Our Drug Infested Den

I've stopped listening to stories which begin with "Donald Trump." Well, mostly. It just sort of goes to some back room file in my brain when I hear those syllables and I zone out for a while, until something new comes across the air waves.

Pia Guerra

But reading this week's New Yorker, I learned Donald Trump said he won New Hampshire because of his bold and effective approach to the "opioid crisis" in New Hampshire, which is a "drug infested den."

I would not deny we have a problem with deaths from opioid here, although I really don't know for sure. According to the New Yorker's Amy Davidson Sorkin, we had 22 deaths out of every 100,000 attributed to opioid use. How many of those were people with terminal cancer who chose to end their lives with opioids and how those numbers got generated, I do not know. I do know that death certificate data is garbage in, garbage out. But I'm willing to believe we have an opioid crisis.

Welcome to Hampton, Drug Infested

I'm not at all convinced there is anything government or the medical profession can do about opioid use or addiction or deaths. Watch "The Wire" before you object to that. Until you've watched "The Wire" I don't even want to hear from you about this topic.

But opioid use  is not really what this posting is about. 

It's about New Hampshire. 

As Ms. Davidson Sorkin pointed out, Trump did not win New Hampshire. Hillary Clinton won New Hampshire. By about 1,000 votes, but she won.

Pia, again

Which brings me to my actual real subject: Somehow, New Hampshire voters, at least 50.1% of them kept the state blue, and rejected Donnie Dubious.

How this happened continues to be a subject of earnest debate. 

Mostly, probably, it's demographics.  A lot of people who did not grow up here moved to New Hampshire over the past decade.  More of them were liberal Democrats than there were conservative Republicans. Contrary to conventional wisdom, it was not people from Massachusetts who polluted the conservative state of William Loeb's Manchester Union Leader with liberal ideas. Most of the Massachusetts refugees were anti tax conservatives seeking nirvana in a state without a sales or income tax. They live in Nashua, Salem and the Western border towns. 

But others moved in from farther afield, as I did, and settled in the Seacoast or around the university towns like Durham. 

North Carolina has similar enclaves of liberalism around the towns of the Research Triangle, Durham, Raleigh, Chapel Hill.  And, it ought to be noted, North Carolina voted for Obama the first time and recently, in Chapel Hill, a rowdy band of anti racists pulled down a brass statue of a Confederate soldier, without a single human casualty, as police stood by and shrugged. 

More Pia

But back to New Hampshire. 
I don't know how Clinton won the state. 
My intrepid neighbor, a rabid Democrat, born and raised in New Hampshire, from Manchester to Londonderry and now Hampton, worked the phone banks, knocked on doors, talked to people she had never met, stood on lines outside the polls with Hillary signs, and she says, after all that, she is not sure her efforts and those of people who worked hard like her actually made the difference, but she thinks it might have made the difference and she could not live with herself if she did not try.

Hampton, picket fence in the DID

I'm proud to know her.  
Pride is not one of my favorite emotions. Pride leads to all sorts of irrational behavior and it is often misplaced and it is something you feel about what someone else has done, more often than about what you yourself have done. But, still...Somehow I feel better every morning getting up and going on my bicycle ride and thinking, this state voted against Alabama Donald. 

Save Sheriff Joe!

President Snowflake says he will pardon Joe Arpaio for whatever it was he's been found guilty of--violating Civil Rights of dark skinned Arizonans as he rounded up anyone who didn't look American enough to him, to prove he was indeed the toughest sheriff in America.

Sheriff Joe got himself a tank to bring home the point, and paraded it like Kim Il Jung, down the street to show what a tough guy he was.

He also took men who had been arrested in Maricopa County, not convicted mind you, but he decided they deserved some humiliation for looking un-American and being possible illegal aliens, so he made them wear pink underpants and marched them down the street to the jeering Arizona throngs, thereby evoking the London of Dickens or the Paris of the Revolution, where prisoners were subjected to the vituperations of the mob before they were hanged or beheaded.

