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Flies in your Eyes is a dynamic source of uncommon commentary and common sense, designed to open your eyes and stimulate your thinking.

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Sunday, October 19, 2014

Is There a Doctor in the House?

Southeast Asia - photo by JoAnn Sturman

Scott Sturman

CDC Director Dr. Tom Frieden's vexing interview with Megyn Kelly demonstrates how an intelligent man can sound foolish when he becomes more politician than physician.  Historically, the prudent manner to deal with fatal communicable diseases where appropriate therapies are lacking has been quarantine.  As the medical community gains greater understanding of effective therapies, the extent of the quarantine is adjusted.  The handling of the issue has been so incoherent that even the main stream media and CNN have joined the chorus of more sensible people who prefer to combat the disease at its source rather than in the United States.

Ironically, it wasn't the AMA or other medical organizations which exposed the breach, but the Leftest press which embarrassed the Obama Administration to deign to address the fiasco by naming an Ebola Czar.  A wise choice would have been to appoint an independent epidemiologist, who by training is best suited to investigate diseases and coordinate treatment.

Ebola is no less a medical problem than a patient with a coronary artery occlusion or a ruptured colon. It would be ludicrous to suppose anyone other than a cardiologist or surgeon should treat these problems.  What about a situation when a powerful politician is suspected of malfeasance and a special prosecutor is warranted? Would the public be best served if anyone other than an attorney handled the investigation?  Yet if there is any question whether Mr. Obama sees Ebola as a medical or a political problem, the appointment of a lawyer and consummate political hack to spearhead the response answers the question.

Bandido Brewery

Bandido Business Card

Scott Sturman

Our guide Freddy had a hard time finding Quito’s Bandido Brewery and arrived very late to help us celebrate climbing, or in some of our cases, attempting to climb Cayambe, Cotopaxi, and Chimborazo.

“People used to get killed in this part of town.  Before the economy improved and the government got serious about protecting tourists around the Old Town, their were a lot of knives stuck in the wrong places,” Freddy informed us.  “Now it’s not so bad since there is a police station a block away.” 

 Dan Tending Bandido's Bar

We had taken a taxi to the Bandido this time around, but when we visited the first time two weeks ago we walked from our hotel through the Old Town.  It was filled with tourists and the narrow streets separating the classic Spanish buildings didn’t seem particularly dangerous.

A few months ago we had heard about the Bandido Brewery from our climbing partner, Steve, who discovered its whereabouts quite by accident at the REI store in Portland.

“I’m going climbing in Ecuador and need a new backpack,” Steve informed the clerk.

“You’re not going to be in Quito by any chance?” the clerk replied.

“Why, yes, I am.  I’ll be there for a couple of days before and after climbing, and probably for sometime during the acclimatization process.”

“Well, if that’s the case, you should drop by the Bandido Brewery.  My friend Dan and some of his old college friends went to Quito a few years ago to run a youth hostel.  It didn’t work out, so rather than come back to Oregon, so a year ago they started a micro brewery in Ecuador from scratch.”

When my wife JoAnn, our friend Rick, and I met Steve in Quito this past May, he insisted that before we spent the next two weeks climbing volcanoes we visit the Bandido Brewery near Quito’s Old Town district, a UNESCO World Heritage Site that is Latin America’s best preserved historic center.  With map in hand and some roundabout searching, we found the brewery tucked away on Calle Olmedo just east of Old Town.

Quito - photo by JoAnn Sturman

The beer industry in Ecuador is dominated by Pilsener Beer, a light lager sold in large volumes.  It’s a mild, not unpleasant tasting brew meant to be drunk in large quantities.  The company has a virtual monopoly on all levels of the production process to such an extent that it is difficult for competitors to even buy bottles to bottle their beer.

Art Work at the Bandido

The craft beer industry in Ecuador is virtually non existent, so in 2013 three Americans in their early 20s, Nathan, Ryan, and Dan, who had not brewed a bottle of beer between them, decided to open a brewery.  They rightly concluded that young Ecuadorians and foreigners visiting Quito would prefer stronger beers with a variety of tastes.

They read a few books about brewing and began to make craft beers in a small room behind the bar in a rented building near the youth hostile.  Even today the beer is made in the same room, and customers are welcome to take a peek at the process.  Bandido rotates their beers, and on the week of our first visit the selections included an IPA, a porter and an ale, along with a couple of other craft beers made by other small time microbrew operators in Quito.  The beer was delicious, and we told the bartender Dan we would be back in a couple weeks to celebrate, when we were finished climbing and more used to Quito’s 9250 foot altitude.

