Soon after I took a similar plane on my first real cross-country flight to see my wife’s cousin play Tevye in “Fiddler on the Roof” in Palo Alto. All was blissful until somewhere over Monterey Bay when the electricity went out. That meant no gauges or radios. There had been headwinds (somehow there usually are, even on round trips) and I wasn’t sure about my fuel supply, so I landed at a little mountaintop airport near Santa Cruz. After gassing up, I realized I had no starter power. Fortunately little planes have a socket for just that purpose, and after a jump start we arrived alongside Palo Alto tower. One of the things you learn that seems superfluous is flashlight signals from the tower when unable to communicate by radio. I expected a green and white light clearing me to land, but instead saw a green/red flash – extreme danger! Turns out some bozo was cutting me off, entering the pattern illegally. After landing I had to present my case to an FAA official who certified that it was a true emergency.

In 1973 my pal John (I had three close friends named John, all of whom were pilots and all died, two in crashes) and I flew to Wichita with Kearnes to pick up our first airplane, a beautiful Cessna 172. Nicely equipped for instrument flight, it cost about $23,000. That same plane with same airframe but with modern avionics and safety features now goes for about $200,000; most of the difference goes to our friends, the trial lawyers. We had a memorable trip home and were greeted by our wives and children as if we were Lindbergh.

In 1974 I earned an instrument rating, which among other things made me realize how little I knew about flying up to then. In some ways it was tougher than medical school. Given the weather in this area, it’s hard to clock enough real instrument hours so we fly “under the hood” with an instructor. A pilot must also undergo training every time he wants to rent a new model aircraft or rent from a new facility. In those early years there were a lot of $50 hamburgers, but I also discovered a few enchanted spots that pilots can get to quickly such as Sedona, Catalina, the Gold Rush towns and so many others.

In the bicentennial year I took my first real vacation in my new Rockwell Commander, which I picked up at the factory in Oklahoma City with my two older sons. The 112 was the prettiest and most comfortable in its class, although not that fast. In April we departed on a great adventure, overnighting in Tulsa and then spending a day in Nashville, where a doctor friend showed us around his beautiful city. Then on to Atlanta and a CDC alumni conference, thence to Washington where we met up with wife and two younger kids for a tightly-planned DC tour. On deplaning, my wife mentioned that the youngest, Laurence (7) had a few bug bites. After doing the Capitol, White House, FBI, Library of Congress and Smithsonian, we visited Arlington National Cemetery. By that time the bites had blossomed into full-blown chickenpox, a fact I announced loudly while we waited behind hundreds of folks waiting for the bus out of Arlington. (Nobody budged). Narrowly averting an international incident, we flew Laurence to his grandparents’ house in Atlantic City where he recuperated while the rest of us visited more historic places including Philadelphia, where I had interned, and Yale, where our pal and best man, Sam Thier, had become Chief of Medicine at age 39. After returning to Atlantic City where we landed in the midst of a rainstorm with 50-mph winds, I wrote a letter to the Press complaining about the airport’s miserable service and maintenance. It was published on the front page. Within a few years the casinos arrived and Atlantic City finally got a serious airport, but they didn’t name it after me.

The rest of that trip resumed with my two older boys visiting Cornell (we tried for Cooperstown but in the 95 degree heat and haze were unable to find its airport, a 1600-foot strip indistinguishable from a driveway). We did make it to the Football Hall of Fame in Canton, Ohio, where I had also arranged to visit with an old patient who nine years earlier had been my smallest premie to survive, at 1 pound 9 ounces. The hamburger she ate that day was probably bigger than she had been. (Sadly she was killed by a drunk driver at 18). We stopped in Chicago to visit Steve’s birthplace at the University of Chicago, where an old black nurse greeted us and actually remembered his birth! We then spent two days with a former mom in my practice on a ranch near Sioux Falls SD, where she had moved following a high-profile divorce and child custody battle. Her girls were beautiful and of similar ages, and my boys had a lot of fun going into “town” with them and infuriating the locals who did not care for these intruders from “Hollywood”. Eighteen days after we left, and a last stop in Casper WY we made it home. Compared to that adventure, flying cross-country in an airliner is flat-out boring!

