On Being Professional

Professionalism is one of those concepts I can't get my head around, like this guy:
But I have never felt professional in my life. I have felt conscientious, occasionally to the point of agony and sleeplessness; I have felt devoted at times and indifferent at other times; I have tried to understand those in my care as best I could; I tried to be interesting and friendly and interested: but I never regarded these things as professionalism. Professionalism was getting my reports in at the right time, phrasing them in the correct way, taking my part in the career structure, making constructive criticisms and looking for ever greater efficiency, or rather, ways of registering ever greater efficiency even when the result of registering was less efficiency.

This process has come a long way. First, students were invited to evaluate classes on forms, which is fine and even useful. Then students were instructed to anonymise their work so that we shouldn't be able to discriminate against them, and to put their evaluations of the class into an envelope that we might deliver their sealed evaluations to the appropriate place. Then it was further determined that only students should carry the envelope to the appropriate place. Why? Because we were not to be trusted, of course.

Not trusting us, or anyone, is truly professional. Distrust is the one true mark of the professional.
Go read the whole post.

Saturday Cartoon Fun: Good Speech Edition

Child Hunger Is A Complex Problem (It's More Than Just Food)

The hunger problem, like the achievement gap, is more complicated than one might think due to multiple factors that Americans are not equipped to deal with; unequipped due to consumerism, selfishness, and an inability to hold 2 thoughts in one's head at a time. Life is complicated, lots of grey. Complexity is not bad, just harder than simplicity. Americans are good at simplicity.
Missing more than a meal
Child hunger, called the 'silent epidemic,' is an increasingly complex problem

Even when children are not hungry, studies have found that slight shortages of food in their homes are associated with serious problems. Babies and toddlers in those homes are far more likely to be hospitalized than children in families with similar incomes but adequate food. School-age children tend to learn and grow more slowly, and to get into trouble more often. Teenage girls are more prone to be depressed or even flirt with thoughts of suicide.

Solving the problem is further complicated by its subtle nature. "Most people who are hungry are not clinically manifesting what we consider hunger. It doesn't even affect body weight," said Mariana Chilton, a Drexel University medical anthropologist who is part of Children's HealthWatch, a network of pediatricians and public health researchers in Philadelphia and four other cities. Hunger cannot be solved by food alone, their work shows, because it is one strand in a web of pressures that trap families, including housing and energy costs.

A nuanced problem

This more nuanced picture is emerging as the problem has become more widespread. With the economy faltering, the number of youngsters living in homes without enough food soared in 2008 from 13 million to nearly 17 million, the Agriculture Department reported last month.

Help The Military With Holiday Gifts That Matter

From DWT:
My friend Mimi's nephew Devin is a Marine Captain stationed in Iraq. He's been there for several tours and he wrote a letter home to his family this week that Mimi gave me permission to publish.

Dear family,

If you were wondering "what does Devin want for Christmas??," please follow the below link and choose from a number of great products:


Do not worry, I have done thorough research on the organization and it is legitimate. Also, a close friend from high school used to work with them and can vouch. The International Rescue Committee (IRC) was founded in 1933 at the request of the head of the International Relief Association (IRA), Albert Einstein, in order to assist Germans suffering under Hitler (sean-hope I have your attention). Since then the IRC has provided aid to Refugees fleeing from conflicts in Vietnam, Zaire, East Pakistan, Uganda, Chile, Soviet Union, Lebanon, El Salvador, Poland, Rwanda, Yugoslavia, Iraq, and most recently Afghanistan. For over 75 years, the International Rescue Committee has been a leader in humanitarian relief. They mobilize quickly, bringing sustained support to regions devastated by violence and deprivation. The most important aspect of their mission, in my mind, is that they provide hope to extremely vulnerable populations. I will explain what that means in a minute.

First, I'm sure you're asking at this point.. "uh.. is he serious? Isn't he a Marine? Has he gone soft? Is this spam??.." Nope, just hang with me. Providing support to a population who have become refugees as a result of armed conflict benefits more than just those individuals. It benefits you, your family, and your MARINES fighting abroad. How you ask?

