Category Archives: Medicine

Addictive Thinking

by Katharine C. Otto, M.D.
January, 2002

Loosely defined, addiction is any attachment that compromises free will.  Addictive compulsions become problematic when they take precedence over more important life concerns, in defiance of reason and good judgment.

Everyone can identify with some measure of addictive thinking. Understanding your own compulsions – whether eating, exercising, working, television, sex, lifestyle, or even a prevailing mood, like anger, sadness, or guilt – helps to appreciate that the difference between addicts and non-addicts is merely a matter of degree.

With addiction you feel powerless, victimized, or lacking in free will. Thus, the first of the 12 steps of Alcoholics Anonymous states, “We admitted we were powerless over alcohol – that our lives had become unmanageable.” The key words here are “powerless” and “unmanageable,” because the substance could just as easily be tobacco or food.

When your compulsion becomes your priority, affecting more important areas of your life, such as health, relationships, work, or society at large, you become diagnosable. At this point every choice you make is colored by your addiction. For this reason, addiction treatment and AA emphasize making recovery a priority – a concept hard to grasp by many addicts, who fight this step because it is so powerful. Making recovery a priority and “walking the walk” on a day-to-day basis requires conscious choice and confers over time confidence in your ability to change your life. This subtle change in thinking from “power over” to “power to” reflects a shift from the role of victim to that of a responsible, self-directed individual.

Recovery is a growth process, requiring time to mature.  Building a healthy sense of self within the context of the environment takes patience.   We live in an addictive society, and enablers abound. Our systems foster and perpetuate dependency. Mainstream assumptions that the answers are “out there” lead us to doubt our own inner wisdom, yet relying too heavily on external authority eventually results in disappointment, victimization, and power struggles. Power struggles with either internalized or external authority eventually must be balanced by a cooperative spirit.

Relapse is part of the disease of addiction. Addictive thinking includes a rigidly held set of rules, whether consciously acknowledged or not. When these perfectionistic – and frequently unrealistic – rules are violated, the addict will often give in to his underlying sense of powerlessness and intensify his self-destructive activity, becoming a victim once again. Here, the power struggle is within himself, but the whole self loses in the see-saw struggle between “absolute control” and “out of control.”

In the past, addiction treatment took a punitive approach to relapse, but the winds are shifting. The addict who relapses already feels like a failure, and the punitive approach reinforces his negative self-image. At this point he is likely to run from treatment, if he is not reassured about the relapsing nature of addiction and the importance of keeping the relapse short.

Addictive thinking presupposes boundary confusion, a lack of definition of where you end and the next person begins. This inability to establish and maintain appropriate boundaries contributes to the escapism of addiction, and this leads to physical and/or emotional isolation. The “higher power” of Alcoholics Anonymous can just as easily refer to society as it does to a god, because the group is stronger than the individual. It helps set boundaries when the addict is unwilling or unable to do so. It’s also good for supporting the recovering addict in his strengths. For this reason, addiction treatment relies heavily on group process.

Everyone is susceptible to negative attachments, to situations and circumstances that lead to unwise choices. Addictive belief systems perpetuate those attachments, employing such tactics as victimization, power struggles, perfectionism, impatience, and deception. As the recovering addict walks the walk, he learns through everyday experience how to avoid those pitfalls and live a more fulfilling life.

 

Involuntary Manslaughter?

Twenty-year-old Michelle Carter was convicted last week of “involuntary manslaughter” for encouraging the suicide of her friend Conrad Roy III, in July, 2014. While I’m not surprised by the outcome, I’ve always wondered if anyone should be held responsible for another person’s actions, up to and including suicide and murder.

The law says they should.  Psychiatrists, in particular, can be held liable if their patients–present or past–kill themselves or anyone else.  A mere hint of “suicidal ideation” in an emergency room is enough to get someone committed to psychiatric hospitalization, at least for an observation period of up to 72 hours.

That homeless people, alcoholics, drug addicts, and those escaping the law or outside enemies use this ploy to obtain “three hots and a cot” on cold or stormy winter nights is common knowledge in the medical world.  There are also the drug seekers, who hope to receive controlled substances to alleviate their pain.  While others want to blame the patients, I look to the crazy-making system itself. Those who learn to “work the system” are only doing what they believe is necessary for survival.

