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The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

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Saturday
25Feb

Buckshot

First Pellet

I have been reading here and there about President Bush's plan to turn over contracts at 6 U.S. ports (including the Port of New Orleans) to a company based in the United Arab Emirates.

As with most public issues, once you get below the superficial discussion on the airwaves, the matter appears less clear cut than the pundits would have us believe.

Yes, two of the 9/11 terrorists hailed from the UAE. And yes, the UAE was the site of some terrorist money-laundering prior to 9/11. But since 9/11 the UAE has been cooperating with U.S. intelligence, if the White House is to be believed. Dubai has also been allowing the U.S. Navy to use its port for its Persian Gulf operations. This is not a small thing, given the current climate in the Middle East.

The ports contract appears to have been a carrot offered to the UAE for its help. In this sense, the contract was a good political move. Building up trust and mutual support with Arab nations is a very important foreign policy goal, especially now.

The problem is that it was a poorly chosen carrot. Of all the contracts the US could have offered the UAE, a ports management contract is certainly one of the dumbest choices, considering America's current security concerns. Why not let Dubai sell hot dogs at Giants' stadium? Or put them in charge of a truck stop on the Jersey Turnpike. Anything but put them in charge of a port.

As a former resident of New Orleans, though, what offends the most is the way President Bush immediately went to the defense of the UAE when the controversy erupted. He as good as told his opponents that they were racist for opposing the contract. The only reason people are attacking the contract, he argued, is because the company is Arab-based.

I wish he exhibited such passion when he talks about the Gulf Coast. Here is a president who feels so strongly about prejudice against an Arab nation that he is willing to go to the mat for them. He has never, ever shown such determination to rebuild the Gulf Coast after Hurricane Katrina.

It is not as if Louisiana or Mississippi have not been loyal supporters. Both states went for Bush in 2000 and 2004, and both went for Bush, Sr. in 1988. And even more maddeningly, the Gulf Coast has almost as great an oil reserve as the UAE has (77 billion barrels vs. 91 billion barrels). We supply 15% of America's crude, which is more than the UAE supplies.

Any respect I ever had for George W is gone, all gone.

Second Pellet

I was dismayed to read that the Commonwealth of Virginia is trying to pass a law making it illegal for doctors to ask their patients about handguns in the home. This proposed law has been written as a response to recommendations by the American Academy of Pediatrics to ask about handguns as part of a routine review of patient safety in the home.

Critics of this policy complain that it is obtrusive and politicizes the doctor-patient relationship. It is tantamount, they say, to doctors discouraging private gun ownership.

Maybe so, but is threatening to revoke a doctor's license the solution? I have asked all kinds of private questions of my patients, such as: Do you have sex with men? Have you ever cheated on your wife? Do you use cocaine? How many abortions have you had? When you laugh do you pee on yourself? Asking about firearms cannot be any more intrusive than any of these questions.

It bothers me that this nonsense comes out of Virginia. I lived in Virginia for 11 years, and have strong feelings about the place. Virginia is the home of George Mason, the father of the Bill of Rights, not to mention George Washington, Thomas Jefferson, James Madison, and James Monroe. The House of Burgesses, founded almost 400 years ago, was the first democratically elected legislative body in the Western Hemisphere. With that pedigree, one would think that the Commonwealth would be more careful than to enact a law that so clearly runs counter to the spirit of the First Amendment.

Kevin, MD has further discussion about this topic here.


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Reader Comments (7)

A few comments on your excellent post:

First Pellet:

I agree. They've chosen one of the worst possible "carrots." Any little thing going wrong at this point, with whomever to blame, could turn this into a very large issue some time in the future.

Second Pellet:

"I have asked all kinds of private questions of my patients, such as: Do you have sex with men? Have you ever cheated on your wife? Do you use cocaine? How many abortions have you had? When you laugh do you pee on yourself? Asking about firearms cannot be any more intrusive than any of these."

I respectfully submit that, in this particular paragraph, you've hit squarely upon one of my many problems with this issue -

. . Medical question: do you have sex with men?
. . Medical question: have you ever cheated on your wife?
. . Medical question: do you use cocaine?
. . Medical question: How many abortions have you had?
. . Medical question: When you laugh do you pee on yourself?
. . NOT a medical question: do you own a gun?
. . . . (Unless you're also going to ask the following:
. . . . . . - do you drive a car?
. . . . . . - do you own a bathtub?
. . . . . . - do you have a stove?
. . . . . . - do you use cleaning chemicals?)

