I get earworms all the time. I have a surefire cure. If there’s a tune rattling around my brain that refuses to leave, a verse of ‘It’s a Small World After All’ usually banishes the culprit back to the misty regions whence it sprang. Today’s earworm, which I’m sure was inspired by the gleeful annihilation of post-World War II American society represented by the revelations of each new choice for the incoming cabinet, is the old Tom Lehrer song ‘Who’s Next?’ Lehrer wrote it in the early 60s in response to the proliferation of nuclear weapons during the Cold War, but the rising tension and comic dread of the song could apply to any rapid sociopolitical change outside the control of the average citizen. The last lyric of the song ‘We’ll try to remain serene and calm when Alabama gets the bomb” was a dig at the contemporaneous civil rights violence but it still hits home. The nutty politics of this state disfigured by the overemphasis of God/gun/gays have metastasized out of Montgomery and are basically the engine that runs the current Republican party. It’s more or less prevented any improvement in the lives of Alabama citizens for years and that’s coming soon to a state near you.
Tom Lehrer, who is still very much alive and with us at the age of 96, was a comic genius. As a young Harvard math professor, he took his skills at musical pastiche and wordplay and had a brief, but illustrious career as a musical satirist, performing in night clubs and releasing three albums of comic songs which, for the most part, remain funny to this day. As someone who wrote political satire for fifteen years for the Politically Incorrect Cabaret, I don’t think most realize how difficult it is to write this sort of humor in a way that doesn’t quickly date and grow stale. Listen to some Lehrer (if you’ve never heard of him, you might start with ‘Poisoning Pigeons in the Park’) and then listen to some Capitol Steps recordings from the Bush/Clinton years. Lehrer still works. The Capitol Steps is way too topical and of the moment to have any resonance decades later. They’re almost painful. Speaking of the PIC – don’t any of my Millennial theater friends or Gen Z theater kids want to take it over? I’ll help with the transitions and the first show of a new regime, and I think I have an appropriate venue which can host it for minimal investment. Cabaret type satire is one of the most effective ways of punching up at the power structure and holding a mirror up to the audience to show them the parts of themselves they’d rather not acknowledge. Besides, there’s always the fun these days of getting on an ‘Enemies of the State’ list.
I’m remaining relatively calm as the bus lurches towards the cliff. I’ve been here before. I think I expended all of my angst and weltschmerz during the first Trump administration and its sequel, Covid pandemic. No point in wasting energy doing that again. Nothing I can do is going to change any of it. We all had our chance to cast our votes, and we chose. However, for my mental health, I am keeping my television off news channels. I have replaced news radio in the car with audiobooks. I am staying out of the darker corners of the internet and social media where the unhinged loons of both the left and the right gather and hurl invective at each other as if that ever solved anything. I’ve come up with a new mantra (that one of my friends turned into a meme which is now rocketing around various places). Get up. Get dressed. Go out. Do good. After all it’s all any of us can really do. As my career has progressed, I find that the macros I keep in my head for explaining the complex paradoxes of geriatric medicine to patients and the lay public keep getting shorter and shorter. Back in my early career, I would speak for five minutes to older people about the importance of balance and the use of assistive devices in fall prevention. Now I just look at them and say ‘Floor hard. Fall bad.’ At least they remember that.
I’m not quite sure who the highly unqualified and in some cases downright mentally disordered individuals being served up to guide the nation are supposed to appeal to. There is a wing of the modern Republican party, whose most vocal mouthpiece appears to be Steve Bannon who have decided the post War nation state which runs on bureaucracy and a professional civil service is a great evil that must be quickly destroyed. I’d be willing to listen to that argument if any sort of alternative that will allow a nation of 330 million, living in the richest society this planet has ever produced, function in a globalized technocratic world were placed on the table. But they only seem to have thought about the destruction and not what comes after. And this is a problem. Destruction happens quickly. Construction can take decades.
