Tag: Prescription Drugs

This piece is a result of a couple of pieces that I have written before and some interaction in comments on pieces from others about prescription drugs advertisements.  They are rife in the popular culture these days, on TeeVee, on radio, and in print.  I really think that this is a horrible idea, and will explain as time progresses.

First, I must do a bit of historical treatment.  When I was in pharmacy school (I did not stay long, because I decided that I should be on the other side of the wall, developing new drugs, but that did not work out either) adverts for prescription drugs were only allowed in professional medical journals.  I mean it.

Those you 50 or older will probably, if you think hard enough about it, days when these drugs were not in the popular media.  Some of you might also recall that tobacco adverts were!  I still remember the jingles for cigars and cigarettes.

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.

Much as credit card companies have charged exorbitant interest rates in the period leading up to the passage and enactment of reform, so too have prescription drug companies added more cost to their already prohibitively expensive products.  Afraid that health care regulatory legislation will cut too heavily into their soaring profits, the industry feels no shame, nor any compulsion to give heavily burdened consumers much of a break.  This is a side of the debate that has not gotten the same attention as other areas and one that I have tried to bring to light quite frequently, being that I myself stand to lose quite a bit if out-of-control price increases are not sharply curtailed.  I do not deceive myself into thinking that I am the only one who stands to lose.  Though I do not mind invoking personal experience if it facilitates greater understanding and urgency, I wish it didn’t take the anecdotes of the chronically ill to impress upon a skeptical public the importance of health care reform.          

On the subject of psychotropic medication, something of which I am an amateur expert, I have closely monitored new classes, types, and formulations of prescription drugs in a desire to find the best way possible to treat my condition.  For every new medication that breaks new ground, wins approval by the FDA, and is then prescribed by GPs and psychiatrists across the country, it is a never-ending source of frustration for me to observe the three new offerings which are merely slightly different formulations of existing medications.  This is a covetous process undertaken mainly to reap maximum profit when older scripts are on the verge of losing patent status and thus being offered as generics.  For example, the anti-depressant which is the most recent addition to a family of medications known as SSNRIs has been marketed under the name Pristiq.  Pristiq has a very similar chemical structure and as a result works only slightly differently from an existing drug in the same school, Effexor, that has been around for over ten years.  Sometimes, however, even generics occasionally have limitations.  Though a lower-cost equivalent to Effexor exists, the less-expensive form has been reported to work not nearly as effectively as the name brand formulation.

An article in today’s New York Times reports on Big Pharma’s side of the story.

But drug companies say they are having to raise prices to maintain the profits necessary to invest in research and development of new drugs as the patents on many of their most popular drugs are set to expire over the next few years.

That may be, but before one gets misty-eyed listening to the woe-is-us violin, rest assured that the pharmaceutical industry isn’t exactly hurting for business.  Conveniently they don’t mention the larger picture.  Another example of this kind of infuriating slight-of-hand is the sleep aid Ambien, which has had a sufficient generic alternative for a while.  A relatively new formulation dubbed Ambien CR produces an only a slightly different reaction, mainly by time-releasing the absorption of the drug into the blood stream.  The drug is the same, but the gimmick is different.  Returning to psychiatry, it is either a testament to how little we know about the function of the brain or how unwilling we are to risk radical change that the medications used to treat depression, anxiety, bipolar disorder, and schizophrenia have broken only relatively limited ground in decades.  The best treatment for depression are still a class of powerful anti-depressant known as a MAOI inhibitors, which are close to fifty years old.  They are rarely prescribed, however, because taking them requires strict dietary restrictions that, if not adhered to, can result in serious damage to the body and, in extreme cases, even death.  In treating bipolar disorder, some patients still respond best to Lithium, which has been used in treatment for over a century, but extensively since the Fifties.    

Newer medication often cut down side effects and make the period of adjustment less painful, but do little to increasing the stated objectives of the drug, namely to drag people out of depressive episodes and set them on a course towards health and functionality.  Experimental trials are often plodding affairs proceeding at the pace of a snail, targeting a relatively limited area of the brain, and unwilling to take any unnecessary chances.  Despite this, some medications do pass muster and do end up being taken by who are suffering in the hopes of providing relief.  Even so, the drug makers and those who formulate them sometimes fail to take into account such crucial details as major side effects in a rush to get out the next big thing.  SSNRIs like Effexor, for example, are infamous for producing absolutely awful issues when someone stops taking it.  Though not strictly classified as such, one might even say that such drugs are addictive because the brain acts violently when the medication is discontinued.  These serious matters somehow never find their way onto the commercials on television or the ads inside glossy magazines.  

