The initiative, the biggest expansion of Medicare since its creation in 1965, proved wildly popular. It now serves more than 35 million people, delivering critical medicines to patients who might otherwise be unable to afford them. Its price tag is far lower than expected.
Archive for the ‘Medical’ Category
Bill Moyers talks about a study that reminds one forcibly of the Tuskegee syphilis study, which also restricted the study to African-American subjects. It was, I believe, never explicitly stated why White subjects were excluded from the studies.
In the 1990s, a prominent research facility associated with Johns Hopkins University conducted an experiment that knowingly exposed children — mostly African American, some as young as a year old — to varying levels of potentially dangerous lead, as part of a study comparing different degrees of lead paint abatement. The researchers, at Hopkins’ Kennedy Krieger Institute, recruited poor families to move into homes that had only been partially abated using three different methods of lead paint removal at three different levels of cost.
The research was “conducted in the best interest of all of the children enrolled,” Dr. Gary W. Goldstein, president and chief executive of the Kennedy Krieger Institute, said in response to a class-action lawsuitfiled by the families in 2011. “Over all, the blood lead levels of most children residing in the study homes stayed constant or went down.”
But in some cases, children placed in homes that received the two cheaper forms of abatement were exposed to levels of lead known to cause permanent neurological problems.
Here, public health historians Gerald Markowitz and David Rosner tell the story. You can read about it in more detail in this chapter of their book, Lead Wars.
Watch Bill’s entire interview with Gerald Markowitz and David Rosner.
Industries hate regulation, though they love voluntary guidelines and standards (“voluntary” means that they can legitimately and legally be ignored), and they fight against regulation fiercely, usually on the basis that following a regulation may impact profits, and profits are the only goal. Myron Levin has an intriguing article at FairWarning.org (“news of safety, health, and corporate conduct”):
They crowded in for the hot dog show.
An Oscar Meyer wiener, serving as proxy for a finger, was pushed into the spinning blade of a table saw. The demonstration, at the International Woodworkers Fair in Atlanta, mimicked the way gruesome table saw injuries often occur. But this saw was equipped with a safety device called SawStop that allowed the blade to distinguish between wood and flesh, and to stop fast enough to prevent serious harm. Sure enough, the blade came to a dead stop in about three one-thousandths of a second, leaving the dog with only a minor nick.
Table saw accidents are painful, life-changing and expensive. Each year, more than 67,000 U.S. workers and do-it-yourselfers suffer blade contact injuries, according to government estimates,including more than 33,000 injuries treated in emergency rooms and 4,000 amputations.
Gerald Wheeler had other numbers on his mind as he watched hot dog meet blade that day in August, 2002. As the operator of a wood shop in Hot Springs, Ark., Wheeler was all too aware of the unforgiving nature of table saws. Not long before, two of his employees had been maimed within a few weeks of each other. Wheeler felt awful about the injuries, the loss of two good workers, the $95,000 in medical bills, the doubling of his workers compensation rates.
Wheeler thought: If only this had come along sooner. He took out his Visa card to order two of the saws, but was told none were available. As the SawStop guys explained, they had been seeking licensing deals with the big power tool makers, but had found no takers.
Faced with the prospect of never getting the invention to market, the little company, also known as SawStop, eventually started making its own saws. Since the first went on sale in 2004, SawStop says it has recorded 2,000 “finger saves”—customer reports of accidents likely to have caused disfiguring injuries with conventional saws, but that resulted in minor cuts or a few stitches at most (SawStop also acknowledges two reports of amputations.).
“Bravo!” a man named Frank Oslick emailed SawStop, explaining that he had lost two fingers and part of his thumb in a table saw accident when he was 14. “I have not lived a single day without regretting that accident,” he wrote. “If your device prevents even one person from going through what I have gone through it is a world class accomplishment.”
The hot dog demonstration
However, SawStop still makes the only saws with skin-sensing technology, and accounts for a tiny fraction of sales. Tens of thousands of fingers have been sliced off since the system was invented, but the rest of the industry, which is self-regulating, has been allowed to go on as before.
Over the years, top saw makers and thePower Tool Institute, their trade group, have defended the design of their saws and the decision to snub SawStop.
They’ve argued that injury numbers have been inflated and that the government’s estimate of $2.36 billion in annual costs to society from table saw accidents—including medical bills, lost wages, pain and suffering—is exaggerated. They say the market for popular, lightweight saws costing as little as $100 would be destroyed by the added expense of SawStop. They note that under some circumstances, SawStop can stop a blade without skin contact–such as when the blade touches conductive materials like metal or very wet wood. In such cases, the owner usually has to replace the blade and an electronic cartridge.
But as court records and testimony have shown, the companies rejected the safety advance for another reason, too: They worried that if a way to prevent severe injuries got traction in the market, they would face liability for accidents with conventional saws.
Even so, they have had to defend lawsuits. About 150 have been filed in recent years, focusing on the companies’ decision not to use available safety technology.
The industry is also trying to keep the Consumer Product Safety Commission from requiring injury reduction systems on all table saws—either SawStop or something similar. Indeed, another firm, Massachusetts-based Whirlwind Tool Co., says it has developed a “proximity detection” systems that will shut down a saw when a hand comes close to the blade.
But the industry may have little to fear from the commission. . .