In the next few years I continued to upgrade planes and stake out more places. One trip took us to Mazatlan and some of the best beaches in the world. A year later we attempted to fly to New Orleans (made it to San Antonio but had to fly commercially over a stationary front which hadn’t moved four days later – the pilot had to climb to 45,000 feet for a 45-minute flight – and found our luggage compartment flooded after a 6″ rainfall). The rest of the trip, to Puerto Vallarta, was delightful.

In 1978, and again in 1980, I joined the Flying Physicians on fantastic Alaskan tours. We met up in Edmonton, Alberta (the second trip included a stay in Grand Teton National Park) and flew the Alaska Highway, stopping in Whitehorse, Yukon for a world-class burlesque show and ending up in Anchorage. There were 39 planes on the first tour, 26 on the second (after four years of Jimmy Carter everyone was going broke). Side trips included Fairbanks, Denali (Mt. McKinley to the uninitiated), Kotzebue (north of the Arctic Circle!) and almost Nome. Almost because I had a mishap that could have been disastrous; my oil cap came loose and the windshield became almost useless, to say nothing of the real risk of the engine seizing up. Now the Alaskan tundra is like nothing you’ve ever seen, and it was covered with an almost solid undercast. My five passengers (I had a Cessna 210 by now) did not panic because I did not panic. Straight ahead was an old airbase which, unlike commercial airports, had what’s called Precision Approach Radar. That fellow talked me down (turn 2 degrees left, etc.) like an invisible hand, and when we broke through the clouds that runway looked like Shangri_La. I had lost 4 quarts of oil, about a pint short of calamity. N761YM needed a bath and we all enjoyed a beautiful, although unscheduled, detour back to Anchorage. Later in the week we visited Kodiak Island, one of the most scenic and unique places I’ve ever been. We also got to fish for salmon in the Bay of Alaska aboard boats belonging to the sons of our hospital administrator. I love salmon almost any which way, but barbecued salmon right out the bay is incomparable. They have a saying up there: when you visit Alaska you never come all the way back. It’s true. Seeing it from such an intimate height, its glaciers and unspoiled beauty, is challenging but unforgettable. And by the way, we saw what was then the new Alaska Pipeline up close; it is one of the most handsome man-made structures you’ll ever see, and the caribou love it too!

People always ask about close calls, and besides the one above there were several others. The most memorable was so much so that I had it published in a magazine. I shared a condo in Sun Valley, ID for a few years. While my wife and the two youngest flew commercially, an 8-hour ordeal by way of Salt Lake City, I headed north with my two big guys for what was forecast to be a clear flight. Of course within two hours we were in a huge snowstorm. Strangely, it was totally calm but like the inside of a ping-pong ball. I planned to stop in Ely NV but the tower operator discouraged that because he couldn’t see his own runway! That meant climbing back up to altitude, burning extra fuel and hoping to make it to Twin Falls ID. A helpful Western Airlines pilot got on my frequency at one point and said I could circle down through the clouds from my present position and I’d find a little airport on the Nevada border, but I calculated that with my 35-knot (40 mph) tailwind I could make it, and I did. But the tower asked me to go around and approach from the north and I declined. My fuel bill was 64 gallons; I probably had half a gallon of usable fuel left. But we did beat the rest of the family by several hours!

There were many other adventures. In 1981 I took my daughter to several colleges she was interested in, and visited old friends on the way. (She wound up at UCLA for her freshman year). In 1983 I joined a bunch of friends from Valley Presbyterian in an investment program in a beautiful spot in Colorado, Pagosa Springs. On the sunny west side of the Rockies at 7500 feet, with a ski resort an hour away, it seemed like Paradise and a sure bet for eventual retirement. What could go wrong? We bought several acres on a golf course, time shares, and other parcels. Some of the group actually moved up there. Best thing for me was that it was an excuse to fly. I made about ten round trips, less than four hours each way, seeing Grand Canyon, Monument Valley and so many other incredible sights. But the oil bust in 1986 wiped out most of the investor base, virtually all of whom were from Texas and Oklahoma. The rest of our group was hit by death and bankruptcy, and I had to walk away from what had become a dream. Lesson learned: stick to medicine.

