Give 'Till It Hurts!

As a public service to my readers, I wish to extend the fine opportunity offered by the PRESIDENT OF THE UNITED STATES, Barack Hussein Obama, to forgo giving gifts to friends and loved ones, and divert the funds to the President's reelection campaign, where they will do much more good.  You may use this link.

Register with Obama 2012

Got a special milestone or event coming up?

Instead of another gift card you’ll forget to use, ask your friends and family for something that will go a little further: a donation to Obama for America. Register your next celebration—whether it’s a birthday, bar or bat mitzvah, wedding, or anniversary—with the Obama campaign. It’s a great way to show your support for a cause that’s important to you on your big day.

Just log in or sign up to build and customize your page—and congratulations!

Let's review...THE PRESIDENT OF THE UNITED STATES is asking you to ask your friends to donate to his reelection campaign instead of giving you stuff. How noble. How patriotic. How...well, come up with your own epithet.

Personally, I think this goes way over the line. THE PRESIDENT OF THE UNITED STATES is pandering to newlyweds, 13 year-olds, birthday babies, for money to boost his campaign coffers past $1 BILLION, so he can stay in office four more years (at least). I can't think of any other candidate for PRESIDENT OF THE UNITED STATES who has appealed to CHILDREN for money. The man is asking for kids to give up their birthday presents for Heaven's sake! Perhaps all the Bar Mitzvah's are supposed to include a prayer for reelection? I've got a good prayer, borrowed from "Fiddler on the Roof":  May God Bless and Keep Mr. Obama....FAR AWAY FROM US!!!!

So, what's next from THE PRESIDENT OF THE UNITED STATES? Oh, I've got it!

SKIP A MEAL FOR BARACK!

"Michelle says the nation is too fat, so stop putting your money where your mouth is, and put it in my hands!"

How about this:

DRIVE BARACK TO VICTORY!

"You know you don't need to take that big gas-guzzling SUV out today. Save the cash and send it to me so I can run over the opposition! Or better yet, sell the darn thing and send me the proceeds!"

And finally:

HELP BARACK WIPE OUT THE GOP!

"If you overweight folks cut down on the intake with my SKIP A MEAL FOR BARACK program, you won't be needing as much toilet paper. Instead of buying that extra roll of Charmin, send me the cash, so I can wipe Washington clean!:"

Personally, I just want to vomit. This is the most sickening performance by a politician I've ever seen. Can't wait until November...

Too Big Not To Fail?

Our Agfa IMPAX 6.5 failed for over three hours this past weekend, and that's not the first time that's happened. This sent the three hospitals it services into complete pandemonium, as you might expect. At the moment, there is no hardware disaster recovery option. Hopefully, this will be implemented...eventually.

Fortunately, I was not on call when this little disaster occurred, but I certainly heard about it. To this point, we don't know quite what went wrong, but bouncing the servers seemed to fix it.

I guess we should be quite grateful, as the IMPAX installation in Western Australia continues to misbehave. I've received no word from Agfa as to why they think this might be happening, nor when it will be fixed Personally, I would hesitate to buy anything new until I knew the answers to these questions.

I have to contrast the IMPAX experience with our other hospital (and our group-owned system) that uses AMICAS Merge PACS. Merge (I still have some trouble with the concept) is a simpler product, using Windows Server and SQL databases instead of the supposedly more robust Oracle and Unix boxes galore. But it is much more stable. We've had perhaps two or three hours total unplanned downtime in the past 8 years.

PACS is not rocket science. It is simply a database of images and associated text. But the images are rather large, and have MEDICAL stamped on them, and thus has grown the culture of complex, expensive, and cantankerous big iron systems.

Most of the next generation of PACS are not a whole lot more than web-servers and associated databases. In this manner, they are robust, (relatively) simple, and while not quite bullet-proof, they have fewer points of failure, and are more easily maintained.

Could it be that the legacy designs are so complex that there is no way to avoid failure? I have to wonder...

Thank You For Funding Imaging Advantage

You may remember the string of articles published here on DoctorDalai.com concerning Imaging Advantage.

In brief, Imaging Advantage insinuates itself between radiologists and hospital administrations, promising the latter huge benefits and screwing the former. Think Enron and the energy market, and you have the idea. IA's most famous take-over and subsequent flop in Toledo is well documented here and elsewhere.

The model is one only a doctor-hating administrator could love. IA claims that they are usually able to successfully hire on the group they are displacing from the hospital, and ultimately that group loses a good chunk of its salary, which goes back to IA, and probably is kicked back in some subtle form to the hospital. Administrators seem to be buying into the platitudes, as IA claims "hospitals and partners across 14 states."

Since I've declared my love for capitalism on numerous occasions, the Socialists out there are probably just drooling (more than usual) over the opportunity to point out that IA represents the "free" market in action, so how could I possibly object? Basically, this is anything but a free market scenario. C-Suite types, who make these decisions, are NOT the end-consumer of my product. They are choosing IA and their ilk in theory to "improve care" which somehow never seems to happen. Perhaps they think they will save some money on those horribly expensive rads, although how this happens when most hospitals don't directly pay rads is a mystery to me. My personal theory is that these interlopers take over the interpretive revenue stream from the rads, and somehow promise, maybe surreptitiously, to return some of that to the hospitals. No, this is about as much of a free market operation as the collection of protection money.

But only greedy capitalistic administrators would fall for this greedy capitalistic scheme? Wrong, borscht-breath. Your very own United States of America is buying into the inflated egos of Mr. Hashim and company. I assume our pal Naseer still runs this thing...the IA website isn't very informative these days.

Read this and weep:

Health Care Innovation Awards: Illinois

Notes and Disclaimers: 

• Projects shown may also be operating in other states (see the Geographic Reach)
• Descriptions and project data (e.g. gross savings estimates, population served, etc.) are 3 year estimates provided by each organization and are based on budget submissions required by the Health Care Innovation Awards application process.
• While all projects are expected to produce cost savings beyond the 3 year grant award, some may not achieve net cost savings until after the initial 3-year period due to start-up-costs, change in care patterns and intervention effect on health status.

IMAGING ADVANTAGE LLC    

Project Title: “The right exam, at the right time, read by the right radiologist"
Geographic Reach: Illinois
Funding Amount: $5,977,805
Estimated 3-Year Savings: $14,935,320

Summary: Imaging Advantage LLC, in partnership with Vanguard Health Systems and other hospital systems in the Chicago metropolitan area, is receiving an award to re-engineer the end-to-end workflow process for hospital-based imaging services, including by leveraging technology to integrate immediate consultations with radiologists and other decision-support tools into the “front-end” of the patient-care continuum, where imaging exams are ordered and critical care decisions are made. A key objective of the program will be to reduce duplicative and/or clinically unnecessary advanced imaging exams. The program also will (1) deploy a unique disruptive innovation — RealTime QA® — which applies “double-blind” interpretations to high-difficulty exams in advance of patient treatment, (2) eliminate preliminary (or “wet”) reads after-hours and (3) materially improve exam turn-around times.  As a result, the program will reduce inappropriate advanced imaging utilization, improve quality assurance and, ultimately, improve patient safety and experience. A 30% decrease in CT use and decreased utilization of other imaging modalities is expected. CMS will also be evaluating planned centers in Detroit, San Antonio, and Boston.

Over a three-year period, Imaging Advantage LLC will train 495 workers in health care-related jobs. The new workforce will include clinical staff as well as IT development and operational staff.

Yes, folks, that would be about SIX MILLION DOLLARS out of YOUR pocket and mine, to fund this "experiment". There's a sucker born every minute, and most go to work for the government or become hospital administrators, it seems.

IA is doing nothing more than slapping a few buzz-words on its anything-but-clever "Real Time QA", labeling it a cost saving measure, (which is like wrapping a turd in fancy paper) and selling it to the morons civil servants at CMS.

Imaging Advantage is committed to advancing patient care and optimizing radiology services healthcare by introducing our RealTime QA Program. Imaging Advantage is the first in the healthcare industry to create a program specifically designed to address issues and resolve discrepancies while the patient is still present in the hospital, clinic or imaging center.

How it Works
Using our double blind parallel reading and review process, targeted high-risk cases are selected and interpreted simultaneously by two radiologists. If the results differ materially, the interpreting physicians review and resolve discrepancies, and correct any reported results prior to the patient being discharged. Simply put, higher quality of patient care is provided if discrepancies are resolved prior to the patient leaving the facility.

Why it’s Important
Catching mistakes before they are made, our RealTime QA Program adds value to healthcare facilities by:

--Reducing errors in high-risk exams lowering malpractice claim potential
--Reducing the need for patient call-back or report addenda
--Improving operational efficiency

Anyone who buys into this should be committed, in my humble opinion. What is a "targeted high-risk case"? Where are the most errors made? Probably mammo, but I don't see them applying this in that venue. How many of these double reads will be forced on the already overworked and underpaid rads? And I suppose cutting imaging utilization is the primary goal of a company that makes money from imaging utilization? Sure it is. Actually, utilization was cut at the IA flagship in Toledo, according to one of the displaced rads there, as clinicians took their business elsewhere.

