Bicycle
Summer 1972
I was in summer school, taking organic chemistry, to make up for being out of school last fall. I was living on the fifth, top floor of the House and I carried my bike up and down the stairs. The organic chemistry class was held in a big lecture hall north of the House, across the overpass and past the old Hall. We always walked to class– it was too close for bicycling.
We had lab in the afternoon on most days. The lab was held in a big drafty hall with tall, wide open windows, and it got pretty warm on most afternoons. We didn’t have those new-fangled exhaust hoods over our experimental benches, and some of the reaction chemicals did stink.
After class on the day before the last day, I went out for a bike ride on Massachusetts Avenue, going north on the left side of the northbound lanes, next to the center line, fast. I was trying to go up the Ave a few blocks, not going anywhere, and I decided to turn around and go south at an intersection.
I never got to turn around. I crashed into a car (a Toyota Corolla) going south. I was hit by the car on the left front quarter and went up on the hood, then back onto the roof with my butt going through the windshield. For a tiny fraction of a second, I laid back on the hood of the car, striking the edge of the roof with my back at about the lumbar-thoracic junction.
Then the driver hit his brakes, and I was catapulted forward. I performed a full sumersault in the air as I was thrown forward from the car and landed on my feet on the street, facing south and only a few feet behind a bus also going south. For a moment, I thought I had almost hit the bus. I didn’t realize that I had somersaulted off a car that was still behind me.
I turned and stepped back to the car, which was motionless in the street with a smashed windshield and dented roof. I was not aware of any pain. Looking at my hands, I could see tears in my gloves, and there were red gouges on my knees and lower legs. I sat on the hood of the car.
A passing driver offered to take me to the hospital, and for a few minutes I sat in the front passenger seat of her car. The ambulance showed up within moments, and a fireman gingerly helped me into a chair-like stretcher, strapping me in sitting down. I began to be aware of something wrong in my back, and reaching backwards, I could feel pieces of glass on my shorts and shirt.
As the ambulance drove south on Massachusetts Avenue, I looked back out of the open door at the traffic, all the cars pulled to the side of the four lane road. It was a short ride to the infirmary, which was in the building complex just to the southeast of Harvard Square. They had a small emergency room and could put people to bed for a few nights upstairs. It was the students’ idea of divine intervention.
At the hospital, I lay quietly on a gurney while the resident sutured up two rounded gouges in my left shin. Then I turned over and he examined my back. There seemed to be a bruise forming over my lower back. They relieved me of my clothes and shook the glass out of them.
Next I was sent to Xray, where they checked my lower legs and I stood up for an Xray of my midback. There was something about the Xray of my back that the technician didn’t say, but she went back and talked to the doctor, then came in and repeated the Xray. I never found out what was wrong, if anything. I just know it was painful to stand up at that point.
Then they put me to bed with instructions to collect any urine that I might pass fully into this urinal, please. I think i was rather dehydrated because my kidneys were inactive for a long time. Finally, early in the morning, I got up and urinated as instructed, then rang the nurse.
I was released around 8:30 or so and made it to class a half an hour late. I sat next to my room-mate, who had visited me in hospital, and commiserated for a while. We took notes of the last lecture. At lunch-time, we walked over to the corner where the accident had happened, and retrieved my bicycle from the basement of the restaurant across the street from where I had landed.
The man who worked there said he had, by chance, actually observed the moment of the accident, and that I had flown from the hood of the car when it stopped and I had done a complete somersault before landing on my feet on the street. This was news to me, as I didn’t remember anything about the hit. Just being hit, then being in the street.
We walked back to the House, my room-mate carrying my wrecked bicycle. Back at the House, we had a little something to revive us and discussed the future. Then we went to lab.
I had a good-sized bench to myself, with all the equipment needed to do organic syntheses and extractions, and the day’s experiment involved a simple synthesis and the concentration and characterization of the synthetic result. I went through the instructions and followed them as well as I could, but I began to feel a little wobbly, and the pain in my legs was worse.
Mostly it was in the knees, where I had two big shallow gouges taken out right below my kneecaps, but also there were my shins, with several small holes and two larger ones closed with a couple of stitches. My elbows also had some small abrasions. All this was carefully covered with sterile bandages and gauze wrappings. My hands, fortunately, had been protected by the gloves I wore.
The thing that bothered me the most wasn’t bandaged. As the hours wore on after the crash, swelling began to occur in the thoraco-lumbar region of my spine. My back began to ache, especially that afternoon as I stood at the laboratory bench.
I spent a long afternoon in the organic chemistry lab, performing the last lab exercise of the summer. I knew I had to finish this exercise to get a decent grade, otherwise all my work this summer would be wasted. I finished the exercise and got a reasonable yield for the final product, not up to my usual standards, but good enough to get a passing grade for the day’s lab.
Then I went back to the House and rested. My girlfriend came to visit that evening, and we talked over a glass of wine. My room-mate had left early, as usual, zooming away in his Porsche to get back to his dad’s home in New Greenwich.
We talked about the crash, and how I had really been at fault, and if I had been watching where I was going, it wouldn’t have happened. I agreed with everything she said, because it was true. I had made a turn where I wasn’t supposed to, in the face of oncoming traffic that I had ignored. Why did I do that?
All I remembered was that I had gone for a bike ride to blow off steam, so I had cycled really fast north on Massachusetts Avenue from northwest of the House. I had gone fast for a couple of blocks, then got in to the left lane. At the corner just north of the park, I had made an attempted U-turn to go back south on Massachusetts Avenue, but there had been traffic coming south that I just didn’t take into account. I still couldn’t answer why.
I didn’t sleep well that night. Early in the morning, a backache woke me up. I got up and took a couple of aspirins my room-mate had left me. I lay back down again, and fell back asleep for a little while.
I did well overall in the organic chemistry summer session, so I didn’t have to take it again that fall. I started taking biochemistry classes instead.
I still had a backache, especially in the morning. I went to physical therapy, and they gave me a lot of relief, especially with the infrared heat machine. The backache receded to the point where two aspirin in the morning completely took care of it, and it never came back all day.
The driver of the car got a lawyer. He came to see me one day a month or so later. We had coffee in a shop on the southeast side of Harvard Square, past which I walked every day on my way to class now. We talked to him about the accident. I told him it was really my fault that it had happened, the driver couldn’t have seen me.
