http://www.leftbrainblog.com/index.htmlThe Latest From Left BrainenDrTim@leftbrainblog.comCopyright 2007 Tim2007-07-16T11:26:52-04:00 hourly 1 2000-01-01T12:00+00:00 Tue, 29 Jan 2008 00:13:38 -0500DrTim@leftbrainblog.comMedicine & Science2007-07-16T11:26:52-04:00http://www.leftbrainblog.com/files/Report_Card_Childrens_Health_July_16_2007.html#unique-entry-id-21http://www.leftbrainblog.com/files/Report_Card_Childrens_Health_July_16_2007.html#unique-entry-id-21Federal Consortium Issues Comprehensive Annual Report on Health and Behavior of Children

In case you were paying attention to other things this weekend (like the Tour de France), a report was issued Friday that is basically a report card on several parameters of children’s health in the U.S. The report, America’s Children: Key National Indicators of Well Being, issued by a consortium of federal agencies, has some good news and some bad news. Of surprise to no one who has watched Bush slash every program related to children’s health and education:

• The percentage of children covered by health insurance decreased from 2004 to 2005;

• The percentage of low birth weight infants increased;

• Sixty percent of children live in counties with air pollutants above maximum federal levels.

On the good news side of things, the birth rate among teens 15-17 went down and immunizations of children are improving. For conservatives, the biggest news of “success” was that fewer high school students are having sex. The improvement, however, is less than stellar: Forty seven percent of high school students in 2005 report having intercourse, down from fifty four percent in 1991. While that’s encouraging, that’s still about half of all high school students, and this includes 10% of high school girls and 4% of high school boys forced to have sex.

What's the Definition of Sex?

Also, it only gives the statistic for sexual intercourse, not sexual activity. Traditionally, it has been noted that children who delay sexual intercourse have fewer lifetime partners, lower rates of STDs, and do better overall. However, with the pornification of the U.S., sexual activity as opposed to just intercourse, appears to be practically ubiquitous among teenagers. It would be interesting to see a study that surveyed all sexual activity among teens, since many of these activities are at least as effective at spreading STDs as intercourse.

If the popular media is to be believed, the “girls gone wild” phenomenon has become an intractable rite of passage for young women and, optimistic national reports notwithstanding, shows no sign of abatement. The question remains, then, when will the current sexual revolution end?

The End of Girls Gone Wild?

For an answer, we need only look at the history of the last sexual revolution and its demise. The baby boomers’ sexual revolution, the “free love” phenomenon, fueled by hippie morals, widely available contraception, and the assurance that antibiotics could fix any disease, ran into a brick wall in the 1980s.

Hippies Gone Straight

The former-hippie baby boomers were by that point living in the suburbs and voting republican, and the generation reaching adolescence was caught up in a perfect storm combining the rise of the Reagan Youth and the appearance of AIDS. With lots of pompous morality posturing in the media to keep up appearances coupled with a horrific disease to ensure compliance, the sexual revolution of the sixties and seventies was dead and gone. If you were carving a headstone for the absolute final demise of the FL revolution you could pinpoint November 7, 1991, the day that basketball legend Magic Johnson announced he was HIV positive.

Six More Years

What replaced FL, of course, was the era of “hooking up,” with emphasis on oral sex, nontraditional sex, and complete removal of all pubic hair to facilitate the aforementioned. The result, from a disease standpoint, has been the rise of HPV, to the point that some estimates have HPV as pandemic among adolescents, teens and twentysomethings. While not nearly as deadly as HIV, it can lead to unsightly genital warts and cancer, which has at least gotten the attention of many young people.

But don’t look for an increased virulence of HPV to be the death knell of the GGW sexual revolution. Like Magic’s announcement, the end will come via the media, although this time not by a single celebrity’s press conference. And it’s still a few years away: It will occur July 1st, 2013, via the internet.

The date of the final demise is just an estimate, of course, but we will probably be seeing the beginnings of the end soon, and here’s why: The first of the GGW videos came out in 1998. Since the videos are mostly college and spring break related, assume an average age of 20. The average age of having a first child for women in this country is 25. Assuming a normal distribution of birthdays across the calendar, the “average” child born to the “average” woman displaying herself in video format for all to see would be about four years old as of now.

Mom Did What? That is so Gross

One trait of adolescence that has been absolutely invariable across generations is a complete disgust at the thought of their parents doing anything physical. Today’s children are internet savvy. Assuming the normal curiosity of preteens, it will be at about age 10 when these children of the GGW will stumble across the internet videos of mommy being taken doggie style by an entire frat house. Their disgust, coupled with the natural desire at that age to be very different from one’s parents, will be the doom of the GGW revolution.

The Next Revolution

What will replace it is anybody’s guess. Since hormones will always be there to stir young people into some kind of sexual experimentation, something will certainly come along. Given their love of computers, maybe it will be some type of virtual reality. Or maybe, if they really want to try something different, it will be the SWL (sex with love) revolution. How’s that for a far out idea?

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]]>DrTim@leftbrainblog.comPolitics2007-04-09T10:34:53-04:00http://www.leftbrainblog.com/files/Man_Who_Would_Be_President_April_9_2007.html#unique-entry-id-20http://www.leftbrainblog.com/files/Man_Who_Would_Be_President_April_9_2007.html#unique-entry-id-20Al Gore: Presidential Candidate or Presidential Footnote?

In this brave new world of the permanent campaign, one of the most enviable positions for a candidate to be in is to not need to campaign. While there are some doom and gloomers who say that it will soon be too late to get in the race, there are a few heavy hitters who have yet to make up their minds. The right, nervous about Rudy’s liberalism (we haven’t heard about a right-wing crazy man in a dress since J. Edna Hoover’s death), is still looking for their knight in shining armor, thus the flirtations with Newt and Fred. The left is more optimistic about their chances in 2008, but should Barack and Hillary go down in flames, the choice for knight-delegate is obvious: Al Gore.

Not that Al is actually running, mind you, but to be able to pull off a solid third place in most polls while not having made a single fundraising phone call, raised a single penny, or even declared that he seeks or would accept the job, must have the likes of Bill Richardson and John Edwards seething with envy.

In what has to be the greatest slacker campaign in modern history, Al Gore is using every forum possible to spread his message, a good chunk of which is that he is not running for president. He is not running for president, his only campaign is against global warming, he enjoys life much more now, feels he is doing more good now than he ever did before, and has no desire to get back into politics. He has said all of things but conspicuously absent has been one single phrase that would end all speculation: "I will not seek election in 2008." He wants to leave the door ever so slightly ajar.

In 2003, Gore ended speculation of a Bush-Gore rematch when he endorsed former Vermont Governor Howard Dean and asked the grassroots organization draftgore.com to cease and desist. DraftGore is back in business, along with an army of believers ready to sign on to the cause. So why won’t he announce his intention to run? Two reasons: He hasn’t made up his mind, and he’s getting the best publicity possible by shunning publicity.

Traditional advertising has reached its limits. The constant assault by print, billboard, radio, television and internet advertising has led to a general numbness towards the industry. The average American will view an estimated 2 million television advertisements by age 65, to say nothing of the other mediums. Speaking in round numbers, probably 20 million advertisements in a lifetime, which brings new meaning to the term way too much information. The brain can’t hope to process or retain even a fraction of it, so we learn to ignore it, and this has led to the rise of two enormous growth industries in advertising: targeted advertising and guerilla marketing.

Targeted advertising makes use of extremely sophisticated statistical analysis looking at past behavior to predict future interests. It works extremely well for select groups, but not so well if you’re trying to reach a large generalized audience. To reach a generalized audience, for example registered voters, you need a much broader scope in your advertising, but you need your voice not to get lost in the din. The point of guerilla marketing is to get other people to do your talking for you, constantly and repeatedly, as happened in February with the Adult Swim cartoon network’s ad campaign that first caused a bomb scare and then became national news for days. For the moment, Al Gore is running an incredibly effective guerilla campaign. But is he really running for president, or is he just having fun? Probably a little bit of both.

Reasons Al Gore Might Not Want Run For President

Iraq: Even with the best, most effective management possible in the last 21 months of his presidency, George W. Bush will be leaving an enormous mess for his successor, and if the numerous current scandals surrounding the White House are any indication, the mess will only get worse with each month of the countdown until W is history. Yes, a sensible president could put us on the road to recovery in the middle east, but the cleanup job will outlast the next president, and Al knows he would never get credit it for it anyway.

There will be no “winning” solution in Iraq in the short term, and the Neocons have concocted a fail-safe method of assigning blame to others: always raise the stakes. They will never admit failure in Iraq or do anything to correct their mistakes, they’ll just keep compounding them, knowing that eventually a democratic congress or president will end the madness, and then everything will be the democrats' fault, ie, “If only you had the strength of will to continue our policies just a little longer…” John McCain still think we could have won in Vietnam, if only the politicians had done a better job.Vietnam beat President Johnson and Gore must realize it could beat him too.

Terrorism: The foreign policy of Dick Cheney and George W. Bush have done more to foster terrorism than Osama Bin Laden could ever hope to. Bin Laden’s skillfully timed broadcast in 2004, tying in the war in Iraq, terrorism and global warming, had the intended effect of driving Republicans to the polls. The Bin Ladens have always been chummy with the Bushes, and Osama probably thinks of George and Dick as his two best recruiters. With so many new terror cells being formed and so much hatred engendered, sooner or later something bad is going to happen. If it happens with a Republican at the helm, well that just means we need to spend more money, clamp down more, send more people to Guantanamo, eviscerate the constitution a little more, tap a few more phones, and torture a few more citizens. But if it happens with a democrat in charge, then at best, the democrat’s “liberalism” undoubtedly allowed it to happen or, as the Hannity and O'Reilly clones will undoubtedly accuse, was actually in on the conspiracy.

