AAPS News July 2014 – 2 + 2 ≠ 5


Volume 70, no. 7 July 2014

“Do you remember,” [O’Brien] went on, “writing in your diary, ‘Freedom is the freedom to say that two plus two make four’?”
“Yes,” said Winston.
O’Brien held up his left hand, its back toward Winston, with the thumb hidden and the four fingers extended.
“How many fingers am I holding up, Winston?”
“And if the Party says that it is not four but five — then how many?”

George Orwell, 1984

The torturer’s goal was not simply to force Winston to say “five,” but to get him actually to believe it—and to change his belief to “three” if the Party so required.

The objective truth is that two and two always make exactly four, and for every such equality, there is an infinity of inequalities. If [some] inequalities are defined as “disparities,” which are “unfair” (see AAPS News, February 2014 and March 2010), reformers have an unending task to “right” them.

Human beings are often discontented with the natural order and may go to extreme measures to alter it. In the topsy-turvy world of Gilbert and Sullivan, Princess Ida wants to overturn the old order in her all-female academy, but does see where it leads:

The narrow-minded pedant still believes
That two and two make four! Why we can prove, …
That two and two make five or three or seven;
Or five and twenty, if the case demands!
Let all your things misfit, and you yourselves
At inconvenient moments come undone!…
[Let] the bashful button modestly evade
The soft embraces of the button-hole! …
Let old associations all dissolve, …
In other words let Chaos come again!

The Source of Inequality

The obviously unequal distribution of beauty, talent, strength, happiness, health, and wealth was previously accepted as the decree of Fate, Nature, Providence, or Karma. In a special section on “the science of inequality” in the May 23 issue of Science, Adrian Cho explains the most probable distribution of energy in the molecules of a gas: exponential, with many molecules of low energy and a few of high energy. That is the natural inequality arising from entropy. A similar distribution, with some caveats, arguably applies to income and wealth.

But is it fair? While humans, like animals, are born unequal, our ancestors in “our egalitarian Eden,” writes Elizabeth Pennisi, adopted an egalitarian way of life that lasted up until 10,000 years ago. The appearance of storable surpluses was one of the “ancient roots of the 1%,” explains Heather Pringle. This inequality “plagues” economies, writes Cho, and disparities can be deadly, writes Emily Underwood. Leveling income inequality might, some suggest, avert up to 1.5 million deaths annually, worldwide.

The culprit is capitalism: “While emerging economies boom, equality goes bust,” writes Mara Hvistendahl.

‘Le Capital’

Science editors applaud Big Data, with benefits potentially as great as the Human Genome Project. A century of income data and two centuries of wealth data have been compiled, and the Gini inequality coefficient calculated for 117 nations.

French economics superstar Thomas Piketty, author of Amazon number-one best-seller Capital in the Twenty-First Century, has crunched the numbers and revealed that the rate of return on capital (r) is greater than the rate of economic growth (g). “This simple formula (r > g) means that families who own capital tend to acquire more and more wealth,” writes Eliot Marshall.

Piketty concedes that the pattern broke down in the mid-20th century. Thanks to the Great Depression and the destruction wrought by two world wars, we had a “golden era” between 1950 and 1980, “triggering a pause in the concentration of wealth.” But now we have reached an “extreme point” that could lead to “terrifying” disparities that threaten democracy.

Fictional accounts of efforts to level disparities have been terrifying dystopias: for example, Kurt Vonnegut’s “Harrison Bergeron,” in which the hero must carry 300 pounds to compensate for his natural advantages; Facial Justice by L.P. Hartley; and We by Yevgeny Zamyatin, which probably inspired George Orwell and Ayn Rand. In the real world, we have experiments like Cuba and Mao’s China (see p 2).

Piketty’s proposal, greeted by Paul Krugman and other Keynesians with ecstatic applause, calls for punitive taxes on wealth (see John Goodman’s analysis at http://tinyurl.com/mjwjyg5). The tax would have to be global and involve an international banking regime to prevent capital flight (http://tinyurl.com/ml2qtgu).

