Amazing Facts about Dr. Hosseinkhani
The following story appeared in the New York Times online on December 2, 2011:
Doctor Accused of Crimes Against Mice and Lab
By ANEMONA HARTOCOLLIS and AL BAKERThough not quite in the league of real estate, modeling and Wall Street, academic medicine is not immune to cutthroat behavior.
But what a researcher at Mount Sinai Medical Center is accused of doing might take back-stabbing to new heights, or lows. The authorities say the researcher, Dr. Mohsen Hosseinkhani, burglarized a hospital laboratory — twice — after being fired, taking valuable materials and sabotaging the lab mice by switching their name tags.
Dr. Hosseinkhani, 40, who was involved in cardiology research, was arrested on Tuesday and charged with burglary and grand larceny. His lawyer at his arraignment, Barry Apfelbaum, a public defender, said on Friday that Dr. Hosseinkhani’s friends had posted bail for him and he had been released.
The hospital released a statement saying only: “Mr. Mohsen Hosseinkhani was a post-doctoral fellow engaged in research until June 2011, and had no contact with patients. Mount Sinai will continue to cooperate with the investigation.” The hospital administration declined further comment.
The world of academic medicine was buzzing about Dr. Hosseinkhani’s arrest, which was reported in The New York Post, with some saying that his behavior reflected the competitive culture of the research world.
But Peter Palese, a prominent researcher and chairman of microbiology at Mount Sinai, said that while he had never met Dr. Hosseinkhani, he believed his behavior was unique to him.
“There are always bad apples everywhere,” Dr. Palese said. “But I don’t believe it has anything to do with general unhappiness or difficulty in the institution. I think cardiology is particularly good here.”
Dr. Hosseinkhani was fired in June because his work was not considered good enough and because he had been taking a lot of time off, the police said.
In July, he returned to the lab, and was able to gain entry because he had been fired by e-mail, not in person, and thus his identification had not been confiscated, the police said.
He stole “secret scientific material,” including stem cell cultures, antibodies, invitrogen and other items worth thousands of dollars, which he may have tried to sell in Russia, according to the police and the criminal complaint.
The police said he also switched the name tags on laboratory mice, possibly jeopardizing projects if researchers did not recognize the switch. It was unclear Friday what research the mice were being used for, or if the research had been compromised.
About 7 a.m. Monday, according to the complaint, Dr. Hosseinkhani again returned to the lab, at 1425 Madison Avenue, and stole pipettes worth more than $3,000. Someone noticed that he was not supposed to be there and notified hospital security, which asked him to come in for a meeting.
Dr. Hosseinkhani brought some of the items he was accused of stealing to the meeting, where the police, unbeknown to him, were waiting to arrest him.
In his LinkedIn biography, Dr. Hosseinkhani said he was educated at Harvard Medical School, but a Harvard spokesman said he could not find a university connection, though that did not rule out that he had participated in one of its programs.
In another biography, Dr. Hosseinkhani said he had been a research associate at Brigham and Women’s Hospital of Harvard Medical School, and had earned his M.D. from Tehran University and his Ph.D. in cardiovascular medicine from Kyoto University in Japan.
On Friday, Mr. Apfelbaum, who said he was no longer representing Dr. Hosseinkhani, said his former client did not deny, at least “to a certain extent,” that he had committed the acts he was accused of, but denied that it had been his intention to steal.
“He may not have performed his job duties up to their satisfaction, but that doesn’t mean he’s a fraud,” Mr. Apfelbaum said.
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There were six comments on this article. On December 12, 2011, Ned Aren of Japan wrote:
“He was a pathological liar in Kyoto, Japan. He would say he was from Manchester, Cicily,… that he was a heart surgeon,… and he would fake injuries to get people to pay him money. I am amazed to hear he went so far as to get into Mount Sinai. He has always been just a charlatan.He might have graduated in nursing or so… that is all he may qualify for. He used his brothers work to claim he was a researcher. He deceived Kyoto, and other universities on false claims by his brother and fake documents. His brother is in MIT now!”
I do not think that the combination of this article and this comment require further elaboration to qualify as an astounding find that reveals the content of a confidence man’s style and character entirely by accident.
Hurricane Sandy, a small part
I am driving down Father Capodanno Avenue in a blinding rainstorm with Brandon and Connor strapped in their safety seats behind me. Normally my Ford Explorer is impervious to shocks and wind, but now it is rocking back and forth, the steering wheel threatening to tear itself out of my hands momentarily. My windshield is opaque with flooding water.
I’m only doing 25 mph because I’m can’t see a thing in front of me. The rain is coming down in sheets that obscure the road ahead only a hundred feet or less. My windshield wipers are on “high” but they don’t seem to be able to clear the water off enough to see.
I’m beginning to feel a sense of panic, far worse than what has affected me up til now. An hour ago I was just worried. A half hour ago, really worried. Now, I’m starting to panic.
Normally, Father Capodanno Avenue goes along the shore with a slight, gentle curve, all the way to where it turns ninety degrees and changes into Lilly Pond Avenue; right away there is the entrance ramp to the Verazzano-Narrows Bridge and Brooklyn. On one side, Father Capodanno borders the sea with a beach, and a boardwalk, but the sea is really a tranquil bay with only a slot exposing it to the open Atlantic.
Usually, on the landward side of the road are trees and occasional rows of houses, after you get past the hospital; there is a marsh beyond the trees that extends a mile or so inland before you get to more houses.
Usually, I enjoy driving along Father Capodanno and looking at the water, especially early in the morning when the sun is low in the east and renders figures in dark contrast. I like the sea, at least to look at.
Tonight, however, conditions are extreme; a heavy rain and wind has turned into a hurricane, predicted a week in advance, rotating counterclockwise, heading towards the Atlantic Coast of New York City. The rotation of the storm means that its powerful winds of more than 90 mph are blowing directly into the bay along which Father Capodanno Avenue runs.
In addition, there is a high tide because of the full moon, which enhances the high surf churned up by the hurricane. Flooding is affecting all the low-lying areas around the road. The waves are running 20 feet high. All buildings not above that line have been ordered evacuated. Most people with anyplace to go have gone.
Now I am driving on a road that is intermittently under water, with streams of black obscuring the pavement and rushing wildly across to the inundated marsh on the other side.
There is a median with a curb and I am keeping that on my left side as I drive, slower and slower, having to hold the steering wheel way over to the rightside to keep from running into the curb. Finally I reach a wave that crests over the hood and my engine stalls. At the same time, something hits the rear window on the right side and smashes it out.
Now I’m really panicking. The truck isn’t safe anymore with the windows blown out. I’ve got to get the kids out. I can’t hear anything because the broken window has let in a howling wind. The children are screaming but I can’t hear them.
I unbuckle myself and reach back to trigger the buckles on both kid’s seats. I pull them both into the front seat, then open the driver’s side door, which is somewhat shielded from the wind. The water rushes in, up to my lap.
I pull both kids out of the front seat and put them on the roof of the truck. It seems to be the only thing which is above water. After a few minutes, the waves die down and I can see the pavement again. There is a row of houses in front of me on the land side of the road.
I decide to try for the nearest house, and I take the boys down from the roof and stand them up, holding their hands tightly. I try to point and indicate where we’re going. I don’t know if they understand; their faces are crazed with fear.
