Cologne and The Graft vs. Host Reaction of Immigration

In transplant medicine, there is the curious response called "graft vs host" in which immune cells contained in  the donor organ actually attack the recipient, rather than the recipient's immune system attacking the donated organ as "foreign."

What Germany., France and, to a far lesser extent, America are dealing with is whether or not we face a "graft vs host" reaction. 

The events on New Year's Eve in Cologne suggested the transplants from Syria and Turkey have found themselves to be strangers in a strange land. Groping, even raping un-escorted women in Tahrir Square, in Cairo or in the market in   Saudi Arabia,  may be considered a social norm, but it is not acceptable behavior in Cologne.

In France, the Muslim population has never been accepted fully into French life, as the origins of these people were mainly North African, Algerian, and they were more or less isolated in the suburbs of Paris where rather than thriving, they festered.

Speaking on NPR about his new book about US immigration policies since the 19th century, Tom Jelton notes that until 1965 the United States favored white, primarily Protestant,  Northern Europeans over Asian, South American immigrants. So while the quota on people from China or El Salvador might have been 100 a year each, 50,000 a year were allowed from England, Scotland, Ireland, Scandinavia.  This kept the country white.

After World War II, some Americans felt badly about having turned away boatloads of Jewish refugees fleeing Hitler, and attempts to change the quota system were launched in Congress and failed. Lyndon Johnson, in his early years in Congress voted to maintain this racial bias, but 12 years later, as President, in 1965, he pushed through a change. The change was actually fashioned by a conservative, who suggested the idea of keeping families united, so rather than having an advantage if you came from Sweden, you had an advantage if you were living in the country and you wanted to bring over your wife and family. 

Of course, the idea was if you had lots of Swedes already here, they would bring in their family members and the racial balance would remain stable. But it didn't work out that way because the Scots, the Swedes, the Norwegians, the Germans and even the Irish living in America found their family members who wanted to come to America had already come over and those who remained in Europe were happy there and so it was the South Americans, Asians and Caribbean people who were here who were able to import family members.

Now, we are faced with folks of Middle Eastern descent in the upper Midwest who want to bring in their relatives, who are desperate to escape the cauldron that has become the Middle East. 

The Donald tells us this is a huge threat to America.

He is, of course, pandering to the worst demons of our soul, but we should, in quiet moments, reflect that even in the most hideous and repugnant lines of thought, there may be some ideas we need to examine.  It is true some second generation Middle Eastern kids have got on planes to go fight for Isis.  But we have not seen the sort of Tahrir Square episodes in American cities. 

In "The Serial" the Middle Eastern mother storms into a high school dance to drag away her adolescent son who she thinks is being contaminated by the free love of a high school prom, where girls are present who do not have a male family member to protect their virtue and where music is played and, horror, girls dance with boys.

We do have among us people who reject us, reject our values. But the Muslims are not the first who have done this: Orthodox Jews, and even Catholics have rejected prevailing American values about pre marital sex, contraception and the proper behavior of males and females.

What we have going for us in the United States is we accept the idea that you parents may have been born in Lebanon or Egypt, but if you dress like us, talk like us, go to our schools, play on our teams, you are as American as anyone else.

It's only Republicans who believe you do not qualify if you worship Allah rather than Jesus.

Voting for Bernie, Hoping for Hillary

Here's how rational Mad Dog is:  He is voting for Bernie in the NH primary but hoping Hillary wins the nomination.

Voting with the heart, but hoping with the head.

During last night's debate, one exchange solidified Mad Dog's shift in thinking Hillary would make the better President:  Bernie laid out the case for a single payer, Medicare for all--it would cost less overall; it would include the 29 million still not covered; it would simplify a byzantine system. It would be fair and fair is nothing our American health care system ever has offered. 

But Ms. Clinton responded with the straightforward realist's response: Even when we had both houses of Congress and the Presidency, we could not get the single payer option attached to the ACA. Not even as an option.  The votes simply were not there.  There simply were not then, are not now, will not be in the foreseeable future enough votes for Medicare for all. 

