Sunday, September 27, 2020

Ruth Bader Ginsburg Lights the Fuse

Before Justice Ruth Bader Ginsburg’s death certificate was signed, Judicial Warfare commenced.

Both sides, of course, were prepared for this moment.  Justice Ginsburg, seemingly indefatigable, was well into her ninth decade and had numerous collisions with cancer.  It’s cruel, but entirely expected, that the nation was not given a proper opportunity to honor her legacy and accomplishments which should command admiration from all Americans.  One need not agree with her judicial philosophy or her opinions to admire the breadth of her accomplishments, her work ethic, her intellect, her vision and her humanity.  Indeed, her storied friendship with the late Justice Antonin Scalia shows a nation overflowing with anger what is possible.

The efforts to recall her legacy were soon subsumed in partisan warfare.  The Democrats accused the GOP of monumental hypocrisy as they juxtapose their statements in 2016 when Judge Merrick Garland was nominated to their current proclamations that confirmation must now go forward.  The GOP, brushed this flip flop aside with some slight of hand claiming justification to proceed now since the Senate and the president are of the same political party.  I can barely grasp their point even after engaging in rhetorical contortions followed by linguistic acrobatics. 



Senators McConnell and Schumer Sharing Love

So, what’s next?  The GOP are poised to achieve confirmation prior to the presidential election.  Perhaps, this effort should be called Operation Warp Speed, instead of the COVID-19 vaccine development.   The Democrats can’t stop it but they won't soon forget this power grab!  If they capture the Senate, particularly with the rise of the political left wing, they will be pressured to consider adding justice seats or curtailing the justices’ lifetime appointments with shorter terms.  They will demand measures to ‘balance’ the court.  (Read:  install justices who will likely make rulings that Democrats want.)   Democrats are also understandably fueled by the shameless stiff-arming of Judge Merrick Garland 4 years ago.  If Biden wins, Judge Garland's Supreme Court opportunity may be rejuvenated.

And, then what happens when in the future the GOP recaptures the Senate?  For a hint, consider the words payback, retaliation and revenge.

But, let’s remember that the judicial fuse was first lit by Democratic Senator and Streetfighter Harry Reid who abolished the filibuster for confirming judges at all levels of the judiciary below the Supremes. 

Look, each side blames the other and crafts their own supportive narrative.  Here’s what I think.  If the Democrats retake the Senate, they should restore the filibuster for all judges at every level of the judiciary.  Our best chance to lower the hyperpartisan temperature, to foster collegiality and to achieve more balanced courts is to restore the status quo ante when both parties had to cooperate.  With the filibuster, neither side will be able to install extreme candidates as 60 votes will be needed for confirmation.  Indeed, the filibuster is a deep senate tradition that gives the minority party influence.  If the Democrats take over the senate, they might eliminate the filibuster entirely - a true nuclear legislative option - that would create more enmity between the parties, if this is even possible.

What is the probability that the Democrats would pursue my high road strategy if they take over the Senate?  Probably as likely as Senator Mitch McConnell inviting Senator Chuck Schumer to his porch on a lazy Sunday afternoon to shoot the breeze as they sip Kentucky bourbon. 

No, the Democrats will be out for blood.  And so the cycle will be perpetuated.  And who will be the real losers here?

 

Sunday, September 20, 2020

Stopping Coronavirus on College Campuses

Perhaps, October 31st will be an inflection point in the pandemic since more folks will be wearing masks on Halloween.

I assume that the annual ritual of trick or treating will be suspended this year, as have so many of our performances, celebrations, concerts and athletic event spectating.   It has been my observation in Ohio that more folks are masking up, although there are exceptions everywhere.  Our governor has directed concern for some rising case numbers toward college youth, who astonishingly haven’t followed the rules.  Just because one is a college student doesn’t guarantee that his decisions will be graced with wisdom.  And, if there is to be any chance that college kids who are drawn toward campus parties like iron filings are attracted to a strong magnet, there will need to be sure and certain enforcement.  What if a college made students aware that violating public health rules would result in expulsion with no refund of monies spent?   Yes, I know this sounds draconian, and it may not always be clear when an actual violation has occurred, but if we expect students to resist all of their impulses, then proper incentives and accountability need to be in place.



News Flash!  College Kids are not Saints!

Let’s recognize that not everyone does the right thing for the right reasons.   As an example, let me offer three reasons why people do not shoplift.

  1. It is wrong to steal property.
  2. It is wrong to commit an illegal act.
  3. Fear of getting caught and facing the consequences.

Once again, if we were all saintly, then laws against theft wouldn’t be necessary.

