Monday, December 27, 2010

Parliament Building, Budapest, Hungary (Mystery Photo)

     For those of you who pondered where this photo was taken, the answer is Budapest. Actually the view is of the Parliament Building in Pest, Hungary, the third largest Parliament building in the world. Perhaps not everyone knows that Budapest is really two cities. Buda is on the high hilly side of the Danube River. It is quieter, more hilly and more green, less urban. It is the side where the Imperial Palace (Buda Castle), Matthias Church, and the fortifications known as Fisherman's Bastion are located. It is from the Buda side that this photo of the Parliament Building was taken. The city of Pest is located on the flat plain on the other side of the Danube River. Pest is more bustling, commercial, and urban. It contains the government buildings including the Parliament. The two were separate in ancient times because there were no bridges to cross the wide Danube River. But in 1873 the two cities merged along with Obuda, or the Old City of Buda, and have been under the same administration since that time. But guides and some locals still talk about the two sides of the Danube as separate cities and it comes up in conversation of both historical and current nature.

     We were in Budapest about 4 years ago but the weather was bad. I recall running in the rain from the guide's car to the shelter of Fisherman's Bastion to get some photos. But we could barely see the Chain Bridge or Parliament Building below, it was so foggy and with the rain. As you can tell from our photos this time the weather was beautiful. Budapest is a very attractive city. It is filled with wonderful architecture, sidewalk cafes, beautiful government and public buildings, lots of churchs and the second largest synogogue in the world. It has monuments, and history, having been the Capitol of the Austro-Hungarian Empire for a time. The population was once 23% Jewish but World War I and II changed that. Still inspite of WWII there is still a fairly large and active Jewish population. We spent considerable time in the Jewish Quarter. Perhaps I will do another post later about the beautiful large synogogue and its surrounds. The city also has the oldest underground railway or Subway in Europe.  We enjoyed our stay in Budapest very much. Following are some photos of the sites we saw from perhaps a different perspective than the typical photos on Wikipedia, etc.

    
     Here's the old couple sitting at a sideway cafe savoring our soft drinks. Do we look like the world travelers that we are? Well, at least we weren't doing what the following man was doing, though we wondered what this would taste like.


                                                       St Stephen's  Basilica                                                         
 Danube River Promenade, along major hotels and outdoor cafes.

                                                  Gresham Palace, near Parliament                                   

The Parliament Building from the street side.

                                                Pariliament central tower, at night.
                                    Hero's Square
                                             Liberty Bridge across the Danube
   
Memorial Silver Leaf Tree, behind The Great Synogogue, seen above from the front..                  


Matthias Church and the Hilton to its right, Fishermans Bastion in midground.

Foot of Fisherman's Bastion on Buda's flank, along Danube River

The Chain Bridge at night.

The Imperial Palace which now houses 2 museums, and a library, Fisherman's Bastion in forground.

the modern Performing Art Center along the Danube River.
The Inner City Parish Church, often called The Church of Our Lady, thought to be oldest church in Pest, dating from the 1700s. There was a church on this site in the 12th century. The church built here in 1688 burnt down in 1723 and was replaced by this current church.

     How is this for the follow up on a mystery photo? As you can see Budapest is indeed a beautiful city. If I had a chance I would go back. There is lots to see. I didn't even put any photos of a trip we took out of the city to Lazar's Borthers Carriage Driving Farm, and to Godolla, the baroque palace of the Austro-Hungarian royalty when Budapest was the capitol for the Hungarian part of the empire, called the Dual Monarchy, from the mid 1800s to 1918 when the Autro Hungarian Empire was defeated in WWI. As on many of our trips there is much complex history to be learned and not always remembered.

Thursday, December 23, 2010

Mystery Photo 1


What is this building and where is it located? Enter your guesses in "comments" below.

Wednesday, December 22, 2010

Holiday Greetings!!

                                                      Christmas at Grandma's House 1940

 I would like to send Holiday greetings to all my readers from around the world!! Of course, most people know the origin of the Christmas Holiday, the birth of Jesus Christ, in about 2 BCE, whom the Christian Church has proclaimed Son of God, and center of the religion of Christianity. The early centuries of Christianity did not recognize this holiday or even the importance of Christ and his life story to the Christian religion. It was not until the Roman Emperor Constantine made Christianity the proclaimed religion of the roman Empire in the 4th century CE that Christianity spread. Then multiple edicts from the Roman authorities over centuries changed the face of Christianity so that it probably would not be recognized by Christ himself should he appear again.

     With my research in genealogy over the years I have read about, thought about and written about Christmas traditions and memories of more modern times. In the United States, as I learned, Christmas was not always a heart-warming holiday as we think of it today. We know that the Puritans in New England didn't begin to celebrate Chritmas until the late 1800's because it was regarded as a Pagan holiday and because of the rowdy nature of the celebrations in non-Puritan circles. Cromwell in England had outlawed Christmas celebrations because they were "papist", i.e. too Roman Cahtolic. In other areas of our country, Christmas was a man's holiday and consisted of revelry and rowdiness, and bawdiness. The Victorian Christmas as we know it combined English and German customs when Prince Albert of Germany married Queen Victoria in 1848. The Holiday first became civilized in England and the observances brought men home to be with their families. Also at Christmas, society moved towards taking care of the "lowly" and powerless, i.e. presenting gifts to servants on Boxer's Day, (the day after Christmas), to the poor, and last but not least to the little children. Decorating the house, Christmas trees adopted from German pagan custom, family gatherings, and emphasizing the meaning of Christmas are really relatively modern day interpretations of the holiday. In this country, Christmas in the South first became a warm family holiday following in the footsteps of England and Germany. Finally through the years those warm customs overtook the Puritan ethic in the north of the country and slowly the Christmas of today developed. Of course now many people think that the Holiday has outgrown its britches, so to speak. The commercialization and tremendous growth of gift giving and spending has become important to the economy but many feel it has outshown the real meaning of Christmas.

     Aren't we lucky that these traditions have become the source of modern memories? Currently I think that most countries, at least most that we have visited, no matter their religious practices know of Christmas and love the festivities. Also from my SpiritMindBody group study of spiritual traditions from around the world, almost all religions share traditions of their own that provide that warm, homey feeling of family and memories.

     So no matter your spiritual tradition, worldview, or belief system, I would like to wish you all the warm feelings in the Spirit of Christmas. May you all enjoy happiness, good fortune and health during this season and into the New Year of 2011.

Winter break

It is time for my annual winter blogging break. If you leave comments, they will be moderated when I return.

Happy holidays to all! See you after the new year.

Tuesday, December 21, 2010

Books to consider -- IV

I end my series of possible gifts more topical than those mentioned below with two books about which I have written before. I hesitate to say that I have saved the best for last, but these two are truly excellent, moving, and inspirational. (And I would say that even if the authors were not friends and if they hadn't blessed me by allowing me to write prefaces for both!)

e-Patient Dave deBronkart's Laugh, Sing, and Eat Like a Pig is a great story about his experience with kidney cancer and his journey to patient empowerment and collaboration with his doctors.

Monique Doyle Spencer's The Courage Muscle, A Chicken's Guide to Living with Breast Cancer is an often humorous account of things to expect and how to prepare for this disease.

Both books are perfect for friends or family members going through all types of cancer (not only kidney or breast cancer), and also for their caregivers.

Books to consider -- III

We continue our series of possible gifts more topical than those mentioned below.

In The Communicators, Leadership in the Age of Crisis, Richard Levick, with Charles Slack, offers forty rules that can help leaders deal with the instantaneous nature of information flows and the challenges and opportunities that emerge from that environment. From rule number one ("Learn to accept death") to number 40 ("People want to be inspired"), there are stories and insights that are engaging and helpfully provocative.

