My $800 prescription Costa del Sol sunglasses are falling apart. I justified the purchase, banking on the reputation of Costas for durability and their lifetime warranty, knowing that if my prescription changed in time, I could just replace the lenses and keep the frames. Now the rubberized portions are breaking down and coming off the plastic stems. I don’t abuse them. I keep them in a case when not wearing them and I don’t wear them all that often in rugged outdoor activities for which they are supposedly designed.
I took them to the optician, where I bought them, and she informed me they no longer carry Costas because the quality and support have gotten so bad. The lifetime warranty has been replaced with a two year limited warranty, so I am SOL. She said the decline began when Costa was bought by the French eyeglass company, Essilor, and accelerated in 2018 when Essilor merged with Luxottica to become the single largest supplier of eyeglass lenses and frames in the world. EssilorLuxottica now owns Oakley, Ray-Ban, Chanel, Coach, Polo Ralph Lauren, Prada, Costas, and dozens more.
What does this have to do with the state of medicine today? It shows what corporatization does to small firms that start out producing a high quality, popular product or service. The firm loses its soul. The same thing has happened to medicine.
My maternal grandfather, a retired physician, once took me on a walk around his neighborhood in Rio de Janeiro, Brazil when I was somewhere around five or six-years-old. “I want you to meet a very distinguished gentleman,” he said. In those days, his neighborhood street was cobblestone with high curbs on either side. Today, we have big trucks with air-conditioned cabins and large, rotating brushes to sweep off our street. Back then, street sweepers were day laborers, most of whom lived in the ‘favelas’ (slums) for which Rio is known. They were transported each morning to their respective locations throughout the city with their large garbage cans on a hand cart, broom, and shovel to sweep the gutters.
As we approached one of these street sweepers, Vovo (grandpa in Portuguese) greeted the middle-age black man by name and the greeting was returned with a smile, “Bon dia, Dr. Abel (my grandfather’s first name).” Vovo introduced me as his grandson and we shook hands. Vovo inquired about the man’s wife and children and they spoke for perhaps 5 minutes or so before we left and the man resumed work. I later learned that he was one of my grandfather’s patients from years earlier.
You will not hear about this in the mainstream media.
Thanks to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 the push for adoption of electronic health records (EHR) began with a vengeance, long before these programs were truly ready. The government adopted a carrot-and-stick approach, rewarding those who jumped onboard and punishing those who did not.
If you ask any physician what they think about HER, be prepared for a profanity-laden reply. The programs are too complicated, requiring more data input than necessary. The screens are too full of extraneous information. The endless point and click to accomplish a simple task is maddening. They abet abuse such as copy/pasting the same patient information over and over. They allow for upcoding simple encounters, a form of fraud to increase reimbursement. Things get missed. They slow physicians down. Even the manufacturers of these programs acknowledge they decrease physician productivity. We are promised improvements as new programs come out, but this seems to never be realized. The recent switch to EPIC at local hospitals is an example.
Ever have one of those days that just don’t start well and put you in a foul mood from the get go? Last Friday, I had two surgical cases scheduled at the hospital. I love surgery and being in the operating room is my happy place, most of the time. The first case was to start at 09:15. It was a straightforward debridement and skin grafting of an open wound on the leg in a patient with a complex medical history. The surgery itself, however, was relatively easy even if the outcome was not assured. My second case was much more complex, a bilateral breast reconstruction. These are always a challenge because there is so much that has to go right for success. I wasn’t stressed about the first case but the second weighed heavily on my mind. I was looking forward to getting the first case done with dispatch so I could focus my attention and energy on the second.
I recently watched Uncharted,the latest Netflix offering on cable. At least I tried. I really did. After two failed attempts to watch this steaming pile of cinematic crap, I gave up on the third, barely getting halfway through. And I’ve watched some real dogs from start to finish. How does it end? I don’t know and, to quote the immortal words of Rhett Butler, “Frankly, Scarlett, I don’t give a damn.” Life is too short.
The fact that this dog of an action film made over $400 million at the box office means either I am out of the loop- not necessarily unlikely- or the hunger for getting out to the movies after three years of Covid is such that we’ll watch anything if it means getting out of the house and among people.
The script and screenplay for this pathetic excuse for a movie is borrowed, or should I say plagiarized, from a dozen or more movies of similar genre, all of them orders of magnitude better. If you want a globe trotting action movie in search of a mystical archaeological treasure, watch Raiders of the Lost Ark. Search for pirate treasure? Goonies. Conflicted buddy film? The Hitman’s Bodyguard. The last is very funny with non-stop action and profanity (after all Samuel Jackson is in it so the M*F*s just seamlessly string together. Amazingly, Salma Hayek matches him expletive for expletive). I can name a dozen buddy movies that have better chemistry. Think Billy Crystal and Gregory Hines in Running Scared. Heck, go watch Butch Cassidy and the Sundance Kid or The Sting again if you want to see how it is really done.
The writers must have been stoned, drunk, or just didn’t give a sh*t when they wrote the completely incoherent plot. The different scenes seem disconnected. The big action moments and ridiculous CG cause you to cringe. There is a universe of difference between “That’s amazing!” or “Wow!” and “That’s insulting” or “That’s just idiotic”.
