It gratifies me to see that the Republicans and the Bush administration have finally abandoned their efforts to undermine civil rights. Instead, they have chosen to cut them down in huge swaths.

In one afternoon, in a series of bills passed in both houses of Congress, Republicans have decided that it is appropriate to set aside the Geneva Convention rules against torture, the writ of habeus corpus, and the prohibition of warrantless search and seizure.

This being modern politics, this major defeat for freedom was followed by more than its share of political posturing. In both the House and the Senate, Republican leaders directly baited the opposition, promising to label anyone who dare vote against the measures pro-terrorists.

First we have Senate Majority Leader John Boehner: "The Democrats' irrational opposition to strong national security policies that help keep our nation secure should be of great concern to the American people. . . . To always have reasons why you just can't vote 'yes,' I think speaks volumes when it comes to which party is better able and more willing to take on the terrorists and defeat them.""

Not to be outdone, Representative Dennis "New Orleans should be bulldozed" Hastert added as he vigorously pounded his chest: "Democrat Minority Leader Nancy Pelosi and 159 of her Democrat colleagues voted today in favor of more rights for terrorists. So the same terrorists who plan to harm innocent Americans and their freedom worldwide would be coddled, if we followed the Democrat plan. "

Yes, Dennis, that's right. The Democratic party is trying to encourage terrorist attacks on the United States. Just to clarify a point for your ignorant, addled brain, Democrats are not in favor of giving terrorists more rights. They are in favor of maintaining the rights accused people already have. Rights you are trying to take away.

No, I don't think terrorists are good people. But I would remind the Republican leadership that Saddam Hussein is being tried right now based on the principles you want to set aside. Timothy McVeigh was tried, convicted, and executed without any of his legal rights being abridged. What's good enough for Timothy McVeigh should be good enough for any terrorist.  

The Geneva Conventions have been the standard of international law since 1949. Habeas Corpus was codified into British Law in 1679. The Founding Fathers were so concerned about the process of search and seizure that they formulated it into the Fourth Amendment and ratified it in 1791.

These laws have been around for a very long time, and for the most part, no American leadership has had the audacity to tinker with them. (Some have violated their provisions. But attempts to legally modify them have been thankfully rare.) It should not be my responsibility to defend these principles. It should be the responsibility of the Republican leadership to explain with great, great thoroughness why laws that have been accepted without question for decades and centuries are suddenly no longer appropriate for modern living.

I cannot sit quietly while this is happening.

Messieurs Hastert and Boehner dare their opponents in Congress to vote against them and face the wrath of the voters. I will take up that challenge.

I promise that I will never, ever, vote for a candidate for office who has voted for these measures or has publicly supported them. If a politician wants my support and my vote, he had better get to denouncing this, right here, and right now.

The Saints-Falcons football game yesterday was memorable, even more memorable than I thought it would be. The result was unexpected, with the Saints thumping the Falcons like a parson’s Bible, 23-3. More remarkable was the broadcast itself, and all the news commentary surrounding it. The media were fascinated by the game, but also almost embarrassed over it. Every out-of-town sports commentator, from television to the radio to print, felt a need to balance the joy of the event with the tragedy of Hurricane Katrina.

The television broadcast was interspersed with pictures of destroyed neighborhoods. Repeatedly ESPN reporters emphasized that the Superdome rebuild cost $181 million (I lost count of the number of times that was repeated – three, four, five times) but that the city is in support of this. Everyone they talked to, one reporter after another said, believed a new Superdome was vital to the recovery and a symbol of the new New Orleans. They said it so often that it was obvious they were trying to persuade even themselves that it was all right to drive past the Ninth Ward and attend a party at the Dome.

Tony Kornheiser, one of ESPN’s announcers, expressed this angst before the game in this way: “You . . . have to take into consideration that if the people of New Orleans think that this is a wonderful thing that's happening, so should I. So should I, because it's their lives, and I'm just coming for a few days. But so should I.”

In other words, I am happy because you are happy. But I do not necessarily agree with your priorities.

In the Washington Post, Michael Wilbon wrote: “With everything else in upheaval, with family members and friends having been displaced and scattered to the winds, with an entire way of life demolished, there's one thing and pretty much only one thing that makes them feel connected: the Saints.”