As Paul Krugman points out in today's NY Times, there are simply too many people with too much to lose in this fight. All those people with Cadillac policies through their work places are doing better than Medicare would do for them, and Medicare is a very good insurance, just not the best possible. So, it's not fair--you work for General Electric and all your prescriptions are covered; you work for General Aquatics and you have huge copay's. 

There is also the problem of transition. You've got millions of people who are providers who have borrowed for medical and nursing schools, invested in loans, taken the risks of signing office leases, equipment leases, who would fear going belly up financially if Medicare for all slammed in and cut compensation. All those doctors with huge student loans, all those doctors with 10 year leases on office space which puts them on the hook for millions of promised payments. The web of finance and borrowing which supports the current doctors, nurses, hospitals, offices, free standing clinics would wobble under the earthquake of such a revolution.

And that is the nub of it: Bernie really is talking about a revolution and Hillary is talking evolution. 

Even Medicare began small, and got added to incrementally, year after year, until most of the kinks were ironed out. 

Even if Bernie can win, would Mad Dog really want revolution, at this stage in life?

It's the old case of the thrill and seduction of someone who sets you dreaming and gets your heart pounding vs the quiet realization that once that night is over and you wake up in the morning, there is still real life to lead.

Guns and the Paranoid Style of the American Psyche

"Power grows out of the barrel of a gun," said the Chinese revolutionary, Mao Tse Tung.  
"A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed," said the revolutionary Americans who wrote the 2nd Amendment. 

Apparently, the importance of guns to a sense of power and a sense of security against those who may wish us harm is cross cultural.

With 300 million, imperishable guns at large in America today, one has to ask what the point is in trying to prevent more people from getting guns.

One might argue there is some benefit to reducing the number of guns just as there is benefit to reducing the number of nuclear weapons, if only to make these destructive elements less readily available to the nearest maniac, but neither premise has ever been proved. 

It strikes me as reasonable that restricting where guns can be hauled around makes some sense, if only to impede  the rash, impulsive decision for a man or woman who feels enraged or threatened to pull a gun and shoot.  Guns at a football stadium among a throng of drunken fans does not sound like a good idea and the power to restrict access to the stadium generally resides in private, commercial hands, who are worried about the bottom line, which would not be enhanced by a mow down at the next Patriots game. 

New Hampshire state Representatives have made fools of themselves by insisting guns be allowed in the state house.  It's important, apparently, for Representatives of the people to pack heat while they argue with each other about whether or not to make the Red Tail Hawk the state bird. Never can tell whether someone will get so worked up he will charge across the floor and attempt to behead someone who thinks that hawk is pernicious and should be the mascot of Planned Parenthood, but not the state. (Because, you know, the bird rips apart its prey, unlike other more decorous birds, who simply peck.)

Then again, New Hampshire Representative rarely pass up an opportunity to make fools of themselves.

In New Hampshire, last I looked a the law:
1. If you walk across someone's lawn uninvited, you are trespassing. But if you walk across that same lawn, carrying a rifle, you are not, because you are hunting, and that is specifically protected by state law. The homeowner, or the owner of the woods in the back of his house must post "No Hunting" signs.  
2. It is legal to fire a gun within 300 feet of any house in New Hampshire, if you desire, especially if you are trying to shoot a raccoon or a skunk, or perhaps a Red Tail Hawk.

3. It is legal in New Hampshire to shoot across any road to kill a deer or moose or skunk on the other side with 8 specific exceptions, including, Rte 95, Rte 93 and Rte 101. I forgot the five other roads.

Whatever the approach to gun violence, it will be at least partly ineffective--that we must accept.  Gun violence is a part of America and has been from the start.

Exactly what sorts of gun violence we will try to prevent, or can prevent, is the real discussion. We'll never prevent the lunatic who, using the element of surprise, shows up at a schoolyard or a shopping mall or movie theater and starts firing.  We might make it more difficult for him to kill lots of people by limiting his choice ordinance, and even die hard gun lovers would likely agree on limiting access to grenades, howitzers and atom bombs, but that particular form of carnage will continue no matter what we do.

