Science and Spirituality

When I fly, I know there are angels beneath the wings holding us aloft. I don’t have to see them to know they’re there – and don’t expect I ever will see one. But flying is magical, and wouldn’t be possible without divine intervention. I am not ignorant of the science behind flight. In college I studied Bernoulli’s laws, and the dynamics of how wings pull a plane up into the sky. After 21 years, I’m a little rusty on the equations, but I know more or less how wings work. That knowledge never for a moment made it any less magical.

I also know that sometimes planes fall out of the sky with devastating effect, and pray that mine will not be one of them. Typically my prayers never rise to the level of consciousness, but on particularly turbulent flights, they are very much the center of my attention. But I’m also aware that when planes fall from the sky, the good folks at NTSB can usually piece together what went wrong from the parts that remain – and that the results of their investigation are never ‘angelic inattention’.

As much as I find the technological details of flight fascinating, there are existential questions for which these reveal nothing. Though unnatural, flight is the manifestation of one of humanity’s longest held dreams, and its reduction to mere aerodynamics and metallurgy somehow seems a vulgarity.

On the other hand, it is precisely that vulgarity I hope for on the part of those designing, building, and maintaining these lofty miracles. It does not matter to me at all whether these engineers, technicians and mechanics find poetry in human flight, or consider it a gift from God, or whatever. I want them to know and flawlessly apply the relevant science – period.

When somebody I care about is sick, I pray for a quick recovery and a return to full health. Those prayers are as sincere, and immediate (if perhaps less demonstrative) as any medieval supplicant depicted by the creative minds of Monte Python. I believe fully in the power of those prayers – and take comfort in sharing them. But for many illnesses there is a scientifically prescribed treatment – whether it is bed-rest, antibiotics, surgery, or whatever; and my prayers are accompanied by advice to follow doctor’s orders. When my Mother was fighting lymphoma our fervent prayers were accompanied by helping Mom stay on her meds schedule. Six years have passed, and Mom’s smile remains a part of our lives today. Was it the prayers, the meds, the dietary changes? I don’t know and don’t care.

So am I a hypocrite? A man of science who falls back on religion when I’m insecure? Maybe – but if so, I’m a sincere hypocrite, because I truly believe in both science and faith, and don’t feel any irreconcilable conflict between them. Maybe a term would be a ‘belt and suspenders’ believer. Am I superstitious? Yup! Let’s go to the source – Stevie Wonder defines ‘superstitious’ as ‘when you believe in things that you don’t understand …’, and I’m willing to cop to that. I also happen to believe in quantum theory, and I don’t really understand that (and neither do you).

Science and faith fulfill different yearnings in our desire to understand our universe. While they sometimes overlap—and occasionally even come into conflict—that conflict often disappears upon further reflection.

As fibers which support an integrated view of the universe, science and faith each has its strengths, and its weaknesses. But when woven together, the strengths complement and reinforce one another. It should probably not come as a surprise that some of the best minds in science and in faith often hold one another in high esteem - and that at the frontiers if knowledge, they face many of the same questions.

I suppose it is good that this esteem is not universal. A bit of creative tension between these realms of reality is good for each, since it keeps each honest, and discourages intellectual complacency. The view that the lens of faith allows us into ethical matters of science moderates the dehumanization which a purely scientific perspective might engender. And scientific advances often require a revision of the distinction between foundational tenets and traditional beliefs. Solid theology and sound scientific practice are both strengthened by this intercourse.

The wonders of our world and the universe tantalize our human need for intellectual exploration. Our imaginations soar to the furthest reaches of immense galaxy clusters millions of light years away, then return to delve into the infinitesimal quarks, leptons, and other components of sub-atomic particles; from the universe’s origins within an infinitely dense pre-Big Bang center, to our speculations of the eventual end state—these are the grist for our mental mills.

And the inestimable magnificence of God—however we perceive him/her/it to be—is likewise an incredibly tempting diet on which we may sustain ourselves. While some may maintain that everything we need to know about God was revealed long ago through a finite chain of prophets, others find fresh nourishment in the world around us, and our expanded exchange with diverse cultures. Neither is wrong, but openness breeds inquiry.

The old saw that ‘Great minds think alike’ is no truer in science than in religion. Good minds think alike; great minds diverge violently on matters most of us never consider. For every conflict between somebody like Martin Luther and Pope Leo X, there is a Newton vs. Leibnitz. The blood that is let in these exchanges fertilizes the soil on which the next generation of knowledge will flower.

