The Hate Filled Language of the Gun Debate

We have lost the ability to disagree with one another.

This is not a new thing, but it seems to be on the rise. I thought incivility of political discourse might have peaked with the last presidential election, but the last week has proven me wrong. The discussion (if one can call it that) about gun control has been hateful, demeaning and devoid of listening. The ability to see goodness and reasonableness in those who don’t take our side seems to have vanished from our society.

Marco Rubio seems to be a decent man. He was caring and gracious enough to attend the Townhall meeting attended by those directly affected by the Parkland school shooting. His presence was not appreciated by many of those in attendance. One student told Senator Rubio that looking at him was like looking at the shooter, that looking at Rubio was like “looking down the barrel of an AR-15.”

Dana Loesch, a spokeswoman for the NRA, was booed at the townhall when she told a story of a young rape victim who believes that she might have saved herself if she had been able to carry a weapon. She was jeered and mocked from the audience.

Wayne LaPierre, the executive vice president of the NRA, showed a similar level of incivility the next day in his speech to CPAC, the conservative political action conference. He said, ” These elites don't care—not one wit—about America's schoolchildren.”

Dana Loesch, the aforementioned victim of audience intolerance, was not above slandering others either. At the CPAC conference she said, “Many in legacy media love mass shootings.”

It seems that both sides of the gun control debate are refusing to believe the best in the other side. While there are disingenuous and dishonest people, while there are some politicians who intentionally mislead and who seek personal gain, the overwhelming majority of Americans have many things on which they can agree.

No one wants innocent people to die.

No one wants lethal weapons in the hands of mentally ill individuals prone to violence.

Everyone wants to be safe and wants their children to be safe.

If we all agree on these points there is no reason for us to hate and demean one another. Thinking someone is wrong does not require us to believe they are bad. Bad ideas can be associated with good and noble intentions. We need to believe the best in one another.

We have common goals, even when we disagree on how to best achieve those goals. If we cannot respect one another and listen to one another the  chance of achieving these goals decreases. 

Bart

Prostate Cancer and Solving Societal Ills

Death from prostate cancer can be agonizingly painful. It spreads to bones, eating them away. Patients feel as if they have fractures all over their bodies. It is a sadly common disease, killing 1 in 50 men. The medical profession has for years sought a solution, tried to find a way to catch the disease in the early stages and prevent the suffering. We have failed miserably.

For a while there was hope. Over 30 years ago someone discovered a protein in the blood, the Prostate Specific Antigen, that was elevated in the blood stream of prostate cancer patients. It was high when cancers were diagnosed, went down as the cancers were treated, and then rose again when cancers recurred. It was a good marker of cancer activity. Eventually doctors thought. “What are we waiting for? Why not use the PSA test to find cancers before they spread? Let’s start testing every man and end the suffering!”

It was a great idea, or so it seemed based on the available knowledge. What no one knew at the time was how many harmless prostate cancers were present in the population, cancers that did not need to be found. Prior to PSA testing, almost all of the prostate cancers diagnosed were deadly, for these were the patients that came in for treatment. Harmless cancers were almost unheard of.

It turned out that these silent harmless cancers made up the vast majority of prostate cancers. When PSA testing became widespread these were the cancers that were most often found. To the surprise of everyone prostate cancer diagnoses increased 600%. There was an exhilaration in the medical profession as people considered how many lives they were now saving due to early diagnosis.

The exhilaration soon faded. It turned out we weren’t saving very many lives at all. The prostate cancer death rate barely budged. In spite of the 6 fold increase in diagnoses the death rate declined a pitiful 5%.

To make matters worse, we soon learned that we were doing more harm than good. As we could not (and still cannot) tell which cancers were deadly, doctors treated every cancer they found. Thousands, if not millions of men with harmless cancer cells in their prostate glands had their prostates removed. Given the extremely high incidence of long lasting complications from the surgery, such as impotence and incontinence, incredible harm was done in the effort to save lives. Most studies suggest that 50-60 men were harmed for every life saved from PSA testing.

I realized the potential for this harm early on. I never endorsed or recommended routine PSA testing for my patients. Over and over again, day after day, with patient after patient, I explained the potential harms. For nearly 2 decades patients argued with me. Some patients got angry. They told me stories of friends and family members who had died from the disease and accused me of not caring. Many left my practice, including some with whom I felt particularly close. It was not easy being a dissenting voice.

It is only in the last few years that the majority of medical societies have accepted the reality that we do not have a good screening test for prostate cancer. PSA testing is no longer recommended.

People are finally acknowledging that the law of unintended consequences once again has come into play. The desire to do good resulted in a great amount unforeseeable harm.

The lessons of the PSA test have far reaching applications. Our society has many ills that plague us, from poverty to gun violence. Debates rage in legislative halls and internet forums. The cry to “DO SOMETHING!” resonates with all of us. It is frustrating to see others suffer needlessly. We want action and we grow tired at the perceived inaction of our leaders.

The prostate cancer story serves as a reminder, we can do much harm in the pursuit of doing good. Simple solutions do not always exist, and we would be wise to proceed slowly as we search for answers. 

