Archive for February, 2011


Bob Cavnar: Responding to the Hydraulic Fracturing Issue

Wednesday, February 9th, 2011

As we’ve discussed before, the practice of hydraulic fracturing to produce oil and gas has grown into a controversy being argued about in local townhalls all over the country all the way to the halls of Congress in Washington.

Making matters worse, as usually happens when it comes to environmental issues, it’s hard to sort out fact from fiction.  Hydraulic fracturing and the issues surrounding it is no different. 

This controversy started years ago with environmental groups (without much actual evidence) claiming water well contamination directly caused by hydraulic fracturing.  The issue boiled down to groundwater contamination and who was responsible for regulating underground injection activities.  There was even an argument about whether hydraulic fracturing even qualified as underground injection according to clean water regulations. 

The controversy started in Alabama back in the late 1980′s, but spread to other oil and gas producing states as state agencies, the courts, the EPA, and Congress struggled with the problem, passing around the hot potato to one another.  As this issue gained attention, the rhetoric grew more heated.  The industry, believing they were doing nothing wrong, dismissed the claims as unfounded, and anti-development groups tried to use the power of the courts and government regulation to shut down all oil and gas operations. 

The issue was partially resolved, at least from a regulatory point of view, when the Congress exempted frac’ing from the Safe Drinking Water Act in its 2005 energy bill, displeasing the environmental community, but establishing some permanence to the regulatory regime.

However, the rapid increase in recent years of shale oil and gas development, which is totally dependent on multiple frac jobs per well to be productive, has once again raised the public awareness of the issue.  The documentary Gasland by Josh Fox raised the awareness in some cases to hysteria.  He filmed several examples of landowners lighting the natural gas in the water coming from their faucets, implying that nearby oil and gas development was totally responsible, ignoring the fact that many water wells are completed in water bearing zones that contain naturally occurring biogenic gas.  In simple terms, biogenic gas is associated with shallow formations, and thermogenic gas is associated with deeper strata normally explored by the industry.  While there are some real cases of contamination from oil and gas operations, many are not, but Gasland ignored all those.  In late 2010, some of the errors in the documentary were refuted by the Colorado Oil and Gas Conservation Commission in an attempt to set straight at least some of the public record, but the industry generally dismissed all concerns, the normal response.

The problem with a complex issue such as hydraulic fracturing is that the public often panics over the wrong issues, and the industry panics about the money.  Anti-development environmental groups focus on lighting gas from faucets, leaping to the conclusion that it comes from frac jobs applied thousands of feet below and miles away, using that false conclusion in an attempt to shut down all oil and gas operations, an unrealistic and zealous position that our economy and, indeed, our society, simply cannot tolerate.  The industry, on the other hand, generally takes the position that it’s just too complicated for the public to understand, denies that there has ever been any problems in the history of hydraulic fracturing when there has, constantly waving the money/jobs flag.

So, having framed the problem, is there an example of anyone in the industry trying to get in front of this issue rather than just fighting the environmentalists and regulators?  Yes, there are several, but one notable company is Chesapeake Energy, who has been very active in establishing a program they call Green Frac, an effort to make hydraulic fracturing a more benign process.  Recognizing the inherent risks to the environment, water resources, and, (let’s be honest) their bottom line, the company has aggressively been working on several fronts to improve the frac’ing process and their transparency.  Out of necessity due to water shortages in the Fort Worth basin in 2007, Chesapeake began an effort to recycle the water they use;  they now call the progam Aqua Renew and use it throughout their operations to reduce water usage.  They have also looked for more green solutions to frac issues, and have, by their own admission, eliminated 25% of the additives used in their frac fluids.  Their CEO, Aubrey McClendon, has not been afraid to get in front of the public to talk about the tough issues, including the environment, natural gas for transportation and power generation to help us reduce our dependence on foreign oil.  As an aside, one of the huge mistakes we make as an industry is hiding behind closed doors while we let lobbyists and corporate mouthpieces issue tightly controlled messages rather than speaking for ourselves.  Aubrey breaks that mold by speaking openly to the industry and to the public, setting an example for the rest of us.  You may not agree with all of his positions, but at least you hear from him directly.

Another company working to improve frac technology to limit its affects on the environment is a relatively new one called FracTech.  This company is focused on more green ingredients to frac fluids and a strictly controlled environmental management system to minimize potential damage caused by hydraulic fracturing.  FracTech just recently hired a former Chesapeake executive, Marcus Rowland, as their CEO, a nod to that company’s visibility on this issue.

Hydraulic fracturing will continue to be a controversial issue for the near future until we, as an industry, get our arms around the real environmental risks and embrace the public’s concerns about this necessary completion technique.  If we do so, perhaps then some of the rhetoric will cool off so we can truly develop a long term energy solution (and regulatory framework) that not only provides for our country’s needs, but also protects the environment for our children and their children.

Read the original article at The Daily Hurricane.

Bob Cavnar’s book, Disaster on the Horizon, is available now.

Our Local Economy in Transition

Tuesday, February 8th, 2011

If you’re in or around Boulder, Colorado late this month, don’t miss the Our Local Economy in Transition Conference taking place February 26th and 27th. Chelsea Green author Woody Tasch, author of Inquiries into the Nature of Slow Money, will be a featured speaker at the event, along with Michael Shuman of the Business Alliance for Local Living Economies (BALLE), Nicole Foss of The Automatic Earth, and Transition Colorado’s Michael Brownlee.

Sponsored by Transition Colorado, Slow Money, Elephant Journal and others, the event focuses on Food Localization as Economic Development and takes place primarily at Boulder’s Millenium Harvest House.  Panel discussions will include Reskilling for the Challenging Times Ahead, Food Security and Access in a Chaotic Economy, Forging a Foodshed Alliance, and more. The conference also includes a premiere screening of the documentary film “The Economics of Happiness“.

From the event flyer: “The economy is on the precipice of an unprecedented transition – and this has profound implications for our local economy. This conference is an opportunity to explore how local food and farming can contribute to the resilience of our local economy, reduce our contribution to global warming, and ensure the health, well-being and self-reliance of all our citizens.”

To learn more about Transition Colorado, visit this link. For a full conference schedule and additional information, click here.

