How my midlife crisis got defeated one afternoon

I had been blue for a month. Didn’t know why - well, lots of little stuff, but so what? I’d known that my business sucked - and have wanted out for while. Actually – I had grown to hate it, and dreaded walking into my office each morning. And, well, yeah I’ve been married to my first wife for ten years in a row now - and ole Suzie - well she’s been working in my office full time for the last year - and as much as I should appreciate her help - well, the glow is - tarnished. I’d rather her at home - greeting me with open arms and a warm home, rather than us both tired at the end of the work day - make a cursory dinner - clean up - get the kids to bed – watch the bad news -up for another day - for what I don’t know - other than trying to get the practice in shape so someone would take it, and take over my responsibilities to my patients so I could escape.

Then I got shingles. I’m not supposed to do that. I’m healthy, buff - strong, in great condition - aren’t I? Admittedly I have to baby both shoulders because of rotator cuff problems - but I’ convinced that don’t need surgery on them, and so I have a torn medial meniscus - O.K., O.K. Yeah yeah, I had it checked and was told I wouldn’t be walking in three years without having surgery on it. But if I don’t admit to this stuff and keep it from my wife - and ignore it -- it could go away.

But the shingles are visible and feel like the devil is chomping down on my right nipple with tiny sharp fangs still 3 weeks after the rash has dried up and my thyroid hormone is low and my neutrophil count is 802 and as a doctor I know what that means - I’m healthy like I said before so its probably a lab error (if it isn’t multiple myeloma or some other short form of death) so I put the report on the shelf and promise myself I’ll repeat the labs in three weeks. (I did repeat it. And I promised myself that I would repeat it again in two more weeks - it's sure it be better next time.) In the mean time – if my white count is so low in the middle of the winter sick season –maybe I should avoid my coughing hacking patients - but - that’s why they come to see me, isn’t it.?

And I resent it. And I resent that even more! Damn. I did this small town Peace Corps like doctor thing instead of going for lucrative city practice as a spiritual exercise and damn if right now I don’t resent their self induced diseases, and self abuse, and sense of entitlement, when they cough in my face when my immune system is shot, and I know I’ll never get paid by them, and I resent most of all that my resentment annuls any iota of spiritual growth - negating the general purpose of the entire exercise. In times like these is so much easier to love the downtrodden from a distance.

Its the end of the year, and we worked twice as hard this year. I ran the numbers on the computer. Between my wife and I, we cleared about $42,000 from current operations. What's that? $34K take home, less $8K for health insurance. Then I get the letter form my malpractice insurance carrier. Canceling me and all my colleagues in the state, and by the way, please remit and extra $23,000 to cover the last two years - and good luck finding a new policy – premiums are up to 2 to 3 times if you can find insurance. When I find a policy – the only one available – its $32,000 a year. Wanna buy my practice? Cheap? Don’t tell, but Medicare is lowering their rates which would mean $10,000 less gross proceeds next year. Yeah, I should be able to turn this baby fast.

- so I’m old and sick and bankrupt emotionally, spiritually and soon to be financially. My wife doesn’t look at me any more, we don’t play - we work, and I don’t feel any love.

I was fine with my lot until about two weeks ago, then I had a sense of unease for about a week. Followed by a week of intense - overwhelming feelings of remorse and defeat. I laid awake feeling trapped, and with the deep conviction (out of nowhere) that my life was over. That I had not accomplished much of what I had expected to, and that my time and energy was too limited to expect much of anything more. My hair is thinning, showing gray, the creases aren’t smile lines. I didn’t like or respect the man in the mirror.

I didn’t want to admit this stuff to my wife, or really to anyone. Aren’t I the rock? I needed to talk so I called my big sister - I don’t call her for this stuff - but we have occasional gripe sessions we don’t take too seriously.

She said - You feel your life is over.

“Unhuh” I said.

She said - You feel haven’t gotten to do the things you wanted to.

“Yeap”.

She said - “You feel that you haven’t gotten as much as what you feel you deserve.” “Mmhmm”

She said - “You feel unloved.”

Unhuh.

She said - “You feel jealous of those with hope”.

Damn she’s good!

She said - “Your going through your mid-life crisis. Yeah, Mikes (her husband) been a bear for the last two years - he’s just like that” and she related that my brother who is a year and a half older had been in his for a year and a half.

