Wednesday, January 22, 2014

The Power of the Prosecutor

     The Florida medical license renewal process is not a simple matter.  Besides filling out a standard demographic form there is a series of questions containing legal language requiring translation into layman's English, thirty Florida Statutes and Administrative Codes* that must be navigated, and a multitude of continuing education requirements the applicant has to prove he or she has met, including specific classes on domestic violence, HIV and prevention of medical errors.  Links to two different agencies, CE Broker and the American Academy of Family Practice, are supposed to make it easier to collate one's study and class credits accumulated over the past six years, but they don't itemize the precise categories of credit required by the Board of Medicine.  After four phone calls and hours of gathering education data, I was allowed to pay $379 to renew my license.
     The fourth phone call was to my lawyer.  Given that it's a crime to fill out the license application wrong, an act which could be interpreted as misrepresenting one's position, I had to make sure that certain questions meant what I thought they meant.  Have I entered "a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another jurisdiction"?  If so, "any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration," unless it's been more than 15 years since the probation period for the plea has ended, for a first or second degree felony, and ten years for a third degree--except under section 893.13(6)(a).  What did all this mean?  And was it applicable to me?
     My lawyer returned my call promptly and told me none of this applied to me, at least not yet, since I haven't been charged or convicted with anything, nor have I plead "no contest" (nolo contendere="I do not wish to contest," meaning I don't accede guilt or innocence, which is viewed, in the eyes of the Medical Board, as about as damning as a guilty plea).  I finished my application and paid the fee, but not without calculating how much power the federal prosecutor has to ruin everything I have worked for in my chosen profession.   
      Having made it through medical school and residency training, having practiced without triggering malpractice lawsuits for twenty-one years,** having studied for and passed the Family Practice Board Certification exam (required every seven years) in November for the fourth time, having earned 138.25 hours of continuing education credits in 2013 (similarly for all preceding years), having jumped through all the hoops to maintain a clean medical license, DEA privileges and Board certification, having attended workshops and conferences to keep abreast of medical advances, having devoted at least 30 minutes a day to reading current medical journals, I could lose it all with one swoop of his sharpened statutory scythe, if the prosecutor should decide, out of boredom, or irritation with me and my blog, or a necessity, begotten by pressure from his superiors, to make something happen in a case that has been in limbo for forty-three months.
     There you have it, the power of the government--the power of one prosecutor--to destroy a person's world, a profession built up over decades--and to wave a victory baton afterwards, followed by hurrah's from a propagandized public--glad that greedy doctors and other villains have been brought down--and maybe even to get promoted to newer and more purposeful positions of power.

*Here's an example of one of the codes:  
     456.0635 Health care fraud; disqualification for license, certificate, or registration.
(1) Health care fraud in the practice of a health care profession is prohibited.
(2) Each board within the jurisdiction of the department, or the department if there is no board, shall refuse to admit a candidate to any examination and refuse to issue a license, certificate, or registration to any applicant if the candidate or applicant or any principal, officer, agent, managing employee, or affiliated person of the applicant:
(a) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another state or jurisdiction, unless the candidate or applicant has successfully completed a drug court program for that felony and provides proof that the plea has been withdrawn or the charges have been dismissed. Any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration unless the sentence and any subsequent period of probation for such conviction or plea ended:
1. For felonies of the first or second degree, more than 15 years before the date of application.
2. For felonies of the third degree, more than 10 years before the date of application, except for felonies of the third degree under s. 893.13(6)(a).
3. For felonies of the third degree under s. 893.13(6)(a), more than 5 years before the date of application;

(b) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent period of probation for such conviction or plea ended more than 15 years before the date of the application;

(c) Has been terminated for cause from the Florida Medicaid program pursuant to s. 409.913, unless the candidate or applicant has been in good standing with the Florida Medicaid program for the most recent 5 years;

(d) Has been terminated for cause, pursuant to the appeals procedures established by the state, from any other state Medicaid program, unless the candidate or applicant has been in good standing with a state Medicaid program for the most recent 5 years and the termination occurred at least 20 years before the date of the application; or

(e) Is currently listed on the United States Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities.

This subsection does not apply to candidates or applicants for initial licensure or certification who were enrolled in an educational or training program on or before July 1, 2009, which was recognized by a board or, if there is no board, recognized by the department, and who applied for licensure after July 1, 2012.
(3) The department shall refuse to renew a license, certificate, or registration of any applicant if the applicant or any principal, officer, agent, managing employee, or affiliated person of the applicant:
(a) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another state or jurisdiction, unless the applicant is currently enrolled in a drug court program that allows the withdrawal of the plea for that felony upon successful completion of that program. Any such conviction or plea excludes the applicant from licensure renewal unless the sentence and any subsequent period of probation for such conviction or plea ended:
1. For felonies of the first or second degree, more than 15 years before the date of application.
2. For felonies of the third degree, more than 10 years before the date of application, except for felonies of the third degree under s. 893.13(6)(a).

**The average family doctor is sued every seven years.

Monday, January 20, 2014

Is Exercise Really So Great?

     Now that the holidays are over, if you're one of those resolution-makers who's vowed to start exercising again, don't be surprised if you get sick.
     Gym memberships are at their peak in January, paralleling a rise in respiratory illnesses.  Despite new insurance deductibles, which ought to be a deterrent to doctor visits, January remains one of the sickest months of the year.  No one has ever properly correlated illness with freezing temperatures, so Grandma's admonishment, "Bundle up, or you'll catch your death of cold," isn't validated by research.  December's visiting relatives and the viruses they distribute account for a percentage of sore throats, bronchitis and colds in January, but not all.  I wonder if vigorous exercise could be a cause of illness, rather than the preventive it's touted to be.
     When you exert yourself at the gym, especially doing muscle work, your body perceives it as injury and gets to work repairing torn muscle filaments.  The reparative process recruits an army of satellite cells, the oldest known stem cells, with large nuclei and very few intracellular organelles, located adjacent to muscle cells, capable of differentiating into and fusing with muscle cells.  Satellite cells receive marching orders via chemicals secreted by your body in response to exercise.
     Exercise triggers release of many inflammatory substances--cytokines and growth factors--as well as an increase in the sub-contents of muscle cells, like mRNA, ribosomes, Golgi apparatus and mitochondria.  In short, when muscles are damaged, inflammation results.  Inflammatory chemicals rush to the site of injury, as they ought to, but they get there via blood and lymphatics, which are your body's public transport systems making local stops along the way to drop off their chemical passengers everywhere, including nasal and bronchial membranes, the gastrointestinal tract, and the meninges, which enfold the brain and spinal cord like Saran wrap.
     Sometimes exercise hurts in places you didn't stress at all, causing headaches, distant joint pain, neck stiffness, gouty arthritis, and stomach upset.  Overexertion has been linked to more frequent respiratory illnesses, perhaps because it stimulates the body to manufacture and deposit inflammatory chemicals all over, especially in highly sensitive membranes like the respiratory and gastrointestinal tracts, increasing susceptibility to ubiquitous viruses.
     Inflammation is the scapegoat in medicine these days for cancer, coronary disease, aging, dementia, and almost any problem you can name.  The cytokines and growth factors which were designed to repair tissues sometimes do their job too well, creating nodes of panic in anatomical locations that become the setting for worse problems.  Inflammatory cells that help pave over damage to the endothelial lining of coronary arteries can leave scars on top of which cholesterol and protein debris get fixated, strangling the flow of blood and causing heart attacks.  A similar process may take place in joints, tendons and organs, triggering arthritis, tendonitis and organ inflammation.  Inflammation in one body part may ignite inflammation in other parts.
     Arthritis patients often say, "The pain started in my knee, but it traveled to my back and neck."  The idea of arthritis "traveling' used to seem unscientific to me, so I'd nod quizzically when I heard this.  But so many patients described their pains in the same way that I began to understand:  inflammatory cells from one body part can travel to distant sites and ignite inflammation in other parts.
     Here's the sequence.  1) vigorous exercise causes muscle fiber damage;  2) cytokines and other inflammatory factors are produced in response to this damage;  3) these inflammatory factors hitch a ride via blood or lymphatic circulation to the rest of the body;  4) susceptible body structures, like the joints, coronary arteries, lungs, or oropharynx receive messages from these inflammatory factors and go on red alert, producing more chemicals of alarm, more cytokines;  5) the body parts affected by distant inflammation may have something to do with a person's genetic make-up or previous medical conditions--if you're prone to neck pain, headaches, asthma or a bum knee, those areas will be the first to pick up inflammatory signals and start hurting.
     Like all doctors, I had many patients from a previous generation that never exercised.  Many people in their seventies and eighties grew up with the idea that the only ones who used their muscles were manual laborers, therefore they weren't going to join that group.  In many countries today, the leisure class really is at leisure, leaving exercise to those lower-class workers who have to make a living with their muscles.   Among the many older folks who never exercised, I saw few people who truly suffered ill-health, as long as they lived lives of moderation and weren't completely sedentary.  If we were to interview the centenarians of this country, I doubt if many of them would be found to have exercised in a formal way--lifting weights, running marathons--for any part of their lives.  There is even some evidence that regular bouts of vigorous exercise taxes the heart, making cardiac rhythm problems more likely.
     It's an unpopular idea in medicine nowadays, but my recommendation is that people get whatever physical exercise is needed to support their lives, and no more:  carry groceries, mow the lawn, wash the car, pull weeds, take walks, hang out clothes, plant flowers, clean the gutters, sweep the driveway-- and forget about joining a gym, training for triathlons, biking across America, and impressing people with your biceps.  