If there is anyone better suited to editing a volume called Lessons Learned in Changing Healthcare . . . and How We Learned Them than Paul Batalden, I am hard-pressed to know who that might be. A dozen knowledgeable and self-reflective practitioners relate the stories of their progress in improving health care, creating a tapestry of thoughtful observations and lessons.

Books to consider -- II

Continuing our attempt to offer gifts more topical than those mentioned below, I offer two more recent books for your consideration. I'm sorry I cannot include all that I have received. Feel free to mention yours in a comment if you want to self-refer.

Lois Kelly, author of Be the Noodle, Fifty ways to be a compassionate, courageous, crazy-good caregiver, starts by noting:

This morning, approximately 50 million people, mostly women, woke up to a job they never wanted and have no training for -- caring for a loved one who is dying.

This little book then provides pithy lessons and helpful suggestions to those in this situation.

Social media practitioners are very familiar with the work of David Meerman Scott. They and social media wannabees will find Real-Time Marketing and PR a valuable tool. He notes, "Awareness of information as it happens, in real time, can give you an enormous competitive advantage - - if you know how to use it." A few chapter headings will give you a sense of what's up in this book to help you get there:

Speed versus Sloth: Dispatches from the Front
Laying Down Some Real-Time Law
Real-Time Attitude
Tap the Crowd for Quick Action
Business at the Speed of Now

Monday, December 20, 2010

Books to consider -- I

In a spirit of Christmas gifts more topical than those mentioned below, I offer today and on subsequent days some recent books related to health care and medicine that might warrant your consideration. I start with two today, one from the patient's point of view and one from a hospital administrator's.

Notes from the Waiting Room, Managing a Loved One's End-of-Life Hospitalization was written by Bart Windrum. I met Bart during the patient advocacy session we helped organize at the recent IHI Annual Forum. He starts by explaining the genesis of the book:

This book is not abstract. . . . I write from my involvement as a son who watched both patients die. . . . In both my parents' cases, their dying process was rife with unnecessary grief. I don't mean the grief that accompanies loss. . . . I write as a layperson for lay people. I expose what causes much of the needless shock (and resulting grief) that can accompany any hospitalization and end-of-life experience.


Chapters include: Be an effective personal representative; Making effective declarations; Care and communication in hospitals; family involvement in hospital care; forecasting and ethical support.

Transforming Health Care, by Charles Kenney, tells the story of Virginia Mason Medical Center in Seattle, which has become famous as the hospital in America that has most dramatically endorsed the Toyota Lean Production System. The senior administrative and medical team, led by CEO Dr. Gary Kaplan, started the process with a visit to Japan and then designed a hospital-wide program to bring greater efficiency to many aspects of the institution's operations. They entitled their program the Virginia Mason Production System and made significant improvements in many aspects of health care delivery.

Sunday, December 19, 2010

Lives and times

This is a spectacular visual display by Hans Rosling of the correlation between income and life expectancy, over the decades, for dozens of countries.

If you cannot see the video, click here.

Two of My Favorite Toys

    It occurs to me that in this blog I have not returned to my antique toy collection since one of the very first blogs. It is Christmas time and it would seem a good time to describe two of my favorite toys and what I know about their history.




     This first toy you saw in the video is a tin wind-up walker. The late 19th century and early 20th century was the time of tin wind-up toys. These toys were made of pressed steel coated by tinplate. Then bright color was applied to the flat pieces of tinplate by chemical means, called chromlithography. After coloring the tinplate was formed over molds and then pieces were attached together with little metal tags. These toys were lighter weight than cast iron and therefore could be shipped less expensively. Tin toys came as still toys, as mechanized toys, sometimes with friction mechanism that would make the toy vehicle or animal run forward after gettings its wheels going. Another type of tin windup was the walker. This was a person or animal that would walk when wound up. Various personalities were made as walkers, especially the character, Charley McCarthy.

      My walker is Harold Lloyd, a silent film actor also known as Funny Face. Harold Lloyd (1893-1971) was born in Burchard, Nebraska on April 20, 1893, the second son of James Darsie and Elizabeth Lloyd. His ambition to perform… “ goes back to the first time I can remember knowing what an actor was. I never had any other idea. And when my family moved around, as it did frequently, I began to play in amateur theatricals. When I was only twelve years old, I was playing Little Abe in Tess of the D’Urbervilles.”
Stage roles in school productions led to work in stock productions. Harold was down to his last nickel in San Diego when the Edison Film Company came to town looking for extras. After shooting his four-second film debut as an Indian, Harold set his sights on a career in the movies and moved to Los Angeles. He used to sneak onto the Universal lot by putting on makeup and moving in and out of the gates with other actors that were going to lunch at an outside lunch counter. While on the Universal lot, Harold met Hal Roach who would later produce the films of Laurel and Hardy and Our Gang comedies. When Roach formed his own company, Lloyd joined him. Lloyd portrayed early comic characters that were not very different than Charlie Chaplin’s Little Tramp. Then Harold decided to transform his screen character into someone more like himself and his career took off. Harold was the first comedian to portray a character that looked and acted like someone sitting in the audience. He wore everyday clothes and a simple pair of horn-rimmed glasses. With this character he could experience the humor in everyday life and as an average fellow, Harold’s boy next door could have a romance. His character was the beginning of romantic comedy in films.

     Lloyd often did his own stunts in his films. On a Sunday in August of 1919, Harold posed for a photographer to promote his new feature length comedy. The set-up called for him to light a cigarette with a prop bomb – the round, black type you might see in cartoons. The bomb wasn’t a prop at all; it exploded in his hand. It ripped open the sixteen foot ceiling and left Harold blind and with most of his right hand missing. Doctors told him he would never see again and his career was over. But the doctors were wrong. Eventually, his sight did return, his scars healed, and a glove was crafted to hide his handicap from his public. He wrote the glove into every movie he ever made after the accident because he was afraid his public would worry for his safety and not laugh at his stunts and antics during the comedy. He became known as the “King of Daredevil Comedy.” His films out grossed the movies of Charlie Chaplin, and Buster Keaton and he made more films than both of them put together. In 1928, Variety proclaimed him the highest paid film star.
     Harold was an innovator in the movie business. He pioneered new camera techniques and was one of the first filmmakers to preview his comedies to a test audience, and then re shoot recut and preview them again. At a time before unions, Harold paid his crew year-round, even when they weren’t shooting a film. When talking pictures came along, Lloyd was one of the first filmmakers to embrace the new medium. “Welcome Danger” opened in 1929 and was Lloyd’s highest grossing film. But 12 days later the stock market crashed and everything changed. Lloyd’s all American go-getter character no longer seemed in fashion to an audience struggling to survive the depression. His sound films in the 1930s lacked the success of his earlier silent work. He had made 200 films since his 4 second debut in 1913 and it was time to move on. In his later years, he became the highest ranking position of the Shriners. He devoted an entire year to visiting 130 temples across the country and during the last 20 years of his life worked tirelessly for the 22 Shriner Children’s Hospitals. He developed an interest in 3-D photography and traveled the world tasking pictures in stereo. He was the 5th film star to immortalize his hand and footprints in the pavement outside Grauman’s Chinese Theatre in Hollywood. In 1953, Harold received an honorary Academy Award for being a “Master Comedian and Good Citizen”. Over 20 years after his death, his bespectacled face appeared on a US postage stamp.

     Quote from Harold Lloyd, “It has been amazing to me that these comedies can still strike a responsive note of laughter with audiences of all ages and in all parts of the world. Laughter is the universal language. It establishes a common identity among people – regardless of other differences. It is the sweetest sound in the whole world.”