Hand gun violence, which occurs on the street, usually in connection with robbery or adolescents who feel disrespected, or enraged fathers/ husbands will likely be beyond our control.

There are no simple solutions and background checks, limits on assault rifles will likely have minimal impact  on certain types of events (e.g., street corner shootings, spousal and domestic shootings) and liberals will continue to look clueless after each new incident, as they sputter in impotent rage.

Is Our Economy Rigged?

What We've Become

When Bernie Sanders shouts "The Economy is Rigged"  a full throated roar goes up from the crowd. I'm one of those roaring.

Because the Economy is "Rigged"

Why? Because many of us feel that a few have been unjustly and disproportionately rewarded, while the many have been unjustly denied the benefits of a rich economy.

This is called "income inequality," which, if you think about it, is the essence of capitalism and a non communist state.  But the rule is supposed to be, those who deserve more get more, while those who deserve less get less, or to put it as politicians put it, if you play by the rules, work hard, you'll get yours.  

All of this is, of course, so simplistic as to be dangerous. 

Reading about income inequality, there are 6 much discussed hypotheses for why incomes have diverged:
1. Globalization: which subsumes the notion Americans are being driven down by competition with slave wage 3rd world economies, China in particular
2. Skill based technology change: the unwashed, uneducated masses aren't worth much in today's computer driven economy
3. Superstar culture:  which structures all the big bucks going to the star quarterback while the linemen who make his success possible go unrewarded
4. Immigration of less educated workers: who take jobs from uneducated Americans
5. Changing institutions: loss of labor unions to demand a greater share of profits and take them from stock holders and CEO's
6. Policy changes: mostly taxing the rich at lower rates.

Apart from economists, who review big data, most of us have to understand these forces as we see them in our own lives. We have the "worm's eye view" not the eagle's eye view of a Paul Krugman or James Surowiecki.

From my own worm's eye view, I have three stories which appear to be revealing, at least to me:
1. The CEO story:  which essentially means to me the CEO's and their decisions I have seen up close are incompetent and inadequate and yet they get paid as if they were successful.
2. The hoi polloli story: in which the efforts and mindset of the workers at the lower end of the scale are simply inadequate and tend to perpetuate their "loser" status
3. The certificate story: in which the advantages of high levels of education are arbitrary and unrelated to the actual value of these workers--what one might call the "value gap" in economic reward which is built into our corporate, financial and governmental systems.

To describe each of these in detail would entail a marathon blog post, so I'll simply start with the last one, and I'll get to the other two in subsequent blogs. 

In medicine, to make higher levels of income, you need more and more "certification" i.e., you have to pass more and more exams, each of which is claimed to validate your claim that you have a higher level, usually a more specialized level of competence, and this entitles you to more money because you made the investment of the time and effort to become this more finely tuned producer. 

Medicine is set up this way, starting with your organic chemistry certificate and working through your MD.  If you eventually certify in opthalmology, you are ready to start saving eyesight in patients.
Or, you can also do the most profitable of all procedures: laser surgery to correct myopia, LASIK.  When you do that procedure, you do not need any of the stuff you learned over the prior 10 years; you need only to know only how to operate the computerized machine which does the LASIK surgery.

There are many specialties like this:  Gastroenterologists need to progress through the BA, the MD, the basic training in internal medicine before they can be "board certified" in gastroenterology, which allows them to learn colonoscopy, which they learn in about 6 months,( and which a high school graduate or a smart person with no high school could learn in 6 months,) and reap the huge benefits of a procedure which bills at $2500 a pop.

So, you have the Mount Sinai School of Medicine medical student who is called in by the Dean and asked why he turned down the internship at Harvard/Mass General and he says, "In 5 years, I want to be doing 6 colonoscopies from 7 AM until 1 PM and out of there, on the boat with my wife and kids. I don't need to slog through Harvard for that. I can train at Southern Florida community hospital, learn colonoscopy and be there."

What that medical student saw clearly was that all the talk about becoming the best physician you can be, learning as much as you can in the precious years of medical school and post graduate training was hogwash in his value system. He went into medicine to get rich and becoming a good doctor had nothing  to do with that goal. Colonoscopy gets you rich.

