Background on Food Safety

Food safety has been a concern since the advent of ancient civilizations. Although many areas of the world had small populations of hunter-gatherer tribes, a few regions with temperate climates and resources of domesticable livestock and cereal grains found the establishment of agrarian
societies. These early farmers had to develop methods of collection, processing and storage to keep their food wholesome until the next growing season. With the advent of ‘new’ technologies like plowing, fertilizing and irrigation leading to excess food production, these societies moved away from subsistence agriculture to cultures with divisions of labor. Thus this agricultural revolution left some members of society free to be bureaucrats, soldiers, laborers, artisans, innovators and heads of large families.

Excess food production created a need to find methods for food storage and food preservation. After 10,000 BCE, people living in the Fertile Crescent found themselves with an abundance of cereal grains and in response developed technologies needed to keep food edible. That early cultures invented techniques for cooking, preserving and storing food is shown through archaeological evidence as well as writings from ancient civilizations including the Chaldean, Egyptian, Greek and Roman. [1]  Passages from Genesis 12 and 42 inform that while other parts of
the Middle East were experiencing famine, Egypt could be depended upon as a source of grain. Egyptians had developed silos to preserve their crops by keeping the grain cool and dry. Many other inventions and technologies, like pottery, fermentation, and smoking, were developed world-wide as the availability of food increased.

However, these ancient peoples learned that the presence of food did not necessarily lead to good health. After removing wholesome grain from storage, the Egyptians would make flour by
grinding the grain on stones in the open air. This led to a high level of contaminants and particulates in the food, and the Egyptians suffered from excessive tooth wear as well as dental infections and abscesses. [2]  In 500 BC in China, the Confucian Analects gave warnings about
fish, meat and grains that were improperly cooked or kept long enough to spoil. [3]

In more recent times, many developments in food storage and preservation were travel-related, where people needed food that they could carry with them for extended periods of time in different
climates.  Mainly this travel was due to exploration, war or trade. During the Renaissance period, brining became a common method of preserving food and salted food became the main staple of sailors and soldiers.   Nicolas Appert from Paris became the ‘father of canning’ and won a prize from Napoleon who was attempting to expand across Europe and needed a way for his armies to
carry wholesome food with them. [4]

The Spanish-American War lasted for only a few months in 1898, and of the 5642 related deaths, only 379 were due to combat; food poisoning was responsible for ‘thousands of deaths.’ [5, 6]  The US Army bought a 500,000 pound shipment of meat from Armour and Company of Chicago, IL. This meat shipment traveled to and from Liverpool England in 1897 and had been inspected and
stamped by the Bureau of Animal Industry. An army inspector discovered that in the boxes of this meat (which one general referred to as ‘embalmed’ meat, having been preserved with nitrate of potash and boric acid and also had food coloring added) many of the tins had burst open and the rotted meat had contaminated the rest of the contents . [7]

Only a few years later, the meat-packing industry suffered a major blow following the release of the book ‘The Jungle’ by Upton Sinclair based on his undercover experiences in the Chicago slaughterhouses. Sinclair’s goal was to expose the corruption of capitalism, and his story was about a fictional immigrant family set in the real world of Chicago and the meat industry with its unsanitary conditions and inhumane treatment of animals and workers alike. ‘The Jungle’ shocked the world with its revelations, and American citizens demanded action from the government.
President Theodore Roosevelt, who was a leader in the progressive movement to reform political corruption and corporate powers, responded by passing the Meat Inspection Act of 1906 and its companion,  the Pure Food & Drug Act. The Meat Inspection Act gave the government jurisdiction over meat-related commerce and applied standards for product inspection and plant sanitation. [8]

Many acts of legislation have been passed and many programs implemented to protect consumers from unsafe food. Perhaps the most important occurred in the 1960′s after the United States
entered the space race. NASA needed a way to provide food for astronauts that was nearly 100% pathogen free, so they turned to the Pillsbury Company, whose researchers worked on that problem plus the complications from providing quality food in situations with zero gravity. Pillsbury realized that their usual quality control programs could not provide the safety requirements; they needed control over the raw materials, environment, production and employees to meet these goals. This multi-step program, the Hazards Analysis and Critical
Control Points System (HACCP), was adopted by the FDA and is now the primary tool used in this country and provides a basis for food safety protocols world-wide. [9, 10]

Despite the progress made in food safety, transportation and storage, there are still many challenges facing the world. With the increase in industrial food production and international shipping, adverse events that used to occur locally (such as food poisonings at church dinners, weddings, etc.) now have the capability to have global effects. The access to nearly instant
internet communication allows any food-related event to be noticed very quickly. Products that are contaminated or potentially dangerous can be swiftly identified and removed from store shelves.