The professional’s challenge and dilemma is always to determine intent to act. Psychiatric evaluation is meant to assess the seriousness and immediacy of the threat.  It includes questions about access to weapons, past attempts, serious stressors (like medical diagnoses, relationship breakups, financial crises, for instance), level of intoxication (if any), mental stability (such as psychosis) and other possible contributing factors to the person’s distress.

In most cases, a 24-hour hospitalization is enough to alleviate the symptoms and allow a person to be discharged safely.  By morning, most people have changed their minds, at least until the next time.  Those who are truly suicidal can remain in the hospital for weeks, months, or even years, although this is becoming rarer. Psychiatric hospitals are so crowded that there’s constant pressure to discharge as soon as possible, or at least as soon as insurance coverage ends.

Bottom line is potential suicidality is taken very seriously in the medical and psychiatric world, and each case is different.  Although it is an ethical no-no for psychiatrists to diagnose or analyze people they have not personally examined, I deduce from news reports that there were a number of factors playing into the Carter case, including the un-examined belief that anyone can prevent anyone from doing what they intend to do.

News sources say Mr. Roy had attempted suicide four times in the past.  Ms. Carter met him in 2012, had emotional and mental problems of her own, and needed to be needed.  She fancied herself a helper, and up until the last two weeks of his life, she tried to convince him not to kill himself.  Then she suddenly changed tack and began encouraging him to act on his threats.  She even ordered him back into the carbon-monoxide filled vehicle when he became scared and got out.  Most of this was done long-distance, say the reports.

Witnesses for the prosecution claimed her motive was attention, as she was communicating various moves in this two-year dance to a variety of other people. It’s not clear whether anyone intervened or tried to break up this dangerously destructive dynamic.  Was this so-called need for attention a desperate cry for help by Ms. Carter herself?  Apparently Ms. Carter at one point encouraged Mr. Roy to seek professional help, but did she consult anyone herself about this problem? Chronically suicidal people can be exhausting, even for professionals, when they begin to manipulate for sympathy, attention, or to control the relationship.  At what point does the helper give up and say (or think), “Quit talking about it and just do it.”?

I don’t mean to excuse Ms. Carter for her actions.  She apparently gave a lot of bad advice over a long period of time, and she was way out of her depth.  Who can ascribe motive? For all anyone knows, Mr. Roy may have killed himself sooner if not for Ms. Carter’s friendship.  I happen to believe suicide is a personal choice.  I don’t recommend it, but I also believe we all choose our time to die, on some level.  We only differ in how we do it.

The Power of Life

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May 28, 2017—The following thoughts give an overview of my reasons for skepticism about Western, allopathic medicine and the paradigm it represents.  I claim the overriding belief in external agents for healing or symptomatic relief ignores the basic dignity of the individuals in question and the “vitality” that keeps us going.

The body is a marvelous homeostatic instrument, for which health is the natural state.  This understanding pervades Oriental medicine, which is based on the concept of “qi” (“chi”) or life force.

I’m an amateur student of Oriental medicine so can only describe it in general, simplified terms.  Essentially, it holds that there is a continuum between spiritual, mental, emotional, and physical levels.  Problems begin as spiritual.  If not resolved at that level, the problems become increasingly “dense” until they show up in the physical body.

In Chinese medicine, the idea of qi underlies and informs the entire system.  This sets Oriental medicine at odds with the Western, mechanistic viewpoint we Occidentals take for granted.  With the advent of the industrial age, the “scientific method,” and the requirement for “objectively verifiable” evidence, we’ve come to rely on instrumentation and a cause-and-effect sequence for assessment and treatment of any given condition.  The body is treated as though it’s a machine, with the resident human being largely a passive recipient of the diagnoses and treatments decided by the technician/physicians who administer them.

While the official stance of “science” receives almost religious devotion and some legitimate respect, it is exceedingly limited in what it can do.  “Science,” which relies on measurable “proof” has yet to prove that life exists.  Nor has it located the “mind,” although most believe the “mind” is in the brain.  The scientific method relies on studies that theorize causes, then set up conditions that limit variables to one, to determine whether there’s a significant correlation between cause and effect.

My unorthodox approach to life, health, and medicine stems from a fundamental belief in the power of the life force.  I call it “vitality,” but others may refer to “qi,” “quality of life” or use any number of terms to describe this battery that keeps us going.

Whether individuals survive physical death, and if so, in what capacity, is a question no one can answer, although religions and philosophers of all persuasions have tried.  What is life, anyway?  Is it a candle flame that can be extinguished?  Is it an essence, like “qi” that joins the “qi” of the cosmos, to be re-born in another place and time?