And finally, from Douglas McCollam of Slate, we have this: “It's fair to ask why, in a city where vast swaths remain uninhabitable, all this money is being spent to fix a stadium. You won't hear that question in New Orleans  . . . If they can fix the Dome up after all it endured, then perhaps other things can be fixed as well. Perhaps, after all, the city need not die.”

This angst is real, the conflict between tragedy and frivolity. New Orleanians feel it too, just as they felt it before as they celebrated the first Mardi Gras after Katrina. But in this town, tragedy and frivolity have always walked hand in hand. Name another city where cemeteries are promoted as a major tourist attraction. Where its most famous holiday (Mardi Gras), a celebration devoted to excess and debauchery, is counter-levered against the most solemn religious period on the calendar, Lent, and on purpose. In New Orleans, the jazz funeral starts with a dirge and ends with a riotous party at the gravesite. We don’t sweat it here. Maybe because we ignore tragedy. Or maybe because we are so used to it that we understand that if you don’t dance at somebody’s grave there is nowhere to dance at all.

Sports and history have often crossed paths. We can think of many examples. Jessie Owens winning four gold medals at the Nazi-dominated 1936 Olympics. Jackie Robinson going to bat for the first time in a major league baseball game. The 1980 U.S. Olympic hockey team beating the Soviets. And now, at least for New Orleans, the Saints crushing the Falcons in their first game back after Katrina.

Sports is irrelevant to history in the sense that sporting events never change historical events. Jessie Owens did not stop Hitler from invading Poland. He did not prevent a single death at Auschwitz. The U.S. hockey team did not end the Cold War. Only Jackie Robinson, it could be argued, opened any doors for anybody, but even with Robinson this is debatable. If Robinson had not lived someone else would have taken his place. And as millions of feet of film showing Southern police dispersing protesters with fire hoses can attest, Robinson did not solve the problems of racism. If he did anything, he only turned the clock forward a tick or two towards the midnight of the bloody conflict between blacks and segregationists.

But sports is a form of fiction. And fiction has a way of becoming living history. People love stories, and a good story will beat a quiver full of facts any day. I do not mean this as a cynical observation that people refuse to face facts. It is simply human nature – people organize their memories as a narrative, rather than as a series of unrelated events. A register of factual events, such as

                     7:03 AM Woke up.

                     7:13 AM Ate breakfast.

                     7:28 AM Showered.

                     7:45 AM Shaved and brushed teeth.

                     7:48 AM Got dressed.

                     8:01 AM Left for work

                     8:07 AM Got in car wreck

                     8:10 AM Taken to hospital by ambulance.

simply does not have the power of a narrative: “On the day I broke my neck, I ate breakfast, showered, and dressed for work as usual.” The story beats plain facts.

In a broader context, society often uses stories to string events together in a memorable way. This is where songs, movies, fashion, and even sporting events can become “history.” Jessie Owens is the opening chapter of America’s war against Nazism. He went to Europe and, in a sense,  proclaimed that our system was better. Then, five years later, our soldiers came to Europe and proved what Owens had foretold.

Jackie Robinson, taken alone, looks like a historical singularity, a first among many firsts in human statistics. But link him to Martin Luther King, and you have a story of civil rights, starting in baseball, then moving to Selma. This is how people remember the story. Whether there was a cause and effect or not is not important. What is important is that there is a story to tell, and its progression organizes our thoughts and promotes understanding.

When the U.S. hockey team beat the Soviets in 1980, it was one of the most unlikely upsets in sports history. It happened at the height of the Cold War, and most people at the time saw it as a small victory against the evil Communist Empire. To us thirty years later, it looks like the beginning of the end for the Soviets – the first crack in the Berlin Wall. Another story. In 1980 we did not know how the tale would end, but knowing the ending now, we can organize it. Somehow that sports contest, which at the time seemed like a taunt in the face of Leonid Brezhnev, now seems like a transition from the standoff of the 70s to the crumbling and fall of Communism in the 80s.

