Are Doctors and Nurse Practitioners/Physician Assistants Really the Same?

A week ago, I was asked to write an OpEd in response to the following AP article:

"Doctor shortage? 28 states may expand nurses' role"

http://news.yahoo.com/s/ap/20100414/ap_on_he_me/us_med_dr_nurse

Here's my response:

The three legs on which healthcare rests are Access, Cost, and Quality. We all agree healthcare is fragmented and horribly broken. Problem is, we are grasping at straws to try to fix it, instead of repairing the basic problem.

Mid-level providers, or physician extenders as some have termed them, have long been an essential part of healthcare provision. However, now, because of the perceived shortage and high cost of physicians, they, with the support of the government, are out to replace doctors.

As this article states, Nurse Practioners (NP), and Physician Assistants (PA) for that matter, are well trained, do spend more time with patients, and do cost less to produce and utilize than physicians. In addition, many of the compared outcomes are indeed similar – numbers of tests ordered, numbers of referrals, and overall health. But the beliefs that NPs/PAs are “as skilled” as physicians, and are “just like a doctor except for the pay” are misleading and incorrect. The wrong measures are being utilized to gauge differences and similarities if we want to assess true patient outcomes.

The pathway to even doctoral level NPs is nowhere as academically comprehensive or as clinically rigorous as the pathway to becoming a Board Certified Physician. The environment and the length of time in which each must train are likewise very different. To believe and promote the concept that the end result is the same, is intellectually dishonest and calls into question the entire proposition. The old maxim comes to mind, “When something seems too good to be true, it usually is”.

Despite all the rhetoric, the basic desire here is to enable one to shortcut the entire process of medical education by allowing less work for the same pay. In the end, it is the patient who suffers because of a lowered standard of care being propagated with regard to diagnostic acumen, disease recognition, and the depth and breadth of academic expertise. My advice to those wanting to be physicians? Go to medical school.

That said, we certainly need NPs and PAs. But to confuse the roles by equating them with MDs and DOs will only worsen our currently handicapped healthcare system. We must work together for the good of our patients and start by repairing the basic problem. Encourage the physician-patient relationship to be just that; and remove the economic and medicolegal pressures and distractions from the exam room.

The Sudan

I recently attended a conference in Atlanta given by Open Doors addressing the needs of the Persecuted Church. Many times we forget they exist. Many times we forget their struggles. Many times we forget their sacrifices and even their martyrdom.

In less than 2 weeks, I will be going to an area in Sudan that is just south of Darfur. Leitnohm has recently been devastated by war, destruction, rape, and murder. I am going with a team of 5 others to minister to the people there.

Lloyd Shadrach and I will be discipling and teaching a large group of pastors who have a very limited education in Bible and Theology. He will be teaching on the topic of Marriage and Family, and I will be teaching on the topics of the Theology of Sin, and Spiritual Power & Authority.

The 4 others in our group will be interacting with the Women and Children in the areas of Trauma and Grief Counseling, and Marriage and Family. Keep in mind that this is a polygamistic society, so that is no small task!

I really hate writing letters appealing for financial support. It is most likely a pride thing. However, given where we’ve been for the past few years, it is necessary. I believe the Lord wants me to go to the Sudan because it is not something I sought, but is something I couldn’t seem to avoid though I tried.

Friends have told me that there are many who want to go, but can’t for one reason or another. However, they go vicariously through another by giving financially to support the missions effort.

The total cost of my trip is $3,000. That includes roundtrip airfare to Nairobi, food, lodging, visa, malaria meds, and then a chartered MAF flight into and out of the Sudan. If the Lord so moves your heart to join me in ministering to our brothers and sisters in the Sudan – either through daily prayer and/or through a financial contribution, please let me know by responding to this letter via email at olhamada@comcast.net.

All contributions are tax deductible when made out to ‘Fellowship Bible Church’. Please remember to put “Omar Hamada – Sudan Trip” on the Memo line and mail to Fellowship Bible Church, 1210 Franklin Road, Brentwood, TN 37027.

Thank you for your prayer and support.

The REAL Reason We Invaded Iraq

When I was in Afghanistan with the US Army Special Forces in 2002 - 2003, we began to notice a significant reduction in our air assets towards the end of 2002 (EC-130 Talons, AC-130 Spectres, AH-64 Apaches, etc...). This told us that regardless of whatever message the White House was delivering over the airwaves, the decision had already been made to launch a full-scale attack on Iraq in short order, as essential assets are never removed from an active battlefield to be used simply as a show of force or even placed in a staging or holding pattern in a different AO unless that engagement was imminent.

Most all of us were thoroughly puzzled and began voicing great concern that our CInC (Commander-In-Chief) was making a very bad decision. We were where the bad guys were. We had UBL (Usama bin Laden) in our sights more than once - and were told to stand down. We found numerous caches of Chinese weapons that we destroyed in place with C4 and diesel fuel. Though we were deployed to "seek and destroy our enemy and to prevent freedom of movement and deny sanctuary to them", we saw our mission change over a short period of time into policing various regions and burning opium fields.

The reasons Americans were given for us going to war with the Iraqis were myriad - and they changed with each passing week. In fact, the reasons changed so rapidly that it was next to impossible to keep up with what the current rationale was.

First, was the excuse that the Iraqis were involved in terrorism and were providing sanctuary and training to Al Queda (we KNEW this was untrue). Then it was the "fact" that they had weapons of mass destruction. Though it had been true 10 years earlier, that was quickly discounted as well, as sanctions and UN oversight were in fact working, and Hussein was known to be bluffing in order to keep the Iranians at bay. Then it became an issue of human rights and the provision of freedom to the Iraqi populace. In fact, one of the primary messages used to garner support for this argument was the gassing of Iraqis by Saddam Hussein in 1988, though, as CIA and US Army reports acknowledge, we knew that he was not the one responsible for this, but the Iranians were (the Iraqis had no such nerve agent in their arsenal). That did not stop the WH from using this misinformation to sway the American public towards supporting this war.

