Edicts of an Empire

December 25, 2021 (1,937 words)

Today’s catchy title is taken from the subject line of this week’s email blast from the long-time President of a small but highly-regarded liberal arts college located in the beautiful Shenandoah Valley region of Northern Virginia. He is a stalwart man of principle, and his weekly message always inspires. This one also got me to thinking.

Our oldest attended this fine institution for two years early in the last decade, which is the only reason I’m still on their mailing list. It seems they hold on to every last one of their formerly-active contacts, forever. No one ever gets dropped.

This little college’s claim to fame is not accepting any financial subsidy from the federal government. It is therefore exempt from Edicts of the American Empire as they pertain to admissions and curriculum. It’s quirky approach to higher education attracts a total enrollment of approximately 500 young people from 46 states and 5 countries, each of whom feel drawn by the school’s unique mission. Business-as-usual at this place is to boldly proclaims what are understood to be timeless truths, in everything from campus policies to the syllabus specifics of course offerings.

At the same time, this independent stance puts the school in a precarious financial position, year after year. In order to survive and prosper, it must appeal to a select group of relatively well-off families who can afford to enroll their children without the benefit of standard issue, low interest student loans.

Along with finding its fair share of relatively well-off benefactors with a little spare cash to spread around, who will help bridge the ever-widening gap between tuition fees and actual operating costs.

Having to contend with outsized financial obligations can prompt one to turn an occasional blind eye to the ways and means of meeting those obligations. Or force an outright compromise on principle from time to time. This can happen to anyone. It can even happen at a highly regarded liberal arts college located in Northern Virginia, that prides itself on being uncompromising in its pursuit of truth.

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Given today’s volatile political climate, one is forced to immediately identify as either conservative or liberal, to avoid being confused with the enemy. This paradigm may have its practical application in navigating daily life. But it ultimately limits one’s ability to discern the bigger picture, and develop an appreciation for the warp and weave of history. To say nothing of gaining a grasp on the meaning of life.

Most of my immediate circle of associates are salt-of-the-earth types. They are responsible and independent-minded, and don’t much care for being told what they can and cannot do by any governmental agency, at any level. When forced into making a choice on the matter, they tend to identify as “conservative” more often than not.

When I arrived at a semblance of adult political awareness around the age of forty, my inbred sense of rugged individualism led me into the conservative camp. Its set of assumptions became my dominant Linqua Franca. Now, almost thirty years later, my familiarity with those contours of speech prompts what I hope is a more nuanced analysis of our cultural stalemate.

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There are two distinctly different kinds of conservatives, and there is more than one way to describe each of them. “Fiscal” and “social” is one way. I also happen to like “affluent” and “salt-of-the-earth.” I grant there is some overlap between these two designations. Some salt-of-the-earth folks aspire to affluence, or may have achieved a measure of same. And a few of the now-affluent may retain a trace of their salt-of-the-earth upbringing.

But the motives and objectives of these two economically disparate groups frequently do not align. In fact, they are often at odds with each other. This lack of alignment and outright opposition somehow manages to go undetected. Or at the very least is routinely downplayed.

What keeps them bound to each other is a shared belief in the essential goodness of America. Both fiscal and social conservatives view the United States as the best of all possible political arrangements – a nation that promotes individual freedom and material advancement at home, and operates as a force for good around the world.

Both feel their constitutional freedoms are being abridged by the expanding role of government in the lives of ordinary citizens. This is where things get tricky, though, and the fundamental differences start to assert themselves.

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The freedom fiscal conservatives long for is “an absence of obstacles” first articulated by James Madison in the Federalist Papers. For all intents and purposes this is an economic argument, meant to facilitate the making of money. A citizen should enjoy carte blanche in becoming as rich and powerful as his or her ambition and diligence and skill will allow. With any sort of consideration for others being strictly optional.

Social conservatives, on the other hand, while not opposed to making a decent living, are more interested in what they think of as religious freedom. They want to live their biblical beliefs without interference from the State. They have noticed the categorical rejection of the Ten Commandments in recent years, and how those tenets have been replaced with a decidedly secular take on freedom centered around bodily autonomy. To them, legal abortion and marriage equality and gender fluidity form a renegade dogma that’s managed to receive official sanction from the government.

