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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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Friday, December 12, 2014

Karl Marx and UCSF School of Medicne

Mr. Karl Marx, new Dean at UCSF School of Medicine

Scott Sturman, M.D.

This week the following unsolicited message was sent from UCSF Medical School’s Office of Diversity and Outreach to the addressees seen below.  The name of the author has been redacted. The highly charged, controversial nature of the document generated by a faculty member of a public institution supported by the taxpayers clearly demonstrates the politicization of academic medicine.  The plea for social justice with all the trappings of wealth redistribution, equality of outcome, and proscription to levy any value judgment along with the author's call for disruptive demonstrations makes even the most indifferent observer raise an eyebrow.  However, it is the salutation "In Solidarity," the old Marxist-Leninist call to arms, that reaffirms the notion that the Left is deeply imbedded in more that just political science and sociology departments.

Rather than lecture the medical community on the benefits of group think, civil disobedience, and socialized medicine, the author should spend more time in the operating room or on the ward teaching medicine, unless, of course, this was never his forte.  And in that case, there must be plenty of openings on the faculty at a medical school in Havana or Caracas.

December 10, 2014

UCSF Student Learners, Faculty, Staff, and Community Members,

The recent events in Ferguson and New York City have brought national attention to long-felt issues surrounding systemic inequalities that disproportionally impact underrepresented minorities, particularly Black men. We extend our condolences to the families of Michael Brown, Eric Gardner, and those touched by these incidents. Our nation has witnessed a response, which has brought together communities of color and allies, many who have engaged in peaceful protests and non-violent demonstrations. Inherent in the tenants of our values, UCSF and the Office of Diversity and Outreach (ODO) know that “Black Lives Matter”.  As a public institution, we work tirelessly to address health disparities and promote social justice in our work as learners, educators, clinicians, and researchers.

On behalf of the UCSF leadership, I want to acknowledge how proud we are of our UCSF Community for living these values, and we want to commend our student leaders who have organized and engaged in peaceful demonstrations that acknowledge the relation of racism and violence to health, as awareness is the first step towards change.  The Chancellor’s Executive Leadership Committee, The Office of Diversity and Outreach, the Multicultural Resource Center, and countless campus partners are working together to implement effective strategies to address unconscious bias, increase cultural competencies, and engage in socially just practices. The wisdom of Dr. King reminds us that as human beings, our freedom is inextricably bound together. All lives matter, and our UCSF community stands united in this journey.

In Solidarity,


Friday, November 7, 2014

African Genesis?


Scott Sturman

I have been to Africa four times, less than three months, but it’s more than enough time to come to the conclusion that Africans are dissimilar racially, ethnically, and religiously, and Blacks in the United States are not culturally African.  Not surprisingly, real Africans do not use first names fraught with rhyming, alliterative syllables and plentiful apostrophes, as do American Blacks.  Muslim Africans use traditional Islamic first names such as Muhammed, Qasim, and Fatima. Christians opt for names like John, Joseph, and Mary.  The truly African names often begin with unusual letter combinations like “Mb,” “Nk,” or “Nd.”

From Morocco to South Africa and Egypt to Tanzania, Africans are a diverse lot.  The Muslim north historically has treated their black neighbors to the south poorly.  Tribal loyalties often take precedence over national boundaries established by the Europeans.  The similarity of sub Saharan tribes penetrates no deeper than skin level.  The term African American is imprecise at best and stereotypical.  A Coptic Christian from Cairo, a Muslim from Mogadishu, an Afrikaner from the Transvaal, and a Bantu from Kinshasa living in the United States all could be tagged with the appellation “African American.” 


