Salmon Upstream, LLC

Developing and implementing real-world community solutions.

  • MoveUP

  • DeltaSport

Musing of a Radical Cooperatist


A Convener of Stature

Governor Leavitt continuously championed collaboration throughout his career, and he authored a book entitled “Finding Allies and Building Alliances.” In the book, he outlines the commonalities of successful alliances from analysis of hundreds of organizations and programs at both the state and federal levels, in government and private sectors, spanning large publicly traded industries and nonprofits. His analysis identified eight elements that are essential for success. Some of these elements are almost obvious, like committed leadership or a common pain point for involved parties, but one in particular is not only critical but is often the most difficult to secure: a “convener of stature.”


ACTiN Frequently Asked Questions

ACTiN is an Advanced Connected Transportation Network. It is one of several interconnected networks that allows a community to interact with every conceivable transportation asset – including new ones – all in one place. To do this, we use a specially designed smartphone app called MoveUP.


Here's What I Believe

One of the most influential medical studies I read about was performed in the 1950s. The goal was to evaluate how we form and internally rationalize our belief systems.


Mixing Elixirs in a Sea of Bias

Man is required to deal with a multitude of challenges to live a healthy and happy life. Some of these challenges are environmental, some are physical. Some result from other lifeforms or even quasi-living things taking advantage of preexisting human systems for their own benefit.


Curing Our Community's Disease

People are suffering and dying, but you can do something about it. These are not people in a distant land, and they don’t have a communicable disease, these are people all around you, of all walks of life, of all races, young and old.


To Dad

My dad was pretty nerdy, so it’s not like I thought he was cool when I was growing up or wanted to be just like him. The fact is I would cringe when people said we looked alike or had exactly the same mannerisms.


Moving air in a good way

The amount at stake with education cannot be overstated. This is our Normandy. To all of the teachers out there, this is a call to battle, to you and to our society as a whole.


Do as I say. No really, I mean it.

My whole world now revolves around designing and implementing a therapy for poverty. How this relates to an app that facilitates transportation and deliveries is a bit much to get your head around, but the best part is that if it works, you won’t have to understand why.


Beating COVID with masks that work

If your knee-jerk reaction is, “make everyone wear masks,” then you are headed for disappointment, because what we are doing now is clearly not a solution. Think of the two biggest problems: continued isolation in nursing homes and total disruption of education. If masks are a solution, then why don’t we all put them on and just go back to regular life?


Is that a mask you are wearing, or just a placebo?

For my non-medical readers, the placebo effect is the somewhat dismissive term given to effects from a therapy that cannot be attributed to the treatment itself, like what might happen if you were given a sugar pill instead of an antibiotic. It is actually a manifestation of the poorly understood mind-body connection that we all have but is frustratingly difficult for physicians to manage. In this case, the placebo effect would include changes in mindset and related behavioral adjustments that a person might adopt while wearing a mask or even while seeing someone else wearing a mask. Some of these are good (reminder to maintain safe social distances in public places; inability to put your finger in your nose). Some of these are bad (reduced ability to meaningfully connect with others; continuous reminder of potentially deadly risk).


More fear thank logic.

This headline is just as criminal as yelling “Fire!” in a crowded movie theater.


Weak sauce and the spread of COVID-19

The intent was to look at how the virus spreads. The methods are solid, and we would be unable to duplicate it in the US due to differences in personal freedoms.


Just another COVID case

If I see another headline talking about increasing COVID cases, I think I may lose what little is left of my sanity. Why do you even put that out there? That’s a rhetorical question. We all know why you do it: because it’s scary and gets people to click on your so-called news page, even though you are telling us nothing of value but are instead trying to stoke the smoldering remains of a fire almost put out by riots.


Well this is just swell

We have been fighting about politics and religion since the dawn of man, and we have managed to twine them together throughout. I have been arguing with the same friends over the same issues since college (I don’t think I really gave any of it much thought before then). This isn’t going to change, so stop trying to get it to change. No one is going to win – we aren’t going to fight the ideological differences out of our philosophical foes. Yet we continue swinging with this false pretense that we have two parties with two philosophies so if we argue about it all we will somehow meet in the middle.


Life is essential

Since the very first time I saw this story, this guy has been an inspiration to me.



My goals are different, and I want to face life on my own terms. I want to teach my kids by example, to encourage them to look where they want to go and reach for that goal with fierce tenacity. And that’s how I want them to remember me.


