William F. Buckley Jr. once wrote a piece for Playboy -- I actually have never read Playboy -- and the title of the piece, it was brilliant. The title was: "How Do You Define Smart?"
I never read Playboy. Honest -- I never did.
I learned about this article through various other media outlets I read. You know, the one's that warp my mind. Actually, nothing I read ever warps my mind because I'm a free thinker. I believe as long as one is a free thinker nothing and no one can warp him or her.
So I think the question Buckley posed in this playboy article was a brilliant question. The answer to it, though, is multifaceted.
When I was a kid I always thought of my grandpa as smart. I say this knowing my grandpa quit high school despite his principal telling him he'd never amount to anything if he quit. He ended up starting an auto dealership from the ground up, and this ultimately became a Chrysler dealership in Shoreline.
Whenever I had a question he always had the answer. Yet there are old people in Washington and Lord knows many of them sure aren't smart.
So do we become smarter when we become educated? Well, Lord knows there are graduates of Harvard in Washington, and there are tons of ignorant politicians making laws who have no clue what they are doing.
We have many doctors who are definitely educated who don't have a clue what a bronchodilator is supposed to do, and they order bronchodilators for anything that causes a wheeze and treat any person who's short of breath as though they had asthma. And there are doctors who think a 1,000 tidal volume is appropriate for a 5 foot lady just because she's 550 pounds.
So there are lots of doctors who are not smart.
So what is smart?
Here you have a lifelong asthmatic who abused his inhalers because his asthma wasn't controlled, and yet all the other asthmatics he knew were gaining control of theirs. Then one day he woke up and thought, "Hey! Take your medicine, stupid!"
Yet, how can a blogger who has gotten every thing wrong for so long, be called smart. How can someone who did everything wrong in every way, shape, manner, or form be called smart? How does that compute? He's educated; he can string a couple sentences together; proper syntax. What the hell is smart? Why would someone read his blog.
This has always been something that has bugged me. Common sense is smart. Education does not mean you're smart. In fact, education, depending on where you get it, can corrupt you.
There are idiots with degrees all over Washington, DC. There are idiot doctors prescribing medicine and running ventilators. So how do you define smart?
Either way, I don't think it takes a smart person to make a smart decision. All you need are the facts on your side. Yet sometimes talking to people who think they are right yet they are wrong can be frustrating.
Let me explain my situation to you this way by asking you a question. Have you ever been in a situation, you're arguing or not even arguing, you're just discussing things with a group of people, and you know you're right, and you know you can prove it, and it doesn't matter to them.
And the reason that you know you're right is that you know things they don't know. And because they don't even have that baseline of knowledge to chat with you, they can't even understand where you're coming from. They get mad and walk away. Or, better yet, they laugh and mock at you and tell you that you are being ridiculous.
They'll say things like, "Well, that breathing treatment is toooooo doing that pneumonia patient some good. It dilates his lungs so he can cough up that pneumonia."
Yet you know that not only is the 0.5 micron particle size of Albuterol too large to get to the 0.1-2 micron sized alveolar sacs, there are no beta receptors in the Alveoli for the Albuterol to attach to. And even if there were, there are no bronchial muscles in the alveoli, to dilate, so the medicine will have no effect. Likewise, it's not an anti-inflammatory.
Yet your wisdom doesn't matter. You are the unruly one. You're the one who is being lazy and trying to get out of work. You're the grumpy one. Your the one who is out of his or her league. You're the one who's inappropriate. You're the one who's going to be written up if you take your stupid facts too far.
Have you ever been in a situation like that? You can go into politics here too. There are people who have a political position, and then you come into the discussion and say, "Hey! Wait a minute! If you consider this fact, what you guys are saying is poppycock!"
In fact, if I remember right, Socrates was sentenced to death for this exact reason. He questioned authority. He would walk up to successful business men and question them about how to succeed in business, and he'd get some very useful wisdom. Then he'd ask the businessman about how to make, say, horse shoes. The person would talk as though he knew what he was talking about, as though he were an expert in that area too, when Socrates knew he was not an expert in horse shoes. The businessman, in essence, was pretending to know everything, when in fact he was ignorant in nearly every area except running a business.
So, for questioning authority, for encouraging people to think, and to admit they did not know what they did not know, he was sentenced to drink a poison that killed him. Although, Socrates went down in infamy by his dying.
