Losing Lostness

lostNot my home
   Exiled here
Pulled upward
   Pulled down
Walking in light
   Surrounded by dark
Against the flow
   Buffeting self
Put together again
   Frustrated into brokeness
Loved before born
   Away from completeness
One heart with you
   Heart bursting into you
Angels fly, stars collide
   Take me away from here
Falling into you
   Clinging but letting go
In safe arms
   Feeling them more
Life everlasting awaits
   Fear of death gone
Royal garments
   Dirty rags removed
Heavenly manna
   Feed me yourself
All of you
   Nothing of me

Major Lab Companies Fleecing Patients

vacutainerIt used to be that when one would go to a physician’s office, the greatest cost was paying for the visit itself. Nowadays, that cost is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help us through the un-Affordable Care Act. In the last few years, add the cost of laboratory testing to that list.

Most people can remember the days when lab testing was done in the physician’s office and the billing for it was reasonable in most instances. If a physician had prices that got too high, patients could choose to go elsewhere. Competition would take care of any price gouging problem with no government intervention was needed. How all of this morphed into the current problem started with the introduction of CLIA laws which were intended to improve laboratory standards and were generally well intentioned, but have increased costs. After CLIA laws went into place, many physicians stopped offering in-house lab work, but there were still many continuing to operate labs in their practices. It was then decided later by Medicare that if a patient had lab testing done which was not approved as “medically necessary” (that means they don’t want to pay for it, not that it isn’t necessary), the patient was not responsible for it and they could not be billed for it. After several years of that, the last nail was driven into the coffin of most physician office labs. While the physician labs were declining in numbers, the large reference lab companies were growing in leaps and bounds. Eventually, most lab work was being done by these lab companies and still is. Then, Medicare decided to change the rules again in allowing that patients could now be billed for any lab work that Medicare didn’t approve. Whereas before in the physician office, a much lower price, or even a negotiated amount, could have been charged for a non-approved lab test, now there is hardly an option as larger and larger lab companies have made it difficult for patients and physicians to avoid these companies and their policies.

For one example, patients are restricted in how many lipid profiles that they can have performed within a year, but if there are complications with adjustments to medications being required, then the rechecking may not be approved. It is certainly necessary to know how a medication is working or not. A lipid profile is reimbursed by Medicare at just under nineteen dollars, but if Medicare denies it, these companies are sending bills to patients for over one hundred dollars. If one could make over 500% more money instead of the usual payment, it is not a stretch to think that these companies would not have as much interest in trying to help patients get their lab work covered through Medicare. Medicare has went from one extreme to another and patients are being put into financial jeopardy. A common sense solution is for anyone performing lab tests to be able to charge the patient what they would have gotten from Medicare had it been approved, but allowing over five times as much to be charged is allowing inflated pricing to occur.

Upon learning about what these reference lab companies are being allowed to do, I contacted via telephone one of Congressman Gregg Harper’s (R-MS) offices and discussed my concerns with one of his staff members. I had thought that there would be interest in protecting people from being charged such outrageous prices for inexpensive lab work. However, I was accused of not being a “capitalist” and questioned about how could I possibly “desire for (them) to tell these lab companies what (they) can charge”. I was stunned at such indifference and at being made to feel as though I was out of the mainstream, maybe even not American in my thought, according to their viewpoint. I replied to them Medicare, which is regulated by Congress, certainly did not mind telling physicians what we can charge and restrict us all so severely that hospitals and clinics are having trouble making ends meet now. If it is good enough for the doctors, hospitals, and other health care suppliers and workers, why should these large reference lab companies be exempted from price regulation? I could not get an answer to that question and was left frustrated that this is apparently okay with Congress while patients are being fleeced. Just as Congress is allowing this to occur, they can also decide to not allow it to occur. Concerned citizens should contact their U.S. Representative and U.S. Senator and let them know that they should reign in this unnecessary extra expense being placed on the backs of those who are already overloaded.