The wind continues to rise, until my truck is swept over, on its side, into the marsh on the land side of the road.
There is a tree that has been uprooted near the corner and I push the boys into the relative shelter of the roots, which are sticking up above the water.
The wind is howling so loud I can’t hear the boys screaming but I can see their faces drawn with horror. I can’t imagine what I’m going to do next; the wind is strong enough to knock me down if I try to stand up straight.
Exhausted, I hug my two boys to my chest and collapse among the tangled branches hiding me from the wind. A long time passes, I don’t know how long. Despite my daily workouts, I feel as if I have been carrying a thousand pounds. I try to get up, carrying Brandon and dragging Connor. I manage to get back up on the pavement next to the tree with both boys.
I’m not a big person, just five foot three and a hundred and thirty pounds. Brandon is thirty pounds, almost too much to carry by himself. Connor is bigger, and I can’t carry them both. In five minutes, I am exhausted again. My arms feel like rubber. My thigh muscles are burning.
The wind picks up again, rapidly pitching above even what it had been before. There is a dark mass in the sea that rapidly approaches, becoming higher and higher until, even as I grab the boys to my side, it covers us over and slams us back into the flooded marsh. I am rolling over and over, and the boys are no longer in my grasp. Finally the water subsides enough that I can stand up but the boys are both gone. It’s easier to swim through the chest-high water.
I manage to get back on the road to where I’m high up enough to look around, but I can’t see either of the boys anywhere. Before, I was running on adrenaline; now, I’m in complete shock. They’re gone. Both my beautiful little boys are gone. I’ll never run my fingers through their fine, curly hair again. I make my way through the surf towards the houses.
Freed of the weight of my children, I make rapid progress. At the first house in the row, I see a light in the second-floor front window. I climb up the stairs to the front door and start banging on the door. After what seems like a long time, someone opens the front door slightly, on the chain.
I start screaming incoherently, then stop and start again more slowly. “My two little boys were swept away in the storm–please help me find them.”
The man–I can see part of him through the crack in the door–isn’t much bigger than me, dressed in loose shorts, a T-shirt, and flip-flops. He says, “I can’t go out there and look for your kids, I’m not a rescue worker, I can’t even swim. What are you doing out there anyway? Are you crazy to be out in this storm?”
I turn around and go down the stairs, walking now heedless through the howling wind, and make my way around to the back of the house. There are stairs, like in the front, but there are these two concrete flower pots sitting on the bottom of the stairs.
I pick up one of the flower pots and throw it at the door. It cracks but doesn’t open. In despair, I climb over the fence to the house next door, but it is dark.
I look for lights in the windows and knock on the door when I see a light, but sometimes the light just goes out and nobody answers the door. When they do answer the door, they refuse to come out and help me look for my boys. I become completely exhausted without realizing it and I begin to notice the ceaseless wind and rain again.
Finally, after what seems like hours, I huddle myself in a recess on the front porch of an empty house. I sleep, fitfully, seeing the boys’ faces rushing away from me in my dreams.
At last, it is light again, and I stretch myself out, standing up slowly because I feel like my arms and legs are made of wood. After a few steps, I begin to walk a little better. I go up Capodanno Avenue, noticing the devastation now that the wind and rain have stopped and it is possible to see again. All the trees have been blown down, and cars are washed up against the steps of the row houses.
To my surprise, within a few minutes a police cruiser drives up, slowly, lights on. I explain to the officer what has happened to me: my beautiful little boys were swept away by the storm. He gets on the radio. The other officer gets out with a blanket and wraps it around me. He guides me to sit in the back seat. I am utterly and completely exhausted, and I can’t stop shivering.
For two days the police search for Brandon and Connor; they send out divers and everything else they have, combing through the marsh behind the row houses. They even bring out a fan-boat. They seem to be putting out even more effort for a fellow city employee. My husband, when he reaches me, tries and tries to comfort me, but I can see that he is barely holding on to his own sanity; he can’t see anything but their faces, thinking they’re gone.
Two days later, Wednesday, they find Brandon and Connor drowned in waist deep water, covered by the waving reeds, piled up against the curb of another street, only a few yards apart, less than five hundred yards from the landward side of Father Capodanno Avenue, on Staten Island, New York City.
Unknown to the woman in the story, two other people have died in a small cluster here in the community of South Beach:
Andrew Sammarco drowned in his home on Mills Avenue. He was 61 years old.
Artur Kaszparzak was 28 and a police officer. He led his family upstairs to safety and then returned to the basement. At 7 the next morning, his family came downstairs and found him dead. He had apparently been electrocuted.
For no apparent reason, in a deadly storm that left more than 100 corpses, including a dozen or more whose names are apparently unknown, there are clusters of deaths, especially in the hard hit areas like Staten. Island. Just glancing at a map of deaths on Staten Island in the New York Times, we can see four distinct clusters of deaths and two individual or paired deaths. The largest cluster is in Midland Beach. Looking at New York on a larger scale, Staten Island itself is a cluster, as is the area of Rockaway. This clustering is a well known phenomenon but its causes are obscure.
The fact that clusters occur, especially in a phenomenon that is known to be uncommon, is sometimes understood by the use of Poisson statistics. “Poisson” is French for “fish”, and the clustering phenomenon can be observed in fishing; what other reasons for calling the mathematics of Poisson statistics after a fish there are, are also obscure.
The mathematics of the “Poisson distribution” are well suited to rare phenomena, while the mathematics of the “normal distribution” are more appropriate for common phenomena. Why this is so is unknown but relates to our ability to make decisions about the occurrence of such phenomena. We should behave as if the likelihood of rare combinations of disasters is higher, or more probable, than we would normally think it is. This means that we should prepare for the unexpected. In this case the unexpected is an incident, called Hurricane Sandy, that takes over a hundred lives and destroys a hundred billion dollars in property.
The Baffler is another Internet Blog that, in this case, traffics in true wisdom, which accounts for its obscurity. I have just read an article from The Baffler No. 21, entitled “The Long Con: Mail-Order Conservatism.” This long, fascinating, and enlightening article explores the relationship between the conservative movement and mail-order fund-raising. By mail-order fund-raising I mean the letters that come in the mail, asking you to contribute to a cause, such as distributing Bibles in Asia. The article was written by Rick Perlstein and emphasizes the conundrum of Mitt Romney’s political lies: why does he lie so consistently and transparently?
Mr Perlstein explains that the origins of the current conservative movement are deeply tied in to the development of a direct-mail fundraising organization by a Richard Viguerie in the early 1960’s. After Goldwater was defeated in the Presidential elections of 1964, he tapped in to the official list of people who had donated fifty dollars or more to Goldwater’s campaign, which at that time was maintained by the Clerk of the House of Representatives. Before he was stopped by the Clerk, he was able to write down 12,500 names and addresses of donors to Goldwater, presumably reliable conservatives.
By writing to these people and asking for donations, he was able to raise enough money to dramatically increase the scope of his mailing list: by 1980, he had twenty-five million names on computer tape. The key to his financial success was that the causes for which he requested donations usually received less than fifteen percent of the money he raised. In the case of the organization that wished to raise money for Bibles in Asia, they actually paid him more than they received in contributions from him.
