On global warming

I  haven’t written in a little while because I have been quite busy with organising things for a change in job (location, not career) and also some personal difficulties which I won’t go into just yet. But I have managed to give myself 2 weeks off work to just settle the pace in the last few months, and I have been watching some mostly mind-numbing television but also some interesting stories. One that particularly surprised me was a debate on nuclear versus fossil fuel derived energy. Here’s the link if anyone is interested in watching it.

What I found particularly interesting about the debate on fossil fuels versus nuclear energy are the premises and assumptions the debate (for both sides) are founded on. You see, every debate argues that one “thing” is better than the opponent’s “thing”, but there is also common ground – there has to be. So one opponent may say, for example, “I’m trying to do the most just thing for everyone and this ‘thing’ I represent is better for justice than the thing that my opponent is backing. The other opponent goes and makes the same argument, but proposes his thing is better for justice. The debate is interesting and relevant because it focuses on a common ground: justice. And you know what I found interesting in this fossil-fuel vs. nuclear energy debate? That the common ground that both parties were intent on protecting was climate change. Yes, here were big energy industry representatives arguing that they wish to protect the environment, prevent further climate change / global warming, and therefore nuclear energy is bad. On the opposite side of the debate were nuclear energy proponents arguing that they wish to protect the environment, prevent further climate change / global warming, and therefore fossil-fuel energy is bad (and also that other non-fossil-fuel energies are non-viable). I was fascinated not by the points of argument each team debated, but that suddenly global warming and climate change was a given, not the point of argument itself. No one was debating whether climate change was real in and of itself!

In political and legislative forums, the existence of this concept of global warming is negated by representatives of the fossil fuel industry. Now, in a debate whether on whether nuclear energy or fossil fuel energy is worse, global warming and climate change is taken as a fact – and the people arguing these both these things are almost the same people. That is what I find quite interesting. Environmentalists get invited to these events to present the debate on behalf of nuclear power companies, mining companies, and “green energy” companies (which are usually owned by the mining companies themselves). Of course, for the sake of arguments such as this, all the types of energy companies claim to have one thing at heart: the environment. In reality we all know that thing at the heart of any company are monetary profits. I mean, that is exactly the reason why mining companies invest heavily in “green energy”: because if the market happens to shift and “green energy” becomes more profitable than fossil-fuel energy, then you want to be the guy that owns this market already...

It’s all nice and interesting, but now I’m more confused. Is global warming considered a real thing or not in Australian politics? If so, then what are we (including the energy industry and other big carbon emitters) doing about it? If not, why not if even the energy industry can at times concede that it is a real thing?

On owning a house

I have always been scared of owning a house, but until the last week I haven’t really been able to explain it even to myself. Everyone has always told me that I should want to own “my own” home, that it’s the adult thing to do, that it’s the Australian dream, that it’s the successful person’s dream, that it’s the most financially savvy thing to do, etc… And yet at the same time knowing that it’s not my dream, I thought that I may be lacking something: maybe maturity, maybe the drive to think big. The thing is that I have rarely met people who “own” their houses, just a lot of people who think they own homes and really only own mortgages. In other words, in my eyes I know a lot of people who own large debts. I also, and not coincidentally, know a lot people who feel enslaved to jobs they no longer enjoy, a lot of people who feel a constant pressure that if they don’t earn they will lose a large sum of money and pride. I know a lot of people whose prisons are their jobs for the crime of loaning large sums of money to buy the illusion of owning the structure they take shelter in. Is the illusion worth it? Is a house really worth the slavery most people submit to for 20-30 years? But, people tell me, I am missing the point. See, they tell me, at the end of it you’ll own the house! And you were already going to be pay rent, so may as well use that same money you were already going to spend on the same thing (shelter and a living space) towards something you will eventually own. Yes, something I will own when I am over 50… and which serves me for what? Oh yeah, to live in. That’s it. That’s all the good I can see come of this.

