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Abortion/California/compassion and choices/Death and Dying/Dying Unafraid/End-of-Life/General interest/Health/Law/Politics & Causes/Reproductive rights/seniors/Women
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End-of-life compassion slowly winning

by Fran Johns

If you think you might die some day, and you’d like to do it with as much dignity and as little pain as possible, things are looking up. Which is encouraging to me, a believer in end-of-life and reproductive rights both — and progress in one out of two causes is something to cheer about.

credit acpinternist.org
Credit acpinternist.org

The outlook for a compassionate end to this life in the U.S. continues to brighten. In a recent New York Times article summing up advances that are being made in multiple states,reporter Erik Eckholm quotes my good friend Barbara Coombs Lee, President of Compassion and Choices: “There is a quiet, constant demand all over the country for a right to die on one’s own terms, and that demand is likely to grow as the baby boomers age.”

Lee, a baby boomer herself, is in a position to know. She has been at the forefront of the death with dignity movement since it was in its infancy. We first met when I was researching Dying Unafraid (Synergistic Press, 1999) and she was head of Compassion In Dying, headquartered in Seattle. That group had formed, I learned during a weekend spent with leaders and volunteers in the late 1990s, “because we got tired of reading headlines about people with AIDS jumping off of highway overpasses. And we thought there had to be a better way to die.” Compassion In Dying later merged with End-of-Life Choices, which had itself grown out of the somewhat more in-your-face Hemlock Society, to become Compassion and Choices. (And I am proud to have been a part of C&C since its inception as a volunteer, former local board chair, current leadership council member and general cheerleader.)

In those early days, all was not optimism. While Oregon was proving that a physician-aid-in-dying law could work, efforts elsewhere were failing with heartbreaking irregularity. The one most painful to me culminated in the defeat, in 2006, of a bill which would have legalized compassionate dying — in other words, with the aid of one’s physician if one so chose — in California. Assembly members Patty Berg and Lloyd Levine introduced the legislation, and polls showed overwhelming support among Californians, including a majority of California physicians. Victory seemed all but certain, despite a vigorous and expensive campaign against the bill by the Catholic Church (not most Catholics, just Catholic officialdom) and the California Medical Association (of which a small percentage of CA doctors are members.) At the judiciary committee hearing chaired by then CA Senator Joe Dunn  — who had loudly proclaimed his support —  Dunn suddenly had a change of heart. Something about a conversation with his priest, he said in a rambling commentary. Dunn then cast the deciding vote against the bill and it died an unnatural death in committee. A few weeks later Dunn was termed out of the California legislature and took a job — surprise, surprise — as CEO of the California Medical Association. It was not my personal most encouraging experience with the democratic process.

Now, however, sanity is prevailing. The option of choosing a compassionate death is legal in Washington, Vermont, Montana and New Mexico and the cause is gaining in other states. As Steve Heilig, another highly esteemed friend who is co-editor of the Cambridge Quarterly of Healthcare Ethics, points out in a current letter to the New York Times, “Progress is possible if carefully and ethically pursued.”

If only there could be a careful, ethical pursuit of progress — instead of the ongoing, reckless, politically and religiously-driven backward march we’re seeing — for reproductive rights.

California/economics/Lifestyle/Money/seniors/teens
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You and your brain are in the crosshairs of neuromarketing

by Fran Johns

Why does this not seem altogether good news? Details have recently been revealed about new insights into the human brain — and how marketers can make use of them to sell more stuff.

Just in from Daily News & Analysis — which reportedly “has fast entrenched itself in the lives of a young and dynamic readership in India’s commercial capital Mumbai” and from that position offers its readers “a composite picture of India and the world” — is a story about new discoveries in neuroscience that are expected to revolutionize the marketing world. How? By using tests to measure, with a high degree of accuracy, your brain’s responses to whatever catches your eye. Well, maybe not your brain, but focus groups of brains enough like yours that sellers will be homing in on you as never before. It’s called EEG-based neuromarketing.

It’s all covered in a new book titled The Buying Brain: secrets for selling to the subconscious mind, by A.K. Pradeep, founder and CEO of NeuroFocus Inc and a Silicon Valley entrepreneur whose MySpace page says that his brain research company is going to change the world as we know it forever.

“Companies around the world, including the largest and most successful global giants”, reports DN&A, “are increasingly turning to EEG-based neuromarketing that measures the whole brain because it offers far more accuracy, reliability, and actionable results than conventional market research methods.” That “actionable results” business refers to you and me, Mr. & Ms. Target Market.

But to move from the Daily News & Analysis over to Amazon.com, here are a couple of tips from its Product Description segment which says “The Buying Brain is your guide to the ultimate business frontier – the human brain.”