This brings us to the Superdome. Though not as grand an event as Owens or Robinson or the U.S. Hockey Team, it nonetheless has equal importance in the minds of people around here. In the Book of Katrina, a page was turned and on the new, clean sheet someone wrote: “Chapter II: The Recovery” and then: “On the night the Superdome was re-opened after Hurricane Katrina, 70,003 fans and an international audience watched the Saints beat the Atlanta Falcons 23-3.”

The first line of a new story. Why not?

I rarely write about sports, not because I have no interest but because everyone has an opinion and there is no reason to think my opinion is any better than anyone else’s. However, I would like to comment on tonight's New Orleans Saints-Atlanta Falcons game.

This is the biggest sporting event in New Orleans in years, if not ever. People outside the city have no idea the effort that was required to bring the Superdome back into condition for this game. The Superdome, long a New Orleans landmark, became a mark of shame after Katrina. Bringing it back is no less a monument to the comeback effort than repairing the Pentagon was for Washington, or rebuilding on the World Trade Center site will be for New York. It is the ultimate life-goes-on statement. And New Orleans is immensely proud to make it.

If you want to do something for New Orleans, something that will not cost a cent, watch part of the game tonight. The two Monday night NFL games ESPN has broadcast since taking up Monday Night Football have been the second and third highest rated shows in American cable TV history. (The number one show was a 1993 CNN broadcast of Al Gore and Ross Perot debating NAFTA. Remember that one? I do.)

It would be meaningful if the re-opening of the Superdome set the all-time cable record. And a shame if we placed second to Al Gore.

And enough about the contaminated spinach! We are supposed to be fighting a global war on terrorism and we are afraid of a salad.

Taking the facts in hand, which no one ever really does – in all 25 people have gotten sick from eating spinach. Two have died. In that same period of time, how many people have died of heart disease? Hint: the rate is about 13,000 per week in the U.S. according to 2003 statistics. In fact, at this rate, in the next year alone the average 10 year old child has a 50 times greater chance of dying of heart disease, a 100 times greater chance being murdered, and a 750 times greater chance of dying in an accident.

And yet the average mother, reading all this garbage in the paper, will happily pack all her kids into a car and drive down a two lane highway singing Disney tunes all the way, and then panic when she finds out one of her precious ones ate a leaf of spinach.

We have all lost our minds.

Although I do think a few people will be scared away from raw vegetables with this, my main concern is the large number of fried food addicts who use news like this as justification for their habits. I can hear them now: “You see that? You just can’t win. Eat all that nutritious food like the doctor says, and you die from e. coli. I’ll just stick with what I eat and take my chances.” Here are your chances, pal: 650,000 to 2. That is the ratio of people dying from heart disease versus death-by-spinach this past year.

I thought Anna Pou looked pretty credible in her interview on “60 Minutes” last night. In her first public statement since being accused of euthanizing 4 patients in Memorial Hospital in New Orleans, Dr. Pou did exactly what I predicted she would. She denied everything. And as I said in a previous post, since there were no eyewitnesses to the deaths, just the testimony of people who say they heard her say she was going to do it, it is unlikely Pou will be convicted from the evidence.

The Louisiana State Attorney General Charles Foti said in the piece that the two medications given together to the 4 patients – Versed and Morphine, in all likelihood – guaranteed that the patients would die.

Complete hogwash. Those two medications are given together all the time for outpatient surgical procedures. And I mean in every single hospital in the nation, every single day. If that is all he’s got, Foti should be tried for false arrest and slander.

I know there is testimony from at least 3 people that Dr. Pou said she was going to euthanize patients. There are two problems here. First, if she intended to do this, why would she go around telling people that? Dr. Pou is not stupid. You would have to be a complete idiot to walk around a hospital telling everyone you met that you are about to kill 4 of your patients. I cannot believe she did that.

Secondly, the witnesses in the affidavit also say that Pou repeatedly told them that this was not their responsibility. That seems like the luckiest thing in the world when a person who is accused of a crime just so happens to tell everyone else involved that they are guiltless as the driven snow. Are you kidding me? While she was at it, did she take responsibility for assassinating Kennedy?

