Monthly Archives: October 2012

Spoons, Smiles and Romney

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This morning I listened to a discussion about whether the Democrats made a mistake in campaigning that Romney was severely conservative, especially in light of Romney’s recent moves to the center, adopting moderate positions not uttered in a GOP campaign.

As if this move to be moderate reflects Romney’s real nature.

It reminded me of feeding my children when they were still in bibs and high chairs.

Old enough for that first streak of independence, that insistence to hold their own spoon, I’d watch and encourage them as they slathered food up towards their own mouths, slurping and cooing as they gummed pureed fruits and veggies.

Inevitably, small stomachs fill, attention drifts and play starts; that’s when spoons hit the floor.

I pick it up, wash it, and hand it back, with a gentle reminder of ‘no’.

My child’s head shakes sideways a few times, echoing ‘No’, even as their hand, firmly grasping the spoon, moves ever so slowly to the side of the chair tray.

The head shakes again… ‘No’. The beautiful baby blue eyes fixed on mine. A slight smile rests above a pudgy chin.

The spoon, now clear of the high-chair tray, drops to the floor.

Did my child, this pre-toddler, just look me in the eyes, smile and use misdirection to lie to me?

Yep.

I pick it up, wash it, and hand it back, with a firmer reminder of ‘No’.

My child’s head shakes sideways, agreeing ‘No’, even as their hand, firmly grasping the spoon, moves steadily to the side of the chair tray.

I point, as my Mother used to, saying ‘No’ in a firm, serious, fatherly way.

The hand stops. I smile and say “very good, now finish eating”.

The hand starts again, moving to the edge of the tray, my child’s eyes fixed on mine, somehow brighter and bluer than a moment ago, the smile now broader, making the chin even pudgier.

The spoon hits the floor.

We can learn at an early age that a smile and a sincere look can carry us far, letting us get away with things we want to do, fooling others into thinking we mean something we don’t.

We also learn how to spot those people, so that we’re not taken advantage of by their dishonesty.

As a social observer with time on my hands, I’ve had the opportunity to follow the Republican Primary and watch the debates. By Romney’s own words, he’s a ‘severely conservative’ kind of guy. By his own words, he’ll defund Planned Parenthood and Obamacare on day one. By his own words we should still have soldiers and marines fighting in Iraq and Afghanistan, and for years to come (“the Taliban may not have watches, but they have calendars!”).

By his own words, and frankly the most comfortable I’ve seen Romney when speaking (it was behind closed doors to people who could afford $50,000 for surf and turf, and he thought we couldn’t hear), he said he doesn’t care about 47% of us because we don’t take personal responsibility, get government benefits and think we might deserve them.

That’s the spoon.

Once he had the GOP nomination, the move to the center began. He said his health plan allows for pre-existing conditions (it doesn’t). He says he supports womens’ rights to health and choice and fair salary. He says he agrees with the President’s foreign policy and doesn’t believe in sending in troops to the Middle East. He’s now for veterans and seniors and retirees who receive government benefits, and he wants to raise the middle class back to the middle.

That’s the smile and head shake ‘No’. It’s not real, it’s saying whatever works to get his way.

Romney has a good smile, and a preacher’s demeanor, one not so different from car salesmen and hucksters. Regardless of what he says lately, it’s just smiles and misdirection, and not any different from that of my high-chair kids years ago.

Don’t be fooled, if he’s elected, it’s the spoon that is going to drop, and we’re the floor.

The Free Market of Cancer

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A recurrent theme here at Now Think About That for a Second is that of business and industry using government to impose bad things on us good people. Here’s a couple more examples of why the free market isn’t ‘free’ or working for we the people.

The National Institutes of Health publishes a report every couple of years letting us know what new carcinogens (cancer causing agents) have been found, as well as  more evidence of existing carcinogens in our environment. It’s called the Report on Carcinogens.

Who could be against that?

Well, for starters, the American Chemistry Council, a lobby representing Big Chem companies like Dow, DuPont and Exxon/Mobil.  They’ve pulled the strings of their GOP buddies in Congress to not only squelch the last report, but also to pay for another one to research just the unwanted claims and insist that no other report is produced (paid for) until the special report is finished. One estimate is that we could go four years before the next report can be issued.

Why the uproar?

Formaldehyde and Styrene.

Formaldehyde is in too many home products to list. Carpets, glues, particle boards, insulation, plywood, paneling… our homes, where we eat and sleep and raise our children, are literally steeped in formaldehyde.

Don’t think you can move into a tent to get away, because formaldehyde is also in many of our personal care items, like nail polishes, soap, shampoos, toothpaste… and baby wipes.

Styrene is the key ingredient in take out cups and containers, and is also found in plastic and fiberglass and insulation and boats. Most people get their biggest styrene dose from smoking cigarettes.

The new report makes it pretty clear that these two are cancer heavies. Formaldehyde was given ‘known carcinogen’ status, while Styrene was ranked ‘reasonably anticipated to be a carcinogen’.

And those companies are really ticked off about it.

Not in the “Holy cow, formaldehyde is dangerous and we have to find something safe to use!” kind of way, but rather in the ‘Don’t let people know, it’ll affect our profits!” kind of way.

That’s why, rather than recall products, or promise new and improved research on safer products, the response from the industry is to bury the information, to knowingly cause more cancers in us consumers in order to pad their bottom line. It’s what they did to our parent’s generation with asbestos.