     My walker is made by Louis Marx Co, a toy company that made tin windup and many playsets from the 1920s to 1960s. Since the early tin toys were made in Germany especially by a company called Lehmann, it was not until there was anti-German sentiment after WWI ended, that US made tin toys began to take off. Louis Marx was born in Brooklyn, NY to Jacob and Clara Lou Marx in 1896. After graduating from high school he became an office boy for Ferdinand Strauss, the mechanical toy manufacturer. Eventually he advanced to managing the Strauss New Jersey plant, but was fired for urging volume manufacturing/sales.

After returning from WWI, he established Louis Marx Stamp, Co with his brother David.
Louis Marx Co marketed toys from other toy manufactureres such as Girard Model Works, C G Wood, Strauss and Carter and ended up buying out many of these companies over the years.
By 1922 he had already sold over 8 million of each of his famous tin minstrel dancer and Zippo climbing monkey. In 1928 he produced the Yo-Yo, making over 100 million destributed through Sears.
Unlike A. C. Gilbert, (the man who saved Christmas) during WWII he turned to defense work. In 1948 he switched to Plastic toys with poly ethylene for strength. He is known first for his tin toys, including wind up mechanical, and later tin model trains, then for his playsets including both lithograph  tin buildings and plastic figures and accessories, and then later for the Big Wheel. In 1972 his sales had slipped and his company was purchased by Quaker Oats Co. and toy manufacturing was closed in 1975. There have been a couple attempts to resurrect the old models by American Plastics but there was limited success. Many of his tin toys and playsets survive in many collections around the world.Circa 1930. Made by Louis Marx Company. Working.

         While clearly intending to produce a toy featuring the silent era and early talkies comedian Harold Lloyd, Marx did not have a license to use his image. Unlike his rival Charlie Chaplin, Lloyd never licensed any toys, dolls, figurines or other collectibles. The toy is dated from about 1930.

     My Funny Face walker is even more special to me because it belonged to my father. It shows moderate wear where the arms swing against the body but as you saw still walks just fine.

     My second favorrite toy is a blackboard easel made by Richmond Educational Furniture Co, Muncie, IN. This is a very unique toy which provided both my mother and myself as well as our siblings hours of educational play. You see I have two of these easels. One belonged to my mother and probably dates to the late 1920s. Then my parents bought me one in the late 1940s. The lithographic scroll at the top of the easel is delightful in both versions. My mother's is a bit torn up and can't be scrolled easily, but mine is in fine shape as you will see in the video below. The fold down blackboard has a blackboard surface on both sides and can be used as a desk. There are storage pockets inside the fold down desk. The whole structure is made of oak and is very sturdy when folded out. It can also be folded up for easier storage in the closet against the wall.

     The Richmond School Furniture Company was founded by a Quaker attorney named William Foulke Spencer in Richmond, Indiana in 1892. It made school desks, bookcases, benches, chalkboards, etc. (Spencer had formerly partnered with another furniture company that was destroyed by fire.) At the same time he formed the American Lawn Mower Company and the two businesses shared facilities. The companies moved to Muncie in 1902 to be nearer the recently discovered natural gas sources, so we know that your chalkboard was made after that date. The company stayed in business, essentially producing the same sort of things, until the mid 20th century. (The American Lawn Mower Company is still in business today!)


I'm gonna scream!

The New York Times offers this summary of words that were introduced or popular during 2010. I'd like to give my candidate: Gonna.

As in going to.

Look, this has always been a lazy contraction. I remember reading a transcript of my own testimony over a decade ago, certain that the stenographer had misquoted me. But no, I had often slipped into this slurred version of going to. It caused me to train myself not to, and I have pretty much killed the habit.

But none other than our Commander in Chief has now made it acceptable. He uses it all the time. Here's one example.

I argue that his persistent use of the word has now influenced the entire country.

A sign of how pervasive it has become is that I heard it from an NPR radio announcer! OMG, the bastion of good grammar and pronunciation has been corrupted. Are we gonna have to stop listening to Weekend Edition?

Even the spellcheck on this blog service does not recognize it as a mistake.

Please, Mr. President, along with giving up smoking, can you give up gonna?

Good move in Congress

I am very pleased that Congress has now eliminated the ban on gay people serving openly in the US armed forces. I know many gay people who have served with distinction during the last decade, and it always pained me that they could have been discharged if their sexual orientation had been made known. Who knows how many other qualified people chose not to serve because of the previous law.

I am struck by how long it takes for society to overcome its prejudices. As I welcome our new employees each week, I tell them the story of the establishment of Beth Israel Hospital in 1916, which occurred because of discrimination against Jewish doctors and Jewish patients. Young people look at me in incredulity, wondering how a society could be so prejudiced. Well, I know doctors who tell me that such discrimination lasted through the 1960's for them here in Boston, limiting their professional options, or causing them to legally change their names to keep those options open.

I have read that prejudice and discrimination may have an evolutionary basis, rooted in the nature of primate and human subsistence groups. Here's just one example, gleaned from a quick Google search, from a 2004 paper by Harold D. Fishbein, Department of Psychology at the University of Cincinnati:

Our genetic/evolutionary heritage provides the initial push toward prejudice. My essential argument is that three sets of genetic/evolutionary processes that lead to prejudice and discrimination evolved in hunter-gatherer tribes. They were appropriate and necessary for that subsistence mode, which characterizes 99% of human existence.

I guess it is hard to counteract this stuff if it is really wired into our brains as a result of thousands of years of genetic selection. On the other hand, we should be advanced enough not to let us use our evolutionary inclinations as an excuse for inaction or continued discrimination or political grandstanding.

Saturday, December 18, 2010

Manly gifts for Christmas

I was listening to Tom and Ray on Car Talk today and heard their suggestions for Christmas gifts for guys. You can listen to that here, show #1051. Suggestions included, "Two words no guy can resist: ratchet and socket." Also, a cordless drill -- "You can never have too many" -- and other manly items.

I was attentive because just yesterday a colleague told me of his household's pattern. My friend who is, shall I say, a boring dresser, each year is given many items of clothing by his wife. His practice has been to unwrap each box, but then store it unopened in his closet.

This year, in the spirit of frugality, he said to his wife, "You know, if you just take the boxes from my closet and re-wrap them, when I open them on Christmas morning, I won't even suspect they are the same gifts, because I never knew what was in the boxes anyway."

This being family television, I dare not describe his wife's response.

Disappointment by Gastroenteritis!!

      A personal story and some info about gastroenteritis -- the stomach flu.

     This weekend we were planning a trip to our son's home in Indiana to attend our grandson's 1st birthday celebration. We also were planning on celebrating Christmas the next day. With birthday presents and Christmas presents all lined up at the back door ready to be loaded in the car, with some bottles of wine from my wine cellar to also celebrate my son's earning his master's degree (on top of his MD), and an Edible Arrangements fruit basket to pick up on the way, and some of my son's favorite food in the form of a chicken enchilada to take along, I was excited about seeing both our grandsons. I should have known something was brewing when I didn't feel like eating any dinner Thursday night.  Seldom do I not have an appetite. Then I woke up at about midnight and the rest of the night I spent in the bathroom-- one of the worst cases of gastroentiritis I ever remember suffering. I won't go into the details but it was wretching and wretched. After no sleep the following morning I was very weakened, and afraid I wouldn't keep anything down including just liquids. But the whole thing subsided during the day we were supposed to be traveling. Needless to say we didn't go; you don't take a gastroenteritis bug into a home with two small children. We canceled our orders for the Edible Arrangements and for the chicken enchiladas. Today is the birthday and my daughter-in-law just called after the party ended. She said half of the people who were supposed to come to the party with their children also suffered similar illnesses. So this bug must be going around all over the Midwest. I know my mother and my sister got a similar illness after attending a Church Fellowship in Illinois the Sunday after Thanksgiving. About 20 people who were at that event got sick. As a doctor I wonder what the germ is, and wonder if it could have been the Norwalk virus because of its virulence and its infectiousness.