Both types of conservatives think the answer to their respective problem is a return to the principles espoused by our Founding Fathers. And for fiscal conservatives that would indeed do the trick. Life, liberty, and the pursuit of happiness amounts to their dream scenario. But for social conservatives, the American Creed of me-first self-sufficiency is a repudiation of the Golden Rule they seek to emulate.

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I sympathize with the awkward position social conservatives find themselves in. And I think they should be commended for taking a stand against certain Edicts of the Empire which are antithetical to what might be called authentic human flourishing. But these intrepid souls need to come to grips with the fact we live in a pluralist democracy, where everyone is entitled to his or her own version of the truth.

Look at the bright side: No one is insisting a woman abort her unborn child. And no one is being forced to marry someone of their own gender. You may not like living in a world where infanticide is legal, but our modern-day version of morality is simply the natural result of five centuries’ worth of “emancipation” from custom and tradition, in favor of what we like to euphemistically refer to as “the rule of law.”

In my view there is a pressing need for social conservatives to re-boot their thinking on how we got here, and how from their perspective things might be improved, moving forward.

HOW WE GOT HERE
Today’s unrestrained sexual shenanigans do not represent a sad betrayal of our nation’s Christian roots. I realize the origin of present-day degradation continues to be hotly debated by learned scholars. But this commoner agrees with those who think we were, at best, only nominally Christian to begin with. Since the betrayal in question started a couple of centuries before the Founders even thought of saying goodbye to George III.

The licentiousness that causes social conservatives such consternation actually grew out of the economic revolution that preceded it. Or that emerged in conjunction with it, depending on how you choose to date things. Everything got underway about 500 years ago, at the dawn of modernity. Fiscal conservatives are solely responsible for fomenting this economic revolution, as they will be only too happy to tell you. They note with pride how capitalism was the accelerant that fueled the Industrial Revolution, unleashing a marvelous engine of economic activity that created a rising tide and lifted many a boat. But that’s not the only thing it unleashed.

MOVING FORWARD
It is absolutely imperative for social conservatives to disengage from their fiscally conservative cousins. They must stop letting the latter’s lip service against abortion and the rest trick them into believing capitalism is “inherently moral.” My goodness, no activity on earth is inherently moral. To think otherwise is naïve, or disingenuous. We can, however, take heart in knowing there is really nothing wrong with how capitalism is currently practiced that a strong dose of love-thy-neighbor Christianity wouldn’t cure.

Social conservatives should then reconsider their hands-off approach toward economic behavior. As things stand now, they are loath to criticize capitalism’s obvious excesses and shortcomings, on the grounds economics is a “science” that operates outside the bounds of morality. Their squeamishness comes from chalking the whole thing up to being a matter of “prudential judgement.” Right and wrong do not enter the picture when making economic decisions, since those decisions represent value-free choices. What nonsense.

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Which brings me back to a consideration of my favorite little liberal arts college located in Northern Virginia. That place gets everything right, with one glaring exception. It accepts the ideology of fiscal conservatives at face value – namely, that free-market capitalism implicitly honors human dignity and free will. By this logic, any government intervention in economic affairs amounts to a form of socialism. And socialism is not only opposed to the American way, it is more importantly opposed to Christianity itself.

At least that’s how we hear things framed by social conservatives these days. Which is odd, since for most of our country’s history this group was on the side of working people, not the plutocrats, and helped bring collective bargaining to the industrial workplace, among many other reforms. The social justice battle lines had always been clearly drawn, until the sexual revolution went mainstream in the 1960s, followed by the passage of Roe v. Wade in 1973. Since then, social conservatives have gotten their wires crossed.

Untangling this ideological mash up will take some doing. That’s why I’m so disappointed in my favorite liberal arts college on this score. Its political science department should be spearheading the effort to bring Christian social teaching to bear on contemporary economic policy. Instead of parroting fiscally conservative boilerplate.

To its everlasting credit, this relatively small institution of higher learning is playing an outsized role in the restoration of the culture. It is the proverbial beacon of light in the darkness, not least when it reminds us being dutiful citizens does not extend to violating one’s conscience. In this week’s email message from the college’s President, the example of Thomas More is cited, for his famous rebuke of Henry VIII: “I am the king’s good servant, but God’s first.”

And on that note, I believe God most definitely has an opinion when it comes to economic behavior.

