The well recognized contrast between the disciplines of Health Policy and that of the Practice of Medicine essentially resides in the difference in scope and application; the former investigates and studies population and societal disease trends, while the latter, by its very intrinsic nature, necessarily deals with the individual patient.

Informed by this inarguable and obvious difference, we are disturbed and confused by the vast number of television commercials aimed at marketing of medicines to the general public. These merchandise efforts deal with the most serious conditions such as coronary disease, stroke, cancer, hepatitis C, diabetes and others, as well as less threatening maladies such as digestive discomfort, dry eyes or mouth, dental health, allergies and many others. They often clearly point out that the product has been approved by the FDA, but even such welcome assurance is part of an irresponsible and potentially dangerous program to merchandise medicine on an indiscriminate basis to the general public.

There is crucial importance in the selection of a competent personal and family physician. The physician should be selected on the basis, if available, of a reliable personal recommendation, and should possess the requisite medical knowledge and training, as well as an aptitude for the art of practice. It is of crucial importance that the physician be familiar with the individual patient, his medical history and individual physiology, and to record the same for future reference. The diagnosis and treatment of presenting problems, including the prescription of medicine, where warranted, should be specifically tailored to the needs and personal nuance of the individual patient.

It would not be too much of a stretch to surmise that even the least sophisticated television viewer would not order a pair of leather shoes in response to a commercial, for fear of not getting the right fit. Certainly, the act of offering for sale, any medicine to the general public runs at the very least, the same dismal prospect. Furthermore, the administration of the wrong medicine has the strong probability of leading to disastrous results. A direr scenario is possible if the viewer foolishly engages in his own self- diagnosis, based upon his uninformed understanding and assumptions from the content of the commercial. That species of viewer has the same chance of success as a blind air traffic controller.

Nor is the danger to the unsophisticated viewer by the public advertisement of medicinal cure in any way assuaged by the inevitable legal disclaimer statement, defensibly included by the advertiser at the conclusion of the sales pitch; the same are uniformly delivered with the speed, and articulated clarity of a Civil War Gatling gun and are incomprehensible and useless. Moreover, the purported “authenticated” testimonials of successful past users, especially, the show business or sport celebrities are unprincipled, Even, theoretically, were there any veracity at all to these testimonials, they would still remain far outweighed by the substantive peril created by the confident recommendation of  potentially harmful medication to the general public.

To be entirely fair, many of these commercials do recommend the consultation with the consumer’s doctor to ascertain whether the advertised medication is appropriate. Yet we fail to understand the

basic purpose of advertising the medication to the patient as opposed to the doctor who is presumably aware of the medicine deemed indicated for the patient’s needs. A patient would have the right to conclude that the underlying premise for the nature of this species of advertisement is the ignorance of the physician as to the suitable medicine.

What are truly bizarre experiences is seeing and hearing certain commercials extolling the virtues of a particular medicine, and on the very same days on which such advertisements are running, to have attorney solicitations offering to represent any and all parties seriously injured by the use of that same advertised medicine.

Please do stay well!



After extensive and pleasurable reading, when one’s eyes are too tired to continue, he may be inclined to try his luck at finding some further acceptable diversion by means of his very accessible television set. He most likely will be disappointed, but not (experientially) surprised.

Specifically and expressly excluded from this critique, are the many worthwhile media offerings of public and educational television (whose existence and success are eternally under threat from our populist Administration and Congress) and the occasional good movie.

The medium of television, considering its vast potential capability for quality programming, and the unlimited extent of its public reach (even the most modest household has at least one television set) has eternally and shamelessly, offered low quality programming, presumably in accord with the mass marketers’ low esteem for, and stereotypical perception of the taste of the public consumer.

We know of no suitable or rational method for their respective ranking, but would nominate the following as equally deserving of an Olympic gold medal for consistent and ample generation of ennui and nausea:

Among the top contenders is any and all programming featuring the religious preacher. These oily, smarmy, self-adulating egotists espouse the “ultimate truths,” based upon their neurotic claims of personal inspiration from the deity; such inspiration guiding their perceived life mission to convert the non-believer and to secure compliance with every identified syllable of the bible. The latter, to be clear, was authored by various men, all of whom were so divinely inspired with ultimate wisdom, that they believed that the sun orbited abound the earth. We will confess, with only a little twinge of guilt, to our feelings of divine satisfaction and authentic schadenfreude when, as often has been the case, these zealous merchants of religious morality are discovered to be a loyal patrons of a rural house of ill repute.

