Standing Up for What Matters: On Sicko, Unspeakable Things, and Medical Reality

Dirty Work 

This can be disturbing work for a doctor, as you might imagine. After all, we’re trained to provide care to the sick, not withhold it. This is why the insurance companies assuage their physician employees by assuring them that there is no moral conflict here, because the physicians are not actually denying care, they are only “denying payment.”2

This pharisaical hairsplitting is not always convincing. Some of these company physicians have developed such a bad conscience that they have repented publicly. Moore shows a film clip from the 1996 congressional testimony of Linda Peeno, MD, a former medical reviewer for the health insurer Humana. Peeno, who is trained in internal medicine and infectious disease, confessed how her decisions doomed people. In a blistering statement prepared for the House Subcommittee on Health and Environment,2 she said, “As a former medical director, I have done the dirty work of managed care. This prompted me to leave and work aggressively for health care ethics…. I wish to [make] a public confession: In the spring of 1987, as a physician, I caused the death of a man [by denying him a heart transplant]…. I was ‘rewarded’ for this. It bought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the ‘good’ company doctor: I saved a half million dollars! Since that day, I have lived with this act, and many others, eating into my heart and soul…. I accept my responsibility now for this man’s death, as well as for the immeasurable pain and suffering many other decisions of mine caused.”

For Peeno, the problem is systemic in the industry. “We have created a monster system,” she maintains, “one in which among other transgressions, a physician can receive a high income for doing the reverse of the profession. Instead of delivering care, a physician can be significantly rewarded for denying it…. We have no ethical foundation if we are producing discord and destruction of human bodies and spirits…. The greatest irony to me is how the words ‘quality’ and ‘outcome’ have come to be industry buzz words, yet neither are ever applied to the managed care practice itself. We have enough stories of [malfeasance] by managed care to fill tomes, and yet we continue to allow the industry to claim that these occurrences are simple anecdotes. As long as we accept that rationale, we sanction a system that is functioning with virtually no checks and balances—ethical or legal. At a time when nearly every other human endeavor faces ethical scrutiny, how can we allow a particular industry to escape—especially one with so much potential [to] harm?”2

In November 2006, I discussed in this column another ethical lapse of physicians—their complicity in the torture of detainees currently held in US military prisons, which has led to scores of documented homicides.3, 4 These activities violate the Geneva convention, to which our country is a signatory, and every code of medical ethics written since World War II. Torture may seem unrelated to the denial of insurance claims, but they have this in common: both actions are directed toward those who are powerless and helpless before a faceless, impersonal bureaucracy, and both actions result in the psychological and physical degradation and occasional death of individuals.

But it is not just highly placed claims deniers like Peeno who need an ethical gut check. Almost the entire medical profession in the United States is in bed with medical insurance companies and HMOs. To the extent that physicians affiliate with these health plans and accept patients who are insured by them, they accept in advance the right of the insurance company to deny payment, which, practically speaking, is the same thing as denying care—the realization that triggered Peeno’s ethical meltdown. Most practicing physicians never consider that they are aiding and abetting the “monster system” Peeno described before Congress, yet we are part of the problem.

That’s not just my opinion. To see how physicians’ views of ethics are influenced by methods of reimbursement, we have only to review the codes of medical ethics in countries that have some form of universal healthcare and compare those ethical codes to ours. For example, the Code of Ethics of the Australian Medical Association offers this guidance to physicians: “In order to provide high quality healthcare, you must safeguard clinical independence and professional integrity from increased demands from society, third parties, individual patients and governments. Protect clinical independence as it is essential when choosing the best treatment for patients and defending their health needs against all who would deny or restrict necessary care. Refrain from entering into any contract with a colleague or organisation which may conflict with professional integrity, clinical independence or your primary obligation to the patient [emphasis added].”5 In contrast, the ethical code of the American College of Physicians (ACP) concedes the right of higher-ups to intervene in the actual delivery of healthcare. “Resource allocation decisions,” the ACP ethical code says, “are most appropriately made at the policy level rather than entirely in the context of an individual patient-physician encounter.”6 It’s as if medical insurance companies and HMOs wrote this section of the ACP code.

