Pick A Problem, Any Problem

Woke up a little earlier than usual and sat on the balcony. I'd made coffee and while I waited for it to cool, I took in the unfamiliar scene of My Street coming to life just past dawn.

I thought about health centers seeking federal funds and how to expand their reach to under-served communities, a task made more problematic by the lack of doctors and nurses. According to a 2013 study, We have 18% fewer doctors for every 10,000 people than We did in 2005.

I thought about the declining performance of Our public schools and how several efforts were being made to expand classroom offerings to include art, music, theater and dance. The main obstacle was, as ever, the Department of (Mis)Education, mummified in stupidity and centralized to the point of jamming its own moronic head up its own fetid cloaca.

I sipped some coffee.

A local agricultural cooperative was trying to come up with a revenue stream that could sustain small farm and ranch efforts. Their primary focus was federal funds, but the bureaucracy to qualify for proper registrations was apparently going to take another 4-8 months, extending the effort into its second year. The members, down to 17 from a high of 39, were close to letting the whole thing fade away. Like the other four cooperatives did, all of them overwhelmed by red tape measured in miles and months rather than pixels and minutes.

More coffee.

Should I blog about Our misbegotten excuse for an economy? Political claptrap? The continued collapse of what passes for journalism on My Island? The impending meltdown of Our infrastructure?

Finished the coffee. Sat for a few minutes, with other problems flitting in and out of the picture I was trying to make sense of. The minutes became longer as the list grew.

Can't solve them all, or even most of them. Not by Myself.

Ann Marie Sastry

So I picked one.

Got to work.

Hopefully tomorrow I'll sleep late.



The Jenius Has Spoken.

Health As In HELLth

I had surgery yesterday, for an umbilical hernia I aggravated more times than I care to admit. It wasn't as traumatic an event as one might think for three very good reasons:

1--This was My third operation, the first occurring when I was 3 years old.

2--I wanted the operation, since My overall health was being compromised.

3--My Wife is a medical doctor.

What struck Me most about My surgery was several seconds after having an anesthetic dropped into My IV, while watching the nurse place a blood pressure cuff on My arm, I went blank. Out like a light. Zap. Woke up about 3 hours later with Dr. Mrs. Jenius sitting next to Me and within an hour of that I was getting into the car to go home.

All's well that ends well, right?

Not exactly. For although My surgical experience was relatively painless, the whole procedure leading up to it was a sidewalk in the upper levels of Hell.

It took a total of eleven visits to doctors' offices to get the required paperwork, seven of them to the same fat toad of a bitter bitch who after the fourth visit "suddenly remembers" at 3:00 o'clock that I need an X-ray done that day... with the radiology center closing at 4:00. If I had followed My instincts, the fat toad's bitter box of an office would have harbored My arrest for vandalism, but Dr. Mrs. Jenius' wisdom and practicality prevailed.

The problem, as several doctors took the time to tell Me, is that Our health system is a shambles, where insurance companies make out like bandits, specialists are being used primarily to pad medical records (in attempts to ward off lawsuits) and general practitioners are treated like wage slaves. And since the focus of the health system is on treatment rather than prevention, We as patients get less-than-stellar service that borders on fostering addiction rather than enhancing health.

Nothing new, right? Well then Why do We put up with this? I see 3 reasons:

1--Health care as politics: The overwhelming vision about Our society's health system is that it is a political issue rather than a medical one. In other words, health care is manipulated to garner votes, not to actually improve health services. And since We are what We are, the political side invariably leads to corruption, so hospitals are sold in sweetheart deals, insurance companies play merry-go-round with health services and medical personnel are respected yet treated like peons.

2--The business of health care is business: If mechanics worked on Our cars the way the health system works on Us, they'd staple, glue, tape or jury-rig autos to run for a few miles and then break down again in order to create a steady stream of clientele. Insurance companies count as profit the money they don't spend on Our health, so the system is set up to generate revenues by not really curing a patient and not really treating a patient. That's where the real tug o'war emerges, further pushed by pharmaceutical companies and laboring under the weight of potential lawsuits...that raise the already-crushing insurance rates for doctors.

3--We believe in "magic cures" rather than taking care of Ourselves: Take Me. Knowing I was already injured, I kept indulging in sports, hell-bent on competing. I knew surgery was needed to patch the break in My abdominal wall and kept putting it off until it wasn't optional anymore. Many of Us do the same with Our diet, alcohol, drugs, laziness and more. In short, We do what We want and then expect the health system to fix Us up so We can go back and do what We want again. Because We don't take care of Ourselves, We care very little about the system. Because We don't take care of Ourselves, We end up needing the system, especially when it comes to diabetes, high blood pressure and heart conditions. And because We don't take care of Ourselves, We end up being held hostage by fat toads with bitter bitchiness spewing from every pore.


I'm feeling fine now, somewhat sore and walking in a hunched manner. I already know I'm going to very careful in the next several months, exercising to get back into shape, but making sure I don't let My competitive side take over and push Me too far. What's crystallized in My Mind is that to every extent I can, I will not be held hostage by another fat toad of bitchy bitterness. That's part of hell I don't want to visit again (or have Dr. Mrs. Jenius do for Me.)

Odd, but the very hellish nature of the system make actually be My strongest incentive to focus on prevention. That and avoiding another look at the ugly toad's sour wreck of a face.



The Jenius Has Spoken.

Yocasta Brugal: Fire Her Now

In a surprising development, the Liaison Commission on Medical Education (LCME) reversed the San Juan Bautista School of Medicine's loss of accreditation (Public Announcement, 18 November, 2011). The SJBSOM is now under probation, pending a visit by the LCME in late January/early February 2012. The good news: The students, including Mrs. Jenius, can continue or complete their studies under accreditation, a huge academic and professional difference. The bad news: I was wrong about the possibility of a reversal, but I can take that because the right decision was made and I have been right about everything else.

Which brings Us to worst news: Yocasta Brugal MenDacious and her lying liars are still at the head of the SJBullshitters. And the possibility that they will get kicked out on their fat asses anytime soon seems remote. My guess is that they won't be kicked out before the LCME visit and I would LOVE to be wrong about that.

But I won't be.

The reasons to kick these incompetent lumps of uselessness out are legion, and many of them have been detailed in previous Jenius posts and the comments. (Check out "Yocanda Brugal: Incompetence Recognized" for a lengthy comment thread.) There are plenty of reasons, in truth, a veritable excess of plenty of reasons why Brugal MenDacious and her ilk have to go. The disease is diagnosed, the remedy is obvious and has proven quite often to be the successful cure for the disease. But the will to act is missing. And without the will, the action doesn't exist.

The will can only come from two collective minds: the Board of Trustees, a gang of monkeys with the total integrity of a frog's cloaca. Their interests--based on their inaction so far--seem to be deeply intertwined with that of Brugal MenDacious and the lying liars, so the incentive to dump their partner/ally/crony/shield/protector/benefactor is virtually nil.

The second group is composed of the students. If the students raise their voices in clear objections to giving the S.S.JBullshitters back to the captain and crew that piloted the leaky vessel into rocks, eventually that captain and crew will be replaced. Staying silent, acquiescing, granting approval by simply continuing with business as usual will doom the SJBSOM to lose its accreditation in 2o12. And this time, it will be for a very long time. I have absolutely no doubt on that point.

A comment on the post linked above called for the students to refuse to register for classes until Brugal MenDacious and her lying liars leave. Good start. But more needs to be done. There are three flanks to attack:

1) Revenue: Why is the SJBSOM begging for scraps from Antigua and the Dominican Republic?

