Dr. Tweedy shares his discovery that he also matters

I assumed Dr. Damon Tweedy's Black Man in a White Coat: A Doctor's Reflections on Race and Medicine would be interesting; I didn't expect that it would be gripping and that I'd love it. Yes -- this is a memoir. But it is also an unstinting examination of how the US health non-system works and doesn't, told through an engaging story of personal education and evolution.

Medical school at Duke was unsurprisingly harrowing for Tweedy, a first generation college graduate from an unheralded public university, attending on an affirmative action scholarship. It didn't help his equilibrium when a professor assumed the only reason he could be in the classroom was to repair the light fixtures. Being the brilliant achiever he seems to have been, he aced the class and med school.

Subsequent medical education introduced him to a series of patients and circumstances that illustrate how our medical system fails black patients. There was the black, drug-addicted, young mother whose baby died stillborn -- and for whom there was no possibility of drug or psychological treatment because she lacked insurance. There were the black, rural, clinic patients who could no more afford drugs or obtain treatment for high blood pressure than fly. There were the black, urban, emergency room patients who never saw a doctor until their medical problems overwhelmed their bodies beyond what any doctor could offer them.

Beginning practice as an intern and later a resident, he learned to deal with patients, white and a few black, who didn't "want no nigger doctor."

No matter our successes that led us to medical school or our achievements there, it seemed some segment of the population would never fully recognize us. The insults didn't stop once you became a doctor. ...Nor were these stereotypes restricted to the South. [A researcher of these incidents] concluded that the pervasive nature of the negative race-related experiences leads to "racial fatigue" that contributes to higher rates of job dissatisfaction and greater changes in career trajectory among black physicians. ...

Tweedy recounts the dismissive treatment by senior white doctors of a black patient who insisted that, rather than take a prescribed blood pressure medicine, he'd try weight loss and exercise first. For resisting their authority, the patient left the hospital with a psychiatric diagnosis. He also describes, subtly and gently, occasions when being a black doctor for black patients unleashed patient insecurities that meshed and clashed with his own.

The chapter which completely drew me in is called "Doing the Right Thing." After discussing the many black patients he sees whose accumulated stress, bad diets and cultural conditioning nudge them toward early onset diabetes and heart disease, he discusses in detail his own struggle to maintain a healthy weight, exercise program and blood pressure. He learned from his patients.

Why was making long-term healthy change so difficult?

... it's hard to change patterns formed in childhood, perhaps even more so among blacks. ..."Soul food," especially popular in the South where the largest number of black people reside, tends to contain large amounts of red meat, added fats and salts, and is often deep fried. ... I believe the problem runs deeper than simply the food choices themselves. ... surveys indicated that black people are more accepting of -- and in some cases indicate a preference for -- heavier body types. Skinniness is more likely to be seen as a sign of illness ...

I embraced some of these ideas. Despite being a physician, I still viewed some aspects of healthy living -- eating salads, drinking water, going to a yoga class or jogging on a treadmill -- with disdain. ...I had internalized such behavior as the domain of perfectionist white women who struggled with self-esteem... Given my struggles with assimilation since high school, particularly so since starting medical school, adopting [healthy] habits to any extent over the long haul meant selling out some essential aspect of both my manhood and my racial identity -- even if my rational mind knew such a belief was self-destructive. It was not so much the differences in the food or exercise themselves as what the lifestyle change represented.

[His patient] Henry's progress caused me to rethink my distorted logic. He was a middle-aged, working-class black man with significant mental illness who required long-term use of a fat-promoting antipsychotic medication. In short, he was not the sort of person I would expect to succeed in revamping his lifestyle. Yet he'd been able to do just that ...

Both Henry and Dr. Tweedy had both affirmed that their own Black Lives Matter. I've been awed by watching black friends who've identified with that affirmation become enabled to take care of themselves as part of the struggle to care for all Black lives. This very bourgeois story is Tweedy's contribution. If you have any interest in either the US health non-system and/or the struggles of black doctors within it, this is a good place to broaden your horizons.

Saturday scenes and scenery: Hawaiian birds

All these are from Waikoloa Beach near Kona on the Big Island.

She seems to move with a sense of purpose. Considering she's sharing the road with cars, that's probably smart.

This goose on a golf course however seemed to know it should expect to be protected. It's a nene, the official state bird. In the 50s it had nearly been hunted to extinction, but has been successfully reintroduced.

Some kind of shore bird, also a little out of place on pavement ...

Here's another little yellow fellow, just because I liked him.

The revolution is dead; long live the revolution

General Abdel Fatah el-Sisi whose coup overthrew Egypt's new government

Five years ago this month, with a rush of joy, Egyptians threw out their oppressive military dictator Hosni Mubarak. Just two years ago, some Egyptians were still proclaiming that their revolution could not be repressed, even as the military reasserted its power to overthrow an elected president.

This month, Helmi Al-Asmar asks Did the 25th January Revolution die under torture?

