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Monday, July 4, 2016

4th of July, 2016, the summer of our myriad festering discontents

If you're paying any attention, you know that acrid, increasing unhappiness abounds at every turn. First, a couple of recent posts emanating from the Health IT blogosphere:
The Physician’s Case For Trump
Anish Koka, MD

Brexit has been hailed as a turning point in the history of Western Democracy by a collection of liberal and conservative elites that decry the vote of a disenchanted and ignorant populace.  The greatest threat to democracy in the modern age turn out to be the very same people that make up the democracy.  We are told these are the same forces that propel Donald Trump forward.  It is a convenient narrative that extinguishes any real debate on policy.  If you support Brexit or Donald Trump you are an uninformed, xenophobic bigot.  Yet here I am – an Indian immigrant, a physician, and a lifelong democrat to boot, who sees no other choice than Trump this election cycle.

I must confess that I have no emotional connection with Mr. Trump – his public demeanor, braggadocio, and above all, the coarseness of his manner when he engages opponents are not what are familiar or soothing to eye or ear.  Yet, as a physician who has struggled through the last eight years of policies and regulations that have made my ability to take care of patients more and more difficult, Mr. Trump has taken on the form of an orange-tinged life preserver...
Then there's Margalit Gur-Arie, who I respect greatly in general, and whom I've cited here many times (relatedly, see also here).
Confession of a Liberal
TRIGGER WARNING: Long read, Trump

I am a woman and I am an immigrant to this country. I am Jewish by birth and atheist by faith. I am fairly well educated, borderline socialist and straight Democratic ticket voter. I have no use for guns, I despise hunting, and I believe the death penalty is state sponsored murder. I think abortions are perfectly fine and I think everybody should be free to choose how they use their own body for their own happiness and joy. I have no respect for authority, strength, power or large wads of cash. Come to think of it, I have no respect for anything or anyone in particular.

On November eighth, barring any natural disasters, Iwill be voting for Donald Trump and according to my liberal bible, I will be doing so for all the wrong reasons...
I've read and re-read their posts, along the the many comments, and I remain flummoxed and disconcerted. But, that's just me. I just don't like the guy.

With respect to health care and Health IT specifically, you need not look far to read volumes of discontent.
How to End MACRA, Meaningful Use and ONC Certified EHRs Programs/Mandates
Hayward Zwerling, MD

While the Federal Government’s promotion of EHRs via the HITECH act has been successful at increasing the prevalence of EHRs, their continued advocacy of Certified EHRs, Meaningful Use (MU) mandates and MACRA seriously impedes innovation in health information technology realms. For this reason, I think it is time for our Federal politicians to alter provisions of the HITECH ACT so as to end all legal mandates resulting in Certified EHRs, MU and MACRA...

...I have submitted the below resolution to the Massachusetts Medical Society which, if passed by the next House of Delegates (HOD) meeting, will make it the official policy of the MMS to use it’s [sic] political influence to end these Federal mandates... 
My comment below his post.
“…use it’s [sic] political influence…”

Which is likely nil. But, President Trump® will make everything Terrific. Patience.

All snark aside, notwithstanding that I worked in the MU program at one of the RECs, I routinely bit the hand that fed me:

The EHR Cert program is a joke.
Yeah. We have our chronic frustrations and irritations. And, this year, we seem to be in increasing thrall to a political nihilist sentiment, worldwide.

As we ignite colorful celebratory explosives in effusive commemoration of the 240th anniversary of our Declaration of Independence, I cannot get other imagery out of my mind. e.g., Syria today.

We live in an age of disintegration. Nowhere is this more evident than in the Greater Middle East and Africa. Across the vast swath of territory between Pakistan and Nigeria, there are at least seven ongoing wars — in Afghanistan, Iraq, Syria, Yemen, Libya, Somalia, and South Sudan. These conflicts are extraordinarily destructive. They are tearing apart the countries in which they are taking place in ways that make it doubtful they will ever recover. Cities like Aleppo in Syria, Ramadi in Iraq, Taiz in Yemen, and Benghazi in Libya have been partly or entirely reduced to ruins. There are also at least three other serious insurgencies: in southeast Turkey, where Kurdish guerrillas are fighting the Turkish army, in Egypt’s Sinai Peninsula where a little-reported but ferocious guerrilla conflict is underway, and in northeast Nigeria and neighboring countries where Boko Haram continues to launch murderous attacks.

All of these have a number of things in common: they are endless and seem never to produce definitive winners or losers. (Afghanistan has effectively been at war since 1979, Somalia since 1991.) They involve the destruction or dismemberment of unified nations, their de facto partition amid mass population movements and upheavals — well publicized in the case of Syria and Iraq, less so in places like South Sudan where more than 2.4 million people have been displaced in recent years...

Everywhere nation states are enfeebled or collapsing, as authoritarian leaders battle for survival in the face of mounting external and internal pressures. This is hardly the way the region was expected to develop. Countries that had escaped from colonial rule in the second half of the twentieth century were supposed to become more, not less, unified as time passed.... - Patrick Cockburn
Below: as I made my news rounds today.