The growth of this direct-mail plan was not unnoticed by liberals; in 1977, Democratic congressman Charles H. Wilson of California proposed legislation that would lightly regulate mail-order fundraising. The Heritage Foundation counterattacked with a hysterical screed called an “issues bulletin” that implied that the regulations would be a direct attack on Christianity and Christian organizations. The legislation failed to take root. Thus, mail-order fundraising solicitations are not required to indicate what percentage of funds raised will go to the organization that solicits and what percentage will go to the cause solicited for.
Perlstein states that conservative organizations that stopped using Mr Viguerie’s company found themselves able to keep, after expenses, more than half of the funds they raised on their own. However, companies that continued to use Mr Viguerie were apparently not dissatisfied; perhaps some of them were in on the con, while others were unaware that their names were being used. One example is Citizens for Decent Literature, which took in about $2.3 million in two years and was run by a certain Mr Charles Keating, he of Savings and Loan fraud fame; Mr Viguerie apparently kept more than 80 percent of the take. On the other hand, Efrem Zimbalist Jr., who lent his name to a mailing for the “Friends of the FBI”, quit after four months and complained that he had been defrauded.
The practice of raising money by direct-mail solicitation is extremely common and is engaged in by many entirely different groups: from the Society for the Prevention of Cruelty to Animals to Doctors Without Borders to political organizations from far left to far right. The difference in the case of the conservative movement is that most of the “groups” are front organizations that collect in the name of causes and then pocket the money (almost all of it.) In order for these appeals to have maximum impact, the writers find themselves making up complete fabrications as well as grossly distorting statements by “enemy” groups.
The rhetoric and objects of these appeals are stereotyped in such a way as to make the reader feel that he or she is being made privy to baleful secrets. These secrets are critical to the reader’s survival and are with-held at the behest of the villains: the liberals. Perlstein explains the hero-villain dialectic and the overlap between economic and political appeals in a powerful and clarifying fashion. Read his article to get a full appreciation of how this come-on has worked so powerfully.
The best part is that the Mormons have a catch-phrase for this behavior: it’s called “lying for the Lord.” Perlstein describes the elaborately constructed central “truth” of conservatism for the last fifty years: that “liberalism is a species of madness[insanity]” but “conservatism is the creed of regular Americans.” Finally, he says, Mitt Romney lied because “lying is an initiation into the conservative elite.”
Mr Perlstein doesn’t mention Paul Ryan; the only comment I can add about him is that he doesn’t just lie for his cause. Paul Ryan is a pathological liar, one who lies habitually about trivial things for no reason. That isn’t opportunism or a career choice, it’s mental illness.
The result of these fundraising letters has been the growth and persistence of numerous derogatory lies about American (and foreign) liberals. There is an entire alternative reality relating to liberal politics that has been created by letters and speeches, and their authors are profiting handsomely from this deception. The “conservative” authors maintain this alternative reality by feeding lies to their audiences. They then obtain contributions from these audiences, which they use primarily to reimburse themselves for their time and effort. Fortunately, they do not need to spend any of the money they collect on fighting the evils against which they rail; those evils are primarily in the imagination.
So, dear readers, Mr Perlstein has explained far more effectively than I could how conservatism in America has at its roots a pyramid scheme, multi-level marketing, with the elites at the 0.1% level being the only winners. Read his article in the Baffler, No. 21.
On Friday, October 26, the Daily Kos published an article claiming that the GOP will steal the election by using its control of computerized voting machines. The article claims that a computer analyst has worked out the technique that is used, and has been used at least since 2004, to tilt elections to the Republican side by 10 or more percentage points. The cheating is only done in large precincts, where it is harder to detect, but the analyst claims that the effects are still detectable.
If this is true, then we are facing a Republican victory on November 6. There is no hope for the Democrats, because to win, they would have to pile up a huge majority of votes–more than 60%, equal to the landslide Obama received in 2008 (which prevented the Republicans from using their ability to control the machines, because “everyone knew” that Obama would win and a loss would have been very suspicious.)
In fact, it almost doesn’t matter whether the Republicans have a plan to steal the election with their voting machines. Studies have shown that, for adults eligible to vote, the more inclined towards Obama a potential voter is, the less likely he or she is to actually vote. To the contrary, the more inclined towards Romney one is, the more likely one is to vote. It is as if we are a nation of morons, and we will get the government we deserve.
We will know that the election has been stolen if Romney wins. The reason we know this is that a column in the New York Times has tracked all the public opinion polls produced during the last year, even the most extremely Republican of them (Rasmussen), and has synthesized an excellent probability set of outcomes. We recommend “Five Thirty Eight” (the number of elector votes) as a good column on NYT online. It has consistently shown Obama winning the Electoral college with a probability ranging from sixty to seventy-two per cent, versus Romney’s chances of as low as twenty eight per cent. The reason Obama has such good odds is that, in the swing states, he has winning combinations; Ohio is the state most likely to swing the election.
Therefore, given these odds, we can predict the likelihood of Republican electoral fraud based on the states that Romney wins versus their pre-election probabilities.
There doesn’t seem to be anything we can do, as a people, to stop the Republicans from taking over the government based on their ownership of the companies that make all the voting machines( not just Diebold). After the election of Romney, it will be necessary for the forces of good to go underground, so you should look to this blog for further instructions. If Obama wins, we can all stand down. But I’m not optimistic.
A Death in Hazen and my thoughts afterwards
When we first moved to Hazen, I rented an office downtown that had been previously occupied by another doctor several years ago; it was small, with a glass front door, a lobby, and three side rooms, one of which I used as an office. The two side rooms up front were my exam rooms, and a big old enclosed table was my front desk, cordoning off an alcove where the secretary sat.
We moved in to a third floor apartment across the highway from the hospital; rents were inflated because of the construction project going on 20 miles northwest of town. A coal-gasification plant was underway, with two billion federal dollars behind it. The facility was gigantic and used the anthracite coal which everywhere around lay only twenty feet below the wheat and sunflower fields which surrounded town.
The process of conversion was arcane and complex, and it was performed on an enormous scale. Coal, hard, low quality anthracite, was input into a rotating furnace without oxygen, and methane, propane, other gases, and rocky slag were output. Enormous cooling towers were used for the cooling water which relieved the thousand degree heat of the process.
The facility was so large that it employed a full-time biologist to monitor the microbial population of the cooling water in the towers. She became one of our patients early on, a lovely woman who had been recruited from a university back east.
We were immediately very busy; my wife, acting as receptionist and nurse, just couldn’t keep up so we immediately hired two medical assistants, one of whom was about sixty and the wife of a high level engineer at the plant. We received important tips from this woman, whose husband kept her well informed about plant activity. The other assistant was a young girl who got poison ivy by lying in a thicket by the river; she was incompetent and lasted only a few months.
Our apartment was on the top floor of a three story building with four flats on each floor. It had been newly built the previous spring to accommodate some of the construction workers. The roof was flat, which I thought was a novel design feature in this climate. In late September it started to get very cold, below freezing every night, and it snowed a little bit, just enough to stick to the roof. In October it really started to get cold, staying below freezing all day, with the same light, intermittent snow. By late December, serious cold took over; every night it was at least 40 below zero, and it never got above zero during the day.
