Another Death in Vietnam (revisited)

The following post was published on this blog 20 months ago, less than 70 days after Trump inauguration. It was striking to me how so little has changed since then that I felt compelled to re-publish it:

My brother Bobby was killed in Vietnam. We didn’t know it at the time, for that matter neither did he. It took 43 years for the herbicide that entered his body at age 21 to end his life. The Agent Orange causing the particular lymphoma that killed him was just as reliable as the bullets, bombs, accidents, and illnesses that took the lives of the 58,220 Americans that were recorded as dead “in-country” during that military engagement.

There’s undoubtedly no accounting of what the real number of Americans lost was, any more than the incomprehensible number of non-Americans who died with them and since. There’s also no telling when it will end.

Lately I am weighted with pangs of responsibility in realizing I am of the last generation of Americans to remember firsthand what we as a nation were experiencing at that time, roughly between the years 1965-1972. What should I be sharing…what should I just forget?

The historical experience of World War II was quite different, as I was taught by my father’s generation and in countless stories and films.  There was near total engagement by the American population. Even with carnage that pales all military conflicts that have followed; the unification toward a common goal resulted in a remembrance that is mostly Romantic. The somewhat unique American post-war euphoria that resulted from that Romance is the “Great” in Donald Trump’s “Great Again”.

Vietnam was essentially its antithesis.  It was ill-conceived, non-transparent, over-weighted in politics, ultimately divisive, and too easy to discount and disregard.  If it weren’t for the existence of a draft carried over from WWII and Korea, the whole conflict might have been relegated to second page news and its opposition might have more resembled our recent fiasco in Iraq.

Thankfully the lessons it left are not clouded in Romance and their relevance has never been more important than they are today in Trump’s America.

What I remember from the Vietnam War era and how it relates to 21^st century America is not the foolish ideological tools that were used by equally foolish leaders to begin and sustain the conflict. What I’m recalling is how the nation reacted to that foolishness daily and why. Such was the national response to the War that lunacy became lucid and, therefore, insulated from reason.

The presentation of the Vietnam War to the American people was insidious.  It started slowly, utilizing the undercurrent of manufactured fear of Communism to justify deaths and injuries.  Long before the devastation of the Conflict reached its height, the bullshit of falling dominos to the “Red Peril” vanished. It simply became a “them vs. us”.

News reporting on the War basically folded into the routine of people’s lives.  There was little to report daily other than the number of dead and wounded, and where in that little country it occurred. In 1968, an average of 46 US soldiers were killed every day, with 6 to 8 times that many wounded or injured…every day. The Pentagon and the White House released whatever they could to make it sound acceptable. The most common was to list North Vietnamese (and Vietcong) killed and wounded in numbers so large the accounting was not believable. But few expressed skepticism and it was hardly questioned.

You see, as a Nation, we got used to it. Protesting was considered unpatriotic and didn’t really take hold among ordinary Americans until the 5^th year of the War. Nixon was elected in 1968 by the “silent majority”.  Like Iraq, if people didn’t have someone in the conflict the news of the War was just and only that. The current day's news made yesterday's vanish into desert air.

Donald Trump has not (yet) drawn us into an extended military conflict, thankfully. His “playful” attitude regarding nuclear weapons gives pause, but for now the lesson of Vietnam doesn’t actually relate to how we are reacting militarily.  It relates to how we as a nation are reacting to the fundamental functioning of government.

If Donald Trump feels he has a mandate it is based on an irrational concept that he was elected to dismantle whatever he can and by whatever means he is able.  He has no more ideological basis for his attack on the existing US Government than Johnson or Nixon had in perpetuating the Vietnam War.  He is freewheeling and his disabling narcissism has resulted in him being surrounded only by his family and those who were loyal when anyone with a half a brain viewed him as scary clown.

The truly serious problem is that the Nation and the media have gotten used to it. His and his administration’s bizarre actions have become habitual and routine. There have been so many instances of disinformation, distasteful antics, subversive behavior, incompetence, nepotism, pandering, lying, and psychosis over the course of the election and the first few weeks of Trump’s term no one is keeping count anymore. And those are just the public ones.

Nearly any one would have torpedoed a prior administration.

Just like another death in Vietnam, the next Trump shoe to drop hardly moves the meter, and even then only briefly.

The danger is that complacency to incompetence, indecency, corruption, and (most of all) dishonesty may take many years to undo. In nations that find difficultly in thriving, these factors seem often insurmountable, especially where public division is encouraged.