Speaking on a well-known Egyptian television channel sympathetic to the regime (the opposition has no such access to the media any more), [Egyptian lawyer and human rights activist Negad El-Borai] said that the judgement against two national security officers accused of torturing lawyer Kareem Hamdy to death is an example of how judges show “compassion” towards state officials while ordinary citizens face harsh sentences. ... According to El-Borai, the court has sent a message to the torturers within the interior ministry that, basically, they needn’t worry about what they do ...

“Better than nothing” sums up the story of the revolution, which may have died under torture, or may be clinically dead waiting for someone to wake it from its coma, which may take some time. Egypt is back to square one just five years after the revolution. ...

... Information gathered by international human rights organisations shows that the number of those killed due to torture and medical negligence in Egyptian prisons since the coup on 3 July 2013 is much higher than the official figure of 350; in any case, the statistics do not include those who have simply “disappeared” or whose death has not been recognised. The reasons given for death include electric shock, severed body parts, broken bones and the failure of the authorities to provide medical attention. Sometimes it is claimed that the prisoner has “committed suicide”, as happened on Tuesday when a member of the Muslim Brotherhood detained in Abu Hammad Prison was said to have killed himself. The number of those dying under torture has hit a record high, not only in Egypt, but also around the world.

All or most of those who wrote about Egypt’s 25th January Revolution have admitted, in one way or another, that the country is back to square one. It is as if there was no rebellion; as if Egypt did not hear the chants of “We are all Khaled Saeed” in memory of the young man from Alexandria who died after being tortured by the police. At that time, the interior ministry said that he died as a result of swallowing a bag of hashish. This sparked-off the revolution and inspired the rebels. Today, five years later, the Egyptians do not know whose name to use instead of Khaled Saeed, there are so many candidates who have also died under torture.

I am certain, though, in the midst of such darkness, that nations do not die even if their revolutions are in a coma; there will be a sudden awakening. We do not know when, but the reasons for having a revolution in the first place still exist, on top of which there are even more. The people require a revised and intensified revolution which protects them from oppression and being seized and killed under torture.

Perhaps, but when and how do ordinary people live in the meantime?

Far distant observers cannot pretend to really understand the complex politics within other peoples' countries. But we should not allow the US government to get away with funding this repression either. The Obama administration has shoveled military aid to Egypt's usurping generals for more than a year. These deals with devils never end well.

Do either of the aspiring Democratic presidents have anything to say about this? In the Wapo, David Ignatius is applauding Hillary Clinton for encouraging Obama in 2011 to back half-measures while Egyptians demanded that Mubarak had to go. The Prez opted instead to give Mubarak a verbal push. Hillary does label Egypt's current government "an army dictatorship." Her campaign website says nothing that I could find about policy toward that torturing regime. Neither does Bernie's.

Friday cat blogging

Waikoloa seemed to be cat colony paradise. These critters look like they are hunting. Between human cat fanciers and the sparrow population, they probably had easy pickings.

A tired looking old-timer watched from a nearby tree.

Data-driven politics: what is it? what is it good for?

If, like me, you are interested in the nuts and bolts of U.S. political campaigns -- not just ostensible issues but the mechanics -- you'll appreciate a two part interview with Daniel Kreiss of the University of North Carolina issued as a podcast by the geeks at 538.

The discussion left me with lots of thoughts, some of which I'll throw out here.

• Kreiss dates data-driven politics to the late 1890s when disgust with corruption in elections (think city bosses and patronage) led political reformers to try to aggregate potential voters as individuals who could be persuaded by issues, rather than attracting them with social events, parades and booze. He only mentions in passing that the old "social" regime of boisterous elections created the highest percentage turnout in our history. We may have gotten more serious, but a lively element was drained from democracy with the clean up.

• The professor describes how William Jennings Bryan built a card file of some 200,000 voters who had written him letters over a 30 year career in politics. In the mid-19th century, hand written letters (snail mail sent by post) were a central medium of campaigns, The reason that there are so many surviving letters from Abraham Lincoln is that he sat in Springfield and wrote literally thousands of notes urging on supporters before and during the 1860 campaign.

• Kreiss stressed that early and mid-20th century campaigns always worked with some sort of voter file, with lists of names, addresses, party affiliations and sometimes other information. What they didn't have was computers, so upkeep was terribly laborious.

My mother maintained this system of data file cards for the 20th District, 20th Ward Republicans for decades.

• He pinpoints the 1970s and 80s as eras when parties were relatively weak and voter lists became commodities provided by commercial political vendors. I can testify that these lists were lousy! To mount a campaign, you bought from the best vendor you could find and accepted that huge numbers of people, addresses and phone numbers included on them would be just plain wrong. This was also the era when campaign consultants made TV the center of electioneering -- a very lucrative strategy for them and probably initially effectual.