Some years ago I had the good fortune of having Samia Asindamu as a guide on Mount Kilimanjaro.  His expertise was not confined to guiding, for he proved to be an able manager, physiologist, and psychologist, which are essential skills to lead 97% of his often inexperienced clients to the top of the 19,340 foot mountain.  Wilderness Travel, his contractor, recognized his abilities and sponsored him to visit the United States to promote the company’s treks on Kilimanjaro.  He enjoyed the experience and remarked about the hospitality and generosity of most Americans with one notable exception - inner city urban Blacks, who treated him in a confrontational manner and were not indisposed to employ physical intimidation.  The irony perplexed this thoroughly African gentleman, who could not understand why those were closest to him phenotypically were the source of his greatest angst.

In Tanzania elderly males are respected and provide stability within their communities.  Mr. Asindamu offered this example:  If two young Tanzanian males get in a fight and are ordered to stop by an elder, they are compelled to do so.  To defy an elder in these circumstances is a grave mistake that would have lasting repercussions on the young men’s standing in the community.  Order is maintained and violence avoided.  This African custom is consigned as a bygone memory in American inner cities.

Volubilus, Morocco

For all the fanfare and talk of African roots, Black inner city culture is not African.  It is a dependent, matriarchal, urban lifestyle, which has morphed from its African roots.  It is an  unsustainable life style without the infusion of enormous resources over long periods of time from government and charitable agencies.  The stabilizing influence of elders, the functioning family unit, and the traditions of hospitality were abandoned decades ago and thousands of miles away.

Political correctness emphasizes differences, keeping old wounds open and providing careers for those who make their living in the dirty business of racial politics.  The Left and the talking heads of the media bear as much to blame as Black leaders whose influence wanes when Blacks think independently.  My friends and colleagues whose ancestors came from Africa have little more in common with the continent that I do.  We have similar goals, among them raising children, working hard, maintaining a solid professional reputation, and getting through life with as few bumps as possible.  We tend to perceive ourselves as individuals rather than by racial identity.

Oddly, tribal behavior at the ballot box is one of the few African traditions which has survived in America.  By blindly supporting their chieftains and the Democratic Party at voting percentages well in excess of 90%, even Comrade Stalin would be proud.  American Blacks would do well discard this self destructive behavior and adapt the uniquely American custom of placing individual interests above those of their self serving leaders.   


Saturday, October 25, 2014

The Kurdish Women’s Movement

Kurdish Soldiers: Where's the Burkha?

Scott Sturman

Bleak times afford opportunities that otherwise may not have been possible.  World War II gave American women access to jobs and professional options outside the home.  With men fighting in the Pacific and Europe women provided an untapped resource working in factories and serving in the military to support the war.  Victory would not have possible without their efforts.  Since then they have never looked back, continuing to make progress to gain parity in society.  ISIS and its medieval minded leaders may give Kurdish women a similar chance in a region of the world with strong links to the past.

Rosey the Riveter

In the long term no modern country can compete on the world stage when it denies women equal opportunity.  With talent evenly distributed between the sexes, religious and cultural strictures consigning millions of intelligent women to be subservient to stupid men is an enormous waste of resources.  No where is this scenario more graphic than in the Middle East, where sectarian machismo mires the region in incessant conflict at the hands of corrupt, despotic rulers.

Kurds are ethnically and culturally different than Turks and Arabs.  Living in Iraq, Syria, Iran, and Turkey, they number 35 million, making them the largest minority in the world without a sovereign nation.  They have been steadfast allies of the United States, despite our nonsensical insistence they remain part of Iraq.

Kurds tend to be more secular than their neighbors, and women enjoy relatively more freedom than women in other parts of the Middle East, including our self serving Saudi allies.  Kurdish women have a great deal to lose if ISIS subjugates the Levant.  They would be compelled to live under Sharia Law, forfeiting all rights as human beings.  They fight along side men in combat, a condition rarely found in any part of the world.  It is rumored ISIS fears fighting women soldiers, for to die at the hands of a woman in combat denies them the death of a martyr and pleasures awaiting them in Paradise.

If Kurdistan become an independent country and the ISIS threat stopped, much of the credit will go to Kurdish women, who like their American female counterparts in WWII, made enormous sacrifices to stop a deadly menace that threatened civilized life.  

 Much to Lose and Much to Gain

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
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