     Wikipedia tells me that one or another genotype of the RNA virus now called Norovirus (used to be called the Norwalk agent)  is responsible for 95% of epidemic gastroenterities. Two genotypes of this virus are most responsible. This virus is very infectious with as few as 10 virus units enough to cause infection. The incubation time is 24 to 48 hours and the illness usually lasts 24 to 60 hours. But worse is that people tend to shed the virus for weeks after they are well. This means that I could have gotten it as I suspected when I visited Mom, either from surfaces or from a kiss I gave her as I left. I hate to blame my 93 year old mother but that could have been the source. I learned that alcohol does not kill the virus well, but chlorine does. So surfaces should be disinfected with chlorine bleach. Washing the hands with hot water and soap also helps but is not 100% effective at preventing the spread of the illness. In one source study a single food handler who was infected transmitted the disease to 30 people. Does it help me that I now know this information about this germ? No, but it is the doctor in me that demands I look it up.
     The disappointment of our canceled trip will soon fade, and we will schedule another weekend to take the presents to the two grandsons. I am still looking forward to this date. Life deals in surprises and disappointments and fortunately they usually don't last. We just have to keep that fact in mind.

Friday, December 17, 2010

Hospital visiting day for Red Sox Scholars

The current class of Red Sox Scholars came to BIDMC today for a visit to our neonatal intensive care unit and our surgical skills and simulation center. You can meet these talented students in this video and get a glimpse of their day.

If you cannot see the video click here.

Two Degrees of freedom

As you know, I don't often write about commercial ventures here, but from time to time, one that has a broader public service mission emerges. Here's the latest, recently announced.

A company called Two Degrees is marketing a new, nutrition bar.* That's nothing special (although it does taste good**), but what is special that for every one they sell, they will produce and distribute -- working with Partners in Health -- a nutritional pack to a hungry child in the world. The nutritional packs themselves are manufactured locally, so the company is creating jobs in the areas being served. Here's more information about those packs.

"Nutrition packs are revolutionary treatments for severe and chronic malnutrition. Known as Ready-to-Use Food (RUF), these nutrition packs have been endorsed by the World Health Organization and treat chronic and severely malnourished children with up to 95% success rates. As convenient packs that do not require water or refrigeration, they have shifted the treatment of hungry children from doctors in hospitals to a community-based model focused on mothers in homes."

--
* Disclosure: My friend Lauren Walters is a founder, but I have no financial interest in the company.
** The other founder's grandmother says: "I can't believe how good this is! I usually don't eat bars unless they have the word 'candy' in front of them."

Thursday, December 16, 2010

Evidence of the Afterlife: The Science of Near Death Experience by Jeffrey Long MD

     I am a member of a small group of seekers. We call ourselves the Spirit Mind Body Group. We meet weekly and we take turns presenting various topics that interest us in the field of spirituality, and its relationship to our lives, our bodies, our physical and mental health. Sometimes we just have what we call a Bake Off Session when we just throw out items that members have read and which moved them outside of the normal mundane day to day rhythms.
     Recently I presented a review of a 2010 book which I read and which impressed me immensely. The book is by Jeffrey Long MD, a radiation oncologist. I am posting my somewhat lengthy review here. I do apologize for its length but it really took that many words to even touch the surface of this fascinating subject.

Review of Evidence of the Afterlife:The Science of Near-Death Experiences

By

Jeffrey Long, MD with Paul Perry

Harper Collins, 2010

Dr. Jeffrey Long is a radiation oncologist in Houma, Louisiana. He has served on the board of directors of The International Association for Near-Death Studies, and is actively involved in NDE research. Dr. Long and his wife, Jody, established the non-profit Near Death Experience Research Foundation and a website as a forum for people to share their NDEs and then to collect scientific data on this phenomenon.

Near Death Experiences were first talked about and written about to any extent in about 1975. Many books have been written and journal articles have tried to express the experiences in scientific terms but most previous studies have been small. This might be because people are reluctant to tell about their experiences. Many times what they say is not accepted. The medical profession in particular has not always been very open to these narratives. Patients who report to their caregivers often have their narrative belittled; they are told they are crazy or their experiences are just a manifestation of how sick they were, was confusion from lack of oxygen or delirium from the underlying medical problem. Patients also hear this line from their friends and relatives so that many do not relate their experiences to others and live with their knowledge for years. Dr. Long and his foundation thought that perhaps Near Death Experiencers (NDErs) would be more likely to relate their experiences over the Internet. They developed a 100 item questionnaire which is amenable to statistical analysis. Over 10 years of collection of data on the website, they obtained 1300 answers to these questionnaires coming from all ages, all cultures and from all over the world. These experiences are so powerful that NDErs recall them vividly years later and recall not only the characteristics of these experiences in detail but also report how these experiences have transformed them in their life.

Dr. Long, being a man of science, has examined the data created by this Internet questionnaire in a scientific way. The results are remarkably consistent among responders. This study finds that what people discovered during their near-death experience about God, love, afterlife, reason for our earthly existence, earthly hardships, forgiveness, and many other concepts is strikingly consistent across cultures and races. Because NDEs happen to people all over the world, they are a spiritual thread that binds us together, a common experience that reminds us of our mutual spiritual nature.

Dr. Long developed 9 lines of evidence found in NDEs that there is life after death. The convergence of several lines of evidence builds a much stronger case than only a single line of evidence. For example suppose we had only two lines of NDE evidence. We may not be 100 percent convinced that these two lines of evidence prove an afterlife, but perhaps each line of evidence by itself is 90 percent convincing. Combined these two lines of evidence by mathematical calculation are 99 percent convincing that the afterlife exists. It would seem to be very complex to analyze mathematically 9 different lines of complex evidence, but Dr. Long et al were able to design a custom form for the website which provides for automatic calculations and allows each reader to calculate how strongly he/she believes the 9 lines of evidence prove the existence of an afterlife.

In the website questionnaire, the author considered individuals to be near death if they were so physically compromised that they would die if they did not improve. The NDErs interviewed were generally unconscious and often apparently clinically dead with absent pulse and respirations. Also the experience had to be lucid, to exclude descriptions that are fragmentary and disjointed memories.

The episodes were collected from all over the world and eventually translated into English so that the conclusions would be multicultural. Also there were about 60 childhood experiences though many were recalled years later. But this supplied data from all ages.

The NDERF website explores the data collected on the website and how it provides evidence for an afterlife. http://www.nderf.org/afterlife.

No two NDEs are the same. However, when many near death experiences are studied, a pattern of elements that characterize NDE is easily seen and these elements occur during NDEs in a consistent order. NDEs may include some or all of the following elements:

1: Out of Body Experience. This element is often the first sensation experienced in a NDE. 75% of NDErs experience this. People often see their own body and the medical professionals working on it. But they also are often able to see things even outside of the area where their body is. One of the most telling such experience was reported on the website. A NDEr reported ascending as usual from her body, but passing outside the hospital and along its wall and seeing a tennis shoe on a windowsill on a 5th floor window. She described the shoe perfectly even to the point of one shoe lace lying under it. After she recovered and told someone of this, they went back to the window sill and found the shoe just as she had described. She had not been in the hospital before nor had any of her family or friends.