Check out Woody Tasch’s book, Inquiries into the Nature of Slow Money, now.

Inspirational Recipes to Guide You Through Each Season’s Harvest

Sunday, February 6th, 2011

A wonderful new resource for local, seasonal cooking and eating is now available! We are thrilled to announce the release of the beautifully illustrated Cooking Close to Home: A Year of Seasonal Recipes, written by award-winning chef Richard Jarmusz and registered dietitian Diane Imrie.

This book brings you more than 150 original recipes designed to follow the seasons, helping you prepare savory meals throughout the year while supporting a sustainable, local food system.

Eating locally is becoming a priority to people everywhere, but preparing local food throughout the four seasons can be a culinary challenge. Common questions like, “how can I eat locally in January?” or “how do I prepare what my CSA provides?” can confront even the most committed locavore. Cooking Close to Home answers these questions and more, inspiring you to create delicious and nutritious meals with ingredients produced in your own community. A chef and a dietitian make the ideal partners to stimulate your creativity in the kitchen, teaching you how to prepare fabulous local foods without ever sacrificing flavor for nutrition.

Library Journal writes of Cooking Close to Home:
“Imrie and Jarmusz’s beautiful, simple recipes that use local sustainable ingredients will please any cook looking for delicious guilt-free meals.”

Cooking Close to Home has earned a permanent place on my kitchen bookshelf. The recipes and photography make me hungry for the coming season making it easier to say ‘goodbye until next year’ to asparagus, strawberries and tomatoes. This book celebrates the true spirit of the Localvore movement with recipes that star seasonal ingredients that I can easily find at my farmers’ market here in Vermont and throughout the Northeast.”—Robin McDermott, Co-founder, Mad River Valley Localvores

“This is a completely lovely book. This is a cookbook for the future—in the world we’re building, where local food means both security and pleasure, this will be a companion for many a pioneer!”—Bill McKibben, Author of Deep Economy

Check out Cooking Close to Home and get a free sample recipe!

Naomi Wolf: WikiLeaks, Revolution, and the Lost Cojones of American Journalism

Saturday, February 5th, 2011

Now that the WikiLeaks releases about Tunisian corruption have directly sparked a peoples’ uprising in Tunisia; now that Egypt is in the throes of pro-democracy protest driven in large measure by WikiLeaks’ revelation in the Palestine Papers about US manipulation of Palestine, surely one would expect key U.S. news organizations and journalists to rally prominently to the defense of the right to publish that that site represents. One would expect lead editorials supporting Assange’s right to publish from the New York Times, the Wall Street Journal and USAToday, not to mention every major TV outlet. But instead, what we have heard is the deafening sounds of what middle-schoolers call ‘crickets’ — that is, an awkward silence. As Nancy Youssef in the McClatchy papers reported recently, most U.S. journalists — and, even more shamefully, journalists’ organizations — decided, regarding supporting Wikileaks’ freedom to publish, to “take a pass.”

How on earth could this be? This cravenness represents one of American journalism’s darkest hours — as dark as the depth of the McCarthy era. In terms of the question of the legalities of publishing classified information, most American journalists understand full well that Assange is not the one who committed the crime of illegally obtaining classified material — that was Bradley Manning, or whomever released the material to the site. So Assange is not the ‘hacker’ of secrets, as People magazine has mis-identified him; he is of course the publisher, just as any traditional news organization is. He is not Daniel Ellsberg, in the most comparable analogy, the illegal releaser of the classified Pentagon Papers; rather, Assange is analogous to the New York Times, which made the brave and correct decision to publish the Pentagon Papers in the public’s interest.

U.S. journalists also know perfectly well that they too traffic in classified material continually — and many of our most prominent reporters have built lucrative careers doing exactly what Assange is being charged with. Any sophisticated dinner party in media circles in New York or Washington has journalists jauntily showing prospective employers their goods, or trading favors with each other, by disclosing classified information. For we all, in this profession, know that seeking out and handling classified information is what serious journalists DO: their job is to find out the government’s secrets in spite of officials who don’t want these secrets revealed. American journalists also know that the U.S. government classifies information mostly out of embarrassment, or for expediency, rather than because of true national security concerns (an example is the classification of suspicious deaths in Guantanamo and other US-held jails). The New York Times garnered kudos — as they should have — in 2005 with the publication of the SWIFT banking story — based on leaked classified documents, which makes Bill Kellers’ recent essay trying to put distance between his newspaper and WikiLeaks all the more indefensible.

Here is what readers are not being told: We have ALL handled classified information if we are serious American journalists. I am waiting for more than a handful of other American reporters, editors and news organizations to have the courage — courage that is in abundance in Tahrir Square and on the pages of Al Jazeera, now that we no longer see it on the editorial page of the New York Times or the Wall Street Journal – to stand up and confirm the obvious. For the assault on Assange to be credible, they would have to come arrest us all. Many of Bob Woodward’s bestselling books, which have made him America’s highest-paid reporter, are based on classified information — that’s why he gets the big bucks. Where are the calls for Woodward’s arrest? Indeed Dick Cheney and other highest-level officials in the Bush administration committed the same act as Bradley Manning in this case, when they illegally revealed the classified identity of CIA operative Valerie Plame.

So why do all these American reporters, who know quite well that they get praise and money for doing what Assange has done, stand in a silence that can only be called cowardly, while a fellow publisher faces threats of extradition, banning, prosecution for spying — which can incur the death penalty — and calls for his assassination?

One could say that the reason for the silence has to do with the sexual misconduct charges in Sweden. But any serious journalist in America knows perfectly well that the two issues must not be conflated. The First Amendment applies to rogues and scoundrels. You don’t lose your First Amendment rights because of a sleazy personality, or even for having committed a crime. Felons in jail are protected by the First Amendment. Indeed the most famous First Amendment cases, the ones that are supposed to showcase America’s strength and moral power, involve the protection of speech most decent people hate.

So again: why have U.S. journalists and editor, as Youssef reported, “shunned” Assange? Youssef reports an almost unbelievably craven American press scenario: The “freedom of the press committee” — yes, you read that correctly — of the Overseas Press Club of America in New York City declared him “not one of us.” The Associated Press itself won’t issue comment about him. And even the National Press Club in Washington made the decision not to speak publicly about the possibility that Assange may be charged with a crime. She notes that it is foreign press organizations that have had to defend him.