Besides approaching the records, cold below 45 below zero is problematic because the propane everyone uses for heat begins to become slushy at this temperature. Fortunately, it never got that cold.
One day a man came in to our office with his wife; he complained of stomach pain and generally not feeling well. He was a Baptist minister, a very obese yet well muscled man of about forty, and his wife was equally obese. He had been in good health until a couple of weeks ago, and was very active in his local ministry. I examined him but he was so obese that I couldn’t feel his abdominal organs. He had relatively mild generalized tenderness.
He looked ill but the light in the rooms was so poor that I couldn’t see any jaundice. Even mild obesity totally obscures the outlines of the abdominal organs and makes accurate palpation impossible, and most of the white people that I saw here in this rural Northern state were fairly obese. I was unable to pin down what organ within his abdomen was causing distress.
I ordered blood tests, and when these came back (that afternoon) I went over them with him and his wife. His liver enzymes were off the scale, but at first I didn’t notice them. His blood sugar was about 220, so I felt he obviously had diabetes, but that was expected given his obesity.
It took me a while to realize that his liver enzymes were so abnormal that they registered on the graph only as a pegged line (this was the now obsolete line graph that came with sequential multiple automated blood chemistries (SMACs) at that time.
This graph was confusing and pointless as there was little relationship between the tests on the x axis, thus no logical reason for lumping them together in one graph; this made the pattern drawn on the y-axis completely arbitrary and essentially meaningless, just one more thing to memorize in the mistaken impression that it was important.) Nowadays, each test in the SMAC gets its own simple one dimensional graph that is easy to understand: it is high, low, or normal by about so much.
I didn’t at first realize the significance of what I held in my hand: this man’s death sentence, prescribing when and how he was to die. The numerical value of his serum gamma amino transferase (SGOT) and serum gamma peptidyl transferase (SGPT) was undefined; it was too high to accurately measure with the reagents in the SMAC machine.
Finally, as I stared at the paper, I began to realize that there was something seriously wrong. I asked him to let us order further tests on his blood. Fortunately, we already had enough blood, thanks to my wife’s thoroughness and sagacity as a laboratory technician. We sent out for quantitative determinations of his liver enzymes and added hepatitis A and B antigen/antibody tests for the definite possibility of acute viral hepatitis.
The next day, his wife called back for the results; I told her that we had found hepatitis B and we didn’t know how he had gotten it. She said he was feeling very bad and I told her I would admit her to the hospital. I usually admitted patients who were acutely ill, even if nowadays we wouldn’t put them in the hospital, because everyone lived so far apart that I felt they were safer in the hospital. This was understood by all the patients and staff.
Another factor that argued for early admission to the hospital was the weather. In the depths of winter it was often difficult to keep a vehicle functioning. At temperatures of 40 below zero, a car battery only retains about 5 % of its rated power. This is enough to start the engine if the oil isn’t too stiff from the cold; 5w-20 weight oil is usually used, and small electrical heaters are attached to the engine block to keep it warm overnight.
The day I admitted him, his bilirubin was sixteen. This was about as high as I had ever seen it in acute viral hepatitis. He continued to be ill but his spirits seemed good at first. I didn’t tell him he was going to die because I didn’t know, but I was worried. I called a specialist in the capital to discuss his case and ask him a few questions. He offered to take the patient if I felt it was too serious, but I thought he could stay here as there was little to do for him but give him IV’s and keep him comfortable. The specialist warned me not to give him any benzodiazepines as his liver woouldn’t metabolize them at all and he would be extremely sensitive. He didn’t warn me that the patient would develop uncontrollable restlessness a few hours before lapsing into a coma from which he would not wake up, no matter what I might do.
Every day, I checked his bilirubin and every day it went up by two points. His liver enzymes, reported out at astronomical levels initially, dropped day by day as the necrosis of his hepatocytes dwindled off; there were literally no more hepatocytes left to die. Despite the toxicity and enormous amounts of bilirubin and ammonia in his blood, he remained conscious and functioning. He conversed with his wife and children, and they kept up a continuous vigil at his bedside.
The last few days were a parade of other organs shutting down as the toxic effects of bilirubin and ammonia in his blood began to take hold of his system: kidneys, adrenals, gastrointestinal, cerebral. The last couple of days, he began to be extremely restless and confused. His bilirubin was 40. For twenty four hours, he tossed and turned continuously in bed, exhausting himself and the nurses. Finally I succumbed to their sufferings, pleadings, and ordered a tiny dose of a benzodiazepine. I decided on a minimally metabolized form, one that would flush out in the urine, perhaps 15mg of Serax. I gave him just enough to calm him down. Within an hour, he lapsed into a deep coma. Within four days, he would be dead.
My first reaction when he collapsed was “Oh my God, I’ve killed him.” For some reason, I still had not processed the fact that his disease had been fatal from the beginning. I began to feel terribly guilty.
When he became comatose, I called the family together and told them that his liver had completely failed him and that, without his liver, he could not survive. The family got together around the bedside, and I joined hands with them in intense prayers. That was around ten PM. The prayers lasted perhaps twenty minutes. Afterward, I hugged his wife and eldest son.
A couple of hours later, I called my colleague at the hospital in Bismarck. I told him the patient was failing and could I please send him to the medical center? There was nothing anyone could do, but I just couldn’t accept it. I still felt, more and more, that I had killed him with the tiny dose of Serax.
I transferred the patient, in a coma, to Bismarck, where he died two days later. The local public health workers were extremely interested in the case. It seems I had forgotten to inform them that there was a case of a reportable disease in my hospital. A couple of months later, they told me that they suspected he had been taken by a variant of hepatitis B which was especially deadly.
None of the people from the public health service or any of the doctors said anything negative to me about all the terrible things I had done in this case which had obviously killed the patient and endangered the community. Apparently, they didn’t notice what I had done wrong, much less that I had done anything wrong at all. Or maybe they were just too nice to say anything to my face.
I gave hepatitis B immunizations to all the nurses who had been in contact with the patient; the vaccine was relatively new, and looked like it was guaranteed not to carry AIDS, that scary new virus that everyone was afraid of at that time.
I went to the patient’s funeral, held in the largest church in town. It seemed that there must have been five hundred or a thousand people there; in any case, the rather large church was packed. The ceremony was long, and it seemed, everyone had heartfelt sorrow at his passing. One of the other attendees recognized me; he had seen me as a patient. He came over to me and asked why I had come to the funeral, seeing as I was already known never to go to church or attend local Lions meetings. I told him, “I had to come.” I don’t know if he realized I had been this man’s doctor too.
I began to think about this man after he died, at first in a guity way, then later in a more obsessive way since no one had bothered to indict me. There was nothing I really knew about him.
Not having known him from before he walked in to my office that day, about a month before he died, I couldn’t say that I had any personal knowledge of him. I felt that he was a man with a fat wife at his side, a rather fat man to be sure, and coincidentally a preacher or parson of some sort, but a completely responsive and cooperative forty year old who laid out his symptoms clearly and simply, and had an enlarged and tender liver when I first examined him, if I had given any thought to his examination, despite his obesity, and showed on his first blood test ten times the level of liver enzymes that he was supposed to have.
