Tag Archives: medicine

Opiates: Crisis du Jour

Opiate abuse is the crisis du jour in the medical and psychiatric world.  I’ve seen reference to it in the psychiatric journals, in the New York Times, and in the Summer, 2017 issue of Utne magazine.  There are Continuing Medical Education credits available for it.

Do I believe opiate abuse is a new problem, or that it has suddenly grown into the gigantic epidemic the “authorities” claim?  I know there is a push for funding for substance abuse treatment.  Other than that, I believe the “crisis” is fueled by enablers who need to be needed.

First, the literature I read makes no distinction between heroin, which is an absolutely illegal drug in the US, and the other opiates.  There’s a vague claim that the heroin is coming in from Mexico, but I wonder if it’s coming home with troops from Afghanistan, too.  No one has asked that question.

The legal-with-a-prescription opiates are presumed to be used for pain, and apparently there is a growing trend to abuse prescription opiates.  Doctors who prescribe too many of them fall under the DEA’s watchful eye, so I wonder how many doctors are willing to risk their licenses to support an abuse habit.  There are pain clinics sprouting up around the country, specialty clinics in which opiate use is standard.  These are carefully monitored by the DEA, as are pharmacy records that show which docs are prescribing controlled substances.

A large number and variety of substance abuse treatment methods and facilities exist, but effectiveness over the long term is poor.  Most studies into substance abuse treatment only follow patients for a year.  Long term studies are rare.  Alcoholics Anonymous (AA) and its spin-offs, like Narcotics Anonymous and Cocaine Anonymous—with their reliance on the 12-Step Program—have remained the standard since 1935.  These are free programs, peer supported, in which names and paperwork are not required.

My questions about this new “crisis” stems from my cynicism about our current drug-centered world.  The difference between “good” drugs and “bad” drugs is only a matter of legality, according to me.  Drug laws confuse the issue and create problems that needn’t exist.  Even the Psychiatric Times is beginning to take a fresh look at substances such as marijuana, looking to explore its potentially therapeutic effects.  There was a recent article suggesting hallucinogens like LSD and psilocybin might deserve more attention as therapeutic agents, under controlled conditions.

Unintentional injury from accidents and drug overdoses, according to one Continuing Medical Education (CME) course I took, is now in the top five causes of death.  The course didn’t distinguish how the overdoses occurred, but my experience tells me a surprisingly large number of people take ten or more medications, don’t know what they are taking, how to take them, or what they are for.  They don’t know about side effects, and their doctors don’t explain.  They take them “when I feel like I need them.”  or don’t take them at all if they can’t afford the cost.

Direct-to-consumer advertising by pharmaceutical companies has grown exponentially since it was approved by the FDA in 1997.  Pharma spent less than $800 million/year on advertising in 1996, but by 2000, that sum grew to $2.5 billion.  Of that, 20 percent was for psychiatric medications, and these constituted 10 percent of the top 100 selling drugs.

Obviously, there is a great demand for “feel-good” drugs, either over the counter or under the counter, and I have to wonder why.  From what I’ve seen, none of these drugs satisfies the long-term cravings of those who have lost their way.  The psychiatric drugs, like antidepressants, are not proving themselves over time, so there is a constant turnover of medications used to treat depression.  Yet advertising, the “health care industry,” and the world at large seems to believe there is a quick fix to problems, lifestyle problems, relationship problems, financial problems, employment problems, health problems, loneliness problems, and all the problems people’s fantasies tell them should respond to drugs.

As long as people put faith in solutions outside themselves, they will be disappointed, I believe.  Maybe a pill can help, temporarily, but there is no pill for financial problems, unless you’re selling it on the street.

That, in summary, may be the underlying impetus behind the “opiate crisis.”

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July, 2007 Retrospective

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Ten years ago this month, I was working in a public mental health outpatient clinic, preparing to retire my medical and DEA licenses the following month.  These journal notes give a profile of my reasoning at the time.

GOSSIP AND SECRETS

Sunday, July 1, 2007 – I have been victimized by gossip more than once.  I tell patients therapy wouldn’t be necessary if not for gossip.

I remember excluding myself from cliques – the lunchroom crowd at Duke, composed of several girls in my dorm, and the group in medical school who gathered at lunch – because I didn’t like the mean-spirited gossip and chit-chat that characterized the gatherings.  I couldn’t sit with them without judging and seeing sides of them they couldn’t be proud of.

