iAddiction

smarphone-addictionSome would say that I am the last person who should be writing a piece about smartphone addiction.  But, at the same time, there are few more qualified to write about the subject than someone with experience.  As an interventional cardiologist, I am dependent on my phone for my livelihood, and often my patient’s lives.  As such, I have no option to turn it off or to ignore it.  Over the years, however, my phone has become much more than a tool of communication, and I have become increasingly dependent upon it in every aspect of my life.

When Apple launched the smartphone revolution in 2007 they made a significant error in naming it, choosing to call it the “iPhone“.  This moniker labeled the device as a phone first and foremost, and relegated its other functions to secondary features.  As any smartphone owner can attest, the telephony features of these devices are truly incidental to their vast capabilities.  These devices serve as nothing less than virtual windows which look out simultaneously onto every corner of the world, peering into every country, every library, every movie theater, and every resource.  The fact that they can also make telephone calls is almost gauche.

Just as a child bored in school may stare wistfully out of their classroom window, so too will a smartphone user turn to their virtual “world window” for an escape when faced with even the mere suggestion of boredom.  As long as anything anywhere in the world is more interesting than what they are doing (and when is that not true?), the temptation to be virtually transported to that activity may prove irresistible.  Teacher droning on?  A good time to look at movie reviews for the flick you want to see.  Conversation take a dull turn?  Let’s join a facebook friend on their Hawaiian vacation instead.  In addition, smartphones provide instant access to references which we may have otherwise ignored.  The annoying feeling one gets when they can’t recognize an actor on TV would probably go unnoticed, but with a smartphone in hand it can be remedied immediately.  The congenial debate with a friend over meaningless historical trivia can be solved immediately, to absolutely nobody’s lasting benefit.  The examples, and the possibilities, are truly endless.

This kind of power and access can be detrimental however.  Numerous scientific studies have warned us of the deleterious effects of being too “plugged in.”  Instant access to all of the world’s data causes us to place unreasonably high expectations on ourselves and others for accuracy, speed, and connectivity.  Such expectations can lead to dangerously high stress levels, deterioration of interpersonal relationships, and eventually a total dependence on the information stream.

Smartphone addiction is the end result of such pressures.  The user not only feels the need to continually access the information stream, but eventually considers it essential to existence, wondering how he or she ever lived without it.  One crucial point of this relationship is that while the addict may consider this access “necessary,” he or she may not actually enjoy it; in fact craving of the object may actually be linked to simultaneous feelings of repulsion for it.   To speak candidly, I fall into the latter group.  I occassionally resent being tethered to my smartphone, but until recently found no way to actually divorce myself from it, while upholding the responsibilities I have to my patients.

Everyone must deal with this issue in a method particular to their own circumstance.  Given my need to constantly maintain a certain minimum degree of connection, this continues to be especially difficult for me.  One solution I have found is simply turning off cellular data and wifi when I come home, effectively transforming my smartphone into a “dumbphone” capable of phone calls and texts (allowing my patients access to me), while not allowing me to look out of my virtual window.  Of course, the power is mine to turn data back on with a few swipes.  I have found that the time it takes to make those swipes, however, allows me the requisite time to reflect on the relative importance of what I am doing, and prevents me from absentmindedly accessing my information feed.  In those precious moments, I can ask myself the questions my Sensei taught us in order to bring about focus in martial arts training, “Where am I? What am I doing? Is it real?”  When it comes to my smartphone, most often the answers are not encouraging.

Another solution I hope to implement soon is the addition of a “smart watch”.  Perhaps it is an addict’s delusion to believe that a device designed to increase connectivity can actually be used to decrease it.  I am hopeful, however, that by allowing me to screen phone calls and text messages without ever touching my phone, I will be less tempted to access the other features of my phone every time it rings or dings (which unfortunately is quite often), or to immediately respond to every communication.

I have resigned myself to always having an increased level of connectivity due to my chosen profession; a day has not gone by in the last seven years when I have not been in touch with patients, the hospital or the office.  However, the novelty of the capability of our current devices has worn off to the point where we, as a society and as individuals, need to make serious decisions about curtailing our use of these technologies in order to preserve the operation of the most powerful computer we own–our minds.