2) Federal grant funding: Why is the SJBSOM so utterly useless in securing funding that nearly every other private medical school receives in bulk?

3) Clinical services: In a nation with a huge population density and complex widespread health problems, why can't the SJBSOM develop alliances and programs strong enough to secure accreditation?

Here's the crux of the matter: the SJBSOM is a miserable failure as a healthcare resource, and its recent actions prove it is also a miserable failure as a school. For the students, some 30-40 of whom have already chosen to leave, the battle must be seen as more than "getting Mine now": it has to be seen as "getting better for all Our sakes."

The chance to turn the SJBSOM from a pigsty run by retarded barnyard rejects into a worthy institution has to be won now...for if it isn't, if the animal farm is allowed to continue its manure-dumping ways, then the SJBSOM will quickly become shuttered, ignored by everyone as it closes its doors.

At that point, it would be very much like locking the door after the horse is gone, so why don't We focus on kicking the horses' asses out first and then making sure the barn is run by competent people?


The Jenius Has Spoken.

C-Sections Get An F

Mrs. Jenius is going to be a pediatrician...ostensibly to deal better with The Jenius.

Sigh.

So when it comes to health issues, especially those related to children, My mild attention to them is now enhanced. (As to why it was mild, it just was: I have many interests and millions of things I don't care about.) From this report comes another confirmation of a long-standing problem in Puerto Rico: 48% of Our births are by cesarean section, the highest rate in the world.

According to the The Unnecesarean blog (great name), the ideal number (percentage) of C-Sections is 15%, a reflection of the ratio of difficult deliveries, where the operation is needed, to normal ones, where vaginal delivery is possible.  That Puerto Rico has over 3 times that percentage has been a problem for at least four decades, but especially so since the 1990s, when the "health deform" (yes, I wrote "deform"; you get the joke) basically turned treating patients into something akin to a sausage factory.

As noted in the original article--from local fish-wrapper Primera Hora--the two trends that moved C-sections into unconscionable frequency were the baseless notion that vaginal deliveries were unsafe after a C-section and the need to tend to "dozens" of births a month, forcing doctors to "cut the babies out" rather than wait for Nature to deliver. That second trend is also behind the common tendency of inducing labor, to speed it up, so that a majority of babies are born on Mondays, Tuesdays and Wednesdays, between 8 AM and 5 PM. Office hours for Nature's greatest gift.

Notice that neither "trend"--no vaginal deliveries and mass production--is reasonable: the first is based on bad science and thus bad health practices and the second is based on bad politics becoming bad economies of scale, thus leading to bad health practices. In other words, this is not an inherent problem My Island has--like lacking even one reasonably intelligent politician--but a created one, by lazy doctors, stupid politicians (redundant) and ill-informed patients.

Now a system that forces doctors to choose between having a life outside of the hospital or providing quality health care is idiotic; it's what We got and doctors have to choose in their best interests. No problem there. But the blame for the "no vaginal deliveries after C-sections" claptrap falls squarely on the medical community. 

Their argument that "C-sections are safer"--usually linked with "insurance costs"--is self-interest of the worst kind: self-serving and deceitful. Mothers know that giving birth is not at all easy, but a C-section is the deliberate slicing open of a woman's body, through muscle and fascia, to remove a baby who--according to the statistics-- 2/3 of the time would have been born safely anyway. Yes, there's physical damage in a natural delivery, but ask women who have had both birth methods which one left them weaker and less capable of tending to themselves and their baby.

The human body is incredible, and what women go through to bring Life to the world is an astounding process, one men cannot duplicate. Even though Nature has pushed human childbirth to an extreme (again, ask a mother), the process is--pardon the pun--natural. Millions of women give birth every day; it doesn't diminish an iota from the wonder of it all. To think that cutting a body to get to another is a frequent "improvement" over Nature is hubris and idiocy of the highest order.  That a so-called "health reform" makes a C-section a coin flip decision is moronic, like calling "heads" on whether a heart attack patient should be treated or left untreated. 

Think about that...

Puerto Rico must also face its own blinders, the idea that "they" are the experts and "We" do what "they" say. Doctors and other professionals hate when their clients come in with incomplete information and act as if they have all of it. Neither party benefits from that. But the best professionals love it when their clients come in with some knowledge and the curiosity to learn more, by asking relevant questions and listening critically to the answers.

If your doctor hates to explain and won't listen to your concerns, change doctors. And as patients, We have to learn to take charge of Our responsibilities, to ask good questions, to confirm opinions with outside and secondary sources and to understand that if We don't do it, the system doesn't care and most professionals barely take the time to care. If We find a good one, then by all means, stick with him or her.

Motherhood is a beautiful part of Life. That too many of Our babies are coming into the world through needless slashing is criminal. Our health care system is failing Us in this very crucial aspect, and however difficult it may be to fight the system, Our future children--and their mothers--absolutely deserve that We strive for their greatest welfare, rather than settling to merely serve the system.


The Jenius Has Spoken.


[Update: 26 June 2011: From the Daily Mail, the idea that women choose C-sections for "image", a "too posh to push" option.]

[Update: 8 July 2011: According to local Health Department statistics, Our birth-related numbers suck when compared to U.S. of part of A. averages, which suck when compared to other industrialized nations. Some of Our lowlights:

--18% of Our births are from teenage moms; the average is closer to 8%.
--57% of the births are from single mothers; the average is closer to 24%.
--In 2007, 49% were C-section births; the average should be 15%, as noted above.
--19.4% are premature babies; other industrialized nations average less than 5%.
--12.5% are underweight babies; other industrialized nations average less than 3%.
--Our infant mortality rate is 9.1 per 1,000 births; the U.S. of part of A. averages 6.9; the top 10 industrialized nations average 1.8.

Affordable health care? Ha. We're more concerned with gossip..."up there" and "down here." We can't be bothered to vote right where it counts, and in any case, malformed and dead babies don't vote for "American Idol," "Nace una estrella" or any of the literal motherfuckers who keep trashing Our health system.]

Fast Food (Indig)Nation

Poor people tend to be fatter than the middle class or upper class. It's a well-studied phenomena; probably should be called "The Mississippi Effect." The reasons are fairly easy to enumerate: less access to lower-priced healthy options, an over-reliance on foods that are high in calories and low in nutritional value...and frequent fast food consumption.

For poor people, their options for buying groceries are limited to smaller stores or convenience marts where food prices are often substantially higher. And even when they can buy groceries at large supermarkets, the limited income reduces their options. As I read in a recent article, a woman said "Yes, I know milk is better for my kids, but a gallon costs $3 and I can get 3 gallons of soft drink for the same price. You do the math."

Poverty, in its absolute or relative form, forces a person to seek comfort in aspects of survival, whether the expression is escape, sex or food. Fast food, high in fat, salt and calories, is made to appeal to the baser side of a person's appetite. It's success is based on being so tasty you want it again, no matter that its nutritional components can destabilize your body towards obesity.

Now take poverty and food program support to help those in poverty and watch as The Fools here on My Island make a blatantly crass appeal for votes by opening up the "food stamp" program to buying fast food. Uh-huh, your government dollars are now going to McDonald's, Burger King, Taco Bell and further points south of healthy eating. This at a time when the incidence of diabetes and cardiovascular disease, both strongly linked to diet and nutrition, are on the rise in Puerto Rico.

