The North Carolina Budget: Controlling the Growth of Government

The North Carolina Legislature recently passed this year’s budget.  They had to override the threatened veto of Governor   Beverly Perdue, and they did it by convincing four Democratic Senators  to vote with the Republicans. It was a victory for taxpayers, and a victory for our American system of government.

Not all will agree with my musings on this issue, but self reflection is useful, so scrutinizing these legislative actions will have value for all of us—agree or not.

Our country has been in a serious economic decline for over two years, and we currently find about 2 million of our citizens unemployed and unable to find work. Any action by our government must be focused on alleviating this catastrophe. The North Carolina legislature has moved to decrease this pain by its actions.

Governments have a tendency to increase in size and scope as time passes. Beginning as a country of 13 million persons in the early nineteenth century, we have reached a population of over 300 million. This increase in our population does not explain, by a long shot, the increase in influence, scope and control of our Government.

As a small example of this

continued “fattening” of government, who has not watched a street repair in their local community, and noted the abundance of workers (cousins, special friends, and relatives) “needed” to patch a divot in our well-used streets. Do we need all those people to fix a one-foot hole in the asphalt? Spending “other people’s money” is easy, especially when there is little public scrutiny. Our Governments—Federal, State, and local—have become bloated at multiple levels, as we citizens have tried to financially support them. I have worried that our Government has become a government of itself, by itself, and for itself because we have not watched closely enough.

This recently became evident in Bell, California when the citizens discovered the enormous salaries and benefits of their elected officials. Subsequently, these officials were removed from office and some face serious criminal charges. If one would take the time to closely investigate the details of hiring, salaries, and benefits of their local government officials, I believe the tendency to incrementally increase all these factors would become evident.

It is too easy to spend our money, and governments must have controls over this weakness. That control, unfortunately, is supposed to come from the people, but frequently, the people are too busy trying to earn enough money to pay their taxes to scrutinize the spending of their government.

It is clear, that Government has become the distributor of resources (money) between different factions. Giving to one group insures their support at the poles, so the “giving” itself has a fundamental conflict of interest. Witness the current federal administration and the favorable treatment of organized labor. This kind of behavior does not benefit the national interest. South Carolina is fighting for over 8,000 jobs while the National Labor Relations Board tries to force Boeing to hire union workers there before they can open their new aircraft plant. It’s clear, in this example,  whose hand is in whose pocket.

The “change” in our recent elected State government in North Carolina is an example of an effective and appropriate public response to the profligate spending of our elected officials. How many new bureaus, with multiple employees, have been created over the years? Does government ever, EVER get smaller? No, it will not, and it will not unless the people force this change.

I have hoped that this economic downturn would be an “opportunity” to decrease the size of government, and our North Carolina Legislature has accomplished that. Thank God.

The most welcomed relief was rolling back the “temporary” increase in the sales tax from 7 3/4%.  Our Governor, threatened   veto of this and other changes, but was fortunately overruled even by members of her own party.

If citizens can change their spending habits during times of financial stress governments must also. Now is the time to accomplish this goal. These changes will make North Carolina a better place for all of us to live, not just the Government. Checking Government growth is healthy for North Carolina’s financial growth. We should all remember this at the next election.

Pradaxa, A New Drug, Be Careful

Drug ads are now filling commercial time on most television programs. On the evening news the other night,  I watched an ad for a new drug, Pradaxa, which is supposed to "sometimes" take the place of Coumadin for people with chronic atrial fibrillation. Sounds like a real advance, mainly because Coumadin is a "terrible" drug. It requires constant (monthly) monitoring to avoid serious complications, and it interacts with just about everything we consume, including other drugs. Frankly, it's dangerous, and I have personally witnessed complications in patients. So Pradaxa may, I say MAY, be the answer to replace Coumadin. We must just wait and see.  Unfortunately, we need to wait until a multitude of patients use it to really see what it does.

There is an expression in the medical field that applies to Pradaxa, “Be sure to use the new drugs early while they still work.” This might sound strange, but there are real reasons for this insightful statement.

Do you remember Fen-Phen? It was introduced in the mid 90s as a weight loss drug, and many flocked to its promise, because we are almost all overweight. Turns out, that by 2004, the FDA pulled it off the market. Further experience with it revealed that it caused pulmonary hypertension, and heart valve problems. Legal damages have amounted to $13 billion, and Wyeth—the unfortunate pharmaceutical company that marketed it—has allegedly put away another $21 billion for other potential legal problems.

How about Vioxx ,which had 80 million users at one time. This drug was introduced in the 1990s as a Cox 2 inhibitor that helps with chronic pain syndromes. This drug was withdrawn in 2004 because it apparently significantly increased the incidence of myocardial infarction and strokes in patients. As of March, 2006, there had been 10,000 lawsuits, and 190 class action law suits filed against Merck.  Are we beginning to see a pattern?