One answer for this silence has to do with what happens to the press in a closing society. I warned in 2006 and often since that you don’t need a coup to close down America’s open society — you need to simply accomplish a few key goals. One critical task — number seven — is to intimidate journalists; this is done, as in any closing society, by creating a situation in which a high-profile reporter is accused of “treason” or of endangering national security through their reporting, and threatened with torture or with a show trial and indefinite detention. History shows that when that happens, you don’t need to arrest or threaten any other reporters — because they immediately start to police and censor themselves, and fall all over themselves attacking the “traitor” as well. That way safety lies, whether the knowledge is conscious or not.

Another motive is revealed in the comment that Assange is “not one of us.” U.S. journalism’s business model is collapsing; the people who should be out in front defending Assange are facing cut salaries or unemployment because of the medium that Assange represents. These journalists are not willing to concede that Assange is, of course, a publisher, rather than some sort of hybrid terrorist blogger, because of their self-interested prejudices against a medium in which they are not the gatekeepers.

In this, paradoxically, they have become just like the outraged U.S. government officials who are threatening Assange: the American government too is in the position, because of the Internet, of no longer being able to control its secrets, and is lashing out at Assange as it faces a future in which there are no traditional gatekeepers, and all institutions live in glass houses.

It is for this reason that the prosecution of Assange — and his betrayal by his fellow journalists and publishers in America — is so almost absurdly futile. Even if they lock Assange up forever, the world of the future is a WikiLeaks world. Trying to extradite and to convict Assange is like trying to convict the first person who dared to install a telephone. The WikiLeaks necessity — for citizens who are upset at government or private sector abuses of power — to release documents, is not going away, ever. Egypt is showing us that conclusively: they turn off the news and people create the news on their cellphones. The technology of leaking government secrets globally is not going away either. In five years one can expect that every major institution will have its own version of WikiLeaks — so shareholders, members of university communities, citizens of governments all over the world, and so on, can read the secrets that are in the public interest that the traditional gatekeepers wish to keep under wraps.

History shows that journalists only protect themselves, when bullied like this, by fighting back — as a group. And history shows that when a technology and its social change are inevitable, it is better to integrate the way the future will work, into an open society — rather than trying pointlessly to punish it, in this case by seeking to ship the inevitable future off to Guantanamo Bay.

An earlier version of this post appeared at Project Syndicate.

Read this article at The Huffington Post.

Naomi Wolf is the author of the New York Times Bestseller, The End of America: Letter of Warning to a Young Patriot.

Wall Street Robber Baron Nets $2.4 Million an Hour While 28 Million Need Jobs

Friday, February 4th, 2011

The following piece is by Les Leopold, author of The Looting of America. It appeared originally on The Huffington Post.

January’s reported unemployment rate remains stubbornly high at 9.0 percent. The Bureau of Labor Statistics’ U6 jobless rate, which stands at 16.1 percent, is more accurate, since it counts “discouraged workers” who’ve given up looking for a job. Right now, more than 28 million Americans are without work or have been forced into part-time work. It will take more than 22 million new jobs to bring the official unemployment rate down to 5 percent (our current definition of full-employment).

Please don’t wait around for John Paulson to create those jobs. He might have raked in a record $5 billion in 2010, but his job isn’t about employing people to make things or provide services. He’s a hedge fund manager. Paulson (a spiritual but not a blood relation of Henry, Bush’s Treasury Secretary) leads the list of America’s top “earners” for the year. If you divide his 2010 take by the standard work year of 2,080 hours, you’ll find that this ubermensch had a wage of $2.4 million an HOUR.

The robber barons of old earned their moniker by commandeering railroad, meatpacking, oil and steel monopolies. Paulson’s was a different kind of theft — but theft it was. In fact, he barely evaded prison for his role in Goldman Sachs’ Abacus deal, which suckered investors into buying securities that were explicitly designed to fail. Paulson colluded with Goldman Sachs to build a synthetic collateralized debt obligation (CDO) that bet on the very worst kinds of mortgage securities. Goldman got the fees and Paulson got a billion dollars for betting against those securities. The investors, trusting GS’s sales pitch, had no idea that Paulson was allowed to pick the most toxic securities to mix into the stew. As Paddy Hirsch of American Public Media’s “Marketplace” points out in this entertaining video , it’s like a gambler and a bookie colluding to field a horse they’ve groomed to lose. Eventually, GS was flushed out into the open by an angry mob of CDO investors and forced to cough up a record $550 million in penalties for “not disclosing the role of Paulson and Co. Inc. in the portfolio selection process and that Paulson’s economic interests were adverse to the CDO investors.”

Meanwhile, Paulson got off scot free. Not only was he never charged, he actually kept his winnings from betting that Abacus would fail — which it did spectacularly. More miraculously still, the financial media now hail him as the Harvard-educated genius who so wisely bet against the housing bubble — supposedly a cool head bucking against an irrational stampeding herd. But if Paulson was so insightful about the housing bubble, why did a near criminal conspiracy with Goldman Sachs to pocket a cool billion? Don’t ask CNBC. Ask Tony Soprano.

Given the enormous percentage of the nation’s wealth that is flowing into a high-stakes gambling casino, it hardly matters if Paulson bet on black or red, or if he rigged the roulette wheel. (Apparently, his 2010 riches mostly came from doubling down on gold.) What matters is that he’s part of the grand casino that will crash our economy again. And in the meantime, he’s enjoying and manipulating the wealth of our nation while creating nothing at all. Almost makes you misty-eyed for the days of Rockefeller, Ford and Carnegie. (Please see The Looting of America for the sad tale of how we got here.)

Is Paulson really killing Jobs?
Remember all the urgency in Washington to save Wall Street from collapse? It sure isn’t there for the jobs crisis. Instead, all we get is a yawn and a mouthful of platitudes about the blind forces of GDP that must run their course — that can’t be hurried by human or even divine intervention. So patience, please, the recovery is in process. The jobs will come. Besides, there’s no public money to spur job growth now that we emptied Fort Knox to rescue Wall Street.