But all that time he never told me what his life had been like, what his work was like, what his wife and children were to him, how he felt about them, if he had any ambitions, what his hopes and dreams and fears were.
I thought of him as a generic, ordinary man, and he had brought me his death papers and he had shown them to me. It was as if he had opened his shirt and had shown me his dying insides. There was nothing I could do about it, this sentence of death, its weight and size were beyond reversal.
The ineluctability of death rends your life’s perceptions like claws. You can’t get around it, you can’t get over it, and you can’t get under it. He died, and there was nothing I could do to stop it; everything I did was useless, a waste of effort. Worse, I had killed him a few hours early, just to quiet him down and relieve the nurses.
In the months after he died, I began to order more blood tests on patients, on their first visit, if they had any kind of distress, even if it was vague. Nausea, diarrhea, vague abdominal pain, fatigue, weakness, all vague symptoms but all harbingers of impending mortality.
I never found out what caused his hepatitis B. This virus is characteristically transmitted from one person to another by blood or extremely close contact. We were never able to locate someone who had hepatitis B who would have given it to him. His wife and children had no evidence of exposure to the disease. He had never had any blood transfusions.
We had no reason to suspect that he was sexually active, even with his wife. The only history we got from his wife was that he had visited someone who was dying of hepatitis six months ago; but even if that person had had hepatitis B, which we weren’t able to ascertain, transmission by casual contact is thought to be impossible.
A person from New York City, even in 1983, when this patient died, would suspect that this parson had a secret homosexual love life through which he was exposed to hepatitis B. This patient, to my knowledge, was never asked if he had ever had sex with another man by anyone other than myself, and he denied it to me. How could he possibly do otherwise.
There has been a significant change in practice, encouraged by insurance companies, who pay for the procedures. A patient who comes to the doctor for the first time will now be expected to have a blood and urine test regardless of whether he or she has any complaints. This change came about partly because it was discovered that these patients frequently had not seen a doctor in a long time and often minimized or denied symptoms because they were so embarrassed.
In areas where there is expected to be a high risk of, say, HIV/AIDS, all patients will be offered the relevant tests on their first visit. For example, at a clinic that treats young men and women with sexually transmitted diseases, it may be routine to test all patients for the presence of the viruses that cause cervical and penile cancer.
Back in Hazen, North Dakota, in 1984, it was early spring, and the ceiling of our apartment in the bedroom closet began to dribble water. The traces of snow that had been falling all winter began to melt and immediately penetrated the flat roof. Soon water began to dribble down the walls. Two weeks later, My wife and I, and our kitten, and our finches, found a much nicer place to live on the other side of town.
Paul D Ryan, Republican candidate for Vice President, is a liar, and you can tell when he is lying
Among all the other claims and advertisements circulating around the Presidential campaign, there is one that simply and clearly shows what is really going on and who is a good person versus who is a bad person.
This one thing is the radio interview that Paul D Ryan, Republican candidate for Vice President, gave recently. In this interview, Ryan claimed that he had run a marathon, a race of just over 26 miles, in less than three hours.
Runner’s World broke the story that they had searched the records and found only one marathon that Mr Ryan participated in. In this race, in 1990 (when he was twenty), he finished in four hours and one minute. There is no record of him ever having run any other marathons anywhere, ever. It really need not be explained that marathoners keep extruciatingly detailed records of finishing times.
In a comment to the Runner’s World story, bellheezy wrote:
[September 2, 2012 at 1:28 pm]
“I came on here to look for running shoes and came across this article… [bellheezy explains the story caught his interest, so he then went to the transcript of the radio interview for more details]
…I read the transcript of the interview and then listened to it. The interview is fascinating. In some parts, Ryan recalls things very vividly and talks quickly and directly. In other parts, he talks round about with side stories and does not answer the question directly.
For instance, when asked if he was a speech and debate guy in high school, Ryan quickly lists that he was in student government and athletics, in the honor society, was class president his junior year, was school board rep his senior year and received varsity letters in track and soccer. Also, when asked about his mentor, Bill Bennett, Ryan rattles off directly the names of the guys he worked with, how he was the economics guy and that that was a very formative stage in his life.
Contrastingly, when asked what his first job was, Ryan does not even answer the question initially. Instead he says, “Well, you can get a job as a very young kid in Wisconsin in detasseling corn. So for people not in the Midwest, what that means is you walk down a corn row, and you snap the tassels off the corn to help pollinate the corn. I had a lot of landscaping jobs…” and he lists several other jobs he had. Since he didn’t come out and state his first job was corn detasseling, instead he explains what it is, I wonder if he really did that job he implied he did.
…[it is] rather easy to see when he does this as the manner in which he answers the question changes from a quick and direct approach to a roundabout and animated answer.”
Bellheezy has discovered Mr Ryan’s “tell”: the unconscious, automatic behavior that indicates when he is lying. Mr Ryan is not only a chronic, pathological liar, but an obvious and easily discovered one. When will Americans learn that some politicians lie and some tell the truth?
It is abundantly clear from Mr Barack Obama’s prior behavior that he avoids lying whenever possible and tries to remain silent rather than having to lie. I don’t think it is fair that we should expect our chief executive to never lie to us… that just isn’t possible.
Therefore, I dare any reader of this column to quote to me an obvious (or even not so obvious) lie that Mr Obama has told, about anything, even his twenty year old marathoning record. Then we will have a basis for, at least, considering the possibility of not voting for Mr Obama. It is already impossible to consider the possibility of voting for the Romney-Ryan ticket.
A Pneumothorax
I am standing in the hallway outside the emergency room, with a couple of nurses, chatting about something. It is mid-afternoon, and through the glass doors I can see the driveway shaded by the wall of the hospital, with the trees on the side of the driveway still in sunlight. The walls are red brick, looking older than the thirty years since the hospital was built. I can see part of the lawn, already turning brown with the approach of winter.
I can’t see the street in front of the hospital, but I know it is quiet and only a few blocks long. The prairie waits to swallow up anyone who ventures out on the two lane road that starts at the end of the street…there is thirty miles of empty highway before the next town. There aren’t even any fences between the road and the prairie, just a foot of gravel and a ditch. You can look out across the prairie and see nothing but rolling hills and sky on either side. Looking down the road, it dwindles away ahead of you with nothing out there in front of you but a fading dot.
Drive a couple of miles down that road and you will be lost in the immensity of prairie, with nothing behind you and nothing in front. You have to stay on the road. There is no way to tell where you are, or how far you have gone
An old station wagon is coming up the hospital drive; it turns around and backs up to the door. The driver gets out and frantically motions to us inside.
We come out through the glass doors as the driver is opening the back of the station wagon. Inside there is a woman lying on her back. The driver, a man in his forties, says “we were horseback riding and she was thrown off her horse into a tree. She hurt her shoulder really bad and now she can’t breathe.”
One of the nurses crawls inside the station wagon, and we all help to pull the woman out and onto a gurney. She looks pale, and her breathing is labored. We take her inside to the emergency room. The nurses undress her with difficulty; she moans and winces with any movement, especially when they try to take off her coat.
As soon as she is undressed, I order oxygen by face mask at fifteen liters a minute.
