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Author Archives: Paul Bryan Roach

It’s Time for a New Constitutional Convention

05 Tuesday May 2026

Posted by Paul Bryan Roach in Uncategorized

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In the United States, individual states do not have the authority to enact amendments to the U.S. Constitution without the involvement of Congress. The process for amending the U.S. Constitution is outlined in Article V of the Constitution, which specifies two methods for proposing and ratifying amendments:

  1. Proposal by Congress: The most common method for proposing amendments is for Congress to propose them by a two-thirds majority vote in both the House of Representatives and the Senate.
  2. Proposal by a Constitutional Convention: The second method allows for amendments to be proposed by a constitutional convention called for by two-thirds of state legislatures.

Regardless of how an amendment is proposed, ratification by three-fourths of the state legislatures or by conventions in three-fourths of the states is required for it to become part of the Constitution. This means that state involvement is required in the ratification process, but states alone cannot enact amendments without the involvement of Congress in proposing the amendment.

It is important to note that the process of amending the U.S. Constitution is intentionally rigorous to ensure that amendments reflect broad consensus and are not easily changed.

It’s pretty obvious that the US Congress, self-licking ice cream cone that it is, will never be able to modernize so it’s up to the states to propose a constitutional convention for our 250th anniversary. If we can get one of those going, what amendments would you want proposed and perhaps enacted?

My personal two (or three or four) proposed amendments:

1.  US Govt has a primary responsibility to act as steward of the environment 

The Environment: The physical environment of the USA is a precious resource easily squandered.  Once ruined or exhausted, it takes monumental efforts and or time to restore (for instance, it takes thousands of years for lost topsoil to reform).  For anyone interested in making a personal profit there is always an easy explanation why whatever they’re doing, say dumping untreated waste chemicals into a stream, makes sense to them; for a nation that is responsible for what happens to the water down-stream, or to the people who ingest the fish that swim in that water, or to a nation interested in preserving the wider ecosystem, that same explanation or justification might be approached from another —a broader— perspective, and the idea may still make sense, or, in the broader context, it may not.  By making an Amendment that the government of the USA must always consider its “Stewardship” responsibility in its laws and actions, and by extension the laws and actions throughout the land, it would ensure that the broader perspective was always taken into consideration.  This Amendment would not by itself preclude any/all development or usage of the natural resources, but it would have to consider and favor the broader perspective in such proposals and actions.  It’s not the sort of amendment that a nation would enact in its infancy or even in its adolescence, but like it or not the USA is maturing at this point into full-adult status, or it needs to at least, and at this point in our collective development it begins to make sense.

2.  No more anonymous internet usage (all users need national internet ID or international internet passport ID)

The Internet:  in the existent bill of rights we are protected against “unwanted search or seizure.” But in using the Internet —which at this point (just like the national roadway system) is essential to virtually everyone’s livelihood and is no longer something optional— one must consent to unwanted searches all the time. Google & others know and hoard virtually everything about each one of us, and we’re powerless to oppose this practice. It’s a constant unwanted search, but they get to do it because the law although in the books is not enforced.  Therefore current internet practices are already in violation of our constitutional rights.  Similarly and furthermore, two of the principal functions of any government are to (a) maintain law and order and (b) to protect its public against malign actors from outside its borders (national defense).  But on today’s internet I can be hoodwinked by fake websites, fake actors, fake accounts, sophisticated robbers, criminal networks and even state actors (like North Korea = major cybercrime and cyberattack sponsor) —none of whom are required to reveal who they are, what they are, where they come from. One cannot legally drive on the road without a current driver’s license + insurance yet anyone, or anything, can be on my nation’s Internet and invite themselves into my business, or my life, or my kids’ lives.  They have no equivalent responsibility to prove they are using this public resource safely or responsibly. They have zero responsibilities whatsoever.  The Chinese Communist Party has built an internet wall around its nation, and it uses the internet to control its people; we are on the opposite side of that we have completely “open boarders” on our system with zero protections for us whatsoever, and, because of the anonymity afforded to the vagabonds, bandits, raiders and scoundrels out there, we people of the USA are victimized and controlled by the internet.  What we need is a system that balances somewhere in-between. A completely free internet is nothing more than a utopian ideal and not something for the real world; freedom of expression doesn’t mean I can impersonate someone else, or anonymously bully, etc. A driver’s license doesn’t impugn my rights to travel, nor would an internet license impugn my rights to freedom of expression. There should be some national rules to the internet established by Congress, we should have to learn and abide by them, and if we violate them (such as pedophiles do) we would lose that right to access it further, in the name of the public good. Similarly, if someone from a Russian cyber farm wants to hold my local hospital’s intranet hostage, or someone from a Chinese spy network wants to access our public works website, we should support the local companies cyber defenses (who would be no match for a state agent hacking) and make it harder for outsiders to do this.