Other reasons that were floated were oil and economic control of the Persian Gulf (though we had been in complete control of the Gulf since GHWB's term as we had wrested it away from the Russians in the first Gulf War using Kuwait as bait), GWB seeking vengeance for GWHB's being targeted for assassination, democracy, Iraqi Freedom, violations of a UN resolution (though the leading violator of UN resolutions was and continues to be Israel), and on and on and on.....

Most all of these reasons were hollow, had little merit, and were easily seen through by most "in the know". However, the sales job on the American populace was rather effective.

The REAL reason we went to war in Iraq was for the sake of Palestinian autonomy and Israeli security. Every US president since Woodrow Wilson has been trying to bring peace to the area after he agreed to partition Palestine in order to give European Jews a homeland. Every US president since Wilson has failed. President GW Bush thought he could make it work. Unfortunately, he was wrong.

His motives were admirable. His plan was naive.

In order to make this happen and in order to secure Israel's safety, we agreed to eliminate Israel's biggest threat - Saddam Hussein. In exchange, PM Ariel Sharon formed a third party and agreed to remove settlements from occupied Palestinian territories, grant Palestinians autonomy, and work towards a two state solution. This plan was masterminded and negotiated by Paul Wolfowitz, John Ashcroft, and Donald Rumsfeld.

This was told me by a friend who had very close ties to the GWB WH and was then corroborated by several other independent sources - including one who serves on the Council on Foreign Relations, and another who is on staff at The Fund for American Studies. This scenario does seem to make the most sense. In fact, SEC Powell's statement, "The decision to go to war was made well before evidence was gathered" which he made around noon on the day of his resignation as he and his wife stood on the steps of the US Capitol, seemed to support this argument by weakening the other reasons given for the war. Food for thought.......

Rights of Conscience

The US Constitution lays out fundamental rights that preserve individual religious liberties and freedoms of conscience. 

For decades, workers in all sectors of our society have enjoyed legal protections with regard to their religious liberties and freedom of conscience. Of course, this unfortunately hasn't completely obliterated discrimination in the workplace, but it does provide the legal framework to protect the individual and to prosecute those who infringe on these rights. In general, these laws require that recipients of federal funds comply with all non-discrimination laws regarding race, color, national origin, religion, gender, disability, sexual preference, etc... 

Various legislation has been passed that prohibit recipients of certain federal funds from discriminating against individuals or coercing individuals in the health care field from participating in actions they find morally or religiously objectionable. However, recently some groups have come to believe that rights of conscience and individual self determination apply to all, except those within the health care field. 

The piece of legislation in question is nothing new, but simply raises awareness to the fact that religious freedoms and rights of conscience against performing morally objectionable acts are, in fact, also protected. 

A few examples: The Conscience Clauses in various legislation throughout the 1970s restate the same. The Public Health Service Act of 1996 signed by WJ Clinton reinforces these laws. The Weldon Amendment of the Consolidated Appropriations Act in 2005 and 2008 as signed by GW Bush also strengthens these laws of our land. 

The most recent piece of legislation as signed by GW Bush and as castigated by BH Obama simply clarifies and further defines these specific laws which are already in effect, and have been so for almost 4 decades. These laws apply to hospitals, nursing homes, medical schools, dental schools, pharmacy schools, nursing schools, home health care services, etc.... and applies to an individual's rights of conscience with regards to elective sterilization, abortion, euthanasia, etc... 

The ACLU, Planned Parenthood, and other organizations and groups want to demand tolerance in all things except those things which are morally objectionable to Christians. In those areas they are insistent on compelling everyone to take part in some form or fashion, in abortion and sterilization, and eventually euthanasia. 

For some, the right of a woman to abort her child supercedes a physician's right and obligation to be true to his or her own conscience and his or her God. That is backwards. We cannot force people to act in a way to which they are strongly opposed. 

In fact, we take an oath to "do no harm, take part in no euthanasia or execution, perform no abortion, have no sexual relations with a patient, and to preserve the purity of life". Over the past 30 years many medical schools have abandoned this oath. Today only 14% of the oaths medical students take prohibit euthanasia, 8% prohibit abortion, and 3% sexual contact with a patient. 

We are losing our ethical bearing as a profession, as a society, and as a nation. These are important decisions that will determine how far the slippery slope we slide. Unfortunately, we are gaining speed with not much left to slow us.

Economics 101

Just got this email from Tom Cloud.  It certainly rings true!

An economics professor at a local college made a statement that he had never failed a single student before but had once failed an entire class.

That class had insisted that socialism worked and that no one would be poor and no one would be rich, a great equalizer.

The professor then said, "OK, we will have an experiment in this class on socialism. All grades would be averaged and everyone would receive the same grade so no one would fail and no one would receive an A.

After the first test, the grades were averaged and everyone got a B.

The students who studied hard were upset and the students who studied little were happy.

As the second test rolled around, the students who studied little had studied even less and the ones who studied hard decided they wanted a free ride too so they studied little.

The second test average was a D! No one was happy.

When the 3rd test rolled around, the average was an F.

The scores never increased as bickering, blame and name-calling all resulted in hard feelings and no one would study for the benefit of anyone else.

All failed, to their great surprise, and the professor told them that socialism would also ultimately fail because when the reward is great, the effort to succeed is great but when government takes all the reward away, no one will try or want to succeed.

Could not be any simpler than that.

