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ONE LIFE . . . MANY DEATHS

Monday, March 11th, 2013

“Death and life are in the power of the tongue; And they that indulge it shall eat the fruit thereof.” -Proverbs 18:21

“Thou shalt not lie with mankind, as with womankind; it is an abomination.” -Leviticus 18:22

“Therefore, send not to know/For whom the bell tolls/It tolls for thee.” -John Donne (1572-1631)

The physician, garbed in hospital-scrubs and looking glum, approached the obviously apprehensive parents. “Mr. Mayfield. Mrs. Mayfield.* I’m sorry . . .  terribly sorry. Your son, Robbie, just passed away. The infection? It became just overwhelming.”

His words elicited immediate, racking sobs from the distraught mother. Gradually, the woman began to compose herself. “I don’t understand, Doctor. Robbie didn’t have any infections when he was admitted. He came here for a simple surgery . . . a simple hernia-repair, you said. How could he suddenly die of an overwhelming infection? “

“The surgery was successful . . . .”

“And the patient died. Is that it?” The mother’s grief suddenly was transforming itself into anger.

“Unfortunately, after the surgery, as you know, he suffered urinary retention. It’s not uncommon, especially in older men.”

“He’s . . . he was . . . an adolescent boy not an older man.”

“True, but even so, it can occur in anyone. His urinary bladder was becoming distended, so we were forced to drain it by inserting that indwelling catheter you saw. The catheter . . . a foreign object to the body . . . apparently became the focus of the infection. As you know, we detected the situation almost immediately. We called in a specialist in infectious diseases. He used every antibiotic in our arsenal. They failed. These things happen . . . unfortunately, with increasing frequency and ferocity.(1)”

“Why?”

“Do you prefer a less unpleasant lie or a more unpleasant truth?” Now, it was the physician who was showing anger.

“Of course, I want the truth! Who wouldn’t?”

“Apparently, a majority of Americans,” replied the physician bitterly.

The grieving mother was taken aback. The physician’s attitude, even more than his words, alarmed her.

“Alright, Mrs. Mayfield, I’ll tell you the truth. There are thousands of perv . . . persons . . . with HIV and AIDS. The virus compromises their immunological systems, seriously weakening their capacities to combat infections. Ultimately, even with the most powerful antibiotics, the patient must cure himself.

“When persons with AIDS contract infections, even infections that would be relatively benign in otherwise normal patients, treatment may require massive doses of our most powerful antibiotics. Eventually, the bacteria develop resistance to these antibiotics, a kind of genetic learning. Worse, the bugs not only develop resistance. They become more virulent . . . more lethal . . . more deadly.

“When other patients . . . sexually normal patients such as your son . . . contract the same, now more virulent infections, they are more likely to suffer higher morbidity and higher mortality than otherwise would be the case.”

“Can you say what you just said in plain English, Doctor.”

“Sorry. Thanks to homosexuals with HIV, normal people are suffering infections that are making them sicker and killing them more frequently. Your son was one of those victims.”

The woman turned to her husband, who had remain seated, silent with an ashen pallor. “Howie . . . Howie killed our son!” she screamed.

“Who’s Howie?” asked the physician.

“He’s a friend of mine since childhood,” mumbled the husband. “He’s ‘gay’.”

“Gay?” screamed his wife. “You mean he’s a queer . . . a faggot . . . a pervert. He’s not ‘gay’. Gay is a feeling not a way of life . . . or, more accurately, a way of death. Your son was gay until Howie . . . and those like him . . . murdered our little boy, my innocent baby.” Her eyes seemed to dissolve in a pool of tears.

The husband arose, pointing his finger into his wife’s face, raising his own voice. “How conveniently you forget that you’re the one in favor of ‘homosexual marriage’ . . . not I. Well, there are consequences, aren’t there?”

The woman sank onto the hard, plastic bench behind her, breathing rapidly but shallowly. Slowly, she seemed to regain a modicum of composure.

“So, what you’re saying, Doctor,” she began, “is that possibly to save one homosexual afflicted with HIV, potentially thousands of other, innocent people will die.”

“You might put it that way.”

“I believe I just did.”

“Mrs. Mayfield, we physicians can’t withhold treatment from homosexuals, irrespective of the long-term consequences for the rest of the population.”

“Is there a name for this insanity?” the husband interjected.

