The Nobel committee today in a published announcement granted the 2009 Nobel Prize in Medicine to 17 year old intern Doogie Howser in recognition for his contribution to the way we feel about medicine. His supervisor's at St. Swithen's Hospital acknowledged that he hasn't actaually practiced medicine yet but he let's the older doctors go hog wild and he does a nice job of talking about medicine. He is currently deeply in discussion with his advisers regarding the possibility of performing lifesaving surgery. He stated in March- "I totally understand lifesaving surgery and have a plan going forward"- but when actually faced with the decision he stated"I need more time to deliberate".

In another note, the Nobel Peace Prize Committe appologized for their oversight in not granting the prize in 1938 to the late British Prime Minister Nevil Chamberlain. In their statement the proclaimed "He was a man who understood the value of diplomacy in the protection of human life. His ability to reason with an insane despot saved the world from a Holacaust and a World War. Thank goodness we have a statesman with his talents in the world now".

As a 58 year old physician I watched with interest as President Obama assumed the role as chief expositor on the way all of the "greedy" physicians use surgeries only to line their pockets when his version of the new "preventive" care model will both save money on health care and put the greedy physicians in their places. In his usual non-teleprompter fashion he chose.....poorly. His examples included tonsillectomy and amputation for diabetic foot ulcers. I don' know what he chooses as his source material but it needs to be changed immediately.

Tonsillectomy is a procedure now done much less commonly and for different indications than in the 1970s when I attended medical school. In the '70s 1 million tonsillectomies were done annually but in this decade it is more in the range of 280,000. Only 20% of these are done for recurrent tonsillitis only small numbers for acute tonsillitis (usually for life-threatening abscess), the remainder are done for sleep disorders. Actually, given the total cost of doctor visits, antibiotics, lost work and school time the procedure would probably save money if done more often. Doctors themselves felt that the surgical risks were better avoided if more conservative treatments were chosen thus decreasing the number of these procedures.By the way "Dr." Obama, there are more cosmetic breast enlargements done in America every year than tonsillectomies. Lawyer/politicians like "Dr." Obama didn't drive the decision to decrease the frequency of tonsillectomies.  By the way, the typical reimbursement to the physician for the procedure and 90 days of follow-up care is $200-$300, less than an hour's charge by most lawyers like the President, his wife, and most of Congress. Perhaps we really need legal reform. Like that will ever happen.

Amputation is an unfortunate and uncommon consequence of diabetic microvascular disease. Even the most compulsive of diabetics can suffer this problem and diabetics (as I know from my own family) vary in their ability and willingness to provide themselves with proper foot care.Doctor visits and other "preventive" measures do not stop the progression of the vascular disease. Unless the President expects the soon-to-be overburdened doctors offices (who is going to care for the additional 40 million newly insured people?) to provide this care perhaps the bill should include a "National Corps of Pedicurists". Amputations would still occur and again these are not reimbursed highly. When an amputation is done it is certainly as a last resort in virtually all cases.I have never known a surgeon-including myself- who did an amputation on a diabetic that did not feel bad about having to so significantly alter a person's life. What you seem to not understand "Dr." Obama is that the vast majority of doctors and nurses are caring individuals by their very nature. Decisions on the best course of treatment should be made by those who bear the consequences of those decisions, not by a group of bureaucrats who never have to face their patients and families.

With the impending closure of containment facilities at Gitmo the "thorny" problem of the future of terrorist detainees hhas been difficult to determine for the Obama administration. The problem they seemed not to understand is that these are bad people that nobody wants. Gitmo is perfect- isolated in a place that is hard to get into and virtually impossible to leave. Where, oh where, can we go to replace those characteristics? Problem solved! Thanks to my birth state- Montana- an answer has appeared. Montana is a long way from anywhere ( the classic "you can't get there from here" kind of place). The natives would probably make an escapee wish he was being water boarded rather than facing an angry cowboy. Only one problem. We will have to rename the state Guantanamontana. Framed properly in the context of "hope and change" the name change would be just fine. Think of the tourist PR potential. See the Big Sky state and 200 terrorists all in one visit!