Many physicians are troubled by the ethical compromises they see in medicine today, and they believe these issues are tied to the way medical insurance companies have inserted themselves into the doctor-patient relationship. An example is Physicians for a National Health Program (PNHP), which favors universal healthcare for all Americans.7 On their Web site, PNHP cites a recent poll showing that “managed care had a respectability rating just above the lowest-rated tobacco industry.” Physicians for a National Health Program quotes Peter van Etten, president of Stanford Health Services, who says, “In this insanity of economics of health care, the patient always loses.”8

Turning a Blind Eye 

How do physicians become involved in activities such as these? What deal do we make with ourselves to justify our behavior? Where is the line crossed, beyond which ethics no longer matter?

I suggest that this road is paved with a thousand small decisions that, if wrongly made, gradually erode ethical norms, make compromise easier, and degrade behavior. These choice points involve truth telling. They require the courage to stand up for what matters, and as the late Senator J. William Fulbright said in the epigraph, to be willing to think unthinkable things—things that go against the grain—and to speak of them as well, in spite of the fact that it may be unpopular to do so.

One subtle way these compromises gain traction is when we ignore the significance of what we observe clinically as physicians—when we pretend that a particular event does not really matter all that much or that it never existed. Taken singly, these choices are not earthshaking, but when considered collectively they have the power to shape our medical reality—often in the wrong direction.

Let’s consider, for instance, how we respond to the spontaneous remission of lethal diseases. In particular, let’s look at the case of four-year-old Ann O’Neill, who was hospitalized with acute lymphocytic leukemia in Baltimore in 1952.9 At this time, this disease was 100% fatal. The priest had given her a final blessing, and her aunt had prepared her burial garment, a hand-stitched gown of lovely yellow silk. When the head pediatric nurse asked the little girl if she’d like to go to heaven, Ann’s feisty mother said, “No, Sister, not yet.” Dr John Healy, a pediatrics resident at the time, has vivid recollections of the all-consuming faith of Ann’s mother. “She never even questioned for five seconds that this girl was going to get better,” he recalls. Shortly thereafter Ann’s parents bundled her up, took her out of the hospital into the rain and to the cemetery where Mother Elizabeth Seton, a revered Catholic nun, lay buried. Surrounded by praying nuns, they laid her on the tomb and asked for a healing.

Back in the hospital, blood tests a few days later showed no trace of cancer. Ann’s physicians were baffled. When word reached Rome, Vatican investigators trooped to Baltimore to see for themselves. Nine years later, the Church insisted that Ann undergo a bone marrow biopsy to confirm her cure. At this stage Dr Sidney Farber, the well-known Harvard pathologist who had pioneered the first effective treatment for leukemia, oversaw the investigation.

Dr Milton Sacks, Ann’s physician and one of the country’s foremost hematologists, testified at the Vatican tribunal that she should not have survived in view of her 105° fever, severe anemia, and the bloody sores on her neck and back. He emphasized that, at the time, her disease was “inexorably fatal.” Eventually, the Pope declared Ann a miracle, and not long afterward he canonized Mother Seton as the first American-born saint.

This important case was never reported in the medical literature. In 1993, Dr Sacks told Tamara Jones, a Washington Post reporter, “The only reason this case has not been written up is that I have been afraid to.”10

Afraid of what, exactly? The fear involves mainly one’s reputation among colleagues. Publicly acknowledging that an apparently impossible cure took place following prayer is risky. It suggests, God forbid, that one believes in miracles.

When physicians remain silent and shrink from truth telling, the transgression is one of omission, not commission. Sins of omission seem the less serious of the two; they require no effort and are easier on the conscience. But their collective impact can be significant, because, as in Ann O’Neill’s case, they distort medical reality and our view of what is possible. It may not have mattered greatly that this individual case was not reported, but when hundreds or thousands of such instances are ignored, a false picture results and disease wins out.

In 1993, the Institute of Noetic Sciences of Petaluma, California, brought together thousands of Ann O’Neill-like cases in a landmark work, Spontaneous Remission: An Annotated Bibliography.11 Researchers Brendan O’Regan and Caryle Hirshberg found more than 3,500 cases of spontaneous remission after combing 800 journals in 20 languages. Seventy-four percent of the cases involved cancer, but all major diseases were represented. This database, the largest in the world, demolished the prevailing notion that these cases are exceedingly rare.