But… what about Paulson’s billions?

Yes, there is a connection between the hedge fund manager’s magnificent 2010 haul and our 29 million unemployed. But it’s not just Paulson. It’s the entire class of financial billionaires and their junior wannabes (making mere tens of millions) who are responsible for the jobs crisis — every single bit of it.

Just follow the money. In the years before the crash, hedge funds and giant banks gambled, big-time. As the bubble inflated, they took in billions by creating, buying and selling phony securities that turned out to be toxic. Some, like Paulson, made even more money by rigging bets against these securities. Then suddenly, in 2008, the entire house of cards we call high finance collapsed, killing upwards of $14 trillion in wealth and tens of millions of jobs. Desperate to prevent even more damage, we taxpayers bailed the bankers out. And now, a couple of years later, the bankers are making record profits again while millions of regular Americans are still searching for jobs that Wall Street destroyed.

The financiers gambled, won big, and when they lost, we made them all winners again. The money that is now whirling through their precarious casino is being siphoned away from the real economy — where it could be used to create jobs — where it could actually land in workers’ pockets.

How are we ever going to reclaim that money? We can start by abandoning the debilitating myths that prevent us from seeing that the money really is ours.

Do billionaire financiers help our economy?
Our economic experts don’t really know how financial elites haul in so much money. To cover up their ignorance, they wax euphoric about the wonders of “liquidity” that the hedge funds and big banks bring to markets. Odes are recited to the mysterious ways financial elites “deepen” markets and make them more efficient — how they even out prices. Supposedly, that means we pay less for securities and credit, and we can always trade our bonds and stocks without worrying about finding buyers or sellers (if that’s something you stay up late worrying about).

But here’s the test. If their contributions were so important, what would happen to our economy if hedge funds and the proprietary trading desks at too-big-to-fail banks disappeared entirely? Absolutely nothing. We wouldn’t notice any more than if a few high rollers were banned from the Vegas strip.

In fact it would be wonderful if hedge funds and proprietary desks at large banks disappeared entirely — since they’re robbing us blind. They exist only because avaricious policymakers decided around 1980 not to put them out of business. Instead of clamping down on speculation, we deregulated finance, and gave speculators incredibly favorable tax treatment. We also reduced taxes on the super-rich in general to make sure money flowed into the casinos. We called all this financial innovation, and it’s gotten us where we are today.

But it wasn’t always this way. From the New Deal to the late 1970s, government policy squashed the life out of financial speculation — because everyone knew it caused the Great Depression. We taxed the hell out of the super-rich for the same reason: We didn’t want to give them surplus capital they could play dangerous games with — like the toys we call hedge funds. And what do you know? We didn’t have a financial crash during that entire era — even globally, except in Brazil in 1964. And during the same period we created the largest, most prosperous middle class in history.

Things changed after we deregulated Wall Street. The world has suffered about 180 financial crises since 1980, including the big one that’s still crippling us. And the greatest middle class in history? It’s collapsing.

Speculation run wild torpedoed our economy and it still isn’t adding jobs to our economy. Sooner or later we will have to make a stark choice: Either we rein in speculation and invest in real goods and services ( like green jobs to save energy and the environment), or we learn to live with permanent high levels of unemployment and debt.

Do financial industry elites pay their fair share?
Were it not for the bailouts, Paulson and company would be on life-support. All their clever bets would have come to naught had the big banks and investment houses gone down. Mr. Paulson wouldn’t have been able to collect on his short selling if his counterparties all had gone under. His buddies in crime at Goldman Sachs were only days away from destruction when they were rescued by their Goldman alumni in government. We saved Paulson’s butt. In fact we saved all their butts. That’s why Paulson’s “earnings” belong to the taxpayer.

But — Paulson walks away with the money…and then doesn’t even pay his share of taxes on it! You see, his hedge fund take home isn’t even taxed as income. It’s taxed as “carried interest,” at a rate of 15 percent — assuming it’s taxed at all. If Paulson’s income was considered income by the federal government, he’d be paying the top tax rate of 35 percent. Paulson should be paying $1.75 billion in federal income taxes. Instead he’s paying at best $.75 billion. That extra billion he’s not paying? It’s enough to cover the wages and benefits for over 33,000 entry level teachers. But, sorry teachers, kids, and parents — we just don’t have the tax revenue to support those educators — we’ll have to lay them off.

Time is running out.
We watch the Egyptians out in the street, determined to bring down a corrupt government that has impoverished them. We’re still on the couch, but we’re getting a little antsy. We don’t really want to face up to this gargantuan Wall Street ripoff. It makes us squirmy to think about how the bankers are getting even richer with our money while we’re told to tighten our belts and get used to cuts in education, Social Security and health care.

Maybe to keep our sanity we’ll just have to make peace with the idea that Wall Street can never be controlled, that our political system has been bought, and that we’re in for generations of austerity. If so, people will start plugging their ears when they hear from crazies like me.

But before you turn me off, let me lay out this simple program one more time. It’s a big first step in getting control of Wall Street, our politicians, and our country. We squeeze Wall Street just like we did after the Depression. We suck money out of the financial sector, especially from financial billionaires, and use it to rebuild our economy. Conceptually, it’s not that hard:

1. End the carried interest loophole for hedge funds.
2. Institute a small tax on all financial transactions.
3. Pass a 50 percent windfall profits tax on all financial “earnings” until unemployment returns to 5 percent.


That alone will tame the deficit, and give us the money we need to create good green jobs and get the real economy moving. Eventually we’ll look back at this period as a time when we went collectively insane by believing that there was nothing we could do to keep financial markets from wrecking our lives.

But it all starts in our minds. Do we act? Or keep sitting on the couch?

Read the original article at The Huffington Post.

Les Leopold’s The Looting of America is available now.

To Err Is Human – Unless You Are A Doctor

Friday, February 4th, 2011

The following is excerpted from Maggie Kozel’s newly released memoir, The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine. It appeared originally on the web at KevinMD.

