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Ask Dr. Salvo

September 27, 1994

Ask Dr. Salvo

Dear Dr. Salvo,

Greetings from the progressive state of Virginia. I read with interest your objections to MASA and PRN's actions. I myself am on indefinite probation in Virginia for "allowing" a patient to choose a birthplace outside of our fair university hospital. "Aiding and abetting the practice of midwifery" was added for once ordering a CBC on a woman who had seen a midwife. I have been dropped by all HMO's and the job offers have dried up. Our indigent care practice suffered a blow from the $9,000 (ineffective) lawyer's bill, which is more than I make in a year.

Reading your column of 8-9-94, I am less inspired to lie down quietly like a whipped puppy, especially since my statement to the investigation of "I don't drink alcohol at all, because I have depression from time to time, and alcohol would worsen it," was converted to a charge of "alcoholic depression," for which a closed door hearing took place.

One of my fellow family practice residents lost his license in exactly the same scenario as you described. He tested positive for cannabis on routine discharge from the Navy, and years later, his VA license was pulled for answering the question "Have you ever lost your license in any state for any reason?" in the negative. He was forced into prolonged treatment (inpatient) and years of care at his own expense. The weirdest thing was, he wasn't one of the residents with a problem. The real partiers knew how to not get caught. We had residents stealing valium out of the drug closet, and others abusing prescription drugs -- and no one cared or offered support. They all knew what retribution treatment would bring. Any mental health treatment of a physician in our state is equated with drug abuse treatment. The progress notes from my few trips to a counselor were all read by the BOM. I was told by a psychiatrist friend of the BOM that if I ever did need treatment, I should go under a false name.

Someone said once that medicine is the last profession to shoot its wounded....Dr. Salvo, why, or why, did I leave a waitress job?

Your faithful reader,
Susan P. Osborne, D.O.

P.S. Please send names of constitutional attorneys who like to feed on boards of medicine....

Dear Susan,

Please excuse the familiarity, but your letter has made us kin. We are and will be together in applying the P.K. enlightener (usually applied upside the head in an effort toward persuasion) to the B.O.M. of our respective states. As you know, in your state BOM means "Brownshirts' Own Madness." This, in Alabama, might well become the BME, or "Board of Medical Executioners." It is all the same and I am alarmed that it has spread to Virginia, but relieved and flattered that you've been faithfully reading The Harbinger, so that you could alert us. This argues for firmness, courage, which will come in handy as we march forward through Virginia. Wherever we find some doctor with your courage we will establish strong legal attack bases. If we can generate 2 or 3 law suits per year from doctors who have been mistreated -- why we can bring to their knees the PRN's and BOM's of this world. Then we can consider such matters as disbanding the current medical central committee, and having new legislation voted in to replace the current totalitarian laws that allow PRN's et al to trample all over the individual doctors.

It cannot be overemphasized that RIGHT NOW the only way to deal with the B.O.M. of Virginia (or anywhere) is by taking the offensive. This means finding a very smart, very sharp lawyer who is not abnormally fond of physicians and who feels pretty secure financially. Get her/him to the task of protecting your medical license so it can't be grabbed and withheld by the BOM for any reason. By this means you can bring down the enemy to your size and paralyze him with injunctions "until certain constitutional issues have been resolved -- such as denying you the rights of due process, equal protection, and more. Thus you will keep your license and continue to work and raise money for legal expenses for the lawyer. If he be magnanimous, and a pugnacious opponent of tyranny, he will work on contingency, i.e., will assume you'll win, and then you'll collect your damages and he his lawful and reasonable fee. I have sent him a copy of your letter. You will hear soon from him.


P.S. How is it you get Harbinger up there?!

P.P.S. All of us who have witnessed or/and been part of the Physician's Recovery Network should form a nationwide support group. And raise money to hire tough lawyers and sue the medical society officials. They are smug, ignorant of their and our civil rights -- and thus easy targets for suits.

P.P.P.S. We have 3-4 doctors at USAMC in Mobile who are just waiting to see if my suit prevails. If it does, 3-4 new suits will be filed.

Dear Dr. Salvo,

You suggested that I venture to a casino and learn the effects of gambling. I went over and had an excellent meal at a very low price. One would pay twice to three times the price in Mobile and not have near the view or atmosphere. The entertainment was great.

A former co-worker and church deacon was working the crap table. I asked him to explain craps to me as part of my theological research project. He agreed and gave me the following information.


10. No one will kill you for not shooting dice. (But will, for shooting too well)

9. Dice don't tell you how to have sex. (They never tried it)

8. Dice have never caused a major war. (But they're as good as any reason)

7. No one forces dice on minors who can't think for themselves. (The age of reason is 7. If you are R.C. Pius XIII)

6. When you have dice, you don't knock on people's door trying to give them away. (Only to avoid gunfire)

5. Nobody has ever been burned at the stake, hanged, or tortured over his brand of dice. (A loose assertion, or loose canon)

4. You don't have to wait 2,000 years for a second roll. (Duration means nothing; like speed or mass it depends on comparison)

3. There is a law saying that dice can't lie. (However, some do. Watch for dice that seem tired on one side!)

2. You can prove you have dice. (Only for one deputy for one minute)

1. If you have devoted your life to dice, there are groups that will help you give them up. (Perhaps you can help them give up snooping and meddling)

I am thinking of opening the Church of Holy Crap Shoot in downtown Mobile. I could call the losses "love offerings" and the winnings "blessings." Just imagine the church secretaries serving communion and the deacons working the tables. And everything would be tax free.