We should be raging against legislators who think they can personally benefit by supporting this dangerous new “normal” and to media moguls who are devoted first to ratings.  To want and expect something better from government we need a better government, not its elimination in favor of some kind of chaotic oligarchy.

Reject any legislator who supports Trump, restore the Fairness Doctrine (ended in 1987), and seek with an open mind to understand why overall health care in the United States (and ONLY in the United States throughout the developed world) is an abject fiscal failure.

We don’t want another Vietnam lingering around for another four decades or longer.

My Daughter Trulicity

I find it curious the creative nature at which new parents name their children these recent years (or even decades). Where do they come up with those names? Where can they find more? I have one thought:

 I came home the other night forgetting the slumber party my daughter had arranged for that evening. I walked in and was gleefully accosted by my daughter’s two best friends Cymbalta and Pamelor.  They were immediately joined by Lyrica, Latuda, and Humira all very anxious to introduce me to their new Latino friend Fetzima.  I went into the family room to meet her and first saw Eliqus (a bit mature for her age) lounging in front of the TV. Before I could say a word the doorbell rang. I went to answer it with my nervous looking daughter and there on the doorstep were three familiar boys Paxil, Lipitor, and Cialis, plus an Italian exchange student named Entresto. I said “not tonight fellas”, and asked my daughter, Trulicity, to close the door gently.

That’s right, in the endless quest to find names that distance themselves from such as Kathy, Susan, Jane, and Amy you need go no further than your flat screen TV. At almost any given time you will be subjected to long, drawn out prescription drug commercial that features a clever name that’s just perfect for your next born. Further, they’ll use the name repeatedly in the most comforting of situations; romantic fall colors, bubbling brooks, colorful kites, loving smiles, you name it. How could you go wrong? Besides, you’ve paid for this creativity…dearly.

In the 1980s, under the banner of deregulated free markets holding sway during the Reagan years, the FDA made no attempt to restrict pharmaceutical companies to advertise on television and radio. Today only one other nation in the world (New Zealand) allows such advertising. Since that time our Nation’s drug suppliers have spent hundreds of billions of dollars on “direct to consumer” (DTC) advertising of prescription drugs (Rx). 

There has been a bit of controversy to this practice surfacing from time to time, but mostly there has been a passive acceptance. The affect of advertising is normally positive in a free market, even necessary, but it is also potentially insidious. We view advertising submissively, rarely thinking about it.  Its very purpose is to create recall only at that the time of or decision to purchase.

The limited debate over DTC Rx advertising has mostly focused on the effect advertising has had on the decision making of the doctor: to what extent does the motivated patient sway the doctors decision making on which drug to use.  I believe that debate is useless and nearly irrelevant. It requires second guessing physicians and cannot be determined in any practical way even if we intuitively know it’s true.  The primary debate should be centered on the economics of DTC Rx advertising, what is really happening and what the obvious consequences are.

Advertising by definition is targeted toward a consumer who might be interested in purchasing the product advertised, or to the individual who might influence the purchaser (such as advertising to small children).  DTC Rx falls loosely into that second category.  The identity of the Rx consumer, however, is the first misnomer.

The patient is not the consumer when it comes to Rx, rather the purchaser is the physician. It is important to understand that the patient doesn’t buy Rx for himself, rather he/she buys it for the physician.  Prior to the development of retail drug distribution, doctors disseminated Rx when the patient was seen and the patient would pay or reimburse the doctor as part of the overall cost of treatment, just as it’s currently often done in hospitals.  As the number of Rx expanded it became impractical for doctors to maintain the drugs and so Drug Stores became a centralized point from which doctors could disperse medications. 

Therefore, DTC Rx advertising is directed toward individuals who can’t buy the product, any more than a three year old can buy that box of Cocoa Puffs she’s seen on TV.  The difference is, of course, the Rx purchaser is an adult who actually thinks they are the one buying the Rx. At least the 3 year old intuitively knows their Cocoa Puffs are coming from mommy. I believe it is this misunderstanding by adult patients which fundamentally impedes this debate from reaching the American people.  It is our profit driven health care system that suppresses the issue.

Cost of Healthcare and Prescription Drug Advertising:   The American health care consumer should constantly be reminded that the cost of health care for him/her is revenue for someone else.  There is a transfer of wealth in the US of over $4 trillion annually.  An estimated $30 billion of that amount goes to those involved with the marketing of Rx (advertisers, media, and the marketing overhead of the pharmaceutical companies).  It matters not what health care plan our current or prospective political leaders espouse, none will work unless the cost of healthcare in the US is reversed. The billions spent on DTC Rx advertising are perhaps the most wasteful dollars spent in our ongoing healthcare catastrophe as they do not directly benefit the healthcare recipient or the system generally. In fact, there is no benefit, direct or indirect, to the patient. The only purpose is to generate profits for the pharmaceutical companies.