It is only the failure of our own imaginations that imposes an ‘either/or’ decision in matters of science and faith. While scientific theory doesn’t require the existence or majesty of God, it also doesn’t preclude it– zealots on either side notwithstanding. When Galileo worked through the motions of the planets, it posed no threat to Christian doctrine – but the doctrinaire reaction of the church did. Likewise, the development of the science of evolution doesn’t set itself up in opposition to spirituality –evolutionary scientists include strong believers of every faith tradition. If they don’t cite God in their research, it should be no more surprising than that an aircraft engineer doesn’t cite God when he defines what weld to use to support a wing spar.

Are there evolutionary scientists who reject the existence of God? Of course there are. Atheists, agnostics, and believers of every stripe populate all professions. If somebody like Richard Dawkins can’t see outside his little silo, that doesn’t invalidate his science – it simply identifies him as a human being, with all the prejudices that accompany that status. If he wishes to nourish only his intellect, and starve his spirit, I wish him ‘vaya con dios’ … or , more to his preference, ‘vaya sin dios’. I’ll read his science, and ignore his theology. Likewise, if a spiritual leader can’t bridge the gap between spirituality and science, I will do my best to form my opinions of his spiritual teachings on their own merits – and look elsewhere for science.

I choose to see the hand of God in science – but placed there with such subtlety that no fingerprints remain. How much more wondrous it is to know a God with the skills to design a dynamic world; one which need not be micro-managed – but one in which life instead employs natural processes to adapt and achieve continuity. Rather than refuting the existence of God, to my eye, this reinforces it, and leaves me in even greater awe.

So in this spirit I applaud the 150th anniversary of the publication of The Origin of the Species – not as a poke in anybody’s eye, but as a fitting recognition of the transformative nature of knowledge.

What’s the matter with Medicare?

Medicare has been treated as a whipping boy in the discussions around reforming our current healthcare financing system. I maintain that most of the criticisms are flawed, and don’t stand up to critical scrutiny. Medicare is a fundamentally sound program, which has been compromised both by unaddressed demographic changes, and by intentionally unfunded program expansions.

Among the unavoidable challenges Medicare faces, most have nothing to do with program efficiency, and everything to do with the demographics of the beneficiaries: 
 High-cost population. Older people are simply more expensive to cover. Medicare disproportionally covers these populations. These people were not covered before, which is why Medicare was developed, and why it’s so popular.
 Increased expectation of heroic life-extension measures. Dying people seeking to extend their lives are very expensive.
 Fewer workers support more beneficiaries. Longevity increases, shifts in the demographic age profile of our population, further magnify the first two imbalances.

Despite this, by most key metrics, Medicare operates far more efficiently than do private insurance companies. Critics state that because of the client base, its 75% administrative cost advantage may be somewhat overstated. But even if we adjust for these concerns, Medicare is still much more efficient.

Among the other obstacles, some have the specific intention of driving Medicare to bankruptcy – and discrediting the idea of any public approach to insurance:
 A steadfast refusal to adapt the funding model to address the looming demographic imbalances listed above. A system designed in the 1960s, with contemporary life-span and treatment expectations, needs updating to reflect current and future realities.
 Medicare Part D. (See Below)

What’s Wrong with Medicare Part D (prescription drug coverage)

From its inception, Medicare supporters have tried to add prescription drug benefits to the plan. This was always blocked by the pharmaceutical lobby, because it posed a threat to their profits.

But when the Republican Party gained control of both houses of Congress and the administration in 2002, the pharmaceutical industry was able to customize an plan that would create a cash cow. They literally wrote the Medicare Part D law that was then passed with virtually no amendments. It contains a key provision which prohibits Medicare from negotiating prescription drugs prices. This means that the pharmaceutical industry was to be given a huge captive base of high usage customers, who pay retail. This would have been a budget-buster – except that there was no budget to pay for Medicare Part D in the first place. This exorbitant expense was piled on top of an already fiscally challenged program.