“Some call it ‘Radical Maternalism’ (www.inescapableconsequences.com).”

“Interesting term,” opined the husband. “Tell me, what do you predict will be the ultimate consequences of this . . . this Radical Maternalism?”

The physician paused. “It depends upon advances in medical technology. If the genetic advances among the bacteria outpace the technological advances in medicine, possibly worldwide pandemics with millions of deaths.”

“In order to make the world safe for homosexuality?”

“You said it, Sir, I didn’t. There’s another problem, however.”

“What’s that?” inquired the wife.

“Profit.”

“Yes, I know what you mean,” the woman replied. “Greedy pharmaceutical companies making huge profits at the expense of the sick and injured.”

“No, ma’am! Quite the opposite to your widely held opinion. As we develop new antibiotics in America and Western Europe, they’re stolen by undeveloped countries that rob the developers of their rightful profits necessary for investment in future research. These thieves defend their thefts by proclaiming the need to save lives now not later. Meanwhile, these same countries refuse to control their mindless breeding, so a life saved today means more lives to save tomorrow . . . at someone else’s expense. Radical Maternalism!”

The husband raised his hand as though he were a pupil in school. He meant the gesture as a sign of respect for insightful knowledge over blind opinion. “My son is dead. We can’t restore him to life. Can’t we protect other innocent Americans and Europeans? If so, how?”

“From what I know, I’d say that the answer is to employ biobehavioral science.”

“Never heard of it. Have you?” the husband asked his wife.

“Never.”

“Neither have most others,” admitted the physician. The most frightening aspect is that most people don’t want to learn about it even though it’s the only road to our survival as individuals and as a species.”

The couple looked stunned. Then, the husband asked, “Can you give us an idea what it’s about?”

“To answer your question as best I can, firstly you describe the context in which the situation-in-question is occurring. Then, you specify the antecedents, behaviors, and consequences . . . the ABC’s.”

“That’s it?” the wife asked.

“No. Then, you define the problematic behavior in terms of it being either an excess or a deficit, you target appropriate and attainable goals, you design practical plans and put them into play, then you measure the outcome.”

“Why aren’t we doing that now?”

“Ideology controlling politics. The consequences? Short-term gains enjoyed by the politicians and ideologues . . . long-term losses suffered by the rest of us. We prefer to ignore one basic fact.”

“What’s that?” the couple asked in chorus.

“Ultimately, reality always wins.”

The couple remained silent. Then, the wife hesitated, “You seem . . . How should I put it? . . . quite bitter, Doctor. Is your attitude only a consequence of Robbie’s dying?”

The physician sighed. “You’re an observant woman, Mrs. Mayfair. The sad fact is that my own, beloved wife . . . mother of our two children . . . died in this same hospital last year . . . from the same sort of infection that killed your son. Two innocents . . . victims of our current ignorant, arrogant, misguided, suicidal ideology.”

The couple, bereaved themselves, again remained silent. Then, the husband asked, “You focus your attention on homosexuals. What about patients with cancer or with transplants receiving immunosuppressant chemotherapy?”

“Your point is well taken. The difference is that their plight typically isn’t the consequence of their own wanton lust. It’s more of a happening than an action. The issue, nevertheless, is similar, and there’s no easy answer . . . but there is an answer. It’s a biological balance between the interests of the individual and the interests of the species . . . a balance to be decided rationally via scientific methodology and the morality of the Ages not emotionally via ideology and the morality of the moment.”

The physician looked at his pager. “Now, please excuse me. Ironically, I’ve another innocent patient down the hallway, dying from the same infection.”

Reference

1. “Deadly Bacterial Infections On the Rise.” The Wall Street Journal, 06MAR2013, page A6.

*The characters presented herein are fictitious. Any resemblance to persons living or dead is coincidental.

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MEDICAL DELIVERY: A TALE OF WOE

Monday, August 6th, 2012

“An error lurking in the roots of a system of thought does not become truth simply by being evolved.”
- John Frederick Peifer

Forward: Will Mr. Obama’s “Patient Protection and Affordable Care Act (PPACA)” improve the American system of medical delivery, or will the nation slide from American-style medical care into Soviet-style “healthcare”?  Given the data from its model, RomneyCare in Massachusetts, the answer is the latter.(1) The following is a highly abridged excerpt from the semi-fictional novel, Inescapable Consequences; “The Doctor” and “Uncle” are two of the characters therein.‘Tis the kind of tale likely to be told and retold millions of times:(2)

The patient, a thirty-eight-year-old, married, obese, mother of three had a past psychiatric history of a single brief psychotic episode ten years previously, treated successfully with complete remission and without recurrence. Her recent health had been good until the current presenting complaint of several days duration characterized by abdominal pain with nausea and vomiting.