And the Hits Just Keep on Comin'...
Trust in Government Is Collapsing Around the World
The trend helps explain Trump and Brexit. What’s next?

...Richard Edelman, the head of the communications marketing firm Edelman, sees something more significant in the change: proof of a new “world of self-reference” that, once you notice it, helps explain everything from Donald Trump’s appeal to Britain’s vote to exit the European Union. Elites used to possess outsized influence and authority, Edelman notes, but now they only have a monopoly on authority. Influence largely rests with the broader population. People trust their peers much more than they trust their political leaders or news organizations...
Interesting "Trust in Government" chart therein:

I was born in 1946 after my Dad came home from WWII in Europe, minus a leg, so this chart covers most of my lifetime. In our house the 4th of July was not about 3-day-weekends, cookouts, and Dollar Daze Sales. It was about reflective patriotic reverence for our nation of self-governance  -- won and recurrently defended at such unspeakably high prices. I continue to find ignorant, flip, dilettante calls to sedition the object of my utmost scorn.

If the data comprising the foregoing graphic are to be taken at roughly face value, ~80% of respondents are cynical about governance. A distressing trend. The U.S. population has doubled across my lifetime thus far. Are we becoming "ungovernable"?

apropos, demagogic flamethrowers like Mr. Trump rarely pass on an opportunity to crassly diss "expertise" across the board. Yeah, we know, Donald; experts are always wrong about everything (except you of course).
Why the World Is Rebelling Against ‘Experts’
An unconventional, sometimes incoherent, resistance arises to the elites who keep explaining why changes that hurt the middle class are actually for its own good.

The Great Rebellion is on and where it leads nobody knows.

Its expressions range from Brexit to the Trump phenomena and includes neo-nationalist and unconventional insurgent movement around the world. It shares no single leader, party or ideology. Its very incoherence, combined with the blindness of its elite opposition, has made it hard for the established parties across what’s left of the democratic world to contain it.

What holds the rebels together is a single idea: the rejection of the neo-liberal crony capitalist order that has arisen since the fall of the Soviet Union. For two decades, this new ruling class could boast of great successes: rising living standards, limited warfare, rapid technological change and an optimism about the future spread of liberal democracy. Now, that’s all fading or failing.

Living standards are stagnating, vicious wars raging, poverty-stricken migrants pouring across borders and class chasms growing. Amidst this, the crony capitalists and their bureaucratic allies have only grown more arrogant and demanding. But the failures of those who occupy what Lenin called “the commanding heights” are obvious to most of the citizens on whose behalf they claim to speak and act.

The Great Rebellion draws on five disparate and sometimes contradictory causes that find common ground in frustration with the steady bureaucratic erosion of democratic self-governance: class resentment, racial concerns, geographic disparities, nationalism, cultural identity. Each of these strains appeals to different constituencies, but together they are creating a political Molotov cocktail...
Brings to mind my latest read.

[U]ltimately, it is our self-conscious awareness and ability to shape the world around us that is the most distinctive aspect of our species. 

A concern shared by many is that we seem to have lost our way with regard to this particular ability in recent years. So, while we can now sequence a human baby’s genome in twenty hours or image its brain patterns as it learns to speak, at the same time other children are dying for lack of clean water or being blown up by smart missiles in some distant war. Meanwhile, despite our vast technological capacities our governments and political leaders seem incapable of doing anything to tackle the most urgent issue of our times— the warming of the planet. So perhaps it’s not surprising that some people feel more threatened than empowered by the growing prospect of scientists soon being able to decode the genomes of every individual on the planet. Personally, I am excited by this prospect, but it will need to be coupled with a real and democratic debate about the ways we intend to use this information. As such, my conclusion to this book is the hope that it has stimulated a desire to know more about the workings of the genome and how it affects our lives, but also that it has reaffirmed the importance of what truly distinguishes our species— that is, our potential to not only shape the world, but to do so for the good of every human being on the planet and all the other organisms (who are, after all, our biological cousins) with whom we share this miraculous blue biosphere within the cosmos.

Parrington, John (2015-05-28). The Deeper Genome: Why there is more to the human genome than meets the eye (p. 207). Oxford University Press. Kindle Edition.
"...our potential to not only shape the world, but to do so for the good of every human being on the planet and all the other organisms..."
Dunno. Sometimes I get the feeling that we are drifting slowly the other way.

Have a safe holiday.


"What Trump offers is an easy escape from the pain. To every complex problem, he promises a simple solution. He can bring jobs back simply by punishing offshoring companies into submission. As he told a New Hampshire crowd—folks all too familiar with the opioid scourge—he can cure the addiction epidemic by building a Mexican wall and keeping the cartels out. He will spare the United States from humiliation and military defeat with indiscriminate bombing. It doesn’t matter that no credible military leader has endorsed his plan. He never offers details for how these plans will work, because he can’t. Trump’s promises are the needle in America’s collective vein..." - "Opioid of the Masses"

More to come...

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