A utopian state of income and wealth “equality” cannot occur without changing human nature, attempting to wipe out natural differences—and existing institutions that oppose the totalitarian agenda. This includes religion, the family, and what George Bernard Shaw called “middle class morality” (see p 2).

If she carried out her glorious scheme to get all the maidens to abjure tyrannic Man, Ida thought all Posterity would exalt her—save for the question, “How is Posterity to be provided?”

Casualties of the War on Inequality

Starting in 1949, “Mao Zedong waged war on inequality of all kinds. The administration seized property from privileged classes, imprisoned intellectuals, and appointed teams of workers to run universities. The revolution upended the class structure, and the party campaigned against inherited wealth and gender discrimination” (Hvistendahl, op. cit.). The Science article does not mention the tens of millions of casualties, though it does concede that the “leveling” of society concentrated wealth in the hands of the party cadre. Since China’s about-face in the 1980s, the Gini coefficient has leaped from 0.28 to around 0.55, cf. 0.4 for the U.S., where 0 represents perfect equality of incomes, and 1 means a single person holds all the wealth. The government fears a backlash, but “many Chinese view inequality as the price of economic growth and accept it as a ‘fact of life.’”

Another model for total equality is Cuba, which had a higher per-capita income than most of Europe in 1958. Now people eke out life in the ruins, with a maximum wage of $20/month for most jobs (City J, spring 2014).

Piketty’s 700-p tome has no index entry for Cuba or Mao.

Inequalities Absent from Piketty’s Formula

Noneconomists know inequality of outcome by another term: life (Transom 4/23/14).

Inflation benefits owners of assets like art, while struggling families fall farther and farther behind (James Cook).

The strongest statistical correlate for inequality in the U.S. is single-parent families. More than 20% of children raised in single-parent families live in poverty long-term compared with 2% of those raised in two-parent homes (WSJ 4/21/14).

In many nations, massive fortunes accumulate more as a result of thievery and corruption than as a consequence of
capital investment (Atlantic 5/27/14).

In the U.S., states with the most redistributionist policies have the greatest inequality (Moore, Vedder, WSJ 6/5/14).
Great fortunes come from extraordinary technological innovation, such as the microprocessor (Gordon, WSJ 6/5/14).

Cultural Revolution First

The working class failed to rise up and overthrow capitalism. The explanation, according to two of Marx’s disciples, was the immune system—Christianity and Western culture. Georg Lukacs instituted a radical sex education program in Hungarian schools, to promote licentiousness as a way to destroy the family and annihilate the old values. Antonio Gramsci promoted the “long march through the institutions”—arts, schools, media—to subvert traditional values (MIA, March 2014, excerpting Pat Buchanan).
The centerpiece of Kristallnacht in 1938 was the desecration and burning of the Torah all over Germany—part of the Nazi effort to create a new German identity (Commentary, June 2014).

“As Marxist despots from Cuba to Greece have discovered to their huge disappointment, governments can neither create wealth nor effectively redistribute it; they can only expropriate it and watch it dissipate.”
George Gilder

Resolutions, Nominations

To be considered for the annual meeting, resolutions must be submitted in writing by Aug 4. Contact [email protected].

The Nominating Committee submits the following slate:

President-elect: Melinda Woofter, M.D., Granville, OH
Secretary: Charles McDowell, Jr., M.D., Alpharetta, GA
Treasurer: W. Daniel Jordan, M.D., Atlanta, GA

Directors: Claud A. Boyd, Jr., M.D., Augusta, GA; Kenneth Christman, M.D., Dayton, OH; Albert L. Fisher, M.D., Oshkosh, WI; Kenneth S. Jago, M.D., Canton, GA; Stephen L. Piercy, M.D., Fort Dodge, IA; Tamzin Rosenwasser, M.D., Venice, FL; and James H. Vernier, M.D., Hampshire, TN.

