Social Matters

Written by John H. Akhavan, M.D.

What is wrong with America? (and its treatment.)
United States' Health System in jeopardy! (by NEJM)
How to improve Public Health (June 2009)

What is wrong with America?(as I see it)
  1. Right and wrong confused:
  2. Ethical vs Legal:
  3. Mass media failure:
  4. Fetal Abortion,"Prochoice" or "Prolife":
  5. Lobbying:
  6. A 2% Minority Governs!:
  7. American Democracy is not flawless:
  8. Is at the present, Israel an asset or a liability for the United States' national security?Subvertion of Democracy to Plutocracy in the United States.

    1. Right and wrong is not considered absolute anymore in America and people can not agree on what is good and what is bad anylonger. One says eaves-dropping (like listening in someone's private telephone conversation without his knowledge, wiretapping, scanning a cellular call, etc.)is wrong and should be avoided, someone else says that was a "historical event" and I listened to and even recorded so my grand children could hear it and be proud of their grand parents!!
      One says "bribe" is evil in any form and shape so should be avoided, but someone else changes the name to "lobbying", "donation" ,etc to get access to government officers and treats it as a routine practice without any shame!
      I can write many more examples, the question is: Why is it so and what should be done to correct this?
      From the dawn of humanity till now many good people believe that good and bad is revealed by God to his prophets who explained them to others. God is one and prophets are truthful so all the devine commandments are the same, good and evil is absolute and wont change with time.
      There are other people who don't believe in God or if they say they do, they dont accept the devine revelation and prophecy. To them there is no absolute good or evil, they decide what is good according to their situation and as they wishes. Unfortunately the scientific renaisance of the past three centuries been regarded and promoted as anti-religion era by the university graduates. Psychologists and sociologists been busy modifying people's behaviour substituting ethical rules with other regulations resulting in moral decay, social anarchy and increase in crimes and drugs. I believe while technological progress continues , ethical teachings of religions should be revived and re-emphasised.
    2. Ethical vs Legal: While democracy and abiding by law is one of the best kind of government, if laws passed and enforced are against the Divine law, there would be confusion and anarchy. Again those legislating do not mostly believe in Devine law, they think whatever they believe in, is correct and should be accepted as the truth by others and to be obeyed. Well, it won't be! And when one law is not obeyed, gradually no laws would be respected.
      What should be done? Supreme Court judges should be appointed more carefully. Those with high religious convictions will be able to properly decide which enacted law is unconstitutional. Say if all three faith (Judaism, Christianity and Islam) which constitute the majority of American's faith, proclaim adultry and homosexuality a sin punishable by God, how a law could say it is permissable and to be tolerated!? If all three faith say that killing innocent person is sin, how could that be allowed under a deceptive name of "late term partial abortion", with the President's support!?
    3. Mass media (Radio, TV, Newspapers and Magazines) failure to Inform and entertain.{September 2007}
      Mass Media is supposed to inform and cheerfully entertain the public but in USA it mainly mis-informs and dis-pleases: I believe one of the reasons America has so much pain and suffering is the mass media inapropriate activities. America can not make a good decision because good information is not available to her. We have had hard time in Middle East i.e. with Islam, with Palestinians even with Iran because of the lack of correct information about them. Those who call themselves "Neo-Conservative, born again christian and even American! Zionist!!" have recently overwhelmed much of Media, spreading their fear and very wrong informations about the situation in Middle East.. No wonder the whole world especially those in Middle East have lost their profound respect for the USA, Those who own and control the Mass Meia especially TV and Radio stations think "news" should be only bad news- horror news- to excite and attract the public who is needed for "Good Rating" (and good rating is necessary for getting more ads and more income). They are not concern at all for the public well being.
      Entertainment was meant to be a pleasurable event but now most programs are horror movies, agressive events - killing, raping, steeling- or destructive natural scenes like storms, hurricanes, earthquake, etc.... causing fear, displeasure and powerlessness in the audience.Those who are not alert and conscious enough to know, may focus their attention to these negative events feeling negative emotions and attracting more of the similar negative events.Those who become very afraid of future terorist attack may actually attract another attack, or if you are thinking of war and killings all the time there would be more conflicts and war in your future, for sure. Positive thinking and focusing on love, peace, health and wealth is needed to bring joy, peace and more satisfaction to our life.