(3) US Govt has as primary responsibility promoting the employment of its citizens 

The Lower and Middle Classes: The US is organized about profit. Whenever things don’t make sense, look at it through that lens and it starts to make sense: The horrors of slavery, the horrors of the industrial revolution, the horrors of the Civil War, the horrors of the Gilded Age and the Robber Barrons, the horrors of the income disparity of today… What if we organized about something else, like “employment.” What if it was more important for people to hold jobs than for Jeff Bezos to get to have automated trucking and automated taxis? Who really benefits from driverless taxis? What do you do with all those people who are out of work? You might say that I’m resisting “progress” but is the average net worth of each of the households in the top 0.1% being $200M and at the middle class in steady decline for decades really progress?

To provide a clearer picture of the wealth controlled by the top 0.1% in the United States, we can put the figures into perspective in terms of actual dollar amounts. In 2020, the total net worth of the United States was estimated to be around $114.4 trillion. If the top 0.1% of households held approximately 20% of this total wealth, their combined net worth would be around $22.88 trillion. With approximately 115,000 households in the top 0.1%, this would mean that each household in this category has an average net worth of around $198.7 million. These figures highlight the significant wealth disparity between the top 0.1% and the rest of the population in the United States. It underscores the concentration of wealth among a very small segment of society and the challenges associated with income and wealth inequality.

(4) Campaign Finance Reform

The Congress: This will have to be an amendment proposed by anyone other than Congress, but we’ll need a separate blog post to take that one on.

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I, We, and USA

30 Saturday Nov 2024

Posted by Paul Bryan Roach in Uncategorized

≈ 1 Comment

In the USA we had an election recently, and the subtext –the thing unsaid but underpinning it– of the whole event was “I or We?” In fact the same subtext seems to be unsaid but influential in England, Western / Central / Eastern Europe, South America, Australia, and probably in Asia as well but admittedly I don’t know much about Asia (and that’s on me; I should know more).

In the USA, partly because we’re nestled in-between two comfy oceans and, in the longitudinal, between two close allies (closer since the 1989 US-Canada Free Trade and subsequent 1994 NAFTA treaties but will be further apart once upcoming tariffs set in), we tend to forget there is a broader world out there. But in fact I believe the whole of the world is debating, right now, between “I” and “We.”

What am I talking about? Although I’m just an everyman, if it’s not a crime I would like to venture an opinion which is the following: with the onset of the Tech Revolution and the Global Village thing [and an enduring century of post-Modernist ideology (i.e. no absolutes and everything is subjective)], the level of complexity in our lives, worldwide, has become simply too great for any person to be in control of their own head; ordinary life has become so very confusing that even assuming a stance on the simplest human problems has become hopelessly convoluted.

“Are these the best of times or the worst of times? Is Global Warming a thing (like my senses tell me and like all the scientists say it is) or is it not a thing? Should the Internet be controlled, or, unregulated? Vax or no vax, mask or no mask, obligatory or voluntary? Are the borders okay or not? Trickle down economics are bullshit, right? Are genetically modified crops good or bad? Are farms too big? Are corporations too big? College is $80k a year (ditto for health care)?? My wages are stagnant and my town has dried up… who/what is to blame? Automatic weapons are protected in the Bill of Rights so we’re just going to have to deal with the periodic mass-shootings; or, are they not and we should not? Why are athletes with 37.4 trillion XY chromosomes competing in sports against athletes with 37.4 trillion XX chromosomes? and, what do we do for those whose chromosomes are XXY, or XYY? By the way who’s fault is it that there so much urban crime and what do we need to do to improve that? Should people be allowed to choose to die when they’re very old or very sick? What should we teach in public schools? Who cares if Putin invades Ukraine or Eastern Europe that’s not my problem over here?” And so on, and so forth, 24 hours a day, 7 days a week, 52 weeks a year, 24 time-zones and across seven seas and seven continents….