The morning prior to admission to the hospital, she had complained to her husband of a slight sore throat and a persistent mild but increasing nausea. She had declined to accompany the rest of the family to services at church. Upon his return, the husband found the patient still feeling ill. Her nausea had intensified somewhat, and she continued complaining of diffuse, dull abdominal pain.

Through his employer, the husband subscribed to a “healthcare-plan” issued by a “health-maintenance organization” or so-called HMO, the premium representing a significant portion of his wage. He telephoned the number provided by the HMO for such occasions, receiving only a recorded message with the usual disclaimer instructing him to telephone “911” if he, a layman, determined that the situation was a life-threatening emergency. Then, pursuant to the subsequent instruction by the recorded voice, he left his own brief message with his telephone number.

Approximately one hour later, a woman identifying herself as a nurse returned his call. She had no records of the patient available. As best he could, the husband described his wife’s current complaints and past history including her psychiatric history.

Addressing him by his first name, the nurse quizzed him primarily about his wife’s past psychiatric history, neglecting her present illness.  She then suggested that he telephone the following morning, Monday, to schedule a regular appointment.

He informed the nurse that, since his wife had been feeling increasingly ill for several days, she herself already had called for that regular appointment. The soonest that the receptionist would agree to schedule one was three weeks hence.

The nurse replied by advising him, nevertheless, to try again the next morning and to inquire whether there had been a cancellation. She also prescribed bed-rest and a diet of clear liquids.

Concerned about the typically long wait at the Emergency Room of the HMO, he asked if he could take his wife to a nearby ER. The nurse answered, “You’re free to do whatever you think best, but we can’t authorize an Emergency Room visit ‘out -of-network’.”  Her parting words reverberated in his brain like car-brakes without a lining. “Have a nice day.”

Late that afternoon, his wife was feeling no better. He decided that he would drive his wife to the Emergency Room of the HMO and hope for the best. Upon arriving, he registered his wife with the clerk, who told him that there would be “a considerable wait”.

One hour later, a nurse approached them in the waiting room for a “screening evaluation”. After a brief conversation, she said that she did not believe that his wife’s symptoms warranted a visit to the ER but that his wife would be seen “in due course”. Three hours passed. Feeling as sick as she looked, his wife was pleading for him to take her home. Instead, he took her to the Emergency Room at their local hospital, the financial risk be damned.

There, the clerk advised him that, if his HMO should decide, in its sole opinion, that the patient’s case was not a true emergency, he himself would be responsible personally for all charges. He agreed. He allowed the clerk to take an imprint of his credit card.

Another hour later, a nursing aide escorted them into an examining room. She recorded the patient’s vital signs, noting a slightly rapid pulse and a slightly elevated temperature.

Another thirty minutes of waiting. Then, a man in a white coat with a stethoscope entered. He introduced himself as “Dr. Faki”. Neither patient nor husband understood that Dr. Mohandas Faki was not a physician with an M.D. from an American medical school but a nurse with a Ph.D. from a foreign nursing school, nor did either understand the right to be attended by a physician not a nurse.

The husband again reviewed the course of events and again made the mistake of mentioning that his wife tended toward anxiety and did have a past psychiatric history. Upon hearing about the patient’s psychiatric history, as had the telephonic nurse before him, the “doctor-nurse” focused his questioning in that area.

He then performed a brief physical examination, noting only a slightly injected pharynx and mild, diffuse, abdominal tenderness. He ordered some routine studies by the laboratory “stat”. The couple returned to the waiting room.

Two more hours passed. The nursing aide reported that the results from the laboratory returned as “non-specific” and that the doctor-nurse had said that they should return home then see the patient’s “healthcare-professional” the next day. At no time did a doctor-doctor examine the patient.

Having returned to their home, by late that evening the patient’s husband could see that his wife’s condition was deteriorating further. Her nausea had intensified. She had vomited. Her abdominal pain had intensified. Emotionally, she was becoming distraught.