Saturday, January 18, 2014

Lessons from Dounton Abbey

     TV shows with stories about other people's problems and heroic resolutions offer a voyeuristic escape from the inexorableness of our own lives, even if the settings and costumes of those other lives are no more familiar than a Tolkien fantasy.  The main thing is, the characters suffer, and the acting is so good that their suffering feels familiar and can make us cry.  At least, I cried.
      Last weekend I watched all the episodes of Dounton Abbey back-to-back in two and a half days--that's 28 shows, 1,602 minutes.  I stayed up way past midnight, engrossed, like120 million other viewers, by this fanciful rendering of one British upper-class family's set of personal lives in the early 1900's, and their shadowy underbelly, the butlers, maids and kitchen laborers whose fussy industriousness and unquestioning devotion stabilize the pillars of this extravagant world.  It's hard not to tally up the hundreds, maybe thousands, of working-class people who buck up the highborn Granthem family's superiority complex, from the farmers who grow and deliver those daily wheelbarrowsful of fresh flowers--to freshen up countless parlors and ladies' dressing tables--to the crew who iron the morning newspapers, whip up fish souffles and fruit-filled meringues for lunch, and help the lords and ladies don their underclothes..  The show parallels "Upstairs, Downstairs," and garners most of its appeal from the mirroring that takes place between the two echelons of characters:  the ego-based ones upstairs, who are visible, beautiful, poetically in their suffering, and attentive to their images, and the frenetic ones below, who work, make messes, smoke, steal, moon, plot, and scheme in a windowless maze of scullery, wine cellar, hiding places, corridors and dark record-keeping rooms that are as mysterious and convoluted as a dreamscape.
     At the outset I knew which character I couldn't stand:  Cousin Isabelle, also known as Mrs. Crawley.  There is probably a character or two who grates on every viewer's nerves.  But this isn't a good-guy, bad-guy story, with a clear set of villains..  Except for two overtly mean-spirited figures, Tom and O'Brien, who prowl around downstairs with devilish deliberation, and who plot against newcomers (accruing a smidgeon of self-awareness, along the way) the show is cast with characters you might love or hate, depending on your complexes-- and this is where there are lessons to be learned.
     What are your complexes?  How much do you want to know about the estimated eighty percent of your personality that's wriggling behind the image you see in the mirror every morning?  Who is it back there who's responsible for botching things up, getting confused, drunk, or angry, falling in love, choreographing accidents, forgetting appointments, losing keys, overeating, slipping into reveries about how different life could be, and hating certain people?  However you censor or rationalize your thoughts and behavior, they're always pointing to that eighty percent you'd rather not acknowledge.  But cutting yourself off from it is like disavowing eighty percent of a sizable inheritance.  Why live on less than you have to?
      Some of the ways to get access to the parts of you you don't know are:  1) analyze your dreams;  2) pay attention to your slips of the tongue, forgetfulness and jokes;  3) watch how your world unfolds around you, especially when it's not going well;  4) listen to your criticisms of others, especially the ones you don't really know;  5) study the person you married;  6) identify the people you can't stand.
     Let's do a little exercise with that last one:  Who do you really dislike--in politics or Hollywood, at work, in your personal life, on TV, at the auto mechanic shop or grocery store, anywhere?  Describe the person, listing the things you don't like, including the ones you presuppose.  The people you dislike are the ones who have the most to teach you.  In Jungian parlance, they're your shadow.
     Mrs. Isabelle Crawley is a do-gooder whose excessive concern for others, especially the downtrodden, masks both her self-scorn and an unacknowledged wish to be loved and looked after.  The care she showers on others is what she might wish for herself, but because it's a wish that remains unconscious she sees neediness only in those around her, not in herself.  The sick, the wounded, the dying, and the castaways of society are the people who most resonate for her, because they personify her inner woundedness.
     I would describe Mrs. Crawley as stiff, moralistic, oppressive, and out of touch with her body and the deepest longings of her heart.  She is especially cut off from herself when a doctor-friend makes an oblique avowal of love, because she can't possibly see herself as lovable.  She's a workhorse, constantly  ministering to the debilitated, the lame, and the fallen--those who, in allowing her to care for them, give her access to tiny bits of herself.  But she doesn't have the self-awareness to open these bits up, or to be cared for, too.  She is too rigid to seek affection or pleasure, and if they tap at her windowpane she rushes out the front door to perform more good deeds, dodging self-recrimination.  She never laughs, or revels in the world.  She's the ultimate Puritan:  denying herself, giving to others, rigid, righteous, virtuous, chaste and no fun.
     There is something about Mrs. Crawley that reminds me of myself, but not a self I'd own.  That's why I need to pay attention to her.  If I can see her flaws as a finger pointing to my shadow--a do-gooder hiding behind virtuosity as a way of avoiding a secret wish for more of the world, for love, laughter, revelry, gaiety, and saturnalia--I might be able to dismantle some of the scruples that limit my experience of life and cause unhappiness.  As long as Mrs. Crawley remains other, I'll never get to know that other me, the one Mrs. Crawley makes look so bad, the one she represents.  But is she so bad?  I was shocked to overhear another Dounton fan say how much she admired Mrs. Crawley:  clearly the do-gooder character wasn't her shadow.  Instead, this fan hated Lord Grantham--which reveals something else altogether.  Accepting that Mrs. Crawley's mirrors my own rigidity would allow me to see how such a stance limits my life (whereas the same trait might be desirable for another person, especially someone without self-discipline), from which I might then allow for a different attitude going forward.  Mrs. Crawley could have accepted the doctor's marriage proposal, and had a very different life, if she had wished to change.  Without change, there is stasis and death.
     The first step in getting to know one's unconscious self is to look at the shadow, which is right behind us all the time, and mirrored by the people who irk us, or whom we abhor.  Television shows like Dounton Abbey can bring one's shadow into relief by giving voice to characters who personify our rejected self, the shadow.  If you enumerate the qualities you don't like about a character in any show, you can then assume that those qualities belong to you, and are waiting for you to acknowledge and integrate them, because doing so will open up your life a little.

Friday, January 17, 2014

Stuffed Cabbage

     This is a Pennsylvania Dutch staple, also known as "pigs in a blanket," but without ground meat.  Many filling substitutions and additions work well.  December, January and February are the best months to buy cabbage in Florida.  Use canned tomato sauce if you're pressed for time.  Good as leftovers, for lunch.

     2 cabbages, cored, with whole leaves separated

     Plunge cabbage leaves into a pot of boiling water and cook 1-3 minute, until flexible enough to fold.  Remove gently to collander and allow to cool.

     4 cups rice, cooked
     2/3 c olive oil
     2 large onions, diced
     8 stalks celery, diced
     8 carrots, peeled and diced
     6 cloves garlic, minced
     1 cup chopped pecans
     1/2 cup nutritional yeast
     2 Tbsp dried basil
     1 Tbsp dried sage
     2 tsp pepper
     2 tsp salt
     4 Tbsp soy sauce or Liquid Aminos

     To cook rice, rinse three times, then cover with 6 1/2 cups water. add 1 tsp salt, bring to boil, cover, and cook over very low heat for 45 min.
     Heat olive oil in large skillet and saute onions, celery, carrots, and garlic until soft.  Add nutritional yeast basil, sage, pepper, and salt, mixing thoroughly.  Sprinkle in pecans and add rice and soy sauce, stirring to mix.

Tomato Sauce:
     1/4 cup olive oil
     1 large onion, minced
     2 cloves garlic, minced
     10 tomatoes, diced, or 2 large cans stewed or diced tomatoes
     1 Tbsp dried oregano
     2 Tbsp dried basil
     2 can tomato paste
`    1 Tbsp salt

     Saute onion and garlic in olive oil until translucent.  Add tomatoes, spices and tomato paste.  Cook over low heat for 30 min or more, until flavors meld.

     To compose:  Gently fill each cabbage leaf with spoonfuls of filling, roll into cylinders, and place in oiled casserole or baking dish with the folded side down.  Line the stuffed cabbage roles side by side and cover with tomato sauce.  This makes two casseroles full of stuffed cabbage.  Cover with lid or tin foil and bake in 350 degree oven for 45 minutes.  Serve with fruit salad, carrot-raisin salad, or Waldorf salad, to add crunch and sweetness to the meal. 



