Mark Pine

I wasn’t born when FDR held fireside chats on the radio. But I think the effect must have been similar to what I felt watching and listening to Obama during the prime-time televised news conference last evening.

It wasn’t what he said but how he said it: Calm, reflective, occasionally humorous. But most of all, intelligent and relevant.

You don’t need to agree with Obama to marvel at his unmatched ability to field questions and give answers that are frank and unrehearsed, at the same time as they are germane and insightful.

He gives the impression of a man who knows what he’s doing and where he’s going. Perhaps more than any other factors, his confidence and command of the issues is responsible for the polls that show more Americans believe the nation is on the right track now than on the wrong one.

I’m overjoyed that our national has such a leader. During the Great Depression, FDR appeared and was elected to inspire and reassure us. In this, the next gigantic economic calamity to come along, Obama has emerged and taken office.

The problems are huge, but somehow, I’m not too worried. I feel as if the man has things in hand and the damage won’t be great. Silly feeling, I know. What can Obama do about preventing a world wide pandemic? Nothing. Still, it’s remarkable how reassuring it is to have him at our helm.

The story in the NY Times this morning says pork producers are protesting and complaining. You don’t get swine flu from buying or eating pork chops, they say. In a paraphrase of the gun industry, they might proclaim, “Pork doesn’t spread disease, people do.” And in a desperate attempt to use PR techniques to reframe the story, they want to change the name of the virus to “North American influenza.”

Americans, I think, have learned in recent years to look askance at attempts to deal with serious problems by changing names and spouting slogans.

This disease has come from hogs and pigs, making the jump into human beings in the person of 5 year old boy who lives in a Mexican town with a large pig farming industry. Two children died there of the flu in the last several weeks.

The pig producers may protest that their finished products are safe. But as with the gun manufacturers, the problem doesn’t lie with the products, but with the methods of the industry. In the case of pig farmers, it seems evident that the huge factory farms they set up to mass-produce meat, keeping pigs in close quarters, must be a major factor in the development of the disease. It has to provide a fertile environment for virus’s circulation and evolution.

So even if pork products don’t carry infection, that doesn’t mean that pork production isn’t the part of the problem.

I gave up eating pork years ago. Too, too many problematic issues with the meat for my taste: High in calories, high in saturated fat, in the form of ham and sausage, high in salt too. Not healthy.

But there are also all the other problems. Pigs, who are intelligent animals, spend their lives in close quarters without room to run.

There are all the environmental issues: Manure stinking up the air of the surrounding communities. Pools of pig poop polluting the ground water. The high energy cost of producing pig protein.

So perhaps the pig producers aren’t being justly blamed for the spread of swine influenza among humans. They still have a lot to answer for. And if the swine flu scare cuts down pork consumption, in my view, that will be a good thing.

TV news coverage of the flu epidemic in Mexico City shows people everywhere wearing facemasks. But public health officials haven’t pushed them in the U.S., and they appear to be equivocating about whether people here should be wearing them. For instance, on its web site, the CDC says that information on the effectiveness of facemasks is “limited.”

The agency advises “frequent hand washing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household.” Yet at the same time, it admits, “If used correctly, facemasks and respirators may help reduce the risk of getting influenza.” And wearing masks is advised for health workers in frequent contact with people who may have the flu. So do the masks work or don’t they?

Are public health officials pulling their punches on wearing masks? The available evidence may not support the officials’ de-emphasis of mask use. MacIntyre et al. in Emerging Infectious Diseases in February (15(2): 233-41) reported a clinical trial of mask use of about 300 adults at risk for household transmission of influenza-like illness from their children. The article is available online at pubmedcentral.nih.gov. The results suggested that mask use significantly reduced infections in adults by 3-4 fold.

The study also showed problems with adherence to mask use with less than half of the adults reporting they used the mask all or most of the time on day 1 and adherence declining thereafter.

Perhaps the CDC is concerned that if mask use is recommended, people won’t use them correctly or consistently, and they would be more likely to go to work or school or venture into crowds, contrary to advice.

Perhaps so, but I wonder if our public health officials aren’t giving the public enough credit. People are capable of understanding that staying out of crowds is very important, and yet they are also capable of understanding that face masks, used correctly, can reduce transmission.

An article in the NY Times today raises the issue of too many medical specialists in comparison too few primary care doctors. This will be a problem for the Obama Administration and the Congress in establishing universal health care. In Massachusetts, the only state to try to ensure every citizen, there aren’t enough primary care doctors to handle the extra patient load that universal care has produced.