She is young, with long dark hair, and thin. Her lips look bluish, and her breathing is rapid and shallow. She responds readily to questions, but otherwise lies still and quiet, not wanting to move. Examining her, I find a developing bruise on her left supraclavicular area extending back onto the upper scapula and up onto her neck. Her shoulder joint is intact. It is hard to hear her breath sounds, especially on the left upper lung fields. Her heart sounds are rapid and regular, without any murmurs or extra sounds.
Looking around, I see the nurses are anxious and don’t know what to do. Their anxiety could be a pressure on me. I will show a calming and directive personality to deflect the pressure of their anxiety. This is clearly a serious case and I need them to keep their anxiety under control so they can help me.
I direct the nurses to take our patient into the X-ray room to shoot some films of her chest. Laying her on her side, we shoot a cross-table lateral view. In the dark of the small viewing room, the light shining from the view boxes is obscured by the films covering their surfaces. The films are thin and stiff, and make a peculiar rattling sound as they are shuffled around.
The X-ray technician and I stand looking at the film from her cross table lateral. I can see that there is an abnormally dark area over the patient’s heart, with a clear line between her lung and the air that fills her upper chest cavity. The air is much greater than the lung.
She has a large pneumothorax, the air pushing her lung down and shifting her heart towards the right side of her chest. There are fractures of the first and second ribs, jagged edges showing where her lung has been punctured. Air has leaked from the lung puncture into the potential space of the pleural cavity. The edges of the puncture wound act like a flap valve, increasing the pressure in the pleural cavity with each breath. Gradually the pressure shrinks the space available to the lung tissue. Compression takes over and the patient’s vital capacity shrinks.
Back in the emergency room, I am looking through the equipment the nurses have brought out. There is nothing that looks like the tools I would have used to insert a thoracostomy tube into her chest, and there are no tubes that look small enough. However, there is an old looking instrument that has a sharp pointed rod inside a tube with an oblique opening on the side, about four inches long. It was designed to puncture the abdomen to insert a tube into the bladder, but it looks like it would work to punch through the chest wall.
Since there are no thoracostomy tubes, I ask for their largest urinary catheter and one of the older nurses brings out a large red rubber tube in a sterile sealed bag of white paper and clear plastic. I have lidocaine two percent with epinephrine drawn up in a twenty cc syringe with a 5/8″ 25 gauge needle, plain lidocaine two percent, and an array of hemostats, probes, a number eleven scalpel, an automatic retractor that worked by screws, a pile of sterile 4 by 4s, and so on.
I try to reassure the patient, who is as anxious as the nurses and restless. She is looking paler, and her lips are definitely blue. Working quickly, I prep an area on her upper anterior chest wall and anesthetize the skin. I make an incision about two cm long transversely, just above her fourth rib anteriorly. Using the bladder puncture instrument, I push in just above the rib margin to avoid the nerves and artery running along the lower surface of the rib. There is a loud hissing sound as I push through the muscle and outer membrane over the chest cavity.
The air trapped in her chest cavity has escaped! The woman immediately looks better, and her breathing slows. Her lips lose their bluish tinge. She smiles at me. I can feel the beating of her heart through the sharp pointed rod and I suddenly feel the fear that I might puncture her aorta as well. I remove the bladder puncture rod.
I insert a Foley catheter into the wound and close it with a couple of sutures in the skin. I attach a 60 cc syringe to the Foley and withdraw more air. Meanwhile, the woman rapidly improves and her lips look pink again. We continue her with oxygen by face mask but turn it down to eight liters a minute.
The head nurse hands me the telephone receiver. It is the emergency room doctor on call at the hospital in Rapid City. The distance is ninety miles. I tell the doctor that I will be coming with the patient. He doesn’t seem surprised. I hand the receiver back to the head nurse and ask her to look for my new physician assistant. He will be on call at our home hospital until I get back–probably about three and a half hours. Likely no one will call on him for help.
The room is quiet and most of the nurses have gone back to what they were doing before. They are no longer anxious; the crisis has passed quickly. I step outside. It is dark already, and it is getting cold. The ambulance is slowly backing up to the rear entrance, making its steady beeping noise.
The ambulance crew consists of a driver and two attendants, one in front of the patient’s head, and one by the patient’s side. I sit on the patient’s “other” side, her right. There is no hurry and they haven’t picked up any anxiety from the nurses, so they take my presence without questions.
The ninety mile drive to Rapid City is completely uneventful except that I twice try to aspirate more air from the catheter inserted into the patient’s pleural cavity. I obtain no more than ten cc’s each time.
At the hospital in Rapid City, the doctor on call puts the patient’s chest Xrays up on the screen in the doctor’s call room. He is describing the pathology to a young lady in a white coat. I introduce myself as the doctor who saw the patient out in the field.
He introduces me to the young lady; she is a resident from Denver who is rotating through the Rapid City emergency room. She seems to feel that Rapid City is the town at the edge of the unknown wilderness. She looks at me as if I am some kind of weirdo, working out there.
The patient’s Xrays show a classic pattern. When the top two or three ribs are broken, there is a high risk of pneumothorax. The emergency room doctor explains the pattern to the resident as I listen myself; it certainly seems reasonable that a first, second, or third rib fracture could be directly associated with trauma that could push the rib into the lung and provoke a pneumothorax.
I mention to the emergency room doctor that there were no thoracostomy tubes available, so I have used a Foley catheter. He laughs, and so does the visiting resident. I guess the Foley catheter is somehow humorous. There is also the imputation that I am short on supplies, which is also humorous.
Before returning to the ambulance, the driver, attendants, and I go down to the cafeteria and get cups of coffee, loaded with sugar and cream. It is late, almost nine in the evening. When we open the side doors to the ambulance bay we feel a rush of chilly air.
Outside, the sky is clear and we can see the stars between the tall trees in the parking lot. The temperature has fallen to forty-five degrees with a northwest breeze.
We take the freeway out of Rapid City back towards Phillip. There are almost no cars on the freeway at this hour. There is a stillness settling down like a black, soft, felt curtain over the road. Leaving the freeway for the final thirty miles, we take a two lane blacktop and meet no-one driving against us.
The Republican Representatives and Senators in our House and Senate have shown impressive unanimity over the last three and a half years. They have, without fail, rejected every proposal put forward by our President regardless of its content. As a result, the government of the United States has not been guided by any laws that our President might have used to enact his policies.
Republican leaders explicitly stated, immediately after the election of President Obama, that they would oppose every measure he might put forward in order to prevent his re-election four years hence. They have kept that promise, and as a result, the ship of state has been effectively rudderless for the last three years. Even before the by-elections in 2010, the Democrats were unable to command a supermajority in the Senate except on a few occasions.
Now that three years have passed with essentially none of President Obama’s policies in force due to Republican obstruction, the Republicans are campaigning on the slogan that “President Obama’s policies have failed.” How can a policy be described a failure when it was never put in place? Perhaps what they mean is that President Obama has failed to endorse the policies that they want, despite the fact that their candidate for President lost the election.
There is a certain lethal apocalyptic attitude to the Republican Party these days. Even their bureaucrats left over in President Obama’s executive division are toeing the line while their legislators are preventing new directors from being seated.
