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General interest/Health/Money
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Cancer, Viruses & Informed Consent

by Fran Johns

A commentary about cancer screenings and surrounding questions posted yesterday brought a thoughtful reader response: “Science, including public health,” wrote davidlosangeles, “is an evolving process.”  Unquestionably so.

What we the consuming public need to understand is not the science as much as the personal responsibility. Today’s New York Times features another story on the front page of the Business section (some of us still follow old-fashioned newsprint) by Duff Wilson about “Research Uproar at a Cancer Clinic”, namely the highly regarded Carle Foundation Cancer Center in Urbana, IL. It’s another instance of respected professionals questioning each others’ respectability — or protocols, or carefulness, to use gentler terms than are actually being used. One of the issues raised is that of informed consent, and here is where we the consuming public come in. Whether we are cancer patients, CFIDS sufferers or mostly healthy people susceptible to the usual ails, it is incumbent upon the individual to know what he or she is agreeing to, and to know as much as possible about the projected outcome. We’re all in a giant clinical trial here on the planet. Nobody really knows about the outcome, but participation in mini-trials along the way can be valuable and is certainly laudable. Just know what you’re doing.

I am a continuing participant in the Women’s Health Initiative study now well into its second decade, though the primary issues are over and done with. I didn’t try any new hormone replacement therapies or drastic lifestyle changes, mainly because I’m pretty wimpish, but I read every word of the small print in the reams of documents that came along and tried hard to appreciate what the pitfalls and premises were. It was a valuable study, and hopefully will continue to turn up usable data.

Other studies are underway, and more will undoubtedly begin, regarding the current hoopla over XRMV, and H1N1. And heaven only knows how many other viruses, techonological advances, genetic possibilities and scientific wonders are out there to create great harm or great benefit.

Since the benefits are to the buyers, it’s appropriate that the buyer beware.

California/General interest/Health/Politics & Causes
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Cancer Gurus, CDC – Whom can you trust?

by Fran Johns

In the news of the past several days are reports that the American Cancer Society is about to concede that screenings for breast and prostate cancer — long touted as the holy grail of preventive medicine — have instead led to a great deal of over-treatment, and worse. Plus admission by the Centers for Disease Control and Prevention that their pooh-poohing of Chronic Fatigue Syndrome has left a lot of folks suffering, perhpas needlessly, for decades.

Who in the world is there left to trust?

I do trust my physicians at Kaiser, and continue to hope the crafters of our elusive health reform bills are looking in Kaiser’s direction. My breast cancer was detected through a regular mammogram. How frequent these screenings should be is still a matter of debate, but in my case early detection led to a quick mastectomy, a small price to pay for living happily a few more years after. (The ever-after business is not a principal to which I subscribe.) On the other hand, small as my tumor was, who’s to say it might have sat there harmlessly a few more years untreated? Please don’t get me wrong; I would not have opted for waiting to see. Just wondering.

I’m not so sure about prostate cancer screening. But since what seems nearly every man I know over 65 has been diagnosed with prostate cancer after a routine screening, it’s possible to wonder about this too. An October 21 New York Times article cites a new analysis by Dr. Laura Esserman, a professor of surgery and radiology at the University of California, San Francisco and director of the Carol Frank Buck Breast Cancer Center and Dr. Ian Thompson, professor and chairman of the department of urology at the University of Texas Health Science Center, San Antonio that “runs counter to everything people have been told about cancer: They are finding cancers that do not need to be found because they would never spread and kill or even be noticed if left alone.” We the healthcare consumers aren’t getting any breaks. Here’s a whole new dilemma to mull over and decide upon: to screen or not to screen, to treat or not to treat. In one group of gentlemen friends I know, others newly diagnosed with prostate cancer are invited to hang out for an hour or so and listen to the pros and cons of the various treatment options — because within the group are men who have gone down at least 4 or 5 different paths.

