Are you in?

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The generations since World War II have been separated into marketing niches of Greatest and Boomer, then X,Y, and Z, but I suspect that no set of people since Homo erectus figured out fire, speech, and monogamy, have faced as much rapid technological and cultural change as have the people born since 1950. This unmooring of cultural institutions, socioeconomic niches, and family structures is remarkable and deeply unsettling to many.
Modernity has atomized the family, but we are still the Pleistocene mammal subject to possessiveness, territoriality, and stranger anxiety. We are just a handful of base pairs removed from our mutual ancestor with the chimpanzee who kill and eat intruders. And so we naturally flock with our kind in our hominid fashion, and wish to destroy the other if they get in the way. What stops us?

Strong ideas keep us from burning witches. Ideas of justice, equality of human worth, and an appreciation of value of freedom and liberty bind us together in a common identity. These ideas are shared across borders instantaneously, usually in English, on the internet via smart phones and social media. These are rather old American ideals and should not be new to those wary of change. Instead, it is the broadening of the definition of *American* that jars people. It is an America that people are still looking towards as they overturn dictatorships and established tyrannies. We see it in the Arab Spring, in the continue march of the huddled masses to the gates, and in gay Americans fighting to achieve equal status. We witness it as a force that China is trying to subvert with overt fascism, with likely failure in the long term.

This neo-Americanism is the lingua franca of business and diplomacy. It is the common operating system that everyone demands. At home, to succeed in this new America, you have to learn how to pass for a new kind of American. It is a fact that if you make yourself smile, your brain will register positive in its happiness centers, and you will transition to happiness (try it!). If you carry a smart phone, participate in social media, and read at above elementary school level, the centers of the brain that are stimulated will drive change. Corporate HR policies, public school codes of conduct, and public social mores are aligning around and driving this change, even for older Americans who one would assume would be all for not changing. It used to be said that you are basically set in your ways by the time you are forty, but I think even that generalization is done because I increasingly see retired people with smartphones and tablets watching the latest Youtube videos and family photos on Facebook. This at least informs them about the tectonic shifts in society, and at best changes deep seated notions.

Public perceptions of gun ownership, healthcare, education, equal rights, and our relationship to the world are being debated because the minds of the people are changing. And contrary to what even the history books say, it was not the federal government and federal troops that desegregated the schools, it was We the People. The shibboleth of these times, our times, are the smart phone, social media accounts, and the networks connected by these. Are you in?

What Good is a Stinkin’ iPad?

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My good friend SY wrote me yesterday asking basically, “what good is a stinkin’ iPad?”

Hi Mike!

How are you??
My husband and I bought an iPad for my dad, but he decided he didn’t really have use for it (i.e. he uses his laptop and his phone and can’t get Java to work on the iPad so he can’t play ba-dook on it).

So now we are deciding whether to take it back or keep it for us–How useful is it really? You can’t edit documents or talks on it can you? Is it good for taking notes at conferences? Isn’t the wireless plan expensive on it? I pretty much bring my Mac everywhere with me, but I’m not sure it’s more than an indulgent toy for us.

SYP

I wrote back.

Hi Sung Yun. I have been asked this same question many times and can answer in the affirmative that tablets are overall great for reading and looking at stuff on. For editing and taking notes, it depends on what you are used to. And for portability, tablets>laptops. Tablets in general get a lot done, and of the tablet choices that you have, the iPad is still, for now, the best tablet a lot of money can buy.

I went all in when the first iPad came out, buying not one but two iPads. It occurred to me from the start that the pain of lugging my 15 inch Macbook Pro was soon to be relieved by the magic iPad, but I was worried that I would not be able to multitask. I normally keep several desktops and multiple windows going at the same time on my laptop, and to get a similar functionality from tablets, I feel you have to have multiple tablets. I also figured two iPads were still more portable than a single Macbook Pro (2007 issue).