1) Your brain gets scared in some stores. Your conscious mind doesn’t know it, of course, but your subconscious mind views sharp corners as a threat. Who knew?

2) Too much of one thing can make your brain go blind. “Repetition blindness” sets in when we see too many of the same objects. (The TV department of Best Buy either has not figured this out yet, or has found that TV buyers like to buy blindly.)

3) Men and women are hard-wired to shop differently. Men shop by looking for targets; women shop by looking for landmarks. Women explore their territory; men make maps.

There are fewer and fewer secrets. You may indeed be able to improve your memory or strengthen brain function, but marketers are probably going to be one step ahead of you. That caveat emptor phrase has morphed from “buyer beware” to Be Very Afraid.

California/Health/Lifestyle/Medicine/physicians/teens
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Medicinal pot, Yes. Legal pot, bad idea

by Fran Johns

Wafting around California these days is a lot of rhetoric about legalizing marijuana, a proposition (#19) that will be on the ballot in November. Californians being Californians — I’m one; I know — and pot being pot, there is no shortage of heated opinion. Here is one more.

Countless Americans suffer from chronic or short-term conditions which could be relieved by marijuana. To deny them such relief simply makes no sense at all. The sooner everyone wakes up to the logic of marijuana as comfort care, and it becomes universally legal and available, the better.

Legalizing the weed for recreational delight, though — essentially making it available to all comers — makes very little sense at all. It’s an addictive substance, folks. It messes with your mind. All we need is a whole new population of messed-up folks to add to the messes we already have.

This is just one addict’s opinion. But if one addict’s opinion is only anecdotal, some others, below, are worthy of serious consideration. They were offered by the California Society of Addiction Medicine in an op ed piece by the Society’s president, Dr. Timmen Cermak, in the San Francisco Chronicle, August 22. The Society is taking no position on Prop. 19, Cermak explains, “but we wish Californians would look at the research before they make up their minds on how to vote.” This space applauds that suggestion.

The Society of Addiction Medicine is made up of “the doctors who specialize in the treatment of drug abuse; we work every day with people addicted to drugs, including alcohol,” Cermak writes. “We are a diverse group of doctors committed to combining science and compassion to treat our patients, support their families and educate public policy makers.”

Since very few of the Society of Addiction Medicine’s 400 physician members believe prison deters substance abuse, legalizing marijuana would have that small, back-handed benefit. “Most (of us) believe addiction can be remedied more effectively by the universal availability of treatment,” Cermak writes. “When, according to the FBI, nearly half – 750,000 – of all drug arrests in 2008 in the United States were for marijuana possession, not sales or trafficking, we risk inflicting more harm on society than benefit. Prop. 19 does offer a way out of these ineffective drug policies.”

But other research should raise alarm bells. Cermak’s essay is excerpted below, with a few points worth pondering bold-faced:

“Two-thirds of our members believe legalizing marijuana would increase addiction and increase marijuana’s availability to adolescents and children. A recent Rand Corp. study estimates that Prop. 19 would produce a 58 percent increase in annual marijuana consumption in California, raising the number of individuals meeting clinical criteria for marijuana abuse or dependence by 305,000, to a total of 830,000.

“The question of legalizing marijuana creates a conflict between protecting civil liberties and promoting public health… between current de facto legalization in cannabis clubs and revenue-generating retail marijuana sales… The society wants to make sure voters understand three basic facts about how marijuana affects the brain:

“– The brain has a natural cannabinoid system that regulates human physiology. The flood of cannabinoids in marijuana smoke alters the brain’s delicate balance by mimicking its chemistry, producing a characteristic “high” along with a host of potential side effects.

“– Marijuana is addicting to 9 percent of people who begin smoking at 18 years or older. Withdrawal symptoms – irritability, anxiety, sleep disturbances – often contribute to relapse.

“– Because adolescent brains are still developing, marijuana use before 18 results in higher rates of addiction – up to 17 percent within two years – and disruption to an individual’s life. The younger the use, the greater the risk.

“Marijuana is a mood-altering drug that causes dependency when used frequently in high doses, especially in children and adolescents. It’s important that prevention measures focus on discouraging young people from using marijuana.

“Prop. 19 erroneously states that marijuana “is not physically addictive.” This myth has been scientifically proven to be untrue. Prop. 19 asks Californians to officially accept this myth. Public health policy already permits some addictive substances to be legal – for instance, alcohol, nicotine and caffeine. But good policy can never be made on a foundation of ignorance. Multiple lines of scientific evidence all prove that chronic marijuana use causes addiction in a significant minority of people. No one should deny this scientific evidence.”