With the express exception of a discreet number of quality discussion programs such as Charlie Rose, The Open Mind, Metro Focus, To The Contrary, Tavis Smiley and a few others, talk shows, especially afternoon talk shows, are so repulsive as to defy adjectival description. These, less than erudite populist “seminars,” generally feature panelists distinguished only by their excessive cosmetic use and garish attire in combination with a tasteless show of glitz and bling, all of which accompany a remarkable deficiency in mature judgment, good taste and basic good sense. The typical subjects discussed, are vital philosophical and esoteric mysteries, such as the latest mode in interaction between the sexes, show business divorces and celebrity culture, and trends in “cool” attire. They feature the articulation of the very latest in inane populist wisdom, peppered with useless aphorisms and expressed with unhesitating (and unjustifiable) confidence, to the raucous applause of an appreciative studio audience.

The ubiquitous game show is another contender in the race for the gold.  Consistently hosted by a  host whose entire toolkit of qualifications consists of the possession of a smile white enough to qualify for toothpaste commercials and the ersatz happy personality of a lady’s shoe salesman .The selected subjects for the typical game show contests are barely challenging enough for a  middle school sophomore, yet the correct answers are applauded by the studio audience and  congratulated by the game show host with an enthusiasm appropriate to the discovery of penicillin. In the past there were a small number of game shows hosted by erudite personalities and dealing with challenging subjects; these of course, never survived the test of perceived commercial criteria.

The viewing of television sports programming is certainly acceptable for those who are sport fans. But many sport fans have little interest in other, possibly life enhancing means of entertainment, and forgo  exposure to many valuable cultural experiences. What is especially deplorable are sport shows, featuring retired, semi-literate professional athletes, sitting in professorial seminar, discussing the performance or peccadillos of performing athletes, or the perceived significance of player trades. To put it sardonically, these exchanges do not quite attain the quality of the Lincoln-Douglas debates, nor the erudition and significance of the contest between Clarence Darrow and William Jennings Bryant, over evolution; but seem nonetheless to be conducted with like energy and presumed significance.

By the process of elimination, it would seem that major news programs would be our remaining choice. Certainly, it is a useful practice to remain knowledgeable in current affairs, national and international and with issues concerning climate change, scientific and medical advances and other developments. However, since the (disastrous) election of Donald Trump to the American Presidency, the subject of Mr. Trump’s unprofessional and erratic behavior has apparently overpowered and displaced most of the media time needed for more essential and more appropriate news content. Reporting on Trump is akin to reporting on the bad behavior of an insecure and neurotically needy child who tactically invites parental punishment as a proven mode of attracting desired attention.

The television medium, with its vast resources and capabilities can do better. This clearly has been demonstrated by its PBS, educational and nature programming, as well as its occasional offerings of quality entertainment in music and drama. It has instead been led Pinocchio-like, down a wrong and irresponsible highway; one emphasizing, in the purported interest of mass marketing, the erroneous necessity of catering mainly to the unsophisticated, low information viewer. In addition to improving the quality of its offerings in entertainment, it has the capability, by virtue of such resources and unlimited outreach, to perform vital societal services in many areas of need, including employment, education and literacy, language instruction, health and responsible social outreach.

We continue to live in hope.



Blog # 179     ANGST A LA FAMILIA

The composition of a “family,” by reason of numerous societal changes in our mores and culture, has morphed into many distinct, but societally acceptable configurations. Nevertheless, the family remains recognized as the principal entity for the rearing and socialization of children.  We have an observation to make however, with regard to certain dynamics of that entity; a fact which seems to tax credibility and defy any view of societal justice (since the family is universally considered a salutary institution) is its frequent causation of angst to the individual family member.

Leo Tolstoy, in his great novel, Anna Karenina, stated that all happy families are alike, while unhappy families are unhappy for their own individual reasons. The theme of this writing, relates exclusively to functional (successful) families and would exclude dysfunctional ones, whether due to parent and child conflict, serious sibling rivalry, domestic abuse, extramarital affairs, drugs and alcohol abuse and the like. We seek to call attention to a frequent phenomenon which, all too often, seems to emerge from the unavoidable organic nature of the functional family.