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A Dark Night

On July 20th, shortly after midnight, a 44 year old neuroscientist suffered a massive heart attack while driving down the freeway.  His car spun out of control, killing 12 innocent bystanders and wounding scores of others.

This didn’t actually happen (that I know of).  But I hope for the reader to take a moment and reflect on how they reacted to the above paragraph, and compare it to the paragraph below:

On July 20th, shortly after midnight, a 24 year old neuroscientist opened fire in a crowded theater.  Twelve people were killed, and scores of others were injured.

A very different reaction to that news, I would think.  Unfortunately, however, the second event did occur, and many innocent lives were lost as a result.

The reaction to the first paragraph is usually a feeling of remorse, and a reflection on the fragility and randomness of life and death; accompanied by a feeling of sympathy for all the victims (including the driver).  However, feelings about the second paragraph are more often going to be dominated by anger, blame, and sympathies for the victims (exclusive of the shooter).  Therein lies a major key to understanding this human tragedy.

In our society, mental and psychiatric illness is not treated in the same vein (no pun intended),or with the same degree of respect, as physical illness.  Despite countless years of research indicating the physiologic basis for psychiatric disease, the basic feeling remains that somehow the person suffering from the illness, whether it be depression, psychosis, neurosis, or any other manifestation, is to blame to some degree.

Gun control advocates have been quick to blame lax gun laws for the shooting, and they have been anxious to use this shooting to restart a national discussion about gun control.  I don’t disagree with them, or with the premise that our gun control laws are too lax in this country.  Unfortunately, while they are addressing an important issue, they are missing the true root of the problem.  The fact is that this man suffered from a severe psychiatric illness which hijacked his actions.  And the sad fact is that even if guns were illegal, his illness would have demanded of him that he either find a way to obtain them, or use whatever weapons were at his disposal (such as tear gas and explosives–which he did use) to wreak the havoc that he did.

Assuming news reports are correct, the man, James Holmes, considered himself to be the “Joker” from the second Batman film–a character who sees himself charged with a mission to expose society’s ills through the institution of anarchy.  The shooter’s methods, like the Joker’s, were deliberate, highly organized, and intelligent.  I am not a psychiatrist, but these characteristics are highly consistent with psychosis, likely schizophrenia.  It is unclear whether this was ever even diagnosed, much less treated.  In fact, when the suspect’s mother was called, her first words were “you have the right person.”  This intimates that the family was potentially aware of these tendencies, even if they were in denial.

I would contend that Mr. Holmes’ psychiatric disease was allowed to progress to this homicidal conclusion precisely due to our inability as a society to deal with it as a true medical illness.  The taboos associated with psychiatric disease of all variants are so strong and pervasive that patients are often unwilling to seek treatment, families remain in denial, and proper precautions and treatment are not undertaken.  Imagine the reaction among his peer circle or his employers if he told them he was taking medications to control schizophrenia, and compare that to the reaction they would have if he told them he was taking high blood pressure medication.  These social mores are a strong disincentive to seek treatment; and a lack of treatment is what leads so many psychiatric patients to end up at the end stage of their disease–gravely disabled, a danger to themselves, or a danger to others.  The end stage manifestations then reinforce the social taboo, and the vicious cycle continues.

What happened in Colorado is inexcusable, and I am not suggesting a lack of culpability on the part of the shooter by any means.  However, if we are to use this tragedy as a springboard to a social discussion, let’s make sure that we at least have the correct discussion.   I believe that as a society, we should grieve for all the victims of this heinous, preventable strategy, including for the young man whose brain was hijacked by a relentless disease.

I Do… Sort of

The issue of gay marriage, rightly or wrongly, has once again played an important role early on in this election cycle.  While the president actually has little control over the specific implementation of policy regarding this issue, it is a convenient litmus test, and an excellent “wedge issue,” designed to excite both bases and increase voter turnout.

Proponents of gay marriage argue about civil rights and government sponsored discrimination based on sexual orientation.  Opponents most often cite Judeo-Christian law as defining marriage as between one man and one woman.  As a peace offering (and a vote pandering) gesture, however, they often offer “civil unions” as a method of assuring civil rights.

