Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Friday, August 30, 2013

Elmore Leonard

Elmore Leonard
Last week marked the passing of a unique writer who was both prolific and excellent: Elmore Leonard.  The media was flooded with remembrances, not surprising as he wrote more than 50 books and short stories, 26 of which were adapted to film or television.  He was the resident expert in Westerns, Crime, and at the beginning the genre that would give one of his greatest fans, Quentin Tarantino, a title for his memorable film: Pulp Fiction.

He started as an ad writer but found it too boring and quickly began turning out Pulp, not so much for creative outlet as for money.  As he often said he was separate from creative writers as he always wrote for profit and was not ashamed that he did.

I wrote a book: Harnessing a Heritage, a memoir, which is not surprising since the author’s most prophetic advice is, “If you want a good book, write about what you know.”  I continue to write in this Blog medium as it fulfills my creative need and takes about as much time as I can dedicate to writing, in a full and fruitful life.

When I stop and think why I don’t write fiction, I believe it is not because I couldn’t craft a plot, or even because I couldn’t handle the twists and turns that make Mysteries so attractive.  I believe the flaw in my writing is character development and dialogue.  Perhaps that is why I had so much respect for Leonard.  In an interview on NPR by Scott Simon, he was asked, how he captured the dialogue of his characters.  He opined (he would have never used opined, as rule umber 3 of his “10 Rules of Writing is “Never use a verb other than ‘said’ to carry dialogue”) , “Well, don’t you hear the people talking?  That’s all I do. I hear a certain type of individual.  I decide whatever he should be, whatever it is, and then I hear him. Well, I don’t hear anybody that I can’t make talk.”  He also explained his talent of making really bad people, likeable:  “I think of them as normal people.  The guy who is going to rob a bank gets up in the morning wondering what to wear today.”

He was 86 years old when he died of complications from a stroke.  He wrote to the end, with an ongoing television show, Justified, in its third season on FX. Interestingly, he stayed involved with his film and television projects.  The cast and staff of Justified, based on a character in several of Leonard’s books named Raylan wear wristbands that say WWET (What Would Elmore Think?).  He wrote many of the screenplays for his film adaptations and some for movies other than from his books.

Leonard openly admitted, with a certain measure of pride, that what set him apart from the crown was that he wrote to earn a living while others wrote for prestige, tenure, or for other writers.  Whatever his motivation, his style brought entertainment to me and many others.

He’ll be missed!

In my next post I will share some recent knowledge I gained about PTSD.  I hope you’ll join me.

Thursday, August 22, 2013

Tax Reform

Congress is about to return to session and one of the big issues that will likely be considered and postponed is Tax Reform.  I believe this is partially due to the fact that they make tax law too complicated in an effort to provide stimulus and protect the turf each member of Congress considers theirs.

WD PEO Calendar
Recently Mary was involved in a fundraiser for a charity that provides college scholarships to needy women.  It was tied to a calendar of events of the organization to call attention to what was happening in the month as well as raise a modest amount of money to support the college fund.  The hook was you were assessed for certain possessions.

Brilliant!

If we structured the tax code in a similar manner we could create stimulus, redistribute wealth, encourage good health and education, and return Social Security to what it was intended to do.

Here’s how it would work.

Every tax payer who makes any amount of money declares that income and offsets it only by legitimate business expenses.  There would be no exclusions for property, or education, or gas: just paper and pens and pencils and stuff.  Oh, and I guess rent if you are working someplace other than your residence.

Then there would be a series of thresholds to establish poverty level and upward gradients thereof.  Initially (each year) you would pay a small portion of the remainder as a base tax.  So, if you netted $23,500 (considered the US level for a family of four in 2012). You would pay nothing, but for every $10,000 above that your base tax would be 20% of that. So, if you made $223,500 your base tax would be $40,000.  And you couldn’t shelter your dividends as some lesser income.

