Category: Health Care

Lyme & IDSA Criminal Conspiracy

 I got a new doctor at the end of September and in 72 hours flat I was ready to go back to work full time. I’m thrilled by that, but I am still dangerously sick, so much so that a small mistake can tip me from seemingly normal into a dangerous place where I am physically and mentally disinclined to care for myself.

   I have a regimen of several antibiotics which change about once a month. I fumbled the switchover mid February, losing a big chunk of Valentines day. I’m writing this after a three day antibiotic break to see how I feel, having just started a mixture of clarithromycin and plaquenil moments ago.

 So … here’s a peak into what life is like with chronic Lyme. And a deeper look at what it could mean for health care reform.

This Week In Health and Fitness

Welcome to this week’s Health and Fitness.

I will be traveling most of today. As time permits and access allows, I’ll be “popping in”. I leave Haiti reluctantly but in a few months I will return, mostly in an administrative capacity. I’m headed for New Orleans for a short vacation and then back to NYC. I want to thank everyone here for their support for the Haitian people in there time of extreme need. This is going to be a very long road for recovery if they ever do.

Haiti: Steps Toward Recovery

MSF Haiti, 2/09/10

Jerry is seven years old. On January 12, he was seriously injured in the earthquake that devastated his hometown of Port-au-Prince, suffering a severe open fracture to his femur when his house collapsed.

Jerry’s mother, Louismerre, lost two of her five children in the quake. Determined not to see a third child die, she immediately brought Jerry to a Doctors Without Borders/Médecins Sans Frontières (MSF) hospital for emergency medical care.

MSF staff started Jerry on antibiotics to prevent the spread of infection. He was then taken to an operating theater, where an MSF surgeon performed a debridement of the wound, cleaning it out and removing dead tissue. A few days later, the doctors brought Jerry back so they could examine and clean his injury again. They discovered the infection had not abated and they became extremely concerned that it would spread to the rest of his body, putting his life at risk. They were forced to make a difficult choice. “The wound was very near the groin,” said MSF’s Dr. Karin Lind. “If the infection went above it, there would have been very little we could have done to save him. We knew we had to amputate if we wanted to keep him alive.”

Haiti: Working through the disaster (Feb 11, 2010)

On Health Care, Vegas-Style, Or, Figure It Out In The Ambulance, Chump

I was supposed to begin the long-delayed series of PTSD stories I’ve been planning, but before we begin, I need to tell y’all about something that just happened in my house.

For us it wasn’t a matter of life or death, but it is the kind of story that explains, perfectly, why we need to reform the health care system we have today-and for that matter, it’s also a great explanation of why a single-payer system would be a giant step forward for everyone in this country, whether you’re insured today or not.

It’s also hilarious and sad and frustrating, all at the same time-which makes today’s story a pretty good allegory for the current American way of doing health care.

So follow along, have a good laugh…and at the same time, take a minute to consider what could be, and how much less irritating things should be.

Change You Can Believe In

Midterm Momentum Is All GOP’s

November Is Looking Grim For Democrats, And It Could Still Get Worse

by Charlie Cook, via nationaljournal.com, Tuesday, Jan. 26, 2010

Whenever someone asks if the 2010 midterm elections will be “another 1994” it makes me roll my eyes. No two election years are alike — the causes, circumstances and dynamics are always different to anyone who takes more than a casual look.

But 1994, and for that matter 2006, were “nationalized” elections, elections where overarching national dynamics often trump candidates, campaigns, local political history and natural tendencies.

Often in these elections, inferior, underfunded or less-organized candidates and campaigns beat more amply funded and better-prepared candidates and campaigns.

The primary difference between this year and previous nationalized elections is that this one looks so bad for Democrats so early.

These kinds of years also see states and districts that normally fall easily into one party’s column inexplicably fall into the other’s hands.

There is no reason to believe that 2010 is not just as nationalized as 1994 and 2006 were, or for that matter 1958, 1974 and 1982. To be sure, the causes, circumstances and dynamics are different, but the trend line is the same for each. At least today it is.

This Week In Health and Fitness

Welcome to this week’s Health and Fitness.

