167. What Barack Obama learned from my urologist.

 
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The President must have the same urologist I have.  He believes in watchful waiting.

Let me tell you about "watchful waiting."  It's the greatest treatment ever to rise to the top of the options-list doctors give their patients.  You know, in those waiting-room brochures. 

For prostate malignancies "watchful waiting" used to be well below the aggressive treatments — prostatectomy, radiation therapy, hormone therapy.  My first urologist, as soon as he saw the biopsy results, wanted to do major surgery.  A later one wanted to chemically castrate me.  "We've got to go right at this thing."  That fit the temperament of most of his manly patients.  This is malignant, man.  We don't want to mess around.  "OK Doc, let's roll."

This was so common in my town and in the literature that I began to think urologists all had the same mentor.  Some Edmund Burke.  "All that is needed for the triumph of prostate cancer is for good urologists to do nothing."

Well, my present urologist, the one I share with Barack Obama, didn't follow him.  He advised something pretty close to nothing.  You just keep an eye on the tumor and not until you get a reliable sign that it's going lethal do you act.

What led him to differ from his colleagues then, or what led so many of them to come over to his side since then, I don't know.  Maybe they saw so many people (like my brother) suffering so much from the aggressive treatment that they began to have doubts.  Maybe the experience of a few patients (like me, with seven years of normal life) was so happy that they thought it was a good gamble.  Whatever it was, the order on the list was reversed, no dire consequences followed, and my urologist (Eric Klein of the Cleveland Clinic) is getting praise from all over the country.

Now I want to praise Obama for the way he, ignoring the manly Republicans, has adopted "watchful waiting" as his approach to malignancies in world affairs.  Where George Bush, with nearly all of Congress behind him, wanted to roll in Iraq, Obama wanted to wait.  Where John McCain wants to roll in the Middle East Obama wants to wait.  To Bush Saddam Hussein was clearly malignant.  To John McCain Bashar al-Assad is clearly malignant. " When you've got a malignancy why mess around?"

Maybe by now the suffering caused by the roll into Iraq is changing some minds.  Maybe Congress and the electorate are ready to join the small, unmanly cohort (the French, those accordion players) who wanted to watch and wait in 2003.  They clearly seem less willing to roll against that evil monster Assad.

I use the word "evil" there because that's the word gung-ho spin-doctors use when they want to move a nation's citizens to roll with their client in international affairs.  It's the word George Bush's doctors used for the Iraqi and Iranian and North Korean malignancies.  It's the word Ronald Reagan's doctors used for the Soviet Union.  It makes watching and waiting much harder.  "This is evil, man."  But it's very effective with a religious electorate.  It makes the malignancy more "theological" — as Bush's speechwriter explained when he inserted it.

"Evil" is just one of those words that Republicans (and some Democrats — mainly out of the need to compete with them for votes) use to tap into American testosterone (see "holy testosterone" in Post #158).  And the users are nearly always vague with respect to specific action.  What do you do to stamp out evil?  What do you do to show you are not "soft on" communism?  that you are not surrendering in the "war on terrorism"?

Well, one thing about my urologist, he was not vague.  And he made sure you knew what he meant. "Watchful waiting" did not mean "gentle acting."  If the threat was lethal there would be no limit to his aggressiveness.  He was ready to cut, plant, and castrate.  All in substantive action.  Nothing symbolic. 

OK, here's where I see President Obama, listening to a physician who didn't just say "malignancy!" but asked right away, "How fast is it growing?  What can it do to change this patient's life, in comparison with the other options?  Is it a lethal threat?"  All are specific and precise questions whose parallels I see in the questions I think Obama is asking about the malignancies his countrymen urge him to treat around the world.