The one bit of information that was new to me was that the staff at Memorial was told early in the week that they were not a high rescue priority, and then the Thursday after Katrina that help would not be coming at all. That would be a devastating blow, to be trapped in a hospital with over 100 patients, no electricity, food, or water, and then to find out that no one is coming. Ever.

That is beyond bad. That is flat-out cruel.

I will say it one more time: No one should have to go through that kind of abuse, neglect, and cruelty and then be accused of murder unless the accuser is absolutely sure. Foti is not absolutely sure. In fact, he has no idea what he is talking about.

An interesting item in this week’s news: Wal-Mart has announced plans to make over 300 generic drugs available to the public for $4 a month. Wal-Mart plans to roll out the new pricing soon in their Tampa, Florida stores, but will eventually expand it to every store in the United States. (In a later development, Target stores pledged to match Wal-Mart’s pricing).

Behold the latest turn in the serpentine path of health care in the United States. It is also the opening foray of deep-discount retail into the medical business: One might think of it as Wal-Mart’s version of the McDonald’s 99-cent menu. Although low drug prices are always welcome, there are cynical ways to read this. For example, this could be Wal-Mart’s effort to deflect criticism from the fact that the majority of its employees do not get health insurance. Or this effort could share qualities with the 99-cent menu gambit – people will come in for the great deal and end up walking out with a more expensive (and profitable) alternative.

But setting cynicism aside, there is something else worth considering. Does this dramatic markdown suggest that the free market is finally influencing health care costs, or is it a window into our health care future, one that may be less happy than we would like it to be?

It is easy to see how this could be construed as a great victory for free markets. A huge retailer strikes a mega-deal with generic manufacturers to buy 300 common medications at a deep discount. It then passes the savings on to patients. Low prices for medical care is a good thing, and the goodness of it should not be discounted (no pun intended).

On the other hand, I can see long-term effects on the horizon that may not be so positive. Patients start showing up at their doctor’s offices asking to have all their medications switched to the Wal-Mart $4 plan. Then, the next step: HMOs start adapting Wal-Mart’s $4 menu as their own preferred drug formulary. This would be an interesting and dramatic change. Suddenly the marketing department at Wal-Mart, Inc. becomes a major player in U.S. health care policy.

In setting this pricing, Wal-Mart has placed itself in what may be an impregnable position in the pharmacy retail business. I cannot in my experience ever remember a patient of mine ever filling a prescription for less than $4. It may be that a few large drugs store chains will be able to match this pricing, but no one will undercut it. Mom-and-pop pharmacies will rapidly disappear in this environment, leading to a steady consolidation of the pharmacy business.

This consolidation, which is already underway, will accelerate under the pressure of Always The Low Price. As the number of retail pharmacies dwindle the market will be increasingly dominated by fewer and fewer companies. Over time, possibly over very short time, a retailer that was never a major player in health care before could end up in control of the national market on drug sales, and possibly setting the pace for HMO, Medicaid, and Medicare formularies to boot.

Insurance companies save money by creating drug formularies, or lists of medications they prefer their patients to take. Insurers negotiate with manufacturers to get a cheaper price, or identify drugs with the lowest cost, make up a list of thes drugs, and then use financial incentives to get patients to buy the drugs on the list. Usually this is done by requiring patients meet a higher co-payment for drugs not on the list. (Sometimes it is also done by burying the prescribing doctor in so much paperwork to get approval for drugs that are not on formulary that the doctor just gives up and prescribes what the insurance company wants.)

With the $4 menu, Wal-Mart has created a ready-made generic formulary. Insurers can encourage their patients to use drugs on the Wal-Mart list by offering a copay of pennies, or even offering the medication for free. Because Wal-Mart has gone through the hard work of making up the list, negotiating wholesale prices, and setting the retail pricing, all insurance companies have to do is adapt the list. For insurers, simply picking up the list without question is so easy and so profitable, that there is no reason insurance companies will not do it.

So what’s the problem, critics may ask. Cheaper drugs for more people. The American way. But there is a possible problem. If Wal-Mart’s list becomes everybody’s list, that means Wal-Mart is setting national health care policy. Put another way, someone at Wal-Mart will be deciding if your blood pressure will be treated with atenolol or metoprolol. Or if, after a root canal, your dentist will send you home with Lortab or Darvocet. In that light, it may matter just a little.