In doing all this, he earned the undying affection of Donnie Dubious, who likes a tough guy, and who will now pardon Joe for violating the Bill of Rights dictums about cruel and unusual punishment, a presumption of innocence, due process and equal justice under the law.

White Trumpland: All the President's Men

Every day each of us makes a cancer cell or two or three or three hundred, and our immune system, as part of its "immune surveillance" function sees  that, labels it for destruction and then zaps these aberrant cells.

We are such heroes; fearsome, too

White racism is sort of like, that, always cropping up, trying to burrow into a tissue, an organ somewhere and then, hoping to metastasize.

You can speak your mind, if you don't mind getting shot

If you give people immunosuppressant drugs, the malignant cells can see there aren't as many immune killer cells around to suppress them and they start multiplying, digging in, getting bold and happy.

Heroes from a prior decade

If you give the white racist a little less oversight, same thing.

Gather a hundred of these little nasty White supremacists in a room and you have a collective IQ which does not add up to more than 90.  They are there, stoking each other, telling each other how brave and heroic they are and organizing to go to a Trump rally.

Expressing their opinions

That's what we had in Charlottesville, I have no doubt.

That's what we have in that great Alabama of the mindless which exists in every state, out there from Rhode Island to Texas, from Wisconsin to Colorado, from Florida to Maine.

Our forebears circa 1950: The South Shall Rise Again 

It's always out there, but here in the happy shire, we don't have to think about it. Every once in a while a guy drives his pick up truck down Exter Road (Rte 27) with his Confederate stars and bars flag flying across the pickup bed from his American flag, as if there is no contradiction there.

Freedom of Speech Alt right sytle; fire in a crowded theater 

It's everywhere.
The price of liberty is eternal vigilance.

Just here to express our opinion

Charlottesville and the White Supremacists

Recently, statues of Jefferson Davis and other Confederates have been removed from their places around the South.

Robert E. Lee, of course, is the Zeus among the gods of the Confederacy.  Some have argued he would have been a better, more successful general if he were less concerned about his dignity and more concerned about winning--thus his foolish and arrogant charge at Gettysburg, ordering Picket to charge up hill along a mile's open field, he repeat the mistake Ambrose Burnside had made at Fredericksburg, where Lee watched Union soldiers dying in heaps and remarked, "It is well war is so terrible or we would grow to love it."

Don't we look like Robert E. Lee? I feel like a hero.

It's not worth wasting much thought or breath about those little men with their big guns and their camouflage get ups, strutting in the streets of Charlottesville, as if they are fighting the Civil War again, fighting in the war against White people, resurrecting the Lost Cause.  Pretending to be heroes, like those football fans who show up at NFL stadiums wearing their team jerseys with the names of their heroes on the backs--Oh, your jersey says "Brady!" Are you Tom Brady? 

Now Lee is remembered as a saint among saints, a sort of martyr to "The Cause."
But as Grant remarked, as he looked at Lee at Appomattox, as Lee arrived to hand over his sword and surrender:

I felt like anything rather than rejoicing at the downfall of a foe who had fought so long and valiantly, and had suffered so much for a cause, though that cause was, I believe, one of the worst for which a people ever fought, and one for which there was the least excuse. I do not question, however, the sincerity of the great mass of those who were opposed to us.

I am very sincere about my Cause

We can take some sage advice from Unconditional Surrender Grant when it comes to our current state of affairs and our current President to seems to occupy every liberal's mind, to preoccupy every person on every TV news show.  As Grant approached Richmond with his army, his generals kept arriving at his tent, with news of what Lee was doing, or was said to be doing or planning: 

Oh, I am heartily tired of hearing about what Lee is going to do. ..Go back to your command, and try to think what we are going to do ourselves, instead of what Lee is going to do.