The President’s Martyr Complex

martyrWhile President Obama is adept at portraying himself in a way to give the appearance of a victim and has been suggested by Dr. Keith Ablow ((Is Obama locked in a victim mentality?, http://www.foxnews.com/opinion/2013/10/10/is-obama-locked-in-victim-mentality/) to have a victim mentality, his behavior points to something deeper than that. President Obama seeks martyrdom status. Victims and martyrs have different characteristics and these need to be explored to find some answers which would explain the actions of a president who some believe is just making poor choices or is incapable of leading. It is much deeper than that and it could very well be that he is following his plan of action exactly to achieve not what the great majority of Americans want to see happen, but what his martyr mindset compels him to seek.

People who are victimized typically try to remove themselves from the presence of those whom they perceive as being their enemies, but martyrs choose to remain in their situation to achieve a goal they have set for themselves, or that was set for them by someone else. Martyrs use obstinate behavior to belittle their enemies and constantly report about how they are being treated rather than seeking to focus on their own actions which contribute to the problems of which they complain. This is in contrast to victims who do not want to stay in their situation, but try to leave it while not wanting to continually dwell on their past circumstances. Martyrs use their circumstances that they enable to remain the same, or even worsen, so that they can build up supporters for their cause; they will create a crisis and then have a self-fulfilling prophecy that they were meant to suffer persecution at the hands of those whom they want to portray as their enemy. When more people are in disagreement with them, it doesn’t affect them as much because they are convinced of their own righteousness and that they know what is best in spite of any evidence to the contrary. Actually, with more and more people in opposition, instead of questioning their own behavior, they resort to thinking that they are just in a smaller minority of people who fully understand what is needed to be done—it will reinforce them rather than destabilize them.

Through examination of the person with a martyr complex, many times it will found that there were too many responsibilities placed upon them when very young, such as with one absent parent and the other parent over-burdened. With the child being placed in a position to have to sacrifice their own childhood, they usually start acting like a responsible adult – on the surface. It is reinforced to them that they exist to cater to the needs of others and repress their own needs. Because of love and attention being given for suffering, they feel that they can receive love only through suffering in some way while trying to be a savior to others. Love was not provided to them in a manner that was best for them to learn what it really is so they are actually seeking to feel loved through their behavior and cannot understand when their efforts repel others because they feel they know best what others need. Interestingly, for those who do behave as adults with them and are able to see past the exterior facade, the person with this martyr complex will actually become like a child and seek to receive love and guidance from them.

A martyr complex is commonly associated with those who practice asceticism which is common to many different religions, including Christianity. However, in the case of President Obama, there is no evidence of a life of abstinence from worldly pleasures for gaining spiritual benefit. The seeking of suffering and persecution by those who have a martyr complex apart from religious reasons is not for the benefit of others, but to fulfill a psychological need for it themselves with the result being the emotional manipulation of others they seek to control. When they cannot achieve the result they desire, it is never understood other than as being someone’s fault with their own behavior being beyond criticism to themselves. When others are not impressed with their victim-seeking role, they resort to passive-aggressive strategies such as nagging, complaining, whining, and behind the scenes sabotage to achieve their goals and then appear as the savior to others. When that doesn’t work, actively aggressive tactics will then emerge. For their suffering, they seek a reward for it. Providing it to them only enables them to stay like they are and reinforces that pattern of behavior.

The current border crisis has provided yet another opportunity for President Obama to attempt to strike out on his own while not allowing solutions for this manufactured crisis. Consistent with his martyr complex, he will predictably not allow for any solutions other than ones he devises and implements, in spite of warnings not to do so, to intentionally provoke more calls for his impeachment. If his actions do not result in him being able to appear to his faithful followers as being persecuted so that they would rally to his support, then his actions are going to get even more bold and provocative in nature. These are not the actions of a victim mentality, but of someone with martyr complex. Understanding this is a key to other leaders being able to understand how to be able to more effectively govern in conjunction with someone of this mindset, which will be fraught with difficulties even in the best circumstances.

The Steps to Nowhere


The Steps to Nowhere


I pass by those steps every day.

Sometimes more than once.

Up to step three and then nothing.


Why are they there?

Maybe a reminder to someone?

A sign of what used to be, or could be?


Those concrete steps sit there alone.

Just a few weeds on their sides.

Up to step three and then nothing.


A child’s playhouse, a tool shed?

