Says Who??

Verstehen, through shared perspectives


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DISCOVERIES ON ANCESTRY.COM

For the past decade, my discoveries through the use of Ancestry.com have delighted, amazed, frustrated and humbled me. I have discovered that Queen Elizabeth is a 6th cousin, 3 or 4 times removed (I have forgotten the exact details). I have also discovered that Clyde Barrow of Bonnie and Clyde fame is also a remote cousin of similar connection. And those are neither the best nor the worst of it. The humbling part is that I can accept neither one nor the other without accepting both. My heritage contains heroes and villains, rich and poor, peasants and royalty, geniuses and the learning disabled—in other words, some of everything. But today I am most concerned to focus on a family relationship that I cherish equally with the members of my most immediate family.

Like thousands of others, I sent my DNA sample to Ancestry to learn more about family connections. I grew up in New York State, far from the southern families of my maternal and paternal heritage. I waited far too long to question the few family members I did meet, to learn much about my family history. I therefore set out to learn what the combination of DNA and recorded history could tell me. Thanks to Ancestry, there were also professional genealogists to help when I needed them. I soon learned more than I could have hoped.

Looking at the big picture, I found confirmation in the results of the Human Genome Project that supports Anthropology’s claims that there are more differences within the so-called “racial groups” than there are between them; that human ancestry can be traced back to its origins in East Africa, where we became human. This, by the way, does not in the least challenge my equally strong understanding of a Creator of the Universe and all that is in it, who also gifted everything in the universe with a portion of Himself, finally giving the first humans a portion of His spirit. The Bible tells us that the Creator longs for restoration with the portion of His spirit that is within us, explaining also our longing for Him.

But I digress. My point is that our earliest ancestors lived in Africa. Probably East Africa. When I visited Uganda a few times while living in South Africa, I heard over and over how its inhabitants believed Uganda to have been the Garden of Eden. Their proof is the amazing fertility of the ground in Uganda, such that I also heard that “our children may be naked, but they are never hungry!” Fruits and other growing foods are plentiful in Uganda, almost seeming to grow wild. Today, that is an unusual claim for any part of Africa. The Garden of Eden claim may just be local lore, but it brings home what has become a scientific claim: We human beings are all descended from the same family, and that family lived in Africa, and they were therefore black. And, I might add, they were also beautiful, and perfect. The Creator said so.

That is the big picture. Let’s focus in now on my personal ancestry, keeping the big picture firmly in mind.

After I sent in my DNA sample, an avalanche of names of new relatives hit my inbox on a regular basis that continues to this day. Some connections were easier to make than others, but one particular type of connection brought home to me the importance of remembering the truths of history. Names began appearing on the list that belonged to present-day African Americans. While my mtDNA history did not place any immediate ancestry in Africa, it definitely connected American African people to me. Our combined histories confirmed the stories of the past, where African women enslaved to the owners of southern plantations were frequently impregnated by those same owners and/or their adult male relatives. The resulting children were not acknowledged by these same men, and they were raised as slaves. If they survived to have children, the children of those children are alive today and are my cousins. If I had been alive during the era of slavery, they would have been my sisters and brothers.

So I cannot say that I had nothing to do with slavery, because still today it affects members of my own family. My ancestors and their families owned southern plantations, and owned slaves. Some of them fathered children by those slaves. I am definitely not alone in this reality. It happened everywhere.

So it follows that if I quietly accept the institutional racism of my country, and the economic injustice that has grown out of it, I am guilty of denying the blood of my blood–the children of my own forefathers–the justice I would seek for myself or my own brother. And if that doesn’t bring the reality of the brotherhood of mankind, who are children of the same Creator, into focus…well then, we are deliberately blind and fully deserve the consequences that will be visited upon us.

 Or, we could accept our responsibility for failing to stop and reverse the sins of the past, and work for the equality—social, economic and legal—of all who share this nation with us, until we are able to join those in the world about us who have understood that our fate as a human family depends on our combined efforts to honor and care for this planet and those who share it with us.