Powering MoveUP with PHIsion

The name MoveUP doesn’t refer to moving people or even stuff, it refers to this idea that we might evolve as a s ociety by improving how we connect. We believe that intelligently designing and implementing a platform that allows us to live together cooperatively could facilitate reaching our maximum unified potential.


Social Policy - Simplfied

This is intending to explain the complexities of public health. The most important lesson: it’s complicated.


MoveUP. Finally

It's here. 4 years of planning, 2 years of software development, countless hours devoted to fixing a ubiquitous problem.


Logic / Fear

I am a doctor and I do not support the widespread use of cloth masks in public, and strongly oppose a government mandate to this effect. Many of you are already looking for the biggest thing you can pick up, so before the rocks and chairs are in the air, I will try to go through this logically.


Building digital infrastructure share networks

Over the past few weeks, I have been interacting with as many business and people as I can. The goal is to choose a platform for electronic fund transfer, which is why we haven't embedded this function yet.


If you want something done right...

There are three main forces that shape our lives, that hold together the framework of our modern society, listed here in the order in which they were created: government, industry, and healthcare.


Think Dunkirk

We are facing a crisis of a magnitude that few of us alive have ever seen. If we want to avert disaster and minimize the damage, we are going to have to do it ourselves.


Keep Living

It has become virtually impossible to even know who to listen to, as there are thousands of experts talking about everything from molecular biology to statistics to epidemiology and who is right?


Just like old times...

In those bygone days, I was a force to be reckoned with, provided you were over the age of 40 and lived within the city limits of Lynchburg and preferred long-course to sprint triathlons. Ah, those were the days.


ACTN (Advanced Connected Transportation Network)

This is the supporting document to the grant application I have submitted to the Virginia Department of Rail and Public Transit in the hopes of implementing MoveUP as a digital backbone to a comprehensive, collaborative transportation system for smaller cities and rural communities.



I bet you never thought small aftermarket auto parts companies could be critical to community health, but give me a bit to circle back around on this one.


Murica IS the best :) !!!

A bit ago, I picked up a twenty one year old 355 F1 berlinetta, my third example of this model, making my car ownership look much like the marriage history of a corporate executive or pro team owner.


Risky Business

Man has always been at his best when he is goofing off. A friend snapped this picture of me coming back from the grocery store today.


Letter on Vaping to Governor Ralph Northam

This is a new threat in a smoldering battle that has been going on as long as I have been in practice. As the director of our lung cancer program, I am well past tired of seeing people die from a disease that largely wouldn't exist were it not for smoking.



Unified4Kids is a cooperative community support program for kids with cancer, and the best thing about it is how it is going to enable everyone to make a meaningful impact in what has to be the most unjust disease process in the known universe.


Getting It

Let me state a hard truth: if this is a far as you are going to read, you aren't going to get it. Which is really frustrating, if getting it turns out to be important.


Goals for 2019

It's time to look back at my goals for 2018, see how I did, and set a few for 2019.


Moving the Needle

A very important two day meeting just finished. I have been to a lot of meetings over the past three years, but this one is going to stand out for a long time. Five senior executives from a very big company -- a multi-billion dollar industry leader -- came to our city to begin the step-by-step process of assisting us in becoming the healthiest city in the world.


Figuring it out is all that matters

We are all responsible for each other. It doesn't matter whether you like it or not, it's the way it is. So we have to build systems that enable us to help each other out, that connect us, that make life easier.


Cultural Shift

Our culture has long been one based on competition, and that's a hard core value to shake. So every time I see evidence that someone else has beaten us to an idea or solution, I have to suppress the gut reaction that we are too late.


Confidence in Chemistry

Everyone wants to be connected. Everyone needs connections. We can now provide safe, effective, connections without cost, and without strings attached.


Cooperatism and our unified potential

Writing is a way to vent frustrations, but it is also a way to organize thoughts. Putting ideas together in a way that other people might read them and understand what you are on about is a critical part of the process, certainly for me.


Going All In

What if you had an idea that might lead to world peace? How far would you go?


Taking control, for the right reasons

This one is for my fellow healthcare providers, an attempt to explain my bizarre actions of late. Drilling down to the heart of it, I am very frustrated, a little scared, and cautiously optimistic.


Bond. James Bond

Though the big V12 cars like the DB9 and Vanquish have been the flagships, the smaller and perfectly proportioned Vantage is arguably one of the best looking cars ever made.


No one fuels passion like the italians

My personal hero was Ferrari, with Lamborghini (specifically the Countach) a very close second. When I say that, I am referring to the cars, not the people. Honestly, as a teenager I knew little about Enzo Ferrari, or Ferruccio Lamborghini. Or racing or engineering for that matter.


