Living in an Immaterial World

A few weeks ago, Amazon.com did something that rocked the whole system of private property. And all most of us did about it was kvetch. We saw it as a mere inconvenience. You buy a copy of 1984 for your Kindle™, and some days later, you log back on and discover 1984 isn’t there. Since then, Amazon has explained, and apologized, and most recently cleared up the legalities between Amazon and George Orwell’s estate or whatever owns the rights to 1984, and most of those who bought it have had it restored. Most of us regard it as a mere pothole on the road of life. It’s patched now, all’s well that ends well and so on.

Given that most people buy books before reading them, rather than after, can we then conclude that those inconvenienced bibliophiles are only now reading 1984 for the first time, and only now realizing that Orwell pretty much predicted what has happened to his book? George Winston, after all, was in the business of making, and remaking, history, in the most basic sense, de-happening events that had now become inconvenient for Big Brother’s current ideology. Those of us who read the book before Amazon put it onto Kindle™, or at least some of us, are bloody spooked. Anybody who can make a book disappear from your library without any kind of notice, much less permission, can just as easily change the content of the book so that (for instance) Big Brother turns out to be the hero, and poor George Winston is just a pathetic dupe. Or rewrite the history of the Civil War to make slavery a noble cause. Or rewrite the JFK assassination to make Lee Harvey Oswald a Wahhabi Muslim and Marina Oswald a femiNazi.

How do you know that when you Google™ a news story from 2005, you won’t see George W. Bush™ filling sandbags and pitching in to reinforce the levees in New Orleans? Or Silvio Berlusconi™ inventing a new and vastly improved version of linguini bolognese? Or Governor Sanford entering a monastery?

Back in “the Sixties,” when Mr. Wired and I were active in all kinds of countercultural religion and politics, I took to clipping the papers regularly, to preserve stuff that I felt the next generation would never believe if I couldn’t produce it. (In the Talmud, BTW, you run across all sorts of weird stories to which the Rabbis themselves add a little note: “If it were not written, it would be impossible to believe this.”) I filled up most of a 4-drawer filing cabinet with high-acid-content paper (that was the flaw in my reasoning), which I only recently went through and mostly discarded, since it has mostly turned into stiff yellow snowflakes of indecipherable memory and I needed the drawer space for client files. Now, like most other people, I am at the mercy of the Mass Media and what little paper documentation the librarians have managed to preserve.

The Buddhists (with whom I have been hanging out occasionally of late) would not be seriously distressed by these developments. Nor would a client of mine from thirty-odd years ago who was trying to get discharged from the Navy as a conscientious objector because, while on maneuvers in Hawaii, he sat on a beach for an evening and became Enlightened. My usual approach to these cases is to refer the client to a psychiatrist who firmly believes military service is bad for most people’s mental health, especially that of people who think killing people is wrong, and encourage Uncle Sam to discharge the client for reasons of emotional stability. It’s usually faster and cheaper than using the official regulations for Conscientious Objector discharge. This client objected to the tactic. He wasn’t crazy, he explained. The Navy was crazy. They still believed in the reality of the material universe. The real universe is an eternally-flowing mesh of causes and consequences, assumptions and reactions.

Now, causality can reach backward as easily as forward. If we need the Reconstruction to have been a Bad Thing in order to accomplish some current political goal, we can revise it without even recalling and re-publishing the encyclopedias and textbooks that will shape the next generation’s understanding of history.

Which assumes, of course, that the next generation will have an understanding of history. Yesterday, a paralegal in our office, a smart and reasonably well-educated young woman, asked me who was on the other side in World War II. While Big Brother’s right hand is busy rewriting history, his left hand has managed to make the whole idea of history irrelevant to those who would ordinarily be expected to create its next chapter. When Seward, mourning the just-deceased Lincoln, said “Now he belongs to the ages,” he meant that Lincoln would always be part of what shaped America and the world. These days, when somebody says that a particular person or thing is “history,” they mean it’s gone, disappeared, never to be seen again. Even the History Channel™ is mostly taken up with the exploits of ice road truckers in Alaska and myopic analyses of the DaVinci Code pitting the Freemasons against the Bavarian Illuminati.

