1. Featured Article: The Information Factories by George
Gilder, Wired Magazine
The desktop is dead. Welcome to
the Internet cloud, where massive facilities across the globe will store all
the data you'll ever use. George Gilder on the dawning of the petabyte age.
THE DRIVE UP
INTERSTATE 84, through the
verdant amphitheatrical sweep of the Columbia River Gorge to the quaint Oregon
town of The Dalles, seems a trek into an alluring American past. You pass
ancient basalt bluffs riven by luminous waterfalls, glimpsed through a filigree
of Douglas firs. You see signs leading to museums of native Americana full of
feathery and leathery tribal relics. There are farms and fisheries, vineyards
arrayed on hillsides, eagles and ospreys riding the winds. On the horizon, just
a half hour's drive away, stands the radiant, snowcapped peak of Mount Hood,
site of 11 glaciers, source of half a dozen rivers, and home of four-season
skiing. "I could live here," I say to myself with a backward glance
down the highway toward urban Portland, a sylvan dream of the billboarded
corridor that connects Silicon Valley and San Francisco.
Then, as the road comes to an end, the gray
ruin of an abandoned aluminum plant rises from a barren hillside. Its gothic
gantries and cavernous smelters stand empty and forlorn, a poignant warning of
the evanescence of industrial power.
But industry has returned to The Dalles,
albeit industry with a decidedly postindustrial flavor. For it's here that
Google has chosen to build its new 30‑acre campus, the base for a server
farm of unprecedented proportion.
Although the evergreen mazes, mountain
majesties, and always-on skiing surely play a role, two amenities in particular
make this the perfect site for a next-gen data center. One is a fiber-optic hub
linked to Harbour Pointe, Washington, the coastal landing base of PC-1, a
fiber-optic artery built to handle 640 Gbps that connects Asia to the US. A
glassy extension cord snakes through all the town's major buildings, tapping
into the greater Internet though NoaNet, a node of the experimental Internet2.
The other attraction is The Dalles Dam and its 1.8‑gigawatt power
station. The half-mile-long dam is a crucial source of cheap electrical
power - once essential to aluminum
smelting, now a strategic resource in the next phase in the digital revolution.
Indeed, Google and other Silicon Valley titans are looking to the Columbia
River to supply ceaseless cycles of electricity at about a fifth of what they
would cost in the San Francisco Bay Area. Why? To feed the ravenous appetite of
a new breed of computer. To read more, please go to www.medicaltuesday.net/feature.asp.
Moore's law has a corollary that bears the
name of Gordon Bell, the legendary engineer behind Digital Equipment's VAX line
of advanced computers and now a principal researcher at Microsoft. According to
Bell's law, every decade a new class of computer emerges from a hundredfold
drop in the price of processing power. As we approach a billionth of a cent per
byte of storage, and pennies per gigabit per second of bandwidth, what kind of
machine labors to be born?
How will we feed it?
How will it be tamed?
And how soon will it, in its inevitable turn,
become a dinosaur?
One characteristic of this new machine is
clear. It arises from a world measured in the prefix giga, but its
operating environment is the petascale. We're all petaphiles now, plugged into
a world of petabytes, petaops, petaflops. Mouthing the prefix peta
(signifying numbers of the magnitude 10 to the 15th power, a million billion)
and the Latin verb petere (to search), we are doubly petacentric in
our peregrinations through the hypertrophic network cloud.
Just last century - you remember it well, across the chasm of the crash - the PC was king. The mainframe was deposed
and deceased. The desktop was the data center. Larry Page and Sergey Brin were
nonprofit googoos babbling about searching their 150-gigabyte index of the
Internet. When I wanted to electrify crowds with my uncanny sense of futurity,
I would talk terascale (10 to the 12th power), describing a Web with an
unimaginably enormous total of 15 terabytes of content.
Yawn. Today Google rules a total database of
hundreds of petabytes, swelled every 24 hours by terabytes of Gmails, MySpace
pages, and dancing-doggy videos - a
relentless march of daily deltas, each larger than the whole Web of a decade
ago. To make sense of it all, Page and Brin
- with Microsoft, Yahoo, and Barry "QVC" Diller's Ask.com hot
on their heels - are frantically taking
the computer-on-a-chip and multiplying it, in massively parallel arrays, into a
computer-on-a-planet.