Another re-evaluation, this one a little more sinister, centers around the dismissive attitude long held by the venerable Centers for Disease Control and Prevention, guardian of our national health and welfare where things like viruses and other causes of infectious disease are concerned. In a Times op ed piece titled ‘A Case of Chronic Denial‘, Hillary Johnson reports on a recent study in the journal Science about a virus found in prostate cancers which will be referred to here by its shorter name, XRMV. It now turns out that there may be a link between XRMV and Chronic Fatigue Syndrome, more commonly referred to these days as CFIDS, and the work now going on in this area of research could be significant in treatment of the latter. Having had a number of friends and family members suffering from CFIDS, I admit to being among those who occasionally thought it might be partly in one’s head, but also aware of the degree of misery and disability CFIDS can bring.

This space is not a health authority. It is, rather aimed at those of us 50-somethings and over, many of whom have trusted many of the above. Trust is good. Open-mindedness is better. Questioning might be best of all.

California/General interest/Health/Lifestyle/Money/Politics & Causes/USA
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Obama shifts justice department resources away from medical marijuana

by Fran Johns

A little ray of sanity from President Obama: the feds won’t be going after legitimate users of medical marijuana. This will be welcome news in San Francisco, where federal raids on legal suppliers during the Bush administration met with widespread protests; possibly unwelcome news in Los Angeles, which is cracking down on its over-supply of dispensaries; and interesting news in the U.K., where guardian.uk.com reported on it Monday.

The US justice department today told federal law enforcement officials to shift resources away from investigation and prosecution of medical marijuana users and suppliers.

In a memo sent this morning to federal prosecutors, officials at president Barack Obama’s justice department said that prosecutions of individuals who are clearly using or supplying marijuana for medical purposes are “unlikely to be an efficient use of limited federal resources” if the targets otherwise comply with state and federal laws.

Fourteen states allow some use of marijuana for medical purposes, though it remains banned under federal law. The Bush and Clinton administrations – the first to grapple with the conflict – essentially ignored the state laws, treating medical marijuana as illegal.

“The federal government is no longer at war with the 13 states that have chosen to allow patients to use marijuana for medical purposes,” said Bruce Mirken, spokesman for the Marijuana Policy Project, which favours decriminalisation of the drug.

“It’s going to provide relief to a lot of people who have been anxious about whether or not they’re going to be arrested for helping patients get their doctor-recommended medicine,” said Tom Angell, a spokesman for Law Enforcement Against Prohibition, which claims 1,500 former police, prosecutors, border patrol agents and other one-time fighters in the war on drugs among its membership.

This would’ve been good news for my sister, whose brief search for relief a few decades ago was mentioned in the post below. It would’ve made life a little easier for a lot of people with AIDS in recent decades.  Set aside the arguments pro or con recreational use; when a drug is known to help suffering people, and is legal in a particular city or state, wasting federal tax dollars to interfere seems to make very little sense.

The memo doesn’t legalize marijuana or end prosecution of illegal, for-profit sales etc. It does, though, leave these to local federal officials. And clarifies the federal government’s position.

It puts into writing remarks by attorney general Eric Holder, who in March said the federal government would end raids on legitimate medical marijuana dispensaries. Obama has indicated he is sympathetic to medical marijuana use, noting during the presidential campaign that his mother had died of cancer and that he saw no difference between morphine prescribed by doctors and marijuana used to relieve pain.

I don’t do pain very well. Given its prevalence in long, drawn-out illnesses today, I’m in favor of whatever palliative care and pain-relieving medicines there are. It is nice to have a president who understands.

via Obama justice department to shift from investigating medical marijuana cases | World news | guardian.co.uk.

California/General interest/Health/Lifestyle/Money/Politics & Causes/USA
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The aches & pains of medical marijuana

by Fran Johns

An article in Sunday’s New York Times details the struggle in Los Angeles to regulate the cannabis dispensaries which have proliferated around the  city over the past six or eight years, raising the old medical marijuana questions about how to control, whether to tax and how useful it is in the first place. Reporter Solomon Moore cites Oakland, California’s Harborside Health Center as the place to which many are looking for a model.

‘Our No. 1 task is to show that we are worthy of the public’s trust in asking to distribute medical cannabis in a safe and secure manner,’ said Steve DeAngelo, the pig-tailed proprietor of Harborside, which has been in business for three years.

Harborside is one of four licensed dispensaries in Oakland run as nonprofit organizations. It is the largest, with 74 employees and revenues of about $20 million. Last summer, the Oakland City Council passed an ordinance to collect taxes from the sale of marijuana, a measure that Mr. DeAngelo supported.