We are just now realizing that all the gee-whiz forensic technology that lies at the foundation of any criminal prosecution in which the State has somehow not managed to persuade the defendant to plead guilty, is highly fallible, precisely because it contains nothing so physical as a smoking gun, just a bunch of digital impressions on “a media” [sic] that the next generation of forensic “scientists” won’t even be able to read.

Friends of mine with libraries as extensive as the one in the Wired residence are contemplating selling them, or donating them to schools in the Third World, or recycling them for pulp, now that the best that has been thought and said is available in digitized format through Google™ or whoever, on “a media” the size of a good Cuban cigar. But a good cigar is, at least, a smoke. The best that has been thought and said can be rendered unreadable through a simple electromagnetic hiccup or an “updated” digitizing format.

We have already allowed ourselves to become accustomed to the best music and drama that has been composed and performed being recorded onto one short-lived medium after another. Those of us who really cared about such stuff now have more than six generations of it in our “media rooms,” accumulated over only a mere half-century. More reasonable people just throw out the last generation when the new one reaches an affordable price. The newest generation, of course, doesn’t exactly accumulate at all. Like the Kindle™ books, it merely takes up residence on our current “media” until we get bored with it, and then makes way for the next batch of stuff. We never own any of it.

I think (maybe I’ve been hanging out with Buddhists too long?) that this might be okay if the generations of ideas and songs and plays that wander into and out of our minds originated among real thinkers and artists, and not just the minions of media conglomerates who “own” most of what gets “created” these days. I’ve been through distributing the books and records and pictures of my deceased parents and friends, and part of me doesn’t want to put anybody through the same process again for my stuff. But if the alternative is to let Sony, Bertelsman, and Gulf Western do my thinking and my enjoying for me while I live, and leave no thoughts or music of my own to those who come after me, then, thanks, I’ll stay in the material world a while longer, even if it means stumbling over my accumulated books and music while I live and burdening my friends and family with them afterward.

Jane Grey

Health Care: the Reform Before the Reform

We’re hearing a bunch of different messages about what “health care reform” involves. Obama is now saying it means “health insurance reform,” which many of us have trouble with.  I have a very good auto insurance policy. It neither drives nor maintains my car.  But we all seem pretty clear that we want to cover everybody (or nearly everybody), and that we want to reduce the cost of both health care and health insurance. Whether these various goals are mutually compatible is a whole other question.

But there are things that we can perfectly well do before getting into the details of who is to be covered for what, and perhaps one of the most important is to solve the medical data problem.  Right now, your medical records are paper full of illegible doctor longhand, plus some transcribed and typed notes, plus X-ray films plus images from scans, EEGs, and EKGs.  Depending on your age and state of health, those records may fill a single folder, or, like Mr.Wired’s, be the thickness of the entire New York City phone directory. Furthermore, those records may be taking up space in the office of several different offices and facilities, because Doctor #3 wants to know what Doctors #1 and 2 found when they checked you out for hallux valgus, how they treated it, and whether the treatment worked, before she takes up where they left off. So she has had you send for all of the records from Doctors #1 and 2, and, when necessary, pay for the copying and shipping.  Copying, meaning the originals stay where they started out.  Most health care facilities have at least one room devoted entirely to record storage, sometimes a lot more.

Sometimes, not unreasonably, patients decide they want to keep a set of their own medical records.  This requires another set of copying fees, and another quantum of storage space.  In addition, it requires the patient to find someplace to store X-ray films (which are, essentially, photographic negatives with all their attendant storage problems, and furthermore are roughly four times the size of most paper documents and places to store them.)

BTW, in many other countries (Chile is the one I know best), the medical records are considered the property of the patient, who keeps his/her own set of copies and takes them from doctor to doctor as needed.  I don’t know whether the doctors in question make and store their own set of copies. Considering that doctors do retire, move away, and die, this approach has a lot to recommend it.  Indeed, these days, doctors move around a lot more than they used to, and tracking down one’s records after a few years can be really difficult.

So anyway, creating, maintaining, storing, and transmitting paper medical records is expensive.  Regardless of what happens with the more global aspects of health care reform this year, we could cut medical costs a lot by digitizing the records.  Many practitioners do that now.  My orthopedist puts my X-rays on his computer monitor, where he can zoom in on areas of particular interest and show me utterly cool and fascinating things about them.  He can also email them to anybody who wants them. But his software may or may not be compatible with that of my physical therapist.  That’s where the Reform Before the Reform comes in.
We not only need to digitize medical records, we need a standard system for doing so, so that this information can be readily transmitted to anybody with a bona fide need to see it.  We could, of course, just wait till Microsoft crams their version (which they are undoubtedly working on in some cellar in Seattle) down everybody’s throat.  And in the meantime, health care providers who have committed their resources to some other system will of course be out of luck.  VCR vs Beta, anybody?