The family has often been referred to as the building block of societal civilization; but each block, unlike those of brick and cinder, is not uniformly composed and has its own independent chemistry. In all cases, however, families do factually appear to play an unwitting role in the causation of angst to their individual members. The originating source may be external or internal, as demonstrated below.

Often the qualities, good or bad, or the talents and abilities of individuals, are unfairly projected upon their offspring, creating advance expectations or unfounded predictions concerning the child. Thus, good business acumen, great mathematical or musical abilities, charitable inclinations, or in the negative category, inclination to do evil, miserliness, strict disciplinary tendencies, and many others, cause erroneous expectations, imposed by thoughtless and insensitive people, within and outside of the family; such unwanted and irrational expectations causing great stress or pressure unfairly to the child. The great English philosopher, John Locke, remarked that children are born with a “tabula rasa” or, clean slate.

Every family has its own distinct history; however, its history is not objectively and accurately recorded in some accessible and referable record. The communicated past of the family, to the extent known, is by necessity subject to oral history. The latter, by its nuanced nature, is vulnerable to inaccuracy, editing or amending, depending upon some approved collective memory and the subjective inclination of the reciter of the history. Often, family provenance is open much energetic dispute and productive of stress.

The emotional experience of being a family member of a specific family, conceivably suffering the stress imposed by projected groundless expectations, regarding aptitudes or character with its disputed history, does perform a service, nevertheless, which serves to distinguish the identity of the members of one family from others in society and facilitates the creation of identity. It is certainly fair to refer to the societal value of family and yet proclaim that it is an efficient producer of stress or, angst. Please consider the following example:

If I were to utter a faux- pas, or inadvertently, an insulting remark to a friend, I would have every reasonable expectation of forgiveness and a forgetting, following my sincere apology. By contrast, should such a mistake be made within the confines of the family, the wrong is never forgiven, and certainly not, forgotten; it festers and metastasizes as a permanent subject for treasured critical comment at each and every family gathering. People, who should love each other with the especial warmth of being intimately related as  a family member,  are potentially willing to villainize another.

Your guess is as good as ours.



One might surmise that the practice of care and nurturance of the sick and injured is as old as civilized society. It is to be noted, however, that it is the celebrated Miss Florence Nightingale, who is justifiably honored as the founder of modern nursing.  Rejecting the societal expectations of the 19th Century, relative to a daughter born into the English privileged class, she became an outspoken reformer and staunch advocate for enlightened and improved care for the afflicted.

Her kindly nocturnal visits to the bedside of countless wounded and suffering English soldiers, languishing in a squalid Turkish hospital during the Crimean War, earned her the saintly name, “The Lady of the Lamp.” By reason of her tireless and dedicated efforts the Turkish hospital was transformed from a virtual cesspool of sepsis and predictable death to a sanitary healing institution, with clean bedding, sterile bandages, proper food and necessary ventilation. Such prodigious and heroic efforts markedly reduced the hospital’s high level of mortality and historically created the foundation for the modern nursing profession.

The natural evolution of the nursing profession, from the confined role of a bedside assistant to the treating physician to today’s independent health care professional, can be seen as the logical result of a combination of societal need and the laudable aspirations of many towards the healing arts.

Certain medical associations, for various reasons, have persisted in their opposition to the independent functioning ( i.e., without physician oversight) of the advanced practice nurse, despite the demonstration by many respected studies that nursing outcomes have been comparable to, and in certain categories better, than physician outcomes.

The continuum of nursing education and certification, proceeds from the education and training of the licensed Registered Nurse (RN) to a Master’s prepared application and certification as a licensed Nurse Practitioner (NP), and if pursued and officially qualified, the Clinical  Nurse Doctor (DNP). There is a current trend towards proceeding (with the requisite education, training, and certification) from the status of RN with a BS degree directly to the NP with a DNP degree.

Society has continued to manifest an ever growing need for increases in the number of advanced practice nurses, particularly in the areas of primary care and illness prevention, by reason of the evident increase in population and in the numbers of the aged community. Additionally, there is a great need to be met in furnishing health services to our many underserved communities.