A small roadside store long ago?

Maybe a small home for a young couple?


Worn and rough with small rocks you see.

Refined and smooth edges gone away.

Up to step three and then nothing.


Possibly what is left of something that burned?

A glimpse of the what remains to remind them of the past.

Or maybe, could they be steps to the future?


A beautiful field with flowers and trees.

A picture of beauty is behind those steps.

Up to step three and then something.


Those steps almost call out for someone to use them.

For someone to see them for more than they appear.

Driving at a slower pace to get a glance.


They draw you to them and make you curious.

Maybe I’ll stop and take a look.

Up to step three and then something.


A very visible path led the way.

Up to step one. Don’t worry what others think.

Stepping on the first one and everything grew brighter.


Then, two and three were like I didn’t take them myself.

What was not visible before now sprawled out before me.

Up to step three and then everything.


By David P. Smith, MD

Mississippi Sudafed Law May Be Short-Sighted

The State of Mississippi passed a law in 2010 which banned sales of pseudoephedrine without a prescription. The law has resulted in a dramatic improvement in which 698 total methamphetamine (meth) incidents with 314 operational labs were identified in 2010 while there were 119 incidents with only 8 labs in 2013. Other states such as Tennessee are considering similar laws and Oregon already has a law in place as restrictive as the Mississippi law. In Tennessee, there has been a product tracking program which restricts sales, but has not resulted in a decline in the number of meth lab incidents. These statistics make it clear that banning sale of pseudoephedrine without a prescription has stopped a large number of the producers from operating within the state with precursors obtained in the state.

Along with the numbers of incidents and labs decreasing, usage has decreased. According to the Center for Disease Control’s Youth Risk Behavior Surveillance System, among Mississippi 9th through 12th grade students, usage dropped from 6.3% in 1999 to 3% in 2011. Usage of certain drugs is well known to follow trends and there was already a decline is usage occurring even prior to Mississippi’s law being enacted. Educational programs have attempted to teach youth about the dangers of meth usage and this has helped to have a positive effect along with the law changes. The United States Government Accountability Office (GAO) reported that the number of homes with drugs where Mississippi children were present fell by 81 percent after the Mississippi law took effect.

This all looks great, however, the current improvements may only be temporary. Oregon has had a law similar to Mississippi’s since 2006 and then saw arrest rates related to methamphetamine increase by 36 % from 2009 to 2012. The Tupelo Daily Journal reported that there had been an increase in the number of meth arrests in 2013. While local meth labs have declined in Mississippi since 2010, in Alabama, they saw a decline in the rate of meth labs in 2011 and have only a tracking program in place. Therefore, the picture is not completely clear how effective the law will be in the long term.

Initial declines in meth incidents may result from product being initially unavailable until drug trafficking can bring it back into the state through other means. The primary supply (80%) of meth now comes from Mexico, according to the U.S. Drug Enforcement Administration. Mexican drug cartels are now replacing the small in-state producers. Coastal areas of Mississippi have had an increase in local production. In Hinds County, MS, nearly ten kilograms of meth was found during an arrest valued at $1.3 million; it originated in Mexico. It has taken time for these drug cartels to get their distribution linkage of small groups together so that they provide for the demand that will increase if the supply is here available and they would not be supplying it if it were not being used. The Mississippi Bureau of Narcotics has had to shift its focus from the local small suppliers to having to track the drug cartels which are fewer in number, but have the potential to supply even more meth than what used to be available. While a home lab can produce a few ounces of meth, these Mexican “super labs” can produce a reported ten pounds of “ice” daily, according to a GAO report to Congress. Also, the homemade meth is only half as potent and dingy colored compared to the crystalline appearing ice which is said to look like rock candy.

With the passage of more time, it will be more clear if Mississippi’s law will continue to have the effect that was intended. While the users of meth now are getting greater access to more potent forms of the drug, Mississippi consumers are still frustrated with not being able to treat their colds without greater expense and inconvenience which results in lost productivity at home and in the workplace. Those leaders, such as State Senator Chris McDaniel (currently running for the seat held by Thad Cochran), who urged caution and voted against the more restrictive laws in Mississippi, already look much more intelligent than they used to appear to the more short-sighted among us.

