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Archive for January 11th, 2018

“Best healthcare system in the world”: Social media fury follows video of dazed woman put out in cold by Baltimore hospital

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I am always surprised when someone opines that the US healthcare system is the best in the world. It’s not even close. Watch the videos in this Facebook post.

John Woodrow Cox, Theresa Vargas, and Justin Wm. Moyer report in the Washington Post:

The man hurried up the Baltimore sidewalk with a camera in his hand as four black-clad hospital security guards walked toward him, then past him. One of them was pushing an empty wheelchair.

“So wait, y’all just going to leave this lady out here with no clothes on?” said Imamu Baraka, referring to a dazed woman wearing only a thin hospital gown who they had left alone at a bus stop Tuesday night in mid-30s temperatures. Her face appeared bloody, her eyes empty.

It was the latest incident of “patient dumping” that has sparked outrage around the country — one that, according to an expert, probably violated a 1986 federal law that mandates hospitals release those in their care into a safe environment.

“This kind of behavior is, I think, both illegal and I’m sure immoral,” said Arthur L. Caplan, founding head of the division of medical ethics at the New York University School of Medicine. “You don’t just throw someone out into the street who is impaired and may have injuries. You try to get them to the best place possible, and that’s not the bench in front of the hospital.”

The phenomenon was pervasive two decades ago, when the law was largely unenforced, Caplan said, but remains a problem from California to Virginia.

On Tuesday, the woman left outside the University of Maryland Medical Center Midtown Campus could barely walk and seemed unable to speak.

Still filming, Baraka turned and followed the guards back to an entrance.

“That is not okay,” he shouted.

“Due to the circumstances of what it was,” one of them said.

“Then you all need to call the police,” replied Baraka, a licensed counselor.

At the doorway, Baraka asked for a supervisor, demanding to know why they were leaving her outside.

“She was . . . medically discharged,” one of the guards said, before the camera captured them walking into the hospital, their backs turned.

What Baraka filmed next — the woman, staggering and screaming into a night so cold that the sidewalk remained speckled with salt and bits of unmelted snow — has been viewed more than 1.4 million times on Facebook, triggering a cascade of online fury and an apology from the hospital.

At a news conference Thursday afternoon, the hospital’s chief pledged to investigate what he described as “a failure of basic compassion and empathy.” . . .

Continue reading.

Do read the whole  thing. The other examples are even worse.

Profits before patients.

Written by LeisureGuy

11 January 2018 at 6:43 pm

Posted in Business, Healthcare

The Irrationality of Alcoholics Anonymous

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Gabrielle Glaser writes in the Atlantic:

J.G. is a lawyer in his early 30s. He’s a fast talker and has the lean, sinewy build of a distance runner. His choice of profession seems preordained, as he speaks in fully formed paragraphs, his thoughts organized by topic sentences. He’s also a worrier—a big one—who for years used alcohol to soothe his anxiety.

J.G. started drinking at 15, when he and a friend experimented in his parents’ liquor cabinet. He favored gin and whiskey but drank whatever he thought his parents would miss the least. He discovered beer, too, and loved the earthy, bitter taste on his tongue when he took his first cold sip.

His drinking increased through college and into law school. He could, and occasionally did, pull back, going cold turkey for weeks at a time. But nothing quieted his anxious mind like booze, and when he didn’t drink, he didn’t sleep. After four or six weeks dry, he’d be back at the liquor store.

By the time he was a practicing defense attorney, J.G. (who asked to be identified only by his initials) sometimes drank almost a liter of Jameson in a day. He often started drinking after his first morning court appearance, and he says he would have loved to drink even more, had his schedule allowed it. He defended clients who had been charged with driving while intoxicated, and he bought his own Breathalyzer to avoid landing in court on drunk-driving charges himself.

In the spring of 2012, J.G. decided to seek help. He lived in Minnesota—the Land of 10,000 Rehabs, people there like to say—and he knew what to do: check himself into a facility. He spent a month at a center where the treatment consisted of little more than attending Alcoholics Anonymous meetings. He tried to dedicate himself to the program even though, as an atheist, he was put off by the faith-based approach of the 12 steps, five of which mention God. Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.

J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence. He went back to rehab once more and later sought help at an outpatient center. Each time he got sober, he’d spend months white-knuckling his days in court and his nights at home. Evening would fall and his heart would race as he thought ahead to another sleepless night. “So I’d have one drink,” he says, “and the first thing on my mind was: I feel better now, but I’m screwed. I’m going right back to where I was. I might as well drink as much as I possibly can for the next three days.”

He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like J.G., Alcoholics Anonymous says that person must be deeply flawed. The Big Book, AA’s bible, states:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.

J.G.’s despair was only heightened by his seeming lack of options. “Every person I spoke with told me there was no other way,” he says.

The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.

For J.G., it took years of trying to “work the program,” pulling himself back onto the wagon only to fall off again, before he finally realized that Alcoholics Anonymous was not his only, or even his best, hope for recovery. But in a sense, he was lucky: many others never make that discovery at all.

The debate over the efficacy of 12-step programs has been quietly bubbling for decades among addiction specialists. But it has taken on new urgency with the passage of the Affordable Care Act, which requires all insurers and state Medicaid programs to pay for alcohol- and substance-abuse treatment, extending coverage to 32 million Americans who did not previously have it and providing a higher level of coverage for an additional 30 million.

Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over booze, make amends to those they’ve wronged, and pray.

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered. According to AA, these figures are based on members’ experiences.

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

I spent three years researching a book about women and alcohol, Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, which was published in 2013. During that time, I encountered disbelief from doctors and psychiatrists every time I mentioned that the Alcoholics Anonymous success rate appears to hover in the single digits. We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?

When my book came out, dozens of Alcoholics Anonymous members said that because I had challenged AA’s claim of a 75 percent success rate, I would hurt or even kill people by discouraging attendance at meetings. A few insisted that I must be an “alcoholic in denial.” But most of the people I heard from were desperate to tell me about their experiences in the American treatment industry. Amy Lee Coy, the author of the memoir From Death Do I Part: How I Freed Myself From Addiction, told me about her eight trips to rehab, starting at age 13. “It’s like getting the same antibiotic for a resistant infection—eight times,” she told me. “Does that make sense?”

She and countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine. “Well, no kidding.”

Alcoholics Anonymous has more than 2 million members worldwide, and the structure and support it offers have helped many people. But it is not enough for everyone. The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods. At the top of the list are  . . .

Continue reading.

Written by LeisureGuy

11 January 2018 at 11:17 am

Chiseled Face brush, Vintage Blades soap, Stealth slant, Penhaligon Blenheim Bouquet

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I don’t think this Chiseled Face synthetic is available any longer. I do like the treated-wood handle. The knot is similar to other Plissoft synthetics, so it’s really the handle that defines this brush.

The soap, very like the old Truefitt & Hill lavender shaving soap, was purchased from the old Vintage Blades site in Maryland, when Jim Ayers owned it. He sold it and the same site is now in Idaho and one that I don’t recommend.

The Stealth got a new blade and so I tried it again this morning to see if yesterday’s extra work in getting a smooth result was the effect of a dull blade. It seems to have been the case: no problems at all today, the razor delivering a perfectly smooth result with no effort (and no problems).

A splash of Penhaligon Blenheim Bouquet finished the job. Very rainy day, today.

Written by LeisureGuy

11 January 2018 at 8:47 am

Posted in Shaving

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