Florence’s saintly light has continued to illumine the plight of the sick and disabled through its reflected glow, emanating from a multitude of lenses caringly focused on them by a competent and dedicated nursing community.



In earlier writings, we have excoriated the use of electronic devices in lieu of personal communication. The absence of actual person-to-person, interactive experience results in the loss of the comforting recognition of the familiar voice, the loss of ability, when desired, to stress or downplay a point, the ability to console or express empathy or sufficiently express deeply felt emotions.  We have described text and e- mail messages as effectively, the mere transmission of data; a far less than satisfactory, substitute for actual, spontaneous interaction. An electronic “friend” is in no way comparable to the benefits of having an available, responsive one.

In the present writing, we are especially concerned with the potential for cognitive loss and, ultimately the resulting atrophy of the ability to reason and problem solve, by reason of the more convenient, and disabling, use of smart phones and other like phenomena. With the exception of computation and directional assistance, the regular use of these handy solution devices has the potential to  result in the atrophy of our natural, heuristic capabilities for analysis and problem solving.

Countless people willingly fork over substantial fees to health clubs for the personal privilege of what can functionally be described as hard labor, with the goal of keeping their body fit and in healthy condition so as to enable proper lifetime functioning.

Esoteric subjects are taught at schools, such as calculus, logic and philosophy, to students who will conceivably have no practical use for them in their adult life, but with the admirable goal of training and developing their mind’s cognitive skills.

Human cognition is the active mental process of acquiring knowledge and understanding through thought, life experience and the senses. Thought or, cognition, is inclusive of understanding meaning, exercising judgment, evaluation, reason, routine computation, problem- solving, decision making, comprehension, and even, speech. It is inarguably true that the thought process uses existing knowledge to generate yet further cognition.

As physical exercise strengthens our physical bodies, so does the study of academic subjects (and esoterica) improve cognition. The expression is, “Use it or lose it.” It would truly be an unspeakable and unpardonable act of ingratitude, in the face of man’s most fortunate gift from evolution, for him to cause this magnificent organ by reason of its non- use to atrophy and become vestigial, like the appendix.

In the earlier critique on electronic communication, we posited the question, “Would you propose marriage by Morse code”? Here, we would imagine a wedding night where, upon the loving invitation to the bedchamber by the bride, the groom responds, “Wait, wait, I have an APP for that.”



It was only fortunate happenstance that on one of our prospecting excursions into the ancient realm of etymology, we struck gold. The subject of our casual investigation was the celebrated word “sincerity.”

As appears, the furniture makers in ancient Rome, who possessed less than the requisite skill in the crafting of furniture (but not guile), would employ a waxy-type glue to hold their furniture together and give the false appearance of first class quality. The authentic artisans, however, were able to so craft their products that they fit and dovetailed together permanently, without the artificial device of glue or wax. These craftsmen had the enviable reputation of being “sine cere” or, without wax (sincere).

Sincere is a commendable adjective, awarded to those persons manifesting true intention and practicing legitimate acts, entirely devoid of misrepresentation or guile. One may necessarily assume that the people, with whom he is in close relation, for moral or practical reasons, would refrain from making misleading statements or performing deceitful acts; when the exception does occur, it is uniformly condemned as unnatural or perverse.

Practical experience has schooled us in wise caution regarding declarations of politicians, the representations of salesmen, and where appropriate, statements of officials and politicians; these conceivably would wisely merit some further thought or investigation.

However, the media, the sole institution which provides primary and effective protection to the individual citizen and to society, in general, has historically, proven itself to be a reliable, consistent and dependable source of truthful information.

Regrettably, with the ascendance to office of the current administration, a novel and defensive maneuver has been conjured up; the oxymoronic word for this perverse designation is “fake news.” This  administration,  bent upon attempted denial of wrongdoing, obvious and undeniable conflicts of interest and sheer incompetence, would deny media revealed malfeasance and miscreant acts, by the tactical defense of fake news. This most obvious artifice is a cheap and obvious ploy; but the danger is in its possible acceptability by the gullible, low information, flat earth portion of our population which was successful in electing this Kafka-like administration.