KKK Monument Next to MLK’s ?

The Satanic Temple, a group represented by the ACLU, wants to place on the Statehouse lawn in Oklahoma City a bronze monument featuring Baphomet, a symbol of The Church of Satan. The Satanic Temple group doesn’t like it that, on the Oklahoma Statehouse lawn, there is a monument of the Ten Commandments so they want to put their monument right next to it. Oklahoma Governor Mary Fallin’s spokesman, Alex Weintz, told Fox News, “There will never be a satanic monument on the grounds of the Oklahoma State Capitol and the suggestion that there might be is absurd.” As might be anticipated, the courts will have to weigh in on this matter along with all of the other attacks from the emboldened people of recent years who do not like hearing or seeing anything regarding God.

Lucien Graves, spokesman for the Satanic Temple, stated that they were “really coming along fast” and had raised $20,000 for this project. Baphomet has features including the head of a goat, two angelic wings, a raised right arm and left arm down symbolizing the Hierophant (as if to bless, with two fingers pointing skyward and two pointing down as if to form a bridge between Heaven and Earth), and hooves sticking out below its robe. Baphomet is thought to be a demon and was first named in writings dating back to 1098, but also which for several hundred years, at least, represents Satan.

The monument has a pentagram in the background and two smiling children in the foreground standing and looking up to Baphomet. Also visible on the figure of their monument is a caduceus in the place of phallus emerging from under the robe, which is right in front of the two standing children. The robed figure, however, has hidden other features of Baphomet which represent male and female, including female breasts; if that had been featured on this statue it would have been even more shocking. Even with this ghastly symbolism, this monument is designed to give the appearance of Baphomet being admired and revered by these children. Just as the deceiving robe allows for hiding some of the shocking features of this demon, the monument is deceptive also with the blatant usage of children. If The Satanic Temple wanted to be truthful about Satanists, they should have placed an altar in front of the demon to symbolize their ritualistic sexual abuse, torture, and murder of children as sacrifices.

The Oklahoma chapter of the ACLU has already filed suit against the state for placing the Ten Commandments monument and thinks there should be no monuments to anything religious on state property. Quoted on FoxNews.com, Brady Henderson, Oklahoma ACLU’s legal director, stated, “We don’t think the state should place religious artifacts on state property unless the people of the entire state agree with its message. One of the concerns is that even if you allow all faiths to place something in a public area, it quickly becomes a farce.” He pointed out that when Florida recently allowed for other religious expression near a manger scene, “What happened is that you had someone placing a festivus pole made out of beer cans and one group placing a pile of spaghetti on top of a chair. So these types of things do nothing to uplift people’s faiths and beliefs. There’s nothing served by belittling them.” What Mr. Henderson should consider is the federal holiday of Christmas is about the birth of Jesus Christ and it is not about anything else. Even considering allowing the side show like happened in Florida is ludicrous. Allowing a manger scene, which depicts what the Christmas holiday actually represents, to be shared by other unrelated displays makes no logical sense.

The Ten Commandments is a logical display to be on the lawn of Oklahoma Statehouse and other displays should not be allowed. This monument does not represent the establishment of a state religion any more than it does above the east entrance to the Supreme Court building in Washington, D.C.; Moses is sculpted there along with two tablets, inspired by the Ten Commandments. The Oklahoma Statehouse is displaying the truth about our laws being based upon Judeo-Christian concepts; no knowledgeable person can deny that fact.

Putting a monument depicting a demon next to the Ten Commandments is just another move by those who do not want to acknowledge God, or hate God. If their illogical approach to trying to get this monument placed succeeds, then the ACLU may want to also consider filing suit in Washington, D.C., regarding the monument of Martin Luther King, who was a Christian preacher. If a group wanted the right to have a monument extolling the Ku Klux Klan next the Martin Luther King statue, because they objected to King’s representing Christian faith, then they could use this same approach. Most would recognize such a blatant and disrespectful attempt for what it was and not for what it claimed to be. It should be the same for the Oklahoma Statehouse Ten Commandments monument. Of America’s fifty -five founders of the Constitution, fifty-two were members of established orthodox churches in the colonies. The chaplaincy of the U.S. Senate has been in place since 1789. There are Bible verses etched in stone on buildings and monuments all over our nation’s capital. It is truly a very significant part of our history; can the adherents of Satanism claim the same? I think not. Atheists and Satanists need to get over it – there was a very strong influence of the Ten Commandments upon our nation’s founding fathers, and the laws and institutions they founded, from the start and this display simply acknowledges that fact.