Health care is more important than home movies.  It’s important enough for the government to play a role in deciding on a digitization standard.  Presumably the National Institutes of Health would be the place to start.  But obviously the real world of private medicine has to be involved as well.  AMA?  There may be some professional organization of medical IT specialists with contributions to make as well.  Ideally, the private side should be getting together to formulate its standard, which the NIH boffins can then examine for obvious and not-so-obvious glitches.  Mr. Wired suggests that unless the glitches are deal-breakers from the point of view of NIH, their critique should be kept out of the process, or a very minimal amount of tweaking done to produce a workable product.  That product, with recommendations from the private sector and NIH, should then be forwarded to the Surgeon General for his rubber stamp.  Probably the resulting system should be open code and licenseable to everybody who wants it. After a reasonable period of time (5 years or so), all government agencies that deal with individual medical records can legitimately require that they be digitized in the Standard Format, whatever it may be, and then, probably, everybody else will follow suit.

Within ten years, the system will have eliminated at least half the paper storage space (I’m assuming that the original originals will continue to be kept on paper, as a backup), and most of the costs of transmission and copying.  As an additional benefit, that digitized information can be made available almost instantly on demand for emergency responders.

Obviously, such highly personal records will need to be kept under varying levels of security.  One level for emergency responders, another for primary care providers, maybe another level for insurers, and so on.  Which is a lot easier to do (and where necessary, undo) digitally than on paper.  A person’s entire medical record could be kept on a single memory stick, and the emergency provider portion of it, probably, on a chip the size of the one embedded in my cat’s back to identify her if she goes astray.

No matter what else happens to the health care system over the next decade, this single advance can cut costs and improve care by significant amounts.  I don’t offhand know whether any other country has done this yet.  I know that various providers are doing it locally. The Veterans Administration is working on it.  But universality is more important here than anywhere else.  I welcome comments from the docs here, and anybody else with specialized knowledge to contribute.

CynThesis

It All Started With the Witch Doctor

Since our Fearless Leader wants more stuff on health care, I’m contributing an abbreviated version of my first lecture in a course I occasionally teach, called “Professional Standards for Mental Health Workers.”  It has a heavily historical/anthropological slant, since my students, though highly competent and hard-working, generally have a lousy background in history, which I feel puts them at a serious disadvantage.

Let’s start with the premise that all professions are priesthoods, and all originate with healing the sick.  Terms like “witch doctor” and “medicine man” point clearly in this direction.”  “Medicine”, in Native American religious tradition is a synonym for “religious ritual/power.”  Like most pre-industrial medical traditions, it is based on the assumption that “sickness” can arise from or affect the body, the intellect, the emotions, and the spirit, in varying combinations.  Among the Navaho, for instance, many illnesses are believed to result from “sleeping with kinfolk,” contamination from proximity to corpses, or witchcraft–that is, the improper behavior of the patient or somebody else.

So the “medicine man” has to know things about the patient that the patient would  never want to become public knowledge. The patient will submit to treatment (and pay the doctor) only if the confidentiality of that information can be guaranteed.

Arthur C. Clarke, the science fiction writer, says that any technology we don’t understand is for all practical purposes magic. Healing the sick has always been one of the major attributes of divinities and their priests/shamans—a much more useful form of miracle than making water flow uphill or rods flower or whatever.  The ability to heal implies POWER, which is scary to those who lack it.  It implies, specifically, four kinds of power:
 power to heal
 power to withhold healing (“I don’t like you, or your brother killed my brother, so I won’t set your broken leg, nyah nyah nyah”)
 power to kill (anybody familiar with herbs knows poisons and abortifacients as   well as healing herbs)
 power derived from knowledge (about the natural world and about the patient–unavoidable access to confidential info) (imagine a delirious patient raving about a passionate interlude with a person to whom s/he is not married, for starters.)