Okay, maybe the Fools are trying to kill poor people. Wouldn't be the first time. Or maybe in their nano-sized peabrains they believe that by allowing federal funds to be spent in fast food nation they will (a) make poor people happier, (b) get them to eat better or (c) stimulate the economy. All three are bogus, but the Fools are synonymous with bogus.

The bottom line is clear: a program aimed at supplementing poor nutrition to preserve health is now a bandwagon politicians and freeloaders can use to super-size their chow. Puerto Rico has got to be the most bass-ackwards nation on Earth, canceling chess in schools because it's too passive while flinging federal funds around to promote fast food excesses.

Hopefully that waist-expanding largesse will be struck down, just as the chess idiocy was overturned. But if it isn't, if Our poor are going to line up more often to order combos with nonchalant agrándalo glee, then I hope We make it the last of the mega-stupid ideas.

Yeah, like that's going to happen.


The Jenius Has Spoken.

[Update: 7 Oct 2010: New York seeks to ban the use of food stamps to purchase of sugar-sweetened drinks. Make up your own joke at Our expense.]

Orphan Cure Research Center

No, this isn't about sick orphans. But it could be.

Dichloroacetate. Bacteriophages. Copper. Scorpion venom. A list such as this could go on and on, with each element being a potentially world-altering treatment against disease. And the other factor that binds these elements together is that none--none--is being studied by pharmaceuticals because they cannot be patented.

I understand pharmaceutical companies are businesses and they need to make a profit. Let them. But to leave potential cures as orphans because the investment cannot be fenced for profitability is a chasm that business and industry may not bridge...but can be bridged, nonetheless.

I wrote several times about dichloroacetate, also known as DCA. I suggested We undertake the clinical trials of DCA's effects, of "switching on" cancer cells to make them extremely vulnerable to radiation and chemotherapy, here in Puerto Rico as a national project and make it a gift to the world. I now say We should do so for "orphan cures" of all types, cures that pharmaceutical companies will not touch because the ROI is too low for their stockholders.

Bacteriophages are microorganisms that eat bacteria. The eaters eat only specific bacteria, so if you need to eliminate Bacteria A, you get an A-Eating Bacteriophage and once the Bacteria A is gone, the A-Eater dies. Has done so for millions of years. And the bacteria have no defense...unlike antibiotics.

Phage therapy, as its called, is a big deal in Eastern Europe and the former Soviet Union. Has been for decades because antibiotic research was out of reach. To this day, you can take a sample of your infection to a local drug store, get it analyzed and you'll receive a phage blend specifically blended for you. Cost: about $3.00.

Although phage therapy is gaining adepts in the U.S. of part of A., most of the research is academic, i.e., not aimed at medical treatment of diseases in humans. The cost of shepherding a drug--or just one bacteriophage--through the near-endless hoops of the FDA easily exceeds a few hundred million dollars. Imagine trying to do that with thousands of bacteriophages.

Phage therapy works, but it won't become a powerful new weapon in medical centers unless it gets researched and proven. As antibiotics lose potency, phage therapy is the clear low-cost alternative. But low-cost also means low or no profit.

Copper reduces the potency of bacterias and viruses. Yes, viruses, particularly H1N1, known as "politician's flu." (Swine, hogs, pigs, politicians, same species.) Copper's myriad effects could revolutionize sanitation in hospitals and clinics, not to mention daily life. But it remains outside the realm of patents, so Big Pharma won't care.

Scorpion venom, a powerful neurotoxin, has been found to be very effective at reducing brain cancer tumors. But you can't patent scorpion venom unless you isolate the specific chemical and make that your wonder drug. (Digitalis, anyone?) But since anyone can get scorpion venom, Big Pharma won't dare.

There are other examples and more will emerge as researchers comb the Earth and its details with new eyes. But where can this research be supported, with government money so that the profit motive is sidestepped in favor of broader results?

I say Puerto Rico should be that Orphan Cure Research Center. As I wrote before: One doesn't become an adult until one achieves what is considered "adult" things. Lacking a war, nations must rise to their levels of adulthood by taking on unique challenges. Puerto Rico's imposed transformation from economic rut to world-class prosperity ended some 25 years ago. We can now stand on Our own...if We only believed enough in Ourselves. And that belief cannot--will not--be built by winning beauty crowns, boxing belts, statuettes or rings. It will be built by creating something larger than an individual or a sports team, something larger than one institution, agency or company, something so large that other nations turn to Us and recognize that not only are We putting forth an admirable effort, We are capable of achieving such a worthy goal.

LIke I said before, it will take money. But one of the irrefutable axioms of economics (one of the very few) is that goverment investment in research has invariably high ROIs, in the range of 50% to 150%. So altruism can also lead to pure profit in terms of economic growth. And the impact of Puerto Rico taking center stage in such an effort is inspiring, an affirmation, a step forward for a nation that too often has waited for the world to act in its favor.

It won't be easy; nothing truly worth doing ever is. We have to do something, We have to be something more than what We are now and unless We strive, We will shrivel, more and faster than We have up to now. And if not this, then something else, but it has to be a goal that stretches Us to reach Our potential and not a goal that has Us throwing away what's left in the mindlews pursuit of the unearned.

The Jenius Has Spoken.

Update: 17 August--We can add bug repellants, too...

Facts in Five (Minutes)

Facts We should be looking at:

The current local swine flu "super-catastrophic-apocalyptic-doom" epidemic has claimed fewer lives--3--than the number of people shot since the headlines went insane: 7.

The local legislature--a latrine in the same spot would be more useful and morally fragrant--has spent more hours debating their own consulting contracts than tending to health and education issues.  

The local Department of (Mis)Education is headed for a shakedown of "chief heads rolling" level. Proof: (non)governor Luis "The Larva" Fortuño has stopped using education as a topic to divert attention and the DoE itself has stopped seeking to get into the news. 

According to a Civil Defense report, issued in May of this year, the level of preparedeness Puerto Rico has for a major hurricane is "5" on a scale of 1 to 10. How bad is "5"? A "10" means that 80% of the people injured or displaced by a hurricane are tended to with food, shelter and medical help within 48 hours. A "5" means 60% of the "refugees" would be left to fend for themselves for as long as 10 days. The estimate of "refugees" in a Category 4 storm that hits the Island head-on is estimated at 45,000 to over 600,000, depending on the level of flooding and shore damage.

From the same report: Number of the 78 local Municipalities that are rated "7" or higher: 0. Number rated "1" or "2": 16.

Tax revenues are declining again, far more than ever projected by government wartheads incapable of spelling "projections." As the sales tax revenues drop even faster, the pressure on the government to slash costs increases only slightly less than the nerve of The Fools to find new tax revenues. Some targets: homeschooling (pay again to keep your child out of public schools), cell phone usage (under the notion that "minutes" are actually a "product"... I swear The Fools need large doses of rat posion) and--ta da!--flea markets.

And kudos to anyone who recognizes the origin of this post's title (related to a couple of letters: AH.)

The Jenius Has Spoken.

Rhoads to Hell

From Mercola.com: (1931:) Cornelius Rhoads, a pathologist from the Rockefeller Institute for Medical Research, purposely infects human test subjects in Puerto Rico with cancer cells; 13 of them die. Though Rhoads gives a written testimony stating he believes that all Puerto Ricans should be killed, he later goes on to establish the U.S. Army Biological Warfare facilities in Maryland, Utah and Panama, and is named to the U.S. Atomic Energy Commission, where he begins a series of radiation exposure experiments on American soldiers and civilian hospital patients.