So, in order to get our heads around the numberless and complex issues like these or so many others, we’re (again, worldwide) typically signing onto one of two –polar– ideologies in order to conceptually organize and make sense of each and every thing that happens to us or to the world around us, everyday. Then, when an event happens, we dial into (by TV, by Internet, by social media, by podcast, whatever) whichever ideology we’ve chosen in order to find out what is our stance on it. See? I or We? One single, easy choice; not a million.

The “I” camp is conceptually cleaner. “I” is more easily defined, and from that Cartesian rock things become straightforward enough to produce a cohesive thought: a, then b, then c. Whether or not that straight-line of thought is sufficient to answer the complex problems of the modern Earth is not precisely the issue; at least the line of argument is comprehensible and it can follow a simple logic. And, as Shakespeare’s Hamlet, Prince of Denmark never figured out in time, a clear, actionable approach definitely solves some of Life’s conundrums, perhaps many of them; but maybe not all of them, or maybe not the most existential ones, or perhaps not solving them from every perspective?

The other one, the “We” camp, has a different problem: who, pray tell, IS “We?” In particular issue “X,” “we” may represent groups a, b, and c; however in particular issue “Y,” it might better be represented by d, e, and f… or even more confusingly, by a, c, and f? And who by the way who decides if it’s “a, c, and f” and oh yeah, by what authority do they decide it and for how long do they get to keep that authority? And so on, and so forth. The “We” camp therefore has an inherently difficult problem: getting everyone organized and unified to the point of crafting effective responses and approaches to one of Life’s big problems. Then reorganizing and reunifying for the next one. It is indeed a tall hill to climb. But with human ingenuity and social skills it can and does work… even, very well! Sometimes at least. Even Donald Trump famously admitted that “Democrats do a better job of the economy.” But, truth be told, the Democrats nevertheless have a hard time selling that point! So, for example, from one perspective the “We’s” may bump up the economy, then they lose an election, the economy keeps doing well for a bit before it craps out, and the cycle continues.

In the USA, a few years after being Democrat for 8 years, Donald Trump took over the Republican party and since then, the through line that this writer has most prominently heard from that camp has been self-focused: me, me, me… in so many words. For instance, “Make America Great Again” translates into “Make it my demographic’s again” [which happens to be my own demographic, as well, not that it matters]. “America First” means exactly what it sounds like –to forget about NATO, forget about global partnerships, etc and be our own island. “Build a wall” is not just a metaphor. And the Don, personally, famously, neither old-school Republican nor old-school Democrat, is an army of one and, all about the Don. And, particularly for a voting demographic that was once in power and then has consistently lost share over a half century, that issue of “the complexity out there is impossible and I’ve only done worse with it, anyway,” is quite a valid and a resonant one.

In contrast to the conceptual clarity of “I,” the USA’s Democratic Party –the party of “We” in my scenario, and, as it happens but not that it matters the party I’ve always affiliated with– can get caught in a conceptual morass and trip over itself: Trying to organize; trying to include the excluded; trying to include everyone; trying to do the right thing –if it can define the right thing, and agree on that definition, and move forward with it– and to save the planet.

So that’s my conceptualization of the state we’re in. I’m personally convinced that we need both the I and the We to solve our various problems across the globe but the mix of how much of each and when and where is not so clean, not so easy… so I guess, by default, since it lacks the clarity of “I,” that’s a “We” kind of stance…

And it seems to me that while Homo sapiens is a conceptual creature meaning we think in pure, Platonic concepts like squares, or chairs, or love, we unfortunately or fortunately live in actual circumstances which are messy, are not black or white they are shades of grey (yes, I’m taking that phrase back because it’s useful and it belongs to everyone), they are imperfect. But the human problem is we don’t realize this about ourselves and then we constantly fight over the discrepancy between the conceptual and the actual, which is why “forgiveness” is the greatest human superpower ever, but I digress….