We were fully acclimatized when we returned to the Bandido, which is helpful when drinking beer with a higher alcohol content.  There were a number of young Ecuadorians and American tourists at the bar who obviously understood the difference between beer that is drunk for volume as opposed to taste.  After having nothing but Pilsener for the past two weeks, we tended to agree with them.

Dan with Steve, Rick, and Scott

One has to admire the entrepreneurial spirit of three young men living in a foreign country and having to deal with capricious bureaucrats and monopolistic competitors.  Yet with all the impediments, the prospects for success seemed brighter than to deal with the stifling business climate in much of the United States.  Yes, Ecuador is corrupt, but the level of corruption at least gives a fledgling business room to maneuver.  They preferred to take their chances with the crooks in Quito rather than the ones back home.

Sunday, October 12, 2014

Proposition 46: “And, Oh, By the Way…”

Yosemite Falls - photo by JoAnn Sturman

Scott Sturman, M.D.

The euphemistically entitled Troy and Alana Pack Patient Safety Act of 2014 appears as Proposition 46 on the California ballot in November 2014.  Purportedly, it will save patients lives by compelling physicians to submit to random drug screening and to check electronic data bases prior to prescribing controlled substances.  As if he were making final arguments to a jury in a personal injury case, the proposition’s author Bob Pack contends doctors’ mistakes kill up to 440,000 Americans a year, or as he puts it, “as many as two fully loaded 747s crashing everyday.”  He goes on to conclude that many of these deaths are due to impaired physicians, who could be identified and culled from the system by mandatory, random drug screening.  The presentation is set to music to maximize the dramatic effect, and at its conclusion Mr. Pack makes the pitch to increase pain and suffering awards for medical malpractice from its current $250,000 to $1,000,000 just because the current arrangement “isn’t right.”  Prop 46 Promo by Bob Pack

No one disputes the grief suffered by the Pack family, but in these incidences it is all too easy to cloud the real problem and its solution by resorting to emotional arguments.  For instance, are we to believe 0.15% of the entire United States population dies each year due to doctors’ errors?  What does the phrase “contribute to death” actually mean?  Two acetaminophen pills rather than the intended one, and a patient with a myriad of problems dies two days later?  When reviewing independent  sources to corroborate the scope of the problem, most reports ranged from 98,000 to 200,000 deaths per year.  Unacceptably high to be sure, but one half of a fully loaded 747 crashing everyday does not have the gravity or shock effect of the video’s claim.  Furthermore, the audience is lead to believe that the preponderance of these deaths are due to actions of impaired physicians, but, of course, this is no more than conjecture.  No one really knows what fraction of a 747 crashes each day due to physician negligence stemming from alcohol or drug abuse.

If passed, MICRA legislation will be gutted, so trial attorneys have profound motivation to place their considerable political heft and money behind the measure.  This is clearly the least popular portion of the proposition, and certainly the reason it is addressed in the offhand, “and, oh, by the way” fashion.  Not surprisingly, there is no mention of the increased cost to patients due to higher malpractice insurance premiums or the unwillingness of physicians to continue practicing in a more hostile legal environment.

The proposition’s authors avoid an obvious solution, which would lay the groundwork for a suitable compromise:  any changes must include reasonable tort reform which protects doctors from frivolous law suits and places substantial financial or legal penalties on attorneys who engage in these practices.  These changes would reduce the cost of defensive medicine and hold the legal community responsible for disreputable behavior.

As it is, the tone of the proposition is accusatory and holds doctors in contempt.  It represents another lost opportunity to address a serious issue in a systematic, even handed way.  Checking a computerized data bank before ordering controlled substances has its merits, as long a the data source secure.  Requiring physicians to undergo randomized drug testing is not.  The stipulation was added to the Proposition 46 because it is popular with the public and increases the chances of passage.  Physicians are not pilots or policemen, and most are not union members.  For the vast majority of physicians who do not abuse drugs or alcohol and took an oath to care for their patients, this mandate is an affront to their profession.

From time to time I hear colleagues conceding that pain and suffering limits should be adjusted upward to account for inflation.  This also is a bad idea.  History should teach us the current proposed increase is only an interim step for trial lawyers, who will not rest until there are no limits on pain and suffering.  Despite the proposition’s cited purpose, a few facts are certain:  It certainly will make medical care more expensive and less accessible and trial attorneys more wealthy than ever but not yield the intended safety dividends.  

        Potala in Lhasa - photo by JoAnn Sturman

Sunday, September 21, 2014

How’s the Forest Treating You?