It is essential that we continue to maintain our proven confidence in our legitimate media, as well as to explicitly and loudly voice our opposition to guile and deception when confronted with it. We also can take heart that this shameless administration will wax, but wane, in the next few years.



Traditionally, Americans could justifiably take pride in our two party system, as the most representative expression of the will of an electorate, in comparison to alternative modes. In our American system, winner takes all, and for such reason, there is an identifiable and responsible polity. The public’s perception of its success is always addressable in the succeeding election.

By contrast, in countries which feature proportional representation, it is regularly required of the party which received the plurality of votes to negotiate with a small (usually extreme) losing political party in order to constitute a quorum requisite to form an operating government. The necessary concessions in party platform so negotiated were not the choice of the successful party’s electorate.

While there are many experts who feel that the American system needs certain modifications, such as the elimination of the Electoral College system and greater protection of access to the polls, historically, our system has consistently proven to be acceptably fair and representative.

In earlier writings, we have lamented the recent polarization, and consequent fragmentation, of our society into separate insular groups, each respectively sharing an identical belief and militantly opposed to any and all other such groups which maintain an opposing view. We have noted the antipathy existing between such groups which has led to what we have previously termed, “the death of civic amity.”

Reference has been made to the intention of our founding fathers, that the freedoms protected, especially, freedom of speech, would provide a necessary platform for regular, useful debate between citizens holding opposing views. Such anticipated respectful and positive exchange of disparate opinions, consistent with the English utilitarian philosophies of Jeremy Bentham and John Stuart Mill, was thought to result in salutary national policy.

However, the recent inability to constructively interact and responsibly exchange opposing ideas has frustrated the founders’ aspirations and their plans for the proper democratic process of governance. People of disparate views have virtually declared war on others over differences on issues (such as a women’s right to choose, immigration policy, gun control, governmental assistance to the needy, climate change, gay rights and a host of others) rather than submitting such controversies to constructive debate. Usually, it is a single issue which is the object of great emotional concern and is reductively (and foolishly), determinative of the single issue voter’s choice of society and candidate. This, among other concerns, distorts any rational comprehension of the democratically expressed will of the populace; and may well result in such a voter overlooking other platform positions of the selected candidate, separate from his mono-focused issue, to which he has been decidedly opposed.

The traditionally understood approach to the selection of a candidate has demonstrably been based on the voter’s general assessment of the candidate, and the selection of the person who is perceived to be most representative, on balance, of his point of view.

The American democratic philosophy and system are fundamentally hampered by short-sighted, single issue voters (who, regrettably, are all too common) so that the manifested message of the voters is irresponsibly fractured and distorted. It bears repetition that a vote for a candidate solely because he is perceived as supporting, for example, Israel or gun control, can unintentionally and irresponsibly, be a vote to support other policies in his platform to which the voter may be energetically opposed.

The plethora of vital issues and available choices of proposed resolution have by our basic philosophy been matters upon which the will of the people is materially relevant. The single issue (mono-focused) voter selfishly and irresponsibly distorts the heard voice of the voting public and thus is functionally destructive to the operation of a democratically responsive government.



Blog # 174        THE PAGE TURNER

Followers of (bless their magnanimous hearts) have been regular recipients of our many lamentations concerning the recent success of the populist movement in America. We have often made reference to the formulaic advice of Thomas Jefferson, that an informed and literate society is essential to the success of a democracy; and observed of late, that the absence of the same has manifested itself in the present disastrous and embarrassing state of affairs in Washington.

We have consistently posited, as the indicated antidote for the presenting malady, the active encouragement of reading good literature. We will express a specific basis for our sincere belief in this “page turner,” for fear that our general prescription may seem remote, idealistically theoretical, or essentially impractical. We are necessarily confident that the “low information” and “flat earth” portion of our population, can be persuaded that this is their way to a more enhanced and satisfying life.

When we speak of “good literature,” we have reference to writing having excellence in form, and expressive of ideas of universal and eternal interest. We will go so far as to state that good literature is importantly related to man’s life on earth, in the same ratio as science bears to the earth’s nature.

Reading is the process of interpreting symbols to ascertain their meaning and is an effective and useful means of sharing information and ideas. The interaction between the printed word and the reader will naturally be colored by the extent of the reader’s knowledge, his past experiences, and his cultural context. Low information people would deposit the words they read, their observations and vicarious experiences into their existing base of knowledge, such as it may be. The effort required to read good literature, for everyone, gets easier with practice; suitable means for its promotion must be construed.