Hillary Clinton: Al Gore has up close and personal experience with just how formidable the Clinton machine is. The thought of taking that machine on probably doesn’t fill him with dread as much as profound weariness. Anyone going against Clinton will have a tough time, but Al will constantly be fighting a two-front war against the Clinton slash-and-burn-win-at-all-costs machine as well as the very similar right-wing-slander machine.

The Right Wing Slander Machine: Does anybody know how much Bill O’Reilly’s electric bill was last month? Or Sean Hannity’s or Rush Limbaugh’s or any other fatcat Republicanazi millionaire’s? Of course not. But Al Gore’s was front page news. This is a well-used RWSM trick: Take your opponent’s strength and turn it into a weakness. Thus, Micheal Dukakis was Boston Harbored, John Kerry was Swift Boated, and now Al Gore is being Inconvenient Truthed. The RWSM will continue to use this technique for as long as it’s effective, which will be until the slandered fight back. Hillary and Bill love a good fight, but Al does not. Historically, he has shown that he would much rather take the high road. From his early days in the senate until his current campaign against global warming, he has consistently held to the belief that if you present the data, people will do the right thing. Gore knew he had won in 2000, not just the popular vote but in the electoral college as well. A recount of the Florida 2000 vote, which he did not request and which did not take place until after the vote was certified, showed that in fact he had won in Florida. But knowing he had won he also knew that he would have little chance of governing effectively. To win in 2008, he would have to wade neck deep into the mud.

Money: To effectively compete for the presidency in 2008 will probably cost half a billion dollars. One hundred million by the end of 2007 is considered the entry fee for serious contenders at this high-stakes political poker tournament. To become a high roller means lots and lots of phone calls, lots and lots of begging, and lots and lots of favors called in and favors promised. This is exactly the kind of sleazy dollars-for-favors politics that Al Gore despises and he would have to saturate himself with it.

Reasons Al Gore Might Want to Run for President

Iraq: No politician has been a more vocal critic of the ill-advised and ruinously managed invasion of Iraq. If ever Gore was tempted to play the role of knight in shining armor, what better opportunity than to right the wrongs of his archnemesis?

Terrorism: The Neocons love to go after Bill Clinton for failing to do more to get Bin Laden, conveniently forgetting that 9/11 happened on Bush’s watch. Whoever comes next is going to need a wealth of political experience, not to mention international experience, as well as the ability to change tactics as necessary. It is possible that Gore looks at the current democratic field (to say nothing of the repubs) and recoils, and sees himself as the nation’s only chance.

Hillary Clinton: Cookie-baking attempts to soften her image aside, the adjective “nice” is not among the many strong adjectives used to describe the former first lady. This is an organization so formidable that it’s tracking Al Gore’s weight. Having been pushed around by Hillary for eight years, it’s possible that Al would like a little payback. And as far as Hillary as president, Gore probably has two fears about that: that she won’t win, and thus we’ll be stuck with Wasit-Deep-In-The-Big-Muddy McCain or Onward-Christian-Soldiers Romey, or that she will win, which amounts to about the same thing.

The RWSM: The problem with shock value is that it only works once, and then you have to change tactics. Thus, a Borat II would be hard to pull off because too many people are now in on the joke. It’s possible that Gore is a little gun-shy after his own bashing at the hands of the RWSM, but he may be emboldened by how flat their techniques fell in the 2006 election, and he may have noticed how easy it was to fight back after the electric bill nonsense. Or maybe he’s just itching for a rematch.

Money: All kinds of would-be presidents set records for the first quarter of 2007, with Clinton, Obama and Romney all checking in at about $23 million. (Hillary’s actual total was $26 million, but she wouldn’t disclose how much of that must be saved for the general election, so the real numbers for her, Barack and Mitt are probably very close.) And as sitting US Senators, Hillary and Barack are able to get a certain amount of free publicity. But does any of that compare to the free publicity that Al has been basking in lately? And as far as donations go, Al has an army at the ready, and there’s no law against donating to more than one candidate, something that will probably do the democrats more good than the repubs for the first time ever, since now more high-end donors are giving to the dems. And that’s to say nothing of the soft money that could come pouring in for Al, given his long list of high roller pals.

Gore’s Decision

So will he or won’t he? He likely hasn’t made up his mind, but to keep his options open he’ll keep himself in the spotlight. For those of us on the sideline, we can only guess. And maybe keep an eye on that waistline.
]]>DrTim@leftbrainblog.comPolitics2007-02-19T16:21:47-05:00http://www.leftbrainblog.com/files/Hillary_Clinton_Admit_No_Mistakes_Feb_19_2007.html#unique-entry-id-19http://www.leftbrainblog.com/files/Hillary_Clinton_Admit_No_Mistakes_Feb_19_2007.html#unique-entry-id-19Senator Clinton Alienates Progressives With Her "Never Admit Mistakes" Campaign

Hatred of Hillary Clinton on the Far Right approaches the pathologic, and is so prominent it ought to be given its own name; call it That Damn Woman Syndrome. Tapping into that hatred is keeping a hopeless candidate like Rudy Giuliani at the current head of the GOP pack, with the simple logic that any hard-nosed conservative—most of whom would rather see him pilloried than elected—will vote for him if the other choice is that damn woman! Given that such hatred is the ultimate “street cred” for Progressives, it is surprising that TDWS is almost as pervasive on the Left as it is on the Right.

Months before the 1992 election, Hillary Clinton first brought infamy to herself by saying, during an interview on Nightline: “I suppose I could have stayed home and baked cookies and had teas, but what I decided to do was to fulfill my profession which I entered before my husband was in public life.”

Conservatives didn’t need a whole lot more reason to hate Hillary; just her assertion that children should be declared legally competent (which would allow children to sue their parents) was plenty. But the “cookies” statement turned a storm of anti-Hillary sentiment into a hurricane. It was, in their view, arrogant, anti-family, anti-marriage, cold and calculating. The rest of the campaign only hardened their opinion of her.

The view on the Left, meanwhile, was quite the opposite. The election of Bill Clinton in November of 1992 meant to Liberals and Progressives that there would be a First Lady who was anything but window dressing to her husband. She was smart, articulate, and had a strength of will that hearkened back to Eleanor Roosevelt. But a lot has changed in the last fifteen years, and now there are probably almost as many new-generation Progressives as there are old-school Conservatives who see Clinton as cold and calculating.

There are many reasons for this: First, there is the Iraq War. She voted to authorize it in 2002. So did a lot of other Democrats in the Senate, but most of them have disavowed that vote. But Clinton steadfastly refuses to recant that vote, or call it a mistake, as former Senator and 2008 hopeful John Edwards did in an opinion piece in November 2005. Even the fact that it’s costing her votes does not faze her. Progressives are starting to feel that the formidable Clinton shares one chilling trait in common with George W. Bush: Never admit you’re wrong, even when it’s painfully obvious that your lack of candor is costing you support.

She has displayed other too-close-to-George sentiments that are setting progressives teeth on edge. On the Iraq war, she has said repeatedly that had she been president in 2002, we would not have gone to war, but that she still made the right decision in authorizing, because she was given bad information. In other words, I was a pawn, and did as I was told, but make me Queen and I’ll do a better job.

Besides not admitting the Iraq vote was a mistake, she states that she will not redeploy all troops out of the region if elected president. “There will be missions,” she said ominously. And while there rest of the country (and the whole world) is screaming to Bush to not make the Iraq mess worse by attacking Iran, Clinton insists “No option can be taken off the table,” in dealing with Iran, including military action.

In trying to break the glass ceiling of presidential politics, she obviously thinks that her admit-no-mistakes policy is the best way forward, but if she thinks that by sticking to her guns (literally) she is going to avoid John Kerry’s fate of being labeled a flip-flopper, it’s already too late: The Necons, remembering their success with Kerry, have already started calling her a flip flopper. Meanwhile, she is fooling no one with her nuanced “If I had only known” explanation; if tens of millions of progressives were able to see through the Bush Administration lies that led up to the Iraq invasion (Iraq-Al Qaeda, weapons of mass destruction, 9/11 connection), how is it that a US Senator was not able to see through them? She would do better to take a lesson about learning from mistakes from another politician, the Gipper himself, who escaped unscathed from a completely botched Lebanon deployment by taking responsibility, admitting his mistake, and moving on.

Moving on is exactly what progressives want to see in any presidential candidate: Moving on in Iraq; moving on in the stalled Israeli-Palestinian peace process; moving on in economic development at home and abroad; moving on toward a balanced budget that stops giving the best pieces of the pie to the super rich at the expense of the middle class; moving on toward reclaiming this country from the badly misguided policies of politicians who can’t admit mistakes. And moving on is something the steadfast Clinton shows no inclination of doing, giving progressives a bad case of TDWS.

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]]>DrTim@leftbrainblog.comPolitics2007-02-15T22:21:30-05:00http://www.leftbrainblog.com/files/No_Soldier_Dies_In_Vain_Feb_15_2007.html#unique-entry-id-18http://www.leftbrainblog.com/files/No_Soldier_Dies_In_Vain_Feb_15_2007.html#unique-entry-id-18Senator Obama says he meant no offense by saying soldiers' lives “wasted.”

