Healthcare
Growing up drugged
For the first time ever, millions of today's adults were raised on psychotropic medications. What does that mean?
This article is adapted from the new book, "Dosed: The Medication Generation Grows Up," available April 10 from Basic Books.
I fall hard for coming-of-age stories, and my list of favorite books and movies contains many in this genre, from “Pride and Prejudice” to “The Catcher in the Rye.” The movie “Garden State,” which starred Zach Braff and Natalie Portman, also struck a chord with me when it came out in 2004. It dramatizes a few days in the life of Andrew Largeman, a twenty-six-year-old struggling actor in Los Angeles who returns to his native New Jersey for his mother’s funeral. Andrew is nothing if not alienated: he feels disconnected from celebrity-studded Hollywood as well as from his old hometown, which he hasn’t visited since leaving for boarding school nearly a decade earlier.
For the first time in sixteen years, Andrew has stopped taking the psychotropic medications his psychiatrist father prescribed after ten-year-old Andrew caused an accident that rendered his mother a paraplegic. Like the illegal drugs his high school buddies take, Andrew’s meds serve as a metaphor for the feelings of inadequacy, disappointment and rootlessness endemic to my generation of twenty-somethings. Judging from the film’s cult-hit success, its target audience of my peers apparently found the metaphor apt. When Andrew falls in love with a quirky, vibrant girl he meets in a doctor’s waiting room, she shows him how to reengage with his feelings—and the world. Presumably, he leaves the medications behind.
For several years, “Garden State” remained my favorite movie about my generation. It spoke to me as a young person growing up in turn-of-the-millennium America—though not as a young medicated person. In fact, I completely forgot psychiatric drugs were even mentioned. Funny, because I myself have been taking medication since high school, and “Garden State” is one of just a couple of films I know of to allude to the psychological impact of growing up taking psychotropic drugs. Although it touches on this important phenomenon, the film never really examines its underlying assumptions that medications numbed Andrew’s pain and guilt, and that getting off them allows him once again to experience the agony and ecstasy of life.
The Court’s innocent victims
The justices' consideration of healthcare reform left out the people to whom it matters most: The uninsured
So what did this week’s oral arguments in the Supreme Court tell us about the constitutionality of the Affordable Care Act? There are two ways of predicting what the Supreme Court will do. One is legal analysis. You read the Court’s decisions, see what broad principles the judges have endorsed, and then apply those principles to the case before you. But there is a second approach, which I’ll call Kremlinology, after the old practice of analysts trying to guess what the Central Committee of the Soviet Union was up to. This attempts to piece together any evidence one can find of the whims of those in power, in order to intelligently guess how that power will be used.
One needs to keep that distinction in mind when one reads CNN legal analyst Jeffrey Toobin’s now-notorious statement Tuesday on CNN: “This law looks like it’s going to be struck down. I’m telling you, all of the predictions, including mine, that the justices would not have a problem with this law were wrong. I think this law is in grave, grave trouble.”
Some ACA opponents have taken this as vindication of their constitutional claims, showing that those claims were right all along. But, of course, they show no such thing. They show only that there are members of the Supreme Court who are tempted to exercise their power in a certain way. Determining whether legal claims make any sense is an entirely different undertaking. Before the oral argument, Toobin’s only source of information was the law. And legally, the objections to the statute were garbage. The Constitution’s text and the Court’s decisions provided no basis for finding any constitutional problem with the statute. The only justice who could vote against the mandate in a principled way was Clarence Thomas, who made it clear years ago that he wanted to radically restrict federal power. Now it seems possible (all of this comes with the caveat that the judges’ questions are not reliable indicators of how they will ultimately vote) that the oligarchs in robes are happy to disregard the rules they’ve followed in the past if that means that they can help out the Republican Party.
Remarkably, everyone conceded that the purported constitutional difficulties could be resolved if the statute were changed in minor, technical ways. Justice Kennedy declared that “the reason this is concerning, is because it requires the individual to do an affirmative act.” This is the action/inaction distinction about which so much ink has been spilled: Congress is trying to regulate you when you’re not doing anything! But as Justice Sotomayor pointed out, Congress does the same thing every time it gives anyone a tax credit or deduction for doing something, like putting solar panels on their home. Anyone who doesn’t do that is penalized for inactivity. A tax credit for having insurance is clearly constitutional, and the mandate is just the functional equivalent of that.
Read more: The Court’s innocent victims
An Apple a Day Might Just Cut Profits
My mom said it. Her mom said it. I have even repeated it to my own children. “An apple a day keeps the doctor away.” Yet as patients, healthcare professionals, and others who eat in our healthcare facilities around the country may notice, eating healthy fare – including apples – isn’t promoted among the food offerings in cafeterias or on patient food service trays. Often the most readily available foods in our healthcare facilities are laden partially or wholly processed foods with unhealthy levels of salt, sugar, and/or fat.