The difference in cost between name brand and generic drugs is quite vast.  Often it is a matter of several hundred dollars for a one month supply, though it can be as high as a thousand dollars or more.  As one might expect, those with employer-based or individual plans paid for out of pocket have to pay substantially higher co-pays for name brand drugs.  When I had private insurance, the co-pay for generic medications was $10 and for name-brand drugs, it was $60.  Sometimes I had no choice but to take a name-brand medication, which are often treated by insurance companies as something bordering on cosmetic and not essential, when the fact of the matter is that they are highly necessary and highly unavoidable at times.  

Those who don’t have the luxury of private insurance, of course, have it rougher.  Those who have to rely on Medicaid find that they have no choice but to settle for generic medications when a name-brand drug would be a much better fit and work much more effectively.  Medicaid programs vary, but in the state of Alabama, the most expensive medications are only covered if a doctor or specialist one can provide proof that at least two lower-cost alternatives have failed or been insufficient to treat the condition.  Not only must they have failed, one must also work within the confines of a 90 day coverage window.  If a claim to cover a more expensive medication is not filed within 90 days of failing the requisite two medications, then coverage is not granted.  This is ridiculous in lots of ways, mainly that few medications used to treat mental illness work quickly, and many take weeks upon weeks before any psychiatrist or doctor can make a judgment either way.  It’s also ridiculous because it uses a broad brush of convenience, painting all illnesses as basically the same and all treatment regimens as similar.  Some name-brand medications, regardless of the need are not covered at all, since whomever set up the system decided that covering it would unnecessarily drain the General Fund and that it was an unnecessary prescription in the first place.      

Returning to the Times column,

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year – $80 billion over 10 years – from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

Those who trust Big Pharma do so at their own peril.  

Additionally, The news broke today that, quite unsurprisingly, much misinformation exists surrounding the Public Option™.  As Politico points out,

The debate has placed disproportionate emphasis on the creation of a government insurance plan, raising the expectation that everyone could ditch their employer-provided coverage and enroll in the public option.

But that won’t happen, at least not at the start. The reality is that only about 30 million Americans – 10 percent of the population – would even be eligible.

It could be accessed only through a new insurance marketplace known as an exchange, where consumers would shop for plans. Only certain categories of people could use the exchange: the self-employed, small businesses, lower-income people who qualify for tax credits to purchase insurance and those who are otherwise unable to find affordable private coverage.

This might deflate the hopes of supporters and pacify opponents, but since so much of this debate has been a three-ring-circus based on raw emotion and faulty logic, I sincerely doubt it.  However, as proposed, it is interesting to note that the Public Option™ would be more like Medicaid than anything else.  My hope is that we do not make the same mistakes with the current bill as we do with existing systems it seeks to augment or replace, particularly those in red states who likely would opt-out altogether if provided the opportunity to do so.  Though at least red state residents would presumably have the fall-back of Medicaid, provided they could qualify, the framework is based on ignorance and tunnel-vision of an almost incomprehensible degree.  One cannot simplify the complexities of humanity, nor its diseases, which are as multifarious as its people.  

Returning to the treatment of mental illness, what is often not cited is the disconcerting fact that often African-Americans and Latinos respond much less favorably to medications used to treat the condition.  This is a contentious topic with lots of disagreement, but the argument some advance is that cultural stigma factors in to a very large degree.  If minorities feel shamed or guilty about seeking help for psychiatric needs, they are much less likely to engage in medical research.  Furthermore, many believe that therapy is a more viable option than medication.  Often it is difficult to make any kind of pronouncement when the truth is obscured by so many different interrelated factors.  And though one can easily make a case for mental illness, one could also make a case that minority and low-income residents might be less inclined to visit a doctor for a more run-of-the-mill ailments as well.    

The lifetime prevalence of major depression in the United States is estimated to be 16.2 percent, with considerable social and role impairment evident in the majority of patients. Previous studies found only minor differences in depression rates among African Americans, Latinos and whites. But various studies have found patients from lower social economic groups often have less access to mental health care, are less likely to be prescribed and to fill prescriptions for new antidepressants and are less likely to receive care beyond medications when compared to whites.  

This fear and anxiety so many have that resembles to these eyes a case of St. Vitus Dance may not have any basis in reality.  Doesn’t matter how good the system is if no one uses it.  God forbid everyone in this country have a high standard of living and good health.  As the article points out, minorities and low-income citizens often have the highest need for quality care and are apt to put off seeking help until the pain becomes intolerable.  That these are the people most likely to be eligible for enrollment in the government-run (gasp) option, those now building it from the ground up would do well to consider its target audience.  We speak out of our own privilege when we assume that somehow the Public Option™ will directly affect us for better or for worse, when the poor and less fortunate will be the ones who either reap its rewards or suffer from its limitations.  While it is true that middle class individuals and the reasonably affluent have struggled under the yoke of skyrocketing health care costs, I recall going in that I assumed the changes needed and intended were meant to appeal to our tired, our poor, our huddled masses yearning to breathe free.  Somewhere along the way this became all about us.        