So most cultures generate some kind of code for their priests and healers, to restrain this power and keep it channeled in paths likely to be useful for the culture as a whole. In this lecture, I assign the students to ask any professional or skilled craft person they meet during the week about the professional ethics of that craft, and get written documentation if possible.  I have gotten some fascinating samples: taxi drivers, sexual surrogates, veterinarians, child care workers, chefs—a long way from the Hippocratic Oath, which I generally see as the Ur-Document of its kind.  But they all have pretty much the same restrictions in common:
 Restrictions on use of knowledge and information
 first, do no harm:  for instance
 no poisons;
 in some cultures, no abortifacients
 no exposure of patients’ secrets (no blackmail)
 No favoritism in use of skills and knowledge, which must be made available to all, regardless of personality, affiliation, or resources
 No “overreaching”–using rare and necessary skills to extort undue recompense (pecuniary, or, for instance, sexual favors) (The course, naturally, has a whole lecture devoted exclusively to the issue of sex with patients/clients, which seems to be a problem for every profession with the possible exception of accountants, engineers, and veterinarians.  We’ve been blogging about Fountainhead lately, so you know it’s an issue for architects.)

The lecture then goes into a wildly condensed and popularized history of medicine, which I figure the various docs here are perfectly capable of providing us far beyond my poor amateurish power to add or detract.  The point of it, however, is not what technology and information has become available at various points in our history, but how we use it. Thus, it’s important to keep in mind that there is a big difference between:
(1) what we can conceive  of doing
(2) what we can actually do
(3) what we are  actually doing
(4) what most people actually have done.

These days we pretty much presume that we can develop any technology we decide we want to develop. The areas of cosmetic medicine, infertility treatment  and organ transplantation seem to be where we have actually decided we want to develop technology.  Economics is probably the driving force behind these choices.  Doing things people want is almost always more profitable than doing things people need.  It took medicine a while to come up with serious work in the former area, but now medical science has clearly taken that ball and run with it.  More about this later.
At the same time, mental health issues, which seem to be more and more salient as a source of real social problems, are being offered less and less attention from everybody except the drug companies.  This is probably economically driven too.  Drug companies can make lots of money in large gobs, while the more labor-intensive methods of treating mental illness dribble out the money in tiny drips to lots of people. .  The things psychotherapy can do–usually over long periods with close attention–are miles away from what most psychiatric patients actually get.
All of the chapters of the history of medicine exist in the US today, side by side, like the rings on a tree.  There is a ring in which sickness is still believed to result from the patient’s improper behavior (these days, we have given up on policing health in the bedroom, and taken up jackbooted thuggery in the dining room instead, but the results are the same.)  There is another ring in which the most drastic intervention is the most highly regarded (especially in the treatment  of cancer, where chemotherapy does a lot of the same thing that purges and bleeding used to do–the Ben Tre “destroy the village to save it” theory of medicine.)   There is a ring in which the doctor’s job is to keep the patient comfortable until nature takes its course (that’s what hospice care is all about.)  There is a ring in which medicine actually works, like a well-run car repair shop.  And finally, the local “wise woman” is still around (herbal shops and healers in Chinatown, Hispanic neighborhoods, and New Age enclaves, etc.)

The economics of medicine work differently in each of these rings.  Undoubtedly, whatever finally comes out of Congress (if anything) will not be fine-tuned to these distinctions.  Probably we should be looking for a minimalist and mostly-preventive approach: make sure everybody, regardless of ability to pay, gets vaccinations, wellness counseling, treatment for infectious diseases, mental health care, and palliative end-of-life care, and let the Almighty Free Market do everything else. Mental health care, BTW, should be required to include some treatment for whatever DSM-V calls the compulsion to scream and shout disruptively at public meetings.  Without it, our democracy cannot survive.

CynThesis

Do Americans Watch Too Many Hospital Shows?

Watching Marcus Welby may have led Americans of a Certain Age to expect house calls and long conversations with their doctors.  Watching ER may have led younger Americans to expect a lot of noisy rapid action.  Watching Grey’s Anatomy or General Hospital may have led many of us to sneak a peek into supposedly empty hospital rooms in hope of catching younger medical personnel in flagrante delicto.  Popular culture undoubtedly shapes our expectations of the health care system, for better and for worse.

Age, class, and gender play their part, too.  Younger males, especially blue-collar men, want as little contact with the health care system as possible.  Real men don’t go to doctors and don’t take meds.  Real blue-collar men watch ESPN, which rarely deals with medical issues other than the ingestion of illegal substances by professional athletes. Naturally, this tends to make doctors, when seen at all, the bad guys.