Then it seems to me, from my everyman –nay, solitary– perspective so obviously obvious that women should be respected and have full access to health care; that our police must be funded and well-trained and supported in their essential (and dangerous) work; that no sovereign nation can exist without a proper border policy; that NATO must get its act together and come unequivocally to Ukraine’s assistance / Putin cannot be allowed to take Eastern Europe (imagine the nightmare if he wins and then has Ukraine, its army, and the momentum? Europe will never be able to stop that); that the Internet cannot remain laissez-faire any longer it needs like the highways and railways and waterways and airways before it some corporate governance; that college is way too expensive; that middle class jobs need to come back; that white collar jobs need to be protected from AI so we all don’t become modern day serfs; that Global Warming must be effectively addressed right now… and so on… and so forth…

But it also seems so obvious as well that some of these conundrums require straightforward solutions from diverse coalitions, some need elegant solutions from a unique perspective, some straightforward from unique and some elegant from diverse… but… similar to Kurtz’s exclamation in The Heart of Darkness “the horror, the horror!” I ask you, dear reader, “the how, the how!” How are we going to do this?

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This Memorial Day, Our Modern Korean War Moment

26 Sunday May 2024

Posted by Paul Bryan Roach in Uncategorized

≈ 1 Comment

Try to imagine yourself back then, just done with first WW1 and then WW2 and settling down with your slippers, instant coffee, and rolled-up newspaper ready to enjoy that very hard-earned peace dividend for a few decades at least (“we earned it, right?”) and then… it’s only 1950’s but now Communism is relentlessly attacking, advancing, taking over the world and we’re facing an open contest of wills in some place called the “Korean Peninsula” with the underlying question of who’s planet is it going to be? the rules-based order of the West, or, the Communist juggernaut’s.

Enter the slugfest of the Korean Conflict: a brutally ugly war.  Much of our USA tech advantage was nullified by the remote, mountainous terrain, so it was pretty much mano-a-mano and a battle of wills. We entered into the contest soft and unwilling, more adapted to garrison-life than to brutal fighting, and quickly got shellacked by the hard mountain-men of the Northern peninsula and the Southern Chinese. In no time flat we were driven immediately back to nothing-more than the toe-hold called the Pusan perimeter, and we were about to be annihilated completely.

Enter the audacious Hail-Mary of the Inchon Landing halfway up the peninsula in one stroke cutting behind enemy lines and saving our proverbial bacon.  The landing was assumed too difficult to be achievable but we did it: made possible by a new combination of Frogmen who could scope out the bay, the tides, the landing sites for the ships; and the recent still-fresh corporate knowledge of the Big Military on how to conduct the hardest of all stunts, a major amphibious landing; and spiriting the whole thing was the commitment and audaciousness of a once committed and audacious nation.

The fighting turned because of this incredible feat and we knocked them back, way-back, all the way up to the far North thinking for a moment that maybe we’re going to pull this one off and then “wham!” they sneak one past us this time and in a big way with their low-tech hardiness (we had assumed what they actually did to have been impossible) sneaking tons of everything past our vanguard by foot in the dead of night & winter, without mechanization or flashlights so our surveillance aircraft never saw them, and didn’t we get bolloxed by it which resulted in the “frozen Chosin” and a partial retreat by us and their initiative restored.  

We subsequently found ourselves in a stalemate at the 38th parallel and there, individual hills were viciously fought over just to see which side would fight the hardest and longest and suffer the most, and the truce negotiations were intentionally slow-walked for years because the Communists figured they could drag their feet and break our will, and all the while young fighters were sent into the meat grinder for no apparent reason at all other than be as tough as the other side was but with it as awful as it was we stopped the advance of that truly hellish ideology, and we’ve been holding that line for about 75 years since.  And the difference between modern-day South Korea and North Korea tells absolutely everything we need to know about whether or not it was worth it:   Were we willing to let them win and make the whole damn world into a North Korea, as was the Communists’ stated intent?  Or were we willing to fight and make our own decisions about how our world would be?  Remember the difference between East Germany and West Germany?  Between the Warsaw Pact and Western Europe?  Those days, and that fighting is unfortunately not over. 

Because now we have the authoritian Putin and his conquest war into Ukraine (and soon enough into Eastern Europe) and all this is falling on the heels of an exhausting 20+ years of US led Global War Against Terrorism.  Never mind the details of that GWOT right now; what people in the USA and the Western led global order feel is that “we want our Peace Dividend!” And that’s natural, that’s normal, that’s idyllic, that’s without a doubt “how the world should be.”

