Health Care and Gun Control

Gun Violence

ShootingcolumbineShootingVirginiaTech

ShootingauroraShootingNewtownShootingRoseburg

April 20, 1999-Columbine High School: 13 dead and 21 wounded

April 16, 2007-Virginia Tech: 32 dead and 17 wounded

July 20, 2012-Aurora Century 16 Theater: 12 dead and 70 wounded

December 14, 2012-Sandy Hook Elementary School: 26 dead

October 1, 2015-Umpqua Community College: 9 dead and 7 wounded

STUFF HAPPENS?

That’s just BS Jeb Bush, aka Mr. Wanna-be-the-President-of-the-United-States. And you know it.

But without the NRA on your side, your political goose is cooked. And after your insensitive and unpresidential comment about “stuff,” I hope your political goose is decimated.

And make no mistake about it: Our elected officials don’t control the NRA. The NRA controls our elected officials.

These officials, whom we voted into office, need to stop kowtowing to the NRA and do something bold and courageous. And we need to put pressure on those officials and force them to effect change and take charge of getting us on the right path. It is up to us to force our elected officials to curb gun violence in America and protect the safety of the public.

I have always felt that we need stricter gun laws. But I also think that our elected officials need to significantly reform our mental health system. Guns and mental health issues are a cataclysmic combination.

And until we as Americans take the necessary steps to ensure that our representatives in Washington, D.C. are looking for solutions, “stuff” is going to continue to happen. BAD STUFF. DEVASTATING STUFF. HEARTBREAKING STUFF.

The U.S. loses 90 people every day from gun violence. And since our elected officials are incapable or plain old afraid to do anything about it, it’s time for the entire country to stand up and take charge.

And sorry to inform you Jeb, your simpleminded opinion that “stuff happens” just doesn’t cut it.

Baa Baa Black Sheep

Family & Relationships,

Black Sheep
Out to dinner with a friend a few weeks ago, she gloomily confided in me that she was the “black sheep” of her family. Her sorrowful declaration raised the hair on my arms and gave me the chilly willies for two reasons:

1. She is beautiful, successful, generous, compassionate, considerate, well-grounded, strong, selfless, and a loving and nurturing mother and wife. The type of woman that anyone would aspire to be.

2. Over the years, I’ve heard this expression more often than I would like to admit. And worse, I’ve heard it used to refer to me. Many times. So many times, that I developed “Black Sheep Syndrome,” if there is such a thing.

So the two of us bitterly asked each other what I have been asking myself for close to fifty years:

Why and how does a child become the black sheep of their family?

When I got home from dinner that night, I looked up the Baa Baa Black Sheep nursery rhyme. Baa Baa Black Sheep is an English poem, dating back to sometime around 1731. But very little is actually known about its origins. While I found several interpretations of the words, there was little to no evidence to support any of them.

I also found several variations of the rhyme, although the one that I prefer is the Mother Goose Melody published sometime in 1765. This version is usually sung to the tune of “Twinkle Twinkle Little Star,” and the “Alphabet Song.” The last couplet is printed as “But none for the little boy who cries in the lane,” as opposed to “One for the little boy who lives down the lane.”

Mother Goose’s version:

Baa, baa, black sheep,
Have you any wool?
Yes, marry, have I,
Three bags full;
One for my master,
One for my dame,
But none for the little boy
Who cries in the lane.

A common interpretation is that the rhyme was against Medieval English taxes on the wool industry.

But I don’t really understand the black sheep part. It doesn’t take a genius to know that white wool is more desirable in the commercial marketplace because it can be dyed any color. Black sheep in a flock, are useless in terms of wool production as it is impossible to dye its fleece. A fleece with even a few black fibers is considered less than desirable.

So if the wool from a black sheep is impossible to dye, rendering it useless, and undesirable, it would be unsaleable, thus no need to tax it at all.