It is right and just to be unequivocal in one’s opposition to legal abortion, which certainly represents an all-time low in the history of Western civilization. But social conservatives should be doing a better job drilling down to the root causes of abortion and all the rest. Those causes can be found in the radical notion of freedom favored by fiscal conservatives in the pursuit of individual prosperity, without regard for damage to the social fabric such pursuit leaves in its wake.

It’s time for social conservatives to realize economic policy does not fall outside their purview. They should not leave these matters in the hands of fiscal conservatives. Economic policy affects every single one of us, in everything we do, every single day. It determines whether we will ever achieve authentic community, or continue to splinter into a nation of individualists, each hell-bent on our own momentary self-interest.

Robert J. Cavanaugh, Jr
December 25, 2021

Women in the Church

December 8, 2021 (401 words)

Concern over finding oneself on the wrong side of history forces intelligent, well-intentioned people to abandon the formal practice of religion, while still thinking of themselves as being “spiritual” at heart. There are any number of problematic issues to be faced, including what is now considered a lack of respect shown toward women on the part of so many orthodox traditions.

With Catholic thought and teaching perhaps the most egregious offender in this regard. Just look at how It denies women equality in priestly ordination, relegating them to a secondary role in which they can only dedicate their lives to serving others as consecrated religious, aka, nuns. Just as a point of reference, the nuns I have encountered over the course of my life have been some of the most self-actualized people you could ever hope to meet. Sharp as a tack, and always on point. As far as I could tell, these highly productive women did not suffer from an inferiority complex. They never sang the second-class-citizen blues.

That teaching also flagrantly violates the contemporary notion of bodily autonomy, stubbornly insisting legal infanticide represents not the emancipation of women from biological determinism, but rather an all-time low in the history of Western civilization.

Catholics get it from both sides, so to speak, as they are disparaged by Evangelicals and other Protestant denominations for venerating the Virgin Mary as the mother of God. This vexes the Protestants, who believe nothing and no one should get in the way of a direct, personal relationship with our Lord and Savior, Jesus Christ. They are unable or unwilling to see that Catholic veneration of Mary only enhances one’s love for Christ as the son of God – true God and true man. And for what he tried to teach our world once he got here.

What also flummoxes those pesky Protestants is the way our calendar is filled with feast days of female saints, whom we regularly call on for their timely help and intersession. We Catholics like having friends in high places. And our admiration is not bound by gender bias.

(Editor’s Note: A saint is someone who battles the same inclination toward sloth and selfishness we all do, but has a higher batting average than our own in warding off such temptation. They do a better job imitating the life of Christ, and therefore serve as examples of how it might be done.)

Robert J. Cavanaugh, Jr December 8 2021

Original Sin

December 1, 2021 (593 words)

How can an innocent newborn come into this world burdened with what religious zealots refer to as “the stain of Original Sin”? This is just the sort of mean-spirited clap-trap that turns compassionate people off. It’s the reason so many now identify as “spiritual but not religious.”

And why self-proclaimed deep thinkers fancy themselves “agnostic,” while the most audacious walk the farthest plank and proudly present as “atheist.”

I sympathize with such skepticism because I shared it for many years. But the time came when I had no choice but to change my mind. It wasn’t a single, dramatic Road to Damascus moment that prompted my return to the fold. It was a slow, deliberate process. I could never quite shake what I had been taught in my youth. Or lose respect for those who did the teaching. Eventually I brought a mature mindset to the project, and that made all the difference.

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With apologies to orthodox theologians everywhere, I would say the “stain of Original Sin” teaching needs to be explained with a bit more nuance, to help the independent-minded among us accept and digest it. What may have convinced the great unwashed in an earlier, more observant era no longer flies.

So here is an alternative definition, from a humble layman’s perspective. The only thing any of us are burdened with when we come into this world is an inclination toward evil. The evidence in support of this thesis is plentiful and irrefutable. I can’t tell you why it is so. I can only use the eye test to reach an informed conclusion.

Is “evil” too strong a word for you? Okay, let’s insert “wrong” in its place. Still too judgmental? How about “a tendency to be inconsiderate of others.” The word “selfish” is more to the point of course, but that, too, may offend one’s educated and refined sensibility.

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In what strikes me as a blatant contradiction, advocates for social justice will push back against the strong taking advantage of the weak, yet turn up their nose at anything resembling what they contemptuously deride as unduly restrictive religious dogma.