Another interesting part of this element is that people have vision, even those that were blind from birth and have never experienced colors, or visual perception of any type, have perfect clear color vision during OBE. Those who were blind from birth have abstract concepts of what things look like and have trouble matching those concepts with actual sight should their vision be restored. They are even unable to visualize well or describe what light is. Those who experienced vision for the first time during a NDE have no trouble with the perception and describe things as they would seeing, not as they would if depending on their other senses such as hearing, touch, etc. One person saw her wedding rings for the first time during a NDE and she then described them as a visual person would. Even the sighted report unusual characteristics of their vision, unusual clarity, or 360 degree vision in all directions. Colors are often described as intensified and the vision seems unusually clear. Other senses are involved in NDEs also but vision seems the most amplified. Just the fact that blind from birth people experience color vision in NDE seems proof of some sort of existence outside and away from the body that is unrelated to the senses of the body – an afterlife of some sort.

The author personally reviewed 617 of these OBE descriptions. He required that they be personally described by the person who had the OBE during a NDE, that they describe a single NDE in English. Of the 617, 46.5 percent described OBEs that contained observations of earthly events that would allow others to objectively assess the reality of their observations. In addition, 287 or 23 percent investigated the accuracy of their own experiences, such as reviewing the medical records and comparing what was done with what the NDEr observed. None described inaccuracies.

What Skeptics Say: Some think OBEs are simply fragments of memory that pop up as a person begins to die. They suggest that OBEs might be reconstructions of partial memories from the time of the NDEr first beginning to lose consciousness or from the recovering time period. If that were the case, that some of these are fragments or lucky guesses, it would be unlikely that fully 97.6 percent are memories without any apparent errors, and 23% even checked their accuracy with facts. We know by research that memories formed just before and after a period of cardiac arrest without NDE, if they occur at all, are marked by confusion. NDErs experience the highest level of their awareness, or consciousness not at the beginning or the end, but during the middle and entire NDE.

A further characteristic of some NDEs is that the OBE involves traveling away from the body and seeing, hearing or experiencing things that are going on well away from the abilities of the senses of the person who is unconscious. One person saw her father approaching the house from outside the walls and he found her and began to help her, called for medical help etc.

2. Heightened senses. Of the NDErs, 74.4 percent indicated that they had more consciousness and more alertness than normal.

3. Intense and Generally Positive Emotions and Feelings. 76.2 percent of NDErs selected “Incredible peace, or pleasantness” as the answer to questions about their feelings during NDEs. 52.5 percent also selected “Incredible Joy”. Only a small percentage are frightening to the NDEr.

4. Passing Into or Through a Tunnel. 33.8 percent answer yes to this question.

5. Encountering a Mystical or Brilliant Light. 64.6 percent saw this light. It is usually described as bright but not painfully so and often not coming from a point source but rather being generalized in a portion of the field of vision. There is often a desire to move toward the light or merge with it.

6. Encountering Other Beings, either mystical beings or deceased relatives or friends. 57.3 percent encountered beings. Interestingly either the being seems to be an unknown mystical being, or often is a deceased relative. In some cases the being is unknown, but after recovering from the NDE, the experiencer sees a photo or otherwise recognizes the being they saw as a deceased relative whom they never met, who may have died even decades before them but that the NDEr had never seen before. In some cases the being is not seen but is only heard as an internal voice or external voice – of mystical nature.

7. A Sense of Alteration of time or Space. 60.5 percent answered “Yes” to the question “Did you have any sense of altered space or time? 33.9 percent answered “yes” to the question “Did time seem to speed up?” “Everything seemed to be happening all at once.”

8. Life Review. Though this is often touted as a necessary element of an NDE, only 22 percent experienced a life review. In those cases, fragments of early life may be seen, or the review may be panoramic, covering all of one’s earthly life.

9. Encountering Unworldly (“Heavenly)) Realms. To the question, “Did you see or visit any beautiful or otherwise distinctive locations, levels, or dimensions?”, 40.6 answered “yes”. Another questions was asked in this category, “Did you seem to enter some other, unearthly world?” 52.2 percent responded yes to this.

10. Encountering or Learning Special Knowledge. The questionnaire asked: “Did you have a sense of knowing special knowledge, universal order, and/or purpose?” 56% answered “Yes”. The question was asked in a different way: “Did you suddenly seem to understand everything?” 31.5 percent answered “yes” to the questions “about the universe.” 31.3 percent answered “yes” to the question ending in “about myself and others”.

11. Encountering a Boundary or Barrier. Many people saw doors along the tunnel or at the end of the tunnel, or were just suddenly in front of a door. Some just felt the barrier. In some the barrier was a sense that they could go no further until they made a decision about life and death themselves. Sometimes they were not given a choice whether to cross the boundary or not; they had to go back even if they did not really want to go back to their body and life. 31% “did reach a boundary or limiting physical structure.”

12. A Return to the Body Either Voluntary or Involuntary. 58.5% “were involved in or aware of a decision regarding their return to the body.”

So these twelve things are the identified elements of the NDE and their percentages expressed during the NDEs of these 1300 people who were interviewed on the website. The interviews consisted of a detailed questionnaire with some questions asked in several ways to make the experiences clearer. Then people were offered the chance to write a narrative about their experience; this narrative was unlimited. The vast majority chose to write a narrative and parts of many of these narratives appear in the book.

NOW THE CONCLUSIONS that the author regards as PROOF of an AFTERLIFE:

Proof #1: Lucid Death.

“Speaking both medically and logically, it is not possible to have a highly lucid experience while unconscious or clinically dead.” Being clinically dead means no longer having the perceptions or senses of a living person. The person is unconscious; likely their heart has stopped pumping blood throughout the body and to the brain. Ten to twenty seconds after blood stops flowing to the brain, the EEG goes flat. The EEG measures brain activity in the cortex, which is responsible for conscious thought. Without blood, and with unconsciousness, the higher centers of the brain become increasingly unable to function and then first cell stunning and then cell death begins to occur. Following cardiac arrest, a lucid organized and seemingly conscious experience should be impossible. Even electrical activity in the lower of the brain should not produce such highly lucid and ordered experiences. If this is true, then NDEs are evidence of something of our consciousness existing without brain function.

Some skeptics think these experiences are like dreams. But the question was asked in the questionnaire if these experiences seemed like dreams, and an essay was asked for in answer. Virtually everyone adamantly said these experiences were not like dreams. If we recall our own dreams, most are disjointed and have sensory or visual input that is very abstract, vague, and often doesn’t make good sense. None of the descriptions of NDE were like dreams according to the NDErs.

Skeptics also say that hypoxia of the brain in death produces some of the elements of NDEs. Most doctors are quite familiar with the symptoms of hypoxia: they are headache, confusion, memory loss, and fatigue. As it worsens, the confusion worsens, and then finally unconsciousness occurs. NDErs almost never have confused memories that are typical of the experience of hypoxia. The fact that highly lucid and organized near death experiences occur at the time of severe hypoxia is further evidence of the extraordinary and inexplicable state of consciousness that typically occurs during NDEs.

Other skeptics say that these reports of NDEs result from the “Oprah Factor”. The first book which described NDEs was “Life After Death” by Dr. Raymond Moody which was published in 1975. Later Oprah had many people on her show that described their NDE. This author was able to divide his data base into pre 1975 experiences, and post 1975 experiences. The same elements occurred in both groups and in the same order and in the same frequency. Another author, Geena Athappilly MD , 2006 has compared two equal groups, pre 1975 and post 1975 and found the same result. The questionnaire included a question asking, “Did you have any knowledge of NDE prior to your experience?” 66.4 percent did not.