In today’s international food trade, produce and products are shipped world-wide and finally end up in local supermarkets and on the table. Although the importing of fresh and processed food from developed nations should lead to better nutrition and improved health, access to the modern
technologies that support these industries can be limited or cost-prohibitive in developing and least-developed countries. The breakdown of a local food safety system and bureaucratic corruption can prevent wholesome food from getting to the people, and may lead to fighting over limited resources and widespread malnutrition.

Malnutrition can be due to infectious and immunologic disease as well as limited access to food. A 1997 US survey (Morris) found, of the deaths where diarrhea was a contributing factor, that
89% of the victims were children less than 5 years and adults over 55 years of age. [11] Access to more food can be a two-edged sword – the resultant increase in infant and adult survivability means that there is an increase in the numbers of individuals with weak immune systems who
are more likely to propagate or succumb to an insult. The presence of an effective food safety system is necessary to protect all members of society.

International support for developing and least-developed nations is vitally important. Any progress made agriculturally will lead to additional advances in these cultures and countries. Not only will their citizens be healthier, more individuals will have time and resources to invest in other activities, leading to better physical and economic health within these communities. Historically it has been shown that societies that participate in the exchange of agricultural technologies are more likely to become involved in the exchange of other products, opening new markets and new trade
avenues. [12]

Food safety is no longer merely a local concern. Food-borne diseases can potentially threaten the global community, decreasing the health and economic productivity in any region that it touches. As the international organizations address global issues, food safety, especially freedom from
contaminants and pathogens, must be foremost in their goals.

Notes & Resources

1  http://en.wikipedia.org/wiki/Food_processing

2  http://www.world-foodhistory.com/2008/07/grain-in-egypt-1300-bc.html

3  http://www.enotes.com/food-encyclopedia/food-safety

4  http://en.wikipedia.org/wiki/Food_processing

5  http://www.food-safety-and-you.com/HistoryofFoodSafety.html

6  http://www.spanamwar.com/casualties.htm#American

7  Zinn, Howard. A people’s
history of the United States: 1492 – present. (New York: HarperCollins Publishers Inc, 2003) 309.
Retrieved from http://books.google.com.

8  http://en.wikipedia.org/wiki/Upton_Sinclair

9  http://www.enotes.com/food-encyclopedia/food-safety

10  http://en.wikipedia.org/wiki/HACCP

11  http://www.enotes.com/food-encyclopedia/food-safety

12  Diamond, Jared. Guns, Germs, and Steel: The Fates of Human Societies. (New York, Norton, 1997) Kindle location 3305 of 8299.

Is History Science Or Literature?

“With the historian it is an article of faith that knowledge of the past is a key to understanding the present.”

 Kenneth Stampp, Alexander F. and May T. Morrison Professor of History Emeritus at the University of California, Berkeley (1946–1983) and author.

There has been a debate for centuries among scholars as to whether history is science or literature. There have been historians who apply scientific method to events; in the laboratory of human existence they gather their data from chronology, geography and antiquities. They can point to the fact that certain events look to have a cause and effect relationship. These scientific historians tend to see history in cycles, and will often propose that without an understanding of history, mankind is doomed to repeat past mistakes. Unfortunately though, history cannot predict the future.

The other school of thought is that written (and oral) history is a narrative form of non-fiction. They would argue that all parts of history are unique and can only be understood when they are studied in context. Theodore Roosevelt, as president of the American Historical Association, gave a speech in Boston in 1912 that addressed this very topic. Roosevelt argued that history cannot be limited to merely reciting facts or repeating tales; history needs to be full of powerful images and language that engage the student, fill him with a sense of wonderment, and give him the ability to look at history from a personal point of view.