Her husband tried calming her while he himself was feeling increasingly anxious. Risking the punitive cost, he decided to try a different Emergency Room. He happened to choose a hospital where Uncle’s nephew, The Doctor, held surgical privileges.

Viewing her presenting appearance, the hospital-staff quickly registered the patient then wheeled her into an examining room, where a nurse performed an initial screening. By then, the patient was complaining of increasingly severe abdominal pain in the right upper quadrant. Her skin was cold and clammy to the touch.

The surgeon-on-call that evening already was working on another case in the Operating Room, so a nurse telephoned The Doctor. He ordered her to prepare the patient for immediate surgery, including typing and cross-matching three units of blood, and hastened to the hospital.

By the time that he arrived, the patient was in the Operating Room but going into shock, which the staff, none of whom was a physician, feverishly was attempting to reverse. The Doctor hastily changed from “civvies” into “scrubs”, washed, gowned, and gloved. He took a moment to evaluate the situation before beginning an exploratory laparotomy while the nurse-anesthetist was doing her best to maintain the patient’s vital signs; no physician-anesthesiologist was available. Everyone but the patient was breathing the air of desperate urgency. On her own, she was breathing hardly at all.

Entering her abdominal cavity, The Doctor quickly discovered the cause of the patient’s trouble; a gangrenous gallbladder, now-ruptured. He began to correct the condition by cleansing the cavity of the spilt bile and pus. In the midst of his doing so, the woman suffered a cardiac arrest. Instantaneously, the cardiac monitor screamed its piercing alarm, an unnerving “bleeeeeee . . . .”.

Following a series of frantic efforts, the nurse-anesthetist admitted failure. “We’ve lost the patient,” she reported meekly, gazing fixedly at the floor.

“We?”  The Doctor angrily shot his question at her; his expression, grim; his emotion, impotent rage.

Masking his feelings, he reluctantly entered the hallway, where he found the patient’s husband pacing like the proverbial caged animal. He approached the man slowly and introduced himself. With a quiet compassion in his voice, he informed the husband that his wife had died.

He then attempted to provide what little consolation he could offer. It was difficult for The Doctor to find the right words; actually, to find any words. What could he say?  The wife’s dying had been avoidable. It never should have happened. The medical system had failed her directly and her husband indirectly.

The Doctor’s efforts at sympathizing were in vain; the husband remained disconsolate. The Doctor stood silently while the suddenly-widowed man sobbed.

Then, the tears stopped. Shaking his head, the man looked at The Doctor with a compassion of his own. Paradoxically, he began offering consolation to The Doctor, apologizing for the system foisted upon the country by politicians for whom he himself had voted. Looking into The Doctor’s eyes, he noted tearing.

Whereas the husband felt apologetic, The Doctor felt ashamed, not for himself as much as for his profession or what was left of it. “The medical profession . . . my profession . . . no longer controlled by physicians but by politicians, bureaucrats, lawyers, and profiteers. The consequences? Casualties. This man, his wife, and I are three of them,” he whispered silently to himself.

The husband gently took The Doctor’s hand and held it.“Go home, Doctor . . . get some sleep. You did your best. It wasn’t your fault.” He predicted that, with his wife’s death, the HMO would agree that his wife’s illness had represented a real emergency, after all.

 The Doctor put his other hand on the husband’s shoulder and gave it a slight squeeze. He turned and walked away, leaving the bereaved man behind with his grief-stricken widowerhood bestowed by a system of managed costs euphemistically characterized as “managed care”.

On his way to the locker-room, The Doctor stopped at the desk to request that an aide stay with the husband while the secretary summoned the husband’s brother from home. The secretary said that she would try but that the hospital was understaffed, as usual.

At the moment of the husband’s shock and grief, The Doctor had not wished to disabuse him of his financial fantasy. The Doctor predicted that the HMO would deny the charges, claiming that, in spite of its staff erroneously having told the husband by telephone and at their ER that his wife’s condition represented no real emergency, she should have stayed to be seen “in-network”. He assumed that the charges would force the husband into bankruptcy. Oh, the man would rant and rage and threaten legal action, but, given current law protecting the profiteers, he would find no lawyer to take the case “on-contingency”, and he ill could afford hourly fees.

As for The Doctor’s fees? He would never receive a penny. “The people’s right to ‘healthcare’ . . . their right to my labors . . .” would be his only response, silent and ineffectual.

