If I Were King

I know nothing about muscular dystrophy, but for Carrie Salberg it means that she breathes only with a ventilator and speaks only with an additional piece of gear. To say this makes travel difficult is to say that the Pacific is damp. The Air Carrier Access Act says, since 1986, that the airlines have to accommodate her and her equipment, assuming that her equipment passes certain standards that make it safe for operation in flight.

According to “Airline bumps disabled traveler” (Minneapolis Star-Trib, yesterday, by Lora Pabst), Compass Airlines refused to allow Ms Salberg to board a flight home to Minneapolis from New Orleans on 13 January. Actually, she boarded but was then ejected from the direct flight she had paid extra for. She made it home on another flight via Atlanta, five hours late. (Compass is a “Delta Connections” partner airline.)

This isn’t the universal experience. When flying to New Orleans she was treated well, in fact she was given an upgrade to First Class. But in 2009, 178 disabled travelers were denied boarding, so it isn’t unique.

The story relates that a new regulation in 2009 calls for the issuance of labels to apply to equipment like this so that airlines don’t have to decide on a case-by-case basis which equipment is safe. I don’t find it surprising that nobody has actually had the labels printed, it’s unclear whether that was the responsibility of DOT, FAA, or FDA, but it hasn’t happened.

Ms Salberg travels with two nurses, it’s obviously not possible for someone in a wheelchair to manage an additional hundredweight of equipment and batteries. Delta’s first response was to give each of them a $50 flight voucher for their “inconvenience”. After the Star-Trib contacted them, they became more reasonable, providing $900 in vouchers and refunding the $340/person cost of the flight.

It turns out that the manuals on the Compass Airlines plane were outdated. Delta’s assertion that this oversight was “isolated” does not strike me as being helpful or responsive. The airlines are responsible for making sure that current documentation is available where needed. I’ve had enough connection with Boeing over the years to know that they take this very seriously. Who dropped the ball here? Did Delta not take this particular airplane seriously? Or do they not take disabled passengers seriously?

If I Were King, those labels would get printed, there certainly was something else done in the responsible department that was less important than this. The maintenance records for the operator would be audited to make sure that updated documentation was, in fact, getting to ground crews and flight crews in a timely manner. And though a pilot should be entitled to refuse to carry breathing gear made of rusty welding tanks, garden hose, and duct tape, questions regarding purpose-built medical equipment traveling with a disabled person should always be resolved in favor of the traveler.

The Department of Agriculture has announced its approval for unrestricted commercial cultivation of genetically modified alfalfa, according to “U.S. Approves Genetically Modified Alfalfa” by  Andrew Pollack in The New York Times. Unlike some, I’m not convinced that GM crops are a bad thing. There had been a proposal to restrict the areas in which this crop could be grown to protect traditional strains from contamination from wind-carried pollen. Again, I’m not overwhelmed by the problem. Organic farmers don’t use Roundup (glyphosphate) on their crops and thus don’t need Monsanto’s Roundup-Ready seed, nor would they benefit from it.

What I am convinced of is that there exists a huge problem in Monsanto’s approach to their Roundup-Ready GM seed, specifically the way they have defended their intellectual property. Anyone who uses any of their GM seeds is bound by contract to not save any of the crop to use as seed for the following year. While this seems fundamentally unsound, farmers have traditionally processed a portion of each year’s crop to plant the following year. In every farming community, at least one supplier has operated a seed cleaning operation to process those seeds, presumably treating them with any necessary fungicide and ensuring they were properly dried. It’s a fundamental part of historical farming, the essence of sustainability.

Monsanto is entitled to make a complete replacement of their seed a condition of their sales contracts, and farmers are entitled to sign those contracts. However, Monsanto goes well beyond this. When their crops are grown, pollen blows off those fields into the fields of farmers that have not chosen to grow GM crops, and the resulting seed inevitably contains some that contains the glyphosphate-tolerant gene. Monsanto sends agents out, takes samples, and sues farmers who attempt to plant the seeds they have grown themselves if the gene is found. They have forced hundreds of suppliers to discontinue seed cleaning operations.

