The future's so bright, I gotta wear shades.

I feel a bit like Janus today. He was the Roman god of transitions; usually depicted with two faces, one looking forward and one looking back, Janus stands at the crossroads of our lives, guiding our passages from where we are to where we shall be. Today, I look back on what, in 2015, becomes two decades of private practice, and where I will be going in the future. So for a moment or two, Janus I shall be. 2014 was a year full of new beginnings for me, both personally and professionally. I’ve made a great many new friends, and enjoyed a renewal of both intellect and spirit. It was also the year I rediscovered my voice, as my writing -- once my career -- has again begun to flourish, not only publishing on my blog, but also at other sites such as the Good Men Project. My book has been resurrected, and is finally making steady progress.

The Center for Alternative Medicine, my practice in Litchfield, also saw an incredible amount of expansion in 2014. I introduced my private line of supplements for general health, assisting people with chronic diseases, and to support mental health issues such as anxiety and depression. This, along with my ability to create custom herbal formulas for patients, has fulfilled a life-long dream of mine; the ability to incorporate my knowledge, not only into the recommendation or use of herbs and nutrition, but in their creation. This is a wonderful capability that will benefit all of my patients, regardless of whether they are seeing me for physical injuries or internal disorders.

I am the only doctor in Connecticut, to my knowledge, that has ability to offer both of these services. It has taken years of education and experience to reach this point, and my heartfelt thanks goes to all of those people who have helped me get here.

Growth occurred internally, as well. Over the course of this past year, I went from having a single employee to three employees. Though most of my patients don’t see anyone except the person at the front desk, behind the scenes I now have people handling the medical billing as well as bookkeeping and accounts receivable. This rapid growth also had me working hard on administrative issues, developing the policies and procedures that never had to exist before.

The front desk is now in the capable hands of Giselle, whose laughter is infectious and whose efficiency is becoming legendary. The steely-eyed Joanne is facing off with the insurance companies, making sure that they live up to the promises they made to you, my patients. And Thanhien, who has managed million-dollar payrolls in her sleep, is making sure that our cash flow runs evenly. I could not ask for more capable hands to assist me.

As if those weren’t changes enough, I have an ambitious program outlined for the next year, with some entirely new services.

In December, I passed the examination to become a federally certified Medical Examiner, and am now one of only a handful of doctors in Connecticut who offer the medical examinations required every two years for everyone who carries a commercial drivers license. I really enjoy doing these exams, as I get to explore with drivers the wide range of health issues that effect them. I have already uncovered a few serious illnesses during the course of my exam, and helped drivers find appropriate care for them.

I also now have a CLIA-certified laboratory on site, and in partnership with a couple of other laboratories, we can now provide a comprehensive suite of employment and forensic testing services.

I now have the ability to provide breath, urine and hair analysis for drugs of abuse, for everything from alcohol to opiates. When these test results are required for evidence in court, I have the ability to provide what is called “chain of custody” handling, which means that the sample is overseen from collection to analysis, virtually eliminating the possibility of intentional or accidental tampering.

I can also provide a full range of relational DNA testing, including gestational paternal testing. This means that, with a couple of blood samples, I can determine the father of a child even before it has been born, with 99% accuracy. I can also perform non-invasive parental DNA tests, as well as testing for multiple siblings.

My DNA testing, like the drug testing, can be done with chain-of-custody handling for the court or other agencies, or even to support immigration and citizenship claims.

The best thing is that I am making all of these services as affordable as possible for the average person.

Anyone who has picked up a paper in the past few years knows that medical services and products are incredibly expensive and have a huge markup. This is, in part, due to the inefficiencies of the medical system, with huge amounts of overhead.

I, on the other hand, have been a sole practitioner for decades. I know how to keep my overhead low, and as a result, I can offer these services more conveniently and at less cost than anyone else.

Ok, so is that the crop? Let me think...private line nutrition, custom herbs, new staff, DOT exams, drug testing, DNA...yep, I think I covered all the bases.

Oh, yes, except for one thing:

I want to thank every single one of you who helped make 2014 the incredible year it was. My patients, my friends new and old, and my family have given me so much for which I am grateful. I can only hope that I have given back in equal measure. I wish for all of you the most wonderful year to come.

The Doctor of the Future

Watching the news, it is difficult to escape the conclusion that humanity is fast approaching a turning point of great impact. I'm not speaking of ISIS or the Gaza-Israeli conflagration; conflicts such as this are older than history. Rather, I'm referring to the ever-growing polarity of our possible futures. On the one hand, you have a rapidly growing income disparity and a civilization utterly dependent on cheap energy which is about to lose its primary source of that energy; a world that is already so overflowing with people that in even rich, technologically advanced countries, such basic things as readily-available water cannot be counted upon; a food supply that is so trucked-up in technology that it now causes the diseases that proper nutrition once prevented; and a worldwide ecology already in the midst of chaotic change.