Medical specialization is one of the main reasons that our health care costs are so high. The article today points out that many doctors specialize to pay off the huge bills they run up going to college and medical school. Specialists drive up costs—that should surprise no one—but you’d think that specialization would improve diagnosis and treatment. And because there are so many specialists, you’d think they would compete and costs would come down. Unfortunately that’s not the way it works.

What you actually get is sub-specialization and sub-sub-specialization. Some surgeons specialize in a single operation—like ophthalmologists who specialize in keratotomy, or abdominal surgeons who do weight-loss operations. Just about every patient they operate on gets one of those procedures. These doctors must make a lot of money, so they build referral networks to bring in patients who might possibly benefit, whether or not there are less expensive alternative procedures that are equally effective or more so.

The situation is not quite so constrained in the some non-surgical specialties, but even there you have doctors who specialize in narrow areas of medicine. The article reports “Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.”

Since many patients have many diseases at once, some patients have several specialists managing their medical care (each one trying to make excellent income). While surgeons become entrepreneurs in particular procedures, some medical specialists may become entrepreneurs in particular batteries of lab tests, some of them setting up labs to do the tests.

To provide the best care at the least cost, medicine ought to be organized around primary care physicians, with physician-assistants handling the most routine cases. Specialists should work mainly as consultants, unlike today where they often become the de facto primary care doctor for many patients.

Primary care providers provide most care at Kaiser Permanente Mid-Atlantic, where I receive my medical care through a federal employee plan (I’m retired). The care is very good, as I can judge since I’m a physician myself. There are no long waits for an appointment. I see specialists for consultation whenever I need to (dermatologist, neurologist, or what ever). My primary physician coordinates it all. It costs me about $70 per month. (Yes!) The co-pays for meds are a bit high in some cases, but I usually fill the prescriptions at Target and get their $4 generic rate. That’s how it can be done, folks.

But it will mean less reimbursement for specialists and eventually many fewer specialists. I think the ideal would be to have the primary care doctors develop areas of specialist expertise. They could derive the bulk of income from generalist work, but some percentage (much less than half) would come from doing specialty consultations, which would provide them intellectual stimulation and prestige, and keep them current.

The article notes that Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, objected to reducing reimbursements for specialists. He said: “If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.” His statement is not quite right. He should have said, “Fewer of them will be done for people who don’t need them.”

On Friday and Saturday, I attended lectures by two fellows of the Jesus Seminar of the Westar Institute, Robert Miller and Thomas Sheehan. The Seminar examines historical evidence regarding Jesus of Nazareth and early Christianity, and these lectures focused on Jesus’ conception (Miller) and death (Sheehan). This is an open email in response to Professor Sheehan’s lectures.

I attended the Jesus Seminar on the Road Friday and Saturday hoping to learn what made Jesus special. He may be the most influential individual in the history of Western civilization and I want to understand why. Although he spoke in wonderful parables with lessons of great importance, many others—poets, philosophers, religious, orators and writers—have also done that, but no other is as significant as he. It has mystified me.

I’m happy to say I think you provided part of the answer. If I understood you right, Jesus made so deep an impression because of the way he lived his life, as a radical rabbi. You said he adapted the Torah to the peasant Jews of his time. He spent his days talking and eating with the downtrodden and outcast people of Galilee, and he showed them the God’s “radical mercy,” and he convinced some of them, including the apostles, to turn their lives around.

His impact was profound and very personal. I think I understand that better after hearing you speak. Thanks.

So I’d like to return the favor, in a sense, by giving you my perspective on a little something you said. It was just a moment near the end of your lecture yesterday, a minor point, perhaps, but to me it’s an important one.

It came in your explanation that Jesus dealt with the subject of his divinity by turning the question away from himself and reflecting it back on his followers and listeners, saying that God is in people, i.e., in all of us. We must use our divine spirit in continual acts of creation or re-creation by performing of good works.

In that context, you said that our lives are their own rewards. Heaven exists (or not) in the life we live on earth by doing good (or harm); there is nothing beyond that. A pastor I heard on Easter Sunday at the River Road Unitarian Universalist Church said just about the same thing. But he was even more explicit in asserting that life on earth is all there is. He emphasized the point by proclaiming that when we die, we are really and finally dead—although, as you did, he allowed that we do live on (in a sense) in the effects we have on those who remain and come after us. Other than that there is no afterlife that he can believe in.