Big Sur - photo by JoAnn Sturman

Scott Sturman

My wife and I were trudging down the path towards the end of a 14 mile hike on the Pine Ridge Trail in Big Sur, and having forgotten to take the customary pre hike Advil, my feet and ankles were killing me.  We probably had met 50 to 75 fellow hikers over the past 7 hours, and greetings ranged from a cursory “Hi” to “good morning or afternoon,” or “how are you doing?”  These brief acknowledgements are commonplace and provide an element of short lived camaraderie among those who do not know one another but are experiencing a similar activity; they generally are not meant to provoke extended conversation or thought.  

A group passed by us on their way up the trail, and I extended a greeting to a less than robust, tattooed lad with long straight hair, pencil thin arms, and wispy mustache.  His reverie interrupted, he lift his gaze from the trail and asked, “How is the forest treating you today?” 

“It’s kicking my ass,” I replied.

And so ended our short lived conversation, with me perplexed about his unusual question and he by my bluntness.  Obviously, this man of costal, Northern California and we from the San Joaquin Valley held different perceptions of nature.  Like a beauty queen, Big Sur offers extraordinary scenery but its steep hills and quirky climate make it difficult to produce anything of tangible value with the possible exception of cannabis.  By comparison the Central Valley invites visions of a less striking female for whom beauty is only skin deep — outwardly monotonous to the extreme but with enough fertile soil and abundant sunshine to feed much of the world.

Personifying nature implies an entity with an intellect and consciousness, and illustrates a reoccurring theme of environmentalists for whom the planet has taken on spiritual significance.  Big Sur, breathtaking and unspoiled, may as well be Mecca West for the environmental movement.  For the true believer management of natural resources differs little between locations, just as long as they revert to pre 7th century conditions. 

With this summer’s extreme drought, the Valley struggled to supply the fruits, vegetables, and nuts on which much of the nation depends.  The West Side, without any water for irrigation, resembles the Sahel — bone dry, dusty, and in a state of disuse.  What’s fallow land and legions of unemployed as long as the delta smelt thrive?

The young man we met on the trail in Big Sur and his kindred spirits are in charge of California.  From billionaire, petrochemical hedge fund managers turned environmentalist to swishy movie stars and politicians who couldn’t grow tomatoes in the Garden of Eden, they have insulated themselves from the agricultural community.  But every once in a while there is a ray of hope — three years of extreme drought actually has convinced a few Democrats that it might be a good idea to build a dam or two and save some of the water which runs unused into the Pacific Ocean. Will wonders never cease?

Pa'san Ridge Trail - photo by JoAnn Sturman

Sunday, April 13, 2014

Hair Brained

Karl Marx Would Be Pleased
Scott Sturman

Clothes make the man. Naked people have little or no influence on society.  —  Mark Twain

I’m a different man, as anyone can readily see from the accompanying portraits.  The hair is no longer worn in the closely cropped para military style, but rather, the locks are long, flowing, and a bit unkempt to conform to my new progressive beliefs: wealth redistribution, position exclusive of merit, and one world government to name a few.  The striking metamorphosis not only includes a liberal physiognomy but ideas to match.  Gone is the healthy skepticism for all politicians, and the all too frequent cynical comments about their motivations.  Nor is the mind cluttered by heartless thoughts about the inadvisability of paying people not to work and rewarding bad behavior.

The inspiration for this epiphany came in the form of a voice message from the President himself, as he pitched the advantages of signing up for Obama Care before the March 31 deadline.  In his rich but measured baritone, he convinced me of the selfishness of preferring one’s own doctor and bristling about paying more for poorer health care.  Now I just have to decide whether to sign up for the Tin or Lead Health Insurance Plans, since I started smoking and eating more fast food to shorten my retirement years.

To be honest, lately I have been warming to the President.  Much to his credit, he has revived the foreign policy doctrines of Jimmy Carter and Neville Chamberlain, where appeasement is the favored tactic to keep dictators at bay.  He understands, whether one is dealing with Hitler, Stalin, Mao, Khomeini, or Putin, that letting them have their way is the best strategy, particularly if they promise their transgressions will not happen again.  As I recall, Mr. Chamberlain taught the Fuhrer a thing or two at Munich, as he waved a signed document proving there would be peace in our time.

Life is all about being fair, and as the President rightly observes, what reasonable person would object giving control of the Internet a more international flavor?  With America’s long history of human rights abuses, it’s time to pass the baton to Russia and China but also Zimbabwe, Venezuela, and Somalia.