He seemed cheered by this prospect. Then we began to discuss my family. He was depressed to learn that my father was a teacher at a small mid-Western college and not a rich man of some sort. I told him we didn’t have any insurance although I suspect my father had a home insurance account that might cover such things as minor son crashing his bike into a car.
The lawyer told me that he didn’t think he’d be able to file suit if my father didn’t have a lot of money, and regretfully bid me farewell. I was surprised, but I really didn’t think it was a big deal at that moment.
Later, I happened to run in to the driver on foot; we were both walking, through the park on the west side of Massachusetts Avenue a couple of blocks from where the crash had occurred. I was walking north, and he was coming south, with his girlfriend, I assumed. We stopped for a few moments to talk, and I asked him if he had been hurt. He said that he had been going to a chiropractor because his back hurt.
I realized that there was more involved, at least in the driver’s mind, than the loss to his car, which he explained to me was declared totaled by the insurance company because of the roof damage. I began to feel proud of my ability to inflict damage on inanimate objects like cars.
That winter I still had a backache; I took two Bufferin in the morning and sometimes in the evening as well. I went to physical therapy and enjoyed the infrared heat machine, especially on cold days. Cambridge got pretty cold, and the snow piled up, dirty and black on the street. I walked everywhere, partly because I didn’t have a bicycle, although my room-mate’s friend offered to let me ride his.
He had built a bicycle from parts recovered or selected individually to fit his requirements. He especially liked my brakes, and since they had been one of the few items on my bike to survive the crash, he mounted them on his bicycle. Therefore, he felt he owed me a share of the rides on his new bicycle.
I did take advantage of the privilege a number of times, although it wouldn’t have been convenient to borrow it just to do an errand or ride to class because he lived in Boston rather than Cambridge and actually drove to class in his car. He drove an old Porsche 356 that I didn’t think was as cool as my room-mate’s 912.
Riding my room-mate’s friend’s bicycle was an unusual and scary sensation. There wasn’t any pain in my back or knees but I constantly had the feeling I was going to fall. My rides usually lasted an hour, no more. It was cold anyway.
Tea Party Propaganda
- I want you to read the following “comment” gleaned from the New York Times online carefully and tell me if you think an ordinary housewife, or perhaps an illiterate janitor, wrote it. I think that it is more likely that it was written by a professional writer who was paid by a corporate entity.
- Mike Mangan
- Comstock Park, Mi.
You people don’t have a clue what the Tea Party stands for. It’s a true grass roots movement with one overriding principle: returning to limited government. We are motivated to action by a debt so large that it threatens the existence of our society. Our ranks are made up of ordinary men and women (more of the latter). If you would like to know what a Tea Party crowd looks like, go to a church basement after services when they are serving coffee and doughnuts and you’ll get the picture. Simple hard working people, most never having participated in politics, with the simple goal of keeping the country from plunging over into the abyss.
For this we have been vilified like no group since Jews in Germany in the 1930’s. We’re called racists. Terrorists. Hostage takers. A sitting Congresswoman tells us to “Go straight to hell!” A union leader offers to “take us out” and “wage war on us” with the President sitting on the same stage. Our simple principles are being warped and distorted by the media and the Democratic party in order to portray us as the biggest threat the country faces.
We’re being scapegoated. And all the while the ignorant, hateful, bigoted people who do the scapegoating don’t have to explain how the $14 trillion debt is not a threat, how the $114 trillion in unfunded liabilities is no problem. Oh well, someone has to be the grownup in the room.
(published September 7, 2011)
The above “comment” posted on the New York Times online “Green” blog is an example of Tea Party propaganda. If you examine it carefully, you will see that it is made up to stimulate sympathy and create an appearance of honest, straightforward discourse. There is one rational point made by the statement: our National debt is “so large that it threatens the existence of our society.” This deliberately shocking, Apocalyptic claim is unsupported by any evidence but referred to as “unfunded liabilities”. The statement tries to make you think that “simple, hardworking people” are behind the Tea Party’s efforts and that they are being scapegoated for their efforts.
In fact, the Tea Party was created back in the 1970’s by Republican operatives who wanted to change the “balance of power” between government and private corporations by impairing government and empowering corporations. It has been funded through convoluted secret channels by top corporate officers in the coal and oil industries as well as individual wealthy conservatives ever since then. Billions of dollars has been spent on creating propaganda that gives the impression that its positions are shared in the opinions of “simple, hardworking people”. What has happened is the reverse of a grass-roots movement. The assertions and identifications of the propagandists have convinced many simple, hardworking people who get all of their news and political opinions from a television channel owned by a wealthy conservative: Fox News.
The Tea Party operated underground until shortly before the 2008 presidential election, when it emerged in full public view. A few demonstrations by costumed employees secured wide publicity for a simple concept: the “Tea Party” was alleged to be a spontaneous outburst by enraged citizens. The concept was easy to report on and easy to explain, although its plans remained somewhat obscure. The only clear demand was a reduction in government spending (which was precisely in line with the original motive of impairing government and empowering corporations.) Through wide publicity, a superficial knowledge of the Tea Party was spread to most Americans.
Polling showed that, initially, people didn’t know much about the “Tea Party” but were generally favorable. After a couple of years, however, polls showed that people felt much more familiar with the concept and had a generally unfavorable attitude towards it. As the plans of Tea Party champions in Congress played out, particularly their obstructionist tactics in the House, people reacted negatively. General polling showed the popularity of the “Tea Party” dropped to perhaps 20-25% once it became clear that their proponents wanted to obstruct the normal process of debt authorization in Congress.
Tea Party Republicans in the House took the “debt ceiling” bill too literally and refused to pass it unless they were promised a drastic reduction in government spending. The “sequester” has been a direct result of the negotiations that President Obama was forced to go through to get the debt ceiling bill passed in 2011. There will be intense and painful cuts to personnel in almost all government agencies as a result of the sequester. Many extremely helpful programs will be cut or eliminated. At present, the military has also been forced to make the same cuts, although the Tea Party people have magnanimously offered to restore many military cuts as a part of the next debt ceiling bill. It has been estimated that the sequester will reduce economic growth by 1/2% over the next year and delay relief of unemployment, on top of firing many important government workers.