• Kreiss credits the research of Donald P. Green (and Alan Gerber and Lisa Garcia Bedolla) with prompting a turn away from TV ads and toward using improved computerized party-maintained databases to facilitate personal contacts with voters in contemporary campaigns. Technology can help target, facilitate, and capture the results of those contacts.

• He also observes that, for all its growing technical sophistication, much of this painstaking data collection still tends to get lost at the end of each campaign. If the data entry wasn't completed before election day, final contacts get tossed away along with useless door hangers and other paper debris. Nobody is paying to capture this final trove once the votes are cast.

• I wish Kreiss and the 538 interviewer had talked about the effects of various mail ballot and early voting systems on campaigning. Managing that well is a new campaign frontier.

Kreiss and the 538 people remain agnostic on how much effect all this technology really has on the vote. It's hard to believe it doesn't accomplish something, but there still aren't good quantitative measures of how many votes are won by how much money and how many person hours through data-targeted campaigning.

Mostly these interviews made me feel sympathetic toward Iowans and New Hampshire residents this month. They are not going to be able to turn on any media or answer their phones or respond to a knock at the door without encountering someone from a campaign. Those of us who live in big states with late primaries in which party preferences are set in stone have little idea of how intense primaries in a year like this must feel at ground zero.

A History Of Data In American Politics (Part 1): William Jennings Bryan to Barack Obama ; A History Of Data In American Politics (Part 2): Obama 2008 To The Present

Our continuing struggle to respect the rights of all "the people"

When one of my immigrant friends completes the naturalization process and is sworn in as a US citizen, I'm usually tempted to offer condolences and ask, why did you do it? (I seldom voice this; why share my misgivings about my birth country with my friends who may have altogether different perspectives? It's their parade too now, after all.) In This Muslim American Life: Dispatches from the War on Terror, Moustafa Bayoumi, a professor of English at Brooklyn College, CUNY, who was born in Zurich and raised a Canadian, shares his answer:

Why did I become a US citizen? The easy answer is that my life is here now, my green card was up for renewal, and I didn't have to give up my Canadian citizenship. But there is more to it.

... there is ... something essentially inclusive about the American system, namely how the Bill of Rights speaks not of the rights of citizens, but of the rights of "the people."

This means there is a professed value in the United States, one that always seems to be contested, of protecting vulnerable minorities, citizens or not, from the passions of the majority. I became a citizen because I believe the fight for preserving the rights of "the people" in the United States, not only of other citizens, is worthwhile and I can do that more effectively as a citizen of the country where I live.

In that fight lies the defense of the American values of tolerance and respect. I also means that I can disagree with much of American foreign policy, as I do, and try to change it. Being a citizen of the United States doesn't mean I'm any better or worse as a person. (Nor will I drop my Canadian "pardon me?" for the American "what?") It means that the United States has recognized me as part of its family, and I have recognized the American people as part of mine. And family relationships, as we all know, require work and communication. I will try to live up to my own professed ideals of fairness and equality for all. And I expect the United States to do the same.

We're lucky this guy wants to be part of our ongoing struggle to preserve and extend our better aspirations!

I can heartily recommend Bayoumi's book of essays. It touches on many aspects of how the 9/11 attacks brought all Muslims in this country under suspicion at best and endangered them at worst. His perspectives have a broad range. He delves into how Muslims have become a "race" in US terms regardless of national origin or skin color; the "bloody stupid" War on Terror (and the war on people like him); and the cultural products of that war including Homeland and Zero Dark Thirty.

In this moment when Republican candidates are competing to propose the most vicious treatment of immigrants and all Muslims, I particularly appreciated the thoroughness with which Bayoumi exposes the so-called "special registration" program under the Bush administration. Too many of us have forgotten or never knew. This program required all non-immigrant males in the US from selected countries (all of which except North Korea had Muslim majorities) to be interviewed under oath, fingerprinted and photographed by the Department of Justice. An acquaintance -- who had very good reason to want to stay on the good side of US authorities because he was a legal student visitor from a country where his homosexuality could have gotten him killed -- told us of being pressured by his interviewer to spy for the Feds on other Muslims. The Obama administration didn't end the "bloody stupid war," but it did end this particular infringement on a selected segment of foreign visitors in 2011. ***A current Mother Jones article, The Chilling Rise of Islamophobia in Our Schools, recounts the experiences of Syrian, Arab, and other Muslim students in the San Francisco public system. We've got a long way to go with this respect thing.

A donation

The makers of Budweiser are donating 51,000 cans of water to Flint. The people of Flint certainly need all the help they can get.

This seems a better use of perfectly good water than using it to formulate the swill Anheuser-Busch passes off as beer.

It would also be nice to see some corporate political muscle behind sending the Michigan governor and his cronies to jail for poisoning children.

The doctor is in -- in a storefront

Dr. Danielle Ofri calls this trend the ‘Mall-ification’ of Medical Care. The health funder Robert Wood Johnson Foundation reports on Retail Clinics. Their trade association uses the label "Convenience Care". I first noticed them while walking around the city. Apparently these facilities are becoming a significant presence in the U.S. healthcare non-system.