I’m still here in Haiti winding up my stay and turning over my responsibilities to my replacement who will be here for 3 months. I still have lots to do. There are still the patients and the never ending reports that need to be done to keep the flow of supplies coming. I’m leaving Feb 13 with mixed feelings becasue there is still so much to be done.

Utopia 18: The Long Now

Death comes to all, but great achievements build a monument which shall endure until the sun grows cold.

Ralph Waldo Emerson

In Defense of Antidepressants

Regular readers will know that I have mentioned many times in many prior posts that I have bipolar disorder.  Some time ago I reached a conclusion within myself that the best way to counteract the still prominent stigma of mental illness and with it the misinformation based on fear and misunderstanding was to offer myself as a concrete example.  I must admit, though, that I never thought I’d need to speak out against anyone or any column that at least concedes that treatment would be necessary, assuming, that is, that it worked.  Most resistance I face and most assumptions I refute are mainly a product of people who, as they inevitably put it, don’t wish to be a slave to a pill or who think that anyone who has to rely on medication to solve his or her problems must have some deficiency in inner strength, independence, or both.

Begley’s article in Newsweek entitled “The Depressing News about Antidepressants” contains much truth, but its underlying assumption that antidepressants aren’t worth the risks involved and might be more harm than good only provides more justification for people of such stripes.  Fear and unwillingness to seek treatment are the biggest of stumbling blocks to health and the idea that someone whose quality of life is suffering mightily might not reach out and seek a highly available and usually quite effective means of obtaining an otherwise normal life distresses me greatly.  

Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill-a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.

This is an unfair across-the-board characterization of psychotropic medication as a whole.  The true problem here is the typically 21st Century liberal sensibility of the back-to-basics, return-to-the earth holistic treatment movement which casts doubts regarding the efficacy of all modern medicine aside from the obviously irrefutable (and sometimes not even then) .  A misunderstanding of the basic elements of psychiatry leads many on a series of wild goose chases and frustrating avenues towards health that, in my opinion, could be better resolved through visiting a medical professional.  To wit, the brain is a very complex organ, one still frequently beholden to mysteries and theories in place of solid data.  Though we might have a good grasp on treating certain diseases, in this instance we only can work with the information and biological advances currently available.  This goes for schizophrenia, senile dementia, and migraine headaches.

We have observed recently that though many might clamor for change in the abstract, or as  long as it doesn’t happen to them personally, the prospect of individual change promises only the unknown.   That which we cannot perceive easily is often frightening and distressing, but those who know intuitively that the life they are living is not the one they need while simultaneously recognizing also that they don’t have to feel the way that they do, psychotropic medication is a godsend.  Sometimes, but rarely, one finds an instant fit with the first drug prescribed, but trial and error is necessary for those who strive for lasting health and stability.  I myself have been on twenty-four different meds over the course of roughly fifteen years, and while I take care to note that I have a very severe and very rare case, I am not completely unusual in some respects.  I long ago accepted this as the reality of the situation as to all of us who seek to find a balance between illness and health.  Finding the proper medication cocktail is a bit like visiting a psychologist.  One rarely finds a good fit the first go round, though not always.  

Even Kirsch’s analysis, however, found that antidepressants are a little more effective than dummy pills-those 1.8 points on the depression scale. Maybe Prozac, Zoloft, Paxil, Celexa, and their cousins do have some non-placebo, chemical benefit. But the small edge of real drugs compared with placebos might not mean what it seems, Kirsch explained to me one evening from his home in Hull. Consider how research on drugs works. Patient volunteers are told they will receive either the drug or a placebo, and that neither they nor the scientists will know who is getting what. Most volunteers hope they get the drug, not the dummy pill. After taking the unknown meds for a while, some volunteers experience side effects. Bingo: a clue they’re on the real drug. About 80 percent guess right, and studies show that the worse side effects a patient experiences, the more effective the drug. Patients apparently think, this drug is so strong it’s making me vomit and hate sex, so it must be strong enough to lift my depression. In clinical-trial patients who figure out they’re receiving the drug and not the inert pill, expectations soar.