If you aren't happy about your tax dollars supporting this, let your Congressman know. As an aside, and this is my PERSONAL OPINION, not reflective of anyone or anything else...any rad who signs on with IA had better have one incredible collection of extenuating circumstances which forced him to do so...otherwise don't ever come to me looking for work. Favorable consideration will be given, however, to those displaced by this operation.

New GE Optima NM/CT640 SPECT/CT Scanner Gets 32 MPG!!!

GE has announced another SPECT/CT scanner, the Optima NM/CT640:

Optima NM/CT640 offers brilliant CT image quality enabled by high speed 1 second CT rotation minimizing motion artifacts while keeping dose and ownership costs low.

Miami, Fla June 11, 2012— At the Society of Nuclear Medicine this year, GE Healthcare is introducing the latest addition to its Nuclear Medicine 600 series with a new performance SPECT/CT system—the Optima* NM/CT 640 — that offers nuclear medicine physicians the optimal balance of image quality, patient dose efficiency and low total cost of ownership.

Based on the innovative 600 series SPECT technology found in the Discovery* NM630, this system integrates the latest generation general purpose camera with a newly developed 4 slice CT designed for hybrid rather than standalone CT use. The CT, available in 2.5mm and 5mm slice thicknesses to optimize dose and resolution required for particular procedures, offers clinicians confidence with routinely low CT dose at 1-2 mSv for a 40cm abdomen CT scan.

The Optima NM/CT 640 can be fully upgraded on location from a Discovery NM630 SPECT only system, and may be upgraded in the future to a 16 slice Discovery* NM/CT 670, expanding not only its clinical capability, but offering the potential for research use. This upgradeability helps protect clinicians’ and healthcare providers’ investments as the needs of their department evolve.

With its small footprint (5.7m x 3.6m) the Optima NM/CT 640 requires minimal renovation and installation costs. With the benefit of optimized CT power, shielding and control room requirements are often eliminated; saving as much as $100,000 compared to higher CT powered systems...

“Building off of our extensive experience in SPECT/CT, the advances we’ve made to our Infinia Hawkeye 4 platform and incorporating the SPECT technology of our Discovery NM630 camera, we’re striving to give our customers unsurpassed diagnostic confidence,” added Hermony.

GE Healthcare believes in nuclear medicine as a powerful diagnostic tool that is efficient, precise and sophisticated and we’re dedicated to harnessing its power. We have a strong vision for the future and with continued investment in technology advancements like the Optima NM/CT 640 and breakthroughs like CZT. In the end it’s a commitment from a global company that’s dedicated to solving big challenges everywhere – all for the benefit of clinicians and their patients.

*Trademark of General Electric Company

†Shorter acquisition times and dose reduction capabilities are possible with Optima NM/CT 640 system only when used in combination with the relevant features offered on the Xeleris 3 processing and review workstation.

Good stuff.

However...I'm a little worried about the diagnostic quality of the "newly developed 4-slice CT", and given the mention of CZT, I'm assuming this is an attempt to create a nicer Hawkeye, with better SPECT, and maybe, possibly a bit better CT acquisition. Otherwise, why emphasize the ability to upgrade to the 670, which has "real" CT capability? Apparently, GE sees a market for the more limited version that doesn't need shielding, and continues to offer the "low dose" enticement in trade for lesser image quality. We'll know when the spec sheet becomes available.

In the meantime, anecdotal reports from the one owner in the neighborhood of the NM/CT 670 has been less than enthusiastic. As in "why didn't we get the Siemens?"

But what I would really like to know is this: How much did GE pay Kia for the rights to the name "Optima"? What? Kia doesn't even know about it? Uh oh...

The Case Of The Vanishing Vibrating Underwear (And iPad...)

Radiologists are no more immune to weird behavior than anyone else. However, it is probably not terribly wise to call attention to yourself when indulging in such. I won't source this, and the names have been redacted, but you can easily Google a snippet of the text if you just have to know more...

A hotel guest told police he was missing two iPads and his vibrating panties after an encounter with a woman in his room.

Dr. X told police he had purchased the items on Tuesday.

Later that day, Dr. X met a woman and invited her to his room.

Dr. X believes the items were still in his room after he took the woman back to her room at another hotel at around 9 p.m.

Wednesday morning, Dr. X left his room at 7:30 a.m. When he came back that night at around 6:30 p.m., he realized the iPads and panties were missing from an open piece of luggage in his room.

The front desk told Dr. X the only access to his room during the time he was gone was by housekeeping at 12:30 p.m.

Dr. X told police he believes that either the woman he met or hotel housekeeping is responsible for the theft.

He told police the woman he brought to his room still had a key.

An officer asked the front desk for the door log for room 405, but the employee who has access to the logs had left and would not return until June 7 at 9 a.m.

Police are still investigating the theft.

Dr. X, who shall remain nameless, turns out to be an interventional radiologist working for one of the BIG radiology corporations, being put up in said hotel. Not that it's pertinent, but Dr. X trained in a nation in the Middle East that is not Israel. I am unfamiliar with the customs in that particular wooded nation relating to reporting of missing items of a personal nature.

You filthy-minded perverts out there, otherwise known as readers of DoctorDalai.com, are almost certainly jumping to the wrong conclusion. Clearly, Dr. X was in the process of an incredible breakthrough in interventional radiology, using the oscillating lingerie as a tactile feedback device during cases. I haven't quite worked out all the details for this yet, but I'm guessing he had modified the electronics in the panties with a WiFi access point for open communication with deep signal penetration, perhaps with an adcock ad hoc architecture.  The two iPads were then made to interface with the lacy drawers (although perhaps he preferred burlap). If I were doing this, I would use some sort of very sensitive probe at the tip of my catheter which could transmit sensations back to the first iPad, which might then map its trajectory. If the catheter bumps and grinds up against the smooth lining of the vessel wall, a sensory cascade might then be triggered causing the vibrating unmentionables to, well, vibrate, thus warning the operator of an impending state of no return. I'm would assume the woman in the article was a technologist or engineer helping Dr. X to perform a wet-run of the prototype device, perhaps helping him guide his catheter.

Or maybe they were both just watching His and Her porn on the iPads.

Anyway, nice to know that the BIG radiology companies deliver rads of such immense quality. Yes indeed.

"How Can Dalai Be A Jewish Conservative???"

Disclaimer Number One: This is a non-PACS post. If that bothers you, skip on to some of my older work.


Disclaimer Number Two: This post favors conservative thinking. If you are a Left-Wing Nut Job (definition: someone who calls conservatives Right-Wing Nut Jobs) please leave now. You won't like what you see. 

This is a post I've been wanting to write for quite a while, now. I'm getting around to it thanks to a relayed message from fellow blogger 23 Skiddoo, who tells me that one of her friends just cannot understand how a Jew can be conservative. Personally, I cannot understand how a Jew can be a liberal/leftist, so I decided to learn more.

An article by Rick Richman appeared rather fortuitously on AmericanThinker.com, which helped me congeal my thoughts on this matter. Titled "Jews, Jewish Leftists, and the Anti-Semitic Left," it outlines several talks given at a recent seminar, "Jews and the Left" sponsored by the YIVO Institute for Jewish Research. Read the summary, but the bottom line is this: the Left is becoming more and more Anti-Semitic, or at least revealing itself to be so, and Jews that still adhere to the Leftist philosophy do so at odds with their heritage. This is the part I have tremendous difficulty understanding. Why would someone support an ideology that just barely hides its desire for his destruction? For many self-loathing Jews (and they do exist, quite a few in Israel as a matter of fact) that may be what they want. There seems to be some lemming-like drive among quite a few Jews to finish what Pharaoh, Haman, Hitler, and Stalin, among many, many others, tried to accomplish. (Joke's on them...we're still here!) Some think the self-destructive psychosis relates to the Stockholm Syndrome, with kowtowing to those who are perceived to hold one's lives in their hands. Perhaps it's just simple embarrassment at being different...diversity is for those who LOOK different, but not for us (mostly lilly-white) Jews, yes? For some, it's simple personal economics...there are too many disadvantages, financial and social, to being a Jew, but conversions and name changes only change the superficial, and when you run away, you take your baggage with you. The genetics are true. Just ask the Nazi's about that.

As it turns out, I am a minority within a minority within a minority: I am a (mostly) politically-conservative, Republican-voting, Reform Jew. There ain't many of us. In general, the more Orthodox a Jewish fellow is, the more politically conservative he will be. Why is this?  From Front Page Magazine:

Put simply, the more Jewish is the person, the more they reject the policies of the Democrat Party. This should not be the least bit surprising as Modern Liberalism – the dominant ideology of today’s Democrat Party – is the very antithesis of Judaism.

