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I’m Marc’s Prostate


As a kid growing up it always seemed that we had a daily newspaper in the house, as well as a magazine or two. We watched the network evening news, of course, everyone did, but for real information we turned to print. Very old school. My Dad was particularly fond of Reader’s Digest and would often consume the entire contents of the latest edition in one sitting. The articles were mostly short, crisply written and, in matters of politics, almost always had a right-of-center slant.

The Digest also had jokes that could be repeated safely in polite company. I particularly remember pages of jokes called “Humor in Uniform” (for the World War II generation like my parents ) and “Life in These United States,” humorous little stories about everyday life.  Sometime in the 1960’s the Digest also started publishing a series of short articles on various aspects of human health all written from the perspective of the vital organ featured. I distinctly remember Dad pointing out to me that I needed to read and absorb a little feature entitled “I’m Joe’s Heart.”

“I’m certainly no beauty,” Joe’s Heart says writing in the first person (or organ). “I weigh 12 ounces, am red-brown in color, and have an unimpressive shape. I am the dedicated slave of —well, let’s call him Joe. Joe is 45, ruggedly good-looking, has a pretty wife, three children and an excellent job. Joe has made it. Me? I’m Joe’s heart.”

Joe’s heart goes on to report that Joe probably eats too much fat, has gained weight, smokes and doesn’t exercise enough. Sound familiar? It was a good, gentle and authoritatively delivered message that remains as appropriate today as it was to the Don Draper generation in the 1960’s. Reader’s Digest pieces on “Joe’s Liver” and “Joe’s Kidney” followed. I don’t recall that there was a Reader’s Digest piece on Joe’s Prostate this was, after all,  way before WebMD and “men’s health” (and women’s, for that matter) wasn’t much discussed in the polite company where Dad told his jokes.

Things have changed for the better in that regard with the Internet full to overflowing with good, authoritative information on “Joe’s Prostate,” or in the case that I have become most familiar with – my prostate.

Like more than 200,000 American men annually I was diagnosed recently with prostate cancer. Next to skin cancer, prostate cancer in the most commonly occurring cancer among American men. The disease claimed more than 28,000 lives in 2009, the last year for which we have the most complete figures. There is almost truth to the line I’ve heard and now use myself – “if you live long enough, I’ll get prostate cancer.” Prostate cancer is indeed widespread and it takes a particular gruesome toll among African-American men.

My case – special to me, for sure – nonetheless seems fairly typical in many ways. My own concerns about heart health lead me some years ago to regularly monitor blood pressure, cholesterol and other blood markers. Often these simple blood tests will also include the somewhat controversial screen for prostate cancer – the PSA test, or  prostatic specific antigen. Early this year my PSA level took a jump in the wrong direction. A re-test confirmed the increase and signaled cause for concern. A number of good and caring health care professionals advised a biopsy of, what until this spring had been, my somewhat mysterious prostate. The biopsy, conducted in a doctor’s office, confirmed cancer.

Like millions of other Americans I now know what it’s like to have a doctor straightforwardly tell you – “you have cancer.” Wow. Didn’t see that coming. It is a moment of coming face-to-face with your own mortality. One’s attention is immediately fixed.

Like any unwelcome news there was for me, at least, a period of denial. There must be some mistake, right? Cancer doesn’t run in the family. From a health standpoint I haven’t been behaving that badly. Maybe too much red meat and too few veggies, but I get my exercise. What gives? Soon enough denial gave way to questions about what can be done to treat the unwelcome visitor in the nether regions of the male anatomy? Answering that question became a research mission of the kind I have never before undertaken.

I offer only two pieces of advice in this little prostate post with the first being the importance of becoming your own best advocate when confronted with any health challenge. Doctors and other medical professionals are (generally) wonderful people, committed, smart, caring and often overwhelmed. They exist not just to treat your condition, but to be a walking, talking sources of first-rate professional information. In order to take full advantage of their knowledge, however, I’m convinced you must do your own homework and engage in the development of your own treatment strategy. Knowledge really is power and information about your health care options truly is empowering.