    4. Fetal Abortion,"Prochoice" or "Prolife": {August 2008}
      For the past two decades, with appearence of Neo-Conservatives and Moral Majority church groups, the subject of "Abortion" has caused so much commotion, anxiety and devision among americans. "Pro-life" group defines abortion as aborting a fetus or an embryo (from the time of conception) which would be equal to killing an individual human being."Pro-choice" group ,on the other hand,believe that what is in the woman's womb is part of her body and she can do whatever she wishes about it. These two extreme ideologies are so much apart that no conciliation been possible up to the present.
      But now I would like to recommend a solution which is scientific, logical, theological and practical: One (like me) could be both "Pro-life" (for fetus-ie 2nd and 3rd Trimester of pregnancy) and "Pro-choice (for embryo-ie 1st Trimester). Following conception, the zygot although has the potential of becoming a human being but it is only a "cell" like other cells- skin cells, muscle cells, etc... For 1st trimester (or several weeks after that) "embryo" has no functioning organs like brain frontal lobe,for sure, to function as the site of consciouness and "soul". So although it is alive, it is not a human being to have human rights. Parents should have the choice to decide about its future according to their situations. There would be no problem for aborting it or allowing scientists to do embryonic cell research on it. From 2nd trimester "fetus" should be considered as a human being and be protected by law. All decided abortions are to be performed during 1st trimester. After 1st trimester, only if the mother's life is at risk or fetus's life is damaged beyond repair, abortion may be permitted.

    5. Lobbying:{November 2008}
      For the last 20-30 years, USA "The Land of Freedom and Opportunity" has been declining in regard to moral values (and recently in material wealth). Why? You may wonder.
      In my opinion the main reason is contamination of the political system to bribery. Although we call it lobbying or political donation (large ones) but the result is the same - corruption and decay. During the election large donations by special interest groups help a candidate be elected who would be obliged to cooperate and collaborate with them later. Lobbyists continue to lobby the officials (especially in the congress and senate) passing laws and regulations that are beneficial to their special interest groups rather than people. Some of these lobbyists representing very powerful PACs( Political Action Committees) and big companies who have so much money and power that intimidate the officials.

      Some of these PAC groups are idiologically very destructive. They believe that:
      1- They are chosen by God! to guide the others;
      2- Others who are called "gentiles" must be forced to submit by any means and at any price (in defiance to "The Seven Noachide Laws").
      These groups have been successful to influence many officials in every level of government also mass media, financial system, universities, neo-conservative christian organizations etc... . According to their assumption whatever is good for Israel is also good for United States! The problem is that their philosophy (during the past 20 - 30 years) been quite detrimental to both Israel and United States:

      - The United States' foreign policy of un-conditional support for Israel been of no benefit to its security but causing anger, powerlessness and terror among the neighbors;
      - Financial regulations (or deregulation) causing the recent economical meltdown;
      - Unjust taxation resulting in a wide separation of wealthy and poor;
      - Mis-informing people by mass media preventing any corrective political action;
      - Anf finally poor educational system producing a generation of wasted talents and purposes.

      Now you may ask what now!?
      Now that we have elected a new president promissing a change in Washington D,C., first step should be to prohibit "Lobbying" all together, to encourage legislative bodies to pass laws and regulations beneficial to the United States and its general population and to inform people of whatever is happening so they would be able to make a correct decision.
    6. A 2% Minority Governs!: { January 2009}
      Why the United States of America has declined so much during past 2-3 decades? And what "Change"should be made to correct it?
      My observation of the US progress since 1960s been a disapointing one. Until recently, although the technological advances been significant - We put man on the moon during Kennedy's era, we invented World Wide Web (WWW)for a better communication and commerce, we worked wonders by progress in genetic engineering, coloning and stem cell research and so on.... but morality and spirituality been declining. When I first immigrated to the United States lying and deception were rare while trust and security were a common characteristics of American people. Everyone felt secure financially, professionally and socially. Traveling was easy and enjoyable - no long lines of "checking", no body search, no taking shoes off! and no demeaning questioning.
      So what is happening? What is the main reason for this terrible declines? One main reason comes to my mind: A minority of 2% been gradually taking over the control of American governing systems - financial, political, educational, judiciary, mass media and security apparatuses.
    7. American Democracy is not flawless: {February 2009}
      Democracy means "people's rule" usually by their representatives and representation is to present views of the constituents. Americans are people from so many different cultures and backgrounds, this could be the greatest strength of America.
      But if we look at the governing body of the United States we see representatives of a 2% minority have occupied the majority of important governmental posts! Why!? How has that happened? - The majority of this 2% group are culturaly "fearful and greedy people". Their greed makes them eager to go for all the "power, money and sex" that they can get. Their greed has developed because of their historical fear of subjugation and sub-ordination. Although they are hardworking and well educated people but their moral and spiritual defects makes their govermental policy decisions unjust and destructive. It is very interesting that their greed anf their fear of future subjugation has been and again will be resulting in their demise.
      If America is to become a great nation again, we should correct this mis-representation as soon as possible and before it is too late.
    8. Is at the present, Israel an asset or a liability for the United States' national security?{April 2009}
      The United States of America has played an important and steadily increasing role in supporting Israel since WWII and particularly since Six-day war of 1967. For the past four decades, in fact, the US has provided Israel with a level of material and diplomatic support that dwarfs what it provides to other countries.That support is largely un-conditional, no matter what Israel does in the region. What is the rational for this uncritical and un-compromising relationship with Israel? Some might say that it is because Israel is a "vital strategic" asset, or an indispensable partner in the "war on terror", or it is the only country in the region that "shares our values". But none of these arguements stands up to fair minded scrutiny. Now that Cold War is over, Israel has become a strategic liability rather than asset for the United States.
      In the war on terror, Washington's close relationship with Jerusalem makes it harder, not easier, to defeat the terrorists who are targeting the US.The Israelis brutal treatment of Palestinian conflicts in the occupied territories for decades been a good reason for terrorists to recruit new members. As far as "share value" there is little similarity between American democracy and Israelis'. Our democracy is based on separation of church and state while Israel is a jewish state with a strong religious ideology behind it.