Just Wondering,
Rev. Hank Shiver

Dear Rev. Hank Shiver,

Your letter gave me a great deal of pleasure, as I found less of the ranter- Pasadena and Purified Snake Oil in the contents. More Bret Harte and S. Clemens, but not derivative. You could have been a bit more forthcoming about the visit to the Mississippi Monaco. What, the menu? And the entertainment? (These are sometimes often hard to justify on the expenses) Do any crap-shooting, yourself? Go-go girls??

I'm going to let the heavy guns of "Quite Rational" pound you to pieces as I snooze off to sleep. I know I could, but don't have to! Meanwhile my snipers may occasionally pick off one of your men who refuses to shoot dice, or who will not indulge in a little "frottage." Don't bother me, it's in the DSMIV.

Some of my snipers' work you can see in the guise of small short, low-to-the- ground statements easily refuting the most cherished notion, or delusion, of our esteemed friend, critic, and scholar Rev. Hank Shiver.

Still, I must scold you for once more slighting Occam and his razor. Do you, in real life appear to need a shave? The next letter may help you, even if you are respectably shorn and anointed with Double Virgin Olive Oil. If you will believe QR, I will believe in double virgins.


P.S. Note above parenthetical replies.

Dr. Salvo,

I know you have declared a moratorium of sorts on letters about religion. But I just read an essay arguing in favor of the existence of God that was so good I wanted to share its main points. If you care to risk opening the gate, perhaps you could print it and see how it plays.

It comes from Richard Swinburne, who is a philosophy professor at Oxford. The full essay, "The Vocation of a Natural Theologian," appears in the new book Philosophers Who Believe, published by InterVarsity Press. Swinburne first establishes that there are only two ways to explain any phenomenon. It has either a scientific explanation or a personal explanation.

A scientific explanation describes the physical laws that cause one state of affairs to give rise to a subsequent state of affairs. A baseball hit with a bat travels in a direction and at a velocity determined by laws of physics. A personal explanation, by contrast, describes the reasons why the person with the bat hit the ball.

The rise of Darwinism in the 19th century seemed (and still seems) to many to make God unnecessary. Previously the question "Why do we exist?" was answered with "God created us." (A personal, not scientific, explanation.) Evolutionary theory replaces the personal answer with a scientific one...we exist because we evolved from lower lifeforms.

But Swinburne points out that the scientific answer doesn't replace the personal one, it just pushes it back a step. Why do humans exist? Because they evolved from lower life forms. Why did the lower life forms exist? Because they evolved from still lower life forms... and so on back until we ask why does life exist? Because a certain set of conditions gave rise to it. Why did those conditions exist?

The chain of questions continue to recede, each answer giving rise to yet another question, until we reach the question: why does the universe exist? And on this point, science is silent.

Therefore, why the universe exists "either has a personal explanation or it has no explanation at all," he writes.

Now the choice as to whether the explanation is personal or none at all hinges upon how likely the conditions necessary for life could have come about by chance.

That is incredibly remote. If the Big Bang had caused just a slight faster expansion, galaxies, stars and planets would not have formed. Just slightly slower, and the universe would have collapsed upon itself before anything happened.

As if this one-in-millions chance wasn't enough, there is a long chain of variables that have to be precisely set or else life never would have developed. Each step makes the odds of all this happening by chance more and more remote. Therefore, Swinburne concludes, a personal explanation for the universe is much more likely than that there is no explanation.

Then, using the principle of Occam's Razor (that the simplest explanation is more likely than the right one) Swinburne argues that the Judeo-Christian concept of one omniscient, omnipotent God is simpler than either a god limited in some ways, or many limited gods.

The only objection to this argument that I can see is "It doesn't matter how unlikely it is, we're here." But this objection doesn't defend atheism, it just assumes it. It is the statement of the atheist's faith that the universe is self-existent, absent any evidence that it is. (And in the face of the infinitesimally small chance that it could be.)

Swinburne articulates for me what I have long believed but had trouble putting into words. And he demonstrates, I think convincingly, that belief in God is a logical consequence of observed facts.

So, the sputtering objections of Hank S. and Jesse B. aside, I feel completely justified in considering myself...

Quite Rational

Dear Q.R.,

As you by now have divined (how's that for word play!) that you are about to be sent to the Front -- there to be osterized by the latest Haitian automatic chamberpots from the Pacific-Rim, the Balkans, etc., etc. -- I may as well be honest with you. (It could change your life, as you are known to be gullible. Or was it I, the gullible one?! "No matter, never mind" as Berkeley and Hume were wont to remark so commonly and inappropriately as to provoke the shining blade of sedentary Occam.)

In the Tau Ceti barbershop I used to frequent about once or twice a month, (or every other millennium -- remember, comparisons are odious: in estimating velocity, man, or position of a sub-nuclear particle -- AND that grave doubt exist as to the "passage" of time etc., and that we know nothing of the above except as they are compared to some other particle.)

And, I agree with you, though I once was a fairly good Shivers and Hank man, (I hankered for girls and I shivered if I caught one) that all attempts to explain How? Why? What For? we are here, are beyond the powers of hard scientists and science.


P.S. I am on vacation, which is why my column is so lazy.

-- September 27, 1994

The Harbinger