The data centers these companies are building
began as exercises in making the planet's ever-growing data pile searchable.
Now, turbocharged with billions in Madison Avenue mad money for targeted
advertisements, they're morphing into general-purpose computing platforms,
vastly more powerful than any built before. All those PCs are still there, but
they have less and less to do, as Google and the others take on more and more
of the duties once delegated to the CPU. Optical networks, which move data over
vast distances without degradation, allow computing to migrate to wherever
power is cheapest. Thus, the new computing architecture scales across Earth's
surface. Ironically, this emerging architecture is interlinked by the very
technology that was supposed to be Big Computing's downfall: the Internet.
In the PC era, the winners were companies
that dominated the microcosm of the silicon chip. The new age of petacomputing
will be ruled by the masters of the remote data center - those who optimally manage processing
power, electricity, bandwidth, storage, and location. They will leverage the
Net to provide not only search, but also the panoply of applications formerly
housed on the desktop. For the moment, at least, the dawning era favors scale
in hardware rather than software applications, and centralized operations
management rather than operating systems at the network's edge. The burden of
playing catch-up in this new game may be what prompted Bill Gates to hand over
technical leadership at Microsoft to Craig Mundie, a supercomputer expert, and
Ray Ozzie, who made his name in network-based enterprise software with Lotus
and Groove Networks.
Having clambered well up the petascale slope,
Google has a privileged view of the future it is building - a perspective it's understandably reticent
to share. Proud of their front end of public search and advertising algorithms,
the G-men hide their hardware coup behind an aw-shucks, bought-it-at-Fry's
facade. They resist the notion that their advantage springs chiefly from
mastering the intricate dynamics of a newly recentralized computing
architecture. This modesty may be disingenuous, of course, but amid the
perpetual onrush of technological innovation, it may well be the soul of
wisdom. After all, the advantage might turn out to be short-lived. . .
THE FASTEST-GROWING search engine
- besides Google - isn't
Microsoft or Yahoo or AOL. It's Ask.com, which has seen its total searches grow
20 percent this year. Like Google, Ask.com has built a petascale computer out
of commodity CPUs, hard disks, and RAM chips. And while Google doesn't permit
outsiders to ogle the hardware inside its data centers, Ask.com is eager for
the attention.
The East Coast branch of Ask.com's machine
occupies a 500,000-square-foot concrete structure at the end of a long and
winding suburban road. The driveway runs a gauntlet of pylons bearing heavy
gray power lines and festooned with smaller yellow fiber-optic cables. The
windowless facility crouches behind a 10-foot-high chain-link fence in a drab
tan camouflage that suggests military-level security. The building holds the
central nervous system of not only Ask.com, which occupies more than half the
space, but also other well-known information technology companies. Corporate
logos are conspicuously absent.
The facility is run by telco giant Verizon.
It was designed not for supercomputing but for communications, steering photons
through glass threads and mostly copper switches toward their telephonic
destinations. MCI, a Verizon acquisition, built it to accommodate UUNet, the
premier high-end Internet service provider. . .
Amid the beckoning fantasies of futurism, the
purpose of whatever comes next - like
that of today's petapede - will be to
serve the ultimate, and still the only general-purpose, petascale computer: the
human brain. The brain demonstrates the superiority of the edge over the core:
It's not agglomerated in a few air-conditioned nodes, but dispersed far and
wide and interconnected via myriad sensory and media channels. The test of the
new global ganglia of computers and cables, worldwide webs of glass and light
and air, is how readily they take advantage of unexpected contributions from
free human minds, in all their creativity and diversity. Search and you shall
find.
To read the entire article, please go to www.wired.com/wired/archive/14.10/cloudware_pr.html.
George Gilder (info@gilder.com)
is a senior fellow at the Discovery Institute and publishes the Gilder
Technology Report.
© Copyright©
1993-2006 The Condι Nast Publications Inc. All rights reserved.
