Tuesday, November 15, 2016

Evidence-Based Politics

I was recently at a conference, completing my government-mandated 16 hours of continuing education.  It was a good thing.  I learned a lot.  It was one of those really cerebral conferences filled with a lot of academic-types.  You know the ones. . . those research guys that do a lot of great work, but don't really have a whole lot of experience actually looking patients in the eye.

We give these guys a hard time.  We kind of make fun of them.  Those of us in clinical practice often cringe at what some of these guys' bedside manner would be like.  Seriously.  Most of them are like Sheldon from The Big Bang Theory.

However, one interesting thing stuck out to me.  These research egg-heads matter.  They do work that matters.  They provide the research to back up something that we, in actual medical practice, like to refer to as "evidence-based medicine".  They help those of us in the trenches of medicine become better at our craft.  They help us, help you.

"Evidence-based medicine". . . I'm sure most of you have never even heard that term before.  My doctor friends get to hear about it all the time.  It became a buzz-phrase a number of years ago, as the art of medicine began it's long and arduous metamorphosis.  Basically, evidence-based medicine goes something like this:

Evidence-based medicine is an approach to medical practice, intended to optimize decision-making by emphasizing the use of evidence from well-designed and conducted research.  It advocates that decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators.  It thus tries to assure that a clinician's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from the scientific literature so that the best course of action, or treatment, can be determined and applied.

In actual practice, evidence-based medicine would look something like this:

A patient comes in to the office and tests positive for streptococcus.  Based on cost, statistical evidence of kill rates with amoxicillin, and relative safety of use (in people without penicillin allergy, of course), a 7-day course of amoxicillin is prescribed.  The patient feels better in about 3 days, since the evidence has shown great efficacy in amoxicillin's ability to kill strep colonies.  Evidence-based medicine:  There are numerous scientific studies showing the rate by which amoxicillin will kill your strep.  It's researched.  It's proven.  It's repeatable. It works in actual medical practice.

So, now that we have that introduction out of the way, here is what I really wanted to write about.

 Why can't we do something similar in politics?  

Evidence-based politics. . . it kind of has a nice ring to it. . . 

Before my more liberally-minded friends start freaking out, please, please, please hear me out.  I would like to repeat the highlighted statement from above:

. . . tries to assure that a clinician's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge

I just wanted to give some more evidence, knowledge, or perspective to the turmoil that is seemingly surrounding our new President elect, Donald Trump.  I understand a lot of you really, really hate him.  I understand a lot of you are really, really scared of him.  I also understand a lot of you are, in general, fearful about the trajectory of our country.  I get that.  Really, I do.  He wasn't my first choice, either.  However, the election is over.  "We the people" have spoken.  It's a done deal.  So, it's time to get out of bed, put our big-girl panties on and get to work.  Let's get to work finding common ground.  Let's get to work on a solution to the problems in our society.  Let's lay down our "limited knowledge gaps or biases" and work toward a common goal.

I say this over, and over: "There is more that unties us, than divides us."  I truly believe that.  Which brings me closer to my point.

But first. . .

let's all do a mental exercise. . .

I would like you to imagine, for a moment, a beautiful outdoor hiking environment.  The trails are well-maintained.  There are rolling hills on one side and a beautiful ocean on the other.  There are miles and miles of trails that overlook the cliffs and the soothing surge of a salty tide.  There are clean restrooms with drinking fountains nestled along the trails.  All of this is available to you completely free of charge.  No fee for parking.  No fee for the restrooms.  No access fee at the trail head.  Nothing.  Nada.  Completely free.

What would you think about that?  No, really.  What would you think about that?  I want you to write down your answer.  Seriously.  Write it down.  I want you to remember your answer in a couple of minutes.

S   e   r   i   o   u   s   l   y. . . .




Now, what would you think if I told you that such a place actually exists?  What would you think if I told you I was actually just there a few days ago?  Wanna see pictures?

Okay. . .

Free public parking.  There is a golf course next door, so they respectfully directed those snooty golfers right on down the road to their own parking lot.

A lovely little creek in the slightly wooded hills.

And just look at that ocean!  Beautiful!  It was a lovely 74 degrees on this particular day. . . with only a slight breeze from the ocean.