The great gift of the Jews was a concept virtually unknown to humanity prior to the advent of Judaism – justice. Prior to the advent of Judaism, reward and punishment were typically predicated on the whim and the will of the powerful. Step on the Pharaoh’s toe and it might cost you your life. The oft-misunderstood (one presumes often intentionally) “An eye for an eye and a tooth for a tooth,” far from being a call for vengeance was, in reality, exactly its opposite, it was – for one of the first times in human history – an insistence that the punishment must not exceed the crime and that, not matter who the person “wronged” or the wrong-doer might be, the consequences must be meted out fairly. But the Modern Liberal rejects the concept of justice (in fact he rejects the concept of right and wrong, good and evil, better and worse, truth and lies and all other such ideas central to the pursuit of the just.) So self-evident is the Modern Liberal’s antipathy for justice that he himself admits that his quest isn’t for justice but rather some modified version of it which is why he inserts the modifier “social” prior to the word “justice” in explaining his agenda.

The Modern Liberal’s definition of “Social Justice” is that the evil and failed should be rewarded and the good and successful must be punished. After all, if all men are created equal, then something must have happened to the rapist to turn him from good into evil and therefore he is the victim (in fact, the great Thomas Sowell argues that, to those with this “vision” the criminal istwice victimized, “first by the special circumstances that provoked his crime and then by those wholust to see him punished.”) Similarly, those who are good and decent and hard-working should enjoy no special rewards for their efforts because clearly they had the advantage of good parents and a good upbringing and thus they had an unfair advantage. Justice demands that the good and hard-working be rewarded and the evil and the lazy be punished (if only by the withholding of the rewards of doing the right things.) Modern Liberalism demands that the good and hardworking be punished as the recipients of an unfair advantage and that the evil and the lazy be rewarded, their acts of evil and their failure all the proof the Modern Liberal needs that somehow they have been victimized by forces out of their control.

Obviously, these two beliefs are diametrically opposed and mutually exclusive. Just as obviously, those who more fully embrace Judaism’s quest for justice are more assuredly supportive of the Republican Party and the conservative movement while those who are least Jewish (even if they call themselves Jews) are more likely to fall into the camp of the Democrats and support the non-Jewish concept of “Social Justice” where good and right is punished and evil, failure and wrong championed.

I'm sure there will be howls of indignation from my more Left-leaning readers on that one. You'll never admit that the above is true. But it is, and deep down, you know it. It just isn't politically correct to say so in front of your other Leftist "friends".

As an aside, there are Liberal/Leftist Jews who are convinced (or have tried to convince themselves) that the Liberal Agenda parallels Jewish Law. If that were the case, the allegiances would be just the opposite, with the Orthodox being the more Liberal among us. No, what we see is the adoption of a New Law by Leftist Jews, more accurately a new religion which worships the State, "diversity" and looting of the producers, and ultimately feeling over logic, and really even death itself (to quote Ayn Rand), instead of the Almighty. (The diversity thing is really sad in many ways...they trumpet how wonderful "diversity" is, and squawk if a Jew dates other Jews exclusively. But most who intermarry don't raise their children as Jews, and thus homogenize into the rest of the population, which destroys diversity.)

23 Skiddo, answering in my defense said simply, "Dalai is a very strong supporter of Israel," which apparently satisfied her questioner. You see, the Left, and particularly Leftist Jews, have a very strong love-hate relationship with Israel. For them, it simultaneously embodies the best and the worst. They "love" Israel, but cannot come to terms with Israel's (99.99999% fictional) persecution of the poor, downtrodden "Palestinians." The Left MUST have a victim to "protect" and in general, brown trumps white, and Islam trumps Judaism or Christianity. (I pity the mental gyrations my Leftist friends must go through when they consider Darfur, where Muslims kill Africans.) Leftist Jews have to hate Israel "The Aggressor" while professing to still love its people. But Leftist Anti-Zionism is Anti-Semitism by another name, and the philosophies do coincide. From Tabletmag.com:

Mitchell Cohen, who as co-editor of Dissent has bravely held out against this trend, began the first day of the conference with a presentation on “Anti-Semitism and Anti-Zionism on the Left,” in which he toured a horizon all too familiar to most of the attendees. “Does the left have a Zionist problem? Yes,” Cohen declared, going on to quote anti-Zionist and quasi-anti-Semitic statements by luminaries such as the American Jewish literary theorist Judith Butler, who has spoken indulgently about Hamas and Hezbollah, and the leading French philosopher Alain Badiou, who as Cohen put it is “obsessed with Jews and Israel.”

Cohen deftly united the two themes of the conference by arguing that the part of the left that is currently anti-Zionist is the same part that “hasn’t learned from the twentieth century”: that is, the left that still indulges in nostalgic reveries about Communism and revolution. On this view, the struggle over left attitudes to Israel carries on an ancient struggle for the soul of the left, which has always vacillated between hostility to Jews, as symbols of the capitalist order, and defense of Jews, as victims of reactionary anti-Semitism. In his speech, the British Marx scholar Norman Geras traced this dualism back to Karl Marx—specifically to Marx’s notorious essay “On the Jewish Question,” which is full of the most vile anti-Semitism, calling Judaism a religion of money and bargaining, and calling for the emancipation of mankind from Judaism. Yet in the same essay, Marx also called for national liberation and self-determination, a call that historically attracted many Jews to the banner of the left.

The problem for the left today is that it has gone over largely—but not, Geras and others insisted, wholly—to the negative view of Judaism as an obstacle to human progress. Israel, Geras held, “has been an alibi for a new climate of anti-Semitism on the left,” a development whose full venomousness can only be seen in Europe. (“I don’t think people here realize,” he said mournfully, “what it’s like to be a Jewish leftist in Britain today,” comparing it to living in a sea of poison.) This is the atmosphere that the Anglo-Jewish novelist Howard Jacobson evoked so powerfully in his recent novel The Finkler Question: one in which hostility to Israel is a reflex and insinuations about Jewish power and the “Jewish lobby” go unchallenged.

If the left in Europe and, increasingly, the United States is so hospitable to anti-Zionist and anti-Semitic ideas, what does that mean for the future of “Jews and the Left”? Michael Walzer explained the historical Jewish affinity for the left as a straightforward matter: “We have supported the people who support us.” The historical insights of the “Jews and the Left” conference suggested that things were never so simple—or mutual. So, when that basic equation no longer holds—if the left are no longer “the people who support us”—will we continue to support them? The “rising generation” of the left will contain its share of Jews, maybe even more than its share; but whether it will be a Jewish left, as it was in the past, is very much in doubt.

The hatred of the Left for Israel AND for the Jews is more succinctly stated by none other than H.G. Wells, as quoted in SultanKnish:

To understand why Anti-Semitism and Anti-Zionism are one, we need look no further than H.G. Wells who wrote, "Zionism is an expression of Jewish refusal to assimilate."

That one sentence is the final thesis on the left's ugly legacy of hatred for Israel and the Jews. It demonstrates why Anti-Zionism cannot be detached from Anti-Semitism, because behind it is a denunciation of Jewish identity. That is the ideological fuel behind the Anti-Zionism of both Western liberals and their Arab allies. The Western liberals demand to know why the Jews just won't assimilate. The Arabs demand to know why the Jews weren't happy being second class Dhimmis in their own country. Anti-Zionism is the denial of the rights of the Jews as a people based on Anti-Semitism, the denial of the equality of the Jews. That double standard joins Anti-Semitsm and Anti-Zionism into two words for the same idea, that the Jews should not exist.

How can Dalai be a Jewish conservative? My God, how can any Jew (or anyone with the slightest degree of intelligence and compassion) be part of the Left? It makes no sense whatsoever.

Some Random Thoughts At The Foot Of Arenal

The Arenal Volcano, from Springs Resort, La Fortuna, Costa Rica

I'm reporting today from The Springs Resort, in the shadow of the Arenal Volcano in central Costa Rica. We are just at the edge of the Rain Forest, and at the beginnings of the rainy season, so you can imaging just how lush and tropical the surroundings are down here. (And by the way, when it rains, IT RAINS!!)

ABC filmed an episode of The Bachelor on the grounds of The Springs, which is how Mrs. Dalai learned of it, and so here we are for Dalai, Jr.'s high school graduation present. Words cannot do this place justice, and the photos on the website don't begin to convey just how wonderful it is. I would place it just below Jade Mountain (another former Bachelor venue) in beauty of the facility and the surroundings. In fact, the view of Arenal is really reminiscent of the Piton in St. Lucia. The service here has been just as good, and by that I mean incredible. 

We even made a new local acquaintance, Señor Gato, although I suspect the next occupants of the room won't appreciate our cultivating his friendship...

