Sunday, June 27, 2004


1st Narrows BridgeIn July 1940, an engineering marvel was completed: the first Tacoma Narrows Bridge. One of the longest suspension bridges in the world at the time, it exemplified the light, graceful architectural trend of suspension bridges built in this era. Called the crowning achievement of his career, designer Leon Moisseiff - the architect of the Golden Gate and Bay bridges in San Francisco - later declared "our plans seemed 100% perfect." Yet 4 months later, on November 7 1940, the Narrows Bridge catastrophically collapsed in a windstorm into Puget Sound. In 1950, the second Narrows Bridge was completed, and stands to this day, enduring weather far more severe than that which doomed Gertie.

In Christian churches, there is often exhortation that our faith in God be strong. Some denominations emphasize this to the point where, if a desired miracle does not occur, it is a problem of weakness or lack of faith. Yet Galloping Gertie has something to teach us about faith, to wit: the power of faith resides in the nature of its object, not in the strength of belief in the object.

Gertie FallsThere can be no doubt that Leon Moisseiff had unshakeable faith in the reliability of his newly-completed masterpiece, and would have had no qualms whatsoever driving over it in any weather conditions. Yet had he been on the Narrows Bridge on November 7th 1940, his faith would have been fatal to him. The object of his faith proved unreliable, and the strength of his faith irrelevant.

Yet there is another common problem with faith, which can be equally fatal: the unwillingness to act on that which is reliable because of doubt, fear, or pride. After the second Narrows Bridge was completed in 1950, many people were understandably reluctant to drive on the new span. Had a life-threatening emergency arisen demanding a trip across the bridge, such fear would have proven equally fatal, although the bridge was entirely reliable and capable of supporting such transport.

New Narrows Bridge at SunsetJesus spoke of faith the size of a mustard seed moving mountains. The lesson is not about seeds or mountains, but rather intended to express the truth that a tiny amount of faith in an infinitely powerful God is vastly more efficacious than unlimited faith in the unreliable. Yet for faith to function, action is required, based on trust in the reliable nature of its object. Such faith, though fearful and timid, has power, and builds the foundation for greater faith based on experience.

Wednesday, June 23, 2004

Sticker Shock & Awe

Blue ParrotsMy bookkeeper's husband recently underwent coronary angioplasty with stents - a procedure which opens clogged arteries in the heart and keeps them open with synthetic tubes. He was hospitalized for less than 24 hours. This miracle of modern medicine came with a price, however - his hospital bill alone (excluding physicians' fees, which are billed separately and will be much less) was nearly $100,000. Breathtaking.

Now, in reality, this staggering price tag is a mirage. Because of contractual agreements with insurance carriers, the hospital will likely receive somewhere between $30,000-$50,000. Not chump change, mind you, but somewhat less shocking than the sticker price. I suspect their net profit on this procedure will be only a few thousand dollars. So what drives the cost of such procedures, and medical services in general, to such stratospheric heights?

I am not privy to the accounting details of hospital finances, but it is not hard to understand some of the factors involved. Take, for example, the stents themselves: tiny collapsible tubes which are passed through a narrow catheter into the arteries of the heart, then expand in place, coated with a drug to resist clotting. The raw materials to produce these stents cost less than $100, but the purchase price for the hospitals is in the thousands. Carefully tested and researched on animals first, then human studies taking many years, they must pass an arduous and very expensive journey before being approved for use by the FDA - and many developed products never survive these hurdles. The cost of both the successful and unsuccessful must be amortized over what is likely to be a short product life - the next-generation device, although very similar, will need to go through the same set of animal and clinical trials, which are likely already underway when the product is approved for general use.

Now, assume for a moment that the device, so promising at first, develops problems or complications after several years which were not apparent despite long and detailed clinical trials prior to release. The complexity of human physiology and disease virtually guarantees such an unpredictable outcome in some medical products, no matter how thorough the prerelease vetting. The device will then be pulled before its projected product life, killing future sales, with no small likelihood of a class-action suit by injured patients against the manufacturer. Suddenly the apparently-lucrative medical device business begins to look more and more like a high-stakes dot-com gamble. So companies recoup the costs of these risks with sky-high product prices.