You can even hike down the beach. . . for free. . .

Yes, when we are near the ocean, my husband always has to stick his hand in the water. . . . just to say he did. . . and he did . . . free of charge.

The trail is lovely. . . right along the edge of the magnificent cliffs.

In places, the trail is adjacent to some spectacular fairways. 

So, remember when I asked you to write down your thoughts about such a place?  What did you say?  Did you think such a place would be awesome?  Did you think such a place a fantasy? A fairytale? Did you say there is no such thing as free?

Here's the deal.  Here's the evidence.  Here's my story. . .

This place was free.  This place has miles upon miles of well-maintained hiking trails.  This place is totally open to the public--no guard at the gate, no ID check, no "put your money in the bucket" honor system.  Free.  Free to me.  Free to you.  Free to everyone else we saw hiking on this particular day.

You know who it wasn't free to?

Wait for it. . . .

Donald Trump.

That's right.  This place is not free to Donald Trump.  In fact, this place cost Mr. Trump a whole lotta money.

This place is not a fantasy.  It's not a fairytale.  It does exist.

It exists because "that guy" that you have been conditioned to believe is horrible and evil, chose to create a public space, at his expense, adjacent to one of his beautiful golf courses.

What you have been looking at are photos from the grounds of Trump National Golf Club in Palos Verdes, CA.  Look it up.  Google it for yourself, if you don't believe me.

In conjunction with other generous donors, Donald Trump has leveraged his significant fortune to create access to beautiful open areas for the general public to enjoy, free of charge.  The interesting thing: I have been unable to find this information on the Trump National Site.  However, I did find it on another site. . . Palos Verdes Peninsula Land Conservancy.

Go ahead. . . check it out for yourself.  Impressive.  Really.

So, here's my meandering point:

Evidence-based politics might be kind of nice.  I actually think the next 4 years are going to be filled with lots of examples of evidence-based politics.  Why?  Because we just elected a guy that has been researching and doing small (and large) business for decades.  And, I think most would say, the largest business on the planet is the business of the Federal Government of these United States.

Does Donald Trump have a horrible bedside manner?  Ummmm. . . yes!

Would I want Donald Trump to be the doctor tasked with breaking the news to me about some horrible disease?  Ummmmm. . . probably not.

Do we need people in this world that have tried, failed, tried again, and finally created great solutions to complicated problems?  Absolutely!

Evidence-based politics.  I feel as if the media has been controlling the narrative in our country.  They limit the whole story.  They edit for sound bites.  They create controversy where controversy doesn't even exist.

Remember the definition of evidence-based medicine?

. . . tries to assure that a clinician's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge. . .

This blog is merely that. . . an attempt to supplement with all available knowledge.  I was truly surprised, given the overarching national narrative, that these trails existed.  I suspect many of you are surprised, as well.

This topic has so many interesting rabbit-holes to be explored:

Capitalism with compassion.

The true benevolent nature of wealthy Americans.

Why private enterprise can create a better product for significantly less cost.

How well-run and well-managed companies are able to leverage their power to help the needy.

Why I paid $5 for a bottle of water at the Dallas airport, yet Trump only charged me $3.

Why Dave and I were happy to give Trump our hard-earned money for some spectacular golf. 

Why some of you cheered when I used the phrase "snooty golfers" in the earlier photo.

How the media has created class warfare.

And the list goes on and on. . . 

Personally, I am kind of excited to see what an actual businessman can do about running the largest business on the planet.  This isn't theory to him.  This isn't something he has just read about.  This is evidence-based politics.  He has researched it.  He has tested it.  He has practiced it.  He has failed and succeeded more times than any of us would care to count.  It is much like the practice of medicine.  The more you do, the more you see, the better you become.  

That being said, I will say it again:  There is more that unites us, than divides us.  It is time for America to unite around our newly-elected President.  You don't have to like him.  You don't have to agree with him.  You don't even have to respect him.  

You do, however, need to root for him.  At the end of the day we are all Americans.  A win for Trump, at this point, is a win for us all.

May God continue to bless America!