The Center for Advancing Health published a clear description of how these facilities function.

Most retail clinics operate something like this: Appointment times are guaranteed, but up to 90 percent of patients just walk right in. They start by choosing their problem from the clinic's menu of common complaints — think bronchitis, ringworm, ear infections. Many clinics also offer services such as childhood and adult vaccinations, pregnancy tests, and seasonal items such as flu shots and school and camp physicals. There are set prices for all of these services, displayed at the clinic's entrance. Patients then sign up to see a health care specialist, who could be a nurse practitioner, physician's assistant or even an M.D. in some cases. Most consultations take less than 15 minutes.

The short wait was a big draw for Tim, a Tucson, Ariz., college student who suspected he had a sinus infection. He visited a retail clinic housed in a nearby drugstore: "I got an appointment with my regular doctor last year for this same thing, and I ended up seeing a nurse practitioner there anyway. So I thought I would go where I knew I could probably get the same experience in less time and with less hassle."

Nancy Dawson, a nurse practitioner and manager of operations for Minute Clinic in Tucson, says convenience seems to be a big factor in whom the clinics attract. Parents with young children and young adults are some of the heaviest users, "although we see all age groups," she says. "It depends on the time of year, whether it's flu season, time for seasonal allergies, or with our younger population, time for physicals."

...The retail clinics keep their costs down by limiting their services and their space — exam rooms are about the size of a walk-in closet in most places. There's no room for an X-ray machine or ultrasound, lab, or other expensive equipment.

No need to plan a visit days or weeks in advance, no long waits, and a published price list -- the fact that these might be disruptive innovations in healthcare delivery speaks the truth that the shape of the U.S. system was forged around interests other than those of patients.

There are detractors who may have some valid concerns. The American Academy of Family Physicians opposes management of chronic conditions through these facilities.

Protocol-based decision and diagnostic models are used in most non-physician led retail clinics, resulting in a missed opportunity to address more complex patient needs. These missed opportunities range from preventive care services to critically important diagnoses which may not be specifically covered in the pre-generated protocol decision program. The AAFP is committed to the development of a health care system based on strong, team-based patient-centered primary care – defined as first contact, comprehensive, coordinated, and continuing care for all persons.

Care delivered in retail clinics can be a component of patient-centered care, but must work in coordination with the patients’ primary care physician to ensure that care is not further fragmented. Fragmentation and unaccountable silos of care are in direct opposition to achieving continuous whole-person care with improved health outcomes for both the individual and society.

In plain English, that means that these doctors think patients need their expertise to manage complicated, interacting illnesses. And since medical records don't easily flow between systems, they fear subsequent providers will never learn about a convenience care user's prior conditions and care. This seems realistic.

In 2008, the journal Health Affairs reported on a study that addressed the continuity of care issue.

... We found that three-fifths of patients did not report having a PCP [Primary Care Physician], so for these patients there is no relationship to disrupt. ... Most independent retail clinic providers can provide patients with a printed visit summary from their electronic medical records (EMRs), or the clinic can fax the record to a physician upon the patient’s request. However, we do not know how often this occurs and whether the pattern of communication is better or worse than what is seen between other care providers.

I've never availed myself of a retail clinic. By accident of past employment, I've been ensconced for 20 years in the nation's largest, and probably best, managed care plan, Kaiser Permanente. I can see a doctor within a day if I need one and they insistently chase me down for immunizations and preventative tests. But if I didn't have Kaiser, I'd probably explore these cut rate options for simple conditions.

Does anyone who reads here use these clinics? Any experiences to share?

Hawaii beer post

Usually I don't have much positive to say about beers in the tropics. But this one is quite good.

Perfect image from today's football game

pic.twitter.com/XYvAcK9qax

— Bree Newsome (@BreeNewsome) January 25, 2016

How often do we get to see such exploding joy? It will be easy to root for Newton in the Super Bowl.

Lest we forget ...

On the sidebar here, I've added a permanent counter to remind readers that executions continue in many states. If the Marshall Project's Next to Die coding works as intended, the counter will always show the next scheduled execution. Visit the page for more on the racial and geographical breakdown of executions.

The diligent work of defense lawyers has stymied the death penalty in California for the time being.

California continues to send convicts to death row at San Quentin prison, 746 inmates at present, 14 of them last year. No prisoner has actually been killed since 2006. In 2014 federal judge Cormac J. Carney described California death sentences as actually amounting to "life in prison, with the remote possibility of death." But the ultimate penalty remains in place.

Saturday scenes and scenery: King's Trail

This week I'm enjoying a mini-vacation at Waikoloa Beach Resort on the Big Island of Hawaii, tagging along with a friend who really does deserve a short break. And so, the last two days I've been running at dawn along the "King's Trail".

This improbably straight path runs for 32 miles north of Kona. It was built in the 19th century by forced native Hawaiian labor for the benefit of cowboy mule trains, running across a rugged, empty expanse of 'a'a lava.