To say that war is wasteful is to state the obvious. The trillion or more dollars that will eventually be spent on the Iraq War is indeed being poured down a rat-hole. To say nothing of the good that money could have accomplished for education, health care, tax cuts, energy, or science, we could hardly have used it more foolishly. We have wasted, through ludicrous foreign policy, our international standing, our technology, and our resources.

But to say a life has been wasted is to say something else entirely. A "wasted" life implies one spent for nothing, as for example someone of great talent who wastes their life pursuing low and mean pleasures of the moment, spending their potential on things of no value. Truly, our celebrities’ lives are wasted. The lives of soldiers are never wasted.

The founders of our country had the foresight to place ultimate control of military might in the hands of a civilian government, that zealotry and dictatorship would be checked. The United States soldier does not swear an oath of allegiance to any one man, as German soldiers once swore to Hitler, but rather they swear to defend the Constitution. It is from this simple oath that the honor of the soldier, living or dead, rests securely. Whatever the motivations of those who sent him, the soldier offers his life in defense of the core values of his country.

The United States Military, from the Air Force to the Navy Seals, makes one unique demand of those who serve that is unequalled in any other profession: that they be willing to lay down their lives in service of their country. There are many professions in which service to community is paramount and danger plays a large role; police and fire fighters come to mind. But in each case, other than the military, the risk is always a calculated risk. That is, the individual has the luxury to assess the risk and to avoid it, as in a police officer awaiting backup before arresting a dangerous suspect. For soldiers, there is no calculating to be done; they are told to go into the line of fire and they go.

I have served as a fire fighter, risking myself to save others. But never did I feel that the flames had a special hatred for me; I never worried that a burning structure hid the fixed eye of a sniper; not one time did I fear that our truck would be blown to atoms by an IED buried under the street. The calculated risk of dangerous jobs, whether police officer, fire fighter, or underwater welder, cannot compare with a soldier’s risk, because it is not constant. Our soldiers in Iraq live with the fear of death 24 hours a day, 365 days a year, for as many years as those in power care to tell them to stay there.

They can be held beyond their tour of duty and they can be recalled after discharge. They can be sent to die at any time, from the time they volunteer, for the rest of their lives. They are on call all day and night, every day and night, for pay that is less than minimum wage, knowing that if they are killed the survivor benefits are so poor that their families may live in poverty.

Whatever his motivations, whatever her intentions, the soldier makes a lopsided bargain with his country: For small pay and modest chances to improve his lot, he will face death that we may know our country is secure. As payback for this ultimate sacrifice we do not have much, but we must give all that we have: Respect for the soldier, honor for the dead, knowledge that they fell doing what they were supposed to do, following orders, ready and willing to die that others may live.

Senator Obama, your wish to chastise the president is well founded. George W. Bush is a dangerous fool, and all of us will pay the price for his follies for decades to come. But with every generation we learn anew what we have known since our founding: that to have the blessings of life, liberty and the pursuit of happiness for the many, a few must be willing to give up those blessings. Those who die are to be remembered forever for having given us that precious gift, and no such gift is wasteful.

You recanted your statement immediately and you have been forgiven. But do not be swept away by your current fame and seeming invulnerability so much that you forget those whose lives were not spent in the libraries of Harvard but the deserts of Iraq; not the streets of Chicago but the streets of Baghdad; and who now reside not in the Senate but in the grave.

To all our fallen heroes, you are not forgotten, you are not gone from within us, your spirit moves us, your lives were indeed not wasted.

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]]>DrTim@leftbrainblog.comLove and Other Messes2007-02-13T21:06:05-05:00http://www.leftbrainblog.com/files/Missed_Opport_VDay_Feb13_2007.html#unique-entry-id-17http://www.leftbrainblog.com/files/Missed_Opport_VDay_Feb13_2007.html#unique-entry-id-17What’s the worst kind of love? The kind that never happens.

Warning: This is not a drippy, soupy, fuzzy, glurge-filled Valentine’s piece, nor is it a bitter, angry, scathing anti-Valentine’s Day piece. It’s not about love or love unrequited. It’s about missed opportunity.

Reflecting on missed opportunities has nothing to do with the happiness of your current relationship. You can be extremely happy with your currently relationship (I’m super extremely happy with mine, for example, so you can put down the knife, darling) and still wonder what might have been, or just wish that the process of getting where you are not hadn’t been so laden with pain. Probably the most foolish sentiment ever to misrepresent itself as wisdom is the statement: “What doesn’t kill you makes you stronger.” This is pure unprocessed horse manure. How many diseases leave you stronger for having ravaged your body?

Breakups are evil. I don’t mean the ordinary, went-to-college-in-different-states-and-drifted-apart or got-bored-and-separated-amicably type of breakup, but that simmering, seething, lots of yelling spiteful venomous things at each other, gut wrenching, stick-the-knife-in-and-twist kind of breakup that we’ve all suffered. Saying that you’re stronger for that kind of experience is like saying you’re stronger for having survived smallpox. You’re not stronger, you’re a shadow of your former self, withered, wrecked, and scarred.

I admit I bear my share of smallpox scars. I don’t wear them proudly and I wish I didn’t have so many. It’s not that I’m not happy where I am (did I mention I love my soon-to-be-wife very very much?), it’s that I have a pretty good memory for unpleasantness. What I really wish is that I could have ended up exactly where I am, but by a much less tortuous road. More specifically, at each “disaster point” I had a choice to race ahead or put on the brakes. By not braking, not only did I eventually crash in spectacular fashion, I missed out on all the better roads along the way.

Using myself as an example of What Not To Do In Love I will reach back in time and revisit some of my own lost moments. Some were relationships that ended for no apparent reason, some were relationships that never happened, some were women I barely knew. But each of them left a deep impression of Missed Opportunity. In chronological order:

Nancy: My first love. It seems so retro now in our thoroughly pornified society, but in those days only the “bad” kids dated in junior high, while for the rest of us dating began at the first dance in the fall of ninth grade. You were smart, pretty, and kind, and you were the one I was going to ask you to that Freshman Fall Dance, but I moved three days before the start of high school. And if I’ve always crushed on green-eyed brunettes, you were the source of that crush. I hope you’re well.

High School: An awful time in every way, except for three little gems, one I worked with at the local bakery, and the two girls who sat in the back row with me in AP English class. I really should have asked one of you out, but I was overwhelmed with the awfulness of my life. I still tremble to think of all time I wasted crushing on stuck-up bubbleheads, when the three of you were right there in front of me. Even if all of you had said no, at least I would have been rejected by sweethearts, instead of the soulless airheads I chased after.

Rachel: College is a wonderful and precious time of life, and I squandered it on three women, as vapid as they were average. You, on the other hand, little brunette dazzler with violet eyes to die for, were sensational, gorgeous, funny, intelligent, every man’s dream. We worked together at a pizza place, even went out occasionally. But I was so sure you were way out of my league I never asked you out. You can’t imagine my pain when I ran into you years later and found out you had been waiting for me to ask you out! I still cringe at the thought that had I worked up the nerve to ask you out, I might look back on my college years with fondness instead of as a string of unbroken misery.

DC Bike Courier Girl: You’d be in your late thirties now, I’d guess. I was working a summer job as a temp, doing computer stuff, and had to dress in a shirt and tie every day. It was a warm day, you were dressed in your spandex biking shorts and tight-fitting shirt, sitting on a park bench, your legs stretched out in front of you, your bike courier radio blaring out some other biker’s delivery. You were the best looking woman I have ever seen, way beyond model pretty, but it was your legs that had me ready to worship you: The best, shapeliest legs I have ever seen, and torn. to. shreds! Not like just one bad fall, but scabs and scars all up and down your legs in various stages of healing, like the most hardcore, balls-to-the-wall, slam-pedaling bike courier to ever strap on a radio. And no helmet of course.You were drop-dead gorgeous, you knew it, and you didn’t give a crap! That made you more beautiful than any woman who has ever lived. I was too ashamed to talk to you, dressed in my yuppie scum outfit, I probably would have at least said hello if I’d been on my own bike, but what I should have done was gone to the nearest jewelry store, maxed out my Visa, and proposed marriage on the spot. Sigh. I hope you’re well, and if you’ve had children, I hope you make them wear helmets and pads.

Shelly: Among a long list of mistakes and missed opportunities, I’ll be kicking myself forever about letting you slip away. You were perfect in mind and body and we clicked on a level that I had never clicked with anyone else, and it had the passion of total surprise. We met in an evening calculus class, I was preparing for medical school, you were doing some kind of engineering thing for the Forestry Service. We were both seeing other people when we met, we just became friends, then we started hanging out a bunch, then it was clear we were really into each other, but then I suffered through a slow and disastrous breakup with my girlfriend and I was out of it for awhile. But I still had your phone number, and I got over my ex, and I heard you had broken it off with your guy, and I called you up. You said, “I’m really busy, but I can see you Friday night.” What an invitation! And I didn’t take you up on it! Stupid, stupid, stupid! I don’t even remember what it was that I had to do that Friday. To make matters worse, I said I’d call you the following week, and I never did! It took me several years and further disasters to realize what a mistake that was. I’m really sorry. I hope you’ve married, have a wonderful career and several beautiful children. I think of you often.

Michelle: I’ve come close to marriage several times, and when I look back, I realize that all of them would have been horrible relationships doomed to end in messy divorce. Except for you. You were sweet, stable, intelligent, sexy beyond belief, and with true panache. You were ready to move in with me when I left for med school. So why didn’t we get married? I’ve never found an answer; at least we could have given it a try. I’m especially sorry about the last time I saw you, that morning after the night I spent in your apartment, and you made that fabulous breakfast, sausage, eggs, bacon and coffee. And I didn’t touch any of it. That was really rude. I’m a jerk. At least I could have drunk the coffee. Most of your life has been way harder than it should have been, you deserved much better. I hope you’ve found true love.