Life is much easier being a progressive.  One does not have to say no to anyone or anything unless it doesn't agree with you, of course.  And the ego is constantly being validated and reenforced by the media and the entertainment industry.  When advocating equality of outcome or the immorality of carbon based fuels, it’s comforting to know every high school educated movie star will come to my defense.  Who knows, maybe the new me with get an interview on The View or CNN.  It’s amazing what a new hair style will do. 

 Leaning LEFT at Torre del Paine

Wednesday, April 9, 2014

A Prince of a Man

Yosemite Falls - photo by JoAnn Sturman
Scott Sturman

He was by all accounts a prince of a man, and when he died unexpectedly after a short illness, the world was a lesser place.  Dr. Bernie Freeburg practiced obstetrics and surgical gynecology for over 50 years and was considered by peers and patients alike as the the standard setter of the community.  A kind and empathetic man, who never voiced a derogatory word about even the most loathsome character, he epitomized the concept of gentleman, physician, and scholar.

Dr. Freeburg and his generation of physicians are a vanishing breed, who shunned the employee model of medicine and developed private practices which spanned up to three generations.  The rewards were great but so were the responsibilities of caring for patients every hour of the day, every day of the year.  It is difficult to imagine this group of independently minded doctors interviewing their patients from across the examination room with their eyes fixed on the computer screen.  We’ll miss the human element and continuity they gave to a profession which is becoming increasingly bureaucratic and distant.

The passing of a man of considerable stature and integrity, who was a fixture in the community for a half a century, peeked a personal interest as to how the local paper The Fresno Bee would report the event.  The paper’s editors, after all, saw fit to make front page news of the deaths of two personal injury attorneys, one of whom was extolled for her penchant for fashion which matched the decor of her office, and the other with mental health issues who some say every felon between Bakersfield and Sacramento had his phone number in their back pocket.  Honoring the Saints    Despite the paper’s long antagonism toward the medical community, the death of a revered physician should transcend politics and institutional prejudices.

No front page eulogy accompanied Dr. Freeburg’s death and perhaps that is the way he and his family wanted it.  But to those of us who had the pleasure of working with him, it seemed fitting that his life should have been celebrated in a public forum and reminded readers that there are many among us, who by nature are not attention seekers but nonetheless great human beings. 

 Bridalveil Falls - photo by JoAnn Sturmans

Saturday, March 29, 2014

The Only Story Worth Reporting?

 Cairo, Egypt - photo by JoAnn Sturman

Scott Sturman

Since the disappearance of Malaysia Flight 370 on March 8th, Russia annexed the Ukraine, a devastating mud avalanche in Washington killed nearly a 100 people, Obama deemed the United States should relinquish control of the Internet, and Democrats running for reelection this fall disabused their constituents that they had anything to do with the enactment of Obama Care.  Yet CNN devoted nearly all resources to covering the ill fated airliner for every minute of the day.  It is, after all, a challenge to crow about the President’s foreign policy, which smacks of the invertebrate, Neville Chamberlain.  Thanks to those like New York Mayor Bill de Blasio, history is taught so poorly in public schools that most under the age of 40 have never heard of the appeasing English Prime Minister and the events leading to WWII.  Alas, for the last three weeks the masses could tune into CNN, listen to speculation of experts and soothsayers alike, and pretend one missing airplane was the only problem in the world.

Just when one understands why CNN’s news coverage has been compared to Pawn Stars, the progressive network shocks its listeners.  Sandwiched between endless recaps of the intended path of Flight 370 and scenes of anguished Chinese relatives, a noteworthy report aired:  This past week the Law Society, which serves lawyers in England and Wales, published guidelines to allow solicitors to create “Sharia compliant” wills.   The recommendation would be recognized in British courts as “good practice” in integrating Muslim religious law into the judicial system.  It was an astounding revelation to learn a parallel system would be recognized, which discriminates against women, adopted and illegitimate children, and non Muslims by legalizing their disinheritance.     

Parallel systems have been dismantled systematically in Western cultures.  Separate but equal is a euphemism for discrimination.  Certain sectarian practices are incongruent with democratic principles and strictly forbidden despite sanction by religious text.  The recognition of Sharia Law and its incorporation into common law should provoke grave concern among women, who have battled religious and secular proscriptions for centuries.  Perhaps the editors at CNN, who long ago abandoned journalism for political correctness, realize this latest effort to meld mosque and state is so inimical to civilized society that for once they took the duties of a free press seriously

 Bright Angel Trail - photo by JoAnn Sturman

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