Should such a (national) program be sensibly and realistically instituted, the individual participant would eventually come to personally realize a fuller and more enhanced life experience and the nation would benefit from the improvement in the quality of its participating citizenry. Needed motivation, especially at first, might be accomplished by tying government financial assistance to required attendance at tutoring sessions; we predict that the program would be attractive to service oriented volunteer tutors.

Reading has been proven to stimulate brain activity and growth. Regular reading has been scientifically linked to cognitive advancement, most especially for adolescents, but continuing into old age.

One discovers that the most exciting and pleasurable feature of reading books is that there is absolutely no restriction, but instead, allows the reader to manufacture his own personal images, introspectively, affording the full exploitation of one’s personal interpretation.

The increase of “Jefferson qualified” citizens would be a real page turner in restoring our historic trademark and brand, as an admired and exemplary nation.



Were it possible to reliably predict the response of other people to our chosen words and acts, the potential benefit in person-to-person interaction would be inestimable, especially as to the needed minimization of misunderstanding and preventable discord. Unhappily, there would seem to be no discipline or formulation capable of such a salutary capability, and it would appear that this useful aspiration is destined to remain utopian.

Whatever potential benefits may accrue in the future from the promised  “artificial intelligence,” in the spectrum of computational or analytical facility, it cannot reasonably be expected to furnish any assistance in our quandary, which is intrinsically dependent upon individual nuance and perception.

Even with reference to the ratio-driven discipline of probability mathematics, we come up far short. This area of mathematical application deals only with the “likelihood” of an occurrence, as compared with all other calculated possible occurrences, and affords us no assistance for the above stated reasons. It has utility in such areas as weather forecasting, gambling and to some degree in finance; none of which are affected by the vagaries of human perception or subjective behavioral phenomena.

The same may be applicably said for those who would prefer to apply the theory of cause and effect to this behavioral area. With the rare exception of the most exceptional traumatic events, such as the decease of a loved one, or the receipt of an unexpected fatal diagnosis (or the most fortuitous and unexpected good luck) a specific cause’s effect on another is unpredictable for such subjective reasons.

We have written extensively on our recommended concept of proportionality as between a stimulus and its response; emphasizing the proper reservation of one’s profound responses for matters of appropriately extreme circumstances (stimuli) and lesser reactions to matters of relatively minor significance, as is appropriate to a rational life and a normal balance of priorities.

For purposes of this writing we expressly exclude the subject of the neurotic or otherwise unhealthy personality; in such cases the problem is pathological (regarding which we are not qualified) and not ascribable to social or perceptional failings.

We would accordingly conclude that predictive selection, from the unlimited array of possible responses (except in extreme cases, as noted) is not feasible, since they are universally motivated by subjective considerations; the latter, by their nature vary with individual perception and personal nuance. As a very simple, but common example, critical comments may be defensively perceived and asserted where none were in reality intended. Borrowing two words from the area of probability mathematics, one can reasonably assume that the “likelihood” of unintended offense may be “lessened” somewhat by knowledge of the previous history and known inclination of the other person. Otherwise, we are prudent only when we speak or act with an awareness of the possibilities of misinterpretation.  On the receiving end, we are obliged to accept the natural meaning of the words used, and not exercise our considerable talent for creativity. –p.

Blog # 172 NAMASTE

Attend it close, excluding all
So as to sense and mindfully hear
The cardiac beat of planet Earth
Those pulses soft in depths profound
Life’s vital tattoo, its organic sound
In synchrony to man’s own heart
In star set universal time.

If you would hear, go out of mind
Attend the Earth, embrace its sound
Enfin,-do you mark the base tattoo?
That all may hear and apprehend-
It ticks the steady tune of life
With its eternally measured strikes
That beat, indeed, from babe to crone
And then, from crone to dust, so soft.

My sight is only for your self
And not your lovely eyes or limbs
It is perforce your heart I seek
That beats along with that of mine
Both timed unto that earthly drum.

What I would see and do salute
My planetary heart and earthly self-
The pure, ethereal love of you.