Why is it that healthy, nutrient rich foods are often more difficult to find at healthcare facilities when the rising levels of heart disease, Type II diabetes, and other serious health issues have at their core at least some component of nutritional trouble?
We are told bad food habits in America contribute to obesity and the health issues that often flow from our unhealthy eating habits, yet our health providers are complicit in making sure those bad eating habits are reinforced. What is that all about? Job security? Do our providers really want us to be healthier?
Another phrase my mom used to banter about was, “Do as I do, not as I say.” Well said, Mom. So when I recently saw a toddler reaching into the donut case as her breakfast choice at one of our leading hospitals, should I have blamed her mother for allowing her child to eat the high sugar, high fat, low nutrient offering? Or might I wonder why a leading hospital chooses to have a donut case at the front lines of the cafeteria like the candy counters at the grocery stores? Why encourage bad eating?
In that same hospital cafeteria where the toddler poked the donuts one by one with her index finger before finally choosing one (I am not making that up), the section with fresh fruit and whole grain cereals and other healthy choices was in the back, darkly lit section. Why wouldn’t we put the fresh fruit up front and remove the ice cream and other frozen, sugar treat coolers? Many hospitals and clinics also have big fried food stations, pizza counters, and their own burger stands. Why? Why sell saturated fat? Why sell processed foods?
For the life of me – really for my life and yours – I cannot imagine a good reason for our healthcare providers to serve unhealthy foods.
I know a great deal of focus on improving nutrition has been aimed at school cafeterias and food services across the country, and rightly so. But as a patient and caregiver who has seen many of this nation’s most prestigious healthcare centers, I promise the food offerings are at least as unhealthy as we might find in many of our schools. And I would argue it is an assault on any message those providers may offer about their desire to heal the human body when what is offered in their own facilities so clearly harms the bodies they claim to serve.
Read more: An Apple a Day Might Just Cut Profits
Drug-Resistant "White Plague" Lurks Among Rich and Poor
By Kate Kelland
n New Year's Eve 2004, after months of losing weight and suffering fevers, night sweats and shortness of breath, student Anna Watterson was taken into hospital coughing up blood.
It was strange to be diagnosed with tuberculosis (TB)- an ancient disease associated with poverty - especially since Watterson was a well-off trainee lawyer living in the affluent British capital of London. Yet it was also a relief, she says, finally to know what had been making her ill for so long.
But when Watterson's infection refused to yield to the three-pronged antibiotic attack doctors prescribed to fight it, her relief turned to dread.
After six weeks of taking pills that had no effect, Watterson was told she had multi-drug resistant TB, or MDR-TB, and faced months in an isolation ward on a regimen of injected drugs that left her nauseous, bruised and unable to go out in the sun.
"My friends were really shocked," Watterson said. "Most of them had only heard of TB from reading Victorian novels."
Tuberculosis is often seen in the wealthy West as a disease of bygone eras - evoking impoverished 18th or 19th century women and children dying slowly of a disease then commonly known as "consumption" or the "white plague".
But rapidly rising rates of drug-resistant TB in some of the wealthiest cities in the world, as well as across Africa and Asia, are again making history.
London has been dubbed the "tuberculosis capital of Europe", and a startling recent study documenting new cases of so-called "totally drug resistant" TB in India suggests the modern-day tale of this disease could get a lot worse.
"We can't afford this genie to get out of the bag. Because once it has, I don't know how we'll control TB," said Ruth McNerney, an expert on tuberculosis at the London School of Hygiene and Tropical Medicine.
International Alarm
TB is a bacterial infection that destroys patients' lung tissue, making them cough and sneeze, and spread germs through the air. Anyone with active TB can easily infect another 10 to 15 people a year.
In 2010, 8.8 million people had TB, and the Geneva-based World Health Organization (WHO) has predicted that more than 2 million people will contract multi-drug resistant TB by 2015. The worldwide TB death rate currently runs at between two and three people a minute.
Little surprise, then, that the apparently totally untreatable cases in India have raised international alarm.
The WHO has convened a special meeting on Wednesday to discuss whether the emergence of TB strains that seem to be resistant to all known medicines merits a new class definition of "totally drug-resistant TB", or TDR-TB.
If so, it would add a new level to an evolution over the years from normal TB, which is curable with six months of antibiotic treatment, to the emergence of MDR-TB, then extensively drug-resistant TB (XDR-TB).
What's so frustrating about that progression, says Lucica Ditiu of the WHO's Stop TB Partnership, is that all drug-resistant TB "is a totally man-made disease".
Read more: Drug-Resistant "White Plague" Lurks Among Rich and Poor
The Battle for Vermont's Single Payer System
MONTPELIER, Vermont — You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.
Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.
When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.
“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.
The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.
During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.
Read more: The Battle for Vermont's Single Payer System