It may not be too late.

photo of four persons uniting hands

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“I SEE YOU”

 

Although I returned to the USA twenty-three years ago, my experiences and relationships in South Africa are still very much an important part of who I am now. The Apartheid regime that governed the country was still in operation when I arrived there in January of 1989, and the signs of its potential demise were only simmering underneath the appearance of Afrikaner control. The changes came about quickly, however, and Nelson Mandela was installed as the first African President of South Africa in 1994. I recall the day of his election vividly, as I sat glued to my TV watching scenes of Africans and Europeans (mostly Afrikaner and British) standing in long lines together–Africans patiently awaiting their very first opportunity to vote in their own nation of origin. The awe in the announcer’s quiet voice was obvious, as he stated “Today, PEACE broke out in South Africa.” Like our own nation, however, the peace was not a permanent characteristic. But it was a dramatic beginning.

I felt concern for my country only days after getting home just before Christmas in 1995. Had it only been seven years since I left? This does not seem to be the same country where I used to live. In fact, I noticed many unsettling events that reminded me very much of Apartheid South Africa. How I hate to report that over the next 23 years those similarities would grow in number and severity. I cannot escape the knowledge that while the histories of the two nations are widely different, the root causes of their worst similarities are exactly the same: (1) Blatant, deep racism; (2) A belief that God chose white, male property owners as the elite of the earth; and (3) Greed, for both wealth and power.

Granted, these false beliefs and the self-serving actions that accompany them are not unique to our two nations, nor to the four-century long histories they possess. They are not even universal in either country. But they are as old as time, for as primitives we humans feared others who were different from ourselves and believed in strengthening ourselves (in many ways, such as land, weapons, etc.) for the purpose of protection from the outsider. Along the way, fortunately for civilization, some groups began to understand that human beings were all one race, and our different languages, appearances, lifestyles and mores were mere expressions of the many possible ways of being human.

The Zulu, for example, use the word Sawubona as a greeting. I was told that the word was translated as “I see you,” but the Zulu explained to me that there was a deeper meaning: “I see you, and I recognize that you are a human being just as I am.” Now, I have unashamedly used this example as being evidence that the Zulu (and many, many Africans like them) had a precious understanding of what it means to be human in a human world. Which is true, and this particular greeting was used when I was greeted by many Zulus, and I saw and heard it used to many others who were not Zulu or African at all.

But like all good values and habits, there is a downside. What if the “other” is a stranger, or a member of a tribe with which my group is not in good standing? What if they belong to a group of oppressors, who have colonized my country and taken over its resources and governance, and killed my people? What if they just look and sound different, and I am afraid of them?

We humans are not completely civilized. Our primitive fears of the stranger, or the other, lurk in our subconscious. They arise fully established when we feel threatened. But if we are to accomplish our own growth as human beings, we still must look at any other human being and deliberately state with all the empathy and honesty we can muster: “I see you, and I recognize that you are a human being just as I am.”

Just as I am. Made from the energy and stardust of the universe, and imbued with the Spirit of our Creator, to grow out of our primitive fears and beliefs, protect the planet we all depend upon for our lives, and work towards peace with those other humans. To look people in the eye and see that Spirit within them and know that born in their place and time, we would be no different. To make sure that we do not take more from the earth than can be renewed, and that we stop fouling our own homelands to the detriment of its inhabitants. To remember that we all descend from the same roots in Eastern Africa millions of years ago, and underneath our differences we are the same human family. To build, instead of tearing down. To share, instead of hoarding. To speak with civility and respect to all, and receive the same treatment. To be thankful for our home planet, our neighbors and families, and our own lives. To nevertheless welcome the stranger, protect and care for widows and orphans, and work to empower others to become what they were meant to be, rather than punishing them and destroying any chance they might have to be a productive human person.

In other words, to REALLY look at the people we come in contact with, and to be present to them. To show respect, and eschew arrogance, as well as ignorance. To grow into a civilized world, respecting the lives and rights of all and whenever possible, to help others to do the same. To be worthy of the category HUMAN.