We have all seen these past months how many folks reject mask wearing and maintaining adequate physical distancing rejecting the advice of health experts and government officials.  I suggest that more rigorous and certain enforcement would have increased compliance.   Remember, we are discussing an issue that has life and death consequences.  A person who prances about maskless and mingles freely with others can cause a death or serious illness of someone downstream who he does not know.  Since the stakes are high, our tolerance for non-compliance should be low. 

How would you bring folks into line who threaten all of us?

 

 

Sunday, September 13, 2020

Dealing with Angry People - Better to Do Right than Be Right

 The nation’s racial upheaval, particularly vis a vis law enforcement, has shown us the value of the skill of de-escalation.   A situation arises and several outcomes are possible, although some are clearly preferred.  The specific technique and approach utilized may determine the end result.  A range of options are often available.  What can make these situations so difficult to unravel afterwards is that an option that may lead to escalation may be deemed to be acceptable, according to the training protocol.  In other words, even the approach taken was acceptable, there may have been a better way.

Obviously, we all endorse training and practices that has the highest probability of bringing calm to a potential combustible situation.   I expect law enforcement – the professionals – to pursue de-escalation as their default mode.  But, the citizenry can and should do its part to de-escalate.   If all parties share the desire for a calm denouement, then it is much more likely that this will be the result.

I realize that my views here may sound naïve and idealistic, particularly as the nation is a cauldron of anger and dispute, but we all have to try.



Even a face mask can light a fuse.

It seems to be that de-escalation has never been more important than it is now.  Who would have imagined that one would need de-escalatory expertise when confronting an individual in a store who is not wearing a mask?  We’ve all had the experience of inadvertently annoying another driver on the road who proceeds to either tailgate within a foot or two of our rear bumper or to display a well-known digital gesture of displeasure? 

Even in my own profession, I am facing a patient and their family who bring anger and frustration into the exam room.  While I may not be responsible for their state of mind, I am responsible in how I deal with it.  Do I want to win the argument or win the peace?

The reason why de-escalation is so critical is because we are suffering from an epidemic of anger.  Our current fractious and divided nation is in part the result of malignant escalation by our leaders, elective officials, interest groups and individuals.  What would life be like here if all of us served as fire extinguishers instead of arsonists?

 

Sunday, September 6, 2020

Labor Day 2020

Labor Day is a time to pause, reflect and to thank all those who keep this nation vibrant. You are the guts of the country.

Labor has battled many adversaries over the decades.  It has sparred with management.  It has railed against 'right to work' legislation.  It has struggled to compete against low wage workers in foreign countries.

But this year it has been sucker-punched by the most formidable adversary that has ever entered the arena. And Labor is still reeling.  And, so are the rest of us.



An enemy like no other

It will be a slow grind, but it will lumber forward.  Yes, we will reach the other side.  How will we get there?  Of course, we will need our medical and scientific community to put the virus in its place.  And everyone will have a role to play.  But, the grit, sweat and determination of Labor will be a major force leading us out of the abyss.



Sunday, August 30, 2020

Why I Don't Tell Alcoholics to Quit Drinking.

 

I have seen many alcoholics during my gastroenterology career.  It is likely in the majority of cases that I was not aware of their abuse history.  Patients often deny or minimize their alcohol history when queried. 

“Do you use alcohol regularly?”

“Only socially.”

At this point the physician and the patient engage in a linguistic tete-a-tete on the precise meaning of ‘socially’.

Patients are more forthright about their habits when they have a medical condition that has a clear an obvious connection to alcohol, such as jaundice or liver injury.  And, if family members are present, they often serve as fact checkers and truth tellers.

What is my approach to these patients?   Do I wave my arms and preach like an evangelist that they should throw their bottles away?   Do I tell them that they must quit or face medical damnation?  Do I threaten to sever them from my practice if they persist with their addiction?   I have adopted a rather different approach.  I do not advise alcoholic patients to quit their drinking.  Yes, I know that this may sound like an abdication of my responsibility to protect my patients’ health, but I do not see it that way. So before you report me to the state medical board, here me out.

I certainly do not endorse or otherwise support injurious addictions.  I wish that everyone could unshackle themselves from their suffocating tentacles.  And I conduct my personal life in a rather abstemious manner with regard to spirits and hard drink.  But, I do not directly implore patients to cease and desist as I believe that they must make this decision themselves as the very first step in their hoped for recovery.  In my experience, all successful recoveries start from within, not from without.  

I lay out the hard medical facts to these patients with clarity and candor.  I discuss the natural history of the disease and the dreadful and irreversible complications that they are at risk to suffer.  I review their available medical data emphasizing that their lab reports and imaging studies may not accurately reflect the depth of injury present in their liver and other organs.  For example, a patient with cirrhosis of the liver may paradoxically have completely normal liver blood tests.