There are two major flaws in these arguments opposing gay marriage.  First, in 1954 the Supreme Court of the United States decided the landmark case of Brown v. the Board of Education.  In this ruling, the court ruled in a unanimous decision that separate institutions (in this case, in education) were inherently unequal.  The same can be easily applied to the current question.  A separate institution (of civil unions) must be considered inherently unequal to marriage; even if the same civil protections were to apply.  However, proponents of civil unions will reluctantly admit that the real reason they oppose actual gay marriage is to give themselves cover at withholding specific civil protections (notably, the ability to adopt).  Thus, the gay civil union (or domestic partnership, or whatever the fashionable euphemism of the day is) is inherently unconstitutional even with the purest of intentions, which admittedly do not even apply in this situation.

Second is the question of the Judeo-Christian definition of marriage.  The problem comes when one tries to reconcile the definition of marriage as a religious institution with the definition of marriage as a civil institution.  If one considers marriage a predominantly civil institution, then this argument has no bearing.  If one considers marriage a predominantly religious institution, then the government has, in effect, recognized and condoned an official religious viewpoint regarding a fundamental institution.

For much of the United States’ history, this problem went undetected but has now been brought to the forefront.  The only logical solutions to this paradox are for marriage to become either entirely civil (and thus defined any way the government sees fit), or entirely religious; the latter is the only feasible one, as churches and other religious bodies will not, cannot, and should not cede the institution of marriage.  Thus, in the name of fairness and equality, the government must stop recognizing marriage as a civil institution altogether.  Rather, all couples (including heterosexuals) who chose to “marry” religiously would need to establish a civil union as well (indistinguishable from a civil marriage currently) in order to qualify for the government rights and benefits of a committed couple.  Only then can we move forward as a society to decide rationally which types of unions (in addition to traditional heterosexual couples) should qualify for this institution.  In this way, and only this way, can the government endeavor to treat all of its citizens fairly, maintain control over its own institutions, and not offend hundreds of millions of religious taxpayers (and voters).

My personal views on homosexuality and homosexual  couples/marriage are irrelevant to this discussion, which is entirely about fairness, constitutionality, and the separation of church and state.  There is too much water under this bridge, and this issue will not go away as long as one side stands to benefit from its discussion (even if it becomes settled law).  Personally, regardless of my own views, I am convinced that someday in the future, the history of gay marriage will be looked upon much as the history of interracial marriage is today.  Every public figure would be wise to choose prudently which side of history they want to be on.

‘Tis The Season To Be Jolly…

I love this time of year.  There is a crisp chill in the air (Los Angeles gets just cold enough so we can enjoy the cold, not cold enough that we grow to hate it).  People are humming, stores are buzzing with excitement.  Consumer thoughts are directed towards what others might like, instead of ones’ self.  Kids are emerging from their self-imposed homework holes for winter break.  Let’s face it… Christmas is in the air, and I’m excited!

That may sound strange to some, coming from a devout and practicing Dawoodi Bohra Muslim.  And yet, it’s entirely true. When I was growing up in an Indian-Muslim immigrant family in the 1970s Midwest, diversity was not as celebrated or as recognized as it is today.  My parents saw no harm in a certain degree of assimilation, and this included celebrating Christmas, albeit in a muted way.  Lights were put on the house, a cheap plastic christmas tree in the living room, and token gifts were exchanged on December 25th.

Now, here I am as a parent of my own two girls, and struggling with similar issues with our kids.  As Christmas is celebrated alongside Hannukkah and Kwanzaa, my children have no holiday to celebrate (aside: I am convinced that those holidays are celebrated out of proportion to their religious/cultural significance simply because of their proximity to Christmas).  Eid is our closest equivalent, but being based on a lunar calendar, Eid has no seasonal affiliation and currently falls in the summer months.

