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!