Sunday, June 12, 2016

Our War on the Mentally Ill

(Image from wikamedia commons)

According to a police report in the June 9th Towanda Daily Review, a 34 year-old woman was arrested at the Robert Packer Hospital Behavioral Science Unit for aggravated assault and was sent to the Bradford County Prison in lieu of $20,000 bail. The Review wrote that the woman was "smashing windows with a dinner tray" and "began stripping tissues out of every tissue box in reach and began to explain that she had magical powers and that she was going to burn the building down, and then she would flood the building to put the fire out." The police were probably called after the hospital security and staff realized that they were unable to properly control the situation, and the woman was subdued by the police after she punched and slapped one of the officers.[1]

The situation seems to have been handled with a minimum of property damage and no serious injuries, and to my knowledge, everyone acted correctly. Yet, a woman with a probable serious mental illness was arrested and incarcerated in an institution not equipped to diagnose or help the mentally ill.

The U.S. has had a sordid past treating the mentally ill as have most other countries. In 1773, the first U.S. hospital for the mentally ill was opened at Williamsburg, VA -- the “Public Hospital for Persons of Insane and Disordered Minds."[2] In 1841, Dorothea Dix, a Boston school teacher, was appalled at the living conditions of the mentally ill in the East Cambridge Jail. Her advocacy and lobbying efforts resulted in the establishment of 123 hospitals for the mentally ill by 1880.[3] Construction of state mental hospitals continued throughout the U.S., and by 1955, these hospitals housed 558,239 mentally ill patients, 71,619 patients in 1994 [4], and fewer than 55,000 in 2015.[5] From 1955 to 2015, the U.S. population increased by 92%, yet patients being treated in mental institutions dropped by 90%. The proportion of people with mental disorders has not changed, yet the proportion of people being treated has dropped by 95%.[6]

The problems began over 50 years ago when the John F. Kennedy's Community Mental Health Act of 1963 was enacted in response to the too often horrific conditions and treatments of the mentally ill in state run institutions. Deinstitutionalization was supposed to move mentally ill patients from state run institutions to community health centers with more humane treatments and the possibility of patients to be located in their own community closer to their own families. However, the community treatment phase was never fully implemented and far too many seriously mentally ill people were and still are left undertreated or untreated.[7]

Mental disorders include bipolar disorder, depression, personality disorder, post-traumatic stress disorder, and schizophrenia.[8] Consequences of undertreating or not treating the seriously mentally ill have been disastrous.  In the U.S.: of 7.9 million people with severe mental illness, 3.9 million go untreated; there are 216,000 homeless adults with severe mental illness; there are 400,000 adults in jails or prisons with untreated mental illnesses; 13,000 suicides are committed each year under the influence of schizophrenic, manic or depressive symptoms; 50% of mass killings are by people with severe mental illnesses; about one-third to one-half of the mentally ill also suffer from drug abuse.[9][10] Deinstitutionalization has overburdened medical emergency departments, it has overcrowded jails and prisons, and it has left untreated mentally ill people on their own in the streets.[11]

Proper treatment of the mentally ill should include state mental institutions for those cases that are inappropriate for other facilities, and they would house the criminally insane, sexually dangerous persons, and those too dangerous to discharge.[12] It is vital that these hospitals do not become overcrowded and that staffing be sufficient. Community mental health facilities, as promised by the Community Mental Health Act of 1963 but never fully funded or implemented, would prevent overcrowding of the state hospitals. However, the intentions of the 1963 act needs to be fully implemented. It will be expensive to do, but vastly more expensive to continue as we have been. Otherwise, emergency departments will remain overwhelmed, jails and prisons will house those who should not be there, suicides and mass killings will continue, the mentally ill will still abuse drugs, and a 34 year-old woman who should have been treated for a serious mental illness ended up in even more miserable circumstances.

John L. Ferri

Friday, June 3, 2016

The FBI's Anti-Drug "Chasing The Dragon"



"Chasing The Dragon" (screened at the Keystone theater, Towanda, PA in early June) is an anti-drug documentary produced through the office of the FBI director James Comey. It shows, in vivid detail, the tragedies of seven families resulting from addictions to opioid drugs, typically initiated by prescription OxyContin, and escalating to other opioids, usually heroin. Most of the victims are teens and young adults; two appear to be in their thirties or early forties. Two of the young adults died from overdoses. One died a few days after spending 7 months in rehab.