Thursday, January 16, 2014

Million-Dollar Lawyer No. 3

     With shiny shoes, shiny blue tie, and head held high, Million-Dollar Lawyer No. 3 charged down the heart-pine hallway like a steed on a runway and caught my hand in his big, bold grasp just as I turned to see what was the commotion was.
     "What an incredible office," I commented, pointing out some fancy woodwork.  But he was way ahead of me.
     "Come on down and meet my associates," he bellowed.
     One more lawyer's conference room, one more handcrafted table as big as a mortuary's workbench. In fact, I was told, the swivel chairs were left over from a murder trial.
     "We've done some homework on your case," the first associate said.
     "A massive case," the steed-lawyer interjected.
     "It's going to be a lot of work," the junior chimed in.
     "How can it be massive?" I asked.  "I'm a single doctor."
     (What would they call a case involving a multi-hospital corporation?  Super-massive?)
     "Oh, there's a lot of paper in your case.  At least 2,000 lawyer-hours."
     "Hasn't anyone done discovery in this case yet?" Junior asked.
     "Who are your lawyers, that they can be sitting on your case this long?" added the steed.
     "Haven't they done anything?"
     "Stop!" I said.  "Stop with the prior-lawyer bashing. That's what blue-collar workers do, not professionals."
     "How long has it been?" Junior sneered.  "Three years?"
     "All we're saying," the steed went on, using a softer tone, which must have cost him effort, "is that someone should have been doing something in this case before now."
     He rested his eyes on me, full of sympathy, to let me know that if that someone had been him, the case would be all wrapped up by now.
     "Right," I answered.  "And what is it you plan to do?"
     "We'll get documents."
     "We'll make calls."
     "We'll move this thing along."
     All three spoke at once.
     "It won't be cheap," said the steed, rolling his shoulders forward.
     (Isn't rolling-shoulders on the list of warning signs in How to Spot a Liar?)
     ("A lie has no power whatsoever by its mere utterance;  its power emerges when someone else agrees to believe the lie"--Pamela Meyer.)
     "I didn't think it was going to be cheap," I said.
     "It's going to cost you a million dollars," he clarified.
     "We've got to review every single one of those charts," the associate said.
     "Eleven thousand records?" I asked.
     "Lots of man-hours," the steed said. "I mean, lawyer-hours."
     "And the only guarantee," I ventured, "is that I pay you a million dollars."
     "We can't guarantee success, if that's what you mean," the associate said.
     "But I'm a truly brilliant trial lawyer," said the steed.
     "Isn't that what other people are supposed to say about you?"
     "But it's true!" he answered.
     "Yes, it's true!" said his associates.  "He is brilliant!"
     I looked out the window.
     It was a nice, cool day, and I wanted some air.
     "Thanks a lot for your time," I said, standing up.
     The head honcho lawyer opened his arms to me, for a hug.
     For everyone's information, I don't do hugs for million-dollar lawyers.

Monday, January 13, 2014

Cure for Autism?

     Deep Brain Stimulation (DBS) has been an FDA-approved treatment for Parkinson's disease for twelve years, and for essential tremor for sixteen.  In both conditions electrodes are implanted into the motor cortex of the brain, resulting in improvement in motor function.
     A non-FDA-approved use of DBS is for severe depression (DBS-Psychcentral).  A few intriguing pilot studies have shown that some people--six out of seven according to one report--have been cured of intractable depression with this treatment.
     DBS, known in neurosurgery circles as "stereotaxic surgery" involves "placement of unilateral or bilateral electrodes in target brain regions connected to a permanently implanted neurostimulator which electrically stimulates that brain region" (DBS--German study).  No one knows how it works.  The electrodes are not unlike pacemaker wires:  instead of being lodged in heart muscle they're implanted in the brain and connected to a rechargeable battery that rests above the clavicle.
     In Parkinson's disease the electrodes are placed in the basal ganglia, a region known to release dopamine, a neurotransmitter deficient in this condition.  More than 30,000 patients have been safely treated with DBS.
     Between 2003 and 2005, five studies reported that DBS resulted in improvements in Tourettes syndrome.   In 2005 one patient was cured of depression when DBS was applied to an anatomical region of the brain called Brodman area 25, a place that is metabolically overactive in people who are extremely sad.  The authors of the German study cited above believe that using DBS on a brain region called the nucleus accumbens will relieve depression because it acts as a gateway for information going to and from the emotional centers of the brain.
     Like stem-cell research, the possibilities for GBS seem as boundless as the places in the brain it might succeed in manipulating:  appetite centers for obesity, new motor regions for people with partial strokes, speech centers in autism, areas for memory, sleep, vision, anxiety, impotence, cardiac rhythm, smoking, drug addiction, music appreciation, you  name it.
     Because DBS has been used with success in obsessive-compulsive disorder, and because autism is an obsessive-compulsive syndrome with a wide range of expression, a few years ago I began to wonder whether it might be effective for autism--especially for my son, Carmine, whose autism is so severe that he cannot initiate any activity, except breathing, without nonstop verbal or tactile prompts from caregivers.  Over the past few years a team of behaviorists and I have made modest progress in reducing Carmine's prompt-dependency, using upgraded, nonviolent Pavlovian techniques, but he continues to live a life so completely dependent on us that without someone alongside him every minute of the day he would remain in one position, immobile, all day.  He can't respond to the internal prompts we take for granted, the physical stimuli that impel us to move our limbs, eat, drink, use the bathroom, or shift position.  He can't voice preferences--he can't speak at all.  Assistive communication devices and iPad apps have been, mostly, a waste of effort.
     I did an internet search and found a case study in Frontiers in Human Neuroscience from January 2013 describing a favorable response to DBA in a 13-year-old autistic boy (DBA for autism ScienceNews) (DBA autism Frontiers in Neuroscience).  This may be the first time DBA has been used in autism, and it was justified by the boy's extreme self-injurious behavior.  Electrodes were placed in areas comprising the amygdala, a region of the brain that regulates emotion.  Not only were the boy's behaviors reduced but his parents reported that after DBS surgery he used two words for the first time, began to try new foods, and continued to improve for months.
     Autism affects one in every110 children (one in 80 boys), and most parents of severely autistic individuals, desperate for help, have tried dozens--if not hundreds--of treatments.  While we parents don't think in terms of cures once our children are adults, even small improvements in communication and social functioning can make dramatic differences in an autistic person's quality of life.  DBS is a minimally invasive surgical procedure and is completely reversible, so it's likely to be safe, as the DBS-treated Parkinson's population has proven.  If there is any current treatment that shows promise for curing some of the symptoms that make autism so difficult to bear, it's probably DBS.  I will continue to follow news about this innovative possibility, and may even look for a research center where Carmine might evaluated as a candidate for DBS.             

Sunday, January 12, 2014

Mark Your Calendar: My Trial Dates

     The government has set a date for a trial in my case.
     A trial, without an explanation for the SWAT raid on my clinic?  A trial, without enumeration of charges that have any connection to reality?  A trial, without a crime?
     The court has announced that each side may conduct "no more than thirty depositions" which may take "no more than seven hours each."  My lawyer says we have to move quickly, because there is a lot to do before then.
     I keep asking, "What have I done?"  but there are no answers.  I am straining to hear, but like one afflicted with deafness, who has not yet accepted the affliction, I can't hear a thing.
     Are there answers?  Or is it n more than noise, the clang of plastic and metal at a garbage dump.  It's our government doing this, and I'm supposed to be respectful, the way the lawyers are.  They talk to one another about my case, across an arid expanse of injustice, like real professionals, with interrogatories and depositions, motions and hearings, services of process, amended hearings, continuances and other couture of judicial "proceedings," the dressing-up that adds verisimilitude to a scarecrow.
     A nurse who worked in my clinic, a seasoned man with experience that included years in emergency room trauma centers and prisons, who claimed to have "seen it all," once told me the story of the worst accident victim he had ever treated.  It involved a steamroller.
     Those of us who work in the medical field talk intensely with one another, when we have time, as a way of unburdening the suffering we carry in our chests.  This particular conversation took place seven or eight years ago, during a rare pause in our clinic schedule, because we stood in the break room drinking coffee and picking at a box of cookies, waiting for the next rush of patients, and telling stories.
     We must have been feeling that constriction in the chest that comes from holding too much grief inside, grief that can be unstopped, a little, by opening the valve of real human interaction, because we were relating the most heartrending medical cases in our careers.
     The nurse's story was of a deaf man who had been standing directly in the path of a steamroller.  The driver of the steamroller was "on a roll," saw the man, and honked his horn with great energy.  But the man's back was to him, and he didn't move.
     "The guy must have been mentally impaired," he said, "because the steamroller operator said he honked and yelled the whole way, and couldn't stop.
     Not hearing what was coming toward him, the man didn't know to move.  Not able to translate the rumbling in the ground as potential danger, he stayed where he was, looking the way people do in a trance.
     Steamrollers are tremendous, bulky machines that can't be made to change direction at the last minute, so the poor man was killed.
     "He was flattened like a pancake," the nurse said, shaking his head, "and that's how they brought him into the emergency room." 
     "How can such a thing be possible?" I asked.  I was wondering how a grown man's physique, filled with pulsating organs and warm blood, and with a spongy brain sparking neurons like fireworks, and with bones like the branches of a sycamore tree, could be flattened.
     "You know those cartoons where a guy is run over and looks two-dimensional?" the nurse asked..
     "Yes," I said.  "Like on 'Road Runner,' where an innocent bystander comes along afterward, and holds him up like a sheet of cardboard."
     "That's what it was like," the nurse said.  "There was nothing we could do."
     The nurse had never been able to put the horror of the memory out of his mind, and now it's stuck in mine.  I have felt very sorry for that man, whom neither of us ever knew. 
       Like a steamroller, the government has started moving toward me, it's accelerating, and it cannot stop.  I should move, but I don't know what direction it's coming from;  the clamor seems to come from all directions.  There may be innumerable steamrollers--the government has great stores of heavy equipment--headed in my direction.
     The date of my running-over, the dates for my "trial," that is, though no criminal charges have been made, let alone proven--is September, 8, 2015 to September 23, 2015..   Put it on your calendar, if you care want to watch.