The plan has another bizarre provision, commonly known as the ‘donut hole’. Above a certain annual spending threshold, the program stops paying for drugs until a second threshold is reached. This was presented as a way of controlling costs – but in reality it was a way of placating the insurance industry, which immediately moved in with a whole new portfolio of products to ‘fill the gap’ which had been created for them.
Medicare Part D was a perfect finesse for the national Republican Party:
 It was designed to be difficult to vote against—despite the poison pill—because it provides a needed benefit to seniors.
 It tremendously increased the profits of the pharmaceutical industry, who wrote the law. These increased profits now bankroll resistance to any meaningful modifications.
 Created an entirely new, highly profitable category of insurance (‘donut hole’ coverage).
 Greatly accelerates the insolvency of the overall Medicare program, setting it up as an example of government inefficiency, and justifying continued resistance to any public insurance plan.

Despite the finesse, House Democrats were nearly unanimous in opposition to this fiscally irresponsible program. And despite incredible pressure from their leadership, many conscientious House Republicans opposed it as well. Despite a large Republican majority in the House, passage was only achieved after an unprecedented three-hour roll-call vote in the middle of the night (roll-call votes normally last 15 minutes), during which some members of the Republican caucus were blackmailed to change their votes. Rep. Walter Jones (R-N.C.) refers to this as the ‘ugliest night’ he has ever seen in politics. Check out this interview with him and fellow House Republican Dan Burton (R-Indiana):
http://www.cbsnews.com/stories/2007/03/29/60minutes/main2625305.shtml

Two months after passage of Medicare Part D, the man who steered it through the House, Rep Billy Tauzin (R-LA), left government to become the President and CEO of the pharmaceutical lobbying group PhRMA.  This was a job change for Tauzin in name only.  His seven-figure salary was a small thanks for the billions in profit they will reap from his efforts. 

The blatant corruption of this act, and the perpetrators, presupposes that the American people—distracted as we were by the War on Terror®—were not paying attention, or would soon forget.  They were wrong.  We were watching every corrupt step, and we will not forget.

William Safire

William Safire died Sunday.
http://www.nytimes.com/2009/09/28/us/28safire.html
I almost always disagreed with him on issues—sometimes less than politely—but I admired and learned from his style. He was of a disappearing breed of commentators who would listen carefully to opposing views, then fully incorporate them in his rebuttal. If his opponent needed more verbal rope to hang himself, Safire was confident enough in his position to play it out for them. I don’t know if it’s out of my own love for a healthy exchange of opposing ideas, or the fact that he reminds me so much of my Dad, but I have always had affection for him.

Safire had the respect for his the other speaker and his audience—as well as the confidence in his own position and ability to communicate it—to truly match wits.  This is such a sad contrast to the excuse for political discourse that dominates today. It seems that success now hinges upon making one’s point within the bounds of what can be printed on a bumper sticker, and repeating it until supporters learn it by rote – a methodology more useful in training a hunting dog than trying to resolve complex societal issues.

I shared, and continue to share Bill Safire’s love of the English language.  Though I learned from opposition to him politically, I learned in harmony with him linguistically.  He knew that—as a living language—English must nourish and maintain the strength of its fundamental structure, even as we encourage it to breathe in the fresh air of new learning.  And, lest there be any doubt, he would not tolerate that word (learning) being used as a noun, with the risk of an ‘s’ being appended to make it plural. There are some basics that cross party lines.

But I digress – as, I dare say, Mr. Safire may have done on occasion.

I will sign off with two quotes attributed to this worthy gentleman. His sense of skepticism and subtle wit are present in each:
 ‘Never assume the obvious is true.’
 ‘Last, but not least, avoid cliches like the plague.’


It is not for me to judge whether the world is a better place because William Safire lived and achieved prominence. But I know my life is richer for witnessing his.

Preventable Chronic Disease

The United States cannot drive down the cost of health care if nothing is done to address preventing many of the preventable chronic diseases that account for a large percentage of the health care costs in this country. According to the CDC "The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs". Lifestyle choices result in many preventable chronic diseases, and result in the associated medical care costs. The prevention of these chronic diseases cannot be medical intervention alone, but must include lifestyle change if health care costs are to be driven down. None of the health care reform proposals being considered address encouraging life style change, or penalizing poor choices with respect to one's health, and perhaps they should not. But without such changes, won't health care costs continue to rise? So, should the legislature attempt mandate personal responsibility? Can it?

Issue with Comments - Hopefully Resolved

Hey Tonya, I noticed that there was no way to respond to your posting with a comment.  I went into the system and made some changes, and it looks like new posts may allow that, but something must have been temporarily reset to prevent it. 

Will another bureaucracy be better?

