Why gun violence research has been shut down for 20 years – The Washington Post

Lamenting the absence of studies has been a part of our post-massacre what-can-be-done for a number of years and a larger number of mass shootings. But what could research do to get us out of these dire straits?

Scientists, lab coat-ed spreadsheet fillers, create the data that uncovers the truth. I’m not sure if you’ve heard yet but truth is a powerful thing. Evidence is the fulcrum on which change is leveraged.

Traffic deaths, often sited by gun lobby as dead even with gun deaths, get a healthy amount of study. The Federal Transit Administration gave out 7 million in grants to advance transportation safety.  Research is done, evidence is collected, and regulations (seat belts, which I find sexy) are put into place. The auto industry isn’t going to make those crumple zones, laminate that glass, put in that little switch that turns your passenger airbag on and off so a tiny seat occupant is not killed by its deployment, out of the goodness of its heart.

To make industry safer, we need regulations. To make regulations, we need evidence. To make evidence, we need research.

The gun industry has put an impressive chill on learning anything about the safety of firearms. The 1996 Dickey Amendment, legislating that no research may advocate gun control, has been reauthorized every year by Congress. Data quoted in the aftermath of mass shootings is culled from CDC databases that collect cause of death information. It’s enough to tell us that guns are killing people in epic numbers. But epidemiological data alone does not a policy make.

Source: Why gun violence research has been shut down for 20 years – The Washington Post

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No more free birth control, says worst possible president

No more free birth control, says worst possible president

That’s right. I was pretty stoked about the Affordable Care Act requirement that birth control to be 100% covered by all insurance plans. What a great thing! To not have to pay more for health care simply because you have a uterus! To make accessible the means of controlling when you will have children, thereby increasing your chances of advancing your education and career, making you, a uterus-haver, more able to pursue the dream of being an independent and self-sufficient citizen-contributor.

Allegedly the pres. wants to put a stop to abortions. Presumably the fewer abortions the better?  Since free birth control provided by the ACA became available the number of abortions per capital dropped to its lowest level since data collection began at Roe v. Wade.

MAKE UP YOUR MIND.

This is abysmal health policy. Terrible public policy. Bad economic policy. And its perfectly in tune with the administration’s regard for women. NONE.

American guns and public health and hope.

America is not a hostage to itself in the battle over how to handle guns. We are able to change. The evening after another massacre, the word weary for being trotted out month over month, I’ll make an appeal.

With the will, we can get better.

Our current president dismissed the Surgeon General Vivek Murthy, the first in the position to declare gun violence a public health issue. Like HIV/AIDS in the 1980s and tobacco in the 1960s, the Surgeon General can be the first political officer to acknowledge a public health disaster. This should not be a controversial position…I’ll quote from Healthcare Triage, which has a very worthwhile primer on gun death stats:

guns hctraige

There is evidence to show that a gun-loving nation can be made less violent. You may know the history of our fellow former colony (and the only place where you can make a grittier western than home) Australia, and it’s remarkable policy-driven turn around addressing gun violence. Through compulsory buy-backs, stricter regulations, and cutting off the flow of new guns among other measures, the country responded to a harrowing mass shooting with sweeping policy change that turned their gun violence trajectory upside down. Sure, they are more than ten times smaller than the US. But in most all measures they are our closest comparator. There is no reason that their success could not be seeded here.

No reason not counting money and gun makers and, most important, political will. All of this is just to say we’re selling ourselves short with thoughts and prayers and other things offered in the face of hopelessness. We can get better.

 

 

 

 

Puerto Rico nearing becoming a public health catastrophe | Miami Herald

Every time you hear about Americans in Puerto Rico with no water, no fuel to boil water, no way to get rid of waste water…think water-borne infectious disease. This will be an epic disaster. One that was entirely predictable.

Public health officials should be shoulder to shoulder with the military, staged for response. I’ve searched the CDC and looked at the reporting coming out of the island in the many days since the storm, and I see no trace of action.

I pray they are not waiting for a call.

Below, from the Miami Herald, is an appeal from the Dean of Florida International University’s College of Social Work and Public Health, Tomas R. Guilarte, describing what the chaos looks like to a public health expert:

In the days since Hurricane Maria ravaged Puerto Rico, conditions on the island continue to deteriorate and become a humanitarian and public health catastrophe that could rival the damage caused by Hurricane Katrina in New Orleans.