Am I overreacting? Maybe, but I can offer an historical comparision — the Panic of 1907. Prior to the Federal Reserve Act of 1913, the United States had no central bank. Before the Federal Reserve Bank, the U.S. monetary system – and by extension, the economy – was controlled largely by a combination of private banks. In 1907 the U.S. stock market entered a major selling crisis and there was great concern that the country would plunge into a recession. J. Pierpont Morgan, the legendary banker, stepped in and lined up bank loans and credit to stabilize staggering companies, thus preventing a major depression.

The Federal Reserve Bank was established in response to the Panic of 1907. When American politicians realized that the stability of the U.S. economy depended on the goodwill of a small group of bankers to bail it out, they pushed for a federal bank. This kept the stability of the money supply out of the hands of people like J.P. Morgan and under the control of the people.

There was not necessarily anything wrong with what Morgan did. The U.S. economy was in deep trouble, and he stepped in to avert a disaster. But for the leaders of the day, the Panic of 1907 raised an important question: Do we want to depend on a small cadre of private bankers for the stability of the national economy?

I think the heath care system in the U.S. is much as the banking system was in 1907. It is controlled by a combination of public and private interests, and specific private interests have a lot of control. That is what concerns me about the Wal-Mart announcement. I have nothing against Wal-Mart’s action in itself — in fact, many people stand to benefit from cheap medications. But it is easy to foresee that a huge retailer like Wal-Mart, or a combination of retailers including Wal-Mart, Target, and Walgreens, could gain tight control the generics market with programs like the $4 generic plan. They could, as a group, strongly influence what medications millions of Americans take. This influence would be subtle, hardly as dramatic as a national banking crisis. But as any educated observer knows, sometimes very subtle influences can be the most profound.

We need to be very careful about underestimating this influence. Most people in 1907 had no idea one man like J.P. Morgan had the power to avert a major stock market collapse. They were shocked when Morgan emerged from the shadows and set the entire financial industry back on its feet, almost single-handedly. We need to do some careful thinking about how this lesson applies to us; and we should do it now, before it becomes a problem, rather than after.

I pose the larger question again: To what degree do we want large corporations setting health care policy in this country?

She came in for a cold, or something like that. And then the real complaining started.

"I'm so fat," she said. "I just can't get the weight off."

Maria was in her mid forties. She had birthed five children (gravida 5, I wrote in her chart), which certainly had something to do with the excess weight. She was a bronze skinned, brown-eyed Hispanic. Her accent was strong, but her English was so easy it left no doubt she had lived in America for many years.

("My children taught me English," she had told me quite some time ago. "They went to school and learned it the way Americans know it. If you closed your eyes and listened to them, you would not know they were Hispanic. I talked to them in Spanish, they answered me in English. Before long, I knew English almost as well as they did.")

She shifted on the exam table, and repeated herself just to make sure I heard her. "I'm fat, you know?"

Well, now that you mention it, yes, I did know. Maria was barely five feet tall, and weighed 170 pounds. Her BMI was 33. Yeah, fat.

"What have you done to try to get the weight off? Diet? Exercise?"

"Oh, doctor, I don't exercise. I'm not going to do that. I have never exercised in my entire life. I just know I won't do it."

I had to give her credit for honesty. It wasn't what I wanted to hear, but it was better than a lie. I told her that.

"I believe in living within myself. If I can't do something, I can't do it, that's all. It doesn't do me any good pretend I will do what I know I will not."

"Well, if exercise is out, what about diet?"

"I have tried every diet in the world. High fat, low fat, protein, liquid, all fruit, all vegetable, all nuts and berries. I haven't lost a pound. So what can you do about it?"

This is not the position I relish being in. I can't do anything, so what are you going to do for me? If there were a medical cure for obesity, I would be retired and living in Paris by now. There is nothing, not really. Stimulants help a little, but they have a mild addiction potential and can cause heart problems if they are used for too long. Xenical causes diarrhea. Meridia works sometimes but is ridiculously expensive. Moreover, none of them work in the long term. They are great for losing a few pounds over a short period of time, but usually, as soon as the pills are stopped the weight starts coming back on. The only people I have ever seen permanently lose weight did so with lifestyle changes. Or by contracting a horrible disease.