I shall explain:

As I'm sure you can imagine, refugee camps are a terrible place. They are filled with displaced individuals who are jobless, moneyless, education-less, hungry, and angry because they were forced from their home/family (directly or indirectly) and moved to a trash heap in a countr that doesn't want them.

The depression that results from this environment breeds something called "hopelessness," especially in youths. Back in my F&M days while studying the Hopelessness Theory of Depression I learned that experiences in such negative environments can lead to the formation of dysfunctional beliefs, which in turn lead to negative self views, which in turn leads to depression, followed by desperation. THIS is why you have a "vulnerable population" within these refugee camps. Desperate people are easily exploited. Many terrorist organizations or extremist groups recognize this and are taking advantage of the social and psychological dysfunction within these camps to breed dysfunctional beliefs (Radical Islamic Extremism) and recruit suicide bombers.

You often wonder, "how can someone walk into a crowded square and blow themselves up?" Research refugee camps on the border of conflict ridden regions and Im sure you will understand how easy it would be for an al-Qaida operative to recruit individuals using promises of hope, meaning to life, and a guaranteed spot in heaven. A large majority of the suicide bombers who are killing our troops in Afghanistan are not Taliban. They are extremists who grew up in refugee camps bordering Pakistan. Look deeply into conflicts in Somalia and the Congo, you will find similar backgrounds in the majority of the extremists, guerrillas, or terrorists involved.

SO, by getting me my Christmas present you can save a life and disrupt the proliferation of terrorism by providing these underprivileged individuals with an alternative form of hope. Give them education to fight extremist views, food and medicine to maintain their desire to live, and HOPE that they can create a better life for themselves and their families. Help fight the long war.

If you can find a present like this in a store at the mall.. Let me know... I'll buy stock.

Thanks for taking the time to consider my Christmas list. There are many organizations to give to during the holidays and this is certainly not the only one you should look into. I look forward to seeing/hearing from you all this Christmas. Take care, Miss you!!


One Man Peace Protest

BUSSIGNY, Switzerland — A Swiss businessman appalled by his fellow countrymen's decision to ban minarets has extended a chimney above his company building into a minaret in protest.

"It was scandalous that the Swiss voted for the ban. Now we have the support of all the far-right parties across Europe. This is shameful," Guillaume Morand, who owns a chain of shoe stores, told AFP.

The businessman, who is not a Muslim, explained that the he had constructed the mock minaret at his building near western Switzerland's city of Lausanne in protest, and at the same time, to "send a message of peace."

h/t Sully


Do You Know These Kids? Updated Again

I got lost navigating the tubes of the interwebs. It happens. I don't even remember what tumblr site these photos are from, but I downloaded them and some others. You know, for fun. So here's the fun:

Who are these kids?

Malcom X

Yoko Ono

Update: The handsome young man was born in 1925 and the adorable little girl was born in 1933. One is dead, the other is not. They are both incredibly famous (or infamous, but mostly famous).

Update II:  A friend emailed me with the correct answer for the little girl:  Yoko Ono

Update III:  Another friend emailed the answer about the fella on top: Malcom X


War Eighteen Times

Nobel Prize-winning Obama used the word "war" in his acceptance speech 18 times.
Full text of Obama's Nobel Peace Prize speech
Remarks of the U.S. president in Oslo
updated 6:15 a.m. PT, Thurs., Dec . 10, 2009

OSLO, Norway - Your Majesties, Your Royal Highnesses, Distinguished Members of the Norwegian Nobel Committee, citizens of America, and citizens of the world:

I receive this honor with deep gratitude and great humility. It is an award that speaks to our highest aspirations - that for all the cruelty and hardship of our world, we are not mere prisoners of fate. Our actions matter, and can bend history in the direction of justice.