I feel the same way today: Stop worrying about what Donnie Dubious has said or will say. Think about your own plans; talk about what you intend to do for the country, for the 99%

Choose Your Apocalypse

As disappointing as the PBS News Hour has been on political reporting, their series with Paul Solman and Miles O'Brien reporting on the financial and scientific aspects of the agricultural uses of antibiotics has been nothing short of wonderful. This long neglected subject is well explored, complete with the interview with the owners of an industrial chicken operation who said they had their scientists look at the question of whether their use of industrial doses of antibiotics could possibly cause any problems in the world of drug resistant microbes.
The owners looked earnestly into the camera and assured the viewing public that their very own company veterinarians and assorted scientists looked into the matter and determined none of the antibiotics the company was pumping into their chickens was causing any problems at all for the chickens, the consumers or the world of microbial resistance. In fact, the antibiotics were being used for the "health of our chickens" the company owners said. And we are all for healthy chickens.

Upton Sinclair observed:  "It is difficult to bring a man to understanding, if his salary depends on not understanding." Thus it is with the company's veterinarians. 

All of these chicken producers, the owners, the scientists were on TV and so visibly, willfully blind to the harm they do. 

It is a wondrous thing to behold, actually, watching people talk themselves into obvious lies. Oh, we have been looking into Obama's birth certificate and you just wouldn't believe the things we're finding. Oh, those slaves were happy to be slaves. They were clothed, fed, housed, just happy, happy, happy.

Ditto for the pig and cow farmers who shove all their livestock into pens, snout to tail and keep them there, standing in their own excrement, developing open sores and infections which they try to prevent with large doses of antibiotics.

The English and most of Europe refuse to import American pork, beef or chickens, pointing to the horrid conditions in which these animals are kept. Of course, the Europeans have financial reasons of their own for not wanting to compete with the American mass production machine, but the Brits have said they don't want to emulate the efficiency of the Americans because it is a ruthless efficiency and cruel. The Germans, after all, were very efficient at Auschwitz, moving the cattle, branding them, disposing of those who could not be worked. 

Americans have turned living, sentient beings into industrial production centers, packed tight, unable to move, fed, slaughtered and packaged. And with all that crowding, infection control demands industrial doses of antibiotics, and with that, drug resistant, pathogenic E. coli and a variety of super bugs.

And meanwhile, your local doctor is spending hours on the phone with patients who are demanding antibiotics for their viral sinus infections, which the antibiotics will not help but the patients want them and the doctor is determined to fight the good fight and prevent the overuse of antibiotics, so he fights on, patient by patient,  saving a 500 mg dose of antibiotics while the cow and pig and chicken farmers are pouring tons of antibiotics over the land every day.

Bacteria do love to mutate around whatever antibiotic we bring out to hammer them with. The agribusiness giants are out there looking at their ledgers and their private bank accounts. They don't care if humankind dies off with infectious diseases, just as long as there are enough customers left to fatten the wallets of the corporate owners.

The great American business creed.

The big question is which will get us first:  superbugs resistant to all antibiotics or global warming with the North Pole melting and all Santa's elves drowning.

Democrats Wimp Out in the Game of Thrones

Pray tell, who were those guys with Chuck Schumer talking about a "Better Deal?"
Teddy Roosevelt had the "Square Deal."
Franklin Delano Roosevelt had the "New Deal."
And now, the best we can do is a "Better Deal?"

Oh, well, it's not Trump's deal. It's better. It's not good. It's not inspiring. It won't bring you health care or a job or a chicken in every pot, but then again, do we really want to wring the necks of a million chickens?
It's maybe an okay deal. Or a pretty fair deal. Or a better than nothing deal. Or a sort of pretty good deal. Or, how about a better than the crummy deal you had got.


Sad to say, this is no surprise.
You know how when you got to know your kids' friends, and there was this wimpy little guy with arms like pencils who would make Woody Allen look like Arnold Schwarzenegger by comparison, and when you met his parents at the PTA you knew the kid never had a chance.  HIs parents begat what you would expect them to begat.