“Just like clockwork” I said.

She was right - it was so obvious! I had known earlier that day when I started feeling jealous of my seven year old daughter that that was a pathological mindset. Now I hadn’t left my wife for an unsuitable younger woman - Hadn’t bought a bright red ragtop two seater, or a boat. I had made a few “Hail Mary” investments leading up to my mid-life crisis (“if just one of these babies come through - I could do...”. You can guess at how they went).

Yes! I am still a lucky guy. I hadn’t completely screwed up my family yet! And I knew what to do! Repeat the blood work in two weeks and make love to my wife and tell her that I am having my mid-life crisis and I need her to hug me and kiss me and give me googoo eyes - and I didn’t care if it was sincere or if she thought I was nuts or repulsive - I really needed this and it would be of great benefit for both of us. And it was over! Like that. The next day - Shazamm! As soon as I knew what it was - a temporary pathologic delusional state - it was like being told that pathology report for cancer was negative. The worries were gone.

I’m still going to dump my practice as soon as I can - and I will do the things I want to in my life, (which don’t involve convertibles or boats). And as far as an unsuitable younger woman - I married her 10 years ago and there’s no way I’m giving her up.

Epilogue – 5 years later: The pits of my midlife crisis lasted something like 6 days. It took nearly a year to get out – but I donated my practice to a homeless shelter, and took a job as medical director for a technology incubator. I’m still having fun. My wife and I recently celebrated our 15^th anniversary. I run 3 times a week and my knee has not locked up in 5 years – no surgery – just chicken cartilage. My rotator cuffs haven’t hurt either. My white blood cell count, thyroid and cholesterol got better when I got happy and started running. My point is that the Midlife Crisis is a pathologic emotional delusional state, and if you can see it for what it is you don’t need to let I make you miserable or destroy your family. Not everything you emotions tell you is valid.

I did not need a new wife, new toys, and my future was not bleak. I did not have much reason to be jealous of my 7 year old daughter. I didn’t want to continue in a solo practice.

The Midlife Crisis can be useful if you use it to motivate you to make good choices about what you want in your future. If it is expensive toys (cars, boats, women); my best guess is that you are about to make a mistake. If it is sure fire get rich quick schemes; think again. Thomas Edison said that most people miss opportunity because it is usually dressed in overalls and looks like work. If what you what looks like work and your up for it – that may just be what the doctor ordered.

© 2008

What should Biofuel agriculture look like?

Foresight will be required to prevent biofuel agriculture from creating problems as serious as the issue it tries to resolve. It is said that every problem started its life as a solution. Our huge requirements for energy started life as a solutions; transportation, creation of tools, increased agricultural productivity. Thus, biofuel agriculture can create problems larger than the problem it is envisioned to resolve. Competition with food resources, destruction of forests, depletion of the soil, destruction of aquifers, and economic disequilibrium may occur.

Following are a list of criteria for successful long term biofuel production.

Local adaptation: Plants should be selected for the environment where they are to be grown. For dry lands appropriate plants should be selected. Trees may be more appropriate for hilly or dry areas. Wind breaks can be made with biomass tree species, which can help protect the soil and provide shade and habitat.

Perennials: Perennial plants which re-grow from their roots after harvest are advantageous. This avoids damage to the soil, and can actually enrich the soil and take more carbon dioxide out of the air. It saves on cost. Grasses such as switchgrass and miscanthus can be repeatedly harvested. Some fast growing trees may be cut and allowed to regrow either as coppices or as single stem trees. Examples include poplar, willow, alder, and certain acacia trees.

Low irrigation requirements: The large aquifers of our country are being depleted by agriculture. Water shortages have been predicted to be more damaging to our civilization than fuel shortages. It would be a mistake to deplete our reservoir of fresh water to supply fuels. Biofuelstock plants should ideally be adapted to the rainfall patterns of environment were they are grown other than irrigation to get the plants established. In dryland farming use of perennial crops and non-till methods are especially important for retaining moisture in the soil.

Low pesticide requirements: Some plants are more resistant to disease and to insect attack. Biomass plants are less susceptible than seed crops. Disease resistance may be bread into plants, and this is more safely done in biomass plants than in food crops where the resistance to insects may be because of alteration in flavor or toxins in the plant. Native plants are usually more resistant to the insect and diseases found in the native environment. Polyculture usually lowers the requirements for insecticides.

