Monthly Archives: November 2014

2014 Thanksgiving Wishes

Wishing all of you a beautiful Thanksgiving with people you love.

May there be enough food on your table.

May there be enough sweetness in your desserts.

May you have enough heat in your home that the chill outside is refreshing to step into, rather than frightening.

If you are not able to spend today with everyone you would like to, may you enjoy the miracles of the telephone or Skype.

And if those you can’t be with are not people that a phone or Skype could reach, may your heart and soul be filled with warm thoughts of them.

May you feel that you have much for which to be thankful.

May you have leftovers.

May you have family and friends with whom to share those leftovers over the next couple of days.

May any snow that falls blanket the view out your window with beauty and create that peaceful quiet that happens after a snowfall.

And may the snow melt gently and before it turns all gray.

May you and those you love make it safely to your destinations if you travel.

May the conversations around your table tonight be both serious enough and light enough.

May someone hug you today.

May you laugh at least once today enough to make your stomach muscles hurt.

May you hear music today.

Happy Thanksgiving!

Exponential Ire

I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the title, “doctor” (although none of them were MDs, DOs, or PhDs). I felt mortified.

The evening began like any other business networking event. We walked around, munching on some hors d’oeuvres and shmoozing informally. Then we all gathered for the formal part of the evening, where we all took turns introducing ourselves to the group with a brief “elevator pitch” (quick spiel) of what we did for a living, and if we were a visitor we told the group whose guest we were that evening. And then, the presenter began. And I almost fell over.

This was not a networking thing. This was a pyramid scheme.

The presenter had a board with little velcro hearts and rainbow-colored umbrellas arranged in a triangle shape with the apex at the bottom. There were four layers, so above the one cute little velcro item on the bottom there were two on the layer on top of it, four in the next layer, and six (with two empty spaces) at the top. The presenter then explained how each little symbol represented a person in this wonderful system, and how each new member was added to the top layer when they paid a “gift” of $1,000 to the person at the bottom. She added two symbols to the top to complete the row of eight and to then demonstrate that when the person on the bottom had received her $8,000 in “gifts,” having originally only payed in a gift of $1,000, thereby netting $7,000, the pyramid above split into two, and each of the people who had been in that next layer above the recipient would now be the recipient of the $1,000 from each new member in the next layer of people who joined, with this pattern repeating so that each person would end up netting $7,000.

There were multiple assurances from the presenter and confirming enthusiastic shouts from people in the room that this was all perfectly legal, since it was all in the form of “gifts,” and that it was not at all a “pyramid scheme.” A pyramid scheme is a model in which members make money solely by recruiting new members to pay into a program, and new members pay in with the expectation that they will have a turn as a money recipient. This was absolutely a pyramid scheme.

Pyramid schemes are unsustainable. They implode. The people who start them and get in on them early will make money off the many people who will lose their money when they join later.

In the room that evening, people bragged that they were on their second time through. They spoke of how wonderful it was to be able to “help” the person on the bottom who only invested $1,000 but now was on her way to receiving many times that amount. And they spoke of how noble it was to help the people in this group, who each had reasons for needing to grow their money – tuition for their children’s college, seed money for starting their own businesses, etc.

What they neglected to discuss was the basic math involved. The concept of exponential or geometric growth. The one person who started the program needed to recruit 14 other people to fill in that first triangle cycle with the top layer of people each paying in $1,000. For each of those 8 payers to receive their $8,000 and split the triangle in two for the people in the next layer up, they needed to recruit one hundred and twelve people (sixteen to pay the two people in the original second layer, thirty-two to pay the four people in the original third layer, and sixty-four for those eight people in the original 4th layer). For those sixty-four who paid in to the original fourth layer of eight people to receive their own payout requires recruiting eight hundred and ninety-six more people. This is because each layer of people must double three times for the payout to be complete. Within about 9 of these complete cycles you’ve covered the population of the United States, and in less than two more full cycles after that you’ve covered the population of Earth.

Obviously this contrivance collapses fairly quickly. A lot of people will lose their money, since the number of people buying into the game plan is finite. The system is designed to have a lot of people lose their money. This particular scheme tries to make it ok by describing the buy-in as a “gift,” thereby trying to excuse themselves from being obligated to each person buying in.

How scuzzy. How unethical. Or, if giving some of the people involved the benefit of the doubt, how ignorant.

And as I mentioned above, several of the people who were a part of this scheme (not people who were brought in as guests to this “networking party”) were members of professions in which they have patients and people call them “doctor.” They are not MDs or DOs, but they refer to themselves as “primary care doctors.” They are practitioners of “alternative medicine.” And here at this event they were actively taking part in a scheme that showed they either lacked a basic understanding of high school math or they understood it quite well and were willing (and hoping) to exploit the ignorance of others for their own financial gain. Either possibility is frightening in members of professions that purport to care for the health and physical well-being of others.

