Wednesday, April 3, 2013

Morning Reading -- April 3

My "Morning Reading" blog post experiment appears to be working, at least for me. I'm sure my Facebook timeline looks less cluttered and pedantic to my FB contacts, and yesterday's post received about seventy or more hits according to Google. There is no way to discover how many people look at a Facebook entry so getting any number is more rewarding than getting none at all.  The statistics exist, of course, and are used by Facebook for any number of projects, most of which have to do with tweaking the brand, improving the revenue stream and advancing whatever nefarious agendas Zuckerberg and company has in mind. 

Visitors should know that these notes are published piecemeal. There will be one or two paragraphs or links when first published, but as the morning progresses more content will be added til I get tired.  Checking yesterday's notes is an example -- there are seven separate sections in no particular order.

Thus far the only "comments" here have been my own. Sometimes I'm too lazy to open the edit screen to put something into the post or add a follow-up, so comments are an easy way out.  Readers and visitors are urged to leave feedback and I'll try not to be defensive in my responses.


Eyeless in Gaza: When will Israel let its People Go?
Juan Cole posts another plea for sanity in the Middle East.
Israeli war planes struck the Palestinian Gaza Strip on Tuesday. Israel has roughly 7.5 million people, Gaza roughly 1.7 million. Israel bombed and destroyed Gaza’s only airport and refuses to let Gaza port operate. It still places severe restrictions on Gaza imports, and lets Palestinians there export almost nothing of what they make. Nearly half of Gaza families were forced out of what became southern Israel by militant Jewish nationalists, and many still live in refugee camps. They could walk home in an hour if allowed to. Instead they are kept in a huge open-air cage. 
Gaza’s population is roughly that of Houston, where 217 people were murdered last year. Gaza’s Palestinians are far, far less violent. A few young militants send tiny home made rockets (not katyushas) over the border and almost never hit anything. (Occasionally they smuggle in a real rocket; but those don’t typically hit much either.) The Israelis justify their air strikes and other actions with reference to what they call terrorism but Palestinians call resistance. Israel offers the Palestinians nothing for making peace, and even punishes the suckers who sometimes negotiate. 
The Israelis have 400 nuclear warheads, a fleet of F16s, and the best military in the region. Palestinians in Gaza have virtually nothing. 
The other big news from Palestine is hunger strikes among Palestinian prisoners in Israeli jails. It is a good symbol for the situation. The Israelis have kidnapped and jailed the Palestinian population. Palestinian politics and activism is one big prison riot 
What Israeli authorities seem unable to understand is that the Palestinians will never disappear and will never get used to their prison. The F-16 air strikes on a pitifully weak people (often directed at the gulag of Palestinian refugee camps) may make some Israeli officers feel macho. But they just fuel more violence, and aren’t a policy. 
It is true that their captivity to Israel and the poverty imposed on them (they are less well off now than in the 90s) has allowed Muslim fundamentalist HAMAS to come to power there. Desperation does not produce moderation.
Illustrating the point, he continues with belligerent remarks from Ismail Haniya, current Hamas leader, from last Friday, the day when sermons fan the flames of political heat. And he concludes by saying "I don’t care for Hamas or Haniya, but they are a product of an unjust policy. The Palestinian prison riots will end when the captivity of the Palestinian people ends."

Readers need to know that Israel's maltreatment of Palestinians in general and the Gaza population in particular is a broken record with me. I may be just an old guy blogging in retirement but something in me keeps alive the need to peck away at causes that may not be resolved in my lifetime. But I have lived long enough to see many developments I never expected, but I realize that I will die with many more left unfinished.

North Korea Blocks Southern Workers From Crossing the Border
This is a big story which broke last night. I'm only noting this for the record but nothing I comment here will have any meaning. I learned on NPR this morning that this kind of thing happened in 2009 and was over in three days, so it is not without precedent. It looks like the embarrassing equivalent of a kid holding his breath and turning blue, refusing to eat or cooperate until he gets his way.
Every day hundreds of South Korean workers make their way across a special border crossing to workat a North Korean industrial complex that is jointly run by both nations. But not today. Authorities in the North have shut down the crossing and blocked Southerners from entering, taking their ongoing feud from the level of idle threats to very real action. 
The Kaesong Industrial Complex sits on the North side of the border and is pretty much the only legitimate avenue of partnership between the two nations. Yet, because they've recently made it their mission to antagonize the South at every turn, this move is one of few they have (short of actual war) that can actually hurt their neighbors economically. (But not as much as it hurts the North.) 
Authorities in Pyongyang have shut down the complex before, temporarily preventing some South Korean workers from returning home back in 2009. That standoff lasted less than a week, before operations resumed as normal. The park, which opened in 2004, was financed and built by South Korean businesses (the South even provides the electricity) and in return, gives those firms access to more than 40,000 North Korean workers. It's just a few miles north of the Demilitarized Zone and is connected to the South by special rail and road access.