* * * * *
2. In the News: Nobel Peace Prize Goes to Muhammad Yunus,
Lender to the Poor
Richly
deserved prize for banker to the poor by By Tom Hundley, Chicago
Muhammad
Yunus, the Bangladeshi winner of the Nobel Peace Prize, has helped lift
millions of women and men from poverty, nurturing the entrepreneurial spirit
one small loan at a time
LONDON -- It would have been more charitable--and certainly a lot
easier--just to give the poor woman the money. But instead, Muhammad Yunus lent
her $27.
"Charity is not the answer to poverty," Yunus wrote earlier this
year. "It only helps poverty to continue. It creates dependency and takes
away the individual's initiative to break through the wall of poverty."
The woman and several of her friends used the small loan to start a successful
furniture-making business and to escape the bonds of poverty in their rural
Bangladeshi village. They repaid the loan in full.
Thirty years and more than $5.7 billion in loans later, Yunus' insight into the
nature of poverty and the spirit of entrepreneurship has earned him the Nobel
Peace Prize.
On Friday, the Norwegian Nobel committee awarded the $1.4 million prize jointly
to Yunus and Grameen Bank, the lending agency he founded in 1983 to pioneer the
concept of microcredit--small loans that have helped lift millions out of
poverty.
"Muhammad Yunus has shown himself to be a leader who has managed to
translate visions into practical action for the benefit of millions of people,
not only in Bangladesh but also in many other countries," the Nobel
committee said in its citation.
Yunus is the first Nobel laureate from Bangladesh, a wrenchingly poor South
Asia country that usually makes headlines for floods and famines.
"I am so, so happy. It's really great news for the whole nation,"
Yunus told The Associated Press from his home in Dhaka, the Bangladeshi
capital.
Yunus, in a 2004 interview with AP, said the idea of using seemingly
insignificant loans to help the poor came to him in 1974 while he was doing
field work as a rural economist at the University of Chittagong. He met Sufia
Begum, a 21-year-old mother of three, who was trying to make ends meet by
making bamboo stools.
She explained to him that she had borrowed about 5 taka (9 cents) from a
village moneylender for the raw materials to make each stool but collected only
2 cents in profit on the finished product after repaying the interest on her
debt.
`She has become a slave'
"I thought to myself: My God, for 5 taka she has become a slave,"
Yunus said in the interview.
"I couldn't understand how she could be so poor when she was making such
beautiful things."
Yunus investigated further and discovered that the female artisans in the
village owed the moneylender a total of 856 taka, or $27.
"I couldn't take it anymore. I put the $27 out there and told them they
could liberate themselves," he said. By cutting out the moneylender and
his exorbitant interest rates, the women quickly earned a decent return on
their labor and repaid their loan to Yunus.
Yunus' revolutionary idea was that the poor could be as creditworthy as the
rich and that small loans could unleash the entrepreneurial talents of people
who had historically been written off as economic basket cases.
He founded Grameen Bank on this principle. Since opening its doors in 1983, the
bank has made small loans--usually about $200, but some as little as $20--to
more than 6 million borrowers, almost all of them women.
Instead of the usual tests of a borrower's creditworthiness, Grameen's approach
was to lend money to small groups of people, with each responsible for the
other's debt. The culture of personal shame and honor that prevails in rural
Bangladesh served as sufficient collateral.
Grameen Bank boasts of a repayment rate of 98.5 percent. In most developing
countries, government-subsidized banks that lend money to businesses and the
affluent usually write off about 50 percent of their loans.
"Yunus and Grameen Bank have shown that even the poorest of the poor can
work to bring about their own development," the Nobel committee said. . .
In announcing this year's unconventional winner, the Nobel committee recognized
that "lasting peace cannot be achieved unless large population groups find
ways in which to break out of poverty.
"Microcredit is one such means. Development from below also serves to
advance democracy and human rights," it said.
Yunus said he would use part of the $1.4 million prize to start a company that
makes low-cost, high-nutrition food for the poor.
To read the entire report, please go to www.chicagotribune.com/news/nationworld/chi-0610140237oct14,1,3952805.story.