Only the world isn’t that way, is it?  Homo sapiens is a very fraught species of animal, a beast that is constantly at war with itself. Our present peril is Putin who is evil, violent, on the march, and he’s totally going to win in Ukraine if we in US and Europe don’t do more to oppose it. Then he’s going to kill, deport, imprison, work-camp, and brainwash them all exactly as they used to do over and over again in the Soviet Union, and exactly as he’s already done in the occupied parts of Ukraine; and then he will use the young ones that he’s grabbed, coerced, and brainwashed and force them to fight-on in Lithuania, Estonia, Latvia, Poland, Moldova, Romania, Czech Republic… and he will fight to take back everything that the Soviet Union once had and everything that Imperial Russia once had, because that’s what he wants.  

And he’s not just doing it militarily but with all domains:  he’s got legions working to produce a comprehensive parallel universe of fake news, cyber attacks, and bought-off candidates throughout Europe, and the list goes on and on.  Ordinary, normal people like us cannot even comprehend or believe that he’s up to so much perfidy so we deny it, we minimize it, we look away to make it go away, and we thus enable it all to proceed unopposed.

Seizing the opportunity of Europe and USA floundering in Eastern and Central Europe, Xi Jinping will take Taiwan and all of the South China Sea, at a minimum, because he has a shopping list of his own that he’s been waiting to get done.

So this Memorial Day I visit my Dad’s grave, a Korea War vet who served his tour at Panmunjom, and ask him what to do.

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Cyber Bill of Rights

13 Tuesday Feb 2024

Posted by Paul Bryan Roach in Uncategorized

≈ 1 Comment

The hyper polarization within the United States of America is going to tear us apart, no question about it. Note historical examples of the French Revolution, and the Russian Revolution: polarized actors on both sides that resulted in chaos and catastrophe. As far as I can tell, for us in the USA at least, the hyper-polarization is the consequence of two major elements: (1) the invention of the internet [specifically the major search engines’ algorithms that reflexively promote extremes of anything (extremes get more clicks), and also encourage self-obsession (the “internet bubble” phenomenon)]; and (2) the gerrymandering of congressional districts [which has rendered congressional seats excessively secure and preempts any “art of compromise”].

I’ve no good ideas about the gerrymandering: It should already be obvious to all voters that it’s out of control, anti-competitive, and nullifying our rights to a representative government. It should be obvious that the Democrats and Republicans are both ineffective and inflexible because of it, but they get to be as bad as they are because within their districts, at least, they’re not the other side. And it leaves us citizens with a lot of turds in congress who are far more adept, attuned, and incentivized to keeping their jobs than doing their jobs. Because of the gerrymandering + our system of Primary elections there is no incentive in Congress to compromise, ever, because if you do you’ll lose next election’s Primary. But, Democracy is built upon compromise, and most of us in the country are disposed to compromise, especially if it means we can move forward. But the gerrymandered representative will never compromise; they will only sway with the prevailing winds of their respective districts’ most hardcore voters –the ones who vote in Primaries. Nevertheless, despite it completely undermining their chance for proper representation, ordinary voters don’t seem all that focused on the gerrymandering issue. They’d rather spit and hiss at one another, so it seems. So I’ll leave that subject to politicos on Substack. Maybe someone can make it a ballot issue, someday?

But the cyber issue… now that’s something we can fix! We can make a “Cyber Bill of Rights.”

First, what is the U.S. Bill of Rights? Noting that the U.S. Constitution was imperfect, ten amendments were passed by Congress Sept 25, 1789 and ratified by the states by December 15, 1791, to make it a lot better. These were:

Amendment I

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. 

Amendment II

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed. 

Amendment III

No Soldier shall, in time of peace be quartered in any house, without the consent of the Owner, nor in time of war, but in a manner to be prescribed by law. 

Amendment IV

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized. 

Amendment V

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation. 

Amendment VI

In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence. 

Amendment VII

In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise re-examined in any Court of the United States, than according to the rules of the common law. 

Amendment VIII

Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. 

Amendment IX

The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people. 

Amendment X

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

Okay, so why would a Cyber Bill of Rights be something we should have? And, why would it be important?