Since April I’ve spent hours reading, consulting friends who have dealt with the same issue, and quizzing health care professionals trying to learn about what I now consider my favorite gland. I gave that gland up to surgery a little over a week ago after it became clear to me that what the surgeon’s call a “radical prostatectomy” was my best option given factors like age, overall health and the state of my cancer. The surgery, again from my perspective, was a very big deal. Thousands of men undergo this treatment every year, but facing major surgery, time in hospital and recovery was a brand new experience for me.

Friends and family faced this new challenge with me and 10 days on I’m feeling better and better. There will be months ahead of coping with and overcoming the undesirable side effects of prostate removal, but thanks to early detection, superb medical care and those who have helped – they know who they are – I feel today like a 60 year old guy with a new lease on life.

Second piece of advice: don’t be confused about the controversy and debate over the utility of PSA testing after age 40. Every male needs to have enough information in order to formulate a personal point a view on this central issue of male health. In my case, because a savvy family practice doctor has rather routinely checked my PSA levels, which led to my early diagnosis, I am an advocate of the checks on a regular basis. The rap against the test is that it’s not precise, produces false positives and causes many men to undergo expensive testing that may not be needed.

In short, whatever you decide for yourself, don’t be a victim of a lack of knowledge. Take charge of your own health. Decide what works for you. It just might save your life. In my case I’m convinced regular testing and early diagnosis did save my life.

Finally to all the family and friends who have sent endless good wishes my way for the last couple of months I can only say – thanks a million. In the busy world of the 21st Century it is all too easy to take for granted, or not fully appreciate, the awesome power of people who take the time and trouble to care. Take it from me: it means the world.

Late last week a call from my surgeon confirmed that the pathology work up on my former prostate and the other tissue he removed during surgery was negative. My cancer had not spread beyond the prostate. In the textbooks they call that a good outcome.

My personal brush with the disease that is described as the “most rapidly rising” in most countries around the world was both frightening and enlightening. I am richly blessed to have had access to (and been able to afford) world-class health care and the tools to seek out information upon which to make life changing (and saving) decisions. I come away with a new appreciation for the American public health crisis of obesity, poor nutrition and lack of access to care and I’m convinced that knowledge and awareness of a whole range of health care issues is at the heart of a healthier country.

I’ve always taken good health for granted. I now consider it a gift, indeed a miracle.

Primary Colors

Defeating the Incumbent…in Your Own Party

Sen. J. William Fulbright of Arkansas– that’s him in the photo when he was at the height of his influence – still holds the record as the longest serving Chairman of the Senate Foreign Relations Committee. He created the Fulbright Scholars program, was himself a Rhodes Scholar, at a young age the president of the University of Arkansas and in the 1960’s an early opponent of the Vietnam War. None of that seemed to matter much when he lost re-election in his own party’s primary in 1974. When Bill Fulbright died in 1995, The New York Times called him a “giant” of the Senate, but he’d once been rejected by his own kind.

Burton K. Wheeler of Montana was arguably the most powerful politician that state has ever produced. Elected four times from 1922 until 1946, he was one of the Senate’s great mavericks, battling presidents of both parties and forging a bi-partisan political movement in Montana. He lost re-election in 1946 in his own party’s primary.

In 1946, Sen. Robert M. La Follette, Jr. of Wisconsin seemed like a sure thing for re-election. He’d been in the Senate since 1925 having replaced his famous father who was regarded by many as one of the Senate’s greats and hated by some for being a dangerous radical. Young Bob lost his re-election by just a shade over 5,000 votes to a young, mostly unknown Republican by the name of Joe McCarthy.

An incumbent United States Senator losing in his own party primary is rare in our history – very rare – but that may be about to change as more and more Republicans face challenges from the far right of the GOP.