GOP members of Congress are doing their part to protect the cancer market and it’s ‘job creators’ from any government regulations that would protect us ‘job doers’ at the cost of a few points of profit.  They bury the information, cast doubts on the science, and load up the House Science Committee with science challenged people like Todd Akin and Michelle Bachmann.

There’s nothing ‘free’ about that kind of market.

A similar game is being played with our health by the GMO industry. Genetically Modified Organisms (GMO’s) are all the rage these days, primarily because of the profits that can be made by the Big Chem and Big Ag companies.

When I first heard of GMO’s, I played down the fears, thinking that farmers and gardeners have been playing with plant genetics since someone first planted a garden. You can’t get through high school without learning that Gregor Mendel had a pea garden and selectively bred many different pea characteristics. He was using the slow method of breeding to change genetic makeup. I see it as progress that we can now breed drought tolerance, or early/late frost tolerance, or resistance to blight into our farm plants and vegetables

Today, scientists can do that quickly. That and much, much more.

Like inserting a foreign gene (not from a pea) into a pea (or corn, or soy) and giving it resistance to RoundUp.

RoundUp? The weed killer?

That’s right, there are GMO’s being grown and sold to the public that have foreign genes designed to give the plant industrial strength, so that it may be grown on the biggest plot possible with the most automation. Where cultivators used to weed between rows, we can just spray it all from above with RoundUp now, and add to the bottom line.

Since GMO’s are new, and not much work has been done proving the safety of each modified gene, some enlightened groups have asked for a moratorium on their use.

California has Prop 37 on this year’s ballot. Prop 37 would require that any food containing GMO’s and sold to the public be labeled as containing GMO’s. They’re not asking to stop, only to let us know what brands contain a GMO so we can make a choice.  That seems fair to me, and consistent with free market principles.

Guess who is pouring millions of dollars into California in an effort to defeat Prop 37?  The Big Six Pesticide companies.

First, I’m against any effort to hide what goes into the stuff I buy for my family to eat and drink. I’m ok if Colonel Sanders and Coke have secret flavor ingredients. I’m not ok if my corn on the cob has RoundUp inside and they don’t want to tell me. If you have to hide what goes into your product, I don’t want it.

Secondly, I’ve always found it interesting to see how the sides line up on any certain issue. When the billionaires all line up on one side, I can usually tell that I’m for the other one. Same with chemicals.

When the top poison manufacturers in the world line up against us knowing what’s in our food and drink … that’s a big sign telling me something is not right.  Maybe I saw Soylent Green at too young an age…

I saw one study that showed that eating food that was genetically modified for RoundUp resistance caused more cancers than the non GMO, and as many cancers in mice as eating RoundUp itself. Granted, it was a single, relatively small study, and not at all definitive from a scientific standpoint.

From a practical standpoint, however, it’s a big smoking gun.

Republicans believe in “getting the government out of the way” of business. They tell us that business and industry will self regulate, will protect us the consumer and the earth our home out of the goodness of their hearts. That’s what they tell us, and what they want us to believe.

Their actions say more. Their actions tell us they believe that leukemia in our children is an acceptable risk, that the breast cancer that took my Mom is nobody’s fault, that the profit margins of the industry that most contributes to re-election  ranks highest in priority, regardless of the danger to consumers. That’s why they want to dismantle the Environmental Protection Agency (EPA) and Food and Drug Administration (FDA).

They think that what we don’t know can’t hurt us, so they do everything they can to hide truth from the people.

That’s not a free market. That’s a manipulated one.

One that is killing us.

Privacy, the Internet and You

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Privacy: the quality or state of being apart from company or observation.—-Merriam-Webster Online Dictionary

A handful of reads this week prompt me to write about privacy and our use of the internet.

First was the story that some GOP members of Congress, doing, as always, the bidding of Big Business, have taken issue with modern web browsers ability to toggle a ‘do not track’ button. Like firewalls and virus checkers, everyone who surfs the ‘net should be aware of these security tools.

Basically, there is code inside the internet (cookies are just one type) that is designed to not only track where we go and what we see, but then to report our movements to businesses, or whoever is doing the tracking.

They want to use our internet habits to better ‘know’ us. Now think about that for a second…

Modern web browsers have a “Do not track” button that lets ethical marketers know that we choose to ‘opt out’ of their tracking. Seems fair to me.

Until recently, advertisers have said that they would honor our preferences. That’s been changing, and the final straw, apparently, is Microsoft’s decision to launch their next Internet Explorer version with the ‘do not track’ switch now a default, and a setup question asking the user if they want to be tracked.

Microsoft says that today’s computer users expect security and privacy protections to be built into their products.  I know that I do. Good call Microsoft!

The Board of the Association of Advertisers disagrees, though. If everyone using IE chooses to not be tracked, “companies would be prevented from collecting data on 43% of American web browsers”, ‘browsers’ meaning us, not the software.

As a result, some advertisers (the Digital Advertisers Association) are letting us know that they will no longer honor the ‘do not track’ button, since we have to say “yes, please track me” as opposed to “no, I’d prefer not to be tracked”.

It’s an honor system anyway, and one that I don’t really believe is followed to any consistency.

There are tools and browser add-ons that, rather than ask not to be tracked, block invisible trackers in their, well, tracks. Many are free. If you don’t want your internet browsing habits known by just about anybody, you owe it to yourself to use these kinds of browser tools.