As of 1993, only two texts and one monograph had explored the field of spontaneous remissions, all of which had been out of print for years. The picture they painted was that, although spontaneous remissions existed, they were rare as hen’s teeth. None of these publications compared with the Noetic Sciences’ project in thoroughness. The result had been a virtual blackout on a subject that, if fully engaged, could have radically altered our perceptions of self-regulation and repair, and how human consciousness fits into the equations of healing.

The Cost of Denial 

When we physicians triage particular clinical experiences to the category of the unspeakable and clam up about them, we contribute to a false accounting of medical reality. But the results don’t end there. These mini-lapses of honesty take a toll on us psychologically and physically.

Psychoanalyst Elizabeth Lloyd Mayer, in her magnificent book Extraordinary Knowing: Science, Skepticism, and the Inexplicable Powers of the Human Mind, describes a patient whose unusual abilities made him famous.12 By the time he came to her for help for intractable, severe headaches, he was a world-renowned neurosurgeon. He was summoned when heads of state, dignitaries, and the wealthy needed their brains cut on. He told Mayer that he never loses a patient, no matter how drastic the surgery.

His life seemed to click on all fronts; he was at the peak of his profession with a loving marriage and wonderful children. The only problem, he said, were the headaches, for which no physical cause could be found. They were destroying his life, and he had come to Mayer as a last resort.

Mayer probed for leads and clues. Because he was on the staff of a large university hospital, she inquired about his teaching duties. Sadly, the man said that he did not teach any longer.

“I had to stop,” he stated.

“You had to?” Mayer asked.

He explained how he could not keep up his teaching and had abandoned it, although he loved it as much as surgery itself. He disclosed to Mayer what he’d never told anyone—that he stopped teaching because he believed he could not teach what he actually does.

“He tells me why his patients don’t die on him,” Mayer writes. “As soon as he learns that someone needs surgery, he gets himself to the patient’s bedside. He sits at the patient’s head, sometimes for thirty seconds, sometimes for hours at a time. He waits—for something he couldn’t possibly admit to surgery residents, much less teach. He waits for a distinctive white light to appear around his patient’s head. Until it appears, he knows it’s not safe to operate. Once it appears, he knows he can go ahead and the patient will survive. How, he asks me, could he possibly reveal that? What would the residents think? They’d think he was crazy. Maybe his is crazy. But crazy or not, he knows that seeing the white light is what saves his surgeries from disaster. So how can he teach and not talk about it? It’s a horrible dilemma. He’s adopted the only possible solution: he’s quit teaching.”

When Mayer asks him when his headaches began, he is startled. “It hits him and hits him hard,” she notes.

“That’s interesting,” he says. “The headaches started two years ago. And I remember when I noticed the first one. It was the day I resigned from teaching, right after I told the dean….”

What is that white light that guides this world-class neurosurgeon? If I were one of his patients, it would not matter to me if the light was physically real, an angelic presence, or luminescent pixies. I’d get down on my knees and thank the high heavens that I had the best person operating on me, even if he were crazy as a bedbug.

Mayer doesn’t reveal whether the neurosurgeon’s headaches improved or if he owned up to his experiences and went back to teaching. Instead, she leaves us with a vivid picture of his dilemma. “The neurosurgeon with his headaches was an emphatic demonstration of how the fear of appearing credulous or crazy leads many people to disavow their reality, which can paralyze their creativity, conscience, and freedom to be themselves.”

Dropping the Pretense 

Those outside of medicine may find it difficult to imagine the pressure on physicians to remain silent about matters such as the neurosurgeon’s white light. One researcher who bumped into this situation is Jeffrey S. Levin. Levin is one of the outstanding modern pioneers in consciousness-related medical research and a member of the editorial board of Explore. He is a social epidemiologist who founded a new field of study he named the epidemiology of religion. The National Institutes of Health funded his landmark research for many years.

Levin’s passion and great gift is deciphering the impact of religious and spiritual practices on health and longevity. When he began this research in the 1980s, it was considered scientific heresy, hardly the best way to advance your career as a young medical scientist. He persevered, however, and other researchers followed. As a result, there are now thousands of studies in this field, and they reveal a consistent picture: those who follow some sort of spiritual path in their life—it does not seem to matter greatly which one they choose—live longer and are healthier than those who don’t. They have a lower incidence of all the major diseases of our day, including heart disease and cancer.

