Sunday, November 30, 2008

Steven B. Tamarin, MD

I’ve just received the terrible news of the sudden passing of Steven B. Tamarin, MD.
I had known Steve for several years through our joint service on the Board of Physicians for Reproductive Choice and Health, and considered him a wonderful person and a friend.
I am just attaching the text of an email sent out by a much closer friend of his, Neal Calman, MD, who so articulately honors him.

We will miss you very much, Steve.

Dear Friends:

I am deeply saddened to relay to you news of the death of Steven B Tamarin MD, a personal friend, a great physician and one of the founders of Family Medicine in New York City. Steve died unexpectedly in his sleep last night while visiting his cousin in Massachusetts. His loss is a tragedy for all who knew him and loved him.

Steve was an outspoken advocate for women’s rights, an ardent supporter of the Tipitapa project in Nicaragua where he visited and worked many times over the years – as well as being one of the smartest and most dedicated physicians I have ever met. He read medical journals like they were novels that he couldn’t put down – enthralled at every new study that provided insight into the workings of the human body in health and disease. One could not spend even a single dinner with Steve without him being called on his cell phone by his patients – many of whom he had cared for over decades.

Steve was a long-time member of the Institute’s Board of Directors and as the only physician on our Board, was depended upon to challenge our clinical protocols when needed and provide advice on issues of medical controversy. He was also a past president of the New York State Academy of Family Physicians – a position he held with distinction and one of which he was most proud. He continued to be involved in the Academy on a local level, bringing politically important issues to the forefront at all times.

Steve was one of the first of the new generation of Family Physicians in Manhattan. Along with the late John Falencki, they forged the path that many of us followed. We are forever indebted to them for their foresight and courage.

Steve will be sorely missed by his family, his patients, his friends and his colleagues.

There is no information at present as to funeral arrangements but information will be forthcoming when it becomes available.

Personally, I am heartbroken to lose him.

Neil Calman MD

As am I. Steve, we will continue the struggle!


Saturday, November 29, 2008

Mumbai, Valley Stream, and the Economic Meltdown

There is no shortage of news to write about today. The horrendous terror attacks in Mumbai have finally ended with the death of the final terrorist in the Taj Mahal hotel; the toll of hundreds of deaths and hundreds more wounded is staggering, but when the NY Times (November 29, 2008) notes that: “Perhaps the most troubling question to emerge Saturday for the Indian authorities was how, if official estimates are accurate, just 10 gunmen could have caused so much carnage and repelled Indian police officers, paramilitary forces and soldiers for more than three days in three different buildings,” it is hard to argue. I suppose the best response is “Obviously, they had help.” We await the answers which will probably come slowly and painfully and involve a lot of collaboration not only within residents of the city and employees of many of the institutions attacked, but likely the security forces themselves. We have become accustomed to life-imitates-“art” – or at least the movies and TV – with the Obama election’s eerie similarities to “West Wing”; with Mumbai we are reminded of “Vantage Point”.

Back in the USA, in a scene most Americans would think of as more likely to happen in India, a crowd of shoppers who waited all night outside a Wal-Mart in Valley Stream, Long Island, NY, stormed the entrance this “Black Friday”, trampling to death a young worker named Jdimytai Damour who was behind the door. The Times quotes Detective Lt. Michael Fleming, who is in charge of the investigation for the Nassau police: “I’ve heard other people call this an accident, but it is not,” he said. “Certainly it was a foreseeable act.” As a side note, the Times also mentions that “Wal-Mart has successfully resisted unionization of its employees. New York State’s largest grocery union, Local 1500 of the United Food and Commercial Workers, called the death of Mr. Damour ‘avoidable’ and demanded investigations.” Frankly, I do not see how unionization could have prevented such an event, but perhaps the officers of the UFCW believe that collective bargaining could have had the employees demand more security. If this attention increases the probability that Wal-Mart workers will enjoy the protection of unionization, however, it would be a very good thing.

If the Mumbai crisis has its roots in religious and ethnic conflict, and that in Valley Stream may indicate a new level of anti-social behavior in the US, they also both can be discussed in terms of the current economic meltdown. It may be more obvious in the case of Long Island (consumers rushing in to get bargains turning into a total mob), but the Mumbai-related events can certainly exacerbate this crisis if it escalates the India-Pakistan conflict.