Saturday, January 11, 2014

John Stacks Gets Indicted

     My friend John Stacks was indicted last month.  He is the owner of Mountain Pure Water, a bottling plant in Arkansas, and owner of Home Bank of Arkansas in Little Rock.  More than a year ago his water bottling plant was raided at gunpoint by dozens of FBI agents, the drama having been reenacted in his video, Rampant Injustice (, very much like the raid on Colasante Clinic on June 16, 2011.
     No one wants to be indicted, mostly because of the terrible effect it has on one's reputation but also because the legal costs for criminal representation are extraordinary.  Greatly disturbing to any of us who have been unjustly accused, is the persistent belief on the part of so many Americans that an indicted person is, de facto, a criminal.  "Indicted" means accused, not guilty, not proven guilty, not tried in court, not formally judged.  It's refreshing when a news story implies that government agents might have made a mistake (even a deliberate mistake) but stories like this are rare, and besides, readers prefer to assume criminality--maybe it's satisfying to assume that other people are bad, and we, by contrast, are good.
     Here are the news stories about John Stacks's indictment.

John Stacks local newspaper story

John Stacks local TV story

     Last year, John Stacks and I went to Washington, DC to describe to our senators and house representatives how government agents and the IRS violated our constitutional rights when they raided our businesses.  We made a brief impression on these beleaguered representatives, whose office buildings are crammed with polished-looking lobbyists toting Power Point presentations, and alongside whom John and I looked like two hillbillies, but it will take lots more Americans who have been wronged to show up in our nation's capital before anyone really listens.
     Therefore, John Stacks is now dealing with all the sequelae of being indicted.  It's not a quick process, I learned:  over three weeks he has been required to attend three arraignments, and any time he needs to leave the state for business he must request permission.  Government agents told him that if he doesn't voluntarily resign from his own bank, he'll be forced to do so.  He has a platoon of lawyers who forecast a long and costly battle for his freedom.  Most of the big vendors for his bottled water, including Walmart, retracted their contracts in the months after the highly publicized raid, forcing John to fire half his employees--that's ninety people who filed for unemployment.  Now he's considering bankruptcy, because it's one mechanism for him to "start over," if he has the gumption.
     I should be grateful (to whom?) that I haven't been indicted, after an investigation that has lasted, at least so far, three and a half years.  But the costs of defending myself against civil allegations, though not as drastic as criminal charges, are no less daunting.  Years of attorneys' fees add up  If I had been smart I would have done what Pat McCullough did:  run my business into the ground, pocketed the cash, left creditors with huge negative balances, then filed for bankruptcy and unemployment compensation.  Pat was granted both, and has fostered, to the feds at least, an appearance of having been victimized.  But I'm not that smart.
     I admire John Stacks because out of his lemons, as they say, he is making lemonade.  The raid on his business was so terrorizing, and his subsequent enragement so unsettling that he couldn't sleep.  Night after night he lay awake, reliving the incident and smoldering with anxiety, but also stoking his right lateral prefrontal brain, where creativity has its playground, until he kindled an idea for a new bottled drink for promoting sleep.  He talked to pharmacists, biochemists, and marketing gurus who helped him develop a formula that works.  Soon he'll be bottling it and putting it on our local grocery store and Handiway shelves.  He drinks a bottle of his new soporific every night and tells me he "sleeps like a baby."
     John wants me to help fine-tune the formula for his burgeoning product and to write some endorsements.  I haven't decided whether to take him up on this project or not, because I don't feel motivated in any direction these days.  I guess I'm waiting for my own prefrontal lobes to throw me a little lemonade.

Friday, January 10, 2014

Foods That Contain Cyanide

     Cyanide is a poison which kills by starving cells of oxygen, mainly cardiac cells.  Specifically, compounds with cyanide inhibit an enzyme necessary for cells to produce energy.  Although cyanide is considered dangerous, and has been used for ages as a means of doing away with one's enemies, many edible plants naturally contain cyanide, presumably to defend themselves against grazing animals.  Any chemical with CN in its formulation is one of the cyanides;  hydrogen cyanide is one of the most dangerous because it's a gas, delivering a lethal dose quickly when inhaled.
     If you have a diet like mine, you probably get cyanide in your diet every day.  Foods known to contain cyanide are:

     soy beans
     lima beans
     kidney beans
     bamboo shoots
     apple seeds
     pits from apricots and peaches

     Cyanide is also present in tobacco smoke and combustible engine fumes, so toxicity can accumulate through daily inhalation of small amounts.  Because certain plastic products contain cyanide, released when the plastic is heated, it's best not to put plastic containers of food in the microwave unless you're sure they aren't made from acrylonitrile, a precursor to cyanide.  Acrylonitrile is present in styrofoam-type plastics that are widely used, for instance, as packing material.  If styrene products are heated above eighty degrees, cyanide can be released.  Most plastic manufacturers are not required to label their products (with the recent exception of BPA), so it's a good idea to use only glass or ceramic dishes for heating food in the microwave, not plastic.
     The foods listed above, though they contain cyanide, or perhaps because they contain it, are considered, oddly, to be healing foods, not toxins.  The soft nuts inside the pits of apricots and peaches, contain amygdalin, also known as laetrile, a substance that has been used for treating cancer patients, mainly in Mexico (the FDA banned laetrile in 1977). Almonds are good sources of laetrile, too.  Laetrile is broken down into cyanide in the body, and therefore can lead to cyanide poisoning if the amounts ingested are too large to metabolize.  It has been documented that people who eat diets high in natural laetrile, like the Hunza, have very low rates of cancer.  Bitter almonds, which contain more natural laetrile than other foods, are used as a source of laetrile, but can be eaten raw and are considered by some to be an anti-cancer food.  Amounts larger than a bitter almonds or apricot pits a day may be toxic.
     Throughout the history of medicine, both eastern and western, substances known to be toxic in large doses have been used to cure disease in small doses.  Hence Aristotle's dictum:  "All things in moderation."  It's seems likely that life and nature include toxins in otherwise palatable foods because sometimes they are good for us--and perhaps we can extend this phenomenon to experiences and people that are unpleasant, even toxic, people who make us want to run for cover.  If it's not too much of a stretch, I might even include people like my prosecutors and those FBI agents, who may have been dosed into my life in (barely) tolerable quantities, like cyanide, because they're somehow good for me, extending my awareness of the workings of society, which is the matrix within which most of us live, so that I will respond to it the way the human body responds to natural cyanides, by getting stronger, by using it to heal deeper ills both in myself and in the world around me.  The evils of the world, like cyanide, are natural to the world.  They occupy their positions, we learn to relate to them, and in the process we change both ourselves and the world.

Thursday, January 9, 2014

The Problem with Conspiracy Theory

     Here are three youtube videos I watched today, thanks to the suggestion of one of my blog subscribers.  They are not unintelligent pieces of journalism, but they promote a theory about the country and the world that doesn't appeal to those of us who have been steeped in fantasy about what America represents and how the world works.  The older I get the more I realize I don't know much of anything about our country--or what I thought I knew happens to be wrong.  My personal experience with the government, our lawmakers, and our justice system has made me exclaim, along with Aaron Russo:  What if it's our own government we have to be afraid of? What a terrifying thought!

