The “Standard of Care” and Facts of Life

It had been a shock to be told a few years ago that I had so much plaque in my coronary arteries that I was in imminent danger of a heart attack or stroke. The cardiologist told me that I must immediately follow the protocols of the “standard of care” in cardiology and begin a course of treatment using a strong statin drug or risk the grave consequences of the failure to do so, that’s all. “Stat!” Crestor was the latest highly promoted statin, widely prescribed around the time doctors began recommending statins as “preventive” treatments for suppressing the dreaded cholesterol.

Yet, I still had questions. Why, as I mentioned previously, had I performed so well on the standard stress test? I had walked the accelerating tread-mill, climbing its increasing incline, while monitored by multiple instruments tied to me by a dozen wired sensors. I had done fine; no anomalies whatsoever. And, why had the multiple imaging methods shown no arterial blockage at all? The answer: “you’re lucky.” It was assumed that ‘so far’ the dreaded plaque was so evenly spaced that blockage had not occurred – an unlikely scenario, it seemed to me.

Now isn’t this just the typical thing a man is likely to encounter in his mid-seventies? Medical challenges abound, as do anomalous events. We don’t usually expect what we don’t want to happen.

We take our Vizsla puppy to a nearby dog park every day because she has so much energy. By nature she is a major runner and loves to play with the other dogs. Most of the dog owners there are retired too. As the dogs run and play, we sit around and chat – no, we don’t run and play, we’re not pups anymore. I’ve noticed that conversation often turns from politics to health issues. Experiences with failed diagnoses, spouse’s failing health, our own, etc., are routine. Various “alternative” health practices are a common topic of conversation. “I hate doctors,” is often heard.

But the dog park conversations were not the source of my hint of another approach to what is commonly called cardiology. Apparently, there is more to it than meets the cardiologist’s eye. One friend, a retired obstetrician, told me that he had been seeing a “lipidologist,” who had an approach to cholesterol, plaque, and heart disease in general, unlike that of the cardiologists. “I get thousands of dollars worth of advanced lab testing, and it is all covered by Medicare or is written off by the lab as part of their research.” My ears perked up. I’m always looking for some good science in medicine as an antidote to the stagnation of the “standard of care.”

Another friend who is a consummate researcher and whose wife was doing well despite having been diagnosed with stage 4 lung cancer metastasized to her brain four years before, recommended that I see the same lipidologist my other friend had mentioned. This friend had been tracking all the latest clinical trials of new experimental cancer treatments and jumping through all the hoops to get his wife into the most efficacious ones. Cancer treatment techniques are fast approaching the ability to target specific cell mutations and kill only cancer cells. If he and his wife had simply listened to the “authority” of the local oncologist and gone with the “standard of care,” (chemotherapy and radiation) I am convinced that she would have died years before she did. Even the latest treatments cannot stop some cancers. But many diseases characteristic of aging can be prevented, moderated, or delayed by wise choices, which have little to do with the “standard of care.”

Next time: the Mad Jubilado encounters the Eccentric Lipidologist.

Seventy-Five and One

Oh my! Seventy-five! Seems like it happened just yesterday. Actually, it was two and a half years ago. Copper is no longer a puppy. Yet, full-grown now, she still has quite a lot of that puppy playfulness. I have not changed much. When I turned seventy-five years of AGE, three quarters of a century seemed a strange reference to me. Never been there before… In comparison, seventy-seven doesn’t seem to matter…much.

I remember my mother used to say at various points in her later years, “…but I don’t feel like 80 years old; I feel like I’m forty.” She was a vigorous ‘power walker’ until her hips gave out, and she lived until just before her ninety-fifth birthday. She always retained her curiosity. Life’s trajectory remains a mystery in some ways, especially in terms of how we feel and how we categorize , interpret and judge who we are.

Often, I think, people fall into a narrow range of categories by which others defined them most of their lives. They perceive and define themselves by the categories that stuck to them, even though many of the alternatives they refuse to consider may have had better reflected their talent and potential. But if you study language much, you begin to see that all categories are largely illusions anyway.

Some illusions work just fine, some much worse than others. But they are all mental constructions. Language grew out of need and capacity. Before the massive changes of the modern era, language and life were often quite stable for long periods – if not necessarily easy. Now, change is rapid and increasingly catastrophic. The concepts we use to define ourselves and our lives can be liberating or constraining forces, because we believe in them.

So, however mythological we may judge the concepts and categories of so-called “primitive” peoples, they worked just fine for those folks in their own times and places. We live in a different kind of language environment today, just as we live in a different technological and economic environment. In my 77 years, change has accelerated in the extreme, resulting in a New Great Transformation, which I’ve discussed in other blog posts and my forthcoming book, At the Edge of Illusion.

We live in an environment of change, rapidly accelerating change by any historical measure. With this in mind, we need to recognize that most categories are contingent and increasingly transitory. One of the most dangerous things you can do these days is to lock on to some categorization, of yourself or your world, and firmly believe that it is some permanent “reality.”

IMG_0731Copper turned one year old a few days before I turned seventy-five. I noted the contrast. Well, of course, Copper was a puppy then, a beautiful Vizsla whose name matches her color. In puppyhood, of course, she knew nothing of the world, but was open to and sought out all new and interesting things – everything.