So I have been naive about gossip’s power.  In a culture built on hearsay, I am an odd duck, indeed.

Of course, my way is better, because it’s more practical.  I like forming my own opinions and always wonder what the gossiper’s agenda is.  I agree with Anne Scott, my history professor at Duke, who insisted on primary sources.  I believe in getting my information from the individual in question.  What he or she doesn’t tell or show me is none of my business.

In theory.  When people are plotting behind my back, it becomes my business, because I end up being the victim of their gossip.  I have been blindsided too often by those I trusted too much.

FREEDOM

Monday, July 2, 2007 – My unconventionality surprises me more than anyone.  Rather, I’m surprised to be growing so confident in it.   Perhaps I always knew it was there – that I was “different” – but it was unexpressed until revealed by the contrasts with the groupthink.  I live what others profess to believe, yet I am castigated for it by those who claim the beliefs most strongly.

No one attacks me directly, but they use triangulation, hurting things and people close to me, such that no one is safe.  I believe at some point the winds will shift, and I won’t stand so alone.  I will not actually lead, except in ideas and methods, as I feel I am already doing when opportunities arise.  After the fact, everyone wants to claim credit.  I don’t care who or how many people get credit, because everyone who takes a stand on her own behalf deserves credit for it.  I do for myself what I hope others will do for themselves, in commitment to self-reliance and freedom from bondage.

A PATIENT-CHURNING, PRESCRIPTION-WRITING MACHINE

Tuesday, July 3, 2007 – The more I work as a patient-churning, prescription writing machine, the more I hate it.  If they want to hire me to do staff development, groups, lectures, or anything that doesn’t involve writing prescriptions, we can spin it as education, and I won’t need a license.  I think these drugs are overrated and/or do more harm than good.  I spend all my time reducing meds and warning about side effects.

ON DRUG REPS

Wednesday, July 11, 2007 – Drug reps were lurking in the halls again today.

I’m reducing people’s meds, and they are grateful.  These folks seem healthier than the system.  Politically manufactured diseases justify churning tax dollars.

As psychiatrists like Dr. W (who plans to be a stay-at-home mom) and me (who plans to be a stay-at-home survivor) leave the system, the exploiters wring their hands in agony, wondering how they can perpetuate the illusions when the docs won’t cooperate.

ON THE HEALTH SNARE RACKET

Friday, July 13, 2007 – I undermine the system with every patient.  A hip replacement?  I ask.  Surgeons like to cut, and they have overhead to pay.  You need a hip replacement?  If you lost weight and restored some flexibility to your joints, your hip pain may not be so bad.  You’re thinking about replacing something living with something dead.  A living hip joint is infinitely more capable of regenerating itself than a plastic substitute.  Do you know how bacteria-infested hospitals are?  And bone surgery is the most invasive of all.  Microbes can hide and fester best in bones.

Your drug rep says you need to up your Cymbalta from 20 mg to 60 mg because that’s the standard starting dose?  But you feel better on 20 mg, and you’re super sensitive to meds?  Your drug rep wants to sell drugs.  Listen to your body.

Turn off the television to alleviate depression.  Dance for exercise.  Journal for self-discovery.  Reduce meds.  People treat side effects with more meds.

The whole world is crazy, so if you’re crazy, you’re normal.

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FOOD

Thursday, July 19, 2007 – In the check-out line at the grocery store, the man in front of me, an elderly black man, had several chicken pot pies and orange juice in a plastic container.  I think about the cost of all that packaging.

Several patients have gained significant weight, so I’ve begun to talk with them about diet.  They spend lots of money on food at restaurants like Applebee’s, but don’t get takeout boxes.  I’m watching what people buy in grocery stores.  People are using food stamps for things like bottled water and soft drinks.

One patient told me her food stamps go farther since she started eating more vegetables.  She weighs close to 300 pounds.

PFIZER REPS AND DRUG CULTURE

Wednesday, July 25, 2007 – The Pfizer reps were blocking the halls yesterday, flirting with the head nurse, who was laughing and flirting back. As I squeezed past her to collect my next patient, she loudly mentioned that the other doctor was late.  She couldn’t much stop me, could she, considering I was generating money.  And no, I will not sign my name for samples of those poisons.