So we could use the tax revenues from legalized pot. But it may surely be worth thinking twice about what the concurrent costs will be, in illness and crime and human lives.

California/Health/Lifestyle/Medicine/New York/seniors/USA/Women
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Early cancer tests, surgeries questioned

by Fran Johns

Was this mastectomy necessary? It’s a question few breast cancer survivors want to ask, and one that few are likely to answer absolutely. But after years of aggressive emphasis on early diagnosis and treatment, some previous imperatives are being called into question. Noting that breast biopsy has long been considered the “gold standard,” a report in today’s New York Times addresses the new rethinking:

As it turns out, diagnosing the earliest stage of breast cancer can be surprisingly difficult, prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant, according to an examination of breast cancer cases by The New York Times.

Advances in mammography and other imaging technology over the past 30 years have meant that pathologists must render opinions on ever smaller breast lesions, some the size of a few grains of salt. Discerning the difference between some benign lesions and early stage breast cancer is a particularly challenging area of pathology, according to medical records and interviews with doctors and patients.

Diagnosing D.C.I.S. “is a 30-year history of confusion, differences of opinion and under- and overtreatment,” said Dr. Shahla Masood, the head of pathology at the University of Florida College of Medicine in Jacksonville. “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”

Much of the current finger-pointing is toward pathologists, where their money comes from, whether they are ‘certified’ or not and in general, how good a job they do.

In 2006, Susan G. Komen for the Cure, an influential breast cancer survivors’ organization, released a startling study. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment.

After the Komen report, the College of American Pathologists announced several steps to improve breast cancer diagnosis, including the certification program for pathologists.

For the medical community, the Komen findings were not surprising, since the risk of misdiagnosis had been widely written about in medical literature. One study in 2002, by doctors at Northwestern University Medical Center, reviewed the pathology in 340 breast cancer cases and found that 7.8 percent of them had errors serious enough to change plans for surgery.

This space has argued occasionally for reconsideration of yearly mammograms and for longer, stronger consideration of other options before a mastectomy is performed. Especially in the case of older women.

Would I insist on further studies or opt for less radical treatment if I were diagnosed with breast cancer today? Probably. Can I undo the mastectomy I had at 72? Not exactly. Second-guessing is beside the point for someone who is healthy and fit, but asking questions won’t ever hurt.

Earliest Steps to Find Breast Cancer Are Prone to Error – NYTimes.com.

California/Education/Lifestyle/Literature/Politics & Causes/seniors/USA/World Affairs
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Afghanistan suggestion: Make tea, not war

by Fran Johns
Greg Mortenson in Afghanistan 3500ppx
Image via Wikipedia

A glimmer of good news from the endless bad-news war in Afghanistan: the people doing the fighting are in touch with someone who was winning, a long time before they started fighting.

In the frantic last hours of Gen. Stanley A. McChrystal’s command in Afghanistan, when the world wondered what was racing through the general’s mind, he reached out to an unlikely corner of his life: the author of the book “Three Cups of Tea,” Greg Mortenson.

“Will move through this and if I’m not involved in the years ahead, will take tremendous comfort in knowing people like you are helping Afghans build a future,” General McChrystal wrote to Mr. Mortenson in an e-mail message, as he traveled from Kabul to Washington. The note landed in Mr. Mortenson’s inbox shortly after 1 a.m. Eastern time on June 23. Nine hours later, the general walked into the Oval Office to be fired by President Obama.

Mortenson, of course, hasn’t been winning any battles. What he has been winning are the trust, and occasionally the hearts, of Pakistani tribal leaders in a long-running effort to educate their daughters.

The story of this school-building crusade, which came about as a thank-you gesture after Mortenson received help during a mountaineering mishap, is told in Three Cups of Tea. The story of the book — it went nowhere when published with a warrior subtitle, then caught on like wildfire when Mortenson won a mini-battle to bring it out as his originally intended plea for peace — is told in the talks he has been making around the country for several years.

To hear Mortenson talk, as this writer has happily done several times, is to become a believer in hope. Most of us have been coming home saying, “Gee, could we spend a few billions less on platoons and give a few billions to Greg Mortenson’s schools instead?” Mortenson, a giant of a man who clearly has no personal agenda, is not a motivational speaker. But his tale is compelling.

The title of that first book comes from his discovery, early on, that the first step in building anything — school, relationship, whatever — is to sit down over three cups of tea. Hundreds of cups of tea and a few near-death episodes later, he has quietly managed to forge relationships with isolated tribes and build schools for girls who will grow up — perhaps — to think there’s something good about America. Some schools have been destroyed (and occasionally rebuilt), some relationships have gone sour, but the idea that something good can be developed between the U.S. and that wild land without bombs and guns — or despite guns and bombs — is heart-warming. And more than a little surprising.