Conspiracy Theory, Jesse Ventura

Freedom to Fascism, Aaron Russo

Reflections & Warnings, Aaron Russo

     In the first of these films, Jesse Ventura tells the story of his visit to a 70,000 square-foot fortress-like building being constructed in the Ozarks, a building that's connected to an enormous network of underground tunnels big enough to accommodate 18-wheelers, and likely, he says, to be a place the Illuminati, or world-elites, plan to hide out during a World War III of their own making.  While the rest of us are killing ourselves in battles staged by this powerful group of billionaires who control world politics and public opinion, or while we're suffocating in fumes from massive nuclear explosions, these privileged few are going to be eating caviar and playing cards in their mountain bunkers, protected from fallout.
     Aaron Russo's documentary and interview paint a picture of America as a country that started being taken over by the Illuminati in the early part of the twentieth century, people who figured out how to seize power by controlling money, first by inventing the Federal Reserve which could make money whenever they wanted it, then by pulling off the biggest hoax in history by convincing Americans to pay federal income tax--a "requirement" that isn't supported by law and could be challenged (and won) by any one of us who wants to stop paying taxes on wages and who feels like going to court with the IRS.
    Russo's final interview, "Reflections and Warnings," portrays a sensitive and good-natured guy, Russo himself, as a rare person who has dared to publicize questions about how our system really works, uncovering ignorance, lies and corruption within the DOJ, and making another case for the existence of a few wealthy individuals who control international politics and the marketplace, and are in the process of remaking everything, the so-called "new world order" with them, no doubt, at the helm.
     The problem with all this is:  Why?  Why would a privileged few who already control the world want to destroy that world and plunge us into another version of Animal Farm?  Why would anyone want to live in an underground city while the rest of the world is being blown up?  What could this elite group of people be planning to do after everything settles down, with dead bodies everywhere, and so much stench, ash, fallout, smoke, and rubble?  Who will shine these spoiled brats' shoes or fix their meals?  Which of them is planning to install toilets, write books, mend eyeglasses, and fix their cars? Who will even build those cars, or grow apples, or make their diamond rings?
     I see the elite of the world crawling out of their tunnels like hibernating animals after a long winter, scrounging around for food and things to do, recreating the same pecking-orders that existed before their absurd war.  The slaves and masters would sort themselves out soon enough, like that band of kids stranded together in Lord of the Flies.  the social order they created mirroring the one they destroyed.   The same dynamics among people would reproduce themselves, and give rise to the same sort of world.
     Who would want to be down there with the elite, anyway?  Not me.  The elite are still human, after all, and would not have defeated death.  Every one of them would be slated to die.  As for continuing a world order, does this mean the wealthy survivors plan to hand down power and wealth to their children and great-great-great grandchildren, like old British aristocracy?  They don't even know those kids;  they might not even like them, so why bother?
     I don't doubt that some multi-billionaires, who have nothing better to do, might want more power than they already have, and might imagine they're controlling the minds of their underlings.  But they need those underlings, without whom there would be no one to control.  After World War III, who and what would be left for them to control?
     People are obsessed with outliving themselves--none of us truly believes we're going to die.  Bomb shelters and secret tunneled cities like the one in the Ozarks might fuel a fantastic belief that any one of us could survive anything, if only we were "the chosen."  The resentment that springs from such fantasies is a waste of emotional energy.
     There is corruption and oppression everywhere, whether we see it, in our minds' eye, in terms of secret societies or blatant totalitarianism.  Instead of subscribing to notions that a secret group of arrogant, self-designated rulers-of-the-world are organizing themselves for a more insidious and global take-over than Hitler's, we ought instead to be doing all the things the German people--if they hadn't been lulled into the torpor of indifference, material acquisition and faith in their leaders--might have done, en masse, to stop Hitler's takeover.  Right now, we can identify corruption, prejudice, and injustice wherever we see it, even in our interpersonal lives, when prejudice and unfairness show their ugly faces;  we can tell everyone what we see, and we can gather together to fight it.
     Subscribing to conspiracy theories is like belonging to a cult:  the decision to think in such terms absorbs your brainpower and your legitimate rage, the very resources that might fuel change.  Every little alteration in the way people feel, think and act matters.
     We must change the world, it's true, but we can't wait around for other people to do it, idling away our time like voyeurs in hushed gossip, pointing fingers, accusing, acquiescing, turning over our rights, by not exercising them, even our right to fight injustice.  Governments thrive on intimidation and fear, says Russo, and propagating theories about mega-conspiracy for subjugating the masses (who, in most places, have chosen to be subjugated) is a way of perpetuating intimidation and fear.
     "In a time of deceit, telling the truth is a revolutionary act," Russo says.  What is the truth, as you see it, in your everyday life?  How have you been wronged, how have government peons violated our constitution, how have the rights of people you actually know been taken away?  Don't hide behind "conspiracy theory," which probably can't be proven, which you can't even point to, any more than you can point to invisible devils and gods.  Don't waste energy grumbling about how bad the world is getting, and whose fault it is.  It's our fault.  

Wednesday, January 8, 2014

Why Does the DOJ Go after Little Guys?

     "Not a single high-level executive has been prosecuted in connection with the recent financial crisis" says journalist Jed S. Rakoff (New York Review of Books, Jan 9, 2014*) even though the Financial Crisis Inquiry Commission has made a statement that "the signs of fraud were everywhere to be seen."  The Department of Justice (DOJ) agreed with the conclusions that "fraud at every level permeated the bubble in mortgage-backed securities," quotes Rakoff, but, five years after the market crash that has left many Americans broke and without homes, the DOJ now says proving fraudulent intent is "too difficult."  What the DOJ means, Rakoff tells us, is that the executives are "too big to jail."
     If big criminals are too big to jail, the DOJ has to go after small criminals--maybe even after people who aren't criminals at all, if its prosecutors are going to prove they're doing any work at all.  I guess that's where I fit in.  I'm not too big to attack.  I keep remembering my lawyer's explanation for why my clinic was raided in June 2011:  "You're low-hanging fruit," he said.
     The DOJ's explanation for not prosecuting the companies--or their executives--who were responsible for the economic crisis that started in 2009 and continues to have devastating consequences for millions of Americans, is that such prosecutions "will have a negative impact on the national economy, perhaps even the world economy."  What about the millions of Americans who have lost their homes and declared bankruptcy since 2009?  Aren't their plights having a negative impact on the national economy?  How is prosecuting the executives who permitted, or may have choreographed, such high-level mortgage fraud going to harm America, or do anything but send the message that they're welcome to do it all over again?
     "The Department of Justice has never taken the position that all the top executives involved in the events leading up to the financial crisis were innocent;  rather it has offered one or another excuse for not criminally prosecuting them--excuses that, on inspection, appear unconvincing, " says Rakoff.  Going after these executives who profited massively from the mortgage fraud, requires years of difficult investigations, and too many resources.  Prosecutors want to make names for themselves, and they don't want to take years to do it.  If there are easier cases to nab, cases that draw a lot of public attention and are easy to win or settle, they'll taken them instead.  Enter:  medical fraud.  Doctors are notoriously easy to intimidate, and they don't hire big firm lawyers.  They settle quickly, because their livelihoods depend on their reputations, their honor.  Whether they've done something wrong or not--lately I'm convinced that a large number of them have not--they want out of the limelight, and fast.
     DOJ prosecutors go after small fry like me because we're easy to pick on.  I guess they think destroying a solo doctor isn't going to "ruin the national economy."  But I disagree:  making doctors who are simply doing their jobs look like criminals is terrible for their employees and their patients, for the community, for medicine, and for national morale.  Attacking doctors, one by one, because it's easier than going after multinational lending institutions, isn't doing the job of justice, it's eroding the backbone of America, the many small business, like solo doctors, who built up this country, and who are now getting the message that if we want to be safe from the grasping hands of the DOJ we'd better either get really, really big--as big as the banks who got away with trillions, five years ago--or disappear from the workforce altogether. 

Tuesday, January 7, 2014

Salad with Warm Roasted Pumpkin Squash

     This is a great winter salad and is best served when the roasted squash is still hot so that it gently wilts the greens.  I have several dozen Seminole pumpkin squashes matured on vines in the garden almost all the time.  The sandy soil must be hospitable, because this squash grows with no help.  It's extremely nutritious, low in fat, high in carotenoids and fiber.  If you live in Gainesville, FL, the best place for smoked paprika is Wards, where it's always fresh-tasting and sold for a great price in the bulk section.

     2 large Seminole pumpkins, seeded, peeled and cut into 2-inch chunks
     1/4 cup olive oil
     3 Tbsp maple syrup
     2 tsp salt
     1 tsp pepper
     2 Tbsp smoked paprika

      2 heads of Romaine or other leafy salad greens, washed, diced and spun dry
      1 tomato, diced into small pieces

     1 tsp salt
     1 Tbsp maple syrup
     2 Tbsp champagne (or other light) vinegar
     drippings that accumulate from roasting squash
     2 tsp smoked paprika
     4 Tbsp olive oil

     Preheat oven to 450 degrees.  Combine squash with olive oil, maple syrup, salt, pepper and smoked paprika in a large bowl, tossing the pieces until all are coated with the mixture.  Pour onto a raised-edged baking pan keeping the squash in a single layer.  Roast in oven for 30 to 60 minutes, turning every 5-10 minutes, until the squash is golden and caramelized.  If juices collect in the pan, pour them into a Pyrex container to use for the salad dressing, or they will  burn.
     Mix all dressing ingredients rapidly with a fork to emulsify into dressing.
     Divide greens onto four plates.  Sprinkle with diced tomato.  Transfer roasted squash while still warm on top of greens, dividing among the plates.  Pour dressing over squash and greens, and serve.