We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, some­one else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave lip service to learning from our mistakes, but in morning report or on rounds, those left standing were the ones who most effectively pointed the finger at someone else. There is no greater pain a doctor can experience than that which comes from making a mistake that causes harm, so we try anything to convince ourselves we did nothing wrong, to protect our sanity. Once we are out in practice, this unhealthy denial goes beyond the personal. The threat of a malpractice suit means we must never, ever acknowledge our fallibility. The wolves are at the door.

I made a terrible mistake when I was an intern in internal medi­cine at Bethesda Naval Hospital. I was on call in the coronary care unit—the CCU—supervised by two residents. B. C. was the junior resident, two years out of medical school. The senior resident, Roy, was responsible for B. C. Roy reported to the chief resident, who took call from home. Roy and B. C. must have been very busy that night with other patients in other parts of the hospital, as I was left alone with the CCU nurses minding a very busy store.  There were six patients in the unit, each of them lying almost motionless on a mechanized bed behind glass walls. A web of lines connected their arteries and veins and chest walls to banks of screens and monitors that flashed around their rooms and across the nurses’ desk in a constant illuminated display. Large flow sheets the size of opened newspapers sat at the foot of each bed, document­ing pulse and oxygen levels, IV fluid rates, and medication orders. The constant electronic beeping was reduced to a background noise in my brain. The scene took on a certain eeriness at night, with over­head lights dimmed to help the patients rest, and the staff talking in hushed voices. The beeps and monitor lights rose to fill the void in an uneasy standoff between vigilance and catastrophe.

I moved quietly from patient to patient that night, watching the watchers—the blood pressure monitors, the EKG tracings. I scanned the elaborate flow sheets to assess vital signs and urine output. Looking at the patient was almost superfluous.

One of the patients, Mr. P, began showing signs of decreased cardiac output a little after midnight. He had been admitted earlier that day after suffering a heart attack. Now the catheters that threaded far into his arteries and veins were transmitting signals that his heart was not pumping blood as effectively as it had been. I paged B. C., but he must have been tied up because he didn’t answer right away. So with Mr. P’s nurse hovering anxiously over my shoulder, I called Roy. We agreed on a medication, Nipride, that would help Mr. P’s heart pump better. I calculated the dose by hand and wrote the order. His nurse efficiently sent the order down to the pharmacy “stat,” meaning we needed it urgently, and in a short while a small plastic bag containing the Nipride arrived in the unit and was connected up to Mr. P’s IV. In all those transactions, no one noticed that I had written for ten times the recommended dose.

I watched that patient closely for the next several hours. Mr. P showed signs of improvement, and I let Roy know that when he called to check in. By 3 am, all the beeping and buzzing and trac­ings had settled into a constant reassuring rhythm, and I crawled into an empty bed so I could catch a nap. I dozed uneasily over the next two hours, so when the nurse jostled me awake just before  dawn, I wasn’t sure if I was dreaming. She looked worried and told me the chief resident wanted to talk to me; there was a problem with Mr. P.

I hopped off the bed and into defensive mode. The chief resi­dent, Carl, was a brilliant superhuman who rolled his filing cabinet around the hospital with him so that he would have instant access to all his cutting-edge journal articles in this pre-cyber world. I imag­ined that with black-rimmed glasses he would even look like Clark Kent. He didn’t usually waste a lot of effort on facial expressions, but as I hurried toward him across the CCU I could read fury and contempt in his face.

“Nice dose of cyanide you gave Mr. P,” he said as soon as I was within civilized earshot.

I was still trying to shake the half sleep from my brain; I couldn’t make sense out of what he was saying. One of the dangers of using Nipride is that it is metabolized to cyanide in the body. Even appro­priate doses of Nipride need to be monitored with blood testing for cyanide. An overdose could be lethal.

“You wrote for ten times the correct dose.”

“No way,” I protested as my shaking finger ran down the order sheet. I blinked at my handwriting—the neat feminine cursive so appreciated by the nursing staff—and began to recalculate the dose, but Carl had already done that and shoved his scratch sheet in front of my face. My stomach contracted, and my own pulse roared through my head as I took in the enormity of my mistake. I stood defenseless as he drove his message home:

“You could have killed him, you know. Didn’t you wonder why his oxygen requirements were increasing?”

“I didn’t know he was having a problem,” I answered weakly. I glanced over at the nurse—I would have expected her to let me know if the patient’s oxygen levels were dropping—but she just stood there, tense. There would be no help from her corner.

B. C., my phantom resident, had been hovering off to the side with the medical students but now chimed in. “Why didn’t you notice? What were you doing?” Of course, he knew perfectly well what I had been doing, so this was a safe avenue to chase me down.  “I was asleep,” I mumbled, as if I was admitting to getting high off the anesthesia machine while my patients screamed for help. “No one notified me . . .” I trailed off. The nurse waited silently at the bedside now, watching closely to see which way this ill wind would blow.

“But you’re the doctor,” B. C. hammered at me. I wanted to smack him.

“You know, we generally don’t try to kill our patients here,” added Carl in disgust.

I was utterly defeated, just a white coat and scrubs draped over the shell of a lousy doctor. “I’ll change the order right away.” My voice sounded as if it were coming from far away.

“Never mind,” spat Carl. “I thought I’d stop the drip myself before he started turning blue.”

I turned without another word and walked into the break room, shutting the door behind me, and began to sob as quietly as I could. I had the sudden feeling that over the past four months I had been fooling everyone into thinking I was a good doctor. In fact, I had even fooled Georgetown into thinking I should have been admitted to medical school. What would that admission committee think now if they could see what a danger they had unleashed upon the world?

A few minutes passed, and then B. C. walked in, closing the door behind him and settling into the opposite chair. “Shouldn’t you get out there and see to your patient?” he asked gravely, a caricature of a wise old TV doctor—though only a year older than me.

Screw you! I thought. I was in no mood for melodrama.

“You know,” he restarted, “I almost wrote a wrong antibiotic order once.” There was a hesitation as he chose his words. “But then I caught it before I sent it off. But still, it could have been serious, I suppose.”

My breath caught, and I stopped crying. A slow burn worked its way up my chest and into my face. “Are you consoling me by telling me that once you almost made a minor mistake, but then you were smart enough to catch yourself?”