Fortunately for me, my patients all showed up, and I had a blast with them while avoiding Pfizer at every turn.

They even brought lunch.  There must have been 20 boxes of pizza in the break room, and everyone but me gravitated to the food.  I heard the other doctor’s voice, so the Pfizer rep had his fish.

I was too busy seeing patients until 12:30 p.m., so they knew not to stop me

I have said over and over the drug reps shouldn’t be allowed to hang out in the back.  It’s unprofessional.  But this is the way business is conducted these days, in these “public-private partnerships.”

The drug culture?  Here’s what I think of the drug culture.  Grow it, just like you do food.  If you can’t grow it, you don’t need it.  Tobacco, corn for ethanol, marijuana.

Here’s an idea.  Individuals should be allowed to have private ethanol plants, formerly known as stills, to fuel their personal energy needs.  Whatever they sell, they can pay taxes on, if they must.

Same with tobacco.

Individuals could grow corn for their energy needs and sell designer corn liquor by the side of the road.  This would give farmers more value for their ethanol and save taxpayers from the middlemen.

Why, if investment bankers and oil companies can get government mandates and subsidies to force commercial ethanol plants, individuals should have equal status under the law.  Corporations don’t vote.  Individuals do.  Corporations vote behind the scenes, with money and favors, but the public pays the taxes and other costs for the fat cats’ deals.

THE TRUTH ABOUT THE DRUG COMPANIES, MARCIA ANGELL, MD, 2004, 2005

Friday, July 27, 2007 – I’m on the last chapter of The Truth about the Drug Companies:  How they deceive us and what to do about it, by Marcia Angell, MD.  I read about how the Food and Drug Administration (FDA) basically works for the pharmaceutical companies.  Far from protecting the public, the FDA protects snake oils, since approved drugs are not required to show superiority over current drugs, only over placebo.

Monday, July 30, 2007 – Dr. Angell castigates drug companies and FDA throughout the book but at the end, she recommends more legislation and more money for the FDA.  Of course she’s part of the establishment and can’t rock the boat too much and expect to be published.  A Boston Yankee, liberal Harvard elitist in an ivory tower, she depends on government for funding so is ultimately a GoverCorp slave.

And, she doesn’t mention insurance.  How does insurance, which costs more for giving less, get away with being so transparent?  Like with cellophane, you don’t recognize the costs until you’ve been shrink-wrapped and can’t breathe.

Tuesday, July 31, 2007 – So Dr. Angell is sadly naive about government and Medicare, either that or she chose to focus on one problem at a time.

Not I.  The FDA, for instance.  Waste of money.  Have the drug companies market directly to patients, starting with FDA employees, and pay them to participate in clinical trials. This could constitute true consumer marketing, drug company accountability, earning opportunities for all, and publicly supported large scale scientific research.  Capitalism in a nutshell.  They already do it in third world countries, under the pretext of giving free medications and vaccines to the poor.

Secrecy is the problem, and regulations make secrecy necessary to survive.  The more rules, the less anyone knows about cooperation.  Communication plummets, except by hearsay, and this further tangles networks.

Perhaps the FDA should focus only on safety and leave the efficacy to market-based consumer trials.  Abolishing drug laws would give taxpayers direct access to drugs of choice, and MDs could assume advisory and educational support but not have to play middleman in the government’s war on taxpayers.

 

 

 

 

 

Memories, June, 2007

 

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Above:  The Department of Human Resources (DHR) building in Columbus, GA

In June, 2007, I was finishing a short term psychiatry contract in the public health system in Columbus, GA.  Columbus is one of Georgia’s largest cities, on the Alabama border, and home to Fort Benning, one of Georgia’s largest military bases.

In August, 2007, I would attempt to retire from psychiatry, by letting both Georgia medical licenses and federal DEA licenses expire.  The stress was literally ruining my health.  Seeing patients was my favorite part, but the system itself was so dysfunctional that I risked everything if I missed a call.

BUILDING DESIGN

Saturday, June 2, 2007 – I fantasize about taking a sledgehammer to the walls at work.  It’s a maze, inefficient, unnecessarily confusing, and downright dangerous, with too many blind alleys, locked doors, and long, narrow halls.  Everything is so disconnected from everything else that the entire organization functions like a mindless blob of quivering protoplasm.  Individual effort dies in situ, never achieving enough momentum to spread beyond the 12’ X 12’ walls of the private offices.