Email: thundley@tribune.com Copyright © 2006, Chicago Tribune
To receive an update each month on the
microcredit, send your e-mail address to grameen.bank@grameen.net.
Dr. Yunus has spoken at the last two World
Health Care Congresses. For details, please note the lead paragraph on the
first MedicalTuesday Newsletter each month. To review, please go to www.medicaltuesday.net/archives/Oct1006.htm.
* * * * *
3.
International
Medicine: NHS Centres 'Rationing
Consultant Visits' By
Beezy Marsh, Health Correspondent, London Telegraph (Filed: 15/10/2006)
New
centres that "screen" patient referrals from GPs to hospital
consultants are being used by the NHS to ration health care by stealth, say
medical professionals.
More
than a third of primary care trusts (PCTs) have established "referral
management centres" that, critics say, are preventing patients from seeing
the doctor of their choice and in some cases are prolonging waiting times in
order to save cash.
In
one case, GPs found thousands of referral letters stashed in a cupboard for
weeks. Patients' groups and doctors' leaders say the referral schemes, which
are sanctioned by the Department of Health, are creating another tier of NHS
bureaucracy and could actually harm people's health.
GPs
say some centres are refusing to let patients see consultants sooner than the
Government's outpatient target of 13 weeks. This limits the number of
appointments in any one year - saving the PCT money.
In
some trusts, people are being sent back to their GPs by doctors employed by
referral centres, who decide they are not sick enough to warrant a hospital
consultation.
In
a survey carried out by the medical magazine Pulse, 10 per cent of all PCTs
admitted they had a specific target to cut GP referrals.
When
patients in Milton Keynes started complaining of long delays, their GPs
investigated. Milton Keynes PCT had set up a referral management centre, which
was meant to scrutinise all referrals in order to speed access and ensure
patients got the right treatment. But Dr Peter Berkin and colleagues discovered
a backlog of more than 2,000 letters locked in a cupboard by the centre's
secretaries until just short of the 13-week waiting-time target. . .
Katherine
Murphy, of the Patients' Association, said: "These centres are springing
up all over the place, but who's monitoring what they're up to? It seems to be
another way of rationing patient care by stealth." Dr Hamish Meldrum,
chairman of the British Medical Association's GPs' committee, said: "There
is considerable concern among doctors. Where clinicians have been involved,
things may be working well, but in other places there has been no effective
consultation and it seems the main intention is to cut costs. This is
potentially harmful to patients' health."
A
Department of Health official said referral centres were a "local
initiative" by PCTs, but national guidance had been issued on running
them. "They must only be set up where they will have clinical benefits and
should add value to patient services. They should not conflict with giving
patients more choice [and] must not lengthen the patient journey or create 'hidden'
waiting times."
To
read the entire report, please go to www.telegraph.co.uk/news/main.jhtml;jsessionid=NP5FWX32L1XSTQFIQMFCFGGAVCBQYIV0?xml=/news/2006/10/15/nhs15.xml.
Canadian
Medicare does not give timely access to healthcare, it only gives access to a
waiting list.
--Canada's
Supreme Court
UK NHS also
only gives access to a waiting list that can be bureaucratically manipulated.
* * * * *
Airbus
CEO's Resignation Reflects Company's Deep Structural Woes By DANIEL MICHAELS, WSJ,
The resignation of Airbus Chief Executive Christian
Streiff after just three months on the job underscores the steep hurdles facing
the big European aircraft maker as it tries to overcome damaging delays in its
largest jet program and overhaul a cumbersome structure beset by politics and
bureaucracy.
The major French and German
shareholders of Airbus's 80% owner, European Aeronautic Defence & Space
Co., quickly named a top EADS official to succeed Mr. Streiff, who resigned
after a clash with the EADS board over his demands for greater autonomy as well
as over how to quickly implement a planned tip-to-tail restructuring of Airbus
announced last week. . .
The structure of Airbus --
created in 1970 by technocrats in
Those tensions are a further
example of the troubles arising from European efforts to maintain national
balance within multinational companies. Petroleum giant Royal Dutch/Shell,
industrial group ABB and consumer-products giant Unilever have all stumbled in
recent years in part because of split management that was guided as much by
political forces as economic interests.