I wrote yesterday of the struggle Sen. Richard Lugar is facing in Indiana. Sen. Orrin Hatch is in trouble in Utah where his former colleague Bob Bennett was taken out two years ago. For a while it appeared Maine Republican Sen. Olympia Snowe, one of the least conservative GOP Senators, would also have a tussle with a Tea Party-inspired opponent this year, but that challenge seems to have faded. Still, Maine may be the exception that proves the rule.

[BREAKING NEWS: Late today, Sen. Snowe announced she will not run for re-election in Maine.]

Of the historic and contemporary examples I’ve cited, only Wheeler’s post-war experience in Montana, is an outlier. In every other case, the incumbent senator faced a challenge from the right. Wheeler’s demise was orchestrated from the left, primarily because he fell out of favor with some elements of organized labor in Montana. Generally speaking – and of course there are exceptions like Sen. Joe Lieberman in Connecticut – imposing party discipline in the form of a primary challenge is a tactic employed by conservatives against someone who isn’t perceived as being conservative enough.

With the GOP more and more a branch of the Tea Party, look for more primary challenges to Republican incumbents and color the vast majority of them bright red.


FDR’s Great Blunder

As Court Showdown Looms, an Anniversary of Note

Two years ago in his State of the Union address, Barack Obama called out the Supreme Court of the United States for its ruling in the Citizens United case involving campaign financing.

With most members of the Roberts Court looking on from their seats in the well of the House of Representatives, Obama told the country that the Court had “reversed a century of law to open the floodgates for special interests—including foreign corporations—to spend without limit in our elections.”

With perhaps the exception of his reference to “foreign corporations” – it’s hard to tell the source of much of the new money flooding campaigns – Obama explained exactly what has happened in the subsequent two years. And predictably, the president was roundly criticized in the aftermath of the speech for an “unprecedented attack on the Court. Justice Samuel Alito, one of the five judges in the majority in Citizens, could be seen mouthing the words “not true.”

In retrospect, not only was the president right on the substance of his criticism of the Court – Obama did teach at one of the country’s great law schools – but he had the guts to deliver his critique right to the faces of those in the black robes who hold so much sway over the policy and priorities of American life. It was hardly an unprecedented attack, either, particularly in the context of an anniversary of, what I would argue, was a defining moment in the evolution of the modern U.S. Supreme Court.

Just over 75 years ago – February 5, 1937 to be precise – the president to whom Obama is so often compared and contrasted, Franklin D. Roosevelt, took a decidedly different tack with the high court he took issue with. FDR didn’t just criticize the justices, although he certainly did criticize, he attempted – and came reasonably close to succeeding – to fundamentally remaking the Court in his more liberal image. Roosevelt’s “court packing scheme,” as it quickly became known, turned out to be his greatest single blunder as president. It also presented the country with the greatest Constitutional crisis since the Civil War.

Now, with the Supreme Court poised to hear, in unusual detail, the arguments for and against Obama’s health insurance reform initiative – the Affordable Care Act – it’s worth reflecting on the history of the court over the last 75 years and considering what might have been and what has become.

The normally surefooted Franklin Roosevelt made misstep after misstep with his plan to enlarge the Court in 1937 and when his efforts at a judicial power grab finally ended he reaped the political whirlwind. Never before, after the court packing fiasco, would Roosevelt command a working majority in the Congress for his domestic agenda. With one ill-considered move, FDR squandered his massive 1936 re-election mandate – Democrats held 76 seats in the Senate after that election – he shattered the myth that he was politically invincible and, it seems, Roosevelt forever took off the policy table any effort by any president to “reform” the nation’s highest court.

Roosevelt’s tools in attempting to enlarge the Court were secrecy and subterfuge and each got him in trouble. With the encouragement of his Attorney General, Homer Cummings, FDR hatched a secret scheme to add one additional justice to the Supreme Court for each justice over 70 who refused to retire. He consulted with no one on the idea except his politically tone deaf attorney general and then sprung the idea on unsuspecting Congressional allies. They were first stunned and then outraged.