I won’t try to answer these questions but raise them simply to note that a belief in life beyond death strongly influences how I live mine.  Certainly others wrestle with the question, especially as they get older and wonder what lies ahead.

I became a psychiatrist partly to help make philosophy practical, but the profession—and Western medicine as a whole–is going in the opposite direction.

“How so?” a reasonable person may ask.  The most obvious answer is that it devalues the most basic principles that keep us healthy or make us sick.  Western medicine systematically undermines the individual’s faith in his or her own body’s self-correcting mechanisms.  It pits mind against body, which is deemed untrustworthy, a thing to be feared, unreliable.

The intangibles that formerly distinguished psychiatry from other medical specialties, the “quality of life” issues—now take a back seat to “evidence-based medicine” and the vain attempt of psychiatrists to align with the more “scientific” practitioners.

The antidepressant Prozac (fluoxetine) was introduced in 1989, two years before I graduated from medical school.  This began the separation of psychotherapy and other “talk therapy” from “medical management” of emotional problems.  While other antidepressants, anti-psychotics, anti-anxiety agents, and mood stabilizers had been on the market for decades, Prozac began the trend toward a raft of new, patented, drugs that could treat symptoms while ignoring the larger life pattern that led to the problems.  “Talk therapy” was shifted to psychologists and social workers, with the move heavily supported by government and insurance reimbursement criteria.

Since that time, the avalanche of patented drugs, technologies, diagnostic tests, and other interventions has made the “health care industry” one of the most profitable sectors in the United States.  Costs for the individual have skyrocketed, such that few can afford medical help without insurance.  Now, the government has made insurance mandatory.  No one seems to recognize that insurance does not equal health care.  In fact, insurance impedes, rations, and delays health care, and it raises the price for everyone.

Medical care costs twice as much in the US as anywhere else.  Medications are significantly more expensive.  A continuing medical education article I read says medical error is now the third leading cause of death in the US, after cardiovascular events and cancer.

That medicine and psychiatry seem obsessed with finding or creating problems already puts patients at a disadvantage, in a defensive position.  Psychiatrists don’t get reimbursed for “no diagnosis.” They must find or invent a diagnosis, a label, to justify the time they spend.

No wonder Oriental medicine has such appeal for me.  Here, diagnosis is based on patterns of disharmony within the body and mind.  The hands-on approach is individualized and personal.  The patients and the practitioners are partners, with the belief in the treatment’s effectiveness–“the placebo effect” in Western terms—a desirable component.  In short, it respects the dignity of the vital forces that medicine presumes to reinforce.

I hear people say that “health care is a right.”  We also have a right to refuse health care, especially when it’s forced on us by hostile, predatory forces.  We have the right to eat nutritious foods, life a balanced life, and keep stress levels low.  We have the right to maintain our vitality and health they best way we know and to choose who and what to trust for help when we need it.

 

The More Things Change . . .

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Above:  The professional literature in Psychiatry remains funded primarily by pharmaceutical companies.  I get up to eight Psychiatry periodicals every month, all containing about 50% advertising, most of it by Pharma.  This junk enjoys a privileged postage rate, because it is “educational.”

April 12, 2017–Reading old journal entries helps me focus blogs and show the trend of my thinking over time.  In April, 2007, ten years ago this month, I was considering allowing my medical and DEA licenses to expire, because I felt used by a medical system that causes more disease and suffering than it alleviates.  As a psychiatrist, I was under a virtual mandate to prescribe drugs that promised more help than they delivered.  Not only that, but the system itself was so dysfunctional that it put everyone at risk.

ON MEDICINE AND PSYCHIATRY
Wednesday, April 18, 2007 – If I can get out of the business of medicine, I can enjoy the fun of medicine, when it’s done right.

It starts with honesty.  We have created a sado-masochistic society that feeds failure and punishes success.  In today’s climate, the individual doesn’t matter.  “Equality” means bringing everyone down to the lowest common denominator, statistically speaking, to save the “economy” from the individuals who take more than they give.

Our society has rendered them so dysfunctional that they are incapable of doing anything useful and resentful of those who expect them to make an honest living.
What kind of psychiatrist would I be if I didn’t point out the insanity of that?  I believe the individual matters, if only to herself.  I matter enough to stand my ground in the face of society’s power struggles and to comment on the process.