That night, The Doctor managed to get an hour or so of sleep. Then, he was off to make rounds at the hospital; then, to see patients at the office.

Given the schedule of fees dictated by the government and by the various governmentally-promoted “healthcare-plans”, caring for many of those patients also would generate little financial gain, if any; caring for a few of them would generate financial losses; caring for all would risk unfounded lawsuits filed by unscrupulous, avaricious lawyers.

Months later, The Doctor’s prediction would prove valid. The premiums that the husband had paid to his HMO were for naught when an actual need arrived. His HMO had denied care by delaying care then had forced him, the subscriber, to take the financial fall. Ironically, the same day that the man filed for bankruptcy, the HMO filed a fifteen percent rise year-to-year in its profits.

© Gene Richard Moss (2009)

References
1) “RomneyCare 2.0″. The Wall Street Journal, 06 August 2012, p. A12.

2) Already, under “Expansion of Physician Assistants Training”, the PPACA is directing tens of millions of dollars to training paramedical personnel. Meanwhile, under Medicare, funding for physicians-in-training and payments to physicians-in-practice are being slashed.

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MEDICINE: QUANTITY IS NOT QUALITY

Monday, July 23rd, 2012

To reiterate from a previous posting (1), so-called healthcare is not synonymous with medical care. The difference is not mere semantics. “Healthcare” is cutting your toenails. Medical care is treating a cancer with surgery then radiation then chemotherapy.

Recently, a fellow named H. W. Brock . . . neither a Medical Doctor nor a biobehavioral scientist but a financial type . . . wrote a piece claiming a resolution to the problematic situation of delivering medical care in the USA.(2) His resolution? Increase the supply.

Unfortunately for Mr. Brock, his postulates are invalid. As he confuses”healthcare” with medical care, he confuses quantity with quality.

The elements of his so-called supply-sided resolution? 1) Federal training of more physicians. 2) Financial aid for physicians-in-training. 3) Financial incentives for physicians going where shortages exist, medically and geographically. 4) More foreign-trained physicians. 5) Reformation of medical malpractice. 6) Fewer redundant diagnostic tests. 7) More nurses and other para-medical personnel replacing physicians. 8) Promotion of cheap, “retail”, quasi-medical shops.

As always, the devil is in the details. Let’s look at Mr. Brock’s recommendations.

1 & 2) Training more physicians may be a good idea, but who’d be financing the training? With monies from where?

The individual states? The concept of state-based financing is nothing new. State-based budgets, however, are strained . . . California, for example, is broke. Increasing state-based funding for training more physicians seems rather unlikely.

Who’s left? The federal government? The concept of federal financing also is nothing new. It’s been on-going for years through Medicare and other programs; e.g., Title VII of the

“Health Professions Educational Assistance Act” of 1976. Okay, why not just increase it and expand it?

Wait! Congressman John Boehner recently stated flat-out, “We’re broke!” . . . not that a lack of funds usually stops federal spending. Under ObamaCare, for example, Big Government ironically will spend tens of millions that it doesn’t have to train “physicians’ assistants” under “Expansion of Physician Assistants Training (EPAT)“. Meanwhile, current funding for training physicians through Medicare is being slashed. Music to your ears, Mr. Brock?

Stop! Look! Listen! Those who love individual liberty never should forget that government . . . especially Big Government . . . is a dangerous servant and a terrible master. “He who pays the piper calls the tune.” The federal government already is directing American medical care through Medicare and Medicaid. How would Mr. Brock block further empowering its dictatorial control over physicians via increased financing of their training?

Now, who’s left? Private enterprise? Only Big Business could afford financing medical training on a meaningful scale. What would be any reward to any business, say, to offer scholarships? What would be “the catch” for the physician?

3) Rewarding physicians financially for going where shortages exist, medically and geographically, also may be a good idea. Who should do the rewarding? The federal government? Individual states? Under-served municipalities? Private enterprise? Governments already do, to some extent. What must the physician promise in return for increased funding? Mr. Brock might consider that using oneself as chattel for a mortgage is unconstitutional.

4) Importing more foreign-trained physicians may sound like a good idea economically. Is it a good idea medically? On average, is an American-trained physician more competent than a Grenada-trained physician who passed the examination designed by The Educational Commission on Foreign Medical Graduates . . . even without the time-honored cheating?(3) Under whose knife would Mr. Brock care to put himself when his is the life at stake?