Some tools block tracking of your habits by disabling the code when it shows up. Some block who you appear to be by changing the address that you’re coming from.

All put the power in your hands, with the result not depending on the ‘honor’ of the business world.

There is one down side, however. The speed at which google works for me, and your search engine of choice works for you, is greatly dependent on the engine learning our preferences through tracking previous searches and the results that we choose from that search. Turn off tracking, or hide yourself through location tools, and these searches will slow down some and become somewhat less fruitful.

I can live with slower searches to not have what I’ll describe below.

The next article I read was about how today’s political campaigns have purchased our browsing history, to the point of creating profiles of us and using those profiles to alter what we see on their sites. One example I remember is if you have a conservative profile with church or religious sites in your browsing history, you’re greeted with a ‘have a blessed day!’ and content is presented that meshes with your profile; but if conservative with no church or religious sites in your history, a more business oriented site is presented, and without the  homilies.

Both campaigns are using this tactic, it isn’t limited to conservatives and evangelicals.  Liberals can be polarized into environmentally oriented or civic oriented, each with their own buttons to be pushed. We expect campaigns to want to push our buttons, but I prefer they tell me what they stand for before they know what I am for. When I go to the Romney or Obama web site, I want to see what they are about, who and what they stand for, and not just the parts they think I’ll agree with. And if greeted with a “hey y’all” when the page opened, because I live in the South, of course… well, that would be just too much.

Another way the campaigns use our bought information is to tap into the network of people they have and cross match to see if any might know us as well. Have you gotten a call from a long-lost friend who just happened to call about the election? Or maybe a call from a neighbor you haven’t met, wondering which route to the polling place that you think is best, with your local streets as choices?  If you do, the chances that it is happenstance are slim indeed. And more than a bit creepy.

The third article I read was a snippet about the privacy at Facebook. Many apps (Skype, Horoscopes, games) used by Facebook users give hidden permission for the app’s makers to access not just your data history, but that of all of your “friends” as well, and will even use your non Facebook contact lists, such as e-mail and address books, to get them. I say “hidden permission” because most users don’t know that’s what they are agreeing to, and would not agree if they understood the meaning.

What is scary about these situations is that the information on us is there to be had, to the highest bidder, information that many of us would not care for our parents, our children, or our employers to know. I know, some of you are thinking porn sites, and maybe poker rooms, but it’s really much broader and less sinister than that.

And it’s being used to manipulate us into doing things. Some might argue that all sales is manipulation, and that may be. But imagine if the used car salesman had your browsing and prior purchase history to negotiate with.

We have some control, and no, I don’t mean in choosing only acceptable-to-every-conceivable-person-down-the-road web browsing. I mean that we can use easily available tools to block the tracking of everything we do online.

We can also let our government know that we do expect a measure of privacy in America, especially in our homes.

But geo, you say, the internet is certainly outside of our home.

Sort of.

When you clicked the link to read this post, you effectively dialed my number. A server picked up, saying ‘hello’ by sending you this post to read. It’s not much different from a phone call, which is why Skype works.

We expect our telephone calls to be private, both who we call and what we say.

If you are reading this in an internet café, maybe because you are not in a public place you also have no expectation of privacy.

Same if you’re reading on your cell phone at work or in class or at an Arby’s.

But if, like me, nearly 100% of your internet use is in your own home, I do believe that there is a reasonable expectation of privacy.

Most people who live around here aren’t comfortable with the notion that the government wants to know who owns a gun. I’m one of those people too.

So how comfortable can we be, knowing that the government, or the church, or the neighborhood association, can buy that information, and everything else about us, from those ‘advertisers’ who would take it without our knowledge or permission?

I say not at all.

A Question of Value(s)

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There’s a lot being said these days about health care, from Medicare to Obama Care. Get past the lies and rhetoric, and most of it boils down to questions of financing and access. Think of them as “who makes the rules over who gets to play”.

Republicans believe that we should ‘get government out-of-the-way” and let the free market provide financing of health care, and people can choose and buy whatever they can afford; Democrats believe that the most cost-effective way is partnership between government and the private sector, with basic health care available to all Americans whether they can afford it or not.

Beliefs that are as different as can be.

“Getting government out-of-the-way” is a catchy phrase that sounds good on paper, until we stop to consider that it’s our government that makes possible Social Security and Medicare and Medicaid and WIC (a Federal program for Women, Infants and Children). Only those who will never need those programs are against them being available for those of us who do.

My parents and grandparents (and one great-grandmother too!) benefited greatly from social security and Medicare; my nieces and nephews and their kids have benefited from Medicaid and WIC.  Not because they  refused to take personal responsibility for their lives, but because they were either very young and victims of un-employment and divorce, or retired after a career of working and paying in their fair share, or very old and widowed to men who did the same.

I think about what life would have been like if Social Security hadn’t been there to keep them independent, in their own house with their own stuff; if Medicare hadn’t been there to get them the lowest prices on their health care, and to cover their hospital bills which ran into the mid six figures for each of my parents.

It’s a picture that more people need to consider.

Once upon a time, when I started working in health care, Medicare operated as a fee-for-service operation. What that meant was, we provided a service, any service for any reason, and we’d get paid what we billed.

When I worked directly for the hospital, we had guidelines for care. When I worked for the private, free market company that the same hospital contracted with to provide services, instead of “care” guidelines, we had “charge” guidelines.  That’s our first clue as to the differences in purpose between a public and a private health organization in how they approach treating patients.