Commerce is not about morals. Commerce is about making the most money you can as quickly as possible.

The system supports this thinking.  The truth is, colonoscopies, LASIK surgery, most dermatology procedures can be done by the proverbial "highly trained chimpanzee" but those are where the money is. In medicine, you have to progress through irrelevant steps, earn your merit badges, pay your dues, until you finally can get to the more or less mindless skill which makes you rich.

Medicine has now got the "ROAD" to happiness--jobs which pay $500,000 to $1 million a year for work which is less demanding in terms of time and effort than family practice or primary care--Radiology, Opthalmology, Anesthesiology and Dermatology. 

It's a system which does not reward according to the rules of "talent" or "hard work" but which exploits the  capitalistic reward system on which our  American medical system is based on.

The rich, in this system are not the hardest working, most talented but the shrewdest exploiters. In that sense, it's a "rigged" system. It's also a system which ensures there will be only a few high earners at the top, because there are only so many slots for training programs in the "ROAD" specialties, which ensure the supply of these services remains tightly controlled.

If we had a true "free market" system, then anyone who could master the techniques of LASIK or colonoscopy could set up shop, with or without a MD, and the stranglehold of supply would be broken and you could get your procedures done for $150.  Milton Friedman would likely approve. I heard him interviewed years ago, and he asserted we don't need a FDA monitoring safety of medical products in a free market system. Poor products and poor actors will be sued out of existence.  

Of course, there would be some carnage before the bad actors got eliminated.

But there you have it: A rigged economy, rigged by "certification" and a process which requires irrelevant hurdle jumping by a lucky few, a tightly controlled supply of services,  and disproportionate reward for those who provide those services. 

Oh, the Company We Keep

Get Angry, Hillary.

 This morning, on CNN, I watched Hillary Clinton's Town Hall meeting from South Church, Portsmouth.

What struck me was the difference in the crowd at Portmouth from those shouters at the Trump rallies. Are these two sets of citizens even inhabiting the same nation?

Even the setting was so un Trump: South Church is just so pretty, so warm, so welcoming. There were poinsettias in the background. (Not to mention the sign: "Don't believe in God? That's okay. We welcome everyone.")

Hillary kept getting questions from women and children. Someone asked about helping students burdened by student loans. She did not answer that we bail out Wall Street banks, but we are not willing to forgive or restructure student loans for struggling middle class students.  One woman asked what Ms. Clinton would do for her mentally ill son.   Another asked what Hillary  would do to stop hand gun violence. Another woman stood up and said she taught art in prisons to women inmates and what would Hillary do for women prisoners of color?

Everyone wants something. 

Most of the questioners had a sob story and they wanted Hillary to save them, as if they were beseeching Jesus incarnate. Their voices dripped with pathos; at Trump rallies we hear voices filled with rage.

Hillary was trying hard to project warmth and empathy, which she has doubtless  been told, is something she lacks and needs to work on. I don't think she needs to work on that much longer. She needs to work more on "angry."

I could only imagine what any Trump supporter watching all this would be screaming at the TV:  Get a job! A real job, not a government job teaching criminals how to finger paint in the lock up! And why should I care about your student loans from Pheonix University or Hesser College where you studied dance?

The people Hillary had to project warmth toward are not the people Trump supporters care about. Well, Trumpies do care about them. Trumpies  want them locked up.

Trumpies have problems of their own.

I did reflect, listening to this crowd, how much I'd like to hear Hillary say, what I think Bernie would have said: 
 "Look, government cannot solve every problem. 
But we can solve basic problems and if you solve these basic problems,  a lot of these other  problems solve themselves.
 If we had income equality, if we'd stop this senseless 'war on drugs', if we started treating drug addiction as a public health problem,  not a crime against society, well then we wouldn't have all these women locked up in the first place.

 If we had jobs  that paid a living wage, then we wouldn't have 25% of all Black males with a criminal arrest record. Mr. Trump says we pay our workers too much. Well, from the perspective of a rich 1 percenter, I'm sure we do. From the point of view of the hard working men and women, working 2 or 3 jobs, I'd have to say Mr. Trump ought to spend more time on this planet, and less flying at 30 thousand feet above the planet  in his private jet.