Jennifer: The fact is, you broke up with me, but I had been hinting that way myself for weeks. We were both in residency, got along great, had similar interests, talked about everything, never fought, and ended it. Why? Considering the relationships that followed, I would have done much better to stay with you. At least during my five years of surgical residency I would have had something to look forward to, instead of the insanity that took place with the women I dated after you. I hear you’re starting your own practice. I wish you the best.

Anne Marie: My professional life stabilizing, I took a long hard look at my social life and realized what a shambles it was. But how to meet new people? With fear and trepidation, this child of the seventies turned to the Internet. The first thing I learned is that there are a lot of really weird people in the world. But then I learned that, if you’re willing to take the time to pan the river slowly and carefully, there are real golden nuggets in the stream of Internet Dating and you were one. You had everything I’ve ever wanted in a woman, you were even of the same religion and political persuasion, and you were just a little shy and awkward like me. We went out a few times, had a great time each time, and then I let it drop. I’ll never know why. I hope you’re well.

To all of my Missed Opportunities from over 20 years of dating hell, I wish you the happiest Valentine’s Day on this February 14, 2007. And now, at long last, having found true love, I would like her to know that she has all of my love and affection. Lastly, I admonish all of the single, lonely or unhappy: Stop wasting time, and don’t let another opportunity disappear. Love is the riches of the soul, don’t squander it’s wealth; one good relationship will make up for a lifetime of misery. Trust me, I speak from experience.

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]]>DrTim@leftbrainblog.comMedicine & Science2007-02-10T18:42:43-05:00http://www.leftbrainblog.com/files/VIP_Syndrome_Feb_10_2007.html#unique-entry-id-16http://www.leftbrainblog.com/files/VIP_Syndrome_Feb_10_2007.html#unique-entry-id-16Want great care in the hospital? Don’t try to pull rank!

True story: A man, let’s refer to him as Junior VIP, comes into a major hospital in the wee hours of the morning with abdominal pain, mostly located to the right and downward from the belly button. His lab values indicate he has some type of infection, and he has been running a slight fever. Appendicitis is suspected. A CT scan is obtained, which neither rules in nor rules out appendicitis. At this point, about two hours after presenting to the ER, Junior VIP has been seen by the ER physician, ER nurse, senior surgical resident and chief surgical resident. The attending physician now examines the patient and agrees that appendicitis cannot be ruled out and admits Junior VIP to the hospital, explaining to JVIP that we don’t want to miss anything but we also don’t want to do an unnecessary surgery for what may turn out to be a viral illness. Therefore, we will admit, obtain further labs, give fluids, keep him from eating, and observe his condition during the day. If he improves, there will be no need for surgery. If he gets worse, we will take him immediately to the operating room. JVIP agrees to this plan, but soon becomes agitated in the ER. “When am I going to get my room,” he complains to the ER nurse, followed by “It smells in here. Did someone crap their pants?” followed by “There are drunks in here, get me out of here right now!” The ER nurse, then the ER physician, as well as the residents, explain that the hospital is very full but they are working as fast as they can to obtain an available bed as soon as possible. JVIP tells them to hurry, and make sure it’s a private room. But after one more hour of being in the ER, JVIP decides he can’t stand it any more, and checks out Against Medical Advice.

Being a (Junior) VIP, he is incensed at his “shabby” treatment, and uses his connections to contact the local newspaper outlet, the local television news outlet, the mayor’s office, and several prominent friends who are tight with the hospital board members. The attending surgeon, who saw the patient two hours ago, and is now in the OR where he plans to finish his first case of the day and then check on JVIP to see how he is doing, gets a phone call from the CEO of the hospital, demanding that he break scrub to discuss this “unacceptable” matter. This, within five minutes of receiving a phone call from the surgical resident explaining that the patient has checked out AMA, another phone call from the local television news asking for a comment on a story they are doing about Delays In Diagnosis For Severe Medical Conditions, another phone call from a physician colleague in the hospital who wants to know what happened with her friend JVIP and why he didn’t get treated, and a phone call from JVIP’s lawyer. Two more phone calls from the Chair of Surgery—all this while the attending surgeon is trying to operate—and it is established that JVIP will be returning to the hospital, will go directly to preop and be taken immediately to surgery. No more tests, no observation, no more “flimflam” is the word from above.

Eight hours after checking out AMA the patient is seen by the attending surgeon in preop, advised that his problem may have nothing to do with his appendix and that this surgery may be unnecessarily exposing him to risks of infection, bleeding, and further surgery in the future, to which JVIP answers: “Get on with it!” He is taken to the OR, a diagnostic laparoscopy is performed, no intra-abdominal pathology is noted, and per protocol the appendix, although it does not appear inflamed, is removed. The patient is discharged home the following day. Final pathology on the appendix shows a normal appendix with no infection.

Not only is this story true, it is repeated every day in hospitals across the country. It even has its own name: VIP Syndrome. The VIP Syndrome has been a recognized phenomenon in medicine since at least 1964. It is described as generally poorer care that is given to a patient of particular influence—due to money, fame, political power, or connections to powerful community members—because of deviation from the standard of care. The changes made to the standard of care can be too much of something, too little, or things totally inappropriate. These decisions are made because of fear of causing discomfort, or embarrassment or lack of privacy to the VIP, the VIP’s own demands, and the feelings of caregivers that they must do something different for the special patient.

As a surgical resident, I spent many months on trauma rotation at a very busy "Level One" trauma hospital. As there were dozens of traumas every day, we got very good exposure to trauma care, and consequently became very competent at it. The Chief of Trauma used to admonish us often that he hoped if his wife was ever the victim of a motor vehicle crash and brought in as a trauma patient that we would treat her exactly like a Saturday Night Drunk. Starting at about 11 p.m. Saturday and continuing until dawn Sunday, the SNDs would crash their cars, sustain various injuries, and be brought to us by ambulance. They would he bloody, messy, smelly, often screaming and cursing, and reeking of alcohol. We followed the same procedure on everyone: Primary Exam, with a quick look at airway, breathing, major circulatory problems and immediate threat to life, with life-saving interventions as needed; Secondary Exam, head to toe, every body part inspected; standard labs; standard set of X-rays called a trauma series; a decision made to proceed to the OR or obtain further testing; followed by a series of CT scans determined by the findings of the xrays, usually including head, cervical spine, chest, abdomen and pelvic CT scans; then admission to the appropriate ward of the hospital, followed by another complete head to toe exam several hours later, to ensure nothing was missed. To accomplish this took at least two ER nurses, two surgical residents, an attending trauma surgeon, an anesthesia attending, a nurse anesthetist, two OR nurses, an ER technician, a radiologist, as well as consults from many specialists, depending on their injuries (eg, orthopedics, head and neck surgery, neurosurgery). The process took hours to get through, often with the SND screaming and puking all over us, all in the middle of a busy, noisy, smelly ER, all of which we ignored and carried on with what we knew was the right thing to do. Yes, they were drunk and annoying, and many of them were repeat customers, but they were also very at risk for severe injury. Yelling and cursing, for example, might be due to the alcohol, or it might be a sign or severe pain or a head injury. We knew the protocol and we knew if we followed it we were not going to miss anything.

Now imagine a scenario in which the Trauma Chief’s wife comes in to the trauma bay, with the following results: We can’t cut her clothes off, it might embarrass her, meanwhile missing a major injury. Or: We can’t put this cervical collar on, because it might be uncomfortable, and then it turns out she has a c-spine injury and is paralyzed because of our “niceness”. Or: Don’t put such a big IV into her, it might hurt, meanwhile having no way to resuscitate her when it turns out she has a major bleed. Or: Let’s not get so many CT scans, it’s too scary for her to be in there all alone, meanwhile missing any number of internal injuries. Examples abound, but the bottom line is VIP = substandard care. In the end, the SNDs were getting the best care, which is what the Trauma Chief wanted for everyone, including his wife.

I had many opportunities to witness this phenomenon as a resident. Many patients have the idea that residents are not “real" doctors and therefore provide a lower level of care, and insist that the attending physician is the only one who they will talk to. What these people never realized is that they are hurting their own health. The general practitioner “one doctor for everything” phenomenon works fine when all the GP has to do is prescribe physics and pull teeth, but that concept has no place in modern medicine. Medicine today is a team sport, involving, in a typical hospital stay, 50-100 professionals—attending physicians, consultants, residents, nurses, technicians, physician assistants, pathologists, lab assistants, radiologists and a host of other hospital personnel. It’s expensive but comprehensive. Removing integral parts of that team is like trying to fly an airplane that's missing several of its components, or having a patient tell me to operate blindfold and with one hand tied behind my back. Both can be done, but with similarly disastrous results.

The greatest irony in the case of Junior VIP is that the reason the hospital was full on that particular day and he didn’t get a room right away—beyond the bed shortages that are now endemic to hospitals that must operate at 100% occupancy or go bankrupt—is that another VIP, let’s call him “Super VIP,” had given the hospital a substantial donation so that he could have an entire wing to himself for recovery after an elective surgery. The wing was needed to accommodate all his guards and gofers and general hangers-on, all of whom provided a blockade to his health care providers. Which meant that nurses and residents and fellows and lab techs were sent away, which added up to care way below the standard for Super VIP. A homeless drunken man who trips and falls in front of the hospital will receive better care than either Junior or Super VIP, because Mr. Homeless Guy will get the standard of care with no deviations, while the VIPs use their power to hurt themselves.