But wait, you don’t have to just own one house, you can own several. You can own one and rent the other/s, or resell them at a higher price. And if you’re smart, you can earn a profit from doing this. Profit? Yes! Of course that is how people like Donald Trump have amounted massive amounts of wealth. However, I have to admit that I haven’t met many Donald Trumps. At the very least I haven’t met anyone who is made happy purely by the fact that they own many properties or have a lot of money. Is my view in this skewed? Yes, for two reasons: 1) I don’t know a lot of people who are made happy by money or property because I don’t share the same values as them and so don’t associate or attract these people as friends; and 2) it means little to me or my happiness how much money or property I own. If I am to be convinced that owning property is going to be beneficial to me, I have to be able to see how it would help fulfill me; unfortunately the properties and the money to be made from them would not make me feel more fulfilled.

What do I care about? My family, participating in and enjoying life while I am alive, and not making a world a worse place for anyone or anything. Call it Christian values or call it hedonism or my own particular philosophy, but it’s as simple as that for me. Yet wouldn't having more money allow me to spend greater time with my family, or “enjoy” life more, or participate in life to a greater extent, or increase my likelihood of what I could do to improve social justice or the environment? Probably. And don’t get me wrong, I usually support thinking “long-term”, but I have come to realise that life is actually not that long. Perhaps it’s as a result of the environment I grew up in with the life-expectancy of those around me being so unpredictable due to poverty and warfare, or perhaps it’s because of the job I do, but I think it’s not always wise to put off living. I genuinely worry that if I spend too much time engaged in earning (to provide for my family or enjoying life, etc), I may well miss out on my family or the time to enjoy life. Sure, most of us in Western society can quite safely expect to live past the time we would've finished paying our mortgage and past retirement, but should we really wait until then to start enjoying the profits of our labour? Maybe it is my yet immature thinking or the fact that I don’t yet have children that clouds my vision, but I don’t want to it put off too long.

Now, what if -worst case scenario- and I work, pay off my mortgage, and then die? Shouldn't I be proud and glad that at least I will have provided for my children a house for them to inherit? I mean, that’s good, right? Sure, that’s noble. How many of us, however, have not inherited houses and still turn out quite OK? I’d say that’s the majority of people. So I’m not convinced at this stage that that is a good reason to own a house. I think it was the billionaire businessman Warren Buffett who said that the perfect amount of money/things  to leave your offspring is "enough money so that they would feel they could do anything, but not so much that they could do nothing”. That is exactly what my mum did for my siblings and I and she never owned a house or anything of that cost; she just made sure to be supportive and educated us. I want to do exactly that for my children. The rest they will provide for themselves if I manage to teach them responsibility and self-reliance well enough.

OK, OK, now back to the financial reasons as to why buying a house would be good for me. I am told that if I continue to rent, then I am throwing away money, that it is “dead money”. Dead because I can’t profit from it, apparently. But you know what else is “dead money”? The money paid on interest on a home loan. Yes but I’m forgetting about the part where I get to keep my house after I have finished paying the bank back the loan and the interest! Yes, that’s nice, don’t get me wrong; and I do get the fact that you can do whatever you like to a house you have a mortgage on as opposed to one that you’re renting. For all the money I “throw away” by renting, I could be slowly paying off my house, wouldn't that be nice? Yes… if things in life could be guaranteed. I wish someone could guarantee that I will want to work with the same agility, strength, passion, and desire in 10, 20, or 30 years as I do now. Because if I lose my enthusiasm, that is when work becomes my jail for the crime of owing my house to a third party: the banks.  So most people have to keep working in order to avoid defaulting on their loans, working past the time that work became enjoyable, and working with the pressure and fear of keeping the bank fed. That is stressful! It kills the joy in life. How do I know this? Precisely because I meet people who are overwhelmed by these stresses every day at work.

I know there is stress also to pay the rent if you are renting, but I have noted one fundamental difference between those who are happy to rent and those who want to own a house: those of us who rent may stress about getting the money together at the end of the month also, but we don’t share the stress of potentially losing a large sum of money that people who default on loans take on. When you’re renting and you move house, that is it; you pay again for the chance to occupy a space you can live in. Renting is the same as any other consumer product. When we move house or as time goes by, rarely do those who rent sit to add up all the money we have “lost” by continuing to pay our rent. It is the same way that I don’t feel bad when I buy food that I have spent a small amount of money for something that is gone after I eat it when I could have instead put the money aside to buy a farm so that I could grow my own food, which eventually will overall turn out to be cheaper than all that food I bought over the years. Housing to me is just another consumer product. But those who have a mortgage and are unfortunately unable to keep paying it for whatever reason, end up owing a lot of money – and that scares me! Houses cost a lot of money and I don’t enjoy the pressure of having a debt that big.