First: Cyber is fundamentally different than anything ever invented before: it is an entirely new domain of existence. But it’s not just a place we can go visit, if we like; cyber –like a brain’s subconsciousness– now underpins every element of everyone’s lives. You don’t have a choice about cyber. You’re on it. It’s on you. Whether you’re working on a computer or not it’s ubiquitous and influential in your life. And yet there are essentially no rules for it. It’s a completely Laissez Faire approach to dealing with this new domain. My point is, it shouldn’t be. It’s not right, it’s not fair, and as you can see with respect to our stupid, completely unnecessary societal polarization, it’s destructive.

When the founders of the USA were confronted with the problem of how to create this entirely new country, they reached back to the principles of their classical educations (ancient Rome and ancient Greece), and mixed in examples of how the nation-states of the indigenous peoples already living here balanced power, and presto, they created something new –that over two and a half centuries has actually worked. 

We need that kind of initiative right now. Google, Facebook, X, TikTok, etc., are leading us by the nose. Like robber-barons of old, they can make their own rules, and they make them to serve their own interests. Not ours.

So, what would be good cyber amendments to make? For this I’m going to need your comments. I’m no lawyer. I’m no tech-ie. A few things that seem obvious to me:

  1. Anonymity on the internet is problem. When outsiders (other countries or agencies) can enter into our “sphere” without any trace and create / promote any kind of discord that serves their interests, that’s a problem. Note Putin’s dedicated cyber farms that influence US elections, and in fact how they distort elections across Europe. When insiders can spout any kind of language on a national stage without ever having to own the consequences of their speech, that kind of sniper position promotes bullying, slander, recklessness, discord. We have a right to free speech, but –as far as I can tell– not a right to anonymous speech. I think anonymity on major platforms is destructive and should be illegal. I have a driver’s license to drive on the public roads, don’t I? And if I drive like a menace, I can lose that license. I cannot be completely anonymous as a driver; I must answer for my driving. This is much bigger than that.
  2. Invasion of privacy. Our movements are tracked (by our cell phones), our speech is listened to (Siri), our emails are culled (Gmail), our internet usage is sold to other agencies. That’s spying. But it’s spying on such an unimaginably massive scale, we’ve failed to notice it. That expression, “I don’t know who discovered water, but it certainly wasn’t a fish” really applies; we’re so spied upon we don’t even notice it. And I don’t care how it impacts their business models: it needs to stop. Cell phones are fundamental to today’s society, so not using one isn’t really an option. We need some kind of legal protection from this constant violation of our privacy.
  3. Truth. This is the hardest one to consider. Somehow, on the major platforms, truth needs to become a thing once again. Because right now we’re stuck in this post-modern Hell of no “correct” anything. If we’re basing our society on the internet, but the internet has no inclination to or predilection for “the truth,” that’s a problem for our society.

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5: Charlie Rinehart: Bladder Cancer

24 Saturday Dec 2022

Posted by Paul Bryan Roach in So... It's Cancer

≈ Leave a comment

1 – Mike Riordan, Charlie Rinehart MD, and Paul Roach MD embark on a full discussion of Bladder Cancer: what it is, how it happens, how it behaves, and how it’s treated.

2 – Guest: Charlie Rinehart, MD, a practicing Urologist and medical officer in the U.S. Navy, (formerly an officer in the USMC), undergraduate at Georgetown, Medical School at Columbia, and Urologic Residency at US Naval Medical Center, San Diego. Currently practices at the Captain James A. Lovell Federal Health Care Center, in North Chicago, Illinois

3 – Timestamps relevant to points within the episode, in this format:

[00:24] – Intro & Charlie Rinehart, MD

A. Disclosure

B. Dr. Rinehart background & training.

[06:22] Overview of Bladder Cancer:

A. Incidence and Epidemiology

B. Clinical Presentation

C. Urinary system

[14:10] Hematuria and how is bladder cancer causing me problems?