Please, Mr. Smith, End My Misery, Offer Something

     Carmine and I went out for pizza with a friend two nights ago.  It's nice to be free, I thought, because I know how easily the feds can twist all the facts of my case--they have, in fact, by turning my career into a "case" to begin with--and make my life miserable.  Contemplating this, my life becomes miserable.  Eating pizza helps.
     I wouldn't say I'm miserable twenty-four hours a day, but the suspenseful silence in which I've been held by the federal prosecutors, especially Corey Smith, is not exactly a party for a person with professional aspirations, or for anyone, for that matter, and sometimes, when I get to obsessing about the whole thing my days are pretty heavy-laden.  There must be some people who are gloating about this, including Pat McCullough I suppose, and I wonder:  Why?  What exactly have I done? 
     Mr. Smith, there are other things I want to be doing with my life, and the same must be true for you.  What do you want?  Holding a solo doctor hostage year after year is acting a little like that deranged guy who kept women chained up in his basement--was it in Ohio?  Didn't he end up in jail, taking his own life?  Or maybe it's more like Heathcliff, who locked his wife in the attic of his mansion for a decade or more, his wife being all the unsavory aspects of himself::  his rage, his outspokenness, his passion, his perceived weaknesses, his feminine soul.  That can't be you, can it?  Release her, release me, so we can both live our lives.
     The next phase of my life is to build an autism farm.  There's no way I can do it with this case hanging over my head. 
     "What would you do with your blog, if the prosecutor dropped the charges?" my friend asked.
     "He can't drop the charges."
     "Why not?"
     "He's got to have a good reason for spending all the money he spent on this case."
     "A good reason?"
     "Yeah, he's got to get permission from his boss to drop the case.  And his boss will ask, 'What have you been doing all this time?'"
     "What has he been doing?"
     "I don't know.  Trying to think of some way to justify the raid, and the attack on my character, and whatever investigation they say they're doing, those dozens of agents."
     "But what if he dropped the charges, would you keep writing your blog?"
     "No, I'd write a different blog, about the autism farm."
     "Would you do a victory dance?"
     "No.  A victory dance?  For what?"
     "You know, splash all over your blog how victorious you were?  How bad the prosecutor was?"
     "What a waste of time that would be."
     "Wouldn't you want to let people know?"
     "I've been letting them know all along.  The story would be over."
     "But aren't you angry?"
     "I'm angry at the system.  But someone else is going to have to change it."
     "Don't you blame the prosecutor?"
     "Corey Smith's not bad.  He's just doing his job, but it's not a job I'd want."
     "Why not?"
     "It doesn't allow for the admission of a mistake.  At least, not without losing face.  That's not his fault, it's the fault of the system."
     "Yeah, we have a super-macho judicial system. Everyone in it has to be right."
     "It's ridiculous, and no one is always right.  It's not a human system.  But it's not Corey Smith's fault."
     "Would you admit guilt, in order to get out from under the case?"
     "Of course not!"  I exclaimed.  "Do you work for the government or what?  I'm not guilty of anything."
     "Don't you want to change things?  Fight to change legislation, for example?"
     "Maybe in another life, but not in this one."
     "Why not?"
     "I have other things to do.  I have an autism farm to build."  I looked at Carmine.  "Right, Carmine?"
     "Right, Carmine," Carmine answered.
     "At this rate, I'll never get to it."
     "Let's hope it comes to an end soon," my friend said.  "Three and a half years is a long time."
     "Please, Mr. Smith, end my misery, offer something," I pleaded, looking up at the ceiling as though to an invisible deity.
     Then the pizzas arrived:  one with roasted eggplant, one with Little Neck clams, and one with basil, olives and goat cheese.  Mercifully, we forgot about "the case" and talked about other stuff:  the weather, the restaurant, the practice of law, the practice of medicine, sickness, health, and the future of everyone.  


Monday, January 6, 2014

"Do You Think Marijuana Should Be Legalized?"

     This is a question I was asked a lot when I had my clinic.
     The answer is, yes, I think marijuana should be legalized, not just state by state, but across the country, at the federal level.  I'm not so sure all drugs shouldn't be legalized, and heavily taxed, and the taxes used to pay for rehab centers that offer free services to anyone who walks in and wants to quit.
     I believe in whatever gives us more free choice, and I don't think the government has a right to regulate a drug like marijuana when other drugs, like tobacco and alcohol, are not regulated in the same way.  Giving states jurisdiction over marijuana legalization would be fine, except for the schizoid condition of making a behavior legal at the state level and illegal at the federal.  Moreover, using marijuana as a pretext for incarcerating people is silly and wasteful:  our prisons are filed to capacity with non-criminals.  Prisons function as an industry in this country, with their prime motive being to make profits, and they've become an economic necessity for many towns whose entire citizenry rely on jobs at the local prison for their survival.  If we legalized drugs we'd have to stop jailing people for them, and we'd be forced to close all those prisons.
     I believe in less government, especially when a law hasn't been shown to effect the change it intended, or has had the opposite effect, of increasing the prohibited behavior.  In countries where marijuana is either legal (Holland, Canada, Pakistan, Peru, Argentina, Russia, Jamaica and Uruguay) or has been decriminalized (Switzerland, Belgium, Portugal, Spain, and Bangladesh) there is no evidence that national tolerance for marijuana possession and use has led to increased use.  There is evidence, in fact, to the contrary.
     There's another argument which recalls, for forcefulness, the economic condition of China in the mid-1800s when, according to some estimates, one-third of that country's male population was opium-addicted.   Won't we have a nation of lazy, no-good, non-taxpaying, lollygagging, weed-smoking derelicts on our hands, if marijuana is legalized?  And after marijuana, what?  Should we legalize opium?  Cocaine?  Meth?
     Opium addiction in China was first recognized in the seventeenth century.  After it was prohibited by law in 1729, according to Wikipedia, "there followed two centuries of increasing use."  Tight governmental regulation of any substance doesn't necessarily correlate with reduced use of that substance.
     The United States is the biggest consumer of prescription opioids--morphine and codeine being the most common, substances derived from the poppy plant, from whose seed pod a rubbery paste can be extracted and dried into opium.  Opium is the base ingredient for most pain-killing medicines in the world, including morphine and codeine, which, therefore, are "natural" and "organic" products, though they are standardized in the laboratory.  A variety of synthetic opioids is now available, imitation-opium, products manufactured by pharmaceutical companies and touted for their purity;  these include methadone and fentanyl.
     All of the opioids are extremely addictive, but morphine also happen to be the most effective pain medicine in the world and its availability is essential for physicians if they are to ease suffering in a civilized world.  As a physician, I can confirm that there is nothing like morphine for patients who would otherwise be in agony.  It has been an essential tool and, in the physician's armamentarium, the main means of exercising compassion, probably going as far back as 4000 BC.  Poppy seed capsules have been found in neolithic burial sites like the "Bat Cave" in Spain, and evidence of poppy cultivation has been found among ancient Sumerian ruins from Mesopotamia (3400 BC) as well as in Babylonian and Ancient Egyptian settlements.  
     These substances have been around for all of recorded human history.  Most of us can regulate ourselves so that we aren't victimized by the substances we use, and don't use substances we don't need.  But if we do fall into addiction, we need government-supported help.  We need fewer police, fewer laws, fewer jails, fewer costumed role-players in SWAT gear, and more assistance where it really matters.  Managing addiction is like managing a pack of devils;  the more allies you have, the more likely you are to prevail.
     But the American government has been like one more devil, when it comes to drug issues.  It's not an ally in the "war on drugs."  Detoxification and rehabilitation centers are too few and too expensive.  One of the biggest problems I experienced as a physician was finding help in the community for addicts.  AA, NA and the emergency room provide minimal assistance for people who say they're ready to confront an addiction problem.  The local inpatient facilities are often full to overflowing, whenever doctors call them. Most of the time they wouldn't even consider taking my patients because the patients didn't have insurance.
      The best way to control drug trafficking is to reduce the number of drug users.  Therefore, we need to address socioeconomic factors that make addiction in some sectors of our population more likely than in others, and we have to get rid of the stigma associated with addiction.  Much of the money our government spends on apprehending people for marijuana possession and drug use is wasted, because addiction and rehabilitation aren't addressed in prison.  Ninety percent of those who are incarcerated for drugs come out of jail no better--they're worse, in fact, because they have prison records and can't get jobs--so they return to their old lifestyles.
     Yes, I'm in favor of legalizing marijuana, maybe even all "drugs of abuse."  People must be given the opportunity to choose how they live, so long as they don't harm others, without an overbearing, finger-wagging, gun-toting government to contend with when they're at the bottom of their game.  