Polyculture: Polyculture is the agricultural practice of using multiple crops in the same space. This is what is found in natural environments. Crop diversity decreases the susceptibility monoculture has to diseases. Even planting several genetically diverse varieties of the same species can have a large benefit. In a study by Youyong Zhu et al, planting a mix of rice varieties was found to give a yield of 89 percent greater than that with single varieties, and that after 2 years use of fungicides could be eliminated when a mix of varieties were. In a study in Minnesota of native grasses a mix of species gave a greater biomass yield than any single species grown in monoculture. When genetically similar plants of a single species are grown together in large areas the risk of destructive insects and for plant diseases is high. Disease can easily spread and find ready hosts, since all the plants are closely related. Insects can resist pesticide if frequently used, and a large enough population of them is present. Agricultural Research Service plant geneticist Michael Casler has spent the over 10 years breeding switchgrass. He believes that this plant’s biofuel future lies in specially designed seed mixtures with beneficial legumes that fix their own nitrogen such as native pure prairie clover and Illinois bundleflower

Polyculture would be difficult for food crops, as different harvest times, and harvesting techniques would be required, and separating the crops would be difficult. This much less of an issue for biomass production. Even if oilseed plants were mixes with cellulose mass plants, separation of seeds or of the oils from the cellulose would not be a technical and may not be an economic problem.

Low fertilizer requirements: With corn a large amount of the fossil fuel investment is the natural gas used to make fertilizer. Pesticides and insecticides are also made from fossil fuel feed stock. Corn yield increases dramatically with high levels of fertilizer, and this is required for it to be economic. Not all crops require this level of agricultural intensity. Many legumes have root nodules which are able to fix nitrogen from the air, and thus add nitrogen to the soil. Other plants increase the availability of phosphorus in the soil. Perennial plants often had lower fertilization requirements. Polyculture, where more than one plant is grown together may reduce need for fertilizers. Cover crops in the brassica family, such as oilseed (canola) which may be used for biodeisel are deep rooted plants that can help open subsoil hardpan (Schonbeck & Morse 2006). It has been recommended that Vetches, a leguminous plant, perform well over a wide range of soils be planted along with brassica to suppress weed growth. Vetch can fix over 100 pounds of nitrogen per acre and release about half of it to the following cash crop. They also make soil phosphorus more available and provide habitats for beneficial insects.

Low Lignin biomass plants: Lignin in plant growth decreases the ability of current alcohol producing technology to extract energy from plants. Lignin is made up of 5 carbon sugars rather than 6 carbon sugars as cellulose is. Technologies are being developed for utilizing lignin as biofuels stock, but these may have added costs. Paper production also prefers low lignin sources. Low lignin varieties of fast growing trees can be used for biofuels. There are hybrid poplar, aspen, willows, and eucalyptus varieties low in lignin. Low lignin sorghum has also been developed.

Biomass rather than seed crop: With corn it is starch in the seeds which are used to make grain alcohol. The plant itself is usually not used. In Brazil where the alcohol is made from sugar cane the stem of the grass is crushed for the sugary juices in the stem, and the crushed stem is used as fuel for drying the sugar and for generation of electricity as a byproduct. Higher yields can come when the biomass of the plants are used. Even if the crop is an oil producing plant, the rest of the biomass may be harvested for its cellulose content.

High efficiency growth and carbon fixation: C4 photosynthetic plants, such as many grasses, have a more efficient photosynthetic pathway than C3 plants. C4 pants include corn, sorghum, sugar cane and switchgrass. C4 plants have an advantage of better adaptation to heat and drought conditions compared to C3 plants. This does not limit biomass production to C4 plants. A hybrid Larch tree has been developed which can fix 30% more carbon than typical larch trees. High carbon fixing varieties of switchgrass sorghum and eucalyptus have been selected. Cassava has one of the highest rates of CO2 fixation and sucrose synthesis for any C3 plant. Researchers from Ohio State University have recently developed a transgenic cassava with starch yields up 2.6 times higher than normal plants

Low Processing Energy: Corn ethanol has a high processing cost. Seed oils have a much lower cost, as the oil is easily separated and do not require distillation. Ethanol has a high processing cost as separating the alcohol from water is energy intensive. Other biofuels have lower processing costs.