Continue reading. It’s important to keep in mind that corporations routinely operate in bad faith.
Corporations, as we are continually reminded by their actions, will do anything that increases profit. Here’s one horrendous example—and I imagine the company will happily pay a fine so long as they can continue to reap profits. Katherine Ebert at CNN Money:
On the morning of Aug. 18, 2004, Dinesh Thakur hurried to a hastily arranged meeting with his boss at the gleaming offices of Ranbaxy Laboratories in Gurgaon, India, 20 miles south of New Delhi. It was so early that he passed gardeners watering impeccable shrubs and cleaners still polishing the lobby’s tile floors. As always, Thakur was punctual and organized. He had a round face and low-key demeanor, with deep-set eyes that gave him a doleful appearance.
His boss, Dr. Rajinder Kumar, Ranbaxy’s head of research and development, had joined the generic-drug company just two months earlier from GlaxoSmithKline, where he had served as global head of psychiatry for clinical research and development. Tall and handsome with elegant manners, Kumar, known as Raj, had a reputation for integrity. Thakur liked and respected him.
Like Kumar, Thakur had left a brand-name pharmaceutical company for Ranbaxy. Thakur, then 35, an American-trained engineer and a naturalized U.S. citizen, had worked at Bristol-Myers Squibb (BMY) in New Jersey for 10 years. In 2002 a former mentor recruited him to Ranbaxy by appealing to his native patriotism. So he had moved his wife and baby son to Gurgaon to join India’s largest drugmaker and its first multinational pharmaceutical company.
When he stepped into Kumar’s office that morning, Thakur was surprised by his boss’ appearance. He looked weary and uneasy, his eyes puffy and dark. He had returned the previous day from South Africa, where he had met with government regulators. It was clear that the meeting had not gone well.
The two men strolled into the hall to order tea from white-uniformed waiters. As they returned, Kumar said, “We are in big trouble,” and motioned for Thakur to be quiet. Back in his office, Kumar handed him a letter from the World Health Organization. It summarized the results of an inspection that WHO had done at Vimta Laboratories, an Indian company that Ranbaxy hired to administer clinical tests of its AIDS medicine. The inspection had focused on antiretroviral (ARV) drugs that Ranbaxy was selling to the South African government to save the lives of its AIDS-ravaged population.
As Thakur read, his jaw dropped. The WHO had uncovered what seemed to the two men to be astonishing fraud. The Vimta tests appeared to be fabricated. Test results from separate patients, which normally would have differed from one another, were identical, as if xeroxed.
Thakur listened intently. Kumar had not even gotten to the really bad news. On the plane back to India, his traveling companion, another Ranbaxy executive, confided that the problem was not limited to Vimta or to those ARV drugs.
“What do you mean?” asked Thakur, barely able to grasp what Kumar was saying.
The problem, said Kumar, went deeper. He directed Thakur to put aside his other responsibilities and go through the company’s portfolio — ultimately, every drug, every market, every production line — and uncover the truth about Ranbaxy’s testing practices and where the company’s liabilities lay.
Thakur left Kumar’s office stunned. He returned home that evening to find his 3-year-old son playing on the front lawn. The previous year in India, the boy had developed a serious ear infection. A pediatrician prescribed Ranbaxy’s version of amoxiclav, a powerful antibiotic. For three scary days, his son’s 102° fever persisted, despite the medicine. Finally, the pediatrician changed the prescription to the brand-name antibiotic made by GlaxoSmithKline (GSK). Within a day, his fever disappeared. Thakur hadn’t thought about it much before. Now he took the boy in his arms and resolved not to give his family any more Ranbaxy drugs until he knew the truth.
What Thakur unearthed over the next months would form some of the most devastating allegations ever made about the conduct of a drug company. His information would lead Ranbaxy into a multiyear regulatory battle with the FDA, and into the crosshairs of a Justice Department investigation that, almost nine years later, has finally come to a resolution.
On May 13, Ranbaxy pleaded guilty to seven federal criminal counts of selling adulterated drugs with intent to defraud, failing to report that its drugs didn’t meet specifications, and making intentionally false statements to the government. Ranbaxy agreed to pay $500 million in fines, forfeitures, and penalties — the most ever levied against a generic-drug company. (No current or former Ranbaxy executives were charged with crimes.) Thakur’s confidential whistleblower complaint, which he filed in 2007 and which describes how the company fabricated and falsified data to win FDA approvals, was also unsealed. Under federal whistleblower law, Thakur will receive more than $48 million as part of the resolution of the case. . .
Whew! Thank God that none of those responsible was charged with any crime or faced any prison or, indeed, had to pay a fine: the company paid that. So the same people are free to cook up other frauds.
Why on earth does ANYONE think that a company’s paying a fine will do ANYTHING to change its behavior? Send executives to prison and you’ll quickly see some serious reforms. But we don’t send executives to jail—we let their companies pay for the fines. Executives are like reckless teen-age males, who get into serious trouble and cause serious harm and leave it up to their parents (the corporation) to pay restitution and damages, while they themselves get off scot-free.
Fascinating look back at the difficulties and dire predictions that accompanied the launch of Medicare. Take a look at the collection of anecdotes and clippings in Sarah Kliff’s article in the Washington Post.