“Well . . . yeah.” He shrugged. I could tell he had no idea how furious I was—or that I had just found him out. B. C. had made a mistake last night, too—maybe even bigger than mine, because he should have known better. He should never have left an inexperi­enced intern in charge of six critically ill patients. He should have been checking on us all night or called for help if he was too busy. It turned out he had been too involved in an “interesting case” from the ER; he would make a big splash at morning report.

“Leave me alone, B. C.” My voice had gone flat and cold. “Mr. P is fine now. Carl took care of him. I’ll be out in a minute.” He tried to offer another pearl of wisdom, but I cut him off. He had already helped me more than he realized.

What an asshole! I thought as I washed my face and blew my nose. These guys weren’t any smarter than I was (except maybe for Carl), but now I suspected that B. C. had made plenty of mistakes, and I was pretty sure that everyone else had, too. But nobody was talk­ing. Blame was deflected, rationalized, minimized, swept under the rug—anything to avoid the horrible epiphany I had just endured: We were all capable of royally screwing up, and that was as good as we were ever going to get.

Mr. P did miraculously well—so well, in fact, that he was trans­ferred out of the unit to a “step-down” bed the following afternoon. His cyanide levels had risen briefly but then cleared. My troubles lingered. On attending rounds later that day, shaken and exhausted, I had to relive the experience with the cardiology attending. Later that evening, I asked the senior resident if the cardiologist had said anything to him about me. Roy was a kind soul and took no pleasure in squashing an errant intern. He hesitated but then opted for the truth. “He said, ‘If I ever collapse from a heart attack, don’t bring me here.’” I swallowed hard, and moved on to finish my tasks so I could go home. It had been a long thirty-six hours.

I trudged home alone that night, slowly making my way across the large expanse of lawn that rimmed the navy base as the sun set behind the high-rise buildings across the way. I was parched, and my head throbbed as I walked in slow motion toward the traffic lights of Wisconsin Avenue. I kept playing the course of events over in my mind, trying to find a way to let myself off the hook. The resi­dents had left me alone with desperately ill patients. Why hadn’t one  of them stopped by the unit to check my orders, see for themselves how this critical patient was doing? And that nurse must have tran­scribed hundreds of orders for Nipride in her career. Did she think we were treating a gorilla this time? What about the pharmacy? If they didn’t know drug dosages, who the hell did? This reasoning might have held up in a court of law, but none of it relieved the sick­ness in my stomach, the ache in my chest.

Blame was a tricky thing. It didn’t get rid of guilt. It just wrapped it up in a package, stored it safe from the light. There was so much I had to learn; finger pointing and making excuses wasted precious time. As much as I hated to admit it, B. C. had been right about one thing. I was the doctor now. The fear of making a mistake would follow me the rest of my career. It would be the caution that made me double-check orders, the defensiveness I would have to keep under control when patients questioned me, the meticulous docu­mentation that would follow every clinical encounter. I had discov­ered the greatest and loneliest burden a doctor carries.

Fortunately, in all my years as a pediatrician, I was never sued. Pediatricians have some of the lowest rates of malpractice suits in the profession and therefore pay the lowest premiums. By the time I left practice, I was paying about $13,000 a year for malpractice insur­ance—a drop in the bucket for obstetricians or neurosurgeons, who pay that much in a month. There are a number of theories for why pediatricians are the specialists least likely to be sued. One is that we are more likely to have connected with the family on a personal level. But meticulous charting helps, too, even before an issue has the chance to land on a lawyer’s lap.

“Dr. Kozel,” accused Mrs. C in an imperious voice through the phone line, “we told you months ago that Jamie was having head­aches, and you told us it was nothing. Now the neurologist is sending us for a CT scan. Why didn’t you do something back then?” I could tell over the phone that this mother was loaded for bear.

“How did she end up seeing a neurologist?” I asked.

“Well, I had to do something. The poor child was suffering.”

“Mrs. C,” I began, already fighting the anxious defensiveness that  flared up reflexively, “I am looking at her chart right now. Jamie had a very normal neurological exam at that visit. If you remem­ber, I went over her from head to toe. You have a family history of migraines. We talked about that and the likelihood of this being childhood migraine, especially since they seemed to be triggered by sleepovers. I asked you to have her avoid sleepovers, use ibuprofen as needed, and call me in two weeks if things were not improving. It doesn’t look like you called back. But I agree with the neurologist. If she’s continuing to have problems, she should have an imaging study.”

Mrs. C mumbled her way out of the conversation, my record keep­ing having removed most of the wind from her sails. Even if the CT scan, God forbid, showed an abnormality, my records would support my stepwise evaluation—although I would still almost certainly get sued. But I hardly felt vindicated for doing a good job, just adequately armored. I sat staring into space for several minutes, feeling defeated by something unseen, knowing I had to switch gears, see the next patient, try to connect. Two weeks later, I got a letter from the neurologist stating that the CT scan was normal and he had diagnosed childhood migraine. Brilliant. Mrs. C started taking her daughter to another doctor in the practice.

For surgeons and obstetricians, lawsuits are a way of life, like broken noses to boxers. But all kinds of doctors can get sued, and when they do, it can suck the lifeblood out of them. One highly regarded colleague, a close friend of mine, was asked to consult on a patient of his who had been hospitalized with an infectious disease. The consult was for a minor intestinal problem the patient had had for years, unrelated to the mysterious fever for which she was admitted. Her current doctors were checking to make sure they didn’t need to address that intestinal condition while she was being treated for this infection. The family later sued about some controversy around the diagnosis of her infection; the gastroenter­ology consultant was named in the suit. He was sure there was some mistake. When he asked his lawyer why he was included, the answer was quite simple: “Because your name was on the chart.” It cost that doctor over a thousand dollars in legal fees to get his name dropped from the suit. The greater, hidden cost was the bitterness and frus­tration that settled into his gut. “I gotta get out of this goddamn business,” he said.

So when I sat down at the end of the day to fill out my charts, it was with more than healing in mind. I had come a long way from my teenage image of a doctor, from that naive image of a gifted healer, reaping the gratitude of patients. Much of what I put down on paper was written because I might need protection from the very patients I was trying to treat.

