American rage: We the People, and our legislative leaders, are out of control

On the floor of the U.S. House of Representatives, Rep. Randy Neugebauer (R-TX), angered by Rep. Bart Stupak’s (D-Mich) support of the health reform, called the bill a “baby-killer.” Protesters screamed racial epithets at Reps. John Lewis (D-GA) and Andre Carson (D-Ind) and yelled anti-gay slurs at Representative Barney Frank (D-Mass.) This comes not that long after Rep. Joe Wilson (R-SC) shouted “You lie!” at the President of the United States during a speech to Congress.

Just in case anyone is inclined toward civility, the Rush Limbaughs (“we must defeat these bastards”) and the Glenn Becks (only “losers” need help…) of the world are fanning every little flame around. The rants and rages are not limited to right-wingers, it’s just that those are the most prominent these days, what with congressmen standing on the balcony whipping up the crowd — while anti-anti-reformers shout their own epithets.

All this rage may not be healthy. A recent ‘Personal Journal’ piece in the Wall Street Journal explored the idea that anger is, in many cases, an illness unto itself.

Scream at the boss? Snap at a colleague? Throw your cell phone into your @#$%%&* computer monitor? If so, you may find yourself headed to anger-management classes, which have become an all-purpose antidote for fit-throwing celebrities, chair-throwing coaches, vandals, road ragers, delinquent teens, disruptive airline passengers, and obstreperous employees.

Demand for such programs is coming from courts seeking alternatives to jail sentences and companies hoping to avoid lawsuits and office blowups. Aware that high-pressure jobs can make for hot tempers, some professions offer pre-emptive anger management. A few state bar associations now require “civility” training for lawyers renewing their licenses. And as of last year, hospitals must have programs for “disruptive” physicians as a condition of accreditation.

Programs run the gamut from $300-an-hour private therapists to one-day intensive seminars, weekly group sessions or online courses with no human interaction. Many advertise that they satisfy court requirements—even if all they offer is six CDs and a certificate of completion.

It’s not clear if the programs work, as few studies have analyzed their effectiveness. There are no licensing requirements for anger-management trainers—anyone can open a business. And since participants don’t usually sign up voluntarily, trainers say it’s possible to complete a program without actually changing one’s behavior.

Part of the problem is that professionals can’t agree whether a pattern of angry outbursts signals a mental illness or simply a behavior issue. As a result, people who need psychiatric help may instead get shunted into a short-term anger-management course. Employers and courts may not adequately evaluate people before sending them for anger interventions, nor provide sufficient follow-up.

There have been some notable failures—the Columbine shooters, for example, attended anger-management classes before their 1999 killing spree. Amy Bishop, the University of Alabama biologist who allegedly killed three colleagues and wounded three more last month, had been advised by prosecutors to take anger-management classes after an earlier incident in 2002. Her lawyer says he doesn’t know if she did.

It is hardly the same, but the rage that exploded into these tragedies is still akin to the shouted obscenities of recent political scenes. Maybe all those shouters aren’t mentally ill, just badly behaved. Maybe they are protected by the First Amendment. Maybe the anger and ugliness is, as more than a few defenders maintain, perfectly excusable in response to “totalitarian tactics” or other perceived wrongs. But does that make it right? Or worth the loss of civility?

Maybe a little anger management — and civility — would be a good idea.

Demand for Anger -Management Grows. But Does It Work? – WSJ.com.

You can go home again — but should you?

Yearning to go back to your childhood? It may or may not work.

For many of us, memories of what seems such a carefree, safer time are linked to a place. And now, thanks to Google Maps and other sites, we can find – and sometimes physically revisit – those houses and territories at the center of a powerful, nostalgic pull. But, like adoptive children searching for birth mothers (and vice versa), the adventure carries risk. That site at the end of the rainbow might be psychological gold – or it can turn out to be a pot of mud.

Saturday’s Wall Street Journal featured a ‘Journal Report’ article and related story about the going-home phenomenon, including one particularly fascinating segment:

When John Beebe, a Jungian analyst in San Francisco, was invited to speak at a conference in China, he decided he would try to find the house he had lived in there as a child. His father had been a military attaché in the 1940s, and Dr. Beebe remembers living in a “rather grand” house before the family was evacuated and before his parents divorced.