Low transportation cost: Biomass conversion should be decentralized and local for low density products. For example, alcohol production should be decentralized so that the fuel stock does not have to travel far, and the alcohol may be used locally. Butanol can be transported by pipeline, and development of pipeline transportable biofuels is desirable. More energy dense biofuels may be transported further, but local conversion is advantageous. Vegetable oils should be processed local when possible to save on transportation costs. Biomass agriculture will be limited to species which can be processed locally.

Good Field Storage: Sweet sorghum has many advantages for biomass production. One disadvantage is that it has poor field storage properties. When it is ready to harvest, it should be done then, or it begins to loose its sugar content. Switchgrass can be allowed to dry in the field, and this may even lower the transportation and processing cost as it looses excess water. Woody biomass such as low lignin poplar may be harvested when the market is ready, and even after cutting have a good shelf life.

Biodiversity: Corn is a monoculture where huge tracts of land are devoted to a single crop. In test done in Minnesota, mixtures of native field plants gave more biomass than single species of grasses and more than intensively grown corn without use of fertilizer or pesticides. This biodiversity supports wildlife and beneficial insects.

Protection of native species: Plants used for biomass promotion should preferably be native species, or species not likely to become invasive. Plants which require spread by rhizomes, or which are not seed bearing are less likely to become invasive. Chinese tallow tree can give enormous biodiesel yield, but can become easily invasive.

Wildlife and migration corridors and habitat: Long cycle biomass or tree crop biomass can be used as habitat and migration habitat for birds and other species, while monoculture of annuls does this poorly.

Protection of wild lands: Wilderness is a desirable asset to our society. Science has much to learn from the remnants of the great wilderness that made up much of America. Palm Oil plantations in Southeast Asia for biodiesel has caused the destruction of large areas of forests. Destruction of our forests and other wild lands must be avoided in the pursuit of bioenergy.

Soil protection and enhancement: Moldboard plowing turns the soil over and helps eliminate weeds and softens the soil for planting. With repeated plowing however, plowing causes the formation of hardpan. The soil becomes impenetrable to roots and restricts growth and yield. Water trapped above the hardpan can drown crops. Plowing decreases organic matter in the soil and thus decreases the carbon sequestration of the soil leading to increased CO2 content in the atmosphere. Plowing breaks up the root structure and cohesion of the soil increasing soil erosion. Plowing compacts the soil decreasing air space and restricts root growth. Hardpan and compaction increase runoff, flooding and depletion of groundwater. Methods with limited or no tillage can protect the soil from erosion.

Some species will break up hardpan soils and some will increase the availability of minerals. Some mesquite species will tolerate high salt content in soils and actually remove salts from the soil. Biomass species can be used to rest and repair soils. This may be done as crop rotation.

Does not replace food production: Biofuels should not compete with food production. If done correctly, biofuel production should complement food agriculture. Some biofuel byproducts may be used as animal feed and replace feed which is currently grown.

Supports Beneficial Insects: Honey bees pollinate one third of all U.S. Crops. We have become dependent on one species, which acts as migrant laborers with hives moving farm to farm. Meanwhile faming practices continue to destroy colonies of native bees because of use of pesticides and plowing which destroys hives of native bees which nest in the earth. Monoculture robs them of a succession of flowering plants throughout the season on which they can forage. Insecticides are fairly indiscriminant and kill beneficial as well as harmful insects. Planting strips of clover between rows of cotton has been shown to increase yield and support songbirds and beneficial insects.

Sustainability: The great hardwood forest of the Ohio Valley were the worlds largest temperate hardwood forest. It took less than 50 years of charcoal making for steel production to destroy these forest. I took tens of millions of years to create the planets petroleum reserves. In a span of less than 50 years over half of the world’s oil reserves have been depleted. In less than 50 years of farming 625,000 square miles of grasslands were turned into the Dust Bowl of the 1930’s which displaces 2.5 million people, teaching us how easily soil and water are depleted. Biomass production should be geared towards improving these limited resources. Agricultural mining will undermine the long term viability of biomass and food production. Fossil aquifers, such as the Ogallala aquifer in the U.S., are not renewable resources should not be used for production of biofuels. In parts of Texas, Oklahoma and Kansas the aquifers have fallen 30 meters. China is quickly depleting its ground water with large aquifers falling as much as 3 to 6 meters a year, and China's fall in grain production of over 20% over the last years has been blamed in part on this. Unsustainable depletion of water resources will only make for another crisis.

