Friday, December 19, 2014

Thoughts On Christmas

I love the extended end-of-year holiday season.  I enjoy everything about it.  Given a choice between the two major cultural-Christian holidays of Easter and Christmas, I’d take Christmas every time.  Don’t get me wrong.  I’m not saying “humbug” to Good Friday and Resurrection Sunday.  In the framework of western philosophical and religious thought, Easter – or its equivalent – is inevitable.   Humanity is inexorably drawn to reminders of our imperfection and alienation, our struggle to define the sacred, our emptiness apart from something greater than our self.  Easter is the perfect complement for such ruminations.  .
By contrast, the advent season is the antithesis of that.  Christmas reminds us that the story of humanity need not be bound up in the existential angst of uncertainty and despair.

It’s about innocence, new beginnings, gifts and celebrations. It’s about family and community.  When distilled to its essence Christmas is a proclamation of the good.  It’s a reminder that humility, truth, love, compassion - and all else that defines what is good and honest and true about us -  is worth celebrating.  It begins with an announcement from an other-worldly choir heralding “peace on earth, good will to all people”.  Angelic messengers usher in this season, their joyous song a reflection of what Deity thinks about us and envisions for us, and what we should envision for ourselves. It is not a time of doubt and estrangement but of faith and community.  Fear not, we are told, for this is an occasion of good tiding, a time of great joy. 

The miracle of Christmas may lie not so much in the fact of incarnation as in the expression of worth revealed in its effect - that the manger’s babe is a child of humanity.  Our merit, indeed our intrinsic value is revealed not in that God has come to visit with us but that He has become one of us, and more importantly, that he has become one of the least of us, a helpless child.  By this simple yet profound act God affirms the value of who we are.  Christmas is a reminder that life is pregnant with purpose and meaning and that each of us independently and as an organic whole is favored and deserving of good will and peace.

Sunday, August 10, 2014


I have a fascination with consciousness, which is why I was excited to read Robert Lanza’s book,  Biocentrism.  The premise offered a tantalizing promise of further investigation into the nature of this mysterious aspect of the natural order.  And since Lanza and the co-author were recognized experts in their respective fields (biology and astronomy), a logical, analytical approach with strong supporting arguments was sure to follow.
Not so much.
Biocentrism is the idea that life and consciousness are fundamental aspects of reality, forces upon which the universe – and existence itself - depend.  That sounds intriguing.  Unfortunately, Lanza falls flat when it comes to offering any meaningful support for this concept.  While I didn’t expect a grand theory, it would have been helpful if the author had offered an opinion about the most basic questions the book presupposes, like “What is the nature of consciousness?”, “How does consciousness arise?”, “How does consciousness create reality?”   Instead, Lanza assumes all of these notions a priori, without offering any explanation whatsoever.

Lanza believes that quantum theory holds the key to understanding consciousness and he spends a great deal of time reporting on the results of quantum particle experiments.  He never manages to connect the dots, however, between these experiments and his general premise, instead making broad assumptions that one is necessarily correlated with the other simply because he wishes it to be so.

The one area of the book which holds promise is his treatment of the anthropic principle and a specific reference to physicist John (of "black hole" fame) Wheeler's concept of a "participatory universe".  But even here Lanza fails to use this to his advantage.  

Wheeler has stated that " every item of the physical world has at bottom—a very deep bottom, in most instances—an immaterial source and explanation; that which we call reality arises in the last analysis from the posing of yes–no questions and the registering of equipment-evoked responses; in short, that all things physical are information-theoretic in origin and that this is a participatory universe."

Yet this remarkable comment by a giant among scientists, which fully supports Lanza's thesis, appears nowhere in his chapter on the anthropic principle.  This kind of sloppy, colloquial approach quickly diminishes the book's authority.

Although passing itself off as a book based on the science of quantum theory, invoking Einstein’s name every third or fourth page, and repeatedly asserting that he has no interest in philosophy per se,  this is essentially a work of philosophy, not science, and poorly constructed philosophy at best.  Lanza’s premises are a superficial rehashing of George Berkeley’s Idealism, with a dash of Spinoza and (an apparently accidental) shot or two of Kant’s Transcendental views on space and time. 

All in all, Biocentrism is a muddy mishmash that left me completely dissatisfied and fails in its attempt to offer insight into the beautiful mystery that is consciousness and subjective experience.

Wednesday, May 21, 2014

Redefining Primary Care

This is a guest post by Jennifer Brennan, a nurse practitioner in Southeast Texas (and my daughter) on the merits of advancing and expanding the role of Nurse Practitioners as primary care providers. Enjoy!