The most annoying part of all this is that Junior VIP is probably going to sue. For what? It doesn’t matter. Lawyers know that juries often hand out large cash awards, not because the doctor did anything wrong, but because they feel sorry for the patient. After all, it’s only insurance money, those insurance companies have plenty of money, and who cares if the doctor’s career is trashed. And who writes the laws that allow this foolishness? Other lawyers, of course. So JVIP will sue for Delay of Care (even though that was his own fault) or Pain and Suffering (never mind that he caused way more of that to the people around him than he suffered himself) or Unnecessary Surgery (even though he demanded it). And caught in the middle of all this is the surgeon, who just wants to do his job, treat his patients, make them well, and send them home healthy.

Even for those rich enough or connected enough to have a personal physician follow them around the world, that’s not going to help with anything except little stuff. For anything major, someone needing medical help is going to end up having to talk to a specialist, a surgeon for example, or a neurologist or whatever, and then have to be seen by that doctor either in a clinic, if it can wait a few days, or in an ER, if it’s an emergency. And on any given day in any ER in this country, even to foo-foo private ones that cater to the rich and powerful (like the Frist family’s Hospital Corp.), there are going to be drunks, and nasty smells, and noise, and lots of chaos. And bed shortages. Screaming and complaining and calling your congressman won’t change that.

This is not to say that patients shouldn’t be advocates for their own health, of course they should. They should ask questions, and read all about their diseases, and get second opinions (or third and fourth opinions if they're not satisfied). But anyone who thinks that pulling rank is going to improve care should conduct the following experiment: The next time you get on an airplane, first go to the air traffic control tower and fire everyone in there, since you know so much; then fire the aircraft mechanics and service the plane yourself; then fire the pilot and fly the plane yourself. And afterwards, if you survive the crash, consider not making those same mistakes when you get sick.

We may not be as well-connected as politicians, or as famous as celebrities, or as rich as lawyers, but we do know about health, and we do try to do our best for our patients' health, even those patients who do everything they can to prevent us from helping.

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]]>DrTim@leftbrainblog.comPolitics2007-02-06T20:07:18-05:00http://www.leftbrainblog.com/files/Right_Wing_Loves_Nader_Feb_6_2007.html#unique-entry-id-15http://www.leftbrainblog.com/files/Right_Wing_Loves_Nader_Feb_6_2007.html#unique-entry-id-15Perennial candidate and presidential spoiler Nader says he may be back; Republicans breathe a huge sigh of relief

With George W. Bush’s approval ratings hovering in the low 30s, the Iraq war grinding on with no end in sight and costs spiraling into the stratosphere, and a field of Republican Presidential candidates as inspiring as corned beef, the Republican base finally has something to cheer about: Ralph Nader is back. This is the same Nader, you may remember, who handed the 2000 election to Bush on a silver platter. If not for Nader, there would have been no recount, no Katherine Harris, no 5-4 Supreme Court decision, and no Iraq war.

The 72-year-old activist, self-promoter, and multimillionaire, rose to fame with his 1965 work Unsafe at any Speed, a very poorly-conducted study of automobile safety that purported to show how horrible many cars were, heaping gratuitous abuse on General Motors. Rather than argue the safety of their vehicles or dispute the study, GM foolishly decided to go after Nader personally, and in comically inept fashion: They tapped his phone, they followed him around, they hired hookers to try and entice him into sexual escapades they could use for blackmail. Nader won a lawsuit against GM easily, garnered just under $300,000 for himself, got tort law rewritten in the process, and landed himself in the spotlight. And like a grinning high school girl at her Sweet 16 birthday party, Nader has loved the spotlight ever since.

His foray into presidential politics began in 1980 when he urged voters not to support Carter, his reasoning being that "Reagan is going to breed the biggest resurgence in nonpartisan citizen activism in history." Actually, Reagan’s election led to the birth of the Reagan Youth, who were very active in moving this country far to the right. And Reaganomics, which devastated the working class, and support of the paramilitary death squads in El Salvador, which left tens of thousands dead, and a costly war and illegal support of the Contras in Nicaragua, which led to trading arms for hostages in the Iran-Contra scandal. As in Iran, that pesky soon-to-be Nuclear Iran, which is currently using weapons technology supplied by the US against US soldiers in Iraq. Nader proved to be as wrong about the harm that Reagan could do as he was about most things. But being wrong never stopped Nader.

Nader continued with his presidential politics in 1992 with a small write-in campaign in New Hampshire, followed by a very disorganized coalition with the Green Party in 1996. And then 2000. Without rehashing the details of the 2000 debacle, Nader set out to deliberately hurt Gore’s chances of election, to the exclusion of his own chances of making the 5% cutoff for federal matching funds. As an example, many liberals in swing states were terrified of a Bush victory but wanted to support a third party and so began the “vote pairing” (more accurately, vote trading) in which voters in swing states would vote for Gore while voters in solidly Blue states would vote for Nader. But Nader denounced the movement and focused his energies on those very same swing states.

Having gotten the message, most Nader 2000 supporters deserted him in 2004, but John Kerry was such a disaster of a candidate that it didn’t make any difference, the result being that we have had eight long years of George W. Bush, the Iraq war, thousands of our own soldiers killed, tens of thousands (possibly hundreds of thousands) of Iraqis killed, hundreds of billions of dollars wasted, furthering the cause of Jihadism, making this country more unsafe and more likely to be hit by terrorists, record profits for the oil industry at the expense of the working class, a widening of the gap between rich and poor, tax breaks for the rich, slashing of family planning funds, and general damage to the country that it will take at least a generation to undo. But that, of course, is not Nader’s problem. He maintains that Gore, the same Al Gore of An Inconvenient Truth and outspoken critic of the Iraq war from its beginning, would have been just as bad. Is it possible, in the tiny part of his brain not occupied by his ego that Nader actually believes this? Probably not. But it does sell books and continue to make him very rich and keep him in the headlines.

What Ralph Nader does not seem to realize (or does realize but doesn’t care) is that by saying: accept this bad thing, so that hopefully people will see how bad it is and then things will improve, he is effectively saying: the ends justify the means. Republicans, including Bush, are famous for this kind of flawed logic that was the hallmark of Nazi Germany’s “final solution.” The ends never jsutify the means, a moral life is lived only by making the best possible or least bad decisions at all times. Nader may sleep well at night for his own clear conscience, but he ought to be an insomniac from nightmares of the thousands of dead and maimed in Iraq.

What would be really nice is if we could draft Ralph Nader and George W. Bush, put them through basic training, and ship them off to Iraq to learn, first hand, what they are really accomplishing in this world. They could go out together and look for snipers or try to disarm IEDs, work and live with the devastation being wrought there, live in fear daily of loss of limb or life, perhaps even earn a Purple Heart experiencing the pain and horror of war, the agony of shattered bodies and wasted lives. Then, marked forever as those who experience war are, they could return to their respective work, and maybe have learned a little bit more compassion for humanity.

Wars are not fought by toy soldiers on computer battlefields. These are real people with real lives and real families that are devastated. People who die are dead forever. Species that become extinct are gone forever. Opportunities for progress that are missed are missed forever. Global warming will not improve by saying it has to get worse before it gets better. The effects on humanity of 100 million climate refugees may not be felt by Alzheimerish multimillionaire septaugenarians, but the rest of us will feel it. Three steps forward and one back is still two steps forward, and that’s infinitely better than 20 steps back. When the choice is between mediocre and disaster, we had better choose mediocre; this country can’t survive too many more disasters in the presidency. Life is finite, the fight to move forward is ongoing, never-ending, and every step yielded is ground lost forever. The cerebral existentialist nonsense that things must get worse before anything can get better plays directly into the hands of evildoers, as it always has. By opposing pollution standards that are not strict enough, leaving existing pollution unchecked and growing, do Nader and his minions want to wait until New York City looks like Mexico City before they will get off their rear ends and actually support progress? It is unlikely that Nader has thought much about this, or would care if he did. He has his millions, and his minions, and his 15 minutes.

So now he wants to reprise his spoiler role, and has announced that he is gunning for Hillary Clinton. Many progressives are not fans of Hillary Clinton, and not because they’re not sure if a woman can win the general election in 2008, but because of her support for the Iraq invasion in the first place. Whatever her faults, she’s smart enough to have seen through the lies being used by the Bush administration at the time, which can only mean that her vote was cast with an eye toward a future presidential run and not for the future of this country. But if she survives to become the eventual Democratic nominee, everyone and anyone who considers themselves to be progressive had best vote for her, or endure the police state we will live in under Romney or McCain.

Not content to let the democratic system of primary and caucus take its course, Nader wants to direct its course himself. He sees himself as crown-maker, or at least as crown-spoiler. Asked by CNN’s Wolf Blitzer if he would support Clinton’s candidacy, he called her a panderer and flatterer, then went onto say that he was more likely to run his own campaign if she wins the Democratic nomination. In other words, he’d much rather have Romney or McCain for another four years. Surely this time it will lead to a progressive revolution. His conscience is clear. But for those of us who will be the ones to suffer under such an administration, Ralph Nader should stand down, stay home, and shut up.

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]]>DrTim@leftbrainblog.comMedicine & Science2007-02-04T12:15:12-05:00http://www.leftbrainblog.com/files/HPV_Vaccine_Feb_4_2007.html#unique-entry-id-14http://www.leftbrainblog.com/files/HPV_Vaccine_Feb_4_2007.html#unique-entry-id-14Want your daughters to be protected against cervical cancer? Get them immunized against HPV. But good luck finding the vaccine, thanks to high costs and political roadblocks.