Women generally get stuck functioning as the designated interface with the health care system on behalf of everybody else in the family until they are old enough to need somebody else to handle those duties on their own behalf.

Middle-class, educated, white-collar Americans have higher expectations, because in addition to watching Private Practice and Hawthorne, they read Scientific American and the Health section of the daily paper.  Which leads them into the same trap we collectively fall into:  losing track of the distinction between what we can imagine being able to do, what science has worked out the how-tos for but not implemented yet, what elite medical care can provide if paid enough for it, what is actually being done in the majority of American facilities, and what poor people can get if they’re really lucky.  The popular culture culprit here may not be a hospital show at all, but CSI and other purveyors of gee-whiz technology.  In an earlier generation, we didn’t have so much trouble realizing that Dr. McCoy’s scanner was a couple of centuries away. Today, we rarely think about the fact that the various non-invasive technologies for imaging and surgery  that we really do have available now are EXPENSIVE.  ER was pretty good about discussing the financial facts of medical life where they were relevant to the plotline, but of course, in an emergency room, the law requires every bona fide emergency patient to be treated regardless of ability to pay, so the issue didn’t necessarily come up until much later, usually long after the show was over.

Quite possibly what popular culture and the health care system should be working on together is a medical version of Car Talk.  You know, that Public Radio show on which, every Saturday morning, two Italian-American mechanics (both MIT-educated, and one of whom has a PhD, so much for blue-collar credentials) take questions from listeners nationwide about the foibles and failings of cars and mechanics.  They have a pretty healthy and realistic attitude toward both.  Cars are mortal.  All cars eventually disintegrate and die.  Mechanics are fallible and sometimes greedy.  Car dealers and their repair and maintenance facilities are not necessarily much better.  But most of us can keep our cars running for well over 100,000 miles by paying attention to telltale noises (Car Talk makes me wonder if good hearing and possibly even perfect pitch are Bona Fide Occupational Qualifications for a car mechanic), tending to routine maintenance regularly, and not doing Really Dumb Things.  Some car problems are Really Dangerous, and some are just trivial or unpleasant.  Check with your mechanic to see which is which, and don’t hesitate to get a second opinion when the first one doesn’t sound right. Since most of their calls involve cars over five years old (that’s forty-five in people years), they have no gee-whiz technology to call upon, just basic grease-monkey stuff.  [Cars with GPS and rear view cameras are still brand new and under dealer warranty, so the Car Talk Boys never hear about them.]

This is precisely the level of technology most of us need to hear about when our bodies act up, except that we don’t usually give off telltale noises (other than the stuff stethoscopes listen for, which was probably a much larger part of the practice of medicine seventy years ago.)  Unfortunately, doctors are mostly too nervous about getting sued to offer medical advice to strangers on the public airwaves (note that the Car Talk Boys never issue any disclaimers about their advice. Is this because so far, most of us don’t sue our mechanics?)  There should be ways to work around this.  Because, at least until we start heading into the Geezer Years, most of us think of our bodies pretty much the way we think of our cars: we just want to keep them running reasonably well at reasonable cost for as long as possible.  We want our doctors to function like good car mechanics.  Mostly, we want them to specialize in doing things we mostly think we could do for ourselves if we wanted to take the time and trouble, but it’s easier to let somebody else do it.  We want hints on how to do some of the easy stuff for ourselves, and then we just want to leave the complicated stuff to them.  If we could drop our bodies off at the hospital and come back for them later, most of us probably would, especially if we could get a suitable loaner in the meantime (Here’s a slightly used Mel Gibson, shouldn’t give you any trouble, but it’s only got a quarter tank of gas, be sure and have dinner on the way home tonight…)

And in the Geezer Years, we probably don’t expect what the medical establishment seems to think we do.  We don’t want to live forever. We just want to keep functioning more or less normally for as long as possible. We don’t want to fight as long as possible.  Whose idea was it to depict medical intervention in terms of combat in the first place anyway?  These days, a lot of patients regardless of gender seem to buy into the model, but I suspect that’s mostly because they are made to think they ought to.  I know the denizens of That Other Blog will say I’m pushing euthanasia or assisted suicide or something, but I think if the medical establishment were willing to tell patients it’s okay to give up or give in beyond a certain point, a lot of people would, thereby sparing themselves a lot of unnecessary pain and perhaps also cutting down on the enormous proportion of lifetime health care expenditures that is now spent in the last six months of life.    Nurses are often better at talking about these realities than doctors, and maybe they should be encouraged to do it more often.  It is their primary job, after all, to care about how the patient feels. Maybe hospital chaplains should be recruited for these discussions too; they are mostly connected with faith traditions that tell us the soul is more important than the body, after all.  Doctors, on the other hand, tend to see themselves as the patient’s designated champion in the combat against death.