Mr. Mortenson, 52, thinks there is no military solution in Afghanistan — he says the education of girls is the real long-term fix — so he has been startled by the Defense Department’s embrace.

“I never, ever expected it,” Mr. Mortenson, a former Army medic, said in a telephone interview last week from Florida, where he had paused between military briefings, book talks for a sequel, “Stones into Schools,” and fund-raising appearances for his institute. (The Central Asia Institute, a nonprofit foundation dedicated to community-based education, primarily for girls, in Pakistan and Afghanistan.)

But thanks to a few military wives, who read Three Cups of Tea and then insisted their husbands read it too, a connection was made between the warriors and the peacemaker. It is an unlikely, and in many ways perilous, partnership, but if you’ve read the book or heard the talk you probably feel a glimmer of optimism.

The military’s Mortenson-method efforts  in Afghanistan thus far are outlined in Elisabeth Bumiller’s July 18 New York Times report. His own job will now involve convincing the elders that he hasn’t become a tool of the military. It’s a strange world out there. But it seems somehow more hopeful.

Unlikely Tutor Giving Military Afghan Advice – NYTimes.com.

California/Health/Lifestyle/Money/seniors/USA/Women
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Death wish for boomers & elders?

by Fran Johns

Reaching for the hemlock in order not to be a burden…. this seems a little farther than most of us want to go. But the idea is crossing more than a few aging minds, reports CNN intern Sachin Seth on a recent blog.

Rather than burden their children with the daunting task of caring for them as they age, some baby boomers may be considering an extreme form of “relief.” Suicide.

Psychiatrist Mark Goulston says he’s been approached by some middle-aged patients who say they’d rather “take a bottle of pills” than inconvenience their children.

Dr. Goulston blames the problem on the impatient nature of “millennials” – the offspring of baby boomers – a trait he says was passed down from the boomers themselves.

Adding to their angst is their own experience of taking care of elderly parents, which sometimes leads to feelings of resentment. Baby boomers don’t want their own children to grow to resent and begrudge them when they get old and feeble.

There’s a video exchange between Goulston and CNN’s Don Lemon that’s worth watching, but won’t lift your spirits much.

Add to this don’t-be-a-burden dilemma — and it IS a dilemma that crosses the mind of everyone over 60 and most folks who have a parent over 60 — the bizarre situation of estate taxes right now and the whole business of dying gets seriously complicated. It was okay last year, when you knew estate taxes were magically going to disappear on January 1, 2010, so the focus was on staying alive until then.

California/crime/Education/Law/Lifestyle/Media/Politics & Causes/seniors/USA
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The Oakland you didn't see on TV

by Fran Johns

[youtubevid id=”0MNcWUX5oU4″]You may have read the reports of how few of the vandals in Oakland CA last week came from Oakland. But what you may not have read about (or seen) were the peaceful folks who also gathered to encourage both protest and peace.

There was after-dark violence in Oakland, contained within a fairly small area, following the involuntary manslaughter verdict of transit officer Johannes Mehserle in the death of Oscar Grant, reported on TV news across the country. Oakland takes a lot of guff. There were rallies in support of Mehserle, and gatherings in remembrance of Grant, and worries because many wanted a murder conviction. Following the verdict, a crowd estimated at fewer than 1,000 gathered downtown for a peaceful demonstration of their dissatisfaction with the verdict. A small group of about 100, after the sun went down, turned to vandalism and looting. There were 78 arrests; three-quarters of those arrested were not from Oakland. It’s a sadly familiar story, especially in the way it was reported; what was reported was far from the whole story.

Interestingly, right in the middle of the troubled block is the headquarters of an organization called Not In Our Town (NIOT). “We thought it was important to set the record straight,” the NIOT folks said in an e-mail today, “by filming the encouraging community response taking place right outside our door. Here are the young people of Oakland expressing their love of this city, and their commitment to keeping the peace, no matter their reaction to the verdict.”

NIOT is a national movement that “encourages and connects people who are responding to hate and building more inclusive communities.” On their home page is a U.S. map featuring recent hate incidents (red dots) and recent anti-hate action (green dots.) The green dots outnumber the red dots, which is a heartening development to recognize, although the red dots tend to get better press.

This space is a certified member of NIOT. This space is regularly fingered as a Pollyanna. But the active (as opposed to the certified, who are often wimps) NIOT people are not Pollyannas, but courageous and simultaneously gentle souls. Check them out. You may want a NIOT in your town.

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