The term "sexually transmitted disease" is a term charged with emotion. The effects of STDs range from gross, like the draining sores of herpes simplex, to lethal, such as AIDS from HIV. For most STDs there is treatment but no cure or prevention. Recently, a vaccine was found that prevents a potentially lethal STD—human papilloma virus. But the HPV vaccine, which has the potential to save hundreds of thousands of lives, has run into serious political and legal roadblocks.

HPV is an STD nearly endemic in our society, the low estimates being tens of millions of affected Americans. As one medical school professor once described it to our class during a lecture on STDs: "If you have ever had unprotected sex with a partner who has had unprotected sex with anyone else, you have been exposed to HPV." Because a person can be infected but show no symptoms it is easily passed from partner to partner. Also, it can take weeks to months for symptoms to appear. To further complicate the issue, HPV has multiple strains, each of which has a different effect. To date, more than 100 strains have been identified, with more than 30 of the strains being sexually transmitted. Some of them are cleared from the body without any symptoms ever presenting, others cause genital warts, and some cause cancer. By age 50, according to the Centers for Disease Control estimates, at least 80% of women will have acquired genital HPV infection.

While HPV can lead to several types of cancer in men or women, including cancer of the penis, vaginal area or anus, the concern about HPV has always focused on cervical cancer, because it is a silent killer, typically without symptoms until it is very late stage and too late to do anything about it. Until the development of a vaccine, prevention of cervical cancer has relied entirely on women getting regular pap smears, which can detect changes in the cervix, leading to early treatment. In 2004, according to the American Cancer Society, over 10,000 women contracted cervical cancer and nearly 4,000 women died of it. Almost all of the deaths occurred in women who had not had regular pap smears.

The FDA approval in 2006 of Gardasil, an HPV vaccine that targets four HPV strains that together account for 70% of the cervical cancer and 90% of the genital warts caused by HPV, was a huge leap forward in the fight against cervical cancer. It is recommended by the FDA for women age 9 to 26 who have never been exposed to HPV, with immunity provided for close to five years. But even before it appeared on the market it met with strong opposition. Among the first to fire preemptive sorties against the vaccine was the group Concerned Women of America, a Right Wing Christian Conservative organization that seeks to “bring Bible principles into all levels of public policy.” Prior to the vaccine’s FDA approval, CWA Executive Vice President Wendy Wright said her organization was against immunizing preteens against HPV. “It would seem to send a message that we’re expecting the girls to be sexually active,” she said. The ferociously conservative Family Research Council, initially vocal in its opposition to the vaccine, has softened its tone, if only a little. FRC Vice President for Policy Peter Sprigg, in a July 15, 2006 opinion piece for WashingtonPost.com, shied away from opposing the vaccine outright, but opposed states making it a mandatory vaccine. In other words, the great defender of states’ rights while the Democrats held the presidency now wants to take power away from the states, so that the vaccine will remain out of the public eye and most girls won’t be immunized.

But even with FDA approval and CDC support, the HPV vaccine has slammed into another wall: cost. Merck, the company that owns Gardasil, charges $120 per dose, with three doses required to provide immunity. But insurers are barely willing to pay for each dose, much less the costs of administering it. CNN.com reports in a Feb. 2, 2007 article that doctors are expected to stock thousands of dollars in inventory, store the vaccine in highly specialized refrigerators, pay for any broken or damaged vials at $120 each, provide syringes, administer the vaccine and pay for disposal of the sharps all for as little as $2 over the cost of each dose administered. Thus, being forced to lose money by providing the vaccine, many pediatricians and family practitioners have stopped providing it. With the public spotlight on the vaccine, some insurers have relented and are raising their reimbursement. But for those without insurance, or insurance that doesn’t provide coverage, or only partial coverage, the vaccine remains out of reach.

There’s an old saying in the pharmaceuticals business: The first pill costs you half a billion dollars, everything after that is profit. Merck says that it will provide the vaccine for free to those who can’t afford it, but the big drug companies say this about all their expensive products, and as any patient who has tried to apply for such fee waivers or any physician who has tried to help their patients apply for the waivers can tell you, cutting through the red tape involved in actually getting a waiver requires a bulldozer. In fact, Merck gave away only about 800 doses in the last three months of 2006. To have an idea of how expensive $120 per vaccine is, consider the following CDC list of vaccine costs, per dose, in 2007: Diptheria/Tetanus/Pertussis: $12.25; Hepatitis B: $26.25; Hepatitis A: $35.57; Mumps/Measles/Rubella: $17.28; Varicella (chickenpox): $56.90.

It is expected that the overall cost will decline over time, but given the prevalence of HPV, the high cost of the vaccine, the reluctance of the insurance industry to pay that cost, vocal opposition from politically connected Right Wing organizations who think money is better spent telling youngsters to wait until marriage, and tepid support from a presidential administration that sees eye to eye with the Conservative Christians, it is likely that cervical cancer will continue to be a killer for a long time. For parents who would like their daughters immunized and young women who would like to be immunized against HPV, and thus drastically reduce their chances of contracting cervical cancer, the struggle continues.

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]]>DrTim@leftbrainblog.comPolitics2007-02-01T19:50:31-05:00http://www.leftbrainblog.com/files/Obama_vs_Gore_Feb_1_2007.html#unique-entry-id-13http://www.leftbrainblog.com/files/Obama_vs_Gore_Feb_1_2007.html#unique-entry-id-13She May Be Leading Now, but a Democratic White House is Going to Take a Different Kind of Star Power

Hillary Clinton may be leading in the polls, but with negative ratings of over 40%, her poor resonance with independents, her flipflop vote on the Iraq war, and a general wariness among Democrats that she is unelectable in the general election, her race to the nomination is anything but assured. The best indicator that her front-runner status is on shaky ground is that fact that most of the buzz about other possible candidates centers not on other “heavyweights” like Senators John Kerry (gone) and Joe Biden (going), both of whom have terminal cases of foot-in-mouth disease, but rather it is all about two surprise candidates; the first, surprising because he’s brand new, the other because he isn’t running at all. But that’s not stopping millions from looking forward to a President Obama or a President Gore.  

Senatorial heavyweights have a long-history of presidential aspirations but there are a very short list of success stories. The last person elected to the presidency who had served as a senator was Richard Nixon. He had also served in congress and as vice president under Dwight Eisenhower. The last sitting senator to be elected president was John F. Kennedy. In fact, the only other sitting US Senator to be elected to the presidency was Warren G. Harding, who served for two short years before dying in 1923 of complications of pneumonia, his administration mired in scandal. In all, 15 of our 43 presidents have served in the US Senate. One out of three might sound like reasonable odds (most of the rest were governors), but in considering the actual success rate, take into account that there have been 55 elections for the presidency, and more than twice that number of major-party candidates.  

The reason that US Senators have done so poorly is that, just like Hillary, they come with lots of baggage: a long history of public scrutiny, controversial votes, and for a sitting senator, the perception of stealing time away from the “day job,” as in: Why are you spending all your time fundraising when you’re supposed to be doing your job in the Senate? As far as public scrutiny, anyone remember Whitewater? You’ll be hearing a whole lot more about that and every other scandal that came out in the 90s as Hillary gets further into the campaign. And as far as controversial votes, being a “flip-flopper” on the Iraq war did a lot better job of sinking John Kerry’s presidential ship than the Swift Boaters ever could have hoped to. Know any other prominent senators with presidential aspirations out there who also flip-flopped on Iraq? The junior senator from New York will have a lot of explaining to do. 

The success story behind the last sitting US Senator to be elected the White House had to do with one very simple phenomenon: star power. JFK had his medals of honor for rescuing fellow crew members during World War II, his humility about his war service, his  Pulitzer Prize winning book Profiles in Courage, and that first-ever nationally televised debate, in which JFK looks cool and calm and Nixon looks like a sweaty child molester. Plus JFK was darn handsome. Unfair though it may be, looks and star power count for a lot in presidential politics. 

If any of this is starting to sound familiar, it should: Obama has two best-selling books, he is articulate, calm, reflective and humble. And darn good looking. Obama also has the Teflon factor going for him. It’s a rare thing among politicians, the last person who comes to mind being Ronald Reagan. Something about their star power, their affect, their way of handling bad news, and the way the media treats them, that makes them immune to the general nastiness of modern politics. Obama is the poster child for the Teflon phenomenon, while Clinton might be more accurately known as the Velcro Senator. 

And in case the electorate is looking for someone more experienced, someone who has decades of experience in the highest echelons of American politics, vast foreign policy experience, and lots of star power, there is one potential candidate who fits that description exactly. And if you’re a candidate being coy with the media, what better time to kick off a campaign than at the same time you’re picking up an Academy Award? Want tens of millions of dollars of free media coverage in this era of everything is about how much money you can spend? Then you couldn’t ask for a better scenario than to pick up a Nobel Prize two months before the New Hampshire primary. Al Gore, winner of the popular vote in 2000, disputed winner of the electoral vote, his movie An Inconvenient Truth nominated for an Academy Award, recently nominated for the Nobel Peace Prize, benefeciary of the hugely energizing we was wronged sentiment among Democrats, and multimillionaire with lots of deep-pocket connections is a hugely popular potential candidate.  