And yet I would be remiss if I did not acknowledge the considerable controversy that your generous decision has generated. In part, this is because I am at the beginning, and not the end, of my labors on the world stage. Compared to some of the giants of history who have received this prize - Schweitzer and King; Marshall and Mandela - my accomplishments are slight. And then there are the men and women around the world who have been jailed and beaten in the pursuit of justice; those who toil in humanitarian organizations to relieve suffering; the unrecognized millions whose quiet acts of courage and compassion inspire even the most hardened of cynics. I cannot argue with those who find these men and women - some known, some obscure to all but those they help - to be far more deserving of this honor than I.

But perhaps the most profound issue surrounding my receipt of this prize is the fact that I am the Commander-in-Chief of a nation in the midst of two wars. One of these wars is winding down. The other is a conflict that America did not seek; one in which we are joined by forty three other countries - including Norway - in an effort to defend ourselves and all nations from further attacks.

Still, we are at war, and I am responsible for the deployment of thousands of young Americans to battle in a distant land. Some will kill. Some will be killed. And so I come here with an acute sense of the cost of armed conflict - filled with difficult questions about the relationship between war and peace, and our effort to replace one with the other.

These questions are not new. War, in one form or another, appeared with the first man. At the dawn of history, its morality was not questioned; it was simply a fact, like drought or disease - the manner in which tribes and then civilizations sought power and settled their differences.

Over time, as codes of law sought to control violence within groups, so did philosophers, clerics, and statesmen seek to regulate the destructive power of war. The concept of a "just war" emerged, suggesting that war is justified only when it meets certain preconditions: if it is waged as a last resort or in self-defense; if the forced used is proportional, and if, whenever possible, civilians are spared from violence.

For most of history, this concept of just war was rarely observed. The capacity of human beings to think up new ways to kill one another proved inexhaustible, as did our capacity to exempt from mercy those who look different or pray to a different God. Wars between armies gave way to wars between nations - total wars in which the distinction between combatant and civilian became blurred. In the span of thirty years, such carnage would twice engulf this continent. And while it is hard to conceive of a cause more just than the defeat of the Third Reich and the Axis powers, World War II was a conflict in which the total number of civilians who died exceeded the number of soldiers who perished.

Taibbi On The Greedy Bastards

John Turley Explains Justice Department: Power Mongering

Jonathan Turley explains how Obama's Justice Department is defending the indefensible. Did Nuremberg mean nothing?
The Obama Administration has filed a brief that brushes over the war crimes aspects of Yoo’s work at the Justice Department. Instead, it insists that attorneys must be free to give advice — even if it is to establish a torture program.

In its filing before the Ninth Circuit Court of Appeals, the Justice Department insists that there is “the risk of deterring full and frank advice regarding the military’s detention and treatment of those determined to be enemies during an armed conflict.” Instead it argues that the Justice Department has other means to punish lawyers like the Office of Professional Responsibility. Of course, the Bush Administration effectively blocked such investigations and Yoo is no longer with the Justice Department. The OPR has been dismissed as ineffectual, including in an ABA Journal, as the Justice Department’s “roach motel”—“the cases go in, but nothing ever comes out.”

The Justice Department first defended Yoo as counsel and then paid for private counsel to represent him (here). His public-funded private counsel is Miguel Estrada, who was forced to withdraw his nomination by George Bush for the Court of Appeals after strong opposition from the Democrats.

Yoo is being sued by Jose Padilla, who was effectively blocked in contesting his abusive confinement and mistreatment as part of this criminal case and in a habeas action. The Bush Administration brought new charges to moot a case before the Supreme Court could rule. The Court previously sent his case back on a technicality.

It is important to note that the Administration did not have to file this brief since it had withdrawn as counsel and paid for Yoo’s private counsel. It has decided that it wants to establish the law claimed by the Bush Administration protecting Justice officials who support alleged war crimes. They are effectively doubling down by withdrawing as counsel and then reappearing as a non-party amicus.