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I ALMOST WISHED I HAD DIED

lighthouse in storm

One of the major adjustments I have had to make as a retired Sociology professor is no longer having a captive audience for my carefully considered observations of American society: The problems and the joys. I do love writing this blog, which does not require the same degree of objectivity, but let’s face it. I am no Dan Rather (whose daily contributions to Facebook I look forward to reading). Thanks to social media, I am but one tiny voice buried in the cloud of articles hourly produced by everyone with a computer, cell phone or camcorder and an opinion to share. So, to be perfectly clear, I am writing today not to be read, or “heard,” or even to keep in touch with the world. I write today because I must. For me.

I do my best thinking when I write. This blog is for me, but if you want to read it, challenge it, agree with it, or ignore it…just feel free. But do not think that I am trying to take on the world. I no longer have that kind of energy. I just want to try to get all that I have internalized about our social environment outside of my head and heart. I am in sensory overload from being bombarded with angry, hurting, hating, yelling, profane, lying, manipulative messages from the world outside my apartment.

As I write this, I have received 13 emails already that are unsolicited ads for things I don’t want, don’t need, or don’t agree with. I am a registered Independent, so both Republicans and Democrats feel free to email and/or call me with requests for financial and electoral support. I am so very grateful for those quiet, caring people who are all around me when I turn off the tv, the computer and the radio and get out and share time with them. I don’t answer the phone if I don’t recognize who is calling, and I don’t open any mail not from family or friends (or bills I know I owe). When it all gets to be too much, I listen to my classical piano CDs, or drive down to the river and just sit in the quiet, now cool afternoon and breathe fresh air.

Many of my friends no longer really want to talk about politics. Life is so full and rich, relationships thrive and laughter once again seems normal, when I am with my neighbors and friends. So long as we don’t talk about politics.

Yes, there are pressing issues that must be addressed, must be advocated for. Babies in cages. Chronic pain patients losing their pain medications, physicians and pharmacists being threatened. Members of all three groups committing suicide at ever higher rates. Private prisons being filled with drug users who could become productive citizens again with the right treatment, but whose prison terms will leave them right back where they began and worse. Families, communities and organizations being divided by political differences. More problems than any one person or organization can possibly resolve. More finances needed to be directed toward rebuilding communities devastated by nature. It seems overwhelming. I can’t address all the things I am deeply concerned about, and I feel frustrated and guilty for neglecting the ones I can’t get to.

Yet deep in my soul there is a calm, quiet place in the midst of this storm. A place where I know that all is not lost. That there are wonderful people in my world, and in the greater world in general. People who value honesty, integrity, caring, and excellence, the beauty of the gift of our natural world, and the shared intimacy with a loved one in a monogamous relationship. People who know that we cannot be truly human without being part of a community that works, plays, and worships together. People who accept me as I am, and who are in turn accepted by me as they are.

That is the beauty I see in my world, and it is more important to me and to my well-being than money or status. Because I live in a community where this beauty shines brighter than all the noise of the media and the political world, I regain my will to live on a daily basis. Once again, I can accept that I can only fight these battles on one front at a time, and trust that others will work where they are best suited to deal with other battles.

God did not bring us this far to abandon us. Today, I was tempted to say that I wished I had died five years ago, when undertreated chronic pain had brought me so near to that end. Then, I would not have had to see the devastation being brought about in my country. But I cannot wish that. These five years have been a great gift, and I have gotten to meet and work with people whose willingness to make a difference…no, not just willingness. Determination. Whose determination to make a difference to those who are being marginalized, stigmatized, pushed aside and left to die is greater than any I have seen in this country in my nearly 78 years. Policies we have lost by reversal in the last two years cannot compare to what we are gaining in finding the deepest good within ourselves and our families, friends and neighbors. In our communities and states. Soon, hopefully, in our nation once again.

Yes, it is hard and frustrating. But we come from good stock from all over the world. Our ancestors knew worse times and better times than these, but they persevered. We know that, because we are here. The way ahead is in our DNA: not in specifics, but in inner strength and outer relationships.

I am so glad I lived to see it begin.


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AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

UPDATE 12/5/17:  A revised (shorter)version of this blog has been posted in KevinMD, at the following location.  Thanks, KevinMD!

https://www.kevinmd.com/blog/2017/12/stop-opioid-crisis-war-physicians-must-end.html

 

 

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


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REFLECTIONS ON THE EFFICACY OF OPIOID PAIN RELIEF OVER TIME

pain photoBefore addressing the issues of this article, I will need to explain the position from which I write. At the present time I am a 76-year old, semi-retired sociologist and former nurse. As a sociologist, it was natural for me to include the sociology of medicine as one of my major interests. As a nurse, I worked for three years in the county jail nurse’s office, several years in the emergency room, and for six years as a hospital corpsman in the navy reserve.