On the other hand, you have technology so advanced that robots will soon be able to replace men in dangerous, life-threatening jobs, saving countless lives; the possibility, albeit remote, of extending mankind's territory to other planets; genomic manipulation to the degree that natural selection can be replaced with social selection, and entirely  new species can be created; and artificial environments designed to replace the one that our overpopulation has begun to destroy.

The latter scenario is highly unlikely, except, perhaps, as a time-limited state in the longer progress of the former. We have already passed several points of no return in the alteration of our worldwide ecology, as CO2 levels have passed the 400 ppm mark, global temperature has reached the highest peak of this geologic period and shows no signs of stopping, and we are in the midst of a mass extinction of species. Our technology is nowhere near the point of replicating on any large scale, the vast diversity of the once-living earth, and that is critical to our survival at anywhere near our current population. Anyone who places their faith in unlimited technological progress in a reality circumscribed by limited natural resources is bound to be disappointed.

This shouldn't come as a surprise. From the beginning of history, civilizations have outgrown their habitats and outlived their creative energy, leading to periods of turmoil before another another order arises.

But the cry arises: "It will be different this time!"

Perhaps, perhaps. But not in the way the hopefuls imagine. The laws of physics and biology make it inescapable that we are headed for a post-industrial society of some sort. The only real question that remains is what that society will look like.

Certainly, the cheap transfer of goods and materials will cease. The days of raising chickens in the U.S., sending them to China for processing, and then shipping them back here to be sold will be long gone. With the disappearance of cheap energy, we will primarily be able only to move knowledge, not products, over long distances. Computational devices may remain, as they are less material- and energy-intensive, and can be supported by low-powered, decentralized power grids. Though they require exotic materials, they require them in small amounts, making their continued manufacture a possibility. Large-scale, centralized manufacturing will disappear, and if we manage our affairs right, we can arrive at a safe landing with local economies intact, using local resources for small-scale creation of goods. The post-industrial society, it turns out, will have quite a different flavor than the one first imagined by Daniel Bell, instead being closer to the future predicted by neo-Malthusians.

My interest, of course, is primarily in how this will affect health and health care delivery. A lot will change under this scenario, not all of it bad.

First of all, the changes in the transportation system will yield many positive results. With people walking and cycling more, obesity and many related sedentary lifestyle co-morbidities will greatly decrease. The incidence of diabetes, heart disease and cancers will drop significantly.

With energy-intensive factory farming techniques all but obliterated, a return to local production and harvesting of foods will further enable improved health through better nutrition. Indeed, a cultural shift in this direction has already begun, despite regulatory and economic  roadblocks that have been put into place to protect the Monsanto-dominated paradigm.

A return to a more pastoral and village-centered lifestyle will also be accompanied by a decrease in the anomie of life that is a direct outcome of our currently disconnected, disembodied and overly-embroidered lives. Less depression and anxiety almost always accompanies stronger social networks.

Of course, all of this is predicated on the maintenance of a society relatively protective of both individual liberties and cognizant of the need of our strong social obligations to one another. And it's not all sun-dappled rides on two wheelers through abundant fields of grain, either.

Drug production and distribution will be inhibited, putting those dependent on such drugs, such as insulin-dependent diabetics, at risk. Essential vaccines, such as pertussis and measles, would become scarce. And antibiotics, which are already on the wane would be hard to come by, though as I have previously mentioned, that's not necessarily much of a calamity. Certainly "advanced" medicine, with its exotic potions and technology-dependent surgical techniques, will go by the wayside.

I'll make the argument that, in fact, much of that medicine and technology is largely superfluous. The advanced medicine of the latter half of the 20th century and the first decade of this one has made no impact on human longevity, measured in productive years. Many of the surgeries and medicines that are employed today are only necessary because of the society in which we live. Change the parameters of that society, and these disorders would largely cease to flourish.

What does that leave us with, health-wise? It leaves us with a health-care delivery system which is supported by locally-available resources, and which utilizes low-technology manual interventions. It would also leave us with a health care system supported by a truly interdisciplinary population of healers, unrestricted by practice laws and insurances aimed more at preserving the power and income of a protected class of professionals.

In this health care milieu, there would be more shamans and crones and fewer psychiatric wards, more midwives and fewer cesareans. There would be doctors who know the properties of herbs, where they could be found, and how they could be prepared. Who know the use of food and nutrition to turn on the genes of health. Who know foodstuffs and how to use them to cure disease, and who know the human body and its anatomy, and who can alleviate pain with their hands. Doctors who can continue to work when the lights go out.

The fact of the matter is, the doctor of the future looks very familiar. And as I more frequently walk upon the Old Paths in search of the knowledge that can help my patients, I am increasingly cognizant that the wisdom I gather is not only for the benefit of my patients today, but also for the doctors of the future.