The first great use of the iPad was as a reader. I own several Kindles and while I love reading books on my Kindle Paper White 3G, I equally enjoy reading them on the larger screen of my iPad. The skeuomorphic iBooks with their faux page turns are fun, but the iPad Kindle App with an Amazon Prime Account is reading heaven. Toss in FreeBooks app that feature everything out of copyright, and you have a public library in portable form. Overdrive reader app lets you access your local public library -you can look up and check out eBooks from your library! If you read magazines, most magazines feature an iPad App. Harder to find magazines can be found in newsstands like Zinio, but the killer app for magazines is Next Issue which for a monthly 8 to 15 dollars features hundreds of magazines like Esquire, Time, and People. I can’t live without my New Yorker magazine, and now rather than a mess of magazines around the house, they are all in my iPad.

The next use of the iPad is as a portable widescreen TV. While iTunes lets you purchase and then download movies and TV shows from iCloud onto your Mac, AppleTV, or iOS device (iPad, iPod Touch, iPhone), the streaming app trio of Hulu, Netflix, and Amazon Prime gives you access to thousands of current and vintage movies and television shows. Hulu Plus, a monthly subscription, gives me access to every episode of South Park, the Daily Show, Colbert Report, Community, and The New Girl. It also features the Criterion Collection of critically acclaimed but difficult to find foreign films -I am in the midst of watching Riso Amaro (Bitter Rice), an Italian post war film of lust and crime in the Italian rice paddies. Movies-Riso_AmaroNetflix has a great selection of movies and TV shows as well, and the ability to have DVD’s mailed to you. Amazon Prime’s video player also features many recently released films for streaming, and beats iTunes by letting you stream rather than download then watch rental movies. Amazon also has every Ken Burns documentary, if that is your thing.

These two features are the core of how the adults in the house use the iPad. Jen enjoys watching Downton Abbey in the bed while I read the NY Times and listen to Paloma Faith on Spotify. The NPR app, by the way, lets you listen to all the NPR that you missed during your busy day. The boys love watching their shows anywhere, anytime. The funny thing is, because we watch shows on our terms, the TV goes the whole week without being turned on except for family movie night or when dad watches sports. During baseball season, by the way, I buy an MLB season ticket to watch major league baseball games -usually as a ten minute summary of outs and hits the next morning, but often I stream the live radio broadcast just to hear John Sterling howl, “Yaaaaaaankeeeees Winnn!”

The third feature is up to you to decide if you want in the house. The iPad is a great gaming platform. While not as immersive or complicated as an XBox, Wii, or Playstation, games on the iPad are no less fun or addictive. Words with Friends pops on a larger screen. Pinball is a great stress reducer. My boys play all manner of games -most of which are free or cost 99 cents which is a lot cheaper than the average XBox game.

The utility of tablets is that eliminating the keyboard frees you to interact with the computer in a far more natural way. Drawing and music creation are two ways I put mileage on the iPad. My favorite art app, Paper, was the App Store’s App of the Year last year, and I doodle constantly. The Brushes app is used by David Hockney and other artists to create serious art. I frequently use Adobe Ideas to sketch on top of CT scans for patient consultations.

For note taking, there are innumerable apps for taking freehand notes and the better ones allow you to record the presenter’s audio synced to your notes. My favorite second brain app is Evernote which lets me data dump important files, notes, and ideas for access across all my gadgets. If you type fast, you probably aren’t going to change note taking tasks but I have to mention that it’s less intrusive to write notes on iPad than click clack away on a keyboard.

This brings me to the last part -work. I composed this blog entry on an iPad using the Logitech Slim Keyboard Case, which I recently reviewed. It turns the iPad into basically what the Microsoft Surface wants to be, a post-laptop work device. While Office for iOS isn’t out in the wild yet and probably never will be, there are many options for writing and editing. Pages is a good word processor, but Word is more universal and more importantly has collaborative editing and version control that is superior to anything on iOS. That said, Pages is unmatched in its ability to layout documents. That’s how I use it -after composing the content in a simple text processor like iA Writer, I open up and prettify it in Pages and save it as a Word file for sending out.

For presentations, Keynote is how I make all my presentations. I can make them on the fly during and after cases to present complex operations to patients and their families. You can export into Powerpoint or PDF, but equally powerful is the ability to present directly off your iPad, either via a cable or wirelessly to an AppleTV (an unpromoted feature). The usual way I create presentations is I upload all the pictures and graphics to a Dropbox folder and then compose the presentation on my iPad after taking intraop photos with my iPod Touch or iPhone. I’ve uploaded a sample presentation SFA-POP-Tibioperoneal Trunk EndoRE that I created right after a case for explaining what I did for a patient’s family.