As for the clinical trials of varying effectiveness mentioned in the article, I had a much different experience.  Beginning in late 2008 into last year I spent nearly six months in-patient at the National Institute of Mental Health (NIMH) in Bethesda, Maryland.  I can’t say that I ever doubted the antidepressant effect of any or all of the existing trials and protocols that were being performed on site.  My reservations mainly were that the process of research was so minutely calibrated and overcautious that psychiatrists and researchers took huge pools of patient data samples before publishing their studies.  Individual results were secondary to examining a whole cloud of results and then proceeding warily from there.  Often long-term studies ran not just for months, but for years.  The focus of each was equally narrow, examining a relatively small number of variables on a very particular desire effect.  This makes for safe science and prevents results from being challenged or questioned, but it doesn’t exactly advance the discipline and the available scholarship at anything more than a snail’s pace.

A particular study I observed as a patient comes to mind.  Participants were given the drug ketamine, known to vets as a tranquilizer and anesthetic and a few generations of recreational drug users as Special K.  The drug was administered in the form of an IV infusion.  The injection was given, mild hallucinatory and/or dissociative side effects subsided after a few minutes, and then almost every patient who underwent the protocol experienced a very pronounced anti-depressant effect.  The effect lasted only four or five days in a row, and each day that passed promised less and less of an impact at counteracting depression.  Only a single active injection of ketamine was given during the entire study as a whole.  The point of the study was to measure how long one treatment achieved its stated purpose, to what degree, and at what point the patient returned to a state of full depression.  After the first and only injection that quite clearly wasn’t placebo wore off, patients naturally went back to being depressed.  Those who felt a pronounced lifting of mood and depressive symptoms knew instantly that the next injection was going to be placebo, regardless of what the nurses or doctors informed them to the contrary.  

Those who wish to vent at the pharmaceutical industry for its role in nixing health care reform have a worthy target, but I find more deplorable the means by which it artificially inflates cost of medication, meaning that without insurance, the price of a month’s worth of prescription drugs start at the hundreds of dollars and sometimes are priced in the thousands.  I myself would have to pay $1000 a month minimum if I didn’t have basic coverage and in prior posts I have noted the needless complexities I encountered achieving even that.  Certainly it sets prohibitive cost and pushes product, regardless of quality, effectiveness, or grounding in solid research to make money.  This is a travesty of the highest order, but I have never in my own life encountered more than a bare minimum of people with mental illness who were not substantially improved by medication, once they found the optimum possible cocktail.

What I have found much more prominently among those with mental illness who have gone off their meds altogether or have only given them a cursory trial is that they couldn’t handle the initial side effects or felt discouraged that a single medication either didn’t work well, or worked up to a point and then petered out.  I am always suspicious of people who push diet regulation or therapy or some combination thereof in place of pills because I can count on one hand the number of people that have adopted that routine and found it wholly sufficient.  I have known scores of people who have mental illness over the years because I have been hospitalized at least thirteen times myself, have participated in support groups, and have ended up being curiously inclined to seek company with people who also have mental illness, whether I knew it up front or not.  I am a big proponent of therapy in addition to medication because it has helped me out tremendously over the years, but I know that I can never stop taking my meds, ever, for any reason.  It is for this reason that when I encounter any article like Ms. Begley’s that I feel a compulsion to tell the whole story as I understand it to be.    

So, having seen for myself the tedious and sometimes unnecessary safeguards employed, I recognize that much of this delay and frustratingly incremental progress is unavoidable.  The existent understanding of brain function and its impact upon mental illness is measured in inches, rather than miles.  It is accepted that certain chemicals and neural pathways associated with them determine emotional well-being and mental health, but aside from that, medications have often been developed that use existing treatment regimens to treat disorders, but aim to lessen side effects than try new chemical structures or neurotransmitters.  I suppose one could obsess about the unforeseen consequences that daily medication use promises, negative impacts upon the body as a whole that we might not recognize for decades to come, but I’m much more interested in being able to go about my daily tasks unhampered by my disease.  Three hundred years ago, after all, the conventional treatment to address physical ailments was bleeding the patient white to release toxins.  We laugh now at how primitive and even barbaric a practice that was, but for those who lived in those times, that was all they knew.  We can only go with that which we know, and returning to the past or refusing to embrace the newest solutions promises nothing any more or less solid.  All of our choices are half-chance, the same as everything else.

