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Dr. Darrell White's Personal Blog

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Archive for January, 2017

Equality is the Enemy of Enough

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? This came up this week in my day job. A study was done that proports to show that male and female eye doctors are paid unequally. The conclusions are false at the outset in this particular case because by law, services in this particular arena are paid exactly the same no matter who performs them, when or where. Unfortunately, the sensational lede taps into all kinds of notions of fairness, and all kinds of perceptions about what people assume must be true, that women make less than men for equal work. There is no question that this is the case is some walks of life, but interestingly the data (some of which the authors ignore in their quest to prove their preconception) proves otherwise in medicine. An opportunity to examine real differences in how men and women practice medicine is thus lost in the pursuit of an examination of the spiritual quest to combat inequality, even where none exists.

Is this the unicorn of equality? Is payment under government programs the only place where equality actually exists? Heck if I know. What interests me is the fact that the first assumption is that inequality is present. Inequality is the default setting. That there is an inherent degree of unfairness in pretty much any and every setting. Know what I think? Equality doesn’t exist. It cannot exist if we are to have an ever-improving world. There is nothing unfair about that in the least.

A just civilization establishes a floor below which allowing people to live is ethically wrong. For example, in healthcare it is my contention that we have a moral obligation to see that every citizen has access to care when they are sick. Inherent in this contention is that there is a basic level of care that meets this moral obligation by ensuring the same outcome as any other level of care. One could apply this same concept to food, clothing, and housing without missing a beat. We can think of the rights enshrined in the U.S. Declaration of Independence as a proxy for this baseline if you’d like. Life, liberty, and the pursuit of happiness make a very fine baseline.

One’s right to “life” necessarily includes a right to be fed, would you agree? Equality would mean that if one among us dines on Beef Wellington, than each among us must do so as well. This is where unthinking and unquestioning fidelity to “equality” brings you. In so doing it forces everyone to expend energy protesting “inequality” better put toward fulfilling the moral obligation to see that no one goes without protein. In healthcare we see all kinds of protests againts the inequality of care demonstrated by the horror of a VIP of some sort or another recuperating from a procedure in a luxury suite, while the proletariat must recover in the equivalent of a Hotel 6. The reality is that the outcomes will be equal; the moral obligation has been fulfilled. Above a basic level in pretty much any domain you wish to examine, equality does not exist. Sorry. Scar is right. Life’s not fair.

Is he really though? Saying that it’s not fair is the same as saying that inequality above that level at which everyone has a right to live is wrong. Here is where I part company with those who hew to this viewpoint. What does it matter that someone drives a Cadillac while another drives a Kia? Do both not get you to work on time? Or that Beef Wellington again: do you not get the same amount of protein from a hamburger? The example I am using in another conversation about equality in healthcare is similar: if a medicine is effective taken 4 times a day, is the fact that someone can pay more for a version that must only be taken once a day a measurement of unfair inequality? I vote “no”.

My strong feeling is that energy spent in some way protesting “equality” is energy that is not expended on the much more important task of fulfilling the moral obligation of raising everyone to that acceptable basic level. In may, in fact, work against that effort. That constitutes unfairness in my opinion. Advocacy and protest should be directed there, toward making sure that everyone has that most basic obligation covered. Once universal entry is accomplished across all applicable domains, the next task is to continually raise that basic level for everyone, no matter how far the gulf may be between that level and whatever the “sky’s the limit” level might be. One need only look at “poverty” or “hunger” and how the bar has moved ever upward there to see how this might work.

We have a moral obligation to see that true rights are available to all. It is unfair to those who have not yet achieved that most basic level when efforts to help them are diverted to the pursuit of an unachievable conceptual goal that neither feeds nor clothes nor cures those in need: equality.

 

It’s Too Expensive to Eat Healthy Food, Right?

While I write this I am in the company of a group of women who ride horses. Some of them have nearly limitless means and the expense of owning and riding horses does not require any sacrifice whatsoever. Others, once having identified their passion, must prioritize their financial world, dropping things that others consider essential so that they can continue to pursue their equestrian goals. When we discuss proper nutrition one of the first things I hear is something along the lines of “it’s too expensive to eat well.”

I don’t buy it.

How often have you heard some version of that phrase. Whether it be Zone, Paleo, Whole 30, or just “stay out of the middle of the grocery store”, this is uttered with some degree of exasperation and oppression with a kind of mind-numbing, self-fulfilling frequency.

How so? Per the folks at Whole Foods, regularly skewered for being too expensive (seriously, they sell fancy potatoes), on average we in America spend 7% of our disposable personal income–that’s SEVEN–on food. 50 years ago that number was 16%. We now spend less than 1/2 of our after-tax income on food compared with what we spent 50 years ago.

And eating well is too expensive.