Some provision should have been made so that organic-certified farmers would be protected from the encroachment, as selling their crops as “organic” becomes impossible once genes from the GM crop has contaminated it. This is regrettable, one hopes that the farmers themselves will decide to not plant the expensive Monsanto product in enough areas that untainted seed continues to be available. Monsanto should be responsible for the additional expenses needed by farmers who choose to continue with the traditional product.

The very idea of patenting a gene still causes me some difficulty, but it’s currently the law and I don’t resist it. However, the law is running exactly the wrong direction on enforcing this. If I Were King, farmers who innocently ended up with the Monsanto gene in their seed would absolutely have the right to plant it the following spring. I would be tempted to consider Monsanto’s suits against such farmers to be frivolous and malicious and order that the farmers be granted at least three times their legal expenses and lost time spent in defending themselves.

A story in The New York Times, F.D.A and Dairy Industry Spar Over Testing of Milk by William Neuman, discusses a bit of a controversy going on between the FDA and the dairy industry over testing.

Disclosure: My dad grew up at Carnation, Washington, a company town for one of the major dairy companies, so I tend to be on the side of the dairy farmers. I have no use for milk, but there aren’t many cheeses I don’t enjoy, I do like cream in soups, and along with Julia Child, butter is my favorite ingredient. On the flip side, I detest agriculture subsidies, which the dairy industry gets a lot of. I’m also solidly opposed to the prescription drug system in which doctors and pharmacists have the monopoly on deciding what drugs can be taken, but note that if there is one class of drugs where I see a public interest in controlling drug use, that one class would be antibiotics. And I’m always in favor of more information.

So here’s the kerfuffle: The FDA currently tests loads of milk for four to six common antibiotics. If the tests shows that the drugs have entered the milk, the entire load has to be destroyed. The FDA, based on results of testing on dairy cattle sent to slaughter, wants to test for two dozen other antibiotics, as well as flunixin, a common pain killer and anti-inflammatory used in the industry. However, the tests aren’t instant like the current simpler ones are, they can take a week.

The industry is frightened by the prospect of holding that milk until the test results are known (they obviously can’t actually do this, no dairy has the facilities to segregate and safely store that much milk), or that after processing the test results will lead to recalls of the product. At least one cooperative dairy has announced that it will not accept milk that has been sampled for the additional tests, and it’s likely that other processors will take the same stance.

Are these people as smart as the cows? They would clearly prefer to process milk with no idea what the level of drug contamination is than to consider the possibility that there might be a problem to address. I doubt that the FDA is guiltless here, it wouldn’t surprise me to learn that the rules require destroying the product if those traces are present. Zero-tolerance rules are much beloved by the mindless, a group that is often involved in government.

The question of antibiotics entering the food stream is important, and it would be a most excellent thing to understand the situation, monitor any trends, set standards, develop best practices in the industry, and finally establish go/no-go rules. But none of those things can be done without the result of the tests.

If I Were King I would have no power to increase the intelligence of stubborn farmers and bureaucrats. I could, however, insist that the tests be performed and the information recorded, charted, and analyzed. I could, and obviously would have to, declare that the results of these additional tests would not result in the destruction of any milk until everybody, on both sides of this issue, knew what the hell they were doing.

According to a story in yesterday’s The New York Times, Senator Mitch McConnell of Kentucky, the Republican leader, said after passage of the $4.3 billion bill, “Some have tried to portray this debate as a debate between those who support 9/11 workers and those who don’t. This is a gross distortion of the facts. There was never any doubt about supporting the first responders. It was about doing it right.” This is a crock. For the Republican leadership, the issue was about doing it cheap. Royalty is not always generous, but one hopes some semblance of style prevails. If I Were King, you can bet the needful costs would have been covered without giving weasels like McConnell any chance to do anything but marvel at our good judgment.

Today is Coming Out Day, an occasion for showing support for civil rights of the LGBT community. I’m straight, and I support human rights for humans and civil rights for those who are civil (and for some who aren’t, actually), without consideration of race, creed, age, sex, religion, national origin, or sexual orientation. (Is “confused” a sexual orientation? Seems that fits a lot of folks.)

