Might as Well Pile On Michael Jackson Like Everyone Else

Though I am no pop culture analyst, the death of Michael Jackson has been on my mind for the last week. Just a few scattered observations. Jackson isn’t the kind who inspires coherence anyway.

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Some commentators have tried to put Jackson up against the Beatles and Elvis. In terms of record sales, sure, but in terms of influence, please. I didn’t even own a Michael Jackson album until a few months ago, when Thriller went on sale on iTunes in celebration of its 25 anniversary. How often did Jackson’s songs turn up on the radio before he died? Not often. Compared to the Beatles, Elvis, even Queen, the Eagles, or James Taylor, Jackson wasn’t played much. “Beat It,” “Thriller,” “PYT,” and “Bad” seem somewhat dated. Not bad songs, but highly stylized and more flash than innovation.

I hate hearing that Michael Jackson broke new ground. Parliament broke new ground. Jimi Hendrix broke new ground. Marvin Gaye, Rick James, Diana Ross, Isaac Hayes, and of course James Brown, did everything Jackson ever did, and did it better. The most shameful part of this Michael Jackson idolatry is that it glosses over the people who really pioneered African-American music. The Jackson 5 had a couple of early hits. So what. Take the Jackson 5 out of Motown, and Motown is still Motown. Jackson a pioneer? Give me Stevie Wonder and Ray Charles any day.

Not that MJ was bad. Jackson’s got danceability going for him, but immortality? I don’t think so. I sincerely doubt our grandkids will know Jackson the way we know Dylan or Sinatra.

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Michael Jackson is well-remembered because he was the last of a breed. The New York Times reported he sold 750 million albums in his career. An astonishing number, and impossible in the days of the internet. Jackson kicked off his solo career shortly before CDs got big, and Thriller was one of the early albums that sold huge numbers in digital format. In the 1980s the music industry made a killing selling CDs, which were far more popular than the less durable LPs and cassette tapes. CDs were the medium pop music was looking for, and Jackson became a superstar just as CD sales took off.

Then the internet came and crushed the music industry. Thriller sold 28 million units in the U.S. alone, and there is no chance, in the age of piracy, that this will ever happen again. Thus Jackson arrived on the music scene just in time to benefit from an industry boom and flamed out as the industry collapsed. The biggest acts that were also Jackson’s contemporaries, U2, Madonna, the Police, Phil Collins, Mariah Carey, all were beneficiaries of the CD boom. WIth CD sales only a shadow of what they were even as recently as 1995, we won’t see another Michael Jackson.

Jackson was also the beneficiary of MTV’s success in the 1980s. The fragmentation of the cable TV market, and the dissolution of MTV from a true music channel to a trash reality TV station also precludes successors, though I feel this is a lesser issue than the influence of the internet.

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750 million albums worldwide. And died bankrupt, in a rented mansion. Who the hell rents mansions? If you can afford to rent a mansion, can’t you afford to buy a regular house? If he got a dollar in royalties for every record sold, he should easily be a billionaire. Instead, he died broke. I can’t in my wildest dreams imagine burning through a billion dollars, but Jackson did it. Did it by building a private Disneyland at his house and inviting children for sleepovers, even while he was being accused of child molestation. Maybe I can’t tell you for sure that he molested children, but I can tell you that a person who can’t stay away from children even while he is being investigated for improper conduct with a minor has a serious problem. The definition of compulsive-addictive behavior is when a person can’t stop doing something even when the consequence of continuing the behavior is personal destruction.

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I can’t think of a person who better fits Daniel Boorstin’s definition of a celebrity: “The celebrity is well known for his well-knownedness.”

In fact, Boorstin, an American historian who died in 2004 and so must have known about Jackson, has many quotes in his books that remind me of the self-crowned King of Pop.

Nothing is really real until it happens on television.

We suffer primarily not from our vices or our weakness, but from our illusions. We are haunted, not by reality, but by those images we have put in their place.

Some are born great, some achieve greatness, and some hire public relations officers.

A sign of celebrity is that his name is often worth more than his services.

The last quotation was the the most prescient. Michael Jackson is dead, and every channel on TV fills its hours with his face. Even when he can no longer deliver any services, he still sells.