There were a few more thrills, such as flying into Chicago for my 25th medical school reunion, several samaritan trips to Baja California with a group of doctors, dentists, nurses and others to minister to a remote village called Punta Prieta; trips to Carlsbad Caverns, White Sands National Monument, the 1986 Worlds Fair in Vancouver. My penultimate trip was to the Bay Area where I took my oldest son and his new bride on a scenic tour of San Francisco that was magical. But after one last trip to Palm Springs (ironically, to an aviation expo where I could salivate over the new planes I couldn’t buy), I hung up my magic carpet key for the last time. Perhaps 200,000 miles later, after 1268.9 hours, there’d be no more $100 hamburgers (forget $50!) but the memories have grown more wonderful. What a privilege to have been a pilot!

Now the missus and I spent a day strolling the Venice boardwalk last summer and it is laughable that “medical marijuana” clinics seem to have proliferated in the numbers they have. If treating cancer pain were their true mission, would we need dozens of them every few blocks? And why is most of their clientele in their 20s? In point of fact, no medical condition exists that can’t be treated as well or better with other less controversial drugs. In fact marijuana has been available for years by prescription (Marinol) and can be ingested if needed.

I do believe that military metaphors such as the “war on drugs” have made lots of folks feel self-righteous but have accomplished little, and that it is time to decriminalize marijuana (I think all my kids just fainted). Prohibition didn’t work either. Tax the hell out of it and admit that people who intend to use it will find a way, as they do with alcohol. It is the most valuable cash crop in much of California and will remain so as long as pot users want it.

Speaking of alcohol, people often equate the two but there are important differences. (Full disclosure: I have never tried it, although I got punched in the nose in 8th grade for refusing to buy “reefer” from a classmate – this during the Truman administration!) Alcohol is a food which can be processed and eliminated at about an ounce an hour by the liver, which is an organ capable of rapid restoration when injured. Marijuana, by contrast, contains thousands of chemicals (as do cigarettes) and also delivers carbon monoxide and radiation to the lungs. Most worrisome, cannabinoids are deposited in the brain and remain there, probably forever. We know that cannabis disturbs memory, robs users of ambition, and delays the development of adolescent problem-solving ability. If you doubt it, check out the “Occupy Wall Street” protests going on all over the land. Penalties for marijuana use tend to be much more severe in emerging countries which cannot afford an unproductive horde of young people getting high (e.g. India).

All the arguments against legalization have validity and I’ve used them myself. It is a gateway drug, it is illegal, it is carcinogenic (more so than tobacco), plus the above behavioral issues. Adolescence is challenging enough, and youngsters are influenced by their peers which makes their choice of friends critical. The family remains the #1 bulwark against all the traps teenagers must avoid, including drugs and alcohol, premature and reckless sex, careless driving, etc. Government at any level is a poor substitute, especially when its messages are purposely kept free of traditional moral standards. And it doesn’t help when, for example, Obamacare enshrines the “right” of young people up to 26 to remain dependents on their parents’ insurance. Are we heading for the European model, where we stay in school until 30 and retire at 50?

Decriminalizing pot is a gamble. One hopes that law enforcement would be able to go after heavy drugs, that prison populations would go down, that tax revenues would help fund rehab programs, etc. Alcohol is far more destructive to society in terms of drunk driving, domestic abuse, and actual medical costs, but trying to make it illegal backfired. (I hope you’re all watching “Boardwalk Empire, by the way) I’m not a libertarian by any means, but it’s obvious that there are things the Nanny State is no good at, and trying to regulate stupid behavior is not an effective use of taxpayers’ dollars.

I attended a tea-party conference a few weeks ago and heard several speakers give updates on the pushback efforts going on. The Supreme Court will rule shortly on the constitutionality of the requirement to buy health insurance. As with an overtime hockey game, we know the final score (5-4) but we don’t know the winner. Never has the Constitution been interpreted to mandate participation in a marketplace. If the insurance mandate falls (it has already been ruled unconstitutional by Judge Vinson in Florida) the whole house of cards crumbles. The administration has already issued waivers to over 1100 of its political favorites, even individual businesses in Nancy Pelosi’s home district of San Francisco, making a mockery of a fiasco, if there is such an animal. One of the general principles which makes socialism anathema to most Americans is that the government gets to pick winners and losers, and the only thing new about this “waiver” scandal is its in-your-face hypocrisy. These techniques are right out of Saul Alinsky’s “Rules for Radicals”, Obama’s playbook.