Return to the Asclepeia: A Physician’s Enduring Obligation to Patients

ImageThe straining loads being placed upon the backs of physicians are immense these days. We are being squeezed by hospital administrators, insurance companies, patients, and, for those in the shrinking numbers of private practitioners, add in all of those overhead costs that are onerous. It would be easy if we could just take care of the patient the way we were trained, and everyone else would help us to accomplish that worthy goal. However, the reality is that we have a multitude of non-health professionals, who believe they know what patients need, constantly not just suggesting to us what we should do, but outright now dictating how it should be done. I do not need to list the multitude of ways that this is occurring. All of us are very familiar with these stresses from the impossible task of pleasing everyone at once, although I think most of us do attempt to do so, especially for those of us who view ourselves as more than just “providers.”

There are huge financial pressures upon our hospitals right now, and physicians are being asked to be increasingly efficient to the point that the only person who could do it any better is God Himself. Governmental programs are notorious for one-size-fits-all approaches which do not allow for the individual variation in patient care that individuals who are all made a little differently should be allowed to have provided for them. Not everyone, especially the very elderly, can be discharged safely from a hospital at the prescribed number of days, assuming they even “qualify” for admission past observation.

We have to remember why we decided to practice medicine in the first place and do what is right for the patient whether others, who do not do what we do, understand or not. Of course, we should try to help administrators and bureaucrats to understand why another day is really needed before someone can go home, but in the end we have to do, and should only do, what we truly know is right for the patient. A good question to ask yourself might be what would you do if this patient were your parent, or maybe even better, what would you do for yourself?

In the waiting room of my clinic, I have hanging the framed copy of the Hippocratic Oath which was given to me by MBMC upon graduation from my family medicine residency at UMC. This oath calls us to a higher calling in the practice of our profession which cannot be allowed to transform us into cook-book technicians. Looking back in history around the time of Hippocrates, we also find another symbol that is commonly used today – the rod of Asclepius. Asclepius (or Asclepios) was the Greek god associated with healing and medicine. During that time, there were places which were called Asclepions which were built for people to visit who were ill. While at these temples, which were run by priests, patients could bathe, meditate, and were encouraged to get plenty of rest and sleep. While sleeping, it was thought that Asclepius and his two daughters, Hygeia and Panacea, would visit which would cure everything. The priest would dress as Asclepius while the Therapeutae entourage would make their rounds in the evenings to care for the patients.

For those who used the asclepeia, an offering, which for the poor was not much while for the rich a more generous contribution would be expected. It is interesting that many of the poor would bring a rooster, which was thought to ward off evil spirits, and sacrifice it to Asclepios hoping for a cure while in the temple. In the early days of medical practice in this country, it was widely practiced that those seeking treatment from a physician would bring a chicken for payment. Observing the way our country is heading presently, those days may not be completely in the past.

While we have greatly advanced modern hospitals, in many ways still though we can find similarities to those asclepeia of thousands of years ago. Let’s keep the modern advancements we have made, but let us also keep in mind the art of the practice of medicine which requires us to do what is right for the proper treatment of the patient first and put what is right for the finances further down on our list of priorities. If we do not do what is right for the patient first, we may find ourselves like Asclepius, who is said in mythology to have been killed by a thunderbolt from Zeus because Asclepius accepted gold for raising Hippolytus from the dead. If we get our eyes focused on the gold instead of on the patient’s best interests, everyone loses. None of us are gods, but patients do generally look to us to have a higher standard for how we lead our lives and practice our profession. Luke 14:11 reads, “For everyone who exalts himself will be humbled, and he who humbles himself will be exalted.” We have a responsibility to stand up for our patients first, and then all of the rest will fall into its proper place.