Another drug that deserves mention is  Avandia a relatively “new” diabetes drug. In September 2010, the NY Times reported that this drug was “banned in two European countries.” One study reported that from 1999-2009, claimed 47,000 people needlessly suffered heart attacks because of this drug. Apparently, the use of this drug has now been highly restricted.

I guess this history of unintended side effects makes me uncomfortable when I see TV adds for new drugs. Pradaxa may eventually work well, but the fact is we just don’t know.

"Using the new drugs early..." makes sense, because once millions begin to use them, side effects may become evident that were not discovered in the clinical trials, and some of those “effects” can be serious.

The human body is complex and delicate, and putting chemicals into it, and into the cell, can have effects that don’t become evident for a time. If we imagine the complexity of the cell, with its multiple interrelated chemical reactions, and the delicate balance of these reactions, we can begin to understand why there might be some untoward side effects when we “tamper” with this chemistry. My guess is that we only measure a few of the effects of medicines, and that there are possibly other effects that we don’t completely understand or know about. Those “side effects”  are the ones that show up over time when enough people begin to use a “new” drug.

As a physician, I have great respect for the pharmaceutical industry. It has brilliant scientists working for it, and it has given us many life saving drugs that have stood the test of time. There have been some pit falls along the way, but name an industry that has not had them.

Pradaxa may turn out to be just what we are looking for to replace the unpredictable and precarious Coumadin drug we are currently using. I hope it is. But it is a “new” drug, and even if I needed it, I might stick to the old stand-by, and wait and see what Pradaxa really does to our bodies.

Instant Play Review in Baseball? No Way!

I went to a AAA baseball game last night and enjoyed a close 1-0 victory for the

Durham Bulls. They are doing well again this year, and all Durhamites have hopes for another "World Series" victory. But as I was enjoying the atmosphere of classic baseball and watching these excellent players apply their skills, I couldn't but think about the tempo of the game and its accurate reflection of what all of us experience every day in our lives. The tempo of life.

You see, baseball has a unique tempo, that no other sport has,  that reflects everyday living. I'm convinced that this is one reason that it is the National Pastime because we sense this familiar rhythm when we attend a game  During a basketball game, we have to keep our eyes glued to the court, otherwise we might miss a critical moment of the action. Basketball is  almost ALL action, but life isn't, and either is baseball.

Baseball is a slow, and sometimes routine, and one might even say boring for some. Pitch the ball, catch the ball, throw the ball back. Pitch the ball, catch the ball, throw the ball back. Pitch the ball, catch the ball, pitch the ball, hit the ball to the second baseman, and throw him out. Pitch the ball, etc. It goes on. Get up, go to work, come home, watch the news, and go to bed. Get up, go to work, come home, watch the news, and go to bed. Get up, need I belabor the point? I don't think so.

In life as in baseball, every once in a while something happens, and all hell breaks loose. Can I mention 911, Pearl Harbor, 1929 crash? I could go on. In baseball it's the line drive over the shortstop's head with a man on second. When this happens everyone on the field must react to the incident, and figure out how to get out of it. Baseball is a slow, relentless unfolding of events marked by "short" bursts of real "action." When I played high school baseball, I started out in left field, but  was so bored, I moved to first base. Just the right amount of action.

You can sit with a friend at a baseball game, and, during the game,  have a nice in-depth conversation  about multiple topics, but you can't to that at a basketball game, or a soccer match, because there is too much "action." In this sense, compared to life, all this action is artificial. If life had this much action, we would end up in the hospital.

This tempo I am talking about is something that we should not tamper with. If we do,  it will take away one of baseball's treasures: a familiar tempo we can all "dance to" as we sit and feel a baseball story develop during an afternoon's game.

One clearly developing threat to this tempo and this national game is the instant replay of questionable calls by the referee. It is going on in most sports now, and has begun to creep into baseball with the review of questionable home runs. That's enough, and let's not go any further with this in baseball. Imagine the first base calls, or the slides into home, or even the individual pitch that isn't certain, should we stop the game and review that "call"? What will "instant replay"  do the rhythm of the game but ruin it.

Life isn't certain, and, the vast majority of the times,  we don't get to review or  change  decisions  we make in life either. Uncertainty is something we live with every day, and trying to eliminate it from baseball will surely cripple one of it's major appeals: that touch of uncertainty that adds the spice of surprise to the play.

This drive to "review" calls is another example of questioning of authority, isn't it?  Unfortunately, with the exposed nature of many of our authority figures today, I guess we should question it. But with baseball, leaving that element of uncertainty there adds that dollop of the unknown that pervades all of our earthly travels: some good, some not so good. It just makes the experience of the game more real.

I guess there are some who want to know the "truth" of each encounter on the ball field. I think the enjoyment of the game is more important, and stopping the game to review a questionable call will remove one of baseball's appeal to all of us: a familiar tempo we can dance to. Finally, is it THAT important anyway? To most of us it really isn't, and if it is I suggest you "get a life."