On top of these inflationary factors for medical drugs, supplies and devices, you have the cost of the hospital's own liability risk, with their malpractice premiums soaring to cover spiraling malpractice settlements which compete with the lottery for big winnings. And then, of course, there is the unintended consequences and costs of health care regulation. According to the Law of Rules, in a regulation-heavy society, rules intended to solve one problem invariably create more. So regulations designed to prevent "dumping" (transferring sick patients without insurance to other hospitals - a relatively rare abuse) have required hospital emergency rooms to care for the uninsured in record numbers with no reimbursement whatsoever. The costs of expensive emergency room diagnostics and medical care must be absorbed by increasing charges for services to insured patients. Federal health care reimbursements - Medicare and Medicaid - are also typically at or below the costs of providing those services, and therefore act as another large hidden tax on the insured which drive up costs.

There are no simple solutions to these problems, until we as a society address issues which until now we have been unwilling to face: the "somebody owes me" mentality and greed which helps drive the malpractice and liability crisis; the loss of perspective on the inevitability of error in complex human endeavors such as medicine; and the unwillingness to accept death and suffering as an inevitable part of life, even when the costs of such denial are prohibitive.

Saturday, June 19, 2004

Liberalism and Gnosticism

Sunset SkyIt takes only a brief review of conservative web sites, print media, and pundit blogs to be left with the impression of a deep frustration with liberalism. Not merely the disagreement with their beliefs and priorities, mind you - that is a given - but rather with their peculiar unresponsiveness to arguments of reason and logic. The scenario goes something like this: Some Democrat in Congress or liberal pundit makes an outrageous charge about Bush, or Iraq, or Republicans, or Christians, or whatever. The conservative blogs explode with the news, followed shortly by detailed rebuttal of the charges, or ample testimony to prior events proving the hypocrisy of the attack. Well-reasoned, factual defense is the rule rather than the exception. Yet all to no avail. Those on the Left either shrug, or respond with even more outrageous accusations, or go ad hominem. I often wonder whether all this energy and effort has accomplished anything beyond making us feel better about ourselves and venting our frustration.

I believe the problem is that we don't understand liberals.

Now, before you start thinking I'm having a kumbaya moment, hear me out: we don't understand liberals because contemporary liberalism is the new Gnosticism.

Gnosticism as a religion is ancient - predating Christianity by at least several centuries, and coexisting with it for several more before dying out. It was in many ways a syncretic belief system, drawing elements from virtually every religion it touched: Buddhism, Indian pantheism, Greek philosophy and myth, Jewish mysticism, and Christianity.

Gnosticism (from the Greek gnosis, to know, or knowledge) was manifested in many forms and sects, but all shared common core beliefs: dualism, wherein the world was evil and the immaterial good; the importance of secret knowledge, magical in nature, by which those possessing such knowledge could overcome the evil of the material world; and pantheism. It was also a profoundly pessimistic belief system. As J.P. Arendzen, in his excellent summary of Gnosticism, explains:

This utter pessimism, bemoaning the existence of the whole universe as a corruption and a calamity, with a feverish craving to be freed from the body of this death and a mad hope that, if we only knew, we could by some mystic words undo the cursed spell of this existence -- this is the foundation of all Gnostic thought ... Gnosticism is pseudo-intellectual, and trusts exclusively to magical knowledge.

So in what ways is modern liberalism Gnostic in nature?

First and foremost, in modern liberalism, what you believe is more important than how you act. Gnostic sects were often hedonistic - after all, since you possess special knowledge of the truth, and the physical world is evil, why pursue noble behavior with an inherently wicked material body? While not all - or even most - liberals are hedonistic (although Hollywood does come to mind...), contemporary liberalism has enshrined tolerance of hedonism as a core belief.

More fundamentally, there is a disconnect in liberalism between belief and action. As a result, there is no such thing as hypocrisy. So the National Organization of Women, tireless in its campaign on violence against women, sexual harassment, and the tyranny of men in the workplace and in society, stands wholeheartedly behind Bill Clinton, who used a dim-witted intern for sex (in the workplace, moreover!) and who was credibly charged with sexual assault on Juanita Brodderick. Hypocrisy? No, Bill Clinton "understood" women and women's issues - his knowledge trumped his behavior, no matter how despicable.