Proof #2: Out of Body. We have discussed this above.

Proof #3: Blind Sight

Proof #4: Impossibly Conscious. In this proof, the author reviews general anesthesia and what it does to the brain. We know that the five states induced by general anesthesia are pain relief, loss of memory of the procedure, ie amnesia, loss of consciousness, motionlessness, and reduced autonomic nerve responses, such as reduced blood pressure, heart rate, and slower breathing. Yet in spite of all these goals being maintained, NDEs have occurred during general anesthesia during surgery due to the heart stopping, or hemorrhage, or other clinical death during surgery on very ill patients. There were 23 cases in the data base in which the NDE occurred during general anesthesia. The author compared the results of these folk’s NDEs to the 590 in the database which had answered in English and whose experience included the stoppage of the heart. All elements, frequencies and percentages were the same for the two groups.

Skeptics may say these experiences resulted from “too light” anesthesia. Well, some of these NDEs resulted from anesthesia overdose which would rule out “too light” an anesthesia being administered. But also the type of experience is totally different. They are unpleasant, painful, and very frightening experiences. Fortunately they only occur 1-3 in 1,000 cases. Usually anesthesia awareness as it is called are not visual, but are hearing. Some skeptics have claimed NDEs are REM dreams or strange experiences during REM sleep when there is paralysis. But REM dreams are often bizarre and frightening dream imagery and are not ordered and pleasant, accompanied by the peace that accompanies NDEs. Also if indeed REM dreams do explain NDEs, then how can NDEs occur during appropriate general anesthesia combined with a clinical death. The author says that “there is no explanation for NDE’s occurring under anesthesia other than accepting that full consciousness can exist apart from the physical body. For that reason, I consider them significant evidence of an afterlife.

Proof #5: Perfect Playback

Here the author discusses the life review that is often part of a NDE. At the very least, the review contains part of the NDEr’s life experience. Sometimes it is like a rerun of a play or film, sometimes seemingly on a screen. 26% described it thus. 21% said they judged themselves during the review. Some saw the good, the bad, and their effects of their choices. Some reported feelings instead of visual content. Some reported feeling others feelings or reactions to their own early actions.

If these NDEs are realistic they should show life review that is real and contains accuracies from the NDEr’s life. 14% of the 617 English reviews had life reviews. When asked, none said that the life reviews contained inaccuracies about their life. Some of the events had been long forgotten but were recalled to memory after the NDE.

Skeptics say that life reviews or even out of body experience can be produced by stimulating the exposed brain in certain areas and postulate that these experiences are just the brain’s memories being triggered by such a stimulation, for whatever reason. But these reported stimulations are not like the life review or the OBE. They are fragments, like a piece of music, or voices, or fear, or bizarre imagery. If they are an OBE they are often a view of just a leg, or a trunk. They are often distorted, and incomplete, are not organized and like the NDE life review, orderly and in chronological order with each fragment or sequence having meaning and being accompanied by appropriate feelings which are not usually fearful or painful.

Proof #6 Family Reunions.

95% of beings seen or heard during NDEs are of deceased relatives, while only 5% were of friends or acquaintances. Only 4% of the NDEr’s saw living relatives or friends. If NDE’s were a product of a dying brain, or dream like sequences, then one would expect that the people seen would be those which the patient most recently saw and would much more likely be living than dead and certainly not long dead as is often the case in NDEs. Other studies have also confirmed the identity of these beings as being mostly deceased relatives. They often talked telepathicly, and the reunions were described as joyful, and supportive. The relatives appeared youthful and with full capacities if they appeared visually. Interestingly though for 32% of the deceased beings encountered, the NDErs were emotionally neutral or distant from the beings and had never previously met them. Yet they sometimes knew how they were related. In one instance at least, there was an unknown being whom the NDEr later identified from a photo as a long deceased relative whom she had never seen before living or in any photos. In some cases, the NDEr met a deceased relative whom they thought at the time was living, ie had been alive before the person experienced their NDE. After recovering from the NDE, these few people learned that the person they saw had died during their NDE or during that illness and they learned of the death later.

Proof #7 Out of the Mouth of Babes.

There were 26 NDErs under the age of 5. One would expect that they would not be overly influenced by Oprah or have read books that describe NDEs. When this group is looked at and compared to the remainder of the 617 over age 6, the elements, order of elements, and frequencies are statistically identical to the larger group.

Here is a remarkable story and I would like to cite this whole story of an NDE:

Jennifer was 11 years old when she was involved in a severe car accident. She saw her “limp and lifeless” body below. The voice of a spiritual being told her that she was needed back at the accident site to help the unconscious driver. Here is her experience as she wrote it:

Then the voice said: “His nose is cut off his face; you will need to go back and help him; he is bleeding to death.” I said, “no, let somebody else do it. He will be fine without my help. I don’t want to go back down there. No!” The voice said, “I will tell you what to do. You take off his shirt after you pick his nose up off the floorboard of the car. It will be next to your feet and his right foot. Place his nose on his face, pressing down to stop the bleeding. It’s just blood, so do not be afraid. I am with you always.” (I knew I was never alone from as far back as I could remember.) “So, then, Jennifer, you will begin to walk him up the right side of the road, and a car will come. Tell the man to take you to the nearest hospital. Keep the man calm, and lead him to the hospital where you were born. You know the way and everything will be all right. You must do this. Understand?”

Jennifer goes on to say that when she returned to her body everything happened as she was told by the spiritual being. A car stopped and carried them to the hospital where she was born. She was able to calm both the anxious driver and the accident victim who lost his nose. And there was a happy ending; a skin graft was used to reattach the nose with “barely a scratch left to notice.” The astonished emergency room doctor said, “I cannot explain what kind of miracle I just witnessed in this emergency room today.”

Proof #8 Worldwide Consistency

Because the questionnaire was translated into multiple languages by volunteers, 2000 NDE’s have been obtained from people whose primary language was not English. Many of those questionnaire answers and portions of their narrative have also been translated by volunteers. 79 of these were studied statistically and compared to the larger 617 English reports and again there is no statistical difference between the elements, the order of the elements and the frequency percentages of these two groups. This suggests that NDEs are not just cultural but universally human. Also it adds further evidence that these experiences are not just due to a cultural Oprah Factor phenomenon. This is further strong evidence that NDEs are not products of cultural beliefs or prior life experiences. NDE are in a word real.

There are a lot of studies of NDEs from around the world that are different but when these studies are examined closely they included many stories that were not NDE by this author’s definition. The people were not clinically dead. These experiences are much more often like hallucinatory experiences. More work is being done and studies have been done and are being done on this author’s database with translation work, but it appears that by his definitions, NDEs are remarkably similar around the world, from East to West, from English speaking to non English speaking countries.

Proof #9 Changed Lives.

A NDE is a very powerful experience, needless to say. And of course, that person was so sick they almost died. You would think that most people would want to talk about that experience right away. But this is not usually the case. Even if they try to share their experience, they often run into indifference or even negative reactions. They might be crushed by being told it was imagined, or a dream, or a hallucination, or even that it was some crazy psychotic break, or just due to drugs. This may make them suppress their memory of it and this reduces the chance of strong positive aftereffects.

In spite of such negative responses, still 73% of the NDErs do share the experience and report that it changed their life. But it can take many years. One other NDE researcher reported that it takes the average NDEr 7 years to adjust to the knowledge and memory of the experience. Common aftereffects are increased self confidence, stronger sense of spirituality, reduced interest in material gain or status, and a greater appreciation of life. Others experienced a belief in the sacredness of life, a sense of God’s presence, an awareness of meaning and purpose to life, willingness to reach out and help others. Some become more religious or spiritual. They may reevaluate their life, their jobs, their relationships and belief system. Many cease to fear death. And many have an increased belief in an afterlife.