Ezra Klein interviews Bill Gates in the Washington Post:
“I always use this chart of childhood death,” Bill Gates says. “In 1960, 25% of kids died before the age of 5. And now we’re down below 6% of kids dying before the age of 5.”
We’re sitting in a bare conference room at his foundation’s D.C. headquarters. Gates — who Bloomberg News calculates is once again the world’s richest man — is in town to talk to members of Congress about his top priority this year: Global health – and, in particular, the total eradication of polio. He wants to drive that 6 percent even lower, and he believes he can. Wiping out a disease like polio sounds impossible. But it’s actually, Gates tells me, completely achievable. Perhaps even by the end of 2013. This is a transcript of our conversation, edited for length and clarity.
Ezra Klein: Your Foundation is known for taking a particularly data-driven approach to its work. So how do you know what’s actually working when you’re in failed states with very little data-collection capacity?Bill Gates: Of all the statistics in health, death is the easiest, because you can go out and ask people, “Hey, have you had any children who died, did your siblings have any children who died?” People don’t forget that. If you say to them, “Did your kids get vaccines or not,” they might have done it and not remember, or they might think, “Oh, this person wants me to say yes, maybe I look bad if I don’t say yes.” Death is something we really understand extremely well.
But you can save a lot of lives. One thing about the childhood death rate is you really can split it into the first 30 days of life versus 30 days to 5 years. Thirty days to 5 years is all vaccine preventable stuff — it’s diarrhea, respiratory and malaria. The first 30 days, the primary healthcare system really has to engage with the mother pre-birth, and then get the mother to do things like keeping the baby warm, making sure to avoid doing things that break the baby’s skin, breast-feeding, and that’s been harder. We’ve had sites in India where we can cut those deaths down by over 50 percent just by training the mother. But the worker has to engage with the patient, hopefully speak the same language or be of the same caste so that they’re willing to trust the advice that they’re getting.
EK: What’s been the biggest surprise? What has the data shown works, or doesn’t work, that you simply didn’t expect? . . .
As you would expect if the economy improves and the wealthy are taxed a bit more, the deficit is declining. And health-care costs are dropping. I expect that the GOP, which has been quite agitated about the deficit and about healthcare costs, will be very pleased and I’m eager to see their happy responses. There are quite a few discussions of this:
It looks like we’ve moved to talking about possible scandals just in time, because according to the Congressional Budget Office, the debt disaster that has obsessed the political class for the last three years is pretty much solved, at least for the next 10 years or so.
The last time the CBO estimated our future deficits was February– just four short months ago. Back then, the CBO thought deficits were falling and health-care costs were slowing. Today, the CBO thinks deficits are falling even faster and health-care costs are slowing by even more.
Here’s the short version: Washington’s most powerful budget nerds have cut their prediction for 2013 deficits by more than $200 billion. They’ve cut their projections for our deficits over the next decade by more than $600 billion. Add it all up and our 10-year deficits are looking downright manageable. Following are the highlights.
1) Swoosh-shaped debt. . .
Paul Waldman and Jaime Fuller at The American Prospect:
In case it slipped your mind during all this talk of scandal and impeachment, official Washington has spent the last couple of years gnashing its teeth about the budget deficit. Even as European austerity policies threw the continent into a period of extended despair, Republicans and their allies in the well-appointed conference rooms of “centrist” think tanks told us sternly that unemployment would have to wait; the most immediate crisis was the deficit.
Well today, the Congressional Budget Office (CBO) issued its latest deficit projection, and lo and behold, it turns out that mercilessly slashing spending and allowing some modest tax increases has an impact. They project the deficit will be $642 billion this year, lower than it has been since 2008. Not only that, the CBO’s projections of future Medicare spending have been reduced as well. Hard as it might be to wrap your head around the idea, there has been some good news of late on the fiscal front.
So here’s a bold prediction: . . .
Good news for many, no change for me: I generally use very little salt—I add no salt to most of my cooked dishes, for example—but OTOH never tried for the (completely unrealistic) 1500mg/day figure. I just tried to use little salt, and since I very seldom eat out or eat prepared foods, I get little salt.
Not that it makes any difference, apparently.
It turns out that enforced solitude can affect even physical health. Judith Shulevitch writes in The New Republic:
Sometime in the late ’50s, Frieda Fromm-Reichmann sat down to write an essay about a subject that had been mostly overlooked by other psychoanalysts up to that point. Even Freud had only touched on it in passing. She was not sure, she wrote, “what inner forces” made her struggle with the problem of loneliness, though she had a notion. It might have been the young female catatonic patient who began to communicate only when Fromm-Reichmann asked her how lonely she was. “She raised her hand with her thumb lifted, the other four fingers bent toward her palm,” Fromm-Reichmann wrote. The thumb stood alone, “isolated from the four hidden fingers.” Fromm-Reichmann responded gently, “That lonely?” And at that, the woman’s “facial expression loosened up as though in great relief and gratitude, and her fingers opened.”