Roosevelt compounded his “born in secrecy” problem by dissembling about the real reasons behind his proposal. Clearly he wanted to liberalize a court that had come to be dominated by former corporate lawyers and Republican appointees, but he let Cummings peddle the fiction that he was trying to improve the Court’s efficiency. The “nine old men” on the Court had fallen behind in their work, it was alleged. That argument never gained traction and simply wasn’t true.

Had Congress adopted his audacious idea, Roosevelt could have immediately added six new justices to the Supreme Court, as well as a slew of other federal judges. The Supreme Court would have gone from nine members to 15 and, of course, the president would have the chance to appoint justices who held out the prospect of liberalizing the Court that had shot down so many of Roosevelt’s New Deal initiatives.

[On one particularly Black Monday in May 1935, the Court struck down three important New Deal initiatives, including much of the centerpiece of Roosvelt’s domestic agenda – the National Industrial Recovery Act.]

In a rare rebuff for Roosevelt, the Congress simply wouldn’t buy his court packing. Republicans, of course, rebelled, but so did many Democrats. Montana liberal Burton K. Wheeler, a fierce foe of concentrated power in government or the economy, was chosen to lead the Senate opponents of FDR. Ironically, Wheeler had been among the very first to encourage Roosevelt to seek the presidency having publicly done so in 1930. By 1937 Wheeler had enough of what he saw as Roosevelt’s accumulation of personal power and made common cause with Republicans like Idaho’s William E. Borah and Oregon’s Charles L. McNary to battle the president.

As the battle was fully joined in the summer of 1937, Wheeler collaborated with Justice Louis Brandeis, ironically the greatest liberal on the Court, to obtain a letter from the patrician Chief Justice Charles Evans Hughes. Hughes’ letter, quickly drafted over the weekend prior to Wheeler’s Senate committee testimony, completely demolished FDR”s argument that the Court was behind in its work.

Borah further complicated Roosevelt’s plans when he prevailed upon his neighbor, Justice Willis Van Devanter, one of the most conservative members of the Court, to strategically announce his retirement to coincide with the release of the Hughes letter. The combination was a classic political one-two punch, but Roosevelt still refused to compromise or fold.

The American Bar Association opposed Roosevelt, as did most of the nation’s editorial pages. Still, through the hot summer of 1937, Roosevelt soldiered on with his proposal, driving an ever deeper wedge into the Democratic Party. Roosevelt was offered a compromise. If he backed off, one or two additional members of the Court would quickly retire and he could have his more liberal appointees. He refused. Seeking another route to compromise, some senators suggested the president might get two or three new seats rather than six. He refused.

Even the 10-8 vote in the Senate Judiciary Committee against the president’s bill – the committee was dominated, of course, by Democrats – failed to move the president. Incidentally, Borah wrote much of the committee report; a report that has been characterized as one of the harshest denouncements of a presidential initiative in the history of the Senate.

Ultimately, it took a dramatic Senate tragedy to bring an end to Franklin Roosevelt’s biggest blunder. FDR’s loyal lieutenant, Senate Majority Leader Joseph T. Robinson of Arkansas, while no fan of the court packing plan, still believed that loyalty to “the boss” demanded that he try to get something passed in the Senate. Robinson worked himself into a lather debating the court bill and managing the president’s expectations and in the stifling mid-July heat in Washington – the days before central air conditioning – the Majority Leader grew red in the face, announced he was done for the day and stormed off the Senate floor.

Senator Royal Copeland of New York, a physician, had warned Robinson that he was working too hard and that no bill was worth killing himself over. Robinson retreated to his apartment close to the Supreme Court building to rest. On the morning of July 14, 1937, his maid found the gruff, but much respected and well-liked Senate leader, dressed in his pajamas and slumped on his bathroom floor. Robinson was dead of heart attack. Nearby he had dropped his copy of the Congressional Record. Robinson had been reading the debate over the court bill.