Not the Same

“Gender equity” or “addressing gender disparity” is a prime objective of ObamaCare. The contraception/abortion mandate, states the National Center for Public Policy Research, is “about promoting the economic and social power of women relative to that of men” (http://tinyurl.com/pll68hg). It enables women, like men, to have sex without having a baby.

Though one may question the assertion that same-sex attractions are genetic and hence unalterable, sex is indisputably genetic. Differences between men and women are profound—though researchers have been warned not to study them, lest they “kill their career.” Male and female brains are organized differently, and there are large differences in behavior with only 10% overlap in the distributions. There are even sex-specific patterns in the expression of immune-system-related genes (Larry Cahill, Dana Foundation 4/1/14).

The Y chromosome is not just a male-determining switch: “It has an impact on gene regulation across the genome in males, potentially influencing biological functions throughout life and in every tissue” (Clark AG, Nature 2014;508:463-465).

Yet “sex change” (or “gender reassignment”) surgery is claimed by some as a right (see p 3). Facebook introduced a drop-down menu with 56 gender-identity choices (Townhall.com 3/4/14). In other words, Chaos.

“The deconstruction of gender implies nothing less than the splitting of the personal atom: social nuclear fission.”

An article on “Same-Sex Marriage—a Prescription for Better Health” now comes from the University if Minnesota (NEJM 4/10/14). Chicago public school kindergarten teachers are required to devote 30 minutes/month to sex education. About one-third of the U.S. population, and one-fourth of teenage girls, has at least one sexually transmitted disease. The marriage rate (6.8/1,000/y) is at an all-time low (MIA, June 2014).

AAPS Calendar

Sept. 4-6. 71st annual meeting, Charleston, SC.


Invite colleagues and students (scholarships available!) to our annual meeting. Post flyers—extras available from [email protected], or (800) 635-1196.

A Right to Sex?

President Obama is preparing to sign an executive order adding homosexuality and transgender status to the protected class of employees of federal contractors. This would codify, for such businesses, the Employment Non-Discrimination Act (ENDA), which passed the Senate but not the House. The Republican Party has officially withdrawn from the culture war, despite the fact that such special “rights” subtract from the right to freedom of speech, religion, and association. ENDA, warns the Heritage Foundation, “treats moral convictions as if they were bigotry” (LifeSiteNews 6/17/14).

The Office of Personnel Management has lifted the ban on coverage of “sex change” procedures for federal employees. Federal employers who do not provide this coverage may face legal action, despite the OPM policy that allows them to choose, warns the National Center for Transgender Equality. The National Gay and Lesbian Task Force commended the Obama Administration for being on the “right side of history,” and looks forward to “the day when every health insurance plan in America is affirmatively required to offer the full range of medical care that transgender people need” (http://tinyurl.com/obc9gkm).

OPM states that “transsexual surgery is safe and effective and not experimental.” Dr. Paul McHugh, former chief psychiatrist at Johns Hopkins, said its advocates were “collaborating with madness rather than trying to study, cure, and ultimately prevent it” (ibid.). He cited a 20-fold increase in mortality from suicide in transgendered individuals 10 years after surgery (WSJ 6/13/14).

In response to a lawsuit filed by a 74-year-old Army veteran, Medicare’s 33-year ban on coverage of “sex change” surgery has been lifted. The American Medical Association and the American Psychological Association now consider this a “safe option.” Other insurers are likely to follow suit (Washington Post 5/30/14).

New Jersey and California ban “reparative” or “conversion” therapy to deal with unwanted same-sex attractions for minors, and other states are considering similar laws. The American Psychological Association claims that such counseling could do serious harm, but the Texas Republican Party passed a platform plank endorsing it (CNN 6/8/14).

As of Jun 15, all State churches in Denmark must perform same-sex weddings in their sanctuary. If a particular clergyman refuses, the church must arrange a replacement.

“Absolute equality is absolute despotism,” comments Theodore Shoebat of Rescue Christians.