The reality is that our government is running at a deficit because we are not collecting enough in taxes. The average, historically, has been taxes at 18% of GDP; we are now running at 14% of GDP. For good fiscal management, it is essential that we raise taxes, and for fairness, it is essential that this be done in a progressive fashion. Raising taxes on “capital gains” and raising the percentages on high incomes are the only way. Our deficit would quickly disappear if we taxed ourselves appropriately. This is not in the interest of those who are behind the Tea Party. They want to reduce government to the point that they can “drown it in a bathtub.”
It is clear that powerful interests are trying to prevent economic recovery in the United States. They are behind the Tea Party as well as other retrogressive initiatives that have come forward recently. They are actually profiting from the high unemployment and sluggish growth that afflicts us. These interests are not publicly held companies, they are private corporations and industries that find the conditions of high unemployment and depressed wages to be helpful to their businesses. They feel that the employees are more docile when they feel lucky to have any job, even at the minimum wage.
Unfortunately, these conditions are unstable. The extreme levels of income and wealth inequality that exist now cause social unrest and intensify anger in dispossessed populations. Extreme inequality leads to social disintegration. Our current systems are trending towards more and more inequality. I think that there will inevitably be an increase in social unrest and just plain violence (like the Newtown massacre). To this end, it is useful that there are an estimated 276 million firearms in private hands in the United States.
To combat inequality, government must be established that takes effective measures. Progressive taxation is one measure that is likely to prove efficient over the long term. Insulation from financial risks for the individual is also essential. One of the most serious individual financial risks is currently serious illness: 60% of bankruptcies list medical bills. Single payer medical insurance is the most effective answer to this problem. Premiums for medical insurance would be paid through the income tax, thus progressive as well. European countries that use this system pay half of what we pay for medical care, and no-one is bankrupted by illness or injury.
One aspect of government that must be established in order to achieve greater equality is truly representative government. This will be established by outlawing all campaign contributions. All publicity for campaigns must come from a public fund that includes free television time. The right to use the public airways will include a tax on broadcasters that covers the cost of providing TV time. Candidates will first be selected locally by small groups, say a hundred people, and then progress to larger groups, say of ten thousand. After passing through these primaries, candidates can use TV time to reach voters en masse.
Voting will be required of all citizens; the right to vote will be conferred by a free identity card issued by the federal government. The card will contain a unique number that can be used to vote through any medium, including the telephone. Ballots will include, in addition to the names of all qualified candidates and a write in line, a choice of “none of the above.” The polls will be open continuously from the time the campaign starts until a prescribed cut-off date and time.
That’s my plan.
- Linda’s View Massachusetts
As an individual who has experienced severe adverse reactions to a number of medications, my problem has been with medical professionals failure to report to the FDA reactions I have had. I do believe, in a number of issues, including near death from a Baycal-type reaction to Lipitor as well as permanent physical injury caused by an over usage of the IV antibiotic, Ciprofloxacillin(joint damage, tendon and ligament tears as well as all my teeth breaking loose and now must wear dentures) doctors do not want to turn against “BIG PHARMA” and do not report these reactions. Also, there is always the fear of class action lawsuits. I just know the harm that has been done to me by just these two drugs is not just applicable to me;especially in the case of the two drugs I have specifically named! something has to be done about the seriousness of the adverse reactions, but how can it when medical professionals fail to do the right thing?If these adverse reactions could happen to me, how many others in this nation are suffering without knowing it came from an adverse reaction to a drugs and either singularly or in a combination of other medications! Also, from what i understand, the same group of medical professionals within the FDA that approve drugs are also responsible for having to pull them when enough people suffer side effects that it can’t be kept secret. Just a thought.
my post, to Linda:
Just to let you know, Linda, the tendon damage you suffered during treatment with ciprofloxacin is a serious, known adverse reaction to this drug/class of drugs… so what you had could have been predicted, in, say, 10% of people who received ciprofloxacin…
As to the “Baycal-type reaction” I assume you mean “Baycol” and, as apparently you already realize, Lipitor can be responsible for a smaller number but equally serious type of reaction as Baycol, starting with hyperglycemia and going on and on…
So, your doctors should have warned you that you could have a reaction, as it was already known that people could have that type of reaction (it’s even in the drug information passed out to all doctors, the Physician’s Desk Reference) but then, I’m sure they were much too busy with other things, and I mean this very seriously as the average doctor has little time to do anything so complex as giving informed consent on all of the six or eight different drugs on the regimen of the average patient with chronic illness.
I guess this is turning into a rant…my apologies…
Your chances of getting better as a patient depend critically upon your doing your own research on the drugs you are given and upon your making a personal decision to take the drug given the known advantages and disadvantages. You must also, at the same time, use all the non-drug remedies available to you as a patient, starting with rest, rehydration, and withdrawal from stressful situations of all types. Enuf.
My question: where is the smallest difference between the two posted texts? to vs too.
I would like to draw your attention to an article by Steven Brill published in Time on February 20 (http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/) which explains a great deal of what is wrong with medical costs in the USA today. This is a long article, based on several example bills that struck real patients recently. I encourage you to peruse its contents and ponder if there is any possible solution to the problems it presents.
There is a serious impediment to changes in our medical cost system, naturally. This stumbling block is the way our government is organized, specifically the system of lobbying. The medical establishment spends more than any other on lobbying–more even than the military industrial complex. With lobbying to retain their comfortable, legally mandated position of privilege, it is unlikely that the medical system will change. The only thing that could force change now is the collapse of one of the institutions that keeps the status quo.