I met someone a few years ago that told me that he was overwhelmed by the amount of work he had to do in order to provide for his family and maintain all the properties he owned. I asked him why he had so many houses. He said that it was because that was the Australian dream. It wasn't his dream, though. And I started wondering to myself ‘who is selling us these dreams, then?’ And then I read an internet post recently that answered this question and summarised the financial reasons of my fear of getting a home loan: “It is necessary that you be forced deeply into debt, and therefore forced into slavery, for the banks to make a profit”.

On money and healthcare: Work & Subsidies - Part 2/3

In Australia, up to 80% of general practitioners accept the rebate provided by Medicare as the total cost of their medical consultation service. Essentially that is to say that they provide to Australian citizens with a Medicare card a “free” consultation service with no out-of-pocket cost to the patient (excluding medications sold through a private pharmacist). That’s a great thing for patients! They can’t use the ‘I don’t have enough money to go see a doctor’ excuse too often since most GPs will see them for "free". Of course, the doctor has to get paid, too – because medicine is a job, not a charity – and Medicare will pay him for doing his job. However, remember, how Medicare is a rebate and not meant as full payment of the doctor’s service?...

There is a big group of people in non-government health care systems (e.g. private allied health professionals, private medical specialists, and around 20% of general practice doctors) who don’t accept the Medicare rebate as full payment for the service they provide. Are they the “better” health professionals, worthy of more money than Medicare provides for? Are they greedy ‘fat cats’ like some politicians will call them? No. They are the same as other health care professionals providing similar services. Often they are the same people who will see some patients at a fully-subsidised cost or charge an additional fee on top of the rebate. They’re not bad people; they are just people in paid employment. They’re people working in a private system practising within their legal right to set their own fees for their service, often actually very realistic fees to cover the true costs of doing their job. Unfortunately, because both types of practitioners operate within the same country, the one who charges what he or she has deemed his service is worth is seen as some sort of evil, money-hungry, exploitative person. Conversely, the one who provides “free” (to the patient) services is often considered less than – and this is what most general practitioners in the eyes of the public are seen as.

On money and healthcare: Rights & Systems - Part 1/3

Rights

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services”  (Article 25, The Universal Declaration of Human Rights). The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Of course, to the majority of the world’s population, complete attainment of our human rights and of health are only ideals and not reality. Nevertheless, they are ideals worthy of our consideration.

Ideals

In an ideal world every time someone fell into an unhealthy situation (physically, mentally, or socially), he should be able to access medical health care, mental health care, or social care and have his “health” restored. He should be able to access these things regardless of the amount of money he has, his sex or age, his political or religious affiliation, his ethnicity or language, his sexual identity or practice, his birthplace or site of residence, his employment status, etc. Basically, his right to health care is universal and his human right. That’s the ideal; reality is very different for a lot of reasons.

Reality

Every country has different health care systems, which impact on the way patients access health care. Some countries will have a health care system that is exclusively government-funded and all you may need to access it is proof of citizenship to that country. Usually that means that there is no cost to the patient for an “encounter” (i.e. every time you access health care) as funds are usually derived from a portion of pooled taxes payed by that country’s citizens. Other countries may have a system where accessing health care requires payment to a private health care facility or a private company that coordinates provision of health care (e.g. supplying and paying for the medical staff’s wages, the medical equipment, the facility fees, etc.). A lot of developed countries, Australia included, operate both of these public and private health systems concurrently where the public system is the default for all citizens unable to afford private health care. The private system exists and thrives because it promises certain perks and advantages like your choice of health care provider, faster access to elective surgery, more ready access to specialist medical reviews and allied health services, and often newer premises, medical equipment, and technologies. And yet other countries have a third system, like a lot in South and Central America, a “worker’s” health care system that provides health care services exclusively to that country’s citizens whose employers pay for access to this service. The worker’s health system is closer (or equivalent) to the private health care system than to the public system. I don’t intend to argue which system is better or which worse or which country does it best, but it’s interesting to consider what’s out there.