Adam Smith
As a side note the concept of a poverty level came to this country when Adam Smith wrote Wealth of Nations in 1776.  He felt that a family of four or five not only had the right for adequate money to (purchase) not only the commodities which are indispensably necessary for the support of life, but whatever the custom of the country renders it indecent for creditable people, even of the lowest order, to be without”.  Interestingly that now includes what has been termed  the “Obama Smart Phone” (with service).

But that’s just the start!  Here is where the calendar idea comes in: everyone would pay something for each pair of shoes in their closet made in another country.  Everyone would pay something for each hour spent watching TV or sitting at the computer (encouraging exercise).  Similarly each automobile you have would cost you something.  Cell phones wouldn’t cost you much, nor would personal emails or text messages, but tobacco, alcohol, marijuana and vices, like prostitution, wagering (even March Madness), traffic tickets and other misdemeanors could bring in a lot of loot.

And we could give percentage credits for things we would encourage; for example, we could issue everyone a pedometer tied to a massive iCloud database and credit a certain percent for every 100 miles, or photos of cookbooks with preparation stains on them might get you something.  You could get credit for the number of gallons of milk consumed, or even the number of American Flags you own. 

Don Novello
The Evangelicals could lobby for credit for church attendance or bring back some credit for charities (those with the lowest Administration costs would have the highest credit.  And while my initial thinking is that you should pay for the number of years you WENT to college, you might get credit if you were ATTENDING college or trade school.

Father Guido Sarcucci
This concept was captured in 1980 very well by Don Novello when as Father Guido Sarducci, he described Life is a Job. Where, when you die you get paid for every day you lived but then have to repay for each of your sins.  It is six minutes of humorous revelation.

I had so much fun in a recent post on Burt Bacharach that I think I’ll do one on another favorite who recently passed away: Elmore Leonard.  Hope to see you there.

Wednesday, August 14, 2013

HeLa Revisited

In much the same way as the old adage as to why a dog licks his balls on the front porch (because he can), scientists seem bent on using new technology to map the genome of almost anything they can get their hands on.  Recently German scientists mapped the genome of the remarkable cells of Henrietta Lack and briefly put their results on the internet.

Henrietta Lacks - 1943
Understandably, the family, who had not given permission to even map the cells, was incensed.  The National Institute of Health interceded and arrived at a protocol as to how the cells could be used in research and by whom.

I was reminded of a Post I wrote a year and a half ago after reading a book authored by Rebecca Scloot on the cells. So here it is again.  I hope you enjoy it.

HeLa


Rebecca Skloot
I have scrupulously avoided making a post seem like a book review, although I have recommended books in the past.  But I am currently engaged, and that is an appropriate word, in a book titled “The Immortal World of Henrietta Lacks” by Rebecca Skloot.  This first novel by a very prolific author was a New York Times best seller in 2010.

It tells the story of a poor black woman who died of aggressive cervical adenoma-cancer in 1951: a growth so unusual that her treating physician, George Otto Gey of Johns Hopkins Medical Center, cultured biopsy sample both before her death and at her biopsy.  The humanity of the story centers on the lives of her surviving siblings and their progeny, all of whom were poor, in poor health, and unaware for twenty-five years that her cells were changing medical science and making some people a lot of money.

But the greater story in my mind is the evolution of cellular research and the doctrine of Informed Consent.

For more than twenty years I have been closely involved in a course designed to establish standard evaluation of dental care, under the umbrella of the California Association of Dental Plans.  In that course we have carefully constructed a definition of Informed Consent as coming from Tort Law and Battery.  We teach that it has four elements: Risk Assessment, Benefits, Alternatives and Financial choices, to which we have cleverly assigned the acronym, BARF.  While we do teach that California in a court case in the early 1970s defined the concept, I was unaware until I read Henrietta Lacks, that the first U.S. court case to mention the word Informed Consent was in 1957, when Dr. Paul G. Gebhard was found guilty of malpractice and had his license suspended because he performed an hysterectomy after discovering a cancerous tumor while the patient was under anesthesia.