At one stage of his career, Levin was recruited for the faculty of a medical school on the East coast. By this time, his accomplishments were widely known. His reputation preceded him, and his new colleagues regarded him as someone who was open to unconventional ideas.

Levin told me that as soon as he was settled in his new position, his fellow faculty members began to drop by his office to share things they’d never told anyone else. They’d quietly enter, close the door, and often speak in a whisper, as if the walls had ears. They revealed weird premonitions that had come true, “funny coincidences” that had shaken them up, and visions and revelations that had occurred out of the blue. They always did so with a sense of secrecy, as if they might pay a terrible price if anyone discovered they harbored such thoughts.

Eventually it came time for Levin to present a talk at grand rounds, the weekly conference at which some faculty member discusses research in his or her area of expertise. He concluded with a personal appeal. He described to his colleagues how they had visited his office over the past few months and unburdened themselves of their strange experiences. “Look around you,” he said. “The person on your right has told me things he or she is unwilling to reveal in public. The person on your left has done the same. Over the past year, nearly all you have told me things you won’t tell each other. We all know these things happen. So can we just drop the pretense and be honest with one another?”

They could not do it. They were unwilling to speak about unspeakable things. They opted instead for a make-believe version of reality in which everything is well behaved, orderly, and, most importantly, professionally acceptable. Their visits to Levin’s office ceased as they put their masks back on, and once again became mute about some of the most meaningful experiences of their lives.

Laser Meditation 

When things become unspeakable for physicians, patients sometimes get caught in the middle, as in the following example from Levin’s remarkable book God, Faith, and Health.13 It involves, once again, that pesky white light.

Carl, a retired pharmacist in his 80s, had always had an adventuresome spirit. Back in the 1970s, at the suggestion of his daughter, he attended a class in Transcendental Meditation. He took to it quite naturally and began a faithful practice. Twice a day, for 20 minutes at a time, he’d sit on the sofa and enter the peaceful state that mystics have described for millennia.

One day Carl developed severe abdominal pain that his physician diagnosed as gallstones. Because of his age, Carl’s doctor advised not surgery but lithotripsy, which uses ultrasound shock waves to fragment the stones so they can be passed naturally. Carl traveled out of state for further evaluation at a specialty clinic, where this procedure, then quite new, was offered.

The specialists determined that Carl was an ideal candidate for lithotripsy, and they decided to use him as a demonstration case at an upcoming international conference to be held at the clinic. Specialists worldwide would be coming, and Carl would be a star subject. He went home to wait out the two weeks before the conference.

Once home, he resumed his meditation practice, just as he’d done for a decade. Twice a day he would repeat his mantra, enter a blissful state, and visualize clear, white light entering the top of his head, radiating through his body, and burning like a laser through the stones in his gallbladder. He kept this up for two weeks and then returned to the clinic.

While medical specialists from around the world watched, Carl was wheeled into the imaging area to determine the location and size of his gallstones. When the tests were finished there seemed to be a problem, so they were run again. Again something was not quite right. Carl saw the doctors conferring, and they looked confused.

The specialist in charge approached Carl and asked accusatorially, “What have you done?” Carl did not understand why the doctor was so angry and was not entirely sure what he was being asked. So he revealed his Transcendental Meditation practice, his blissful state of awareness, and his white-light visualizations. The specialist was incensed. In front of the visiting doctors, he screamed at Carl, “You ****** up our conference!” Carl, it appeared, had completely dissolved all his gallstones.

He was sent back to his room, like a scolded child. Just before being discharged, he was visited by a specialist from India who was attending the conference. The physician smiled and shook Carl’s hand. “Don’t you worry about what that other doctor said,” he reassured Carl. “I’m from India and I know exactly what you did. That was very good.”

At the time Levin published this account in 2001, Carl was nearly 100 years old and in remarkably good health. He was continuing his practice of meditation, bringing the white light into his body twice a day.

Intuitive Obstetrics 

There is good news. Unlike the above examples, many physicians have risen to the challenge of truthfulness by thinking the unthinkable and speaking the unspeakable. In doing so, they have added richness and depth to our picture of medical reality.