The wireless plan is pricey if you’re not needing it, but I find it indispensable because my iPad 3 with Verizon 4G has a hotspot function which will allow me to tether other devices like a Macbook Pro or iPod Touch at high speeds. The typical use scenario is on long car trips where the iPad is the hotspot for streaming video to the boy’s tablets and I listen to This American Life episodes (every episode ever is available on their app). In a pinch, the iPad can act as a ridiculously large phone via the Line 2 app, which gives me a phone number (in Manhattan no less) for non-work use.

Now here is the last tip -I suggest you trade in your iPad for an iPad Mini with Verizon Wireless. The big screen is great, but impossible to carry around the hospital in a white coat. The 8 inch size fits perfectly. I’m holding out for the retina display iPad Mini which hopefully is next. For now, my Android Tablets fulfill this in the pocket function, and match the iPad largely feature for feature except for speed (they are older single processor devices) and ease of use. I think if you are adventuresome, the Nexus 7 is probably hits the sweetspot of price (about 200 bucks) and size (fits white coat pocket), but for cheaper, you don’t get the cellular wireless or nifty form factor, and you have to geek out on Android.

Hope that helps.

Mike

The Metro Municipal -Highland Park GC

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One of the things about the USGA and GHIN is that you have to be part of a club to register your golf scores. I could join the several Northeast Ohio based golf associations, but it would be nice to just join a club. The problem is that a private club is a considerable commitment of time and money.Image So it was with some joy that I found Highland GC, which is a large 36 hole municipal course. The Red Course is two traditional nine holes that go out and back into the clubhouse, while the Blue Course is an 18 hole track that does not come back for a breather between nines. They are about ten minutes from my driveway, and there is hardly ever a line.

That kind of convenience comes with some compromises. There is no pro shop. There is no driving range. And finally, there is no club for affiliation and registering of scores. It is a municipal golf course and there is a golf egalitarianism that is lost in the rarefied districts of private club golf. In the parking lot, there is an eclectic mix of luxury sedans, beaters, and even a loaded pickup truck. At one time in America, all the different classes mixed in the public sphere, at school, work, and play. This has eroded and you can see it in the economic gerrymandering of neighborhoods and suburbs reflected in their anchor malls and grocery stores. The municipal golf course is the last preserve of the public commons. On the first tee this morning, I saw three groups lined up, Asians, African-Americans, and whites.

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Sadly, they were segregated and rather prickly, being all men of a certain age. If you are in the late fifties and are playing golf on a municipal course with swings that could be good for tree chopping, you worked hard all your life, never got handed anything, and have generally skeptical view of the world. On line, the reviews complain of lack of services, poor conditions, and discrimination (both forward and reverse). Yet even with the apparent race relations of a prison yard, and stiff necked, flinty eyed glare of blue collar pride, golf etiquette prevailed and all the groups let me play through with courtesy and even a little banter about the good weather. And that is the lesson for us all. In golf there is hope.

The African American twosome were the first to let me through. Both had the mien of philosopher kings, ancient wise men, spiritual healers. They clearly enjoyed each other’s company and were in no hurray, and shooed me onwards. The Caucasian twosome were clearly betting on everything that could be bet upon during a round of golf, and seemed to be making bets about me as I played through. They were congenial and courteous. The foursome of Koreans were the most fearsome. They didn’t smile at me when I asked to play through, and I held off speaking in Korean because I thought it might trigger some kind of outburst that could only come from 4 Korean dads, but I overheard them their captain say, let him through in Korean. They watched me tee off in silence and I bid them adieu.

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On the fairway!

The course had its problems -I suspect from lean budgets and a very hot and dry summer. There were dead patches on the greens and fairways, and uneven mowing on both. That said, from the tips, the course was a lot more fun than I could usually expect to get for 35 bucks.

Addendum: found out they mow on Monday. Once mowed, the fairways and greens are very nice. This place is growing on me. Plus, the starter asked me if I was a golf pro or golf writer, which really made my day.