Prescription Drug Advertising as a Disincentive for Drug Research: The argument frequently heard from drug companies is that the price of a drug is often very high due to the large investment that took place prior to the drug being released to the public. It is a good point as those costs must be recovered, as well as the costs of research on failed drugs that ultimately are not released.  However, once the drugs are released the revenues can be used for further research on new and improved Rx, but what happens?  The Pharmaceutical Companies continue to invest in these drugs, in the billions of dollars, through mass marketing. Not only are those billions not being used for further research, but they drive up the cost. Further, with the Pharmaceutical Companies continuing to invest billions in a drug to make it more profitable, there is a disincentive to develop a new and better drug that might replace the highly marketed drug. It is simple human nature (and therefore business nature) that they will continue to support these marketed drugs rather than new ones due to the continued investment from which they have calculated an expected financial return.  None of this equates to any benefit for the patient…past, present, or future.

Prescription Drug Advertising Adversely Impacting the Quality of Rx: As the Pharmaceutical Companies continue to invest in a prescription drug they become less likely to continue critical review of that drug, or maintain even a practical semblance of objectivity in any critical review. Again, why would they?  Not only have they invested in the development of the drug, but after its release they continue that investment and now have projected levels of profits to defend.  There is a further element, however:

With mass marketing the pharmaceutical companies have exposed themselves to more liability; both on a retail level which can affect shareholder equity, and on a tort level with possible injured parties.  This has already been made obvious by several highly public drug failures such as with Vioxx and several statin drugs. The heavily marketed drug increases public awareness, which is what mass marketing is supposed to do.  With that visibility, however, comes equally visible news worthiness should a drug fail. This becomes merely a cost of doing business and an indirect expense added to the retail cost of the drug.

There are other less critical reasons why Rx advertising should once again be banned from radio and television:

The information regarding the prescription drug that is supposed to be provided with the advertisements is laughable and completely ignored by the FCC.  It is the audible and visual equivalent of an 80 year old trying to read minuscule type on a label without glasses, she knows it’s there but it has no meaning. Warnings of death or diarrhea while people are dancing in flowered fields or hugging babies are pointless. In fact, it is a practical impossibility for such communication further strengthening the point that drugs are marketed to the wrong people.

We know the uninformed influence of the patient adversely affects the doctor’s best decision making, we only don’t know how much, and we never will. We also will never know to what extent mass DTC Rx advertising contributes to defensive medicine, although it surely does, putting both the patient at some additional risk and driving up cost.

Mass marketing of prescription drugs exists because, for the most part, it accomplishes what it seeks to do.  It gets the patient to influence the consumer (the doctor) to buy the Rx thus increasing sales and profit.  However, in a world where healthcare should be an available standard commodity to all people, like clean water, then prescription mass marketing takes us in the wrong direction.  It is far from an answer to the overall healthcare problem, but its elimination would take us one step further in the direction we need to go, and at $billions a year it would be no small step.

Think about it. How worse off would your life be if you never saw another prescription drug commercial again?  Call or write your Congressional representative.

The Brain of an American Anti-Semite

If aliens dropped in from outer space and absorb American and World history they would no doubt be astounded by the contributions to humanity by one relatively small group of people. No matter the discipline; e.g., social, arts, science, medicine, literature, education, entertainment, or philosophy, people of Jewish decent have had a greater positive impact on the human condition, pound for pound, than any other sub-set of modern Homo sapiens that have roamed this planet.

It therefore begs the question of why many non-Jews are often manipulated to believe Jews should be contained, restricted, and (in historically extreme cases) eradicated.

Jews and those of Jewish decent are no different than any other sub-set of people in that they face the same trials all individuals face. There is no objective or mystical power that isolates them, negatively or positively, from the rest of humanity. Their individual numbers spread across the same spectrum of success and failure, happiness and misery as everyone else.

Why they have had such a genuinely constructive impact on our culture could be due to a number of things; history, education, family structure, values, social support among others, but that is not the point of this discussion.  I want to look at why in today’s American culture they are still used as a threat for those who want to attain or retain power, and what kind of brain is so susceptible to that threat.