 “One man finds what is of most importance to his own mind and heart in tracing the effect upon humanity of the spread of malaria along the shores of the Ægean; or the effect of the Black Death on the labor-market of medieval Europe; or the profound influence upon the development of the African continent of the fatal diseases borne by the bites of insects, which close some districts to human life and others to the beasts without which humanity rests at the lowest stage of savagery. One man sees the events from one view-point, one from another. Yet another can combine both.”

Annual address of the president of the American Historical Association, delivered at Boston, December 27, 1912. From the American Historical Review, Volume 18, Issue 3, p. 473-489. http://www.historians.org/info/AHA_History/troosevelt.htm

The greatest historians, Roosevelt thought, were those that had a great command of literary skills. For centuries, when the Greek and Roman cultures were dominant in the world, poetry was seen as the appropriate way to record history and to teach science as the rhyme and meter made it easier for the student to retain the information. These scholars understood that it was important to have a strong grasp of history to be able to make better decisions and question others who had different points of view.

When writing instruments became more accessible and mankind became more literate, the oral tradition was replaced by written passages and monographs. Unfortunately, there were many ‘historians’ who embellished their work or combined bits and pieces of various events and personalities. Another problem that arises with historical literature is that many authors advocate for their point of view without considering other alternatives; the facts presented with an emotional argument must always be held suspect.

So how should history be approached? In researching for this essay, there appeared to be some consistent steps followed by modern historians.

1. Research the topic, gathering information from the different sources of evidence: public and private texts, data and antiquities.

2. Analyze the information and examine the historical context of the event.

3. Scrutinize the event’s interpretation from other historians; it is at this point that the logic of their conclusions must be accepted or discarded.

4. Examine other events for similarities & differences; gather more evidence and finally consider a personal interpretation of the episodes.

5. Develop and propose questions that arise; organize the facts, thoughts and arguments to develop sound conclusions that will make better policy.

[a good resource is http://www.historyguide.org/index.html ]

Today, as the economies and cultures of our world are more intertwined than ever, it is especially important for history to be examined. As historical events are understood, the knowledge gained can be applied to incidents that are in common for all nations: those of trade and public health at all levels.

History is fun!

Until next time…

http://hotair.com/archives/2011/02/05/epa-to-regulate-dairy-milk-spills-as-per-oil-spills/

http://www.thecompletepatient.com/storage/WIorder-clarification9-11.pdf

Once upon a time, in the land of the free and the home of the brave (and the rest of the world for that matter), there was this amazing substance called ‘milk.’ So magical was this liquid, that it was fed to the babies of many & varied creatures in the animal kingdom known as ‘mammals.’ More wonderful than water, milk was composed of proteins, fats and sugars, vitamins, minerals & water, the basic nutrients needed to keep the infants alive. So important were these nutrients, that female mammals actually had a way to produce and store milk until it was needed by their young. After the babies grew up and were able to find their own food supply, the mothers quit producing this ‘milk’ until it was needed by the next round of offspring. Some mothers produced extra milk, much more than their young ones needed, and these became known as ‘dairy’ animals.

How blessed the mammals felt to have this ‘liquid nutrition.’ Humans, too, recognized the importance of milk. The starry path in the night sky was called The Milky Way. The Promised Land was referred to as the Land of Milk & Honey. Even acts of generosity were recognized as ‘the milk of human kindness.’

The wise people of the kingdom realized how precious this milk was and they looked for different ways to share with others and keep it for future use. They discovered contamination, fermentation, & coagulation, and they called their products ‘cheese,’ ‘buttermilk,’ & ‘cottage cheese.’ Other learned people developed the processes of pasteurization & homogenization to keep the milk safe & creamy. Best of all, a method called ‘refrigeration’ was invented and people learned just how good milk was when chilled or frozen! Some humans would stand in lines at a store to buy this milk, others would pay to have it delivered fresh to their homes.

The people in the kingdom rejoiced. ”Happy Cows” (California Milk Advisory Board) were celebrated and Dairy Princesses were appointed. Many dairy lovers would greet each other in the street by saying, “Got Milk?” Meanwhile word spread quickly in the kingdom: ”Milk – It Does a Body Good,” (National Dairy Council); “It Builds Bonnie Babies,” (Glaxo Dried Milk); and “Drinka Pinta Milka Day,” (Milk Marketing Board).