Utopia 18: The Long Now

Death comes to all, but great achievements build a monument which shall endure until the sun grows cold.
Ralph Waldo Emerson

Conservatism is Often Less than Compassionate

Flying somewhat underneath the radar this week has been a controversial remark made by South Carolina Lt. Governor Andre Bauer (R).  Last week, the Lt. Governor of the Palmetto State made a particularly toxic and highly offensive remark regarding the nature of assistance programs designed to aid the poor and disabled.  

“My grandmother was not a highly educated woman, but she told me as a small child to quit feeding stray animals. You know why? Because they breed! You’re facilitating the problem if you give an animal or a person ample food supply. They will reproduce, especially ones that don’t think too much further than that.”

I’ve mentioned this before, I know, but at that instant my mind couldn’t help but flash back to a particular quote made by Earl Butz, Secretary of Agriculture under Richard Nixon and Gerald Ford.

The only thing the coloreds are looking for in life are tight pu**y, loose shoes, and a warm place to s**t.

I think conservatives assume that welfare services and the safety nets provided to those living at or near the poverty line are some kind of all-you-can-eat buffet line whereby some dubiously defined underclass can stuff themselves silly on taxpayer funded giveaways.  The most obvious response to this is, of course, that they are desperately needed, often life-saving, otherwise unavailable options which those with adequate means already have and as such frequently take for granted.  But for some reason this isn’t sufficient enough in and of itself to satisfy the concerns of the average GOP voter or elected official, so perhaps a description of the incredible limitations of welfare agencies needs to be noted once more.  As you will see, one can either decry them as money drains or lament their inefficiency, but certainly not both.

Social service agencies and welfare services are almost always underfunded, meaning that they are also almost always understaffed.  Without enough manpower to answer phones, attend to daily business, and keep things running smoothly, the average applicant must be persistent and also must be his or her own advocate.  Often it is necessary to spend hours on the phone attempting to find someone who either knows to even be connected to a competent worker who has had enough experience with the system to know how to properly process a claim or initiate a service.  Those who lack the patience or the time are often left out altogether.  The working poor don’t have the luxury of being able to devote more than a small fraction of their time to sign up for basic services and have to divide their attention among demanding, often thankless jobs, and the constant time and energy drain that is known as parenthood.  Those with families and dependents often are the ones who need these services the most, but can’t carve out extra time in already busy, over-booked schedules.  Regarding food stamps, which supply one of the most basic of all human needs, what transpires often is that deserving individuals don’t have the time to come into an office or wait for hours, or have great difficulty scheduling a block of time in which to speak on the phone with a worker to complete the process.

Social service agencies and welfare services are dependent on state and local tax revenue, and though the amount of funding varies from city to city, county to county, and state to state, most are barely able to absorb the needs of the less fortunate in good economic times.  In bad economic times, budgets are stretched to the gills, the deficiency in number of workers needed is much more visibly pronounced, and as a result the system quickly grinds to a halt or at least a slow trickle.  In situations like these, with three and four times as many applicants in the pipeline, it takes even longer to obtain even the minimum and it may mean that three and four times as much effort and persistence is needed until one finally receives a place on the rolls.  When budgets are tight, it also means is that coverage for any service can be terminated at any time, for any reason, based on some mysterious internal audit or the flimsiest of justifications, all implemented based on the compulsion to save money and keep from depleting the General Fund.  

Speaking to my own recent experience, just to obtain a referral to a clinic that treats basic physical ailments the way any GP would took two frustrating days on the phone, whereby I called at least seven different numbers and spoke to close to ten people.  Eventually I finally, quite by chance, stumbled across the right person who finally got everything in order.  I was told at the time that the reason for the vast amount of confusion was, in part, a result of the fact that low salaries at certain centers designed to direct patient inquiries meant that there was always quite a bit of turnover.  Since the system itself was complex, it often took a while before any worker properly understood it enough to convey accurate information to anyone.  Though I am thankful for my success, I couldn’t help but think about all the others who found themselves with blood pressure raised high enough for long enough to set aside any subsequent efforts to see a doctor.  It is no wonder that the rates of easily preventable conditions are high among the working poor, since if it takes this degree of effort, I know many will go without rather than undergo what at first seems like a fruitless search.