The Obama Administration has gutted the hard-fought victories in Nuremberg where lawyers and judges were often guilty of war crimes in their legal advice and opinions. The third of the twelve trials for war crimes involved 16 German jurists and lawyers. Nine had been officials of the Reich Ministry of Justice, the others were prosecutors and judges of the Special Courts and People’s Courts of Nazi Germany. It would have been a larger group but two lawyers committed suicide before trial: Adolf Georg Thierack, former minister of justice, and Carl Westphal, a ministerial counsellor.

They included Herbert Klemm, who was sentenced to life imprisonment and served as minister of justice, director of the Ministry’s Legal Education and Training Division, and deputy director of the National Socialist Lawyer’s League.

Oswald Rothaug received life imprisonment for his role as a prosecutor and later a judge.

Wilhelm von Ammon received ten years for his work as a justice official in occupied areas.

Guenther Joel received ten years for being an adviser (like Yoo) to the Ministry of Justice and later a judge.

Curt Rothenberger was also a legal adviser and was given seven years for his writings at the Ministry of Justice and as the deputy president of the Academy of German Law.

Wolfgang Mettgenberg received ten years as representative of the Criminal Legislation Administration Division of the Ministry of Justice.

Ernst Lautz (10 years) had been chief public prosecutor of the People’s Court.

Franz Schlegelberger, a former Ministry of Justice official, was convicted and sentenced to life for conspiracy and other war crimes. The court found:
‘…that Schlegelberger supported the pretension of Hitler in his assumption of power to deal with life and death in disregard of even the pretense of judicial process. By his exhortations and directives, Schlegelberger contributed to the destruction of judicial independence. It was his signature on the decree of 7 February 1942 which imposed upon the Ministry of Justice and the courts the burden of the prosecution, trial, and disposal of the victims of Hitler’s Night and Fog. For this he must be charged with primary responsibility.

‘He was guilty of instituting and supporting procedures for the wholesale persecution of Jews and Poles. Concerning Jews, his ideas were less brutal than those of his associates, but they can scarcely be called humane. When the “final solution of the Jewish question” was under discussion, the question arose as to the disposition of half-Jews. The deportation of full Jews to the East was then in full swing throughout Germany. Schlegelberger was unwilling to extend the system to half-Jews.’
It was the “ideas” that these lawyers advanced that made the war crimes possible. Other officials were tried but acquitted. All of these officials used arguments similar to those in the Obama Administration’s brief of why lawyers are not responsible for war crimes that they defend and justify. Bush selected people like Yoo to justify the war crime of torture. If they had written against it, the Administration might have abandoned the effort. The CIA director and others were already concerned about the prospect of prosecution. The Obama Administration’s brief revisits Nuremberg and sweeps away such quaint notions. Indeed, the brief for Yoo could have been used directly to support legal advisers Wolfgang Mettgenberg, Guenther Joel, and Wilhelm von Ammon.

If successful in this case, the Obama Administration will succeed in returning the world to the rules leading to the war crimes at Nuremberg. Quite a legacy for the world’s newest Nobel Peace Prize winner.

They Own Us

Robert Reich concludes:
From the start, opponents of the public option have wanted to portray it as big government preying upon the market, and private insurers as the embodiment of the market. But it's just the reverse. Private insurers are exempt from competition. As a result, they are becoming ever more powerful. And it's not just their economic power that's worrying. It's also their political power, as we've learned over the last ten months. Economic and political power is a potent combination. Without some mechanism forcing private insurers to compete, we're going to end up with a national health care system that's controlled by a handful of very large corporations accountable neither to American voters nor to the market.


I Am A Socialist

From Joe Bageant
There are endless rationalizations proffered as to why Obama has not come within a mile of fulfilling the promise and potential of his presidency, and the Democratic Party is writing more of them every day. Disappointed Democratic voters grab at them, and desperately defend each one on internet forums and in letters to the editor. But we must use our own personal capabilities as free rational human beings to assess Obama, and decide why he is failing. Or not failing. To hell with highly crafted official explanations about "wars of necessity" and trillion dollar blackmail payments.