Skeptics claim that it is the near death itself that changes people. But a study was done that compared those who suffered a cardiac arrest without NDE and the study showed that it is the NDE, not just a brush with death that produces more afteraffects. There were also more afteraffects the deeper and more detailed the NDE was.

Another profound effect is the development of psychic ability. This is usually not common and is not profound, but various people do report this after an NDE.

Summary and Conclusions:

1. The level of consciousness and alertness during NDE is usually greater than that experienced during everyday life, even though the NDE occurs while a person is unconscious and clinically dead. The elements of a NDE follow a consistent and logical order.

2. What NDErs see and hear in the OBE during their NDE is generally realistic and often verified later by the NDEr or others as real.

3. Normal or supernormal vision occurs in NDEs among those with significantly impaired vision or even legal blindness. Several NDErs who were blind from birth have reported highly visual NDEs.

4. Typical NDEs occur under general anesthesia at a time when conscious experience should be impossible.

5. Life reviews in NDEs include real events that took place in the NDErs’ lives, even if the events were forgotten.

6. When NDErs encounter beings they knew from their earthly life, they are virtually always deceased, usually deceased relatives.

7. The NDEs of children, including very young children, are strikingly similar to those of older children and adults.

8. NDEs are remarkably consistent around the world. NDEs from non-Western countries appear similar to typical Western NDEs.

9. It is common for NDErs to experience changes in their lives as aftereffects following NDEs. Aftereffects are often powerful and lasting, and the changes follow a consistent pattern.

Dr. Long’s research has made him a believer in the afterlife. It has also made him more concerned for others and he believes it has made him a better doctor. He believes NDErs have brought back a piece of the afterlife and when shared it makes all of us better people.

The Jubilee Project

If this video doesn't warm your heart, you have serious emotional problems. It was produced by The Jubilee Project, a non-profit that that harnesses the power of Internet videos and the spirit of philanthropy. As noted by the founders:

- Our mission is to make videos for a good cause.

- Our core value is to partner with those in our communities to help make these videos possible.

- And our hope is that we can create entertaining videos that will empower, enable, and inspire others to do good as well.

The team prepares videos, posts them publicly, and receives payment from sponsors based on the number of views. This one that has been particularly successful, with about 200,000 views.

Here's their Facebook page. They seek ideas for other worthwhile causes.

If you cannot see the video, click here.

Wednesday, December 15, 2010

We're all entitled to move

Please check out this story from the PBS NewsHour about how dance can be used to improve the lives of people with Parkinson's disease.

I wrote about a local version of a similar kind of program back in 2008, sponsored by Ed Rudman, one of our former Board chairs. It is wonderful to see this expand to other settings. The group Dance for Parkinson's has "classes right now in about 14 states, from California to Washington State to Texas . . . all the way down to Florida."

My father died of this disease back in 1992, and there was nothing like this available where he lived. As I watch these dancers, I have to express great admiration and appreciation to the professionals and volunteers who have made these programs available.

As noted in the story, "Joy, it's not a quality you associate often with Parkinson's. And, yet, it is what you see here. There are people in this class whose condition limits how they move, but not their smile or spirit."

I say "Bravo!" and "Encore!"

Tuesday, December 14, 2010

The value of standard work

"The most important thing we can teach our residents and trainees is the value of standard work."

Imagine if that were the philosophy in every academic medical center. It is the philosophy at the Mayo Clinic, according to Dr. Stephen Swensen, Director for Quality. Dr. Swensen commented on these matters during last week's IHI Annual Forum. I was not able to attend his session, but a colleague did go and reported back to me.

For years, I have been hearing about the quality of care given at Mayo and was having trouble learning what distinguishes the place. I should have figured it out. The simple summary of process improvement is that you cannot design and implement improvement if there is too much variability in your process. Why? First, you cannot design an experiment for change unless you are confident that your change is being applied to a relatively uniform "prior." Second,
you cannot measure improvement compared to a base case if there is not base case.

Dr. Swensen talks a lot about the "cottage industry" and "farmers' market" approaches to medicine, as opposed to the Mayo way of standard work, decision support, and forced protocolization. Mayo has a Clinic Clinical Practice Committee that has the authority to set practice standards and methods across the organization. When improvements are discovered, there is rapid diffusion of learning.

When it comes to residents, they must be bronze-certified through Mayo Quality Academy before treating patients. This includes training on simulators before being allowed to practice procedures (like central lines) on patients.

Dr. Swensen also discussed four
conflicts in academic medical centers that prevent truly patient centered care:
  • Physician Autonomy - As mentioned, a high variation environment is inherently unsafe.
  • Financial conflicts - Some care receives higher payments; there are financial conflicts between the doctors and the hospital; and fee-for-service creates conflicts of interest.
  • Research - The well-intentioned focus on the mission that "we're here to advance knowledge" can interfere with care.
  • Education - The well-intentioned view that "we're here to provide training opportunities" lets trainees practice on patients and causes care to be organized around the training program, rather than vice versa.
As I heard this, I thought about our place. While we have instituted some standard practices, it is clear that we have not gone as far as we might. On the financial front, we have started to move away from fee-for-service, but there is not a uniform payment system across all of our payors. And his comments about research and teaching are often likely to be valid.

I will state immodestly that we are viewed as one of the leaders among academic medical centers with regard to quality, safety, and process improvement. If we still have so far to go, after several years of concerted effort, the academic medical sector as a whole has miles to travel.

When borrowing is a good idea

There is an element of the economic downtown that unfortunately aggravates the prospects for recovery. In Massachusetts, employers fully fund the state's unemployment insurance fund. During periods of high unemployment, payments made from this fund go up, and employers are asked to help keep the fund balance current.

In this chart from the Associated Industries of Massachusetts, you can see this during the increase in insurance benefits paid during the recessions of the 1970's, early 1990's, 2002, and currently.

During these hard times, when unemployment claims go up, the state faces a deficit in that fund and has to consider whether to raise the unemployment tax. You can see that in this chart.

Massachusetts is currently considering a very large increase -- 40% -- in the unemployment insurance tax, from an average of $638 per employee to $897. Statewide, this would represent an increase over 2010 of $662 million. This would go into effect on January 1.

Of course, a recession is precisely the worst time to raise such a tax. It would be better if accruals into the fund could be timed more smoothly and in a counter-cyclical fashion.

There is an alternative: To borrow from the federal unemployment fund, at zero interest. From the point of view of the state's employers, the alternative is clearly the way to go.

This approach has no adverse impact on the families in the state who benefit from unemployment insurance, but it provides a reasonable opportunity to smooth out the effects of the recession, making it more likely that a recovery will not be stalled.

Monday, December 13, 2010

Vietnam on our trip to Southeastern Asia, December 13, 2010

     APOLOGIES!! Just when my readership numbers were getting up there, I don't post anything on blogger for 6 weeks. A sure way to lose your interest, dear readers. But I have a good excuse and not only that this last trip will provide gist for several new travelogs. Yes, that is correct. We took another trip!

     On November 13, we flew 13 hours from O'Hare to Tokyo, endured a 2 1/2 hour layover in the business lounge in the Tokyo airport, and then flew 5 1/2 hours from Tokyo to Hanoi. A Very Long Trip!. But such is the requirements if we want to travel 1/2 around the world -- exactly 12 hours away. This trip would take in several locations in Vietnam; Angkor Wat, Cambodia; and Chiang Mai and Bangkok, Thailand.