Redefining Primary Care
By Jennifer Brennan, RN, MSN, FNP-C

Jeff Guillory, a Family Nurse Practitioner practicing in Lumberton, Texas, has owned and operated his primary care clinic, NP Health Clinic, for over 8 years and sees approximately 100-150 patients per week. He manages a variety of health conditions-both acute and chronic- including, but not limited to, colds, diabetes, high blood pressure, high cholesterol, well-woman and well-child examinations, and annual recommended screening tests for both children and adults. He performs labs tests, EKGs, suturing, immunizations, and sports physicals in his office.  Mr. Guillory is one of a limited number of primary care providers in Hardin County, a relatively rural county of 54,635 people which has seen the ratio of medical providers-to-population decrease a whopping 33% since 2001.  (source: Texas Department of State Health Services).   

Mr. Guillory is typical of  Nurse Practitioners, having practiced for years as a Registered Nurse, developing and sharpening clinical skills and knowledge, before attending an accredited graduate school, completing a rigorous masters degree program in Nursing and passing a state board examination in order to be credentialed as a Nurse Practitioner

Each state has different laws governing the specifics on what a Nurse Practitioner can do.  In Texas, Nurse Practitioners must have a collaborating physician and must have a Prescriptive Authority Agreement in place, an agreement between the physician and the Nurse Practitioner, describing the delegated categories of drugs and devices a Nurse Practitioner can or cannot prescribe. In the United States, 19 states and The District of Columbia have passed legislation giving Nurse Practitioners Full Practice Authority, meaning NPs in those states work as independent medical providers. They can deliver primary care commensurate to their education.

Last week, an article featured in the Texas Tribune and NY Times illustrated a story about a Nurse Practitioner in Katy, Texas facing difficulties keeping her primary care clinic open due to state regulations not allowing NPs to be reimbursed by insurance companies unless the delegating physician has a contract with those specific insurance companies.

Mr. Guillory is facing similar hardships in his primary care clinic as are many Nurse Practitioners in the state of Texas. Because NPs in Texas must have a collaborating physician to practice, when that physician does not have a contract with certain insurance companies, the Nurse Practitioner cannot see patients with those specific insurance plans. This has left many patients unable to see their chosen Primary Care Providers, and especially in rural settings, may leave patients with no primary care at all.

So, what exactly is a Primary Care Provider?  A primary care provider (PCP) is a health care professional who sees people that have common medical problems.  This person is your main health care provider, the “gatekeeper” who coordinates care and provides referrals to specialists when appropriate.  The role of a PCP is to:

Provide preventive care and teach healthy lifestyle choices
  • Identify and treat common medical conditions
  • Assess the urgency of your medical problems and direct you to the best place for that care
  • Make referrals to medical specialists when necessary
Mr. Jeff Guillory, NP, is a primary care provider.

Increasingly, a PCP is not limited to physicians.  In practical terms, NPs have been acting in the role of primary care providers since the 1960’s. Whether the associating physician works alongside the NP on a day-to-day basis or visits the clinic periodically in an oversight capacity, the reality is that NPs carry their own patient loads, assessing, diagnosing, and prescribing in a setting that is essentially independent of all but cursory supervision.

With the burgeoning patient base introduced by the Affordable Care Act, a broad range of medical professionals is needed to provide adequate and affordable services. Nurse Practitioners are capable and prepared to fill the void caused by the projected shortage of primary care physicians in the United States.

Nurse Practitioners have been proven for decades to be safe and effective healthcare providers exhibiting positive outcomes and satisfaction in patient care. This is not the issue nor is comparing NPs to physicians and debating which is better. Often patients have a clear preference for one or the other, and for those who prefer to see a Nurse Practitioner for primary health care needs, making access and reimbursement easier and more accessible is key. It is time that the term “primary care provider” encompasses both physicians AND nurse practitioners and that current state regulation and insurance companies delineate and recognize the role that NPs play in society’s health care needs.
By appropriately redefining the primary care provider terminology, patients throughout Texas can have easier access to their chosen PCP, avoiding unnecessary constraints in their health care needs and ultimately improving the common goal of centering patient care as priority. Nurse Practitioners are and will continue to be PCPs and should be fully integrated into health care delivery.