For better or worse, there is WiFi in the room, and so I've managed to keep in touch with the outside world.

Let's start with the "for better"...From lifeIMAGE comes word of some tools to ease image exchange from within any other system, which means that if IT cooperates, my PACS could talk to your PACS:

Newton, Mass. – May 29, 2012 – lifeIMAGE announced today it is releasing certain open application programming interfaces (APIs) that can be used by developers of healthcare information technologies (HIT) or imaging devices to enable the secure exchange of medical images and related patient records directly from their software.

The lifeIMAGE network has been used to share over 160,000,000 medical images across diverse healthcare providers representing 40,000 affiliated physicians. lifeIMAGE is the go-to network for on-demand  clinical exchange of imaging exams along with related information such as reports or EKGs. This secure and high-speed network is used by physicians on five continents to collaborate on time sensitive patient cases.

With API integration, more providers will have the ability to tap into the network by enabling their existing systems to securely share imaging information on demand. PACS, EMR, dictation and reporting, CD/DVD writer, visualization, or personal health record (PHR) application vendors can integrate with open APIs to give their end-users the added benefit of a simple workflow for sharing patients’ imaging history.

“Our CD burning systems that have been in place for several years at an academic medical center in the Washington D.C., in addition to other customer sites, are used to publish imaging results to other providers outside their network using the lifeIMAGE cloud service,” said Cyrus Samari, a co-founder of Sorna. “When our customers have an exam that needs to be sent to an outside referring physician, or to the patient, with a single click, they have the option of burning a disc or sending it electronically on the lifeIMAGE network, all from the same interface - automatically.”

Norman Young, President & CEO of ClearCanvas, said “We were founded on the simple belief that medical imaging informatics should be accessible to all.  Now, using a lifeIMAGE open API, users of our FDA-cleared diagnostic viewer will be able to instantaneously share images that are in front of them with any one.”

“Whether it’s a simple CT or a complicated cardiology exam, whether it’s arriving through the door on a CD with a patient or arriving via the cloud, open and secure exchange of patients’ imaging history is key to improving patient care and driving down our country’s healthcare costs, said Hamid Tabatabaie, President & CEO of lifeIMAGE.   “We are eliminating the technological barriers to timely access to information by making our API available to all developers of related software. Now, HIT companies can use the open API to differentiate their services and ensure their users have the power to exchange information on demand.”

“lifeIMAGE recently delivered an API to a large academic medical center to enable their Epic users to upload or view images directly from the applications they use to check patients in or when accessing medical records of patients,” Tabatabaie added.  “A separate API is being used to provide access to employees who use WebMD’s PHR. Employees are able to share imaging content with any physician directly from their PHR, where other important medical history may also be available. ”

Companies that want to use the API can visit lifeIMAGE at the annual SIIM conference in booth #426, or request more information at www.lifeimage.com/api.

Since I won't make it to SCAR SiiM this year, I'll request more information. Does it work with IMPAX?

Which brings us to the "for worse"...

I've heard nothing from Agfa about Western Australia, and I would really like to know their take on the situation. Have I been fed incorrect information? Is the system working perfectly? Or is it such a disaster that no one wants to talk about it? As always, I will gladly post any official (or semi-official) statement from Agfa.

And worse yet, an email trail has been released, courtesy of the GOP, rather clearly outlining the level of Thugocracy under which we must live and function. Did you think the authors of the Affordable Care Act really had your best interest at heart? Ha. The ACA was gleefully crammed down this nation's collective (pun intended) throat by the Obama/Pelosi/Reid axis of evil, and there were any number of back-alley deals, in truth, threats and bribes, to assure the lock-step (goose-step?) cooperation of the drug and insurance industries. Read this from the (Republican-chaired, thank Heaven) House Energy and Commerce Committee:

WASHINGTON, DC – The House Energy and Commerce Oversight and Investigations Subcommittee, chaired by Rep. Cliff Stearns (R-FL), today released a memo and supporting documentation outlining a series of intricate policy negotiations used to craft the health care law, the full details of which have never been released to the public. The memo is part on an ongoing investigation the committee launched more than a year ago to shine light on a process that excluded both the American people and many of their elected representatives. Despite the White House’s unwillingness to make these negotiations transparent, even after the fact, the investigation has uncovered a series of emails and internal documents that paint a much clearer picture of the tools and tactics used by the Obama administration to secure a narrow, partisan victory and see PPACA signed into law...

Documents released by the committee today show major negotiation milestones throughout 2009 as the White House attempted to secure a deal with the interest groups who had been invited to the bargaining table. The materials reflect negotiating tactics used by top White House personnel including threats of public criticism and policy declarations. They also show that PhRMA was assured a “direct line of communication” with the White House, and that the organization was offered private reassurances about the deal remaining intact in spite of congressional concerns.

From the Washington Times:

Top administration officials cut backroom deals with the nation’s top drug companies to win support for President Obama’s health care overhaul, threatening them with steeper taxes if they resisted and promising a better financial deal for the industry if they acquiesced, according to internal documents released Thursday by House Republicans.

In some of the key deals, Mr. Obama agreed to drop his long-standing support for letting Americans buy cheaper foreign prescription drugs — something the pharmaceutical industry vehemently opposed — and the drugmakers promised to mount a public campaign to sell the public on the health care legislation...

The material released by House GOP members provides a rare insider look at the wheeling and dealing on Capitol Hill as Mr. Obama tried to shepherd his bill through Congress, in the face of near-unanimous GOP opposition.

The details emerged as House Republicans released emails it obtained during a yearlong investigation into the closed-door negotiations between the White House and lobbyists for drug companies. House Republicans said those negotiations violated the promises of transparency Mr. Obama made during his 2008 campaign.

“We really have now been able to build a case that there was a sequential, planned, organized strategy for the White House to trade policy for politics, if you will,” said Rep. Michael C. Burgess, Texas Republican. “They were willing to give up on things they thought were sound principles.”

The documents show that former White House Chief of Staff Jim Messina and health care reform point woman Nancy-Ann DeParle told drug company representatives in June 2009 that if they didn’t cooperate on the initiative, Mr. Obama would demand a 15 percent rebate on Medicare drugs and push to remove the tax deduction for direct consumer advertising — items that could cost the industry $100 billion over the next decade.

The threats appeared to work, and the parties met the next month to hammer out a final deal. The drug companies agreed to pay higher Medicaid rebates and a new health care reform fee to raise $80 billion for the legislation, and promised to run positive television ads about it.

In exchange, the White House gave them direct input into the new policies and promised to let them continue to set their own drug prices. Ms. DeParle threw in an extra prize to reward pharmaceutical companies for their cooperation, saying she and other officials decided to reverse the administration’s position on drug importation, which Mr. Obama supported while running for president.

“I made [the] decision, based on how constructive you guys have been, to oppose importation on this bill,” she wrote to Bryant Hall, chief lobbyist for the Pharmaceutical Research and Manufacturers of America(PhRMA).

Administration officials have denied that they negotiated directly with PhRMA, instead saying it was Senate Democrats who brokered the agreement.

But Republicans said their findings contradict the White House and confirm what the GOP has long contended: that the White Housebypassed members of its own party to iron out specific details with the drug companies.

The White House didn’t respond to requests for comment, but congressional Democrats defended the deal-making, saying it was no different from what had been done for major legislation under previous presidents...

PhRMA said the industry’s negotiations with the White House were a normal part of doing business...

Republicans said the investigation punctured a hole in Mr. Obama’s pledges of transparency during the 2008 campaign — including a vow to televise all of the health care negotiations so Americans could see who was lobbying for the drug companies and other big players in the debate.

“When you are supposedly acting in the public’s behalf, when you have promised that this is going to be the central feature of your administration, you darned well better behave that way,” Mr. Burgess said...

Yes, yes, I know. Business as usual in D.C. Except this piece of garbage gives the Socialists Democrats control over our very lives.

I'm presently in a nation with Socialized Medicine, and I've asked around about it. Everyone in Costa Rica pays a 9% tax for their "free" healthcare. However, if you need something beyond the basic, you have to wait (sometimes a year or two) for an appointment, or pay $30 for a primary-care visit outside the "free" system, or have your employer dock you for more insurance, which is a big hardship on most. As my guide Juan Carlo put it, "you might not think $30 is a lot, but for me and my friends, it's impossible."

Americans who believe in the increasingly mis-named Affordable Care Act would do well to heed the examples of the rest of the world. Governmental CONTROL (as opposed to Regulation) does not work very well for any prolonged period of time. Don't even bother to tell me of the few anecdotes you've heard about wonderful "free" care your cousin's friend's uncle received in England. The majority of the care isn't wonderful, and it certainly isn't free. Someone is paying for it, rest assured.