Sunrise is magical.

The adjacent lava field is forbidding.

Down a side road, there's a tropical shoreline.

This stand of palms at WeliWeli Point looks like an oasis.

The rugged coastline makes for a difficult return trail.

Given a choice, the King's Trail provides an easier passage.

Friday cat blogging

This old fellow was just dozing in the sun when some stranger with a camera wandered by.

Waking up required a Big Stretch.

Followed by a big yawn ...

And an even Bigger Yawn ...

After which, he decided the interloper wasn't very interesting anyway...

Musings on Democrats "shallow bench"

A telling quote from a Republican woman in South Carolina:

“I thought that the showmanship would have died down and somebody real would come forward. ..."

Molly Ball at The Atlantic

What does this voter mean by "real"? Pundits are using the label "authentic" to try to catch what people are seeking this year; many analyses take "real" to mean persons who bellow unvarnished opinions to segments of the electorate who feel unrepresented by Washington conventions. The Donald has proved so far that being outrageous and obnoxious evokes a positive response.

But I suspect that the "real" the South Carolina voter is seeking means something else, something more akin a candidate who crosses some unarticulated, but potent, standard that marks an aspirant as legitimate, as "Presidential." In my lifetime, at least two candidates have flunked the legitimacy test: Barry Goldwater who was seen as a right wing insurrectionist (and reveled in it) and George McGovern who was not only out of sync with the electorate, but also failed miserably at his convention and afterwards to demonstrate his competence to lead, no matter how well meaning he was. Both candidates suffered blowout defeats.

Mother Jones blogger Kevin Drum contends the present campaign shows that neither party has more than a very shallow "bench" -- that is, a set of possible leaders who might jump the legitimacy hurdle.

... the big story isn't so much Trump as it is the failure of the Republican Party to field even a single decent mainstream candidate. The Democrats aren't much better, but at least they have one. The truth is that both parties seem to have an appallingly shallow bench. I don't quite know why, but to me that's a bigger story than Trump. ...

Now it is possible that eight years of denying President Obama's legitimacy has largely erased that requirement from the Republican zeitgeist. That's what you get when you pander to racists, know-nothings, and blowhards.

But Drum is also right about the Democrats. Among people who would ever consider voting for a Democrat (and that's a majority right there), Hillary is automatically viewed as "Presidential timber" as the mildly sexist phrase used to say. We're so used to her having climbed that hill that we hardly notice what an unexpected triumph that is for a woman introduced to the limelight as a wife. Bernie is currently trying to claw his way past the legitimacy hurdle; he's got the support of one third of Dems and he's not disqualified, even amazingly by the "socialist" label, but he's not quite over the hump yet either. We'll see if he can get there. Martin O'Malley is invisible; Joe Biden would have been pre-qualified if he'd run, but he didn't.

It's not an edifying realization to see that this year only one clearly legitimate candidate has presented herself. I think it is worth pondering in particular why Democrats are showing such a "shallow bench."

Several thoughts:

• We're living through a not-yet-accomplished, but fraught, generational transition. Boomer politicians have not yet retired; much of Gen X came up conservative under Reagan and is a smaller, less influential, age cohort; and the Millennials haven't yet taken over. President Obama is an exception to this pattern, but barely.

• The Reagan years in a conservative wilderness shaped a generation of Democratic politicians who won carefully controlled, rigidly messaged, and above all non-threatening campaigns. They won not by promoting burning progressive conviction, but by projecting managerial competence and pragmatism. Those virtues played well until the mid-00s; but today are not what a plurality of Democrats want most from elected officials, though we still want some evidence of capacity.

• Democratic politicians with both competence and passion are also rare at the lower level of politics. In some states, Democrats simply aren't competitive. For example, it probably is more politically effective to organize in the streets for Moral Mondays in North Carolina, than to run for office in some gerrymandered district.

• Or let's look at the Democratic bench in my own very blue state, California. We were immensely fortunate to have a recycled and quirky re-tred to fill the Governor's office when the Dem majority really kicked in. This might have bought time for the emergence of successors for higher office, but only two -- Attorney General Kamala Harris and Lt. Governor Gavin Newsom -- seem to have qualified themselves. (We'll ignore for the moment that I don't consider Newsom qualified for anything but to wear expensive suits; in the general public's eyes, he's qualified.) These two seem to have divided the plausible upward paths: Harris gets Barbara Boxer's Senate seat this year; Newsom runs for state governor and almost certainly wins in 2018. I don't see other state-level aspirants with much legitimacy emerging.

• How about lower levels of the Democratic political ladder? That's where bench replenishing starts. My own very progressive city put all the state figures I've mentioned on the political ladder, even if we don't much like them. We're been incredibly fortunate over the years to produce a few politicians who got principled things done, notably Congressman Phil Burton (winning Supplemental Social Security for the aged, blind, and disabled), Nancy Pelosi (putting some spine into Congressional Democrats), and state Assemblyman Tom Ammiano (whose name is on most of the progressive legislation for which California is currently known.)
  