In Airbus's case the tensions
have been aggravated by the company's recent problems, especially the repeated
delays in its $12 billion program to build the world's largest-ever passenger
jet, the A380, which is now two years behind schedule and about 30% over
budget. The delays have alienated customers and dented profits at Airbus, but
they are benefiting
Today, sales figures clearly show
that Boeing is benefiting from its restructuring, as well as from Airbus's
troubles. While Airbus is on course to deliver more planes than Boeing this
year, thanks to orders placed several years back, it lags badly behind on new
sales. For the year through Sept. 30, Airbus logged orders for 226 new planes,
of which only 36 were higher-margin widebodies. Boeing, through Oct. 3, posted
orders for 723 new planes, including 184 widebodies . . .
The so-called Power8
restructuring plan, which Mr. Gallois will now spearhead, goes beyond getting
the A380 program back on track. Managers of both Airbus and EADS indicated last
week that they were willing to "break taboos" and tackle politically
sensitive issues. When EADS was formed in 2000 from the merger of aerospace
companies from France, Germany and Spain, the company said it aimed to run
Airbus efficiently, breaking with the aircraft maker's past by keeping a cold
eye on the bottom line. That has proved difficult.
EADS's split management -- with
dual French and German chairmen and CEOs -- was created to avoid tipping the
balance of power inside EADS toward France or Germany. Maintaining that balance
has saddled Airbus with a clumsy division of labor between French and German
factories. The arrangement has helped preserve jobs in both countries over the
years, but has proved costly in building planes. . .
But by yesterday, EADS's board
members, on both the German and French sides, had lost confidence in Mr.
Streiff's ability to implement his plans successfully, say people familiar with
board members' discussions. They felt the executive wasn't diplomatic enough to
handle the politically sensitive task of restructuring Airbus -- especially
because it is likely to entail job cuts, closing plants and shifting
high-profile manufacturing work from one country to another.
--Stephen Power and David Gauthier-Villars
contributed to this article.
To read the entire
article, please go to http://online.wsj.com/article_print/SB116040215416386840.html.
Write
to Daniel
Michaels at daniel.michaels@wsj.com.
Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Going to Urgent Care Centers
Improves Quality
Mr Gambezo, a 47-year-old man with
late-in-life onset of asthma, required steroids to break his asthma attacks.
After being seen and observed closely while medications were adjusted, he was
given detailed instructions to reduce the steroid tablets once his asthma was
under control. He had been told to do this
slowly and if he began wheezing again, to promptly increase the dose to bring
the wheezing under control. However, he stopped them suddenly with prompt
re-exacerbation of wheezing. He then went to the urgent care center and a
number of tests were duplicated, including a chest x-ray. The x-ray was read as
pneumonia and he was given antibiotics.
On returning to the office for a follow up
to re-check his x-rays to make sure the pneumonia cleared, it was noted that
the x-rays were unchanged from his previous ones, with some scarring in the
left base. His steroids were again adjusted and the next week he reduced them
faster than suggested and experienced another asthma attack and went to the
urgent care center. He was again told he had pneumonia (the former pneumonia
had not fully cleared) and he was given antibiotics.
Our follow up chest x-ray again was
unchanged from our previous one, and it was suspected that the x-rays in the
urgent care center were probably also like ours. After acquiring these films,
it was determined that there had never been any changes of pneumonia. The
isolated chest x-ray, read out of context of his other films, was misread as
pneumonia.
This sequence of health-care events points
out two corollaries: 1) to switch health-care teams, from your own physician to
one unfamiliar with your primary disease, for an exacerbation of a chronic
problem is very expensive. This patient exchanged fifty cents worth of steroids,
which would have reversed his asthma attack, for a $500 urgent care call with
duplicated unnecessary tests, including x-rays. 2) The patient, of course,
interprets all these unnecessary tests and treatments as an improvement in the
quality of care, when there was no improvement, just reaffirmation of patient
non-compliance with recommended treatment.