But Van, you’re a Christian, isn’t homosexuality against your religion? Short answer: No. The longer answer? Christ loves every one in every situation, and if you happen to be a lesbian that detail is hardly enough to make a god of love back off, or even hesitate. God is love. “And they’ll know we are Christians by our love,” as we sang back in the ‘sixties.

But Van, doesn’t the Bible clearly say that homosexuality is wrong? Short answer: No. The longer answer? For good and valid historical reasons, the Torah is reproduced in the Bible. Specifically, the book of Leviticus is included. Leviticus has two parts, the Jewish Holiness Code and the Jewish High Priestly Code. I’m not a Jew, and I’ll never be eligible to serve as high priest (because I’m not Jewish and because my name is not Cohen or one of the acceptable variations thereon, both absolute barriers), even if the temple were rebuilt in my lifetime. I’m a Christian, and Christians are not called to follow Jewish law.

But Van, it’s in the Bible. Doesn’t that make it true? Sure it’s true, it’s part of the history of the Children of Israel. They were actually given all these laws over three thousand years ago. And there are even those who follow those rules today, observant Orthodox Jews. They keep two complete sets of pots, pans, plates, and silverware. I appreciate the dedication to tradition that this entails, but I do not follow them, for a number of reasons. I appreciate the fact that Jesus specifically swept the old laws away (story is found in Matthew, “It is not what goes into a man’s mouth that defiles him, but what comes out.”) But even if he hadn’t, there are plenty of good reasons to live by the law of my time instead of the laws of Canaan circa 1425 BC: Lobster. McDonald’s Quarter Pounder with Cheese. Clams. Ham. Every sandwich I make. Bratwurst.

Scholars have proposed reasons for different parts of the Holiness Code, but we can’t really know what they were. But we can be confident that all the rules regarding sacrifices, the separation of dairy and meat, the absolute prohibition on meat from animals with cloven hoofs (i.e., the glorious pig), the prohibition on any seafood that doesn’t have scales, all these things may have had a reason at a certain point in Israel’s past but are not normative for life in the United States today.

And the God I worship would not smile to learn that I was taking a minor point of ancient law, out of context, and using it to be hurtful to my fellow creatures. Sex is a good and wonderful thing. Marriage is a good and wonderful thing. It is unacceptable for a Christian, gay or straight, to forbid these things to anyone old enough to consent intelligently.

Being a Christian is not a logical decision. We specifically believe that you cannot come to faith in Jesus Christ of your own will, that such a faith comes from a call issued by the Holy Spirit. Moreover, the choice to enter ordained ministry, with all the requisite preparation, is subject to call as well, first a call from God and then a call from a congregation. If homosexuality were wrong, there is no way that an omniscient God (who would know who was straight and who was not) would continue to call homosexuals to faith and to ministry, yet he does. Logic says that if a call is necessary for faith, and there are homosexuals in the pews, then God loves them and wants them to be part of his church. There is no escaping that argument.

If I Were King I would still be Christian, I would still be straight, and you would absolutely be treated the same whether you shared my religion or my sexual orientation or not.

Today’s Quotes of the Day were on the theme of “Birth” because this is the anniversary of the birth of Chester A. Arthur. During the 1880 presidential campaign, in which he ran as vice president with James Garfield, it was charged that he was not born at Fairfield, Vermont but rather in Canada. Some said he had been born in Ireland. In his case, there were no written records of his birth at all.

It turned out he was a pretty fair president after Garfield died, so he only served part of one term. He recognized the problems of the “spoils system” then in place, a system that he had benefited from and in which his backers thrived, and created what we now know as the Civil Service System. His administration was probably not absolutely devoid of corruption, but it was dramatically better than any in the decades before him.  Even Mark Twain, who had little use for any officeholder, approved: “It would be hard indeed to better President Arthur’s administration.”.

In the course of my introduction to the quotes I characterized the birthers of our day as “halfwits”. As I mentioned back in April, I encountered my first birther in a public place, having previously not really believed that such persons existed. To my surprise, there actually were a few who were subscribers and they took offense. They basically said that I was the halfwit if I believed that Obama actually had a “birth certificate” that showed him to be a US citizen.