Whatever the reason the rhyme depicts black instead of white, it’s obvious that the undesirable and uselessness of the black sheep is what gives us the term “the black sheep of the family.”

And okay, I can see a sheep farmer who makes a living from wool, considering the black sheep a wastrel. But a family?

Black sheep is a phrase used to describe a pariah, a reject, and a ne’er-do-well, especially within a family unit. Someone who is ostracized and treated differently from the rest. A distasteful outcast, who just doesn’t belong.

Nothing for the little boy who cries in the lane.

Yes, I’m called the black sheep in my family. And I’m finally proud of it.

There I said it. And the best realization and revelation for me is that I actually do feel pride.

And here is my take on the whole “black sheep” defamation:

The family black sheep don’t get picked randomly or by accident. The black sheep are sensitive, unhappy, vulnerable, and usually the outspoken child. The one who refuses to stay silent and just can’t and won’t pretend to be one big happy family.

The designated black sheep is made to carry the hidden blame and shame of relatives who refuse to acknowledge their own flaws and weaknesses.

Toxic and dysfunctional family members tend to project their own jealousies and sense of inferiority onto the shunned and disfavored black sheep.

And even if the black sheep eventually leaves (or is thrown out of) the familial flock, it doesn’t end there. The hated black sheep is more than likely still considered the cause and reason for the family’s difficulties and unhappiness, no matter how much time has passed.

Because the family’s need to place blame and project shame onto the black sheep is the only way, they can live with themselves.
Black Sheep Nursery Photo Cropped

American Express Small Business Saturday Statement Credits Are Canceled for 2015

Observe & Ponder

American Express Cards

The first Small Business Saturday took place on 11/27/10 and American Express encouraged people across the country to support small, local businesses by offering a generous statement credit of $25 off $25. The event was hugely successful, with people coming out in droves to shop and use their Amex cards.

For the past five years, small business owners have relied on the American Express statement credit program on the Saturday after Thanksgiving. The program has helped to counter balance lagging traffic and sales during Black Friday weekend for thousands of small business owners.

My question to Amex: You didn’t think your decision to effectively cancel Small Business Saturday didn’t warrant an announcement on the home page of your Small Business Saturday website?

Shame on American Express for not making sure that small business owners were given a heads up that, for the most part, Small Business Saturday has gone bust.

When I went online today to find out what kind of credit incentive Amex was going to offer for the 2015 Small Business Saturday, I saw nothing on their website. But I did find several articles claiming that an American Express announcement that no statement credits would be offered this year, was buried somewhere in their FAQ section. I looked around on the Amex Small Business Saturday website for quite some time and found no such announcement in their FAQ section or anywhere else.

I ultimately sent an e-mail to Amex directly, asking them if they were in fact canceling statement credits. I received the following e-mail reply back from them:

As in years past, American Express will continue to drive awareness of Small Business Saturday and encourage consumers to shop small through local and national advertising.

This year we are not offering a statement credit offer for Card Members on Small Business Saturday, but are instead increasing the support and resources we provide to help small business owners market the day within their communities and truly make it their own.  Learn about the materials we make available at ShopSmall.com/GetReady:

  • Customizable marketing materials
  • Free online ads
  • Shop Small merchandise kits (while supplies last)
  • Educational event guides

We are also significantly expanding our grassroots advocacy efforts, such as the Neighborhood Champion program, to facilitate more community events and activities to engage local communities to shop small on Small Business Saturday.

Why would Amex have a Small Business Saturday and not have statement credits? What would motivate people to shop on that day vs. any other day?

Sorry, Amex but your offer to increase support and supply materials isn’t going to bring the store traffic to small businesses that your statement credit program did. It won’t even come close.

The popularity of Black Friday Weekend has lessened in recent years, as e-commerce has completely changed the scope of holiday shopping. And now Amex has decided to quietly cancel their statement credit program?

As the Executive Director of my local Chamber of Commerce, I have seen firsthand how successful stores have been on Small Business Saturday, thanks in large part to the American Express statement credit incentives.