Several of the speakers were from socialist countries. Sallie Pipes, a Canadian economist and author of “The Truth About Obamacare” was joined by an Italian-trained physician and an Israeli economist in warning of the mine field that is socialized medicine. As most such countries scramble to stay afloat and are looking at reforms to their antiquated systems through privatization, we, the United States are being dragged headlong into that same abyss. A judge in Ontario, in ruling against the ban on private medicine in Canada, memorably said, “Access to a waiting list is not health care.” The prime minister of Newfoundland, needing cardiac surgery, flew to Florida and had it done. “My heart, my money!” said the defiant Newfie when confronted by a hostile press on his return. We know that over 40% of Canadians on the waiting list for bypass surgery die before getting to the head of the line.

My son Steve just forwarded me a New York Times article, the gist of which is that doctors are becoming “less conservative” in response to the changing marketplace. It is truly sad that a once-respected newspaper regularly sinks to new lows in journalistic standards. First of all, doctors have been largely apolitical. The AMA, which is referred to in the article as if it carried weight, long ago ceased to speak for anyone but itself. Perhaps one in seven doctors belongs to it, and like most organizations that are not specifically conservative, it has become increasingly liberal over the years (that is known as Evans’ Law). Next, the Times based its premise on interviews with a handful of doctors who all agreed with its point of view. That is propaganda, not journalism. More important, the point really made is unspoken; the allegiance of the doctors has shifted from their patients to their corporate or government masters. I see it every day in my travels around the state. In an editorial I had published over 35 years ago I said, “When socialized medicine ensues, the patient will no longer be anyone special to the doctor and the doctor will no longer be anyone special to the patient.” Nothing I’ve seen since then has changed my concern. Pardon me for quoting myself, but I take no pleasure in having been correct.

Everyone I’ve heard or read recognizes that attacking and dismantling Obamacare is not enough. We must change our approach to health care, and there are a great many fresh ideas on the table. All will require political courage but I think they are achievable, obviously with new leadership. Congressman Paul Ryan has proposed among other sweeping reforms a voucher system for Medicare. It has been demagogued before the ink was dry, but it deserves consideration. No one over 55 would be affected and the safety net for the truly needy would still function. But by restoring market incentives, it would put the patients in the driver’s seat, encourage research, and give the doctors the prerogatives that only they should have. Conversely, continuing down the same blind alleys will stifle innovation, allow hospitals to rot as they do in socialist countries, and inevitably lead to rationing of care and deterioration in the quality of physicians. Understand, care is already “rationed”. Not everyone can get every procedure nor should they. But who decides? Kevorkian was monster enough; imagine what he could have done with a government ID!

I am now qualified as an expert on New York. (See, the attitude is back already). New Yorkers are, I believe, not so much rude as self-absorbed. They walk quickly and recklessly, faces pinched, shoulders hunched, in a hurry, not enjoying life. The women are often beautiful, especially the ethnically mixed; they tend to have wonderful legs because they walk all day, Plastic surgery is seldom as obvious or prevalent as in Los Angeles. Except for the lawyers and CPA-types, dress codes have gone the way of the Hula Hoop. Manhattanites always talked to themselves; now they talk into their cell phones which makes them even more dangerous because their elbows stick out. White lines on road surfaces, “Don’t Walk” signs, red lights and “No Parking” signs are mere suggestions, to be ignored. A typical street might be four cars wide but five or six vehicles occupy that space at any given moment. Crossing on the green is never a given; just when you’ve dodged gridlocked taxis and cars, a kamikaze bicycle will fly by. In one of my few quiet moments of contemplation, sitting with Gucci in Union Square, I realized that if the $350 “no honking” and $500 anti-gridlock rules could be enforced, our $14 trillion national IOU could be wiped out!