Fromm-Reichmann would later become world-famous as the dumpy little therapist mistaken for a housekeeper by a new patient, a severely disturbed schizophrenic girl named Joanne Greenberg. Fromm-Reichmann cured Greenberg, who had been deemed incurable. Greenberg left the hospital, went to college, became a writer, and immortalized her beloved analyst as “Dr. Fried” in the best-selling autobiographical novel I Never Promised You a Rose Garden (later also a movie and a pop song). Among analysts, Fromm-Reichmann, who had come to the United States from Germany to escape Hitler, was known for insisting that no patient was too sick to be healed through trust and intimacy. She figured that loneliness lay at the heart of nearly all mental illness and that the lonely person was just about the most terrifying spectacle in the world. She once chastised her fellow therapists for withdrawing from emotionally unreachable patients rather than risk being contaminated by them. The uncanny specter of loneliness “touches on our own possibility of loneliness,” she said. “We evade it and feel guilty.”
Her 1959 essay, “On Loneliness,” is considered a founding document in a fast-growing area of scientific research you might call loneliness studies. Over the past half-century, academic psychologists have largely abandoned psychoanalysis and made themselves over as biologists. And as they delve deeper into the workings of cells and nerves, they are confirming that loneliness is as monstrous as Fromm-Reichmann said it was. It has now been linked with a wide array of bodily ailments as well as the old mental ones.
In a way, these discoveries are as consequential as the germ theory of disease. Just as we once knew that infectious diseases killed, but didn’t know that germs spread them, we’ve known intuitively that loneliness hastens death, but haven’t been able to explain how. Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people.The psychological definition of loneliness hasn’t changed much since Fromm-Reichmann laid it out. “Real loneliness,” as she called it, is not what the philosopher Søren Kierkegaard characterized as the “shut-upness” and solitariness of the civilized. Nor is “real loneliness” the happy solitude of the productive artist or the passing irritation of being cooped up with the flu while all your friends go off on some adventure. It’s not being dissatisfied with your companion of the moment—your friend or lover or even spouse— unless you chronically find yourself in that situation, in which case you may in fact be a lonely person. Fromm-Reichmann even distinguished “real loneliness” from mourning, since the well-adjusted eventually get over that, and from depression, which may be a symptom of loneliness but is rarely the cause. Loneliness, she said—and this will surprise no one—is the want of intimacy.
Today’s psychologists accept Fromm-Reichmann’s inventory of all the things that loneliness isn’t and add a wrinkle she would surely have approved of. They insist that loneliness must be seen as an interior, subjective experience, not an external, objective condition. Loneliness “is not synonymous with being alone, nor does being with others guarantee protection from feelings of loneliness,” writes John Cacioppo, the leading psychologist on the subject. Cacioppo privileges the emotion over the social fact because—remarkably—he’s sure that it’s the feeling that wreaks havoc on the body and brain. Not everyone agrees with him, of course. Another school of thought insists that loneliness is a failure of social networks. The lonely get sicker than the non-lonely, because they don’t have people to take care of them; they don’t have social support. . .
In shaving, I quickly learned of two mindsets: explorers, who look for any excuse to try a new product or technique, and settlers, who look for any excuse to stick with what they have. “If it ain’t broke, don’t fix it” is the slogan of the settler, and many in this mindset are completely unwilling to try (say) a new shaving soap: “The one I have now works fine, so why should I try something different?” The answer, “Because it could be a whole lot better” doesn’t seem to have much impact—as evidenced by the many millions who continue to use cartridge razors and canned foam in preference to trying DE shaving, which offers better shaves at (substantially) lower cost. Settlers tend to settle—thus the name.
But explorers and settlers—also termed “bold” and “shy” respectively—are found throughout the animal kingdom: some minnows will hide back in the reeds while others dart out in search of food. Have both mindsets in a species aids survival: the bold can find new grazing grounds, new foods, and so on, while the shy can preserve the species when an innovative locale or food proves deadly.
Don Cossins in The Scientist has an interesting finding on the two modes:
When a group of genetically identical mice lived in the same complex enclosure for 3 months, individuals that explored the environment more broadly grew more new neurons than less adventurous mice, according to a study published today (May 9) in Science. This link between exploratory behavior and adult neurogenesis shows that brain plasticity can be shaped by experience and suggests that the process may promote individuality, even among genetically identical organisms.
“This is a clear and quantitative demonstration that individual differences in behavior can be reflected in individual differences in brain plasticity,” said Fred Gage of the Salk Institute for Biological Studies in La Jolla, California, who was not involved the study. “I don’t know of another clear example of that . . . and it tells me that there is a tighter relationship between [individual] experiences and neurogenesis than we had previously thought.”
Scientists have often tried to tackle the question of how individual differences in behavior and personality develop in terms of the interactions between genes and environment. “But there is next to nothing [known] about the neurobiological mechanisms underlying individuality,” said Gerd Kempermann of the German Center for Neurodegenerative Diseases in Dresden.
One logical way to study this phenomenon is to look at brain plasticity, or how the brain’s structure and function change over time. Plasticity is hard to study, however, because it mostly takes place at the synaptic level, so Kempermann and his colleagues decided to look at the growth of new neurons in the adult hippocampus, which can easily be quantified. Earlier studies have demonstrated that activity—both physical and cognitive—increases adult neurogenesis in groups of genetically identical mice, but there were differences between individuals in the amount of neuron growth.
To understand why, Kempermann and his colleagues housed 40 genetically identical female inbred mice in a complex 5-square-meter, 5-level enclosure filled with all kinds of objects designed to encourage activity and exploration. The mice were tagged with radio-frequency infer-red (RFIR) transponders, and 20 antennas placed around the enclosure tracked their every movement. After 3 months, the researchers assessed adult neurogenesis in the mice by counting proliferating precursor cells, which had been labeled before the study began.