So, our family has decided to do what my parents did, and we celebrate Christmas (for the record, we make it a point to celebrate Eid more heartily, however).  While Muslims also believe in Jesus; to claim that that is the reason we celebrate Christmas would be disingenuous and misleading.  Rather, we celebrate a cultural Christmas.  White lights on the house to mimic icicles which may have formed if we lived elsewhere, but not the green and red of Christmas or the blue of Hannukah (actually more popular in our neighborhood).  A gift exchange on December 25th, with gifts limited to one gift per adult to each child (no gifts for the adults, unfortunately).  A special re-dedication to charitable work.  A dedicated day on December 25th to spend time at home with family and no distractions.  We used to do a cheap plastic tree as well, but we have weaned the kids off of that with time.

Some people may call this celebration misguided, and I can see how this would be their first reaction.  However, it makes perfect sense to me.  To begin with, the true religious significance of Christmas has long been called into question, as historians have revised their estimate for Jesus’ birthdate.  The true origins of Christmas likely lie closer to ancient Roman pagan holidays than any actual event in Jesus’ life.  Thus devoid of any Christian historical relevance, Christmas becomes an essentially cultural holiday anyway.

Secondly, the values extolled during Christmas are universal to most, if not all, belief systems including Islam.  Being thankful for the season during the worst weather of the year reminds us to appreciate God’s gifts, even when they seem most rare.  Charitable works are universally considered virtuous.  And while it is sad that we rely on an excuse like Christmas to show those we value in our lives how much they mean to us, Christmas reminds us to do so regularly.  The day itself is the one day in the calendar where most merchants close their doors, and detractors from uninterrupted family time are minimal.

It is for these reasons that I celebrate Christmas, and do so as a proud Muslim.  Some have termed this de-christianizing of Christmas to be a “war on Christmas.”  If that is indeed the case, then my wish this holiday season is that all wars follow its example… A war fought entirely through enthusiastic embrace.

Conrad Murray– A Smooth Criminal?

The trial of Dr. Conrad Murray, the physician involved in the death of pop sensation Michael Jackson, is well underway in a Los Angeles area courtroom.  Dr. Murray stands accused of involuntary manslaughter in Jackson’s death.  The accusation is that Dr. Murray used lethal doses of the anesthetic propofol and insufficient monitoring equipment to sedate Mr. Jackson (at his request), and that these actions caused the death of Mr. Jackson.

The real issue in this trial is not about doses of a medication or types of cardiac and respiratory monitors, however.  The over-riding and precedent setting issue of this trial is the charge against Dr. Murray and the type of trial being conducted.  Dr. Murray is accused of involuntary manslaughter, and is thus facing a criminal trial brought by the state.

When boiled down to its essence, however, Dr. Murray was hired for his medical services by Mr. Jackson.  In the performance of those medical services, Dr. Murray displayed incompetence in the dosing and usage of the medication propofol, and gross negligence in the monitoring of his patient.  This incompetence and gross negligence led to the death of his patient, Michael Jackson.  This is clearly an egregious case of medical malpractice, a civil charge brought by the family or other survivors.

The difference between these charges is extremely important.  Involuntary manslaughter, in this case, refers to “death during the commission of a lawful act which involves a high risk of death or great bodily harm is committed without due caution or circumspection”.  Medical malpractice, on the other hand, requires four components to be proven:

1) A duty of care was owed by the physician

2) The physician violated the standard of care

3) The person suffered a compensable injury

4) The injury was caused in fact and proximately caused by the substandard conduct.

Physicians deal daily with life and death decisions, and their actions, negligent or otherwise, can and do result in the death of those in their care.  This particular fact, combined with the fact that no other field is charged with such obligations, is the entire purpose behind the development of medical malpractice laws to begin with.  In a very real sense, medical malpractice laws exist to provide a rational exemption to physicians from charges such as assault, battery, and manslaughter.

I cannot and will not excuse or defend the actions of Dr. Murray, as they were by any standard incompetent and grossly negligent.  However, to try him for manslaughter when this is a clear example of malpractice is a distortion of the legal system which sets dangerous precedents.  Doctors are not immune to the law by any means, but during the act of practicing medicine, as the very practrice of medicine carries a high risk of death or great bodily harm, doctors are and should continue to be held to the standard of malpractice rather than criminal manslaughter.