Anyway, they make you feel like an outcast. And that's how I feel every time a doctor orders a stupid breathing treatment and a nurse defends it. I feel like an outcast. I am the one with the facts, I'm being smart here, and yet I'm the outcast because, to the doctor, it "feels" good to order a bronchodilator. It' doesn't matter that it's doing any good, it just feels good to give it.
These bronchodilator-is-a-cure for-everything crowd are the idealists. People like me with the facts on our side are the realists. There is no science to back up their ideology. We know it's fake science. We know it's a fallacy. Yet these people have educations and degrees in the sense they are great nurses and doctors, yet they continue to fall for this crap.
Yet I've been an RT for 14 years. I know these people like the backs of their hands. I know exactly what they are going to say when I confront them even before I say it -- even before they speak.
Yet I'm always the dummy in their eyes. I'm behind the times. I'm "behind on my research," as one doctor recently told me.
I even make jokes about what they'll do on my blog and the jokes come true.
The only way to understand what's going on here is to understand the difference between different ideologies. You have idealism and realism. Education, years on this planet, experience, has nothing to do with how people think. I think it has more to do with idealism and realism.
Idealists don't like it when you come up to them and are truthful. They say that when you do that you are confrontational. You are causing confrontation. Yet, if you don't, you are being an enabler. I think way too many of us RTs are enablers: we enable doctors and nurses to get away with their false theories about bronchodilators. And all these nurses and doctors think that they're really smarter than everybody else by not having firm opinions on things.
I'm open-minded, I study both sides of the issue, and then I make an informed decision. If that's you, you are one of the biggest dupes, because you are sitting around judging both sides while one of them is lying through their teeth with everything they say to you.
The bronchodilator idealists will say they have the truth on their side, and yet when you tell them to "prove it!" they get all upset and start to quiver in their pants. They do this because they know there is no proof to what they are proposing. There is the history of stupid bronchodilator orders that's for sure, but there is no evidence to back it up the reason for all these orders. You'll even see insurance companies allowing breathing treatments to meet admission criteria because some doctor said this is what will help them get better quicker, but there is no real proof to back up that bronchodilators do any good for anything other than (ahem) bronchospasm.
Bronchodilators are but a small thing and a safe thing thankfully. Yet when you challenge these idealists on their political views, that's when it gets real interesting. Yet when you consider the cost of all the needless bronchodilators given daily, and the costs of employing RTs to dole them out, you'll realize how deep, complicated, and puzzling this really gets.
So I have to consider these things very seriously, the nature of the evidence, the seriousness of the charge that bronchodilators cure everything from rickets to pneumonia, these people are saying we really are saving the planet with Albuterol and so forth. (To get off topic for a minute, I recently read a book written in 1913 about asthma that spent 24 pages trying to prove Rickets was the cause of asthma. He also tried to prove via 24 more pages that asthma was a disease of toxicity, and it was related to urine. He was wrong, but the same principle applies: idealism versus realism).
Many people look at people like me and you as being realists. And they link realism with being judgemental -- which is true. If that's the case, I am more than happy to judge.
So, to come full circle: what is smart? Well, I'm going to tell you. Anyone with an average brain
can see idealism. We know what it is doing to the planet. We know what it is doing to the health care industry. We know what it is doing to the economy with it's regulations and taxes and government programs to create their ideal world.
We know what it is doing to the lungs (Well, nothing if you consider bronchodilators for pneumonia and CHF and rheumatoid arthritis and rickets.)
All you have to do is look at Detroit and California to see where idealism will take you. All you have to do is look at all the failing nations. Look at the old Soviet Union. Look at Cuba. Look at France for crying out loud. France is about to go bankrupt because idealists have been running it for years, if it isn't bankrupt already. Creditors have recently decided France bonds are junk bonds, and no one will loan that country any more money because it has no credibility. Sure idealists have good intentions, but good intentions and sound economics don't always jibe.
All you have to do is look at what is going on in Washington. All you have to do is look at all the people who are scared because the people in Washington want us to be scared. All you have to do is look at your own emergency room at all the people who really don't need to be there, who are complaining because you aren't taking care of them in a timely manner.
That's where idealism has taken us. That's what happens when we all become sheep and never think and never question and never judge. Everywhere idealism has taken you you'll see real disaster.