The acting director of the Federal Housing Finance Agency has refused to follow orders and rejected a debt relief plan handed down by the White House. He happens to be a holdover from the Bush Administration who is still in his post because Senate Republicans are blocking a vote on Obama’s choice for permanent director.
Even though this debt relief plan would help millions of Americans who are underwater on their mortgages and would yield a net fiscal benefit to the finance agency, the director won’t follow Obama’s orders to implement it. For unknown reasons, Obama has not fired him or made a recess appoint to replace him.
There is nothing too low for the Republicans now. They will do anything to regain power over the government.
It is ironic that the popular base for the Republican Party has been shrinking for years as former minorities increase their share of the citizenry. Asian and “Latino” percentages are growing rapidly, while African-American numbers have remained relatively steady. Additional demographic changes have led to a gradually shrinking percentage of Republicans and gradually increasing Democratic and Independent numbers.
Demographic changes have been very uneven across the country, and one area is the polar opposite of another. The presence of a strong majority for one’s party, particularly if it is Republican, will be demonstrated as dramatic bumperstickers and stereotyped behavior towards strangers. Democratic areas tend to be less demonstrative.
In the face of changes that, overall, diminish their base, the Republicans have reacted with paranoia and xenophobia. They have circled their wagons. Look for more wrathful outbursts in the near future.
The following is an explanation of how capitalism subverts and eventually destroys democracy, unless appropriate rules are laid down to separate the influence of money from the electoral process.
We know what democracy is, right? One man, one vote. We know what capitalism is, too. That’s the system whereby people earn money to buy goods, and when they have more money than they need to buy goods, they save their money. When people have less money than they need, they have to buy lesser goods and/or go hungry.
What is the interaction between democracy and capitalism? When we get together to vote, candidates for public office advertise, and to do so, they spend money. Second, when important policies are considered by our legislative and executive bodies, advocates of some policies also advertise to the general public. Finally, advocates of financial interests (companies or groups of companies, for example) pay lobbyists who spend their time trying to persuade our representatives to enact policies that they favor.
There are other, less well known and possibly less legal, methods by which capital influences democracy. For example, a business interest can bribe a political representative to vote a certain way. A business can even pay for the re-election campaign of a judge for the purpose of obtaining the judge’s favorable ruling in a court case affecting the business’s interests. That actually happened just a few years ago: a business (a coal mining company) paid 2.5 million dollars to a state Supreme Court justice’s re-election campaign; after the judge was re-elected, he voted favorably on a case affecting that company that saved the company 44 million dollars in costs (fines for pollution.) In this case, the federal Supreme Court reversed the collusion although the judge remained on the bench.
Clearly, there is substantial room for capitalism to have a profound effect on the operation of democracy. This is an area of potential mischief which was never addressed in our Constitution. At that time, the late eighteenth century, the process of learning for whom to vote and the processes of governance by our representatives were little affected by the presence of money.
Money was assumed to be sufficient for both campaigning for office and while carrying out one’s office because those who governed were independently wealthy. It was assumed that our representatives would have considerably more money than the average voter. It was also assumed that the process of campaigning would be supported by newspaper coverage, public speeches, rallies, and debates.
Bribery of office holders was prohibited. The franchise was limited to men who owned property in most cases, so it was assumed that the voter would be educated and able to comprehend the issues discussed. With the gradual spread of the franchise to all male adults, lack of education became an issue and the probability of ignorant voters easily swayed by propaganda increased. Compulsory education was first introduced in Massachusetts during the Colonial period and gradually spread to the rest of the US, with Mississippi being the last state, in 1918.
During the American Revolution, the newspaper was the popular source of education for everyone who could read. Wealthy individuals bought newspapers which they used as platforms for the promulgation of their political views. Newspapers became a relatively cheap method of propaganda available to almost everyone.
At the beginning of the nineteenth century, money rapidly became essential to the development of the United States. The geographic area of the country was greatly expanded by the direct purchase of control over land that had previously been owned by native Americans (“Indians”) from France. A national bank was established despite the opposition of Andrew Jackson. In 1833 and 1836, Jackson took actions which destroyed the Second National Bank (originally established to handle the debts from the War of 1812) and threw the US into its first recession by forcing people to purchase land with specie (gold or silver.)
During the process of development in the nineteenth century, the United States went through a number of episodes in which it could be seen that capital was having an adverse effect on governance. First, the capital value of slaveholder’s chattel was an important impediment to the resolution of the moral issue of slavery and many solutions were proposed for the orderly disentanglement of the slaveholder’s money interest. None of these solutions were ever carried out.
Instead, a violent uprising by slaveholders occurred and a number of southern states seceded from the Union, provoking the Civil War in 1861. Current estimates put the number of war dead at about 850,000, an increase of 25 % over previously accepted totals.
The second great crisis related to democracy and capitalism occurred during what is known as the “Gilded Age.” After the Civil War, corruption gradually took over both state and federal governing establishments, and wealthy individuals obtained highly advantageous relationships with the government and the utilities that appeared (railroad, oil, and so on.) Government was controlled by wealthy individuals who took advantage of the relative ignorance and apathy of the voter to govern as they pleased.
In 1901, Theodore Rooseveldt became president after William McKinley was assassinated. He did not campaign on a reform platform, but he did, in fact, partially reform the way business was run. He dramatically reduced corruption in the federal government and the government of New York State. He broke up some of the “trusts” that had developed and reduced the advantages the wealthy had enjoyed. He introduced what he called the “Square Deal”, which offered the average citizen a fair share of prosperity. Unfortunately, his reforms did not prevent unbridled speculation on Wall Street.
The third great crisis of capitalism and democracy occurred when the stock market crashed in 1929. This was preceded by the period known as Prohibition, in which, starting in 1920, the consumption of alcohol was forced underground. The creation of a black market in alcohol separated the government from an essential market and forced those who ran the markets to regulate them, never an effective situation. The result was the rise of organized crime, which regulated itself through internecine violence.
At the same time, banking and investment industries were allowed to operate with minimal oversight, resulting in frequent Ponzi schemes, including the eponymous Ponzi scheme. The stock market crash of 1929 apparently resulted from an increase of “leverage”, or the amount of stock one was allowed to buy on borrowed money, to unsustainable levels. Inevitably, a transient drop in stock value snowballed into a complete market collapse when key players were unable to satisfy their “margin calls.”
Worse than the bankruptcy of stock market investors was the wiping out of many small banks by their exposure to the vagaries of the stock market or derivatives markets. The system collapse of 1929 was followed for years by knock-on collapses of banks and industries. Lack of demand led to reductions in production, leading to layoffs, leading to even less demand. The federal government did essentially nothing (if you don’t count actions that made matters worse) until Franklin Delano Roosevelt was elected and inaugurated.
In his first 100 days, Roosevelt put in place a vast array of new programs in an attempt to reverse the effects of the depression. Most of the programs involved such things as hiring people to produce most anything they were qualified to produce. A great many bridges, tunnels, highways, buildings, and other structures were put up during Roosevelt’s administration, not to mention the murals, photographic essays, and other art projects. Other programs were designed to increase demand by deficit spending in many other areas.