But when he finally found the spot, the house was gone. It had been replaced, in his words, by “drab communist housing.” That visit—and watching “Empire of the Sun,” a World War II movie about a boy separated from, and then reunited with, his parents—triggered overwhelming feelings of grief, Dr. Beebe recalls. “Twenty-seven years of Jungian analysis, and I didn’t mourn my childhood until then,” he says.

“A lot of people haven’t fully left home,” Dr. Beebe says. “Some people need to go back [in order] to move on.” Others, while claiming to be “just curious” about seeing their childhood home, may have a deeper motive, he suggests: a desire to reconnect to the way they felt as a child before life—school, careers and families—required so many compromises. “In adapting to the world, we all lose some of our soul,” Dr. Beebe says. “When we make the journey back, we find some of our soul again.”

As the eminent Dr. Beebe happens to be a friend of this space, that sent us to the telephone to ask for free advice to pass along to readers about the pros and cons of returning to childhood in this manner. (Before signing off on the advice, Beebe said he “wanted to put in a plug for the amazingly good writer Kathleen A. Hughes” who authored both stories referenced above, proving out his own reputation as both acclaimed analyst/speaker and genuine nice guy. This space hereby strongly recommends you go out and buy Saturday’s WSJ.)

As far as the potential benefits of revisiting childhood space go, Beebe says that “for all of us, particularly as we get older, withdrawing the projections we make onto things that interfere with right relationships” can be very good. In other words, perhaps “our parents were not as tall as we thought.” Or that room so huge or that shadow so all-encompassing. “We all have a subjective relationship to childhood,” he explains, “and it kind of ties us to unreality. When we see where (our memory) was right, and where it was wrong, it somehow sets the soul at rest.”

As to the potential pitfalls of geographical/psychological returns, Beebe says that “memory is powerful, but so is reality. Certainly I was more upset than I’d imagined in China. In a way, I hadn’t grieved enough. These returns tend to stir things up; it can be shocking to be flooded with emotions and I didn’t expect this. I was taken by surprise, but ready.”

Making the return, and dealing with possible impact, may be something you don’t want to undertake all by yourself. “As they used to say about psychedelic drugs in the 60s,” Beebe comments, “it’s better to have someone around to guide you through the trip. It’s not good to be alone.”

In my 60s I returned to my birthplace in Porto Alegre, Brazil, where the tales and photos I’d grown up with showing idyllic hillsides overlooking the bay turned out to be a jumble of rooftops and high walls. In my 40s I returned to the site of my earliest memories, the Nashville, TN house in which I remembered running merrily up and down the length of a giant kitchen. It was, in reality, roughly 6′ x 8′. Today Google Maps tells me it’s gone, replaced by what seems to be an educational facility for the church (same old church) that was two doors down the street. As there are too many metaphors here even to begin considering, if I do any further revisitation I may invite John Beebe to go along.

What about you? Any more going-home-again stories out there?

Is marijuana a medicine?

Of course it is, to answer this rhetorical question posed by a January 18 headline in the Wall Street Journal. New Jersey is the most recent to recognize that fact, becoming the 14th state to legalize use of marijuana for medicinal purposes. The New Jersey law, signed this week by outgoing Governor Jon Corzine, limits use to patients with specific illnesses such as cancer, HIV/AIDS, multiple sclerosis and ALS (Lou Gehrig’s disease) and specifically forbids grow-it-yourself projects.

What’s needed now are serious studies of how good a medicine it really is, and these aren’t happening very fast. As outlined in a New York Times article this week, getting permission to study the weed is no easy task.

Despite the Obama administration’s tacit support of more liberal state medical marijuana laws, the federal government still discourages research into the medicinal uses of smoked marijuana. That may be one reason that — even though some patients swear by it — there is no good scientific evidence that legalizing marijuana’s use provides any benefits over current therapies.

Lyle E. Craker, a professor of plant sciences at the University of Massachusetts, has been trying to get permission from federal authorities for nearly nine years to grow a supply of the plant that he could study and provide to researchers for clinical trials.