To some extent this is a messaging problem, as I’ve just pointed out. Believers need to do a much better job spelling things out in a way that resonates with the modern ear. Citing Bible verses will not do the trick. The contradiction I refer to, for example, is a basic characteristic of our secular age. It can be traced to an opposing view of humankind: People are good by nature, and are only corrupted by society.

This catchy sound bite is famously attributed to the Enlightenment philosopher Jean Jacques Rousseau (1712-1778), who is said to have experienced an epiphany about human nature in 1749. Though his name no longer

rolls off the tongue, he was regularly invoked when I was a young buck in the 1970s. Rousseau was one of the patron saints (along with the Marquis de Sade, 1740-1814) of the “sex, drugs, and rock-and-roll” culture my peers and I spent so much of our young-adult energy celebrating.

We of a certain generation may have aged out of our halcyon days, but we cling to a fondly-remembered free-thinking past with a vengeance, and allow it to define us still.

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The precious infant you are holding is every bit as pure and blameless as he or she appears. But this sweet child will nevertheless have to battle a default inclination toward evil/selfishness, just as we all do. Jean Jacques Rousseau’s popular thumbnail sketch of human nature notwithstanding.

Robert J. Cavanaugh, Jr
December 1, 2021

Malden Mills

November 21, 2021 (756 words)

Do you happen to remember that twenty-five-year-old story about a Massachusetts industrialist who refused to lay-off his 1,400 employees, even after the textile plant they worked in suffered a catastrophic fire? His name was Aaron Feuerstein, and he died earlier this month at a Boston hospital. He was 95.

Mr. Feuerstein became a national hero when he pledged to keep paying his line workers while he rebuilt. As part of that process, he bought an empty factory nearby to hold new equipment, and within two years opened a gleaming new $130 million complex on that site.

By the time of the fire on December 11, 1995, Feuerstein’s operation was among the last large textile companies operating in Massachusetts, a state which had seen manufacturing employment drop from 225,00 in the 1980s to about 25,000 a decade later.

Others faced with competition from low-wage states and cheap imports either closed or moved away. Maiden Mills, located just outside the old mill city of Lawrence, Massachusetts, stayed put. Its secret to success was a proprietary fabric it named Polartec, and sold to cache clothing brands like Patagonia and L.L. Bean.

Mr. Feuerstein’s commitment to his community and his production employees was in stark contrast to the massive downsizing and lay-offs then sweeping the country in the wake of private-equity mergers and acquisitions that were reviving into high gear. This got him noticed. He received numerous civic awards and honorary degrees, and used his celebrity status to chastise companies that refused to prioritize their workers’ interests.

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That’s as much of the story as I knew, until I read Feuerstein’s obituary in the paper (NYT, Saturday, November 6, 2021, page A19). Turns out the saga of Malden Mills did not have a happy ending. The massive rebuilding effort left the company with a mountain of debt, even as sales of Polartec soared in the late 1990s. In 2001 the company went into bankruptcy. It emerged two years later with a restructuring plan that stripped Mr. Feuerstein of his management roles. His attempt to buy back the company was rejected by the board, and he left in 2004.

Malden Mills did not survive long after that. The new owners moved Polartec production to New Hampshire and Tennessee in the late 2000s, and in December 2015 – on the eve of the 20^th anniversary of the big fire – announced the factory would close at the end of the year.

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So, what is the take-away here? Well, for one thing, nothing lasts forever. Grandfather Henry founded Malden Mills in 1907, and father Samuel later took things over. Young Aaron joined the firm right after college, in 1947. The company made upholstery and other textiles before developing Polartec, and moved to the Lawrence plant in the 1950s.

By any measure Malden Mills had a good run. But apparently not even booming sales of a proprietary product were enough to overcome the debt load incurred by constructing that gleaming new $130 million plant Mr. Feuerstein opened in triumph, just twenty months after the devastating December 1995 fire.

Could he have reopened with less grandeur and expense, and would that have made a difference? Don’t know. The debt load notwithstanding, consumer tastes change, and industries that serve those tastes must either change or be forced out of business. Malden survived as long as it did because it developed Polartec, and no longer had to rely on upholstery to earn its living. Would Polartec have been enough to keep Mr. Feuerstein in the game, if he it hadn’t taken on so much debt? Would he have been able to find a new proprietary product late in his career, and pivot once again?