The fact that the power grid failed creates many obvious problems and some that are not so evident. When the sewer system stops working, wastewater—aka human feces and urine—and seaborne bacteria contaminate the water supply.

This leads to bacterial infections — such as cholera, dysentery, E. coli and typhoid — that can be disastrous. The typical treatments, like tetanus shots or powerful antibiotics, are not readily available on the island, where medical supplies are quickly running out.

Source: Puerto Rico nearing becoming a public health catastrophe | Miami Herald

For the love of kids! Reauthorize CHIP.

The Children’s Health Insurance Plan (CHIP) covers the gap of pregnant women (in my state of Virginia) and children whose families earn above the federal poverty level (FPL) but are still low income and resource stretched. For those between 100% and 250% of FPL, CHIP means prenatal care, regular check ups, vaccines, and access to affordable health care and medicine.

This program is essential. It covers pregnant women and children. Losing CHIP will be costly in terms of quality of health, length of life, and hard dollars. Make good choices, congressmen.

On the eve of it’s expiration check out this CHIP facts and figures thread from @emma_sandoe (policy-wonk, PhD student, and Medicaid warrior):

 

 

Friendly neighborhood sick person weighs in on health care debate.

Friendly neighborhood sick person weighs in on health care debate.

When I used to freak out about losing my health insurance/access to care, not being able to afford medicine, I always pictured my parents losing their house to pay my medical bills. It was the greatest loss imaginable. In the past months my catastrophizing has changed. Now, my mother won’t sell her home, cash out her retirement. I fantasize about dying from lack of care. If my cancer comes back, if I can’t keep my job, if I lose my insurance and I can’t afford to get treatment–I won’t seek care. I’ll die of my illness.

If anyone every told you I’m stubborn they weren’t lying. I’ll cut off my nose to spite my face. Kill myself to spite the healthcare industry. I indulge this fantasy of martyrdom to my hard-hearted country.

I need to express the psychic weight that the debate over who deserves what coverage burdens me with. Watching the monetary value of my continued American existence bandied back and forth just a few miles from where I live. Doing battle for this prize: to snatch survival resources out from under my kind. I cost healthy people too much. My debility or poverty disqualifies me, abdicates rights I thought were mine… life, liberty, something else… but yea, life. Not that.

In my hospital we have special education high school students working as volunteer helpers. Not everyone welcomes them. They are different people and require a slight adjustment in communication. They require accommodation.

They came to the hospital to work with assistance of a career coach and the support of our unit manager. They are kind and interesting, alike to most young people. Tremendously helpful, alike to most young people. Restocking supplies, lending a hand to grab a wheelchair or a drink for a patient, going to the waiting room to track down someone’s elderly family member who won’t answer a cell phone. They complete tasks that keep everyone in the unit moving forward. Days that I’m swamped, they keep me afloat.

The myth of the productive citizen baffles me. I’ve met a lot of people. Strangers coming out of anesthesia tell me dark secrets. No one conforms, not all the time. We are a big interdependent mess. To define productive and make it the measure of value is a terrible effing idea. This ideal, of a completely independent working class American is at the core of the repulsive rhetoric I see daily.

What we are capable of is influenced by what we are told we are capable of. This political dialogue, the demoralizing debate over who is worthy of access to care, corrodes the potential in groups that have renewed American greatness again and again. The striving poor, immigrant, person of color, victim of circumstance. The young. Mounting arguments to deny the very poorest, the sickest, the youngest among us the scan safety net of Medicaid and strip us of legal protection to not be discriminated against due to sex and preexisting conditions, is undeniably passing judgement on who deserves healthcare. These groups of people, my people, have no chance to acquire health insurance without the protections set in place by Medicaid and the Affordable Care Act. To be without insurance is to be without access to care. The message is this: you are uncared for. To be perfectly clear, you are left for dead.

This is deeply personal. The abandonment of my cause, my cause being the pursuit of a productive and healthy life, by so many of my fellow Americans. My president, my representatives.

Since my diagnosis at age seventeen I kept my lupus a secret from most. A learned behavior from my father who shared the same diagnosis. He came of age in this country, a sick person in a time before the Americans with Disabilities Act. The fear of being found out, losing out on educational opportunities, jobs, insurance.