Thursday, October 20, 2016

Day 2: The Good, The Bad & The Ugly

Here I sit, day 2 of my therapy. . . just 12 hours after the last (thank goodness!!) Presidential debate.  Of course, I did not watch it, as I have given up watching the news these days.  I was, unfortunately, lambasted with information in just the few moments I spent checking email and Facebook notifications.  As I suspected would be the case, most of this information was negative in nature--from both sides.

Aaaaaannnnd that brings me to Chapter 2 of The Screwtape Letters. . . . (If you missed Chapter 1, I addressed it here.).

. . . "My dear Wormwood, I note with grave displeasure that your patient has become a Christian.  Do not indulge the hope that you will escaped the usual penalties; . . . In the meantime, we must make the best of the situation." . . . .

. . . . " One of our great allies at present is the Church itself.  Do not misunderstand me.  I do not mean the Church as we see her, spread out through all time and space and rooted in eternity, terrible as an army with banners.  That, I confess, is a spectacle which makes our boldest tempters uneasy. . . . All your patient sees is the half-finished, sham Gothic erection on the new building estate.  When he goes inside, he sees the local grocer with rather an oily expression on his face, bustling up to offer him one shiny little book containing a liturgy which neither of them understands, and one shabby little book containing corrupt texts of a number of religious lyrics, mostly bad, and in very small print.  When he gets to his pew and looks round him, he sees just that selection of his neighbours whom he has hitherto avoided.  You want to lean pretty heavily on those neighbours.  Make his mind flit to and fro between an expression like "the body of Christ" and the actual faces in the next pew.". . .

. . . "I have been writing hitherto on the assumption that the people in the next pew afford no rational ground for disappointment. Of course, if they do--if the patient knows that the woman with the absurd hat is a fanatical bridge player, or the man with squeaky boots is a miser and an extortioner--then your task is so much the easier.  All you then have to do is to keep out of his mind the question 'If I, being what I am, can consider that I am in some sense a Christian, why should the different vices of those people in the next pew prove that their religion is mere hypocrisy and convention?'  You may ask whether it is possible to keep such an obvious thought from occurring even to a human mind.  It is, Wormwood, it is!  Handle him properly and it simply won't come into his head.  He has not been anything like long enough with the Enemy to have any real humility yet.  What he says, even on his knees, about his own sinfulness is all parrot talk.. . . . and thinks that he is showing great humility and condescension in going to church with these 'smug', commonplace neighbours at all.  Keep him in that state of mind as long as you can."

My modern day interpretation?

1.  Our enemy has a lot to lose, so he's going to play dirty.  I need to be prepared for the unexpected distractions.

2.  Sometimes the enemy uses my bad attitude and negative body language to further his cause.

About a year ago, I was driving to church with my kids.  In Amarillo, if you are out and about on a Sunday morning, there is a very real probability that you are headed to a church.  My son decided he was going to start waving wildly (with a large smile on his face) at every car that we passed.  When I asked him what he was doing, he replied, "Mom, these people are going to church.  They need to tell their face.  They all look like they need a hug.  If I can make someone smile, I'm gonna try."  Wow!  Out of the mouth of babes. . . Now THAT is conviction!

I know, sometimes life is hard.  Sometimes we are going through tough stuff.  I get it.  However, one thing I have learned is: having a sour attitude NEVER fixes the problem.  Although, if I'm being honest, sarcasm helps me a lot. . . It generally ends with a smile, though.  So, I consider that a win!

3.  It's important to share with my fellow Christians my failures.

I feel, very often, like the enemy uses the rationale of "I need to have it all together in order to follow Christ".  Nothing could be further from the truth.  Romans 3:23 addresses this pretty simply: "For all have sinned and fall short of the glory of God."  The biggest reason to be a part of a larger group of believers is to, indeed, share life--the good, the bad, and the ugly. . . (insert whistle here. . . )

"Go ahead. . . Make. My. Day. . . "

But. . . you might consider doing it with a smile. . . :)

And now, a few corny quotes to brighten your day

 “You haven’t lost your smile at all, it’s right under your nose. You just forgot it was there.” 

“Use your smile to change the world; don’t let the world change your smile.” » Chinese Proverb

“If you see a friend without a smile; give him one of yours.” 