I suspect you share that point of view. In what follows I will assume you do. Please accept my apology if I’m wrong.

You and the UU pastor hold your views, I think, because of the tremendous influence of science on your thinking. Science is always in the background of what you believe and proclaim, but usually you do not explicitly say so. I consider myself thoroughly scientific, so I agree with that orientation.

But I feel that the role of modern science is often an unacknowledged subtext of presentations such as yours. The work of the Jesus Seminar applies the techniques and findings of scientific inquiry to the study of Jesus and early Christianity. That’s understood, of course, but you usually don’t come right out and say so. The portrait of Jesus you showed was produced through application of forensic anthropology. You also apply textual, historical, sociological, anthropological, medical, and economic knowledge to understand him and his times.

If you assert that life on earth is all there is, as I think you do, you are attempting to bring traditional religious concepts like the soul and afterlife into in the context of modern scientific knowledge. If you had discussed the role of science in your lectures this weekend, I think you might have said something like this: “We educated people of the 21st century can no longer take that fairytale stuff of religion as gospel. We are here today to take advantage of all that science has taught us about how to understand the world, and we will apply some of the methods and findings of science to try to understand the man, Jesus, and the effect he hand on our world.”

I would like to suggest—my way of returning the favor—that modern science does not lay down the restrictions on belief that you and the UU pastor may think it does.

For example, in regard to the pastor’s assertion about dying and being finally dead, I emailed and asked: How can you speak of the finality of the moment of death, when modern physics tells us in the theory of relativity that there is no such thing as absolute time?

In this email, I would like to raise an idea that comes to me from quantum mechanics. Near the end of your lecture yesterday, you spoke about each moment of life as a moment of creation. You said, I think, that God is present in each moment and acts through each of us, in combination with all other life, to create (or re-create) our world. Creation is continual and ongoing, and it is something we do.

In connection with this, I wonder if you considered the concept in quantum mechanics of collapse of the wave function? This concept is part of the mainstream (“classical”) interpretation of QM. Interpretation, in this sense, is what you described yesterday as a step in the process of creating meaning. Collapsing wave functions is part of an interpretation of QM proposed by Niels Bohr to explain what QM means.

In a nutshell: The universe exists as a set of possibilities, and each possibility is associated with a probability quantified precisely by a mathematical function known as a wave function. In the process of interacting with the world, human beings participate in collapsing (transforming) possibilities described by the wave functions into actualities (realities, states of affairs). This is an ongoing moment-by-moment process, and it happens on the smallest scale of atoms and particles, as well as and on the largest scale of the universe. In each moment, the universe re-creates itself. We humans, as part of the universe, participate in this process by interacting with our world and continually re-creating it. That’s what modern physics tells us.

I can’t know whether you may think there is any added value in applying physics to concepts that you elucidated so well in your lecture. But it seems to me that there may well be something to be gained.

The most problematic religious concepts—the soul, the afterlife, immortality, God— continue to create barriers between science and religion. Modern religious thinkers, such as yourself, may have much to gain by incorporating the world views of relativity and quantum mechanics into your papers and lectures. In my view, these modern theories include core concepts very different from the materialistic reductionism that provokes the hostility of many religious people. Far from contradicting religious beliefs about eternal life, I think, modern physics can be shown consistent with some of the most problematic beliefs and even supportive of them.

Duh … what would you expect?

The surprise, though, is that people who prefer awakening late in the morning and going to sleep in the early morning (owls) do equally as well on tests of reaction speed in the morning as lark people, who prefer waking and going to sleep early.

That’s the finding reported yesterday in ScienceNOW online. Sleep researchers at the University of Liege, Belgium, tested larks and owls. They allowed the subjects to sleep and wake naturally and ascertained reaction times to changing numbers on a computer screen, after the subjects were awake 1.5 hr and 10.5 hr. The owls performed as well as the larks in the first test and did significantly better in the second.

The ScienceNow article notes that sleeping is determined by both the circadian clock, which sets the times of the cycle, and by sleep pressure, which builds as time awake increases. Apparently, the owls’ alertness is less affected by sleep pressure than the larks’.

I’m a lark, and sleeping has always been a big issue for me. I often wake between 5 and 6 a.m. That’s a problem, because so many interesting programs and presentations, on TV and at lectures, last past 9 p.m. But if I don’t get to sleep by 10, which is often impossible, I don’t get enough sleep.