Australia

Australia has a dual system of public and private healthcare, the public system funded from federal money and managed (for the most part) at a state level. Medicare can be considered a pool of federal monies reserved for funding certain medical services (including surgical fees and the payment for medical staff), medicines, medical aids, etc. All citizens have access to those Medicare funds provided certain criteria are met, but generally it is a default system for everyone.

An often misunderstood peculiarity of the Australian government’s Medicare system has to do with the way a doctor bills his or her patients. The Australian government decides which medical services are worthy of a Medicare rebate, the amount of money allocated to it, and the conditions under which a service qualifies for a rebate. For example, anybody may approach a general practitioner for medical care and Medicare will provide a certain benefit to the patient to pay for that consultation. The patient may also approach a specialist doctor and pay for the full cost of seeing him in his private clinic; or he may present to his GP first and obtain a written referral to the same specialist and then become eligible for a rebate from Medicare to help pay for his medical specialist appointment. (A patient not wishing to access the private medical system at all for any reason may also be referred to a specialist in one of the state’s hospitals where it is available and obtain medical specialist review free of charge.) Importantly, the Australian government decides which medical services qualify for a Medicare rebate and how much money it allocates to each service – however, how much money Medicare allocates to a service does not always reflect how much money a service actually costs to provide. Medicare in fact operates as a rebate, a subsidy to the total cost of health care, not (at least not always) as the absolute cost to cover the service. Think of it as a discount voucher, not as a voucher for a “free” service.

On poor us

I’ll start by acknowledging that I’ve recently finished reading the book ‘Affluenza’ by Clive Hamilton and Richard Denniss and so I’m not even trying to pass off any of these ideas as things I’ve discovered myself. One aspect of the book I found particularly interesting is not so much the “outing” of our obsession with ourselves and with money, but rather the way we see ourselves as deprived.

I wasn’t raised in a wealthy family (or in a rich country, for that matter). When my family moved to Australia (and my mum still describes it this way), it was like entering paradise. There was no immediate threat of death from warfare, no real struggle to put food on the table or pay the rent, nothing but encouragement to pursue our education, and besides readjusting to a new culture, a new language, and missing friends and relatives, there basically was nothing to complain about. My family was one of the very lucky ones where a large proportion of our family immigrated to Australia also, so in fact after the first year or so there were few of us to miss. We soon learnt the language (we were actively taught it!) and we made new friends. To describe some aspects of our lives in Australia to people back in El Salvador for them is incomprehensible. Things like, for example, free (and high-standard) basic healthcare, housing assistance, and government co-payments for students, disabled persons, the unemployed, single parents, etc. We are fortunate amongst our family and amongst other peoples born in third world countries; and not just my family, but Australians amongst the world’s citizens are so extremely fortunate.

What’s my point? Well, the truth is that if you ask most people in affluent countries like Australia if they are content with their financial situation, the things they have, their jobs, their houses -their lives- they’ll say no!.... But wait, aren’t we so wealthy and well-off and living in ‘the lucky country’? Yes, but that’s other people, not us. We have bills we struggle to pay, things we wish we could own but can’t afford, thankless jobs that consume all our time and energy, and family and friends we have lost touch with. Collectively we are the lucky people in the lucky country, but as individuals we feel deprived. Feeling deprived and being deprived are two different things, though. The reality of it is that if you look at the pure facts, the numbers, the truth of it is the vast majority of Australians are not homeless, are not going without food, are employed, are managing to pay their bills, and most households own at least one car. You can look around you and immediately you know this is not a third world country. That is the reality of it!

What is it that we are deprived of then? We are deprived of satisfaction! And you know what the most intriguing reason of why we are so dissatisfied is? Because if we weren’t dissatisfied, then why would we keep working jobs we don’t like, for the long hours that hurt us in so many ways, just to buy the things we don’t really need? The question then becomes, well, then who is it that is keeping us dissatisfied, who makes us believe we are struggling, that we are a deprived people? In short, industry and government.