But the glory of the dairy days could not last forever. Soon, nannies (those all-knowing dears who only want to do what is in your best interest) complained that this ‘milk’ could be dangerous, so the lords and justices of the kingdom passed legislations and regulations to make the glorious liquid safer for storage and comsumption. And the people of the kingdom rejoiced, although these new rules made the kingdom’s milk more costly and less tasty.

After much study and contemplation, the wisest of the people in the kingdom discovered that these new dairy processes destroyed some of the nutrients in this glorious milk, and the nannies said, “The children need these nutrients that the milk used to have!” So the lords and justices of the kingdom passed more legislations and regulations to add ingredients back into the milk, calling their new product ‘fortified.’ And the people of the kingdom once again rejoiced, even though it required more coins to buy this milk and it tasted even worse than before.

Years passed, and the people of the kingdom still felt blessed by this ‘fortified’ milk (even though it was so bland and costly), and many infants grew into adulthood and then raised their children with this milk. But there were rabble-rousers that began to rumble in the kingdom that they did not want this ‘fortified’ milk from these dairy creatures. So the rousers went to the wise people and instructed them to find a nutritious liquid from other sources. And the wise people, being of course very ingenious, found this liquid and the called it ‘soy milk.’ However, only some of the people in the kingdom rejoiced, as the ‘soy milk’ tasted strange and required them to exchange even more coins.

However, in parts of the kingdom were people who remembered the old ways and honored the dairy mammals. They grumbled at all of the changes that had been made to milk and wanted their glorious milk to come straight from the magical mothers; this milk they called ‘raw.’ And these grumblers went out into the kingdom and gathered these divine dairy creatures to themselves, drinking the ‘raw’ milk without pasteurization and homogenization and fortification. And these people rejoiced and no longer grumbled, for they felt renewed and invigorated by all of the nutrients in their special milk that was so tasty and cost very few coins.

But the nannies, DOING good because only THEY know what IS good, saw these happy people drinking their milk from their dairy animals and exclaimed: “They can’t do that!” The lords stood idly by, worrying about their own lands, jingling the kingdom’s purses and thinking about ways to spend the peoples’ tax monies. The justices agreed with the nannies; ‘raw’ milk was dangerous and the common people must be protected from themselves. So the justices passed new laws stating that people could not drink ‘raw’ milk from their own dairy creatures, nor could they sell their milk to others without complying with the legislations and regulations of the kingdom. And the nannies rejoiced but the grumblers began to grumble once again.

How does this dairy-tale end? If you listen closely, you can hear the grumbling growing louder. But we’ll have to wait and see…

Until next time…

The first thing I noticed http://www.weeklystandard.com/blogs/solar-decathlons-rainy-start_594112.html was that the price tag of the model shown came in at about $450-500,000. The goal is to create an energy efficient home, but at this rate nobody could afford one. That’s a great example of government INefficiency.

Now here are some examples of homes that entrepreneurs are developing to help create affordable housing: http://www.tumbleweedhouses.com/openhouse/  &  http://www.thetinylife.com/what-is-the-tiny-house-movement/ . Cute, affordable, and energy efficient.

OK, so we’ve paid nearly $200K for 19 government-sponsored homes, when we could have gotten 100 tiny homes from private industry. Remind me again, why the government isn’t good at this game?

Until next time…

THE GLOBALIZATION OF HUMAN HEALTHCARE

Wow! There is a lot of stuff to think about this week. I hardly know where to start. But I think
I’ll start with the articles.

 “How Health Insurance Design Affects Access To Care And Costs By Income In Eleven
Countries” by C. Shoen et al. – I found this a very interesting article,
but probably not for the reason the authors intended. What I found interesting
was the efforts to make ‘science’ out of opinion. It’s really quite easy, and
lots of ‘scientists’ do it all the time.