This leads me to my next point, at which I discuss another barrier to obtaining needed services—senseless complications and poor networking between agencies.  Many times these are products of all the barriers I have stated above, but what this also reflects is our compulsion to micromanage the affairs of the poor.  Not only that, we wish to control their lives because many of us believe that they are clearly up to no good and only a step above either common criminals or lazy ne’er do wells with nothing so much as ambition or drive.  I wouldn’t exactly call this tough love so much as I would call it punitive retribution.  One needs only look at the ACORN matter to see evidence of that.  Conservatives saw exactly what they’ve always wished to see in that case, confirming their own darkest suspicions in the process.  I honestly believe if it were up to them, many would do away with all taxpayer funded programs designed to assist the less fortunate among us, unsympathetically remarking like Herbert Hoover that these services ought to be the domain of churches and faith-based organizations, but certainly not of government.    

Where one sees frustrating evidence that the right hand doesn’t know quite what the left hand is doing in any circumstance, or that everyone’s not quite on the same page, it is tempting to deem it indisputable proof that larger government is both a waste and a headache.  This is what drove the Tea Party protesters to spout off and also motivated those who feared and still fear the enactment of some nebulously defined, super scary government-controlled health care plan, but I counter that assumption by noting that with an adequate amount of funding, an adequate amount of staffing, a moderate amount of reform, and a network of customers of ample economic means, the system would run far more efficiently.  Most people who are used to medicine on demand would simply not stand for the degree of complication and delay as currently exists, and money has a way of smoothing out many of the kinks in any system.  Not all of them, of course, but many.  Money has a way of giving people a reason to stay in a job for more than a short time and encouraging competent management that would attend to the needs of a much more educated, much more affluent demographic that would expect more and not a group of citizens who have unfortunately long come to expect that the few concessions thrown them will be of inferior quality.

Returning to the system the way it is today, the elephant in the room, naturally, is a very pronounced element of racist and classist assumption.  Since discrepancies between wage earnings are still very pronounced between Whites and Blacks, most who qualify for and use safety net programs are poverty-line African-Americans, and more recently a rapidly growing number of Latinos.  Most, but not all, of course.  In my experience, I was the only White person applying for food stamps and the only Caucasian seeking treatment and prescription drug coverage.  As we well know, nothing instigates GOP ire faster than the notion of welfare cheats or avoidable drains on Good Honest American Taxpaying Citizens™, as seen above with Mr. Bauer.  I’m not quite sure what I find more offensive about his remarks, the dehumanizing element reducing poor Americans to feral animals, the element of eugenics which suggests that poverty could be reduced or eliminated by means of forced sterilization or starvation, or the implication that all those in need are simple-minded strays who aren’t concerned with anything much more than just reproducing and creating burdens for humans who have to take the time and effort to keep their numbers in check.  I’ve heard some fairly creative theories for population control and elimination of inferior races, but yours, Mr. Bauer, is not one of them.                  

The real enemy here is not conservatism, or liberalism, or an entitlement mentality, or even an underclass.  The issue is equality, pure and simple, or should I say the lack thereof.  I will be honest here.  I was raised by a Father who placed complete faith in Ronald Reagan and his view of the waste and graft of welfare and with it a simultaneously dismal opinion of the efficiency of any government program, regardless of its stated purpose or function.  Indeed, there was a time where I myself held similar beliefs.  But though I had changed by tune well before then, my eyes were truly opened when it came my time to use these same basic lifelines granted anyone who qualifies.  I recognized quickly that had I not been born into a middle class, highly educated family, I might not have been able to chart my way through a very convoluted system and obtain the services I needed along the way.  Working the system requires a good bit of guesswork and tremendous amount of trying to successfully solve a problem with multiple unknown variables.  