Needs: a new approach.

I am not even going to dwell on the fact that we are all responsible for our neighbors who have genuine transportation issues – regardless of what those issues may be – so their needs are, in fact, our needs.


Finding our way.

When I took philosophy in college, I remember wondering what it was that these guys did all day.



Despite what you consistently hear, despite what you may even believe, America is without question the greatest country in the world.


It’s time to MoveUP

Transportation is a problem. It’s also an example. It’s a problem for all of us. It’s an example of how problems today really are all of our responsibility.



Mark Zuckerberg is not to blame for social media, no matter what its long term effects or where in our society it all settles out.


What makes a hero?

How do you define an heroic act? Does it require laying it all on the line at just the right moment, risking or even giving one’s life for another?


Progression to consumption of regression.

Income tax is actually regressive, because the system itself has far greater impact on those with lesser means than those with more. When everything you make goes to necessities of life, any reduction is tremendous.


The right way to think.

This one is for my “liberal” friends. I put that word in quotes because I hate it. I hate it because it is inaccurate, and just the label itself serves to put us into different boxes.


2 Years In…

This is the two year mark, and I am back where it started: Mayo Clinic, Scottsdale Arizona. As before, I find myself surrounded by some of the most incredible people, each tremendously inspirational in their devotion to advancing our understanding and treatment of disease processes, and in particular, cancer.


2018 Racing: preseason jitterbug.

We need to stop fooling ourselves: fun is an important basic need. So in an attempt to apply this theory, I think I will keep a running blog on the 2018 racing season.


Your barking dogma is driving me nuts (Injustice Exposure, Episode 3)

The first step to fixing a problem is recognizing you have a problem, and we have a big problem with dogma. Just like our resistance to change, acceptance and perpetuation of systems and ideology that have rested on outdated or even erroneous concepts makes forward progress all but impossible.


The Best of the Best

No matter what, not everyone will agree with the final pick. You would have people who, for a variety of reasons, thought one of the other guys was a better choice.


Goals for 2018

We have just crossed the one year mark since I snapped and decided to start down this bumpy road. I have listened, I have learned, I have screwed up, I have mode progress.


Does no one else hear that?

We had been driving down 95 with several hours still to go when dad heard something funny. None of us could hear it, but he was convinced it was a new little tick or knock. We pulled into a gas station and he popped the hood.


It really is TIME for a change…

I keep going on about the government being a mess, that they have no solutions for us. If that seems a bit arrogant – I mean, how can I possibly understand all of the intricate complexities that these folks have to deal with?


No, it’s NOT worth fighting over.

I keep going off that we have to stop lashing out at each other and find ways to get along. And right in the middle of our impending descent into a racist, totalitarian empire. How could I be so callous?


It’s not about money, but it’s not mindset either.

I was recently told – and I don’t disagree – that I have little experience swimming in the roiling sea of society’s issues. But here is an equally valid fact: all those super-smart visionaries that have been writing books for decades about how we should be, either individually or collectively?


The Heart of our Health

Look around: beautiful hospitals advertise state of the art care; new outpatient offices and procedure centers streamline access and convenience; revolutionary medicines are advertised on TV; billboards lure the sick by digitally showing the current and short wait time at a nearby ER.


Killing the uninsured

Allow me to try once again to explain what I mean when I say (1) the government can’t fix this, and (2) much of this is overblown crap designed to get you to think the other side is made up of horrible, horrible people. Like me.


We have come so far…

We have come farther than we realize, and it’s causing us issues. Allowing ourselves to backslide should not be an option.


Don’t hold your breath.

The pendulum swings back and forth, and at the peak of each swing something happens, people take credit for pluses, people point fingers for minuses, and yet we remain in the very same rut, just smashing back and forth on the rails like a bobsled with a team that spent a bit too much time entertaining the groupies.


Why Cancer Sucks.

Cancer generates a lot of fear. It is able to strike anyone, it is able to kill across all demographics.


Truth, Standards, Money. And Wagging Tails.

In a clumsy attempt to make a point about our political process, I employed a typical media tactic in suggesting our city’s governing body had made a careless error.


Fixing our biggest issue (with a sprinkle of barbarian).

Anyone that knows me at all knows that this is all new frontier for me.I was a science guy in college, and I specifically avoided taking classes with subjective grades. Like government. Especially government. Because even then, it seemed so illogical.


The Continually Silent Majority

The silent majority needs to find its voice right now, because I don’t know how much more I can take hearing only the noise from the fringes.


Truly Affordable Health Insurance. For All.