The proper sanction against Dr. Murry would be revocation of his license to practice and malpractice proceedings along the most severe lines.  And in the case of almost any other plaintiff, this would have been the case.  This case, however, is different and to deny its differences would be false.  In my own medical community, a patient recently died when having an outpatient surgical procedure by a doctor who was not qualified to perform said procedure and gave the anesthesia himself (which he was also not qualified to do).  This incident made the local news, and may result in license revocation (probably with a stay if he takes certain useless “medical care” courses) and a fine.  But the fact is, this doctor has been busted for the same thing previously and no action had been taken to date.

But Michael Jackson? That’s a different story.  As a public figure and a relatively beloved one at that (we can go into the psychological scrubbing of ones images and selective memories of one’s actions after their death another time), the public outcry was likely irresistable.  A very public spectacle with very severe punishments (what, you mean he’s not even going to jail?) would be necessary for the appearance of justice to be done.

In the state of California, malpractice awards are capped.  One million dollar awards per occurrence, for a total of three million dollars a year.  Such awards would (rightfully) be viewed as a veritable joke to the Jackson family, and would in no way sate the hunger of the public for justice.  In contrast, the ensuing wrongful death suit after a manslaughter conviction will be uncapped, and substantial.

The fact is then, that just as different standards of care exist for the rich and the poor, so then do different standards of justice apparently exist for their doctors.  If we are to argue that health care standards should be equalized across the socioeconomic spectrum, which is no doubt a noble goal, we should also strive to equalize justice across the socioeconomic spectrum.  And the trial of Dr. Conrad Murray is in clear violation of that principle.

Allowing Dr. Murray to be convicted of manslaughter will set a precedent which will have far reaching ripple effects.  It will open up potential litigation against many doctors whose patients die during the deliverance of medical care, either careful or negligent (negligence need not be proven for charges to be brought, after all).  This will serve to render malpractice tort reform and capitation utterly useless.  Insurance premiums will rise and consequently availability of health care will drop.  Costs of health care will increase as defensive medicine is redoubled out of fear of criminal litigation.  In the end doctors and their patients will be harmed.

Dr. Murray should have known what he was getting into when he signed on as Mr. Jackson’s personal physician.  And if Michael Jackson had been any other Joe Somebody, he never would have allowed the deviances in care which he did with Mr. Jackson.  So perhaps it is poetic justice, if not real justice, that by treating his patient differently because he was rich Dr. Murray will now be exposed to a different standard of justice because of his patient’s wealth.

Hello World!

That’s what WordPress, who is hosting this inaugural attempt at a blog, wants me to call my first page. I, however, prefer a more traditional beginning:

Bismillah-Irrahman-Irrahim

In the name of Allah, the most Beneficient and Merciful.  The traditional phrase with which Muslims begin all projects, big and small.  As a proud Muslim, it seems foreign to me to begin this undertaking in any other way.

That is not to say that this site is going to be dedicated to Islam, or to my beliefs.  Truth be told, I am not sure what, if anything, it will be dedicated to yet.  Some summer intern at wordpress (hopefully not a full-fledged employee) has written up a three page guide detailing a process by which to delve into your psyche and determine what your blog will be about, and I received it when I signed up.  It was well written, no doubt, but fell on deaf ears.  I suspect most people who start a blog have an idea what they want to accomplish, and I am no different.

I see this as an outlet, and a way to express my opinions, hopes, dreams, musings, reflections, etc.  Topics will not be limited and hopefully will range from the mundane to the philosophical.  From politics, to life, to religion, and everything in between.  A repository for my ever-changing ideas on the topic of the day, and a vehicle with which to share those ideas.

I don’t foresee a lot of readers of this blog who don’t already know me well, but one never knows what the future holds.  That’s why, while I don’t see the need to introduce myself, I will bore you with a few of the biographical highpoints for posterity’s sake:

I am a thirty something year old (still!) interventional cardiologist in the Los Angeles area.  An active member of the Dawoodi Bohra congregation of the Shia-Ismaili Muslim tradition.  A father of two wonderful girls, ages 9 and 6.  A political moderate–but doesn’t everyone say that? Even the biggest wing nuts I know!  And a hack on the golf course, who loves the game too much to actually keep score.

Enough boring intro stuff… Hopefully you, the reader, will find something here to pique your interest in the coming months, years, or however long this experiment lasts.