     Vietnam was very interesting. My husband and I were very pleasantly surprised about this young country. We were a little worried as Americans traveling to a place where we were the enemies about 45 years ago. But actually 72% of residents of Vietnam are 29 or less. Such a young population has little memory or concern about a war that took place before most of them were born. However, we did take a walk through the central park of Hanoi where the Ho Chi Minh mausoleum is and also where his house is. It was a Sunday and there was a day off of work. Everyone was out in their finest. There were several older men in their full military uniform and a couple were sporting their medals on their lapel as well. We Americans did get "a long serious look" from these men. Our guide says that the guides and drivers like Americans, probably because we know how to tip the guides. We know from personal observation that Europeans do not tip at all during guided tours.

     Some further comments about Vietnam:

     On walking through the Ho Chi Minh Mausoleum. We were asked to line up in a line of pairs or single file. We had to slowly walk from the admittance gate through metal detectors. Cellphones and other electronic gear had to be checked. You could carry only one shoulder bag. Along the street, through the turn into the building, up the stairs and into the viewing room, there were guards posted all along the way. They reminded us to stand up straight, take our hands out of our pockets, hold any purse or bag still in our hands in front of us, not swinging wildly from our shoulders, and we were shushed several times. In this way a very subdued and respectful line filed past the venerated leader of North Vietnam who tirelessly worked for the unification of the North and the South. Of course, he also led the Communist Party to power which subdued the South and made it Communist as well.

     On freedoms in the People's Republic of Vietnam: We were standing at the check in desk of our hotel in Hanoi, when the bellhop came over to stand with me while Amos did the last signing for check in. He asked, "Is this your first time in Vietnam?" Strangely virtually everyone asks this question here. Do they think that US citizens go to Vietnam every few months because it's so exciting to visit?
"Yes," I answered. "We have traveled a lot, all over the world and now it is Southeast Asia."
"I will never be able to travel like that. It is very difficult to get a passport to be able to leave the country. And then it cost a lot of money." volunteered the bellhop.
I said, " Oh, you are very young. You can put away some money and you will be able to travel yet. You have time."
"No, I will never be able to travel outside my country," said the bellboy. "My parents both worked for the US government during the war, so never will I be able to leave."

    You see Ho Chi Minh's ideal came true, but now the whole country is not free.

    But we were very impressed by the people. They are hardworking, honest, and very friendly. We were in the Mekong Delta, walking through the jungle, to visit a small village and a small village tea house. Here while having tea, we were listening to a small group play and sing  with traditional Vietnamese instruments. An elderly grey haired lady was watching us. She then saw the scar on my arm and came over and touched my arm with a great look of compassion on her face. I was touched.

    The Vietnamese are very clean. The ladies and older young girls often still wear the traditional dress. It is called the au dais and consists of two long panels of colorful cloth, sometimes plain color, sometimes with a print. They hang from the waist and are totally open on each side. Underneath these panels, the young women wear long slim pants in a complimentary color. The cloth is either silk or nylon. The women appear very attractive in this outfit.

     The "Hanoi Hilton" was listed on our itinerary. But it appeared that our guide, Nam, in Hanoi was going to over look it. At one point, he said we would be driving by it and we would be able to see it from the road, that he would point it out to us. We were almost by it when he said something like, "That building back there was the "Hanoi Hilton", you know where your Senator John McCain stayed while he was here." We told Nam that we were supposed to see the inside of the museum there and could we please stop. He seemed reluctant but spoke with the driver and we turned around so that we could park and go inside. What is present here is only the entrance and two small wings on each side which now serve as a museum. The rest of the large prison complex which the French used also to house dissident Vietnamese has been torn down and there is a highrise modern hotel on the site. Inside about half of the museum is devoted to the brutality of the French during their control of the country. Then there is a section with propaganda about the "American War" as they call it. There is one room about John McCain with his flight suit and photos of when he was dragged from the Lake in the middle of downtown Hanoi. He certainly picked a lousy place to crash land his plane. It seemed during the whole walk through, that our guide was hurrying us through. It was the only time that we felt uncomfortable about our visit here, and I am still not sure why our guide didn't want us to visit this place.

     In driving up and over the pass through the mountains between Hue and Danang, we made a stop at the top of the pass. Above all we needed a restroom, but also we wanted a chance to photograph the view of the sea below. By the time I made my way from our car door to the restroom inside the tiny building, a young Vietnamese woman knew that my first name was Ann, that I was from Milwaukee, WI, that I had two grown sons and two grandsons, that I was in Vietnam on vacation for the first time, and I had learned that my young attendant's name was Lien and she had four children and a fifth on the way. When I came out of the small, slightly primitive but immaculate restroom, there was already hot coffee and hot tea set out for us. And now Lien began her hard sell. She sat in front of a narrow pressed aluminum table with trays of beads and bracelets all set before here. She seated us in the plastic lawn chairs and began her hard sell on the tiger eye bracelets that had caught my eye. She began to make me a larger bracelet for my wrist and when she saw that I was going to buy this, she began working on my husband to make one for him as well. Just working the bracelet and talking, laughing, joking and selling, Lien was a delight. I couldn't help but buy from here, and we bought two such bracelets.

     I had a mission during this trip. I had in my possession a little 8 inch tall stuffed dog named Owney which was purchased from the Smithsonian Museum. He represents a true dog that existed in the late 1800s and became a mail dog, riding on mail railroad cars all over the US. The postmen fed him and attached mail tags to his color and later to a jacket someone made for him. The Smithsonian sells children's books about Owney's story and this stuffed version of the dog. I took him along with me to get pictures of him all over Southeast Asia so that we can use those pictures and postcards home that he sends to involve our youth stamp club in countries around the world and their stamps. I explained this mission to Tom, our guide in Saigon. Tom is in his twenties and unmarried. He was taken by Owney and volunteered to carry him around until Amos could get some pictures of Owney near some of the sites. I explained to Tom that Owney would be a "chick magnet." He looked puzzled so of course I had to explain what a chick is: a young attractive woman and how the word magnet applied to this situation. He finally understood. And indeed females of all ages and even some boys and young men came over and petted Owney and commented about him to Tom. When we were at the teashop in the Mekong Delta, that grey haired lady made a fuss over Owney and over Tom. I turned to him and mouthed the words: "Chick magnet". He understood. I should really send him an Owney of his own.

     In Saigon, we visited the buildings that had housed the government of South Vietnam. Tom conducted a very nice walk through here. Then we were in the Museum of War Remnants. This museum is very much like similar museums in Russia. The ground floor and outside court are full of various armaments from all wars and both sides, so here there are both Chinese and US planes and tanks, and munitions. On the second floor are photos with propaganda along side showing the so called "atrocities of the American devils." But on the thrid floor was a photo display that Tom said on the way up the stairs, "will show you how things really were." It was a photo display that toured the US and then was gifted to Vietnam and as far as I could tell was mounted without changing the explanations. I could discern no propaganda. It honored journalists that were killed in the Vietnam War and featured their often award winning photo credits. There were at least 3 spreads from Life Magazine. I found a journalist that had actually photographed WWII and then as a grey haired woman had insisted on coming to Vietnam to photograph that war. She was from Shorewood, WI, our neighbor. I had never heard of her. She died their on the battlefields of Vietnam, killed by the war.

     My husband is still organizing our photos from the trip so in this post photos are notably missing. But that will allow me to post again on this country. You have to see some of the photos of the beautiful Halong Bay.
Don't forget about my blog. I am back and will be regularly posting again for some months before we take another trip. It's good to be home.