Sometimes the Most Gluttonous
Behavior Will Be Interpreted As an Improvement in Quality
* * * * *
6.
Medical Myths:
Health Insurance for All Will Improve Our Nation's Health.
A recent health insurance
brochure pointed out that one percent of its members use 40 percent of their
health care dollars. This causes us to reflect on a poorly known fact. The sick
already have Medicare, Medicaid or private health insurance. That covers nearly
all the major health needs of the American people. Making the other 40 million
relatively healthy individuals pay health insurance premiums only increases
profits for big insurance. It adds very little to the Nation's Health. In fact,
the increased bureaucracy for the 40 million will probably decrease their
access to health care.
Health Insurance for All
Will Only Improve Big Insurance's Wealth
* * * * *
7. Overheard in the Medical Staff Lounge: The Holocaust
Mentality
Dr Dave: Did you
happen to hear Grover Norquist on Fresh Air the other morning?
Dr Ruth: I'm sure he
said something that wasn't very welcomed by Fresh Air.
Dr Dave: Fresh Air was on a
tirade to tax the Rich. Grover very calmly remarked that to stick it to a small
strata of society that was defenseless to resist was basically a holocaust
mentality.
Dr Ruth: I can just
see Fresh Air come unglued on that one.
Dr Dave: I could almost feel her coming out of her chair as
she exclaimed what he meant by that.
Dr. Rosen: And now we have a candidate for Governor of
California with the same Holocaust mentality. He wants to tax the rich to pay
for a lot of social programs that generally don't work.
Dr Michelle: But they do. The poor need a lot of help.
Dr Rosen: They do. But
welfare hasnt helped them.
Dr Dave: We also have a candidate for Lieutenant Governor who
has spent his life as insurance commissioner suing big insurance, selling and
liquidating big insurance to a French company financed by the French government
who paid his asking price, then suing that company when it turned out that our
insurance commissioner made a multibillion dollar error in valuation, spending
$165 million in legal fees to overturn his own sale, which was only limited by
budgetary restraints. Doesn't he have the same Holocaust mentality under the
auspices of helping people, only depriving a lot of working people out of their
insurance and pensions, and blaming it on the lack of tax revenues? If only he
could take more money away from the well-to-do, there would be no limit as to
how much good he thinks that he could do. He completely ignores the
testimonials in the papers on the people who lost their homes because of him.
Dr Edward: But he's for socialized medicine. Don't you think
it's about time we follow the rest of the world?
Dr Dave: No. My grandfather escaped Bismarcks socialized
medicine in the 19th century. Where could we escape to if we became
like old Europe? America is our sanctuary. It is the last sanctuary for
freedom.
Dr Rosen: Didn't you read the article in today's paper on the
Nobel Peace Prize? Professor Muhammad Yunus from Bangladesh wrote,
"Charity is not the answer to poverty. It only helps poverty to continue.
It creates dependency and takes away the individual's initiative to break
through the wall of poverty." In addition to his micro-credit, he also
helps the poor with health insurance and efficient clinics that can provide
cataract and other necessary operations at minimal cost, not handouts. Half of
the Nobel Prize went to the Grameen Bank, which distributes the $27 loans. www.grameen.com/
Dr Michelle: I still think it is much easier to help the poor by
giving them money rather than make them work for it?
Dr Rosen: I think you should read what Professor Yunus explains
are the real answers for helping the poor. Handouts never help. They will again
be poor tomorrow. By using micro-credit loans, they will be independent
tomorrow and perhaps wealthy in the future.
* * * *
8. Voices of Medicine: What Doctors are Writing About in
Regional Medical Journals
Sonoma Medicine, the Magazine
of the Sonoma County Medical Association, OUTSIDE THE OFFICE:
A Country
Impossible To Understand By Jose Morales, MD
Over the past two years, our
family has visited China three times. This adventure started off as a fun
family trip to explore my wife's country of birth. We wanted to see the city my
in-laws grew up in and show our girls where half their heritage originated.