Etiquette–Doing is Being

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When my son turned 8, we enrolled him in an etiquette course at our country club. He was one of only two boys in that class, which had four times as many girls. Etiquette is as popular among boys, it seems, as ballet or gymnastics. So how is it that we teach our children, especially our boys, manners? In my experience in the Midwestern suburbs, for the presumptive future alpha males, it is through football that parents teach their boys how to behave in society.

The cult of football, which recently took a hit in the Penn State scandal, is very much the secular religion in the US, and its principles of individual sacrifice, self improvement, and group effort are laudable. The American ideals are poured into the public ethos of football. Much of America’s recent history can be viewed in a football context, explained in football metaphor, and historical events remembered like games and seasons. If you are a space alien needing education in American culture, you need only to review the past five Super Bowls’ worth of half-time shows and commercials. Football is America’s vernacular.

In watching an etiquette class, I realized that the forms and routines –how a table is laid out, how you approach the chair, which side the drinks are, which side is the meal served, what the utensils are for, etc., create the physical input to dial in behavior and ultimately etiquette. Dressing and behaving like a gentleman makes you a gentle man. Let me explain. The mind can be changed based on what you do physically. It has been shown that simply smiling increases the dopamine levels and changes your brain patterns to one that matches happiness. Yes. Smiling can make you happy.

The mind can be changed based on what you do physically… Smiling can make you happy.

Martial arts like Tae Kwon Do or Kung Fu focus a lot on forms –series of rote maneuvers that are memorized which to me as a student seemed tedious but retrospect have the effect of shaping the mind. Focusing on the forms of courtesy eventually makes you courteous. So where does football and football parenting leave us?

As far as I can tell, it teaches impressionable young boys how to dominate the weak. It confuses narcissism as self-esteem. By its nature, football cannot teach empathy, courtesy, or thoughtfulness. There is nothing wrong with this if your goals for a society are to create a core group of warrior that will fight wars, conquer nations, and pull down an eight figure salary in free agency. The unintended side effect is that you readily miss the opportunity to prevent the development of psychopathic bullies and date rapists. You only have to watch parents at football practice to understand why this is so. It is why figures like Tim Tebow are such an anomaly not only because he seems to outwardly practice courtesy, respect, and reverence. It is why Penn State was allowed to happen, because football is more important that a few little boys.

If you want to teach your child how to compete while being civilized, you can try etiquette lessons, but more practically, you can do no better than golf. The first section of the USGA Rules of Golf is focused on etiquette, but in fact, you teach your child important lessons by having them accompany you for a round on the cart. You learn to wait your turn staying respectfully silent. You learn to be timely and considerate of others in your group and in the groups ahead and behind you. You learn to be honest and to be your own referee. You learn to impose penalties on yourself for transgressions and be transparent about it. You learn to post your scores (like submitting tax returns when running for president). You learn to behave in a way that would make you proud and not ashamed.

As a nation, we need more mediocre golfers than we do washed out football players. We will be far better off for it.

Plague, Inc. A Review

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This is an addictive game that takes macroeconomics, epidemiology, and microbiology, and creates an ultimately bittersweet game out of human extinction. I called my first plague Paltrow, and it defeated humanity by taking advantage of human behavior -why let a “cold” epidemic derail the London games which can spread disease to the four corners? If you make the disease a tropical one, the “developed world” ignores it. Make it go to the first world by conferring cold resistance and interest spikes in a cure. Remember not to make it too deadly at first or it won’t leave the country.

I remember in the 80’s playing blue and red team games for the government interested in seeing how some Ivy Leaguers would play out a Kobayashi Maru type WWWIII scenario. This is a red team scenario and it proves one thing -an extinction level event needs a steady hand to guide it.

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Hilton Head, o beautiful muddy island.

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Hilton Head is in the news this time of year because of the golf tournament on the Harbour Town course with the iconic light house on the 18th green. It made the news yesterday because an alligator interfered with play -the golfer unfortunately didn’t take the free drop being ignorant of Hilton Head and alligator rules.