The relationship between healer and patient, which relies so heav­ily on trust, has become too often, in a very fundamental way, adver­sarial. The cloud of mistrust is such a constant in daily practice that its wisps and curls go almost unnoticed in the day-to-day business of treating patients and documenting events. The defensiveness I felt as I constructed my chart entries—and for that matter in all my professional encounters—was not enough to suck the lifeblood out of me. It was more like a slow, barely noticeable trickle.

We have to deal with the reality of medical malpractice, but the process needs to focus on caring for the injured party and improving quality of health care. The current process is driven by how much the malpractice lawyer stands to gain (on average, over half the award), with secondary emphasis on the patient’s well-being and none on improving medical care. Cases should be arbitrated by an indepen­dent panel of health experts, lawyers, and patient advocates who can assess the circumstances in the context of acceptable standards of practice. Disciplinary or remedial action should be directed toward doctors who have practiced negligently, and victims should receive capped compensation from a general fund that doctors pay into. Medical schools could teach, right from the beginning, constructive ways to critique ourselves and our colleagues; once we are no longer target practice for lawyers, trends in poor outcomes could be made transparent, and they could be studied so that we could find more effective ways to deliver care.

It is a sad paradox that the politicians who are most willing to tackle health care reform also tend to be the least likely to take on medical malpractice. They will say it is because malpractice suits do not have a significant impact on health expenditures, but such argu­ments are just grasping at statistical straws. Doctors spend billions in tests every year for no other purpose than to protect themselves from lawyers. It is why so many of us still order MRIs for uncompli­cated back pain. It is why the C-section rate in this country has been on a steady rise. A recent study in the Archives of Internal Medicine reported that 91 percent of physicians admit to ordering more tests and specialist referrals than they think are necessary because they are practicing defensively. A 2008 Pricewaterhouse report estimated the cost of such defensive medicine to be $210 billion annually.

Politicians are, for the most part, lawyers, and they rely on the support of their fellow lawyers. By their very nature, most cannot imagine a bad situation that would not improve with a lawsuit. Tort reform gives them acid indigestion. I say to these political leaders, grab yourself some of those expensive reflux medications that your excellent insurance plan pays for, roll up your sleeves, and do the tough work that needs to be done. Provide this country with a ratio­nal, responsible approach to medical malpracticeone that will protect the health of both patients and medical practice.

Read this article at KevinMD.

The Color of Atmosphere by Maggie Kozel is available now.

Sex and the River Styx named an Amazon.com Best Book of the Month

Thursday, February 3rd, 2011

Exciting news – Edward Hoagland’s Sex and the River Styx has been chosen by Amazon.com as one of the best books of the month for February 2011! Take a look at editor Tom Nissley’s review below, and read Amazon’s announcement here.

In recent years, the best reason to have a Harper’s subscription has been the appearance, once every year or two, of a long and life-giving essay by Edward Hoagland. Whatever topic they hang themselves on – political dissent, the circus (where Hoagland spent two memorable young summers), sex, aging, nature – they circle around and wander through all of the above, each a memoir in miniature, each a guide to life as lived in its seventh and now eighth decades. Hoagland’s best known as a nature writer and has been called “the Thoreau of our time,” but his tolerant and curious affection for human nature too makes him closer to Thoreau’s friend and landlord, Emerson. In any case, his sentences sing like theirs: elegant and aphoristic, but chunky with thought and image, leaping and pausing like a line from Monk’s piano. As you might guess from the title, the essays in Sex and the River Styx, his first new collection in a decade, are both late and lively. Hoagland is far sadder about the accelerating destruction of the earth’s bounty and variety than he is about his own decline; while he angrily fights the former, he happily accepts the past tense in talking about ways he once lived but won’t again. He’s grown wise in the best way: he’s learned some things in his time, none more than how little he knows. -Tom NissleyRecommended for fans of How to Live: A Life of Montaigne in One Question and Twenty Attempts at an Answer by Sarah Bakewell and Pilgrim at Tinker Creek by Annie Dillard.

Check out Edward Hoagland’s Sex and the River Styx in our bookstore now!

February Sale: 25% off Sex and the River Styx and more!

Tuesday, February 1st, 2011

We are proud to announce the release of Sex and the River Styx – an enchanting literary collection from one of the greatest essayists of our time. Named by Amazon.com as a “Best Book of the Month” for February, Sex and the River Styx finds Edward Hoagland reflecting on aging, love, and sex in a deeply personal, often surprising way.

Take advantage of our special February Sale and receive 25% off this book (available in both hardcover and paperback editions), as well as Death and Sex by Dorion Sagan and Tyler Volk, and Deirdre Heekin’s Libation: A Bitter Alchemy. Check out our bookstore for this terrific offer, running now through February 28th.

Sex and the River Styx
By Edward HoaglandCalled the best essayist of his time by luminaries like Philip Roth, John Updike, and Edward Abbey, Edward Hoagland brings readers his ultimate collection. In Sex and the River Styx, the author’s sharp eye and intense curiosity shine through in essays that span his childhood exploring the woods in his rural Connecticut, his days as a circus worker, and his travels the world over in his later years.
Death & Sex
By Dorion Sagan and Tyler VolkTwo books under one cover deliver a brief, incisive, and entertaining romp through the science of sex and death.
Libation: A Bitter Alchemy
By Deirdre HeekinIn Libation, a Bitter Alchemy, a series of linked personal essays, Heekin explores the curious development of her nose and palate, her intuitive education and relationship with wine and spirits, and her arduous attempts to make liqueurs and wine from the fruits of her own land in northern New England.

Tipping Sacred Cows

Tuesday, February 1st, 2011

The following is a review of Simon Fairlie’s book, Meat: A Benign Extravagance, by Jennifer McMullen of The Ethicurean.

Mainstream culture and news abound with broad statements about our food system and the choices we make about what we put on the dinner table. Surely you’ve heard that if you want to save the planet, you should eat a vegan diet, since raising livestock contributes significantly to carbon emissions and thus to climate change. Or perhaps you’ve been told that organic agriculture can’t possibly “feed the world.”Who’s right? What, ultimately, is the best way to produce food in the world today, to both feed our growing population without destroying the earth it depends on?