But the Drug Enforcement Administration — more concerned about abuse than potential benefits — has refused, even after the agency’s own administrative law judge ruled in 2007 that Dr. Craker’s application should be approved, and even after Attorney General Eric H. Holder Jr. in March ended the Bush administration’s policy of raiding dispensers of medical marijuana that comply with state laws.

“All I want to be able to do is grow it so that it can be tested,” Dr. Craker said in comments echoed by other researchers.

Marijuana is the only major drug for which the federal government controls the only legal research supply and for which the government requires a special scientific review.

“The more it becomes clear to people that the federal government is blocking these studies, the more people are willing to defect by using politics instead of science to legalize medicinal uses at the state level,” said Rick Doblin, executive director of a nonprofit group dedicated to researching psychedelics for medical uses.

In California, where a mish-mash of laws and enforcement policies can bewilder all but the expert — (and there are many experts) — the Supreme Court ruled yesterday that lawmakers acted improperly in amending the voter-approved legalization of medicinal marijuana to limit the amount critically ill patients might have:

The high court ruled lawmakers improperly “amended” the voter-approved law that decriminalized possession of marijuana for “seriously ill Californians” with a doctor’s prescription by limiting patients to eight ounces (227 grams) of dried marijuana and six mature or 12 immature plants.

The Compassionate Use Act, passed by California voters in 1996, set no limits on how much marijuana patients could possess or grow, stating only that it be for personal use.

In 1997, the state’s Supreme Court defined a lawful amount as enough to be “reasonably related to the patient’s current medical needs.”

The state’s quantity limits were passed in 2003 as part of a voluntary identification card program designed to protect against both drug trafficking and wrongful arrest by allowing police to quickly verify a patient’s prescription.

The court on Thursday let stand the voluntary card program but found that the limits it imposes should not “burden” a person’s ability to argue under the Compassionate Use Act that the marijuana possessed or grown was for personal use.

California Attorney General Jerry Brown said in a statement the decision “confirms our position that the state’s possession limits are legal” as applied to medical marijuana cardholders.

While conceding that marijuana may have some just-for-fun attraction too, I can’t vouch for the recreational weed. Thankfully, since I am addicted to anything that comes down the pike and question the view that marijuana is non-addictive,  it hadn’t made its way to small-town Virginia when I was experimenting with other mood-altering substances. But I do know its medicinal value. My beloved now-deceased sister could have had much suffering relieved with legal pot. Countless friends I loved and worked with during the height of the AIDS pandemic would have suffered less with legal, easily-accessible marijuana.

We are past time to establish, through definitive studies, the medicinal benefits of this natural bounty, and make it legally available to those in desperate need.

Skip the cold meds – hit the gym

Just in case the cold weather and a few sniffles are luring you toward the couch in front of the TV, you may want to stop and read Wall Street Journal health writer Laura Landro’s article in today’s “Personal Journal” section first.

Regular workouts may help fight off colds and flu, reduce the risk of certain cancers and chronic diseases and slow the process of aging.

Who knew? Well, most of us knew, we just haven’t been convinced. But Landro’s piece is stuffed — no offense to couches or potatoes — with evidence from new research, including data on fitness v the common cold. The fit, it turns out, have fewer and less severe colds, of shorter duration than the afflictions of their less-fit fellow creatures.

No pill or nutritional supplement has the power of near-daily moderate activity in lowering the number of sick days people take,” says David Nieman, director of Appalachian State University’s Human Performance Lab in Kannapolis, N.C. Dr. Nieman has conducted several randomized controlled studies showing that people who walked briskly for 45 minutes, five days a week over 12 to 15 weeks had fewer and less severe upper respiratory tract infections, such as colds and flu. These subjects reduced their number of sick days 25% to 50% compared with sedentary control subjects, he says.

Medical experts say inactivity poses as great a health risk as smoking, contributing to heart disease, diabetes, hypertension, cancer, depression, arthritis and osteoporosis. The Centers for Disease Control and Prevention says 36% of U.S. adults didn’t engage in any leisure-time physical activity in 2008.