We walked about 35 blocks from our appointment to our hotel. That’s not as impressive as it sounds, since New York blocks are 20 to the mile instead of eight as in most places. But the humidity – oh the humidity – makes any physical exertion like navigating through Jello. Every block has dozens of tiny businesses, restaurants and shops as small as closets; every neighborhood has its distinctive aroma: curry, sauerkraut, whatever. Trees are almost unheard of except in Central Park. Dogs are rare until after working hours. Walking a little one like Gucci would be suicidal during the day. Taxis are no longer lumbering Checkers but have been replaced by Escape hybrids and even an occasional Prius. Buildings occupy almost every available block and soar up so high that sunrise is at 11 and sunset at 2, give or take. But only tourists look up and take pictures. Also, it seemed that only tourists were overweight; most New Yorkers seem athletic and fit, perhaps because they walk so much and the food is so expensive.

My mother-in-law’s mother had an expression: “I wasn’t there yesterday and I won’t be there tomorrow.”

During the five years in which I served as Director of Medical Education at Valley Presbyterian Hospital, I always kept a couple of talks in my back pocket in case the speaker didn’t show up for our Tuesday conference. One that I actually gave was on smallpox, which after 9-11 became the subject of renewed interest as a terrorist weapon. The other was on the phenomenon of hormesis, which you may have read about recently if you’re an Ann Coulter fan.

The term refers to a remarkable ability of humans, and presumably all species, to deal with sub-lethal doses of not just radiation but also toxins of other kinds. The atomic bombs that fell on Hiroshima and Nagasaki killed tens of thousands of people; that was their purpose. However, the Commission setup by our government to study long-term effects found amazing results. In the outer circles of the blasts, miles away from the explosion, cancer rates were lower- much lower- than what would have been expected over subsequent decades. In the 80s the Chernobyl explosion occurred in Russia. As you would expect from a Soviet project, there were no safety precautions taken beforehand; reactors were not shielded, construction was sloppy and the response of the government was indifferent. However, fewer than fifty people were killed, and since the blast a generation ago there have been no excess deaths in the surviving population. The area around it still looks like a moonscape, but so does the area in Canada where nickel is mined to build those batteries so Americans can feel virtuous by driving Priuses, which are actually more destructive to the environment than SUVs.

Some forty years ago a natural “experiment” occurred on the island of Taiwan. Huge housing units were built and occupied by thousands of families in one busy area. It was then discovered that radioactive cobalt had been incorporated in the steel. The authorities disclosed the problem to the public but decided to study the effects rather than tear down the entire edifice. Again, cancer rates among the exposed people have been remarkably lower than normal.

In parts of the world included little-publicized places in the United States, people pay premium dollars to go to spas located deep underground where they are exposed on purpose to high levels of the radioactive gas radon. Many people swear their arthritis has been cured and they’ve never felt better. Now, I see ridiculous claims for all sorts of weird treatments every day on the internet, and I’m not rushing off to Montana for the cure. But the general principle seems to hold consistently that we can improve our ability to deal with the environment by experience, just as our immune systems respond to antigens by building resistance. Leakage from the Japanese reactor has the environmental extremists yelling “The sky is falling” as they always do, but my sense of the threat is that except for the poor souls who drowned when the tsunami struck the plant, there will be no excess deaths, the food supply will be safe, and the resourceful Japanese will recover. Leaking radiation from a damaged but well-constructed nuclear plant is to an atomic bomb what a lava lamp is to a volcano.

Radiation is with us every day. Airline pilots are exposed to considerable levels at the altitudes they prowl, but no ill effects have been noted. The harnessing of radiation has benefited mankind tremendously in medical diagnosis. I hope nuclear power will not be set back by this event because we need it so badly.

Perhaps you’ve heard about the doctor, Kermit Gosnell, who was finally arrested after decades running an abortion mill in Philadelphia where he kept a museum of baby parts after systematically butchering not just early fetuses but fully developed infants capable of surviving outside the womb. Those born alive were murdered by snipping the spinal cord. His staff has also been arrested; none of the eight employees (as young as 15) had any medical training. Gosnell himself had no specialty training. His patients were almost all black, as is he, and poor, which he is decidedly not – his operation brought him a reported $1.8 million a year. At least two women died in his care.

Where was the government? Aren’t there agencies charged with oversight of such a “clinic?” Yes and no. You see, abortion is a “right” created out of thin air by the Supreme Court 38 years ago. Governors of both parties have deliberately refused to “interfere” in the exercise of abortion rights by women in Philadelphia and elsewhere. It was the stench, the rats, the rumors of both mother and baby deaths that finally brought down Kermit the Creep and his House of Horrors.