I lied on my college applications. I lied on my job applications. I’m not sure if you’ve noticed, but there is a box to check for “I may require reasonable accommodations” i.e.–I have a disability. NOPE. Nope. Per dad’s advice, cross that bridge if you come to it. You don’t need accommodation. You can pass. My skin is white and I can pass for healthy. I’ve never had trouble getting a job.

But I was ashamed. Sneaking around in the shadows will do that to a body. Fearful of being judged as burdensome. A waste of the world’s resources.

To experience the birth of the Affordable Care Act and its protections after a labor so long and fraught, was elation. Immense validation. I was hearing from the highest office in the land that my worth, my potential, was not degraded by chronic illness. It’s no coincidence that it was in those heady days I returned to school and became a nurse. I chose a challenging career in a field of service. I was pushed, encouraged to dedicate myself to progress personal and political. In no small part because of the leaders of my country put all the chips on the table to codify the belief that health care is a human right.

Since the ACA passed, I’ve checked the “accommodations” box. When I go to an appointment, I don’t lie. My coworkers no longer think I am hitting the dentist’s office monthly. I can pass, but I need everyone to know what a disability looks like. Which is, in my opinion, human. The messages that came from President Obama, from my representation, from advocacy groups all over the land made me feel like it was okay to exist as I am.

Permission to exist is a powerful thing. It isn’t hyperbole to say that the Affordable Care Act is my own civil rights legislation.

It despairs me to hang on as the pendulum swings against it. But hold on, it matters. Keep saying it, no matter how ridiculous it feels to say, children and women and the sick and the elderly all deserve equal protection under the law. Our nation, and me, well… our lives depend on it.

PS- Somebody make me a bumper sticker that says “KEEP YOUR HANDS OFF MY OBAMACARE”

Oliver Sacks and the loneliness of a great humanitarian doctor.

Oliver Sacks and the loneliness of a great humanitarian doctor.

In my long season of heartbreak and loneliness I once more look for a friend. I’m riding the tide of what Freud (who may have been wrong about everything but was also right about everything) called melancholia. Cognitive behaviorists might call it a slew of distortions.

In truth, I’ve many beautiful friends. Who show up. Clean the fridge in my new apartment. Set up my living room. Pour wine spritzers and sit on the deck and roll eyes at our happy, healthy, wrestling children.

So why this aching loneliness that just won’t quit? I fall in love with strangers four times a day. A quirky gesture, a turn of phrase, a graceful gait. That’s all it takes. But it’s unrequited; this sublimated love that has no real grit… maybe that’s what I can muster. Love that can’t be returned and will never be rejected. It’s utterly secret.

I’m in love with the world and my life in it. I’ll sound dramatic (no surprise) but every small accomplishment, every trip I take or task I finish I feel as though I’ve snatched it out from the maw of death. Ha! You can’t take it away now, I’ve lived it! I’ve moon gazed in the pouring rain with bare feet on steaming asphalt. I’ve eaten just-picked berries! I’ve smoothed the hair of my fluish child until he slept in my arms. It’s mine forever infernal eternity.

As is often the case, the right book finds me. I’m reading Oliver Sack’s memoir, On the Move. The fates saved it for the exact right moment. Oliver was not at all like me demographically. He was not like me in temperament. But we share two characteristics that buoy me when I feel low. First, the treatment of medical science as a humanity. Medicine as observation and experimentation in bettering our human existence. It indulges curiosity and regards no dogma in pursuit of understanding, helping, and healing.

Second, a protective self-enforced loneliness. Oliver was uniquely capable in his role as benevolent understander and wizened healer because of the isolation in which he held himself. Hundreds of close friends, thousands of adoring colleagues, tens of thousands of grateful patients, millions of entranced readers, but almost zero binding couple or familial loves in his life. However, I can attest: the grey tedium of monk-like living makes the wider world explosive with color, intrigue, stories to be learned, mysteries to solve, and hallucinations to manifest. That, I suppose, is the trade off.

I take heart that a mind so bright and wide walked the earth. If over the course of my life I manage one one-hundredth of his cleverness, curiosity, tender care of the sick, and generous story telling I would happily suffer an existence one hundred times as lonely.

Be mesmerized by one of his last interviews and storytelling sessions.

This is the gratitude I find at the bottom of the I’m feeling sorry for myself well. It is great and deep and sustaining.