The gators on Hilton Head are hogs -fat, mean, and not shy. All the courses have gator rules as well as poisonous snake rules, and the smart golfer takes the free drop. Hilton Head is not the place where you let your toddlers roam free or they might end up free lunch. It’s only a few steps from being a malarial swamp, but it’s blessed with a strange lack of flying vermin. Few mosquitos is very nice, but the island has hedge fund managers infesting the palmettos like velociraptors clad in Tommy Hilfiger. New Yorkers it has in spades like bed bugs on a transient’s hairy knee. It’s Aspen on the tidewater, the Hamptons unburdened by its Long Island umbilical to Manhattan, a New Yorker’s semitropical Hong Kong on the South Carolina/Georgia sea coast. Hilton Head, like Boca Raton, Austin, and Charlotte, is in the South but not of it.

Hilton Head’s isolation proffers it automatic business class status compared to the economy class experience of jitney creeping to the Hamptons on a Friday evening, but really it takes about the same amount of time to get to either place from midtown. Once you arrive, you will notice that Hilton Head is culturally indistinguishable from 78th and Lexington. Sunday mornings, you would be hard pressed to tell the difference between Harbor Town and Southhampton as you hunt and gather for coffee, bagels, and the New York Times.

The sea air is a hint saltier off Montauk and Southampton. The terroir of Hilton Head is a twee riper with more ferment of low tide than is available in Long Island. The aborigines on both islands have been pushed out -on Hilton Head, the once Gullah speaking inhabitants and their white confreres commute from the mainland, unable to afford their island and its taxes. In the Hamptons, the aborigines are long gone, and the more recent inhabitants, the establishment WASP -an endangered species, survives by intermarrying with the new money like the English did with the Normans, only the invading hordes today sport last names like Cohen, Freeman, Chen, and O’Hanlon (the ethnic stereotypes, not the law firm).

When you see Harbour Town on the TV, you think about some kind of tradition, a deep south Cape Cod, but it’s all a pleasant sham. Look hard as you want for the humble shacks out of Conrack -they’re buried beneath the rusticated mini mall around Publix. You might even think the Harbour Town course is super exclusive like Augusta, but au contraire, you just need enough bank. The irony of the Masters getting annually harangued for their peculiar institutions is in the fact that Shinnecock out on Long Island, while no less exclusive and hidebound, gets off the hook because the USGA moves the target around like a 3 card Monte dealer. While it is unlikely that I will get to play on either Augusta or Shinnecock in this life, I can swing Harbour Town once every few years. That is great.

And I’ll finish with this. The Ayn Rand/Gordon Gekko creed of “Greed is good” does work in America because we lack the education and sophistication to dedicate ourselves to political ideals more sophisticated than “less taxes, less government, more God,” but once you get there, once you have arrived, after all the striving and self improving which can take generations from broken English immigrant green grocers to graduate school educated doctors and lawyers, to pretensions to establishment, you are equally bound by the other great American rule voiced by Marx (Groucho, not Karl), “I would never join a club that would have me as its member.” We’re happy to be on Hilton Head, but we know there is something better. Specifically, it’s a helicopter ride to Fisher’s Island.

Living Fossils

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This rock on a Pacific coast beach was weathered over thousands of years, and revealed within its sandstone this harder rock which is likely the fossilized remnant of an ancient coral or related creature. It reminded me that we have these fossils within our own DNA.

It was recently revealed that up to 2-3 percent of the genome of non-Africans have Neanderthal genes and a third human species, the Denisovans were found to be lurking. But this is just the recent past, being merely 20-50,000 year distant.

I was reviewing the lymphatic system in our bodies –it is the often overlooked third blood vessel system after arteries and veins, and its roots are older than either being present in our distant relations, the tunicates. Where arteries and veins are connected in a closed loop, the lymphatics are open to the extracellular space, and once in the past, to the ocean. This link to primitive chordates goes back nearly half a billion years.

They are now saying that there may be millions if not billions of earth like planets around middle aged stars, even in just this galaxy alone. Over cosmic time, and given those numbers of planets, it is a statistical certainty that life is common and not rare.

This feeling that life is a rare circumstance in an otherwise sterile universe has its roots in the narcissism of an idiot. The assumption that our clever ideas, petty jealousies, and unending appetites are unique is from the cosmic hayseed’s provincialism that gives certainty to the notion that a hundred years is a long time and that the universe disappears when you shut your eyes.