Government policies encourage banks to finance more loans to buy houses
Govt implicitly guarantees debt of Fannie + Freddie
Mort loans are securitized and taken out of hands of local banks
Foreign investors buy securities based on mortgages, many of which are not secure
Loans are highly leveraged by securities firms and banks without govt control of leverage
Govt fails to monitor market conditions and restrict borrowing when it becomes excessive
Loans are made without verification of income, and many are fraudulent (up to one half)
Real wages are stagnant, forcing people to borrow to get things they want
Compensation for securities firms employees increases dramatically
More people get mortgages easily and demand for houses increases
House prices rise rapidly, creating a bubble of “collateral”
People borrow more money based on higher house “value” to buy things
Economy appears to be doing well based on false increases in house values
Credit and housing bubble ends because all who could buy houses have bought them
House prices decline, pricking bubble of collateral and drying up credit markets; average decline is about 30-40%
Unemployment increases dramatically, causing homeowners to default on mortgages
Securities lose value because they are short sold by prescient investors, which causes a stampede
Overleverage causes securities firms and banks to become insolvent
Foreclosure and renegotiation are inefficient due to securitization of mortgages (Mortgages were combined into packages and sold) and “underwater” mortgage loans (loan size exceeds house value)
Securities markets, facing uncertainty, are depressed for prolonged periods
Govt is forced to take over Fannie and Freddie, creating huge deficits buying up worthless securities
Govt does not apply strong policies to increase jobs, and high unemployment persists, depressing govt income from taxes and aggravating deficits
Shortsighted politicians focus on deficit and demand reductions in government spending, which if implemented will aggravate economic weakness and worsen deficit by reducing tax income
Some of these things occurred simultaneously, some occurred earlier, and some happened later. They are not shown here in exact chronological order.
(The approach which was effective at the end of World War II should be re-used here: high, progressive income taxes and expansive government spending on projects that stimulate the economy. The result was rapid economic growth, full employment, and dramatic reduction of the deficit as a percentage of gross domestic product. Ironically, the debt only declined slightly in absolute figures, but the economy grew so rapidly that it became insignificant. The USA was affected by unemployment due to returning soldiers and a huge war debt with a world economy shattered by war, but by using progressive tactics, it was able to grow out of the debt and enhance everyone’s standard of living.)
The mistake that the short sighted politicians make is in assuming that sovereign government debt is the same as household debt. Sovereign debt can be sustained in large amounts if confidence in the government, private corporations, and the people can be maintained. The debt, and the money supply, can be managed to prevent significant inflation while running a “current accounts deficit” , sustained by selling sovereign debt. Confidence in the American dollar is currently high despite the fraught nature of our current government, and our sovereign debt is selling at very low interest rates. We would be well advised, as an American government, to take advantage of the low rates and borrow money to stimulate our economy by careful government spending. It is critically important for the government to provide money to people who will spend it immediately and not set any of it aside for savings. This is what will stimulate the economy “from the bottom up.”
Spending by people who need to buy things immediately for their survival will most effectively prime the economy because the money will move rapidly from consumers to providers of goods and services. Providers will then buy additional stock and invest in enlarging their places of business, and so on. In addition, spending by construction companies will spread quickly into salaries and payments for materials. Government “spending” on such items as tax credits or tax reductions will not be a good stimulant for the economy because the amounts involved are small and spread over large groups of people, many of whom do not need more money.
Practical problems with “gun control”
Advocates of what we can lightly call “gun control” point to its success in reducing access to firearms in countries other than the United States. These countries have very limited private access to firearms of any kind. More importantly, the number of guns is far smaller than the number in the United States. Here there are supposedly 300 million firearms of all types, one for each person; other countries have as little as one for every hundred people. Any discussion of true gun control is based on limiting the access to firearms of people who should not own weapons. There are currently intricate rules for who is allowed to legally purchase a firearm, and a form is filled in, a background check done, and the citizen must wait a week or so. There are vast quantities of “assault weapons” and large magazines legally purchased and stored in the closets of upright citizens, unused.
Alongside this legal framework of registered and licensed owners there is an equally large illegal network that requires no paperwork, only the ability to locate your neighborhood firearms supplier. Suppliers say they don’t sell to people who look like they are unstable, but that is an elastic standard, and no records are kept. Virtually all of the firearms that change hands in this shadow network are pistols and revolvers; assault weapons are usually not chosen because they are too difficult to conceal. According to the feds, about 40% of firearms change hands in this way. 97% of murders are committed with handguns.
Most assault-type weapons and their accompanying large capacity magazines are sold legally to registered owners, who leave them in their closets all of the time, or take them to the range to put them through their paces. However, the recent occurrence of shootings in which the shooter wore body armor and carried an assault weapon has led some local police responsible for school security to stock similar weapons for carrying by officers on duty at schools. This sounds suspiciously like an arms race.
The stocking of assault weapons at schools is occurring despite expert skepticism about the effectiveness of one or two armed guards against an adversary girded with body armor and carrying an assault weapon with a couple of hundred round magazines. The police have been behaving as if every reference to a gun, no matter how vague, warrants and complete lockdown and five hour search of a school. It seems that paranoia rules the day.
However, since almost all murders are committed with ordinary, legal handguns, a more aggressive posture might include a task force of prosecutors to take down illegal gun fairs and track down the black market suppliers. It is possible that restricting the illegal market will have more effect on the number of murders than restricting assault weapons.
Since there are so many weapons in the United States and there is such a strong feeling that each person should have a gun, or several, of their own, it might be more productive, still assuming that our goal is to prevent mass shootings, to target the individuals responsible for these shootings by trying to predict who will do it and preventing them. To take two recent examples, we had young, 20 or 21 year old white men who displayed strong signs of mental illness long before the shootings; the first, in Arizona, had made many Internet postings foreshadowing his crime. The second, in Connecticut, was known to be highly withdrawn and possibly antisocial for, possibly five or six years before he shot his mother and a classroom full of children. This type of person should not be that hard to spot, and we should change our mental health laws so that we can pick them out and treat and/or confine them.
I know that this type of change will be considered highly intrusive, especially if it is done the wrong way. The mental health strategies that will be most successful probably would involve interviewing and testing children at around the age of twelve to sixteen if the appropriately nonstressful screening instruments can be developed. Children who are extremely withdrawn and display antisocial personality traits can be invited (firmly) to participate in treatment programs that, in some cases, might require removing the child from his or her previous environment if the parents are causing problems. Actions such as removing the child from his home could be cast as a big move up rather than a punitive step; it is entirely possible for the remover to state that the child has won a prize and will be going to a special super quality school, and even hand over bribes.
It will be true that the children will be going to a special school, and it is important to make it comfortable and compassionate to them. They will be offered a lot more praise than they had received before.
The children must be taught prosocial behavior traits and profusely rewarded for approaching correct behaviors. It may help to have a mother figure and/or a father figure in a residential counselor, for example. Issues such as this should be subjected to objective evaluation and the program quickly changed to reflect new information.