Consider the following scenarios of possible presidential tickets for 2008, using the current front runner as the presidential candidate and the runner up as the vice presidential candidate: McCain/Guiliani vs. Clinton/Obama. The former sounds like a center-leaning and star-powered electoral landslide in the making, the latter the penultimate in left-wing pandering and an electoral disaster not seen since Walter Mondale. But now consider McCain/Guiliani (or McCain/Romney or Romney/Guiliani or any similar combination) vs Gore/Obama. More of the same Old Guard Nonsense from the Repubs vs. Star Power from the Dems. A Gore/Obama ticket would be a media frenzy (a huge force-multiplier in campaign dollars) and a good balance of old experience and new thinking. Plus, wouldn’t it be nice to have a viable candidate for 2008 and lay the groundwork for a future viable candidate? 

To take a closer look at which Democratic ticket might have the best chance of winning in 2008, look at the electoral map from recent elections: In 2004 Kerry won the Northeast including New Hampshire, the Eastern states Pennsylvania and Maryland and the midwestern states Michigan, Illinois, Wisconsin, Minnesota, the West Coast, Hawaii, and the District of Columbia, for a total of 252 electoral votes. Aside from New Hampshire’s 4 electoral votes, let’s call this voting block Solidly Blue, and Guiliani, McCain or any other centrist is unlikely to peel away any of these states. (Guiliani is not going to win New York nor Romney Massachusetts because they are not well-liked in their home states.) In 2000, Gore won all the Solidly Blue states, plus Iowa and New Mexico, winning 266 electoral votes. (Yes, we know he won Florida also, but the supreme court took it away, no use crying over spilt milk.) Had he won New Hampshire he would have won the election with it, but changes in the electoral map since 2000 mean that Gore 2000 states plus New Hampshire does not equal victory. In 1992, locked into a three-way race with an incumbent president and fiery billionaire, Clinton won Solidy Blue, plus New Hampshire, as well as Montana, Arkansas, Louisiana, Kentucky, Tennessee, Ohio, West Virginia and Arizona. In 1996, he added Nevada and Florida to that list but lost Montana. Those middle and southern states that Clinton won in 1992 and 1996 are reddish, but subject to change if they are particularly unhappy, say for example if they were tired of a particular party’s blind support of an unpopular war. 

To go from the 252 Solidly Blue electoral votes to victory requires 17 more votes. Perennial battleground states Florida (27) and Ohio (20) are slam dunks. Without either of these, a combination of weakly red western or southern states is needed, such as Tennessee (11), Iowa (7), and New Mexico (5). Bill Clinton proved that some states in the South are willing to vote for a Dem if they feel he is one of them, and some Western states, including Iowa, New Mexico, even Colorado, might be up for grabs to the right centrist, and Virginia did just vote in a Democrat for governor in 2005 and senator in 2006. Looking at these numbers, can anyone explain where Hillary Clinton is going to come up with 17 more electoral votes, assuming she can get the 252? Appealing to moderates is not likely to garner her enough votes, because so many people have already made up their minds about her. She can appeal to women, but unless she can appeal to southern and western women she may as well stay in New York. Bottom line, she has very little chance in Florida, a slight chance in Ohio, and very little chance of coming up with 17 votes from the weakly red South and West. Now consider a Gore/Obama ticket: Florida and Ohio are both in reach, there’s appeal to moderates, appeal to the South, and suddenly the weakly red states all come into play. 

So who has the better odds of taking back the White House in 2008? I’m placing my bet on Obama or Gore, or better yet, a Gore/Obama ticket. Maybe I should have some bumper stickers made.

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]]>DrTim@leftbrainblog.comMedicine & Science2007-01-31T22:14:59-05:00http://www.leftbrainblog.com/files/What_Ails_Castro_Jan_31_2007.html#unique-entry-id-12http://www.leftbrainblog.com/files/What_Ails_Castro_Jan_31_2007.html#unique-entry-id-12Miami is set to party, the death watch latches onto the latest details, and Cuban ministries insist Fidel is just fine

Fidel Castro, borrowing a line from Mark Twain, would like you to know that reports of his demise are greatly exxagerated. Fidel Alejandro Castro Ruz, the 80-year-old dictator of the island nation of Cuba, transferred power to his younger brother on July 31st after “intestinal surgery” and has been recovering ever since. The city of Miami is planning a mega-party to celebrate his death, but many of Castro’s most bitter critics have been down this road too many times before and say they won’t believe it until they can spit on his corpse. It’s not surpsing that it is not known what his illness is, or that there are conflicting stories about it, given the web of secrecy, fabrications and double talk that has swarmed around Castro since the inception of the revolution that eventually toppled the Batista regime. But based on what little is known, using a little surgical detective work, we can get a pretty good idea of what happened.

The first report out of Cuba was a statement from the government that said Castro had undergone surgery for stress-related gastrointestinal bleeding. His condition was reported as serious, but his return was to be expected in a few weeks. According to the official statement, Castro said his intense schedule “promoted in me a sharp intestinal crisis with sustained bleeding that obligated me to undergo a complicated surgical procedure.” But during the next several days, when he didn’t appear in public, rumors began to swarm: Was it cancer? Was he dying? The Bush administration, always last to know what’s going on in the world, said it was caught off-guard by the reports of Castro’s illness and had no idea what his condition was.

As the speculation whirlwind reached tornado strength, the Cuban government released four photos of the recovering Castro, including one in which he is seated in a chair, holding up the August 12th edition of the state-run newspaper Granma and dressed in a red, white, and blue Addidas jumpsuit. The irony of the Communist leader dressed in a workout suit with the same color scheme as the American Flag and advertising a US corporation was lost on most Americans, as all attention focused on whether the photos were real or photoshopped. But Venezuelan President Hugo Chavez stopped over for a visit and had some photos taken with Castro, convincing the world that Castro was indeed alive, if not well. Additional state visits followed, with more pictures, an October video with Castro again reading from the current edition of the paper to prove it was not file footage, and lots of speculation.

The statements of any of the politicians who have visited or spoken with Castro can be discounted outright, as they are not physicians, and all have their own axe to grind. The first report of reasonable veracity on Castro’s condition came from Spanish surgeon Jose Luis Garcia Sobredo, the Chief of Surgery of Madrid’s Hospital Gregorio Maranon, who responded to a “humanitarian request” of the Cuban government. He confirmed that Castro did not have cancer and was recovering. Subsequent reports leaked out of Maranon gave further details: Castro was suffering from an infection of his large intestine and had undergone at least three failed operations to repair damage from complications of diverticulits. And here at last the story begins to make sense.

The diagnosis of diverticulitis is likely to be true, not only because of the reports, but also because they match his age, history, and survival this far into this illness. To start with, examine all the major candidates for bleeding intestinal illness: diverticulitis, vascular problems, cancer, pre-cancerous lesions, inflammatory bowel disease, hemorrhoids. Vascular problems, a large group of problems having in common compromised blood flow to the colon, can be excluded because they have very different presentation and course of action than has been seen with Castro, and are almost exclusively treated with medical treatment rather than surgical treatment. Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, are chronic diseases that present long before the ninth decade of life. Hemorrhoids and pre-cancerous lesions (polyps) are easily treated and would not require a 6-month recovery, even in someone Castro’s age. For colon cancer to have been the cause of his illness, given the known symptoms and lengthy recovery, it would have to have been at least Stage III colorectal cancer, but the treatment of Stage III and Stage IV colorectal cancer (meaning that it is a large tumor that had spread at least to the lymph nodes and possibly to surrounding organs) includes chemotherapy, and there has been no hint of Castro having undergone chemo. Also, chemotherapy or not, survivability of Stage III or IV is poor, which could explain his failing health, but does not match with the repeated surgeries. What remains from our differential diagnosis is diverticulitis.

Diverticulosis is a condition of the large bowel in which little outpouchings develop over the course of a lifetime. Think of a long skinny balloon, and along the balloon there are weak spots where the balloon pooches out. Changing –osis (presence of a condition) to –itis (presence of inflammation) means that an infection has set up shop in the outpouchings. This diagnosis agrees with his symptoms, his condition (as much as has been released by the Cuban government) and his history. Brazilian journalist Claudi Furiati, author of History Will Absolve Me, Castro’s authorized biography, reported that Castro suffered from diverticulitis 20 years ago. Again, this agrees with the course of the disease, which develops later in life and can recur at any time.

Diverticulitis can lead to abscess, rupture, inflammation of the abdominal cavity, and if untreated, death. The medical sources close to Dr. Sobredo said that a recurrence of the disease emerged last summer with large amounts of blood loss into the intestine. Why, then, three surgeries? The treatment of diverticulitis depends on its severity and location. It can be treated with antibiotics, CT-guided drainage, or surgery. If left untreated or improperly treated, it can spread to peritonitis (an infection of the lining of the abdomen) and ultimately sepsis and death.

This leaves us with a likely cause and timeline of Castro’s illness: He gets a bout of severe diverticulitis. The disease is more aggressive than the treatment, whatever medical or radiologic-guided treatment was attempted, and it progressed to the point of requiring surgery. A common story and still very treatable, but Castro is no typical patient. This is the same man who in October 2004 tripped and broke his left knee and right arm, but when he had to undergo surgery for his knee was reported to have refused tranquilizers and general anesthesia so that he would not have to hand over power. In all likelihood, he was not inclined to do everthing his doctors told him this time around either. When it came time for surgery, the usual procedure is to open the abdomen, clear out the pus, resect any dead or infected bowel, and if there is severe enough infection, perform a colostomy, with the possibility of being reconnected in 3 to 6 months. Did Castro consent to a colostomy? Probably not. More likely, he put extreme pressure on his doctors to restore normal continence. According to the reports from Madrid, at the initial surgery part of his colon and rectum were removed, and the proximal colon was connected to the distal rectum. But that kind of anastomosis will never heal in the face of ongoing infection, which would lead to the repeat surgeries, including further complications from the abdominal abscess.