Sunday, January 5, 2014

Call for Help

     The next phase in the formal defense of my case is for my lawyers to request a hearing in front of a judge, during which we will use legal arguments (not arguments about the facts of the case, or the substance of the allegations) to persuade the judge to drop some or all of the civil charges.
     I need to find doctors, employees and patients who might be willing to say that the way I practiced medicine was an example of good medicine;  to say that basic testing, done to investigate symptoms or physical findings, is a good thing, a strategy for identifying diseases early, one that saves money in the long run, a way of putting preventive medicine into practice.  The government has no right (revised False Claims Act or not) to interfere in the doctor-patient relationship nor to decide whether or not a test was "necessary" or not.  Doing tests based on reported symptoms, or a doctor's educated, inferred judgments about the possibility disease in a patient is not fraud.
     I need employees who will say they stood by this philosophy of practice and felt good about it, that they were able to sleep at night knowing that if one of our patients had a serious disease, lurking beneath apparently benign symptoms, we weren't going to miss it;  employees who will say they liked being thorough and wanted a doctor who would, when they were sick, in pain or worried, do the same for them.  Employees who told other people about the practice and referred their family members when their doctors were stymied by complaints or unwilling to "do something" to allay patients' fears.
     Where will I find doctors who want to get anywhere close to my case, knowing the federal government is standing over me with a club?  Proximity means danger, in their eyes.  Maybe they tell themselves that if the government is after me I must have done something wrong.  A comforting rationalization, for now.
     Some of my most loyal employees have declined to come to my defense because they're afraid the feds will--as retribution, as payback, pretending it's all coincidental and entirely innocent--audit the last seven years of their tax returns, question their receipts, push them into corners, frighten and embarrass them, hold more sticks over their heads.  So imagine how practicing doctors might feel, solo doctors who need to work to pay their bills, who don't want interference.  If they spoke up, they would be right to expect the feds to come after them next.  Most of these doctors have already fielded audits,  accepted non-payment for their work, been the butts of insinuations, and they've gone through it uncomplainingly, because they want to stay out of the limelight.  Why enter my limelight?
     "I care about you and think it's a crime what they're doing," these people say, "but I don't want to get involved.  I just don't want to be involved."
     "Right," I answer.
     "You see what they're doing to you," they go on.
     "Yeah, I see."
     "Sorry," they say, patting my back.  "Good luck."
    There are lots of patients who benefited greatly by the early-diagnosis approach I took, and therefore would be willing to come forward.  Most of them have nothing to lose.  I'm sure they'll step up and say,  "She helped me with those tests, with the time she took."  I'm very grateful for their repeated exhortations that I call them "for anything, whatever you need," throughout this ordeal.  But will their statements alone move the judge, or make the prosecutors get out of the way?

Saturday, January 4, 2014

How To Find Out if You're Being Bugged

     Eavesdropping devices are illegal in the United States but that doesn't stop people from using them.  And when it comes to the FBI, nothing, it seems, is above the law.
     "I think you're being  bugged," my friends tell me, especially when they hear a click on the phone line.  Some of them won't say anything important except in the back yard.  They speak in hushed voices, sometimes taking a drag on a cigarette, flicking their ashes on the damp grass.  They think being under investigation by the government is enough to warrant their suspicion that my house is full of bugs and wiretaps.  Though they don't have "important" secrets to impart, they want even the fact of their moral support to be kept secret.
     It helps to be a good housekeeper when searching for bugs.  I used to hire a professional cleaning service for the clinic and my house, but since February when I stopped practicing medicine I've had plenty of time to clean, I know every cranny of the house, and I don't need a cleaning person.  Lately I've been washing all the curtains  and there aren't any bugs attached to the curtain rods.   I've checked the books in my library, and behind furniture, and under waste cans, even the blown-glass dragon hanging over the fireplace.
     Bugs are tiny recording devices, no bigger than a zip drive.  They are either wired or wireless, and can be hidden in flower pots, on door ledges, behind bookcases.  If they're in your house and you look for them, you'll find them.  If they're wired you can search for extra wires attached to your modem or plugs in the wall behind your bed or in other hidden spots.
     Wiretaps are hooked into the phone line.  It's a little more work to set up a phone bug, involving splicing of telephone lines or hooking a little device into the phone splitter.  If you suspect a bug, take apart your phone and look for spliced wires or clips.  An easier way for someone to tap into what's being said in the house is to position a specialized cell phone in a room.  When a call is made the phone doesn't ring, but the person at the other end can hear anything being said within range of the microphone.
     But the FBI doesn't need this crude apparatus.  As recent National Security Investigation leakers have revealed, "no digital communication in America is secure."  Looking for wiretaps in my house is useless;  the government has access to every word in my phone conversations, and yours, and all our emails.  Obama believes that the government should have the right to "unregulated spying on its citizens." ( See this link, for more:  Government surveillance.)
     Video cameras have lenses that can be as tiny as bee-bees and are most effectively hidden in clock radios, stuffed animals, smoke detectors or attached to books.  It takes a real sleuth to find these, because you have to look for a reflection in the lens.  They need batteries, but can piggyback off the batteries in other devices.  If you see batteries--especially 9 volts--being used any place you didn't put them in your house, you should assume they're attached to eavesdropping devices.  But someone's got to put them there.  The FBI hasn't visited my house, so if there are video bugs they had to have been implanted by one of my "friends."
     The best way to avoid wiretapping is never to say anything.  The best way to sidestep video cameras is to have everyone who visits you wear a ski mask.  I keep a basket of ski masks next to my front door, in case you want to visit.    

Friday, January 3, 2014

If the Feds Are Reading My Blog...

     "Please, please, please erase that post about how to get rich quick," my billing clerk entreated me a year and a half ago, "and stop writing that blog!"
     "Should I stop writing in my blog?" I asked one of my lawyers.
     "Probably," he said.
     "Because everything you write will be treated as evidence."
     "So what?"
     "It's like giving a deposition, only the prosecutors don't even have to ask questions."
     "Good," I said.  "The feds can treat it like free discovery."
     Discovery, in its legal definition, refers to the process by which opposing parties in a lawsuit seek to obtain adverse information about the other party, information that can advance their own cause.  In the case of the feds, they'd be scouring my blog for an admission from me that I committed a crime, that I knowingly deceived Medicare in order to "make millions."
     "If the feds are reading your blog, who knows what they'll make of it," the lawyer went on.
     "There isn't anything in my blog, or in my life, to attack."
     "Nevertheless, you don't want to tell them anything you don't have to tell them," the lawyer went on.
     "Don't I?  You lawyers put gags on clients like me before we're even forced to sign gag clauses."
     "I'm just trying to protect you."
     "But what if I didn't do anything wrong?"
     "It doesn't matter," he said.  "They'll find something."
     "What if there isn't anything?"
     "They'll invent something."
     "That's absurd!"
     "I've seen it happen."
     "But--what about the truth?"
     He laughed, not heartily, nor with exasperation, but as though my assumption that truth should figure here or anywhere, was pure naiveté.
     "How can they find something if it isn't there?"
     "You'd be surprised how they'll twist what you write, making it say the exact opposite of what you meant."
     "That's insane."
     "Don't forget," he reminded me, "I used to be a government prosecutor."
     Was he proud, or ashamed?  Had he twisted the truth, in his prosecutorial days, to give the government even more of an edge?  Many defense lawyers used to be prosecutors.  They say it's where they got their training wheels.  Then they ride to "the other side," defending people like me.  They say the experience has given them insight into how prosecutorial minds work.
     What they learn is how to mollify prosecutors, because there isn't much "law" on the side of the defendant.  Mollifying prosecutors requires money.  The defendant, scared out of his or her wits by having been ensnared in federal judicial nets, whether or not a crime might be implicated, wants to be untangled as soon as possible.  Disentanglement is accomplished by paying a settlement fee.
     The settlement fee is an informal tax, the same kind that powerful people have extorted from the weak throughout human history.  It's what you pay to stop a bully from bullying.  It's the big guy telling you he'll beat you up if you don't turn over your peanut butter and jelly sandwich in second grade.  Can I afford to be beaten up?  Is my peanut butter jelly sandwich big enough?  Is the bully going grab it from me anyway, after he beats me up?
     We haven't graduated far past feudal solutions to the problem of the bully.  The peasants were indentured servants who turned over their grain to the lords, cheese makers sent their their milk to fiefdom stewards, shoemakers gave the prosecutors--I mean, the feudal lords--their shoes, their pots and pans, their meat, their eggs, their firewood, all on demand.  The second-grader gives up his sandwich, the poor little guy shouting, "Mercy!" when he can't stand the pain of having his arm twisted to the breaking-point.
     "Mercy!" I want to shout.  "Take my wallet, take my house, take anything but my children!  Just leave me alone!"  But it rankles, it's wrong.  No, no, no!--I think.  I won't shout mercy.
     The American Revolution was about standing up to bullies, not paying those absurd taxes, not believing in the nobility of the ruling class, not cowering when the big guys made their threats.  We Americans demanded justice back then, and we finally exacted our freedom from that bloated British government.  What's happened to us?  Have we turned into a country of wusses?
     The problem with bullies and land stewards and the lords of fiefdoms and the British monarchy in 1775 and our American federal prosecutors today, is that they all believe, religion or not, in their "divine right" to steal what isn't theirs.  If we don't stand up to them, they'll keep coming back.
      Here they come again.  They're hovering over me, they're twisting my arm, they're positioned to steal more stuff.  "Say mercy," they're growling.  "Say it, say it!"  They're punching me where it most hurts, they're ripping open my backpack, scattering my books and blog pages, seizing my tofu sandwich, they're going to take, take, take, and if I don't resist I'll never get to eat my own lunch again.
     "Should I stop writing in my blog?"  I asked my second lawyer.
     "I can't keep you from doing it," he answered.
     "Yeah, free speech and all that."
     "It's up to you."
     "But what would you do?"
     "I wouldn't write it."
     He paused, and I thought in the pause there was a kind of blessing.  His hands have bent tied--he's said this many times.  Maybe I'll do something on the back end, maybe not.
     "It's your decision.  You have the right to say whatever you want.  Just make sure it's the truth."
     "I will," I said.
     "And be careful," he added, looking around the conference room, and it occurred to me he might be scanning the place for electronic bugs.  "Be careful."