From Wikipedia: When asked about the reasons for the study on Puerto Ricans, Rhoades replied: “The Porto Ricans (sic) are the dirtiest, laziest, most degenerate and thievish race of men ever to inhabit this sphere... I have done my best to further the process of extermination by killing off eight and transplanting cancer into several more... All physicians take delight in the abuse and torture of the unfortunate subjects."

From the same Wikipedia article: Later, Rhoads was given a seat on the United States Atomic Energy Commission. It is reported he performed radiation experiments on human beings there. He was also awarded the U.S. Legion of Merit by the government for his research.

Many people still criticize the lack of action taken against Rhoads for his experiments.

In 2003, controversy arose again as to the letter and the alleged experiments and the AACR Cornelius P. Rhoads Memorial Award would no longer be associated with his name. The award was not presented that year.

From "America Betrayed," by Rhawn Joseph, downloadable as a PDF file: With regard to the people of Puerto Rico, Dr. Rhoads wrote: “What the island needs is not public health work, but a tidal wave or something to totally exterminate the population.” Dr. Rhoads is alleged to have injected hundreds of Puerto Ricans with cancer. Cornelius Rhoads later became a founder and first director of the Memorial Sloan- Kettering Institute, which specializes in research on cancer.

The American Association of Cancer Research gave out the Cornelius P. Rhoads award for new researchers between 1979 and 2002, renaming and relaunching the award in 2004.

Woo-hoo.

Here's a headline for you: Admitted Mass Murderer Rewarded, Lionized.

The past is dead and buried, right? Remember: He killed Puerto Ricans and almost certainly other "American soldiers and civilians."

Or is it that the past is prologue? Admitted murderers getting away with it, under "sanction" of broken laws and war, whether they be some Rhoads or a Bush.

Hell if I know.

The Jenius Has Spoken.

P.S. From the same Mercola.com article quoted above: (1963:) Chester M. Southam, who injected Ohio State Prison inmates with live cancer cells in 1952, performs the same procedure on 22 senile, African-American female patients at the Brooklyn Jewish Chronic Disease Hospital in order to watch their immunological response. Southam tells the patients that they are receiving "some cells," but leaves out the fact that they are cancer cells. He claims he doesn't obtain informed consent from the patients because he does not want to frighten them by telling them what he is doing, but he nevertheless temporarily loses his medical license because of it. Ironically, he eventually becomes president of the American Cancer Society.

Seems the formula for success in the cancer-doctor groups is (was?) to kill unsuspecting people and then wait for the accolades and prestige to follow...

Of Mice and Men (and Women)

I find it odd that the U.S. focuses a ton of media attention on the percentages of overweight people in each State, pointing out time and again that states such as Mississippi, Arkansas and Lousiana bring up the rear (so to speak), drawing a cause-effect relationship between low income, poor diet heavily weighed to fast food and junk food and the health issues of being overweight.

But.

Puerto Rico has a lower income per capita than any State. It also has one of the highest percentages of diabetes, a condition clearly linked to excess weight. And Our diet also relies heavily on fast food, junk food and high fat/high sugar meals, which lead Us back to diabetes. 

So does the U.S. media focus on this fillip of information? No. We aren't a State. We aren't counted in these statistics. Okay, but what about health costs? We share in those through Medicare and Medicaid.  There We're treated as a special case, since the expenditures and the averages are actually weighed in Our favor (more of Us qualify for the coverage and We tend to outlive Our northern neighbors by a few years.)

What does this mean? To Me it means that if the U.S. of part of A. really wanted to do something about the population's health care, it would focus more on prevention and healthier lifestyle by creating the conditions that help guide the process... and use Puerto Rico as the social laboratory.

Yea, you read that right. I'm advocating Us as lab mice.

For one, it's not like We've never been there before.

In second place, Puerto Rico's isolation (it is an Island, you know) and ambiguous status make it a perfect setting for some social engineering aimed at improving health, with no illusory "State's rights" to get in the way. (Note: NO group has a right. None. Only individuals have rights. Learn it, take it to heart and you won't be misled by demagogues.)

Third, a prevention/lifestyle experiment (for that is what it is) would not only be useful as a health-related solution, it would also save money for the U.S. of part of A. Always a good thing when you can help them pocket some cash, right?

But.

Who am I kidding? Let the government set the lifestyle standards of a population in order to help them be healthier? The government? That's like asking a tremulous wino to fix your pacemaker. We don't need more government intrusion in Our lives.  

Then again...

Isn't the government largely responsible for the conditions We do have, that lead to low incomes, that encourages the proliferation of fast food and junk food and opts to leave out some 45 million in the U.S. and Puerto Rico from the coverage needed to treat the health issues emerging from the setting? True, it is individual choice, but when survival is at stake, as any person in poverty or near-poverty will attest, individual choices are also a luxury.

The Jenius Has Spoken.

Slugs to Scrubs

In the U.S. of part of A., it costs more to house a prisoner than to educate a university student.

The U.S. of part of A. has the largest prison population and the largest percentage of its population in prison of any country in the world.

And Puerto Rico follows along like a lolly-tongued puppy...


Okay, We have a problem here. Let's toss in a few more isolated facts:

There is an estimated shortage of some 280,000 nurses in the (you guessed it) U.S. of part of A., and the shortage is getting worse.

Beginning in 2008, the first of the Baby Boomers, the largest single generation in U.S. history, will begin to retire and already makes up the largest segment of the population in need of health care.

The estimated need for health care workers is some 600,000 more than the available right now, and the gap is growing at an estimated 10% a year.


Yeah, I'm going there: Let's train prisoners--men and women--to become health care workers, medical therapists and nurses.

First objection dismissed: Not all of them. With a prison population rapidly climbing to the 3 million mark (despite Texas' desperate need to kill some of them), one can be choosy.

Second objection dismissed: Recidivism will always exist, but even clean-record civilians show a double-digit tendency to drop out of health care, police forces and fire/rescue services. At least by training prisoners, We're looking to make use of human resources for a greater good instead of fattening them up for economic slaughter when they get out.

Third objection dismissed: Online education services. Forget moving them out of the prison: Just habilitate a computer room and only those who excel at their studies (both in grades and pace) are rewarded with on-the-job education and training.

End result: A reformative penal program that clearly addresses multiple key social needs, from rescuing those who've made a mistake to offering hope to the marginal to providing services to the needy to saving money.

Discuss amongst yourselves.


The Jenius Has Spoken.

Security Solutions - Part 1

My previous four posts were picked up by Global Voices Online. That's always an honor.

Now the following solutions for what I deem are security issues in Puerto Rico:


Double police salaries while significantly raising the standards: If you have a high school diploma, don't have a criminal record and aren't reasonably in danger of dying within the next five years, you can be a Puerto Rico police officer, with your own gun and everything. And you start at $1,400 a month.

What a joke. Just as the political system weeds out capable people to favor sub-normal and sub-evolved cretins (I know, I'm being redundant, but the Fools don't understand what I say), the police force attracts largely marginal candidates for any job, much less ones to engage in the primary function of government: defense of its citizens.

Many in Our police force work two or even three jobs to make ends meet, which is an obvious scenario for stress, dysfunctional relationships and corruption, not to mention thuggery. No police force in the world is immune to bad apples, but when you start with inferior material (Yes, I said "inferior") you can only hope you wind up with a worthy crop.

We're past the stage where hope has any right to guide Our actions here. Beginning immediately, the police force has to seriously raise its standards to beyond "You wan' fries with that?" candidacy. It has to police (pun definitely intended) its own so that the rotten ones are expelled as quickly as possible. And while that happens--only as it happens--do current officers start receiving the higher pay they deserve.