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Time to stop. The more I write about Michael Jackson, the more irritated I get. He was more lucky than good: I can think of a hundred rock artists I’d rather listen to. Not that I won’t listen to Thriller or Off the Wall again, but when I think about the records I listened to back when Jackson was big — R.E.M., the Talking Heads, U2, the Clash, Squeeze — I’m sorry, but Michael Jackson does not fall in that class. I was in college when Jackson was big, and we dismissed him as Rock Lite. He is admired because he sold records, and he sold records because he was admired. He was good. He wasn’t great.

And what took him out at last? The jury is still out, but it appears to have been addiction. In my medical career I’ve seen addiction up close, many prosaic implosions that were miniatures of the supernova that was Michael Jackson. The only difference is that, with a billion dollars to prop him up, it took Jackson longer to crash to the ground.

We can think of this as tragic, but I don’t find it any more tragic than anybody else’s drug addicted death. And in some ways, his death is less dignified, because the media swarm is bound to obscure the realities of his death. We’ll hear every sad detail about his last days except the truth. That he killed himself with drugs the way any third-rate crackhead might have.

Just as those fabulous record sales obscured the bizarre appearance and behavior, the child molestation, the drug abuse, and even his stature as an artist, all that fame will obscure his death, which was dirty, predictable, and altogether common.

This country is wracked by drug addiction. Just as we close our eyes to every other aspect of this terrible scourge, we are going to ignore its realities when it claims one of our most famous citizens. How typical.

The New York Times, "The Ethicist," and Catholicism

In the Sunday New York Times Magazine (6/21), Randy Cohen, author of the column “The Ethicist,” fielded a question from a man studying to be a Roman Catholic priest. The seminarian asked if it was ethical for the school he attended to only give scholarships to students studying to join the religious order. Cohen’s answer seemed reasonable: “There’s nothing wrong with a religious order establishing a school for its members, subsidizing their education, and then later broadening the student body to include tuition-paying nonmembers.”

Then Cohen’s answer took a bizarre turn that will get him in hot water with Catholic readers.

What is at issue…is sex discrimination: your order’s refusal to admit women and, more significant, your aspiring to the priesthood, a leadership position in your church, one closed to women. Calling a practice ‘religious’ does not exempt it from ethical scrutiny.

First of all, I’ll nitpick. The writer didn’t say his order is closed to women. Many religious orders are open to women as nuns (the Dominican order is an example). Admittedly, becoming a nun is not the same as being a priest, but on the other hand, it means Cohen’s implication that women at the college are being denied scholarships could be false, depending on which religious order the seminarian was joining.

Now, about this priesthood thing. In bringing this up Cohen violates an ethic himself — the one about not giving unsolicited advice. This seminarian asked about scholarships at a college, not about the nature of the priesthood. Presumably a man already studying to become a priest knows the priesthood is all male and has come to terms with the fact. For Cohen to bring this issue up is a little like telling an engaged man, “And you know marriage means you can only have sex with your wife.” It is vaguely insulting. If Cohen wants to engage in anti-Catholic polemics, he should do that on his own time, and not as part of an advice column.

No, the priesthood is not open to women. The Boy Scouts aren’t either. That shouldn’t trouble anyone who doesn’t want to be a Boy Scout. I don’t know what Cohen’s religious persuasion is, or if he has one, but certainly he is not so naive that he does not realize that religions often hold positions that make no sense to nonmembers. It makes no sense to me that Jehovah’s Witnesses refuse blood transfusions, even at the cost of their lives, but as long as they are willing to live with the consequences of this rule I am not disturbed by it.

For what it is worth, I am not entirely comfortable with the Church’s position on the ordination of women either. The reason given, however, is fairly straightforward. The priest leads the congregation at the Mass, and the Mass is a recreation of the Last Supper. Jesus presided at the Last Supper, and Jesus was a man. Thus, a priest, as the stand-in for Christ, should also be a man. One way to think of it (though very imprecisely) is that the priest is an actor in a play. We wouldn’t expect a female actor to play a character that is clearly and traditionally played by males — for example, Abraham Lincoln in a movie about the Civil War.