I also witnessed hundreds of shoppers who swarmed the stores that day with loads of Amex cards. And I mean loads—per person. I saw one shopper with at least 50 credit cards. And I witnessed store after store printing out sales receipts that were eight feet long nonstop until they closed at midnight.

A little-known rule regarding American Express cards, is that you can have up to 99 authorized users on any one card—each with their own card, and more importantly, their own individual statement credits.

So I am assuming that American Express was tired of shoppers abusing the program. But they could have easily limited the promotion to one card per person, and that would have been the end of the abuse.

Instead, they canceled the program entirely, with no formal announcement. Not yet, anyway.

Below is a history of incentives going back to the 2010 launch year:

2010: $25 off $25 offer announced on 11/08. Registration opened 11/08. Spending valid 11/27-12/31/10.

2011: $25 off $25 offer announced on 10/06. Registration opened 11/01. Spending valid 11/26/11.

2012: $25 off $25 offer announced on 09/24. Registration opened 11/17. Spending valid 11/24/12.

2013: $10 off $10 offer announced on 10/01. Registration opened 11/24. Spending valid 11/30/13.

2014: $10 off $10 valid 3 times per card announced on 09/27. Registration opened 11/16. Spending valid 11/29/14.

2015:  No formal announcement made yet, that Small Business Saturday statement credits are canceled for 2015.

I get that American Express is trying to cut costs, but in my opinion they should have canceled Small Business Saturday altogether. Let’s get real, without a financial incentive, people won’t pay attention. Wasn’t a financial incentive the whole point of the program?

Incentives or no incentives. At least let small business owners know.

Addiction, Depression, Suicide, Chronic Pain and Their Symbiotic Link

Addiction & Depression

drowning

National Suicide Prevention Awareness month came to a close this past Wednesday.

When I sat down to research and blog about the topic earlier this month, I couldn’t write about suicide without also discussing depression, addiction, and chronic pain.

This country has a serious epidemic on our hands and mental health issues need to be addressed year round—not just in September.

While reading this blog, if you think I’ve made a mishmash out of addiction, depression, suicide and chronic pain, it’s because they are all linked and related in so many unfortunate ways. A heartbreaking and devastating mishmash.

Depression and other mood disorders are the number-one risk factor for suicide. Drug abuse and alcohol (with no diagnosis of depression) are a close second.

Suicide is the third leading cause of death among young people with mental health disorders. Statistics show that nearly 40,000 people die from suicide in the United States every year. And suicide also shares a dangerous and undeniable link with the disease of addiction.

According to the National Alliance on Mental Illness, 1 in every 3 people who die from suicide are under the influence of oxycodone, heroin or alcohol. One of the most shocking facts about suicide for me, is that most people who attempt suicide never seek professional help or care.

When a loved one is addicted to drugs or alcohol, the situation creates a life cycle full of anxiety and fear. The possibility of a loved one overdosing, being involved in a serious accident, or suicide, becomes a full-time concern.

Numerous drugs are all-too-commonly, and in my opinion, all-too-too quickly, prescribed by health care practitioners to treat depression, attention deficit hyperactivity disorder, bipolar, anxiety disorders and really, whatever else ails.

Depending on the diagnosis, the prescribed medications can include Xanax, Klonopin, Valium, Seroquel, Ambien, Adderall, Ritalin, and Concerta.

And then there are the commonly prescribed pain relievers associated with conditions such as migraines, musculoskeletal pain, arthritis, sleep deprivation, bodily injuries, surgical procedures and dental work, to name a few. The list of maladies is a long one.

The pain relievers may include Humira, Celebrex, Ambien, Codeine, OxyContin, Vicodin, Roxicodone, Oxecta, Percodan or Percocet. The list of pain killers is also a long one. But make no mistake about it, every malady has its analgesic.