In fact, the concept had very late origins worldwide, coming only after the Nuremburg Medical trials in 1947.

Ms. Skoot provides meaningful discussion also of the Privacy issues surrounding medical records and treatment.  I had been very aware of the restrictions about medical privacy from the establishment of the Healthcare Portability and accountability Act, and work within those restrictions on a daily basis in my work.  But the nuances of balancing the value of medical research against concerns for patient care were never as clear as this book paints it.

To follow the advancement of cellular research and how much it was and is dependent on the cells from Henrietta Lacks, named for the first two letters of her first and last name, HeLa was absolute riveting: not only to me, but to my wife and her non-medical book discussion group.  The virulence of the cells in the tumor Dr. Gey biopsied was responsible for those cells and their dividing successors to develop freezing of cells with stasis, shipping of cells throughout the world, in vitro fertilization, testing the effects of space on cells, and recombination, identification of chromosomes and ultimately defining the human genome, with development of the Polio vaccine, with meaningful studies of the effects of atomic radiation contamination, and even current and future treatment of AIDS.

I am currently working on a position paper for a dental group that requires analysis of papers written on a subject.  In dentistry, and to a lesser degree in medicine, valid long-term double-blind studies with large populations are rare.  Part of the reason for that, other than expense, is that if patients in the study are made aware of the risks and benefits, many would opt out of the study and few would voluntarily agree to placebo treatment.  So, in order to proceed with those kinds of studies, patients are given very broad-based information on which to make a decision.

In some cases this means that “experimental” treatment, which most terminal cancer patients accept, may actually aggravate a condition rather than cure it.  This was certainly true of Henrietta, who was treated painfully with radiation, the treatment of choice in 1950.

It was also true of my niece who recently died of recurring breast cancer, slowly and painfully, while in experimental treatment.

The book brings more questions than answers to the issue, the family did not suddenly become wealthy or healthy, but it is certainly worth the read.

In my next post I will suggest some ideas to revise the tax code, should Congress get around to addressing this issue.

Sunday, August 11, 2013

Burt Bacharach

Burt Bacharach has written a new biography and Scott Simon interviewed him recently on NPR.  As I listened I found myself thinking what an interesting life he has led: a music career spanning more than four decades with contributions to pop culture, film and even Broadway.  What is it about his music that has such great appeal?

To hear him answer that question he claims it is his trust in melody.  From early training in classical music he used his knowledge of variety to, in his words, “Trust anything you can whistle” leading to movie hits like Alfie, The Look of Love, Casino Royale, Arthur’s Theme (Best That You Can Do), and Raindrops Keep Falling on my Head: all very different but all easy to hum or whistle.  And all songs that stay in your head long after the water for the shower has been turned off.

One of the things that set Bacharach apart is his appeal as a singer’s songwriter.  Setting aside for the moment his long and very lucrative association with Dionne Warwick, he has written signature hits for such superstars as Barbra Streisand, Tom Jones, Dusty Springfield, Roger Williams, B.J. Thomas, Gladys Knight, Cher, and Aretha Franklin, and for such notable musicians as Herb Alpert and Sergio Mendez.

Dionne Warwick
While the words of many of his almost 75 top 10 hits are what stick in our mind Bacharach would be the first to say he was not a lyricist.  The majority of the songs he is remembered for were co-written with Hal David, and of the remainder, many by third wife Carole Bayer Sager.  In the NPR interview he jokes about those collaborations, saying that many of the songs were contentious as to what lyrics fit his melodies.  His prime example was when he and Carole were writing That’s What Friends are for, which went on to raise literally millions for AIDS research.  For some reason Burt felt the song should begin with “And I…”.  Eventually in his words she gave in “just to get out of the room”.  Whether the beginning achieves the conversational element he was trying to achieve, there is no doubt the song struck a chord with millions of fans.