Wouldn’t it be nice if we could all retain much of that openness to the world and the curiosity of youth throughout our lives? But to do that we would have to relinquish the pseudo-control we feel when we retreat into the certainty of the rigid categories that actually stifle us.

I was hesitant at first to get a new puppy “at my age.” But Copper turned out to be quite a resource for me in reflecting on the best outlook for this Mad Jubilado in the coming years – along with being an endless source of joy and frustration. Ah, but that is the nature of puppies, and life too, eh? You cannot become a liberated Mad Jubilado and hang onto the arbitrary social definitions of what it means to be “retired,” or a “senior,” or anything else. Keep moving.

Why Is Social Security So Insecure?

We all know that politics is rife with deceit of the public and deception of the self.  Claims as to the reasons a senator or congressman supports or opposes a bill or a policy are often merely “cover stories” hiding the widespread real reason the politicians vote the way they do – money.  The conflation of the financial status of Social Security with the problems of the national debt and the annual fiscal deficit of the U.S. is a case in point.  Much money is at stake, but rarely is the real issue directly faced.

Social Security is not part of the federal budget.  It is a self-funding program that provides very modest old-age and other benefits to those who have contributed to it during their working lives, and to certain dependants.  As they try to cut back benefits and destroy Social Security, politicians make disingenuous claims that they want to “protect the integrity” of Social Security.  They know that most Americans like the program and want it to survive.  In an economic environment where almost all private pension systems have been plundered by the corporations that administered them for the employees who contributed to them over entire careers only to lose it all at retirement, Social Security has become the de facto fall-back retirement system, despite it’s poverty level “benefits.”

Powerful forces, such as the national financial elite and extreme anti-government political ideologues, bent on destroying Social Security (and Medicare/Medicaid too, of course) don’t always have the same motivations.  The financial elite wants Social Security funds diverted into “private retirement savings accounts” to be managed by, you guessed it, their very own stock market brokerage firms.  What a windfall of commissions and fees that would be for the most powerful economic class!  And what a high-risk future for retirees!

But the growing insecurity of Social Security is a serious political problem simply because the corporate and financial elites and their congressional agents want it to be.  There is just too much money to be made for them to leave it alone.  Several simple changes in the system designed to compensate for both class injustices in the contributions of wealthy high-income employees versus average workers, and for generational changes in the demographics of employment and aging could easily be made without major problems of implementation.  However, those who would profit – either politically or financially – by the privatization/destruction of Social Security, carefully avoid the easy solutions to any long-term cash flow problems because they either want to take over the huge money flow involved or because they are politically opposed to any government social program that assists those in need.  The first group could be called the “Jackals of Wall Street” while the second group consists of extreme right-wing ideologues who oppose government no matter what.

But what’s the real issue?  Simply put, Social Security was originally conceived as an insurance program, meant to help those elders whose employment failed to afford them an adequate pension or life savings, to see them through after they could no longer work.  But with the corporate plunder of pension systems, Social Security became the default retirement system for most American workers.  Now, with the reduction of the vast majority of the middle class to near-poverty or poverty status, with personal life-savings virtually impossible for many to accumulate, and pension systems no more, Social Security is very often the last defense against homelessness and destitution.  If the Social Security payroll tax were applied to all personal income, including the millions of dollars in “executive compensation” in its many forms such as salaries, stock options, “incentive pay,” and bonuses of top CEOs, the fund would be sufficient to support the small “benefits” far into the foreseeable future for those who need it.

So, the real issue is whether the American people will tolerate the plunder of the Social Security system as they did corporate pensions, or whether they will demand that what was intended as a social insurance scheme actually be implemented as such.  That’s where the tricky language often applied to the Social Security debate needs to be overcome.  Insurance works on the basis of every “insured” person contributing and those who suffer losses collecting the benefits.  Simply put, if Social Security were actually implemented as a social insurance program rather than as a last-ditch inadequate retirement system –  and certainly not as a privatized “retirement savings account”  subject to the whims of the stock market – several principles would have to be invoked in order to make it work quite effectively.  They are:

  •  All personal income must be subject to the Social Security Payroll Tax.  Who has ever gotten fire insurance without paying the premium?  Why should high income earners not pay the premium on all their income?
  • Social Security benefits would be dispensed on the basis of need.  Who has ever collected on her/his fire insurance when there was no fire?   Why should wealthy retirees collect benefits from an insurance scheme designed to protect against the lack of income or loss of wealth in old age?
  • If one were so lucky as to have benefited from a prosperous pension system, then any Social Security benefit would be adjusted down on that basis.  And a formerly wealthy man who lost his fortune (stocks, bonds, dividends, buyouts, bonuses, “incentive pay”), would also draw the maximum Social Security benefit.  What’s wrong with that?
  • The net effect of the system should be that everyone could retire with assurance that they can live in at least modest comfort in their final years without fear of economic and social deprivation.

In an economic and social environment where so much income and wealth has been redistributed from the middle and lower classes of workers to the very top 0.1% of privileged Americans, only some form of re-redistribution can at this point re-establish a semblance of balance to the economy and stability to the society.  A real social security system would still be little more than a small compensation to those who have lost the most over their working lives to the insatiable greed of the financial elite.