I don't think anyone is particularly surprised by this latest revelation of corruption by our illustrious leaders, both in the Administration and the Pharmaceutical industry. But it should certainly give us pause. The whole welfare state in America, and with that I include Medicare, Medicaid, and Social Security, are little more than governmental thuggery, redistributing wealth in a very small part to those who are truly in need, but also to the cronies of those in power, and to many (the looters or moochers, as Ayn Rand calls them in Atlas Shrugged) who don't need it at all.

Medicine in particular has been corrupted by the unholy alliance of Left-Leaning (and sometimes Right-Leaning too) Government, Big Pharmacy, Big Insurance, and not a few thieving physicians. It has become all about the money, and only tangentially about the health of the patient. Personally, I blame Government most of all (what a surprise...) It has set the rules, and the rest of the louts simply follow them or skirt them in the most barely legal manner possible to their own benefit. Nothing personal, of course.

I've got the answer, but if I told you how to fix this, too many of the above would be on the next flight down to Costa Rica with the express purpose of dropping me into the active C-Crater of Arenal.

In the meantime, I'll be on my porch, appreciating the beauty of Arenal and the flora and fauna around her, sipping on yet another Imperial.

Pura Vida!

"SO" Is, Well, The New "Like," You Know?

So..........................................................................................................
back in 2006, I bemoaned the phenomenon of the overuse of the word "Like". It seemed at the time that everyone below the age of 21, and at least a third of those above, were using the word "like" two, three, even four times in a sentence. Make that in EVERY sentence. Here is an example I provided at the time:

You know LIKE I feel LIKE students LIKE have trouble LIKE selecting LIKE career awareness LIKE experiences.

Happily, this bad habit has faded, although the "Likers" are still out there, but that isn't the end of the story.

My daughter, Dolly, has graced us with her presence this week, coming home from Medical School for the express purpose of studying for her Step I exams. Mrs. Dalai and I are of course glad to provide a peaceful and quiet atmosphere. Dolly does come up for air every so often, but when we actually get the chance to talk to her, we notice a disturbing trend: Every thought is prefaced by "So......" with a long pause. Apparently, "so" is the new "like".  As my quote in the old post mentioned, there seems to be a trend among the young to fill gaps in their speech with nonsense filler words. Or, to give themselves a bit of time to think before actually saying something intelligent, they begin with a place-holder word. Now, President Reagan used the word "well..." for this purpose, but he did it with perhaps a little more skill than our talkers do today.

So...........................................................................
I felt it my duty to break Dolly of the "like" habit, and I did this with some aversion therapy. Every time she said "like" in my presence, I would loudly erupt with the nonsense syllable "ACK!" rather like (sorry) one would do with a dog about to do a nasty on the rug. After about 50 "ACK's", Dolly's "like" addiction was gone.

I find myself having to do the same thing with "So....." But, well, like, it's my duty as a parent to raise her properly, you know?

So.............. somehow, Dolly is staying mostly in her room this trip.

No Mirth In Perth (And Elsewhere in WA)

It has been two years to the day since the publication of my one and only expose', Blunder Down Under, documenting the dismal failure of a huge AGFA IMPAX installation in Western Australia. You would think the problem might be fixed by now. You would be wrong.

My friends Down Under describe week-long outages, about which no one seems to care anymore. There may have been some progress, but very little, and basically nothing much has changed.

Supposedly, the PACS contract is up for tender next year (that's Australian for rebid) but it seems unlikely that those in charge (definitely not the docs) will be motivated to change to another vendor.

I'll quote my closing from the 2010 article:

As the Western Australia upgrade to IMPAX 6.4 is brand new (they had IMPAX 5 before this that at least stayed up most of the time), there is only one entity that has the ability, and the obligation, to fix it, and that is Agfa. So, guys, fix it. Seriously. This is a very bad, very serious, and very dangerous situation. I'm putting out the pubic call to Agfa: Send whatever resources you must, send whomever you must (you can't have my Agfa PACS Goddess, but you can have me if I can help, and not somehow end up mysteriously lost in the Outback), and send them quickly, please. Western Australia needs you now. Get this repaired before your reputation, and possibly patients, are further harmed. Do what you need to do.

This has gone on for well over TWO YEARS, folks. The implications for those purchasing new systems should be clear. Are we listening?

ADDENDUM

I can see that several folks from AGFA have hit this post. Please feel free to comment and explain to everyone what's happening Down Under.

This Is NOT ME, I Promise!!!

Image courtesy of PoorMD.com and DiagnosticImaging.com.

Do visit PoorMD.com for some absolutely hilarious medical cartoons...

Atlas Shrugged: The Trial of Hank Rearden

To continue the uncannily accurate quotes from Ayn Rand's "Atlas Shrugged," we move to the trial of industrialist Hank Rearden, charged with an illegal sale of his miraculous alloy, Rearden Metal. Hank's defense, if you can call it that, is a certainly a lesson for our times:

For a month in advance, the people who filled the courtroom had been told by the press that they would see the man who was a greedy enemy of society; but they had come to see the man who had invented Rearden Metal.

He stood up, when the judges called upon him to do so. He wore a grey suit, he had pale blue eyes and blond hair; it was not the colours that made his figure seem icily implacable, it was the fact that the suit had an expensive simplicity seldom flaunted these days, that it belonged in the sternly luxurious office of a rich corporation, that his bearing came from a civilised era and clashed with the place around him.

The crowd knew from the newspapers that he represented the evil of ruthless wealth; and - as they praised the virtue of chastity, then ran to see any movie that displayed a half-naked female on its posters - so they came to see him; evil, at least, did not have the stale hopelessness of a bromide which none believed and none dared to challenge. They looked at him without admiration - admiration was a feeling they had lost the capacity to experience, long ago; they looked with curiosity and with a dim sense of defiance against those who had told them that it was their duty to hate him.

A few years ago, they would have jeered at his air of self-confident wealth. But today, there was a slate-grey sky in the windows of the courtroom, which promised the first snowstorm of a long, hard winter; the last of the country's oil was vanishing, and the coal mines were not able to keep up with the hysterical scramble for winter supplies. The crowd in the courtroom remembered that this was the case which had cost them the services of Ken Danagger. There were rumours that the output of the Danagger Coal Company had fallen perceptibly within one month; the newspapers said that it was merely a matter of readjustment while Danagger's cousin was reorganising the company he had taken over. Last week, the front pages had carried the story of a catastrophe on the site of a housing project under construction: defective steel girders had collapsed, killing four workmen; the newspapers had not mentioned, but the crowd knew, that the girders had come from Orren Boyle's Associated Steel.

They sat in the courtroom in heavy silence and they looked at the tall, grey figure, not with hope - they were losing the capacity to hope - but with an impassive neutrality spiked by a faint question mark; the question mark was placed over all the pious slogans they had heard for years.

The newspapers had snarled that the cause of the country's troubles, as this case demonstrated, was the selfish greed of rich industrialists; that it was men like Hank Rearden who were to blame for the shrinking diet, the falling temperature and the cracking roofs in the homes of the nation; that if it had not been for men who broke regulations and hampered the government's plans, prosperity would have been achieved long ago; and that a man like Hank Rearden was prompted by nothing but the profit motive. This last was stated without explanation or elaboration, as if the words "profit motive" were the self-evident brand of ultimate evil.

The crowd remembered that these same newspapers, less than two years ago, had screamed that the production of Rearden Metal should be forbidden, because its producer was endangering people's lives for the sake of his greed; they remembered that the man in grey had ridden in the cab of the first engine to run over a track of his own Metal; and that he was now on trial for the greedy crime of withholding from the public a load of the Metal which it had been his greedy crime to offer in the public market.

According to the procedure established by directives, cases of this kind were not tried by a jury, but by a panel of three judges appointed by the Bureau of Economic Planning and National Resources; the procedure, the directives had stated, was to be informal and democratic. The judge's bench had been removed from the old Philadelphia courtroom for this occasion, and replaced by a table on a wooden platform; it gave the room an atmosphere suggesting the kind of meeting where a presiding body puts something over on a mentally retarded membership.

One of the judges, acting as prosecutor, had read the charges.
"You may now offer whatever plea you wish to make in your own defence," he announced. Facing the platform, his voice inflectionless and peculiarly clear, Hank Rearden answered:
"I have no defence."
"Do you --" The judge stumbled; he had not expected it to be that easy. "Do you throw yourself upon the mercy of this court?"
"I do not recognise this court's right to try me."
"What?"
"I do not recognise this court's right to try me."
"But, Mr. Rearden, this is the legally appointed court to try this particular category of crime."
"I do not recognise my action as a crime."
"But you have admitted that you have broken our regulations controlling the sale of your Metal."
"I do not recognise your right to control the sale of my Metal."
"Is it necessary for me to point out that your recognition was not required?"
"No. I am fully aware of it and I am acting accordingly."