George W. Bush left office wearing the same smirk he came in with. Perhaps it's congenital. But if Bush was smirking when he left office, he must now be convulsed in crazed hysterical laughter. His gang not only got away clean, but Obama carries on the dark Bush-Cheney legacy. And, almost as if to top the whole black escapade with a cherry of irony, the most inarticulate president in American history is now on the motivational speaking circuit at $200,000 a pop. Never let it be said that the Devil does not care for his own.

Will Americans ever rise up in defense of their own common well being through such things as education, health and a productive peace caring society? Nope. Because it has been seen to that socialism -- the administration of the nation solely for the common good and benefit of all the people without preference or privilege -- doesn't stand a chance in America. For over a century those who have attempted to further socialism have been shot, hanged, burned alive in their beds on Christmas Eve, imprisoned, falsely accused of crimes and falsely convicted, and demonized by the capitalist elites of the corporate state. The cause of socialism has effectively been wiped out in the US. Few Americans can even define the word. Most think it is a political system when it is a social philosophy. Hell, half the socialists these days think it is entirely a political system.

But even if Americans understood socialism, they are too terrified to ever admit to its virtues, much less publicly support the cause. And without free and open public participation in some democratic form of socialism, regardless of the name or label given it, there can be no recognition of the people's common welfare and good. And so the most egalitarian social philosophy ever conceived dies within a nation, with very little chance of being reborn because such an ideal, by its definition, cannot exist within the narrow mindset of bankers and oligarchs.

Tuesday Cartoon Fun: Climate Change Denial Edition

21st Century Skills: How To Create Workers, Not Citizens

From Mike Rose at truthdig:
The economic motive has always figured in the spread of mass education in the United States, but recently it has predominated, edging out all the other reasons we send kids to school: civic, social, ethical, developmental. Even those 21st century skills that do deal with the civic, such as cross-cultural understanding, are expressed in terms of workplace effectiveness.

Take, for example, these items drawn from the advocacy group Partnership for 21st Century Skills:
  • Understand, negotiate and balance diverse views and beliefs to reach workable solutions, particularly in multicultural environments.
  • Leverage social and cultural differences to create new ideas and increase both innovation and quality of work.
These are worthy, and we certainly could benefit from their spirit of cooperation. But the focus is very much on getting something done in the workplace. There are other important educational and civic goals related to interacting with others of different backgrounds and beliefs. For starters, there is knowledge of cultural practices—of the very notion of culture—along with the appreciation of our common humanity. There might be nothing immediately “leveraged” from such understanding, but it has great civic and personal value.

Dubious Claims Are Usually Dubious

Sherman Dorn questions the claim that the HCZ has eliminated the achievement gap.
"The gap is gone"

If Aaron Pallas's report is correct, and Roland Fryer did tell Anderson Cooper bluntly in reference to the Harlem Children's Zone and Promise Academy, "The gap is gone," Fryer committed an understandable but all too common sin of education reformers across the centuries: overpromising. I've been in the room as one or more program directors and the like have promised the sky, the moon, and a few thousand stars to stakeholders and potential funders. Every time it's happened I've winced, because I've seen the storyline play out many times before: do something good, overpromise, and then see the program never be able to fulfill the more grandiose claims.

To me as an education historian, this is not an issue of whether we're adjusting for social class and other variables. Nor is it whether Geoffrey Canada is a good person (go read Paul Tough's book if you doubt that). Or whether Canada himself is overpromising: "it's worth about an hour of celebration" is his comment about the test score reports. It's about a persistent dynamic in education reform of being so desperate for something that works that you see more than is there.

I don't get that sense from Canada, who strikes me as driven and gritty and tied to what is happening to the kids in the area he's working. I'm worried about the talk around Canada and the HCZ, of taking Fryer and Dobbie's recent paper on the Promise Academy (which strikes me as fine work, but just one paper) and seeing that one paper as definitive. I've read Paul Tough's work (assigned it to my summer class), and I want HCZ to do everything Canada wants it to.