An outstanding example is Larry Kincheloe, a courageous obstetrician/gynecologist in Oklahoma City.14 By speaking out, Dr Kincheloe has become the chief architect of what he calls intuitive obstetrics. As he writes:

I recently returned from a conference…where…I promised to myself that I would overcome my fears and open a topic that I have been dealing with for the past twelve years, and which has never been discussed openly in obstetrical literature. The fears are that I will be ridiculed by my professional colleagues, with all the potential professional ramifications that could bring. There is also the fear that no other physician will come forward to help validate my insights ….

First some background history. I was working on my doctorate in counseling psychology when I made the decision to go to medical school, and so I entered medicine with a solid belief and foundation in mind-body connections. But while in medical school I felt a strong calling to go into obstetrics and gynecology, even though I had originally believed that I would practice in the field of psychiatry. After completing my training, I went on to join a very traditional medical group and practiced for about four years without any unusual events. Things were pretty routine until about twelve years ago.

One Saturday afternoon I received a call from the hospital that a patient of mine was in early labor. Routine orders were given, and since this was her first baby the nurses assured me that delivery would be hours away. I was working out in the garage sweeping leaves that had blown in when I experienced an overwhelming feeling that I had to go to the hospital. I immediately called labor and delivery and was told by the nurse that everything was going fine. The patient was only five centimeters dilated, and since this was her first baby delivery shouldn’t occur for several more hours.

Even with this reassurance, the feeling got stronger and I began to feel an aching pain in the center of my chest. The best way to describe it is that it was similar to the feeling one has when they are sixteen years old and lose their first love. It was a dull, achingly sad, melancholy feeling that was centered in my chest. The more I tried to ignore the sensation the stronger it grew, until it reached the point that I felt I was drowning and would do anything just to get to the hospital. I quickly got into my car and headed there. I noticed that the closer that I got to the hospital the better I began to feel, and there was an overwhelming, enormous sense of relief when I walked into the labor unit.

When I reached the desk, my patient’s nurse was just walking out of the patient’s labor room. She asked why I was there and I had to honestly admit that I did not know, only that I felt I was needed and my place was here. She gave me a strange look and told me that she had just checked the patient and that she was only seven centimeters dilated. Just then a cry came out from the labor room. Anyone who has ever worked in labor and delivery knows that there is a certain tone in a woman’s cry when the baby’s head is on the perineum. I rushed to the patient’s room just in time to help her deliver a healthy baby. Afterwards the nurse asked how I had known to come to the hospital even after she had told me that delivery was hours away. I had no answer for her.

After that day, I started paying attention to this feeling and trusting it enough to act on it. I can now count hundreds of times that I’ve had these intuitive feelings. I now routinely act on these intuitive events, and usually by the time I get a call from labor and delivery I am already getting dressed or in my car on the way to the hospital. I often just answer the phone by saying, “I know, I am on my way,” somehow knowing that it is labor and delivery calling me to come in. This is now such a common occurrence among the labor and delivery nurses that they tell the new nurses, “If you want Dr. Kincheloe, just think it and he will show up.”

Just last week, I had the feeing that is now all too common. I called the labor and delivery floor and talked to a new nurse who was taking care of a patient of mine who was in active labor. I asked her how things were going with my patient, and she reported that the patient was resting comfortably with an epidural and that she had a reassuring fetal heart rate pattern. I once again asked her if she was sure that nothing was happening that required my attention. With a tone that reflected some frustration, she said, “I told you I just checked her and everything is fine.”

In the background I heard another nurse say, ‘Ask him if he is having chest pains.’ Somewhat confused, she asked me. I replied that I was, in fact, having those feelings and she relayed this answer to the other nurse. I heard the other nurse say in the background, ‘If he is having his chest pains, you had better go check the patient again.’

‘Just a minute,’ she said, and she put down the phone and went to check the patient. I heard the hurried sound of her footsteps returning and she quickly related to me that the baby’s head was on the patient’s perineum, and that I needed to hurry for delivery.

I once tried to bring up the topic of intuitive obstetrics with my professional colleagues, but I quickly stopped after getting quizzical looks of disbelief. Most physicians have a difficult time in dealing with concepts in which they have had no training or experience.

So, what is going on?

Pregnancy is a very special time in a woman’s life, when she is changing on a physical, emotional and spiritual level. It is a time of vivid dreams, strong feelings and intuitive events. The bond between the obstetrician and the pregnant patient is unique in medicine.