Wednesday, February 12, 2014

The Secret Lives of Bats and Martians

Although evolution as it is presently understood involves a very long process of natural selection (among other arbitrary processes) without an overarching goal or forward progression toward a pre-defined or predictable result, this is not always appreciated. Some tend to believe, or at least act as if they believe, that evolution has accomplished its goal and reached its pinnacle, the end result being a species we’ve self-classified as homo sapien. Perhaps that is to be expected given that we are the only species capable of writing  On The Origin Of Species  and similar books that aim to explain the evolution of ourselves to ourselves. This hubristic tendency to think that evolution has done its work and the mantle is now passed to our capable hands (with opposable thumbs!) to mold reality as we wish engenders another false narrative, namely that we can figure everything out.

Because we comprehend many things, there is a tendency to think that we can eventually comprehend all things.  This, however, is most likely not the case.  It is more probable that there are facts beyond the grasp of human beings, facts which can never be represented or comprehended by us, no matter how much we believe the opposite.

Forty years ago the philosopher Thomas Nagel wrote an essay titled “What Is It Like To Be A Bat?”. The thrust of the article concerns questions of consciousness and specifically the mind-body problem of consciousness, but at the periphery of the discussion Nagel touches briefly on another topic, which he describes as “the relation between facts on the one hand and conceptual schemes or systems of representation on the other.”  It is this line of thought, coupled with the notion of subjectivity, which prompted him to invoke a “belief in the existence of facts beyond the reach of human concepts.”

Nagel writes, “Indeed, it would be foolish to doubt this, given (human) finiteness. There are facts which could not ever be comprehended by human beings, even if the species lasted for ever – simply because our structure does not permit us to operate with concepts of the requisite type.”  Nagel uses the example of a bat and what it is like to experience reality as this strange, nocturnal mammal as a way of highlighting the difficulties in a reductionist theory of conscious subjective experience. This example is also useful when considering our inaccessibility of certain facts.

Nagel chooses bats because they are mammals like us, a higher order vertebrate that doubtless has experience. Bats, although sharing our mammalian heritage, are nevertheless a species that Nagel describes as a “fundamentally alien form of life” since they “present a range of activity and a sensory apparatus so different from ours that the problem  is exceptionally vivid.”  Most bats perceive the external world by using echolocation, a form of sonar. Bats emit high-frequency sounds that reflect off objects within range.  Their brains then correlate these outgoing and incoming impulses to gather information that enable them to determine size, distance, movement and other factors which effectively correspond with our sense of vision. 

Even though we can understand and describe the principle of echolocation and recognize that it is a form of “bat vision”, our ability to conceive what such an experience would be like is “restricted to the resources of our own minds, and those resources are inadequate to the task.”  It is, according to Nagel, “not similar in its operation to any sense that we possess, and there is no reason to suppose that it is subjectively like anything we can experience or imagine.”  It will not help my case to think of myself hanging upside-down from a cave by my feet, or growing webbed wings and eating insects in the night sky by locating them with shrill sounds.  These images tell me only what it is like for me to behave like a bat. What we want to know is what it is like for a bat to be a bat.    

The same difficulty arises when we consider what it would be like for an alien species (a race of intelligent Martians, let’s say) to form a conception of what it is like to be us.  As Nagel suggests, “the structure of their own minds might make it impossible for them to succeed, but we know they would be wrong to conclude that there is not anything precise that it is like to be us: that only certain general types of mental state could be ascribed to us (perhaps perception and appetite would be concepts common to us both; perhaps not). We know they would be wrong to draw such a skeptical conclusion because we know what it is like to be us.”  Similarly, it might prove as improbable for us to conceptualize or comprehend the subjective experiences of alien beings vastly more intelligent than ourselves, since it could be the case that dissimilar structures of our respective mental processes would create an insurmountable barrier.

Nagel argues that “the fact that we cannot expect ever to accommodate in our language a detailed description of Martian or bat phenomenology should not lead us to dismiss as meaningless the claim that bats and Martians have experiences fully comparable in richness of detail to our own.”  The case that the subjective experiences of bats and Martians are facts from which humans are excluded from understanding does not invalidate the proposition that they nevertheless constitute a set of facts.  An extension of this rationale is the idea that since it is impossible for humans to represent or comprehend facts that our limited structure (and the limits of our technological inventions) prevent, the possibility exists that facts which are clearly evident to other creatures remain unknown to us.  “After all, the nature of beings with access to humanly inaccessible facts is presumably itself a humanly inaccessible fact”, Nagel suggests.  Only those facts to which we have access are meaningful to us.  This limited set does not constitute the whole.  It is merely the set to which we can gain access.

In summary, Nagel offers this thought, “It would be fine if someone were to develop concepts and a theory that enabled us to think about those things; but such an understanding may be permanently denied to us by the limits of our nature. And to deny the reality or logical significance of what we can never describe or understand is the crudest form of cognitive dissonance.”