At issue will also be the cost of this endeavor, as we may assume that, at least, initial costs will be high. There will be ways to develop income related to the work of the children which can offset costs. In addition, costs should include the costs to society that would be avoided given the success of a necessarily large diversion program like this.
In addition to diverting potentially psychotic shooters at a young age, it will be helpful to develop increased mental health screening and treatment for all ages. This effort will be costly as well. Nonetheless, we can expect a large response, and if sharing information about patients is built in to the medical records software, supervisors can compare and rate potentially dangerous traits or states in patients. At first, this cannot be used to rate patients unless they display obvious symptoms of homicidal psychosis, but the more patient evaluations there are, the better they can be compared and rated for homicidal risk. Since treatment is paired with ratings, the work will eventually fulfill a dual purpose: better mental health and reduced risk of homicides.
One reason why American medicine costs almost twice as much as the rest of the world: drug companies
The New York Times online edition yesterday published an article about how Amgen (a prominent drug maker) was able to have a bit of pork inserted into the emergency “fiscal cliff” bill passed on January 2. Herewith, I print an excerpt of key points in this article. These facts, while an egregious example of high costs in medicine, are only one of many similar methods that private companies use that increase their profits and raise costs for consumers.
The provision, inserted into the bill as “Section 632”, allows Amgen two more years of unrestricted pricing (read: however much the market will bear) on its oral drugs used to treat kidney dialysis patients. Only Senate staffers saw this provision until a few hours before it was voted upon in the full Senate; thus, there was no way to fight its inclusion without derailing the entire bill, creating a disaster for the entire economy (as we were all told.) The two year exemption from controls will cost up to $500 million in Medicare benefits.
Amgen makes a number of new drugs that are critical for the treatment of patients with kidney failure, including Epogen, which fights the progressive anemia associated with loss of erythropoeitin (normally secreted by the kidneys), one of many debilitating side effects of kidney failure. Epogen is given by injection, and, as such, was included in an earlier cost-controlling measure passed by Congress which exempted oral medications. The use of Epogen dropped by 25% in one year when perverse incentives that encouraged its use were ended by this cost-controlling legislation.
On December 19, 2012, Amgen pleaded guilty to illegally marketing Aranesp (another anti-anemia medication) and agreed to pay $762 million. The Justice Department stated that this penalty set a record for size. Amgen had revenues of $15.6 billion in 2011. Since 2007, Amgen employees and its political action group have paid $5 million to political candidates and committees. Major recipients of Amgen contributions include Senator Max Baucus, Democratic Chairman of the Senate Finance Committee, and Senator Orrin Hatch, Republican and ranking minority Finance Committee member. Republican Senator Mitch McConnell, the Senate Minority Leader, also got contributions, including a fund-raiser held this past December during the debate over the bill mentioned above. Amgen has also contributed to President Barack Obama in similar amounts. One of Senator Hatch’s top Finance Committee staff members, Dan Todd, was an Amgen employee until 2009 (he waited until 2011 to join Mr Hatch, but then worked directly on kidney dialysis legislative issues, which concern Amgen deeply).
The final “fiscal cliff” bill, which included provisions that prevented a 25% decrease in Medicare reimbursements to doctors on the first of the year, also called for a $4.9 billion dollar decrease in Medicare payments for dialysis over a period of ten years. Nonetheless, hundreds of millions more could have been cut from Medicare payments without the provision exempting oral dialysis medications for another two years.
We pay about 40 to 60% more for our medical care than do people in other countries with longer life expectancy than the US, countries such as Japan, Germany, Canada, and Great Britain. Most countries have “nationalized” control of their medical care systems, and people in those countries pay a basic tax which functions like an insurance premium, financing the system. These are known as “single payer” systems. In our country, each person is responsible for paying for his or her own medical expenses, and the government exerts little control over costs. Private companies such as drug makers control costs and charge whatever the market will bear.
The basic reason behind the high cost of medicine in this country is the fact that private companies exert control over government policy in a way that supports their profit margins and their control over markets. This is a result of our system of “democratic” government, in which those who wish to win elections and obtain government positions must pay vast sums of money to support their campaigns. Only those who are very wealthy or who can organize groups of private companies into financial support networks are able to present themselves to the public as viable candidates for office. Money alone is not enough to win office, but even those who are highly charismatic and who have highly popular campaign platforms still need large amounts of money, which they must raise privately.
Our so-called “democratic” system is completely controlled by private companies who pay for the campaigns of our elected officials. The publicity needed to be elected costs so much money that the candidates are forced to sell themselves to private companies, who have obligingly created systems of financing that conceal the true source of the money from the voters. Only when this unacknowledged system of money control is ended will democracy serve the interests of the majority of the people, rather than the interests of private companies.
Food crisis in the next couple of years
WORLD FOOD CRISIS
Posted on Dec 26 by John Mason:
According to the Food and Agriculture Organisation in Rome, global wheat production is expected to fall 5.2% in 2012 and yields from many other crops grown to feed animals could be 10% down on last year.
“Populations are growing but production is not keeping up with consumption. Prices for wheat have already risen 25% in 2012, maize 13% and dairy prices rose 7% just last month. Food reserves, held to provide a buffer against rising prices, are at a critical low level. It means that food supplies are tight across the board and there is very little room for unexpected events,” said Abdolreza Abbassian, a senior economist with the FAO. (source: Guardian, October 2012)
(Courtesy of Skeptical Science blog.)
My opinion:
If production continues to fall, within the next two years or so there will very likely be a world-wide food crisis, with some people in the worst areas starving. The price of food will rise astronomically if production falls next year and the year after that at the same rate that it fell this year.
There is a strong probability of this food disaster unless food production can be returned to, at least, last year’s levels. To account for population growth, production needs to increase every year, although population statistics have begun to level off in the last few decades. Nonetheless, we have seven billion people now and we are likely to have ten billion altogether by the time we top off (assuming that the above described crisis DOESN”T happen.)
Clearly, something has to give. Personally, I will resort to the retention of some basic food items in larger amounts. Say, twenty-five pounds of beans and the same of rice. And some corn meal.