And don't give Me that "There's no money" crap: There's plenty of money for this even without implementing My other solutions. Proof: The Fools added more employees in four years than there are police officers in Puerto Rico, many of them at salaries that triple what cops make.

There's money. And then there's money.


Implement preventive care in the health care system: An ounce of prevention is worth a pound of cure. The current health reform--a sick oxymoron at Our expense--is absolutely lousy at health care, but it's light-years better than it is at preventive care. The reason: The system was designed by venal doctors, starting from the top with an ex-doctor who aped rather than shaped.

The specious argument against preventive care is that it's up to the patient to follow-through and that you can't coerce a person to engage in the required activities.

Just shut up.

What is government if not a system to coerce certain behaviors from its citizens, ostensibly for the good of that person and society? Is it better for a government to coerce behaviors after the person is sick and weak or when the person is healthy? Is it better to coerce those behaviors to help the person stay healthy or is it better to coerce them to possibly restore health, if time doesn't run out? Which is more cost-effective, regular check-ups to avoid problems or expensive drugs and surgery to fight for an unsteady status quo?

An ounce versus a pound. People--doctors, hospital owners, insurance company shareholders, Fools-- love the pound...that comes from Our flesh. We'd rather pay the ounce. Here's how: We extend the health system to a schedule of routine yearly or semi-annual check-ups. No one is required to keep the schedule, but if they do, they get progressively smaller deductibles when they need health services. This alleviates two problems:

1) Those with marginal incomes often put off health care due to cost. Here they can get basic care at no cost.

2) By getting that care and developing a medical history, many health problems can be ameliorated or caught early enough to be easily treated. And by "easily" I mean "at lower cost."

An ounce versus a pound. Seems applicable to both solutions, when you come to think about it.


The Jenius Has Spoken.

Douchebag Doctors

The media went to town with the news: Eighty-eight doctors and three others were arrested in what is shaping up to be a massive illegal licensing scheme. Amongst the arrested were a father-daughter pair of losers and a recently-filed mayoral candidate. (Need I point out for the pro-statehood party or is that beside the point?)

For the past five years, brain-challenged would-be doctors have been paying about $6,000 to have their licensing exam results fixed in order to receive their licenses. The director of the Medical Examination Board, under intense scrutiny since early this year, was also arrested, and authorities strongly suggested that more arrests are on the way.

Regardless of whether more arrests are made or not, the damage is already serious. On an island where fully 40% of recent med school graduates leave for perceived greener pastures elsewhere, to know that this many dunderheads are sitting across from patients and engaging in "health care" is a crime.

And no, don't give Me that bullshit about some people being better doctors than those who are legally licensed. THAT is beside the point. The point here is that demonstrably incompetent vermin were allowed to purchase an unearned certification to provide a fundamental service. One of the "doctors" had failed the exams 16 times. Six. Teen. Times. We're not talking driver's license, We're talking human lives and this plusperfect idiot failed sixteen times to prove her basic ability at being a doctor. So giving this waste a space a medical license in exchange for cash is supposed to improve the health care system?

This was not done because Puerto Rico lacks doctors, but because the local medical industry--doctors, hospitals, insurance companies and government--has become nothing more than a pigsty, with porkers and porkettes huffing and snuffling to find a space at the money trough. The basic principle of caring for the patient's health has taken a back seat to greed, narrow self-interest and corporate profits. Nothing new here, but it disgusts in the same sense that an overflowing sewer is nothing new, either.

I hope the authorities arrest another 88 doctors, even 188 more. Because in the end, it won't change a thing. Some doctors will be kicked out, many more will up and leave and the ones who remain will pick up the slack, hoping to cash in big without making much of an effort. For you see, to this industry, taking care of people is deemed an excessive effort: The true purpose of being a doctor is to make money fast. Why else would someone go through the humiliation of failing 16 times instead of actually learning something in order to pass?

The answer is simple: Money means more than knowledge. Remember that the next time your doctor treats you like a bag of cash instead of a human being...and expects you to respect them for it.


The Jenius Has Spoken.

Beyond (De)Capitation

Note: Shout-outs to Janine Mendes-Franco, who selected another of My recent posts for Global Voices Online and to Raúl José, of De todo como en botica, for including Me in his analysis of Stupid Rosselló's pathetic mewl for attention.


From a dear friend, much more evidence beyond capitation that the health care system is a mangled wreck. Statehooders, try to understand that the following happened in the States, okay?

The whole area of medical care is COMPLETELY MESSED UP (and capitation is just one symptom of that).

My main complaint--medical care is basically the ONLY place where the price tag associated with something is completely irrelevant to the end user. People want to walk into a pharmacy and pay their $10 co-pay, regardless of the cost of the drug. Consumers have NO incentive to make rational decisions because they are shielded from the actual cost of care. (Why SHOULD I take the generic or an older drug if my copay is the same for the spiffiest name-brand drug? And why should I take over-the-counter Claritin and pay the full cost when I can take Zyrtec which is still covered under my drug plan?)

You also don't see the price tag until it's too late. Look at Don's broken toe from last year. His $1000 toe. He went to an emergency room at a facility on our list of "Approved Providers." We got their bill - $500 - even though he never got past the waiting room and a triage "curtain." Then we got the doctor's bill - $455. The doctor spent less then 3 minutes with Don. Looked at his toe, gave it a mighty yank, and told an assistant to "buddy-tape" it. For that, we were billed for two separate procedures (one labeled "SURGERY"). That's a heck of an hourly billing rate. And the story gets better... The doctors in the emergency room aren't a part of ANY insurer's plan. They can charge whatever they please and you just have to pay it. No negotiated fees. No discounts. Do not pass go, and pay way more than $200. AND--this is the kicker--although they don't recognize our insurance, because we HAVE insurance, they wouldn't discount the bill (claimed they "COULDN'T"). So we were stuck paying their highway robbery rate of $455. The only reasonable bill was from the radiologist - $11.55 to read the x-ray.

We TRIED to shop--went to what we THOUGHT was a facility covered by our plan. But there's no transparency in the pricing or anything else in the process. That's one of my problems with it.

I have a pharmacist friend in Louisiana who works with a lot of Medicaid patients. Because THEY aren't paying ANYTHING for their prescriptions, it is amazing how picky they can be. They get the name-brand drugs (no generic drugs for them - those are reserved for the paying customers with insurance). She's had parents return a drug because, "My child didn't like the taste of it." They wanted a different drug, AND THE DOCTOR GAVE IT TO THEM. (My child would have been told, "Swallow it. I know it tastes bad, but GET OVER IT.")

Society wants the easy fix ("diet and exercise" would sometimes work as well as a drug, but we want to be able to "supersize our fries," then take a pill for our cholesterol). What happened to personal responsibility? If you watch the drug ads, it doesn't need to exist. Pharma has a cure for whatever ill you may have or think you have. Drug ads make me crazy.

There are too many special-interest groups with VERY vested interests in maintaining the status quo. There are many INDIVIDUALS who like the status quo, too (mainly those with rich employer-provided health plans - just even WHISPER about changing a health plan at a unionized facility and watch the union squawk).

If there isn't a link between the COST and the SERVICE, then individuals will naturally want the most expensive (not most cost-effective) option. People have no incentive to self-regulate their demand for services, or to seek the most cost-efficient options. To me, that indicates a broken system. There will be no easy fixes, and fixes will not be popular.