As a matter of personal opinion, I’m not sure that Catholics would be confused about the identity of Christ if the celebrant at a Mass were a female. But this is the position the Church has taken for centuries, and there is a logic to it. Though, in a certain light, this thinking could be taken as sexist, it doesn’t necessarily have to be. Women can’t father children and men can’t have babies. The Church holds that this difference between the sexes is not incidental, it is intended by God. As a result, it should be expected that women and men would have different roles in religious life. I have been told in no uncertain terms by some feminists that, since I am a male, abortion is none of my business. So the Catholic Church is hardly alone in asserting that gender identification is relevant in moral matters.

However you approach this issue, Cohen’s answer has a burr-up-the-butt feel to it. He should have stuck to the issue at hand, rather broadening to attack the Catholic Church. It was, in a word, unethical.

Does Sotomayor Really Make the Supreme Court Diverse?

Sonia Sotomayor, President Obama’s choice to the Supreme Court, is an affirmative action appointment. That is, she was nominated in part because she is a woman and a Hispanic.

Nor is there anything wrong with that. Diversity is important in any high-level government position, and that especially includes judgeships. Diversity improves the receptiveness of the Court to the interests of the common people, and keeps it in touch with middle class America (a trait that Obama somewhat inaccurately called “empathy” but is better encompassed in the old fashioned word wisdom).

Critics of affirmative action play on the misconception that there is an absolute ranking in fitness for any job, and that the employer is bound by law and morality to rank ‘em all up, and then sign #1. If #1 turns the offer down, then the choice moves to #2, and so on until the job is filled. Any attempt, the theory goes, to deviate from the “list” is reverse racism. This argument serves meritocrats quite well, because it also permits them the only chance they ever have to play the race card.

But it’s pure rubbish. If it were true that objective standards infallibly predicted success, the valedictorian of every class would always become the richest or the most successful; perfect SAT score would be the best predictor of Pulitzer prizes; the player with the fastest 40 yard dash time would always be in the Hall of Fame. But it doesn’t work out that way, does it? Albert Einstein finished 5th out of 6 in his college class and in 1904 couldn’t land a teaching job to save his life. Luis Alvarez and William Shockley, Nobel laureates both, were overlooked in grade school by a famous psychologist trying to identify the best and brightest through school testing. Hank Aaron failed to make the cut the first time he tried out for a professional baseball team. A Confederacy of Dunces, a book written by an unknown high school teacher, was rejected by dozens of publishers, before it won the Pulitzer Prize. I could go on forever. The point is, accepted standards only take you so far, and have an unsettling track record of missing not only the very good, but sometimes the very best of the best.

If the Supreme Court requires a one in a million intellect, in a country of 300 million people there are 300 people qualified to take the job. The truth is the number is likely much larger than that; there are probably 5000 Americans who have both the experience and the intellectual ability to do the job. All of them will be graduates of so-called “top” schools, will have years of experience on the bench, will have finished at the top of their class, will have very good SAT and LSAT and whatever other IQ test acronym the discerning heart could desire. Any attempt to further stratify this small group of people and rank them is superfluous hairsplitting.

As a result, we want to look beyond the standard ranking fare to make a good choice. In decision science (a branch of psychology that looks at how people make choices), there is a broad consensus that a committee’s net IQ — that is, its ability to solve a problem or arrive at the correct answer — depends more on the diversity of viewpoints within the group than on the sum of the IQs of its members. (For the basis of this argument I rely on the book The Wisdom of Crowds by James Surowiecki.)

The reason diversity beats total IQ points is that redundant knowledge is not additive. In other words, if two people in a group know the same thing, the group is no better off than if only one person knows it. On the other hand, if two people know two different things, the two separate pieces of information are additive and thus make the group as a whole more knowledgeable.

Suppose, for instance, that you have two groups of 10 people who plan to have Thanksgiving dinner together. One group is made up of a bunch of poultry experts, and each person in the group resolves to outdo the others by bringing in the most delicious turkey. The second group is made up of a bunch of average cooks, each of whom has his own specialty.

When the first group sits down, the table will have 10 turkeys on it. When the second group sits down, there will be one turkey, stuffing, cranberry sauce, dinner rolls — a whole variety of foods. Clearly the second group will have the better meal. Even though they individually are worse cooks, the second group has a greater variety of skills, and thus is able to provide a wider variety of foods, and a more complete and satisfying meal. The first group, while composed of superior cooks, has redundant skills. Two turkeys are not necessarily better than one.