The advertising industry , the entertainment industry, the manufacturing industry, the pharmaceutical industry, etc, are all trying to sell us things. To sell us any product, you first have to convince the consumer that they are better off with it than without it. Even if there is nothing wrong with you, you could still be better off. Never mind you already having a functional car, a comfortable house, and practical clothes; no, that’s not good enough. They want us to believe that what we should have is a bigger more luxurious house, a luxury car, and the newest clothes of this season. Why? “Because you’re worth it.” There’s another thing that has been marketed heavily by industry: our deity. We deserve everything, just like the celebrities have. When you see yourself as being unable to afford the newest and most expensive of everything, of course you’ll feel deprived! And that’s good news for industry because then you’ll keep slaving away at your job to buy more and more of these things, which only keep getting more and more and newer and newer. Of course, if it all gets too much, then it’s time to make the poor pharmaceutical industry some money and invest in their pills that cure the human soul.

A people who are deprived is a woeful thing; thank God for politicians who can make it all better for us! That’s right, the other group of people interested in perpetuating the myth that we are all struggling are our governments. The benefit to them is that if we believe ourselves to be struggling and they promise to provide for ‘the battlers’, then they can secure our votes. I can’t recall a politician stating as his election plea that he will ensure that wealthy people can afford to buy a newer luxury car. He would be scorned! Instead we would rather vote for the guy who wants to help poor folks like us (who are “poor” only in the sense that our lives aren’t like those on those fictional films or because we don’t own the things that celebrities seem to).

We are sold the idea of deprivation from various levels and multiple interested parties. They sell it so well that we are unwilling then to recognize what is so clearly around us. I wish there were interested parties who thrived instead in helping us see truth, building up our self-worth and self-esteem, someone that would remind us that we are poor only when we rely on material things to define ourselves. I once read about a different sort of dissatisfaction, one I would like now to share:

On prescribing choice... and the hypocrite's spiel

There are many people who will tell you that pharmaceutical companies are the devil. I say the devil is the devil, but I also say the pharmaceutical companies are no angels. Let me first disclose something to you: I eat the lunches brought in by the pharmaceutical sales representatives (almost everyday at my work!), I give my patient’s their drug samples, I enjoy their “educational” dinners at expensive restaurants, I am grateful at their supply of products ‘directly related to my clinical practice’, and I miss the days of the free drug-stamped stationery and random gifts. I do not claim to be immune to their marketing tactics simply because I am aware of them; both they and I know that I am human and the tactics exist because they do work. There are those who directly embrace the drug companies with the attitude of ‘hey, if they want to give money away, they may as well give it to me and I will do what they want me to do’. And there are those that completely shun them, who demonize them, who accuse them of being a… a business. Aren’t we all in business? Those who claim they aren’t, aren't in business very long.

Just this past week I recognized a tactic by the sales reps I hadn’t noticed before: bullying. Now, what I mean to say is not that they wanted to humiliate or hurt me, but they sure as hell wanted to make me feel guilt. Now if I remember correctly from my industrial psychology and marketing readings, creating negative emotions in targets is one of the least effective methods to inspire change of behaviour (in this case, prescribing more of the drug they’re promoting); however, least effective doesn’t mean ineffective. The rep was telling me of some new medication; was I using it, she wanted to know? I said no, I studied a little pharmacology too and I felt more comfortable with another medication. She was horrified! Did I not know that it was the most popularly prescribed medication in its class, prescribed by the greater majority of my peers?! My mind was thinking ‘yes, and?’, but I said, ‘Oh, ok. I’ll keep that in mind. Anyways, thanks for the lunch.’ I went away thinking, wow, really, everyone but me uses it, was she implying that I am doing the wrong thing by prescribing something other than “the most popular”? Is it the most popular because it’s the most effective, because it the newest (and newest we are told is better), because they are better doctors than me and if I want to be good then I must be like them. As I walked towards my consulting room from the lunch room where I had the food brought in by the friendly drug rep, I realised it had worked. I was here second-guessing my clinical management not based on clinical data or evidence, but based on simple human emotion: everyone likes to be liked and to be like the rest. I then laughed at myself.