We have a $10k deductible. I have plenty of reason to try to control what I am paying, but I'm not given the tools to do it. (Just look at our toe experience...)

Imagine: The richest, most successful country in history has a health-care system built on any number of factors... except actual health-care. And rather than seek a better solution, We play "Monkey see, monkey do".

However, in Our defense, so long as We are beholden to the Big Monkeys from the north--Medicare, insurance companies, pharmaceutical companies, etc.--and their incessant lobbying to keep a broken system broken, We'll just have to play along. It's not like We've ever had a real doctor in charge to try to make a difference, right?


The Jenius Has Spoken.

Health (De)Capitation

Imagine that your doctor gets paid to not provide you with a recommended treatment, literally, that he or she makes money for not taking care of your health as would be objectively expected.

Don't imagine. If you live in Puerto Rico's so-called Health Reform--and what mirrors it in many parts of the U.S.--that is the reality: Doctors make money for not treating your health properly.


Of course, this aberration has a name: capitation. In essence, doctors get paid a stipend per patient, but if they recommend that the patient see a specialist or have a further examination their stipend is reduced to help pay for that additional service. So it quickly becomes apparent that it is in the doctor's best interest to deny a patient's best option for treatment because it "costs" the doctor much more than the patient.

Say it ain't so? Doesn't change the reality. Proponents of capitation say that the purpose of the system is to reduce unnecessary medical visits and tests. What they fail to see--or pretend to be blind to--is that the system places the doctor's interests ahead of the patient's. Expecting doctors to be filled with the milk of human kindness and generosity is one thing: asking them to live up to it in a daily grind is entirely another.

For one, doctors have expenses, some of which (malpractice insurance, for example) are going through the roof. Are there insurance companies out there paying out huge settlements without passing costs on to their customers? No. So don't expect doctors to eat added expenses without "passing the cost" to their customers, namely by not letting money in their hands go elsewhere.

Second, and reiterating the above, doctors are human and humans are possessive and self-interested. It makes no sense to try to pretend otherwise. The catch in the health system's blind use of capitation is that the neediest element is strictly beholden to the less needy. A sick patient needs help, but their need is in the hands of a person who can willfully, often negligently, deny their greater need for well-being in favor of a merely monetary whim.

Am I saying that doctors will endanger a patient's life for mere money? Yes I am. If you think money isn't the issue just make the rounds (pun intended) of several medical offices in any part of Puerto Rico. It won't take you long to see signs stating that "Cash Only" is acceptable. No checks. No ATM or credit cards. And certainly, no medical plans, though the doctor is almost certainly on one or more medical plan capitation systems.

Is this right? Depends on who you ask, a sick person or a doctor. A key point is that there are plenty more sick people than doctors...and that there is often a startling and depressing overlap of what sick can actually be.


The Jenius Has Spoken.

Passing Pages, Marking Time

As My dad's remains are being cremated, I spend almost 2 hours leafing through a local daily, turning pages like a metronome, eventually seeing an item or two on each pass-through:

Front page: The Archbishop favors the use of the National Guard to fight the current crime wave. First of all, the archbishop is entitled to his opinion, but his moral authority is suspect at best and nil at worst, so what he has to say on anything outside of Catholicism is not news. If I want prattle, I'll turn on the radio. The underlying cause for this front page ink-waster is the obscene murder rate We have going so far in 2007: Almost four deaths a day. The Jellyfish, governor Aníbal Acevedo, floated the suggestion of using the National Guard as a sort of "hard line" stance on crime. Here's the problem, oh spineless floater: The National Guard will make the problem worse, as they are neither a long-term nor an "attack the roots" solution. All you'll be doing is sending well-meaning citizens into harm's way for purely political reasons. And speaking of which, the top result for a Google search on "the murderous moron" yields Yours Truly. So do yourself a favor, oh indecisive invertebrate, and avoid acting--even in a much smaller scale--like the so-called "commander"-in-chief of the U.S. of part of A.

Page 14: Patient Ombdusman receives over 11,000 complaints about health reform services. Only 11,000? My guess is that most people don't know there's an office to deal with their health service complaints. The general stat breakdown is interesting: 70% of the complaints were against the public sector, with 30% against the private side, but in a more interesting light, roughly 98% of the complaints were resolved in the patient's favor. According to the Office's director, Dr. Luz Teresa Amador, only 2% of all complaints were considered to be "without merit." I wonder what will happen in 2007 when complaints skyrocket to what I expect will be double the current rate...

Page 28: On the way to becoming the best-paid legislators. Uh-huh. The year has barely dawned and the unremittingly debased and morally inept tribe of Fools is on the warpath to raising their salaries and benefits package once again...automatically. See, they have this nifty "If we don't vote against it, it happens for us" deal that makes their cushy and upwardly-mobile living a fait accompli. (And no, I didn't forget to capitalize "we" and "us.") One solution: Make them part-timers, so they'll have less time to screw Us over. Chances of that happening: Same as unicamerality...nil. If We don't slash through this tribe and significantly--drastically--reduce their numbers by voting most of them out and showing the political will to do the same to whoever slimes their way into those seats, We will have the best-paid legislators and the worst-led state/territory in the U.S. of part of A. Oh wait! We already do!

Page 40: Permit halt holds banking back. Residential construction permits are so slow and so backlogged that house sales on this property-mad Island have dropped 50%. Boo. Hoo. Houses are grossly overpriced due to those same "permit restrictions," so when they get back on the market--at higher prices because of demand--the money will eventually flow back to the banks. They're just miffed because they ain't getting theirs at the rate they used to. How much you want to bet that those banks that own "easy loan" services (those that charge a modest 20-28% interest) will go on an advertising rampage in the next eight weeks?

Page 57: Editorial cartoon: A futuristically-dressed newscaster reads: "Greetings. Today is March 7th, 2026 and these are the news. The World Coalition of Nations unanimously agreed to build a permanent Lunar station. As usual, Puerto Rico will not participate in the world effort because they still haven't decided if they want to be an independent nation (and) member of the Coalition or continue as a free associated state." How sadly true, on too many levels.

Page 67: A new book out about a "Most Wanted" criminal who was gunned down by the F.B.I. about 20 minutes from where I live. To think they wasted perfectly good toilet paper on this book...

Taken from El Nuevo Día, on the day We said goodbye to Abuelito.


The Jenius Has Spoken.

Doctor Late, Baby Too

Some stories hurt and make you wonder...

"Linda" is well-loved by her family, friends and co-workers. Almost everyone who knows her knows she and her husband yearned to have children. But over the years, the expected event never mateialized.

Finally, at the age of 40, Linda became pregnant. A first-time mother at that age is obviously a special case and with gestational diabetes a factor, even more so. Her doctor owned a sonogram machine and every month, Linda and her husband would see their baby, growing, moving, breathing.

Linda cut back on work and travel, ate carefully-selected meals and prepared herself for the arrival of her long-awaited baby, thankfully full-term. On a sunny afternoon, Linda started feeling sharp pains, violent slashes through her abdomen. Alarmed, she called her husband and they went to the hospital.

Within minutes, Linda was under the care of nurses who undertook another sonogram, only to discover that the baby didn't seem to be breathing. The nurses called Linda's doctor at around 7:00 p.m. to tell him there seemed to be a problem with Linda's baby. The doctor told the nurses he would see Linda in the morning. The nurses told Linda and her husband the doctor would check on their baby the next day.