The woke factor is huge here. First there is the nod to immoral colonialism represented by Magellan’s voyage. Then there is the unfettered capitalist greed of chasing all that gold. The villain is Antonio Banderas, a white guy with Latinx creds, who relies on his fading charm and accent (remember the sexy “Corrr-do-va” Chrysler commercials with Ricardo Montalban) to sleepwalk through his scenes. But wait! The real villain is a villainess, Tati Gabrielle, who plays an androgynous, sexually ambiguous, black, female whose hair is a skullcap of plastered down white ringlets and kicks ass, including – spoiler alert—slitting the throat of said Latinx villain. The real heroine seems to be Pakistani-American Sophia Ali. You go, girl.
I am embarrassed for Mark Wahlberg, who I truly like as an actor, Tom Holland, indeed, all the cast who seem, at every moment, to be saying, “I wish I was somewhere else.” I hope the pay day was worth it.
I did not know until I wrote this that the movie is based on a board game. Yikes! I think I will go watch Jumanji again…………..
There are a million better ways to spend two hours.
I have never been a rah-rah patriotic zealot. I went through a period in high school and college where I was, if not ashamed, not particularly proud of my country. I even considered eventually moving to Brazil, the country of my mother’s birth, to live because I saw it in some ways better than the U.S.
My draft lottery number was so high, I never had to apply for a deferment and was able to attend college without fear of being drafted. When I was accepted to medical school in 1974, I had to find a way to pay for this. I joined the Navy, which had a scholarship program. While I was proud to serve, and did honorably for 13 years, my reason for joining was almost entirely financial; I preferred to pay back time in the Navy instead of money to a bank. I was discharged in 1987, proud of my service and free of debt.
In November 2013, I completed the Florida Ironman Triathlon. That seminal accomplishment was preceded by one year of cold showers. That’s right, 365 consecutive days, and then some, of taking only cold showers as part of my training. I revisited this in January 2017 briefly when our hot water heater died and could not be replaced for 5 days.
It is now July 23 and I have not taken a hot shower since January 1. An otherwise normal person might ask a perfectly reasonable question: why? To answer that, I have to go back to a chance comment by my son-in-law in 2012 as I was wrestling with the decision to attempt an Ironman. David mentioned that some athletes use cold showers to help them train. There are many benefits to a cold shower. They can help sore muscles recover faster. They can improve circulation to muscles and heart by constricting blood vessels in the skin. They can stimulate a rush of feel-good hormones and neurotransmitters in the body, and provide a host of other benefits as well.
The growing acceptance and popularity of cosmetic surgery brings with it some real concerns and dangers. Altering one’s physical appearance with surgery is not something to be undertaken lightly. Surgery is always irreversible to some degree, if only due to the scar(s). Cosmetic surgery is real surgery and carries all the potential risks of any operation: infection, bleeding, injuring to structures near the surgical site, poor healing, unsightly scars, and anesthetic complications. Then there are the potential life-threatening complications such as blood clots leading to embolism in the lungs, heart attacks, strokes, pneumonia, and more. There are books written on surgical complications.
The weighing of risk versus benefit takes on special significance in cosmetic surgery because it is medically unnecessary. Patients undergo cosmetic procedures because they wish to, not because they need to. Ideally, cosmetic surgery would be free of risk, but that is not reality. It is incumbent, however, for surgeons to do everything in their power to minimize the risks for any cosmetic procedure for every patient. Enter the Brazilian Butt Lift, popularly known as the BBL.
I consider myself a reasonably intelligent person, a man of science, possessing of a degree of common sense, and one who attempts to rationally think through things before expressing opinions. With that in mind, I have a few questions.
1.Why do we allow over 2 million illegal aliens to enter through our southern border without any documentation, vetting, or requirement for testing for Covid yet I, as an America citizen who leaves this country on vacation or business, cannot re-enter without proof of a negative Covid test?
2. Why does the US Supreme Court disallow vaccine mandates for private businesses yet permits them for federal employees and employees of any institution that receives Federal funds? Are those persons more at risk? Do they not deserve the same freedom of choice as private business employees?
3. Why are we acting as though Omicron is the latest apocalyptic plague when all the indications, ALL the indications, are that it is not much worse than a bad cold? Why do we ignore numbers that encourage the country, such as minimal rise in hospitalizations and a decline in Covid deaths, and focus on those, e.g. rising cases, that justify continued draconian measures to “save even a single life?”
I cannot think of a better way to begin 2022 than to speak truth to power because 2021 and the year that preceded it were almost entirely about power over truth. It has been the power of government over the individual citizen; about power of wealthy, elite progressives over the working class; about power of the media, both mainstream and social, to censor and cancel citizens and even entire institutions that did not adhere to their explanation of events; and even the power of a few, elitist, politically motivated scientists and doctors over clinicians on the front lines of patient care. It has been the power of an ideological narrative over facts. It has been the power of gaslighting wherein we are told to believe the media spin rather than our own eyes.