Even lean men and women who are inactive are at higher risk of death and disease. So while reducing obesity is an important goal, “the better message would be to get everyone to walk 30 minutes a day” says Robert Sallis, co-director of sports medicine at Fontana Medical Center, a Southern California facility owned by managed-care giant Kaiser Permanente. “We need to refocus the national message on physical activity, which can have a bigger impact on health than losing weight.”

[INFORMED]

Researchers are also investigating whether exercise can influence aging in the body. In particular, they are looking at whether exercise lengthens telomeres, the strands of DNA at the tips of chromosomes. When telomeres get too short, cells no longer can divide and they become inactive, a process associated with aging, cancer and a higher risk of death.

A companion article goes further, suggesting that “spurring more exercise out of the half of Americans who are already active is just as important as coaxing the sedentary off the sofa.” The jury on this, however, is still out. For the time being, you could focus on warding off the January chest cold and stretching out the telomeres.

The Hidden Benefits of Exercise – WSJ.com.

Your latte or your life

At last, an addiction I can be proud of. Having given up nicotine, alcohol and sin in general over the years, I was beginning to despair about the remaining unbreakable habits:  sugar, butterfat… and caffeine.  But now, suggests Wall Street Journal health writer Melinda Beck, caffeine might just be putting a little distance between Alzheimer’s and me. It might not be an anti-dementia guarantee, and it could have a few downer side effects, but still. A ray of sunshine on the addiction scene.

To judge by recent headlines, coffee could be the latest health-food craze, right up there with broccoli and whole-wheat bread.

But don’t think you’ll be healthier graduating from a tall to a venti just yet. While there has been a splash of positive news about coffee lately, there may still be grounds for concern.

  • Cancer: Earlier studies implicating coffee in causing cancer have been disproven; may instead lower the risk of colon, mouth, throat and other cancers.
  • Heart disease: Long-term coffee drinking does not appear to raise the risk and may provide some protection.
  • Hypertension: Caffeine raises blood pressure, so sufferers should be wary.
  • Cholesterol: Some coffee—especially decaf—raises LDL, the bad kind of cholesterol.
  • Alzheimer’s: Moderate coffee drinking appears to be protective.
  • Osteoporosis: Caffeine lowers bone density, but adding milk can balance out the risk.
  • Pregnancy: Caffeine intake may increase the risk of miscarriage and low birth-weight babies.
  • Sleep: Effects are highly variable, but avoiding coffee after 3 p.m. can avert insomnia.
  • Mood: Moderate caffeine boosts energy and cuts depression, but excess amounts can cause anxiety.

So let’s see. My bone reports have actually upscaled recently, so all that butterfat and a few bone meds are outpacing the latte. I can fall asleep midway through a cappuccino, and I don’t have time to be depressed. Unlikely to get pregnant. Addiction situation looks better and better. Further insight comes from Duke University Medical Center psychophysiologist Jim Lane, who’s been studying the effects of caffeine for more than 25 years, and from a distinguished addiction psychiatrist (I wonder if I should volunteer for a study) at Vanderbilt University.

“When I went to medical school, I was told that coffee was harmful. But in the ’90s and this decade, it’s become clear that if you do these studies correctly, coffee is protective in terms of public health,” says Peter R. Martin, a professor of psychiatry and pharmacology at Vanderbilt University and director of the school’s Institute for Coffee Studies, founded in 1999 with a grant from coffee-producing countries.Still, many researchers believe that the only way to draw firm conclusions about something like coffee is through experimental trials in which some subjects are exposed to measured doses and others get a placebo, with other variables tightly controlled. When that’s been done, says Duke’s Dr. Lane, “the experimental studies and the [observational] studies are in very sharp disagreement about whether caffeine is healthy or not.”

Harmful Effects

His own small, controlled studies have shown that caffeine—administered in precise doses in tablet form—raises blood pressure and blood-sugar levels after a meal in people who already have diabetes. Other studies have found that caffeine and stress combined can raise blood pressure even more significantly. “If you are a normally healthy person, that might not have any long-term effect,” says Dr. Lane. “But there are some groups of people who are predisposed to get high blood pressure and heart disease and for them, caffeine might be harmful over time.”

[HEALTHCOLfront]

Epidemiologists counter that such small studies don’t mirror real-world conditions, and they can’t examine the long-term risk of disease.