The US psyche is caught up in the emotional two-year-old anal stage of psycho-sexual development, the “terrible twos,” the year of potty training, the age in which life-long issues related to power and power struggles emerge.  The “self” vs. “not-self.”
As we play with the shit we have created, we are evolving, hopefully, toward a greater understanding of what it means to be free.  Demonizing and drugging the individual mind and spirit is society’s game, not mine.  I have evolved beyond the anal stage.  I quit.  Get ahead by slowing down.  Take time to smell the roses before you pave them over.

This patient-churning prescription writing machine throws the government credentials—the medical licenses—into the compost bin.  Thus relieved of the paper shield, I step from in front of the DEA’s guns to show them aiming at my back, to control invisibly every aspect of the prescription game.

They need me more than I need them, but only because they believe in drug laws.  If there were no drug laws, we wouldn’t need the DEA, but doctors would still have jobs.

“Doctor,” a word my absentee bosses don’t know, is derived from the Latin “docere” meaning “to teach.”  A doctor is fundamentally a teacher about health.  That’s what I do – teach people about health, especially mental health.

You know what I tell my patients?

“It really is them,” I say.  “They are the crazy ones.  Don’t put your life on hold waiting for the government.  You’ll grow old and die waiting.  Live it up while you still can.  Dance in the living room.  Turn off the television, for your sanity’s sake.  Shut off the mind and noise pollution so you can hear yourself think, and you’ll get back in touch with your common sense.”

ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER)

Tuesday, April 3, 2007 – I enjoyed working with kids and parents yesterday.  I gave practical advice and supported them in their efforts.  A little six-year-old hugged me on the way out.

These aren’t bad kids.  In fact, I think many who are branded with ADHD are brighter and more creative than the rest, with skills and interests that reach beyond the classroom.  A 12-year-old girl who is about to fail sixth grade for the second time daydreams and draws during class.  Likes violin and reading Japanese books in English.

I reassure them school really is boring, and teachers are busy pleasing absentee bosses.  Moms nod vigorously, and the kids stare at me as if they are shocked I would express such heresy.

CME ON ADULT ADHD

Tuesday, April 3, 2007 – I read a Continuing Medical Education article on ADHD (Attention Deficit Hyperactivity Disorder).  Bottom line is there’s nothing new, except the diagnosis of adult ADHD.

Do you think anyone would consider causes pills won’t treat, like multi-sensory fatigue from the environment?  Machine noise from traffic and power tools, airplanes, blowers, coffee grinders, speakers in coffee shops, grocery stores, hardware stores, banks, blaring “I Died and Went to Hell” music and advertising at top volume?  The screeching, attention-starved voices from the halls of hell?  Who can attend to anything with all that noise?

No.

Think they might consider that the same drugs are used by drug addicts and schools to treat the same symptoms, but it’s okay if you have the correct diagnosis?

No.

Think the lack of physical education in the schools, or the fact that kids with too much energy are punished by depriving them of play time might contribute to their hyperactivity?

No.

It’s all in the brain chemistry, you know.  Hit ‘em up with a little Adderall or Ritalin and we’ll let ‘em come back to school.  Never mind that they have been suspended the last X days and are even further behind.  They shouldn’t have acted out.

The other two psychiatrists here, Child & Adolescent psychiatrists, indulge me in my one-to-two minutes of tirade.  Each says separately, unfortunately, the kids who come here need to be on meds.  Doctors have adapted to being prescription writing machines, drones in the endless grind of patient-churning status quo.  They see the hypocrisy, but they learn quickly to keep quiet, to show in behavior the repressed anger generated by power abuses.

Learned helplessness vies with identification with the aggressor, but do you think psychiatrists make the connection between abstract understanding and the evidence in front of them?

No.

Why learn psychiatry if nobody cares?  You could get a computer to write prescriptions faster and more legibly.

The inertia is as cloying as clear gelatin.  Perhaps this is the egg; the yolk, the planet, the albumin the atmosphere, with humans poised at the interface, possibly growing and possibly getting big enough to crack the shell.

 

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The “Health Care Industry” is Sick

THOUGHTS ON THE HEALTH SCARE-SNARE RACKET

Saturday, March 25, 2017—Trumpcare, the Republicans’ answer to Obamacare, failed this week.  Predictions abound about what the government will do next.  It appears Obamacare is imploding, and the media expects it to be saved or replaced.  My right-wing conservative friends declare government control of health care is unconstitutional.  My left-wing friends believe Obamacare needs to be fixed, not replaced.