There are many such similar examples, once you start looking for them. I recall a gay activist on NPR instructing Terry Gross that the solution to "anti-gay intolerance" (i.e., anyone who had qualms about homosexuality, either in its morality or social agenda) was "education". If we religious or socially conservative cretins were only properly "educated" - if and when we finally "got it" - then all of our opposition to homosexuality would melt away like an ice sculpture in August.

It is no accident that many of our most liberal intellectuals reside in the universities, in the rarefied atmosphere where ideas are everything and their practical application moot. We conservatives often marvel at the naivete of the peace movement, where World Peace can be achieved if only we "visualize" it. Like the magic formulae used by the Gnostics to dispel evil spirits and emanations, simply believing that peace can be achieved by "loving one another", and mutual understanding is sufficient to transform those intent on evil, destruction, and domination. Human shields defend tyrannical monsters who would shred them in a heartbeat were they not so useful, in order to "put an end to war". Judges implement rulings based on higher Sophia rather than the law, blissfully dismissing their profound impact on the Great Unknowing Masses below.

The profound pessimism of the Gnostic world view is seen in contemporary liberalism as well. If ever there was a gentle giant in history - a nation overwhelmingly dominant yet benign in its use of power - it is the United States of the 20th and 21st century. Yet we are treated to an endless litany of tirades about our racist, sexist, imperialist ways, which will only end when the Left "takes America back" - ignoring that a nation so administered would cease to exist in short order. American liberalism was not always so. As recently as twenty years ago, it was optimistic, hopeful and other-oriented, albeit with misconceptions about human nature which proved the undoing of its policies and programs. Only at its farthest fringes did pessimism reign, but today this dark view is increasingly the dominant one.

Analogies have their limits, as does this one. Ancient Gnosticism was deeply religious, although pantheistic, whereas modern liberal thinking is profoundly secular and agnostic, for example. But even here similarities persist: how many New Age conservatives do you know? Modern secular liberalism is far more religion than political philosophy, and therefore largely resistant to confrontation or compromise based on logic and reason.

Gnosticism as a religious force collapsed of its own weight, crippled by its internal inconsistencies and the lack of power sufficient to transform and ennoble the human spirit. Yet failed ideas die hard, given the intransigence of human pride. How very odd that our predominant postmodern political philosophy is so ancient in origin.

Monday, June 14, 2004

The Law of Rules

In contemporary political discourse, we often discuss the Rule of Law, especially in our postmodern culture where bad behavior is often justified (and excused) by situation, upbringing, or historical injustice. But no one ever talks about the Law of Rules.

DaisiesToday in the office I reviewed one of Medicare's bulletins, clarifying (at least in intent, if not in practice) their regulations in some arcane area of reimbursement for surgical procedures. Few outside of the health care field have any idea of the complexity of regulations governing medicine. When last I checked several years ago, Medicare had about 150,000 pages of regulations in the Federal Register, approximately 3 times of the volume of the IRS tax code. American medicine is more highly regulated than Soviet state industry ever was, and getting more so by the day.

Without launching into a diatribe on the evils of goverment-funded and regulated medicine (perhaps another time), it strikes me that the explosive growth of rules, laws, and regulations in society as a whole is a reflection of an underlying shift in our culture, values, and individual moral integrity.

There are two ways to implement good behavior in individuals and society: from within or from without. Human beings are morally flawed (a surprisingly controversial statement in our current, "values neutral" culture), and therefore in order to maintain a peaceful, stable, functioning society, laws - and the means to enforce them - are required. Laws exist not for the good in man, but rather for the evil, as a restraint. If man were morally perfect, no laws would be needed. Yet law cannot create morality, but serves only to protect the good from the evil. The more moral goodness there is in a society - restraint from harming one's neighbor, acts of service, honesty, integrity -- the fewer laws are needed and the better those laws already in place function. As individuals (and consequently the society they constitute) change from being other-oriented and self-restrained to self-centered and self-seeking, the more law-breaking occurs, the greater the enforcement required, and the more laws are required to manage and restrict human behavior. Hence the Law of Rules: Rules beget more rules.

We humans are intelligent, resourceful beings who are ever looking for new ways to achieve the goals and desires important to us. If our intent is to deceive, steal, or harm, there is almost always a way around existing law to accomplish our aims. The result of this is twofold: harsher enforcement of existing laws and more laws to cover the loopholes discovered by us innovative creatures, as society seeks to protect itself. Hence the result of a deterioration in individual moral restraint is both more laws and harsher penalties. The logical end result of such a progression is something resembling totalitarianism: there are laws about everything, and brutal punishment for their violation.

