Where Have the Good Men Gone?

“All that is required for evil to triumph is that good men do nothing,” so said the great English politician Edmund Burke. Recent events have proven his words as true now as they were over 200 years ago.

DEA agents stationed overseas were found to have been engaging in sex parties funded by drug cartels. Over a period of at least five years agents repeatedly threw caution to the wind and participated in lascivious parties held in buildings leased by the US government. At least seven agents were directly involved in the misconduct with many others involved in covering up the behavior. Supervisors were made aware of their behavior but chose to ignore it. When news of the misconduct came to light  DEA officials obstructed the investigation.

Hearing the story I found myself asking, “Where were the good men?” If just one person had taken a stand and spoken up about the wrongdoing the problem could have been handled quickly, harm prevented and embarrassment avoided. No one did.

In Atlanta, the city has been torn apart by a scandal that has rocked its largest school district. 34 educators either plead guilty or were convicted of racketeering in a  6 year scheme to fraudulently raise standardized test scores. Investigators found evidence of cheating by 180 educators in 44 schools. As bonuses were handed out based on student performance on the exams the teachers and administrators received thousands of dollars from the government for their lies.

Hearing of a scandal this widespread and involving so many people I find myself asking, “Where were the good people?” Was there not one person who had the courage to stand up and say, “This is wrong!” It seems no one did.

Courage is required because standing against the crowd is risky. Rejection, anger and isolation may await, there is a chance that one will not be heard, that pain may come and change may not. Faced with such personal danger, where can one find the courage to stand?

It must come both from within us and beyond us. To stand we must have a deep rooted conviction within ourselves that evil cannot be allowed to win out. We must have faith that there is a God who sees and who will ultimately judge men according to their works. Only then will we be able to speak out. Only then will we see good men and women rise up against evil. In a world where values are disappearing the need for a few good men has never been greater.

- Bart

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A Christian Physician's Thoughts on Bruce Jenner

This last week seems to have been “Transgender Week” on television. NBC News devoted lengthy segments of its nightly broadcasts to stories about parents who had determined their young children to be transgender and were raising them as such. ABC aired a 2 hour interview with Bruce Jenner in which he declared he was a woman and would be living as one for the rest of his life. In each of the stories, embracing one’s transgender reality was portrayed as brave and courageous and as the right thing to do. As a Christian Physician I was left wondering how I would respond to a patient or a parent in a similar circumstance. What would be the right thing to say?

As I ponder the question I am struck by how society’s definition of the “right” thing to say has evolved over time. In the not too distant past individuals who identified as transgender were considered to have a psychiatric condition that warranted treatment. Homosexuality was similarly considered to be a disorder at one time. What changed? Many assume that it was advances in scientific understanding of sexuality and gender identity that led to the change, that with increased understanding came more widespread acceptance.

The truth is that there have not been any major scientific breakthroughs in the area, that no genes have been isolated nor hormonal alterations identified. While it is possible that such discoveries may be forthcoming the increased acceptance of the medical and scientific communities has not been a result of traditional research. The reasons for the change in perception are primarily cultural and arise from a change in how society defines normal behavior.

Our nation was founded by people who were, at least in the large majority, religious in a Christian sense. Our founding document, the Declaration of Independence, made it clear that the fundamental rights of men were a gift of God. We were “endowed by our Creator with certain inalienable rights, among them life, liberty and the pursuit of happiness.” As rights came from God so did the definition of what was right and what was wrong. Moral law was established by God, not defined by men.

Over time the emphasis drifted away from the Creator who gives rights and more to the rights that are given. Life, liberty and the pursuit of happiness continue to be sacrosanct, but their definitions have become individualized. Happiness is now defined not as a result of doing what is right in the eyes of God but in doing what is right in the eyes of the individual. Liberty is no longer defined as the freedom to do right but as the freedom to do as one pleases. Autonomy is everything.

With this evolution of thought comes the rejection of a universal moral law. Right and wrong behavior are determined, whenever feasible, as what is felt to be right or wrong by the individual actor at a particular moment in time. Behaviors that were unquestionably wrong become first tolerated, then accepted, then embraced and then ultimately defended against those who would disagree.

In the realm of sexuality this cultural evolution can be seen in our views toward premarital and extramarital sex, abortion, homosexuality and same sex marriage. Societal attitudes toward the transgendered are similarly evolving. Attitudes toward the polyamorous are in the early stages of gaining societal acceptance. In every one of these cases scientific “validation” has followed the cultural change, not preceded it.

This is how it must be in such things, for biology can never prove morality. While saying “I was born this way” requires others to give careful consideration to the feelings of another and to proceed with caution in responding, it is not proof of goodness or rightness. There are many conditions with which people are born that are considered unacceptable and in need of correction. Medical conditions such as cystic fibrosis and sickle-cell anemia, and mental conditions such as schizophrenia and alcoholism are not considered acceptable simply because the patient was “born that way.” If pedophilia is one day discovered to be genetic it will not be instantly considered acceptable and appropriate. Science can never prove morality and goodness.