  Awash in tech money, it is not at all clear that we are incubating worthy successors these days in San Francisco. Running for office is such a brutal experience and the money thrown against anyone who presents a threat to the plutocracy is so huge, it would be understandable if normal humans looked for a different career. We do have some up and comers making an attempt in November ... That's where these things start. Or maybe some other California area will have start throwing up leaders who can win legitimacy at the upper levels of politics.

• At every level, the money in campaigns matters. Unfettered political speech by the plutocrats makes it much harder for progressive Democrats to win and maintain both "authenticity" and "legitimacy", especially at lower levels. If they can't get on the ladder, they can't become our bench on the state and national scene.

• And just to conclude on a realistic note, people have probably always worried that our democratic polity is not producing worthy successors to idealized past leaders. We do after all reside inside the cult of the Founders! Maybe we're doing better than these musings suggest.

Anyone else notice something wrong with this picture?

Sorry for the poor quality. Snapped the picture furtively over the heads of some fellow BART riders.

Checking in on the Forever War as Obama's term winds down

The Tampa Tribune, located where the U.S. Central Command makes its headquarters, treats as a local beat the doings of the force charged with carrying on U.S. military activity in the Middle East. President Obama is bringing in three new commanders this year, all of whom come out of the tight-lipped domain of the Joint Special Operations Command (JSOC). Reporter Howard Altman offers insight about the probable direction of the ongoing campaign.

The most significant change leading to this JSOC Trifecta is the choice of Army Gen. Joseph Votel as head of U.S. Central Command in Tampa, which oversees U.S. military operations in Iraq, Syria and 18 other nations in one of the world’s most dangerous neighborhoods.

Votel lives next door to the current Centcom commander, Army Gen. Lloyd Austin III at MacDill Air Force Base, where both commands are headquartered. He will become the first Centcom commander to have come from the ranks of Special Operations Forces.

Army Lt. Gen Anthony “Tony” Thomas is likely to follow the route of JSOC commanders stepping up to take over Socom. Votel and his predecessor, retired Adm. William McRaven, were both JSOC commanders before taking over Socom.

And Maj. Gen. Austin “Scott” Miller, current commander of the U.S. Army Maneuver Center of Excellence, will likely get his third star and take over JSOC.

... Clearly, Obama’s preference, in Iraq, Syria and in Afghanistan, Pakistan and Africa as well (and Yemen before we got kicked out) has been JSOC raids and drone strikes.

So Obama is putting the burden of the Forever War squarely in the lap of this secretive elite force, not the regular branches. Journalist Jeremy Scahill reported the exact moment when Obama discovered these operatives were his best bet for dialing down the visibility of the Forever War (which we don't like when we can see its carnage as in Iraq) while beating back the U.S. panic about terrorism. Remember when merchant ship Captain Richard Phillips was rescued by JSOC snipers from Somali pirates? Those shooters that day handed Obama a public relations triumph (and a live captain) and seems to have made him a believer in using such forces to lead our military adventures.

Obama knows perfectly well the tightrope he's trying to walk. He laid it out in the State of the Union speech.

“Masses of fighters on the back of pickup trucks and twisted souls plotting in apartments or garages pose an enormous danger to civilians and must be stopped,” he allowed. “But they do not threaten our national existence. That’s the story [the Islamic State] wants to tell; that’s the kind of propaganda they use to recruit.”

... And then came an appeal to the carpet-bombing constituency. Calling the Islamic State “killers and fanatics who have to be rooted out, hunted down, and destroyed,” Obama boasted: “With nearly 10,000 air strikes, we are taking out their leadership, their oil, their training camps, and their weapons. We are training, arming, and supporting forces who are steadily reclaiming territory in Iraq and Syria.”

Peter Certo, Common Dreams

The people of this country get from our rulers as much war-making as we want. JSOC gives any President a means to keep much of our military force projection hidden domestically. Meanwhile our war is certainly not hidden from the people involuntarily on the wrong end of those airstrikes.

The Forever War will go on as long as we demand unrealistic "security" and it can be kept secret from us as long as we refuse to look at what we are doing. We do still need a peace movement.

A tale of two empires and the queers

Episcopal Presiding Bishop Michael Curry has a tough job as our emissary to a wider world.

The little corner of Christendom in which I have come to dwell, the Episcopal Church in the United States, received a wrist slap arising from backlash against two empires last week, leading to newspaper headlines. The whole affair has zero impact on those of us who simply go about our business of being church in the USA: feeding the hungry, clothing the naked, welcoming all, resisting oppression, and pursuing peace, while pausing periodically to ponder awe and say "thank you" to Whatever animates this world and makes us human.

But non-religious friends have asked about the kerfuffle, so here's my take at some length.