By the end of the 1940s the World was emerging from its cultural car wreck and beginning to ask the question, “what the hell just happened?” The term Holocaust really has meaning that goes beyond the horror and tragedy inflicted on Jews. Although prejudice has always been part of the human condition, extreme anti-Semitism, as well has other prejudices, had spread world-wide like an infectious disease.  History is clear that Nationalism, relatively new in a worldwide context, was the vehicle used by influential individuals to drive the world into catastrophic conflict. Targeting vulnerable minorities was their fuel.

America today is not 1932 Europe generally or 1932 Germany specifically.  It is not even 1932 America when it comes to anti-Semitism.  Yet many of the same elements now exist and are getting stronger in this period of Trump and the reactionary effect he elicits.

Overt anti-Semitism, Racism, and bigotry in America today is primarily a product of irrational conspiracy mania created by those who skillfully use fear in order to secure support. The fear generated by those who profit from it does far more than motivate (what I call) the lunatic fringe, e.g., white supremacists, Dylann Roof, or Robert Bowers. It impacts a significant portion of adults in America, some you might call friends. Some, perhaps, attracted to Trump Rallies without a lot of understanding of why.

It appears (and it is logical) that Robert Bowers was just as hostile toward (in Trump’s words) the invasion of immigrants as he was toward Jews. The same would be true of the torch bearing Nazi-types in Charlottesville, although their malice was more focused on Jews and African Americans than Latinos.  As tragic as their actions are toward innocent victims and the emotions they generate among survivors, they are not a threat to the United States or any race or religion contained therein. They are part of the disease that can be seen and treated.  

It is the passive racist or anti-Semite who bears no grudge against any individual, but who harbors fears of an amorphous and dangerous adversary; the Deep State, the “Government”, the “Liberals”, the “fake” press (aka: enemy of the people), welfare, Socialism, taxation, or immigrants are all examples. Each poised to rob you of your property and well being. You could throw space aliens into that mix without missing a beat.

It is not a huge step to surreptitiously link such paranoia to Blacks, Jews, and Latinos. The goal is to retain power. The fruits of that power are another discussion entirely.

Since the removal of the Fairness Doctrine in 1987 (an FCC doctrine created in 1948 out of the rubble of WWII to neutralize propaganda) the brains of these Americans have acted like sponges, sopping up the sewage that has been pumped out of talk radio, Fox News, and Sinclair Broadcasting for nearly 30 years. Out of this you not only get a Donald Trump, but you also get an entire Political Party that is willing to compromise almost any degree of decency, anti-corruption, international responsibility, or fiscal conservatism in order to keep their individual jobs.

Please keep in mind that almost all those manipulated brains are in the heads of decent people, but this fear-driven misinformation is all they watch or listen to. That reality gives Trump’s “enemy of the people” effort enhanced meaning. Trump and the Republican leadership don’t want them to listen to anything else. It is the life's blood of authoritarianism.

The election and re-election of Barack Obama did much to unleash the fear among many Conservatives.  “How could a Black man become President of the United State” was a small echo in the back of the anti-Semitic brain (no different than the racist brain).  When it came to public consumption they simply pasted “extreme Liberal” over the words “Black man”.

The answer to that question was tendered through talk radio and Fox News with conspiratorial rhetoric. By the time Trump came on the scene Republicans were scrambling to distance themselves from the “conspiracy” known as the Federal Government, or in Trump speak: the Swamp. It should be no surprise that Republicans made the Faustian bargain of aligning with Trump to avoid primary challenges.

Is Trump an anti-Semite or a racist? Not likely, and certainly not in any ideological sense. His Narcissistic Personality Disorder doesn’t allow for objective labels. Does he trade in anti-Semitism and racism? Absolutely. Is he also responsible for the resurgence in America today of anti-Semitism, racism, and bigotry in general? Of course he is.

That he refers repeatedly to the asylum seekers from Honduras as an “invasion” (calling out for a military response) or warns of Liberal “mobs” or labels the main stream news media as “the enemy of the people” is simply him ringing the dinner bell.

The brain of today’s American anti-Semite or racist wants serenity, like everybody else’s brain. However, it is so stoked with fears that are fed by conspiratorial language that it will often act against its own best interest (such as supporting last year's inequitable tax bill). Pushed far enough it becomes unstable, especially on the fringes. Yet I hope that fear for personal safety does not become the driving focus in the attempt to counterbalance. That would be futile, indeed. Confidence is the element that needs to be embraced, confident that leaders who represent the truth will emerge because the alternative is not sustainable. The first step is to understand that your vote will make a difference.