Oh, puhleeze! No, there is no document that says “birth certificate”. I don’t have one either, mine says “Certification of Birth”. Obama’s says “Certificate of Live Birth”, presumably because the state of Hawaii has enough sensitivity not to issue birth certificates to parents who have gone through the ordeal of a stillbirth. What we refer to as a birth certificate is any document issued by a government or agency thereof that attests to the birth of a child. It lists the name, the place, the date, and the names of the parents. There is no verification that I’m aware of, although if the child is born in a hospital it’s a pretty safe bet that the place, date, and mother’s name will all be accurate. Somebody fills in a form, the form is sent to the appropriate registry, the information is entered in some sort of register or database, and certificates are issued as required by law.

In the case of my daughter, a nurse asked me to go to the hospital office and fill out a form, on which I wrote in my name as father and probably signed it. That was it. No DNA test to prove that I actually was the father. For that matter, there was no test to ensure that the mother wasn’t a surrogate renting out her womb for the occasion. And though I think the resulting “birth certificate” actually used those words, it was small plastic rectangle with embossed lettering – a credit card with no charge privileges.

The birthers are halfwits if they think the current president is ineligible for office based on the fact that his birth certificate doesn’t have the exact wording they prefer. More likely they are looking for anything to beat on the president with, know there is no basis for it, and just don’t mind looking stupid while they beat on a dead horse. I’m not wild about there being a president, as long as there is I can’t be king. But I’m intelligent enough to see that there isn’t any issue here.

If I Were King it would be all the same: There would still be halfwits, cretins, morons, and imbeciles willing to cherish the absurd and consider it as truth.

Yesterday the Star Tribune ran “Schools struggle with gay policies,” an article of some concern that shows that, for all our recent progress, we still have a long way to go in dealing with sexuality. Given four suicides in the past year by GLBT students in or connected with the Anoka-Hennepin School District, it isn’t a minor issue.

The district has adopted a policy of neutrality, sexual orientation simply isn’t part of the curriculum. That’s fine, but that doesn’t mean — it cannot mean — adopting a policy of neutrality toward harassment and bullying.

In the story, Minnesota Family Council President Tom Prichard is quoted as saying, “I don’t think parents want their kids indoctrinated in homosexuality,” and that teachers shouldn’t be saying that homosexuality is acceptable. Codswollop. Or to quote a great litigator of the past, “irrelevant and immaterial”. Schools don’t teach that gravity is acceptable, but they still teach that it exists, and that it has to be respected.

According to an article in The Minnesota Independent, there is a secretive group calling themselves Parents Action League that is campaigning to make sure the problem is made worse. They claim to support the district’s neutrality while campaigning to bring the “The Day of Truth” program to district schools, a program that teaches that homosexuality is a sin, that Christian students should be outspoken in condemnation of it, and that gays can be “cured” through prayer. In other words, a program that claims to be Christian but is completely uninformed by the Gospel of Jesus Christ.

The school doesn’t need to teach anything about homosexuality at all, I’m sure the curriculum has sufficient goals to keep everyone busy. This isn’t about teaching. This is about maintaining an environment in which it is possible to teach math and language and other subjects, it’s about maintaining an environment in which everyone can learn.

If I Were King, I’d still be straight, but education is simply too important to let bigots interfere with the process. I’d still be Christian, but possibly even less tolerant of those who call themselves Christian yet support vicious programs with proof-texting from parts of the Old Testament that they don’t follow in their own lives.

In A Pound of Cure, published in the July/August MIT Technology Review, Andy Kessler challenges the possibility of addressing the cost of health care without addressing the motivations of the health-care industry. He references the recent Dartmouth College study that suggests, based on analysis of 4,000 hospitals, that eliminating 30% of the resources committed to Medicare patients contributed nothing at all to the outcomes of the patients. He doubts that the $19 billion for health-care IT projects included in the $787 billion Obama stimulus package can accomplish anything.