I deliberately referred to the subjects of this deeply flawed documentary as victims because that is exactly what they are--victims of our failed multi-decade, trillion dollar (and counting) War on Drugs. The War on Drugs has not only failed, it has exacerbated the problem. Our problems with addictive substances would be far less if the War had never existed.

The message of the documentary seems to be a continuation of Nancy Reagan's ridiculous "Just Say No" campaign with the added message that if you continue your miserable addicted life, we'll add to your problems with incarceration, a crime record, and little else. It's just more of the same failed strategy, regardless of any recent rhetoric to the contrary.

There were no recommendations other than opioids are addictive, and if you use them, you will get addicted, and if you get addicted, you're screwed. No recommendations about harm-reduction or other science-based treatments. Only arrest and incarceration, just as it has been for decades.

It also attempts to show marijuana as a gateway drug to heroin when this has been shown to be false. Some marijuana users move to opioids; most do not. Also shown are injection sites that were ulcerated and infected, but it doesn't make clear that these are caused by dirty needles and adulterated drugs. Injecting heroin in sterile conditions with pharmaceutical grade heroin under medical supervision is a non-life-threatening issue. In fact, it is one of several harm-reduction methods.

Victims of addictive substances will do anything to get these substances if they are not available legally. They will cheat, steal, sell themselves, destroy relationships with family and with friends to get what they need for their addiction. The documentary shows this very vividly and clearly. The victims are desperate and miserable. The documentary only shows how to continue the victims desperation and misery.

Until all drugs are decriminalized and regulated, and the victims of addictions are treated as medical problems with science-based programs, the U.S. will continue wasting tens of billions of dollars each year making our drug addiction problems worse.

John L. Ferri

Links:
- Consumer Union's Licit and Illicit Drugs
- Chasing The Scream, Johann Hari
Dreamland: The True Tale of America's Opiate Epidemic, Sam Quinones
- Letter-to-editor

Sunday, May 22, 2016

Complementary Health and Psychic Fair in Bradford County, PA

When I read, First Complementary Health and Psychic Fair deemed a success in the May 17, 2016 Towanda Daily Review, I had to check the date to be sure that I was still in the 21st Century.

Products presented at the Fair included reflexology, essential oils, footbath detox, Reiki, psychic phenomena, healing stones, acupuncture, herbal medicine, Plexus for weight loss, body detoxification, and homeopathy.

Reflexology is based on an absurd theory that each body part is represented in the feet and hands. Multiple trials have shown it to be no more effective than a foot massage at curing or diagnosing anything. [1][2][3]

Essential oils cover a lot of territory. It’s like saying that chemical compounds can cure stuff. It depends on what is in the oils, the purity, concentration, and the condition being treated. Anecdotal evidence of effectiveness is not enough. Randomized controlled clinical trials are required, which is how real medicines are evaluated. [4][5]

Footbath detox is designed to cleanse your wallet of money. The footbath contains chemicals that are decomposed by a small electric current in the water, which will discolor with or without your feet in it. It provides no proven health benefits that a good foot soak wouldn’t. Detox footpads are equally worthless. [6][7][8][9][10][11][12]

Reiki is based on a mystical belief system that is similar to Therapeutic Touch, which was disproved by 11-year-old Emily Rosa who had a peer-reviewed paper published in the Journal of the American Medical Association. It should be noted that the Catholic Church considers the use of Reiki to "be inappropriate," and a fundamentalist pastor said, "It goes against Christian belief." [13][14][15][16][17][18][19]

Psychic phenomena don’t exist according to the U.S. National Academy of Sciences. In their 1988 report, they concluded, there is “no scientific justification from research conducted over a period of 130 years for the existence of parapsychological phenomena”, and tests "do not support the existence of psychic ability.” [20][21]