These offices all have the  latest electronic equipment and programs, though, upgraded too often to be useful.  But they have zero reference books, so I bring my own.   I had to retrieve my own DSM-IV from the 500-foot walk to my other office, because the computer only takes diagnosis numbers rather than words.  I have not memorized diagnosis codes and never intend to.   Of course, the intake office does not have a DSM-IV.

HEAVEN

Saturday, June 2, 2007 – Anybody ever consider that heaven is not having to pay taxes?

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WASTE OF TREES

Sunday, June 3, 2007 – Columbus is full of railroad tracks.  As I negotiated 15th Street and around a tangle of other streets, I went under a RR trestle where Norfolk-Southern cars filled with fresh wood chips, piled high, smelled the air of pine.

How sad for those trees, I thought.  Their chopped chips are probably going to make junk mail, paperwork, and packaging.  This while their fellows are burning in a hundred square miles of uncontained forest fire in southeast Georgia.

CURRENT EVENTS

Thursday, June 7, 2007 – I’m becoming bored with current events.  I’ve had fun on the internet message boards, but the columnists remain uninspired – from my perspective – and I battle basic assumptions, like the belief that competition is good.  So, I approach it with the cavalier feather stroke of playfulness.  I balance discussions about nuclear proliferation in Iran with questions about paranoid counter threat tactics by the US.  How much are taxpayers paying for nuclear proliferation under our noses at home?

Lah de dah  . . .

Another world, another opportunity to blow it up, or not, depending on your reference point.  Worlds split off from each other, I believe, and those who believe in nuclear holocaust may well travel along a world chain of events toward that outcome.

Moi?  I’ll let that car pass on by, to avoid being swept up in that drive chain.  I see myself as an illusion-popper, clarifying ambiguities, flipping coins, turning phrases, bringing a sense of hopefulness through flexible thinking and clever (to me) juxtapositions.

Slowly, I see others becoming more confident, more outspoken, more imaginative.  Less victims, more involved, responsive, and reflective.

GONNADOS

Friday, June 8, 2007 – The world is overrun with “gonnados” who expect others to pay huge up-front costs for questionable future rewards.  There was an online Washington Post column extolling the new president of Arizona State University, for his grand vision of developing better communications between Americans.  President Crow starts by firing 20 of 23 deans on the faculty.  This communicates clearly to me.

Next, he creates lots of programs – a biodiversity center, for one – in order to make Arizona State a bigger place, competitive with Harvard and the like.

Another empire builder, think I.  I post my view that he’s another “ivory tower elitist with more theories than sense, standing on a soapbox bought with other people’s money.”  Another megalo-maniacal world changer, think I.  Yawn.

He talks about “stovepipe” mentality, but if he has replaced most of the deans, he’s just creating a different stovepipe for those he’s indebted to, or who share his agenda.

PRESCRIPTION SNAFUS

Thursday, June 14, 2007—I discovered yesterday that writing a prescription for something like Geodon doesn’t necessarily mean the patient will get Geodon.  Yesterday’s patient got four days’ worth of samples because that’s all the pharmacy had, so by the time I saw her, she hadn’t taken it for over three weeks.  By then both she and I decided she didn’t need it.

I’m beginning to wonder if these meds work at all.  As Seth* says, your beliefs determine your reality.  Those who improve give the pills the credit, but I’m not so sure. Antidepressants like Prozac “change your brain chemistry,” they say, but so does any life experience, and the fact of going to the doctor may change it even more.  Perhaps pills are merely transitional objects, tools to link mind with body, as valid for relieving suffering as faith.

I wonder how many people would take antidepressants and the like if they were over the counter.  To hold the claim of potency to the measuring stick of free market capitalism would be an experiment worth trying.

SIMPLICITY

Saturday, June 16, 2007 – Everything has always seemed so simple and obvious to me, issues of right and wrong, justice, fairness.  As I have come to know myself, I’ve shed projections from others, thanking psychiatry for teaching about projections and projective identification.  Psychiatry supplies the words to describe confused feelings.  People’s lack of clarity leads them to assume way too much and act accordingly.

I grew up believing I was potentially a brutally violent person, in need of rigid self-control, yet I’ve learned the opposite is true.  My childhood question, “Why can’t people just love each other?” remains as valid today as ever, and I’ve yet to learn the answer.  My nature has been to look for things to like, and I can usually find something, especially if I’m in a situation not easy to leave.