We often hear totalitarian regimes such as China or the former Soviet Union boast of their low crime rates and the safety of their streets. And Islamic countries and cultures often proclaim their inherently higher moral status over us libertines in the West, cutting off the hands of robbers and the like. But while it is possible in large measure to restrict behavior through law and retribution, such measures do not make a society or its individuals moral as a consequence. In fact, the effect is quite the opposite. Laws intended to restrict evil behavior often have the unintended consequence of negatively impacting those intent on good. So, for example, the law designed to discourage fraud in Medicare by the few (a worthy goal) results in less time for patient care, restriction of access to care by the needy, and the exodus of good health care providers to other professions to escape their crushing burden -- all bad outcomes affecting far more people than the few who would game the system. One need only look at the extreme effects of Islamic teaching on some (not all) of its adherents, with the wanton murdering of women, children, unbelievers - and even other Muslims - to conclude that constrictive law-abiding society does not promote moral goodness as a consequence.

What's the answer? Other than a fundamental reversal in individual moral virtue - an inside-out change - I fear there are few good alternatives. But I am not gloom-and-doom about the prospects for such change - I have seen and know of too many who have undergone such a change to be pessemistic, and am convinced of the existence of a God capable of implementing such change.

Saturday, June 12, 2004

The Evisceration of Language

BarcelonaI am struck by the evisceration of language in our contemporary culture, and wonder about its implications. We humans can communicate by many means - by touch, by expressions, by giving -- even by our mere presence in situations where we would be more comfortable elsewhere, such as when sharing grief or loss with another. But our primary means of communication is by our language.

In Genesis we learn of Babel, where man's great hubris was disrupted by the confusion of tongues. Anyone who has traveled to another country and culture has experienced the discomfort of being in a strange environment without the comfort of clear communication. Yet far more insidious is the dissolution of the power of words within a culture, with a nominally common tongue.

One such example is the overloading of adjectives. In object-oriented software development, we talk of overloading a software object's functionality, i.e., giving a derivative object more capabilities than the parent while using the same name. In language, the effect is the opposite: words are stripped of their original meaning, lessened by hyperbolic use. Consider the contemporary use of the word "awesome". Derived from the Greek achos, meaning pain, it confers an emotion variously combining dread, veneration, and wonder inspired by authority, the sacred, or the sublime. It implies the experience of being in the presence of someone or something far greater than oneself. In modern culture, it has become an adjective for virtually everything even mildly pleasing. Almost anything can be "awesome" - clothes, parties, cars, pleasant situations. But if everything is awesome, then nothing is awesome. The language has been robbed of the ability of describing those things which truly inspire awe, which remind us that there are things far greater than ourselves. If we can no longer speak of awe, then we forget there are things which inspire and deserve our awe.

Another example is the term-swap, common in politically correct speech. My office nurse recently attended a conference on sexual dysfunction and counseling, taught by a specialist from San Francisco. He stated that in his clinic, you no longer ask if people are married, but whether they are "partnered". You no longer inquire whether people are having sex, but ask whether they are "body-fluid bonded". This is an attempt to influence thought by transforming speech. "Married" carries the connotation -- derived from centuries of common use and consensus of meaning -- of two people, man and woman, committed to one another in a contractual relationship, ideally for life, for better or worse. "Partnered" means any two people sharing a roof at this moment in time, here today and gone tomorrow, with commitment optional. Whatever your opinion on gay marriage, surely these two situations have different personal implications for those involved, and unequal impact on society as a whole. But "partnered" is a great leveler, making the lesser equal to the greater. And "body-fluid bonded"? Not only is term-swapping an attempt to remove the influence of higher principles on behavior, but it is invariably cumbersome, lacking in rhythm and impact, and downright ugly. Language is like music, having a rhythm and power of its own. Politically-correct term-swapping is the electronic organ of language - playing all the right notes, but abrasive and irritating to the ear. Even course street-slang is preferable: "Are you two f***ing?", while offensive, is a slap in the face, while "Are you fluid-bonded?" is like lukewarm decaf coffee.

Redefinition is another land mine in the field of language, especially problematic in discussions of religion and belief systems. But time is short, so more on that at another time...