Violence and Mental Disorders
In my opinion, those who look to greater legal restrictions on firearm ownership for protection from homicidal rampages by disturbed individuals are looking in the wrong direction. Instead of passing more laws, we should look to early and aggressive intervention with psychiatric treatment for individuals who are at risk of committing violent acts, as being a more cost-effective approach to reducing violence. It is important to remember that laws do not eliminate bad behavior, they only make it illegal–to reduce a behavior we abhor, it is better to address it directly.
I advocate the development of a mental health treatment system which is vastly more comprehensive than our current system. In this system, persons who express a need for psychiatric help would be only a part of the client base. Persons who show indications that they might have mental disturbances that lead to violent behavior will be identified by case-finding at points where they come into contact with police, medical providers, and even their neighbors. Persons who are identified can refuse treatment, but once identified, they can be restricted from firearm and weapon ownership unless they cooperate with mental health providers.
Under this type of system, if it were working properly, the Newtown killer would have been identified a long time ago as an at-risk individual. His mother would have been warned and advised to keep her firearms carefully locked up (or else have them removed from the house.) If there were issues in his life that were causing mental disturbances or leading to long-term resentment or anger, these might have been addressed if he was willing to accept treatment. In any case, he would have been removed from access to firearms of any kind, not just military-grade weapons.
Here are a couple of abstracts that deal with the issue of violence and mental illness. Despite what we are told in the media and by pundits/media experts, there is an association between mental illness and violence. Sociopathy, antisocial personality disorder, and alcohol abuse are the disorders most commonly found to exhibit violent behavior, but schizophrenia with paranoid ideation is also a major risk. Affective disorders such as depression, bipolar disorder, and dysthymia are not considered a high risk for other-directed violence.
In addition, there is an association of autism and Asperger’s syndrome with violence, but it is very different from the type of violence of which these abstracts speak. The violent behavior that occurs in patients with severe developmental disabilities like autism is typically poorly directed, episodic, and ineffectual. An important paper I found tried to distinguish “temper tantrums” and nonspecific behavior problems from actually violent behavior. It describes “an occasional aggressive outburst or behavioral disturbance” as questionable justification for applying a label of “violent” to a patient.
This paper states that, of reports reviewed and found methodologically sound, only 3 of 132 patients were considered clearly violent. If all reports of any quality were included, only 11 of 197 patients could be considered violent. The author goes on to note the incidence of violence in the USA among young people 12-24 years old is approximately 6 to 7 percent per year (in 1987.) The author concludes that there is no evidence for an increased risk of violence in Asperger’s syndrome. When violence occurs in a patient with this diagnosis, it is probably due to some co-morbid disorder.
This paper was published in the Journal of Autism and Developmental Disorders, Vol. 21, No. 3, 1991 by M Ghaziuddin, Luke Tsai, and N Ghaziuddin.
The kind of violent behavior seen in patients with Asperger’s syndrome is thought to be related to their difficulties with empathy. “Agitation and aggressive outbursts” are typically described in the few patients who show signs of violence. Some caregivers to these patients describe a syndrome of “meltdown” in which the patient becomes extremely agitated and may react violently if disturbed. In these cases, the patient seems to be in a hypersensitive state and probably cannot distinguish individuals in his/her environment, much less demonstrate empathy for the suffering they inflict on others.
This brings us back to the killings that occurred on Friday, December 14, in Newtown, Connecticut. The killer was believed to have Asperger’s syndrome and was living at home with his mother after leaving high school, apparently without graduating. There are no details available now about his condition after he left school or his reasons for not continuing. There is talk in the media to the effect that he was left alone in his mother’s large house, possibly for long periods of time. There is also a statement that he was obsessed with “Call of Duty”, a video game that simulates the activities of soldiers in WW II.
His mother, who was alone with him for the last four years since her divorce, is dead, so our main source of information about his recent activities is cut off. His father is said to have given his wife a generous settlement of nearly a quarter million dollars a year in alimony as well as a 1.6 million dollar house. He is not talking but in any case lost contact with the younger Lanza four years ago. Clearly, the family was extremely well to do both before and after the divorce.
It is possible that one reason for his mother’s ownership of several “sporting” (military grade) firearms was “self-protection” since she was so well off. Since the family lived in an affluent section of Newtown, it is likely that they felt anxious about intruders. A weapon such as a Glock ten mm pistol with fifteen rounds in the magazine, kept at the bedside, is a common household appliance in wealthy homes, and imparts a distinct feeling of security.
Unfortunately, the young Lanza appears to have developed a homicidal rage on or before December 14. What may have occurred between the young man and his mother is unknown, but I suspect that she angered him by some apparently inconsequential behavior or remark. Prior to that incident, he must have developed a resentment or feeling of anger at some consistent feature of his environment that may have gradually become an obsession.
It is possible that the incident that set off the young Lanza may have been dissipated relatively harmlessly in an object-destroying tantrum if he had not had firearms available. It is also possible that a firearm that is not self-loading (semi-automatic) and has ten or fewer cartridges in its magazine may have greatly impaired him in his homicidal rampage; such firearms are often referred to as “hunting” weapons, such as bolt-action rifles and shotguns.
However, it is also possible that, if he had only a hunting firearm, he would have been able to kill an equal number of people if he was able to reload fast enough. A single shot from a 12 gauge shotgun is much more likely to be lethal than a single shot from a Bushmaster .223, especially at close range.
The real point is that it is not the weapon, but the homicidal intent of the weapon’s holder, that causes homicidal violence. While a baseball bat is less effective than a Bushmaster, it is still fairly easy to kill someone by hitting them on the side of the head with a bat just once.
Since we cannot eliminate weapons and potential weapons from the environment (especially because there are said to be 300 million firearms in the USA), it would be more effective to reduce the impulse to homicide by detecting and treating the potential aggressor.
Psychiatr Clin North Am. 1997 Jun;20(2):405-25.
Violence and homicidal behaviors in psychiatric disorders.
Asnis GM, Kaplan ML, Hundorfean G, Saeed W.