My personal theory of his success is that he achieves what one Blues singer said is the lesson learned by the truly great musicians and singers; namely, not what to put in to the music but what to leave out.  This leaves many of Bacharach’s songs memorable because they have unique syncopation: Take Do You Know the Way to San Jose or The Look of Love, or One Less Bell to Answer, or one of Dionne Warwick’s best: Promises, Promises.  The syncopation and phrasing are what keeps us from losing the song from our head.

It is ironic that Warwick, who charted almost 40 Bacharach-David singles during the 20 years from the mid-sixties, finally declared bankruptcy this March, citing as reasons an inability to settle a seven million dollar federal tax liability and three million in business tax liability to the state of California.  As another songwriter who uses syncopation, Bob Dylan has said, “Some will rob you with a gun, others with a fountain pen.”

Bacharach’s book has a lot of anger in it, but it does cover a tremendous span of time when music has morphed itself into an eclectic grouping, which we can now enjoy streaming and personalized in a dramatic fashion.

My next post will be a reprise of a post I wrote about 18 months ago on HeLa.  The revisit is prompted by action against the companies that have used replicated cells for financial gain without compensation to the family.  A decision by German courts caused this issue to be revisited.  I think you will find it interesting.

Friday, August 2, 2013

Rhubarb

It came as a question on a “Test for people who know everything” quiz.  The question?  “Only two vegetables are able to reproduce year to year without being planted.  What are they?”  I knew the answer for one was asparagus, since there are asparagus fields in my Southern California neighborhood.  But the other?  Not a clue.

Turns out the correct answer was Rhubarb, my ignorance of which may have come from the fact that I think of it as a fruit.  Turns out that it was classified as a vegetable until 1947 and remains a vegetable in much of the world, but became a fruit in this country because fruits have a different tax rate than vegetables and it is generally or at least often teamed with fruits such as strawberries.

When I grew up in Iowa we used to find wild rhubarb in the spring.  Such remains the case in my sister-in-law’s part of Wisconsin where she finds it in abundance as she walks her dog.  She gathers it up and cooks with it: two favorites being a rhubarb-custard cake and rhubarb muffins.  The latter was offered to Mary and me on our recent visit.  The former I have now made twice, which was a challenge.

The first time I tried four different stores before I found a store that stocked it.  This year I returned to the same store and again found it, even though the store had changed management and name.  Several single stalks were still in the same place. And three gave me the four cups chopped I needed.  My purchase depleted the supply by about half.

I think the lack of seasonality in Southern California forces our supply to be hothouse grown.  And the limited supply gets consumed by the Polly Pies and Marie Calendars who flesh out the fresh peach and fresh strawberry menu with a rhubarb pie to meet the needs of the geriatric relocated population.  The same way as you can find frozen White Castle burgers at the Laguna Woods golf course restaurant.

While for the most part rhubarb is considered a healthy food, the fact that most recipes call for considerable sugar makes that suspect and, in much more than normal quantities the oxalic acid content could even become fatal. Of no significance to that observation is the fact that when our son Tim returns from chaperoning his eighth graders through the East Coast, he always brings some rhubarb jam to us.  Hmmm...

Once, when I was required to give a Change of Command speech I took advantage of the fields surrounding the base dental clinic to make a point about my staff and comrades of the USMC 13th Dental Company, which I was leaving.  I likened some of the civilian staff, who preceded my arrival and would outlast my departure to the artichokes growing in the field.  At the time, a farmer would need three seasons before he or she would be able to harvest artichokes to sell at market: steady, worth the wait, and once accomplished provided a valuable resource of themselves and as models.  The new civilians and junior officers were like the orange groves I could see and smell from the podium: bright, abundant in their value but less distinguished from each other, more viable as a group.  The core of the unit was likened to the strawberries in the fields: unique in time and location and providing value felt through the unit, the Corps, and the rest of the world.

Years later I heard from someone who attended that they still remembered that speech, in spite of having heard dozens made at similar occasions.  I know I still remember many of those I referenced.

Burt Bacharach has recently published a book and was mentioning it on NPR.  In my next post I’ll share with you what that made me think of, and why.  Please come visit.