The system is not designed for the undereducated and the impoverished, rather it is a construct of those whose job description clearly must include a love of complicated solutions for simple problems and an insistence upon a variety of completely unrealistic constants, like minimal turn over among workers on the front lines and at the field office.  Again, equality in pay would do much to keep that in check, as would a system that was put together with greater skill and dexterity.  I’m not arguing that throwing money at a problem is any adequate means to fix it, but what I am saying is that if each of the individual pieces of the system were designed with the ability to be revised easily and as the situation demanded, and if those who worked this system took a job as a career, not just a vocation, then many of these problems could be eliminated.  

If these social service agencies and welfare programs were run like a business in the private sector, they would have gone bankrupt years ago, but the fault here is once again that we honestly must not really have much regard for human life, particularly for those “not like us” for whatever reason.  Oh sure, we’ll give money to Haiti and vow to offer our services in any way that we can.  I don’t mean to come across as cynical regarding anyone’s motivation to assist the victims of that battered island nation.  The outpouring of help would soften the heart of even the most bitter person, but many will see Haiti as a one-time, special occasion.  I live in the District of Columbia and in a relatively small area based on surface area both the richest of the rich of the poor living side by side.  The ostentatious wealth of Georgetown is countered by the desolation of Anacostia and recently gentrified areas like Columbia Heights or right near by the Capitol paint an even starker view of the discrepancy.  As I’ve seen the money rolling in to be sent to Haiti, I can’t help but wonder what even a fraction of that outpouring could do for the District’s poor, and especially for those infected with HIV/AIDS since the District itself has an obscenely high number of cases that put it on par with an African nation, not a region within the borders of the United States.

Any system designed to assist those without our fundamental advantages depends upon the cooperation of those farther up the totem pole, and if our checkbooks, if not our hearts are closed to them, then the system will always be insufficient and dysfunctional, poverty will always exist, disparities will always exist between race and class, and so too will the desperate attitudes that lead to drug addiction and crime.  The life we save might be our own someday.  So yes, in this instance we do it to ourselves, and that’s what really hurts the most.  And we do it by not recognizing that it is within our power to treat the cause of the problem, much like medicine would in counteracting a disease.  For example, one can treat strep throat with an aspirin, but that only takes into account the effect.  Treating the cause often requires a shot of penicillin, and once it has made its way through the blood stream, healing begins and pain ends.  Aspirin might be far cheaper than a cost of a doctor’s visit without insurance,  but it will merely mask or temporarily delay the pain of the sore throat.  With time, it wear off, the pain returns, and the need to take more returns.  The disease itself remains and will remain until it is properly treated.          

If conservatives are so indebted to scripture and to their assertion that we ought to be a Christian nation, I wish they’d keep these passages below in mind.


For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’  

“Then the people who have God’s approval will reply to him, ‘Lord, when did we see you hungry and feed you or see you thirsty and give you something to drink?  When did we see you a stranger and invite you in, or needing clothes and clothe you?  When did we see you sick or in prison and go to visit you?’  “And the King will say, ‘I tell you the truth, when you did it to one of the least of these my brothers and sisters, you were doing it to me!’

Dateline NBC: Critical Condition

Critical Condition: Are you covered in case of emergency? These families thought they were

March for Life: Health Care and Abortion

originally posted by Will Urquhart at Sum of Change

Operation Rescue’s President Cannot Explain How Health Care Bill Funds Abortion

(Footage purchased from Sam Sumner, originally posted by Will Urquhart at Sum of Change)

As you may be aware, this weekend (tomorrow to be exact) marks the 37th anniversary of the passage of Roe v Wade, the supreme court decision that effectively legalized abortion nationwide. We have been working on a documentary about clinic escorts for some time now (tomorrow we will be making a big announcement about the film, sign up for our emails and you will be one of first to hear about it), so this weekend is a big chance for us to get some footage.

When I got back home from volunteering at the clinic, I saw an email from Operation Rescue announcing a press conference at the White House today. Luckily, I was able to track down a freelance videographer who sold us some great exclusive footage of Operation Rescue’s President, Troy Newman, failing several times to name a single part of the current health care bills that allows for federal funding of abortion (although he knows for a fact it does, he just cannot tell you how):

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