Could intuitive obstetrics be part of the spectrum of nonlocal healing? If intention can be sent out from the healer to a person in need, then could not intention be sent out from the person in need to the healer? Is the ability to receive intention something that has been suppressed in physicians by formal training and academic medicine? We are taught that medicine is a field of science based on hard data and research. But is there a place for “gut feelings” and the trusting of one’s intuitive self?

So, there it is—the notion of intuitive obstetrics. Hopefully this might lead to a discussion by obstetricians and physicians of other specialties who might be able to share their insights and their own experiences.

The View Ahead 

I’ve suggested that there is a common thread in the various ways we healthcare professionals distort medical reality, whether it is the reality of the current healthcare mess or the reality of our personal and clinical experiences. The common denominator involves our willingness to confront our experiences piecemeal, acknowledging some and discarding others.

Our refusal to look facts squarely in the face is often unconscious, and the resulting changes in our behavior are incremental. Sometimes they are so gradual we don’t fully comprehend what we’re doing.

That is how Dr Linda Peeno drifted into a situation she could not live with as a medical claims reviewer for a large insurance company, as we’ve seen. Even when she realized she’d taken these steps, she found ways to avoid questioning what she’d done and what she’d become. “When one is part of a larger organization,” she said in her congressional testimony, “one can create distance and diffuse responsibility such that all ethical responsibility shifts elsewhere or is eliminated altogether. In my work as an executive physician, I sat from a desk never facing patients or physicians whose lives I held in my hand. I wielded the power of payment, which translates to the power of life and death. Was I responsible when an adverse consequence occurred? No, never. The physician taking care of the patient would be, never mind that his or her hands may be too shackled to do what was necessary. Was I responsible if the patient did not get something necessary? No, never. I denied payment, not care. Was I responsible for another’s suffering? No, never….”2

We physicians may be lured into these activities—by six-figure salaries, bonuses, and impressive titles—but we are not coerced into them. We make these bargains willingly. That’s what sickened me in Sicko—the sight of a great and good profession voluntarily debasing itself in the service of profit at any cost.

Filmmaker Michael Moore has been vilified all his career because of his “in your face” approach to his topics. Moviegoers are seldom ambivalent about his films; they either love them or hate them. Many use his tactless methods as an excuse to dismiss his message altogether. In Sicko, Moore once again treats his subject in his rough-and-ready, confrontational style, speaking of things that, as a society, we’ve considered unspeakable for a very long time. Delicacy is simply not Moore’s game. If he has to shed a little blood, eviscerate, shock, or offend in order to get his message across, he’s willing. Will he make a difference?

“Prediction is very hard, particularly of the future,” physicist Niels Bohr once said.15 This is nowhere truer than in healthcare. But a new zeitgeist is forming in which our collective disgust about the current healthcare chaos is building to unprecedented levels. Whether we can find the leadership and courage to walk through the door of significant change remains to be seen.

If we are to do so, many unspeakable things must first become speakable. This includes the fact that, according to the World Health Organization, our country ranks 37th in the effectiveness of healthcare for our citizens, just ahead of Slovenia, in spite of the fact that we massively outspend every other country16; that nine million of our children are uninsured—a national disgrace17; that we lag embarrassingly in longevity and infant mortality16; that the leading cause of personal bankruptcy in America is medical catastrophes, even among educated middle-class families who have some insurance18; and that we are the only wealthy, industrialized nation that does not ensure that all citizens have healthcare coverage, which, according to the Institute of Medicine, results in the death of 18,000 Americans each year—six times the death toll of 9/11.19

In closing, a vision and a hope:

It happened. Contrary to the predictions of all the experts, America woke up to the realization that its healthcare system could be transformed. Faced with epidemic voter rage and the threat of being turned out of office, politicians from both major parties discovered, to the surprise of everyone—especially themselves—something long considered extinct: their spine. Healthcare was finally disconnected from profiteering and within months was available to everyone. The old, the very young, and the poor no longer went wanting. The hackneyed scare tactics that had long been used to oppose universal healthcare coverage—runaway taxes, “socialized medicine,” long waiting lines, and rationing of care—proved baseless. The country did not go broke; prosperity continued, alongside a sense of national pride and the realization that America, at long last, had done the right thing. Everyone knew we were on the right track when the leaders of both political parties boasted, “We thought of it first”—and when, to everyone’s shock, Michael Moore finally made a subtle, graceful, upbeat film he called Wello.