The Anglican Communion, the worldwide confederation of churches in which the action is happening, is a lot like the Commonwealth of Nations, that state residue from the British Empire in which "[m]ember states have no legal obligation to one another. Instead, they are united by language, history, culture and their shared values ..." That last item is where the action is -- what if, though united by our past in having been under Britannia's thumb, we have evolved in our own directions?

The British empire was not an unalloyed boon for any of us who emerged from it. More often than not, it was about brute force, repression and exploitation from "the mother country." Colonists in the United States were the first to shuck it off and enjoyed the advantage of a whole continent to expropriate from its inhabitants and pillage for ourselves. Most other former British colonies were nowhere near so lucky.

As I was recently reminded, for too many former colonized peoples, the empire brought a treacherous religious bargain:

"The white man came to our land and brought us the Bible; when it was over we had the Bible and they had the land."

Obviously the Christian faith offered more than just theft or there would not be strong and growing Christian churches, some derived from the British tradition and calling themselves Anglican, in most of the decolonized world today. Underneath a lot of dross, the story of the Bible is about liberation from various principalities and powers. Many oppressed people have taken readily to Christianity, even as the powers-that-be have tried to constrain both the faith and the people.

Many of the churches of the former empire got the Bible but not the liberation and replicated the hierarchical rigidities of their oppressors. They were taught to read the Biblical stories literally, to confound tales of the social arrangements of the ancient Hebrews and Romans with some timeless metaphysical reality, rather than seeing simply a particular, time-bound, setting in which God reveals Godself. Homosexuality, as contemporary societies know this human variation, hadn't been imagined when the Bible was being written/assembled. For that matter, neither had marriage as we know it. Nor the permutations of gender ...

Literalism-constrained churches of the former empire can hardly be blamed for being repelled when it seems both the old empire and the new American one are telling them they must give up what colonial masters had previously imposed as marks of civilization.

The Anglican Communion is caught in the effluent of this history. It's perpetuation is especially dear to the clerical leadership of England. After all, they have the preposterous task of heading up an established (government-endorsed) national church to which only 17 percent of their population claims allegiance. From that unstable platform, the Archbishop of Canterbury is supposed to be also the leader of the worldwide Anglican Communion, most of whose adherents live in formerly colonized regions.

The Episcopal Church has a slightly different history than the Global South branches of Anglicanism. (The other English-speaking colonial settler states of the former empire also have their own differing histories but I'm leaving them aside here.) After all, we got out first, were almost unimaginably far away, and had our own bumptious new country to formulate ourselves within. We left the Church of England precipitously after independence, elected a bishop for the former colonies and got him consecrated by the Scots, and gave ourselves a governing legislative and administrative structure that mirrors the U.S. Constitution. We built our own version of church. The idea of the worldwide Anglican Communion didn't come along until the mid-1860s, three generations after the Episcopal Church had organized its idiosyncratic self.

So what's all this got to do with last week's hoo-haa? I see the fuss over the Episcopal Church's decision to fully welcome all people in both leadership and marriage (and notoriously thereby include queer folk among "people") as mere pretext for expression of discontent over the depredations, spiritual and intellectual as well as material, of two empires.

An under-recognized feature of the several centuries during which Britannia ruled the waves and sun never set on Victoria's empire was secretive, prurient, imperial homo-eroticism. The Royal Navy was often assumed to be a cesspool of buggery, rather as U.S. prisons are often seen today. Come to think of it, for many sailors, since they had been hijacked into service, that Navy was a prison. Britain's imperial officers and administrators were products of single sex boarding schools; a quick read of that great imperial author Rudyard Kipling's novel Stalky & Co. offers a glimpse of the seething homo-eroticism in that world. Such towering imperialists as Cecil Rhodes (founder and owner of Rhodesia/modern Zimbabwe) and Robert Baden Powell (founder of the Boy Scouts) lived lives and nourished attachments that look to have been gay to modern eyes. But all of this was empire's furtive, dirty, secret,  not the proud, consensual homosexuality we've found today. No wonder that former colonial inheritors of Anglicanism want no truck with homosexuality as exemplified by those tortured and torturing men, whatever indigenous gay traditions may or may not have existed in their lands.

English clerical authorities eager to retain some vestige of past imperial glories have every reason to play along with the homophobic elements of the Global South. All those English clerics lose is their legitimacy in the eyes of more people in their own country. The pain they inflict on others, on gay English Christians, lay and clerical, is a small price for someone else to pay. These days gay priests within the Church of England can have a civil marriage, but not a church one. Being priests, they probably think the latter is important.

And then there's the Episcopal Church in the United States. It's easy to ask who cares? -- and materially, none of this matters much. But we'd be wise to use the wrist slap to help us notice that nobody, anywhere, much likes American imperial pretensions. With our wealth and our power, we bulldoze other cultures and societies and barely notice who we crush. It's no wonder, even when we're occasionally right, nobody is going to follow our lead or have our back. We need some humility around here. That's just how the world works.