I do feel that it politicizes the physician/patient relationship, and that it has no place in a conversation between my physician and I, unless he's seeing me because of a gun related incident ...

However, having said that, I *strongly feel* that no one, under *any circumstances,* should ever be prevented from saying/asking anything they'd like - to/of anyone they want. I feel that this applies to medical doctors, perhaps even more than to any other profession.
February 25, 2006 | Unregistered CommenterMoof
I agree completely, Moof. In fact, I have never asked a patient if he or she owns a gun. In my neighborhood, it would be a moot point -- I am sure at least 75% do!

Certainly doctors should not be putting undue emphasis on gun control as a matter of public safety. I recall hearing once that almost half of all murders in this country are drug related, and that almost three-quarters involve alcohol. Clearly the best way to prevent death by firearm is to control drug addition.

That above remark make me think of something else ... There was a statistician who once showed that if you have to drive 15 minutes to buy a lottery ticket, you stand a greater chance of dying in a car accident than you do of winning the lottery. Some people, doctors included, ignore the real facts when they weigh relative risks in their own lives.
February 26, 2006 | Registered CommenterMichael Hebert
Wow! Are you *sure* you're liberal? ;-)
February 26, 2006 | Unregistered CommenterMoof
I read an interesting book review in the Wall Street Journal last week about "Crunchy Conservatives," people who are conservative leaning but have certain liberal streaks, such as the environment, quality schooling, and healthcare reform. Maybe that's what I am.
February 27, 2006 | Registered CommenterMichael Hebert
Now, I need to ask - do you equate "quality schooling," "healthcare reform" and taking care of the environment with being liberal?

Perhaps the differences between the conservatives and the liberals on these subjects is more *how* the changes should be implemented, rather than *if* they should be implemented.

I'm a conservative who was so disgusted with the school system, that I homeschooled my 4 kids for their last 8 years of school. I have some very definite ideas on that subject.

Regarding healthcare reform, I would still like to explore that issue in a discussion with you, since I think we both know it needs to happen, but don't agree on how it should proceed.

The environment - is a whole other issue. We need a bit of balance there - on both sides. That's another subject I think I could warm to in a discussion ...

"Crunchy conservatives" ... I really like that! :)
February 27, 2006 | Unregistered CommenterMoof
Depends. My form of heathcare reform is definitely liberal. Environment probably also. With schools, I am a grab bag. I like school vouchers. But I also think the government needs stronger support of college grants and loans. Of all the public money spent on education I think support of higher education is the best utilized.

"Liberal" and "conservative" are such abused terms. Very few people are 100% either way. All I know is that I can't stand listening to Rush Limbaugh but I like Al Franken.

There is a test you can take on http://www.theadvocates.org/quiz.html that is supposed to catagorize you. Try it! I have done it several different times and I usually test out as liberal or on the border between liberal and libertarian.
February 27, 2006 | Registered CommenterMichael Hebert
Thanks for that link! I'm still laughing over the quiz. Here's what I scored:

"LIBERTARIANS support maximum liberty in both personal and economic matters. They advocate a much smaller government; one that is limited to protecting individuals from coercion and violence. Libertarians tend to embrace individual responsibility, oppose government bureaucracy and taxes, promote private charity, tolerate diverse lifestyles, support the free market, and defend civil liberties."

The little red dot was at the very apex of the diamond shape. Oh my! *LOL*

I draw my Libertarian line at abortions, though. I believe a woman (or man, or in between!) should be able to do whatever she wants with her *own* body, but I do not include another human being's body in that "choice." The unborn child is dependent on her, but is *not* her. He's a genetically distinct life.

Dr. Hebert, you are an enigma to me, and I would dearly love to have a peek inside of your head. I agree with you that the "liberal" and "conservative" labels leave a bit to be desired, but for a loss of better expressions, I often find myself resorting to their usage.

I still wish you would agree to a discussion about healthcare reform with me. I'd like very much to understand why you believe that the government would acquit itself better in healthcare than it has anywhere else.

Healthcare is a nightmare right now ... and personally, I believe that if the government took charge of the entire thing, that the nightmare would become a "daymare." We would find ourselves with a tangled knot of red tape which would be impossible to sort, paperwork which would cause to system to grind to an abrupt halt, and regulations which would follow rather closely the farces which Dr. Crippen ( http://nhsblogdoc.blogspot.com/ ) so often refers to in his extremely interesting, and often agonizingly discouraging, posts.

I will watch your posts very carefully ... :-)
February 27, 2006 | Unregistered CommenterMoof

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