The same applies to the Supreme Court. As long as each member of the Court has the prerequisite competence to serve, what matters most is a diversity of experience and views. Diversity of opinion sparks interesting debate and brings more issues into play. Overlapping experience will lead to more rapid agreement, but a narrower range of discussion. As a U.S. citizen, I prefer members of the Supreme Court to have a wider breadth of opinions, and stronger and more heated debate. Obviously the more angles the nine judges take in looking at a problem, the more likely they are to come to to the right decision.

Surowiecki’s book cites research showing that most committees tend to divide into two opinion camps. If the group is composed of like-thinking individuals, the two camps are much closer together, and not all options are put on the table. For example, throw a group of Republicans in a room and ask for recommendations about health care reform. The group is likely to split into one camp that wants an entirely private system and another that assents to Medicare but otherwise wants minimal government influence. Add a couple of leftists, and suddenly the two camps consist of one group that wants no government at all and another that wants government to run the entire health care system. Which of the two discussions is more likely to be wide-ranging, intellectually challenging, and therefore fruitful?

The interesting thing about Sotomayor, though, is that she passes the diversity test in one way, but fails it in another. Culturally, as a Latina she brings a certain diversity to the Court. But ideologically, she is does not. Sotomayor was educated at Princeton and then went to Yale Law school. Consider the educational history of the justices Sotomayor would be serving with: John Roberts, Harvard, then Harvard Law; John Paul Stevens, University of Chicago, Northwestern Law; Antonin Scalia, Georgetown, Harvard Law; Anthony Kennedy, Stanford, London School of Economics, Harvard Law; outgoing David Souter, Harvard, Oxford, Harvard Law; Clarence Thomas, Holy Cross, Yale Law; Ruth Bader Ginsburg, Cornell, Columbia Law; Steven Beyer, Stanford, Oxford, Harvard Law; Samuel Alito, Princeton, Yale Law.

To summarize, for law school that’s 5 Harvards, 2 Yales, 1 Columbia, 1 Northwestern. If you live in the United States, unless you are a graduate of Yale or Harvard Law, you can pretty much write off being a Supreme Court Justice. The only person on the current Court who did not go to an Ivy League school is Stevens, and he is the one confirmed the longest ago — way back in 1975. So even as the Court has become more diverse culturally and sexually, it remains as educationally — and therefore, I would argue, ideologically — as homogenous as it has ever been.

And when you think about it, what kind of diversity matters most in the Supreme Court? Do we care more about what kind of food the justice sits down to eat after a long day of deliberation, what kind of music she likes, or where she goes to church — or, do we care about how she was schooled? For me, there is no comparison. In legal decision making, schooling beats ethnicity any day.

It is not comforting to me that we seem to be leaving the makeup of the Supreme Court to the admissions committees at the Yale and Harvard Law Schools..

Most Latinas don’t go to Harvard or Yale. Of all the Latinas in America qualified to sit on the Supreme Court, the number that also happened to go to the President’s alma mater has got to be vanishingly small. By deciding to open up the Court to a Latina, President Obama gave himself an opportunity to pick a candidate who was not only diverse by birth and upbringing but also diverse in education. It wouldn’t have been much of an effort to find one, but instead Obama nominated a member of his own alumni club.

I’m not against Sotomayor — in fact, from what I know about her, I suspect she will make a fine justice. But drawing from such a limited group of schools for nominees is wrongheaded, and makes the claim of diversity hollow. For his next choice, I hope the President reconsiders his definition of diversity.

All in an Afternoon's Work, Counselor?

The other day my iPhone belched and I lost the contents of a little program I used to keep track of all my online passwords. Most of the information I lost was scattered in other places, but, as is usually true when these things happen, I found out the hard way exactly how scattered it was.

So I stepped back a generation and bought an organizer for computer passwords. The old pen and paper variety. And promised myself I would never rely on a computer to track such critical information again (yeah, sure). The organizer I got was a bit overpriced but more or less what I wanted. Instead of spaces that said name, address, and phone it has spaces marked website, username, and password.

Nothing fancy, but at least a spiral notebook has the common sense not to try to sync with an empty file on the internet, erasing itself in the process.