5) Reforming medical malpractice, unquestionably, is a good idea. America has become a nation imprisoned by lawyerism. Too many laws; too many lawyers; too many lawyer-politicians; not enough law . . . think the now-disgraced, lawyer-politician John Edwards or the honest companies bankrupted by greedy lawyers (4).

Who’ll perform the legal reform? A federal government dominated by lawyers? On what constitutional grounds . . . not that the federal politicians and bureaucrats care about the Constitution unless it suits them to do so? The fact is that both physicians and lawyers are licensed by the individual states not by the federal government. Isn’t reform a task for the states . . . but, ah, the ease and joy of central versus provincial (i.e., state-based) control; eh, Mr. Brock?

6) Who can argue against reducing the number of redundant diagnostic tests and procedures? Aren’t many of those tests ordered, however, to preëmpt unfounded lawsuits?

Defensive medicine aside, Mr. Brock neglects to tell us The How. Rap physicians’ knuckles? Fine physicians? Imprison them? Execute them? Nothing as quick and simple as negative versus positive control; eh, Mr. Brock?

7) Allowing nurses and other para-medical personnel to masquerade as physicians may increase the supply of “healthcare-related” services but can it maintain quality of service? Nurses aren’t trained to make diagnoses. Sorry, Mr. Brock, it’s true. With all due respect to nurses, essentially, they’re necessary, valuable, and hopefully caring technicians trained to carry out physicians’ orders. With the use of improving technologies, as time passes, they may become competent to do more. Even so, should nurses and other para-medical personnel operate with no medical supervision? Moreover, who, ultimately, should be responsible . . . medically and legally? Mr. Brock gives us no clue whom to sue.

During the days of the now-defunct Soviet Union, its dictators boasted having an ample supply of “physicians”. . . well, not exactly physicians but physicians-in-name; what we in the USA now call “nurse-practitioners”. The average Soviet citizen rarely was attended by a legitimate physician . . . only the politicians, high-level governmental bureaucrats, and military officers. Do we Americans really want the Soviet-style medicine that Mr. Brock is promoting?

Furthermore, will lower fees compensate for lower quality? Even if they do, won’t those lower fees gradually rise towards the fees charged by real physicians?

8) Promoting cheap, “Wal-mart style” quasi-medical shops to handle “common minor ailments” . . . shops already appearing in supermarkets . . . staffed by quasi-physicians acting in isolation from real medical support undoubtedly will increase availability of “healthcare-related” services. Mr. Brock neglects to state, however, who determines what is a “common minor” ailment. The customer? The nurse? The assistant to the absent physician? The check-out clerk? As a financial type, Mr. Brock might keep in mind that there’s a cost to everything. How about your life, Mr. Brock? Still a good value?

No, Mr. Brock, your “solution” won’t resolve the situation-in-question. Fortunately, however, there is a valid resolution, and it comes from biobehavioral science . . . not from the pseudo-science of economics nor from the polemic of politics nor from the mumbo-jumbo of mysticism (www.inescapableconsequences.com).

So, what’re the odds favoring us Americans resolving scientifically the current dilemma in delivery of medical care? After all, we have the way. We have the means. Ah, but do we have the will? What say, Mr. Brock?

References
1) Categories/Biology & Medicine/”Healthcare” Reform/ ‘Healthcare’ Is Not Medicine”.

2) Brock, HW: “A Supply-Side Solution for Health Care”. Barron’s, 23 July 2012, page 30.

3) Lyons, RD: “Cheating On Exams For Doctors Causes Alarm”. The New York Times, 03April 1984.

4) “The Tort Bar Burns On”. The Wall Street Journal, 23 July 2012, page A12.

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LET THE FEASTING BEGIN!

Monday, November 21st, 2011

Will the Eurozone collapse by the New Year? Can you control it?
Will the USA collapse by the New Year? Can you control it?
Will China collapse by the New Year?  Can you control it?
Will you have gained weight by the New Year? You can control it.

(Note: This essay was written by a lifelong fatty in disguise.)

During World War Two just in time for Christmas 1944, the Germans’ Wehrmacht breached the Americans’ lines in Belgium then raced towards the coast. The ensuing battle became known as the “Battle of the Bulge”.