Well, enough of awkwardly chosen metaphors (a man’s reach should exceed his grasp, or what’s a metaphor?)  Now that Obama has started talking about what used to be health care reform as health insurance reform, we will need to start looking elsewhere to change the health care system.  Stay tuned for The Body Talk Boys, Mark and David Welby, and don’t eat like my brother.

CynThesis

Poison Pills

Acetaminophen turns up everywhere, in anything that bears any relation to making somebody feel better.  It gets mixed into cough medicine, cold medicine, tranquilizers, migraine meds, and prescription painkillers.  Sometime around thirty years ago, it suddenly replaced aspirin everywhere except in doctor jokes.  This happened for several different reasons.

One was that the patent on aspirin had long since run out.  So anybody could use it for anything.  As a result, those who manufactured it couldn’t charge outrageous sums for it.

Another was that aspirin did, and does, have side effects.  Most of them have to do with bleeding, especially in the digestive tract.  People with ulcers are especially at risk from aspirin.  And then, in 1963, aspirin turned out to be connected, in ways that are still mysterious, with Reye’s Syndrome, a sometimes fatal illness that attacks children and adolescents.  So there are good medical reasons not to recommend aspirin for children and ulcer patients.

But the most significant reason for mixing acetaminophen with prescription painkillers has nothing to do with improving the effect of those medications, or avoiding the side effects of aspirin.  Rather, it is added to legal oral medications so that turning them into illegal injected drugs will be difficult or impossible.

Now, the health care industry is starting to worry about acetaminophen.  It too has side effects.  In excessive doses, or in combination with even a small amount of alcohol, it can seriously or even fatally damage the liver.  And since it turns up in so many medications, accidental overdoses can be tragically easy.  Some experts advocate  putting conspicuous labels on any medication that contains acetaminophen, and large-print warnings against overdosing. Others recommend simply eliminating it from any mixture to which it does not actually contribute anything useful. No doubt adding it to oxycontin or codeine was not originally intended to make those drugs more dangerous, but ultimately it does have that effect (rather like adding various poisonous substances to rubbing alcohol to keep it from being sold as a beverage without payment of the liquor tax..)

Mr. Wired suggests, if the pharmaceutical industry really wants to keep addicts from shooting up oxycontin or codeine from tablets, they could just as easily mix fiber into them—psyllium or whatever they use for Metamucil.  Not only would it make the tablet uninjectable, it would also serve to counteract the constipating effect of many opiates.  A whole new marketing gimmick, and one that would actually be useful to the patient.

The underlying question remains, however.  The War on Drugs makes it a lot harder for real patients with real medical needs to get analgesics without risks to their health than for addicts to get their daily fix.  Somehow I suspect that this is not what Hippocrates had in mind.

CynThesis

The Upside to a New Technology

HD Radio

For those of you who haven’t heard of it yet, HD radio offers the possibility of a lot of really good stuff to the listener.  No, it bears absolutely no relation to HD television. But it is digital, and it comes in much more clearly than AM and many FM stations.  For more technical stuff, see http://en.wikipedia.org/wiki/HD_Radio.  At least here in Chicago, stations are really taking advantage of it.  Especially 95.5, which used to be easy-listening jazz and then got bought out by a Hispanic megastation.  Now their HD station has reincarnated the previous easy-listening jazz station.  Good for them!  Most stations are just using HD to broadcast their usual stuff, but we’re hoping to see some more originality soon.  Unlike Sirius and XFM, it’s non-subscription, but you do have to have a dedicated radio.  There are several brands, but most of them are available only on-line.  The only place I know of to buy them in person is Radio Shack.  Obviously things may be different outside Chicago.  It would be nice to hear about what’s available in HD radio elsewhere.

Jane Grey