If we dig deeper into that stat alone we see that modern food production has decreased the cost of food relative to both income and inflation. The cost of producing food of all kinds has risen much more slowly than income. Why? Partly because junk, carb-laden food is cheap. High-fructose corn syrup costs a fraction of grain sugar. Corn-fed protein sources, with or without antibiotics or steroids, is grown faster and cheaper than grass-fed. Stuff like that. Less expensive to produce + incomes risen at a greater rate across the entire spectrum, top to bottom.

How then is it too expensive to eat a more healthy diet. We have 9% of our after-tax income to play with, right? Is some other necessity (shelter, transportation, medical care, etc) eating that up? What are we doing with that 9% (16-7) that we can’t find some of it to eat better? Ah, Grasshopper, now we begin to see. It’s a ‘Nando thing, it’s superficial. It’s not how healthy you are, it’s how you look, or something like that.

Some stuff might be more expensive, but the seemingly obvious culprits are actually false targets (eg. healthcare which for this audience represents only a tiny % of new cost c/w 50 years ago because of insurance, govt. programs, etc. despite all of the apocalyptic talk on SM). Nope, it’s how we CHOOSE to spend that freed-up 9% that makes it feel like we don’t have money to buy better food.

Think about that household in the 1960′s or even the 70′s. One car. One TV. One radio. Once purchased all data was free. A pair of shoes and a pair of boots. Sneaks if you were a jock. You didn’t get your hair done if you were a guy, you got a haircut. You didn’t get your acrylics touched up every 2 weeks; if you wanted long nails you grew ‘em. Stuff like that.

Fast forward to today and think about the stuff you’ve acquired, stuff you are convinced you can’t live without, stuff that costs money that you choose to spend every single day. The ratio of drivers to cars in a household is seldom less than 1.5 people/car, and it’s usually closer to 1:1. The ratio of phones to people over the age of 10 is seldom less than 1/1—everyone carries a phone. It’s not enough to have a phone, or even a phone with an unlimited text plan, nope, it’s gotta be a phone that will let you post your thoughts on today’s weather in Bimini to FB. Right now, from anywhere. If you don’t have Netflix available on each of the 4 flat-screen TV’s in the house you are considered a Luddite.

Listen, I certainly am not saying that all that stuff isn’t great, that it’s not a ton of fun and really convenient (as I type on one of the Apple products that literally litter our household, through the WiFi network at the barn, so I don’t deplete the battery on my phone by using it as a hotspot), or anything like that. What I most certainly AM saying, though, is that people who whine about how hard it is to afford to eat better almost always do so via a FB post from their iPhone 7 while sitting in the salon having their hair done, hungover from too much Bellevedere they consumed last night while noshing on Doritos smothered in Cheez-Wiz.

9 %. The stark reality is that we have let our things become more important than ourselves.

I’ll see you next week…

–bingo

Who Would Write Your Obituary? What Would it Say Today?

On Twitter a rather erudite retired surgeon posted the obituary of a 72 yo physician who died from cancer. She’d been sick and dying, knowing that she would die from her cancer, for some 2 years. Her obituary, obviously written herself, was funny and self-deprecating, an obvious attempt to soothe the sorrow of those she left behind. A women’s basketball player from Northwestern was killed by suicide last week. Who will write her obituary, and what will it say? One of my local colleagues died very suddenly and unexpectedly on Friday at the age of 50, roughly 24 hours after being diagnosed with cancer. Who will write his obituary, and what will it say?

2016 was notable for the number of rather famous people who died. This particular sector of humanity is famous enough that many media outlets pre-prepare obituaries so that they will have material ready to publish shortly after there announcement that the famous individual is deceased. It is unusual that someone not so famous, even someone of a degree of local fame, should have an obituary ready to go. More unusual, to be sure, for that obituary to be as light-hearted a read as that Minnesota MD. No, for the majority of humanity, at least here in the U.S., an obituary is a rather slap dash on-the-fly “just the facts, M’am” effort by whoever is at the desk at the local funeral home.

I know this, of course, because my Mom sent us the draft of my Dad’s obituary before she gave the OK to publish. Now, my Dad was a very good man, hardly great in the sense of, say, FDR or Red Auerbach, but he certainly deserved more than a rote regurgitation of his stats written in 6th grade English. Since I spend more time exercising my writing muscles than my siblings, or maybe just because I can type faster, the job fell to me to capsulize a man who was larger than life to his family, just like I’m sure is the case with my just deceased colleague and that Northwestern basketball player.

The grains of sand that pass through the funnel of life’s hourglass are only dry if observed from afar; up close each one is as colorful as any rainbow, as full of energy as any thunder storm. Poetry is there for the asking.

For most of us there is still a long journey ahead. The bulb atop our hourglass still holds innumerable grains of sand, a countless number of memories yet to create. We have years, nay decades of love yet to give and receive. Life is actually quite long for all but the unfortunate, unlucky few. Their lesson for us is simple, I think: Who will write your obituary? What will it say if it needed writing today?