But I also want someone to look at it judiciously. And here's the irony: while it's common for a program head to be enthusiastic and a professional evaluator to be jaundiced, what is clear in the 60 minutes segment (and everything else I've read about Canada) is that the roles are reversed here. Canada's driven enough to be skeptical, to have changed school and program leaders when he doesn't see the progress he wants. Fryer? Well, check the CBS video of the segment between minute 10 and minute 11 (while watching the whole 14-minute segment). He said "the gap is gone" as baldly as Aaron Pallas claimed.

Yes, you're hearing me wince.

High-Stakes Testing: Korean Killer

The question you should ask: Is testing to death a good idea?
Korean children excel at testing, but at a price
Lessons for U.S.: Fewer high-stakes exams, more respect for teachers
Sheena Choi

As it has done numerous times in the past, America is once again looking to education for solutions to national social and economic problems. While education is in need of reform, it is worthwhile to pause and reconsider the educational reforms we are engaging in, especially high-stakes tests.

Since the 1980s, the U.S. has been fascinated with the economic miracle of the Newly Industrialized Countries of East Asia. Along with economic growth, these countries score high on international standardized tests. Recent Trends in International Mathematics and Science Study scores find U.S. students “still lag behind” those in East Asian countries. The TIMSS average score is 500, with Koreans scoring the highest at 597, followed by Singapore, Hong Kong and Japan. American students scored 508, lower than the Russian Federation at 512.

I can appreciate Americans wanting to do better, but do they know the price these Asian countries are paying for higher test scores?

Recently, I spent a year as a Fulbright Researcher in Korea and had an opportunity to observe intimately the South Korean education system that has produced the highest TIMSS scores in the world.

Students from the moment they start elementary school begin the race toward high test scores. Students take many supplementary classes after their formal school, returning home past 10 p.m. Once students enter high school, the entire family’s attention is focused on preparing children for college entrance exams.

Students sacrifice childhood and family life. Mothers become managers of their children’s studies; fathers, material providers for that pursuit. Poor families spend as much as one-third of the family income on supplemental studies; richer families spend eight times more than poorer ones on supplemental studies. Elite universities become bastions for upper-middle-class students.

The exam preparations leave scars on students and families. Stress and lack of sleep cause students to be physically and emotionally ill. South Korea reputedly has the highest youth suicide rate among newly industrialized countries.

Students protest their role as exam-taking machines and want to know why they have to work longer hours than adults. Adults lament that schooling is relegated to test preparation instead of preparation for citizenship. The public worries that the shadow educational system of supplementary schools is taking over the formal education system.

South Korea is experiencing an exodus of middle class families who are fed up with the highly stressful educational system. Middle class families are emigrating to the U.S. and other countries and, in some cases, even endure family separation to avoid the system built on “examination hell” for their children’s education.

Korea also experiences the lowest birth rate in the world. Education’s high private costs and the examination stress are primary reasons that young couples are having fewer children.

Americans need to learn from Koreans. We need creative educational reforms, not just more high-stakes testing. We can also learn from the positive side of East Asian countries, which endow educators with respect and provide them the equitable salaries of dignified professionals. Respect and financial reward attract high-caliber students to the teaching profession.

We can learn from Koreans about the unhealthy results of an educational system built on high-stakes tests, as well as the positive consequences of respecting and rewarding teachers. We should be investing in teachers, not in high-stakes tests. The price of high-stakes tests is too high.

Sheena Choi is a professor of education at Indiana University Purdue University-Fort Wayne. She wrote this for The Journal Gazette.
h/t Jim Horn


Text Message Scam

I have a cell phone. It has no camera and no touch screen and was free. I don't use it very much. I used to have a friend who would text message me a lot. Each message came in 2 or 3 parts, each time ringing my phone only to see he hadn't completed his sentence, necessitating yet another call. So I blocked text messages. All of them. How the hell can you type on that little number pad with 3 letters or more on each key? Ridiculous.