Limited Subsidies: Biofuel Agriculture should be left to stand on it own in a level playing field, or else external forces will shape it rather than the economics of it on its own. If solar photovoltaics are economically more efficient, the market should decide on the winner, not politics. Subsidies should only occur to get the process started, with any subsidies limited to assuring that biofuel production is environmentally sustainable, or as seed money to prove the required technologies. Of course subsidies for oil and nuclear also need to be eliminated to attain a level playing field.

© 2007

Corn Ethanol is No Solution

We need to move away from our massive consumption of fossil fuels, and from petroleum in particular. The pollution it creates endangers our survival. Oil dependence weakens the economy of the United States and maintains our embroilment in the Middle East. The high prices empower the leaders of Russia, Chad, Iran and Venezuela. The petroleum status quo is not good for America.

There is a lot of talk about corn alcohol as a solution to our crisis.

Corn ethanol is a very flawed product. It in not a green product, as it adds pollution which worsens the climate crisis. The fossil fuels required to create corn ethanol – natural gas to make fertilizers, diesel for the tractors, and coal for electricity to distill it consume about as much energy as it produces. The main economic advantage is that (cheap and dirty coal) electric energy is turned into liquid energy for transportation.

If corn ethanol renders more energy than it takes to produce it, the gain is marginal, and most equations do not factor in the energy cost for producing the farm equipment, the distillation equipment and the transportation equipment. As for greenhouse gas pollution, corn ethanol is barely better than gasoline.

If the environmental costs; the soil degradation and compaction, the effects of pesticides, herbicides, fertilizers, are considered, there is a net loss. If lost opportunity cost from the diversion of food to fuel, and the increase cost of those commodities are considered, it again is a loss to the overall economy. If the impact on increase food and feeds costs is factored in, it is a sizable negative for our society.

Thus, corn ethanol is a defective solution to our energy needs, to the environment and to the economy of our nation.

Corn is not the right biomass product for energy production. It requires intensive agricultural practices. It is a monocropped annual which either uses bi-annual tillage resulting soil degradation or uses large amounts herbicides to control weeds. It demands use intensive use of fertilizers and insecticides. It requires high capital investment and maintenance of equipment. It does not produce as much biomass as other biofuel feedstock crops. It is not close to ideal, and is much less productive than other available crops.

Neither is ethanol an ideal biofuel. It does not work well in cold weather, it has a lower energy density than gasoline so cars need to be filled more often, and it is so volatile that considerable amounts are not burned by the vehicle, but rather just add to air pollution. The production of ethanol requires considerable energy in the distillation process because of its high water solubility. Mark Jacobson of Stanford University has determined that ethanol in E85 or flex fuels will increase ozone and acetaldehyde pollution and may increase cancer risk over the use of gasoline.

The main argument for subsidizing ethanol production was to get it kick started. It has been subsidized for about 30 years. If there was truly an economic market for ethanol, it would be easy enough to add the up to 10 percent ethanol (E10) to all U.S. gasoline vehicles can use. This would require no change to infrastructure, and consume about 14 billion gallons of ethanol a year. Certainly this is a sizable market for biofuels that would support farmers would.

Farmers are risk adverse and corn has a commodity market. If farmers grow a crop and there is no market, they may never recover. If an entrepreneur does a startup business and it fails, they can try again or get another job. If a farmer losses the farm, it is unlikely that they will ever get another opportunity. A farmer can grow corn, and be sure that there will be a market for the product, whether it is for ethanol or cornflakes. If switchgrass or sweet sorghum are grown, they may not be able to sell it. Sweet sorghum requires timely processing. If a processor is not ready when the crop is ready, the sugar content begins to fall. Corn can be stored. Until secure and widely available markets for biofuel crops are established – corn is safe for farmers. When the market is secure for biofuelstock, farmers will switch to more productive and profitable alternative crops. Additionally corn is highly subsidized.