Elsewhere I have stated my opinion that fully 50% of all health care spending could be eliminated with a combination of electronic records and diagnostic software. Electronic records would make it easy to use data-mining software to evaluate the success of different treatment regimes for various ailments. (If a patient knew there was an 80% probability of success with a $1,000 treatment and an 80% probability of success with a $1,000,000 treatment, which one would they choose?) Diagnostic software would help focus diagnosis, eliminating billions in wasted tests.

But as Kessler points out, the health-care industry makes more money when it consumes more resources. The bias of practitioners with an economic stake will always be to spend more. There are few, if any, practitioners with no economic stake.

This is, and will remain, a stubborn problem. If I Were King it would be no different. Better health insurance will not help, that just means that each patient has more resources available. The only thing that has a chance is a combination of patient understanding of the costs and benefits of different options, and an economic stake in choosing among them.

Should we spend a million bucks to keep Mom on life support for another six months? What if that means that nobody in the family will see a dentist for the next ten years? Clearly there are times when heroic (read: expensive) efforts are worthwhile, and times when they provide no more benefit than burning the same amount of currency.

We need better understanding of the costs and benefits, which open electronic records will enable, and then we need to empower patients and families, consulting with health-care professionals, to make judgments about the resources to be used. The industry’s motivation will always be towards growth in spending, I see no reason why we can’t cut that spending in half in the next ten years.

President Obama, in his commencement speach at the University if Notre Dame yesterday, said he supported a “sensible conscience clause” for medical professionals to refuse to perform abortions, and presumably other procedures, which they found to contradict their ethical and moral beliefs.  The exact terms of such a clause weren’t stated, but despite my normal belief that the convictions of the individual should guide their own actions rather than external considerations, I have to oppose this.

That is not to say that a doctor shouldn’t be able to hang up his shingle and define his practice in any way that suits him. If a surgeon opposes abortion and decides to open a practice specializing in ophthalmology, of course he shouldn’t be expected to perform abortions. But if that surgeon went to work in a clinic that provided abortions, and then refused to perform them while drawing his salary, then that doctor should suddenly, and without ceremony or honor, find himself unemployed.

In previous invocations of this concept it has been suggested that pharmacists should be able to refuse to fill prescriptions for drugs of which they disapprove, notably the “morning after pill” abortifacients. But what if a pharmacist was of the opinion, apparently held by many otherwise-sensible persons, that ADD is not really a disorder and that treating it with drugs is wrong? Should that pharmacist be able to refuse to fill prescriptions for Ritalin or Concerta or any of the other drugs that make life with ADD manageable? The answer is no.  Federal law requires most drugs to be dispensed by pharmacists, and as such they are, in effect, a public utility and must not be able to impose their own standards on who can or can’t make use of their services.

I can certainly see a case for professional standards being maintained by physicians.  To say “I do not believe in abortion after the first trimester and therefore decline to seek the training to perform procedures to handle later cases” seems completely reasonable.  But, If I Were King, it would most certainly not be acceptable for someone to take a position that required certain work and then to refuse to perform it.

As mentioned a couple of days ago in our comments regarding the FDA, we need transparency in the health-care field. If any member of the royal household is facing a major health issue, and the physician is recommending a specific course of action, we want to know whether that’s because that specific course is the best possible one, or if it’s because the physician is loyal to the company that sells the device or medication involved because they routinely fly him to Honolulu or pay him to speak at their sales conventions. Worst of all, what if it’s a distant second choice, but the doctor will benefit financially by prescribing it?

Starting today, Park Nicollet Health Services (Minneapolis, Minnesota) is posting all consulting and speaking arrangements between drug and device manufacturers and the 1400 doctors who work at Methodist Hospital and 25 clinics in the Twin Cities. They aren’t posting this in a huge binder you have to ask for at some hidden counter in the administrative wing of the hospital, or filed with some state office, it’s right at this page on their website.

If I Were King, this level of transparency would be universal. We would be delighted to learn that it was universal because the health-care industry saw the need and did this of their own volition, as Park Nicollet has, but we would issue a royal decree if that were needed.