Source
Department of Psychiatry, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Abstract
Our review evaluating the relationship between violent/homicidal behaviors and mental illness/psychiatric disorders used many different data including that assessing the prevalence of violent/homicidal behaviors in former psychiatric inpatients (just before hospitalization, during hospitalization, and after discharge) as outpatients and in community samples as well as evaluating the prevalence rate of psychiatric disorders in people who actually engaged in violent/homicidal disorders (jail detainees, prison inmates, and community samples). Irrespective of which line of investigation, there was convincing evidence that violent/ homicidal behavior was associated significantly with mental illness. Although earlier investigations failed to control for important variables, such as age and sociodemographics, most studies reviewed in this article did control for these items, further underlining the association of violence and mental illness. The question of whether specific psychiatric diagnostic categories are associated with violent/homicidal behavior is less definite across the various studies reviewed. The presence of substance abuse and dependence and alcohol abuse and dependence as well as antisocial personality disorder are particularly associated with an increased risk of violent/homicidal behaviors. The risk for these latter behaviors in schizophrenia, mood disorders, and anxiety disorders may appear somewhat greater than that for a general population but are not of the same magnitude of that for substance abuse or antisocial personality disorder. Interestingly, our outpatient study found that homicidal behaviors were not associated with any specific psychiatric diagnosis. Although understanding whether specific psychiatric diagnostic categories are more prone to violent behaviors may be of importance, most studies have been shortsighted regarding this evaluation. All the studies presented in this article except the ECA project, presented diagnostic data where either the presence of one psychiatric disorder did not preclude the diagnosis of another or assigned subjects/patients into the severest disorder of a predetermined hierarchy of diagnoses or only selected their principal/primary diagnosis. Thus, the effect of having a solitary psychiatric disorder (only one disorder present) as well as the effect of comorbidity per se on the relationship of psychiatric disorders and violent/homicidal behaviors were unexplored. Only the ECA study by Swanson and colleagues reported on the effect of comorbidity. As reviewed earlier in the article, Swanson et al found that comorbidity of psychiatric diagnostic categories further increased the risk of violent/ homicidal behaviors. In most cases, it was many more times than simply adding the rates of either diagnosis alone. Because more than 54% of respondents of the National Comorbidity Survey study who had one DSM-III-R diagnosis also had at least a second Axis I diagnosis, the association of violent/homicidal behaviors to mental illness may even be stronger than originally believed. Within the relationship of violent/homicidal behaviors and mental illness, this article suggests a number of particular risk factors. As just reviewed, substance/alcohol abuse and antisocial personality disorder as well as the presence of comorbid psychiatric disorders are significant risk factors. Which particular comorbid illness increases the risk still needs further elaboration. Studies must continue to try to define and understand the relationship of violent/homicidal behaviors in mental illness. Although mental disorders per se are significantly associated with violent/homicidal behaviors, it is reasonable to believe that targeting certain subgroups of patients should be helpful. Probably the presence of psychotic symptoms is a significant risk factor in violent/ homicidal behaviors in the mentally ill. Only one of the studies reviewed in this article evaluated this issue. (ABSTRACT TRUNCATED)
PMID: 9196922 [PubMed – indexed for MEDLINE]
Encephale. 2009 Dec;35(6):521-30. doi: 10.1016/j.encep.2008.10.009.
[Risk of homicide and major mental disorders: a critical review].
[Article in French]
Richard-Devantoy S, Olie JP, Gourevitch R.
Source
Département de psychiatrie et psychologie médicale, CHU d’Angers, 4, rue Larrey, 49933 Angers cedex 9, France. richarddevantoy@orange.fr
Abstract
INTRODUCTION:
Tragic and high profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed. It is also generally thought that schizophrenia predisposes subjects to homicidal behaviour.
OBJECTIVE:
The aim of the present paper was to estimate the rate of mental disorder in people convicted of homicide and to examine the relationship between definitions. We investigated the links between homicide and major mental disorders.
METHODS:
This paper reviews studies on the epidemiology of homicide committed by mentally disordered people, taken from recent international academic literature. The studies included were identified as part of a wider systematic review of the epidemiology of offending combined with mental disorder. The main databases searched were Medline. A comprehensive search was made for studies published since 1990.
RESULTS:
There is an association of homicide with mental disorder, most particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. However, it is not clear why some patients behave violently and others do not. Studies of people convicted of homicide have used different definitions of mental disorder. According to the definition of Hodgins, only 15% of murderers have a major mental disorder (schizophrenia, paranoia, melancholia). Mental disorder increases the risk of homicidal violence by two-fold in men and six-fold in women. Schizophrenia increases the risk of violence by six to 10-fold in men and eight to 10-fold in women. Schizophrenia without alcoholism increased the odds ratio more than seven-fold; schizophrenia with coexisting alcoholism more than 17-fold in men. We wish to emphasize that all patients with schizophrenia should not be considered to be violent, although there are minor subgroups of schizophrenic patients in whom the risk of violence may be remarkably high. According to studies, we estimated that this increase in risk could be associated with a paranoid form of schizophrenia and coexisting substance abuse. The prevalence of schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of personality disorder or of alcohol abuse/dependence is higher: 10% to 38% respectively. The disorders with the most substantially higher odds ratios were alcohol abuse/dependence and antisocial personality disorder. Antisocial personality disorder increases the risk over 10-fold in men and over 50-fold in women. Affective disorders, anxiety disorders, dysthymia and mental retardation do not elevate the risk. Hence, according to the DMS-IV, 30 to 70% of murderers have a mental disorder of grade I or a personality disorder of grade II. However, many studies have suffered from methodological weaknesses notably since obtaining comprehensive study groups of homicide offenders has been difficult.
CONCLUSIONS:
There is an association of homicide with mental disorder, particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Homicidal behaviour in a country with a relatively low crime rate appears to be statistically associated with some specific mental disorders, classified according to the DSM-IV-TR classifications.
PMID: 20004282 [PubMed – indexed for MEDLINE]
I won’t pretend to be an expert on how to save yourself if you get pushed on to the subway tracks at a station by some madman who takes a dislike to you for wearing green. The most I can say is that I’ve ridden the New York City subway a couple of times. Nonetheless, my interest was aroused when I saw a story about someone who was killed, and the story stated that the last death had been three years earlier (despite the massive size of the subway system). Clearly, the system operates fairly well.