The Last Time

I want to ask you a question that I've been wrestling with over the past couple of weeks.  It seems that in the busyness of life at home, it's easy to ignore, not think about, actually forget about this.  But in the quiet loneliness of a hotel room, it screams at me.  In the absence of children's laughter mixed with the frustration of defiance and disobedience, in the absence of the constant nagging of email and ringing of phones, in the absence of being tied to such a strict schedule of daily chores and carpool lines, God's quiet voice speaks.

How aware are you of God's constant presence in your life?  How often do you speak to Him?  Really?  We know He's in our heart, but how much does He control our lives?  When was the last time you really talked to Him?  I don't mean the last time you asked Him for something.  I mean when was the last time you communed with Him with no other agenda save to get to know Him?  When was the last time you sat in still quietness to do nothing other than listen to His voice?  

It takes a while to clear our minds of all our "to do's".  We drift easily into day-dreaming and have to refocus ourselves onto the task at hand.  It's like talking to our spouses in some ways.  Our minds so easily drift onto tangential highways that it takes effort sometimes to focus on what it is that is really being communicated. It usually takes me a few minutes to stop thinking about my to do's, Tara, the kids, my dreams, my hurts, my embarrassments, my deadlines......and just, well, just quietly sit there and listen, and pray, and not ask for anything other than His Spirit to fill my life, His presence to take over my soul, His word to overwhelm my entire being.

It's not easy to find the time - or the will.

When was the last time?

Dave Ramsey's Common Sense Economic Fix

Years of bad decisions and stupid mistakes have created an economic nightmare in this country, but $700 billion in new debt is not the answer. As a tax-paying American citizen, I will not support any congressperson who votes to implement such a policy. Instead, I submit the following three steps:

Common Sense Plan.

I. INSURANCE

A. Insure the subprime bonds/mortgages with an underlying FHA-type insurance. Government-insured and backed loans would have an instant market all over the world, creating immediate and needed liquidity.

B. In order for a company to accept the government-backed insurance, they must do two things:

   1. Rewrite any mortgage that is more than three months delinquent to a 6% fixed-rate mortgage.

      a. Roll all back payments with no late fees or legal costs into the balance. This brings homeowners current and allows them a chance to keep their homes.

      b. Cancel all prepayment penalties to encourage refinancing or the sale of the property to pay off the bad loan. In the event of foreclosure or short sale, the borrower will not be held liable for any deficit balance. FHA does this now, and that encourages mortgage companies to go the extra mile while working with the borrower—again limiting foreclosures and ruined lives.

   2. Cancel ALL golden parachutes of EXISTING and FUTURE CEOs and executive team members as long as the company holds these government-insured bonds/mortgages. This keeps underperforming executives from being paid when they don’t do their jobs.

C. This backstop will cost less than $50 billion—a small fraction of the current proposal.

II. MARK TO MARKET

A. Remove mark to market accounting rules for two years on only subprime Tier III bonds/mortgages. This keeps companies from being forced to artificially mark down bonds/mortgages below the value of the underlying mortgages and real estate.

B. This move creates patience in the market and has an immediate stabilizing effect on failing and ailing banks—and it costs the taxpayer nothing.

III. CAPITAL GAINS TAX

A. Remove the capital gains tax completely. Investors will flood the real estate and stock market in search of tax-free profits, creating tremendous—and immediate—liquidity in the markets. Again, this costs the taxpayer nothing.

B. This move will be seen as a lightning rod politically because many will say it is helping the rich. The truth is the rich will benefit, but it will be their money that stimulates the economy. This will enable all Americans to have more stable jobs and retirement investments that go up instead of down. This is not a time for envy, and it’s not a time for politics. It’s time for all of us, as Americans, to stand up, speak out, and fix this mess.

Crucified by Christians: Bitterness, Pain, and Forgiveness

My father has always been one of my heroes.  He was a man I looked up to, and in many ways, wanted to be like.  His sense of conviction, his perseverance in the face of adversity, and his unequivocal stand for what was right, inspired me and many others.  He holds multiple degrees from Florida State, Dallas Theological Seminary, and Oxford.  He has published 4 books, and written many others.  He has discipled hundreds.

God has used him to change the world as far as evangelizing Muslims goes.  Dallas Theological Seminary, Campus Crusade for Christ, Zwemer Institute for Muslim Studies, the US Center for World Missions, Open Doors, Operation Mobilization, YWAM, and on and on..., had their mission's philosophies and theologies challenged.  He also revolutionized the way many Western Christians think of Arabs and Jews.  In fact, many have changed the entire way they do Muslim ministry because of his work and teaching.  As the first known Druze convert to Christianity in 1954, his ministry has led to the conversion of many others, starting with many in our own family. 

He came from a privileged background with land, servants, and anything a child could want.  However, as a young boy, he watched as his father, Prosecutor General over Lebanon and northern Syria under the French Mandate rule, was assassinated.  His younger sister, an undiagnosed diabetic, died during my grandfather's week-long funeral procession from Syria to Lebanon.  His mother remarried and moved to Flint, Michigan, where she and her unborn child were murdered.  She was then cremated and her ashes were placed in an unmarked mausoleum drawer, not to be discovered until half a century later.

My father's uncles "appropriated" all of his and his 2 older siblings' inheritance and land and placed them in boarding schools.  He lived life as a scrapper, and eventually discovered his love for the arts.  He became a professional musician and actor in Lebanon and Egypt, and went on to befriend and discover a young lady named Nouhad Haddad.  He introduced her to a producer named Rihbani whom she eventually married.  No one knew that she would go on to become the best known Arabic singer of the 20th century.  The name everyone knows her by is Fairuz.  She is the 'Elvis' of the Middle East.