Our adventure has since evolved into a continuing discovery of what China has
been, what it is now, and what it may become. I documented our discovery in a
series of photographs, some of which are reproduced here and on pages 23 and
47. These particular images show some of the contrasts we witnessed throughout
the country.
Our three trips lasted 10 weeks total and brought us not only to large cities -
such as Hong Kong, Beijing, and Shanghai - but also to smaller cities and
towns, including Fuzhou, its surrounding villages, and Hanzhou. Our trips
differed in many ways from an average vacation in China, particularly since we
did not join an organized tour. Instead, we traveled about on our own.
No matter where we went, we were universally met with kindness and curiosity.
Our girls were treated like little celebrities and often became the center of
attention. Everyone from teens to grandparents wanted to know how old the girls
were (6 and 9), if they were twins (don't forget that China is a one-child nation),
and most important, could they speak Chinese? (a little).
We saw first-hand how rapidly China is evolving. When we arrived in Fuzhou in
2004, for example, I had to ride on the back of a motorcycle to a distant
housing block and use a dial-up modem belonging to a "friend of a
friend" for Internet access. The deal was sealed with a large bag of fruit
I carried over my shoulder. Fast forward to this past May, when all we needed
was to walk downstairs from our apartment and choose between three Internet
cafes within two blocks. The cafes were all full of 20-somethings playing video
games and sending text messages.
Two other signs of "progress" are much sadder. The first is a rise in
the number of overweight kids, and the second is a similar increase in young
smokers filling the cafes and restaurants. These unfortunate trends seem to be
a byproduct of increasingly Western tastes.
The more we have gotten to know this dynamic country, the more it seems
impossible to understand. China is a strange mix of claustrophobic crowds,
crazy traffic, ancient customs, modern life, beautiful colors, rudeness,
kindness, and politics - all revolving around an incredible dynamic energy of
growth.
To read the entire
article and view some incredible photos, please go to www.scma.org/magazine/scp/Fall06/morales.html.
Dr. Morales is a
Santa Rosa pediatrician.
* * * * *
9. Book Review: Final Crossing: Learning to Die
in Order to Live
Sonoma
Medicine, the Magazine of the Sonoma
County Medical Society, Current Books:
Being There When It Happens, by Rick Flinders, MD, a review on
Final Crossing: Learning to
Die in Order to Live, by Dr. Scott Eberle, 187 pages, Lost Borders Press, $19.95.
I once read a book about Zen which began: "If you
like sweets and easy living, don't read this book." At the age of 19, I liked
sweets and easy living, but I read the book anyway. It was one of the most
influential books I've ever read.
Final Crossing, by Dr. Scott Eberle, is a serious work about a serious
subject: death. Indeed, is there any subject more serious? Perhaps, the author
himself might argue, there is only one: life. And it appears to be Eberle's
intent, by exploring one man's conscious journey through the dying process, to
cast light and understanding on the process of how we might more consciously
live.
This is not a superficial tourist's guide. For more than 20 years, Eberle has
worked with the dying as a physician, teacher, and companion. He writes with an
experience and authority that can come only from someone who has done the work.
Like the Zen book I read 40 years ago, Eberle's volume entails some hard work
and self-reflection. But it is well worth reading, and it leaves lessons in
life for years to come. . . .
Eberle forged his physician's skills and temperament literally at the bedside
of hundreds of dying patients. What he heard and saw guided the arc of his
career toward a nearly singular expertise in end-of-life work. He has directed
medical services at Hospice of Petaluma, founded his own Center for Wellness in
Medicine, taught courses and workshops for providers and caregivers, conducted
wilderness retreats, and become co-director of the School of Lost Borders. He
says of his work, "It's not just about death. It's about life, and all
life's transitions."
In Final Crossing, Eberle distills his
experience into the form of an intimate case study. The case introduces and
illustrates a model for life's "Great Transition" that, in my
opinion, enlightens even the best work of Elisabeth Kubler-Ross.