Mr. DeAngelo designed Harborside to exude legitimacy, security and comfort. Visitors to the low-slung building are greeted by security guards who check the required physicians’ recommendations. Inside, the dispensary looks like a bank, except that the floor is covered with hemp carpeting and the eight tellers stand behind identical displays of marijuana and hashish.

There is a laboratory where technicians determine the potency of the marijuana and label it accordingly. (Harborside says it rejects 80 percent of the marijuana that arrives at its door for insufficient quality.) There is even a bank vault where the day’s cash is stored along with reserves of premium cannabis. An armored truck picks up deposits every evening.

City officials routinely audit the dispensary’s books. Surplus cash is rolled back into the center to pay for free counseling sessions and yoga for patients. “Oakland issued licenses and regulations, and Los Angeles did nothing and they are still unregulated,” Mr. DeAngelo said. “Cannabis is being distributed by inappropriate people.”

I don’t know where Los Angeles will go with all this, or how well Harborside will continue to operate for how long. What I do know is that marijuana serves a real medical purpose. Probably serves a real recreational purpose too, and there’s the rub; but since I missed the pot party — thank heavens, as I am addicted to anything that comes down the pike, and please don’t try to tell me one cannot get addicted to marijuana — I can’t address that issue. Everything I know is anecdotal, but convincing.

Decades ago my beloved sister was suffering acute gastro intestinal distress, much later identified as a symptom of celiac disease but this was before anybody really knew anything about celiac sprue. One day she said, “You know, everybody at X High School either smokes pot or knows where to get it. Could you get me some so I could at least try it?” Well, even though the statute of limitations would probably protect the surviving players I think I won’t go into details of this adventure. But what I learned was: buying and selling illegal pot is a little scary for the novice, but the deal was easy and nobody went to jail. It did indeed give relief to my suffering sister. Though both of us wished she could have that relief on an ongoing basis, we reached a mutual conclusion that the risk was not worth the reward, and that was the end of that.

Fast forward to the 1990s, when everyone I knew with AIDS knew how marijuana could relieve some symptoms of the disease, and most had a supply. I was in San Francisco by then, and celiac disease pales in comparison to AIDS. I don’t even recall how legal it was for this relief; too many other issues were more important. But again, I saw its usefulness.

The Times article quotes Christine Gasparac, a spokeswoman for California Attorney General Jerry Brown, as saying his office is getting calls from law officials and advocates around the state asking for clarity on medical marijuana laws. I know that’s tough, and that the answer will in many cases be left to the courts. I also know that legalizing marijuana, whether here in woo-hoo California or elsewhere, raises a multiplicity of sticky issues.

But still. It’s a useful drug. If Big Pharma were producing and marketing it, it would probably come in a little pill that costs a fortune and would be covered by expensive insurance policies. Every governmental body in the U.S. needs money. Taxes raise money. Are there not some dots that could be connected here?

General interest
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Helping Mom die

by Fran Johns

Flight #12 had not even left the gate in San Francisco yesterday before the conversation was underway. The man in seat #16F was talking to his new friend in #16E about his trip: another of many undertaken by himself and his siblings to their mother’s home in the long process of packing up, sorting through, tossing out, agonizing over. The scene is a familiar one to millions of Americans: aging, often isolated mom; far-flung, often cash-strapped, over-stressed children; a bewildering assortment of issues to be dealt with, ranging from health to housing to family dynamics.

I, of course, am the mom. Well, not #16F’s mom, and currently in good health and of relatively sane mind. But 76, with children across the continent and a dizzying amount of Stuff to be dealt with if my husband should have the crass inconsideration to die first and leave me to deal with it. (Actually, he’s been very good about making arrangements for disposition of his Stuff, but still, there are those piles and boxes and shelves of miscellany and cupboards of chipped dishes. And closets full of clothes from the 1950s and still perfectly wearable… but I digress.)

My sisters and I were fortunate that our dad looked after our mom as she slowly died, swearing they had a fine conversation the night before although dementia had long stolen her ability to converse; my father created his own realities. Twenty years later, the town of Ashland, VA, with the assistance of Randolph-Macon College, looked after our dad, because indeed it takes a village. But fewer and fewer of us have the traditional village, and more and more of us have the complications: dementia, physical issues, personal problems, too little financial and emotional resources, too much Stuff.