Once he immigrated to the US, he tried his hand at many things, bellboy at Mackinac Island, waiter, construction worker, driving instructor in Chicago, fencing instructor, etc...  Eventually, he rediscovered his love for music, which is where he settled.  

In the mid-50s, he lost his four best friends in a car accident.  They were driving from Missouri to Brooklyn for Christmas. He was in the front passenger seat of a 1949 Kaiser.  Their car went underneath an 18 wheeler.  All in the car were decapitated except him.  It is after that that Christ rescued him.

In 1964, at 36, he returned to Lebanon and married my mom - a 17 year old spitfire who was outgoing and full of life.  Their marriage was rocky from the beginning and remained so for the 36 years they stayed together as both brought a lot of baggage and immaturity into their relationship.

He had an illustrious teaching career until 1982, when he switched to the full-time ministry.  All went well until 1999.  It started with the daughter of Lance Ledford, one of my High School classmates.  The Ledford's 10 year old daughter was like a grandchild to my parents.  Over the course of about 3 years, she became a small part of our family.  Her parents had grown up "on the wrong side of the tracks" but had since come to faith in Christ, and even attended the same church as my parents - Evangelical Community Church in Jackson, TN.

My parents had just returned from a mission trip overseas.  Mom was out praying with one of her friends.  Dad was at home going through mail and phone messages when this young lady came over wanting to look through my sister's toys.  She didn't find anything that appealed to her so my dad hugged her and kissed her on the cheek, as was his usual custom.  Two hours later, 2 police officers arrested him for molestation.

Dad's case went to the Grand Jury after numerous interviews and polygraph tests which he passed with flying colors.  They chose to not indict as they found no fault.  However, the State insisted on prosecuting.  The judge downgraded the charge to a misdemeanor of simple assault and his case was expunged after a one year diversion.

The part that destroyed him was the reaction of the church and the elders.  Though he was well known and had discipled many in leadership, the pastor told the congregation that his name was not to be mentioned in church, he was not to be prayed for publicly, and he would be removed from the church rolls.  The elders refused to meet with him even once, though they met with the other family on several occasions.  This was all driven by a self-proclaimed and Reader's Digest educated "counselor" named Mary Ann who effectively ran the church.

Dad was essentially excommunicated and denied fellowship though he did nothing wrong.  He has spent the past decade trying to recover from this.  In the end, unfortunately, my mother unwittingly aided in his destruction by spreading many rumors about him.  Some were true, and some weren't.

Here was a man, falsely accused who need help, love, and understanding.  Instead he was met with hate and rejection.  These "Christians" still do not see anything wrong with their unscriptural reactions and believe themselves to be "righteous" when in fact, they were used by Satan himself to destroy and maim.

The reason I chose to write about this now is because EVERYONE I run into that knows him, still treats him as though he has leprosy.  They are scared to even mention his name.  I am tired of having to feel as though he is at fault when in reality, it is everyone else who is at fault.  They act as if they are perfect and he is tainted.  They don't even want to associate with him lest they get dirty.  I thank God that His son Jesus Christ chose to get dirty on my behalf.  What is Christianity - really?  Is this a picture of Christ?  

I agree with my dad, if this is "Christianity", I want none of it.  However, I will never deny my Lord and Savior Jesus Christ.

The Faith of Barack Obama

Well, ok.  So maybe I wasn't as "back" as I thought; but here we go again making an effort to blog more consistently.  What better way to jump back in than to discuss fellow Nashvillian and CPA dad, Stephen Mansfield's new book "The Faith of Barack Obama".

A few weeks ago, Thomas Nelson Publishers made an offer of a free book to the first 100 bloggers who responded with a promise to write a blog report on Mansfield's work.  I was one of the fortunate few.

I wanted to wait until after the convention, and especially until after SEN Obama's acceptance speech to post my thoughts.  Not that it affected my review, but I wanted to gain a better appreciation for the man, the message, and the motivation behind his campaign.  I also wanted to ride the crest of the wave of excitement about the Democrats' inspiring and eloquent candidate.

Mansfield's is a rather short book as books go, and is easily readable in a single day.  Though he makes it clear on his blog that he will not be voting for SEN Obama, his treatise is well written and unbiased.

Since you can find a horde of other reviews of the book that pretty much analyze the entire book from a literary and technical standpoint, I want to take a different approach.  I want to address what the book says about what Obama's faith is and what it is not.  Actually, all I really want to do is answer one simple question - "Is Obama a Christian?"  

Last New Year's, I attended the Lader's Renaissance Weekend in Charleston, SC.  One of the panels I was asked to serve on was the panel on "Living our Faith".   There were several other distinguished guests on the panel - a couple of professors from Harvard and Yale, a couple of published authors, and others who were involved in the ministry in one capacity or another.  All claimed to be Christians save one who said he was an Athiest Jew (his rationale on acceptance of others in Christian love was incredibly compelling - I loved the way he thought.  In fact he was more of a Christian in how he lived his life than any of us were).  

When asked to speak, I tried to set the foundation on what I thought would be safe and basic ground - "What does it mean to be a Christian?".  I found out very quickly that very few agreed on what exactly a Christian is.  

Just to be clear, I firmly believe that Scripture leaves no room for debate about the five essentials of the Gospel - the virgin birth, the deity of Christ, Christ's literal death/burial/resurrection, the second coming of Christ, and the inspiration/inerrancy/infallibility of scripture.  Everything else is debatable (baptism, sacraments, gifts of the spirit, music, prophecy, etc...).  Without the essentials, one can say he or she is a Christian all they want, but that doesn't make it true.  It's sort of like a pig saying he's a horse - it just ain't so.