I’ve always felt safe and protected, though, not only by parents – although they certainly helped – but by life.  Not flamboyantly psychic, I suppose, I’m merely supersensitive emotionally, although there is no objective standard to measure this.  I don’t even believe I’m supersensitive, merely more aware than others, and more trusting of my perceptions.

FOR THE LOVE OF GOD

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Sunday, June 17, 2007 – My desire for solitude stems from a wish to know myself apart from others’ projections and judgments.  I suppose even as a child I was trying to reconcile what I felt with what adults said, and with what I saw.  Basic truths boil down to one truth:  God is love, and I want to do god proud, I will aspire to demonstrate her love in every thought, word, and deed.

It sounds sappy, inconsistent with my tendency to scream things like “Back off, asshole!” to the gas guzzling red truck tail-gaters with mag wheels and attitudes.  This is innately loving, I figure, because if I didn’t yell or otherwise show him where his rights end and mine begin, how would he learn?  If he already knew, he wouldn’t be tailgating.  And just because he’s behaving like an asshole now, it’s not necessarily a character trait, especially if he backs off or passes.  The loving hand of God therefore works through me to teach such testosterone-poisoned creatures how to grow in grace, in terms they can understand.

I’ve found taking my foot off the gas works, too, if yelling doesn’t, and I’ve allowed many such a creature to rush ahead to a destiny too frenzied for me.

DEMOCRACY IN AMERICA, ALEXIS DE TOCQUEVILLE, 1835 AND 1840

Monday, June 18, 2007 – de Tocqueville cites the lawyer class in America as the equivalent of the aristocracy, and the jury as the means by which every citizen sits in judgment over every other.  It strikes me that we do have a society that looks to laws to solve social problems, and perhaps the preponderance of lawyers in government has distorted our national perspective.

DRUG LAWS

Thursday, June 21, 2007 – I flip flop from thinking the drugs I prescribe are dangerous to thinking they are useless, validating Seth’s* assertion that the belief determines the effectiveness.  I really do believe drug laws create an artificial mystique about their effects.  Everyone would claim this is doctor turf, the license to prescribe, but I contend that this is a front for the government and pharma to falsely inflate the price, as well as presumed benefits and risks.

 

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*Seth is the channeled entity who spoke through medium/author Jane Roberts.  There are several books in the Seth series.

 

 

 

 

 

 

 

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 “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 Art of Conversation

 

brainboocwern022017           In 2010, I was a member of a local Toastmasters’ club.  Toastmasters International is a group that emphasizes leadership through developing speech-making skills.  The format is highly structured but inclusive enough to allow for short speeches on a variety of topics.  When my work schedule changed, I left the club but remember it fondly and have considered returning.  This journal entry made seven years ago was inspired by a Toastmasters meeting:

 

LISTENING

Tuesday, February 9, 2010–A Toastmasters member read a blurb last night about being a good listener.  It presumed interrupting means you aren’t listening.  I disagree.  I frequently interrupt to clarify a point, to carry thoughts further, or to convert a monologue into a conversation.  I listen with the intent to understand.  It takes “listening” a step further, into the range of “hearing” the context.

If someone is misinformed, under-informed, or if they are over my head, boring, or otherwise wasting my time and theirs, I believe as a good listener, I have an obligation to set the communication on track.

Few people appreciate the give and take of conversation.  If you finish sentences for someone, does that make you a bad listener?  Maybe you’ve listened to that sentence so many times, you know it by heart.

A reader, by definition, is a listener, even though the listening is through eyes rather than ears.  Anyone who watches TV is a listener, of sorts.  Anyone who watches a movie, ditto.  In the latter, the media provide the visual imagery that readers supply for themselves through imagination.

Since that time I’ve thought more about listening and its role in conversation. Our society seems built on passive listening.  By “passive listening,” I refer to structured learning environments, such as classrooms and lecture halls.  Churches follow a similar format, with attendees listening to sermons.  Expression, such as singing or hymns or recitation of creeds, is by rote.  Passive listening extends to radio, television, and movies.  Cultural events, such as plays or concerts, depend on audiences that listen quietly to the performances. The internet has advanced communication by allowing for interactive exchanges through e-mail, FaceBook, Twitter, or blogging.

Pondering this led me to reflect on how the human brain is wired with respect to language.  Most people, about 96 percent, have language ability concentrated in the left hemisphere. Here, the brain processes receptive language (listening) in a specific area called Wernicke’s area.  Patients with Wernicke’s area strokes can speak fluently but do not understand what is being said, by themselves or others.

Broca’s area controls expressive language, or speaking.  People with Broca’s area strokes  can generally understand what is being said, but they have trouble formulating and verbalizing their own thoughts.  This is not a problem of motor function.  The muscles of speech, like in lips and tongue, are not affected by the stroke.  Strangely, those with Broca’s aphasia (speech difficulty) can often sing, presumably because musical expression is located in the right hemisphere.

Writers and speakers make careers out of developing expressive language skills.  They know the challenge of finding the right words to verbalize thoughts.  They must arrange sentences and paragraphs coherently, and anticipate how others might perceive the words in that context.  But writers and lecturers are not necessarily good listeners or good conversationalists.

Toastmasters is one group that offers opportunities to develop expressive language skills.  At another level, improvisational comedy is potentially a way to develop the art of conversation.  Improv’s primary rule is to move the action forward.  A stated or implied “no” creates an impediment to this flow.  In contrast, arguing is an example of how “no” blocks communication.  A good conversationalist wants to hear the other’s point of view.

This led me to speculate about other opportunities in our society to develop conversational skills, a give-and-take in which all participating parties emerge invigorated and refreshed.  How many people listen only to refute, rather than build on thoughts and take them further?  How many agree in an argumentative tone of voice, such that they sound like they are disagreeing?

The art of conversation relies on equal participation from both receptive and expressive sides of the brain, the yin and yang of communication.  Because the two speech areas of the brain are physically separated, I wonder if making a conscious effort to develop conversational dexterity will help connect the two modes of communication—listening and speaking—to benefit all brains equally.

Any thoughts on this?

 

 

The Mind-Body Connection

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From “The Foot Book: Healing the Body Through Reflexology,” by Devaki Berkson, 1977

Anyone who has a neck has a mind-body connection, assuming the mind is in the brain, which has not been proven.  In fact, with the medical mucky-mucks pontificating about “evidence-based” medicine, I have to ask what evidence do we have that the mind exists at all?  In fact, what evidence do we have that life exists?  We can’t measure either of these on our fancy instruments.

Albert Einstein, who sought in vain for a unified field theory to link the different universal forces, like gravity, and strong and weak nuclear forces, took life for granted, as Western medicine and science do.  Oriental philosophy does somewhat better, with its acceptance of “qi” or “chi,” loosely translated as “life force.”  Philosophically, I prefer the Oriental paradigm, which assumes a living cosmos, emanating from the inside out, like a holograph.  Embryos grow from the inside out, as do plants from seeds.

While people know the brain is in the head, they forget that nerves extend from the brain to almost every cell in the body, in a feedback loop that transmits information and directions back and forth with dazzling complexity.   Chemical messengers and neurotransmitters number in the thousands.   Only a few have been studied, and even these are poorly understood.

The so-called “scientific method,” a construct of the mechanized Western model, assumes cause and effect, yet it requires limiting any “scientific study” to one variable. This creates an artificial situation which attempts to control for confounding factors and leads to skewed results.  Alternatively, the Oriental model, which sees disease, for instance, as a pattern of dis-harmonies, is inclusive.  It presumes there are no single causes and that dis-harmonies create patterns of dis-equilibrium. Disciplines like acupuncture strive to re-balance “qi” to improve health and quality of life.

Ear acupuncture and reflexology are based on the idea that there are correspondences between points on the ears, hands, and feet and the various organs and structures in the body.

earacu

Acupuncture does not lend itself to the “scientific method.”  Because it is holistic, it cannot be reduced to “cause and effect” studies.  Also, studies into acupuncture can’t be double-blinded, as the acupuncturist presumably knows which points are the “real ones.”

However, as East and West develop more ties, acupuncture is receiving more attention and acceptance, especially for such conditions as pain and substance abuse.

Reflexology, which is a specific form of massage, does not get as much attention, but it has the advantage that anyone can do it.  I make no claims about its healing properties, but I can vouch for the fact that foot and hand massage feel good and constitute a safe form of touching in a skin-starved society.