 Here’s how it works…you ask people how they feel about a subject and then use their
response to come up with statistics (confusing subjective and objective
information). The authors of this study did exactly that. To establish incomes,
respondents were told their country’s median income then asked if they felt
they were about average, much or somewhat above average, or  much or somewhat below average.  In other words, how do you feel about your income compared to the average? The biggest problem with this methodology is that it can introduce bias issues into your study, and although the authors
admit this problem when it comes to estimating medical expenses, they don’t
mention it about income. Ideally, the authors would have given an exact range
(if the median income was $35K, then ask if people make $30-40K (about
average), $15-30K (somewhat below average), $40-70K (somewhat above average),
etc.) That is a number most people have a pretty good idea about and can answer
truthfully, giving better data. (And about the truthful answer part, another
way to introduce bias is when the respondent either answers untruthfully
because they don’t think it is your business what their income is – I’ve done
that before – or they reply with what they think the correct answer is trying
to please the questioner.)

 Anytime you ask people about their ‘experiences’ you are introducing the potential for more
bias in your study. I can say this from personal experience. If a survey was to
catch me during a bad time with one of my health issues, my responses may
revolve around that one episode and not necessarily take all circumstances into
account. When I’m grumpy and hurting, I’m not necessarily the font of wisdom.
Likewise, asking a patient if they are confident they could get ‘the most
effective’ treatment, how are they to know? Is this their opinion or have they
educated themselves to know the different options and what will work for them?
Also, are they speaking of their own experiences or are they considering those
of friends and relatives in their answer?

 There were a couple of other things I didn’t like about this article. First, they really stressed
that low-income people are more likely to suffer more chronic conditions and be
elderly. Whereas I believe that it is the elderly and those with more chronic
conditions who are more likely to have lower incomes. I think that dollars
earned by the elderly during their working years are not worth as much during
their retirement years, thus many of them fall into the low income category.
This is especially true during this economic downturn when nearly everyone’s
financial worth has taken a hit. I also believe that people with chronic
conditions are less able to have an active or productive work-life (this would
include me) and that is why many have low incomes. It comes down to the
‘chicken or egg’ argument, but I don’t believe that having a low income leads
you to be elderly or sickly; that isn’t logical.

 Another statement in this article was that the countries varied in their ability to provide access
to 24 hour healthcare outside of the emergency room. My first reaction was
“so?” Isn’t that the reason for emergency rooms? I don’t see why this
topic was presented as an ‘oh my gosh’ one. It just seems like a no-brainer to
me.

 That’s true of many of their arguments. Maybe I’m naïve (some of my friends tell me that!) or
narrow-minded (some different friends tell me that!) so perhaps I’m just not
open to these studies that push the benefits of healthcare reform. Although I
have to say I didn’t know that was the purpose of the study when I started
reading it. But by the time I started going through their survey results, I had
a pretty good idea what their conclusions would be. I do know I am suspicious -
it comes with age and experience.

 I know that surveys are difficult to do (and especially in different languages and cultures); it
takes a lot of work and careful consideration to do a survey properly. Adding
in a potential for a lot of bias, then covering it with statistics, just leads to
the creation of junk science, and that’s what I think they have here. I can
honestly say I was not as impressed with this report as with the other articles
we read this week where ‘real’ numbers were used. And there I’m exposing my
bias against healthcare reform, as I don’t believe one bill can effectively or
efficiently cure all issues. I think there are some ways in which really good
studies could have been designed (like retrospectively looking at
post-hospitalization surveys). I do agree that you will miss some important
sections of society and some important information, but again, I don’t think
you can design one study to get all answers.

THE LONGEVITY REVOLUTION

OK, enough griping.
Now I’ll focus on some of the topics that I really liked this time and how I
see some of them in my veterinary practice. You know, sometimes my kids are
really impressed by how I seem to know everything (that ‘eyes in the back of my
head’ thing); at other times they roll their eyes because they can’t believe
how ignorant I am. I’m not ‘hip’ or ‘with it’, although I know those terms are
as dated as I am!

I really liked the
information about the aging population and the need for more general
practitioners. (I never really considered about the medical practitioners aging
as a group…hmmm.) I totally agree that there needs to be a move towards
family doctors. For many years the medical industry was gaining so much
specific knowledge and technical abilities, and it seemed like medicine became
very ‘targeted’ – if you had a joint problem, you went to a joint specialist,
etc. Of course, many people still technically had a primary physician, but
often it seemed that they did little but authorize the trip to the specialist.