As Russia's Medvedev announces his intention of ramping up the Russian nuclear arsenal I think this would be a great time for the vaunted "sit down and have a cup of coffee (tea) with him" foreign policy. Yes I know we could send Hillary but wouldn't it be better for the anointed one to show his foreign policy chops by actually using the plan he promised us? I can see it now....the chairs around the table with the samovar, the teleprompter perched over Medvedev's shoulder in comfortable view. What a chance to show one's Presidential gravitas without having to spend a trillion dollars. But wait! We could promise the Russians a measly trillion for not rearming! And we could make the rich pay for it.

It's interesting that one editorial cartoon intimating that the stimulus package was so chaotic that it was possibly written by a monkey could lead to an impression that the commentary was racist. It was not even personally directed at the President, as he had little to do with the crafting of the bill. It is particularly interesting in the face of years of political cartoons depicting President George Bush as a monkey. Why is it okay for a leftist cartoonist to deride a conservative President in such a fashion? Political cartoons have never been about sensitivity, but now we must always fear insensitivity in one direction but set no boundaries in commentary about conservatives or devout Christians (who may, in fact, not be political conservatives).

In his inaugural address President Barack Obama reinforced his commitment to a new "green" energy future for America. He has stated that this will be strongly reliant on solar and wind as major, if not predominant, sources for electrical energy in our future. In his vision this transformation of the basis for modern industrial life will occur in less than a decade. I cannot see how this transformation can occur scientifically and industrially much less socially and politically. Currently power is supplied to the user grid from what one may term power plants. These are large facilities that generate power from fairly large generating machine systems. There is much efficiency in this approach as the physical footprint of the system is smaller and maintenance and repair are more efficient as the necessary personnel are at the point-source sites. These sites serve as hubs in a power supply grid designed, owned and maintained by the companies involved. These are generally coal fired, water power or nuclear powered. We are apparently now offending Mother Gaia and dooming the world to massive sudden global warming by continued use of these methods.
Enter the new age of wind and solar power. I admit I am somewhat behind on my reading, but I missed the massive increase in our industrial capability of building hundreds of thousands, if not millions of smaller wind and solar installations. This is the only possible solution, as large solar and wind "farms" can only be constructed in certain areas. Given the NIMBY syndrome, most of us would not want these in our pristine locals. We certainly cannot put them on federal lands since we can't drill for oil in a few acres of ANWAR, much less have hundreds of square miles of wind and solar farms in the wilderness or off the seacoast.
Thus the "personal power plant" with solar panels on your roof and a windmill with a 200 foot tower on your back yard. Who pays for these and maintains them? The solar panels have an initial cost of $30,000-$80,000. Despite assurances, they are not maintenance free. Who pays for the repairs? What if you generate more power than your needs? What if you generate less? What about the massive multistory condo or apartment that sucks energy like a thirsty camel to run all those TVs and internet?
Ideas in the absence of  a full understanding of their consequences can be be expensive and chaotic.

As part of the platform of the new administration a figure of 2 1/2 million to 5  million "new" jobs has been repeatedly promised. A large proportion of these have apparently been anticipated in a new Green Energy sector. As is typical in those to whom "Green Energy" seems more a choice than a radical realignment of our entire economy the proponents of this approach see a seamless jump to an already existing set of energy generation technologies. We can displace workers from those old nasty fossil fuel jobs and employ those hammered by the economic downturn in jobs manufacturing and installing the new energy grid and clean vehicles.

 I have yet to see a meaningful analysis of how this process might occur from the mainstream media. Solar and wind power seem to be the technologies most commonly espoused. Even "clean" coal use has been recommended by the President-elect.Of course, we are 24 YEARS into our attempt to make coal clean enough for the environmental lobby and are not even close. We have had wind turbines in Banning Pass in southern California since the 1970s and anyone familiar with the history of this technology knows its pitfalls. Turbines work only when the wind blows. Constant wind is rare except along the seacoast (no-no, you will hurt the fish and the view). Turbines are a resistance device and require massive maintenance. Solar panels are inefficient and expensive.  There is no current model for large scale production. Electric cars have limited range and are inefficient due to massive battery weight. Nobody knows how to build any of these things on a large scale. Oh, and the cost factor. I priced solar technology to take my house off the grid. $40,000-$80,000 for all our power needs. OK for Ed Begley, not for me.

 Before we jump into training programs for technologies that work poorly and have yet to be integrated into a modern power dependent society maybe a little research is indicated. I expect the research to be as fruitful and rapid as the massive push for the cure and vaccine for AIDS has been.