On Martin Luther King Day in Oakland

For those of us who are seeing San Francisco succumb to the pressure of too much money chasing too little land, it is easy to imagine that the wonderful, chaotic, multi-everything Oakland across the Bay is bleaching away as well. And there is lots of objective reason to think this is true: in November, Oakland ranked as the country's 5th most expensive rental market. (Yes, San Francisco was Number 1.)

But the MLK Day march in Oakland's downtown presented a tableau of how much resistance and hope still remains.

The Oakland still lives stands together.

Families march together ...

... and chant together.

A choir prepared to raise their voices.

Organizers had prepared for all comers.

Victims were remembered; firing Suhr is actually a San Francisco priority.

The "Sangha for Black Resistance" gave silent witness.

Oakland still lives. Resistance still lives.

Good listening: check out "Intersection" in case it disappears ...

Last week the young billionaire owner of the New Republic, Chris Hughes, announced he was putting the venerable magazine up for sale. Apparently losing millions on opinion journalism is not much fun for a Facebook founder.

A little over a year ago, Hughes' changes to the magazine sparked mass departures by long time writers and editors. Good riddance, I thought. I considered the old magazine a nest of snotty entitled white men who claimed to be "liberal" but seldom saw a U.S. military adventure they did not love, who uncritically championed Zionists' right to expropriate Palestinians, and who happily published defamation of poor people, treating propaganda as social science. From my vantage point, the new regime was a big improvement, often interesting. New writers Suzy Khimm, Jeet Heer and Brian Beutler are a distinct upgrade on policy and politics.

And best of all was bringing in Jamil Smith from the Melissa Harris-Perry show and giving him a podcast called Intersection. The show absolutely lives up to its billing:

Every two weeks, senior editor Jamil Smith will discuss and debate issues surrounding race, gender, and all the ways we identify ourselves and one another. We hope the conversations with everyday folks, activists, politicians, and you, too can help us all understand identity a lot better.

Recent shows have highlighted body image issues, the police murder of Tamir Rice in Smith's hometown, the conflicted identities of Black Republicans, and pop culture critic Janet Mock on being a very different transgender role model than Caitlin Jenner.

Let's hope the sale of the New Republic doesn't kill off this extraordinarily vibrant media project. You can sample or subscribe for free at iTunes.

For a wintry Sunday morning

Go ahead, give nine and half minutes of your life to watching this video. Set the image to full screen, relax and enjoy.
This put me in mind of Psalm 19:

1The heavens declare the glory of God;
the skies proclaim the work of his hands.
2Day after day they pour forth speech;
night after night they reveal knowledge.
3They have no speech, they use no words;
no sound is heard from them. ...

Then consider this:

Unprecedented: Simultaneous January Named Storms in the Atlantic and Central Pacific
As we ring in the New Year with record to near-record warm temperatures over much of Earth's oceans, we are confronted with something that would have been unimaginable a few decades ago: simultaneous January named storms in both the Atlantic and Central Pacific. The earliest named storm on record in the Central Pacific, Hurricane Pali, formed on January 7, and now the Atlantic has joined the early-season hurricane party, with Subtropical Storm Alex spinning up into history with 50 mph winds in the waters about 785 miles south-southwest of the Azores Islands. The average date of the first named storm in the Atlantic is July 9; the Central Pacific also typically sees its first named storm in July.

Dr. Jeff Masters, Wunderground

The Anthropocene makes for interesting times.

H/t Climate Denial Crock of the Week.

Death penalty likely to be on ballot in California in 2016

As this Field Poll shows, it's going to be a hell of a fight. Democrats, independents, Latinos, African Americans, and people under 45 seem, marginally, ready to make life sentences without parole the ultimate penalty. A campaign emerging from Death Penalty Focus is working to put an initiative to do that on the ballot in November 2016. They call their measure the Justice that Works Act.

Meanwhile prosecutors and others who want the state of California to kill more prisoners are collecting signatures for a measure to make executions easier to accomplish. More here. This group starts out ahead among whites, Republicans and Protestant Christians.

The electorate in November 2016 is likely to look more like the former group than the latter, but the campaign is sure to be hard fought and emotional on both sides.

Snapshot from the new Mission District

Every Thursday morning around 10 am at 24th Street and Bartlett, any interested observer can catch a glimpse of what tech money and tech workers mean to the culture of this city.

At the massive granite SF Public Library building, a line of women pushing strollers curls around the corner. They are queuing up for the "Toddler Tales" story telling program, offered in English and Spanish.

It's wonderful that the Library offers this introduction to reading. That's the job of this vital institution.

But I can't help noticing that most of these children appear to be blond and blue-eyed and their caretakers appear mostly Latina. Are the women mostly nannies working for the newcomers, for the two-income affluent families who are the only people who can afford to move in here? It certainly looks that way. Where are the nannies' children? Do they have a chance to attend "Toddler Tales"? The library does its best to provide for all, but I wonder.