Combine these commonly prescribed medications with insufficient oversight to curb inappropriate prescribing, and it could be a recipe for addiction, depression, suicide, and even chronic pain.

And add into the scenario, addicts who doctor shop for prescription medications, complaining of symptoms that may or may not be real. And doctors that are all-to-willing to prescribe medications for them.

Any one of the examples of medications I mentioned above, alone, or in combination with other drugs, can produce sedation, euphoria, psychosis, depression, suicidal thoughts, joint and other pain, seizures, paranoia, aggressive behavior, addiction, and cardiovascular complications.

The nonmedical misuse and abuse, and the medically prescribed overuse of prescription drugs for depression and other mental health issues is a serious and growing national public health problem in the United States.

Millions of people struggle with depression and contrary to belief they can’t just “get over it.” Yet far too many psychiatrists and other physicians regularly over-prescribe antidepressants and use medication as their first option. This is especially dangerous for children and adolescents. Depression is a leading cause of illness for teenagers. But no matter how old a patient is, medication without weekly psychotherapy is a mere band aid.

The use of antidepressants has increased 400% since 1988, making them the most frequently used drug by those between 18 and 44 years of age. Many are seen in primary care settings and never referred for mental health consultations.

Depression and mental illness are a huge problem and our country is failing those in need of mental health services. So many people out there just can’t get the help they need. Insurance plans are confusing, with spotty mental health care coverage, and many psychologists and psychiatrists don’t even take insurance.

And let’s be honest: Even without insurance worries, mental health care is outrageously pricey and there aren’t enough health care practitioners and professionals to counsel and monitor all of the needy. And there are more out-of-pocket costs associated with mental health conditions than with most other medical conditions.

Over 42 million adults suffer from a mental health problem, with over eight million reporting suicidal thoughts. Over 19 million adults have a substance abuse problem.

Over eight million adults suffer from a mental illness and are uninsured, and one out of every three adults with a mental disability, are unable to see a doctor due to costs.

Additionally, over six million children suffer from an Emotional, Behavioral, or Developmental (EBD) problem, and more than eight percent of youth have attempted suicide. For most youth, symptoms start to present themselves at an early age. When services are provided early, youth are less likely to drop out of school, turn to substances or engage in risky self-injurious behaviors.

Early intervention and screening can help to reduce the negative impact of mental illness for individuals and their families. Yet, so often mental illness is ignored and services aren’t available until an individual proves harmful to him/herself or others.

The United States has a long way to go to adequately address critical mental health care needs. There are too few psychiatrists and psychologists, individuals face huge out-of-pocket costs, and many patients having to wait months for an appointment.

Let me set up two medical scenarios:

Scenario 1: I’ve had a bad earache for a couple of days now, so I can go to an urgent care facility for immediate treatment. Or I can call and make an appointment to see my doctor on an emergency basis, and he will see me asap. Either way, the visit and the prescription will be mostly or completely covered, and I’ll be on the mend in a couple of days.

Scenario 2: I’ve been severely depressed for several months now so I go online to see which professionals are covered on my insurance plan. I then contact all of them to see if they take my insurance (many don’t take insurance at all). Once I find a doctor who either has the time to take me on as a new patient, or takes my insurance, I am warned that the out of pocket expense for the visit is ridiculously high. I decide to make an appointment regardless of the cost, because I’m basically catatonic, but I’m told that I can’t be seen for four weeks. If it’s an emergency, I should go to my local hospital and commit myself into the psychiatric ward.  

Now I’ve heard a lot of negative talk about “Obamacare.“

But here is the truth: The Affordable Care Act makes health insurance coverage more affordable for individuals, families, and small business owners. But more importantly, this health care law includes prevention, early intervention, and treatment of mental and/or substance use disorders as an “essential health benefit” (EHB) that must be covered by health plans that are offered through the Health Insurance Marketplace.

Health insurance plans available in the Marketplace must cover 10 categories of essential health benefits. One of these categories is mental health and substance abuse services. These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.