In Singapore and some other major Asian cities, there is a glass wall on the platform that is closed until the train stops, preventing anyone or anything from intruding into the train’s space. This is more to prevent suicides than accidental or homicidal incidents. Suicides are much more common in Asia.
A few days ago in New York, a man was pushed onto the tracks by another man who was aggressively insane. Before the incident, the man who pushed him was noted talking to himself, then arguing with bystanders. After the man was pushed on the tracks, about 15 seconds later, the train arrived in the station and killed him. There was a photographer in the station who took many flash photos to alert the driver, despite being threatened by the man who threw the victim on the tracks. Unfortunately, the driver could not stop in time. The victim’s last name was Han, and he was 48. Here are a few interesting comments from eyewitnesses to other incidents.
TTTTrina
East Hampton, NY
People do step up when they can.
Years ago, at the Jamaica LIRR station, I got shoved by the exiting pack of commuters so that I fell between the train and the platform, jammed up to my waist. Knowing the train constantly shifted back and forth, I was terrified, and frantic to climb out. Some gentleman, without hesitation, leaned down, and pulled me up from under my armpits, dumped me on my bottom, on the platform away from the train door, and continued on his way without even the briefest hesitation. Yes, I had a ripped skirt and bloody knees, but I was otherwise in tact and forever grateful to the stranger who never even heard my “Thank you thank you thank you.” Everyone else, like rats leaving a sinking ship, just continued to push their way OVER and AROUND me, as if I were a pile of garbage. Not even a railroad employee came to ask how I was…I eventually got up, went to work, had to quickly buy a new dress and pantihose and clean up my wounds, but never forgot the experience.
The same thing happened to a businessMAN, and a big fuss was made over him, his torn suit, and making sure the DOORS to the front cars on the LIRR trains stopping at Jamaica did NOT open on the curve, where these incidents occurred. In that case, he made enough of an uproar that railroad employees came to the rescue, the train was delayed, and the press got wind of it.
The bottom line, is people will take a risk when they can, and others will look the other way.
R.K.
Toronto, Canada
Years ago I saw a woman jump in front of an incoming subway train. She fell between the rails. I saw a look of terror on the driver’s face that I can still recall. The woman left her purse and a note behind – clearly a suicide attempt. Someone pulled an emergency power switch. Firefighters showed up and talked to the woman under the train and were able to pull her out alive and well. I hope she reconsidered her decision. There are many suicide attempts in subways and they are not publicized in order to avoid copycats. According to that theory, the current publicity could have further terrible consequences. The incident confirmed to me that laying between the rails is the best among bad choices.
John L
Manhattan, NY
If someone is on the tracks and needs to be rescued, here’s how you do it. If you’re able bodied, immediately find another able bodied person. Each of you, side by side, kneel at the platform’s edge and each extend a hand toward the victim. Command the victim to reach toward you with both arms. Each rescuer should grip the victim right at his/her wrist and tell the victim to grip each of you similarly. Then each of the rescuers can pull the victim to safety. This can be done in seconds.
I used it once, with a fellow rescuer, decades ago, to rescue a man who had fallen into the water between a wharf and a docking ferry that was about to crush him to death. As his feet cleared the danger zone the ferry crunched in the wharf. He would have been dead in an instant. It took us less than five seconds to effect his rescue.
Robin
Bay Area
Gawker has a good article:
http://gawker.com/5965694/what-to-do-if-you-fall-onto-the-subway-tracks-…
From an ex-subway conductor (in the gawker article):
The best thing you can do is run as far down the platform as you can (in the opposite direction from where the train enters the station) and wave your arms frantically to get the train operator and passenger’s attention. Believe me, the passengers WILL be doing the exact same thing, as nobody wants to see you get run over and their train get delayed. If you can get to the far end of the platform, it gives the train more room to stop, and there is a ladder at the end of each platform where you can climb back up — do NOT try to climb up from where you are. So many people have been killed trying to jump back up rather than getting away from the entrance end of the station.
Do NOT trust the pits between the tracks —- they are often right next to the third rail which can be just as dangerous (and note that the wooden planks are not designed to hold a human’s weight – they are there to protect the energized rail from drips and weather) and the train operator is less likely to see you if you’re in there. And don’t duck under the train, because most stations do not have enough clearance for the average human. And do NOT jump down onto the tracks to try to save someone else. The best thing you can do is run on the platform towards the tunnel where the train enters so you can get the operator’s attention sooner. Waving your arms over the tracks will tell the operator to stop immediately.
Then there is the balls-out, pedal to the metal approach advocated by Danny Adelante:
I’m a foreigner, and relatively new to NYC. So last March, on my way home from a party at about 3:00am (it was St. Patrick’s Day), I was getting into the N/R station at 8th Street/NYU, and I realized I had gotten into the Downtown/Brooklyn station instead of the Uptown/Queens. Having already swiped my card, I didn’t want to go back outside and wait 15 minutes, or walk to another station……… so I jumped down onto the tracks and walked over to the Uptown side. Everyone was staring at me, but I was pretty drunk, so I didn’t care. I was able to pull myself back up onto the tracks, but it wasn’t the easiest thing in the world.
Also, I had never heard of the third rail. I wasn’t avoiding it (because I didn’t know it was a thing), and somehow I managed not to step on it.
wahine18 is a confirming witness:
I’ve seen people do that more than once. Always thought they were crazy.
and this from VeryShinyLikeAHoliday:
I saw someone climb onto the tracks to get his phone. I thought “Oh, that sucks, he has to get a new phone” because it seriously would not have occurred to me to climb down for something like that. And then he climbed down and I was thinking “!” Nothing happened to him; he climbed back up without incident, but I still think that was incredibly stupid.
So there is a finite probability of surviving after this sort of behavior.
In Singapore and some Asian cities, the Plexiglas wall which controls access to the train and the tracks gives you no choice but to live and board the train. If you want to commit suicide, you’re going to have to find another way.
Finally, from itradedfameforlove, here is a freer solution than the glass walls in Singapore:
In Vienna, they plan for this. (I love the German speaking world). At every station, there is a gap underneath the platform large enough for you to hide from an oncoming train. Everyone is aware of this. The NY subway system is badly in need of an upgrade.
These examples show you the nuggets of information you can get from mining comments on popular news stories. Frequently these nuggets are more productive than the original story.
Conrad Theodore Seitz 