A few weeks ago another drug sales rep was speaking of a medication for erectile dysfunction. Of course it was about the drug, but they alway tells everyone “it’s about the patient”, thinking of what’s best for them. There’s no news or controversy in saying this; no matter what industry you work in, at the end of the day everyone must eat (and you need money to buy food, right?). Every drug rep walks in to that lunch room and comes with 1) our daily bread (or gourmet lunch), and 2) the “educational material” to impart to us that just so happens to show that the drug their company sells is better for our patients for some or another important reason. But this drug rep wanted not to tell me about why their erectile dysfunction drug was better than the other two, but wanted to know what I based my choice on. I’ll tell you what I answered but first I just want to consider another point on prescribing choice.

Now, you could have five different drug reps talk to you about five different drugs from the same class, both targeting the same “disease” (I’ll explain later why a disease is worthy of my quotation marks here), and they can all show you with ‘real clinical evidence’ and ‘scientific studies’ that their company’s drug is the best. The first rep will say their antihypertensive is the best because it, say, doesn’t have this bad side effect. The second one says theirs is better because it reduces blood pressure quicker than the others. The third one says theirs is better because the effects on reducing blood pressure last longer. The fourth one says it their drug tastes better and is in a smaller pill and that this is very important to patient compliance, therefore in fact being the best drug because patients will actually take it. The fifth one will say theirs is the newest and is so many times better than a placebo. Who wants to be associated with the old and outdated, right? Ah, the stories…

What I answered my friendly drug rep is actually not anything new to them. Why do I prescribe a certain erectile dysfunction drug versus another? Honestly, I confessed, my choice was based on whatever sample pack was in stock in our drug samples cupboard. They know this, that’s why they like to stock our cupboard, not because they like to give away “free samples”, but because it works at securing consumers. I have to clarify a little, though, I use this rather non-clinical method to guide my prescription choice only in certain conditions that in my experience the medications are only slight variations on each other with similar clinical effects, for example as in erectile dysfunction. The second reason to why I do this is because these medications are very expensive and I want my patient to try it first before he goes and spends his hard-earned money on something that may or may not be right for him. Most doctors do this, too. You give the patient the sample pack and a script to purchase the medication if they are satisfied with the effect or tolerant of its side-effects. In cases like this, I prescribe what is in the drug cupboard because I know the brand name will make little difference to the clinical effect I am trying to achieve in a patient. For some reason my honesty seemed to surprise the rep and I think it is because there must be some secret pact that we, both the pharmaceutical companies and doctors, must deny that our interactions are in fact business transactions and we should pretend they are purely “educational” and clinical.

As a medical student I did a placement at a clinic that strictly forbade pharmaceutical reps from visiting to promote their products (or should I say, educate us). It was a clinic were most of the clinicians also held academic posts at the university and they were thoroughly involved in evidence-based medicine. I remember one doctor specifically telling me about how he always prescribed the generic version of a particular drug because it was the cheapest and therefore it meant less money spent on government subsidies paid to the drug companies, and subsequently more money left in the health budget for other essential matters. It made sense to me.  Some years later I worked at another clinic where another very noble and more senior doctor advised me that I should prescribed the brand-specific version of a medication for depression that was now off patent. The reasoning was that the company that made this brand of antidepressant was highly involved in drug research and development and also at producing patient education and support materials, but they obviously can’t afford to do that unless they are making money also. It made sense. Yes, besides I also knew that once you allow for the generic version of a medication to be dispensed by the pharmacist, he incidentally happens to supply the patient by the generic version of a medication which is made by his pharmacy chain. Oh, everybody is a businessman. So my choice is then, who do I feed? The pharmaceutical company making the brand-label stuff or the pharmacy chain making the exact same but generic-labelled stuff (which in most cases cost no different to the brand-label medication). Ah, such decisions… Oh yeah, that’s right, this was mean to be about the patient!