"Every time you smile at someone it is an action of love, a gift to that person, a beautiful thing" Mother Teresa

Wednesday, October 19, 2016

Day 1 Of My Election Stress Disorder Therapy

I recently read a report in Psychology Today about something known as "Election Stress Disorder".  Look it up.  Apparently, it's a real thing. . . (insert eye roll here).  Personally, I refer to this as spiritual warfare, but . . . . whatever. . .

That being said, I have found myself unusually on edge and apprehensive about the future of my country.  Hmmm. . . . maybe election stress disorder IS a real thing. . .

Like most of you, (I suspect) I am finding myself in a quandary these days.  I have made the conscious decision to no longer watch the news.  I try to limit my time on social media platforms.  I am trying examine my heart.  I am looking toward the future.  I am doing my best to love on people daily.  I am talking to God.

In fact, . . . .

 I am talking to God . . A LOT!

Fed up with the state of affairs in our country, I recently dusted off one of my copies (I have more than one) of C.S. Lewis' "The Screwtape Letters".  You see, it is one of my very favorite books, . . .  ever.  It was originally published in 1942.  However, on more than one occasion in my life, I have found it just as pertinent today as it was back then.

For those of you unfamiliar with "The Screwtape Letters", it is an allegory about the human condition and spiritual warfare.  It is a series of letters from Uncle Screwtape (one of Satan's demons) to his apprentice, Wormwood.  Wormwood is a "demon-in-training".  The chapters (or "letters") are short, and the book, in total, is not very long.  However,  if you read it with your brain engaged, it will take you some time to get through.  That said, I have decided to read it over again, during this exhausting election cycle.

Being the type of person that processes information better when I am able to write about it, I have decided to put my thoughts down in blog-format.  Read them. Don't read them. Whatever.  Basically, these will be my thoughts, as I re-read this wonderful work of art.

I would, however, welcome some company, as I read through the book.  So, please, comment below if you have something to add.  I will be curious to hear how these amazing words, by a brilliant man, impact you, personally.  Of note: I am only going to blog portions of the chapters.  I would highly recommend getting a copy to read in it's totality.

Chapter 1:

"My dear Wormwood, I note what you say about guiding your patient's reading and taking care that he sees a good deal of his materialist friend.  But are you not being a trifle naif?  It sounds as if you supposed that argument was the way to keep him out of the Enemy's clutches.  That might have been so if he had lived a few centuries earlier.  At that time the humans still knew pretty well when a thing was proved and when it was not; and if it was proved they really believed it. They still connect thinking with doing and were prepared to alter their way of life as the result of a chain of reasoning.  But what with the weekly press and other such weapons, we have largely altered that." . . . . .

. . . . . "The trouble about argument is that it moves the whole struggle onto the Enemy's own ground.  He can argue too; whereas in really practical propaganda of the kind I am suggesting He has been shown for centuries to be greatly the inferior of Our Father Below.  By the very act of arguing, you awake the patient's reason; and once it is awake, who can foresee the result?  Even if a particular train of thought can be twisted so as to end in our favour, you will find that you have been strengthening in your patient the fatal habit of attending to the universal issues and withdrawing his attention from the stream of immediate sense experiences.  Your business is to fix his attention on the stream.  Teach him to call it "real life" and don't let him ask what he means by "real". . . . . .

. . . . ."I once had a patient, a sound atheist, who used to read in the British Museum.  One day, as he sat reading, I saw a train of thought in his mind beginning to go the wrong way.  The Enemy, of course, was at his elbow in a moment.  Before I knew where I was, I saw my twenty years' work beginning to totter.  If I had lost my head and begun to attempt a defense by argument, I should have been undone.  But I was not such a fool.  I struck instantly at the part of the man which I had best under my control, and suggested that it was just about time he had some lunch.". . . .

. . . . "Once he was in the street the battle was won.  I showed him a newsboy shouting the midday paper, and a No. 73 bus going past and before he reached the bottom of the steps I had got into him an unalterable conviction that, whatever odd ideas might come into a man's head when he was shut up alone with his books, a healthy dose of 'real life' (by which he meant the bus and the newsboy) was enough to show him that all 'that sort of thing' just couldn't be true.  He knew he'd had a narrow escape, and in later years was fond of talking about 'that inarticulate sense for actuality which is our ultimate safeguard against the aberrations of mere logic.'  He is now safe in Our Father's house.". . . .