Back to Mansfield's book - Obama says, "The Bible, the Koran, and the Bhagavad Gita sat on the shelf alongside books of Greek and Norse and African mythology.  On Easter or Christmas Day my mother might drag me to church, just as she dragged me to the Buddhist temple, the Chinese New Year celebration, the Shinto shrine, and ancient Hawaiian burial sites."  [She tried to embed in me] "a common set of beliefs about how you treat other people and how you aspire to act, not just for yourself, but also for the greater good."

Mansfield goes on to show that Obama believes that "Christianity is but one religious tree rooted in the common ethical soil of all human experience".  He believes that there are many paths to God (as do 57% of evangelicals according to a recent survey by the Pew Forum on Religion and Public Life).  He believes prayer is a way to check one's ego, take stock of oneself, and maintain one's moral compass.  Regarding a conversation he had with his daughter about the afterlife, Obama states, "I wasn't sure what happens when we die, anymore than I was sure of where the soul resides or what existed before the Big Bang."  When asked about eternal punishment, he said, "I find it hard to believe that my God would consign four-fifths of the world to hell."

Though Obama says he believes that Jesus Christ is the Son of God who died for his sins and rose again, belief is not enough.  His doubts about the exclusivity of Christ, original sin, eternal punishment and reward, inspiration and infallibility of scripture, ethical standards founded on the scripture,  etc... make us question the genuineness of his belief and faith.  The scriptures tell us that the devil believes - and trembles.  Belief must take root in faith which then reveals itself in fruit as both Christ and the apostle Paul tell us.

So, after analyzing Obama's beliefs and background, though he may say that he is a Christian (as do upwards of 70% of Americans), he is not a follower of Christ in all that Christ is and teaches.  He picks and chooses what he believes.  In fact, he has done what many in our day do - he has created God in his own image returning the favor of God creating us in His.  SEN Obama's belief system proves to be rather pluralistic and pragmatic.  In essence he is a humanist, but he is not truly a Christian.  I am not trying to judge his heart, but I am looking at his fruit and making a general assessment based on what he says and how he lives his life.  This is not saying he isn't a good man.  I believe he is a very good man (though with a depraved and dark heart like the rest of us).  I also believe he is a great leader with great vision.  However, his words and life indicate that he does not know the Creator of the universe, our Lord and Saviour Jesus the Christ.

How does this play out in his electablity?  You tell me.

Our Next President

I figured I'd better go ahead and post this before Super Tuesday, so it'll be more believable (just want to be able to say, "I told you so"). Since mid-December 2007, I have been predicting that the Republican nominee will be Mitt Romney and that he would probably choose John McCain as his Vice President, and that the Democratic nominee would be Barack Obama who would possibly choose John Edwards as his Vice Presidential candidate. I believe that in the end, the Obama/Edwards ticket squeaks by to win the White House.

My feeling was that Thompson was done from the beginning because he was essentially disinterested, Huckabee would lag because of his strong religious values and the lack of a presidential "look", and Guliani would just flame out because of way too much baggage. I also felt that Edwards is just too smooth and untrustworthy, and Clinton has way too many negatives.

Unfortunately, the first time I actually published this on the Internet, to some scepticism I might add, was on December 31, 2007 on Ned Williams' WisdomIsVindicated blog, and on January 4, 2008 on Newscoma's blog. However, it is interesting to see how things are developing.

Thompson has dropped out, and Guliani is sure to follow shortly. McCain and Romney are neck and neck, but ultimately, I believe it will be Romney who will take the lead because of perceived strength of leadership and age.

On the "progressives" side - though Clinton is still ahead as far as delegates are concerned, Obama is moving up quickly and will surpass her. The excitement he creates with his message, youth, and honesty resonates well with a populace that is tired, confused, angry, and seeking hope and change. She is definitely in defensive mode and feels that she is quickly losing her grip on the nomination as has been evidenced over the past few days.

Though I am not ready to vote for a Democrat, I've got to be honest, Obama does inspire and excite something deep inside me. Let's see what happens. What do you think?

The Bhutto Assassination and Pakistan as an Ally

As one whose family has been intimately involved with international politics involving the US, the UN, Lebanon, and France (1 ambassador, 2 Parliamentary members, 1 national level minister and cabinet member, 1 Chief Justice, 2 assassinations, 1 attempted assassination, etc…), and as a 10 year US Army Special Forces combat veteran, I have maintained more than a keen interest in international relations and foreign policy.

Though I agree with Senator Bob Corker, Congressman Jim Cooper, and Mr. Kevin Doherty on many points, I must respectfully and strongly disagree with several of their statements and positions.

President Musharraf is dangerous and ultimately untrustworthy. Make no mistake, he is a dictator, is hostile to US interests, and has little support within his own country. Regardless of what we are told by our government, he is at most an ally of convenience and necessity in the most dangerous country in the world as far as US foreign policy is concerned.

As our State Department knows well, he is at high risk of being assassinated in the near future. Pakistan will then be run by Islamic extremists who are sympathetic to Al Queda and Taliban proponents who will have control over Pakistan’s nuclear arsenal. We are one man away from a very serious problem unlike any we have ever seen. Should he be assassinated, we will be forced to ally with Iran in order to try to keep Pakistan in check as we try to prevent a hostile nuclear Pakistan from falling into terrorist hands. Russia is ahead of us here, and is likewise very concerned.

Just 3 weeks ago I spoke with Gail Sheehy who was the last journalist granted an interview with Benazir Bhutto just before she was assassinated (published in this month’s Parade magazine). Bhutto told her “I am what the terrorists most fear”. She was a force for democratic reform; however, though better than Musharraf, even she was tainted with corruption, impropriety, and less than ideal US values.