Another thing that the pharmaceutical companies are accused of is not only of making healthcare a business (which I don’t believe they are solely responsible for), but of also creating disease. What do I mean ‘creating’? This is mostly in reference to the medicalization, the labelling, of certain human existential states as disease. Some years ago I read a story about how bad it apparently is that we have made things like pregnancy and ageing disease-states. In a similar vein, drug companies have been accused of doing either a good or bad thing, depending on your point of view. One could say that thanks to the educational and public awareness campaigns directed by our blessed pharmaceutical industry, so many people can be diagnosed and directed towards the treatment of many ails such as depression, anxiety, mood swings, hyperactivity, etc. etc. Another group of people report that the drug companies directed these campaigns as a diversion to their real campaign: increase uptake of certain medications (mostly psychotropic medications). They convinced people that their sadness, that their agitation and worry, that their child’s childish behaviour, are abnormal and required treatment – by using the drug that their company so happened to manufacture. Oh, so many coincidences…

And what have I achieved in telling you of these few tales? That I am a hypocrite? Maybe. But hopefully I have also reminded us all that we live in a capitalist society and that denying that there is a devil at our table won’t make that devil any more of a saint. Worse than being the devil’s pawn is not knowing that you are. As doctors, as human beings entrusted with the care of others weakened by disease, we must ensure that that truly is the worst thing: that we sell our own souls, and not that we trade in those of our patients for a piece of the devil’s share.

On the consumer instinct

I used to be whatever the opposite of materialistic is. I would never buy things I didn’t “need” and I considered everything but food and basic clothes an extravagant luxury. Incidentally, at the time, I was also a poor student and had no choice but to adopt this lifestyle whether I chose it or not. For the majority of my student life, I had also made this choice. Once I started on a rural medicine rotation, this began to change.

I guess it was back in 2007 when I first consciously noticed the change in me. I was in Gladstone at the time, which is hardly a rural town, but still a small enough place to lack the “variety” and “choice” we have become so accustomed to. In your average city, and in your average suburb really, you have, for example, a store that sells books (many different types of books). But you don’t have just one bookstore, you might have 2 or 3 or 4, etc. bookstores that sell the same books, at usually similar prices. In your average rural/regional town, maybe there is only one bookstore with a sample selection of books. They don’t have the big multi-level bookstore, let alone two. But the town survives; the people eat, drink, and live.

Now, when I was in Gladstone, all I could think about was finding a bookstore so I could read something to kill some time (instead of studying like I should have been doing). I couldn’t find any bookstores (or at least one that didn’t have only boating books), so eventually I resorted to the internet to calm my angst. I bought one book, two, three, some perfume, something else, something else still, and then some more. Back at home I hardly ever bought anything online, let alone what I once considered non-essentials. Back at home I was hardly ever this bored.

I started thinking then about what had brought on my newfound habit of senseless spending. There were several things that for me differed from living at home (in the city) to living in a semi-rural setting. Firstly, I had a lot more spare/free time in Gladstone because I didn’t have my friends or family to hang out with, there was less variety of movies for me to see at the cinema, and I wasted less time driving to places. Secondly, lacking all these things that usually consumed my time (friends, family, and leisure activities), I actually was feeling emotionally disconnected, isolated, bored, lonely even. And I think it is this great void, this being consumed with nothingness, this empty space, that leaves us feeling desiring of something, anything. Unfortunately, when people feel alone or isolated or depressed, they often seek to fill an emotional void with material or physical things.

To me this experience made me think of a few things. Firstly, I started to wonder if in fact this –feeling emotionally unfulfilled – is the reason that people adopt such a consumerist attitude, always wanting to buy more, and not just wanting to but feeling they need to. I mean it’s not rurality that does it to you, there are people living in these rural towns who go about their everyday life, working, etc. without being overwhelmed by some desire to buy, buy, buy. They feel as I feel when I’m at home with my family and friends: content. Me, I wanted to buy things to fill my time, to kill the time I had to be alone and contemplating my loneliness and isolation. I wondered also if that is what other people who are long-term materially-focused feel. If you fill up your time with material possessions, striving to have them, dreaming of more, then you don’t leave time to think about the things that make life really worthwhile, but which we may lack. The physical things can’t fill the emotional voids, though, and eventually some people may adopt their desire to possess more as their substitute for the human lust for life, experience, love, interaction, play, and generally just living.

If there’s one thing that my experience in “the bush” has taught me, is that human needs don’t change whether you’re in one place or in another. Everyone needs love, affection, interaction, social engagement, respect, entertainment, self-efficacy, and health care.