For instance, I
never took my kids to pediatricians. My children are a part of a family unit
and need to be treated that way. They don’t live in a vacuum. And I think this
is the best example of how human medicine has gotten so off kilter. I’ve been
lucky enough to have found some really good family doctors who take the time to
do thorough histories. (Darned if they don’t leave just about the time I really
get them trained.) Doctors who take the time to listen and ask the right
questions are way ahead in treating the whole patient, not just throwing some
medicine at some symptoms.

In my practice a
good history is a must, especially since my patients can’t talk for themselves.
I think the biggest problem is that doctors have to get so many patients
through a day to make it profitable. Also, I think the culture of medicine
needs to get back to teaching the doctors about how important gathering
background information is. Or maybe just that it needs to be done. When you had
small practices in small areas, the doctors probably already knew most of the
family information about their patients because they were a part of the same
small community. That’s just not likely to happen today.

Another point that I
think was really well made this week was that lifespan does not equal
health-span. Whenever the legislature talks about raising the retirement age, I
consider it an interesting issue to tackle. When you look at the older people
you know, some people are ‘old’ at 65 and some are ‘young’ at 85. How do you
differentiate between those people who really need to slow down in their 60′s
(or even 40′s or 50′s), and those who are active and able into their 70′s and
80′s? I don’t see that there is a way to legislate this problem as it would
need to go person by person and case by case.

Hospice is one of my
favorite parts of the medical industry. My grandmother went into a hospice
house in Topeka after a massive stroke, and it was the best experience ever
(relatively speaking). Everyone I’ve ever talked to who have used hospice homes
have had good things to say about them. I don’t know as much about hospice done
at an individual’s home (I really haven’t heard of any in the last decade
personally), but I would imagine there is a move to get people into the hospice
facilities where there would be better access to staff, equipment, medications
and facilities.

To choose hospice is
to choose the right to die with dignity and comfort. But can the same be said
about euthanasia? As a veterinarian, I can say that euthanasia is one of the
most difficult things that I do. I hate the days when I transform from ‘Dr Glaum’
to ‘Dr Gloom.’ I appreciate being able to end the suffering and pain for the
pet of a family. Since I don’t like the ‘Dr Gloom’ I usually try to push the
animals and the families to put that decision off as long as we can maintain
the quality of life.

Once I have a
terminally ill patient, we have a ‘pet hospice program’ we use that helps the
patients stay comfortable and helps the families know when it is time for
euthanasia. This has been one of the best programs that we have instituted in
the past few years. We have a scoring sheet that looks at different topics
(like movement, hunger, pain) so that the pet owner can evaluate their pet, see
trends, and better communicate with us. If something is trending downwards, we
know that is an area to work on (like installing ramps, changing food types,
adjusting pain meds). Better quality of life (QOL) means that pet and parent
have more time together. And it relieves some of the worry and guilt that they
experience when that time does come.

One of the
non-scored topics I have to deal with though is the burden on the caregiver. I
know how important this is to people on the human side more than even the pet
industry. It is one thing to carry a 10# Poodle outside to go potty, but a very
different thing to move a 100# Labrador around. Sometimes the problem is the
clients can’t afford meds or have ‘people’ family commitments they need to
attend to. We, as veterinarians, have that luxury of being able to say,
“That’s OK, it’s time.” I have seen my parents caring for my
grandparents as they aged, and frankly, I’m scared that when it is time for me
to step into that role I may not be up to it. I hope I can find a way where it
is my responsibility, but not a burden. Time will tell.

The last thing I
wanted to note on euthanasia is what a burden it is to have the power over life
and death. It isn’t easy, at least for me. Perhaps that is because of my belief
that animals are all unique as God’s created creatures; I just don’t know. I do
feel honored to be allowed to be a part of the intimate time when the pet
owners say good-bye to their pets. I try not to cry at the moment, but often
the tears come on the way home. One especially bad period a few years ago, I
lost 12 pets in 9 days; it was a hot August and the little old guys just
couldn’t handle the heat stress on top of everything else.  Anyway (probably TMI), I went into a
depression that lasted for months. The point is, euthanasia is really tough and
I don’t think the human medical industry needs to go to that difficult place. I
think that hospice can fill that need.