 If we cared as much about the average Joe as we care about the upper 1/10 of the upper 1% then we'd have jobs and dignity for the middle class."

Someone asked about the climate change thing recently signed in Paris and Hillary gave a very entertaining answer about when she and President Obama tried to get something done in Copenhagen at that previous, failed climate change conference, where she and Mr. Obama chased the Chinese delegation all over the convention center. 

She struck a glancing blow at the Republicans who say they don't know about climate change, that they aren't sure climate change is real, and they always   say, "I'm not a scientist."  Hillary said, "Well, then, go talk to a scientist."

Really?

Of course, she missed a golden opportunity to say,

 "You know when Donald Trump says he's not a scientist, so he can't say for sure human activity is causing climate change, that's a cop out. That's just so disingenuous. 
Do you really expect anyone to believe that, Donald?  
Roosevelt didn't say 'I'm not a scientist' when they came to him and said, 'We need a nuclear bomb because the Germans are working on one.'
 Eisenhower didn't say, 'I'm not an traffic engineer,' when he proposed an interstate highway system. 
That's your job as President, to make decisions about stuff you don't know enough about, but you know who to ask, and you educate yourself enough to make a decision and to choose sides!  
Of course, Mr. Trump is enough of a scientist to tell you vaccines cause autism. For that, he's a scientist. The fact is, it's not that he's not a scientist. The fact is: he's just not very bright."


That's what I'd like to hear from Hillary. 
Fact is, we get closer to this with Bernie.
Hillary, win me over.

Orwellian Trump

"And the creatures outside looked from pig to man and from man to pig and from pig to man again; but already it was impossible to say which was which."
--Animal Farm, George Orwell

The Quagmire of Culture: Radical Islam

A friend, returning from Afghanistan, told of arriving at a village where, a few hours earlier,  the Taliban had beheaded a school teacher in front of his class for the offense of teaching girls. The blood on the ground outside the school house was still coagulating.

I had asked him why he had chosen to work on a project in Afghanistan, when it clearly posed a threat to his life. He used that story as an answer: He was saying we must resist such evil.

He was into "nation building" which is to say, he was into the idea of changing a people's culture.

Republican candidates now speak of denying "safe havens" for terrorists in Somalia, Afghanistan, Syria, Iraq when, across the border in the sovereign nation of Pakistan, lived Osma Bin Laden in the best safe haven of all, and consider that  the 9/11 conspirators lived in Berlin.

Bernie Sanders has called Syria and the whole Middle East, "a quagmire within a quagmire."

We lost in Viet Nam not because, as the gun toting Republicans will tell you, "Because the liberals wouldn't let us win," but because we were an alien culture there and we could never gain the support of the very people we said we were there to liberate.  We tried to "lay a little American freedom and commerce on them," George Carlin said. They weren't ready for it, not for another 30 years.

Today, in the New York Times is a story about a woman beaten to death by a mob.  I assumed she was just another woman who sought refuge in a shelter in Afghanistan because she had the audacity to run away with the man she loved, away  from her family and the husband they had  selected for her, another story about a father murdering his own daughter or a mob doing it for him. But  no, this particular woman had the temerity to object to men defiling a shrine.  There was likely some justification for the murder found in some sacred text. (Even the New Testament speaks of stoning a woman to death for sexual transgression--Jesus neatly side stepped the issue by saying he who has no sin should cast the first stone.)

Afghan police keep young boys boys chained to iron beds at their police compound so they can use them "for pleasure" at night. Unable to bear the screams of the children, an American captain tried to beat the hell out of the police chief, only to find himself drummed out of the Army, for the crime of having stuck his nose in where it didn't belong.

Of course, the issue is, where do any of our American noses belong in Afghanistan, Syria, Somalia, Iraq, Lybia or any of these cultures we do not understand?

Christopher Hitchens has argued that religion is the great poison which defiles life on earth. I cannot know, but I suspect it is culture, and religion is only the excuse or the organizing principle. 