A. Hematuria & its workup

B. Male / Female incidence & etiology.

i. Smoking Factors

ii. Occupational factors

iii. Low, Medium, High Risk

[21:06] Initial Workup of Bladder Cancer

A. Cystoscopy & Biopsy

B. CT Scan

[26:45] Tumor Grades and Depth of Invasion

A. Tumor Grades

B. Tumor Depth: Muscle Invasive and Non-Muscle Invasive

[36:00] Treatment & Surveillance of Non-Muscle Invasive Disease

A. Treatment

B. Surveillance

C. Why not bladder screening for everyone?

[40:50] Local Invasion & Metastasis

A. Pelvic organs

B. Lymph Nodes

C. Metastatic Behavior

D. Bladder removal (Cystectomy) and reconstruction

[50:00] Preventing progression from Non- to Muscle-invasive disease

A. BCG

B. Chemotherapies and Radiotherapy

[54:00] Bladder Cancer Endemic to East Africa & Middle East

A. Squamous Cell Cancer: Chronic Inflammation

i. Chronic Indwelling Urinary Catheter

ii. Parasite: Shistosoma

[57:45] Transitional Cell, Squamous Cell, AdenoCarcinoma Cell types

[59:30] Prevention

[1:01:30] Advanced Disease and Clinical Trials

[1:05:00] Closing

4 – Key takeaways in bulleted format:

— Bladder Cancer happens to Men and Women, typically beginning in the more advanced ages.

— Blood in the urine (either visible to naked eye, or only under the microscope) is a common feature.

— Smoking (and some industrial exposures) important factors in its development

— “Transitional Cell” the most common type in USA and Europe; Squamous Cell (caused by a parasite called Shistosoma) also common in East Africa and Middle East

— Non-Muscle Invasive and Muscle Invasive frequently treated quite differently

— Chemotherapy, Radiotherapy, Immunotherapies available for Advanced Disease

— Important to not smoke, or quit smoking, to lower risk of disease.

— In East Africa and Middle East, a type of bladder cancer can occur because of a parasitic infection.

5 – Relevant links mentioned in the episode

6 – Follow us on your favorite Podcast program, and learn more through the homepage at https://paulbryanroach.com/so-its-cancer/

7 – Coming up next month: “What Is Cancer?”

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4: Malignant Melanoma

01 Tuesday Nov 2022

Posted by Paul Bryan Roach in So... It's Cancer

≈ 1 Comment

I. Intro and hello

II. Rohit Sharma, MD, FACS

III. Sunscreens – thorough explanation of the ins/outs of sprays, lotions, creams for cancer prevention; rash guard clothing; wide brimmed hats; collective measures.

IV. Moles and blemishes: bad and good.

V. Interpreting the biopsy report

VI. Tumor thickness and surgical margins

VII. Lymph nodes and “Sentinel lymph node biopsy.”

VIII. Horizontal and vertical growth phases; four types of melanoma.

IX. How to talk skin with your General Practice Physician or Clinician.

X. Staging the disease: Local, Regional, Metastatic.

XI. Impact and utilization of Immunotherapy & Targeted Therapies.

XII. Predicted survival of different Melanoma stages

XIII. How do I self-advocate?

XIV. Clinical Trials explained

XV. Closing and Thank you

Key takeaways:

1. Ounce of prevention… learn your sunscreen options, how they complement one another, and use them from childhood on!

2. Moles that are uniform and unchanging are safer; moles that are irregular and changing are more dangerous

3. Thicker and ulcerated melanomas are more problematic

4. In certain patients, harvesting a sentinel lymph node gives important prognostic and treatment-related information.

5. Be clear and upfront with your doctor about your moles and blemishes

6. New types of treatments exist that are powerful and important.

7. Stick with established, well-known websites (such as American Cancer Society) when starting your self-education on Melanoma

8. Clinical Trials are fundamental to the advancement of Medicine, but they may or may not be what you’relooking for

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Peter Wagner: Photographer, Chicago area Tour Guide, Volunteer at Children’s Hospital

10 Monday Oct 2022

Posted by Paul Bryan Roach in Fixing Chicago

≈ Leave a comment

Welcome to Fixing Chicago: the podcast focused on “what right looks like,” and, how to achieve peace, educate the kids, restore vitality, and reinvent Chicago for success moving into and through the 21st century

I. Today’s guest is Peter Wagner, from Oak Park, Illinois, and the topic is “Connecting with the City on a personal level.”

A. Growing up & Education

B. Work Experience

II. Work as a tour guide throughout Chicago: Getting the job? What did it entail? Who would you take around? What were their impressions of Chicago, and their favorite places?

