her yet this morning's sunrise over the old city walls is a highlight which is burned into my memory. I go inside to change and leave the porch saddened to leave the perfect morning but excited to spend the last few hours of my trip with my daughter.

I eagerly await the next time I will be able to spend a morning watching the sun rise over the old city walls of Jerusalem. I feel very fortunate to be able to have this experience while generations before were unable and appreciate the sacrifice of the many that have died so that I can be here.

Fallacy #2

Now that I have attempted to dispel the fallacy of the miserable educational system in this country in last week's post I want to go on to counter another myth that seems to have infiltrated our psyche. The notion that the US doesn't produce anything anymore and that we are losing out to the Chinese is ridiculous. I hinted at this this in last week's blog but wanted to expand a little.

I suggest you watch Jim Cramer on Mad Money on CNBC to get a flavor of the number of companies that innovate and manufacture in this country. And, of course, employ a huge number of Americans. These companies are the gems of our nation and are often vilified by the liberals and the left. They compete all over the world with their products and services effectively and grow their profits and shareholder values. We should be so proud of our industry giants and not criticize their practices.

Just think of the industries that originate in the USA. We discover and sell a tremendous number of pharmaceuticals to the world which benefit humanity. We lead the world in biotechnology advances from artificial joints to catheters that open clogged arteries and robots that perform surgery. In technology, we produce chips, software, internet businesses that are used in the entire world. We manufacture beverages (coke and pepsi), diapers (P&G), cars (Ford), tractors (Caterpillar), airplanes (Boeing), weapons, energy exploration, etc. In entertainment our movies, sports and music are enjoyed the world over.

Facebook and google are well known examples of great companies that have started recently and have huge market caps. Apple is the greatest company in the world and continues to improve and innovate. And there are dozens of other less well known companies that are also innovating and growing in that sector and many others. The fallacy that we don't manufacture anything anymore is absolutely ridiculous. Our country is a wonderful incubator for innovation, discovery and creation of businesses that increase the wealth of our country and our citizens. The USA leads the world by far and will continue to outperform the world in advancing the standard of living of Americans and people all over the world.