There’s an old saying in surgery: Complications beget complications. Especially in the edlerly, you don’t want that first complication, because the treatment for each complication can lead to several more. To put it another way, kill one fly and two come to the funeral. So at this point in Castro’s belly there’s an incompletely treated abscess and a broken down anastomosis, which is spilling more stool into the abdomen, leading to more infection, more abscesses, and further complications. Again according to the Madrid sources one of these complications was an inflammation of the gallbladder and bile duct from the liver. The bile duct inflammation is a horrific complication and very difficult to treat. When the common bile duct, which drains bile from the liver into the intestines, breaks down, it’s game over. By the reports, stents were placed to keep the bile flowing, with poor results. And all of this infection would make for a non-healing incision and lots of drainage from the wound, which leads to fluid loss, nutrient problems, and lots of other problems, all of which also agrees with reports.

What next for Castro? First, he will never return to power. At his age, with this amount of complications, he will never fully recover. A study done several years ago on healthy medical students confined to bed for one week showed that it took months to return to their baseline weight, muscle mass, and conditioning. For 80-year-olds who are six months into a severe illness, there is only a downward spiral. How long will it take? That depends on his condition at the moment. Once a person with severe illness such as this gets to a point of disability where he cannot move his own body weight without assistance, survival is measured in days to weeks. As long as he is still able to move as he appears to be in the October video, he may have months to years. But, the complications leave him fragile and highly susceptible to a sudden event such as a heart attack, meaning he could go any day. And he has no realistic chance of being able to return to his former power, except in the most limited way.

Not that anything is likely to change that much in Cuba any time soon anyway, whether Castro survives or not. The 76-year-old Raul, who has been with his older brother since the beginning of the 26th of July Movement began and has been his close confidant, has shown no sign of changing Cuban policy and is unlikely to make radical changes any time soon. More likely, major change in Cuba is to have to wait until a new generation of politicians moves into power. For the moment, the death watch continues.

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]]>DrTim@leftbrainblog.comPolitics2007-01-30T21:50:12-05:00http://www.leftbrainblog.com/files/Betting_On_President_Jan_30_2007.html#unique-entry-id-11http://www.leftbrainblog.com/files/Betting_On_President_Jan_30_2007.html#unique-entry-id-11Even though it’s (sort of) illegal, any time there’s a contest of any sort, someone is going to be taking bets on it.

Probably the most famous gambler still living is Thomas “Amarillo Slim” Preston Jr. Slim, who gained fame with his victory at the World Series of Poker in 1972, and went on to become notorious for taking just about any bet. Among his victories: He beat Minnesota Fats at pool played with broom handles; beat Evel Knievel at golf played with claw hammers; won $300,000 from Willie Nelson by beating him at a game of Dominoes; and won a sucker bet that he could hit a golf ball a mile—which he did on a frozen lake. He also won a bet in 2000 by correctly picking George W. Bush to win the presidency. But did he break the law in making that bet? Popular wisdom has it that it’s against the law to bet on the outcome of elections, a “known known” (as Donald Rumsfeld would say) that nobody bothers to check, because everybody knows it to be true. Except that it’s false. Sort of.

In fact, several jurisdictions do ban betting on the outcome of an election. The District of Columbia, for example, specifically prohibits betting on “contests,” but it is a law never enforced. About the only example of anyone actually brought to justice for betting on an election occurred in Arizona in the mid-1990s, when two elderly men, Jack Bird and Loft Hollamon, were brought up on charges of offering a wager on an election. Their crime caught the attention of authorities because they took out advertisements in the newspaper, in which they each urged voters to vote for their favorite so that they would win the bet. But even with that level of blatant disrespect for the Arizona law, Superior Court Judge Richard Anderson threw the case out as unconstitutional, and called gambling the “favorite national pastime.” An Arizona State Court of Appeals later reversed that ruling, deciding that the state is allowed to prohibit wagering on elections in order to maintain the integrity of the act of voting. By this time in 1995 both men had spent tens of thousands of dollars on legal fees, far more than the maximum $750 fine, and the case was eventually dropped by the Yavapai County attorney.

At the federal level, the Supreme Court has weighed in on two occasions in the last century. A 1973 Supreme Court case, Civil Service Commission v. Letter Carriers cited a 1939 civil service form that provides: “Betting or wagering upon the results of primary and general elections is penalized by the laws of most States and is improper political activity.” Hardly a stern and decisive admoniton. More recently, former Chief Justice and avid gambler William Rehnquist more accurately described the Court's opinion of betting on elections by organizing a betting pool wagering the state by state outcome of the 1992 presidential election. White, Scalia and Souter all recused themselves, but the remaining six justices enjoyed a lively contest, in which Sandra Day O’Connor was the clear winner, collecting $18.30. (Harry Blackmun was the only other winner, garnering $1.70. The remaining four justices had to pony up, losing a total of $20.)

In any case, even if a particular jurisdiction decided to repeat Yavapai County’s experiment with electoral justice, most gambling on elections is done online, and most of the hosts are outside the scope of US law. There’s not much to the mechanics of the betting: There are plenty of online houses that will take your credit card information and place your bet for you. It works just like football; the farther in advance you place your bet, or the more narrow your wager, the better the payoff will be if you turn out to be right. If you want to bet on the Bears today, if they win or if they lose by less than seven points, you’ll win the exact amount of the bet (put in two bucks, walk away with your two and two more). If you want to have a larger payoff, bet on the specific score that will occur. Or, if you had made your bet back in August, your payoff would be many times your wager. So what are the odds of a Hillary Clinton victory in 2008? Five to one (bet one dollar to win five more). John McCain is slightly ahead, running at nine to two, Giuliani and Romney at ten to one, Al Gore—who hasn’t even said he is running—at twenty to one, and recently defeated ex-Senator George Allen at a hundred to one. Want a chance at making some really big money? Bet on filmmaker Michael Moore; the payoff is ten thousand to one. Just don’t bet your life savings. And if you do bet on any candidate or potential candidate, don’t advertise the fact in the newspaper. You never know who might be reading.

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]]>DrTim@leftbrainblog.comPolitics2007-01-29T23:10:22-05:00http://www.leftbrainblog.com/files/Curtain_Call_Jane_Fonda_Jan_29_2007.html#unique-entry-id-10http://www.leftbrainblog.com/files/Curtain_Call_Jane_Fonda_Jan_29_2007.html#unique-entry-id-10Yesterday’s Protesters Can Be Today’s Liability

Jane Fonda is not exactly the household name she once was. The 2005 hit movie Monster in Law offered a little bit of career CPR for both her and co-star Jennifer Lopez, but long gone are the halcyon days of the exercise-video queen’s dominance of the silver screen. Also gone, until Saturday’s Anti-War rally on the Mall in Washington DC, was her position as a symbol of antiwar sentiment. As far as many on the left are concerned, she should have stayed in retirement.

Even though the right-wing think tanks behind Bush-Cheney Inc. are provoking the same mistakes as were made in Vietnam, this is not your father’s war. And ending the war is going to take a very different anti-war movement than existed in the sixties and seventies. For starters, soldiers are much more highly thought of than they were 30 years ago, and rightly so. Assaulting those most in harm’s way is no way to make this country safer. Even those most aggressively against the war in Iraq treat returning soldiers with respect and praise. And while anti-war sentiment is high in congress, it is generally agreed even among those who have been against the war since its inception that attempts to cut off funding for the war would be political suicide, because it would hurt the troops.

Jane Fonda brought infamy upon herself in 1972 when she was photographed sitting in the gunner’s seat of a North Vietnamese Army anti-aircraft gun, laughing and wearing a NorthVietnamese soldier’s helmet. No additional explanation was needed at the time in order to arouse visceral hatred, but more recent historical accounts note that these were the soldiers and weapons being used to shoot down American planes. In 2000, she issued an apology: “I will go to my grave regretting the photo of me in an anti-aircraft carrier, which looks like I’m trying to shoot at American planes. It hurt so many soldiers. It galvanized so much hostility. It was the most horrible thing I could possibly have. It was just thoughtless.” Well spoken, but late in the offering. Not surprisingly, she has shied away from war protests since then. “I have not taken a stand on any war since Vietnam. I carry a lot of baggage from that,” she said at Saturday’s rally, then went on to say: “Silence is no longer an option.”

Actually, silence would have been a great option. To put it another way: Jane, you are not helping! While the anti-war movement will take all the help it can get, what is needed is political muscle, not lightning rods for abuse. Already two-thirds of the country is opposed to the escalation of the war and feel that congress is not being assertive enough in opposing Bush on the war. The last thing that we need is to have the remaining third spitting tobacco juice on the antiwar movement, as happened to Fonda in 2005. There’s some help that is no help at all. Ralph Nader may be progressive and want a lot of good things, but is there anybody left (besides Karl Rove) who thinks that his entry into the 2000 election was a good thing? Does he look at the news every day and realize that he could have single-handedly stopped the disaster that is Bush-Cheney Inc. by standing down? Hopefully, he does. Hopefully, he hangs his head in shame.

The lightning-rod effect is the same concern raised by many Democrats about Hillary Clinton. Yes, she can raise money, but after the nomination is when Whitewater, Vince Foster, and all of the rest of the “culture of corruption” accusations will come flooding back. If it will be enough to derail her presidential aspirations only time will tell, but the very thought of a President Romney is enough to send large sectors of the Democratic party toward newcomers like B