Contrary to Mr. Cooper’s opinion, we do have many Arabists - and very good ones. The problem is that this administration does not truly listen to them. Focus groups meet, people take notes, experts are consulted; but ultimately, their advice goes unheeded as we instead arrogantly proceed with our Americanized worldview devoid of other cultural paradigms and perspectives. We seem to want to colonize instead of convince by winning hearts and minds.

I agree we do need a fresh new approach that includes Palestinian autonomy (the real reason behind the Iraq war and much of the worldwide tension we now see). However, complete military disengagement “from the entire region” is a very foolish choice. It goes without saying, we do not need a “one country solution”, but need a deliberate, intentional, well thought out approach to how we interact on a global scale. Military intervention is a tool, and a powerful one – when used appropriately. We have recklessly abused it and are paying the price.

I'm Back!!

Well, as you've undoubtedly noticed, I haven't been blogging for a while. I've been awfully busy over the past few months as I transitioned out of my job at HCA into a new job at Pfizer, prepared for Christmas, attended Renaissance Weekend, went to NYC twice, and on and on.

But now I'm back. I've got a ton to blog about and am very excited to get started with some great topics - a fresh view on the REAL reason we are in Iraq; the broken healthcare system and what we must do to fix it; the upcoming summer war in Lebanon/Syria/Israel; the assasination of Benazir Buhtto and what that means for Musharraf, the US, Iran, and the entire Central Asia and MidEast regions; the United Nations and its influence on world affairs; my predictions on who will win each party's nomination and who will eventually win the Presidency; HCA's evil empire and why it's bad for the future of true healthcare reform; President Bush's legacy; religion in America and how we can live in unity while maintaining our Christian heritage; living a healthy and prosperous life; eight steps to effective evangelism and giving our lives away; expanding and focusing our worldview; etc...

Please come back - I'm interested in what you have to say.

Afghanistan 2002

I was scared. We all were, though not one would show it or verbalize it. Few of us had ever been in actual combat before. Our Special Forces team was flying on a Talon EC-130 into post-9/11 Afghanistan just months after our initial invasion. Our mission was to rout the Taliban and to deny Al-Queda sanctuary and freedom of movement within the borders of Afghanistan - and sometimes beyond.

We were all locked and loaded, each carrying an M4 Colt carbine and an M9 Beretta with a full battle load of ammo, forty pounds of body armor, and a seventy pound ruck sack. I remember wondering whether or not I'd just bought a one-way ticket, or if I'd make it home in one piece. I wondered if I'd ever see my wife and 2 year old daughter again. After viewing decapitation videos, and the video of the horrendous torture and eventual slaughter of the Navy SEAL who fell out of the back of the MH47 Chinook earlier in the war, we were advised to save one bullet for ourselves should we fall into enemy hands.

We bumped around the country at 10 miles an hour in our dust filled Toyota Tacoma pickup trucks wearing civilian clothes, hiking boots, baseball caps, and full beards - somehow thinking no one would know who we were. Afghanistan was the most heavily mined country in the world with some 20 million land mines scattered throughout the countryside by Russian and American forces 20 years ago. It wasn't just the land mines we were wary of, but the remotely detonated booby-traps set up to kill us, and to set us up for an all out ambush. These booby traps were usually well placed around tight curves and sheer rock mountain walls on one side so the majority of our team would be in the "kill zone" with little way of escape.

As we traveled we saw dozens of burned out Russian armored personnel carriers, tanks, helicopters, and planes. All had been scavenged for any part that was considered usable. We discovered weapon stockpiles - mostly Chinese rifles and mortars. We discovered mass graves with skulls, femurs, humeri. We found fields laden with opium poppies and hashish. Much of this served to remind me of the frailties of human life. Psalm 23 kept running through my head - "Yea though I walk through the valley of the shadow of death, I will fear no evil. Thy rod and thy staff, they comfort me".... The Lord's protection of King David as he engaged in hand-to-hand combat many times throughout his life, encouraged me and gave me hope and confidence.

I was there for a purpose. I was the FOB 201 Special Forces Flight Surgeon and Diving Medical Officer with the US Army's 1st Battalion 20th Special Forces Group, (Airborne). I was responsible for all things medical in the two-thirds of Afghanistan that our unit controlled. My responsibilities included advising our commander with regard to medical issues, training our Special Forces Medics (who I trust more than I trust most medical or surgical residents), setting up medical supply delivery throughout our area of operations, coordinating and providing medical care to our forces in safe houses throughout the country, and setting up, coordinating, and overseeing Medevac routes and logistics - especially for those places north of the Hindu Kush as winter rolled in (helicopters just couldn't make it through the treacherous mountain passes in bad weather). We also organized and ran medical services for the indigenous population.

One of our most successful indigenous clinics was just outside of Asadabad just miles from the Pakistani border. We treated otitis, colitis, pneumonia, chronic pain, leprosy, and shrapnel injuries. This was the same place we mobilized from for our frequent forays into the surrounding areas with the CIA and Delta. We quickly discovered that our "allies" were anything but. We were held at gunpoint until a $50,000 ransom was paid to the Pakistani government. Along the border, Pakistani forces were told to engage us, and even went to arms on our forces - until a couple of Army A10s moved in with a low pass over the heads of our "friends" causing them to stand down.

Some ask why I gave up my job at the University of Tennessee and left my family to put myself in harm's way. As I sat in my living room watching events unfold on the morning of September 11, 2001, I realized we were at war. I realized life would never be the same again. I realized I must act to protect what I believe, and must sacrifice if my children are to grow up in a world free from fear. I experienced every emotion that morning from shock to sadness, from anger to bewilderment. We were at war. It was a religious war, and it was a war of values.