This is my first post on DocuDharma. It is cross posted from a DailyKos essay (of Fri Nov 09, 2007 at 10:51:54 AM EST)

http://www.dailykos.com/story/… I have about 30 diaries on DailyKos. I will not be cross posting them all (that’s good for you). Only the ones I think were my better ones and/or got good response. I want to thank my friend “boadicaea” for turning me on to this site and also her assistance in the last few weeks with helping me with my disjointed, repetitive and lengthy wtiting style. I have read a lot on Docudharma in the last 24hrs and really like what I read and the atmosphere of the community. Expect to see me here daily. I look forward to the day when Docudharma has the membership of sites like DailyKos (150K members), and I know it will, and I can then be an “old timer” with an ID under 1100-:)

I went to the Veterans Administration hospital yesterday for a routine appointment that was to be just a quick check-in with my doc & off I go.

The main point of this diary is about our military personnel. The unfair situations they are faced with & the amazing commitment of many. There are other issues within my blabbering. It wouldn’t be a TominMaine diary without some rambling & personal items wrapped around the issues.

I have an appointment at the VA about once a month between my many doctors. I had to see my doctor who monitors my TBI, Traumatic Brain Injury from an auto accident in 1999.

Without VA health & prescription (22 meds) coverage, my SSDI & my wife’s meager wages (she has no health insurance), we might be living in the attic of my mom’s house. With myself, my wife, 2 dogs & a cat, it would be cramped in that drafty, smelly attic in an old New England house built over 100 years ago. The attic would be better than the cellar with the stone walls & it looks like something out of “Silence of the Lambs”. I also know my mom would push me from mild bi-polar disorder to complete insanity.

I am luckier than the 47 million uninsured who could face such horrors and worse.

None of my many medical issues are life threatening. They are an inconvenience to living “normal”, I am always in at least some pain, they are often frustrating and a pain in the ass, but we all have our cross to bare and I don’t want to trade mine for anyone else’s. I know how to live with mine and remain happy and content.

Because of the several benefits I am entitled to, I am much luckier than many millions in our country. I take some time each day to give thought to this fact. Usually during my early morning regiment. Today though, I spent my morning time thinking more about my “simple” visit yesterday to the VA hospital. BTW, my pets are part of my whole morning routine also.  

Every morning when I get up, I am greeted by my two dogs and my cat. They rise with great anticipation of going out and then getting fed. They all three shadow me around as I go through my morning rituals of about 15 minutes. They know this proceeds their pleasures. When done with my routine, I pour my first cup of coffee, and to my pet’s delight, we head out the door. They do what animals do first thing in the morning and then they wander through the woods a little. While they do that, I view the early morning here in the deep woods of Maine. The quiet and serenity allows me some time to think about things.

My cat goes out with us each morning for this daily routine. She thinks she is a dog. When she is out alone, she always comes home when I call her. In the afternoon, if I’m feeling o.k., we take a walk in and around the woods. She always comes on these walks with the dogs and I. When she is out alone and wants to come in, she paws the screen door so it sounds like someone knocking softly. If I don’t hear it, the dogs will start barking and let me know. Like me, she is not “normal” and kinda unique. Some photos for your viewing pleasure.

ALL THREE ON A WALK.

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PENZA (named after a city in Russia)

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WALTER

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OREO

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Reflecting on my trip to the VA yesterday, I thought of the people I spoke to, the things I learned and the emotions I felt. I thought maybe this would make a decent diary. You can decide that.

While I waited to see my doctor, I got a flu shot. The guy giving shots was a volunteer. He is also an active duty Major in the Army. Since I had a little time to wait for my doctor, we talked about numerous military and political issues.

He told me about an Army General that he knew who was an expert on the middle east. When Bush was planning the attack on Iraq, this General was one of the few with the guts to adamantly and quite vocally disagree with attacking Iraq. He gave Bush a kinda “in your face” explanation of the realities of attacking Iraq. He predicted exactly what is happening today. He said the only way this wouldn’t happen was if we dedicated 600,000 troops to Iraq and we would probably have to keep most of them there for many years. That General “retired” a month later. They are not all Petraus. Rest assured, before he said his piece, that General knew what the results would be. He still said it with all that was on the line for he and his family. That’s a big set of balls with a dose of courage and some honor thrown in. That General was a true commander and patriot who cared about his troops. God, I wish I was there for that.