A fleet of vehicles is currently on the road that can use E95 . Models of the V6 Ford Taurus have been available which can use E85 since 1994. Several design changes were needed to allow for cars to operate on alcohol fuels. Changes included the block material, exhaust valve seat inserts, wear resistant rings, alcohol-compatible fuel injectors specially designed for high flows, a stainless steel fuel system, and unique engine calibration for ethanol operation. Over 6 million vehicles from Dodge, Ford, and GM have been sold which can use E85 and Flex Fuel Ethanol-Gasoline mixtures and are currently on the road. The auto makers get a huge CAFE standard credit for making these Flex Fuel vehicles. Yet the demand is not there.

If as a nation we want to move to biofuels, cellulose based fuels make much more sense. Ethanol subsidies, gasoline subsidies, and corn subsidies should end. Indirect subsidies such as the cost of guarding the Persian Gulf should be added to the price of gasoline.

Subsidies cause perturbations in the market which support one energy source over another, but let politics rather than economics choose the best solution. Environmental impact taxes such as carbon tax can help move towards solutions which help preserve our environment.

Farmers will begin growing biofuels crops which make economic sense for their climate and soil conditions. Lower intensity farming may make economic sense and be less risky for farmers, while being better for the environment and better for wildlife. Biofuels can be rotation crops which allow the soil to rest and recover.

The risk in choosing the wrong biofuel is the risk of locking ourselves into the wrong infrastructure, which cannot be easily changed when a better technology develops. Ethanol is the wrong biofuel. If we are to go down the ethanol path we must be careful that the ethanol production facilities are designed so that they may be later converted to other products such as butanol or one of many other biofuels being or to be developed. Distribution facilities and auto makers should also keep the future of alternatives to ethanol in view. It is essential for success that biofuel technology be future proofed

The goal is not to preserve an unsustainable culture, but to open doors to new paradigms. We can have clean renewable energy. We can restore our aquifers. We can reforest and return land to grasslands. We can replenish wildlife. We can have energy independence. But none of this will occur on its own. It requires vision.

The short term cross-over argument of using corn ethanol to cellulose alcohol is a good one, except it has had 29 years to happen and hasn't... I'm having a hard time believing it.

© 2007

Rewarding Excellence (or just advantage?)

The State has a large stake in the education of its children and future citizens. The public sector not only funds most primary and secondary education, but is responsible for the outcome. No Child Left Behind (NCLB) was signed into law by President Bush in January of 2002. In Florida his brother and then governor Jeb Bush instituted the A+ Program. Schools are graded and rewarded as an incentive for quality. There are not only carrots for high performing schools, there are also sticks. Schools which fail to make adequate yearly progress are subject to loosing students to charter schools, thus loosing funding, and if they persist in not making the grade, they may loose autonomy and be taken over by private companies. Additionally in Florida, bonus funds go to schools which make better grades on the FCAT test. The FCAT is the Florida Comprehensive Assessment Test, and is similar to test done in other states as part of NCLB.

In order to promote excellence, the State of Florida gives monetary rewards to schools which meet state standards. School scores are publicly available, and parents may use these to select where to live in order to provide the best education for their children. Sadly the system is rigged to fail rural and poor children. Below are the 4^th grade reading FCAT scores from the highest and lowest scoring counties in Florida.

FCAT Scores Match Demographics

Unfortunately, FCAT scores tell much more about the demographics of the children than they do about the quality of the teachers or the school. Maternal educational level is one of the most powerful determinants of a child’s educational success and attainment. FCAT scores tell more about the parents than the teachers or the school.

Below, the red dots shown on the map below show the highest ten counties for fourth grade FCAT reading scores and the green dots the lowest 10 counties. It can be seen that the red dots (high performing) are generally in census tracts with a high percentage of the population with a high school education, bachelors degrees, and in low poverty areas. The counties with the lowest performing schools (green dots) tend to be in areas of the lowest levels of adult education and high poverty areas. It can bee seen that the red dots are mostly in the light blue areas, and the green in the dark blue areas.












A high performing school is more likely a reflection of the parent’s socioeconomic status than it is of the quality of its teachers.

What is the outcome of the current system of reward and punishment?

The Winners

· Wealthy districts (low poverty and higher educated parents) get more funding as high performing schools.