Friday, June 11, 2004

Voice Recognition

When doing my medical dictation, I have used voice recognition software for the past several years. It is rather amazing technology in many ways. With sufficient training, accuracy is about 95%. Complex medical terms appear on the screen with surprising ease and accuracy.

It never makes spelling errors, but contextual errors are common. As you can imagine, these can prove humorous at times. Like Doonesbury's strips on the Apple Newton handwriting recognition (back when Doonesbury was funny, not simply vicious), the word swaps can be fun -- to wit:

What I Said:: "The patient said Viagra wasn't working, and wanted to try Cialis."

What It Typed: "The patient said Viagra wasn't working, and wanted to try and see Alice."

Nice ... glad I caught that one before it got mailed to my referring doc...

Thursday, June 10, 2004

Meet Cheap Suit

Meet Cheap Suit...
Cheap Suit (aka Grace)
Her real name is Grace. Like all our pets, she has multiple names, rarely going by that originally issued -- unless they're in trouble. I call her Cheap Suit because of her propensity to be all over you (like a cheap suit) whenever hungry or attention-starved. And like a cheap suit, she doesn't always wear well...

Grace joined our family two years ago at Christmas. Dirty, matted, and needy, we found her at the local animal shelter, where she seemed very sweet. Hours from euthanasia, she won our hearts. Hence the name Grace: saved by no merit of her own, but by the love and compassion of another. In our haste to give her a good home, we neglected to heed the sign on her cage:

So we brought her home to join two Persian cats and a dog.

Our Persian boys were not amused, nor was Grace, so we negotiated an uneasy truce by keeping her separated downstairs. Cleaned up, she was a beautiful animal. Fur soft as down, penetrating blue eyes, and gorgeous coloration. At first curious, affectionate and social, in short time she began to manifest a most unpleasant trait: the ability to change from a purring soulmate to a hissing, biting, spitting maniac in a flash. Unprovoked, unpredictable, utterly volatile.

My wife is a cat lover of the smothering kind - loves to hold them, squeeze them, kiss them - and can't imagine why they are not always amused by such attention. The Persians, being the Kings of Mellow, tolerate this. With Grace, such affection proved an utter disaster.

Hissing, biting, batting and misbehavior quickly became the norm. Her welcome wore out quickly. When the older Persian managed to get downstairs and attacked her, there was cat urine and fur everywhere. Everywhere. My wife began to bring up euthanasia. For real. The Grim Reaper was back in town.

Now, I'm entertained by cats but am a dog person at heart. But I had a special place in my heart for Gracie. You see, she reminded me of myself, and my relationship with God. Saved from the darkest of fates, not even dimly aware of the nature her impending destruction, she returned the favor with spiteful rebellion at the slightest disruption of her comfort or plans. Yet we saw in her at first a beauty not evident on the surface - just as God has little concern about what I was, or am now, but rather what I can be by His grace and mercy. But how at times he must marvel and fume at my insolence and ingratitude.

Gracie is still with us, and likely will be for a long time. We have learned to accommodate to her idiosyncrasies, and now find her quite amusing and very affectionate, albeit on her own terms. She changed in response to our love and patience. And she daily reminds me of how God changes me in like manner.

Wednesday, June 09, 2004

It's a New Day...

Here's adding my raindrop to the ocean of web logs...
The Doctor is In is a blog by a physician philosopher, dealing with medicine, religion, family, politics, current events, philosophy, pets, photography, the Pacific Northwest, software development, humor, and any other area of life worthy of passion and depth of consideration. Here's hoping you find it enjoyable and thought-provoking, and join in on the discussion.

Some background: I'm a physician in a surgical specialty practicing in a medium size city in Washington State. I'm a conservative in political orientation (but not a party-liner), and Christian in faith and conviction. I'm interested in folks of any persuasion who are willing to move beyond slogans and superficial thought to tackle some of the deeper issues in life with honesty and humility. I love to laugh - especially at myself - because I know no better way to approach life - and it releases a bunch of endorphins! I am passionate about my family, my profession, about software development, pets, photography, and cooking... and many others areas, present and to come.

While very familiar with computers and software (database and web development), I am surprisingly new to the world of running a blog. But life's an adventure, so I hope to provide both a mental catharsis and a source for thoughtful consideration for others.