He noted the stillness of the room. By the rules of the complicated pretence which all those people played for one another's benefit, they should have considered his stand as incomprehensible folly; there should have been rustles of astonishment and derision; there were none; they sat still; they understood.
"Do you mean that you are refusing to obey the law?" asked the judge.
"No. I am complying with the law - to the letter. Your law holds that my life, my work and my property may be disposed of without my consent. Very well, you may now dispose of me without my participation in the matter. I will not play the part of defending myself, where no defence is possible, and I will not simulate the illusion of dealing with a tribunal of justice."
"But, Mr. Rearden, the law provides specifically that you are to be given an opportunity to present your side of the case and to defend yourself."
"A prisoner brought to trial can defend himself only if there is an objective principle of justice recognised by his judges, a principle upholding his rights, which they may not violate and which he can invoke. The law, by which you are trying me, holds that there are no principles, that I have no rights and that you may do with me whatever you please. Very well. Do it." "Mr. Rearden, the law which you are denouncing is based on the highest principle - the principle of the public good."
"Who is the public? What does it hold as its good? There was a time when men believed that 'the good' was a concept to be defined by a code of moral values and that no man had the right to seek his good through the violation of the rights of another. If it is now believed that my fellow men may sacrifice me in any manner they please for the sake of whatever they deem to e their own good, if they believe that they may seize my property simply because they need it - well, so does any burglar. There is only this difference: the burglar does not ask me to sanction his act."

A group of seats at the side of the courtroom was reserved for the prominent visitors who had come from New York to witness the trial. Dagny sat motionless and her face showed nothing but a solemn attention, the attention of listening with the knowledge that the flow of his words would determine the course of her life. Eddie Willers sat beside her. James Taggart had not come. Paul Larkin sat hunched forward, his face thrust out, pointed like an animal's muzzle, sharpened by a look of fear now turning into malicious hatred. Mr. Mowen, who sat beside him, was a man of greater innocence and smaller understanding; his fear was of a simpler nature; he listened in bewildered indignation and he whispered to Larkin, "Good God, now he's done it! Now he'll convince the whole country that all businessmen are enemies of the public good!"

"Are we to understand," asked the judge, "that you hold your own interests above the interests of the public?"
"I hold that such a question can never arise except in a society of cannibals."
"What ... do you mean?"
"I hold that there is no clash of interests among men who do not demand the unearned and do not practice human sacrifices."
"Are we to understand that if the public deems it necessary to curtail your profits, you do not recognise its right to do so?"
"Why, yes, I do. The public may curtail my profits any time it wishes - by refusing to buy my product."
"We are speaking of ... other methods."
"Any other method of curtailing profits is the method of looters - and I recognise it as such."
"Mr. Rearden, this is hardly the way to defend yourself."
"I said that I would not defend myself."
"But this is unheard of! Do you realise the gravity of the charge against you?"
"I do not care to consider it."
"Do you realise the possible consequences of your stand?"
"Fully."
"It is the opinion of this court that the facts presented by the prosecution seem to warrant no leniency. The penalty which this court has the power to impose on you is extremely severe."
"Go ahead."
"I beg your pardon?"
"Impose it."
The three judges looked at one another. Then their spokesman turned back to Rearden. "This is unprecedented," he said.
"It is completely irregular," said the second judge. "The law requires you submit to a plea in your own defence. Your only alternative is to state for the record that you throw yourself upon the mercy of the court."
"I do not."
"But you have to."
"Do you mean that what you expect from me is some sort of voluntary action?"
"Yes."
"I volunteer nothing."
"But the law demands that the defendant's side be represented on the record."
"Do you mean that you need my help to make this procedure legal?"
"Well, no ... yes ... that is, to complete the form."
"I will not help you."
The third and youngest judge, who had acted as prosecutor snapped impatiently, "This is ridiculous and unfair! Do you want to let it look as if a man of your prominence had been railroaded without a --" He cut himself off short. Somebody at the back of the courtroom emitted a long whistle.
"I want," said Rearden gravely, "to let the nature of this procedure appear exactly for what it is. If you need my help to disguise it - I will not help you."
"But we are giving you a chance to defend yourself - and it is you who are rejecting it."
"I will not help you to pretend that I have a chance. I will not help you to preserve an appearance of righteousness where rights are not recognised. I will not help you to preserve an appearance of rationality by entering a debate in which a gun is the final argument. I will not help you to pretend that you are administering justice."
"But the law compels you to volunteer a defence!"
There was laughter at the back of the courtroom.
"That is the flaw in your theory, gentlemen," said Rearden gravely, "and I will not help you out of it. If you choose to deal with men by means of compulsion, do so. But you will discover that you need the voluntary co-operation of your victims, in many more ways than you can see at present. And your victims should discover that it is their own volition - which you cannot force - that makes you possible. I choose to be consistent and I will obey you in the manner you demand. Whatever you wish me to do, I will do it at the point of a gun. If you sentence me to jail, you will have to send armed men to carry me there - I will not volunteer to move. If you fine me, you will have to seize my property to collect the fine - I will not volunteer to pay it. If you believe that you have the right to force me - use your guns openly. I will not help you to disguise the nature of your action."
The eldest judge leaned forward across the table and his voice became suavely derisive: "You speak as if you were fighting for some sort of principle, Mr. Rearden, but what you're actually fighting for is only your property, isn't it?"
"Yes, of course. I am fighting for my property. Do you know the kind of principle that represents?"
"You pose as a champion of freedom, but it's only the freedom to make money that you're after."
"Yes, of course. All I want is the freedom to make money. Do you know what that freedom implies?"
"Surely, Mr. Rearden, you wouldn't want your attitude to be misunderstood. You wouldn't want to give support to the widespread impression that you are a man devoid of social conscience, who feels no concern for the welfare of his fellows and works for nothing but his own profit."
"I work for nothing but my own profit. I earn it."


There was a gasp, not of indignation, but of astonishment, in the crowd behind him and silence from the judges he faced. He went on calmly:
"No, I do not want my attitude to be misunderstood. I shall be glad to state it for the record. I am in full agreement with the facts of everything said about me in the newspapers - with the facts, but not with the evaluation. I work for nothing but my own profit - which I make by selling a product they need to men who are willing and able to buy it. I do not produce it for their benefit at the expense of mine, and they do not buy it for my benefit at the expense of theirs; I do not sacrifice my interests to them nor do they sacrifice theirs to me; we deal as equals by mutual consent to mutual advantage - and I am proud of every penny that I have earned in this manner. I am rich and I am proud of every penny I own. I made my money by my own effort, in free exchange and through the voluntary consent of every man I dealt with - voluntary consent of those who employed me when I started, the voluntary consent of those who work for me now, the voluntary consent of those who buy my product. I shall answer all the questions you are afraid to ask me openly. Do I wish to pay my workers more than their services are worth to me? I do not. Do I wish to sell my product for less than my customers are willing to pay me? I do not. Do I wish to sell it at a loss or give it away? I do not. If this is evil, do whatever you please about me, according to whatever standards you hold. These are mine. I am earning my own living, as every honest man must. I refuse to accept as guilt the fact of my own existence and the fact that I must work in order to support it. I refuse to accept as guilt the fact that I am able to do it better than most people - the fact that my work is of greater value than the work of my neighbours and that more men are willing to pay me. I refuse to apologise for my ability - I refuse to apologise for my success - I refuse to apologise for my money. If this is evil, make the most of it. If this is what the public finds harmful to its interests, let the public destroy me. This is my code - and I will accept no other. I could say to you that I have done more good for my fellow men than you can ever hope to accomplish - but I will not say it, because I do not seek the good of others as a sanction for my right to exist, nor do I seek the good of others as a sanction for my right to exist, nor do I recognise the good of others as a justification for their seizure of my property or their destruction of my life. I will not say that the good of others was the purpose of my work - my own good was my purpose, and I despise the man who surrenders his. I could say to you that you do not serve the public good - that nobody's good can be achieved at the price of human sacrifices - that when you violate the rights of one man, you have violated the right of all, and a public of rightless creatures is doomed to destruction. I could say to you that you will and can achieve nothing but universal devastation - as any looter must, when he runs out of victims. I could say it, but I won't. It is not your particular policy that I challenge, but your moral premise. If it were true that men could achieve their good by means of turning some men into sacrificial animals, and I were asked to immolate myself for the sake of creatures who wanted to survive at the price of my blood, if I were asked to serve the interests of society apart from, above and against my own - I would refuse. I would reject it as the most contemptible evil, I would fight it with every power I possess, I would fight the whole of mankind, if one minute were all I could last before I were murdered, I would fight in the full confidence of the justice of my battle and of a living being's right to exist. Let there be no misunderstanding about me. If it is now the belief of my fellow men, who call themselves the public, that their good requires victims, then I say: The public good be damned, I will have no part of it!"

The crowd burst into applause.