. . . . "Do remember you are there to fuddle him.". . . .

My modern day interpretation?

1.  The media is here to distract me.  They are doing a great job.

2.  "Real life" is also a distraction.  My parents used to say, over and over again: "Don't sweat the small stuff, and there ain't nothin' big.  Hmmm. . . seems much more profound now that I am older. . .

3.  Sometimes I need to be quiet, so I can hear the still, small voice of my Creator.  This world is noisy.  The enemy does that on purpose.

4.  The best way for me to see in the dark is to turn on the light.  My enemy is a great deceiver.  Calling him out on his antics merely turns on the light.  It exposes him for what he is: a manipulator that is intent on stirring up hatred and strife.

5.  I will continue to say this over, and over.  There is more that unites us, than divides us.  I would like to start my conversations there.  Finding common ground and common goals is the trail head for my journey.

6.  When all else fails, remember The Golden Rule:

Luke 6:31  Do unto others as you would have them do unto you.

7.  If the commandment to love is hard, try empathy:

"The way to love anything is to realize that it may be lost" G.K. Chesterton

Thursday, February 18, 2016

New Mexico Green Chile Stew

I was at the store the other day and pork loins were on sale.  Being a native New Mexican, I can always whip up some tasty fare with such a find.  Having just eaten some fantastic pork guisada at one of my favorite authentic New Mexican restaurants. . . right here in Amarillo, I thought, "I can make this.  And, I can make it waaaayy cheaper--especially with my pork loin on sale."

So, I hopped on Pinterest, as I had never actually made this variation of green chile stew before.  I was surprised by the lack of legit recipes on my beloved little cookbook in "the cloud".  My head almost exploded when I read one recipe that started out, "I have never been to New Mexico, but I want to go someday".  

Ummm. . . okay. . . never mind on  your recipe. . .

Out of desperation, I posted a quick plea to my fellow Land of Enchantment friends.  I received a variety of responses. . . all of which sounded great!  I kind of rolled them all into one. . . along with the basic staples that any good New Mexican keeps in their pantry/freeze/refrigerator and came up with this.  It was delicious. . . . and now I'm going to share. . . so Pinterest isn't filled with people from New Jersey posting recipes about "Authentic New Mexican Green Chile Stew".

As a disclaimer:  I'm pretty sure mine is not really "authentic" either.  However, I currently live in Texas, am forced to use what is on hand, and I really dislike roasting, peeling, and chopping tons of chile.  So, here's my recipe.  Hope you like it.  And, since I was actually born and raised in NM, I'm gonna just go ahead and claim it to be pretty darn close to the real deal.

1 pork tenderloin
1 onion
2 Tblsp of butter or oil
1-13 oz tub of Bueno chopped green chile (my store, in TX, keeps it in the freezer section)
2 small cans of green enchilada sauce (don't judge. . . it's too hard to make the real stuff, and this is pretty close)
1 cup chicken broth
2-3 small potatoes (chopped into small bite-sized pieces)

I generally slow roast my tenderloin, covered, in the oven @ 300 degrees for 2-3 hours.  I remove from oven and chop into small bite-sized pieces.  Place chopped pork in crock pot.  Saute chopped onion in butter.  Add to crock pot.  Add chile, enchilada sauce, chicken broth and chopped potatoes.  Cook on low for 2-3 hours and serve with tortillas.

My daughter somehow ended up a lightweight with chile, so I made this batch G-rated.  To turn up the heat, I added some of this to my bowl:

To my fellow New Mexicans, I'm sorry.  I'm embarrassed to be admitting this to you, but this stuff is from Target and it is unbelievable!  Seriously, you should try it.  I was skeptical too.  My lips are still burning from it.

Here's the finished product.  Hope you like it!

Of note:  you can add corn or hominy, too.  I just like mine with potatoes, and I was trying to keep the carbs down.  FYI, if you add hominy, most New Mexican's refer to this as posole. . . for those of you from New Jersey. . . :)