Thursday, January 2, 2014

A Dream of Two Eggs

     I dreamed that Crooked-Neck, my hen with a twisted cervical spine, being half the size of her age-mates, requiring special care and protection from the other hens, who is infertile, or at least so far has not produced a single egg in nine months, who may, in fact, not be a hen at all, instead a rooster--but because of the necessity of dragging her head across the ground to perambulate the free-range yard, has eroded all telltale remnants of rooster comb from her crown--laid two eggs, as I watched in amazement.
     That's the dream.  A chicken laid an egg, in the simplest retelling.  But the details are as important to a dream as flesh is to a skeleton, and so are the current affairs of my, the dreamer's, life.
     Here's the simple interpretation.  What I don't like about myself and my world, and what I regard as distorted, is exactly what will deliver to me twin gifts containing the potential for developing for myself a new life, which may be bipartite, of two natures.  Or, the crooked neck is a representation of a twisted connection between head and heart which, if it succeeds in maintaining that connection, will be my deliverance, yielding big possibilities for future life.   What the feds are doing to me, and how I am reacting to it, happen to be the laboratory where inner change, in the form of a new attitude or a new career, is taking place.  I didn't think this could happen, as I have been feeling null and infertile, but my unconscious tells me otherwise, because it's not one of my fertile chickens who lays the eggs, but the infertile, devalued, disregarded one, the one most chicken-owners would have slaughtered by now.
     Most readers of this blog know the salient conditions of my life, which are that I have been under subversive attack by the government, via FBI agents and federal and civil criminal prosecutors, for three an a half years, that my solo medical clinic was raided at gunpoint by a multitude of FBI agents two and a half years ago, that my bank accounts were frozen, and that there has come to light nothing of substance in the way of charges against me nor any evidence to buttress a case for criminality.  Other conditions include the exigency that one of my four grown sons, Carmine, lives at home and has autism of such a disabling nature that he will require special care and protection for the rest of his life, and that this responsibility has fallen entirely on me.  Also, I closed my medical clinic eleven months ago and have ceased caring for patients after twenty uneventful (except for the raid) and satisfying years, and would be living, if it weren't for mysterious reservoirs of spiritual sustenance I didn't know I had, in a state of panic and outrage against the government every moment of every day.
     There are eight elements to this seemingly simple dream:  1) the ego-observer;  2) the chicken;  3) the eggs;  4) the number two;  5) the peculiar neck problem of the chicken;  6) the chicken's presumed infertility;  7)  the process of eggs being laid;  8)  the process of watching eggs being laid.  Volumes could be written about each of these, but I'll try to keep the symbolism simple.
     1)  The ego observer is me, or more precisely, my consciousness.  It correlates with my waking self, at least when I'm not daydreaming or in a trance.  The dream indicates that the aspect of myself with which I most identify is being shown something that it needs to know, it's getting a glimpse at an unconscious process which may have correlates in the material world.
     2)  What is it about the chicken that sets it apart from other creatures?  This is important, because my unconscious chose a chicken, not another bird or animal, to deliver its message.  Chickens are birds that cannot fly;  they are truly "other," not like us at all, yet domesticated to such a degree that their wildness is not so apparent.  We regard them as commodities, like cars and factories;  they do things for us, laying eggs and becoming meat.  The word "chicken" is used to mean coward, because chickens have sensitive nervous systems and are skittish, running at the least disturbance.  Chickens have so infiltrated our world that our language is full of chicken associations:  nest egg, scratching out a living, putting all your eggs in one basket, feathering your nest, flying the coop, ruffling your feathers, getting egg on your face, being stuck in your craw, henpecked, a cute chick.  Animals in general stand for subhuman instincts;  the presence of an animal in a dream signifies incorporation of unconscious elements into waking life.
     3)  The egg is a beautiful and regenerative thing.  It contains a whole life in the embryonic phase.  It represents possibilities, including new beginnings, with all the sustenance required to bring those possibilities to fruition, at least as far as manifesting in the world, and it protects those possibilities from outside damage with a hard shell, so hard that it is said the egg can't be broken if you squeeze it at its poles, even if you have a muscle-amplified vice-grip.  In traditions throughout human history the egg has been a symbol for immortality, for resurrection, and is sometimes depicted as the sun everlastingly coming over the horizon.  It is also the womb, a place of quietude but, as well, a claustrophobic enclosure from which the hatchling seeks to break out.  The egg in alchemy is the seed of new life, the object of transmutation, and the symbol of fruitfulness.
     4)  The number two represents duality.  When the wholeness of one is divided, there is separation, difference, opposition, balance or conflict,  God divided the first wholeness into earth and sky, and out of those developed, through further division, the entire world.  But two can also signify emphasis--it happened not once, but twice, as in twice as significant, twice as important.  Don't ignore this, my unconscious says, it wasn't a coincidence, or it wouldn't have happened twice.  This second way of looking at the number two in a dream is more likely to be correct in my dream, since the two eggs weren't different.  If one had been dark and one light, or one had been big and the other small, or if the two eggs had in any other way been opposites, then the dual nature of two would apply.  Instead, one egg came after another, like two raps on the door, or a series of exclamations, "Yes, yes," or two fish leaping out of the ocean one after another, to emphasize that the first one wasn't imaginary.
     5)  The chicken isn't normal;  it's different, disabled.  Its disability is a twisted neck, allowing it to see behind itself, and to see things differently.  There is a degree of suffering that goes along with this, especially heckling by other chickens and getting dirt in its face and eye.
     6)  The chicken's neurologic problem is rare and thought to be associated with infertility--but this chicken is not infertile, after all.  Infertility is a version of death, at least of the gene line.  Fertility is a symbol of regeneration, like the egg.
     7)  Like most beautiful processes, laying an egg looks easy but requires a lot of internal work.  It takes 1/3 to 1/2 cup of dry grains and beans, and one or more cups of water to produce a single egg.  The conversion of these inert-appearing raw materials into an egg is the miracle of birth.  Egg-laying is about bringing something new and nutritive into the world.
     8)  Watching an egg being laid is being given a window into a deep process of transformation.  It confers the same sense of wonder as catching sight on one's evening stroll of a wild animal, or seeing a falling star, or the ocean, or the human heart beating in a man's wide-open chest.
     So do I make of this dream?
     An unconscious aspect of me, best represented by a chicken--thought to be crippled and sterile but with an unusual, "twisted" perspective on the world--delivers to my conscious self, information of a dual nature which is in its incipient phase, having yet to be either hatched into life or taken assimilated as nutrition, the egg.  There is something about the dualism of my battle with the feds which contains a possibility for new life.  This possibility is a kind of "resurrection,"emerging not from qualities valued by the world (Crooked-Neck would have ended up in most people's stewpot) but precisely from what is devalued.
     I am in a devalued position, currently.  My reputation as a physician has been slandered, my means of earning a living, crippled.  Like Crooked-Neck I have been made to see the world in a backwards way, with dirt messing up my vision and considerable vulnerability to attacks by other "chickens"--i.e., other doctors, who either assume I am a criminal or are too chicken to come forth.  In a parallel way, and less consciously, I have perhaps been allied with my attackers, the feds, in that Stockholm Syndrome way, assuming that because the ones with the most power determine whether I live or die, at least as a doctor, they must be good and right.
     Out of this altered, devalued, disabled way of being, which characterizes my life at this time, comes two eggs, new perceptions, new life, perhaps twins--a duality, a resurrection--but more likely an emphatic declaration of something new being brought into my world.  It was a basic tenet of the alchemists, whose work influenced Jung, that from that-which-is-devalued comes that-which-will-save a person, or the world.  Christ is one of many such symbols, as is the sun, emerging out of darkness, and the dung-beetle, which lays its egg in a ball of dung.  The twin eggs remind might suggest yin and yang, heaven and earth, positive and negative poles, darkness and light, a capacity for discernment, but more likely were laid by the hen to reinforce a message I might not get the first time.  What I am being made to know is not in the spirit realm (chickens can't fly) but of an earthy nature, and so is what will make things right for me, at least in my inner world.  The eggs, to mature and hatch, need to be nurtured, sat on, kept warm.  Therefore, I will keep this dream in my memory-bank and visit it every day, finding ways to nurture whatever new perceptions I have about my impossible-looking situation with the feds.  It seemed impossible that a genetically impaired crooked-necked chicken could lay an egg, and it is similarly incredible that a real, live chicken should emerge from an ordinary egg,
     Sometimes we can't do much about our outer worlds.  At such times change has to take place in our inner ones.  The psyche, when it sends dreams, seems not to care much about the outer circumstances of our lives, but psychoanalysts regard all dreams as mirrors of inner, unconscious processes.  If I can change my attitude toward myself, assuming, because of this dream, that regeneration within my personality and in my life is taking place, either the circumstances surrounding this federal investigation and the fear it is trying to ignite will change, or it simply won't matter any more because I will have hatched something new.