All of the big federal departments impact our lives in a myriad of ways but the two with the most direct effect on me are the Department of Health and Human Services and the Department of Veteran’s Affairs. I occupy a hybrid position half funded by a major academic health system and half funded by the Veteran’s Health Service. Doug Collins, the putative pick for Veteran’s Affairs is a former Georgia congressperson who, on the surface, doesn’t seem dreadful. He has some odd ideas about religion and proselytizing in the armed forces and has sworn his undying loyalty to Trump, but other than that seems rather conventional. The executives that want to privatize the VA system are probably lurking around in some dark corner, but they haven’t been announced for anything requiring confirmation as of yet. Robert F. Kennedy Jr. for Health and Human Services could be an absolute disaster. He has a distaste for science when not in downright denialism. His beliefs regarding the nature of disease and health seem to spring from charlatans, self-promoters, and bloviators rather than those who have spent their lives actually studying the human body and its marvelous biologic workings and how it interfaces with all the other living things on the planet, especially the microbes.
One of the great marvels of modern American society are the academic health centers that house the nation’s medical schools. These are essentially knowledge factories. Since the 1940s, they have been designed to create new information that has helped us live longer, healthier and more active lives. Compare the average 80-year-old you would have met in the 1960s and 1970s to the average 80 year old you might meet today. (Hint: Dolly Parton turns 80 in about a year). They are large, cumbersome, bureaucratic, byzantine, and frustrating beyond belief, both for those living within them and those that merely deal tangentially with them around health care. (I’m allowed to say this as I’ve been part of that world for more than forty years now). But with every year, they have inched progress forward and we can do things now that would have seemed impossible only a few decades ago: robotic surgery, advanced fertility treatments, turning HIV from a death sentence to a manageable chronic disease. But these institutions are fragile. They require funding from Medicare and NIH to survive and thrive. If the Department of HHS begins to monkey majorly with the ecosystem, it may quickly spiral into disastrous unintended consequences. I can say this with some certainty based on historical precedent. In the 1930s, the most famous, prestigious, and advanced medical school in the world was that of the University of Vienna in Austria. When the Nazi’s annexed Austria in the Anschluss and took over the society, the Jewish faculty were purged. The institution went into free fall and has never been able to return to what it was. It only took a year or two.
I have no idea as to what mischief might be cooking with Medicare. The introduction of Medicare Advantage with the Medicare Modernization Act of 2004 has dramatically shifted a number of trends within the program over the ensuing two decades. We could see the entire program forced into that model or we could see cuts which will lead to rationing of services, or we may see physicians required to take courses in the proper application of essential oils. I’m biding my time and watching which way the winds blow. My planned retirement date is in the spring of 2027. If HHS removes science and evidence in favor of hope and belief, I’m going to be moving that up quite a bit. I will not sacrifice my moral and ethical self on the altar of partisan politics. Stay tuned. I’m sure I’ll have a lot to say as things develop. Perhaps that’s another book.
We all know Kennedy’s attitude towards vaccines. I’ve given up fighting people on them. All I will say is that nature and viruses don’t give a damn about your political opinions. If we stop vaccinating our children (and there are parts of the US with worse vaccination rates than sub-Saharan Africa), previously vanquished diseases will come back and eventually we’ll have wards of children in iron lungs. I will have to give him credit for wanting to take a hard look at the American diet and see what can be done to make that healthier. Michelle Obama did the same thing during her husband’s administration to nothing but derision from the Republicans of the time. He’s going to have a couple of problems to surmount though. A healthier diet would require more whole foods, and another branch of the administration wants to deport most of the agricultural labor force that would allow more of that to land on kitchen tables. And then there’s the taking on of the giant food product conglomerates who would rather their revenue streams be left alone. Not to mention the great American public that wants easy access to their Mountain Dew and Funyuns.
That’s enough for tonight. I have to get ready to go off to Massachusetts with the cast of Little Women for a few hours. Get some sleep tonight and tomorrow: get up, get dressed, go out, do good.
Life, The Universe, and Everything 