Healing crystals were tested in 1999 by London scientists to investigate the power of stones and crystals compared to placebo. The conclusion was that "Whether the crystal was real or fake did not produce any significant difference in the strength of the sensations reported by participants." [22]

Acupuncture uses an elaborate theatrical performance to exploit the placebo effect. It was popularized by Mao Zedong in place of science-based medical treatment when he couldn't provide real health care to his people. It may seem to be effective, but serious side effects (nerve damage, infections) continue to be reported. [23][24][25]

Herbal medicine is in a similar category as essential oils. Herbs may contain effective medication, or they may contain ineffective material or worse. Anecdotal evidence shouldn't replace randomized controlled trials to evaluate effectiveness. When herbal medicines are tested and shown to be effective, they can then be properly regulated and justifiably labeled as real medicine. [26]

Plexus for weight loss  - "Based on the available research of Plexus Slims ingredients, it is highly unlikely that the results people are reporting are because of the product.  It is more likely the result of their modified diet and/or exercise.  Plexus Slim is touted as being a safe product.  While a majority of people would not experience side effects, there is enough evidence to suggest, the product is not 100% safe and anyone selling the product should inform everyone of the possible side effects and suggest customers to consult a doctor before using their product. High blood pressure and increased heart palpitations were the most commonly reported side effect to the Better Business Bureau." [27]

Body detoxification is used by real medical physicians in real hospitals to remove or reduce dangerous levels of drugs, alcohol, or poisons from the human body. It is used in life threatening circumstances. Alternative, or complementary, or integrative “detoxification" is simply the co-opting of a real medical term to give legitimacy to useless products and services, while confusing consumers into thinking they’re science-based.” The only cleansing done will be to your wallet. [28][29][30]

Homeopathy is based on taking an active ingredient that was selected by a non-scientific process, then diluting it into oblivion to increase its effect.  Based on all modern theories of chemistry and physics, homeopathy can’t work. At best, it has a placebo effect. At worst, it may delay real medical treatment. Homeopathy has failed every properly designed randomized controlled trial that has tested its efficacy. [31]

The items listed above require what is known as the Quack Miranda Warning in reference to any claims made:
"These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease."
When in doubt about any of the above, ask a real doctor: a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).

John L. Ferri

Links:
Quack attack: Naturopaths and supplement companies press for naturopathic licensure in Michigan
- Letter-to-editor

Saturday, May 7, 2016

Overdose Deaths and the War on Drugs




(I live in Towanda, PA--a small town in Bradford County in the northeast part of the state.  According to the CDC, in 2014 Pennsylvania was ranked 8th in the U.S. for overdose deaths at 219 deaths per million age adjusted population. West Virginia is #1 at 355 per million, and the lowest is North Dakota at 63 per million. The U.S. average in 2014 was 147 deaths per million. I wrote the item below because of the local response to 3 overdose deaths in 3 days in mid-February, 2016. On May 5, 2016, an Addiction Awareness Rally was held in front of the Bradford County courthouse where local residents spoke about friends and family members with drug addictions, with truly heartrending accounts of the deaths of loved ones to addictions. It is tragically ironic that the backdrop for the speeches was the courthouse with the following words at the top of the building: Justice, Law, Mercy. As presented below, the War on Drugs has provided none of these.)


The United States has wasted over a trillion dollars during the last four decades for its war on drugs. Not only has that vast sum been wasted, it has exacerbated the problem. Add several hundred billion dollars to this amount for the purchase of illegal addictive substances and for the loss to society from drug related crime, illness, and death. [1]

Purdue Pharma compounded the problem in 1996 when it introduced OxyContin and lied about its addictiveness and effectiveness. The drug is highly addictive, and it is effective for much less than the 12 hours claimed by Purdue, requiring increased or more frequent dosage. [2] Doctors believed Purdue's false claims and began prescribing OxyContin for patients with chronic pain. Lax oversight in some states resulted in "pill mills", where unscrupulous doctors prescribed OxyContin for anyone without requiring an examination but requiring a cash payment for the visit. [3] Purdue ultimately reaped $31 billion in revenue, and people became addicted. When the addiction problems surfaced, state and federal regulators cracked down on OxyContin use, and some people with chronic pain were unable to get needed medications.