Bart

Olympic Burnout

The Olympics are back, bringing with them stories of incredible effort, devotion and sacrifice. Some champions will ascend from the depths of anonymity, while some anticipated winners will fall spectacularly short of the goal. All who contend worked hard, all have exceptional skill and talent. All are possessed with single minded dedication to their sport, all have sacrificed greatly in pursuit of their goals.

These sacrifices aren't limited to the athletes. Each Olympiad brings stories of parents giving everything they could to support their child's dream.  Over and over again we are told tales of families who relocated so their children could train in the best facilities with the best coaches, who borrowed against or spent their life's savings, or who gave up careers and relationships in order to commit hours taking children to and from practices and competitions. The impact on families is immense. Their are neglected children who grew up in their sibling's shadow, who dealt with their parent's frequent absences, and who did their best to make do with a too small portion of parental attention.

I wonder if it’s worth it.

The winners often declare that winning justifies all of the pain, all of the sacrifice, but does it?

Most winners are quickly forgotten. (Quick- name one of the six US men’s track and field gold medalists from 2016.) Non-winners, all of whom make similar sacrifices, receive nothing in return for their efforts. When their 15 minutes of fame are over they often have little to show for it. The hours spent away from family and friends are lost forever, the pains and scars from injuries endure for a lifetime, remaining long after their brief Olympic moments fade out of memory. It seems a very high price to pay.

Perhaps I am growing cynical with age, but winning doesn't mean that much to me anymore. My earthly achievements do not reach Olympic proportions, but I have had moments of fame and success. When I look back on things that I have won, Chess trophies, Academic honors, and over $100,000 on multiple television game shows, I realize that in spite of the momentary elation I felt at the time, none of these "wins" made a significant difference in my life. Most people I meet have no knowledge of the awards from my past. What matters are not the things I have won but the person I am and the person I am becoming.

It is faithfulness and character that matter the most. There are no medals and trophies handed out for being a better person each day, but I believe that if I sacrifice myself daily working to be the person God wants me to be, if I focus my eyes on eternal things and strive to love God and others with all of my heart, that none of my efforts will be wasted. To me, this is the prize worth giving my life up for.

Bart

A Morality Lesson from The Beatles

Musical careers can be over in an instant. To find proof of this one need look no further than the Wikipedia entry for winners of the Grammy award for best new artist. There are many one-hit wonders on the list (Starland Vocal Band anyone?) In this context it is amazing that a single band placed three albums on the list of top 150 albums sold in 2017. Every more remarkable is that each of the albums was released in the 1960’s. The band was the Beatles, and there music is still popular over fifty years after they invaded America.

While their music has endured some of their lyrics now seem terribly out of date. Consider these lyrics, written in 1963-

Oh yeah I tell you somethin'

I think you'll understand

When I say that somethin'

I want to hold your hand

It may come as a surprise to the current generation but there was a time when holding someone’s hand was a big deal. When I was a teenager it was universally recognized that hand holders were a couple, paired up and off the market. As a result reaching out and holding a girl’s hand was a risky step. Rejection was a possibility. You didn’t hold hands with just anyone, trying it early on a first date was a bold move. Hence the song lyric.

We live in a different time now. Forget holding hands, kissing goodnight or other innocent expressions of affection and interest. Gradual progression in intimacy is a thing of the past. Single people today are jumping the line and skipping steps. People today are engaging in the highest form of physical intimacy with complete strangers.

A recent survey of sexual behavior in America reveals just how far we have fallen. A study published in "Review of General Psychology" discovered that college aged individuals reported twice as many hookups (casual sexual encounters) than they did first dates. According to the book Cheap Sex, when asked at what time in their relationship sexual intimacy began the most common answer was “before we started dating.” What a disheartening revelation this is. My generation was more cautious about hand holding than the current generation is about having sex!

I have seen this attitude expressed by patients I have seen in the office. Not too long ago I met a young woman who reported 15 sexual partners in the previous year. A man in his 40’s shared with me that he had no interest in marriage. He could have sex almost anytime he wanted, thanks to apps like tinder and women who were willing to have sex at the drop of a hat. With sex so easy and cheap he reasoned, there was no need for commitment.

Casual attitudes about sexual intimacy pose a significant threat to marriages. When sex can be had free from commitment, when it can be had with little emotional investment, one of the most powerful motivations for commitment is lost. When intimate relations can be had with strangers there is less interest in intimate relationships. Marriage becomes less essential, less valuable and less important.

Society has advanced in many ways, but there is no question that when it comes to attitudes about sex things have gotten worse. 

I hold out little hope for change. Reversing the trend of increasingly casual sex will require a restoration of old values and a willingness to challenge the attitudes of the world in which we live. Parents will need to teach their children that intimacy is special, that monogamy is desirable and that casual sex is wrong. Moral people need to model for others a commitment to intimacy that places a priority of saving oneself for marriage, of maintaining the sacredness of the marriage bed and that denounces those attitudes and behaviors that threaten it.

The future of marriage depends on it.

- Bart