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What does Malden Mills’ demise say about Aaron Feuerstein’s basic management principle? It certainly does nothing to undermine the efficacy of his approach. Looking out for his production line workers wasn’t just the right thing to do, it was good for business. It was a major reason his textile factory was so successful for so long. This is true of many a burgeoning commercial enterprise. Someone bright comes up with a winning formula. But once that formula is established, it’s the little people who are often the ones responsible for making things happen. Credit Feuerstein with being honest enough with himself to admit as much.

In the interests of promoting a just and equitable society, this same principle of empathy toward production line workers should be implemented by whatever new industries emerge to meet the demands of an ever-changing, ever-evolving marketplace.

Robert J. Cavanaugh, Jr November 21, 2021

November 14, 2021

November 14, 2021 (317 words)

The young balladeer Adele has done it again. Her latest hit, Go Easy on Me, is currently playing up and down the radio dial at all hours of the day and night. It’s yet another lament of anguished heartbreak. Being unlucky in love has provided her with a wealth of song-writing material. As affecting and enjoyable as her output has been since her 2008 debut at the tender age of eighteen, some of us are hoping she will eventually turn an emotional corner and find something else to write about.

I like all her stuff, but this latest song could be her best work yet. It just sounds so natural, so organic. There are only one or two of her occasionally odd-ball vocal inflections you can tell she is especially enamored of, but tend to distract my attention and detract from the song’s overall impact. A minor quibble, all things considered.

And what would an Adele song be without a particular lyric that doesn’t quite jive with the rest of the story being told. In this case, the singer claims there is no chance to stay together, because she and her partner are both set in their respective ways. Then, in the very next line, we’re told no one can deny she remade herself in every way possible to please her mate and make the relationship work.

My theory is we are so taken with the melodic tunes, and with such a lovely voice, that we don’t begrudge this talented artist an occasionally incongruent lyric.

The low-key production values here are just right – the solo piano, the little bit of bass. And her voice seems to have matured, has lost the kitschy-ness of earlier cuts. Much the way Bonnie Raitt’s voice did as her recording career progressed.

Now if you’ll excuse me, I have to get back to humming the refrain of Go Easy on Me.