There is help. There are community centers and assisted living arrangements, there is the new Villages concept (more about that one in the next week or so) and an array of other anti-isolationist possibilities; there are nonprofits of every sort, from the Family Caregiver Alliance to multiple physical/emotional-needs groups to my alltime favorite, in name at least, the National Study Group on Chronic Disorganization. God willing, we may even get health care, but thanks to those earlier, similar battles we at least now have Medicare and Medicaid.

But too many of us still put it all off, and it falls to the children. We cling to the past in the form of too many boxes of old photos and letters and opera programs; we drive too long and invite fender-benders or worse; we think that old chair is worth too much for a garage sale; we forget to take the pills.

The issue, of course, is not about dying; it’s about living. Living as well as possible for as long as possible, as closely as possible to what we would choose for ourselves. But here’s what happens eventually: mom dies. It’s tough, but it’s probably okay.

I gave my card with the True/Slant website on it to the nice people in #16E and #16F; maybe they’ll check in. When I get back home, though, I think I’ll clean out some files.

General interest/Lifestyle/Politics & Causes/USA
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Right time for gay rights?

by Fran Johns

President Obama, having repeated his promise to end “don’t ask, don”t tell” on Saturday, got an additional nudge from the National Equality March on Sunday. Tens of thousands of gay rights supporters from across the country poured through the streets of the nation’s capital to demand equal rights for LGBT citizens. They have their work cut out for them. With a few small, scattered gains having been made, there are battlegrounds shaping up everywhere from Maine to California over the issues highlighted by the events of this past weekend.

My friend Joe, who celebrated 35 years with his partner last summer, asked why I haven’t written about gay rights. Boomers and Beyonders, he says, have a unique perspective. “We have won a few battles that won’t have to be fought again, but there’s a long road ahead and the netroots now taking the lead need to have strong support from the veterans.”

So here goes.

While reiterating his promise to end “don’t ask, don’t tell,” Obama  gave no timetable for doing so. It’s time. Given everything else on his plate, those of us who support gay rights may be willing to cut the president a little slack, but this small step toward clearing some of the large injustices gays and lesbians have lived with since approximately forever is one Obama should be taking soon. 2010 sounds about right.

Other gay rights battlegrounds are active in Maine, where a ballot measure would repeal marriage rights for gays and lesbians, in Washington where a referendum must pass if full domestic partnership benefits are retained, and elsewhere. Meanwhile, according to Change.org, the U.S. Conference of Catholic Bishops “is planning a major statement on marriage in November, preparing to issue new language about how the church views same-sex marriage. Unfortunately, the new language is more of the same… hateful, tired and representative of a theology that views people who are LGBT as less than.”

Compared to the record of togetherness set by Joe and Robert, my marital history is pretty lousy. (Up until this, my final marriage, that is, and its extraordinarily happy 17 years.) So it is hard to see my marital state being threatened by theirs being legitimized. Joe and I were also part of an AIDS support group during the 1990s, and witnessed tragic injustices suffered by dying young men whose hospital doors were barred to those who loved them best. A lot more needs changing than just “don’t ask, don’t tell.”

Senate Armed Services Committee Chairman Carl Levin (D-Michigan) was quoted by Elizabeth Williamson and Neil King in Monday’s Wall Street Journal as saying it was “now possible ‘to get a buy-in from the military’ to end a policy opposed by gays and many liberals since it was passed by Congress in 1993.” The monumental pile of global problems to be solved may keep Obama from seizing this good opportunity; gay rights supporters could keep that door open until he does act.

Global issues aside, one home front fact remains: LGBT Americans have been unjustly treated in innumerable ways, for innumerable years.

Getting rid of “don’t ask, don’t tell” seems a very good way to start putting things right.

General interest/Lifestyle/Money/Politics & Causes/Sports
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Presidents, Patriotism & the Blue Angels

by Fran Johns

The Blue Angels were in town for San Francisco’s Fleet Week in recent days, along with assorted presidents for the President’s Cup golf tournament and planners for the 20th anniversary of the Loma Prieta earthquake, all of which made for a patriotic sort of time. Not to give away the punch line, but two out of the three fell victim to the famous San Francisco fog, which little factoid offers too many metaphors even to think about.