Death: the Ultimate Equalizer

The right (soon to be duty?) to euthanasia marches on.

In Belgium, euthanasia has been legal since 2002. One 44-year-old was euthanized because of disgust over the results of a female-to-male “sex change” operation. Four patients (three disabled and one mentally ill) had their lungs harvested for transplant after euthanasia (Wesley Smith, http://tinyurl.com/ly6aqa8). On Feb 14, the Belgian parliament extended the law to children (JAMA 5/21/14). Euthanasia is also legal in the Netherlands and Luxembourg, and assisted suicide is legal in Switzerland.

Quebec became the first Canadian province to legalize euthanasia by intentional lethal injection (LifeSiteNews 6/5/14). Patients have a positive right to be killed by the doctor of their choice—or his supervisor must find a substitute (Smith, http://tinyurl.com/m5v8y4b). In the U.S., bioethicists suggest, according to Smith, that hospitals and nursing homes should be “legally required to starve patients who can eat and drink, if they have serious dementia and have ordered their starvation death in an advance medical directive.” This is called VSED or “voluntary stopping eating and drinking” (Bobby Schindler, LifeNews.com 6/11/14).

British doctors are said to be killing terminally sick children by secretly giving them a deadly overdose (ibid.). In the UK, general practitioners are reportedly paid £50 to put elderly patients on a death list (MailOnline 10/19/13).

Physicians’ freedom of conscience is under attack. Carolyn McLeod, currently teaching ethics at the University of Toronto, believes it would be wrong to think that doctors “do not have to check their morals at the door” because “there are times when physicians have to do just that”—as with prescribing birth control or referring for abortion (LifeSiteNews.com 6/12/14). Poland’s prime minister, Donald Tusk, has said that doctors must perform legal abortions despite moral objections (LifeSiteNews.com 6/12/14).

International treaties on “human rights” are likely to codify the belief that “the right to health requires that governments meet ‘minimum core obligations,’ including the provision of health…services without discrimination and distributed equitably” (Lawrence O. Gostin and Devi Sridhar, NEJM 5/1/14).

Tip of the Month: An audit of the North Carolina Physicians Health Program by an independent state agency found that there was no reasonable assurance that physicians would receive an objective evaluation without undue burden or that abuse of authority would be prevented or detected in a timely manner if it did occur. There were no due process procedures for physicians who disputed the evaluation, and no adequate oversight.

Physicians who have been obliged to attend a “disruptive physician” treatment center are asked to call the AAPS Sham Peer Review Hotline, (716) 627-7759, for a debriefing. This will help us collect information on what goes on at these centers. If you are heading for such a center, please call to learn what you might expect to experience there. Members returning from a 4-day evaluation report that this information was very helpful.


On the first Feminian Sandstones we were promised the Fuller Life
(Which started by loving our neighbour and ended by loving his wife)
Till our women had no more children and the men lost reason and faith,
And the Gods of the Copybook Headings said: “The Wages of Sin is Death.”

Rudyard Kipling, The Gods of the Copybook Headings, 1919

“We have now sunk to a depth at which the restatement of the obvious is the first duty of intelligent men. It is not merely that at present the rule of naked force obtains almost everywhere. Probably that has always been the case. Where this age differs from those immediately preceding it is that a liberal intelligentsia is lacking. Bully-worship, under various disguises, has become a universal religion, and such truisms as that a machine-gun is still a machine-gun even when a ‘good’ man is squeezing the trigger…have turned into heresies which it is actually becoming dangerous to utter.”
George Orwell, 1939


Common Core and Opting Out. A number of schools in the Buffalo area have adopted a formal “Sit and Stare” policy for students who have opted out of Common Core testing. Students who refuse to take the Common Core tests are forced to sit at their desks for 2–3 hours and stare. They are not even allowed to read (Buffalo News 3/17/14). Are public school officials afraid that students might learn something that contradicts what is being taught? Perhaps Sit and Stare is an intentional “educational” goal. Some mothers tell their children that if they cross their eyes long enough, they might get stuck. If a student sits and stares for 2–3 hours at a time, perhaps his brain might get stuck. Perhaps that is the goal—if socialism is to thrive in our country, it is essential that the education system produce generations of “stuck brains.”