The book is structured on four house calls Eberle makes to his patient - who is
also a dear friend and his former teacher - during the last six months of the
patient's life. Between visits Eberle narrates, educates, and explains his
model, a metaphor for the four stages of the classic human journey: severance,
threshold, transition, and re-integration. The model is based on ancient Native
American ritual and practice, first known among the Mayans in 1500 BC and later
modified by tribes among the Northern Cheyenne. It is a familiar hero's
journey. Odysseus, Arjuna, Black Elk, Siddhartha, and the "Hero with a
Thousand Faces" all come to mind. Eberle brings his own understanding and
experience to the interpretation of each stage.
The heart of this book beats loudest in the home visits, where Eberle
encounters the dying man. More than anything else, Eberle listens, and he
constantly re-invokes himself to be present. It is hard not to relate to these
visits as a physician, and there are innumerable lessons to be learned. While
I've spent my hours at the bedside of dying patients, both as family and
hospice physician, I marvel at the experience and wisdom Eberle brings to the
encounter. In the end, Eberle implicitly asks the reader to see him not as a
physician, but only "as a fellow human being peering into the great
mystery of death."
"Doc, I'm not afraid of death," his patient tells him. "It's the
dying that scares me." I was reminded of the line from Woody Allen, whose
humor is never just funny: "I'm not afraid of death. I just don't want to
be there when it happens." Awareness of death and acknowledgement of our
mortality is the first stage of the journey. . .
In the background of Final Crossing is the
societal awakening that death is not to be denied or ignored. Since the 1970s -
thanks to the work of pioneers like Kubler-Ross and Stephen Foster, and writers
like Joseph Campbell and Carlos Casteneda - the cloak of "Forgetting"
has been lifting. In 1974, the same year Eberle's patient began his career in
life-transition counseling, the first American hospice chapter opened in Marin
County. Death is no longer as secret or hidden as it was back then; people are
allowed to die at home. In modern medicine, death is not always the enemy.
Often the enemy is dying in a sterile and alien environment, surrounded by
futile technologies and separated from the ones we love and the surroundings we
are "at home" with. What does it mean to die "with
dignity"? Thirty years ago we couldn't even ask the question, much less
allow patients and families to acknowledge and participate in the greatest of
all life's transitions . . .
At one point, Eberle quotes from an elderly
man who faces a potentially life-threatening diagnosis. The man reorganizes his
life. He assesses his values. He reconciles and enriches every one of his
personal relationships and considers what work is most meaningful to him in the
time he has remaining. While his outcome is still in question, he remarks to
his daughter, "You know, whether I live or die, I've still got to make the
same changes."
Eberle's thesis, based on a career's experience, and illustrated intensely and
personally throughout his book, is not easy. But it is simple. There are
lessons in the final crossing. Do we have to wait until we die to learn them?
To read the entire review by Dr. Flinders, go
to www.scma.org/magazine/scp/Fall06/flinders.html.
Dr. Flinders,
director of the Family Medicine Residency Program at Sutter Santa Rosa, serves
on the SCMA Editorial Board.
* * * * *
10. Hippocrates & His Kin: Just a Notch Above Congress
Relatives
have an 'inside track' in lobbying for tax dollars. No laws prevent family
members from trying to influence lawmakers or top congressional staffers. Many
have succeeded in getting millions for their clients, a USA TODAY investigation
shows.
Looks like Congress is a
bigger Cesspool than anyone would have thought.
USA TODAY also reports that far too many back surgeries are being
performed. After a long debate, they couldn't decide just what can be done
about it except chastise doctors.
I had a patient that had
five back surgeries. He confided in me that his back pain was far worse than
before the first surgery. After the fifth, however, he became paralyzed from
his waist down at age 43 and lives his days in a wheelchair. When he has a
bowel movement, he uses a hoist to move him over the toilet. When he wants to
empty his bladder, he just reaches into his pajamas and pulls out a rubber hose
that goes into his bladder and opens the stopcock. He is still looking for that
sixth neurosurgeon to fix his back. His search for five years now has not found
a neurosurgeon to step forward. A hundred volumes of Medicare and Health Care
Laws have not stopped this over utilization.
As long as health care is
relatively free, this type of over utilization will continue. It will only stop
when the co-payment is a significant percentage of the cost. Then we will have
the right amount of surgeries.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: