Sunday, December 30, 2012

Guns Guns and More Guns

Well my moratorium on guns is officially off. This was in yesterday's paper about the lunatic who ambushed firefighters and left a note saying "he enjoyed killing." The man, a convicted murder and registered official psychopath, someone alert Wayne LaPierre! He got his arms not from theft as originally speculated, no he got them from his neighbor in a second party purchase.   Unlike his first murder a hammer not so great on killing en mass. And nice of his neighbor to be well so neighborly.  And so nice of him to leave a suicide note with details and relevant information. Most don't.  He puts new meaning to the word exceptional. Everything here is nice and easy, like the hair color, when it comes to getting guns.

This is one of those excellent "loopholes" that enable convicted felons and minors and well anyone who wants a gun be them batshit crazy or not to get one! I am looking for my new gun, the female equivalent of the Bushmaster - the Cockblocker. Anyone know of one willing to sell it to me under the table perhaps?  As I am a Teacher I am going to need it in my classroom.  I just hope that my gal on Etsy who knits all my great goodies can whip me up a gun cozy in time!

Words have never failed me but I am going to have to say one last parting dig. Is this what Mr. Rogers meant when he said "we're neighbors, let's be friends."

Woman Helped Firefighters’ Killer Get Gun He Used in Ambush, Police Say

Published: December 28, 2012

The police arrested a woman in western New York on Friday who they said helped a man acquire the weapon he is believed to have used to kill two firefighters in an ambush that left two others injured; According to the police, the woman, Dawn Nguyen, 24, bought a Bushmaster semiautomatic rifle and a Mossberg 12-gauge shotgun from a gun shop more than two years ago on behalf of William Spengler Jr., who as a felon was not permitted to buy or own a gun.

Mr. Spengler apparently used the rifle on Monday to kill the firefighters, whom he lured to his home in Webster, N.Y., near Lake Ontario, by starting a fire, the authorities said. After shooting at other emergency responders, Mr. Spengler shot himself in the head with another weapon, a handgun, an autopsy revealed. The fire destroyed seven homes.

Ms. Nguyen went with Mr. Spengler to buy the weapons at a shop in June 2010, according to a criminal complaint filed by the United States attorney in the Western District of New York.

When the police asked her about the purchase after the shooting, she claimed the guns were for her own protection. She also said they had been stolen from her car, although the police said no report had been filed to support that claim.

The complaint said Ms. Nguyen had told a friend that she bought the weapons for Mr. Spengler. The police said that assertion was corroborated by what Mr. Spengler wrote in a suicide note, in which he said a neighbor’s daughter helped him acquire the guns.

Since the guns were not intended for her, the complaint said, she made a false statement when she bought them, a felony that is punishable by up to 10 years in prison.

Ms. Nguyen is “the person who purchased that rifle and that shotgun found next to William Spengler,” William J. Hochul Jr., the United States attorney for the Western District of New York, said at a news conference in Rochester on Friday.

Ms. Nguyen’s lawyer could not be immediately reached for comment.

The Webster police chief, Gerald L. Pickering, said that based on the distance between Mr. Spengler’s hiding place and where his victims were found, he most likely used the Bushmaster.

A similar gun was used in the Newtown, Conn., school shootings, which prompted a renewed debate about the nation’s gun laws. Much of the discussion has been focused on whether military-style assault weapons like the Bushmaster should be banned.

On Thursday, the State Police released the autopsy results of the two firefighters who were killed and their attacker.

Michael Chiapperini, 43, died as a result of a gunshot wound and Tomasz Kaczowka, 19, died as a result of two gunshot wounds, the police said. Mr. Spengler, 62, was killed by a self-inflicted gunshot to his head.

Funeral and memorial services are planned for Mr. Chiapperini and Mr. Kaczowka during the weekend. Hundreds of firefighters and police officers from around the region were pouring into Webster on Friday.

The police have also recovered human remains in Mr. Spengler’s home, which was among the buildings that burned, but the remains have yet to be positively identified. Earlier this week, Chief Pickering said the police believed that the remains belong to Cheryl Spengler, 67, Mr. Spengler’s sister.

The two had fought bitterly in the past, friends and neighbors said, and they may have been involved in a dispute over who would take ownership of the family home following the death of their mother, Arline, in October. Mr. Spengler served 17 years in prison for the 1980 murder of his grandmother, whom he killed with a hammer.

It remained unclear what motivated him to target emergency responders, but he made his intentions clear in the note he left behind: he wanted to kill as many people as he could.

When the police arrived at the scene of the fire just before dawn on Monday, they were met by a fusillade of bullets. A SWAT team was called in to help thwart the gunman. As the gun battle raged, the fire spread.

The autopsy report showed that Mr. Spengler was not struck by any bullets fired by law enforcement officers.

Heroin Addiction is Cheaper

My loathing of the Medical Matrix Complex will not be abiding for the new year. In fact on a personal level it ratchets up a notch as I fight the scumbags who "treated" me when I was admitted to Harborview.  Treating in this case and situation means they treated me like an animal to use and abuse, a lab rat. Given that Harborview is an arm of the University of Washington medical school its appropriate.   I have said time and time again the Asylum on American Horror Story seems superior in its care of patients.

And we are all some ways lab rats to the MMC.  And we pay either  directly or indirectly. When anyone in this complex gives anything away someone will pay, it just varies on what that means. Does anyone ever watch Boardwalk Empire? 

And then this article today in the Business page of the New York Times about the rising costs of medicine, literally.  This drug, one invented in the 50s, exempt from FDA trial drug laws and used to cost $40 a vial is suddenly filled with fairy dust and miracles and is now $28 THOUSAND dollars a vial.  YHGTBFKM.  Its my attempt at an acronym, I will let you put the words to the letters.  Its good cognitive testing.

This is a lengthy article and you know I love a good read so you might try to read it in its entirety, given the Polaroid Nation, I have highlighted what I think are the good bits. It has everything one loves, over zealot sales persons, Doctors on the payroll, children in need, Shareholder value, FDA failure and conflict of interest, fake philanthropy, its all good.

I love that its a meat by product. I can see in the Polaroid Nation the PETA vegans or whatever appropriate acronym would be enraged but like all the other ubiquitous acronym groups that would be the singular aspect they would care about, the idea of the costs, the need for appropriate medical treatments and care that is affordable not so much.

And no "Obamacare" does nothing to resolve, amend or even address it. And soon we all will be forced to carry insurance who won't either in every way.   Man you need to really meet the mirror one day and try to explain to me how I voted for a Democrat and got a Republican who was not named Lincoln.

Questcor Finds Profits, at $28,000 a Vial

by Andrew Pollack
Published December 30, 2012

The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.

The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.

“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.

How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers.

At least until recently, that is. Now some doctors, insurance companies and investors are beginning to have doubts about whether the drug is really any better than much cheaper alternatives. Short-sellers have written scathing criticisms of the company, questioning its marketing tactics and predicting that its shareholders are highly vulnerable.

 That Acthar is even a potential blockbuster is a remarkable turn of events, considering that the drug was developed in the 1950s by a division of Armour & Company, the meatpacking company that once ruled the Union Stock Yards of Chicago. As in the 1950s, Acthar is still extracted from the pituitary glands of slaughtered pigs — essentially a byproduct of the meatpacking industry.

The most important use of Acthar has been to treat infantile spasms, also known as West syndrome, a rare, sometimes fatal epileptic disorder that generally strikes before the age of 1.

For several years, Questcor, which is based in Anaheim, lost money on Acthar because the drug’s market was so small. In 2007, it raised the price overnight, to more than $23,000 a vial, from $1,650, bringing the cost of a typical course of treatment for infantile spasms to above $100,000. It said it needed the high price to keep the drug on the market.

“We have this drug at a very high price right now because, really, our principal market is infantile spasms,” Don M. Bailey, Questcor’s chief executive, told analysts in 2009. “And we only have about 800 patients a year. It’s a very, very small — tiny — market.”

Companies often charge stratospheric prices for drugs for rare diseases — known as orphan drugs — and Acthar’s price is not as high as some. Society generally tolerates those costs to encourage drug companies to develop crucial, possibly lifesaving drugs for these often neglected diseases.

But Questcor did almost no research or development to bring Acthar to market, merely buying the rights to the drug from its previous owner for $100,000 in 2001. And while the manufacturing of Acthar is complex, it accounts for only about 1 cent of every dollar that Questcor charges for the drug.

Moreover, the tiny “orphan” market soon became much bigger. Before long, Questcor began marketing the drug for multiple sclerosis, nephrotic syndrome and rheumatologic conditions, even though there is little evidence that Acthar is more effective for those other conditions than alternatives that are far cheaper. And the company did so without being required to prove that the drug actually works. That is because Acthar was approved for use in 1952, before the Food and Drug Administration required clinical trials to show a drug is effective for a particular disease. Acthar is essentially grandfathered in.

Today, only about 10 percent of the drug’s sales are for infantile spasms. The new uses, Mr. Bailey has told analysts, represent multibillion-dollar opportunities for Acthar and Questcor, its sole maker.

The results have been beyond even the company’s wildest dreams. Sales of Acthar, which accounts for essentially all of Questcor’s sales, totaled nearly $350 million in the first nine months this year, up 145 percent from the period a year earlier. In the same period, Questcor’s earnings per share nearly tripled, to $2.12. In the five years after the big Acthar price increase in August 2007, Questcor shares rose from around 60 cents to about $50, in one of the best performances of any stock in any industry.

But in September, the shares plummeted after Aetna, the big insurer, said it would no longer pay for Acthar, except to treat infantile spasms, because of lack of evidence the drug worked for other diseases. The stock now trades at $26.93.

Peter Wickersham, senior vice president for cost of care at Prime Therapeutics, a pharmacy benefits manager that has found the drug is possibly being overused, says the huge increase in Acthar’s price for patients “just invites the type of scrutiny that it’s received.”

Questcor, meanwhile, has disclosed that the United States attorney’s office in Philadelphia is investigating its marketing practices. The company hasn’t been accused of wrongdoing.

Mr. Bailey, Questcor’s C.E.O., defends his company’s practices. He says that when Questcor raised Acthar’s price, it did not initially intend to market the drug for other uses. It simply responded to demand. “Nobody predicted this,” he said. “Nobody.”

He also says that Questcor isn’t competing with low-price alternatives, but that it is marketing the drug as a treatment when those alternatives fail. Used that way — for instance, as a last chance to avert kidney failure — insurers are still paying for the drug at least 85 percent of the time, he says.

Still, given that Questcor is now pursuing billion-dollar opportunities far beyond the treatment of infantile spasms, is the high, orphan-drug price still justified?

“We could lower the price and make less money,” Mr. Bailey says, “and then we would be sued by our shareholders.”

Whatever the case, one group of shareholders has done pretty well for itself. Over the last two years, as the company’s share price mainly soared, Questcor insiders have sold more than $100 million of stock.

THE story of Questcor’s wonder drug begins in Rochester, Minn. It was there, at the Mayo Clinic, that Dr. Philip S. Hench spent more than 20 years searching for what he called Substance X.

Dr. Hench, a rheumatologist, hypothesized that the body could make a compound that stilled the immune system’s attacks on the joints of people with rheumatoid arthritis.

It turned out that another Mayo researcher, Dr. Edward C. Kendall, had isolated six hormones made by the adrenals, the small glands atop the kidneys that are chiefly responsible for releasing stress hormones. When a few patients were injected with one of the hormones in 1948, their symptoms subsided.

But that hormone, now known as cortisone, was then hard to synthesize. So Dr. Hench thought of injecting another substance that would stimulate the body to produce its own cortisone and other steroid hormones. That substance was adrenocorticotropic hormone, or ACTH, which is made by the pituitary gland.

Dr. Hench obtained some ACTH from the Armour meatpacking company, which was extracting it from pigs as part of an effort to develop markets for leftover animal parts. (Its big success was Dial soap, introduced in 1948.)

When ACTH was injected into the first arthritis patient in February 1949, the results were as good as with cortisone, spurring a huge spike in demand for animal glands. By 1950, thousands of patients, not only those with arthritis but also those with gout, lupus, ulcerative colitis and many other diseases, had been treated with either cortisone or ACTH.

That year, Dr. Hench, Dr. Kendall and a third scientist were awarded the Nobel Prize in medicine.

In 1952, Armour won approval from the F.D.A. for H.P. Acthar Gel, or “highly purified” ACTH mixed with gelatin (another animal byproduct) to make it last longer in the body and require fewer injections. The label said the drug could be used to treat about 50 diseases.

But by the 1980s, drug companies had learned to synthesize steroids like prednisone, and those became the treatment of choice. In 1995, when the F.D.A. found numerous quality control problems at the factory manufacturing Acthar, the drug’s owner at the time, Rhône-Poulenc Rorer, decided to discontinue the product rather than invest in manufacturing improvements.

That decision provoked an outcry from some patient groups and pediatric neurologists, who said the drug was the best treatment for infantile spasms. So Rhône-Poulenc, which became Aventis after a merger, continued to make a limited supply that was rationed to treat only infantile spasms or severe flare-ups of multiple sclerosis. With Aventis losing several million dollars a year on the drug, on sales of only about a half-million dollars, the company looked for a way out.

It sold the drug in 2001 to Questcor for $100,000 as well as a 1 percent royalty on annual sales over $10 million. At the time, Questcor, formed by a merger of two small companies in 1999, was losing money and looking for drugs to market. With help from Aventis, Questcor set up its own, somewhat more modern manufacturing through a contractor on Prince Edward Island, Canada.

Questcor immediately raised the price of Acthar to $700 a vial, from $40, and the price rose gradually after that. By the end of 2006, Acthar sales were about $12 million a year, but the company was still losing money.

In May 2007, James L. Fares, left as chief executive and was replaced, initially on an interim basis, by Mr. Bailey, who had joined the board a year earlier. A mechanical engineer by training, Mr. Bailey had retired in 2000 from a 10-year run as chief executive of Comarco, a military contractor and telecommunications concern.

Three months later, Questcor announced the huge price jump, aimed at repositioning Acthar as a specialty drug. The move prompted protests from parents and pediatric neurologists.

“It made us so sick to the stomach — just the fact that something like that could happen overnight with a drug my child needed to live,” says Christina Culver of Colorado Springs. “It’s just like someone saying, ‘I’m going to charge you for oxygen now.’ ”

Ms. Culver’s son Tyler was in the hospital, being treated for infantile spasms, just as the price increase hit. Tyler was due to leave the hospital, and Ms. Culver and her husband, Randy, were to continue the injections at home. Then the Culvers’ insurer, Blue Cross Blue Shield, refused to pay the new high price. After a storm of publicity, the insurer backed down.

Questcor, however, hasn’t, and has continued to raise the price, now at more than $28,400 a vial. Insurers generally pay for Acthar because it is considered the best treatment for infantile spasms. They also tend to pay for other approved uses if cheaper drugs have been tried first. And Questcor has carefully executed the orphan-drug playbook. Patients who cannot pay are given the drug free. The company helps with insurance co-payments, to make sure that a patient’s inability to make a co-payment doesn’t stand in the way of the drug being used and the insurer paying $28,000 a vial.

In other words, Questcor shifts the cost onto insurance companies while staving off consumer protests. It has a staff of 30 people who do nothing but work on insurance reimbursements — about one staff member for each of the roughly 30 prescriptions it gets in a typical day for all uses.

Questcor executives argue that with the free drug program and the ample supply, patients have better access to Acthar now than when it was cheaper and often in short supply.

“We believe we’ve been good stewards of this product,” Mr. Bailey says.

Dr. Lawrence Brown, a neurologist at the Children’s Hospital of Philadelphia and the president of the Child Neurology Foundation, says of Questcor: “They have gone out of their way to help every kid who needs the medicine to get it quickly and efficiently.”

This year, the foundation awarded its first corporate citizenship award to Questcor. Dr. Brown says Questcor’s donations — the amount has not been disclosed — to the foundation didn’t influence the award.

STILL, the price remains a sticking point.

At Children’s National Medical Center in Washington, “we’ve been instructed not to hospitalize a child with spasms unless the authorization has been procured to pay for it,” said Dr. Phillip L. Pearl, chief of child neurology. In practice, however, no child has been turned away.

Dr. Shaun Hussain of Mattel Children’s Hospital in Los Angeles said that the studies showing Acthar to be better than far cheaper steroids used too low a dose of steroids.

At his hospital, he reported at a medical meeting this month, 18 of 30 babies were successfully treated with two weeks’ worth of a high-dose oral steroid. Only the 12 who did not respond were switched to Acthar, with five of them successfully treated.

Given that the steroids cost $200 for each baby, compared with about $125,000 for Acthar, the approach saved more than $2 million. “We have to look at the cost to the health care system,” Dr. Hussain said.

Mr. Bailey says the new price was set to make the company viable based solely on sales for infantile spasms. Executives assumed at the time that the high price would preclude other uses. < But to Questcor’s surprise, he says, some prescriptions continued to trickle in to treat the periodic flare-ups that plague people with multiple sclerosis. So Questcor began hiring sales representatives to promote the drug for that use. Then it hired a sales force to promote the drug as a treatment for nephrotic syndrome, a kidney injury that can lead to kidney failure. In June, it began selling to rheumatologists.

For all these diseases, there are cheaper alternatives. Oral prednisone, which might be used for some rheumatological diseases, can cost $10 a month. Intravenous steroids, used to treat multiple sclerosis flares, cost several hundred dollars.

Because Acthar was approved for these conditions decades ago, Questcor has not had to do large clinical trials to show that the drug works. It has paid for some small studies, mainly by individual doctors, who then publish a paper that the sales force can present to doctors.

The study that justified calling on rheumatologists involved five patients with rare conditions, all of them treated by a single doctor. All the patients had much improvement on Acthar after failing to benefit from more standard therapies, the doctor, Todd Levine, said in a Questcor conference call.

Still, it appears that at least a couple of small studies that may have raised questions about the drug have been suspended. “From my standpoint it just didn’t work,” said Dr. Sungchun Lee, a Phoenix nephrologist who stopped a small study testing Acthar as a treatment for nephrotic syndrome. “I think they were O.K. with me stopping because we weren’t getting the results,” he said. Another study that was terminated sought to determine whether multiple sclerosis patients who did not have a good response to steroids should be treated with either another round of steroids or with Acthar. The study was halted midway through “to analyze data,” according to the summary of the trial on the federal clinical trial database.

A negative result could have jeopardized already growing sales for multiple sclerosis. The company says the trial fell hopelessly behind its goal in recruiting patients.

Given the scarce data, and the high price, most doctors do not use Acthar for multiple sclerosis, nephrotic syndrome or rheumatology.

“It’s absurd,” says Dr. Douglas R. Jeffery, a multiple sclerosis specialist in Advance, N.C. “There’s never a clinical setting where I can justify spending $23,000 to treat an M.S. relapse.”

But some doctors say Acthar can be effective in cases that are not well treated by steroids. They say that there is emerging evidence that Acthar does more than just stimulate the body to produce its own steroids.

“It really looks like the ACTH does bring something different to the table that standard steroids don’t,” said Dr. Ben W. Thrower, director of the multiple sclerosis institute at the Shepherd Center, a hospital in Atlanta. Dr. Thrower, who is a paid speaker for Questcor, said his institute had tried Acthar for about 60 of its 3,000 patients, ones who did not respond to steroid treatment. Acthar made the symptoms subside in about half of them.

GIVEN Acthar’s price, Questcor does not need many prescriptions to make a good business. A course of treatment for nephrotic syndrome can run $250,000, while a shorter treatment for a multiple sclerosis relapse typically costs $40,000.

Questcor sales representatives who are lucky enough or skillful enough to have a big prescriber in their territory can reap bonuses of $50,000 a quarter, according to former employees of the company.

Executives are paid well, too. In 2009, Mr. Bailey hired his daughter Kirsten Fereday as director of business analytics and evaluation, a job that paid $275,000 in cash and stock last year.

Mr. Bailey and Steve Cartt, Questcor’s chief operating officer, say the company’s marketing has been aboveboard and that the company is now starting to sponsor more studies. “This wasn’t possible until the drug was financially viable,” Mr. Bailey said.

Patients report mixed results. Sharon Keller of Austin, Tex., who has nephrotic syndrome, tried Acthar after two other drugs had not worked. But she stopped, she says, because side effects including mood swings and weight gain were “much worse than I’d ever experienced.”

I almost had to fight with my doctor not to push it on me,” Ms. Keller, 59, says. She says her insurer was charged $130,000 for her drug, including a vial she did not use. “I have a Cadillac in my refrigerator,” she says of that leftover vial.

ONE big uncertainty hanging over Questcor is competition. As an old drug without patent protection, Acthar would seem to be a sitting duck for generic rivals. And other versions of ACTH have been sold in the past.

Yet Questcor is now arguing that its studies show that Acthar, despite the “highly purified” in its name, actually contains other substances from the pig pituitary glands that account for some of its effectiveness. The company does not intend to say what those other ingredients are, thus making it extremely hard for a generic company to copy Acthar.

“Coca-Cola is not going to tell you what Coke contains, either,” Mr. Bailey says.

Whether such an argument will work remains to be seen. Even if it does, competitors could still sell other forms of ACTH. Novartis, which sells a synthetic version called Synacthen in Europe, has applied for a United States trademark, a sign that the drug might be brought to this country.

A small Maryland company, Cerium Pharmaceuticals, recently won orphan-drug designation from the F.D.A. for Synacthen to be used to treat infantile spasms. But that does not necessarily mean that Cerium has the rights to the drug or intends to market it.

Cerium is run by Gregg Lapointe, a former Questcor board member. He declined to comment for this article.

Still, Synacthen, or other versions of ACTH, might have to go through lengthy trials before being approved, and would have to be approved for one disease at a time.

So there is at least a chance that Questcor might maintain its high-priced dominance for a long time. In the meantime, the company plans to systematically expand the marketing of the drug to treat other diseases, starting with those already on the label.

Given that Acthar has many potential uses, Mr. Bailey says, Questcor sees no reason to come up with other drugs. The company has been buying back its stock, helping to underpin the price, and recently said it would start paying a dividend.

“We’ll take it where it goes,” Mr. Bailey says of Acthar. “It’s taken us to places we never expected.”

Go Gangnam Style

TRICKED YA! Made you look!

Well if I had said this was a post about Religion, Faith and the role it has in building community would you have even read this far?

Well in truth, this is not about conventional religious dogma but about the idea of Humanism.  This is a broader based concept that embraces faith but is open in the idea that those without conventional faith - aka agnostics and atheists - are members as well

What happened to compassion, to empathy, to the idea that regardless of the name we give God or not at all, is seemingly associated with a place of worship.  Do they hold the patent or exclusive to those traits?

As a child who attended private schools (both non and secular type)  I have always found myself in a very interesting relationship when it comes to what it means to have Religion.  My Mother was very keen on having faith as she felt it was the foundation to who you were. She didn't think it mattered what label, type or name you called your faith, just get some.  And as many things I have come to accept and realize in life, she was right.

She knew then and as I know now its not what it does to you it is what it provides for you, a place to find a community where for at least one hour of one day you leave all differences at the door and share in one thing. At least that is something.

Over the years in the "intellectual elite" circles aka the "white establishment" or  whatever label, name you want to put on it, having faith was equated with a lack of intellect, being a hillbilly or OH NO MR BILL, a Republican.   What it did to people like me is push us into a closet I put akin to being Gay in the 50s.  Heavily in the closet, in denial and seeking those similar by going down dark alleys or having some secret glance, handshake or pocket scarf that sends a signal to others that yes we are of like mind.   For those in the lack of the know one of my most favored "intellectual elites", Bill Moyers,  is quite open about his beliefs and faith and he is even on PBS! You can't get more liberal and elite than that!

I don't know exactly when suddenly all faiths became so extreme and so intolerant but its not just Islam that faces the defense of its existence but across the board from Judaism to Christianity it is now political and not personal and therefore,  private and intimate and more importantly, non judgmental, which is what faith is to many.  And by doing so you are turning that yet undeveloped Polaroid into a black and white snapshot.

I am exhausted trying to reach understanding, agreement and in turn empathy and compassion from those with letters which follow their name, often longer than their name, who advocate such intellectual superiority that even when attached to the end of check, struggle to treat others with dignity and respect.  Meet a Doctor or Lawyer lately?  Enough said.

I have found that I am never rejected in my faith and in my foundation I have a house that stands. I wonder without such would I still be standing given what has happened to me this year, I am unsure. As I said to a member of the Medical Matrix Complex,  "I do have a voice in my head, God's." 

I thought this was an interesting piece that asks the question - where are the Humanists when they are needed in a crisis?  I think of them much like the Occupy Movement, good on intention and not so good on follow through.

We need each other. We cannot continue to think that this idea of our bootstraps are something we simply can pull up let alone hold alone.

In a Crisis, Humanists Seem Absent

By Samuel G. Freedman
Published: December 28, 2012

The funerals and burials over the past two weeks have taken place in Catholic, Congregational, Mormon and United Methodist houses of worship, among others. They have been held in Protestant megachurches and in a Jewish cemetery. A black Christian youth group traveled from Alabama to perform “Amazing Grace” at several of the services.

This illustration of religious belief in action, of faith expressed in extremis, an example at once so heart-rending and so affirming, has left behind one prickly question: Where were the humanists? At a time when the percentage of Americans without religious affiliation is growing rapidly, why did the “nones,” as they are colloquially known, seem so absent?

To raise these queries is not to play gotcha, or to be judgmental in a dire time. In fact, some leaders within the humanist movement — an umbrella term for those who call themselves atheists, agnostics, secularists and freethinkers, among other terms — are ruefully and self-critically saying the same thing themselves.

“It is a failure of community, and that’s where the answer for the future has to lie,” said Greg M. Epstein, 35, the humanist chaplain at Harvard and author of the book “Good Without God.” “What religion has to offer to people at moments like this — more than theology, more than divine presence — is community. And we need to provide an alternative form of community if we’re going to matter for the increasing number of people who say they are not believers.”

Darrel W. Ray, a psychologist in the Kansas City area who runs the Web site The Secular Therapist Project, made a similar point in a recent interview. As someone who was raised as a believing Christian and who holds a master’s degree in theology, he was uniquely able to identify what humanism provides.

“When people are in a terrible kind of pain — a death that is unexpected, the natural order is taken out of order — you would do anything to take away the pain,” Dr. Ray, 62, said. “And I’m not going to deny that religion does help deal with that first week or two of pain.

“The best we can do as humanists,” he continued, “is to talk about that pain in rational terms with the people who are suffering. We have humanist celebrants, as we call them, but they’re focused on doing weddings. It takes a lot more training to learn how to deal with grief and loss. I don’t see celebrants working in hospice or in hospitals, for example. There are secular people who need pastoral care, but we abdicate it to clergy.”

In fairness, it should be pointed out that the families of each Newtown victim chose religious funerals. The interfaith service, by its very definition, precluded the involvement of leaders from non-faith organizations like the Ethical Culture Society or the American Humanist Association. At the most divisive, the former Republican presidential candidate Mike Huckabee asserted that violence like the Newtown shootings occurs because “we’ve systematically removed God from our schools.”
The net effect can be to leave humanists feeling frozen out and defensive. “We send out letters, we send out press releases, we’re on Meetup,” said Anne Klaeysen, 61, leader of the New York Society for Ethical Culture. “But we feel people don’t pick us up. We’re not proselytizers. But the religious landscape has changed so that we have to market ourselves.”

While tacitly excluded from religious coalitions, humanist groups did respond to the Newtown killings. The Ethical Culture Society chapter in Teaneck, N.J., helped organize a gun-control rally there. The Connecticut branch of the American Humanist Association contributed about $370 to Newtown families from a winter solstice fund-raiser. The organization American Atheists reports on its Web site that it has collected more than $11,000 in online donations toward funeral expenses in Newtown. A secular support group called Grief Beyond Belief operates on Facebook.

Still, when it comes to the pastoral version of “boots on the ground” — a continuing presence in communities, a commitment to tactile rather than virtual engagement with people who are hurting — the example of Newtown shows how humanists continue to lag.

That lag persists despite significant growth in the number of nonbelievers. A recent national study by the Pew Research Center found the share of “nones” had risen to about 20 percent of Americans from 15 percent in just five years. The humanist movement of the last decade has had eloquent public intellectuals in Sam Harris, Richard Dawkins and the late Christopher Hitchens.

Yet, in the view of internal critics like Mr. Epstein and Dr. Ray, humanism suffers in certain ways for its valorization of the individual. The inside joke is that creating a humanist group is like “herding cats.”

“You can’t just be talking about cowboy individualists anymore,” Dr. Ray said. “We have to get out of this mentality we’ve been in over the past 50 years of just saying how stupid religion is. We have to create our own infrastructure.” 

Mr. Epstein is currently involved in a three-year, $2.5-million project to study, develop and spread the concept of nonreligious community. But he believes that better organizing must be accompanied by better messaging.

“A lot of humanist rhetoric of previous generations revolved around reason,” he said. “We’d say, ‘We’re people of reason rather than people of faith.’ But I’ve always been uncomfortable with that as the banner under which we march. We need to think of reason in the service of compassion — caring, being cared-about, a life of meaningful connection. Reason itself is the tool. When we see it as the end-product we miss the point.”

Working 9-5

We have long transcended the 8 hour day.  Most businesses are open 7 days a week and no longer from 9 to 5, yet there are those professions that seem to still operate on a schedule that few do.  And that is of course the Medical Matrix Complex.

Many who are fortunate enough to have insurance find that accessing medical care even in the best of times is impossible. Why? Well shit happens and shit happens at any time any where. To today's Doctor, unless that happens during conventional business hours and can be schedule appropriately its a trip to the ER to get the care one needs.

In the every increasing mythology that comprises the American Unicorn storyteller there is the one that its the hideous poors and their lack of insurance flooding ER's causing the ever increasing rise in Medical costs and of course the subsequent hideous care that results.

Well I have long written that is not the case and in fact its mostly well insured who find themselves availing themselves of ER care as they can "afford" it and in turn need it.  Those uninsured find themselves relegated to the second tier of ignored or substandard care at Hospitals designated as those accepting the "poors".  In other words you are not insured you will be transferred or in turn receive a waiting number that is into the next century or higher costs for the same care that the "Richs" get.  Separate and yes unequal.   Modern medicine is a hierarchy in and of itself.

The article below demonstrates that if there are clinics and care available at "off hours" costs are lower and patient satisfaction higher. Go figure.  I have also put a few readers comments that are also very telling about real people and their experiences in trying to get medical (for lack of a better word) "care. Note the one from a Doctor which is usual and expected - loss of income. God shut up already. I wish there was some pill or drug that big Pharma could invent to give Physicians for them to STFU about their loss of wages.  We can only hope. Prayer seems to work today when it comes to finding medical help and at least its free.

The Gift of After Hours Medicine

By Ann Carrns
Published December 29 2012

A new study shows that people who have after-hours access to their doctor use the emergency room less.

Published online in the journal Health Affairs, the study found that one in five people who attempted after-hours contact with their primary care doctor reported it was “very difficult” or “somewhat difficult” to do so. But those who reported less difficulty contacting a doctor after hours, say on nights and weekends, had fewer emergency room visits than people who experienced more difficulty.\

I can relate at least one experience in which our pediatrician’s evening hours saved us an emergency room visit, after a mishap known in our family as the Fork Incident. It was one of those times when we really needed to see a doctor, in person, past regular business hours — not just talk to an on-call advice nurse.

We had moved to a new town and into a newly renovated home, complete with polished hardwood floors. One evening, my then 5-year-old daughter was helping me set the table, and she grabbed a handful of forks from the silverware drawer. She didn’t run. But somehow, in the few steps to the table, she slipped and fell. On her face. On the forks.

When she began howling, I took one look at the blood pouring from her face and felt my knees go weak. Fearing her eyeball was punctured, I yelled for my husband, who calmly removed her to the bathroom to assess the damage.

The utensils hadn’t, thankfully, hit her eye. But the tines of at least two forks did pierce the skin just above her eyebrow, which was rapidly swelling. We thought it should be looked at by a doctor, just in case.

A call to our new pediatrician revealed that the office had extended hours on some evenings, and we were told to bring her in. The doctor looked at the rows of tiny holes above my daughter’s eye. “What kind of a fork was it?” he marveled. “It was more than one!” I blurted, feeling ridiculous. Everyone knows not to let kids get their hands on scissors or knives. But, come on — forks?
She didn’t need stitches, and we went home to put ice on her forehead. The after-hours clinic had probably spared us two hours of waiting and a $100 co-payment at the emergency room.

The study found that among people with a regular primary care doctor, 40.2 percent reported that the doctor’s practice offered extended hours. One obstacle to the wider availability of the service, the study noted, is that doctors are “insufficiently compensated for working evenings and weekends.”
The study concludes that after-hours access by phone or e-mail, too, offers the potential to reduce rates of emergency room use. I’m glad, though, that our practice offered in-person visits.

Does your doctor offer a way for you to get in touch on evenings and weekends, or to receive care after hours?

Reader Comments

More likely six hours in the emergency room, not two.

My internist cannot be contacted even during regular business hours. In fact, I cannot even contact his "receptionist". All I get is a recorded announcement claiming (falsely, based on what I have seen in the office) that she is assisting another patient, and inviting me to leave a message that she may, possibly, return that day or the next. The receptionist needs a receptionist.

I have been a PCP for over 20 that time my salary has stagnated or decreased due to outdated reimbursements. So now you want me to extend hours? 20 years ago, when we were making money, all sorts of courtesies were offered...staying late, an occ. house visit, offering people treatment over the telephone, forgiving someones copays, etc.. I can't afford to do that now. If I put one suture in someones scalp, I make more money that speaking to them about their cholesterol for 45 minutes. If you cut me, do I not bleed?

a few months ago my eye was very swollen. i figured it was probably an allergic reaction and called my doctor on a Saturday to get a referral, hoping someone would be open. he told me to go to the emergency room for a department they had to treat non-emergencies. i saw a physicians assistant who simply looked at the eye and told me i was right. she then instructed me to go to the pharmacy and pick up an over the counter eye wash. that was it...oh, except for the $1,500 bill not covered by my insurance company. i looked up emergency room visit level 3 and did not recognize any of the services they provided as being done when i was there. when i discussed it with the hospital, suddenly it became code 1 for $600.

if you ask me, the medical system is pretty broken. i don't even know if i would be able to get medical treatment at all in an emergency. some real work needs to be done here...


I work as an NP in a primary care office. We are open late two nights a week. After hours and weekends and holidays, one of us is always on call and patients call our service, who relays the message to us and we call the patient back. Many times, patients just need a prescription renewal (like an asthma inhaler they cannot go without). Other times, we can give them advice over the phone or send them to the ER if we think the symptoms they describe merit an ER visit. We really do try to keep them out of the ER, though.

Thursday, December 27, 2012

Money and Mouth Meet

In a true example of putting your money where your mouth is and actually being both a 'Job creator' and in turn Venture Capitalist/Philanthropist, comes this news from of all places a gossip website.

On Jan. 3, Patrick Dempsey plans to lead the charge in trying to buy back cash-strapped, Washington-based Tully's Coffee, which filed for bankruptcy in October. Working with a group that intends to be the top bidder on the floundering chain, he hopes to give the company a
second chance at financial solvency. "I'm excited about the opportunity to save hundreds of jobs, give back to Seattle and become a larger part of the economic growth and fabric of the community," said Dempsey, whose hit show "Grey's Anatomy" is set in Seattle. 

"I've always loved this city, and with the purchase of Tully's Coffee, I plan to spend a lot of time in Seattle and at the stores connecting with the community and growing the Tully's brand. It looks like Seattle may be my home away from home in the very near future."

While the show Grey's Anatomy (of which I have only watched twice but will become its number one fan) is set here in Seattle, the irony is that it is supposed to take place at Harborview Medical Center, which I have renamed Horrorview, The American Horror Story, the Hosptial after the FX show of a similar title.  That said if they actually had medical staff like those on television they might even be slightly competent but sadly the closest I came to an actual competent Doctor was one whom I never met and like everything at that dump his medical orders were utterly ignored.  Well that is fair, what the do to the patients they should also do the Doctors.

But the true story is that Tully's which tried to pose itself as the non-Starbucks simply could not do so. The one by my house closed recently and the rest have been following suit as they attempt to re-organize under Bankruptcy.  

I don't drink Tully's but they are jobs, they have a fantastic roasting plant that they reconfigured from another local brew long gone, Rainier and had a committed presence in the area.  They may be only service jobs but in a service economy they are needed.

And Seattle is known for its coffee but that is becoming less and less so and more single than doppio or triple grande as Starbucks has slowly either monopolized or overwhelmed the market. 

I wish Mr. Dempsey good luck and good wishes and hope this works out.  I can't wait to leave Seattle and perhaps Mr. Dempsey would like my place, its just over the hill from the roasting facility.

Do the Right Thing

Suddenly the AMA has decided to step in and intervene on an ever increasing problem - the consolidation of Doctor's practices and in turn the reduction in services and rise in costs in Medicine. I would go into shock but I might get taken to Harborview Medical Center again and this time not be so lucky to come out alive.

The AMA is much like any appropriate acronym group, once a trade union but now way too white coat for that are now Lobbyists that protect their member's interests and in turn incomes.  They have been quite successful at blocking Single Payer option to health care reform, they have ceilings and caps on medical schools  and in turn licenses issued to limit Doctors, to event the types  of individuals qualified and capable of providing care; their role seems basically ensure their Doctors keep their 1% status while bankrupting 60% of Americans annually thanks to Medical debt.  They are very caring indeed.

But every now and then someone or something surprises you and that was in this announcement below.  The AMA is actually asking their Doctors to do something that well they are supposed to when they become Physicians - actually follow the Hippocratic Oath.

What is next? Actually communicating and listening to a Patient? Well let's not get carried away. One step at a time. 

Doctors Warned on ‘Divided Loyalty’

Published: December 26, 2012

WASHINGTON — With hospitals buying up medical practices around the country and seeking to make the most of their investment, the American Medical Association reached out to doctors this week to remind them that patient welfare must always come first and not be overridden by the economic interests of hospitals that now employ doctors in ever-growing numbers.

“In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority,” says a policy statement adopted by the association.

“A physician’s paramount responsibility is to his or her patients,” the association said. At the same time, it added, a doctor “owes a duty of loyalty to his or her employer,” and “this divided loyalty can create conflicts of interest, such as financial incentives to over- or under-treat patients.”

The association is disseminating its policy to doctors at a time when more of them are becoming hospital employees. About one-third of new doctors say they would prefer to be employed by hospitals, rather than practice on their own. The association is urging hospitals and medical groups to adopt similar policies.

A major goal of the guidelines is to protect the professional autonomy of doctors. Hospital employment agreements often include provisions that discourage doctors from sending patients to providers of services that are not affiliated with the hospital.

The guidelines say that “physicians should always make treatment and referral decisions based on the best interests of their patients.” Moreover, the association says, patients should be told whenever a hospital provides financial incentives that encourage, discourage or restrict referrals or treatment options.

“We never want patients to worry or wonder if a decision is being made in their best interest,” said Dr. Ardis Dee Hoven, a Kentucky internist who is president-elect of the association.

From 2000 to 2010, the American Hospital Association says, the number of doctors employed by hospitals grew by 32 percent, to 212,000. The trend has accelerated since then, in part because of federal policies that encourage doctors and hospitals to band together to coordinate care.

In addition, many doctors have found that private practice on their own is no longer profitable and comes with a host of complications, so they are more receptive to the idea of hospital employment.

“Physicians are squeezed between rising costs and decreasing reimbursement,” and they “see only declining revenue in the future,” as Medicare and private insurers restrict payments, the American Medical Association said.

In a report accompanying its principles for physician employment, the association said that doctors have a “fiduciary responsibility” to patients and should have an “unfettered right to exercise independent professional judgment” in caring for and advocating for patients.

Dr. Jerry D. Kennett, a leader of the American College of Cardiology, said he was aware of cases in which a hospital had told doctors not to place defibrillators in Medicaid patients because “it’s a money-losing proposition” for the hospital.

In other cases, he said, hospitals have told doctors they must use the hospital for laboratory work and certain imaging procedures, even if doctors found that they got better results or better service elsewhere.

Richard J. Umbdenstock, the president of the American Hospital Association, said he had no major problem with the medical association’s principles. “Hospitals and doctors have a long history of being on the same page, doing what is best for patients,” he said.

In compensating doctors, hospitals often pay a salary with a bonus that depends on a doctor’s productivity, contributions to the quality of care and patient-satisfaction ratings.

Productivity is typically measured in terms of “relative value units,” which reflect the time, technical skill, physical and mental effort and judgment required to perform a particular service. Federal officials have assigned a relative value to each service for the purpose of paying doctors under Medicare.

“Use of relative value units is a fairly standard measure of performance for physicians” employed by hospitals, the medical association says in a manual describing doctor-hospital contracts.

Hospitals often set a goal for doctors that can result in a bonus, but if the doctors fall short, their salary may be reduced the next year.

Another issue addressed in the guidelines is what happens when a doctor and a hospital part ways.

Hospitals frequently seek agreements to ensure that physician employees will not work for competitors if they leave the hospital staff. Such agreements typically prohibit a doctor from practicing medicine in a certain geographic area for several years after the doctor’s employment ends.

The medical association discouraged doctors from entering into such agreements, and it said that “patients should be given the choice to continue to be seen by the physician in his or her new practice setting.”

Living and Aging Differently

I found this article in the New York Times about Aging in Place and Independent Living for Seniors. Then I received the standard "Boomers Community Needs as they Age" from Builder online.

After realizing that shit happens regardless of age and that aging is not a one size fits all concept in our society, I began to realize the need to find homes for all ages of all needs. And from that I wanted to figure out how people who have lived "independently" to suddenly realize that living alone is no longer an option and that is not about health or age but often about economics or other extraneous factors. And how do we find the ability to commune together and that became my inspiration for what I call the new "commun-ty" be that family members that share a common DNA or those who choose to call one another family.

A family is multi-generational and in turn multi need.  So how does one find the right fit for those needs in the current economic climate and do so in either suburban or urban homes? The standard solution was the MIL flat or add on to an existing home that is basically separate but equal. But that is not equal as one living adjacent, independently but adjacent to the family home is outside looking in. I am not sure that is an effective way to living collaboratively, effectively and affordably.  Two homes are not better than one.

I also think we have to learn that we can live together independently, successfully if in fact the physical property is remodeled to meet the varying needs but in ways that are not exclusively for one individual versus another.  Private en suites, excellent soundproofing, quality finishes, and communal spaces that are open and yet not part of food preparation or other work spaces.

There is also a design movement away from the great rooms of the past and a move to enclose kitchens and have rooms that are similar to ones of a generation ago.  Frankly just on energy use alone, the ability to appropriately ventilate as need and effectively control humidity in a kitchen versus an entire space is an HVAC dream come true.

Plus its very easy to clean and maintain and if the finishes are well chosen the long term maintenance and upkeep are seriously reduced and that also is cost effective.   Home design and interior decor is more an act of both science and in turn analysis. Understanding what your needs are - both economic and physical - is a psych-social enterprise that few Contractors and even Interior Designers understand.  So finding those whom you can communicate with are essential or in fact finding a consultant who will do the research for you to save time and energy and provide a comprehensive list that gives both pros and cons to make the decision making process easier.  This can then be used to determine budget and costs overall and in turn reduce costs from change orders or worse later frustration when you find out that what was in trend is not working for you.

Homes are like those that live in them - individual. And they have a life and purpose that serve that individual not the other way around.   All residents in home can live together under one roof in ways that we have yet to fully learn but in other countries and cultures its a given.   This is where the idea of community serves a much more intimate but still relevant purpose.  And community is sustainability.

Staying Independent in Old Age, With a Little Help 

By: Jane E Brody

My 92-year-old aunt, who is cognitively impaired and requires a walker or wheelchair to get around, still lives in her own apartment, where round-the-clock home health aides help her get to and from the bathroom, bathe, dress and undress, and go outside each day for some fresh air. The aides shop, prepare and serve meals, do light housekeeping and make sure she takes her medications on time.

But last month, my aunt’s long-term care insurance ran out, and her meager savings will soon do the same. Then what?

Her daughters, both of whom work to support their families, cannot afford the $150 a day for 24-hour care by a certified home health aide, and my aunt has nothing to sell that could bring in the needed cash. Nor does she yet qualify for Medicaid or have a terminal illness that would justify hospice care, which would be covered by Medicare.

Complicating matters, her daughters long ago promised that they would not put her in a nursing home.

Such dilemmas are increasingly common as people live longer. The number of Americans 65 and older is expected to double to 80 million in the next three decades. People 85 and older are the fastest-growing age group; by 2020, there will be 6.6 million people in that age bracket, when rates of debilitating ailments soar.

Most Americans over 65 will eventually need help with the so-called tasks of daily living — eating, dressing, bathing, shopping and the like. But with family members spread all over the map or unable to be full-time caregivers for other reasons, the need for new and better options will only increase.

When asked, 80 to 90 percent of older people say they want to remain in their own homes as long as possible. Yet remaining in one’s home indefinitely is not always the best choice, even if it is financially feasible. As life draws near a close, many older adults need more care than can be provided safely at home. Simply finding reputable home health aides can be a nightmare, and family members often are forced to fill gaps in even the best caregiving plans.

The challenge is all the more difficult when no one has thought through the options before a serious illness or injury makes it impossible for elders to return home without full-time help.

Many elders living independently need outside help long before they require round-the-clock care. A range of assistance and housing alternatives has rapidly sprung up to meet this demand. Many focus on improving accessibility in the home and access to neighborhood conveniences.

An older person living in the suburbs who can no longer drive may become isolated, lonely and at risk of malnutrition if there is no person or community service to shop for her and take her places. Even stairs are a major obstacle.

Elinor Ginzler, director of the Cahnmann Center for Supportive Services at the Jewish Council for the Aging in Rockville, Md., writes that “the ability to age in place is greatly determined by the physical design and accessibility of a home, as well as community features like the availability of nearby services and amenities, affordable housing and transportation options.”

Organizations like Staying in Place, a nonprofit group of volunteers, helps people age 50 and older in Woodstock, N.Y., and surrounding communities “maintain active, independent, fulfilling lives in their own homes.” For $125 a year (plus $50 for each additional household member over 50), the organization assists with paperwork and technology; free or low-cost transportation; referrals to discounted service workers; information about, and transport to, local classes and cultural and social activities; and recommendations for home health care agencies and personnel.

Other services that are free or low-cost include Meals on Wheels; friendly visiting; shopping services accessed by phone or computer; activities at senior centers; and adult day care centers.

There are also more costly commercial organizations like Home Instead Senior Care, an international network of more than 900 independently owned franchises that provide in-home nonmedical care for elders and support for their caregivers.

The organization sponsored a yearlong online study of 1,631 caregivers, 697 of whom were assisted by paid in-home nonmedical care. The study found that people receiving the additional paid care required 25 percent fewer doctor visits and were more likely to participate in adult day care.

Sadly, many aides are seriously underpaid. Home Instead, for instance, has lobbied to keep home health care aides exempt from minimum wage standards.
Henry Cisneros, former secretary of the United States Department of Housing and Urban Development and editor of the book “Independent for Life: Homes and Neighborhoods for an Aging America,” points out that “Americans are aging in traditional homes, neighborhoods and communities that were designed for yesterday’s demographic realities, not those of today or the future.”

Mr. Cisneros advocates changing our communities so that the elderly can remain in them. “Homes can be retrofitted, new age-appropriate homes built, existing neighborhoods reconnected, and new communities planned,” he wrote. For example, to accommodate declining eyesight, homes can be fitted with brighter bulbs, better lighting locations, easily accessed controls and nighttime guide lights.

Mr. Cisneros sees a pressing need for affordable packages of home modifications and maintenance to make residences more suitable for older people.

“A certified renovation package for aging in place could include roll-under kitchen and bathroom sinks, grab bars, curbless showers, lever faucets and door handles, a zero-step entrance, and wider doors and hallways,” he wrote.

While such changes have a price tag, they may cost a lot less than current care alternatives for the elderly.

Needed changes at the community level include affordable small-scale housing and cluster housing situated in walkable communities with nearby amenities, businesses, health facilities and public transportation.

Borrowing from the design of assisted living facilities, individual dwelling units might be located around a common space that includes dining areas and social rooms.

For elders who want to be near family members yet maintain their independence, so-called accessory dwelling units with their own kitchens and bathrooms are being built near or attached to family homes.

Wednesday, December 26, 2012

Mad Mad World

We are mad, we are not going to take it anymore and what are we going to do about it? Well if you are functionally sane and competent probably nothing but imagine you are not. What is the tipping point? What propels someone to suddenly cross into madness?

The article below I think says everything I have been saying for the past few weeks if not before. Our medical system is corrupt and incompetent, our legal system is corrupt and incompetent, and our society is the result.   If we were to assign a grade it would be D - for Disenfranchised, Disengaged, and Disturbed.

We are all victims here be it indirectly or directly.  We have all faced the utter failure in some way or another of how this system and its safety nets are utterly useless and the few that exist are so badly managed and handled they are worn out.  So what is the cure?  Well nothing but make them even harder to reach let alone hold onto.

In this Polaroid Nation take a moment to READ this article and understand the larger picture. Its developed alright and we refuse to look at it wholly and entirely but this one will not fade away.

Our Failed Approach to Schizophrenia

Published: December 25, 2012

 In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot." TOO many pendulums have swung in the wrong directions in the United States. I am not referring only to the bizarre all-or-nothing rhetoric around gun control, but to the swing in mental health care over the past 50 years: too little institutionalizing of teenagers and young adults (particularly men, generally more prone to violence) who have had a recent onset of schizophrenia; too little education about the public health impact of untreated mental illness; too few psychiatrists to talk about and treat severe mental disorders — even though the medications available in the past 15 to 20 years can be remarkably effective.

Instead we have too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking. In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot — at home and at schools, in movie theaters, houses of worship and shopping malls.

“Psychosis” — a loss of touch with reality — is an umbrella term, not unlike “fever.” As with fevers, there are many causes, from drugs and alcohol to head injuries and dementias. The most common source of severe psychosis in young adults is schizophrenia, a badly named disorder that, in the original Greek, means “split mind.” In fact, schizophrenia has nothing to do with multiple personality, a disorder that is usually caused by major repeated traumas in childhood. Schizophrenia is a physiological disorder caused by changes in the prefrontal cortex, an area of the brain that is essential for language, abstract thinking and appropriate social behavior. This highly evolved brain area is weakened by stress, as often occurs in adolescence.

Psychiatrists and neurobiologists have observed biochemical changes and alterations in brain connections in patients with schizophrenia. For example, miscommunications between the prefrontal cortex and the language area in the temporal cortex may result in auditory hallucinations, as well as disorganized thoughts. When the voices become commands, all bets are off. The commands might insist, for example, that a person jump out of a window, even if he has no intention of dying, or grab a set of guns and kill people, without any sense that he is wreaking havoc. Additional symptoms include other distorted thinking, like the notion that something — even a spaceship, or a comic book character — is controlling one’s thoughts and actions.

Schizophrenia generally rears its head between the ages of 15 and 24, with a slightly later age for females. Early signs may include being a quirky loner — often mistaken for Asperger’s syndrome — but acute signs and symptoms do not appear until adolescence or young adulthood.

People with schizophrenia are unaware of how strange their thinking is and do not seek out treatment. At Virginia Tech, where Seung-Hui Cho killed 32 people in a rampage shooting in 2007, professors knew something was terribly wrong, but he was not hospitalized for long enough to get well. The parents and community-college classmates of Jared L. Loughner, who killed 6 people and shot and injured 13 others (including a member of Congress) in 2011, did not know where to turn. We may never know with certainty what demons tormented Adam Lanza, who slaughtered 26 people at an elementary school in Newtown, Conn., on Dec. 14, though his acts strongly suggest undiagnosed schizophrenia.

I write this despite the so-called Goldwater Rule, an ethical standard the American Psychiatric Association adopted in the 1970s that directs psychiatrists not to comment on someone’s mental state if they have not examined him and gotten permission to discuss his case. It has had a chilling effect.

After mass murders, our airwaves are filled with unfounded speculations about video games, our culture of hedonism and our loss of religious faith, while psychiatrists, the ones who know the most about severe mental illness, are largely marginalized.

Severely ill people like Mr. Lanza fall through the cracks, in part because school counselors are more familiar with anxiety and depression than with psychosis. Hospitalizations for acute onset of schizophrenia have been shortened to the point of absurdity. Insurance companies and families try to get patients out of hospitals as quickly as possible because of the prohibitively high cost of care.

As documented by writers like the law professor Elyn R. Saks, author of the memoir “The Center Cannot Hold: My Journey Through Madness,” medication and treatment work. The vast majority of people with schizophrenia, treated or untreated, are not violent, though they are more likely than others to commit violent crimes. When treated with medication after a rampage, many perpetrators who have shown signs of schizophrenia — including John Lennon’s killer and Ronald Reagan’s would-be assassin — have recognized the heinousness of their actions and expressed deep remorse.

It takes a village to stop a rampage. We need reasonable controls on semiautomatic weapons; criminal penalties for those who sell weapons to people with clear signs of psychosis; greater insurance coverage and capacity at private and public hospitals for lengthier care for patients with schizophrenia; intense public education about how to deal with schizophrenia; greater willingness to seek involuntary commitment of those who pose a threat to themselves or others; and greater incentives for psychiatrists (and other mental health professionals) to treat the disorder, rather than less dangerous conditions.

Too many people with acute schizophrenia have gone untreated. There have been too many Glocks, too many kids and adults cut down in their prime. Enough already.

Tuesday, December 25, 2012

Happiness is Warm Gun

I really need to make this my last post about Guns. I really do for many reasons. To awake on Christmas morning and be greeted with the front page about another shooting, this one an ambush in New York by a crazed idiot, and this one officially in the system, alert Wayne LaPierre.  

Right above that article about the maniac who killed 2 Fireman in his ambush that included stolen guns (yes he could not legally own them so stealing them okay as for arson perfectly okay too) was another, which I put below, about the use of real weapons and military assault guns in video games.

And while Wayne LaPierre assumes that they are the reason behind our violent culture,  I am not going to say wrong or well right, I am going to say that everything is on this buffet table when it comes to understanding our culture of violence.

The title of this blog is from a Beatles song. Now you could not find a less threatening band then the Beatles and in fact Lennon/McCartney were using the word Gun as a metaphor. But in a society that is desperate to point fingers and lay blame I thought sure its only a matter of time before Heavy Metal and Pot will be hauled out soon.

But the thought that these games are so de-sensitizing to the idea of what death and shooting is, that young people whose very plastic brains are still developing, to advertising and marketing of guns with the phrase "get your man card", to a planet that is exposing kids to more toxic chemicals in the food they eat, the water they drink, and the air they breath, an Education system in tatters,  and the biggest Economic inequality which kills families when guns don't  is all part of this very complex equation with many many variables.

But in a country that says "don't sweat the small stuff" that is what we do. We sweat and fret over the most mundane small stuff and rarely look at the big picture.  As I wrote in the  last blog entry we are the Polaroid Nation.

As I work on my book, Conversations with Idiots, I had one today that truly made me confirm my thoughts that Education is a big proponent of the problem.  He was a Teacher and when I overheard him talking about video games, I said "getting your man card are you? " He asked what that was,  I said that the NRA is looking for providing Teachers with Guns and that the game of which he spoke was cited in the mass murder in Norway last year.  Men with Guns > Teachers with Guns. 

He then told me he was a Teacher and I did not know what I was talking about as he plays this game everyday.  I asked him if he played it with his adorable little girl that seemed to be about 2 and did she enjoy shooting and killing people and would he allow that in his home.  He goes no she is too young  and I don't want an NRA gun either,  but violence is not because of  video games.    Ah yes, its not video games because it doesn't affect you.  The Polaroid is not finished developing right there.

I showed him the front page of the New York Times with the two articles, he glanced at them did not read them. And yes point two was made, he did not read. Check!

And he and his partner had a little girl with them.  And he is a Teacher. What does he think his students experience in their growing up formative years?  Solid family lives? Great nutrition? Great social activities? Financial security?  I assume no but then our conversation ended as quickly as it began because it was not something one wants to discuss on Kwanzaa, Festivus, Christmas, Hannukah, or ANY day.    It required introspection, conversation and intelligence.  And he is a Teacher.  Must be great at teaching tests. Really that is all it is now. Teaching testing material. Hoops meet jumpers.

And we wonder why most of the shooters of late are young white males in their 20s with stable family lives.  Most do, so what is it. Big pictures need big examinations. Not happening in America.

Real and Virtual Firearms Nurture a Marketing Link

By  and

As Electronic Arts prepared to market Medal of Honor Warfighter, the latest version of its top-selling video game released in October, it created a Web site that promoted the manufacturers of the guns, knives and combat-style gear depicted in the game.

Among the video game giant’s marketing partners on the Web site were the McMillan Group, the maker of a high-powered sniper’s rifle, and Magpul, which sells high-capacity magazines and other accessories for assault-style weapons.

Links on the Medal of Honor site allowed visitors to click through on the Web sites of the game’s partners and peruse their catalogs.

“It was almost like a virtual showroom for guns,” said Ryan Smith, who contributes to the Gameological Society, an online gaming magazine. After Mr. Smith and other gaming enthusiasts criticized the site, Electronic Arts disabled the links, saying it had been unaware of them.

The video game industry was drawn into the national debate about gun violence last week when the National Rifle Association accused producers of violent games and movies of helping to incite the type of mass shooting that recently left 20 children and six adults dead at a school in Newtown, Conn

While studies have found no connection between video games and gun violence, the case of Medal of Honor Warfighter illustrates how the firearms and video game industries have quietly forged a mutually beneficial marketing relationship.

Many of the same producers of firearms and related equipment are also financial backers of the N.R.A. McMillan, for example, is a corporate donor to the group, and Magpul recently joined forces with it in a product giveaway featured on Facebook. The gun group also lists Glock, Browning and Remington as corporate sponsors.

Makers of firearms and related gear have come to see video games as a way to promote their brands to millions of potential customers, marketing experts said. Magpul and Electronic Arts made a video posted on YouTube about their partnership.

“It is going to help brand perceptions,” said Stacy Jones, the president of Hollywood Branded, a company that specializes in product placement in movies and television shows.

Assault-style rifles made by Bushmaster Firearms have a roster of credits that any actor would envy, including appearances in Call of Duty Modern Warfare 2, a part of the popular Activision series.

The gunman in the Connecticut killings, Adam Lanza, used a semiautomatic rifle made by Bushmaster, which is a unit of the Freedom Group.

The most recent entry in the Call of Duty franchise, Black Ops II, featured models of weapons that are also made by Barrett and Browning. Another popular game sold by Electronic Arts, Battlefield 3, depicts assault rifles and pistols similar to those made by Colt, Heckler & Koch, Glock and Beretta.

The American military also uses Call of Duty and other video games for recruitment and to train soldiers

An Activision spokeswoman said she was not able to get a response because of the holiday season. Several other companies, including McMillan, Magpul, Browning and Barrett, did not respond to telephone calls or e-mails. The National Rifle Association also did not respond. A Glock spokesman could not be located for comment.

In a statement, Electronic Arts said video game makers, like film producers, “frequently license the images of people, sports franchises, buildings, cars and military equipment.” The company added that it did not receive payments for using branded images in Medal of Honor.

A spokesman for the Freedom Group, Ted Novin, said in an e-mail that Bushmaster had “received no payment, nor have we paid for placement of our products in Call of Duty.”

“The gaming and entertainment industry routinely use likeness of our products without our permission,” he added in the e-mail. But he did not respond when asked if Activision had received the Freedom Group’s permission to depict its products in Call of Duty.

The Freedom Group is owned by Cerberus Capital. After the Connecticut school shooting, Cerberus announced that it would seek a buyer for the Freedom Group.

Many players of shooting games like Medal of Honor and Call of Duty say they enjoy the simulated violence and the chance to virtually fire weapons even if they never touch a real gun. But along with some gaming fans, some firearms enthusiasts have become uncomfortable with the growing ties between video games and gun companies.

A few years ago, when the marketer of a semiautomatic pistol, the Skorpion, publicized its depiction in some games, the editor of the Firearm Blog, which follows industry developments, expressed surprise.

“I think most companies want to distance themselves from violent video games,” the editor, Steve Johnson, wrote.

Over the past decade, handguns made by Glock have become such standard fare in movies and television shows that the Austrian manufacturer received a lifetime achievement award in 2010 from Brandchannel, a product marketing Web site. \

Game publishers like Activision and Electronic Arts race against one another to create the most realistic games, said Laura Parker, associate editor for Gamespot Australia, a gaming Web site.

“They believe the use of real-world brands — be it clothing, tactical equipment or guns — is a way to ensure that games like Call of Duty and Medal of Honor feel as close to real life as possible,” Ms. Parker said via e-mail.

Some video game makers use depictions of weapons that are slight modifications of real ones or alter their names, avoiding possible legal complications.

But most established video game developers and publishers, given the huge amount of money invested in a game, seek out explicit authorizations or licenses from product manufacturers, said Matthew Syrkin, a lawyer at Hughes, Hubbard & Reed who represents companies in the video game industry.

“There is a material risk in putting anything into a game unless you have a license,” said Mr. Syrkin, who added that such agreements also protect manufacturers from having their products depicted in an illegal or unflattering manner.

The Connecticut shooting is not the first time violent video games have been blamed for causing violence, including mass shootings. A similar outcry followed the 1999 shootings at Columbine High School in Colorado by two teenagers who played Doom, then a popular video game.

Last year, a Norwegian who killed 77 said later that he honed his shooting skills by playing many hours of Call of Duty.

In the case of the recent promotional Web site for partners of Medal of Honor Warfighter, a spokesman for Electronic Arts said it took action after it discovered that gamers could click through to its partners’ sites.

“We felt it was inappropriate and took the links down,” said Jeff Brown, a spokesman for Electronic Arts, in an e-mail.

But Mr. Smith, the gaming enthusiast who wrote about the links, said the company had not gone far enough. Mr. Smith said the direct link is gone, but visitors to the site can still search for a gun and “take a few extra steps to buy it.”

“I personally think they should not have real weapons in the games in the first place,” he said. “It’s just bad to link things you can do in a game with tools of death you can use in real life.”

The Polaroid Nation

As I write this it is Christmas Day.  My Merry Christmas was met here with "Happy Kwanzaa/Festivus/blahblahblah"  I suddenly summoned my inner Bill O'Reilly and found myself saying "I am sorry its just a wish on a day, you could simply say ditto or you too or good day, what is with all the political correct bullshit... I mean really do I look African American"

He just laughed and said you should go on Bill O'Reilly and debate him. I said "why bother and waste my time, the man is a total fraud in it for money and what is the purpose? This is a legal holiday established by the Government who is supposed to under that Constitution that they seem to wave about, separates Church and State so I assume that Christmas is a legal holiday and if you choose to make it about faith do so if not that is cool too."  (yes I am wordy Bitch)

I am getting good at reading and interpreting the condescending looks of my community of late, in fact few get it as good as I get it.  Facing a life anew after what could have been fatal accident ( or would have been a murder?) does that to a person, so few do get it, they really don't.  So my motto which was always call people on their shit and own your own evil has taken on a bigger meaning as I come into the new year.

Here is it Christmas. Be you a person who celebrates it with religion as your focus, as commercial as your focus or not at all, its just a word and a greeting.  I say to people "Happy Labor Day/Valentines Day/Memorial Day/Fourth of July" in the same manner, be you a Union worker, someones lover, a family of a dead soldier or even an American.  Its just a word to a greeting and what it means to you is what you take it to mean. Telling me a stranger who is simply being polite and friendly doesn't want to hear your shit, any day of the week, let alone this day.

The other day I was watching cable news and was listening to an individual go on about the fiscal cliff (another faux created drama) while sitting next to a highly capable an intelligent expert on Economics, Dean Baker.  I immediately questioned his credential, experience and education.  And I found he went to some private college in North Carolina whose seeming claim to fame was that President Woodrow Wilson did NOT graduate from. Right there I thought "whoa what the hell..." I tweeted my thought that this "expert" is really out of his depth on this and I wondered why he was even considered one given his CV.    The response I got was "watch out what you say about North Carolina schools."  Okay, where did I criticize the entire school system of North Carolina?   The response was no you didn't but I went to school there.  Okay, thanks for sharing and this has a point to what?

This is my point? READ. If you don't understand what you just read, ASK.  We are a Polaroid Nation. This means we love to take a picture and without even waiting for it to develop we find ourselves making snap judgements and therefore opinions often based on the most cursory of images.  Its what is doing us a great dis-service and in turn injustice.

So if someone wishes you a happy shove it up your ass day... just say thank you and walk away.  Or if so inclined ask them. I doubt you will unless you can Tweet/Facebook or Blog about it.. I chose the later.  This way it saves intimacy, conversation and actually knowing, responding and in turn thinking. 

So try to imagine that exchange that I had today and the one I had on Twitter, for the record I have ton of similar encounters with primarily children who have limited cognitive responses so they are more volatile and emotional when they see/hear/think perceived indignities or insults, then add guns to the mix.   See this equation and see the variables in this example?  A+B+C = D for death.

Polaroid Camera is coming back and clearly we need to revive this brand in a life philosophy by giving everyone time to develop. Wait and when we see the full picture then we can respond and if it doesn't we need to ask what it was supposed to be.  We want answers, well you need to ask questions first.

Merry Christmas/Hanukkah/Kwanzaa/Give a shit Day!

Monday, December 24, 2012

Pitch a Bitch

When the 1% whine they do it with such better vintage than the lower 99%. I read this today in the New York Times and this was so self indulgent and absurd that I needed the laugh.

Why this was in the Opinion page next to the brilliant Paul Krugman or the fascinating piece by Nicholas Taleb was beyond me. I think this would be better suited for the Entertainment page but then this is the same page that turned an outstanding food writer into a op-ed writer and that is not going well either.

Delia Ephron, a woman of success in her own right and a family lineage that included the amazingly brilliant and clever sister Nora Ephron  who just passed recently, clearly needs to get back behind the pen and write another Harry and Sally as this piece was unworthy.

Why I found it such was the absurd premise that shopping online is fraught with problems and inconveniences that make life so hard.. sooo hard.

This is what I have been saying that despite the political leanings of the Rich's they are so disconnected from what real life is for the Poors that even the best of intents mask an ignorance and oblivion that is tragic if it was not so offensive.

Ms. Ephron is whining about how her Christmas packages she ordered from varying online retailers came unwrapped, mis-labeled and other such massive hideous errors it has caused her to what take to her bed? Go on a mass shooting? Drink a fine Bordeaux?

Does this woman realize that most of the workers in these retailers shipping sites are temporary seasonal workers, untrained, paid minimum wage, working in inadequately heated conditions, with little to few perks and benefits that even their full time colleagues do get thanks to the laws that protect actual employees versus temporary ones.

But god forbid your slippers get shipped to the wrong address? Don't you have people who could do all that for you?  What is the perk of being rich if you don't have your own Mexican?  I mean exploiting someone in your own home is so much more rewarding.

As I said, this piece might have been mis-categorized like her purchases and simply I don't get it. Well I do get it. But I don't care. I like my news and I like my entertainment, I just like them separate but equal.

Well Cheers and Good Christmas to you Ms. Ephron. For many Americans' just having a tree let alone packages beneath them is something you could write about if you knew about it.

The Hell of Online Shopping

Published December 24, 2012

A FEW days ago, I got an e-mail from my sister Amy in Los Angeles saying she and her husband had received boxes from J. Crew. Christmas presents from me, she assumed, since I had ordered them online and told her to expect them.

Gift cards were buried deep in the packaging, and one of them was missing. Nothing was gift-wrapped, either (although I had requested and paid for it). The boxes contained two pairs of shoes (although I had ordered only one pair), a man’s pullover and a sparkly pink woman’s sweater. The sweater was for a friend who also lives in Los Angeles, but somehow ended up being sent to Amy’s husband.

I called J. Crew to complain, and what followed was tedious and time-consuming, as all Internet dramas are, involving a review of numerous e-mails — “your order has been received,” “your order has been shipped” — in this case to the wrong place and in the wrong ways, some of which I might have prevented if I’d been vigilant tracking the flurry of e-mails.

The customer-service representative, consulting records, assured me that the box for my friend had been delivered. It had been left at the front door, she said, and gave me the address, which turned out to be not my sister and her husband’s house but my friend’s office, a gigantic building in Beverly Hills. “Left outside the front door? Are you sure?”

“Yes,” she said, and, as an apology, she would send me a $50 gift card. I e-mailed my friend. Had she received a box from J. Crew? “No,” she said.

My sister offered to gift-wrap and deliver my friend’s present. This was especially kind because traffic in Los Angeles is awful, as bad as New York’s during the holidays, which is one reason I order on the Web. But rather than make life easier, Web shopping only complicates it in new, more frustrating ways.

My husband, in charge of buying for all the children in our life, announced one evening that he had bought all his presents. To be done with Christmas shopping was so exciting that you’d think he’d used up some calories to do it, when in fact he’d never left his desk. The next morning he got an e-mail from Hammacher Schlemmer saying the item was out of stock and would ship after Jan. 1. So he had to phone and cancel the order. He then had to Web-shop all over again.

When I ordered the presents on the J. Crew Web site and checked a box for the gift-wrapping, I received a message back that J. Crew did not wrap shoes, my sister’s present. As Amy and I were sorting things out, I wondered why in the world I thought it was O.K. to send a Christmas present that wasn’t gift-wrapped.

It seems to me — a fact I had completely forgotten — that a Christmas present should be wrapped in pretty paper, maybe with some Santas dancing across it, maybe something glossy and glamorous. Shouldn’t the tag be handwritten? Shouldn’t the ribbon be made of paper that curls when you whip it across a scissor blade? A present should beckon you. Who wants a Christmas tree with a bunch of U.P.S. boxes under it?

Last week a U.P.S. box arrived. I opened it, and inside, unwrapped, was a slate cheese board and a gift card that said, in computer script, “Merry Christmas Julia and Jerry, love Anna.”

Anna is my niece. Jerry is my husband. I assume that I am Julia.

Precious holiday giving cannot be entrusted to a Web site. A gift shouldn’t be something you open by accident — hello, what is this? — ripping open the cardboard outer box with a knife, and then having your present fall out naked.

Ordering Christmas presents on the Web, regardless of the dubious ease, has obliterated the idea that there should be some grace to a present, some beauty, and that the receiver should experience it. Instead it’s become as mundane and problematic as all our Web purchases, which in my family include paper towels and toilet paper.

All this joy of Internet shopping was accompanied by our phone ringing several times a day: a computer voice from Virgin America insisting that my husband owes $70 — a $50 credit-card fee and $20 interest for not paying it. My husband has never had a Virgin America credit card. But to “proceed,” as in clear the problem up, the electronic voice asked him to identify himself by giving the number of the credit card that he does not possess. The telephone, which used to symbolize “reach out and touch someone” — remember that tear-jerking TV ad? — has become a disembodied voice reaching out to drive us crazy.

But I digress. Or do I? It all seems related. Intimacy replaced by expedience.

So this is my New Year’s resolution: I am never ordering another Christmas present on the Web again. Next year I am wrapping all my gifts myself and standing in line at the local post office for an hour or two to mail them. It’s the least I can do for the people I love.