Part of what we did in that class was to journal each week about our studies. Since I spent time on my journal and not posting to my blog, I thought I would publish some of my class journals on the blog. I’m not sure it will mean anything to anyone except me, but I hope you find some jewels just like I did. Sorry the formatting is so funky…I’ll try to work on that.

INTRODUCTION TO HEALTHCARE

OK, I have to admit
that prior to this first week I was very nervous. The subject of human
healthcare is way outside of my expertise, even though I have been a chronic
consumer. It is interesting to hear healthcare referred to as an industry,
because it makes it seem so large and expansive and over-reaching. As a
veterinarian, I know I’m part of the animal health industry, but my goal is to
peel away all of the layers and bring vet care to a personal level in the exam
room. I think that is why my clients like me. I feel like I spend a lot of time
talking, but my goal is to ask the right questions and find the answers that
the clients often don’t know that they have. Good pet care begins with getting
knowledge and ends with giving knowledge back to the client. I like it when I
get the same kind of personal care from my doctors, so thinking in terms of an
‘industry’ is overwhelming and a little scary.

One of the most
interesting parts of the presentations this week was the John Stossel segment
on Whole Foods and their approach to purchasing services from health
practitioners. It makes a great deal of sense and would seem to be very
effective. But as a doctor, I have to confess I don’t know the prices of
procedures and services that my clinic offers. Size of patient and length of
procedure are just two variables that can affect cost. However, I do have my
staff print off estimates and I will go over them with the client. The other
issue that I have to consider, which I think may also have great relevance to
this topic, is that I have to be careful not to only offer services that I
think my clients can afford. It isn’t my place to make those decisions for
them. Offering plan ‘A’, ‘B’ & ‘C’ can help the client receive services
that benefit the patient and also stay in their budget. We’re seeing more people use Care Credit (a medical credit card) and various
forms of pet insurance. I really do recommend that clients have these tools
available; what many don’t realize is that the cost of veterinary care is
closer to what their own health care should be without medical insurance.

Perhaps that’s why I
don’t think ‘healthcare reform’ is a practical approach to addressing this
issue. Because the industry is so big and changing rapidly, you cannot just
whisk in and make sweeping and effective changes. I think compartmentalization
is the key; break the healthcare industry down into its various sections and
functions and work on them one at a time. I also think another key to efficient
healthcare is to keep the administration as close as possible to the consumer.
Too many layers of bureaucracy create waste and inefficiency. Think of the
restaurant owner who walks through his dining room full of customers; he can
get feedback on their favorite dishes, what they’d like to eat, and what isn’t
working (be it food, staff, environment, etc.). The restaurateur is in a much
better position then to address the important topics to improve his customers’
experiences. Ha, if only it were that easy!

I hate that this
topic has become so partisan and so political. It keeps people from coming up
with good solutions that are practical and efficient. And when things get
stalled out because everyone is so busy hammering away at their point of view,
real opportunities are missed. I’m really bothered by the term ‘equality’, and
I’m hoping to learn more in this class about how it is applied. I do think that
everyone should have equal opportunities for health care (and everything else),
but it is unreasonable to expect equal outcomes. So much can happen on that
journey from A to Z, and I believe that the direction of that journey must be
decided by the individual, not by a third party, and  especially not by a government that can’t
even run itself well. I’m sounding more and more libertarian all of the time.
That is too funny.

I love the fact that
the history of public health was brought up. I love history. Here I wish we had
LESS compartmentalization. It seems that most people think that history is for
historians, but we can/should learn all there is about the background of our
professions, families, and politics. Why repeat someone else’s mistakes. Figure
out what worked and what didn’t. There is a lot of interesting knowledge out
there, much more applicable to today than most people realize. In my public
health area, there are diseases that are emerging much in the same way that
they emerged centuries ago.  I think
there are some basic public health principles (like sanitation and quarantine)
that need to be ‘rediscovered’ as people have become so dependent upon
antibiotics and hospital care.

He looks guilty because he’s guilty.

He acts guilty because he’s guilty.