Many independent physicians who have opted out of Medicare, and who refuse to enroll in the government’s “common core” program known as PECOS, are also being forced to “sit and stare,” as they are not allowed to refer Medicare patients for services. As the government seems to be actively implementing such policies, both in education and medicine, I think it is time we demand a new ICD-10 code for “stuck brain syndrome.”
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

Ellsworth Toohey Lives. In Ayn Rand’s novel The Fountainhead, Ellsworth Toohey, looking at the night lights of New York City, notes that without the spirit of perhaps a dozen men, this splendid achievement—“which we can neither equal nor keep”—would not have been possible. Calling himself a humanitarian, he says that “a cave by an oozing swamp and a fire of sticks rubbed together are preferable to skyscrapers and neon lights—if the cave and the sticks are the limit of our own creative capabilities.”

I thought that this attitude, that we should tear down the successful just because they are successful, had become disreputable. But look at the Left’s near ecstatic response to Piketty’s book.
John Goodman, Ph.D.

Negative “Growth.” A Wall Street Journal headline said that the “U.S. GDP Contracted at 1% pace in First Quarter.” Only a Ph.D. economist could be so addled as to believe that government spending (see http://www.usgovernmentspending.com)—which now stands at more than 35% of GDP—is part of the productive output of a nation. If this were true, the government could print $14 trillion and spend it digging and filling holes, then announce that “Gross Domestic Product Doubles.” Subtract government deficit spending from GDP to see where the economy really is.
Craig Cantoni, Scottsdale, AZ

From Letter to Aetna, Terminating Agreement. I will not allow Aetna to sell the promise of my services on the Federal exchange…, because I refuse to enable the blatant discrimination against certain individuals…created by Aetna’s decision to collude with big government. One group of your customers (my patients) [is] offered only policies with benefits…they do not want or need and with new usurious premiums and deductibles while another group…remains free to purchase policies with more desirable terms and benefits with lower premiums and deductibles. [The latter group has received] delay or exemption from the iniquities of Obamacare [and is] free to choose policies of a more Hippocratic, individualized, patient-centered nature….
Kristin S. Held, M.D., San Antonio, TX

Blue ObamaCare. I have had two patients present to my office seeking services who were not informed by Blue Cross that I am not in the Florida Blue Select ObamaCare plan. To enroll in Blue Select as a doctor is a royal nightmare, taking 6 to 8 months for approval and having to comply with countless regulations. One 54-year-old patient pays $800 per month for her plan and is responsible for 50% of the cost of surgery. Florida Blue will not tell our staff or patients which physicians are participating.
Michael Riesberg, M.D., Pensacola, FL

Evidence-Free Equation: P4P = cost control through quality. Medicare’s flagship pay-for-performance program, the Premier Hospital Quality Incentive Demonstration (HQID), failed to reduce surgical mortality or complications (Ann Surg 2014;259:677-681). This should be the nail in the coffin of the conventional “wisdom” of both political parties brainwashed by two decades of HMO Orwellian sophistry trying to explain its record of poor care (by delay and denial) and promised cost control through rationing of supply, when the problem is politically driven demand.
Robert Geist, M.D., St. Paul, MN

Whose Children? Part II. The government and its ancillaries apparently think they have the power to detain and question your child without parental permission. A new Michigan medical records access law reportedly requires doctors to have a private conversation with minors when parents bring them in for care. A mother reported seeing a notice to this effect when she brought her 17-year-old daughter in for a minor foot injury. Is the private visit for sex education and prescribing contraceptives?

One of the major initiatives of Lenin’s Soviet Union was turning children against their parents. This dovetails well with our situation in which sexuality trumps the right of conscience.
Jim Vanne, Aurora, IL

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