The researchers found that . . .
Full disclosure: In terms of ideas and foods and the like, I am an explorer; in terms of sports and travel, I am a settler. Most people are a mix.
An interesting article by Tracy Weber, Charles Ornstein, and Jennifer LaFleur in the Washington Post, along with a ProPublica look-up so that you can see how your own physician stands in terms of prescribing drugs.. My former doctor prescribed more drugs than the average doctor, and my current doctor prescribes fewer. I had already noticed that my doctor likes to wean me off unnecessary meds, though he doesn’t hesitate to prescribe when needed. Look up your own doc.
The article begins:
Ten years ago, a sharply divided Congress decided to pour billions of dollars into subsidizing the purchase of drugs by elderly and disabled Americans. But an investigation by ProPublica has found the program, in its drive to get drugs into patients’ hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive for their patients. Federal officials have done little to detect or deter these hazardous prescribing patterns.
Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government’s most serious “black box” warning that it increases the risk of death. He believes he has no other options.
Some doctors are using drugs in unapproved ways that may be unsafe or ineffective, records showed. An Oklahoma psychiatrist regularly prescribes the Alzheimer’s drug Namenda for autism patients as young as 12; he says he thinks it calms them. Autism experts said there is scant scientific support for this practice.
The data analysis showed widespread prescribing of drugs such as carisoprodol, which was pulled from the European market in 2007. In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug to patients 65 and older. The muscle relaxant, also known as Soma, is on the American Geriatrics Society’s list of drugs seniors should avoid.
The data, obtained under the Freedom of Information Act, makes public for the first time the prescribing practices and identities of doctors and other health-care providers. . .
Continue reading. The lookup for the database, along with a variety of interesting info, is at the link.
Laurie Jo Reynolds and Stephen F. Eisenman report at CreativeTimeReports.org:
In 1998, Illinois opened a prison without a yard, cafeteria, classrooms or chapel. Tamms Supermax was designed for just one purpose: sensory deprivation. No phone calls, communal activities or contact visits were allowed. Men could only leave their cells to shower or exercise alone in a concrete pen. Food was pushed through a slot in the door. The consequences of isolation were predictable: many men fell into severe depression, experienced hallucinations, compulsively cut their bodies or attempted suicide.
The first men at Tamms were transferred there from other prisons around the state for a one-year shock treatment intended to break down disruptive prisoners and make them more compliant. But the Illinois Department of Corrections (IDOC) left them there indefinitely. A decade later, more than a third of the men at Tamms had been there since it opened, and for no apparent reason.
Research has shown that supermax prisons don’t reduce prison violence or rehabilitate prisoners. On the contrary, isolation induces or exacerbates mental illness, creates stress and tension, worsens behavior and undermines the ability of people to function once they get out.
Despite its uselessness as a form of correction, Tamms had many strong supporters: the powerful union to which the prison guards belonged, the nearby towns that welcomed the well-paid jobs, and state officials who thrived on tough-on-crime politics. They all deployed a single phrase meant to paralyze any possible dissenters: the worst of the worst. This slogan was applied to the men at Tamms to suggest they deserved the worst possible treatment—long-term solitary confinement that human rights monitors uniformly describe as cruel, inhuman and degrading, if not outright torture. Challenging this label and this punishment became the project of Tamms Year Ten, a campaign launched in 2008, a decade after the supermax opened.
Punching Above Our Weight
Two years earlier, a group of Chicago artists, poets and musicians formed the Tamms Poetry Committee. Two of them, Laurie Jo Reynolds included, had been members of a group that had protested plans to construct the supermax. Following the practice of two women who sent holiday cards to the prison, we sent letters and poems to every man at Tamms to provide them with some social contact. Their replies demonstrated the necessity of this project: “Hi Committee, is this for real? I can’t believe someone cares enough to send a pick-me-up to the worst-of-the-worst. Well, if nobody else has said it, I will: THANK YOU.” But we quickly found ourselves deluged with pleas for help: “Hey, this poetry is great, but could you please tell the governor what they’re doing to us down here?”
By 2008, we had connected with men on the outside who had spent years in Tamms and family members of current prisoners. Together, we launched the Tamms Year Ten campaign. Our goal was to educate the public about Tamms and hold the IDOC, legislators and then-Governor Blagojevich accountable for the use of long-term isolation. Prison reform is hard enough, but getting people to stand up for “the worst of the worst” was considered hopeless. Attorneys and veteran prisoner advocates warned that this campaign could endanger the men and increase support for the prison. But we believed that recent controversy over solitary confinement and torture at Guantanamo Bay and Abu Ghraib opened a new space for debate. And in any case, after a decade of isolation with no end in sight, the men in Tamms didn’t have much to lose.
Outrage Properly Directed
It was hard to know where to begin. Not many people had even heard of Tamms, located at the southern tip of Illinois, 360 miles from Chicago. Our members consulted with legislators from all over the state and sought advice from every quarter. A turning point was . . .
Given the description of the prison, what conclusions would you draw about a nation that not only allows it but seems to approve of it? This prison seems evil and totalitarian—beyond inhumane. Do you think that the prisoners, once released, are prepared to find constructive roles in society?
For a social animal—such as humans—solitary confinement is torture.
In The American Prospect Paul Waldman points out one of the great benefits of Obamacare: not being locked into a job because of health insurance:
For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was “job lock”—if you have insurance at your job, particularly if you or someone in your family has health issues, then you’re going to be hesitant to leave that job. You won’t start your own business, or join somebody else’s struggling startup (unless they provide insurance), and this constrains people’s opportunities and dampens the country’s entrepreneurial spirit.
That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there’s an article in that pro-Democrat hippie rag The Wall Street Journal entitled “Will Health-Care Law Beget Entrepreneurs?” Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John’s guy cutting employees’ hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime,11This is important: when you hear a story about an employer who cut his employees’ hours so he wouldn’t have to abide by the law, what you’re reading about is a jerk who doesn’t want to offer his employees insurance, not some inevitable consequence of the law. That’s a choice he makes. And don’t forget too that the employer mandate only applies to companies with 50 or more employers, and 96 percent of them already offer health insurance, even without a mandate. it’s a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they’ve never had before: health security.
So what kind of effect could the elimination of job lock have on the economy? That’s tough to say. The study referred to in the WSJ article finds that people are much more likely to start a business if they get their health insurance from their spouse’s job than if they get it from their own job; in the former case you’d still have insurance if you started a business, while in the latter case you’d lose it. In addition, and this is particularly interesting, even though you might think of 65-year-olds as looking forward to days of golf and eating dinner at 4 p.m., a large number of people seem to start businesses pretty much the minute they become eligible for Medicare. While it’s hard to get insurance in the current private market if you’re 44, it’s basically impossible if you’re 64.So it seems that the fact that after January, job lock will be history means that more businesses will be started. How many more? . . .
OTOH, the pharmaceutical companies are delighted. Here’s an article by Megan Scudellari in The Scientist:
Vioxx was on the market for 5 years before manufacturer Merck voluntarily withdrew the arthritis medication in 2004 due to an increased risk of heart attacks and strokes. An estimated 88,000–139,000 Americans had heart attacks while taking Vioxx, and as many as 55,000 died. Soon after, other painkillers in the same class of medicines came under scrutiny, including Bextra, which Pfizer removed from the market in 2005 upon the recommendation of the US Food and Drug Administration (FDA).
Americans cried out for better oversight of approved drugs. Then, in 2007, a cardiologist in Cleveland showed that Avandia, a blockbuster antidiabetic drug, increased the risk of heart attacks. An FDA advisory committee reviewed the evidence and found the claim to be true, but voted to keep Avandia on the market because of its efficacy, while mandating that the drug carry the FDA’s strictest warning label. The cries became louder.
Today, almost a decade since Vioxx was taken off the market and 6 years since Avandia made headlines, the national system for monitoring approved drugs has not gotten any better, critics say—despite the 2007 FDA Amendments Act (FDAAA) that granted the agency more power to oversee drugs once they hit the market.
“I don’t think there have been any significant changes,” says David Resnik, a bioethicist at the National Institute of Environmental Health Sciences. “I don’t think anything has improved at all.”
Postmarket drug safety is a hot-button issue not only because of high-profile drug scares, but also because of accelerating efforts to get drugs to market sooner. Last July, for example, Congress passed the Food and Drug Administration Safety and Innovation Act, which among other things created a new designation called a “breakthrough therapy.” Though the details of the new designation are still being worked out, it is considered one step above “fast track” status, and mandates that the FDA work closely with drug developers to expedite a breakthrough drug’s path to the clinic. A handful of experimental drugs have been granted the status, and at least one company, Vertex Pharmaceuticals, is launching shorter-than-normal Phase 3 trials—24 weeks instead of 48—for a combination of two cystic fibrosis drugs that received the designation in January. . .
So far, the only therapy that has been demonstrated to work is CBT. At Mother Jones Kevin Drum points to a new example of its effectiveness:
Harold Pollack draws my attention today to the results of a large-scale study he conducted recently with several other researchers in low-income Chicago schools. The study design was fairly simple: first, they chose several thousand teenage boys with horrible risk profiles. Their group was 70 percent black and 30 percent Hispanic; had an average GPA of 1.7; and had missed 40 out of 170 days of school the previous year. Over a third of them had been arrested at least once prior to the study.
They randomly assigned these boys to a control group or a treatment group. The randomization was done beforehand to avoid choosing a treatment group that differed in some unknown way from the control group. The treatment group was offered a chance to participate in a program called “Becoming a Man,” which focused strongly on improving poor judgment and decision making. Here’s an example:
At 3pm on Saturday, June 2, 2012, in the South Shore neighborhood just a few miles from the University of Chicago, two groups of teens were arguing in the street about a stolen bicycle. As the groups began to separate, someone pulled out a handgun and fired….Two weeks later, prosecutors filed first-degree murder charges against the alleged shooter, Kalvin Carter — 17 years old.
…. In Chicago, the site of our study, police believe that roughly 70 percent of homicides stem from “altercations,” compared to only about 10 percent from drug-related gang conflicts….At 3pm on June 2 on the south side of Chicago, is Kalvin Carter thinking about 3:01 — or even consciously thinking at all, for that matter? Automatic, intuitive decision-making is also susceptible to systematic biases, partly because the brain’s automatic “system” tends to emphasize explanations that are coherent rather than necessarily correct. Examples of such errors include hostile attribution bias….confirmation bias….or catastrophizing.