By the time the doctor arrived at 8:00 a.m. and started making his rounds, Linda's baby was dead. At 22 inches in length, it was determined that the baby was 3 weeks overdue. Three weeks, despite monthly sonograms to ascertain weight and growth. Linda was told her baby was dead during the night and waited until 3:00 p.m. for her doctor to see her.

At which point he told her that he preferred she push the baby out rather than do a Caesarian. Linda, too weak and heart-broken to make the effort of pushing a corpse, underwent a C-section that evening, her expected day of joy one of unbelievable grief.

As noted before, doctors are leaving the Island in droves and amongst the specialties most affected is obstetrics. Some OB-GYN specialists are tending to 40-50 births a week. What can be tolerable in the short-term quickly becomes deadly in the long-term.

Why didn't Linda's doctor go to her that evening, when the obvious problem was reported?

Why didn't the nurses, who loudly proclaimed "We called the doctor. We did our jobs." insist on finding another doctor to tend to an obviously-agonizing mother and child?

How did Linda's doctor miss the obvious signs of the baby's development, especially when monthly sonograms were available for close monitoring of its progress?

Are We facing an exodus of the excellent, the good and the opportunistic doctors only to be left with being treated by the remaining overwhelmed excellent doctors, the swamped good ones and the increasingly-dangerous mediocre and bad charlatans?

Questions We can--and must--ask, but no question can now bring back what has been Linda's desire of the heart for so very long. Her baby--her ill-treated baby--is gone. And nobody will be able--or be willing--to do anything useful about it.

In the words of Linda Ellerbee: And so it goes.


The Jenius Has Spoken.

A Few Things Off My Chest

Item One:
Hoist. On My own petard.

After taking to task the ridiculously-pretentious and insanely-stupid book "Restoring Growth in Puerto Rico" as the vapid incubator for tubercular cyanosis, someone whose intellect I respect greatly handed Me a copy of that same piece of garbage...to read...because "This is the hot thing with The Fools right now." Seems My near-future projects involve trying to think down to their level and reading this lamebrain "minifesto" is part of the process. I can feel the brain cells revolting already... Two things: First of all, I thought I was the hot thing amongst The Fools. And second, there are those of you who will smile prettily at My discomfiture here. (I'm talking to you, Carol...)


Item Two:
I am fucking sick and tired about hearing and seeing news reports about barely-walking dog food. I'm referring to Barbaro, winner of the Kentucky Derby, who broke a leg in the Preakness and since May, has received hours of news coverage and gallons of ink, not to mention more medical attention than any canned food ingredient ever deserves.

Now, I'm a huge sports fan and one of the biggest thrills I've ever had enjoying sports was watching Secretariat win the 1973 Belmont Stakes and the Triple Crown with a performance that still gives Me goose bumps when I think about it. But back then, I wasn't aware of the business side of horse racing, a facet thrust into Our faces now with nauseating regularity because of Barbaro's condition.

For you see, Barbaro has round-the-clock care by a battery of specialists. He has been operated on several times. His casts are changed frequently, sometimes every few hours, to ensure proper healing. Barbaro's been pumped with a series of antibiotics and other medications and has a team of attendants to make sure his every other need is fulfilled immediately.

In a country where over 44 million people lack proper health care, and maybe 2-3 times more can't get major medical coverage, the spectacle of a (non)fucking horse being treated better than a whole country full of people is repulsive. Hundreds of thousands of dollars being spent to save Alpo fodder so it can live to fuck mares. The message here is that money can buy you the best health care, even if you're a horse. But does that mean that Barbaro deserves to die? Yes it does: Better it than any human being.


Item Three:
Another Saturday, another period of boredom and this time, a single question without any real forethought: What is your dream?

I don't know how many people I asked. I moved from a mall (the location of choice, as you can see) to a coffee shop (NOT one of those latte-venti-overpriced pukeholes, I assure you) to another mall. The answers ranged from "Winning the lottery," (the most popular response; I've got to frequent better malls, I guess...) to "Dancing at my granddaughter's wedding" with a few violent answers thrown in. (Not at Me, but at The Fools.)

The only conclusion I could come to was: Nobody had big dreams. Nobody dreamt of changing their city or creating a better future for Puerto Rico. No one came out to tell Me a dream that would galvanize a group, a generation or a nation. If anything, the dreams were prosaic, passive, more "It will fall in my hands" than "I will make it happen."

Passive. That's the word. Maybe the active people, the visionaries, weren't in the malls or coffee shop. Maybe they don't go there. Maybe they don't have time to waste in those places. I hope that's the answer and not that We lack visionaries and dreamers. I can live with the thought that I wasted My time in the wrong places. I can't live with the thought that I'm wasting My time in the wrong place...just by living here.


The Jenius Has Spoken.

Forty Percent (Dis)Solution

I read the following statement about a month ago:

"About 40% of the medical school graduates in Puerto Rico leave the island."

Forty. Percent.

Four out of every ten would-be doctors decide that staying in Puerto Rico is not a viable option. The culprit, according to majority opinion, is the fact that doctors can make more money in the U.S. than here. But let's take a closer look.

About 28% of the local (Puerto Rico-based) doctors are graduates from medical schools that are not in Puerto Rico or the U.S. (Mexico, Spain and the Dominican Republic, mostly.) Although statistics are very hard to find, the general observation is that these doctors have substantially less student-related debt when they finish than Puerto Rican-based med students do. It makes sense, since almost all of them have to pay their way to complete their studies, unlike local students, who rely on Federal grants and loans.

Is the difference substantial? In a brief survey of 23 foreign-educated doctors versus 27 locally (Puerto Rico or U.S.) educated doctors, the average debt of the foreign-educated group was $62,000, mostly in the form of personal loans and/or second mortgage's, usually on their parent's home. For the locally-educated, the average debt was $171,000, almost all of it in government loans.

Look at those numbers again. Assign a 20% margin of error and you still have the potential for a $74,000-$127,000 debt-ratio. My "survey" was certainly far from methodical, but it quickly showed a huge gap between the two groups.

And there was another: Of the 27 locally-educated doctors, 21 said they were either planning on going to the States (11) or were already making that transition (10; about 40% of the group.) Of the foreign-educated group, only 7 said they were thinking of moving (5) or already moving to the States (2). (One said she was moving to Guatemala to work in an isolated clinic; I didn't count her as a Stateside-transitioner.)

Is it money that makes doctors leave the island? Yes, partially. If you have about $170,000 of debt that you must pay back to keep your license valid, you will seek better pay. It's natural. That Puerto Rico doesn't offer that "higher pay standard" is sad, but then again, there's something even sadder: That these doctors run up such huge debts in the first place.

Foreign-educated students have no government largesse in their favor. Most of the ones I spoke to never received a penny from Uncle Sam. On the other hand, of the locally-educated group, some bragged about how they "cheated" to get their studies paid for up to 100% by Uncle Sam. The ones that cheated were, invariably, children of doctors or licensed professionals (lawyers, engineer and pharmacists. Often both parents were licensed professionals.)

So it isn't necessarily that Puerto Rico is "devoid of opportunities" for these doctors, but rather, that they "price" themselves out of the opportunities that naturally exist here...if they were actually pursuing knowledge instead of cash.

There are other factors, such as social class (children of professionals have a much better chance of securing a spot in a local medical college); work loads (most of the foreign-educated students started medical school at an older age because they had to work while completing their undergraduate degrees); educational costs (can be lower in other countries, including living expenses) and language (most of the foreign-educated group indicated that their English was weak, even though to become doctors, they had to pass the Boards, which are in English.) To the locally-educated, many of whom come from privileged backgrounds, private schools and intensive English exposure, moving to the States is easy, or at least easier than to the foreign-eductated.