I’ve been opposed to government and insurance-controlled medicine since graduating from medical school and psychiatry residency.  Back then, it was Hillarycare, which was trounced initially.  During Bill Clinton’s presidency, Hillarycare began being implemented piecemeal through bureaucracy.

For me, the issue then and now was freedom, including freedom of choice about everything from practitioners to types of treatment.  Government-controlled health care translates into a guaranteed captive market for insurance companies, in which the healthy subsidize everyone else, especially the “industry” itself.  Doctors and patients must kowtow to government and insurance rules.  Out the window go confidentiality, honesty, and compassion, since symptoms must fit a diagnosis code to insure payment for treatment.  In psychiatry, this means the psychiatrist must come up with a diagnosis which goes forever on the patient’s record and can interfere with everything from self-esteem to employment.

AND, SEVEN YEARS AGO THIS MONTH . . .

CURRENT EVENTS:  OBAMACARE

Wednesday, March 24, 2010—Everyone is talking about Obamacare, which passed over the weekend.  Everyone knew it would, but nobody knows what it means except more taxes.  The boat is sinking, but we’re afraid to rock it.

VIGNETTE:  OBAMACARE

Friday, March 26, 2010—I met a 35ish guy in line at Starbucks yesterday.  I was standing at the cash register when Sean mentioned something about Obamacare.  I said Dr.Obama needs to write his own prescriptions.  The guy behind me, a big, burly fella with motorcycle helmet and a completely tattooed right arm but untouched left arm, thick dark hair two-three inches long, eyes brown and intense, said something about economics, bankers, the Fed, or a related subject that tipped me off.

I realized he is an awakened soul, sees things as I do, and so we stood there agreeing with each other until both got coffee and moved out of the way.

Tee hee.  I had told the boyfriends the other day there is no gold in Fort Knox, and the levels of security exist to protect the void.  My new friend, whose name I didn’t ask, agrees there’s no gold in Fort Knox, but for fools’ gold, hahaha.  I told him his generation is much smarter than my generation and got a laugh out of someone behind me in line.

On the way out, my new friend mentioned the book, Creature from Jekyll Island, and said he learned on the net that the US has been selling gold-plated tungsten bars to China and I think France as if they were gold, and the deception has recently been discovered.  Apparently it began during the Clinton years, and the cost was something like $50,000 per bar to produce.

Later, Sean said we were two peas in a pod, an unlikely pair, the two of us, but what the hey.  These younger folks are expected to cater to all these old coots who were gullible enough to trust the Woodrow Wilsons, FDRs, Lyndon Johnsons, and other paternalistic exploiters, and I don’t blame the younger set if they believe Boomers are dispensable.  Why should they support us?  I told my friend he is under no obligation to make good on the government’s promises.

TEN YEARS AGO THIS MONTH:

MEDICAL SCHOOL ATTITUDES

Monday, March 26, 2007 – I’ve been thinking about my medical career.  Starting in medical school, I was appalled by the attitudes, and they got worse in the hospital in our third year.  M. was a good study companion the first two years, but his old girlfriend and the vicious, cut-throat, warfare in the hospital in our third year edged me out.  He played the politics and kissed up to the residents, but he also loved doing the procedures, and was like the rest of them, eager to compete for opportunities to do lumbar punctures, draw blood, drain fluid from lungs and peritoneal cavities, deliver babies, run codes.  While I wanted the experience, too, I wasn’t willing to elbow my way into the situations that offered them, and the rush-rush mentality rattled my confidence and made me afraid to touch the patients.

I was horrified at the frenzy of my classmates when it came to procedures, and the careless disregard for the patients they were so eager to practice on.  I wasn’t willing to follow residents around, hoping for chances to draw blood or run errands or otherwise do their bidding.  They perceived my attitude as insolence, and the OB-gyn boys took it more personally than the others. No one ever told me directly, so I was flabbergasted when Dr. S said they complained and almost failed me for the OB rotation.  I only remembered they wouldn’t let us do much, because they wanted to do it, and they kept medical students in a room together entire afternoons while they saw the patients alone.  I spent my time studying, so made the highest grade in the class on the written test.  I thought the OB-gyn material was the easiest.  Everyone else was bragging about how many babies they were “catching,” as if it were a disease.  I only “caught” one baby, that the chief OB resident helped me with, but he was the first baby with congenital syphilis the attending physicians had seen in ten years.