Clearly I am no fan of abortion. When the court ruling came down in 1973, my scientific training insulated me somewhat from the moral dimension of that decision. Most states had already ruled abortion legal in most cases, and there was the prevailing opinion (largely fictional) that “back-alley” or “coat-hanger” procedures were killing many women who would be safer in approved clinics. But it wasn’t long before abortion touched me personally and I dedicated myself to doing what I could to support the Pro-Life cause.

In the last four years I’ve been privileged to serve as Medical Director of the Pregnancy Counseling Center in Mission Hills. A year ago through the kindness of our donors we installed an ultrasound machine. I took an on-line course and became certified to oversee the work done by our wonderful nurses, and the Clinic even furnished me with an iPad so I could review the ultrasounds while away from the Valley. Our site is close to Planned Parenthood, the leading abortion provider in the country and the site of countless violations of law regarding failure to report incidents of rape, incest and human trafficking. Did you know that its founder, Margaret Sanger, was a Nazi sympathizer and spearhead of the eugenics movement in the 30s, which among other things sought to eliminate blacks? Today abortion is five times more prevalent in blacks as in whites. Jesse Jackson used to be pro-life, as was Dr. King (his niece Alveda is an outspoken pro-life advocate). But since the Reverend ran for president his politics changed. Eighteen million black babies have been aborted in the United States since 1973.

I’ve wandered off the subject, which I’m allowed to do because it’s my blog and I’m old and crotchety. But it is a source of shame to me that so few doctors will stand up for the most helpless, not just babies but the elderly, the disabled, the inconvenient among us. When Sarah Palin used the expression “Death Panels” to refer to Obama-Care, she struck a nerve. By appointing (without congressional approval) Dr. Donald Berwick as his czar, a man utterly committed to rationing medical care (but not for his family), Obama gave the game away. Families and personal physicians have done a fine job of making end-of-life decisions for decades. As a member of our Bio-Ethics Committee at Valley Presbyterian for many years I’ve seen this process up close. It works. It is always painful. It will not work better or be easier if government flunkies intrude in the picture.

Another instance of doctors abusing their authority and mandate has been showcased lately during the protests going on over budget shortfalls and unsustainable pensions and health benefits, especially in Wisconsin. Doctors have openly offered to sign excuses for hooky-playing teachers and others. No big deal, say some, but it is shameful and I hope those individuals are punished appropriately. The excuses specify that the “patients” have been evaluated by the signing doctor. You folks know how hard it is to get a legitimate P.E. excuse out of me for your child. To put my name on the dotted line for a political protester (whichever side they’re on) is a violation of professional ethics, not different than writing a prescription for a patient I haven’t examined.

Salmonella has about 1500 strains, all but one (typhoid fever) native to birds and therefore transmitted via their eggs. The present situation is apparently linked to a large operation in Iowa owned by a fellow with a long record of public health violations. He once paid a $2 million fine but apparently still hasn’t cleaned up his act. The disease is generally mild except in the immunocompromised, including infants and the elderly. Cooking eggs thoroughly kills the bacteria, but sunny-side-up or soft-boiled eggs and even French toast are not guaranteed to be safe. Antibiotic treatment is usually unnecessary and may even prolong the carrier state (remember Typhoid Mary?)
The most common type of food poisoning used to be staphylococcal, the bug that causes most abscesses, boils, etc. Typically a contaminated worker in a bakery would infect a product such as cream puffs or eclairs, which if unrefrigerated for some hours would act as a culture medium, especially in hot weather. Public education and better sanitation among food handlers seems to have made this variety of food poisoning uncommon.

Hepatitis A (“infectious hepatitis”), now controlled by an excellent vaccine, has caused many outbreaks of food poisoning, although the long incubation period (2-6 weeks) makes it hard to detect. A few years ago the L.A. School District had a large outbreak spread by strawberries. For the life of me I can’t understand why the schools still don’t require vaccination when they do require it for hepatitis B and several other diseases. In my CDC days a bizarre epidemic of hepatitis A occurred at a naval base in New Jersey, a “common source” epidemic with a bell-shaped curve of occurrence. What made it odd, and clearly criminal, was that all the cases involved officers and their wives, and eventually some of their children. Turns out a certain career private (he had been demoted several times for insubordination) diagnosed himself with hepatitis based on his jaundice and dark urine, so he urinated into the mayonnaise that went into the potato salad at the Officers’ Mess. The Navy’s punishment was classified. Fortunately everyone recovered.