The debate goes on. Do people remember how many cups they drink? How big is your mug? How random is your study? Did your ancestors have a history of — uh, oh, my parents met and married in Brazil where I was born. Maybe that’s where it all started.

I will welcome your comments on caffeine addictions; they will be compiled over a take-out tall extra-foamy latte.

Seeking Coffee’s Benefits to Health – WSJ.com.


End-of-year look at end-of-life issues

Two end-of-year stories offer stark insights into end-of-life issues in the U.S., one from a purely financial perspective, the other purely about compassion. Between the two, the conflicted American way of dying comes into focus.

First the finance. The Wall Street Journal of December 30 features a front page story by Laura Saunders about wealthy families coming to grips with the disappearance, thanks to a quirk of Congress, of the estate tax beginning January 1, 2010. It will only disappear for a year, and in 2011 it will return at a higher rate with lower exemption. For those approximately 5,500 super-rich taxpayers to whom this tax applies, a lot of money is at stake. Presumably if a member of one of these families is now near death every possible measure will be taken to keep him or her alive into the new year and presumably that will be done for the best of reasons. But imagine the struggles involved if someone is near death this time next year, and his or her heirs stand to benefit in the millions if that death happens before January 1st rather than soon after. An altogether new meaning will have to be added to “letting go.” Not something one really wants to think through.

But the last two sentences of the WSJ article demonstrate how extensively the scenario is indeed being thought through, not from the heir’s point of view but from the soon-to-be-departed:

The situation is causing at least one person to add the prospect of euthanasia to his estate-planning mix, according to Mr. (Andrew) Katzenstein (a lawyer with) Proskauer Rose (LLP in Los Angeles.) An elderly, infirm client of his recently asked whether undergoing euthanasia next year in Holland, where it’s legal, might allow his estate to dodge the tax.

His answer: Yes.

However hard we might try to eliminate costs (and cost/benefit ratios) from considerations of end-of-life care and decision-making, they are here to stay and sure to remain complex. Another complexity — and this one should not be as difficult as it continues to be — surrounds the subject of palliative care. Palliative care is simply comfort care. It means, do everything possible to insure that a dying person might go about his or her dying with as little pain and anguish as humanly, medically possible.  A long, careful look into the issue is in the New York Times most recent “Months to Live” series article, “Hard Choice for a Comfortable Death” by health writer Anemona Hartocollis.

In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.

In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.

The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open.

“Obviously, he’s much different than he was when he came in,” Dr. Edward Halbridge, the hospice medical director, told Mr. Oltzik’s wife. “He’s calm, he’s quiet.”

Mr. Oltzik’s life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken. That drug, lorazepam, is a strong sedative. Mr. Oltzik was also receiving morphine, to kill pain. This combination can slow breathing and heart rate, and may make it impossible for the patient to eat or drink. In so doing, it can hasten death.

Mr. Oltzik received what some doctors call palliative sedation and others less euphemistically call terminal sedation. While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians like Dr. Halbridge, in consultations with patients or their families, are routinely making tough decisions about the best way to die.

Writer Hartocollis covers in thoughtful detail the long, sometimes conflicted process through which the medical team and the patient’s family arrived at his eventual, peaceful death. The article looks at the multiplicity of issues that cry out for reasoned public dialogue — palliative care, physician aid in dying, end-of-life choice, family decision-making — that have been raised on this page in recent months and will be back again. It’s a story worth reading in full.

And meanwhile, the beginning of the year is a fine time to get your advance directives and other documents completed and to have those conversations with friends and loved ones that keep you from becoming another Terri Schiavo. Getting this done is one great way to put dying behind you and go about the business of living for a happy new year.

Months to Live – Hard Choice for a Comfortable Death – Sedation – Series – NYTimes.com.

Thank-you notes come due

E-mails are efficient, text messages — God help us — are here to stay, but the handwritten thank-you note is not dead yet. If Geoffrey Parker and I have anything to do with it, furthermore, the handwritten note will survive and prosper. Parker’s commitment to this disappearing art form was outlined in a Wall Street Journal report by Cheryl Lu-Lien Tan. If you want to make points with gift-givers, you might note his words of wisdom.