I was introduced to the whole drug scene while working in the jail, where it was my job to treat substance abusers who were addicted to paint, glue, alcohol, and various drugs. This was in the very early ‘80s, and the majority of the street drugs were amphetamines, Quaaludes, heroin, and marijuana. It was necessary to control withdrawal symptoms from the time the inmates were booked, to keep them alive long enough to go to court, serve whatever time they were given, and be released back into the same environment with virtually no change in their lives except those imposed on felons. The recidivism rate was extremely high—more so than for any other offense. During the time I worked there, the fastest turn-around rate for a released prisoner being picked up drunk and brought back in to Booking was 30 minutes.

Of course, in the ER and even in the Navy reserve I saw evidence of substance abuse. As a corpsman I was also involved with both diagnosis and treatment. The most heartbreaking experiences, however, occurred while I was working at a private college in Appalachia from 1997-2013. I saw firsthand the growth of the OxyContin and heroin epidemic that Sam Quinones documents in Dreamland, followed by Meth and various other prescription drugs, soon followed by the amoral pill mills that so delighted students who were already dependent or in early stages of addiction. At their age, they were the most vulnerable to the brain disorder of addiction, and the main targets of the dealers who would actually supply their first pills free, to encourage a new customer. I saw so many beautiful, bright students succumb to the promise of a pill that would make their life better, more fun, or at least easier. I was able to help some, but not all, by far. They needed experienced and trained medical attention, and I was no longer in that field. I came to despise the very thought of drugs, dealers, and pill mill “doctors”.

But there is another side to my story. In 1968 I suffered the first experience of a bulging spinal disc. Within 3 years I was diagnosed with degenerative disc disease, and with osteoarthritis of the spine, hands, feet, shoulders and hips. By 2013, there was no part of my spine that was not affected; I had major stenosis at various levels, bone spurs, episodes of bulging and decayed discs, a vertebra that had decayed discs on both sides and was standing on edge, resulting in a spinal S-curve from my waist to the upper thoracic region. Unrelenting pain caused muscle spasms in my entire back and neck, adding to the pain. A meningioma would soon be discovered attached to my spinal cord at T3-4; it is benign—the only worry being that it will grow.

During those 45 years living with pain, I never had any medication stronger than NSAIDS. Like many patients, I could not tolerate narcotics or opioids. I had to learn meditation and “mind control” (pushing the awareness of pain to another part of my consciousness). I had a great deal of physical therapy. I played the piano and organ for distraction, until I could not. I walked from 1-3 miles every day, and I worked full time as a nurse, then as a college professor, usually working between 40-60 hours a week. I spent seven years in South Africa in the middle of a revolution. The more I could distract myself with external demands, the longer I could function. Again, until I could not.

In 2014, so disabled by pain I could neither work nor sufficiently care for myself, I was sent to a pain management specialist in Louisville, KY. After I was finally convinced that he was a legitimate pain specialist who would not try to get me addicted, we were able to work together very well. I learned to trust his judgement, and to follow his lead in determining my treatment.   As a result, I have been able to teach at a local university part time for the last two years, and it has been a year since I have had pain greater than 5 on the 0-10 scale. One of the reasons that the pain has not been greater, and has not persisted, is that when it gets to that point I take hydrocodone, at its very lowest dose. My pain doctor realized that I am able to tolerate very low doses of medications for other problems (many of which were caused or exacerbated by long-term use of NSAIDS), so we tried the opiate. The complete pain relief has been astounding to me. I have never before had medication do more than take the edge off the pain. Equally important, my need for the opiate is becoming less and less frequent. My chronic anxiety levels have dropped considerably, and that also is a source of pain relief.

Which brings me, finally, to the point of this article. I hope I have sufficiently established the experience and credentials that give me the foundation for writing it. I must write it, because for too long I have been reading articles by people who have based their judgement about the dangers and/or efficacy of opiate treatment for pain on short-term, inadequate research. In A World of Hurt, by Barry Meier, he quotes Dr. Jayne Ballantyne as saying that her studies, and those of others, show that after a short term of therapy, there is little to no efficacy (5% of patients) of opiates for pain. I have seen and heard these figures often; yet pain management physicians also have records of people who have been carefully managed on opiates and other pain relieving measures for at least twenty years, who are functioning without severe pain. None of these studies satisfy me that they meet the natural science or sociological requirements of longitudinal studies. The former studies fall far short of twenty years, and the latter are a matter of record but no sufficiently rigorous scientific research has been done to establish credibility.

Additionally, our understanding of the prevalence and range of chronic pain issues, and the new brain studies that have completely revised our knowledge of addiction, have rendered those studies irrelevant. But the continued widespread references to them has created a situation that is clearly morally and ethically bankrupt: Patients with persistent, severe pain—including, in many states, terminal cancer patients—are being deliberately, systematically deprived of relief and therefore from the ability to lead potentially productive lives, or at least to spend their final days in peace, without pain. This, while other substances that are addictive are legal and can be consumed by any adult, regardless of their risk factors for addiction, whether or not there is a “need” for the substance.

What would make opiate efficacy studies reliable and verifiable? First, to acknowledge that all pain patients are unique in their tolerance to pain, their response to pain, and their response to treatment. Not everyone can metabolize medications the same way. Not everyone responds equally to physical therapy, or to psychological counselling. Not everyone has the personality to effectively meditate, or to suppress awareness of moderate pain. But all of these treatments, as well as known risk factors, are variables that must be accounted for if you are judging the efficacy of pain treatment.

Then there is the issue of the selection of participants. When I read the studies done in past years, I found they were limited to a single practice, or a hospital, or other small group of patients with no concern for variables like age, risk factors, history of abuse, previous treatment and other illnesses. The participants were not chosen scientifically in order to be representative, so results are inevitably skewed. I am reminded of early anthropological ethnographic studies where small, isolated villages were researched, then the results extrapolated to all such groups: “from the particular to the general”. We now realize that you can’t do this and arrive at accurate conclusions. Yet, on the basis of these flawed opiate efficacy studies, people’s lives are being damaged, their families are suffering needlessly, and many patients who are cut off from their medication either take to street drugs with the risk of overdose, or just commit suicide in the first place.

We do need more research about the safety and efficacy of drugs. But it must be longitudinal and scientifically designed and the results assessed to be reliable and verifiable. We also need politicians to stop enacting laws and policies based on moral definitions of issues, which we can never come to consensus about, and work on the actual economic and environmental issues that they can actually improve.

Addiction is a disease, not a moral issue. Pain is a disease, not a moral issue. And we are not speaking of just a few people affected by the neglect resulting from ill-informed laws and regulations designed more to punish the innocent along with the guilty rather than to end the War on Drugs. We speak of hundreds of thousands, even millions of sufferers. When properly identified as scientific (medical) problems instead of moral issues, we can see the potential to improve conditions. People could be adding to the economy, rather than being forced to either live off of it, or to live in poverty while their pain continues to worsen.

Big Pharma—for example, Purdue Pharma– are far from innocent in this War. Additionally, the FDA is no longer as concerned with protecting potential patients as they are in protecting corporate rights to profit; witness the countless lawsuits for drugs improperly researched, improperly advertised, and improperly presented to physicians who must rely on that information in order to prescribe successfully. And the DEA is still, regardless of evidence that they are often destroying the lives of the innocent while failing to halt the spread of illegal drugs, using pain patients and their physicians as cannon fodder in their failed war on drugs.

A significant paradigm shift is required here. Educationally, culturally, legally and morally we must illuminate the darkness of our willful ignorance about the suffering of the innocent who have become scapegoats in the failed War on Drugs due to tunnel vision about the relationships between drugs, physicians, and pain; a tunnel vision that cannot see the greed and political will that perpetuates the drug problem. Every institution of our society has failed our physicians and their patients who are in pain, or addicted. Those institutions have either failed to adjust a false worldview that blames patients for their illnesses, or have just failed to assume responsibility for their role in finding solutions to the need for a collaborative approach to these widespread diseases, and to the devastation that has resulted from long term beliefs that they are moral issues that must be punished.

For over a century, that approach has not worked. And as the saying goes, insanity is defined as continuing to do the same thing over and over again (or doing even more of it), expecting different results. From family, to education, to religion, culture, economics and government we need a major overhaul of outdated and inaccurate beliefs, and development of procedures that decriminalize the treatment of chronic pain and addiction, as well as the afflictions themselves. Medical decisions need to be made by medical experts and their appropriate medical agencies, and the Criminal Justice system could concentrate on ridding our nation of illegal drugs by putting the same time and effort into stopping the dealers who daily increase the supply of drugs available on our streets. We might even look to the successes of other countries, and determine if their methods are importable.

I cannot bear the thought of more bright and beautiful college students ruining or ending their lives before they have even begun. The data suggests that it is not stopping with college students, but that high school and even middle school students are being targeted as “customers” of the illegal drug trade. I also cannot live with the knowledge that caring and dedicated physicians, who have spent nearly half of an average 70 year lifetime studying and working for the privilege of becoming practicing physicians, have lost everything they have worked for because they have tried to help their patients. (I am quite ok with pill mill “doctors” being brought to justice for their crimes, however!)

It is Christmas Eve as I write this. A time of hope, a time of expectation that the promises of life can be fulfilled. I am a sociologist because I believe in the amazing capability of human beings to solve the problems of life, separately and together. I am also all too well aware of our capability to create and maintain cultural and social institutions and structures that protect certain groups of humans at the expense of huge numbers of their fellow humans. I believe that most of us are better than this; that we can do better, and that bit by bit we can learn to adapt to change, to each other, and to the requirements of living in our world safely, together.

Please—let’s make 2017 the year we begin to deal with chronic pain and addiction as the disease processes they are, and begin to structure our corporate life accordingly, so that together we can end the war on drugs, and on patients and their physicians, and restore the rationality of the Enlightenment without killing the compassion of empathy.

enlifghtened being

RESOURCES: Books & Peer Reviewed Articles

Alexander, Michelle. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. 2012. The New Press, NY

Bateman, Dustin. Neurological & Sociological Aspects of Addiction.

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial. 1996. University of California Press.

Levinthal, Charles F. Messengers of Paradise. Opiates and the Brain. The Struggle Over Pain, Rage, Uncertainty and Addiction.

Meier, Barry. A World of Hurt: Fixing Pain Medicine’s Biggest Mistake. 2013. New York Times Company.

Parsons, Talcott. “Illness and the Role of the Physician: A Sociological Perspective.” American Journal of Orthopsychiatry 24 March 2010. Copyright © 2010, John Wiley and Sons.

Quinones, Sam. Dreamland: The True Tale of America’s Opiate Epidemic. 2015. Bloomsbury Publishing Plc.

Sternheimer, Karen. Connecting Social Problems and Popular Culture:   Why Media is not the Answer.  2nd Ed. 2013. Westview Press, Perseus Books Group.

Webster, Lynn R. The Painful Truth: What Chronic Pain is Really Like and Why it Matters to Each of Us.  2015  Webster Media, LLC.

Hyperlinks to articles on Web:

Addiction is a Brain Disease http://www.attcnetwork.org/explore/priorityareas/science/disease/

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter 

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter 

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….   http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide http://t.co/4vhF63eD6N

References from this article:

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  3. Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. Jun 18 2003;289(23):3161-6. [Medline].
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  6. Middleton JL. Today I’m grieving a physician suicide. Ann Fam Med. May-Jun 2008;6(3):267-9. [Medline].
  7. Noonan D. Doctors who kill themselves. Newsweek. Apr 28 2008;151(17):16. [Medline].
  8. Petersen MR, Burnett CA. The suicide mortality of working physicians and dentists. Occup Med (Lond). Jan 2008;58(1):25-9. [Medline]. [Full Text].
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  12. Gross CP, Mead LA, Ford DE, et al. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. Nov 27 2000;160(21):3209-14. [Medline].
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  14. Myers M. Doctors’ Marriages: A Look at the Problems and Their Solutions. 2nd ed. New York: Springer; 1994.
  15. Charles SC, Frisch PR. Adverse Events, Stress, and Litigation: A Physician’s Guide. New York: Oxford University Press; 2005.
  16. Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. Nov 2011;213(5):657-67. [Medline].
  17. Sessions S. Dr. Ticktin and the Expert Witness Industry. 2005;[Full Text].
  18. Myers M, Gabbard G. The Physician as Patient: A Clinical Handbook for Mental Health Professionals. American Psychiatric Publishing; 2008.
  19. Lehmann C. Aggressive Intervention Urged for Depression in Physicians. Psychiatric News. November 17, 2000.
  20. Miles SH. A piece of my mind. A challenge to licensing boards: the stigma of mental illness. JAMA. Sep 9 1998;280(10):865. [Medline].
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  22. Hendin H, Reynolds C, Fox D, et al. Licensing and Physician Mental Health: Problems and Possibilities. Journal of Medical Licensure and Discipline. 2007;93:6-11.
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  27. Andrew LB. Survey Says: Many EPs Suffer in Silence. Emergency Physicians Monthly Online [serial online]. March 2006;13:3:1-7. Available at http://www.epmonthly.com/index.php?option=com_content&task=view&id=226&Itemid=15.
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Physician Risks

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict: Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics? http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …

 

dr-murphyFrom James P. Murphy, MD, MMM;

Practicing Pain Management Physician

Board Certified in Pain Management & Addiction Management

https://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture/

https://jamespmurphymd.com/2016/07/24/comparing-apples-to-apples-the-morphine-equivalent-daily-dose/

https://jamespmurphymd.com/2016/06/21/prescribing-controlled-substances-in-kentucky-cme-presentation-for-flaget-memorial-hospital-in-bardstown-ky-june-21-2016/

https://jamespmurphymd.com/2015/02/13/pathway-to-partnership/

https://jamespmurphymd.com/2015/09/a-stellar-time-at-bellarmine

 


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EXPECTATIONS: Helpful and Otherwise

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Overheard in a college hallway: “I am who I am! I cannot be responsible for his expectations of me.”

The tone of voice was stressed, angry. The speaker was obviously struggling in some relationship where she felt the pain of believing she was expected to measure up to some standard with which she did not agree, or believed she could not meet. Her anger at not being accepted for that of which she felt capable seemed fed by her guilt that she had not measured up to the standards of someone important to her.

Or, was I projecting? Was I reading too much into a simple declaration, simply because it resonated so deeply? Who among us has not at some time felt the pangs of inadequacy, having somehow failed to be the person that a parent, teacher, friend or spouse thought us to be? More important, who of us is not guilty of verbally projecting our expectations on another in a judgmental fashion, capable of stripping the other of self-confidence and a sense of belonging.

Strange Family

Strange Family

As the Academic Dean of a small college in an rural area where students received a suboptimal education, as both student and faculty advocate I was often called upon to mediate the issues arising when faculty from more cosmopolitan backgrounds failed to recognize the intelligence and potential of their students, judging them only on their failure to have been adequately prepared for college level work. Faculty would often disparage the students publically, claiming they would not work, could not learn, and should not be in college. Their expectations of the students were as low as their claims, and the relationships between those faculty and their students were broken and painful. Neither group expected anything good to come from the other.unhappy 1

Yet my own experience with these students was that on the whole (of course there were exceptions – there always are) the more I expected from my students and the more I recognized their exceptional qualities, the harder they worked and the more they succeeded. Further, they returned my love and respect for them, and for each other. The same was true for my students in Africa, as well as for my students in a large city-based university.

The principle, I believe, crosses cultures and generations. I first heard it stated from a young OB-GYN physician who had been charged with overseeing residents, interns and patients in a central city hospital clinic. I had the privilege of working for him as he changed the appearance, the attitudes, and the quality of care at that clinic. Where it had been said patients were “herded like cattle” into the clinic area itself, and then into exam rooms where they were prodded, talked about over their heads between the teaching and learning physicians as though the patient was a dumb animal, where the environment itself was dirty and depressing—there was change. In an attractive, welcoming environment where every patient was treated as well as paying patients in a private doctor’s office, we were able to observe the change from surly, quarrelsome and often unwashed patients to patients who were no different from those in any doctor’s office, where they trusted their caregivers and returned the respect they were given.

What that young physician believed and lived by, and helped everyone around him to emulate, was the statement he always made: “People will respect themselves and act accordingly if they are treated with respect and dignity.” Most did just that.

What I told my faculty members was “These students will live up to—or DOWN to—your expectations. Either outcome will be elicited by your treatment of them.”

Expectations make us or break us. Expressed in love as realistic possibilities that honor and dignify the humanity of the other, they can inspire. Expressed as a judgment of the failures of the other, or as a goal absolutely not in accord with the dreams and goals of the other, they are destructive. And that includes the expectations we have of ourselves.

self-confidence


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THE SKY IS FALLING

The expressions of a pervasive sense of impending doom are on the increase, whether you read/listen to the armchair experts on social media, or the professional experts in science, economics, philosophy, or religion. Yet as I look around me in the “real-life” portion of my world, people seem to be pretty much absorbed by the joys and/or challenges of daily living rather than wondering whether the world is going to end in a financial meltdown, climate change disasters, the extremes of social anarchy, or World War III. Then, of course, there are others who only argue about who is to blame for any of these terminal disasters, as opposed to those who fatalistically refuse to think about it: “Whatever will be, will be.” Finally we have those who are totally unaware, perhaps desensitized by a lifetime of failed threats of the immanent End of Time.

-Remember the back yard bomb shelters of the Cold War era, complete with supplies to support a family until it was safe to return to the earth’s surface (however long that would be)?

-Remember the End Times and the Space Ship arrival cults? (True, these are not entirely gone).

-Remember Y2K, and the Mayan Calendar date of December 2012?

Or, just pick up the New Testament and read the words of the prophets who followed Jesus, claiming the Rapture would occur just any day, despite the words of Jesus himself, who stressed that the date could not be known. Yet the Second Coming of Christ has been predicted many times in the past 2000 years. It seems that when we are not fearing the end of the world, we are happily anticipating it.

Widespread dissatisfaction with and/or fear of the world as it is, however, have always been accompanied by cries that “the sky is falling.” And sometimes, it does – though not even close to earth-wide since the destruction of the dinosaurs. It happens to us as individuals, too. When everything goes wrong in our lives – economically, health-wise, or in relationships – the suicide rates go up, while others still consider ending it all or pray to die, because their situation is intolerable. The reasons for coming disaster mount up, while our ability to think rationally enough to take action for positive change in our own lives rapidly disappears. If that is our individual coping mode, how can we expect to fare any better in large groups, or as a nation?

Where is the leadership that can put aside their personal fears and aspirations, and show us the way to work together to solve the problems that have solutions, and learn how to prepare for the “new normal” when change is inevitable?

Where are the families and the communities that can help each other to get through the bad times, and show their children how to deal with disaster and failure as well as with success and wealth? I know for a fact that these exist, but perhaps there simply are not enough of them. Or maybe they have forgotten.

Where are the teachers who used to show us how to apply theory and practice to real life situations, and how to think critically in order to separate truth from fiction when possible? I do know of some.

Finally, we can’t blame all these people for our individual and collective feelings of impending doom. I believe that our lives will improve when we stop rushing head-long and helter-skelter into the end of time and stop to get our common sense back.

Yes, indeed, there are threats to our safety and well-being. There are major changes coming to life as we know it. (In fact, there always have been – they just come faster now). We can’t afford either denial or complaisance, and we never could. We have, however, succeeded grandly as a human race when we have cooperatively put our mental and physical resources together to figure out how to meet the challenges of the day, how to be good stewards of our resources, and how to live together in relative peace. This works for nations, for communities, for families, and for individuals.

The sky is not falling yet. It may never fall. But there are definitely some threats. While those who can, work together to see that the potential for damage is lessened as much as possible, the rest of us need to be cooperating – with those who are knowledgeable, as well as with each other — and not giving in to fears of the future or to total denial.

The way to get through a challenge is to work it out, and work it through. Life has always been like that.