At any rate, I was busy filling the pages up with all the passwords I could remember when I turned to the inside front page, where I found this remarkable paragraph:

       WARNING AND DISCLAIMER

Every effort has been made to make this book as complete and accurate as possible, but no warranty or fitness is implied. The information provided is on an "as is" basis. The author and the publisher shall have neither liability nor responsibility to any person or entity with respect to any loss or damages arising from the information contain, or subsequently stored, in this book.

I am, very nearly, speechless. A disclaimer and warning in an organizer? Surely this is someone's idea of a joke. Certainly no lawyer spent an afternoon -- or, God forbid, several days -- writing up this garbage and then submitted a bill for it?

If the lowly spiral organizer now requires a legal disclaimer, the American experiment is dead.

Denied

Earlier this week, two letters arrived in my mailbox, return post U.S. Medicare office, identical in every way except for the names. They were denial letters, for two patients I admitted to the hospital about two months ago. “There is insufficient documentation,” both letters cryptically and chorally stated, “to justify an IP admission.” IP stands for inpatient, one of the many abbreviations heath care bureaucrats use that doctors and nurses never do. It seems that when you have a health care job that does not entail seeing patients, you make up your own language.

These Dear Doctor epistles respectfully informed me that I would not be paid for the two admissions. Or more accurately, the medical clinic that pays me will not be paid. One of stays was only 24 hours, and the other was 3 days. In both cases, the patients were admitted for vague symptoms that could have been something very serious, or possibly nothing. After a brief work up I was able to determine that the latter was the case and sent the patients home.

Although I have received letters like this before, as every doctor in America has, they never cease to annoy me. Some desk jockey in Dallas or Atlanta or Washington reviewed data from these admissions and, without speaking to me or the patient or anyone else involved in the patient’s care, decided the admission was not needed. In effect, Medicare is accusing me of either incompetence or fraud, even though none of them could pick the patient out of a police lineup, and probably couldn’t find my hospital on a map.

It is certainly true that from time to time we doctors admit patients that don’t need to be in the hospital. This can happen if a patient over-dramatizes symptoms, making a malady seem worse than it is, or if either doctor or patient reacts to the situation with too much anxiety. Sometimes a doctor may remember a recent case that presented with similar symptoms and went irretrievably, horribly bad. Or a patient recalls a family member who, at the apex of health, fell like a bird shot from the sky. So we overreact. Hey, we’re all human.

In my view (within the limits of common sense, of course), it is better to overreact than to underreact. Wouldn’t you want a doctor who would admit you to the hospital even if he thought it was a marginal admission, just to be safe? Certainly no one wants a doctor who would reconsider his gut reaction to a patient’s symptoms because he is afraid he will not be paid.

When I was in medical school, I was taught that a good surgeon will remove a normal appendix 20% of the time. With a complication rate of only 3%, an appendectomy is a very safe surgery — in fact, one of the safest. If a surgeon has good reason to believe a patient has appendicitis, conventional wisdom holds that he or she should go ahead and remove the appendix rather than delay and risk a ruptured appendix, which can be fatal. The operation is safe, and the cost of missing an appendicitis is high. If it were me, I’d rather my surgeon take my appendix if he thinks there is a good chance it is infected rather than hold off just to save money.

The same is true with hospital admissions. Let’s say I examine a patient with chest pain. The patient is a complainer, one of those people who fixates on every little symptom. Ask him what hurts and you get a 20 minute discussion. A patient like that probably has stress-related chest pain, but what if I am wrong? My gut says his pain is probably nothing to worry about, but sometimes chest pain can be the sign of a very serious problem. So I admit him, just to be safe. Better to admit a patient and do a negative workup than risk having to sign a death certificate a week later. A good doctor shouldn’t have to resort to this often, but an occasional miss, like the occasional removal of a normal appendix, is the risk you run to be sure you don’t make any mistakes.

This is the reality of medicine. The reality that people who evaluate “IP admissions” cannot see. Maybe one day the bureaucrat who denied me will end up in the emergency room with vague symptoms that don’t meant the criteria for “IP admission.” That will give him an opportunity to play the scared patient who now has to worry that his doctor may send him home because he is afraid the admission will be denied.

Next time you go to see a doctor about symptoms that concern you, consider that your doctor not only has to think about what treatment you need, but also what treatment your insurance company will pay for. This barrier between doctor and patient is one of the true costs of so-called “managed” care.