The intervention in the study was not really all that intense: the kids all skipped one regular class and attended 27 one-hour weekly sessions during the school year. In addition, some of the kids also attended after-school sessions. The primary purpose of the sessions was to teach cognitive behavioral therapy—”thinking about thinking”—in an effort to get the participants to change the way they interact with the rest of the world. The results were pretty stunning: . . .
The GOP strongly and explicitly opposes teaching critical thinking skills, in school or out. And in looking at the GOP, you can see that they follow their own advice.
Timothy Leary famously used psychedelics with prisoners to try to encourage a positive change in worldview, the measure being the rate of recidivism of treated vs. untreated prisoners. (More here on that experiment.) Now a proposal is being made to the Pentagon to use MDMA (Ecstasy) to help treat PTSD. Greg Miller reports in Wired Science:
For Rick Doblin, being invited to the Pentagon was an emotional experience. Growing up in the 60s, Doblinembraced the counterculture and protested the Vietnam war and the military-industrial complex behind it.
Yesterday he was at the Pentagon trying to persuade military medical officials to permit a clinical trial that would test MDMA, the active ingredient in the party drug Ecstasy, in conjunction with psychotherapy, in active duty soldiers with post-traumatic stress disorder.
“There’s been this history of conflict between psychedelics and the military, and we’re trying to say that’s not the only vision,” Doblin said. “There’s a way for us to come together.”
Doblin is the founder and director of the non-profit Multidisciplinary Association for Psychedelic Studies(MAPS), which is trying to get drugs like psilocybin, LSD, and MDMA approved for medical use. MAPS has already sponsored small clinical trials of MDMA-assisted psychotherapy for PTSD, first in survivors of sexual abuse and assault, and now in military veterans, police, and firefighters.
Doblin spoke with Wired about his military mission and what it says about shifting attitudes towards psychedelic drugs.
Wired: What were you doing at the Pentagon?
Rick Doblin: I am hoping to convince them to back a study with active duty soldiers with PTSD. But I’m not asking them to fund it. MAPS will fund a demonstration project. If it works, I’d hope they will fund future studies. This was our second meeting to talk about some sort of collaboration, and the meeting went really well.
Wired: Was it strange for you to be there?
Doblin: Just walking into the Pentagon and being invited to the Pentagon is a healing process for me personally, and I hope more broadly for society. In the 60s, society went in two directions: There was psychedelics and marijuana and anti-war protestors, and there was alcohol and beer and pro-Vietnam supporters. But now the war on drugs is losing steam, and the culture is coming together again after 45 years.
But I don’t want to underestimate the resistance. When Michael Mithoefer [a South Carolina psychiatrist who has led two PTSD trials sponsored by MAPS] came to the Pentagon with me the first time, he shaved his ponytail off. The last time he did that was when he did his residency interviews after medical school. So we’re trying to do our part not to create countercultural flak, and I think that’s really key.
Wired: The fact that they’re even considering this seems like an indication of how things have changed.
Doblin: For so long the only story that’s been told has been exclusively one of risk. It’s been told for marijuana, MDMA, LSD, and psilocybin, and the risk has been exaggerated. Now that we’ve been able to start getting some evidence on the benefits, it changes people’s calculus. And the benefits are coming in areas that people are more worried about than they are about drugs, like end of life anxiety [in terminal cancer patients] and PTSD in veterans. We’re purposely choosing conditions that will resonate with people.
Wired: What benefits have you seen so far in the study with veterans? . . .
And here’s another article by Greg Miller on psychedelic medicine.
Earlier today I pointed to the Ag-Gag laws as an effort by businesses to conceal their crimes. It’s not just agriculture: Dan Cossins has a note in The Scientist:
The European Medicines Agency’s (EMA) recent drive toward making preclinical and clinical data on experimental drugs more freely available was hampered this week after a European court ordered the agency not to release information from two US pharmaceutical companies, reported ScienceInsider.
The temporary injunction imposed by the General Court of the European Union backs Chicago-based AbbVie and California-based InterMune, which both filed complaints claiming that the release of information about their therapies would jeopardize their commercial interests.
The EMA began pushing for increased sharing of preclinical and clinical data on experimental drugs in 2010, after a European watchdog body ruled that it should release data in response to requests from a nonprofit organization. The agency has since responded to 613 requests for clinical data and released roughly 1.9 million pages of information, according to ScienceInsider.
The EMA has made it clear that it does not aim to aid competitors by allowing access to such information, however, and often redacts certain details. On the other hand, the agency’s head of communications Martin Harvey-Allchurch told ScienceInsider, “our position is that clinical trial data cannot, per say [sic], be considered confidential. There is a legitimate public interest to what we’re doing.”
Because the ruling only applies to these two particular cases, the agency plans to continue releasing data when individuals and companies request it and will proceed with the publication of released data on it website.
None of us are getting out alive, so it’s worth while paying attention to choices regarding death. Jonathan Rauch has an eye-opening article in the Atlantic:
Dr. Angelo Volandes is making a film that he believes will change the way you die. The studio is his living room in Newton, Massachusetts, a suburb of Boston; the control panel is his laptop; the camera crew is a 24-year-old guy named Jake; the star is his wife, Aretha Delight Davis. Volandes, a thickening mesomorph with straight brown hair that is graying at his temples, is wearing a T-shirt and shorts and looks like he belongs at a football game. Davis, a beautiful woman of Guyanese extraction with richly braided hair, is dressed in a white lab coat over a black shirt and stands before a plain gray backdrop.