He talks guilty because he’s guilty.

He doesn’t call the cops on the hackers because he’s guilty.

He calls the cops on reporters because he’s guilty.

He doesn’t deny the picture is his because he’s guilty.

This is not complicated. This is not Twin Peaks.

This whole “Weinergate” thing is sooo funny. And so sad.

Funny, well because the poor guy has a name that just begs for laughs. You know, like the Oscar Mayer ‘weiner song’:

Oh, I wish I was an Oscar Mayer weiner,

That is what I truly want to be,

‘Cause if I was an Oscar Mayer weiner

Everyone would be in love with me!

See, I think poor Anthony took that song to heart and really thinks that everyone wants to be with him. Or at least his twitter pal. Especially if you’re young and hot. And you think he’s hot. Add in the big (R) after my name and that leaves me out on all counts.

But the sad part is what his wife must be feeling. At least I hope she’s feeling something. Because if she doesn’t come out and say anything, I’ll come to the conclusion that she’s alot like Hillary and stickin’ to her man for the money and fame and power. IMHO.

Also sad that folks just can’t man up and admit when they’ve screwed up. (OK, this sentence could be read sooo many different ways!) The guilty who admit they are guilty look a lot less guilty than those who try to convince you they’re not guilty. Don’tcha think?

Thanks, Ace, for the clarity. The funniest part is I was watching a youtube video of Twin Peaks Lego’s just the other night and have had Twin Peaks memories going through my head.

It isn’t Twin Peaks.

Until next time…

http://www.foxnews.com/us/2011/06/02/prayer-prohibited-at-graduation-ceremony/?test=latestnews

want to keep all traces of ‘public prayer’ out of a TX high school graduation ceremony. However, kindly, the judge did allow that students could wear religious clothing or kneel towards Mecca.

Really, I say. Really?

Most parents and educators I know would be much more concerned that students dress appropriately (wearing nice clothes and none of the flip-flops or pants-on-the-ground) and act respectfully (not disrupting the service_oops! did I call it that?_ by getting out of their chairs and moving around) than that people would say a quiet “Bow your heads…” or “amen.” Two things really struck me about this article.

First, how about we have some folks dress up in religious habits or arab garb, then come into Judge Biery’s courtroom. Then, whenever they like, they can get out of their seats and assemble in the aisles, kneeling on their knees towards Rome or bowing towards Mecca. I bet he wouldn’t stand for that disruption in his courtroom, but he says it’s OK for a graduation. HYPOCRITE!

Secondly, if it is true that there is entirely separation of church and state, then it seems to me that Judge Biery has no right to tell a school how they should hold their graduation ceremony. That is a private matter for the school officials and the parents to decide. I don’t care if the school does receive federal dollars, separation should work both ways. Unless there is an obvious physical danger (like yelling ‘fire’ at the movies) anything said at that graduation shouldn’t matter to anyone outside of the auditorium. The school should be able to conduct their ceremony as they deem appropriate, and for Judge Biery to rule otherwise actually creates a relationship between church and state. HYPOCRITE! (Just to add to this point, I really do think the US government should get out of Education and turn it back over to the local governments.)

I’m not entirely certain how the Schultz family can claim that they would “suffer irreparable harm” if someone prays. Maybe it’s like spontaneous combustion or something. My advice to the Schultz’s: don’t pray, don’t go, or get over it. As this is being read, I’m sure prayers are already going up to Heaven on their behalf. Better keep the extinguisher handy!

Hypocrisy is claiming that there is separation between church and state, and then the state tries to assert control over the church. The First Amendment really prohibits the government from establishing a state-sponsored church (like Uncle Sam’s Church of Democracy). As Thomas Jefferson said, the separation is to put a wall between church and state, but it doesn’t mean that you can’t see over that wall or shake hands over it. Good fences (and walls) make good neighbors. And if you don’t like what your neighbor is saying, then leave. Or put your fingers in your ears. Or hum. Or talk louder.

It’s time for Americans to do some studying and read our Constitution for themselves. If you don’t agree with it, you’ve got that right, and the First Amendment protects your right to vocally disagree. But it doesn’t give you the right to be offended by what you see or hear. Get over it, or get out of here.

Until next time…