Yes, the private insurance companies will go nuts, because it is definitely stacking the deck against them. But we have a serious crisis, and in a situation like this, we need to be extraordinarily aggressive.


Race and the Confederate Flag

Sometimes when you screw up, it's hard to know what to do to make things right. (I am well versed). The ultimate solution -- undoing what was done -- is generally not an option.


Belief: The Power of the (Misguided) Mind

I believe the recognition of this power is fundamental to Dr. Z's insistence that it not be used in a disingenuous way. In other words, don't bullshit someone and say you are going to realign their chakra with a Red-Bull and a jade egg.


Competition in Medicine

I know in America we are bred to believe that competition is the ultimate method of bringing out the best, but think about what that means in healthcare: if one doctor or facility is the best, then everyone else is getting substandard care.


Taxes and Culture and Creative Solutions

It's much easier to criticize and point out the mistakes people make or the flaws in some system than it is to actually get things done. Probably 99% of the crap being batted about (including much of this right here) falls into that category.



I would describe my recent discovery of Zubin Damania as stimulating and empowering. My daughter described it as a "man-crush." Whatever.


Planned Parenthood

In an idealistic world, we would never ask the question, but our world is far from ideal. It is reasonable for an individual to take the stance that they will never personally support abortion in any form.



We in America love our cars. We like making them, we like driving them. Our country is big, and we have a lot of people, and we churn out a lot of exhaust. Regardless of whatever data is out there on climate change and carbon emissions, no one can argue that we burn up a lot of gas.


Gun Control: the Compromise

I am not even sure if we remember what a compromise looks like. Because in this case, it isn't the elimination of private firearms, and it isn't a continuation of essentially no regulation.


Gun Control: Stage Right

The major argument from those who are the most dedicated supporters of the second amendment is the ability of the people to defend themselves against a tyrannical government, but there are many who seem unable to get their heads around this entire concept. That sort of thing could never happen here, and we are above the atrocities committed by others around the globe. Besides, what good is a little rifle against the might of the government? If it all goes south, resistance will be futile.


Gun Control: Stage Left

Statistics on gun ownership and death rates in the US are a little grey, but a couple of things are irrefutable: as a high-developed nation, we unquestionably have the largest stockpile of privately held guns in the world. Estimates generally exceed one per person, and I find that pretty easy to believe. Of course, not every person or house has a gun, but a subset of people have multiple guns; part of the “pro-gun” mentality often includes wanting a variety.


Gun Control: Part 1

I was trained in how guns work, in ballistics, in the effects they have on their victims, and the clues to look for to make these determinations. Make no mistake, guns have one purpose: to kill things. Animals, people, it doesn’t matter; they work the same way. But at the end of the day, guns are tools. They have no soul, no morals, they are neither good nor evil. In an ideal world, in a utopia where nothing ever needed to be killed, there would be no need for guns. But that’s not our world. So we have to face our realities. And doing so in a logical and cooperative manner is the only way that makes sense.


Healthcare Reform

The plan was designed to bring in more money to pay healthcare costs by getting currently uninsured healthy people to become insured, thereby bringing in additional money in the form of their premiums.



One of the difficulties we are seeing in the world of healthcare parallels an underlying issue throughout our society: personal responsibility.


The Maze of Medical Billing

Let me show you how the fee-for-service world affects the practice of medicine, and then you can step back out into that world, look around, and decide for yourself if my description is accurate. What I hope to show you is the system we have built and why, and give examples of the reactions to the various attempts to make a fair, cost effective way of taking care of people.


United We Stand

If you read nothing else of the prattle I produce, I beg you to take the time to read this one through.


African American

Every time we choose to use the term African-American, we bring attention to the fact that we have an ongoing issue with skin color, and it’s one that we don’t want to talk about.


Russia and Sanctions: Part 2

So before we can even ask “what am I trying to accomplish,” we need to consider what actually happened. Russia hacked the computer systems of the Democratic National convention. Has any other country tried to hack things? Yes, lots of countries it seems, with China being the usual suspect.


Russia and Sanctions: Part 1

Things are always more complicated than what is said in the media. It’s often more complicated than our attention spans allow, (so I am breaking this up). But that doesn’t change reality.


The Problem

It's not the people, it is the system.



We all have melanocytes. And all of us make melanin (except albino people. And I mean real albino people – people who have a defective melanin gene, not just fair-skinned people like my wife who will blind you first thing in the spring). What determines skin color is how much melanin those cells make. That’s it.



This is probably one of the most heated, complicated, frustrating situations.