Members of these particular professions frequently speak against conventional medicine. They speak of “toxins” in vaccines. They promote homeopathic “remedies” and “preventions.” Do practitioners in these fields not understand the math involved when each person with measles in an un-immunized population infects 12 to 18 others, how quickly that number explodes, and how 2 out of every thousand people infected will die (significantly more, up to 10%, in areas where people are malnourished and don’t have access to adequate medical care) and how many will suffer blindness, encephalitis, or pneumonia secondary to a measles infection? Do they not understand the comparison of those numbers to the one person in a million who will suffer a severe allergic reaction to the vaccine? Do they not understand that a homeopathic remedy, which is created when an herb or a poison (yes, a poison) is diluted multiple times (so that there is exponentially less of the substance with each step), leads to a solution in which there is no detectable active ingredient (which is actually a good thing in the case of the poisons) – the opposite of exponential growth? Or do they understand these concepts well enough but are willing to exploit the ignorance of others for their own financial gain, even if that exploitation is not just financial but is at the expense of the health and well-being of those whom they purport to “heal?”

I do not presume that every alternative medicine practitioner participates in predatory Ponzi schemes. But each of us, especially when we make a point of announcing our profession and describing what we do, is a representative of our profession. If there had been a group of financial planners taking part in that pyramid racket, what would you think of that profession? What if there had been a large contingent of lawyers? Or teachers? What would that do to your trust of that profession as a whole? I know that there are chiropractors who treat back pain and don’t talk their patients out of vaccinations or into useless remedies or out of appropriate medical care. But I have to try harder now to remind myself of that. And I find it easier to understand when the general public complains that “doctors” are just looking to make money when I find “naturopaths” who call themselves “doctor” trying to recruit people into a pyramid financial arrangement that will find their recruits each out a thousand dollars as their “gift system” collapses.

It’s been almost two months since the “networking party.” Rather than continuing to fume, I am stepping back, taking a deep breath, and trying to transform my indigestion and raised blood pressure into helpful words. Think about what you do. Think about what you promote. Think about the consequences of what you do and promote, both to yourself and to others. Ask yourself if you are acting out of greed only, with a disregard for the well-being of others, or out of a sincere desire to make the world a better place. When someone is handing you a line, figure out if they are doing it out of greed (and a disregard for the well-being of others). Go back to basic math, to basic science, and to basic ethics. And when you are making a decision about your health or the health of someone you love, work with a doctor who understands and respects these basics.

Housecleaning and Doctor Visits

I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of coats (it’s cold these days, but varying degrees of cold). There’s a drum set in the living room (because that’s where the piano is). Did I mention the books?

My parents-in-law keep an immaculate house. I don’t think I’ve ever seen a pile of anything in it. Ever. And they’re arriving this afternoon for a weekend visit.

They get that we’re busy. They get that we suck at housekeeping. They have never, in twenty-one years of marriage or the dating years prior to that, criticized us. They focus on our strengths rather than weaknesses. But we all have our limits.

Normally, it’s possible to move the piles around a bit, tidy up around them, and keep a reasonable level of cleanliness in between the occasional deep-clean. But it’s been quite some time since the last deep-clean, and there’s only so much you can do with the touch-ups.

My house epitomizes the problem with the state of medicine today. Stay with me on this.

We’re busy in my family. You should see our Google calendar – so many overlapping color-coded blocks that it actually looks beautiful if you step back and let your eyes go a little fuzzy. So aside from regularly taking out the trash and recycling, cleaning the toilets, and doing dishes and food clean-up, other stuff gets relegated to an as-needed basis. When something gets really gross, we clean it. When something breaks, we fix it. When the toothpaste spatter around the sink reaches a critical radius, we wipe it. But when that goes on for too long without a no-one’s-going-anywhere-until-this-entire-place-is-company-ready cleaning frenzy, it can get really bad.

Bad enough that a visit from your parents-in-law, whom you love deeply, actually frightens you.

A similar phenomenon has been happening in medicine. And, like my house, it’s been getting worse. There’s no time to spend with patients. There’s more and more on the schedule. There are more billing issues to focus on. More regulations. More pressure to see a greater number of patients. More hoops to jump through to maintain board certification. Doctors have time to swab a throat here, adjust a blood pressure medication there, give a quick reminder that someone’s due for a colonoscopy, tell a patient that it would be in his best health interest to lose a little weight. It’s like cleaning around the piles. It can sort of work for a short while, but the dirt builds up.

Every so often, a doctor’s got to sit with her patient and do the equivalent of a deep housecleaning. Find out what’s going on in the patient’s life. Listen to the fact that her son’s been out of work for a year. Maybe that’ll give you the clue that perhaps the reason you’ve had to increase her insulin prescription so much recently is that she’s been giving half of it to her son, who also has diabetes.

My husband and I have spent 8-and-a-half hours so far today straightening and cleaning. We’ve got a little over an hour to finish whatever we’re able before his parents arrive.

It’ll be ok. The bathrooms with which they’ll have contact are thoroughly clean. There is no dust and there are no piles of clothing in the room where they’ll be sleeping. And much of the rest of the house is a heck of a lot better than it was. We’ve done a pretty good job. Not the ideal, whole-house deep clean, but targeted deep clean with broad adequate cleaning. Kind of like a doctor’s visit that focuses on diabetes, high blood pressure, smoking cessation, headaches, ways to reduce stress, healthy eating advice, and ways to fit exercise into a daily routine, The next visit will address the need for a screening colonoscopy, and will describe the preparation for it.

That prep would be the equivalent of our cleaning out our basement. Maybe I’ll wait until I’m 50.