· The community takes pride in those schools

· Property values increase

· Tax base increases – providing more funding

· Teachers and students gain confidence and pride in high performing schools

· The school attracts better students, reinforcing the high performance

· The State gives money where it is needed the least and may not be getting the quality of education it imagines it is. (Thus the winners may be losers.)

· The parent and student may not get the quality education they believe they are. (They become losers too)

The Losers

· Children suffer and are trapped in a cycle of lower education and poverty.

· The State pays more for poorer results.

· Parent are told their children are in a poor educational environment. The parents most concerned about education leave the district

· Property values fall hurting the tax base that pays for education

· Students in poorly performing schools do not take pride in their school or in their education, as they are in a “low quality” school.

· Students believe there school and teachers are of low quality and have low expectations for themselves. They get low test scores and believe they are failures at education and give up

· Teachers in these poorly performing schools become demoralized, and it becomes harder to recruit and maintain motivated teachers.

· The State does interventions to try fix problems, wasting resources.

For a school in a high poverty area to bring those children to near the state average requires doing something that the high performing schools have not been able to do. High performing schools may be not so great, and may perform well mainly because of the student population.

Look at the exceptions.

Calhoun County had excellent scores, but is in a poor county with low educational attainment. Are they doing something right? By stratifying results by demographics, perhaps we can learn what works.

What should be done?

Schools scores should be adjusted for the educational level of the student’s parents or guardians and for their economic level. “Race” based stratification adds little information as presently done. In Florida the children of professionals of Cuban origin are currently considered the same minority (Hispanic) as are the children of Mexican migrant farm workers.

When schools are graded based on the demographics of the children and their parents, we will then have an idea of which schools are doing good and which are failing their students. Then parents will be able to more honestly determine the quality of a school. It will tell the state, the school and parents if the school is doing a good job in educating its students.

Test and torture needs to end.

© 2007

Murderers I Have Known

As a physician, I have met many people and have been privy to details of their lives. I have lived in small towns where there are few secrets and little anonymity. I also worked in a clinic that the sheriff used for the jails residents, and that was sometimes used by a prison up the road.

Perhaps I have not known more murderers than the average American. But maybe I just know it. As I think about different killings that make the news, I think about the lack of public discourse on gun control, or even any discussion as to if handguns provide any personal safety for their owners. That is the argument for having them, isn't it?

“Guns don’t kill people – people do” we have been told over and over again as if that logic should absolve guns from any complicity in those crimes. Perhaps this message is telling us that it is murderers murder people. And although that may seem self evident – it is usually not the case.

Most murderers never murder again. This is not because they are locked away for years until they have repented their evil. Is the nice lady that works in a local office a danger to society? – she shot and killed her husband. Is the geeky computer programmer that worked done the hall from me at the university the department of Medicine dangerous? He would joke about it not being a good idea to get him pissed off. He had shot and killed a man. Neither of these people served any time.

Actually it is fairly rare to get shot by a murderer. It turns out that most murders are committed by novices, and that when armed with a tool cleverly designed for the task of homicide, a gun makes it so easy that anyone can do it. Perhaps most murders never murder again is that it had never been in there career plans, they had never planned to be murderers, and that they are no longer allowed to have a gun.

So who are these murderers that so many Americans arm themselves with guns to protect themselves from? A lot of times it is friends and family. It turns out that all it takes to make a murderers is a regular person with access to a gun and an emotionally charged moment.

In medicine we are taught that rare events occur rarely, and common events occur… You get the idea. So if the murderers I have know are an unbiased sample of murderers, the gun is not as innocent, or as helpful in protecting oneself as the general public might imagine after witnessing hundreds of murders in television entertainment fantasy land piped into their living rooms and bedrooms.

Here is my recollection of the circumstances of some of the homicides by people I have met.

A woman decides to leave her abusive husband. She goes to the house to get her clothes and tells him she is leaving him. She lets him know she has a gun so that he won’t try to stop her. He tells her that if she wants to leave him, she’ll better go ahead and shoot him. She does. (He was lying on the bed watching TV at the time.)

Three buddies are at the home of one of them. One took 20 bucks from the other and bought some marijuana. One says give me my money or I’ll tell my folks. The other says you tell your folks and I’ll shoot you. “Then go ahead and shoot me now”. He did.