It is true that people need some rationalization to commit acts of extraordinary cruelty. Among any population are people who are sadists and psychopaths who live for the opportunity to stone someone to death.  They are unemployed and have nothing better to do than run out and join a mob to stone a girl to death. The best entertainment in town--plus you get your virgins in heaven for participating,

So where does this leave us, here in America?  

I would never claim we should forswear all foreign interventions.  Going to war against Hitler was a good idea. It is true, you could have argued then, as I am arguing now,  we should  never have expected to reverse the culture of the Third Reich, which would send women to concentration camps for marrying a Jew.  But Germany had a capital and flag and a defined set of borders and an army in uniform. That war was a huge undertaking, but doable. 

What about the argument it's better to fight them in the streets of Baghdad than in the streets of New York?  A catchy phrase, but empty and essentially stupid--fighting them in the streets of Baghdad does not mean you will not have to fight them in the streets of New York. If only. Wishful thinking. Oh, we'll bomb the whatever out of them. We'll make the sands of the desert glow.  

How the dirtbags of ISIS must smile to hear that sort of talk.  The bleating of the impotent. They know there is nothing for the Americans to bomb. Their power is in stealth, not munitions factories, in bank accounts, not massed columns of tanks. 

From British officers in colonial America to Wehrmacht officers in Czechoslovakia, to the French in Algeria and Viet Nam, invading armies have complained about stealth attacks from native partisans who fade back into the local population. There is no successful strategy to defeat a determined local guerrilla force.

Listen to the Lyndon Johnson tapes as LBJ asks his most trusted adviser, Senator Richard Russell of Georgia, what Johnson should do about Viet Nam. "Well," the senator tells him, "You really don't want to stay in Viet Nam, do you?"
"Hell, no," Johnson says. 
"Well, them boys on the other side, they know that, too."

John McCain has thought this out. He says we should send an army to the Middle East,  like the army of the Roman Empire, prepared to rule for 150 years, if necessary.  That's what "winning" will look like.

I wish we could free women in Afghanistan, Iraq, Syria, Egypt, Libya, Iran, Pakistan and Indonesia from their bondage.  But freeing the slaves in a well defined area of the continental United States took four years and cost more lives than the United States has lost in all other wars put together. And that war ended in something that looked like victory, only to continue for another 100 years in the hearts and minds and public schools and toilets and restaurants of the South.

A policeman in "The Wire" once observed the war on drugs is no proper war at all because wars end. Policing, however, continues forever. If we had spent the trillion dollars we spent on Iraq on American intelligence and police, would we have detected the 19 "martyrs" of 9/11 before they got on the airplane? Possibly. The problem is, all the money in the world will not solve a problem if organization and intelligence is lacking. Here you have men who take flying lessons in Florida who are not interested in learning how to land the aircraft. That didn't catch the attention of the flying instructors?  And if it had, would our FBI, or CIA or FAA been smart enough to act? 

Could we have detected the shooters at San Bernadino?  Can we predict a shooter at a Denver Planned Parenthood or at Sandy Hook? 

If a group of men meet mysteriously in a motel or an apartment to plan the next attack with a dirty nuclear bomb or Saran gas, will the neighbors notice and if they do will they know to whom and how to report it? And if they call the Hampton police department, will the Hampton police know what to do with that information?

Well, Ted Cruz will tell us he has the answers. Clearly Donald F. Trump KNOWS he has the answers, as do all the rest of the Republican candidates. It's only Mr. Sanders and Ms. Clinton and Mr. O'Malley who are in the dark about what to do about "Radical Islam"  or the next Planned Parenthood shooter, or the next Sandy Hook shooter, all of whom I place in the same category. 

My friend, who had just got back from Afghanistan, so appalled by the beheading of the school teacher, went off to fight again against another evil empire--this one not Islamic. He wound up in a foreign prison for five years, although, ultimately, his life was spared. 

The lesson I drew from that: Passion, outrage, even righteousness is not enough. 

As Bernie Sanders said in the last debate, using his finger to point to his grizzled head: "First and foremost, we have to be smart."