But We--or rather, I--still come back to the original point: money. If My informal survey is close-to-reality (and many of the doctors feel it is), then what We have is not an economic "crisis" but a moral one.

Here's why: I shot the breeze with these doctors, especially about their college years. And I quickly noticed an enormous difference in the kinds of experiences each group had. The foreign-educated spoke about immersing themselves in another culture, making new friends, tackling new ways of seeing Life and spending time in service to poor or marginalized communities. They certainly had their fun, but they focused more on what they shared with others.

The locally-educated group spoke more often about the new SUV or sport car that they bought with the loan money as their graduation gift (and entrance to medical school.) Some spoke about their apartment or house, filled with the latest and the greatest. Many of them spoke about trips to Europe, skiing trips during Spring Break and the fabulous wedding they had, most of this financed by Uncle Sam. Only two mentioned providing service to poor or marginalized communities and both complained that they had been grossly underpaid. One of them actually became bitter at the memory of his one week in "poverty hell."

One week. Though he spent 11 weeks in Europe in a four-year period.

Yes, 40% of our medical school graduates leave the island. Yes, there are major differences between types of medical students. But I feel that the doctors that leave are not better than those that stay. More "successful" at tracking money, yes. But if that were the criteria for better doctors, politicians would be miraculous faith healers.

Doctors leaving isn't because of a new pursuit of money: it's simply a continuation. Hounded by debt they eagerly chased, now they are chased by it. And that's another difference I noticed: the foreign-educated doctors seemed more satisfied, more content with their lives than those educated locally. They shared practically the same lifestyle in terms of house, cars, education for their children, etc., but whereas those who earned their way were "happier," those who "bought" their way seemed stressed.

I could be wrong. But I'm pretty damn sure I'm not.


The Jenius Has Spoken.

Nalmefene for Puerto Rico

Imagine taking a pill that makes you stop shopping...reduces the urge to gamble...and can even stop alcoholism.

Forget imagining: it's called nalmefene and it's being tested as We speak (write, read, whatever...)

Already proven to be effective on 6 out of 10 gamblers, reducing their addictive high of losing (compulsive gamblers do so to lose), nalmefene targets the pleasure centers of the brain and thus can conceivably reduce the urge to splurge (also known as "retail therapy") and even take the edge off the need for alcohol.

Okay, let Me be blunt: Even if Our water is barely above rank sewage, We should be pouring nalmefene in it like it was fluoride. It should be dropped in every cola, every cup of coffee and every freaking bottle of water from now until 2012.

Puerto Rico has long had a problem with alcohol consumption. For years, We were the only non-Communist country ranked in the Top 10 in alcohol consumption. The amount of damage, death and destruction that happens around alcohol in Puerto Rico is frightening to behold. So getting that under control is a good thing.

Gambling in Puerto Rico is also ridiculously high. According to Hacienda (the local Treasury department), the average Puerto Rican spends $306 a year on games of chance, from the state-sponsored lottery and Loto to casinos, horse racing and cockfights. And this doesn't include the monies spent on illegal gambling, mostly in the form of bolita. The "official" number is almost $1.2 billion dollars a year. Please note that the number is per capita and that We must then subtract the children and teenagers who legally don't gamble (about 1.08 million of 3.85 million). Without them, the average is over $420, or about 2 weeks' salary for the average worker. Getting this under control is a good thing.

And then there's shopping, conspicuous consumption, keeping up with the Jimenezes, nothing down and payments that aren't starting this week with interest rates in the 20s, a number twice the collective IQ of The Fools and their dogs. A nation of compulsive buyers that exhibits the two related characteristics of anxiety disorders and low self-esteem. (Yes, The Jenius is saying We, as a nation, have low self-esteem.) A nation that doesn't save, doesn't reduce its spending to prepare for the future and is thus as agonizingly dependent as a parasite on some external flow. (Yes, The Jenius said parasite.) No wonder compulsive buyers suffer anxiety and don't like themselves.

Nalmefene is the solution. Forget trial runs in Great Britain. Crank up the nalmefene mill to 11 and fill warehouses with the stuff. Transport it here. Better yet, make it here: that's what Our pharmaceutical industry is here for and start handing it out like food stamps, WIC checks and political favors. (Okay, maybe not like that last one: We could run out of the damn pills in 72 hours.) Don't even tell Us it's being done: just do it.

Watch Us grind to a halt. Not lightly, like sandpaper on wood, but heavily, like granite boulders dragged over brickyards. Living embodiments of the question "Now what?" Less alcohol, less lottery-based dreaming, less shopping to salve a yawning, endless need.

Less spending. More money in hand. Less money for the government. (A flaw in My otherwise brilliant argument, for The Fools may be stupid, but they are oh-so-sensitive to a reduction of their life's blood.) A chance to look at reality and see it for what it is. No spirits-based softening of the brain to make it through another crappy day. No pursuit of mathematically improbable riches that fuels only The Fools' lust. No quick trips to the mall for a crack high at cocaine prices.

Force-feed nalmefene to Us...for We keep choosing to be enslaved by Our own ids. Make it the magic bullet that will ultimately liberate Us, for We've always had the most magical of bullets--choice--but it seems We pawned it for a lottery ticket and a shot of booze.

The Jenius Has Spoken.

Surgeon General: Example

Dr. Richard Carmona, Surgeon General of the United States, was the Commencement Speaker at the Ponce School of Medicine's graduation ceremony this past Saturday. Speaking without notes, directly from the heart, Dr. Carmona was eloquent and forceful, a presence that elevated what was a dour and otherwise classless event into a memorable one.

Dr. Carmona is of Puerto Rican descent, his family origins tracing to Ponce and Cataño. Although raised in New York, his "abuelita"--the iron-willed matriarch of her 27 children--insisted in teaching him about his roots, ancestry and Latin American culture. This sense of identity, fostered from childhood as a necessity, gave Dr. Carmona a base from which to evaluate the world and its diversity.

A key point to understanding Dr. Carmona is that he is a high-school dropout--who became Surgeon General. In a path that can only be called "varied," Dr. Carmona was a Special Forces combat soldier, paramedic, registered nurse and deputy, amongst other things. With a level of persistence few could match, he willed himself from marginal to central, from dropout to Top Doctor, betting on himself despite the obstacles. He never took any of his circumstances as weaknesses, nor did he let the limitations of the thinking of those around him limit his own.

Dr. Carmona credits his "abuelita" for supporting him every step of his difficult way and for teaching him the true value of community. In a moment of sincere passion, Dr. Carmona asked the newest health practitioners "Who are you helping come up behind you?" and "What is your legacy going to be?"

With simple words, Dr. Carmona told the graduates that they were sitting there because many, many people had helped them along the way, and that their success could only be extended by helping others make the same journey. And when the future left this day far in the past, he urged each and every one of them to make sure they had created a legacy far beyond personal success, one that encompassed the community, their nation and even the world.

Dr. Carmona spoke as Surgeon General to doctors and Public Health officials, but his words have meaning to all of Us. Who are We helping to come up behind us? What will be Our Legacy when Our time is up?

There have only been 17 Surgeon Generals in the history of the United States. Of those seventeen, only one dropped out of school. Dr. Carmona is one of Ours, a bright star of what Our Talent can produce. There are many others. It is time We brought them forth en masse.

The Jenius Has Spoken.