Anyway, I got a text message today. How? I don't know, and neither does Sprint (could be the problem right there!). I called Sprint to let them know a text message made it through even though I have set things up so they can't get through. Sprint told me they were getting quite a few calls today about this text message.

It is a text message scam. The text came from 9099. The message read:
customer issue, visa
service frozen. please call at
270 495 0189
I did call and the first thing out of the robot's mouth was "Please enter your Visa number," so I hung up.

If you get a text like I did, ignore it. Your bank will not text you. They will definitely not text you without identifying information in the text message if they text you at all.

During this holiday season, with poverty on the rise and war all around, there are many scum-suckers out there trying to steal what little money you have by scamming your credit card numbers. Be on the lookout and report fraud to your bank, your cell provider and your friends!

Monday Cartoon Fun: Million Dollar Edition + Links

The EPA has decided global warming is real.

Russ Feingold doesn't understand the Afghanistan surge (neither do I).

The Harlem Children's Zone gets results, but they cost millions and require proximity, paying students for grades and providing FREE HEALTH CARE FOR ITS STUDENTS.


Education Research Sucks (But We Knew That)

From Susan Ohanian:
Dr. Jerome Groopman holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is Chief of Experimental Medicine at Beth Israel Deaconess Medical Center in Boston. He is also a staff writer for The New Yorker. His latest book is How Doctors Think. He makes this observation in an interview in the Dec. 17, 2009 New York Review of Books.

As you read this excerpt, think about how closely it relates to the current Race to the Top and LEARN (sic) initiatives coming from Washington, D. C.
Jerome Groopman: [T]here are important reasons for having a scientific statistical analysis of evidence. I'm a scientist. I'm a professor at Harvard. I've done the clinical trials in my own field that have led to such "evidence." But I'm also acutely aware of their limitations. Statistical analysis is not a substitute for thinking. [emphasis added] Unfortunately, to my mind, because I voted for President Obama and certainly support many of the current reform efforts, there is a very powerful group with an ideology emphasizing evidence-based medicine, what they call "best practices." That is a wonderful term, because how can you argue with best practices?

But if you look at some of the bills, like the House bill, HR3200, and you look at many of the incentives in the Baucus bill from the Senate Finance Committee, they clearly want doctors not to think and lead, but to simply follow. And the incentives are that you are paid more by adhering to specific guidelines, and according to some proposals, your malpractice liability will be tied to whether you follow guidelines or not.

Now many times, there are patients whose illness don't conform to the direction of guidelines. Many people do not realize that in general the committees that draw up clinical guidelines force a consensus and there are often experts who disagree with some aspects of the guidelines or contend that they are flawed. There are numerous examples of this that are familiar to the public. One was the treatment of nearly all women after menopause with estrogen to prevent heart disease and dementia. We now know that the case for such treatment is far from clear and some credible experts had doubts about it from the start. A recent analysis of more than a hundred evidence-based conclusions about clinical practice reported that after two years more than a quarter of the conclusions were contradicted by new data, and that nearly half of the "best practices" were overturned at five years. This shows that guidelines are not gospel from a scientific point of view. Also, patients have different goals with respect to how much treatment they want, what kinds of treatment, and frankly, how much they are willing to comply with prescribed treatment. And you are punished in this system if your patients don't comply.

And so what's happened in Massachusetts is that patients who are in most need of a caring and communicative doctor, patients who are confused about their treatment, patients who are resistant, patients who don't like to take pills, diabetics who are too poor to eat healthy food--all of these patients now may be shunned by physicians because of the risk that you're going to look bad on a report card. I just learned of an older woman who was very fragile and in the midst of heart attack whose cardiologist hesitated to perform a necessary procedure to open the coronary arteries because her outcome might well be poor, and this could be counted against him in assessing his performance. These are the unintended consequences of much of the movement for what is called "pay-for-performance."

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