(Herein lays a lesson – never ever say “shoot me” to a person with a gun.

“What happened?” I asked the patient when the sheriff brought him in. “I shot my brother” was the reply. “Why?!” Still angry “He ate my lunch!!” was his reply.

A man goes home unexpectedly and finds his wife in bed and not alone. He shoots the interloper as he tries to escape with the wives honor even though it apparently had been offered freely. The man and his wife continue as man and wife. (It may seen that I am missing something, but this is the story).

A Korean kid (another computer programmer at the same university) goes to his habitual Korean eatery for lunch. In front of the usual crowd the proprietor tells him that he had left the previous day forgetting to pay for his meal. (There must be something about lunch). The kid says that he’ll be back in a few minutes to take care of it. He comes back in a little while and shoots the proprietor, and then assures everyone that now everything is under control.

It may surprise you, it does me, that none of these murderers seemed to show any guilt or remorse about killing.

A soldier serving a sentence for shooting a fellow soldier while stationed in the U.S. “He needed to die” was the only details the killer told me.

A brother shot his brother because he wouldn’t let him in the house.

A senile man is cared for by his loving and dutiful wife in the home where they raised their children. He shoots her. He wonders where she has gone.

A mentally ill man kills his wife of 50 years, and even after being released from prison still cries bitterly how much he misses her.

I’ve treated many suicide attempts. Either most people are inept at suicide or are ambivalent to the task. One man who swallowed a bottle of pills when I asked him looked at me sheepishly and said, “I just looked at the bottle and decided to take them all, I don’t know why.” No mental illness, no depression, just took a notion. There was a regular stream of suicide attempts in the emergency room, but I remember only one gunshot suicide failure. She put a gun to her belly and the bullet was lodged in her spine. Guns make up for both ambivalence and ineptitude. Guns make it happen.

Then there is the accidental shooting. I’ve taken care of accident gun shot wounds in hunters, but most don't require the care of a doctor. Kids find guns and kids get shot. I’ve had more than one patient who got someone else’s bullet. Wrong place at the wrong time.

There is a lot of drug related violence, and I have met those victims and perpetrators too. One of my patients shot into a trailer to kill the guy who had cheated him on a drug deal, but it was the wrong house, only a woman and her kids. They survived and he got a slap on the wrist, but local lore is that he then killed someone else on another deal. A girl I had once dated was found dead in a dumpster when a drug deal that was supposed to pay for her trip to Europe took her some where else instead. Guns make it easy.

We heard it so often that it became a joke in the emergency room where I did my training “Don’t worry doc, I’ll take care of it”. I saw several drug trade victims. More of the survivors had gotten a blade rather than a bullet. They fell into two camps: either they were dead, or wanted revenge. “No – I never saw the guy before. Just walked up and stabbed me, but don’t worry doc, I’ll take care of it.” Having heard this dialog several times I always wondered why they thought I would be worried, but how they planned to find the “unknown” assailant was all too clear.

I've also know some real assholes. These were guys that carried guns, and looked for a fight hoping to have the opportunity to use it. They were not disappointed. And they were not in jail either.

JAMA published a study of women who owned guns. Owning a gun not only put them at more risk of dying, but much of the increase was being shot with their own gun.

I understand hunting, and sure there are risks. For hunters the cost-benefit makes sense to them. If Dick Cheney is O.K. with that, I’m O.K. with that.

But having a gun to protect oneself from television fantasies helps creates those phantoms. I’m sure everyone who reads this personally knows two or three people who have survived a home invasion only by shooting the burglar, and I’m sure that I will get angry email from throngs of people who personally have saved their families by quick use of hand guns. I apologize, I just have not met you yet.

I only know people who didn’t foil the robberies. I know people who woke up robbed. I know people who were tied up, and I know some had guns in their homes at the time. I had to testify in court on one of my patients now in prison for doing the home invasion, where he fired the gun he found. But me, personally, somehow I just have not met anyone who has told me about how they woke up and used a gun to foil a home invasion.

The only people I know who have fired a hand guns to protect themselves successfully were police (and this is rare) and bad guys. (I’m lying. I know a guy who used one to kill a rabid dog, but he actually wasn’t in any danger from the dog).

Do guns kill people? You betcha. Guns make murderers, and they make murder easy.

© 2007