Nightingale at Large

Anybody could write this summary, but here goes mine. The game is fixed; the good guys are losing as fast as you can say “deficit reduction.” That phrase is a shibboleth used to prevent people from crossing the border between Whatever Land into the land of real concerns (jobs, healthcare for all, getting out of Iraq and Afghanistan, improving public education). “Deficit reduction” is a checkpoint set up by the very rich to prevent any build up of popular forces demanding that Social Security and Medicare be preserved, regulations imposed on corporations, jobs created and unions defended, consumers, schools, and the environment protected against predators.

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I want make this secular contribution to all the prayers for Haiti and for Haitians as they survive through their recent disaster. I want to mention the mortal instruments we possess:

Partners in Health, Dr. Paul Farmer’s organization, has its origin, center, and much of Farmer’s life placed in Haiti. Their health teams in Haiti were involved from the first moments, effectively and without aid bureaucracy pass-through. They are fully invested and are a worthy place for your contributions.

Doctors Without Borders whose Haiti medical teams were involved from the first moments of the earthquake disaster, with additional medical activists streaming in with supplies and extertise. Their administrative and fund-raising overhead is remarkably low.

Disasters such as their hurricanes and this earthquake are “natural.” But U.S. invasions and governmental policy are not. These have long been primarily responsible for creating Haiti’s “Hideous Dream” (as Stan Goff called it in his book by that title, quoting Shakespere). There will now begin our vast and wealthy country’s aid response to the earthquake. I doubt if U.S. government aid will come close to matching, in dollars, the outpouring of aid and philanthropy from Haitian-Americans and all of us together with our small individual contributions. I doubt it will match, in dollars, the United Nations contribution. But that is no reason for reducing our aid.

Perhaps we should hang out heads in shame for passively accepting our corporate-ruled nation’s Haiti policies over all these years. Perhaps the thing is to make our small contributions now as Haiti faces its latest disaster. And, also, perhaps now is a time make a beginning to dealing with those whose racist hatred and automatic right-wing reaction have inspired and supported every cruel thing our government has done to Haiti. They are the likes of Pat Robertson, TV evangelist leader, who has long preached against the very being of Haiti (on Wednesdays repeating that Haiti has been cursed by a “pact to the devil”), Rush Limbaugh, talk radio leader, who yesterday once again denounced aid to Haiti (”We’ve already donated to Haiti, it’s called U.S. income tax”), and those already beginning to decry “Haitian refugees” and the use of even a single Florida hospital bed.

We should do everything we can for Haiti because, in truth, Haiti is a real threat to everything that is bad in America.

Haiti accomplished the first successful armed slave rebellion and achieved independence while surrounded by slave nations created and policed by Europe and the United States. Throughout America, Haitians furnish models of the social gospel in action (those Sermon on the Mount values) while not collapsing their Christianity into exclusivity, unreality, and the hate-filled fundamentalism that is so common in America. Haitians have survived the health effects of extreme and unjust inequality. They have survived our racism and the years of major media distortion of their culture (”exotic,” “perverse,” “incompetent” Haiti). They survived at least two CIA and U.S. military overthrows of their democratically elected governments, kept faith with their unique state “monopolies” that originated in their early independence history, and, to this day, they believe in genuine democracy. Yes—although the phrase is not usually used in this way–Haiti represents “the threat of a good example.”

We should do whatever we can and take pride in whatever acquaintance we have with Haiti and Haitians.

Jim

Today’s Times (Dec. 12, 2009, page 1) has “Poor Children Likelier to Get Antipsychotics” opens with:

“Now federal financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance.”

The rest is summarizing detail: More drugs for less severe conditions, conditions that are controlled without drugs by middle class parents. Severe physical side effects from the drugs. But never mind. A group of medical doctors in 16 states has formed an organization, “Too Many, Too Much, Too Young” and they are ignored. Health Affairs will publish the federally financed research early next year. A “stunning disparity,” doctors say.

The reason is insurance reimbursements: costly (via Medicaid) but cheaper than counseling. The easiest justification is “bipolar disorder.” What is that? Medicaid without co-pay pays for the drugs, which cost up to $400/month. These drugs are the single biggest expenditure for Medicaid. The kids are age 3 to 17. They are often “off label” prescriptions (without FDA approval). Once on the drugs, some parents report comments like “It is impossible to stop now.”

Get the picture?

This has been going on for several years. And, please, we do not give a shit about the cost. After our deficit terrorists, who always declare “We cannot afford it, whatever it is!,” have had their say the responsible (independent) apologists puts it this way: “Medicaid kids are subject to a lot of stresses that lead to behavior issues which can be hard to distinguish from more serious psychiatric conditions.”

Do you smell stink of pitch in that remark?  The non-apologists point out that “a lot of these kids are not getting any other mental health services.”

We are talking schizophrenia, autism, and bipolar disorder. All of these diagnostic categories are questionable; even the related more minor diagnoses (attention deficit, hyperactivity, persistent defiance, etc.) are included when Medicaid, with its big bucks, is involved. .

The structure of this drug pushing is, as you might expect, profit driven. Profit-driven corporations who produce these drugs are a monopoly (Pfizer, GlaxoSmithKline, Sanoff-Aventis, Johnson & Johnson, Merk, Novartis, AstraZeneca). Shame on them. They employ thousands—actually thousands, no exaggeration, of well-paid lobbyists—to pressures legislators, legislative staff, Medicaid and FDA official’s staff, and “opinion leaders,” to promote these drug buys. These thousands of corrupted salesmen are good at what they do. They are smart enough to reach the neighborhood poverty docs and the docs working for peanuts in the hinterlands.

I wanted to share this with you, a piece of everyday intelligence.

Jim

Some see our ship of state floundering, water logged by right-wing bluster, attacked by deficit terrorists, sinking in leftover oil and gas wars, its crew untested, a ship weak in captaincy. Our captain, they say, lacks resolve, tenacity, perseverance, and so on and on.

I do not see it this way.

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Dear Friends, some of you do not watch MSNBC’s prime-time news shows with any regularity. I do not want you to have missed Keith Olbermann’s passionate, 42 minute, going toward 10,000-word, editorial last night in behalf of progressive health care reform. You can find it with ease here and here and very neatly for reading here.  And right here are brief excerpts from the transcript (his introduction, Olbermann on the failure of reform rhetoric, his Victorian analogy, and his naming of the enemies). After these quotations I put my note on what is happening to cable news. You might want to switch from prime-time network news or FOX cable news or CNN to MSNBC. You may gain a conversational advantage, free yourself from that sense of repeating what everybody at work already knows, and have the pleasure of a peek at the transformation now taking place in “news as entertainment.” Here is Olbermann (please supply the proper quotation marks): (more…)

Below under “PROBLEMS” are a series of quotations from doctors I have taken from the transcript of a recent a PBS documentary film. Each thought from these doctors is more or less separate. The quotations are unified only by the doctors’ willingness to be interviewed in a PBS documentary titled “Money-Driven Medicine.” Please assume the necessary quotation marks. Following this I have some remarks of my own titled “MUDDLE IN THE MIDDLE.” Then I present the “SOLUTION.” That is also a quotation, the summary presentation of the widely endorsed, 17,000-member Physicians for a National Health Program. It is essentially what is often called a “Medicare-for-all” solution. My thought was that reading these quotations and remarks will take about a quarter of the time required to watch the PBS documentary (Bill Moyers Journal, August 28, 2009) and is far superior to the readily available YouTube clips.

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As a Bostonian, I am not immune to outbreaks of spots. I suffer; we all suffer.  We take perverse pleasure in our suffering. We talk about spots together all the time. We have special “Spot Bars” where we can compare and examine our spots and commiserate. In a society that specializes in distractions, spots are a kind of perfected irrelevance. Their infinite detail matters to many of us.

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Several years ago, my good fortune was to have a brilliantly narrated personal report on a Mafia house party in Los Angeles. There were minor capos, charming and presentable thugs, lawyers, and family, all very intimate, chatting about crimes (theft, stare-downs, drug confrontations, and worse). For these people breaking the law is their life and limb and the key to their private well-being.

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For my infrequent audience: First, I love you. Being able to say these things is very important to me (other than when dog walking on the street; other then when collaring a friend on the phone or in a drive-by; other than when, on an occasion we’ve forgotten, we are each holding something to drink).

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My wife and I, along with thousands, paid our respects yesterday to Ted Kennedy lying in state at the JFK Memorial Library. Because she was there we were the center of small conversations all along the two hour way. As they do, people talked about their contacts with Kennedy, one of the “famous people I have known.” Any other time it may have seemed like celebrity talk or name-dropping, but here it appeared as a way of saying “Thank you, Ted.”

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These highlights are for those who would hear a bit more about health in California but do not wish to wander, as I’ve been doing, through the valuable and actively maintained web sites of the 86,000 nationwide membership California Nurses Association http://www.calnurses.org/ and the 17,000 member Physicians for a National Health Program http://www.pnhp.org/

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Golden California, our most populated state, was once widely admired. Now you hear of lay-offs and foreclosures and there are wild cries of “fiscal crisis,” “bankruptcy,” and “bail-out.” In fact the current state deficits ($24 billion) are less than under Governor Schwarzenegger in 2004 and substantially less then he decried during his earlier run to replace recalled Governor Gray Davis ($38 billion). Davis’s sin was being one of the first to oppose Enron’s crimes.

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Jennifer, my visiting granddaughter, and I spend an evening watching the expanded—in fact the over-long—“Director’s Cut” of Blade Runner. Then we each read Philip K. Dick’s Do Androids Dream of Electric Sheep? On a splurge we had bought two copies and the DVD at the Harvard Coop. (more…)

I did not forget this personal website. I only desisted. The quantity of opinion out there is not to blame. Reading and constant family conversations—which deserve but never achieve record—are not to blame. Nor can I blame all the ads and plugs and spam that make using the Internet seem as difficult as getting to a major library on a rainy day with a misplaced T-pass and no change. We all should have known that, like any capitalist stampede, the Internet would mean “let him save himself who can.” As for elite disdain for blogging, the elite have decried the “flocks of scribblers” since the invention of cheap paper. None of this is the cause of a neglected personal website. President Obama is to blame. (more…)

A hero is an infrequent, episodic thing at best.  Often, like Shane (Alan Ladd in the movie), a hero does not even turn and wave to you as he rides off into the sunset.  Best case, the hero might leave behind some good advice.  Shane told young Joey (played by Brandon DeWilde) to "grow up strong."  The implication was: be like your father, one who fights steadily, modestly for the rights of homesteaders against the cattle barons. 

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In the homes of the very wealthy, note the bookends as pictured here. The surprising fact is that very often the rich do not give much thought to the content of the books between them. Only bookends matter. Truths about our unequal, unfair society matters less to them than the legislation and policies that create the inequality and favor the very rich. Likewise, many commentators are careful to place their truthful content between editor-acceptable bookends. (more…)

A policy-enforced disparity between the health of the rich and the poor is evident in any major urban hospital. All the staff is aware of it. As you proceed from the worried well to the barely ambulatory, from brief physical examination to technologically sophisticated costly medical diagnostics, from scant to full staffing, from simple to thorough lab tests, from wards to the single rooms with adjoining kitchens and accommodations for family—nice views, hospital-supplied flowers, comfortable seats, etc. —so you proceed from health care for the rich to health care for the middle-class.

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Health policy in America is a nurses’ joke, the black humor that is part of carrying on, doing what you can in spite of whatever. Health policy aims directly at suppressing the demand for health care. Nurses in our hospitals see it most clearly. First, most cost cutting aims at suppressing demand. Understaffing is only the most obvious example. Why should health care always be a matter of hurry up and shortcuts? (“Be patient and I‘ll get to you as soon as I can.”) Then there are the all too obvious deferrals, denials, long delayed treatment, skipped appointments (“Maybe I’ll get better”). Hospital and HMO administrators urge doctors and nurses to a thousand daily decisions whose rationale is “cost containment.” The intent and effect is to reduce demand. What kind of a health god is cost containment? (“They talk of care as if it were some deadly sin?”) Why are there no local clinics? Why are all hospitals monstrosities? Is transport so primitive, so expensive? No.

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Frequent articles and ads promote while others oppose the widespread application of antipsychotic and other powerful drugs to children with mild behavior issues. You might think there is controversy here, that “medical/scientific opinion is divided.” A better explanation is the excesses to which the drug industry, seeking ever greater profits, has gone is pushing these drugs. That industry—ten or so unrestrained, unregulated capitalist corporations (with prescription revenue of something like $250 billion in 2007)—seeks ever larger populations, ever more “conditions” in which to promote their ever growing pharmacy of interventions. Using their grand revenue as weapon, the drug industry has captured the regulatory agencies, institutions, and “thought-leaders” that should have reduced such drugs to a necessary trickle but have brought them to a flood.

In a nutshell it is a war of drugs on children with the drug industry using the trust of parents in doctors, false analogy with developmental disorders such as autism, the helpless anxiety of parents over their children’s behavior, the billions in profits, and the background noise of our judgmental, over-medicated society to sell ever more, and ever more expensive, drugs.

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As we all notice the belated media attention now given to the Democratic Republic of Congo, our first response should be “Utt-Oh! This can’t be good.”

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