In Meat: A Benign Extravagance, recently released in the U.S. by Chelsea Green, UK writer, editor, and farmer Simon Fairlie picks apart study after study in wonkish detail and shows why easy answers are hard to find.

Densely packed with enough studies and statistics and technical information to make even my food-nerdy eyes cross at times, the book offers occasional notes of Fairlie’s dry wit, especially in his scathing comments about industry-supported studies or what he calls the Global Opponents of Organic Farming (yes, GOOFs). As he says in sketching his vision, “Farmers have lived and worked like this with plants and animals for centuries, and it is arguable that advocates of permaculture would have had to coin a new name only because industrial farmers have brought the term agriculture into disrepute.”

Because meat in general has taken a lot of heat from critics of the world’s food systems — mostly fueled by the environmental degradation and cruelty to animals embodied by factory farms — Fairlie focuses his research on the question of “not whether killing animals is right or wrong, but whether farming animals for meat is sustainable.” Unlike the narrow lens of many studies that regard large-scale industrial farms as the norm, Fairlie examines the use of land, water, feed, and energy in animal husbandry operations of varying scales and in different agricultural settings. For every statistic Fairlie can pull from a highly regarded study, it seems that he can offer an alternative statistic that encompasses a broader view of agriculture or insight into the neglected pieces of the farming puzzle.

For example, Fairlie rips apart a well-known U.N. Food and Agriculture Organization report (“Livestock’s Long Shadow”) that holds livestock raising as responsible for 18% of greenhouse gas emissions. Not only does the report reveal a bias in favor of intensive farming, he argues, but it also attributes the largest portion of that 18% to deforestation, a figure that is now decreasing and that is not wholly attributable to animal husbandry. He also addresses a study on soil carbon sequestration, arguing that for every action that could sequester carbon, there’s usually an opposite reaction that releases it. Ultimately, he believes that we should spend our efforts not on “sequestration” as an activity but rather on “increasing the biomass productivity of our land, and its biodiversity, by whatever sustainable ways can be found.”

So what, then, would be a truly sustainable form of agriculture?

Read the full article at The Ethicurean.

Simon Fairlie’s Meat: A Benign Extravagance, is available now.

A Life Lesson Learned In Medical School

Tuesday, February 1st, 2011

The following article was written by Maggie Kozel, author of The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine. It appeared originally on the New York Times “Well” blog.

It was in my second year of medical school that I learned one of the most important lessons of my career: That it can be hard to distinguish truth from a perfectly good answer. Certainty was what I craved the most back then, poised as I was on the threshold of my medical career. But my first patient would cure me of certainty forever.

I had just started my physical diagnosis course and was teamed up with a classmate, Randy, for our first attempt at performing a medical history and physical exam. Our patient, admitted to the hospital with alcoholic liver disease, was dressed for company with crisp blue pajamas and a seersucker bathrobe tied neatly at the waist. He had white hair and white teeth, and his brown face was a little raw, as if he had just shaved. He looked pleased that we had dropped by.

We introduced ourselves and produced the clipboard that held our exhaustive list of questions. He remained as calm and patient as a snow-covered garden as we went through our checklists, assuring us he did not have facial pain or droopy lids, fruity-smelling breath or scrotal swelling. As I stood there perspiring, he calmly relieved us of any concern that his heart skipped beats or that pain radiated down his legs, before recalling what he could about his grandparents’ health at the turn of the previous century.

An hour later, it was time for the physical exam. We worked our way down his body, looking for malformations of the earlobes, listening to his heart sounds and noting every brown spot that had come to grace this man’s surface over the previous seven decades. We managed not to miss the yellow tinge of his eyes, or the rubbery edge of his liver, which we had first tried so insistently to locate at the bottom of the rib cage but which actually extended several inches below it.

A diagnosis of alcoholic hepatitis. Enlarged liver. Got it. Nothing in this world seemed as satisfying as having the puzzle pieces fit together.

The mental status exam came last. Having finished our four-week psychiatry course, we felt we knew a thing or two and conspired in advance to check our patient for alcohol-related brain damage. His unfaltering performance up to this point had not settled the question for us.

A supervising doctor had taught us a trick in assessing cortical function: pretend to hold up a string, and ask the patient what color it is. The patient should, of course, respond that there is no string there.

If he says it is pink or orange, he is confabulating, meaning his brain cortex isn’t working so well. So with thumbs and forefingers pinched together, Randy held up an invisible string and asked this man what color it was. We waited.

After some time, he gave us his considered answer: “It is the color of atmosphere.” A self-satisfied grin broke across his face.

Confused, I looked over at Randy, who was now frowning at the “string” himself, as if wondering if he’d missed something. We were suddenly a couple of rudderless ships, startled into the realization that all the facts in the world couldn’t protect us from uncertainty. Sometimes, it could actually blind us to the truth. After all, the string really was the color of atmosphere. Except, of course, for the fact that there was no string.

Of all the pearls that our patient offered us that day, this was the one I would carry with me throughout my career as a pediatrician, and the lesson never lost its relevance. Doctors, like anyone else, can get so comfortable with a routine that they neglect to question the questions, and we can all be misled as a result.

Clinical truth has only grown more obscure since my medical school days. Throughout the 1980s and ’90s, for example, pediatricians relentlessly used antibiotics to treat the middle ear infections so common in our young patients, as we waged war against the epidemic of hearing loss and delayed language we imagined would occur if we didn’t act. But the goal was invisible. No one had ever shown that not treating the ear fluid would cause long-term language delay. It would be decades before we realized that overuse of antibiotics caused us huge problems, while the drugs accomplished very little for our patients. We had devoured answers without asking the right questions.

Today, as we take on the hard work of health care reform, doctors continue to work under an avalanche of pharmaceutical marketing, malpractice threats and shortsighted health insurance strategies. Clinical approaches to conditions like obesity, for example, or mental illness or a learning disorder are hard-wired into current practice methods, even if those approaches don’t make sense.

And after decades of caring for patients in a complicated health care system, I have learned that if I really cannot see the string, I need to say so.

Read the article at its original source, The New York Times.

Maggie Kozel’s book, The Color of Atmosphere, is available now.


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