“Remember: always slow,” Volandes says.
“Sure, hon,” Davis says, annoyed. She has done this many times.
Volandes claps to sync the sound. “Take one: Goals of Care, Dementia.”
You are seeing this video because you are making medical decisions for a person with advanced dementia. Davis intones the words in a calm, uninflected voice. I’ll show you a video of a person with advanced dementia. Then you will see images to help you understand the three options for their medical care.
Her narration will be woven into a 10-minute film. The words I’m hearing will accompany footage of an elderly woman in a wheelchair. The woman is coiffed and dressed in her Sunday finest, wearing pearls and makeup for her film appearance, but her face is vacant and her mouth is frozen in the rictus of a permanent O.
This woman lives in a nursing home and has advanced dementia. She’s seen here with her daughters. She has the typical features of advanced dementia …
Young in affect and appearance, Volandes, 41, is an assistant professor at Harvard Medical School; Davis, also an M.D., is doing her residency in internal medicine, also at Harvard. When I heard about Volandes’s work, I suspected he would be different from other doctors. I was not disappointed. He refuses to let me call him “Dr. Volandes,” for example. Formality impedes communication, he tells me, and “there’s nothing more essential to being a good doctor than your ability to communicate.” More important, he believes that his videos can disrupt the way the medical system handles late-life care, and that the system urgently needs disrupting.
“I think we’re probably the most subversive two doctors to the health system that you will meet today,” he says, a few hours before his shoot begins. “That has been told to me by other people.”
“You sound proud of that,” I say.
“I’m proud of that because it’s being an agent of change, and the more I see poor health care, or health care being delivered that puts patients and families through—”
“We torture people before they die,” Davis interjects, quietly.
Volandes chuckles at my surprise. “Remember, Jon is a reporter,” he tells her, not at all unhappy with her comment.
“My father, if he were sitting here, would be saying ‘Right on,’ ” I tell him.
Volandes nods. “Here’s the sad reality,” he says. “Physicians are good people. They want to do the right things. And yet all of us, behind closed doors, in the cafeteria, say, ‘Do you believe what we did to that patient? Do you believe what we put that patient through?’ Every single physician has stories. Not one. Lots of stories.
“In the health-care debate, we’ve heard a lot about useless care, wasteful care, futile care. What we”—Volandes indicates himself and Davis—“have been struggling with is unwanted care. That’s far more concerning. That’s not avoidable care. That’s wrongfulcare. I think that’s the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”
Unwanted treatment is American medicine’s dark continent. No one knows its extent, and few people want to talk about it. The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention. . .
Continue reading. The story of the author’s father had a lot of impact on me.
I saw my doctor yesterday in a brief office visit to follow up on my tapering off the antidepressant I used to get through my panic attacks triggered by my getting rid of most of my stuff and moving. The antidepressant did a fine job and restored a more realistic perspective, and now, job done, I’m tapering off. (He likes to taper people off antidepressants in the spring or summer, but not in the fall or winter, for obvious reasons.)
We got to talking about the recent findings on the mechanism by which beef injured arterial health: A diet that frequently includes beef leads to a population of gut microbes that transform the carnitine in beef into TMAO, a chemical that attacks arteries and leads to arteriosclerosis. People who eat beef regularly get a big burst of TMAO whenever they eat beef; people who rarely beat beef have different gut microbes, and on the occasions when they eat beef, they get no TMAO because they don’t have the gut microbes that produce it.
I told him that as soon as I read the results, I went immediately and bought a big steak. (I eat beef maybe once every month or two.)
He responded by saying that even worse in “wheat belly,” and avoiding wheat is a good thing. Since The Wife is gluten intolerant, we rarely eat wheat products, and I told him that I ate almost no wheat.
“No wonder you’re so healthy,” he said.
I looked up wheat belly when I got back and found this book:
A renowned cardiologist explains how eliminating wheat from our diets can prevent fat storage,
shrink unsightly bulges, and reverse myriad health problems.Every day, over 200 million Americans consume food products made of wheat. As a result, over 100 million of them experience some form of adverse health effect, ranging from minor rashes and high blood sugar to the unattractive stomach bulges that preventive cardiologist William Davis calls “wheat bellies.” According to Davis, that excess fat has nothing to do with gluttony, sloth, or too much butter: It’s due to the whole grain wraps we eat for lunch.After witnessing over 2,000 patients regain their health after giving up wheat, Davis reached the
disturbing conclusion that wheat is the single largest contributor to the nationwide obesity epidemic—and its elimination is key to dramatic weight loss and optimal health. In Wheat Belly, Davis exposes the harmful effects of what is actually a product of genetic tinkering and agribusiness being sold to the American public as “wheat”—and provides readers with a user-friendly, step-by-step plan to navigate a new, wheat-free lifestyle.Informed by cutting-edge science and nutrition, along with case studies from men and women who have experienced life-changing transformations in their health after waving goodbye to wheat, Wheat Belly is an illuminating look at what is truly making Americans sick and an action plan to clear our plates of this seemingly benign ingredient.