Alright, you think that you already know where this line of thought is heading, and you’re probably right, to a point . . . fat breaching the Americans’ waistlines of their breeches then racing towards greater obesity. Well, the thesis herein is a bit broader. It offers more than observation. More than analysis. It offers a resolution to the situation-in-question weighing heavily on the mind, if not the waistline, of every fatty disguised or not. Even better, it’s a resolution that’s free, convenient, and available at any time to anybody.

That’s right! No paying some profiteering “snake-oil-peddler” offering weight-loss by selling you smaller portions with less taste at higher prices . . . a proven failure, by the way. No joining some expensive, so-called health-club; only to injure yourself on a variety of mechanical contraptions in a fruitless attempt to burn those excess calories that you shouldn’t have swallowed in the first place. Instead, try employing a little Science to do that which you know in your brain . . . if not your stomach . . . is right.

Background
Before we begin the analysis, here’s a little scientific background. Matter (such as the fat on your belly, hips, or backside) is just a sort of compression of energy. The First Law of Thermodynamics states that energy neither can be created nor destroyed.

Applied to fatties and everyone else, weight becomes a simple issue of CI/CO . . . calories in/calories out. Yes, yes . . . the perennial purveyors of diet-books, diet-foods, diet-programs serve self-selected facts as proverbial red herrings to distract gullible, frantic fatties from the simple truth . . . CI/CO. They tell you that it’s not that simple; for example, claiming that the kinds of food that you consume can make all the difference . . . they can, but they don’t. Ignore the claims and ignore those who make them!

Surely, we can discuss the Specific Dynamic Action (SDA) . . . the percentage of calories consumed required to metabolize those calories . . . of a diet overly abundant in protein; the potentially harmful effects of such a diet, notwithstanding. SDA or no SDA, fats or no fats, “carbs” or no “carbs”, the behavior of these slick salesmen of pseudo-salubrious misrepresentation is under the control of one consequence and one consequence only . . . money, your money! In controlling weight, outcome always can be reduced to CI/CO, which is the reason, statistically, that all of these inflated, self-serving claims end in failure.

Take the notion of eating one group of foods, say protein, over others . . . perhaps, a diet of extra-high protein and extra-low fat. Yes, the SDA of protein is high, approximately 30%; if you consume 1000 calories of pure protein, your body requires 300 of those calories to metabolize the 1000, leaving a net-CI of 700. The SDA of fat is much lower. Conclusion? Eat all protein and no fat? Consequence . . . you die.

The varied and vital, dietary requirements of omnivores such as we humans notwithstanding, with regard to controlling weight, look at the situation-in-question from a practical perspective. A meal high in fat is satisfying; a meal low in fat isn’t. Why?

Fat stays in the stomach longest of any group of foods. A glass of skimmed milk with no fat? Through the stomach in a flash . . . unsatisfying!  A glass of whole milk with the same number of calories? Stays in the stomach for a while . . . satisfying! Would you rather feel unsatisfied or satisfied? I personally know a middle-aged woman who, when she gains a few extra pounds, loses them via a short-term diet composed almost entirely of ice-cream.

Say, ignoring reality, you unreasonable limit your intake of fat at each meal. Consequences? Cognitively, you congratulate yourself about your “willpower”. Emotionally, you feel out-of-sorts. Physiologically, you feel deprived. Behaviorally, you consume multiple snacks of foods extra-low in fat, often at night after an unsatisfying supper. Ultimately, even if you lose weight in the short term, you regain the lost weight, and often more, in the long term.

“Alright, what about surgery?” you may ask. Now, wouldn’t that be an extraordinary gift for Chanukah or Christmas? “Here, honey . . .a gift-certificate to have your stomach stapled.” Clearly, surgery performed by licensed physicians is a different story from worthless, dietary fads touted by charlatans. Even so, surgery is only for the morbidly obese, and it carries its own risks. Moreover, a determined fatty can eat his way around his surgically-mutilated gut.

The basic fact is the basic fact . . . eating is a behavior, a necessary consummatory behavior. Unlike other consummatory behaviors, however, such as drinking alcohol, shooting heroin, or smoking tobacco, eating doesn’t allow for abstinence. Therein lies a most challenging aspect of the situation-in-question.

Analysis
We’ll be restricting ourselves to only the ritualistic feasting of the holiday-season. You, nevertheless, can generalize the message herein beyond the first day of January.