THE MD ROLE

Monday, March 26, 2007 – My no-frills trappings and simple, ascetic life – which it is – runs counter to the doctor stereotype, into which other doctors pour money and pride.  I’ve never felt comfortable in the doctor role.  It belongs to someone else, a non-being, a stereotype formed by others’ expectations, divorced from my self-perceived style.

But I’m good at it, among the best I know, which makes it all the stranger, because it comes so easily.  That I don’t put much faith in the pills I prescribe, the system I represent, the beliefs believed “normal” by today’s standards, ekes out in passing references.

No, I don’t believe in war, competition, health care insurance, the federal government, marriage, or that churches should be property tax-exempt, unless everyone is property tax-exempt.  If I pray directly to god, without need for a priest or rabbi to intercede, why should I pay property taxes when they don’t?  Who’s to say god listens more to them than me, and why should that give them a material advantage?

DRUG AND ALCOHOL LAWS

Saturday, March 3, 2007 – Drug and alcohol laws represent a major human rights violation–as the 1794 Whiskey Rebellion foretold–and should be abolished.  No one has the right to restrict another’s access to her own body.  The key to better health is better education and a free range of choices.  No one feels my pain like I do.

I believe drug laws set the frame for the sadomasochistic power struggles we call addiction. Drug laws are a means by which government seeks control over taxpayers.  Laws put government in a moralistic, paternalistic, top-dog position over the taxpayers who pay its way.

Laws and other social engineering tactics restrict the productivity of the very individuals who support them, and the entire society loses.

CHILD AND ADOLESCENT PRESCRIPTIONS

Monday, March 12, 2007 – Doing child and adolescent psychiatry means prescribing drugs I don’t approve of, because the teachers dictate medical care for unruly kids.

No, we won’t give them physical education, home economics, shop, or any incentive to behave, nothing that will interest them during the long hours they must sit, while some harried, bored, and boring teacher parrots an agenda designed to stifle curiosity and make children hate education.

No, we will diagnose them as Attention Deficit Hyperactivity Disorder (ADHD), and put them on amphetamines to control their behavior, because what we’re really doing is cultivating the next generation of slave labor for the imperialists who formerly were industrialists but no longer even produce meaningful industry.  They produce paperwork, insurance, stocks, cash, and debt, using their forebears’ reputations as collateral, generating paper profits on Wall Street, while product quality and workplace safety plummet.

 

The Medicare Myth

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Introduction:  Friday, February 24, 2017–Back in 2005, when I cared about the health scare/snare racket from a practitioner’s point of view, I began research for a book.  The Medicare Myth  proposed a national health care system that would by-pass insurance and pharmaceutical companies to provide access directly to all comers.

Now I care from a patient’s point of view.  My original idea has grown and thrived under Obamacare.  In 2017, as Congressional Republicans move to re-configure Obamacare, the nation grits its teeth and bites its fingernails, contributing to stress and bad outcomes.  It doesn’t have to be this hard.

Obamacare is the talk of every town these days.  I refuse to call this the “Affordable Care Act,” because it is the opposite.  It steals from the poor to pay the rich–the pharmaceutical industry, the insurance industry, and the government–using criminally abusive scare tactics against a naïve and gullible public.

Sadly, the Republicans are hard-pressed to come up with a workable alternative.  Up to the plate I come, to offer a point of view others may appreciate.  Here we have an opportunity to guide the government toward win-win solutions, and no party can claim credit.

Where better to seek solutions than from the “private sector,” of which I consider myself a member?  I also have insider knowledge of how the system works, having been the daughter of a public health doctor as well as a psychiatrist myself, working in the public mental health system, including five VA facilities, in my time.

Consider this:  We already have public sector infrastructure for a comprehensive public health network.  For outpatient services, community public health departments already provide STD screenings, TB skin tests, birth and death certificates, and other services that benefit the community as a whole.  Accessibility is a huge advantage, otherwise not easily available except through emergency departments.  Another advantage is that direct patient care saves paperwork, time, and insurance costs.  It reduces overhead and restores quality to health care.

The Veteran’s Administration Hospital and outpatient system is already in place for vets, and I’ve enjoyed my time working at VAs.  However, I believe the families suffer as much as or more than the vets, as they are primary caretakers.  Why aren’t families covered in the VA system?  And, while we’re at it, why aren’t we all covered?  We all pay for war, one way or the other.