Well, that's what it's like when you go to meetings of local Democrats, with some happy exceptions. But, for the most part, the Dems are just such jellyfish.

They ooze displeasure with Trump. They do not explode with it.


We have some forceful, energetic, warrior types, but most of them are older and tired.


Listening to a former United States Senator, now retired, I wondered--in what electoral cycle did this guy ever manage to get elected?  He still thinks of himself as a dreamy guitar playing folk singer whose idea of force is getting teary eyed as he works himself up into a passion about being for the little guy and the common man.


We have meetings where sharp contrasts and incendiary conflicts emerge:  A group of Free State Project people arrive for a presentation by a professional Democrat who makes her career giving presentations about the Free State Project. The presiding officer makes sure there is no real confrontation between her and the FSP people.

A bookclub is organized to read and discuss books like "Dark Money"  which contain enough incendiary material to light any room afire, but a professional "facilitator" is hired to "guide" the discussion with talking points and pre formulated "questions" like the questions at the back of the grade school  textbooks: Compare and contrast the Republicans and the Democrats;  what were the author's themes? How well did the author substantiate her points?
Look around the room and take the pulse of the attendees--if you can find a pulse in any of them.

Where is a Rough Rider when you need him? Where is a leader who can rally the troops in the heat of battle? Where is Phil Sheridan or Richard Winters or Teddy Roosevelt or Martin Luther King or Gloria Steinem or anyone with at least a patina of charisma?

Why is it so difficult to find someone?

I love Bernie, but fact is, he's too old.

We need to pass the torch, but to whom?

Failure of the Profit Motive in Driving Good Medical Care (Part 1)

An article of faith among every Republican is the profit motive is the best possible driver of human behavior. From Ayn Rand to Paul Ryan to Mitch McConnell, every deep red Tea Party Republican believes what Ronald Reagan preached, the "9 most scary words in the English language are, 'I'm from the government and I'm here to help."

It's a catchy and absolute simple minded concept, but it's dead wrong when it comes to medical care.


As Alexandre Yersin once observed, when asked why he did not practice medicine--and he was a fabulous physician who discovered the cause and first treatment for bubonic plague--he said, "I simply could never bring myself to say to a patient, 'your money or your life.'"


Examples of this come up daily in every doctor's office, but I'll start with a first installment which occurred at a bar.


I was telling a guy who worked for a major health insurance company about this patient whose father, brother, sister and paternal aunt had all died of colon cancer before the age of 50.  I advised him to have a colonscopy but the insurance company rejected this because he was only 46 years old.  The company official explained the company does not approve or pay for colonoscopy before the age of 50. When I asked why they said the rate of colon cancer deaths does not skyrocket until age 50. The curve of deaths rises abruptly only after that age.
"But this guy does not want to be on the DEATH curve," I pointed out. He wants to get to that polyp with the cancer in the tip of the polyp before the cancer has worked its way down to the wall of the bowel, invaded the lymphatic vessels and blood vessels there and metastasized."
"I don't know of any company which would approve that," my beer drinking insurance guy told me.
"But, tell me," I persisted. "The colonoscopy costs, I don't know, say $2000--overpriced but that's another story--but even at that price it's a lot cheaper than the partial colectomy and the chemotherapy and the radiation therapy you'll be paying for when the disease is finally discovered 5 years from now."
"Ah, that's the rub," my beer guzzler pointed out. "The average customer stays with us 3 years. Then his employer buys his coverage from some other company. By the time that guy arrives with his widely metastatic disease on the doorstep, he'll be some other insurance company's problem."

Insurance Companies Have to Pay Rent, Too

Now this insurance guy is not really a monster. He is doing his job, which is not to save this patient but to protect the profit of the share holders of the insurance company. And if he can spare the cost of the colonoscopy this year, his books look good. That's his mission.


That's the profit motive, pure and simple.