Joe T’s death stunned the Capitol, in part because it was an open secret that FDR had promised the loyal Robinson the first vacancy on the Court, even though as a conservative southern Democrat Robinson was unlikely to become a liberalizing force on the Court. Senators took to calling Robinson, Mr. Justice, as they anticipated that any day FDR would name Joe to the high court.

Roosevelt hesitated. Had he made that appointment it might well have paved the way for a compromise on the court bill, or at least presented the president with a face saving exit strategy. But Roosevelt took no action and, with Robinson dead, hard feelings toward the president grew even worse in the Senate. Wheeler even went so far as to claim God himself seemed opposed to packing the court.

On the train that carried most of Robinson’s colleagues back from his funeral in Little Rock, Vice President John Nance Garner counted noses for the White House. When ol’ Cactus Jack arrived back in Washington he went directly to see Roosevelt and told him that he was beaten. The Senate when it voted, Garner said, would defeat Roosevelt’s plan to expand the Court. FDR was stunned. He continued until that moment to think that he could work his will on the Congress as he had so many times before. He reluctantly asked Garner to negotiate the best exit possible.

Garner went to Wheeler’s office in what is now the Russell Senate Office Building and told the Montanan that he “could write his own ticket” with regard to the court bill. As legend has it, the two old pols had a drink of bourbon and decided that the bill would be recommitted to the Judiciary Committee, in effect killing the proposal. Seventy senators eventually voted to recommit the court bill and Roosevelt had lost an epic battle over the Supreme Court. The whole contest had lasted for a mean 168 days.

Had FDR been willing to compromise, even a little, he might have modestly enlarged the Supreme Court in 1937 and we can only speculate as to what the long-term impact of that political act might have been. It seems safe to conclude that had a political compromise over the makeup of the Court occurred we would think somewhat differently about the Supreme Court today.

Roosevelt would later argue that he lost a battle over the Court, but eventually won a war and there is truth in that statement. Alabama Sen. Hugo Black was soon appointed to fill Van Devanter’s seat. Black, it was widely noted, had supported the court packing legislation and opposed the vote to recommit in the Senate. Black turned out to be one of the Court’s great liberals and a staunch defender of civil liberties. In time, Roosevelt also appointed Justices like William O. Douglas and Felix Frankfurter, who helped define American jurisprudence until the time of the Ford Administration.

Perhaps in an even more important way, Roosevelt’s efforts to expand the Supreme Court 75 years ago removed any possibility that any president could realistically hope to change the court simply because he disagreed with its rulings. It’s unthinkable today that a Roosevelt-like idea could be seriously considered. Instead, the fights over the direction and role of the Supreme Court are fought out each and ever time a president nominates a new justice. These confirmation fights, increasingly nasty and partisan, are still no where near as nasty as the 75 year ago fight over whether the Supreme Court would be fundamentally changed.

The great historian William Leuchtenberg has written: FDR’s [court proposal] generated an intensity of response unmatched by any legislative controversy of this century, except possibly the fight over joining the League of Nations. Southern Democrats feared that an expanded liberal Court would give rights to blacks; progressives saw an assault on the branch responsible for protecting civil liberties; moderates who had always mistrusted Roosevelt now had proof of his treachery.”

It wasn’t as if Roosevelt hadn’t been warned. At one point Wheeler told the president that with many Americans the “Supreme Court is a religion,” and, Wheeler said, it is never smart to get in the middle of a religious fight.

This much seems certain, when the current Supreme Court issues its decision on the health insurance reform law later this summer there will, no matter how the decision goes, both glee and gloom. Still, when the smoke clears, the country, the Congress and the president will accept the verdict of the Court. Some folks, grumbling all the way, will not like the verdict, but just like the controversial decision that ended the 2000 election – Bush v. Gore – we’ll grumble and move on.

We don’t always like what we hear from the pulpit at church, but Burt Wheeler had it right in 1937. The Court may not always be right, but we accept the higher authority nevertheless.

In a way, we can thank Franklin Roosevelt and his furious fight exactly 75 years ago for that now enduring feature of American political life.