During the holidays, Geoffrey Parker, branding consultant for Parker Pen Co. and great-grandson of its founder, George S. Parker, is careful not to overlook what he calls a ‘critical’ aspect of the gift-giving season: thank-you notes.

‘It’s common courtesy,’ he says. ‘If someone does something for me, I need to acknowledge that.’ Mr. Parker sometimes thanks a gift-giver or party host with a phone call, email or text message. But he believes that these modes are ‘insufficient’ and always follows up with a handwritten message. ‘As these modern electronic devices become more common and overused, they become cheap,’ he says.

And more power to Mr. Parker. A phone call or an e-mail message might acknowledge your gratitude, but a handwritten note has soul. Quick: think of a piece of paper with words written on it, addressed to you, by someone of your acquaintance. Some little shred ties those words to that person, doesn’t it? Handwriting used to serve that purpose.

A quick check with several teacher friends turned up no one who could recall the time when cursive was routinely taught throughout the fourth grade year (though you can now learn to write online.) By fourth grade today every student on the planet knows how to text in abbreviated expletives. But nothing conveys a message — expletive or smiley face — like a handwritten note. You will be forgiven if you use a ball point pen, though Parker prefers a fountain pen with a broad nib and fountain pens can emote better than anything else. The flourish that such an implement can create — think John Hancock before he got commercialized — used to be able to paint eloquent pictures in words. My father (broad nib, dark blue ink) favored x’s at the end of his sentences, but when he left off with a dash you knew you had done something fine.

Today, a thank-you note is also an investment. But go ahead, spend the 44 cents, drop a line. Your appreciation will be appreciated.

Of COURSE there's a Santa Claus

We are, it turns out, born to be believers. And that’s a good thing. According to a recent article by Wall Street Journal reporter Shirley S. Wang, imagination is a valuable asset, beginning in childhood:

Imagination is necessary for learning about people and events we don’t directly experience, such as history or events on the other side of the world. For young kids, it allows them to ponder the future, such as what they want to do when they grow up.

“Whenever you think about the Civil War or the Roman Empire or possibly God, you’re using your imagination,” says Paul Harris, a development psychologist and professor at the Harvard Graduate School of Education who studies imagination. “The imagination is absolutely vital for contemplating reality, not just those things we take to be mere fantasy.”

So we start out with Santa Claus and the tooth fairy, and grow up to comprehend health reform. As my daughter, a nurse, said to me today, “Really, Mom, I just have to take everyone else’s word for it; there’s no way I can read those thousands of pages.” Nor I — but we are people of (varying) faith.

Although we grown-ups may have gotten realistic about Santa, studies say most of us have faith. Faith in God, Allah, the teachings of the Buddha — doesn’t make a lot of difference. But faith — belief in some power that controls human destiny, belief that doesn’t rely on logical proof — is worth having at any age. Mary McLeod Bethune, a great lady who was smarter than most of us, said, “Without faith, nothing is possible. With it, nothing is impossible.”

Many of us celebrating the babe in the manger this week, along with many who celebrate other happenings and symbols, cling to the belief that there will actually, someday, be peace on earth. Even if it seems impossible.

My son (who is now 50, so don’t tell him I’m still repeating this story) was a true believer child. We had, at our house, a little green elf who arrived on December 1 and spent the next 23 days perched on light fixtures, curtain rods and high cabinet tops; Elf moved around a lot. He watched to see if everyone was good or bad, and on Christmas Eve he flew off to cruise with Santa. One December night, when my son was about 8, possibly older, I was turning out the light as he posed one last question. “Mom,” he said, “I know about Santa Claus, and I know Dad is the Easter Bunny, and all that — but… but how does the elf get from one room to another?”

You gotta believe. We have a health bill, not what we wanted, but the biggest reform in generations and something to build on. The jobless recovery means millions of kids belong to jobless parents, but Santa will come to many of them with the help of a host of community groups. All over the country, Muslim and Jewish volunteers are pitching in to relieve their Christian friends at soup kitchens so the latter can go home and read The Night Before Christmas to their kids.

Peace on earth, goodwill to all.