The recognition that moral values, not scientific facts, determine societal responses to sexuality is crucial in determining how we respond to the Bruce Jenners of the world. As a Christian physician, if I am asked by a parent how they should respond to a child who they thought was transgendered my response would be different from other physicians, for my moral viewpoint is different. I would have to preface my response by addressing the basis for any response the parent could make.

I would say that how we respond is based on what we believe. The Christian worldview is that right and wrong are not determined by our feelings but by God. It is true that everyone has feelings and desires, many which they are born with and cannot change. It is also true that everyone has a choice as to which feelings they embrace and follow and which feelings they do not. The Christian view is that when we follow those feelings which are good in God’s eyes we will experience blessing, in the next life if not in this one. If the parent embraces this viewpoint they will need to get professional help in responding to their child in such a way that allows them to accept the reality of their feelings and what that means for their future, in helping their child determine God’s plan for their life and how they can live with the feelings and desires given them at birth.

The secular worldview is that right and wrong are not absolute and that our understanding of morality evolves over time. Many in our culture have concluded that multiple forms of sexual identity and desire are acceptable and good. From this perspective parents would be more apt to encourage the child to "follow their heart." I would also encourage parents who embrace this perspective to get professional help in responding to their child in such a way that allows them to accept the reality of their feelings and what that means for their future, in helping their child recognize which feelings are enduring and should be embraced and which are temporary and need not be followed.

As our societal evolution has progressed to the point of aggressively defending individual moral choices against those who disagree (in some cases to the point of punishing those who do not embrace majority thought), Christians need to be especially careful in how we respond to these situations. It seems to me that the best initial response is to say that while many may disagree, we are of the opinion that right and wrong are determined by God and not by men and that not all feelings need to be followed.

 

-          Bart

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Being Popular Can be Bad for You

I was not popular in high school. I was well known (identical twins usually are, twice the exposure at half the price) but I was not popular. I lost more elections than Mitt Romney including for sophomore class president, Student Body leadership and the ultimate defeat, president of the Chess Club. I was a dweeb.

It is one thing to pursue popularity as an adolescent, it is another thing altogether to pursue it as an adult. It seems that for some adults the need to be popular increases with age. If there is anything reality TV teaches us is that people will go to ridiculous lengths to be a celebrity. Ordinary life just isn’t good enough. Everybody wants to be a star and nobody wants to admit that achieving stardom is not dependent on how badly one wants it.

It seems fame is incredibly addictive, as even in small amounts it leads to people wasting their lives trying to gain it again. Almost every high school reunion includes once popular people incapable of dealing with the reality that no one cares anymore. There are a number of reality shows such as “The Apprentice” and “I’m a Celebrity Get Me Out of Here” that provide fading stars with one last chance to shine and there seems to be no shortage of formerly famous people willing to participate.

Watching these shows leads me to ponder how much these people have lost in their pursuit of fame. Multiple marriages and rehab stints seem to be a common theme. True happiness, contentment and meaningful relationships are rare. It seems that the price of fame is tragically high.

I flirted with fame a few months ago. My blog post on measles spread around the world. It reached over 5 million readers and was published in a Norwegian newspaper. Over 3000 people subscribed to the blog and comments flooded my inbox. It was pretty heady stuff. It didn’t last. My follow up post reached 30,000 views and subsequent posts were seen by fewer and fewer people. I found myself wondering what I could write about that would catch fire, what it was that people wanted to read, how I could reach that summit again.

Then I gave up. I realized that if I focused on what people wanted to hear I would lose something in the process. There is much about which I am passionate that is not popular. My Christian worldview is not universally embraced and is even offensive to some. Popularity might require that I constrain myself and not share my heart. I realized that success wasn’t worth it. I returned to writing what was on my heart. The number of subscribers has dwindled but I am okay with that. I have learned the lesson of high school, that being popular isn't what it is cracked up to be.

What leads to popularity and success in high school does not often translate to success in the next life. While I was easily discounted back in the day the life I have today is truly remarkable. I have a successful marriage, wonderful children, a strong faith and a rewarding career. My life after high school is so blessed as to make any of the lost recognition irrelevant.

I think this is true in the eternal sense as well. Success and praise in this life is often not compatible with success in the next one. People who pursue fame and adulation here on earth may be sacrificing what matters in the next. The ultimate winners are those who grasp this truth and live with eternity in mind. The adulation of millions means nothing compared to the joy that awaits those who have gained the favor of God.

-          Bart

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God Talks Like Willy Wonka

Some people say God speaks to them. I do not doubt that He is able to speak to people in an audible fashion but I am not sure that He speaks to me in this way. If He does I do not hear very well. On the few occasions when I thought I was certain He was speaking things did not work out very well. As a result my confidence in my spiritual hearing is pretty low. Over time I have reached the conclusion that I may be listening for the wrong kind of voice.