In the weeks before we deployed, I took my entire medical section to New York City where I had spent a couple of years of my life. I gave them each a New York Metro Subway token to place on the chain with their dog tags. As we viewed the site where the World Trade Centers once stood, we cried - Special Forces soldiers standing there in tears as we imagined people jumping from 80 stories above; we stood incomprehensibly envisioning planes flying into these symbols of freedom; we stood steeling our determination and resolve to find those responsible and meet justice to them.

The line from Braveheart rang true. "And dying in your beds many years from now, would you be willing to trade all the days from this day to that for one chance, just one chance to come back here and tell our enemies that they may take our lives, but they'll never take our freedom".

Would I do it again? Certainly. Do people truly understand and appreciate what the average soldier sacrifices? Hardly. I do wish I could tell America that freedom is bought with a precious price. Appreciate it. Stop whining and complaining. Stop bickering. Unite. Learn humility. Give thanks. Get along. Love one another. Aim high. And remember, "Every man dies - but not every man truly lives".

Iran Ready to Fill Power Vacuum in Iraq

Fox News reports that President Ahmadinejad Says Iran Ready to Fill Power Vacuum in Iraq.

Last night one of my old SF buddies from Tampa paid me a visit while I was pulling "Shock Doc" duty at Baptist Labor and Delivery. He's one of the most talented and intelligent guys I know, and has a great handle on foreign affairs - especially on the Middle East. In fact, I think he's knows more about the people, the culture, and the politics than Paul Bremmer. He was in Iraq for DS1 before hostilities officially began, and then again before OIF kicked off - when there were supposedly no US troops in Iraq.

We talked about almost everything - women, religion, commerce and trade, business, healthcare, politics, life, the future, CAG/SMU (Delta), and the intelligence community. Eventually, our conversation drifted to Iraq and what we believed to be prudent and correct military policy for the area. Unfortunately Congress disagrees, and I fear, will soon and rapidly fill Iraq with our absence. My friend's opinion was that Iran will immediately claim Eastern Iraq, Turkey will overrun Northern Iraq (as they've already tried to do on several occasions), and Saudi Arabians will slowly infiltrate the south.

I found it very interesting to see this article on Fox News this morning. He may be right on target. So much for the oil. (I really don't believe we'll leave the oilfields without some form of surveillence and defense - especially after spending all of that money to get Halliburton/KBR to lay pipeline from Kirkuk to Israel - though I understand they're having a little problem at the Jordanian border).

Officials Rethink Hopes for Iraq Democracy

CNN reported today that US officials have reconsidered plans to pursue democracy in Iraq, and would instead be satisfied with an effective government that can provide services and security to its people. (Wait a minute, didn't they have that 4 years ago - minus all the terrorists?)

MG Benjamin Mixon stated, "Democracy is merely an option, that Iraqis are free to choose or reject", and BG John "Mick" Bednarek said, "Democratic institutions are not necessarily the way ahead in the long-term future". (WHAT!!!???)

Forgive my cynicism, but these are things that many advisers told President Bush several years ago, but were summarily dismissed as pessimistic and unpatriotic forecasts. It was very telling indeed when the President made the comment that after the "liberation" of Iraq "We will be welcomed with open arms", as most who knew anything about Iraqi culture knew he was either deceived or completely ignorant of typical Middle Eastern culture which had been steeped in authoritarian regimes for millennia and would not be converted to a democratic state within a period of 2 to 3 years. (Ignorance, not in a pejorative sense, was the more likely option given that at the beginning of his first term, he knew neither the name of Canada's PM or of Mexico's President - the only two foreign countries that border the United States, one of which bordered his home state of Texas for at least as long as he was Governor).

This has been a major "Charlie Foxtrot" as we lovingly refer to it in the Army. The only hope is not to cut and run and hope for the best, but to do what it takes to fix the problem. As GEN/SEC Colin Powell said, "If you break it, you've got to fix it". This will mean a much larger surge, perseverance, commitment, and sacrifice on the part of all Americans, not just the 1% who have served or are currently serving in the US Military. If we maintain a shortsighted view of what's best in the next year or two, we will regret it in the long run. Like it or not, the American public has an aversion to casualties and we have history of retreating when it becomes politically unpopular to stay the course. (Remember Vietnam, Beirut, Somalia?) Our enemies know this and take advantage of it. Now we want to reinforce this belief?

In addition, we fight wars in the media and are swayed by public (non-warrior) perception instead of freeing up our commanders and soldiers to do what needs to be done in war - and that is fiercely engage and kill the enemy and destroy their will to fight. Instead they are destroying ours.

If a draft is necessary, so be it. What people fail to realize is that we are fighting for our survival. China and Russia are on the sidelines watching, waiting, building, networking, strengthening - all while we are trying to decide how fast we want to run away and lick our wounds. Forgive my language, but we have done our soldiers a disservice as our politicians have fought this war half-assed with one foot on and one foot off the battlefield.

We have created a monster. The only way to defeat it is to win this war decisively, not run away, retreat, ignore it, and hope it goes away. Turn this over to the Generals, don't make them answer to politicians, make everyone take ownership (as the end result will certainly affect everyone), get out of the way, and let the warfighters do what they do best - FIGHT!!!

Who Needs Authority?

Last week, our pastor preached on authority. It brought back memories of Bill Gothard’s Basic Youth Conflicts series which is founded on submission to God ordained authorities in our lives. I began thinking that in our society, there is such hostility whenever anyone mentions the words “submission” and “authority” – even in church, and especially in the context of marriage. We are a nation of individualists who take pride in self-determination and admire self-reliance above all. Submission to authority, is for some reason seen as weakness, when it actually strengthens a society.