      So what explain the unusual behavior of American politicians? Why there is so little dis-agreement among them in regard to Israel while there are profound dis-agreement on almost every other important issues? Why does Israel, and no other country in the world, receive such consistant deference from American leading politicians? The real reason is the political power of the Israel Lobby that actively works to move the US foreign policy in a pro-Israel direction. These groups want US leaders to treat Israel as if were the fifty-first state. Democrats and Republicans alike fear the Lobby clout.
      Reference:The Israel Lobby by John Mearsheimer et al.

      What should be done?

      1- Lobbying activities which has become a sort of bribery and corruption, should be eliminated from both Administration and Congress.
      2- Those with double citizenship should be barred from any high level gevernmental position.

    9. Subvertion of Democracy (toward Plutocracy) in the United States. {October 2009}

      Plutocracy means the rule of wealthy . In plutocracy the degree of economic inequality is high, because the wealthy has a disproportional influence on political processes,- by:

      1-Giving large contributions and donations to politicians. Most western democracies permit individuals and organizations to raise funds for politicians and it is well known that political parties frequently accept significant donations from various individuals(either directly or through corporate institutions). Though it is said that, this has no effect on the legislative decisions of elected representatives however it would be very unlikely that no politicians are influenced by these contributions. Although campaign finance reform efforts seek to ameliorate this situation and it must successfully challenge officials who are beneficiaries of the system which allows this dynamic in the first place, but their efforts has failed.This has led many reform advocates to suggest taxpayer dollars be used to replace private campaign contributions. In reality, it is mostly "lobbying" practice which exert financial pressure on government to pass favorable legislation.
      2- Negative influence like refusing to support the government financially by refusing to pay taxes or threatening to move profitable industries elsewhere.
      3- Influence could be exerted by the owners and/or ad buyers of mass media which can shape public perception of political issues.

      If plutocracy is not controlled, It will gradually subvert Democracy to Kleptocracy which means total political corruption. The effects of a kleptocratic regime or government on a nation are adverse in regards to the state's economy, political affairs and civil rights. As the kleptocracy normally embezzles money from its citizens by misusing funds derived from tax payments, a kleptocratically structured political system tends to degrade nearly everyone's quality of life. In addition, the money that kleptocrats steal is often taken from funds that were earmarked for public amenities, such as the building of hospitals, schools, roads, parks and the like - which has further adverse effects on the quality of life of the citizens living under a kleptocracy.

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United States' Health System in jeopardy! {1987}

United States' Health System in jeopardy, this is an unpleasant opinion of many medical scholars whose voices are not heard clearly by the society. I read a Commentary by the Editor-in-Chief of the New England Journal of Medicine which was very similar to my views so I am very pleased to bring to everyone's attention some of his warnings. He writes:

Physicians have adhered to a distinguished code of professional behavior for centuries. The recent dramatic changes in the system of health care threaten this noble heritage and tempt us to abandon these principles at a time when preserving them is more important than ever.
This is arguably the most tumultuous time in the history of medicine in the United States'. Because of the enormous cost of care and the political ineptitude of our national leaders, the delivery of care is in a volcanic state, reforming itself day by day under market forces. Instead of yesterday's familiar and comfortable model of one patient and one physician, we now have market-driven health care with vertically integrated systems, massive health maintenance organizations, huge for-profit conglomerates with money hungry stockholders, and armies of health care lawyers and consultants.
At the same time, the amount of money that reaches physicians for the care they provide is shrinking. Less money is available from the government, employers, and insurers, and some is globbled up by the new participants in health care. As the dollars available for patient care shrinks, the temptation for physicians to maintain their income grows, and in this environment difficult conflicts of interest emerge. Let me consider only two, both of which threaten physicians' integrity and professionalism. The first is a familiar one-- an arrangement in which physicians benefit financially from referring patients to facilities the physicians partly owns such as laboratories or radiation therapy centers. The second, more important one, is a consequence of the change from fee-for-service medicine to a system that rewards physicians for restricting services. In this new arrangement, physicians' loyalty to patients is threatened. As managed care takes over in a community, some physicians are forced to join managed-care organizations or risk being left with few patients. When physicians join, they may be compelled to sign contracts that contain "no cause" nonrenewal clauses. Then their contracts can be terminated for any reason at all. In addition, some companies' contracts contain nondisclosure clauses that forbid physicians to tell their patients what a plan does or does not offer. Physicians under such restrictions can easily be torn between their loyalty to their patients and their loyalty to their families, because with one or two false moves they can be out of their job.
Tese divided loyalties that threaten physicians' livelihood is wrenching. The incentive for physicians to keep their jobs may be so strong that they may no longer be willing to act exclusively as patients' advocates. They may even be unwilling to advocate for a patient with management when they think that a given service is needed but is being restricted inappropriately. Physicians placed in this position simply cannot tolerate it, and that can produce an even greater threar--namely, a loss of their integrity. Soon some of them will find themselves conforming to the restrictions and deceiving themselves that what they are doing is best for the patient. In short, they will be living a lie.
These are some of the realities that threaten the preservation of medicine's noble heritage. Our ethical standards, which have evolved over two millinnia, never envisioned a market-driven health care system with incentives to undertreat patients. As members of our profession, we alone must be its keepers. We must continue to be vigilant in case the consequences of our market-driven delivery system go too far and prevent us from giving the kind of care we think appropriate.

How to improve Public Health (June 2009)

A - Short-Term = Emphasizing prevention and alternative medicine by:

1. Utilizing "Continuing Medical Education" CME to change doctor's perception from "treating patients" to "keeping them healthy" through preventative measures. It is said " one ounce of prevention is better than a thousand pounds of therapy". For Example, we shouldn't allow our young population to become obese and develop diabetes and then treat their illness and its many horrible complications with drugs, expensive laboratory tests and surgical procedures. Even when they do become diabetic, emphasis should be placed on lifestyle changes such as exercise, diet and meditation rather than pills and injections.

2. Different payment system for the healthcare providers. Presently, there is no financial motivation for the healthcare provider to spend time explaining preventative measures to their patients. On the contrary, if they spend half an hour in the office talking about prevention, their compensation for that time is 1/10 to 1/20th of what it would be if they spend the same amount of time in the operating room or performing a procedure.

3. Placing more importance on the general practitioners and comprehensive caregivers rather than emphasizing the sub-specialties. Encouraging those who make etiological diagnosis versus those who only treat.

4 . Prohibiting ( by law) any pharmalogical advertisement over the public airways or in the physicians office. Any new medical information should be ratified by the faculty of medical schools and transmitted solely to students and physicians.

B - Long Term Measures = Changing the medical education system and research programs:

1. Focusing on research in regard to the pathogenesis of disease and possible treatments of disease, especially chronic ones like cancer, diabetes, cardio-vascular and autoimmune disease. We need to go beyond the molecules - drugs, hormones etc and find out more about mind-body connections, mind - conscious part vs sub-conscious portion, super mind (soul) and its relationship to the brain cortex, placebo and nocebo (belief) effect, accupuncture practices, energy therapy and spiritual healing.

2. Using more wave-particle mechanisms for diagnosis (not just CTscan) and treatment (not only Lithotripsy).

3. More research on epigenetics than genetics. Genes are like books in a library's book shelves. How to use and read them are more important than having them! Cell's membrain is cell's brain receiving environmental signals and directing cell's organels how to react. We should find out more about the life of single cell if we are to know more about the community of more than 50 trillions of them namely human body.
4. We have evolved from a single celled organism with a very limited instinct type awareness to a multi-trillion celled human body with unlimited consciousness. It took more than 700 million yeas to get here, but now with accelerating information explosion and so much environmental changes and stimuli, the pre-frontal lobe of our brain has to evolve fast to be able to handle this terrific overload. Research on mechanism of supermind-brain cortex connection might be beneficial in this regard.