The Blue Angels bring with them, it has to be noted, a lot of ambivalence. Something about all that military might, ear-shattering noise and expensive fuel, plus the radar that lets them know when anyone is considering a quick nap… but then, they are incredibly good at what they do, and strangely beautiful streaking around up there.

Letters to the editor, however, poured in. Against the warrior culture, the display of power, the celebration of aggression and militarism, pollutants in the air. In favor of flyover celebrations and tradition. Nobody mentioned interruption of naps. I remain ambivalent.

A flag-waver to the core, I find myself resentful that flag waving has been hijacked by those who mean God Bless America and the hell with everybody else. I’m even resentful of the hijacking of God Bless America, which is a beautiful song and shouldn’t mean please don’t bless anyone else, Ma’am.

By the end of the weekend, Tiger Woods had come off a hero again, the skies had cleared just enough for a few aerobatics, the spectators had spent a lot of money on extra San Francisco sweatshirts and foot warmers to get them through the festivities and the planners were still planning for the impending earthquake celebration, all proving that Nature bats last. And a few flags of all sorts were out.

Patriotism used to feel good. I yearn for the day when it can feel good again, and we patriots are too busy promoting peace and goodwill around the globe for other stuff. And earthquakes and tsunamis and hurricanes are more to be feared than somebody else’s nuclear missiles. It could happen. Nature, sports and celebrations notwithstanding, does bat last.

Health/Politics & Causes/USA
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Public option still alive: believe it…or not

by Fran Johns

The fact that there are still believers in the public option, and its inclusion in whatever health bill eventually survives, may say more about the believers than the belief. But Nancy Pelosi hasn’t yet caved, and a few among the many who see this as the only way real reform will happen are still betting on it. Two of those are strategic technology consultant Robert Weiner and his research chief Rebecca Vander Linde who penned an op ed in the San Francisco Chronicle Friday. I’m not a gambler, but I cheer their position.

Opponents’ caricatures have become commonplace – the Republican National Committee video puts House Speaker Nancy Pelosi side by side with James Bond’s villainess, Miss Galore. The Iowa Republican, a party newsletter, on Sept. 18 called Pelosi “inept at her job.” Actor and former Sen. Fred Thompson labeled her “naive.” On Sept. 10, master Republican strategist Karl Rove asked, “How much capital will Speaker Nancy Pelosi have” to pass health care?

Pelosi answered that in a conversation Sept. 29 at House Judiciary Committee Chairman John Conyers‘ 80th birthday party, after the Senate Finance Committee had just rejected the Medicare-like public option for all by a 10-13 vote: “We will not be deterred. We will pass the bill.”

The public option is still viable. The House is set to pass it. It is neither “fading” nor “waning” (New York Times) nor on “life support” (ABC News).

Citing a recent CBS News poll that showed public support for the public option rose from 57 to 68 percent after President Obama’s speech to Congress in September, Weiner and Vander Linde argue that keeping it is the only way to “counter the insurance stranglehold” that makes our current system so dysfunctional — and that Pelosi will keep it in the blended version of the three House bills and eventually see it through.

For those who doubt Pelosi’s ability to pass the bill, know that she has passed every bill she has brought forward, usually with 60-plus margins, since the Democrats recaptured the House in 2006. These include the Recovery Act, Credit Card Bill of Rights, Homeowner Affordability, Lilly Ledbetter Fair Pay, Troubled Assets Relief Program (TARP) and State Children’s Health Program expansion to 11 million youths.

About the Senate…

Senate Finance Chair Max Baucus, D-Mont., said he could not vote for the public option because “I can’t see how we get to 60 votes.” The Constitution and the law require only a majority 51. The Senate amended its rules to require a “supermajority” to end debate. This procedure, called cloture, is a pander to allow special-interest contributors (Baucus has a million dollars from insurance companies) to block bills. Pelosi is right to support Senate “reconciliation,” which would allow a simple majority to pass health reform Americans want.

We believers may turn out just to be dreamers, but we’re still sending e-mails to Speaker Pelosi.

via Public option still alive – believe it.

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