I’ve wondered whether it’s possible for a lark to train himself to be an owl. I’m kind of old (past 60) to try to make a fundamental change of that sort, but if it’s true that owls are more alert at all hours and they get more sleep, too, I’ll have to think hard about whether to try to do it.

On another subject, the same issue of ScienceNow reported a promising development in embryonic cell research, especially for people who hope that such cells can be derived from adult tissues without destroying embryos. A chemist at the Scripps Institute has found a way to introduce four transcription factors into cells by tagging the proteins with peptides made of eleven arginines. The factors are then able to reprogram the cells to the embryonic stage.

Previously, the usual way of reprograming cells used viruses to insert the four genes for the transcription factors into adult cells. That technique had the disadvantage of leaving the viruses and the genes for the factors in the reprogrammed cells, raising the possibility that if the cells were used therapeutically they might trigger the development of cancer. The new technique, which relies on proteins instead of viruses and genes, should not create that risk. After reprogramming occurs, the proteins would get degraded and recycled.

A news analysis in the NY TImes this morning discusses the difficulty in determining whether the “brutal interrogations conducted by the Central Intelligence Agency helped keep the country safe.”

In reality, there is no possibility of answering the question of whether torture produced information that would not otherwise have become available, for example by using rapport-building techniques.

The reason is that there is no possibility of a control experiment. The only way to address the question objectively would be to do a crossover study. Half the time. subjects would be tortured, and then in a separate period, they would be treated with rapport techniques. And then the information obtained in the two periods would be compared. Of course, no one would do such an experiment (we hope!).

Therefore anyone on the left or right who says torture did or didn’t work is simply stating their guess and their prejudice. The difference of course is that the left is guessing that inflicting pain and suffering, and violating our laws and treaties, doesn’t work and shouldn’t be done. And the right is guessing the opposite.

Even more problematic for the Bush defenders, however, may be credible indications, voiced last evening by Rachel Maddow of MSNBC and reporter Ron Suskind and based on the Senate Armed Services Committee report released yesterday, that harsh interrogation techniques for questioning “high value targets” like Abu Zubaydah and Khalid Shaikh Mohammed were developed and used in the summer before the invasion of Iraq. One of the likely purposes was to obtain confessions that linked Saddam Hussein with al Qaeda.

Since we know today that no such link existed, the question arises whether the torture was used to force false confessions.

On C-SPAN this morning, we heard Mark Thiessen, former aide to Secretary of Defense Donald Rumsfeld and presently of the Hoover Institution. As so many people with views like his have done, he attempted to justify the harsh interrogation techniques by focusing on fine distinctions. He said, “They—the lawyers [e.g. John Yoo, Jay Bybee]—were so careful in constructing these [interrogation] memos.” As an example, Thiessen explained, only hand slaps with an open hand were used, rather than those with the hand closed. He defined torture as “severe physical and psychological pain” and said a common sense rule was, “If you’re willing to try it its not torture.”

In my view, efforts like Thiessen’s by hard line advocates of aggressive interrogations divert the dialogue from discussing how Americans should behave with terrorist prisoners to another question: Whether what was done was or wasn’t torture.

Those of us who want the U.S. behave consistently with our own laws and international treaties lose the debate if we go along with this diversion. In doing so, we seem to acknowledge that it’s OK to inflict some level of pain and suffering—beyond what is necessary for apprehension and confinement.

It’s not doe-eyed liberalism to prohibit unnecessary pain and suffering—of any kind and degree—unless it’s incidental to apprehension and confinement. The difference between what we should and shouldn’t do resides in our intention in doing it. The advocates of torture talk a lot about distinctions. So here is a legal one: It is like the difference in criminal trials between the mens rea (state of mind) of the defendant and the actus reas (criminal act).

Did the interrogators come to the prisoners with the intention to inflict pain and suffering? If so, in my view, they were wrong, and what they did was contrary to our values and system of justice. If the interrogators did so, they were doing retribution, not intelligence work.

Thiessen’s argued that he knows that the harsh interrogations provided necessary additional information. But there is no objective way to prove that assertion. It is just his guess. And many people with a lot of experience in interrogations make the opposite guess.

We should not be debating whether it’s OK to inflict additional pain and suffering in order to obtain information. As one caller said in confronting Thiessen, “We prosecuted and hung people in World War II for committing what was done…. For us to torture people, we’re no better than al Qaeda.”

But that’s just a guess, and it’s quite possible that this guy could be doing something completely wrong.