It brought to mind a conversation I recently had with one of my relatives regarding this very same topic. His opinion is that authority and respect have to be earned. Just because someone holds a position does not automatically give them the right to expect submission or respect from anyone. He backed this up by saying that he prides himself on the fact that his 9 year-old son and his son’s friends treat him like one of their own, and call him by a shortened version of his first name. When I was growing up, that was a good way to find yourself in the woodshed. We never would have dreamt of calling our parent’s friends by their first names or nicknames. It was always Mr. Jones and Mrs. Smith, not Bobby and Joan.

There no longer seems to be an appropriate level of respect for authority and the subsequent submission it must bring about in our nation today. This is not to say that there shouldn't be accountability. We must certainly hold our leaders accountable. However, we must afford them a certain degree of respect, and must submit ourselves to their leadership - even when we disagree with their decisions. Colin Powell once said, "When we are debating an issue, loyalty means giving me your honest opinion, whether you think I'll like it or not. Disagreement, at this stage, stimulates me. But once a decision has been made, the debate ends. From that point on, loyalty means executing the decision as if it were your own".

People love celebrity but despise authority. From the disrespect our nation affords the Office of the President, to the disrespect many have for their teachers, pastors, police officers, military, parents, and yes, even spouses, I fear the very fabric of our nation is fraying as we rapidly slide down the dangerous slope of rebellion.

Shots Assist in Late Term Abortions

I just did an interview with Charlie Butts of USA Radio out of Dallas regarding the Boston Globe article ‘Shots Assist in Aborting Fetuses’. Evidently, many abortionists are getting around the recent Supreme Court’s ban on Partial Birth Abortion by killing the baby before delivery, instead of killing the baby during delivery as was the old practice. So essentially, in an effort to technically circumvent the partial-birth abortion ban, abortionists have moved the death for the baby by a few inches and a few minutes.

First, as a practicing OB/GYN, there is absolutely no reason I can think of that would necessitate killing a term or near-term infant in order to save the life of the mother. You have to deliver the baby regardless, why not deliver it alive instead of killing it?

Secondly, the reason given for this barbaric practice is to primarily protect the doctor (if you can call him/her that) from legal recrimination while doing absolutely nothing to protect the mother, or the baby for that matter. This procedure in fact, places the mother at higher risk as the doctor is injecting concentrated potassium chloride or digoxin into the baby through the mother. (Incidentally, remember potassium chloride is what is used in lethal injection style executions).

As Dr. Gene Rudd, OB/GYN and VP of the Christian Medical and Dental Association said, “It now remains to be seen if our elected representatives and courts have the courage and conviction to require that the spirit of the law be upheld, not just the letter of the law. It will require a new round of legislation and court challenges.”

What happened to the old maxim, “First do no harm”?

Cry for Lebanon

Since last July’s month-long random and merciless Israeli bombardment, Lebanon has faced the very real threat of internal conquest by a ruthless, militant, and emboldened enemy. Hizballah has intentionally paralyzed Lebanon with the intent of overthrowing the current government, and claiming the throne for militant Islamic rule, courtesy of Iran and Syria. March 14th forces are holding on the best they can, but their grip is weakening. Unfortunately, Lebanon is far from any political solution, and faces a high threat of armed conflict, whether internal or external. On the other hand, Lebanon may get pulled into a regional conflict between Israel and Syria, because Syria will be sure to use Lebanon as a primary staging ground and will attack Israel from the Southern border, the Mediterranean, as well as the Golan. In fact, Syrian troops have already re-entered Lebanon and have fortified positions three kilometers inside Lebanese borders.

It's only a matter of time before internal violence increases given that Hizballah refuses to concede governmental control to properly elected officials and will not give up until they are in control. They also will never have a policy of peace with Israel, but will continually seek conflict once they achieve their goal of governmental control. The only way out of this debacle is open, deliberate, and armed intervention by a foreign power such as France, Germany, or the US, and I don't see that happening. Then there's the Palestinian problem with Fatah al Islam.......

The Lebanese Army, though enjoying wonderful and widespread public support, is weak - as we've seen from the past 2 or 3 months of fighting in Tripoli. This is a conflict that should have been easily completed within a week or two. The fact that it is still dragging on would be almost comical if it weren't for the sad fact that so many soldiers have been killed. Approximately two Lebanese soldiers have been killed for every one militant. That speaks volumes as to the Lebanese Army's knowledge of military doctrine and tactics, and of its ability to properly execute a military operation. They may be slowly winning, but certainly not in a decisive way, and then only because of superior numbers of soldiers available to replace the dead and injured, and open food, water, and ammunition supply routes. On the whole, however, they are being out fought and maneuvered hands down and could never effectively face an organized military force, Hizballah, or global civil unrest. Depending on them at this stage to maintain peace is not an educated or wise position. However, they are trying, and my heart certainly goes out to them. I am very proud of their efforts, but they seem to be little more than cannon fodder. I blame their training, leadership, and governmental support. Additionally, it is always easier to defend than to attack, and unfortunately they find themselves facing a hardened, well emplaced, and defensive enemy with ideal cover and concealment, while they are relegated to poorly emplaced positions that leave them open to sniper and mortar fire.

The social structure of Lebanon is fraying rapidly, and will continue to degenerate until all those who can leave do, and many already have, leaving Hizballah an open door to take over and place Lebanon under some form of militant Islamic law. The fact is that Hizballah has freedom of movement throughout the country, while the properly elected officials are limited to their heavily fortified homes with no freedom of mobility whatsoever. It is only a matter of time. Lebanon is under siege and will fall without aggressive external intervention, which, as we've seen, will not happen, at least not before violence erupts once again. I wish the US would get involved, but we can't given the despicable situation in Iraq, and the political turmoil we are facing within our own country on Capitol Hill.