The slave-owner mentality of our mandated Western medical care paradigm is laughable.  While detractors want to blame Barack Obama for this travesty, let’s all remember that GW Bush-appointed John G. Roberts, Chief Justice of the Supreme Court, cast the deciding vote on Obamacare, declaring the mandate a “tax.”  So, this is bipartisan stupidity at work.

For one thing, I think it’s healthier to get an acupuncture treatment or massage, go dancing or bowling, than sit in doctor’s offices.  Yet, insurance steals money from truly healthy activities to feed the asset plunderers in Washington and money churners on Wall Street.

 

 

 

THE MEDICARE MYTH
Health Care Insurance, Not Health Care
by Katharine C. Otto,  MD
October, 2005

 PREMISE

Medicare was never intended to provide medical care.  It is a government-controlled insurance subsidy.  It guarantees income to insurance companies whether patients are served or not.  This allows for sweetheart deals between government and insurance companies.  Insurance companies profit by delaying and denying treatment.

With the new prescription drug benefit, the stage is set for sweetheart deals between government, insurance, and pharmaceutical companies.  Under these arrangements the aggressively intrusive middlemen profit by collecting payment before treatment and doing everything they can to keep the money.

He who holds the money calls the shots.

Government feeds off taxpayer productivity, exacting payment in advance for services it no longer has incentive to provide.  Are taxpayers getting value for their money?

The government/insurance scam exploits taxpayers under the guise of helping them.  This results in the de facto inaccessibility of timely diagnosis and treatment.

This proposal recommends scrapping the entire Medicare system in favor of public health departments and public hospitals under the Veteran’s Administration Hospital model.  The difference between this and socialized medicine is that it should be easily accessible to all, but voluntary.  Taxpayers are already subsidizing huge investments in Medicare and Medicaid insurance.  Why not spend those same dollars on diagnosis and treatment in a timely and direct manner?

As a citizen and taxpayer, I believe I have an obligation to help care for the community, and I’m happy to support public health, public works, public education, including public libraries, the public mail system, and public transportation.  These are legitimate government functions that provide the nuts and bolts of a smoothly functioning civilization.

America is ripe for the growth of the self-employed, the independent contractor, the small business owner, and those who provide basic, local services that no one can outsource.  The independent contractor could afford health care if he didn’t have to subsidize an insurance-controlled system that shifts costs to those who can least afford them.  A restructured public health system could provide basic accessibility to all and more efficient use of our tax dollars.

Advantages:

  • Public health departments deliver preventive medicine and health maintenance education to local communities. General responsibilities include screening for communicable diseases, providing school outreach, insuring sanitary conditions in public works, public facilities, restaurants, and other places where public health safety may be threatened.  Health departments also provide childhood immunizations, as well as other inoculations.
  • Veterans Administration hospitals already provide direct care to vets. The structure is in place.  VA hospitals are training grounds and essentially supervised apprenticeship programs for students in all health care professions.
  • Peer review and supervision are built into the system. Multiple layers of care provide a clear chain of command and accountability.
  • Reduction of bureaucracy and paperwork. Bureaucrats can be re-trained to serve practical services, like lifting, turning, bathing, and transporting patients.
  • These services could be made available to all but forced on no one. If it’s a good system, everyone wins.  Those who must go beyond what the public systems provide will have easier access to more specialized health care services.
  • Taxpaying citizens deserve better care for the money we spend. Super-inflated costs indicate the health snare system is hopelessly caught in its own trap.  As it increasingly cuts services to swell profits, it becomes even less accessible, more costly, and ultimately less relevant to those who support it.

 

The books pictured above:

  1. Medicare’s Midlife Crisis, Sue A. Blevins, Cato Institute publishers. 2001.
  2. Bellevue Literary Review. BLReview.org.  A literary magazine affiliated with the NYU Langone Medical Center, NYC.  Specializes in medical topics, memoirs, stories, etc.
  3. Two Days That Ruined Your Health Care (And How You Can Provide the Cure), William C. Waters III, MD, MACP, No pub date or copyright.
  4. Rats, Lice, and History: The Biography of a Bacillus. Hans Zinsser, 1934.  A charming story about how the microbes win every war, written before the widespread use of penicillin.  This book is a particular favorite of mine by the original author of medical microbiology texts still used today.
  5. Overdosed America: The Broken Promise of American Medicine.  “How the pharmaceutical companies are corrupting science, misleading doctors, and threatening your health.” John Abramson, MD, 2004.  This Harvard MD begins opening the can of worms about the sleazy pharmaceutical industry that thrives on patents.
  6. The Truth About the Drug Companies: How they Deceive Us and What To Do About It, Marcia Angell, MD, 2004, 2005.  This former editor of the New England Journal of Medicine  gives another perspective on the pill-pushing mentality of the health snare racket.
  7. (Not pictured)  Patient Power:  A Free-Enterprise Alternative to Clinton’s Health Plan.  John cv. Goodman and Gerald L. Musgrave,   The Cato Institute, publishers, 1994.  Remember in the 1990s, when Hillarycare was soundly rejected by the public?  Then First Lady Hillary Clinton implemented its main features through bureaucracy.  The updated and re-configured version eventually morphed into Obamacare.

 

Before the Roosters Crow

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From my porch, 091416

I got up before daylight this morning and took coffee to the porch.  There was a light drizzle, and gusty breezes sang through the trees.  I snuggled in winter bathrobe–thankful that mid-nineties summer heat has finally eased off–and let mind wander, guided by the rhythms of live oak branches and leaves dancing in the wind.

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Squire on his perch, 091416

Otherwise, all was quiet, no machine noise, and only sporadic crows of the roosters.  They seek reassurance, back and forth.  I answer with my translations.  To Squire’s five-note crow, I respond, “I love you so much!”  To Speckles two notes I sing “You, too!  Go back to sleep.”  And they do.

Silence again, but for the rustling crackle of oak leaves in the waves of wind.  For 20 minutes, I watch the sky lightening, as shades of gray transition into tones of green and blue.   Rain slackens.  Then the primal screams begin again.  This time, Speckles wakens the crows in the trees, who cackle an annoyed reply.  Squire answers once, then all is quiet again, but for the breeze and the drip, drip, drip of rain petering out.

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Speckles and Brownie, 091416

I think about how this weather is my favorite, cool but not cold, and breezy, lifting thoughts and carrying them wherever the wind blows.  Absent human noise, even the birds still sleeping.

The roosters set my daily clock.  Their morning greetings are like love songs to the rising sun.  I sing back in human words, believing that my intent to greet the day joyfully, in harmony with nature herself, carries far and wide, inspiring the dreams of those still sleeping.

Suddenly a gust of wind blows the rug across the porch and over my potted herbs.  A moment of panic startles me out of reverie.  Memories of hurricane Hermine, only a week and a half ago, merge with memories of the garden spider that succumbed to the storm’s high-velocity blasts.  As the storm moved in, I saw the spider struggling at the web’s anchor on the asparagus fern, looking panicked.  A  large twig attached to Spanish moss had blown into her web, ripping it apart.  My heart went out to her, but what could I do?  I had the chance to say good bye, because I knew she had little chance to survive the blasts of wind, this late in the season.  The next day, I could find no evidence or trace of her body.  Only the moss-covered twig, swinging on the strong web anchor from above, proved she ever lived.

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Hermine the Spider’s first web, 072016

I have watched that spider all summer.  She moved her web three times, after I kept bumping into it on the porch.  Finally, the web stretched from the fern on the porch to a low-hanging branch of the live oak tree, out of my way and over my head.  The huge spider was easy to see, with body at least two inches long and legs another three inches.

bananasdown091416The storm also broke the top half of a banana tree that had a rack of green bananas.  I had dearly hoped these bananas would have a chance to ripen before the first frost.  My garden this year was a miserable failure, but the bananas showed some promise, for the first time in over ten years of trying.

Storm Hermine threw branches and moss all over the yard and knocked out power and water for 48 hours, but the spider’s struggles and disappearance remain my most poignant memory of the storm’s passage.

This morning, as the dawn broke, I noted the moss and twig swaying in the breeze, and thought about how everything runs its course.  That oak tree may be over 100 years old, but garden spiders live only a season.  My three chickens are five years old and have a projected life span of not much longer.  They keep me focused in the moment, with more vitality packed into five pounds of feathers and mouth than any creatures I’ve ever known.

At 7 a.m., the roosters start crowing in earnest, and my quiet time ends with the primal rooster message:

“I love you so much!”

“You, too!”

 

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Memories of Hermine, 091416

September 14, 2016