Rearden whirled around, more startled than his judges. He saw face that laughed in violent excitement, and faces that pleaded for help; he saw their silent despair breaking out into the open; he saw the same anger and indignation as his own, finding release in the wild defiance of their cheering; he saw the looks of admiration and the looks of hope. There were also the face of loose-mouthed young men and maliciously unkempt females, the kind who led the booing in newsreel theatres at any appearance of a businessman of the screen; they did not attempt a counter-demonstration; they were silent.

As he looked at the crowd, people saw in his face what the threats of the judges had not been able to evoke: the first sign of emotion. It was a few moments before they heard the furious beating of a gavel upon the table and one of the judges yelling:
" -- or I shall have the courtroom cleared!"
As he turned back to the table, Rearden's eyes moved over the visitor's section. His glance paused on Dagny, a pause perceptible only to her, as if he were saying: It works. She would have appeared calm except that her eyes seemed to have become too large for her face. Eddie Willers was smiling the kind of smile that is a man's substitute for breaking into tears. Mr. Mowen looked stupefied. Paul Larkin was staring at the floor. There was no expression on Bertram Scudder's face - or on his wife, Lillian's. She sat at the end of a row, her legs crossed, a mink stole slanting from her right shoulder to her left hip; she looked at Rearden, not moving.

In the complex violence of all the things he felt, he had time to recognise a touch of regret and longing: there was a face he had hoped to see, had looked for from the start of the session, had wanted to be present more than any other face around him. But Francisco d'Anconia had not come.
"Mr Rearden," said the eldest judge, smiling affably, reproachfully and spreading his arms, "it is regrettable that you should have misunderstood us so completely. That's the trouble - that businessmen refuse to approach us in a spirit of trust and friendship. They seem to imagine that we are their enemies. Why do you speak of human sacrifices? What made you go to such an extreme? We have no intention of seizing your property or destroying your life. We do not seek to harm your interests. We are fully aware of your distinguished achievements. Our purpose is only to balance social pressures and do justice to all. This hearing is really intended, not as a trial, but as a friendly discussion aimed at mutual understanding and co-operation."
"I do not co-operate at the point of a gun."
"Why speak of guns? This matter is not serious enough to warrant such references. We are fully aware that the guilt in this case lies chiefly with Mr. Kenneth Danagger, who instigated this infringement of the law, who exerted pressure upon you and who confessed his guilt by disappearing his guilt by disappearing in order to escape trial."
"No. We did it by equal, mutual, voluntary agreement."
"Mr. Rearden," said the second judge, "you may not share some of our ideas, but when all is said and done, we're all working for the same cause. For the good of the people. We realise that you were prompted to disregard legal technicalities by the critical situation of the coal mines and the crucial importance of fuel to the public welfare."
"No. I was prompted by my own profit and my own interests. What effect it had on the coal mines and the public welfare is for you to estimate. That was not my motive."
Mr. Mowen stared dazedly about him and whispered to Paul Larkin, "Something's gone screwy here."
"Oh, shut up!" snapped Larkin.
"I am sure, Mr. Rearden," said the eldest judge, "that you do not really believe - nor does the public - that we wish to treat you as a sacrificial victim. If anyone has been laboring under such a misapprehension, we are anxious to prove that it is not true."

The judges retired to consider their verdict. They did not stay out long. They returned to an ominously silent courtroom - and announced that a fine of $5,000 was imposed on Henry Rearden, but that the sentence was suspended. Streaks of jeering laughter ran through the applause that swept the courtroom. The applause was aimed at Rearden, the laughter - at the judges.

Rearden stood motionless, not turning to the crowd, barely hearing the applause. He stood looking at the judges. There was no triumph in his face, no elation, only the still intensity of contemplating the enormity of the smallness of the enemy who was destroying the world. He felt as if, after a journey of years through a landscape of devastation, past the ruins of great factories, the wrecks of powerful engines, the bodies of invincible men, he had come upon the despoiler, expecting to find a giant - and had found a rat eager to scurry for cover at the first sound of a human step. If this is what has beaten us, he thought, the guilt is ours.

He was jolted back into the courtroom by the people pressing to surround him. He smiled in answer to their smiles, to the frantic tragic eagerness of their faces; there was a touch of sadness in his smile.
"God bless you, Mr. Rearden!" said an old woman with a ragged shawl over her head. "Can't you save us, Mr. Rearden? They're eating us alive, and it's no use fooling anybody about how it's the rich that they're after - do you know what's happening to us?"
"Listen, Mr. Rearden," said a man who looked like a factory worker, "it's the rich who're selling us down the river. Tell those wealthy bastards, who're so anxious to give everything away, that when they give away their palaces, they're giving away the skin off our backs." "I know it," said Rearden.
The guilt is ours, he thought. If we who were the movers, the providers, the benefactors of mankind, were willing to let the brand of evil be stamped upon us and silently to bear punishment for our virtues - what sort of "good" did we expect to triumph in the world? He looked at the people around him. They had cheered him today; they had cheered him by the side of the track of the John Galt Line. But tomorrow they would clamour for a new directive from Wesley Mouch and a free housing project from Orren Boyle, while Boyle's girders collapsed upon their heads. They would do it, because they would be told to forget, as a sin, that which had made them cheer Hank Rearden.

Why were they ready to renounce their highest moments as a sin? Why were they willing to betray the best within them? What made them believe that this earth was a realm of evil where despair was their natural fate? He could not name the reason, but he know that it had to be named. He felt it as a huge question mark within the courtroom, which it was now his duty to answer.

This was the real sentence imposed upon him, he thought - to discover what idea, what simple idea available to the simplest man, had made mankind accept the doctrines that led it to self-destruction.

Atlas Shrugged: Francisco d'Anconia's Money Speech

FYI, this is NOT a PACS entry, and it could be considered slightly to the right of center. Therefore, Left Wing NutJobs might want to skip today's post and return to the nurturing bosom of one of their favorite sites.

Anyway...After last year's "Christmas Carol" send-up, I was asked to consider next a parody of Ayn Rand's "Atlas Shrugged" with a radiological bent. Since I had not yet read the book, I figured that doing so might be wise before starting such a project. I'm about half-way through, and I'm not sure my meager talents are adequate for the job, but in the meantime, I've been absolutely overwhelmed by Rand's prescient writing.

"Atlas Shrugged" was published  in 1957, 55 years ago. Aside from some clearly dated references, this work could have been written today. The description of the criminalization and demonization of wealth and productivity could have come straight from the Left's playbook, tactics promoted by the Administration from Mr. Obama on down.

The character Francisco d'Anconia, an enigmatic playboy heir of a copper mining fortune, overhears someone at a party state that money is "the root of all evil."  His response follows.  Read it all; it's worth your time:

Rearden heard Bertram Scudder, outside the group, say to a girl who made some sound of indignation, "Don't let him disturb you. You know, money is the root of all evil – and he's the typical product of money."Rearden did not think that Francisco could have heard it, but he saw Francisco turning to them with a gravely courteous smile.

"So you think that money is the root of all evil?" said Francisco d'Anconia. "Have you ever asked what is the root of money? Money is a tool of exchange, which can't exist unless there are goods produced and men able to produce them. Money is the material shape of the principle that men who wish to deal with one another must deal by trade and give value for value. Money is not the tool of the moochers, who claim your product by tears, or of the looters, who take it from you by force. Money is made possible only by the men who produce. Is this what you consider evil?

"When you accept money in payment for your effort, you do so only on the conviction that you will exchange it for the product of the effort of others. It is not the moochers or the looters who give value to money. Not an ocean of tears nor all the guns in the world can transform those pieces of paper in your wallet into the bread you will need to survive tomorrow. Those pieces of paper, which should have been gold, are a token of honor – your claim upon the energy of the men who produce. Your wallet is your statement of hope that somewhere in the world around you there are men who will not default on that moral principle which is the root of money. Is this what you consider evil?

"Have you ever looked for the root of production? Take a look at an electric generator and dare tell yourself that it was created by the muscular effort of unthinking brutes. Try to grow a seed of wheat without the knowledge left to you by men who had to discover it for the first time. Try to obtain your food by means of nothing but physical motions – and you'll learn that man's mind is the root of all the goods produced and of all the wealth that has ever existed on earth.

"But you say that money is made by the strong at the expense of the weak? What strength do you mean? It is not the strength of guns or muscles. Wealth is the product of man's capacity to think. Then is money made by the man who invents a motor at the expense of those who did not invent it? Is money made by the intelligent at the expense of the fools? By the able at the expense of the incompetent? By the ambitious at the expense of the lazy? Money is made – before it can be looted or mooched – made by the effort of every honest man, each to the extent of his ability. An honest man is one who knows that he can't consume more than he has produced.