Another source of hepatitis food poisoning is contaminated shellfish. There’s some rule about not gathering clams, oysters and the like during certain months but some enterprising fellows about the New York – New Jersey waterways were making lots of money breaking the law, digging through the ice in the Raritan Bay to collect these critters. Many folks eat clams and oysters raw or steamed, which it turns out does not kill the hepatitis virus. Researchers at that time also discovered what the ancient Hebrews must have known thousands of years ago; shellfish feed themselves by pumping and concentrating garbage, making them quite adept at transmitting germs.
The investigation which included CDC became rather complicated when it turned out that the Fulton Fish Market was run by the Mob as one of their front operations.

There are other kinds of food poisoning as well. During my two years in Berkeley reports came to us of a huge and dangerous epidemic in the north following an annual gathering of thousands of Sikhs. It was an enormous picnic of sorts, with their traditionally spicy food prepared in large metal cauldrons. We quickly learned that Sikhs do not appreciate Western medicine, do not like government authorities nosing into their business, and carry large knives. We were able to get some information, however, and to treat some of the seriously ill patients. The prolonged cooking as done by them was allowing toxic amounts of heavy metals to leech out of the cookware into the food. This was an unusual example because of the size of the outbreak, but we also learned that many individuals were using old refrigerator shelves to barbecue on, and that toxic amounts of cadmium were being ingested by unwary backyard celebrants. These are historical curiosities nowadays but probably still occur in third-world countries.

With November approaching, there is one other important type of food poisoning worth mentioning. Clostridia are anaerobic bacteria which thrive only in the absence of oxygen, producing well-known diseases such as tetanus, diphtheria, botulism and an important type of diarrhea known as C. difficile which tends to occur in hospitalized patients given high doses of antibiotics. Leftover turkey and to a lesser extent chicken can transmit the toxin from these bugs if cooking temperatures are not high enough to penetrate the entire carcass.

I hope I haven’t spoiled everyone’s appetite!

There are over 200 wineries around here. So far I’ve only tasted two. Sounds like it may be time to try another. Be well, friends.

By now you’ve received my letter announcing my departure from private practice after 44 years. At 75 (which they tell me is the new 74) I might be expected to retire. However I wouldn’t if I could. I love what I do too much, and I’m blessed with good health. Except for a 4-week cancer break in 2001 I’ve never taken a sick day, making me the Cal Ripken of pediatricians. The opportunity to sell the practice arose last year and it was a one-time chance to stop the tailspin that I (and most of my colleagues) had been experiencing since the failure of managed care and the recession. There was uncertainty as to where that would lead, but now we know.

I am too independent-minded to work full-time for someone else. The incessant bureaucratization of medicine, the erosion of authority, the replacement of bedside skills with high-technology razzle-dazzle, and now electronic record-keeping have all come between the doctor and his patient. Seventy years ago we headed down a path which joined health insurance with employment, and federal and state government now account for half of all coverage, with all the political fallout that entails. Predictably, the “marketplace” for health care is a mess, partly because no one has any idea what a fair charge is, especially the consumers. In the future virtually all primary care will be group-centered. Perhaps that will be a good thing for both of us.

What I’ve chosen to do is “take my act on the road”, so to speak. I have already been working some nights and weekends at Urgent Care centers around the city, as well as covering practices in both private and community settings. It’s a bit of a gamble because the work is rarely made available more than a few weeks ahead of time. However I’m assured that there will be plenty. Much of my family lives in the Silicon Valley, which I hope to visit more often. Cynthia is excited about all the farmers’ markets and antique shops, and Gucci will get even more attention than usual.

Thank you all for the unforgettable experiences, for the honor of being part of your families, for the trust you’ve placed in me. As the letter mentions, my cell phone is 818-414-6777 and my e-mail, as you obviously know, is harry@doctormaller.com. I’ve also taken a box for my snail mail: P.O. Box 7725, Van Nuys 91409. For the foreseeable future we’ll keep our home here and would love to hear from you.