Emotional Well-Being: Mental Health Deserves Equal Footing

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses, including addiction, are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of months. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

 

A Struggle Just to be Average

Lake Wobegone, where every child is above average. Remember that? It’s a joke, of course, but it’s funnier if you have even the tiniest bit of comfort with numbers, statistics, and probabilities. Every parent wishes for that, right? To have raised a child who rose even just a little bit above.

What does it mean to be average? It begins with the cohort, the population you are evaluating, and the particular variable that is to be measured. The average Division 3 cornerback is a decidedly different specimen than the average guy playing on Sunday. The average working vocabulary in a room filled with Pulitzer Prize winners is quite a bit different than that of, say, the Green Bay Packers booster club luncheon yesterday. On the other hand, the average VO2 max in those latter two groups is likely pretty similar.

Along with average comes a range in any curve. Some groups are tightly bunched around the mean, the average; being average is an expectation. On the line at Ford your performance has to be average at worst. If you are above or below the average in any other group it probably is helpful to know how big the range of differences is in that group. For example, if we are measuring 400M run times at the Olympics there’s a pretty skinny range beyond which below or above average makes you stick out, good and bad.

Average does not necessarily mean mediocre.

I got to thinking about this yesterday when I heard from a bunch of my college buddies sending along birthday wishes. In my life there have been two places where I’ve been average: Williams College and CrossFit. Both here in the CrossFit world and in my college years at Williams it has taken everything that I have just to be in the middle of the pack. This is a double-edged sword. It’s humbling to have to literally give it your all just to hit the mean. However, placed into a group or given a task in which you have the potential to excel, to bust the curve if you will, the experience of having to work so hard just to be middling should drive you to do the same when you have a chance to be the best.

My Mom and Dad did, indeed, raise kids who were above average. It appears that Beth and I may have done so, too. If we are lucky, the Man Cub and his cousins will follow suit. The only way I will know is because I had the privilege of struggling to be average in the company of two very extraordinary groups of people.

My classmates and teammates at Williams, and my fellow CrossFitters.

 

Sunday musings New Year’s Day 2017: Purpose

Sunday musings…

Musing, whether today on my 56th New Years Day or on any other random Sunday, is an entirely different proposition when done in the presence of my 15 month old Man Cub. He takes up an awful lot of space for such a tiny little creature. I’ll give it my best…

This is not going to be just another whatever about making or keeping resolutions just because it happens to be the first day in a new year according to the Western calendar. Hit up that intellectual workout if you please, for sure, but that’s not where my head’s at right at the moment. Nope, not detailed micro-resolutions like “exercise X times each week” or even more global ones along the lines of “get healthier”. At least for me, today is the day I tie the ruminations of prior days, weeks, months and years together into something which feels something like a common thread to which I can cling as I pull myself through the second half or so of this life.

Like so many of the stuff that leaks out of my inner hard drive onto my keyboards and into my life, this slow-cooked epiphany was prompted by a tiny little random thought I stumbled upon in something I was reading. “We spend most of our lives in a reactive trance, not really thinking about why we do what we do.” –Tara Brach. That, my friends, stopped me right in my tracks. How much of my life am I living on auto-pilot? How much of what I do each day is the equivalent of handing over my day to an internal self-driving program that, at best, reacts to not only what has just happened but what is by history likely to happen next?

It is time for me to remember that a purposeful life must be one that is lived proactively, and that in order to be proactive it is necessary for one to have a purpose.

No one can be expected to live every moment of a life in a fully proactive mode, at least not without risking certain insanity. No, what I think I’m feeling is a lack of thoughtful purposefulness in most of my life at the moment. It’s more than goal setting, more than having come through the serial apply-matriculate-graduate kind of purpose of a younger life. It’s not a case of just “going through the motions” of existence either. What I think this New Year’s Day reflection is really about is a need to articulate a 30,000 ft. purpose for at least a portion of my life, and in so doing to give me something about which I can be proactive for a portion of each day.

As I made the “hard turn at mile marker 49” my friend Hari suggested that the second half of a life is spent in living the life that the previous 50 years you’d spent preparing everyone else for. Apparently I am a bit of a slower learner than some as it’s taken me an extra 7 years of so to be ready, but I at least appear to be ready to examine the concept of the purpose of what might be the next 50. For some this is undoubtedly an internal pursuit, but what little self-awareness I have leads me to believe that mine will be a more social, collaborative pursuit.

Should I have gotten here sooner? Is this a call to you if you are younger than I to start now, rather than later? Nah. We get here when we arrive, and not a moment sooner. In all likelihood my purpose will slam me upside the head when I’m looking in another direction. Is that the ultimate in being reactive? Or might the simple fact that I am open to the blow enough to call it a proactive part of the process?

We’ll see, I guess. We’ll figure it out, both you and I. For just this moment though I’m afraid that I have to step away from the keyboard, for out of the corner of my eye I can see the Man Cub headed toward the stairs. Will my dash to snag him before the top step be reactive or proactive?

Sometimes a purposeful life is actually lived in 10,000 3-foot moments.

I’ll see you next week…

–bingo

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