The Major and I got around to talking about a personal issue that is important to me and I think all Americans should know about it. We talked about our soldiers in Iraq/Afghanistan returning with TBI (Traumatic Brain Injury).

Since I have TBI and so do many soldiers returning from Iraq/Afghanistan (65%), I have researched this problem extensively. Another major side effect that has been caused by Bushco’s debacle.

I was very glad to hear from the Major about a new VA program that is to be SOP (standard operating procedure) at all VA hospitals. Every soldier returning from Iraq and Afghanistan is put through a battery of tests for PTSD, mental health issues and TBI to see if they need help or are fit to return to the front line. About fucking time this was done.

I thought the Major’s information was excellent news. During my research, I read that the military was working on this testing but I had not heard that it had been implemented.

It was a little ironic to have this conversation yesterday with the Major. After many hours of research, on the morning of 11/02 (1 wk ago today) I posted a diary about TBI and our returning Vets (I will cross post to Docudharma). This is an issue our nation should be concerned about. The impact on our military capabilities could be devastating. TBI has become known as the “signature injury” of this war. The term TBI will soon be as well known as the term PTSD. Some estimate that there could be as many as 65% of Vets returning from Iraq/Afghanistan suffer from TBI.

Besides the good news of the testing, there was one other thing the Major told me that had a strong emotional impact on me.

The word is getting around amongst the troops about possible ways to “fool” the testing.

NO, not to fake that they have these illness’, just the opposite. Some soldiers who may have PTSD, mental health issues or TBI, want to “pass” the test and be allowed to return to the front. The military is now aware of this and is fortunately making adjustments to make it more difficult for them to “fool” the testing.

I know, this seems pretty fucking crazy to “civilians”. I think maybe you would have to have served to truly understand this irrational behavior.

The majority of these young men and women don’t speak much about the politics of the war. Few talk much about if it is right or wrong. Many believe these things are none of their business.

“mine is not to reason why, mine is but to do and die.” Alfred, Lord Tennyson

This is in spite of the fact that they all know exactly what is being said at home in the USA about the war and the government.  

Each of these men and women stood in front of an American flag and a military officer told them to raise their right hand and repeat after me: “I, (NAME), do solemnly swear that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice. So help me God”.

The vast majority in the military don’t take this oath lightly. It becomes a part of them even if many can not repeat it word for word. Their commitment to the military is a matter of honor, pride and a personal promise to themselves, their nation and their God. Mostly, there is a deep sense of loyalty to their fellow soldiers that impacts much of their bahavior.

If only 50% of our politicians took their oath of office as seriously and deeply as the majority of these brave men and women do, then our country wouldn’t be in the fucking mess it is in right now. Then again, most politicians today don’t have the morals, ethics, courage, personal pride or loyalty to their fellow workers or constituents of most in the military.

As stated, even more compelling for those who want to “fool” the test, is a sense of responsibility to those “friends” they left at the battlefront. A felling of guilt for leaving their comrades in arms. A desire to return to help protect those who helped to protect them.

These men and women make huge sacrifices for you and I and our country. When, where or why there is a war is irrelevant when we are talking about the individuals who serve. When talking about those who defend our country against real enemies or some moron politicians perceived, imaginary, manufactured or fictitious enemies, our military men and women must do their duty. Regardless of the stupidity and futility of Iraq, these individuals deserve our respect and appreciation. They need us to speak out for them. Most absolutely will not say negative things about the futility of their mission or the ineptitude of Bushco while they are on active duty. It just is not done by most regardless of what they think, it is blasphemy. Most of them know the realities of this insanity. It is also punishable under the Uniform Code of Military Justice (UCMJ) which also applies to most for two years after “actice duty” ends and they are “on reserve”. They need us to fight for the benefits they earned and deserve. They need us to fight for the quality medical care they deserve when they come home. They need us to do everything we can to end this war. Most importantly, we must insist, demand and ensure the politicians we elect support all these things our soldiers deserve.

Because I live in Maine with such a small population (1.2million), I don’t see a lot of Iraq/Afghanistan Vets when I go to the VA. I probably average seeing one each time I go to the VA hospital. I always try to speak with each one I see.

I told you about the Major who was just giving me a flu shot yesterday. We ended up having a 20 minute wide ranging conversation that educated me and affected me. By coincidence we discussed an issue very important to me that I posted a diary about that very issue just a week before. This was not something I expected when going to a simple appointment at the VA yesterday.