While I do not hear God speaking directly to me, especially in an audible sense, that does not mean that I do not believe that God is silent or that I think He does not communicate with His people. His Spirit can speak to us through Scripture or by moving other people to share their thoughts with us. He can also speak quite powerfully to us through our conscience. When God does speak through our conscience He speaks a lot like Willy Wonka (Gene Wilder version, not Johnny Depp).

In the movie Willy Wonka and The Chocolate Factory a handful of children won the opportunity to tour Wonka’s chocolate factory. At the beginning of the tour the children were instructed on how to behave during the tour. As the children were selfish and bratty they each violated the rules rather quickly. Each time one of the children started to do something forbidden, Willy Wonka spoke and warned them.

Willy’s warnings were never yelled, never hollered. He did not run over to the children to restrain them. He remained where he was and quietly said, “No. Stop.” He voice was audible and recognizable, but it was also easily ignored and overlooked by those who were not inclined to listen. The children didn't listen and soon experienced the consequences of their disobedience.

I have found this to be true of the way God communicates to me through by conscience via the Holy Spirit. When I begin to do something wrong there is often a quiet “voice”, a thought in my head, that gently urges me to stop. When I am dead set in my ways and bad intentions the voice is easily ignored, yet if I train myself to listen for it, to look for it before I act, the warnings can be heard. God loves me enough to warn me, to move me and motivate me through gentle urgings such as these but like Willy Wonka He does not yell, and does not force me to obey.

If I am to stay out of trouble, I need to train myself to listen.

- Bart

In

Drug Secrets Your Doctor May Not Know

The patient was angry. His pain management doctor had written a prescription for a new pain medication and the patient expected it to be covered by his insurance. It wasn't, and the patient was stunned by the drugs $320 price tag. There was no way he could afford the drug and he went home empty handed and in pain. 

Stories such as this are not at all uncommon. Prescription coverage varies widely from one insurance to the next and seems to change daily. It is impossible to keep current. Previously covered and once inexpensive generic medications become uncovered and expensive seemingly overnight.

A week ago I wrote a prescription for doxycycline, a 48 year-old antibiotic that  a few years ago had a cash price of $4 at Target and Wal-Mart.  Imagine my surprise when the pharmacy called saying it was not covered by insurance and the cash price was now $65! How does that happen?

A few months ago a patient called asking for help with his sleep medication. His insurance would not cover generic Ambien and he could not afford the $85 his pharmacy charged for 30 pills. I had my staff check on what our cost would be if we ordered it ourselves. Our price- 100 pills for $3.10. The pharmacy was charging $85 for a medication that cost them $1!

100 mg Viagra tablets cost almost $30. Five 20 milligram tablets of the same drug from the same manufacturer, sold under the brand name Revatio, can be purchased for $4. When I asked the drug company salesman why this was he could not provide me with an answer.

There are many aspects of medical practice that are frustrating but medication costs and coverage are of particular concern. New drugs are always ridiculously expensive, with thirty day supplies of new medications consistently above $150. The prices are often concealed from doctors by sales people whose presentations focus on co-payments and discount cards instead of total costs. 

What can patients do to navigate such a system? I am often confused and perplexed by insurance coverage of medications, how can a lay person be expected to know what to do? We are in desperate need of greater transparency in how medications are priced.

While we wait for that day to come here are a few recommendations-

1- Tell your doctor when a medication is expensive. There may be less expensive alternatives. My daughter was once prescribed a medication that cost $700 a month. The doctor was shocked to learn of the cost and changed to a more affordable option.

2- Shop around. Prices can vary widely from pharmacy to pharmacy. A few years ago I called several pharmacies to check their price for generic Prozac. The four prices were, $7, $11, $25 and $40 for a one month supply. Do not feel as if you do not have choices.

3- Ask for an inexpensive drug. For common conditions such as high blood pressure, diabetes and sinus infections there are usually very inexpensive options. Target and Wal-Mart sell a 30 day supply of many common generics for $4.

4- Use coupons. Web sites such as goodrx.com can offer sizable savings. Almost every brand name medication will have coupons on their websites.

5- Fight when needed. I recently had a patient who was taking a medication twice a day for chronic pain. It worked well but wore off in the middle of the day. I gave him a sample and suggested he try taking the medication three times a day. He was thrilled to report dramatic improvement so I sent the new instructions to the pharmacy. His insurance denied the claim saying they would only cover the medication twice a day. I wrote two letters and personally called the insurance but they did not budge. He appealed the denial all the way up to the California Board of Managed Care. The Board notified him yesterday that his insurance would be required to pay for the medication. It took more effort than it should have, but he won!

- Bart

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