The one that still rings in my mind’s eye is PRN (as needed) oxygen. We put oxygen equipment in every room, and charged every patient every day, whether they used the oxygen or not. I filled out enough charge forms to still remember the totals after all of these years: $37.50 per day, for just in case.  Another example was post-op breathing treatments ordered to ‘prevent’ pneumonia. Every surgical patient received not one or two, but three different breathing treatments, each four to six times a day until discharge.

The first big round of Medicare reform in the 1980’s stopped those practices, as the Medicare powers that be, among other things, declined to pay for that which wasn’t used, and only covered those things that were proven to be of benefit.  What a concept!

Think of the car dealer that charges for undercoating we don’t want or need, but no undercoat was ever applied. Think of the restaurant that charged you for an appetizer that you neither ordered nor received. None if us would stand for that, nor would we likely continue doing business with those businesses.

My free market industry screamed foul, and said government had no place in health care, and said government was stifling business, and said that government was killing jobs, and they still lost. Millions were saved that very first year by not paying the free market what they said they deserved, just because they said they deserved it. No longer would everyone pay for oxygen they didn’t use; no longer would treatments be covered to prevent pneumonia when pneumonia wasn’t even a risk to be had.

That’s millions in Medicare (taxpayer) dollars, saved by the recommendations of Medicare panels, the first ones to get the moniker ‘death panels’ for daring to come between “the physician and his patient”. My field, respiratory care, was still a relatively new field when I entered, helped lead the way to data driven health care, using good science to get data that showed us what worked, and what had the same or worse impact as not doing it all.

Facts are powerful, but only when people listen to them.

Those Medicare rules didn’t apply to other insurers, although the insurance industry was quick to adopt any reason that limited their payments on claims, because fewer claims paid means higher profits. That’s why they have pre-existing condition clauses.

It didn’t change for the un-insured, however, who to this day pay higher (retail) prices for everything in health care than does Medicare (big volume discount) or private insurance (big stick discount).

And that’s the key, folks… you see, it’s the un-insured, those who are charged retail, that eat up the space in our emergency rooms. They’re the ones who increase everybody’s costs, and by the retail price, not the much lower volume price.  Most un-insured still get emergency care, in the most expensive way possible, but also in a punishing way, one that demands that their basic health needs be neglected until they become emergencies. One shouldn’t have to suffer a life threatening pneumonia just because of lack of money to treat a chest cold. One shouldn’t be forced to buy an ICU stay or lose a leg because of lack of money to treat diabetes or a scraped shin that becomes infected.

I know of a man who spent over 3 months in ICU, on and off life support, because he lacked the money to buy insurance to see a doctor to get a tetanus shot.

He got tetanus. Really.

We all paid his bill, through our higher prices, a bill easily hundreds of thousands of times more than the cost of a tetanus shot.  Now think about that for a second…

That’s just one reason universal health care is a more cost efficient model than what we have today.

Every business in America, and especially insurance companies, are in business not just to make a profit, but rather to make the most profits. That’s how so many were able to literally (and legally) soak Medicare all of those years, and why Medicare went along with it. We should thank them, because it’s because of that soaking that Medicare became data driven and has the control it has today.

I’m not against capitalism, but because I believe that health care should be a basic right, and not just a privilege of the wealthy, I believe that government has to not only be involved, but has to be in the driver’s seat of the financing.

The government has shown, through the VA Health system and Medicare, that they can be both smart with our money and make sure that all qualifying Americans are included. That’s not saying that they each do not have their issues, but it’s a much better system than it was when I started. Much better.

The free market has proven to be into profits, and profits alone, the rest of us be damned. Deaths from the tainted compounded drug, now up to eleven, that fungus filled injectable drug from the unregulated compounding pharmacy which chose profits over our safety… that’s as good an example as any against letting the free market run health care.

Fee for service and the free market works with cars and trucks, and restaurants maybe, but not for health care.

The Will to Die

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I was moved this morning by a piece in the New York Times written by Bill Keller. He described the situation surrounding the last days of his terminally ill father-in-law. Those days were spent in Britain, with a hospice system that honored the wishes of the dying and helped ease the pain of those who survived.

This is somewhat similar to the situation surrounding my father’s death here in Florida. Dad made it very clear to me, and to my siblings close enough to hear, what he did, and did not want. I had to all but twist his arm to go to the hospital when he did… and I’m quite sure that I was only successful because he was already mentally and emotionally spent from his rather minor ailment, that when neglected, turned into a serious physical condition.

He wanted to use the hospital we used for Mom’s cancer, which surprised me, as they had failed to find the cure, so after helping him shower and clean up, and promising that we’d protect him from the doctors, we took a ride to the emergency room. Being Dad, he drove.

When Dad was admitted they asked not only for his insurance information, but if he had a Living Will and/or a health care surrogate. We provided them copies of Dad’s wishes, and I was identified as his surrogate.

The first day was spent with tests and meeting specialists. My sister insisted that she take the night shift with Dad so that I could take the days and interact with the growing army of doctors that we were accumulating.  I agreed, knowing that when the docs did come around, I’d have about 3.6 minutes to hear their spiel, process it for understanding, ask the unanswered questions that came up since the day before, then multiply that by each physician on the case.

Although advertised as a “Stroke Center”, hospital staff did not recognize his ongoing stroke the night it happened, that first night he stayed at the hospital and I left for sleep so to be sharp the next day, the night my sister (not a health care person) told the nurse that something had changed and was very wrong, the night that I let my father down by not being there.

Like too many medical people, — and for whatever reason, I’ve heard them all — the nurse ignored my sister’s comments and, with what my sister perceived as a bit of an attitude, sent aides in to clean up my suddenly unresponsive father, who had uncharacteristically soiled the bed.

By the time I arrived, he was in a coma, and did not move his left side or open his eyes again.

Forty-eight hours of life support later, we made the decision to honor Dad’s wishes, met with the attending physician, and the staff quietly disconnected all the equipment and moved him into a private ‘hospice’ room. It was a version of hospice, an interpretation of hospice, maybe an American one, maybe the ideological one of the religious organization that owned this particular hospital. Whichever, it was one that I personally found short on compassion, both for the patient and for the family. I’m grateful that it was only 6 hours, and not 6 days, or 6 weeks or months. Dad hated doctors and hospitals, not being in charge and maybe me for making him go through all of that.

I have spent years working in and around ICU’s, and have seen the spectrum of death from premature babies to centenarians. I’ve learned that death is a natural part of life, especially when it comes towards the end of our natural lifespan.

I’ve seen families both come together, and come apart, over the questions of what to do, of what is “best”?  The acute care environment does much to wear us down, and does little to ease our pain. It is absolutely not the time or place to be making important decisions concerning our parents.

None of us should want to put our families through that.

So everyone should have a Living Will to spell out how we want to be treated, when the time comes, to spare our families from that way-too-tough decision. Contrary to what some conspiracy theorists out there might think, a Living Will is not an automatic way to “move up on the organ donor list”.

What it can be is a set of clear instructions, your detailed wishes, that is to be used “when the time comes” to both save your loved ones from an incredibly difficult decision, and ensure that whatever is done is done according to what you prefer.

While not required, I recommend that when working on a Living Will, find a friend, or a friend of a friend, with ICU experience, or ask to talk to someone who works in an intensive care environment. If possible, take the person who you want to be your health care surrogate, the one who can legally speak for you when you cannot speak for yourself. I believe that this is important because much of what we do when saving lives has the same label, the same name, the same connotation whether it’s used short-term or long-term. Someone with direct experience can both answer your questions and ask those questions that you don’t know to ask. In this area in particular, the devil is in the details. I’ve seen fights erupt in waiting rooms over interpretations of instructions that were too vague.

One question I asked my father when preparing his Living Will had to do with life support measures. His original request was for “no extraordinary measures” to be taken. After I explained that what he may consider ‘extraordinary’ was actually commonplace in modern emergency rooms, we got down to nuts and bolts.

“No CPR or life support” meant “No life support if I have no chance of waking up”.

Gee, there’s almost always a ‘chance’. We needed more detail. If he were to choke on his grits at breakfast, was CPR okay? Yes. If endo-tracheal  intubation could remove what he was choking on, was that okay? Yes. If he had a major heart attack or stroke, then initial life support was okay, but if he lingered without meaningful chance of waking or resuming independent activity, he wanted it stopped. He also said he didn’t want tube feedings to keep him alive. And he didn’t want to be shocked more than once with a defibrillator. I blame TV for that one. Yes, I’ve seen many hearts start beating again after the third or fourth course of defibrillation.

But it’s his choice, for his body.  That’s what we honored, hard as it was. I believe that everyone has that right and deserves that respect.

And hard as it was, it was a walk in the park compared to what we five siblings would have had to go through if not for Dad’s written instructions to us and the hospital care team, if not for the foresight of  his Living Will.

Do your family, and yourself, a truly priceless favor. Get a Living Will.

Government Oversight: Job Killer or Life Saver?

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The news today of an unsafely compounded drug caught my eye, and not just because of the 5 dead (and counting). I apologize, up front, to you and your families, because I’m going to use this in a distinctly a-personal way. While I may say that my intentions are good, you know what they say about intentions and the road to hell…

What caught my eye in this story was ‘compounded drugs’ and ‘lack of oversight’.

Some years ago I worked with a number of compounding pharmacists.  Compounding, for those who may not know, is the art and science of mixing medications for specific use.

Remember, the Rx we see on prescription pads is short for recipe. I have seen pharmacists create compounds, using recipes the same way they would if making a Brunswick stew for the first time on the back counters of their store, compounds that generated dramatic improvement in ailing people when the medication wasn’t available commercially, or when they didn’t respond or couldn’t take those medications that were available.

Drug companies only make drugs as long as they are profitable, and much of that depends on whether they can be made generically or not. Most older drugs are the ones that can be made generically, and hence the ones that are most likely to be discontinued, in favor of newer, much more expensive drugs by profit oriented corporations.  Newer isn’t always better though.

Some folks are also allergic to the bases (liquids and powders) that are commonly used in medications. A compounding pharmacist can often make the same medicine in a different base to meet the needs of the sensitive and allergic.

From experience, I know that most compounding pharmacists have both an inclination towards the hands-on type of apothecary who has a broad range of knowledge and options to meet your health needs, but also the need of additional revenue streams.  Your hometown pharmacist got pinched by the big box stores just like the rest of small town America did, and compounding became an easy way to differentiate and add to the bottom line.

Which brings us to the oversight part of the equation.

It’s one thing to use a recipe and mix a salve of bismuth and iodine and vitamin E for use on a bedsore that won’t heal; it’s one thing to make hypoallergenic pills that do not contain cornstarch. It’s quite another to mix liquids for injection or intravenous use.

The quick answer is, because it’s way too easy for a lethal dose of bacteria (or fungus, or virus) to contaminate the preparation. And when bacteria or fungus or virus gets a straight shot into the bloodstream the body tends to get what locals around here would call ‘low sick’. Professionals call it sepsis. People who get low sick tend not to walk away from it.

Hospitals are required, as in regulation, to have strict medication preparation protocols and procedures that are designed to make safe the meds that go through our IV’s and into our muscles or spinal cords or lungs. These are not stuffy, unnecessary, job killing regulations (actually they create jobs)… they are based on recognized, best safe practices that minimize the chances for contamination and life taking infection. Take it from one who has spent years in hospitals: few would survive a hospitalization if not for regulations such as these.

Retail pharmacies aren’t governed by those rules, primarily because there was no anticipation that a retail pharmacy would ever be mixing medications for injection or intra-venous use. The FDA is now trying to assert some control in the area and is receiving push back from both the industry and conservatives, who say the FDA has no jurisdiction in the matter.  The fact that the Food and Drug Administration can have no jurisdiction over a demonstrably lethal drug that is manufactured and sold in America is a testament to those who, so far unable to repeal, have successfully worked to marginalize the efforts of the FDA.

Our hometown pharmacist, from the comfort of his backroom desk, amidst the clutter of  dusty boxes holding merchandise yet to make the shelf, the same desk where he has his lunch most days and goes through his bills after closing, the well-worn desk that is also his compounding bench, his kitchen, his laboratory for creating that-which-can’t-be-found-elsewhere, the very bench where he’d compound whatever you needed, even if it was meant to be shot into your spine or mainlined into your heart.

Most people are going to cringe at that thought, and I believe that they should.

Like I said, it caught my eye because it gives us a clear example of one of the questions we need to answer in America today. That question is:

Do we accept  ‘job killing’ government regulation,

 -or-

Do we accept ‘people killing’ free market practices?

… because that is indeed what we’re talking about here. It’s one or the other.

If compounding pharmacies, most of which are independent retail stores, have to put in industry standard laminar flow hoods, and are held to the same standards of safe preparation and monitoring as hospitals are held to with medications for injection or intravenous use, it will surely drive most of them out of the compounding business. It’s a low overhead revenue stream, as soon as you start adding equipment and monitoring procedures you quickly lose profitability. And you know how lawmakers are, it won’t just be the injectables they go after. Many compounded meds are taking the place of a Big Pharma product, and those lobbyists won’t miss the opportunity to shut it all down.

But if the government stands back and does nothing, in the laissez-faire sort of way preferred by those who scream about ‘job killing government regulation’, then more people will die unnecessary, preventable deaths from bad drugs sold by good people, albeit people with only profits in mind.

Like this years presidential election, there’s a distinct difference in choices here.

A number of  years ago I parted ways with a good job in a growing company over my objection to compounding home care IV medications in local pharmacy backrooms without adequate safety measures. In fairness, I should say “without what I was trained to consider to be adequate safety measures.” Individual pharmacists whom I worked with and respected had differing opinions. My belief that their opinions were clouded by dollar signs is beside the point.

At the time, I wasn’t willing to risk my professional ethics and personal morality just to beat a competitor to a market niche. Put yourself in the shoes of the responsible people at the company whose contaminated product has just resulted in five deaths across the country. Mightn’t that bother you… just a bit? Even if it made you rich?

Could you enjoy the wealth knowing that a handful of people died after using your product, one that you knowingly decided to risk a higher chance of impurity for a bigger profit margin? Would it keep you awake at night wondering who might have gotten to walk their daughter down the aisle, or who might have greeted their family’s first grandson into the world, if you had only followed best practice instead of just what’s legal, and not one penny more?

My personal belief is this… one of the stated purposes of our government (Preamble to the Constitution) is to ‘provide for the common defence and promote the general welfare’. Defence is usually assumed to be from a foreign power, but in this case, we the people need defence from industry in order to have any sense of welfare, general or not.

In a capitalistic free market, the watchword is caveat emptor, “let the buyer beware”. There are over 3,000 compounding pharmacies in the USA. Just 162, (not the one implicated in today’s news), meet the standards of the Compounding Pharmacy Accreditation Board, a private agency which establishes quality and safety practices. That means over 2,838 compounding pharmacies that do not: over 2,838 companies that do not meet contemporary quality and safety standards for the compounding of pharmaceutical medications designed for human use, yet they still sell what they make, to us, to use. And we buy it.  Now think about that for a second…

According to the FDA, the medication that resulted in 5 deaths was contaminated with a fungus. Over 17,000 doses were shipped to 23 states. (and some argue that health care doesn’t qualify as interstate commerce!) Nor is this the first time compounded medications have caused deaths across the country. Alabama and South Carolina have both lost citizens to bungled compounded medications.

Companies have shown that when it comes to protecting the public or the environment, they use actuarial formulas to derive cost benefit ratios. Whether it is cars with gas tanks that tend to explode or a drug that causes more than it’s share of heart attacks and strokes, they know the product liability cost if 5 people die, or 50, or 500, or 5000. Only when the cost to them, not to those who died or the cost to those families, but only when the cost to them exceeds their profits will they consider other alternatives. In short, our lives are their acceptable losses. They do not self-police, they do not self-restrict in matters of public safety. It’s not that they don’t do the “right” thing, but that they define “right” in terms of most profitable.

Which is why, when it comes to food, water, drugs, and a multitude of other items deemed necessary for life today, we as a society have said that we need protection of life and limb from those who would profit at any cost.

It is, after all, one of the defining purposes of our government. We should not let sloganeers change that.

Legitimate Rape, Domestic (in)Equality and Why…

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I am continually surprised at how some elected individuals are willing to insult almost half of the voting population. I’m not weighing in on whether there is a “War on Women” by the conservative party, I’m looking into ‘why’ there is such a concerted effort to turn back the clock when it comes to women. It either shows how little respect they have for women, or how much they are beholden to the religious right, or how low they’ll go to keep the white, redneck voter.

First, I don’t for a minute believe that (most) republicans don’t have respect for the women in their lives. Easily half of the republicans I have known have been women.

Women who believe in equal rights, fair pay, and equal protection under the law for the fairer sex. I’ve known both sides of the GOP base, the wealthy and educated, and the low to middle-income, hard-working “we-don’t-need-no-education” side. They are all, as with people everywhere, (mostly) good people, and I’d say that less than a quarter of their men slap them around these days. Forty years ago that number was much higher.

Now granted, while recent republican actions show a great dis-respect for women as… a group, or a concept, they don’t really carry it over to their own wives and daughters. See Dick Cheney on same-sex marriage. Or see the ‘blue collar patriot’ guy whose wife works as a nursing aide in a catholic hospital and has to pay cash for her migraine medicine, which, because it can also be used as birth control, the insurance doesn’t have to cover.

“Legitimate Rape…”

I know this quote was shocking to many. I’m not shocked at all. I know lots of Lindsey Graham’s angry white guys who think that date rape isn’t rape at all, and moreover they think it unfair and highly prejudicial to hold them responsible for using Rohypnol (roofies) or alcohol to incapacitate a girl before using her. Seriously. Here in America in 2012.

You know them too, they are the ones who cheer at the thought of letting an uninsured accident victim die by the side of the road. They are the ones who boo the Marine who fought three tours in Afghanistan and Iraq, but is also gay. Or especially if lesbian.

So Todd Akin’s comment stems from his threatened republican male psyche, reeling from the social progress of the sixties and seventies, resenting the changes in societal norms, yearning for the good ol’ days of the ‘50’s when men were men and women did what they were told and then kept their mouths shut about it. Akin’s type, bolstered by hate trumpeter Rush Limbaugh, is sure of the notion that “feminazi’s” are now taking our jobs and then taking advantage of us by crying rape after the fact, when it really isn’t rape at all (well, from the rapists point of view, anyway).

And that BS about doctors telling him that the female body “has a way of shutting down a pregnancy from rape” (if legitimate, wink-wink)… that’s just the continuation of the abortion fight. After all, there’s no need for abortion in case of rape if there’s no pregnancy that can result. Facts are beside the point.

Combine the two in a public speaker, the GOP and the Religious Right mentality, and you get quotes from Todd Akin, Pat Robertson, Michelle Bachman, Mitt Romney, Rick Perry, Rick Santorum ad infinitum, that make absolutely no sense at all in a modern age. Here’s one that both fits and makes a nice segue:

“I know this is painful for the ladies to hear, but if you get married, you have accepted the headship of a man, your husband. Christ is the head of the household and the husband is the head of the wife, and that’s the way it is, period.” –Pat Robertson

Domestic equality…

This is not meant to be a comprehensive list, but among other things this year (not jobs), the republicans in Congress have:

– failed to renew the Violence against Women act;
– vowed to repeal the Ledbetter Fair Pay for Women Act;
– introduced more bills designed to limit a woman’s choice over her body than any other Congress in history;
– attacked Planned Parenthood because low-income women are the main users.

This years Republican Party platform calls for the end of the Federal Student Loan program. The fact that women now outnumber men going to college might just be coincidence.

But I don’t think so.

Why pick on girls? See the Pat Robertson quote above. There are others.

But I am a male, so these things aren’t about me. Yeah, right.
I’m a father, and I have daughters. So these things really set me off.

Call me crazy, but I think my daughters should have the same rights as my sons; the same opportunities, the same consideration before the law, the same protections in society and the workplace.

Know what? Dick Chaney does too. Todd Akin does too.

Pat Robertson… not so much.

It didn’t happen for my mother’s generation, and even between siblings in my family there are big differences in the gender opportunities and access that were available to us during and after high school.

But our kids deserve better. Our parents believed that, and we got better than they had. We believed that, and our children got better than we did.

Now that our children are adults, they need to believe it as well. The clocks should run forward, not back.

The Religious Right

In the late 1970’s, a Christian based political movement gained momentum and even ran candidates for President. Their goal was to transform our government into one that ran on the principles of the Christian interpretation of the Bible.

Around the same time, the GOP picked up most of the southern white males (and by default, their women and subsequent generations) who couldn’t stomach the thought that blacks had equal rights, and they blamed the Democrats for giving them away.

“But here’s the thing about rights-they’re not actually supposed to be voted on. That’s why they’re called rights.” — Rachel Maddow

That also means that rights can’t be ‘given’ away, only recognized. Now think about that for second…

Anyway, when the Moral Majority couldn’t get elected by the majority of the people, they threw in with the GOP, in a grand bargain to reshape America in their own image. They wanted Roe v. Wade gone. They wanted mandatory prayer back in the schoolroom, the Ten Commandments back in the courtroom and the Bible in our bedroom. The GOP had the political organization to make it happen.

The GOP wanted, as always, breaks for the corporate and wealthy, mostly in the way of deregulating governmental oversight of business practices. The kind of business practices that used sweatshops and child labor. The kind of business practices that caused Love Canal, and the BP oil spill. Business hates regulations, because safety, ours and that of their employees, cuts into profits. It’s not personal or anything. It’s just capitalism.

The GOP’s problem had been there were not enough voting American’s that benefited from perks to the wealthy and corporate. They needed votes, and Moral Majority ones would be just fine. Or so it seemed at the time.

Since the normal democratic process wasn’t working for them, they would attack through the back door. The fact that the majority of Americans didn’t want what they were peddling was of no consequence, because they believe they know what’s best for all of us.

The key for both was to fight a progressive Congress by stacking the judicial system with religious conservative minded judges who would rule in their favor against ‘liberal’ laws.

The key was to get a President elected who could appoint Supreme Court Justices that would decide for conservative and religious causes, and last for years after that President was gone.

Then they both started screaming about ‘left wing activist judges’ who were turning America into a godless, socialist State.

Dominionism

There’s a word that describes what the Religious Right is trying to do: Dominionism. No, it’s not trying to be like Canada. If only…

It’s trying to change our government, from the inside, to one that governs according to Biblical concepts. Think Sharia law (laws and justice based on Muslim holy scriptures), only with Evangelical Christians for Imam’s and Ayatollahs, and with the Bible instead of the Quran.

Both call for stoning people to death in a number of rather minor instances.

I’m all for living by Christian values, a quick read through this blog reveals that I believe in feeding the hungry, and in charity for the poor, and in helping those in need.

But then there’s this:

“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.”

That’s the First Amendment to the Constitution, the first of what is known as the Bill of Rights. Our rights.

Which makes Dominionism more than un-Constitutional. It’s anti-Constitution.

Which makes it anti-America… so I’m 100% against it.

Here’s a little bit why…

The Pilgrims (1620) came here to get away from state enforced religion.

Protestants under Roger Williams (1636) did too.

As did most of the Irish. We were taught in school that it was the potato famine (1840) that brought them to America. They didn’t tell us that the ‘famine’ only affected the catholic Irish, or that most of the food grown in Ireland during the famine was shipped to England, by the Protestant government, intentionally, in an effort to literally starve more catholics to death, in the name of both God and Country. Today we’d call that genocide.

It was State religion, in this case Anglicanism, which drove our ancestors here to found a better place.

The Founding Fathers were open in their expressions of their individual faith, and clear in their intention that religion has no place in the governing of a free people.

The Constitution is clear that we are free to worship as we please, and that there will be no State religion to say otherwise.

The concerted efforts by the GOP to pass legislation and use judicial activism to press their religious views on the rest of America crosses that line between individual religious freedom and State enforced religion. Their actions are, at their core, un-American.

Joseph McCarthy never found the Red threat he thought was trying to take down our American system of government from the inside. I say he was just forty years early and looking for the wrong Reds.

The Point

In America, we are free to go (or not) to the Church of our choice, even one that uses an interpretation of the Bible of it’s choice, or even no Bible at all.

In America, we are free to proselytize, preach, give testimony, or witness to anyone who will listen.

But in America, we are not free to force others to listen, to make others go to our church, to make others say the Lord’s Prayer our way, to tell others who they can’t marry, or to make others also keep their women down.

Those that champion laws that enforce religious belief are free to live here as they believe, yet they would force our compliance with laws when we do not share their belief.

They are even free to make laws making the rest of us live their way. Even bad laws can and have been passed. But they should not stand. The First Amendment is quite clear and the Constitution is the Supreme Law of the Land.

We have a judicial system that is designed to protect the majority from the whims of a minority. As we’ve seen above, that system has been the target of an agenda that has the clear goal of subverting the Constitution in order to make all Americans live their way.

And that’s where the grand bargain falls apart. The “I’m a little bit business, I’m a little bit evangelical” marriage between the GOP and the moral majority hits the wall right here.

You see, the people who make up the wealthy and corporate GOP base are Catholics and Methodists and Agnostics and Presbyterians and Mormons and Lutherans and Jews and various flavors of Baptist and Christian other than Evangelical. They could tolerate the fringe ideas as long as they were walking down the same path to mutual power. But now that they’ve come to the ultimate fork in the road, taking the step to Dominionism leaves them out in the cold with the rest of us masses.

And you know how much the wealthy and corporate hate being mingled with us masses.

Some of the uncharacteristic dysfunction we see this year from the GOP is, in my mind, a result of the growing divide between the religious right and those traditional conservatives who have begun to realize that they’ve been working against their own interests by helping those who, in the name of God, want to infringe on other people’s rights.

Thomas Jefferson said,
“In every country and every age, the priest has been hostile to Liberty.”

…. yes, even that of the wealthy and corporate.

Meanwhile, know whom you vote for, know what they stand for, and vote for those who believe in a diverse and free Country over those who want us all to be the same.

Because there is no freedom in all of us having to be the same.

 

 

 

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