III. Photography

A. Personal interest and commitment to Photography

B. Photographing Chicago, Chicagoans, Aviation, Car show, tell us about the Chicago Photography scene…

IV. Volunteering at Children’s Memorial Hospital: What has been your involvement with the hospital? What was it like? What do you feel you brought to it? What did it give to you? Tell us about the kids…

V. Closing: Thanks again for listening and if you have a topic you would like to have us discuss, or comments or feedback please either log on to http://www.paulbryanroach.com and click on the “about & contact” page, or send them directly to “letters@paulbryanroach.com”

VI. Contact: Peterwagnercreative@gmail.com

https://m.facebook.com/peter.wagner.9822/

https://www.linkedin.com/in/peter-wagner-86a9924/

https://www.instagram.com/peterwagnercreative/?hl=en.

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3: Lymphoma: discussion on what it is, how it behaves, how it’s treated.

24 Wednesday Aug 2022

Posted by Paul Bryan Roach in So... It's Cancer

≈ Leave a comment

  1. Introduction:Paul,Peter,Mike(Courtneyoutthismonth)
  2. Guests:Nogueststoday
  3. Caseoftheday:Lymphoma patient. Workup, Treatment, & Result.
  4. LessonoftheDay:Lymphoma: Hodgkins & Non-Hodgkins.
  5. CancerQuestions:FromPaul:what is Car-T therapy?
  6. CancerNews:None today
  7. Signout

 

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3: Medical Volunteer in Ukranian defense, Rom Stevens, MD

05 Friday Aug 2022

Posted by Paul Bryan Roach in Fixing Chicago

≈ Leave a comment

1 – [00:05] Intro

2 – [00:25] Guest CAPT (ret) Rom A. Stevens, MD

3 – [08:10] Background on the Ukraine Conflict

4 – [17:45] Dr. Steven’s decision to go to Ukraine

[19:00] Getting there and getting started

[24:45] Ukrainian medical system & fitting Into it during wartime

[33:20]Joys & Sorrows of Volunteering

[41:24] Who is helping them?

[46:05] What kind of help is best?

[50:00] Closing and Slava Ukraini

5 – Key Takeaways:

Ukrainian defense an existential situation for the country of Ukraine, and for democracy in Europe

Medical system there improving from Soviet times, but still challenged even before Covid, and the stress (and the intentional targeting of it by Russian bombs) of the war

Volunteering as a Medical staff is rewarding and needed but to be effective, some command of the language is essential; and, issues such as medical supply and medical logistics may be as or more important than physicians lending a hand.

6 – Signout: Please “like” us on social media and follow us on your favorite podcast platform. Comments and feedback, as well as suggestions for topics and guests: https://paulbryanroach.com/contact/.

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2: Esophageal Cancer

17 Sunday Jul 2022

Posted by Paul Bryan Roach in So... It's Cancer

≈ Leave a comment

1 – Intro Three cancer specialists and a graphic design artist discuss cancer.

2 – Bio’s: Pete Schlegel, MD (Medical Oncology)

Courtney Coke, MD (Radiation Oncology)

Mike Riordan (Graphic Design Artist)

Paul Roach, MD (Surgical Oncology)

3 – Timestamps:

[00:05] Courtney, Pete, Mike, and Paul introduce themselves

[06:00] Case of the Day – Esophageal Carcinoma

[28:00] Lesson of the Day- Esophageal Carcinoma

[35:10] Cancer Questions: How do you tell a patient they’ve got cancer?

[41:32] Question: What do I do if my doc doesn’t present me with a plan?

[51:45] Cancer News: Keynote 811 Trial; dual PD-1 & HER2 blockade in HER2(+) Gastric Cancer.

4 – Key Takeaways:

Causes of esophageal cancer (e.g. smoking, alcohol, gastroesophageal disease)

Signs and symptoms of esophageal cancer (e.g. difficulty swallowing, painful swallowing).

Immediate actions (e.g. contact Primary Care Physician; seek family, friends, trusted help)

Workup is pretty involved, so don’t be surprised.

Treatment frequently involves endoscopic or surgical procedures, chemotherapy, radiation therapy, and now sometimes new kinds of medicines (anti-Her2, anti PD-1 medications, etc).

Don’t be shy! Reach out. Get help. Treatment is available!

5 – Sign out: write letters@paulbryanroach.com with ideas, thoughts, questions for next episodes

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