Michael you act as if a public option is the only solution to this problem. A public option is not the only solution to the problem your friend's patient faces, and, in fact, it may not be a solution at all - a government option can, and probably will deny coverage in certain cases as well. It is likely that today your friend's patient can appeal the insurance company's denial, and it is likely the appeal can be "fast-tracked". If he does not have this option today, regulations can be changed such that patients have a recourse when coverage is denied. To answer your FB response, "The difference between non-medical people making treatment decisions in a public system vs. our current profit-driven system has to do with the fiduciary responsibility of the decision maker. In a public system, that duty is to the patient, rather than the company shareholder." I don't find your argument persuasive. Just because an insurance company has a duty to its shareholders does not mean that it cannot also have a duty to those people it covers. In fact, insurance companies do have that duty. All companies serve multiple stakeholders. And many insurance companies serve their customers and shaeholders well (a large percentage of people with private insurance are very happy with their insurance companies). Regarding the insurance company's denial of your friend's patients colonoscopy - I don't have enough information to determine if I would agree or disagree with the coverage denial. Perhaps there are alternatives to a colonoscopy for younger patients. Perhaps the body of doctors that make recommendations on pediatric oncology has guidelines that recommend against colonoscopies for young patients. Etc.

The Bureaucracy we've Got

The father of one of the kids on the soccer team I used to coach is a primary care doc. He has a patient whom he suspects may have colon cancer, and ordered screenings, including a colonoscopy. But the patient is younger than the age threshold for his insurance company to cover a colonoscopy, so they’ve overruled his doc, and won’t pay.

My friend deals wtih this kind of crap all the time. That's part of why he is among the 72% of physicians support AT LEAST a public option.

http://healthcarereform.nejm.org/?p=1790#more-1790

Path Forward on Health Care

If one were tasked to design a health care delivery and financing system, with the goals of maximizing overall costs and minimizing efficiency, inserting as many layers as possible between the provider and patient, maximizing expense for those least able to pay, completely denying protection for those who need it most, and completely excluding over 15% of the population—while maximizing the power of, and the profits extracted by inert middlemen, who play no role in treatment of disease of injury—it would be difficult to improve upon the system we have today in The United States.

If the exclusion of millions of our citizens from health insurance coverage were necessary to maintain an economically efficient overall system, it would still be ethically unacceptable, but might be justified from a purely economic morally indifferent perspective.

Fortunately, we don’t face that conundrum. The same dynamics in our system which make coverage unavailable to millions of Americans, and prohibitively expensive for millions more, also add tremendously to the overall costs to our society.

We don’t even need to invent a solution from scratch. We are surrounded by countries with systems that work – societies that have advanced beyond letting for-profit health insurance companies pick the pockets of their citizens. None of these countries pay anywhere near what we do for coverage, none discriminates against low-income workers, small businesses and entrepreneurs, or the unemployed; and thirty-seven of them have broadly superior public health outcomes. Many of these other systems give consumers a much wider range of choices than most Americans enjoy. And none has anywhere near the US bankruptcy rate, the vast plurality of cases of which result from uncovered medical expenses.

Access to Quality, Affordable Healthcare

In our country, quality, affordable healthcare coverage is treated as a perk – a fringe benefit that comes with a good job. It suggests that one’s employer and/or union has the skills and clout to negotiate effectively with insurance companies, and a willingness to pass on the fruits of those negotiations to employees. Like the nice house in a nice neighborhood (though less visible), it is a status symbol.

In any other country we would consider a peer, the only status implied by such access is that of human being. 

If I'm on a plane, I accept the idea that the person sitting next to me may have paid a lot less for his or her seat than I did. I know that the airlines 'segment' the market, discounting for early purchases, for prefered customers, and excess seats – while charging a premium wherever possible. There are abuses, but it's the system we have, and if I don't like it, I can take a different airline, or drive. 

I'm less accepting of the reality in our country that the person sitting next to me in the doctor's waiting room may have paid substantially less for the same protection that I have, or that he or she is better protected because or market segmentation practices, or other rate/availability discrimination.

Introduction

Welcome to my Clean and Well Lighted space.

I hope to encourage a Clean and Well Lighted venue for interchange of ideas about issues of the day. This is all new to me, so the format may change a bit, but the concept will remain. 
Please feel free to post what's on your mind - whether it's a response to something you see here, or something that you want to bring up on your own. Good manners are strongly encouraged. As adults, we wish to agree or disagree without being disagreeable.