The economic crisis was in fact, as most people (save perhaps the naïf Alan “I never thought people would be so greedy!” Greenspan) believe, caused entirely by the unfettered greed of a relatively (compared to the people they have impact) small number of financial manipulators abetted and encouraged by the policies of the Bush administration. That we have such a crisis in the absence of world-wide famine, the full economic impact of global warming, or regional nuclear war is particularly terrifying given the possibility of any or all of those occurring in the near future. Ira Helfand of Physicians for Social Responsibility (PSR, and the International Physicians for the Prevention of Nuclear War (IPPNW) presented a terrifying analysis of what the impact of a regional war with a relatively small number of atomic weapons used, would be. He identifies India-Pakistan as probably the most likely venue for such a conflict. The abstract of his talk ( notes that:
“The recent study by Robock* et al on the climatic consequences of regional nuclear war shows that even a “limited” nuclear conflict involving as few as 100 Hiroshima-sized bombs, would have global implications with significant cooling of the earth's surface and decreased precipitation in many parts of the world. A conflict of this magnitude could arise between emerging nuclear powers such as India and Pakistan. Past episodes of abrupt global cooling, due to volcanic activity, caused major crop failures and famine; the predicted climate effects of a regional nuclear war would be expected to cause similar shortfalls in agricultural production. In addition large quantities of food might need to be destroyed and significant areas of crop land might need to be taken out of production because of radioactive contamination. Even a modest, sudden decline in agricultural production could trigger significant increases in the prices for basic foods and hoarding on a global scale, both of which would make food inaccessible to poor people in much of the world. While it is not possible to estimate the precise extent of the global famine that would follow a regional nuclear war, it seems reasonable to postulate a total global death toll in the range of one billion from starvation alone. Famine on this scale would also lead to major epidemics of infectious diseases, and would create immense potential for war and civil conflict.”

We have a long way to go before we hit bottom!

Friday, November 28, 2008

Universal Health Coverage

In this week’s Nation (Dec 8, 08), Alexander Cockburn has a very good column that includes the following: “Last week I had the usual urge to machine gun the TV set while listening to the McLaughlin Group, all of whom presumably haul home at least $200,000 a year, as they deplored the unconscionable wages of the line workers in Detroit.” He continues on looking at the Wall St. Journal’s editorial policy (“…the WSJ’s editors have always taken a stern line on letting the weak die in the snow.”), and the fact that letting the US automakers collapse while bailing out the financial sector (and quoting Paul Craig in Counterpunch “A country that doesn’t make anything doesn’t need a financial sector as there is nothing to finance.”) is heavily anti-union in motivation and essentially racist in eliminating the strongest source of good jobs for black workers.

But the attitude of the McLaughlin Group is not limited to reactionary TV pundits, who obviously feel that they are contributing something valuable to the economy. All policy recommendations come from the “prominent” who, when they advocate implementation of restrictions and limitations, are never part of the group that will be negatively effected. Shortly before the election, at the recent national meeting of the American Public Health Association I attended a session inaccurately billed as a “Town Hall Forum” to solicit input on policy from the membership. (It was in fact an hour and a quarter of comments from five illustrious panelists; when a member of the audience went to the microphone as it was opened for the last 10 minutes of the session to express his opinion, he was cut off by the moderator asking “What’s your question?” Whoops.) The general tenor of the panelists’ opinions, with the notable exception of Quentin Young, President of Physicians for a National Health Program and a former APHA president, was expressed by the one who, in response to calls for a universal healthcare program, said “We can’t let the perfect be the enemy of the good,” presumably meaning that if we insist on covering everyone, we may not be successful in getting a program that covers some more people. I will not name that individual, nor the organization for which she works, not only to protect her honor but because the rest all said essentially the same thing. Suffice it to say, she will not be one of those left out if we implement the “good” instead of the “perfect”. The talking heads never are. When was the last time, even in private but certainly in public, you ever heard someone say “I’m really suffering without health coverage, but don’t worry about including me and my family in your health reform plan. We don’t want to let the perfect be the enemy of the good.”?

We hear a lot of talk about health reforms other than single-payer universal health care, such as health savings accounts, employer mandates, buying more people in to insurance-company policies, all of which will cost a lot more and not cover everyone. Last year the Kansas Health Policy Authority (KHPA), a government agency, on request of the legislature and with private foundation funding, commissioned a study on possible health reforms in Kansas. It found that a variety of programs that would cover a few or some more people would all cost about the same. Except single-payer, which would cover everyone and save a minimum of 10% ($800,000,000) compared to current costs, and possibly up to 30%! Of course, such a program, covering everyone while saving a lot of money, was too radical for the KHPA to recommend to the legislature, so they recommended one that would cost a little more money and cover about 1/3 of the currently uninsured. To no avail; not only did the legislature not implement that recommendation, they implemented none of the ones the KHPA made, including those urging people to lose weight and exercise more!

It behooves us to remember that all the talk about non-single-payer programs comes from politicians, policy wonks, professors, pundits and other talking heads. As Dr. Young said, there is only one movement for health reform that actually has regular people in in – labor unions, churches, professional and community groups, and plain old folks who may not have or worry that they may soon not have health insurance – and that is the movement for single payer. We need to make sure that they, and we, never let the pressure up, that the hope generated by our new administration is not smothered by the blathering of self-righteous “important people” who know what is best for everyone else, as long as they do not have to suffer the consequences themselves. We need to hold strong to the simple call to:

Cover Everybody!

Although I do think we need to respect difference of opinion, as long as they are honest and the proponents are willing to live with what they propose for others. I am thinking of a bumper sticker that says: “If you don’t think we need a program to provide health coverage to everyone, it’s ok. We can leave you out!”

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