This created a market for illicit drugs, which were readily available and cheaper, although usually adulterated and of unknown concentration. With the previous flood of OxyContin and the always-available illicit supply, pain patients and others experimenting with drugs, typically teens or young adults, had few barriers, thus setting the stage for the expanding catastrophe.

The CDC reported drug-related overdose deaths of 41,340 in 2012, 43,982 in 2013 [4], and in 2014, over 47,000 -- 1.5 times those killed in car crashes [5]. Almost 500,000 Americans died from drug overdoses from 2000 to 2014. [6] Extrapolated worldwide, the lost lives and wasted money are truly staggering.

The National Institute on Drug Abuse (NIDA) recommendations for treatment include: "no single treatment is appropriate for everyone; treatment needs to be readily available; effective treatment attends to multiple needs of the individual, not just his or her drug abuse; remaining in treatment for an adequate period of time is critical, at least 3 months, the best outcomes occur with longer durations and frequently requires multiple episodes of treatment, and as with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted." [7]

The NIDA treatment recommendations show that drug addictions are a chronic illness and relapses are common because non-drug treatment isn't effective for everyone. Some require drug maintenance to eliminate or minimize deviant behavior (returning to illicit drugs and crime to support their addiction.) Maintenance treatments include methadone, buprenorphine, and diamorphine (heroin.) [8] None are magic bullets, and their use is based on harm-reduction -- basically to keep the addict alive, productive, away from illicit drugs and crime, and in frequent contact with medical professionals until treatment works, which may take many years. There is no defined recovery time. Forcing one increases the probability of failure.

Portugal decriminalized all drugs in 2001, including cocaine and heroin. Personal drug use is still prohibited but it is treated as an administrative offence, not criminal. Offenders may receive a small fine, or referral to a treatment program -- but no jail. The main effect has been that offenders are more likely to seek treatment because the stigma of illegal activity has been removed. Resources that were previously wasted on prosecuting and imprisoning addicts are now available for treatment. [9] The overdose death rate per million between ages 15 and 64 in Portugal is 3. In the U.S., it is 147. [10]

To reduce drug addiction and overdose deaths, the U.S. must change its laws to treat addiction as a chronic illness. We can't arrest our way out this problem, we can't wish our way out, and 28-day rehabs only delay the problem. Until it is treated realistically, the overdoses and deaths will continue.

Wednesday, October 28, 2015

The New Scarlet Letter for Bad Cops in Classrooms

Ben Fields, a white sheriff’s deputy in South Carolina, was fired after he threw a black female student across a Spring Valley school district classroom floor because the student wouldn’t hand over her phone. Another student recorded the attack on his cell phone.


Fields was fired two days after the incident, and Sheriff Leon Lott of Richland County said, “He picked a student up, and he threw the student across the room; that is not a proper technique.... Deputy Ben Fields did wrong this past Monday, so we’re taking the responsibility for that.” No charges have been filed against Fields.

To paraphrase the Bible, assholes will always be with us. Thanks to modern cell phones that are everywhere, we can now readily identify who they are.

Ben Fields qualifies for this new Scarlet Letter, and in his case, the “A” stands for something Hester Prynne probably knew her accusers to be.

JLF

Thursday, September 17, 2015

The Marriage Effect

[This is my reply to a letter-to-the-editor in a local newspaper, The Daily Review, in Towanda, PA]

After I read Jeff Deutschle's letter, "Does marriage really matter?," (The Daily Review, Sept. 3, 2015), I checked the date to see if a temporal anomaly had transported be back to the 1950s. Nope -- I was still in the 2nd decade of the 21st century.

Deutschle started by citing a study, "The Marriage Effect: Money or Parenting?," and claimed that, "children raised by married parents typically do better in life on almost every available economic and social measure." This seems like a reasonable conclusion because of potentially increased income and parental engagement, and the sharing of responsibilities between parents. Then Deutschle regresses back to the 1950s with, "Married parents have gender specific roles." I was expecting him to also cite "The Good Wife's Guide" from a 1955 Housekeeping Monthly that advises women to "have dinner ready", "clear away clutter", "minimize all noise", and "a good wife always knows her place."