Starting from a single cell, our complexity is layered on like a gobstopper. Our DNA is not just a blueprint, but also a blog of life over three billion years. We are living fossils.

Addendum:

The fossil pictured above is Tiktaalik, a lobed finned fish from the Devonian. What it has that is unique is that it has a humerus, radius, and ulna along with shoulder, elbow and wrist that is the rubrik for all land vertebrates. The pattern of one bone with two distal bones are what we experience every time we eat chicken wings, and we owe  it to this class of fish which may be a direct ancestor or closely related to it.

Tilted Sideways, a Colander of Death

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The tragedy in Italy comes so soon after our cruise vacation that I felt compelled to comment. We were passengers aboard the Ruby Princess over Christmas. It is in many respects a sister ship to the unfortunate Costa Concordia, built by the same ship builder with similar tonnage and sibling like launch dates (2006 and 2008). The thing that struck me about our voyage was this: it was very clear that the ship was well run. The ship’s commander was Commodore Giuseppe Romano, whom we briefly met. The whole ship ran with obvious discipline with the first order of business on leaving Ft. Lauderdale being an evacuation drill where we understood the series of events in the event of a disaster before the first shrimp cocktail was served. During the cruise, there were several crew based drills, and I could appreciate the importance of top down leadership.

This is further contrasted by the events last week in Italy, which will be studied extensively, not just in a court of law, but in business schools as a case study of poor leadership. Bad decisions and bad discipline compounded by the elements made this the perfect example of why we have rules and expectations about professionals and their behavior. It also is a sobering reminder of how far we’ve strayed from chivalric ideals of women and children first. In a classroom, the idea of chivalry can be seen as revanchist, antiquarian, vestigial, and oppressive, but in the scrum of a mob climbing towards a lifeboat, the reports of grown men cutting in line, stripping life jackets from pregnant women, and abandoning the disabled all headed by this captain illustrates something.

It’s the death of honor.

One percent of the 1%

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From Evernote:

One percent of the 1%

The recent focus on Kim Jong Il’s lifestyle brought gasps of astonishment -he sent his sushi chef on a private jet to Japan to shop for rice cakes while his country was starving. Fact is, among the wealthy, there are the über wealthy, and among the über wealthy are the super duper wealthy whose daily budget would feed maybe a thousand families. While we do not begrudge anyone success -as this is the cornerstone of America, even the most callous person has to admit there is some injustice in North Korean society. It does not come from a lack of guns -the noncoms always outnumber the officers, and the fact that people can bribe border guards to escape means that some independent thinking occurs. The fact is that a religion, a cult of personality, sustains the vast inequality of North Korean society. Religions demand faith over logic. Directing the resources of a nation to the sustenance of a few humans at the top defies logic. It is a religious-type faith and fear of retribution, fear of apostasy and heresy, and fear of change that causes this gangrene to linger. What are the idols that drive injustice here at home? It is the belief that success comes from being favored by God and that lack of success comes from sin. It is the belief in absolutes that define religion. This idea afflicts our politics as much as the cult of personality afflicts North Korea.

The subordination of logic to dogma and its use in organizing societies is a old tradition. It gets people across desserts, oceans, and helps individuals process grief and the unfathomable concept of infinity. It is a human trait as ingrained as circling three times before bedding in a dog. Yet this kind of thinking is also used to demonize the poor, write off the sick, and rationalize the unemployed. It is extended into contempt for anything for the public good that comes from taxes -clean water, safe roads, national rail, public health, education and safety. It sanctifies success defined as wealth and therefore denigrates anything that might take away from that wealth.

In our still free society, one’s success is the result of not only hard work, but favorable circumstances, good health, and the support of people who were midwives to the success -the family and community that nurtured the individual and the society that provided the fertile ground for success. It’s the good plumbing that provided fresh water for excellent development. It’s the public safety provided community police and fire departments. It is the critical mass of excellent citizens that allow for success and justice. I think that is the message of the OWS protesters, that the people who get tasty morsels flown in for them not get protections at the cost of the people making it possible.

I wish for the new year the restoration of reason and clear thinking guided not by desire for retribution or a return to a past that never really was. I want an America where everyone has available all the opportunities while being good citizens and supporting the community, state, and country that allowed that to happen.