Robert J. Cavanaugh, Jr
November 14, 2021

How Medicine is Practiced Today

November 7, 2021 (2,413 words) The actor Stanley Tucci has appeared in over 70 films, and he always manages to be an authentic, relatable presence, even as a villain. The other night he was interviewed on NPR about a new book he has out, which describes a deep and abiding love of freshly prepared food inherited from his parents, and how his sense of taste was adversely affected for a time by his recent bout with oral cancer. Mr. Tucci praised the medical care he received during his initial diagnosis and extensive treatment, and told the listening audience how one of his cancer doctors has actually gone on to become a close family friend. Many older folks share his sentiments. They enjoy a close bond with their primary care physician, and with other medical specialists their deteriorating condition prompts them to consult. I, however, am not one of those people. Without ever having held any sort of grudge against the medical profession, mind you, I’ve managed to live a doctor-free existence for most of my life. That all changed a few years ago when a series of nagging ailments began to visit themselves upon me. After being fit as a fiddle for so long I found myself in various and sundry waiting rooms, filling out the same form over and over again. Being seen for a few minutes by two and sometimes three assistants, who often ask the very same questions you just answered on that multi-page form you are forced to complete upon arrival. Then the doctor (my primary care guy, an internist, a couple of different urologists, an optometrist) pops in for a few moments, usually with his/her nose firmly planted in his/her laptop, where all my vitals are conveniently stored. Just for the record, I’ve also found my way to the emergency room of my local hospital a few times during this stretch, and had occasion to visit the neighborhood Urgent Care walk-in-with-no-appointment place more than once. I’ve also had a series of blood tests taken, and more CAT scans and MRIs than I can keep track of. * Most of my little afflictions have turned out to be false alarms. Nothing to get overly excited about, just a natural part of the aging process. Unpleasant, but unavoidable. Except for the Type II diabetes I have been diagnosed with. After fainting and falling to the floor in a restaurant, the EMTs who came to my rescue pricked me and said my A1c level was 12% (instead of 7%), and told me I needed to get this checked out. I went to see my primary care doc – a relatively young man appearing to be in his early-forties – who assured me this condition did not require the services of a specialist. He told me straight away to change my diet and avoid starchy carbs, and stressed the need for regular exercise. He also proscribed a common diabetes medication called Metformin, a pill I was to take twice daily. I left his office determined to turn over a new leaf. I immediately gave up what used to be my favorite foods: potatoes, pasta, pizza, and bread. I started swimming laps at the Y. I lost a few pounds along the way, and had to buy some new clothes to fit the now leaner version of me. And I took my Metformin religiously, twice a day as proscribed. When I went back for a follow-up visit, new blood test in hand showing my A1c was now at 7.1%, I expected a round of applause. Instead, the young physician’s assistant peered at her laptop, only to announce my current A1c was higher than it should be. Completely oblivious to the dramatic progress I had made. Same thing with my primary care doc, once the assistant left and he appeared in the little exam room. My next few check-ups came and went, during which I kept giving these two the benefit of the doubt, so to speak. They were the experts and I should follow their advice. Even if their bedside manner left a little to be desired. Then I had a casual encounter with someone who told me that of course Metformin is not really good for you. Like all medications, this civilian explained, it was intended to curb one problem, but it usually interfered with another bodily function in the process. The details were admittedly sketchy, but the overall theme struck a chord, and reminded me why I had steered clear of doctors and prescription medicine over the course of the last five decades. Once I stopped eating starchy carbs and started swimming laps 3-4-5 times a week, I began to regain my equilibrium. The dizzy spells were a thing of the past, and I was feeling pretty good once again. After a year or so I decided on my own, without consulting a physician, to stop taking the Metformin. In advance of a regularly scheduled doctor’s visit this past June I had another blood test done, and it revealed my current A1c level was now at 7.4%. Still manageable, in my opinion. No need to go back on Metformin, as far as I was concerned. When I shared what I thought was the good news, my primary care doc had a fit. How dare I stop taking medication he had proscribed. There was no discussion, no interest in how I was feeling or what diet and exercise regime I was following. From behind my mandatory COVID-19 face mask I calmly suggested another blood test in a few months, to make sure things aren’t trending in the wrong direction. “Not unless you are prepared to go back on the Metformin,” he said with undisguised anger, before getting up and kind of storming out of the exam room. * One could chalk up this doctor’s brusque attitude to any number of things. It was the end of a long day, and perhaps his patience was frayed. Long day or not, over the course of my previous visits a petulant streak seemed to be lurking just below the surface with this guy. Then again, I could be reading things all wrong. He could very well be a perfectly competent physician who just happens to be a little lacking in the empathy department. And let’s not forget the frustration factor. Doctors keep telling us we need to change our diet and start to exercise, but hardly anybody ever does. Most of us go right on eating the foods we love, though they are demonstrably bad for us, and we almost never get any exercise. This has got to frustrate the living daylights out of any conscientious physician. Almost by default, they have no choice but to push a menu of prescription medications to treat what ails us. Another mitigating circumstance contributing to what can be an occasional bout of brusqueness on the part of our medical professionals is the way every practice has decided to “scale.” This business model involves seeing as many patients as possible. More patients seen means fewer time spent with each patient. This is an unfortunate trend that puts an unreasonable demand on the individual doctor, and results in a less satisfying