I’m referring to Treasury Secretary Timothy Geithner, who testified today before the Congressional Oversight Panel for Economic Stabilization. I listened to his testimony on C-SPAN this morning.

The panel is supposed to oversee the efforts of the Treasury to keep the banking system working and credit flowing. The department is spending hundreds of billions of dollars, and the panel is trying to make sure the money is well spent. So is it?

Can’t tell yet. That’s the long and the short (no pun) of the secretary’s answers to the panel’s questions. He didn’t reveal much about how anything was being decided with respect to TARP or TALF or the other efforts to get credit flowing.

Instead he made three main points, it seemed to me, and repeated them.

1. The department is being guided by doing what’s good for the economy as a whole, even if that means that the dollars tax payers are providing to banks and other companies are put at risk and may be lost. And even if some institutions and individuals that may deserve to fail are being rescued and rewarded.
2. He was not at this time able to give specific criteria for deciding when and who got funds or got to pay them back. Much was in process of being assessed and developed. For example, the bank stress tests were still underway. But the decisions would balance the welfare of the economy against the interests of the parties involved.
3. He does not intend to nationalize banks. He wants to involve the private sector in the recovery process as much as possible by providing government backing and guarantees.

He also said he would make himself available to the panel again in the future.

Nothing he said provide assurance that any of it would work, I thought. Geithner seemed to revert to the characterologic nerdiness of his pronouncements in the first days of the Admininstration, rattling off responses that I sometimes found incomprehensible. It was unlike some of his more recent public appearances—on the Sunday talk shows, for instance—when he seemed to make an effort to speak in plain English.

But what gives me hope that he may have found the right path to recovery were the opposed positions of the representatives of left and right on the panel.

Speaking for Republicans and the right, former Sen. John Sununu wanted to make sure that the government did not plan to nationalize banks by converting preferred stock obtained from banks in order to loan them money into common stock which could give the government ownership. He also wanted the banks to be able to give the money back if they chose.

On the other side, Damon Silvers, a chief lawyer at the AFL-CIO, thought that the government was taking on too much of the risk in its partnership with private investors. The plan to purchase “toxic” assets was a bad deal for the government, he thought, since it would suffer most of the loss if the securities turned out to be worthless. But the private investors would lose little because of the government’s guarantees, while they stood to reap windfall profits if the assets proved worth more.

I concluded, after Geithner and his questioners were done, that if the representative of the right thought the private sector might get a bad deal, but the representative of the left thought the same thing about the government, then maybe the Treasury secretary is steering a good route down the middle.

They were held in the middle of a bad recession with unemployment rising. The date was April 15, the tax filing deadline, when people are reminded how much of their hard-earned money is taken by the government. And the government had just paid out hundreds of billions of dollars to bailout the financial geniuses who got us into the crisis. And so, tens of thousands of people all across America got out to protest against all of that.

Should we have been surprised at the turnout? Promoting the tea parties, as Fox News and Republican and conservative operatives did, was a no-brainer for those politicos at a loss how else to regain momentum. Taxes always stoke resentment, especially at times like these, and the right wing has sucessfully raised the anti-tax banner and drummed up support with this issue for four decades.

But right now America needs someone or some group to rally the public in support of taxes. Doing that will take a bit more brains. The reality is that taxes are among the finest things our government does for us. With all our faults as a nation, I believe we remain the world’s best hope, as Lincoln said, for freedom, prosperity, and justice for all. Our taxes are an essential reason we can be that hope for ourselves and the rest of the planet.

Lincoln spoke also of government of, by, and for the people. We all like the “for” part, of course. But what is meant by “of” and “by.” Those words imply that a nation like ours requires a social contract between the government and the governed, and as part of that contract, the governed people must not only give consent but also financial support to their government. Taxes are a vital part of how we sustain our nation and how we act together as a society to continually recreate this wonderful country of ours. Without taxes we would live in a Hobbesian state of nature with everyone fighting for survival.

Our taxes aren’t out of line with those of other nations. As a percentage of domestic gross product, the U.S. government received 27% in 2005, compared to 36%, the average of 30 developed nations (Tax Policy Center, Brookings and Urban institutions).

Americans do not need to keep hearing from Republicans and the political right that taxes are the worst thing besides death itself. That’s a brainless slogan from a party that has not shown recently that they have much.

Americans need a smarter group to put out the message that taxes are good, they fund good government and good work, and that without them in good measure, this nation that we love will not survive.