Deutschle began his letter mentioning the recent Supreme Court ruling (Obergefell v. Hodges) on same-sex marriage, cites "The Marriage Effect" study, then drones on about "gender specific roles," which finally shows the real intent of his letter -- opposition to same-sex marriage with a subtext of homophobia. Interestingly, "The Marriage Effect" study that he cites gives no opinion on gender and argues that two parents, regardless of sex, are generally better than one.

A Columbia Law School project identified 77 scholarly peer-reviewed studies about the "well-being of children with gay or lesbian parents." Of those studies, 73 concluded that these children "fare no worse than other children," and that "this research forms an overwhelming scholarly consensus, based on over three decades of peer-reviewed research, that having a gay or lesbian parent does not harm children." Another study in Social Science Research, "Scientific consensus, the law, and same sex parenting outcomes," (Sept. 2015, vol.53) concluded that "outcomes for children of same-sex parents is marked by scientific consensus that they experience 'no differences' compared to children from other parental configurations."

Deutschle concludes with, "So let's do our homework and put our kids in the best youth programs we can find." I agree. Take your children out of the Trail Life Troop with its antiquated ideas and have them join the modern world. The Boy Scouts finally have and the Girl Scouts have always been there

-----------------------------------------------------------------------------------------




The Good Wife Training Guide


JLF



Tuesday, July 8, 2014

Craig's Friend and GOP News Bubble


As amazing as it sounds, I found the friend that Craig Pierce talked to in his letter to the editor of June 27, 2014. I asked Craig’s friend if he really thought that America was burning and he said that he did because that’s what Fox “News” told him to think. I told him that Fox “News” wasn’t a real news program. I asked him to stop watching it for a while and to read or watch some reliable news sources, and suggested anything but Fox. Being a reasonable fellow, Craig’s friend said that he would and get back to me as soon as he could.

In a few days, we talked again and he said that he couldn’t believe how biased Fox “News” is, and was shocked to find out what was actually happening outside of the GOP and Fox information bubble. He told me of several epiphanies after realizing what was really happening in the country and the world.

- He couldn’t believe how much money the GOP is wasting on investigating the IRS non-scandal, and how Darrel Issa is grandstanding. And he was dismayed how Paul Ryan wants to make poor people suffer more so that they can stop being poor.

- Craig’s friend was shocked that George Bush started the NSA spying program with an executive order for warrantless searches of emails, phone calls, and Internet activity to find terrorist activity, but that the program expanded to spying on U.S. citizens, and that the Obama administration has restricted the NSA’s overreach.

- Craig’s friend was aghast that the Bush administration was aware of the VA record falsification in 2005 but ignored it, that Bush’s war of choice on Iraq overwhelmed the VA system, and that the GOP consistently blocked legislation to help veterans. He said it was unbelievable that Bush insisted that Saddam Hussein was responsible for the World Trade Center attacks on Sept. 11, 2001 and that Bush said that Hussein had weapons of mass destruction.

- Craig’s friend was horrified to find out that Bush signed an agreement in 2008 to release Abu Bakr al-Baghdadi whose leadership helped ISIS become the currently profound threat to Iraq.

- He was appalled by Dick Cheney’s trying to blame Obama for the problems in Iraq when Bush and Cheney got everything wrong about their disastrous war of choice, and that the current problems in Iraq were caused by the Bush Administration’s reckless war that has cost 4400 American lives with many more wounded, and wasted trillions of dollars, none of which is available for the care of veterans, for addressing immigration problems, or anything else, yet the GOP’s answer to any problem is to cut taxes on the rich and powerful, even though supply side economics has never worked.

- He was stunned to find out that Obamacare is doing fine, and because the GOP needs to be outraged about something, they will continue to investigate the Benghazi attacks even though previous investigations over 20 months showed no conspiracies.

Craig’s friend told me that he will be voting for the Democrats in the next election and that he will try to convince Craig to do the same. He also commented that he would try to get Craig to break out of the GOP information bubble and get some real information. He said that friends don’t let friends watch Fox “News” or vote Republican.

JLF

(link to this letter)