Rapid improvement in the economy lead to a premature abandonment of some of these measures in 1937, and the recovery stalled. Fortunately, America became involved in the struggle against Nazi aggression and the need for war materiel relieved the lingering effects of the Great Depression.
The fourth crisis of capitalism and democracy occurred during the Nixon administration. In an all out effort to get re-elected, Richard Nixon hired a number of men who were intended to “spy” on the Democratic side of the campaign. These men were also authorized to perform some “dirty tricks.” This resulted in the Watergate scandal as well as the persecution of Daniel Ellsworth, the man who leaked the Pentagon Papers to the public.
The fifth crisis has been occurring over the last few years. More and more money has been spent on campaigning for election, to the point where each candidate for President this year will have mobilized more than a billion dollars in an effort to attain office. The Supreme Court has essentially removed all obstruction to the expenditure of money in campaigns by declaring, in the Citizens United case, that independent groups (now known as super PACs) can advocate for a candidate “independently” with no restriction on costs.
At the same time, income inequality has dramatically increased with a resulting wealth inequality that, in 2007, equaled levels not seen since just before the Great Depression. The housing market bubble collapsed in 2007 and took much of Wall Street with it; other victims included the American automobile industry and state and local governments.
Because of the monetizing of political office, individuals and groups who already have a lot of money have been able to tilt the system in their favor. The tax system, in particular, has been made highly regressive. This is most obvious in the treatment of investment income as opposed to wage or salary income. Dividends and carried interest (monies received by virtue of the ownership of stock in companies that declare dividends, for example) are taxed at a fixed rate of fifteen percent. Ordinary wages are taxed at a variable rate that begins with a fifteen percent fixed contribution for Social Security and Medicare; in addition, up to 36% taxes are levied on wages above a certain figure. As a result, rich people who do nothing but “clip coupons” (own stocks and bonds) are taxed at half the rate that persons who work full time or more have to pay.
There are many other laws that have been passed at the behest of wealthy individuals and groups that make the American system highly un-democratic. This is the final crisis for democracy. The election this November, even if President Obama is re-elected, will not help because it is quite likely that the Republicans will retain control of the House. Government will continue to be paralyzed in a state that is highly unfair to the average person and clearly un-democratic.
As a result of the Great Recession, an average of 30 to 40 % of all personal wealth (as well as the holdings of institutions such as colleges with endowments) was wiped out. The less wealthy you were before the crash, the larger a percentage of your wealth you were likely to lose. Stimulus measures and rescues of large financial institutions were instituted after the crash, but the stimulus was insufficient to relieve the suffering of the average American. Unemployment has persisted at more than eight percent (nominal) since 2009. Job growth has been extremely weak and demand has continued to be insufficient to stimulate expansion of the economy.
I deeply regret to say that there is an increasing likelihood of violence and destruction as the average American suffers more and more from the effects of our un-democratic system. Unless democracy and rational behavior by the American government can be re-established, the chances for civil war and revolution will continue to increase over the next few years.
What must be done to stop capitalism from corrupting democracy? Capitalism is actually a good thing because it stimulates and lubricates the economy, so it is impossible to remove capitalism as a process. To prevent capital from influencing government, it will be necessary to end private funding of election campaigns and remove lobbyists.
Public financing of elections will involve the use of “free” television time for candidates, extensive petition drives to establish the popularity of individual candidates, and multiple stages in the election process. Conventions will have to be held at the local, city, county, and state levels to set up maximum citizen participation. Voting will have to be required instead of voluntary. Free photo ID for all citizens will have to be distributed. Elections will have to be held on weekends instead of Tuesdays.
To address the influence of ignorance on government corruption, it will be necessary to greatly expand public primary and secondary education. In addition to the basic reading, writing, and arithmetic, students will need courses in good governance, ethics, democracy, and history. For additional benefit, secondary schooling must include vocational education as well.
If adequate education through high school is re-established, it will not be necessary to expand college and postgraduate education. The scams of “vocational” schools that “prepare” people for poorly paid jobs as medical assistants and auto mechanics with ridiculously expensive student loans must be prosecuted and eliminated. These schools have been particular beneficiaries of capitalist corruption in government.
Once candidates are in office, they must be paid in parity for the importance of their offices, and lobbyists must be prohibited from preferential contact with office holders. All citizens and organizations will have to be given equal opportunity to establish contact with office holders to communicate their points of view (presumably through web sites.)
Finally, the election of judges must be prohibited. Judges will have to be nominated and approved at the local and state level just as they are now in federal courts, and limited terms of office will have to be established. For example, Supreme Court justices can be given eighteen year terms, staggered so that every two years a new justice will be elevated.
Most importantly, there must be close oversight and clear penalties for violations of democratic trust by undue influence from moneyed interests. Every department of government must have an inspector general, including Congress and the judiciary.
The key issue will be the commitment of government to democratic, rational principles. Democracy must be freed from the malign influence of money and ignorance. Enlightenment by scientific study must be encouraged and valued through adequate education of the ordinary person.
The alternative will be worse violence than the Civil War and greater suffering for the people. When income inequality reaches unsupportable extremes as a result of the control of government by capital, violence is inevitable. This must be prevented by rational and comprehensive reforms before it is too late.
The following is a copy of a comment I made to an article in the New York Times online. The comment was in response to another comment requesting three actions to help address the excessive cost of medical care in this country. I repeat it here because when I finished it, I realized how important it was. I added a few things in square brackets that wouldn’t fit in the NYT’s 1500 character limit.
I am a retired physician. Here are the three actions that will save the most money: (very hard to accomplish, but worth it.)
1)single payer universal health care. (This involves rationing, electronic records, and many other improvements)
2)eliminate the “fee for service” system: change over to salaries for all health care providers.
3)crack down on the drug industry: have the single payer buy all the drugs and demand discounts for volume.
Note that I am ignoring malpractice, fraud, and a host of other issues because they represent only a small portion of the problem. [Comprehensive reform can address these issues as well, especially because they would be easier to accomplish.]
Making people pay more (large copays and deductibles) will only make the problem worse because (as studies have shown) people economize inappropriately when they have to pay more for their care. They wait too long to treat problems for fear of the cost, and the problems are worse and cost more to treat when they eventually do go to treatment. Keep in mind that in Europe, many countries have minimal to no copays, and the overall costs in these countries are half what they are here.
This is a subtle and difficult problem and I don’t believe it will see improvement in the near future because there are too many industries sucking money from the business: pharmaceutical companies, insurance companies, physician’s group (AMA), device manufacturers, etc. [Medicine has a reputation as a cash cow, so it is very attractive to entrepeneurs, rent seekers, and other hangers-on.]
While I’m at it, I recommend that we throw open our borders to immigrants, especially young workers, to revitalize our Social Security system (think about it.) [The basic problem with Social Security now is that there are too many older workers getting ready to retire and not enough young workers signing on to pay into the system. Look it up, this is verified research: this is the real problem. In addition, eliminate the cap on salaries subject to the SS tax: it’s a flat tax, and having a cap makes it regressive. Making the retirement age older will NOT help, and is unfair to those working low paid, strenuous jobs who are completely worn out long before age 65.]
I could add a lot of additional verbiage to this comment, but I think that it is pretty good by itself.
Conrad Theodore Seitz 