experience for the patient. One can only learn so much from a cursory glance at a series of standard medical history questions that often don’t lend themselves to straightforward yes-or-no answers. It’s hard to know your patient when you only spend a few minutes with them. And when a good part of that time is spent looking at your laptop. This is one of my gripes with how medicine is practiced today, minor malady division. The data our doctors have loaded onto their laptops is fine, as far as it goes. But it can’t tell the whole story. In order to truly “do no harm” you need to pay some attention to the actual human being sitting in front of you. * As a follow-up to that contentious doctor’s visit of last June, I just had another blood test taken the other day, and my A1c level is holding steady at 7.4%. That’s with me being off the Metformin for over nine months. When it comes to treating my version of Type II diabetes, it would appear the ever-popular “diet and exercise” thing is a winning formula. This is not meant as a grand indictment of Metformin, per se, or of the physician who proscribed it. The medication is there if you need it. But if you don’t need it, why take it? I only wish my primary care doctor noticed how seriously I heeded his advice on the diet and exercise portion of his initial proscription. Apparently in his eyes I was going to be on Metformin for the rest of my life. Regardless of what I choose to eat, and regardless of what exercise regime I may adopt. That doctors seem to automatically and reflexively proscribe medication is another gripe I have with how medicine is practiced today. Though I admit they may be spurred in that direction by demanding patients who come in looking for a magic pill that will make everything better. This medication-first approach stems from what strikes me as a denial of the obvious on the part of doctors and patients alike. It’s as if we have all forgotten the human body is not built to last. Sure, it’s good to try and keep things running as smoothly as possible, for as long as one can. But we are all falling apart, some more slowly than others, and we’re all going to die at some point in the not-too-distant future. Granted my sample size is limited, and my evidence is purely anecdotal. But I am walking into these doctors’ offices as a relatively old man now. My best days are behind me. There are going to be aches and pains. My eyesight is failing and I don’t hear so good. I get up in the middle of the night to use the bathroom. I have a slight tremor in my right hand, the one I write with, that appears then disappears then reappears. There are just certain things that come with the territory, you know what I mean? It feels like these youngish doctors are approaching me as if anything less than triathlon-level physical condition is cause for alarm, and requires “treatment.” Instead of a simple annual check-up, they insist on seeing me three times a year to monitor my condition, as if I’m on the verge of imminent collapse. But again, this may not be all their fault. Too many of us are showing up at our doctors’ offices with symptoms that are either a natural part of the aging process, or the direct result of our own negligence, and saying “fix me.” In a world where we have been instructed over and over again to demand the best and have it our way, we are unwilling to accept the inevitable ravages of time. And simultaneously with that unrealistic expectation, we aren’t taking very good care of ourselves these days, either. As has been duly noted in any number of venues, the conveniences that have become commonplace since, let’s say the 1950s, have resulted in a more sedentary lifestyle for most of us. And have inclined many of us to consume a much higher percentage of fast, processed food. These foods taste great but often lack any nutritional value. We end up eating more of them than we should, because our bodies are left craving a basic level of nutrition. Lousy eating habits combined with little-to-no physical activity results in negative health outcomes, as they say. This forces doctors to deal with the by-product of our poor choices. I don’t envy them. * The written report from my latest blood test states: “For someone with known diabetes, a value of 7% indicates that their diabetes is well controlled and a value greater than or equal to 7% indicates suboptimal control. A1c targets should be individualized based on duration of diabetes, age, comorbid conditions, and other considerations.” I would like to find a primary care doctor who is willing to “individualize” my A1c “target” by discussing my circumstances in some detail, rather than relying on a chart that reads “A1c should be 7% or lower.” I’m not opposed to going back on Metformin if my condition worsens. But in my case an A1c reading of 7.4% may be okay, considering how I am feeling otherwise. The bottom line is I don’t want to be on a prescription medication if I don’t really need to be. Is that so wrong? * A lack of personalized attention has infected many of the service industries we come into contact with – not just medicine. As a general rule, the bigness of an enterprise enhances its profit potential, but usually undercuts the quality of service being provided. Then again, in the interest of giving doctors their due, our medical system does a pretty good job with the big stuff: trauma, transplants, cancer, etc. Just think of all those in-depth heart-to-heart consultations you see doctors and patients engage in on your favorite dramatic series. The annoying tests we are routinely sent out to have done are often the only way to screen for these bigger problems. I’m prepared to submit to my fair share of MRIs and CAT scans every so often. But why not make getting those tests approved and paid for less of a bureaucratic labyrinth? The way things are now feels like a giant game of bait-and-switch. No doctor or physician’s assistant or front desk personnel ever tells you what anything will cost, because they’re trying to wrangle as much money as possible out of the insurance company. And you’ll never get a straight answer on costs out of the insurance company in advance of a procedure. The patient is a pawn in a complicated chess match being played far above their head. * I’m not one to sit back and pine for the good old days. But neither do I accept the premise that everything we are doing today represents a step forward from the way it used to be done. It’d nice to hear the actor Stanley Tucci is smitten with his cancer doctors. I’d settle for a primary care doc who would notice what a bang-up job I’m doing of dealing with my Type II diabetes through diet and exercise, without having to resort to prescription medication. Robert J. Cavanaugh, Jr November 7, 2021