Scientific behavioral analysis involves describing the context of the situation-in-question then specifying the ABC’s . . . the antecedents, behaviors, and consequences (www.inescapableconsequences.com). Admittedly, sometimes it can be more difficult than it sounds but, fortunately, not in this case.

Context: The span of time in the USA from Thanksgiving* through New Year’s Day.
Antecedent: The serving of meals, snacks, and calorie-filled liquids . . . think eggnog.
Behavior: Eating and drinking.
Consequence: Gaining of weight.

Analyzing the situation-in-question isn’t so difficult. Facing it? Another matter. Those willing to face it may ask, “Ah, but how to resolve it?”

Resolution
Resolving a problematic situation-in-question is where the proverbial rubber meets the road. Often, it can be difficult. Fortunately, in this case, it’s relatively easy, at least to describe [acknowledging the contribution of the late experimental psychologist, Charles B. Ferster, Ph.D. (1922-1981)].

You begin by specifying the problem. Typically, you do so in terms of behavior and its associated cognition, emotion, and physiology; but, for this situation, you need specify only the behavior. Then, you target a goal, design a plan, and employ measurement of the consequences. Always remember, B = f(x) under c . . . behavior is a function of its consequences under a given set of conditions (i.e., context).

Problem: A behavioral excess of eating and drinking.
Goal: To have maintained your weight pre-Thanksgiving throughout the holiday-season.
Plan: Put into play the following five, simple procedures:
1) Eat only in the place designated for eating; e.g., in the dining room or at a restaurant. Never eat or drink in any other place including the car; plain water excepted. (At parties in living rooms and other places not ordinarily designated for eating, no need to offend your host; simply eat and drink the absolute minimum to be polite.)
2) When eating, only eat. No watching television or videos! No using the computer. No talking via the telephone.
3) Take as large helpings as you wish of whatever you wish but never take seconds. As you’re heaping the foods onto your plate, it wouldn’t hurt to bring a little cognition to bear by asking yourself, “Do I really need a portion this large?”
4) Never clean your plate. Always leave a little of each portion on the plate or in the glass or cup. Forget about the starving children in the Sudan; your eating won’t put muscles onto their bones, only fat on top of your fat.
5) When you’ve finished your feeding-behavior, having left something of everything still on your plate, don’t nibble at that which remains. In fact, render the leavings unappetizing. How? Simply pour a little water or vinegar onto everything; pepper on ice-cream also is quite effective. Truly, others may look with surprise, even shock, at your action; but, once you’ve explained the rationale, they usually respond with approval if not admiration.
Measurement: Immediately after arising and urinating each morning, weigh yourself naked on the same scale, if possible; then record your weight to the nearest, higher, full pound.

Are there other procedures that you can employ? Surely, but if you

Are there other procedures that you can employ? Surely, but if you employ only these five, you’ll be doing more than probably anyone else around you.

“Wait a minute!” those of you still remaining with the program may exclaim. “Easy to say . . . difficult to do.”

Actually, not so difficult. When faced with the immediate reward of a luscious piece of yummy-yummy or another glass of what-the-heck . . . Stop! Think! Inhale! Before filling your mouth, just say the following silently to yourself: “Tomorrow morning, I’ll be facing a delayed punisher even worse than the indigestion that I’ll be facing tonight . . . the scale!”

An old saying goes, “Eat, drink, and be merry for tomorrow you may die.” Absolutely, but, whilst doing so, you also might remember a single word, “Moderation.”

So, Happy Thanksgiving to us Americans. Happy Chanukah to Jews. Merry Christmas to Christians. Happy, healthy, prosperous, and peaceful new year to everyone of good will everywhere.

Ah yes, one more thought. Never mind! My nose detects that supper’s ready, and, to paraphrase Will Rogers, I rarely met a meal that I didn’t like . . . or didn’t eat.

*Thanksgiving: No, Virginia, Thanksgiving was not a day dedicated to feasting. Quite the opposite! Officially, it was a day that President Abraham Lincoln in 1863 declared to be a day of prayer.

Tellingly, within the President’s brief proclamation were the following words: “I do therefore invite my fellow citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens.”

A day of prayer, is it? Hmm, an interesting conundrum for atheists. To whom or what to give thanks on Thanksgiving? The turkey?

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