Under the Affordable Care Act, most health plans must also cover certain preventative services without a copayment, co-insurance, or deductible. And marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions. Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage starts. There’s no waiting period for coverage of these services.

The war on drugs has now become a war on legal drugs, on patients who take them, and on doctors who so cavalierly prescribe them. According to the U.S. Drug Enforcement Administration (DEA), oxycodone has been abused for more than 30 years. But with the introduction of OxyContin in 1996, there has been a marked escalation of abuse.

Take a look at some of these staggering statistics:

  • According to the National Institute on Drug Abuse (NIDA), approximately 1.1 million people abused prescription medication.
  • NIDA also found that 1 in every 12 high school seniors reported nonmedical use of the prescription pain reliever Vicodin in 2010, and 1 in 20 reported abusing OxyContin, making these medications among the most commonly abused drugs by adolescents.
  • Results from the 2013 National Survey on Drug Use and Health (NSDUH) indicate that approximately 15.3 million people aged 12 or older used prescription drugs non-medically in the past year, and 6.5 million did so in the past month.
  • An estimated 52 million people have used prescription drugs for nonmedical reasons at least once in their lifetimes. Young people are strongly represented in this group.
  • Unintentional overdose deaths involving opioids have quadrupled since 1999 and now outnumber those from heroin and cocaine combined. Use of opioids analgesics exposes users to risks of addiction, abuse and misuse, which can lead to overdose and death.
  • Those who abuse opioids sometimes alter the route of administration by crushing the tablets and swallow or snort them for a fuller effect. Others dilute the tablets in water and injecting them to further intensify the high. Users compare the high to the euphoria of heroin.
  • The abuse of opioids, alone or with alcohol or other drugs, can depress respiration and lead to overdose and subsequent death.
  • Adverse outcomes that may result from prescription drug misuse and abuse can also include falls and fractures, and other seemingly unrelated accidents.
  • According to the 2013 National Survey on Drug Use and Health report, 12.5% of new illegal drug users began with their LEGAL use of prescribed pain relievers.

A friend recently told me that after she had back surgery at the Hospital for Special Surgery in Manhattan, she was given a script for Percocet. She told the health care practitioner she did not need pain medication and thought Advil would be sufficient, but was advised to fill the prescription “just in case.” When her husband brought the bottle home from the pharmacy it contained 100 pills.

I am no medical professional, so I have a question for all you “experts” out there: if my friend took all 100 pills every 4 to 6 hours as prescribed, could she have become addicted? And excuse my ignorance, but what is the difference between becoming addicted vs. dependent to a drug?

And as an aside, no one ever called my friend to check up on her, to make sure she was okay. BTW, all 100 Percocets are still sitting in her medicine cabinet. THROW THEM AWAY GIRLFRIEND.

According to the American Pain Foundation, more than half of the patients who complain of pain to their doctors are depressed. Plus depression can magnify pain. Are they depressed because they are in pain or are they in pain because they are depressed?

Some of the overlaps between depression and chronic pain can be explained by biology. From the research I did, I found that depression and chronic pain share some of the same neurotransmitters—the chemical messengers traveling between nerves. They also share some of the same nerve pathways.

So how can a medical expert know if their patient has chronic pain or depression? And drugs will relieve the pain and/or the depression, but will also help feed a possible addiction.

When I fill out forms for many of my yearly check-ups, I’m always asked about my family history.

As a medical professional, when a patient comes forward with pain, and before prescribing medication, shouldn’t they be asked if they or another family member have a history of alcoholism or addiction?

How does a health care professional know who may have had in the past, or has  an addiction or dependence, and/or is genetically predisposed to addiction? From what I have researched, predisposition can go back three generations.

Addiction, depression, suicide, and chronic pain are not new issues. But the severity and rapid growth of the problem, and the ultimate consequences for us as a Nation, warrants our serious attention.