Don't these idealists understand that it might sound good to give out free health care, but all this free health care has done is make health care more unaffordable, as when you increase demand (more patients) and the supply stays the same (same # of nurses and doctors) the price goes up. Since Medicare and Medicaid have been started, all that's happened to the price of medicine is it's gone up and up and up. Heck, now we have federalized medicine, so one should expect this to get even worse. Although, they'll say, it was done with "good intentions."
Bronchodilator abuse may be a small piece of the pie, but it's a perfect example of what is wrong with our health care system. And even while you have 24 million or so who have no health insurance who really want it, we're going to screw up the whole system for all those who have it and are happy. That's idealism. It's all with the intent of creating equality for everyone, but it results in inequality. Unless you consider that everyone with a lung problem gets a bronchodilator regardless of need and regardless of cost.
I think, if we were real smart as a nation, we'd listen to the people like you and me at the bottom of the ladder, the people who actually see what is going on, the people with average brains and average educations, to get ideas for real reform.
I know I'm right because I know who these idealists are. They will not look at it ideologically and the only way they're going to be able to solve our problems is if he asks, "What are we doing here?" The numbers don't make sense. It's a total waste of time here. I don't see the point in doing all this if the numbers are so far off. Is this really science that we're dealing with?" Because if they asked these questions, they'd realize how humorous all their bronchodilator fallacies are. They'd realize our U.S. health care system really is the best in the world as is (or as it was).
Yet they won't ask these questions. They'll continue to believe in their idealist theories and they will continue to bog down the medical system with waste. I know, because I know these people like the backs of my hands.
A scientists should not take the idealistic route because that would pollute science. Yet we see that all the time too. Look at the global warming scandal for one example. I'm neither a believer nor a disbeliever in the global warming theory, yet you have those who support it -- even scientists, willing to do anything to show it is real -- even lie and twist facts. If global warming is real, let the facts and stats speak. So you can see why it's so easy for politicians, scientists, doctors, nurses and even RTs to become rapt in idealism.
But I'm just telling you, folks, the only way to understand this with certitude, with confidence, and then to be able to explain it to others is to understand what being a realist means, and what being an idealist means. Once you understand that it is so easy, because all you have to know is
that everything idealists say -- I know this sounds extreme -- everything they say is a lie. That's basically it. Once you come to accept that, then rest is easy.
Idealists will tell you world peace is possible, while idealists know it's not. Realists believe if we get rid of all our nuclear weapons all the bad guys will all of a sudden go away and the world will be at peace. A realist will look into the past and see that there was war way before nuclear weapons were discovered. Realists know there will always be some scum ready to take advantage of the good guy who is not prepared, which is what would happen if the U.S. ever truly disarmed.
Idealists will tell you that if you raise taxes high enough you will be able to afford enough government programs to help all the needy and to get rid of all the poor. I know this because I've seen the studies, and I've asked questions of them. They really believe some day world poverty will end if we stick to idealist programs. Yet, the realist will know from historical fact that increased taxes raise more money up front, but in the long run revenue will go down, and the country won't be able to afford all the programs. That's what's going on in the U.S. right now.
Idealists will tell you bronchodilators work for all that wheezes, or for all annoying lung sounds, or for all lung diseases. The realist at the bedside giving the treatment sees the truth, that the treatment did nothing.
Once you know that everything doctors and nurses who think bronchodilators cure everything is a lie, the rest is easy. It's easy to understand. You might not want to accept that, might be too tough. "Oh, my gosh, I don't want to think half the doctors and nurses are lying." Well, think about it, they're either lying, or they are simply flat out ignorant. Those are the only options.
Ignorance is not a bad thing. I'm ignorant about what nurses do, and I don't try to do their job. Doctors know much more about how to fix patients. Yet, when it comes to bronchodilators, no one knows more than the realist RT at the bedside who mumbles under his breath, "I'm just wasting my time giving this treatment." And, in the next breath, is defending the doctor's stupid order because he wants to keep his job.
Believe it or not, despite what I just wrote, respiratory therapy is a great career. The nursing program has advanced brilliantly over the years, and the challenge now before us RTs is to advance the RT program forward, which will not happen if idealism continues. Yet it won't happen either if we RTs continue to be enablers, and no one stands up and, in a professional manner, works to make the needed changes. To me this kind of challenge is fun, because I know the facts are on my side. Yet, at the same time, vexing, frustrating, and even daunting.
We gotta face it, folks, because this is, as they say in football training camp, nut-cracking time.