There were fears that a similar "kidnapping" situation might develop this time, but workers are reportedly being allowed to go home. They're replacements just can't get in. Some companies are keeping their workers there voluntarily to prevent the businesses from shutting down completely.

After nearly a month of back-and-forth statements and various shows of force, the last couple of days have seen a serious increase in tensions on the Korean Peninsula, as the North has moved from mere words to behavior of real concern. On Tuesday, they announced that they would be restarting their mothballed nuclear reactor with the express purpose of making more plutonium fuel for nuclear weapons. That prompted Secretary of State John Kerry to hold a joint press conference with his South Korean counterpart in Washington to state that "the United States will do what is necessary to defend ourselves and defend our allies, Korea and Japan."

I just came across a well-done book review in the NY Times pointed out by Abbas Raza's gifted sister Azra at 3Quarks Daily.  Read these last three paragraphs and see if you don't agree that they are some of the best prose you have seen lately.
Still, the democratic examination room is a delightfully seductive fantasy. Even writers of medical fiction don’t venture that far. Like Dr. Louise Aronson in “A History of the Present Illness,” they generally stay so firmly grounded in grim reality that their fiction reads like memoir by another name. 
Dr. Aronson, a geriatrician in San Francisco, joins the ranks of those immortalizing the small, realistic details of modern medical care. She offers up the requisite coming-of-age tales of studenthood, residency and disillusioned midcareer, but is at her best in the world of the much too old — the rooms where dyed hair grows out platinum white and small bodies lie in bed “the way a letter lies in its envelope.” 
Dr. Aronson writes lovely, nuanced description; if her dialogue is occasionally a little stiff and some of her plots stretch the bounds of plausibility, it is still worth staying with her: no revolution in sight, just keen, calm observation, punctuated by sighs.

Happy Easter, Beheaded-Style!
==►Brace yourself, reader, for a case of whiplash from this short post and the link that follows from Brown Pundit.

I don’t have a lot of detailed knowledge about Latin America, but it seems weird to me that the mainstream press in the West continues to focus on AfPak when this is going on right next door! (And, I am not trying to minimize or excuse AfPak violence–these Taliban types are scum.) American “progressives” seem uncomfortable calling “illegal immigrants” by that name–LOL–as a legal immigrant who became a naturalized US citizen I would tend to call them far worse–like, “invaders.” When did the concept of a nation getting invaded go out of style? I guess I missed that by not taking enough humanities classes! I don’t feel particularly “culturally enriched” when I pass by illegal-immigrant heavy neighborhoods–more like harassed and threatened. More Wodehouse, fewer illegals, please! (This would ideally involve limiting Pakistani immigration to the US-I am seeing too many of the sorts I wanted to leave behind wash up on US shores.)
There at the end is a link to Borderland Beat, "Reporting on the Mexican Cartel Drug War." 
It's not even "hot." In order to go to the link it's necessary to copy and paste it into your browser url field.
Maybe this is the writer's way of warning you about graphic content.

Easter Week Ends With 72 Deaths In Four Days
Photos (some grizzly) and fuller descriptions at the link. 
Since the past “Holy Thursday” until the evening of Easter Sunday, at least 72 people were killed in different parts of the country, according to a new overall count of deaths in violent acts by Aristegui Noticias.

Despite the thousands of people who vacationed in tourist zones in the country and the vacation of millions of Mexicans during this season, organized crime did not cede, and the spiral of violence continued.

Most executions occurred in the state of Sinaloa, with at least 16 deaths, followed by Chihuahua with 14, Morelos with 7, Durango with 6, The State of Mexico with 5, and both Guerrero and Jalisco with 4. 
Among the violent events in the country, the one that stands out was the murder of seven people in a bar in Chihuahua on “Holy Thursday”.

This is a comprehensive picture of the various crimes, reported by various local and national media, who are credited and linked to at the end of this article.

Overall, this is an overview of the violent deaths that occurred in various states, since last Thursday leading up to Sunday:

  • Sinaloa = 16
  • Chihuahua = 14
  • Morelos = 7
  • Durango = 6
  • Estado de México = 5 
  • Jalisco = 4 
  • Guerrero = 4 
  • Nuevo León = 3 
  • Michoacán = 3 
  • Tijuana = 3 
  • San Luis Potosí = 1 
  • Quintana Roo = 1 
  • Guanajuato = 1 
  • Sonora = 1 
  • Tabasco = 1 
  • Coahuila = 1 
  • DF = 1

A Doctor Confides, “My Primary Doc is a Nurse”

Okay, this is another important post by Maggie Mahar.
No, I haven't read it yet in detail -- only scanned for the general message. But this is recommended reading for anyone following the subject of healthcare reform.
Maggie Mahar is the author of Money-Driven Medicine which made me a fan and believer several years ago. She is not someone of few words. I put this into a Word document and found it runs to nearly three and  a half thousand words. But she leaves nothing to chance and what she says you may take to the bank. 