I gathered myself for the answer. Evasively I said, "There are a few medications that might help, but the truth is that nothing works well without diet and exercise."

"What about surgery?"

I looked her over again. Yes, she was overweight, but she was not morbidly obese. Generally, surgeons are reluctant to cut on a patient with a BMI of less than 40. She was not a good candidate.

"I don't think that is an option," I responded. "To qualify for weight loss surgery you have to have a documented medical reason for surgery. You have to have a health problem — diabetes, for example — that is aggravated by the excess weight and would be improved with weight loss. And usually, for someone your size, they would expect you to be at least 100 pounds overweight."

"I'm 70 pounds overweight at least. That's not enough?"

"No, I don't think they would consider you as a candidate."

She sat there quietly, thinking. I sensed there was trouble coming.

"So, what you're saying is that all I have to do is gain 30 pounds and I can get the surgery."

Wait a minute. "No, I most certainly did not say that. Ms. Santos, that is no way to handle this problem."

"Of course it is, dear." Dear. "Sometimes you have to do what you have to do."

"What you have to do is something besides gain 30 pounds. There is no guarantee that even if you were 100 pounds overweight that the surgeon would take you. It is like you said —you have to work within yourself to lose weight. Understand what you can and cannot do. Surgery is not an option at this stage, and it would be better if you accept that."

"But I am working within myself. I know I can't diet and I know I can't exercise. You just told me medication does not work so well either. So what can I do? I can eat! I know how to do that. Like you said, it's the 'Living Within Yourself Diet.' I am doing what I know I can do. I gain enough weight, I get the surgery, and it all comes off. I love it!"

I bowed my head in a gesture of defeat, knowing I had lost control of the situation. I briefly restated my opinion for one last time. She nodded yes, but I could tell she was planning out a menu of chocolate fudge sundaes and french fries. She turned her face to me and her eyes smiled. She had a new purpose in life.

I heard her say it once again: "The 'Living Within Yourself Diet.' I love it! Thanks, Dr. Hébert!" And she whirled out.

There was no telling what was going to happen now. This was just the kind of stupid idea that could take wings, and take my reputation with it. I started having, as psychologists say, catastrophic expectations. I had a vision I fully expected to take place a few months in the future. I saw our local bariatric surgeon come into our office to pay me a professional call. He entered my office door with a pile of brochures from his clinic and a smirk on his face. He slapped the brochures on my desk. "I have to thank you, pal," he was saying. "The 'Living Within Yourself Diet.' What genius! Patients eat whatever they want, and when they reach 100 pounds overweight, they come to my office for an expensive surgery. You don't know how much money you have made for my clinic!"

I saw myself flushing, then stammering. "Well, that's not exactly the way I intended it . . ."

"Whatever you intended, it was a great idea. And it would make a great book. You and me, pal. We'll call it The Living Within Yourself Diet Book. Fatten yourself up and then get surgery. We could go in fifty-fifty on the royalty deal!"

"I'd love to help you out," I said, my nervousness rising, "But somehow I don't think it would be a good idea to advise people to gain weight. And in a way, by encouraging people to modify their bodies to meet insurance criteria, we would be showing them how to commit fraud."

He thought about it a minute. "Yeah, you're probably right. Telling people to do stuff that would force insurance companies to pony up could be a kind of fraud. Well, too bad. I was just trying to find a way to cut you in on the bonanza. After all, it is fraud for me to pay you directly, right?"

I said nothing. He pressed a thick stack of business cards into my moist palm. "Anyway, if you do convince more people to try out your great diet, send 'em my way, won't you?"

As the vision faded, I was assuring him I would.

Those are the kind of dreams that wake me up at night. The thought that a patient would attribute a stupid idea to me and then spread it across town like a frenzied Johnny Appleseed.

I have not heard from Maria again, thank God. I imagine her at home this very moment with a  family size bag of Frito's on her lap, doing just what the doctor ordered.