"To trade by means of money is the code of the men of good will. Money rests on the axiom that every man is the owner of his mind and his effort. Money allows no power to prescribe the value of your effort except by the voluntary choice of the man who is willing to trade you his effort in return. Money permits you to obtain for your goods and your labor that which they are worth to the men who buy them, but no more. Money permits no deals except those to mutual benefit by the unforced judgment of the traders. Money demands of you the recognition that men must work for their own benefit, not for their own injury, for their gain, not their loss – the recognition that they are not beasts of burden, born to carry the weight of your misery – that you must offer them values, not wounds – that the common bond among men is not the exchange of suffering, but the exchange of goods. Money demands that you sell, not your weakness to men's stupidity, but your talent to their reason; it demands that you buy, not the shoddiest they offer, but the best your money can find. And when men live by trade – with reason, not force, as their final arbiter – it is the best product that wins, the best performance, then man of best judgment and highest ability – and the degree of a man's productiveness is the degree of his reward. This is the code of existence whose tool and symbol is money. Is this what you consider evil?

"But money is only a tool. It will take you wherever you wish, but it will not replace you as the driver. It will give you the means for the satisfaction of your desires, but it will not provide you with desires. Money is the scourge of the men who attempt to reverse the law of causality – the men who seek to replace the mind by seizing the products of the mind.

"Money will not purchase happiness for the man who has no concept of what he wants; money will not give him a code of values, if he's evaded the knowledge of what to value, and it will not provide him with a purpose, if he's evaded the choice of what to seek. Money will not buy intelligence for the fool, or admiration for the coward, or respect for the incompetent. The man who attempts to purchase the brains of his superiors to serve him, with his money replacing his judgment, ends up by becoming the victim of his inferiors. The men of intelligence desert him, but the cheats and the frauds come flocking to him, drawn by a law which he has not discovered: that no man may be smaller than his money. Is this the reason why you call it evil?

"Only the man who does not need it, is fit to inherit wealth – the man who would make his own fortune no matter where he started. If an heir is equal to his money, it serves him; if not, it destroys him. But you look on and you cry that money corrupted him. Did it? Or did he corrupt his money? Do not envy a worthless heir; his wealth is not yours and you would have done no better with it. Do not think that it should have been distributed among you; loading the world with fifty parasites instead of one would not bring back the dead virtue which was the fortune. Money is a living power that dies without its root. Money will not serve that mind that cannot match it. Is this the reason why you call it evil?

"Money is your means of survival. The verdict which you pronounce upon the source of your livelihood is the verdict you pronounce upon your life. If the source is corrupt, you have damned your own existence. Did you get your money by fraud? By pandering to men's vices or men's stupidity? By catering to fools, in the hope of getting more than your ability deserves? By lowering your standards? By doing work you despise for purchasers you scorn? If so, then your money will not give you a moment's or a penny's worth of joy. Then all the things you buy will become, not a tribute to you, but a reproach; not an achievement, but a reminder of shame. Then you'll scream that money is evil. Evil, because it would not pinch-hit for your self-respect? Evil, because it would not let you enjoy your depravity? Is this the root of your hatred of money?

"Money will always remain an effect and refuse to replace you as the cause. Money is the product of virtue, but it will not give you virtue and it will not redeem your vices. Money will not give you the unearned, neither in matter nor in spirit. Is this the root of your hatred of money?

"Or did you say it's the love of money that's the root of all evil? To love a thing is to know and love its nature. To love money is to know and love the fact that money is the creation of the best power within you, and your passkey to trade your effort for the effort of the best among men. It's the person who would sell his soul for a nickel, who is the loudest in proclaiming his hatred of money – and he has good reason to hate it. The lovers of money are willing to work for it. They know they are able to deserve it.

"Let me give you a tip on a clue to men's characters: the man who damns money has obtained it dishonorably; the man who respects it has earned it.

"Run for your life from any man who tells you that money is evil. That sentence is the leper's bell of an approaching looter. So long as men live together on earth and need means to deal with one another – their only substitute, if they abandon money, is the muzzle of a gun.

"But money demands of you the highest virtues, if you wish to make it or to keep it. Men who have no courage, pride, or self-esteem, men who have no moral sense of their right to their money and are not willing to defend it as they defend their life, men who apologize for being rich – will not remain rich for long. They are the natural bait for the swarms of looters that stay under rocks for centuries, but come crawling out at the first smell of a man who begs to be forgiven for the guilt of owning wealth. They will hasten to relieve him of the guilt – and of his life, as he deserves.

"Then you will see the rise of the double standard – the men who live by force, yet count on those who live by trade to create the value of their looted money – the men who are the hitchhikers of virtue. In a moral society, these are the criminals, and the statutes are written to protect you against them. But when a society establishes criminals-by-right and looters-by-law – men who use force to seize the wealth of disarmed victims – then money becomes its creators' avenger. Such looters believe it safe to rob defenseless men, once they've passed a law to disarm them. But their loot becomes the magnet for other looters, who get it from them as they got it. Then the race goes, not to the ablest at production, but to those most ruthless at brutality. When force is the standard, the murderer wins over the pickpocket. And then that society vanishes, in a spread of ruins and slaughter.

"Do you wish to know whether that day is coming? Watch money. Money is the barometer of a society's virtue. When you see that trading is done, not by consent, but by compulsion – when you see that in order to produce, you need to obtain permission from men who produce nothing – when you see that money is flowing to those who deal, not in goods, but in favors – when you see that men get richer by graft and by pull than by work, and your laws don't protect you against them, but protect them against you – when you see corruption being rewarded and honesty becoming a self-sacrifice – you may know that your society is doomed. Money is so noble a medium that it does not compete with guns and it does not make terms with brutality. It will not permit a country to survive as half-property, half-loot.

"Whenever destroyers appear among men, they start by destroying money, for money is men's protection and the base of a moral existence. Destroyers seize gold and leave to its owners a counterfeit pile of paper. This kills all objective standards and delivers men into the arbitrary power of an arbitrary setter of values. Gold was an objective value, an equivalent of wealth produced. Paper is a mortgage on wealth that does not exist, backed by a gun aimed at those who are expected to produce it. Paper is a check drawn by legal looters upon an account which is not theirs: upon the virtue of the victims. Watch for the day when it becomes, marked: 'Account overdrawn.'

"When you have made evil the means of survival, do not expect men to remain good. Do not expect them to stay moral and lose their lives for the purpose of becoming the fodder of the immoral. Do not expect them to produce, when production is punished and looting rewarded. Do not ask, 'Who is destroying the world?' You are.

"You stand in the midst of the greatest achievements of the greatest productive civilization and you wonder why it's crumbling around you, while you're damning its life-blood – money. You look upon money as the savages did before you, and you wonder why the jungle is creeping back to the edge of your cities. Throughout men's history, money was always seized by looters of one brand or another, but whose method remained the same: to seize wealth by force and to keep the producers bound, demeaned, defamed, deprived of honor. That phrase about the evil of money, which you mouth with such righteous recklessness, comes from a time when wealth was produced by the labor of slaves – slaves who repeated the motions once discovered by somebody's mind and left unimproved for centuries. So long as production was ruled by force, and wealth was obtained by conquest, there was little to conquer. Yet through all the centuries of stagnation and starvation, men exalted the looters, as aristocrats of the sword, as aristocrats of birth, as aristocrats of the bureau, and despised the producers, as slaves, as traders, as shopkeepers – as industrialists.

"To the glory of mankind, there was, for the first and only time in history, a country of money – and I have no higher, more reverent tribute to pay to America, for this means: a country of reason, justice, freedom, production, achievement. For the first time, man's mind and money were set free, and there were no fortunes-by-conquest, but only fortunes-by-work, and instead of swordsmen and slaves, there appeared the real maker of wealth, the greatest worker, the highest type of human being – the self-made man – the American industrialist.

"If you ask me to name the proudest distinction of Americans, I would choose – because it contains all the others – the fact that they were the people who created the phrase 'to make money'. No other language or nation had ever used these words before; men had always thought of wealth as a static quantity – to be seized, begged, inherited, shared, looted, or obtained as a favor. Americans were the first to understand that wealth has to be created. The words 'to make money' hold the essence of human morality.

"Yet these were the words for which Americans were denounced by the rotted cultures of the looters' continents. Now the looters' credo has brought you to regard your proudest achievements as a hallmark of shame, your prosperity as guilt, your greatest men, the industrialists, as blackguards, and your magnificent factories as the product and property of muscular labor, the labor of whip-driven slaves, like the pyramids of Egypt. The rotter who simpers that he sees no difference between the power of the dollar and the power of the whip, ought to learn the difference on his own hide – as, I think, he will.

"Until and unless you discover that money is the root of all good, you ask for your own destruction. When money ceases to be the tool by which men deal with one another, then men become the tools of men. Blood, whips and guns – or dollars. Take your choice – there is no other – and your time is running out."

More to come.