Regarding the subject, I am totally in favor of advancing the cause of nurse practicioners as primary care "physicians." I know doctors get paneezinawad over terms like doctor and physician, but that's secondary to the point. If the out of countrol costs of health care in America are to get under control, and especially since great swaths of our population never go to a doctor until facing a medical emergency, a growing role for nurse practitioners strikes me as a no-brainer. 
Last week I interviewed a doctor who told me that his primary care doc is a “physician’s assistant” –a nurse who has been trained to deliver primary care. He said it casually, dropping the fact into a long conversation. 
Dr. David Kauff is an internist at Seattle’s Group Health Cooperative (GHC), an organization that has a fabulous reputation–both among patients and among physicians—for its primary care program. One reason is that at Group Health, doctors, physicians’ assistants and nurse practitioners work together in teams. “The success of our model is based on the fact that everyone in this together; we are corralled by a common purpose,” says Kauff, who also serves as GHC’s Medical Director for Practice and Leadership.

I’ll be writing more about Group Health Cooperative in a few days. 
In this post, I would like to focus on the growing role of Nurse Practitioners (NP’s) and Physician’s Assistants (PA’s) as clinicians. NPS are registered nurses who have gone on to earn a master’s or a doctorate. Some specialize in areas such as anesthesiology, pediatrics (pediatric nurses) or Ob-Gyn (certified nurse-midwives). NP’s can run clinics; some run their own practices.

By contrast, physicians’ assistants (PA’s) don’t work alone. But they, too, are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. They take medical histories, examine and treat patients, order and interpret laboratory tests and X- rays, make diagnoses and treat minor injuries. 
Currently, 17 states, plus the District of Columbia, let nurse practitioners operate independently. In 33 states regulations vary. As this map reveals, in some places NPs are not allowed to prescribe medication. In others, they may have to consult with a physician when treating patients. 
It’s worth noting that NPs enjoy greater freedom in the Northwest, the Upper Middle West, and Northern New England (areas that some healthcare reformers refer to as “Canada South” because these states are in the vanguard of reform) as well as in the Southwest, where many NP’s started working in group practices, and they went out and established their own clinics. Nationwide, about 6,000 nurses operate independent primary-care practices.

Muppets Co-Creator Jane Henson Has Died
Jane Henson, the woman who helped create and bring the Muppets to the world stage and carried those furry puppets through history, died in her Connecticut home on Tuesday after a battle with cancer. She was 78.

I know nothing about Sherief Gaber but his Twitter followers include half a dozen people I follow.
This is what I found from a search.
I have been an avid observer of events in Egypt for the last two years.
Sherief Gaber is a twenty six year old graduate student at the University of Texas studying law and urban planning. He grew up in Memphis and went to college in Saint Louis. His parents came to America from Egypt shortly before he was born.
Growing up, Sherief visited Egypt many times, going to see his family and friends who live there. After college, Sherief decided to move to Egypt for a while. He studied in Egypt for a year and a half, before coming to Texas, where he has lived for the last five years.
Recently, Sherief Gaber returned to Egypt to witness and take part in the protests and demonstrations going on there. He stayed with friends and family for two and a half weeks. Sherief was also featured in an ABC newscast that followed his story in Egypt.
Sherief is Egyptian-American, which accounts for his dark skin. He has brown eyes and black hair, and is tall.

1 comment:

  1. Great snip from Maggie Mahar's post...

    "Doctors say that they are worried about patient safety. “I see it as physicians being true to their oath “ Dr. Adris Hoven, president-elect of the American Medical Association recently told Marketplace Health Care’s Dan Gorenstein. Hoven insists that doctors are “not threatened” by NPs. “At the end of the day what they want to do is deliver the best healthcare possible.”

    Dr. John Rowe, a professor of Health Policy and Management at Columbia’s School of Public Health, doesn’t buy the argument. As he points out, nurse practitioners are already working without primary care doctors: “The fact is this is going on in 16-17 states,” he told Gorenstein, “and there is no evidence that it’s not good for the patient.” A recent Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation backs him up: “studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar.”

    At the same time, Rowe understands why doctors are uncomfortable. “The physicians feel they have something special to offer,” he explains. “And being told there are individuals who are less well trained can do it as well as they could is a very difficult lesson for them.”

    When I last wrote about nurse practitioners, back in 2010, one physician/reader (“Sharon M.D.”) was exceptionally candid on this point:

    “I think there’s enough work for all of us in primary care,” she wrote,” and I think NPs and PAs are vital to meeting the demand.” But, she added: “I do find myself pushing back against the idea that an NP is as qualified as I am to care for patients, but that mostly comes from me wondering why I went through 4 years of medical school and 3 grueling years of residency if I’m no better at my job than someone with far fewer training hours. But it doesn’t come from any reasoned perspective: it’s mostly jealousy for all those years lost. . . . and all that debt yet to be repaid!"

    Here's the link to the Sharon, MD comment: