Says Who??

Verstehen, through shared perspectives


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COLLEGE STUDENTS GIVE MY LIFE MEANING

bare tree

The university academic year begins for me this week, and—not for the first time—my thoughts are heavy with the implications of the grave responsibility of educating the young. This year, though, seems to weigh heavy on my heart more than any such year in the past, with the possible exception of the years in South Africa during the end of apartheid and the first years of democracy. It could even be because of those years, and the comparisons that can be made between South Africa then, and the United States now, that my concern is great.

Of course, no comparative study would find a perfect correlation between the two countries. But there are many similarities, especially when observing the issues of race, intolerance, social injustice, disenfranchisement, rule of a power elite—I could go on, but already it become obvious that there are points to be made, as well as huge differences in the two situations. Can anything be learned from the past in another country, that would shed light on a way forward for us in the present?

My course load this semester consists of Intro to Cultural Anthropology, Social Theory, and Political Anthropology. All three courses contain a great deal of material that directly relates to August 2016 in the United States. Some of these situations, like the failed war on drugs and its ongoing, devastating aftermath, do not appear to be related to anything that occurred in South Africa. But when you look deeper at the combinations of political misinformation, low intensity violence incited deliberately by the government, and antipathy between police and the often innocent subjects of their brutality, a shared trend appears.

In fact, one can see that the troubles in both nations were not caused by failed societal structures so much as by a shared failed personal accountability for human actions. I always try to find an opportunity to explain to my students why it is true that to the extent we dehumanize others, we dehumanize ourselves. And the more often that we do that, the less human we become. At some point, it no longer matters who we hurt, or how much we hurt them. Having reached that point, nothing is sacred—we can lie to each other, cheat in personal and public relationships, and shame our religious traditions by turning them inside out and using them against each other, rather than in enjoyment of the sacredness of our existence. Some people blame this on the capitalist profit motive; I blame it on unrestrained greed grown to inhumane size, however you want to rationalize it.

Our inhumane behavior is seen in social media pages, day after day. Many posts are deliberate lies, some are propagated by people and organizations who make a great deal of money developing the ways and means of destroying political opponents, or spreading ideas in order to challenge inconvenient truths about how we should live. Our youth often do not trust our government, our news media, or our religious leaders. We have an entire generation of youth who have grown up in the midst of uncontrolled verbal and media bile, day after day. Yet many parents and teachers are still able to reflect the values of integrity and community to their children; too many others have failed.

I don’t want to be one of those who fail those precious young people. It would be safe for me to just present the information in the texts as is, and avoid controversy. Unfortunately, sociology and anthropology are not calculus. They exist to provide a learning situation whereby we may study, compare, theorize, and determine the state of our world, and consider possible ways to improve our situation and that of others. If we learn anything at all from these disciplines, it is that humans are not meant to live just for themselves. We are psychologically and mentally geared to living in community, from whence we learn our sameness as well as our beautiful uniqueness; where we learn to share, to care for others, and to be cared for. It is where we discover the meaning of our lives, as Victor Frankl explains so beautifully.

On the surface, our country is in what Durkheim would call a state of anomie; of “normlessness.” There are too many who live by disregarding the norms of human interactions, of human responsibility. The rest of us are not free of responsibility for this state of affairs. The rapidity of progress has allowed us all to enjoy an unprecedented mobility, separation from family and old friends, from the norms that defined our lives when we were young people. The sense of normlessness that has grown has produced political and religious apathy, as our values as a nation have withered into weapons for some groups to hurl at others in hatred.

It could appear that all is lost. It is not. We can, and must, regain our humanity by treating others as the precious human beings they were meant to be. We cannot separate ourselves from community, especially from communities of meaning. We can look to the examples of those around us who are good people, who live honestly and compassionately. We can seek justice for those whose lives have been broken by injustice.

…..We can demand from our government leaders the same values that we hold for ourselves, and make sure not to repeat errors in judgement on that score.

….. We can bring family life back into vogue, securing the early years of our children with the nuts and bolts of honesty, responsibility, and community.

….. We can demand improvements in our education systems so that our children learn to think, not just to memorize.

And we can treat the people we run into each and every day as though they were human beings like ourselves: imperfect, yet full of potential; sacred to their Creator and therefore sacred to ourselves. Deserving of respect—enough so as to inspire those who have none for themselves to strive for improvement.

 

……Yes, this is indeed a heavy responsibility to owe to the students in my classroom. But why else would I even want to be there? The intergenerational discussions and learning that will take place give my life meaning. My students, who are also my teachers, are the joy of my life. When I meet with them again, that “heavy responsibility” will be rediscovered as a great privilege. So begins another year.

classroom


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WAR ON PHYSICIANS AND PATIENTS, CHAPTER 2

I wanted to believe that the State of Indiana, my new home, was a place where wise, knowledgeable heads prevailed; a place where lawmakers did not succumb to the pressures of being politically correct while morally wrong when lives were at stake. I have even twice used this blog space to compliment them on setting up a law regarding the prescribing of opioids that clearly recognized the difference between regulations and felonies, while protecting both patients and physicians.

I was wrong. The failed war on drugs has affected the State of Indiana as it has so many others, and opioid hysteria is prevailing over perspective in government circles. The law scheduled to become effective on December 31, 2014 will include limits on every form of opioid pain relief for chronic pain patients that are so restrictive as to completely ignore the uniqueness of every patient. Pain patients differ in their perspective of pain, in their experience of pain, their tolerance for pain, and their response to ANY treatment for pain—including opioids.

The treatment of chronic pain is not amenable to cookie-cutter protocols. Nor does it fit nicely into the “15 minute per patient” rule imposed as a necessity to satisfy insurance company/corporate bureaucracy requirements. It takes time, patience and extensive knowledge to successfully treat a patient with chronic pain and disability, to try to bring that patient back to some form of productive life. When this is not possible because of the extent of the disability, then the goal must be adjusted to simply making life bearable for the patient.

Indiana lawmakers once understood these facts. Now they seem to have abandoned reality and chosen to break their own law even before it takes effect. The law demands that physicians spend an almost impossible amount of time and effort being face to face with each patient before prescribing for them – yet lawmakers who never set eyes on these patients and who collectively have no medical license or even relevant training are prescribing what an allowable course of treatment can be for any pain patient. ANY pain patient, regardless of the cause of their pain, the disability it may cause, and the length of time the patient has suffered. Regardless of their tolerance for the treatment. Regardless of their response to treatment.

A physician notes:

“Regulatory overreach has a chilling effect by making prescribers fearful of jeopardizing their licenses.  This fear can result in physicians abandoning pain sufferers, even forcing some patients to seek black market medications or illicit drugs.  Such has been the unfortunate case in states that hastily passed burdensome pain regulations.  Heroin use in these states has increased dramatically as the supply of prescription pain medications has dwindled.” http://jamespmurphymd.com/2013/10/07/an-open-letter-to-the-medical-licensing-board-of-indiana/comment-page-1/#comment-1158

Just last week WHAS News (Louisville KY) reported that since the Kentucky Pain Law of 2012, Heroin overdoses rose from 3% to 40%. Heroin overdose EMS calls have risen a stunning 700%. All this, despite the fact that heroin trafficking arrests have risen 1300%. These statistics were attributed to the “unintended consequences” of the unrealistic, overly burdensome pain regulations.

Unintended consequences. Beautiful, bright college students found dead of heroin overdose. Physicians wrongly charged with felony prescribing, found dead by their own hands. Countless patients, deprived of their medications (many without even the option of being slowly weaned off of them) turning to suicide in their pain, or alternatively, to the criminal activity of street drugs.

And all we can say is “Oops! We did not intend for this to happen.” ???? Wake up, Indiana! Don’t willfully head down this same slippery slope!

The War on Drugs has failed. The War on Physicians and Patients is close to taking more lives than the Iraq war, and ruining just as many others. Simply passing harsher and more impossible laws is NOT going to help anyone. There is a better way.

Education is the better way. We have First Aid Certification, CPR, Lifeguard training and certification – so many lifesaving training programs for the general public as well as medical personnel. We need to add Basic training programs for the public on how to deal with drugs. We need Continuing Education programs for physicians and medical personnel on how to deal with opioids. Early education and continuing education can prevent deaths and disability from drug abuse, and help physicians to prescribe knowledgably. Alliances between physicians and pharmacists in drug management programs would make a huge difference in keeping legitimate patients and their caregivers safe.

Stay on the high road. Political power should be about making Americans safe, and so far the Wars on Drugs, Physicians and Patients have failed miserably in that regard. Please do not wait until that college student dead of heroin overdose is your child, or grandchild. Fight this battle WITH the physicians, not against them.


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THE WAR ON DRUGS HAS BECOME THE WAR ON PHYSICIANS AND PATIENTS

The following article first appeared May 20, 2014 as a guest blog on Dr. Jeff Fudin’s http://paindr.com/blog/ website under the title Patients with Chronic Pain Syndromes are Not Idiots http://paindr.com/patients-with-chronic-pain-syndromes-are-not-idiots/.

From the early days of human habitation on this earth, societies have revered (and also feared) their healers. Even now, from Africa to South America, and wherever modern medicine is difficult to find, the skills and knowledge of healing have been passed from generation to generation of traditional healers. In rural areas of our own nation, many communities still seek medical assistance from ‘grannies” who rely on local herbs and traditional lore to help their neighbors.

So how has it happened that in the 21st century, one of the most technologically advanced nations on earth appears to be conducting a campaign against modern, trained and licensed physicians that echoes some ancient, primitive fear of the healer? We live in the age of Reason. We understand science, including anatomy and physiology, and understand that healers do not possess magic powers that might either hurt or heal us.

Despite this advanced understanding, we have allowed lawmakers and insurance companies to turn our healers into objects to be bullied, threatened, arrested and tried under charges of murder, with prosecutors demanding a death penalty when they have no evidence whatsoever that such a crime took place.[i]

After years of study and practice, sacrifice and struggle, 21st century physicians enter their professional world with dreams and aspirations already shattered. Many have student loans that limit their disposable income for many years into the future. Many more will find that the option of setting up a practice on their own is an unattainable dream – that they will be working for larger organizations and answering to employers who lack both medical degrees and understanding, where the bottom line is profit driven. All will have to deal with insurance companies that limit what they are able to do for their patients, no matter how much the patient might need the medication or procedure. Those companies have even at times contacted their patients, without the knowledge of the physician, and suggest other treatments or tell the patients to ask their doctors for a different treatment[ii]. Somebody tell me – have the laws against practicing medicine without a license been repealed?

And that is not the worst of it. Today, a physician who tries to treat patients according to the knowledge and skills that they worked so diligently to earn is now at risk of losing everything—their licenses, their homes and families, and even their own lives. ALL THIS, NOT BECAUSE THEY HAVE DONE ANYTHING WRONG!!! On the other hand, they can’t seem to do anything right. If law enforcement doesn’t destroy them, they are in danger of being robbed or even killed by drug-seeking patients. [iii]

I could easily believe that it is the failed war on drugs that has created the need for law enforcement to redirect our attention by turning the war against physicians – and their patients, who will suffer without medical care. Sociologists like myself frequently inquire “Who Benefits?” when deciphering seemingly irrational social behaviors. In this case, the lawmakers and enforcers themselves would look like people who would benefit from a better public image by this redirection of the public’s attention.

They say it is because the physicians prescribe too many “pills”, and turn their patients into addicts. Not true. Only a small percentage of patients who follow the orders given by the physician become addicted – addiction is a disease that occurs most often when drugs are abused, against medical advice. Most abused drugs do not come from physician’s prescriptions, but from families, friends, unsecured home supplies, or drug dealers.[iv] Dependency may occur, on the other hand, because people must depend on the medications that help them. Physical dependency is not unique to opioids alone, and can be resolved by tapering when the need for the medication is over. A similar approach is needed with several medication classes such as antidepressants to avoid serotonin withdrawal or beta blockers to avoid hypertensive crisis. Because lawmakers and others often incorrectly blend the lines, differences between physical dependence and withdrawal, we allow people and organizations with vested interests to feed our fears and turn us against the only people qualified to help us.

It is no wonder that over 80% of practicing physicians are reported to have stated that they do NOT want their children to become physicians. It is no wonder that more than 400 physicians are reported to commit suicide, annually.[v]

Why are they targeted, when they are not the problem? Let’s look at the real problem here: Addiction is real. Drug-related crime is real. Drug cartels that launder their profits and use some of the “cleaned” money to lobby politicians are real. Even MD degreed providers who misuse the privilege and set up “pill mills” are real (I refuse to call them physicians). There are solutions to all of these problems, and none of them include punishing physicians and other licensed clinicians with the goal of securing political points. We must stop making the problem worse, and focus on the real lawbreakers. We do know who they are!!

I write this letter, ironically, perhaps, because I am not able to take pain medications or many other drugs that could mitigate against the chronic pain that I have lived with for more than 45 years. Like many older people (who, by the way, may be less likely to become addicted to drugs because of the changes age brings to our physiology[vi]), chronic pain (from degenerative disc disease) has exacerbated other illnesses and ultimately severely limited my life. I have written this letter in gratitude for the four physicians who compassionately and patiently took the time to untangle and address the mingled symptoms that I presented with a few months ago, and who have given my life back to me despite my limited ability to process medications. (And yes – one of those four physicians is a board-certified pain management physician. There are other ways to manage pain when patients cannot take drugs.) With some understanding of what it must take to hold on to that compassion and professionalism in an irrational and vengeful world, I declare that these physicians, and physicians like them, are the true heroes of our day. We need to let them know.[vii]

ENDNOTES

[i] 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
Ex-doctor faces families in murder preliminary hearing http://www.news9.com/story/25395877/ex-doctor-faces-victims-families-in-murder-preliminary-hearing

[ii] Here I cite my own experience with the insurance company that covered my last place of employment. Over a period of several years, my colleagues and I received messages from the insurance company about changing our medications – such as when I was on a prescription medication for GERD, the company insisted that I must discontinue it and take an OTC medication because unless I did, they would discontinue payment on the prescriptions. We were also advised in frequent mailings to discuss alternative treatments with our physicians.

[iii] The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …
Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

[iv] “For this crisis physicians take the brunt of the pundits’ blame, despite the fact that more than two-thirds of the diverted medications are acquired from family, friends, and acquaintances – not from a prescription by their doctor. http://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture/

[v] Pain Physicians Have High Rates of Burnout http://goo.gl/P3z1cY
Dr. Gary Shearer: Suspended Northern Kentucky pain doctor dies of ‘suspected suicide’ http://www.wcpo.com/news/local-news/boone-county/florence/dr-gary-shearer-suspended-northern-kentucky-pain-doctor-dies-of-suspected-suicide

Physician Suicide http://t.co/4vhF63eD6NReferences from this article:
1.Adams D. Physician suicide: searching for answers. American Medical News [serial online]. April 25, 2005;Available at http://www.ama-assn.org/amednews/2005/04/25/prsa0425.htm.2.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].
3.Hawton K, Malmberg A, Simkin S. Suicide in doctors. A psychological autopsy study. J Psychosom Res. Jul 2004;57(1):1-4. [Medline].
4.Holmes VF, Rich CL. Suicide Among Physicians. In: Blumenthal SJ, Kupfer DJ, eds. Suicide Over the Life Cycle. Washington, DC: American Psychiatric Press; 2004:599-618.
5.Middleton JL. Today I’m grieving a physician suicide. Ann Fam Med. May-Jun 2008;6(3):267-9. [Medline].
6.Noonan D. Doctors who kill themselves. Newsweek. Apr 28 2008;151(17):16. [Medline].
7.Petersen MR, Burnett CA. The suicide mortality of working physicians and dentists. Occup Med (Lond). Jan 2008;58(1):25-9. [Medline]. [Full Text].
8.Worley LL. Our fallen peers: a mandate for change. Acad Psychiatry. Jan-Feb 2008;32(1):8-12. [Medline].
9.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].
10.Hendin H, Maltsberger JT, Haas AP. A physician’s suicide. Am J Psychiatry. Dec 2003;160(12):2094-7. [Medline].
11.Shaw DL, Wedding D, Zeldow PB. Suicide among medical students and physicians, special problems of medical students. In: Wedding D, ed. Behavior and Medicine. 3rd ed. Hogrefe and Huber: 2001:78-9 (chap 6).

[vi] “indeed, bad choices, bad behavior, and drug misuse lead to crime, accidents, social instability, and addiction. The developing adolescent brain is particularly susceptible to addiction, while the elderly brain is practically immune.” http://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture/

[vii]“ 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 …