How People Die in America / Gov Facts

One of the most annoying habits of Asperger types is our desire to interject facts into nasty neurotypical debates over “who counts” on the social pyramid – fights over where groups “belong” in the vicious hierarchy that is the American Social Order, and the various and necessary attempts at “rearranging” the “value” of individuals / groups on The Pyramid. One traditional method is “politicizing” “moralizing” “social justice-izing” any and all facets of daily life into conspicuous “tools” of realignment: that is, using a phony “values” argument for improving the status of “minorities” of all types, which in actual practice defends and promotes the inequality of hierarchical social structure.

The totally irrational practice of social “quotation wars” (the chaos of verbal pushing and shoving called “having a national discussion”) utilizing The Declaration of Independence, The Constitution, interpretations of the Bill of Rights, accumulated legislation and judicial opinion-decisions, The Bible, patriotic poetry, pop-celebrities, professional athletes, memes from the internet, dead people, pretentious and phony “experts” – bureaucrats and paper-shufflers now unemployed and with revenge on their minds, retired military “minds” from failed wars, and scattered “citizens” wandering the streets is totally “traditional” and “supernatural”. But! All this “word-slapping” is considered by neotenic narcissistic neurotypicals to represent the absolute facts of “reality” that “ought to” dictate outcomes in their actual physical existence. 

The people close to you are dangerous; not strangers. 

Factual information does not exist, except as ammunition for social wars of domination.

This is the case today; it has been the case in social human life from the beginning of “social life” as it replaced earlier “wild human” behavior in natural environments; behavior that was shaped and dictated by the laws of nature – physical parameters. 

One of the “useful” activities of the United States government is the ongoing collection, tabulation, and presentation of “data” on American Life. And the easy access to this information in many forms, notably, “free” and easy internet accessibility. As an Asperger, I find this to be amazing! Pages and pages of PDFs, charts, tables, summaries; categories, subcategories, topics, recent trends, archival reports, historical snapshots, and on and on. A world of curiosity-satisfying “stuff” about “us” – the American People, past, present and projected into the future. 

As a fundamental outsider(that is, an egalitarian who is de facto rejected and ejected  from The Social Pyramid by virtue of a hyposocial, reality-based “brain type”) my interest in “the human experience” begins with what we all have in common: birth and death. The great equalizing facts of all mankind which serve to “shut up” the narcissistic and delusional shouting about who is “more worthy, more valuable, more important” than “the rest of” the species.

Women need to understand that the “character” of the males they choose to associate with is crucial to their safety and mental health and to that of their children. This consideration seems to be “absent” in far too many choices that women make. 

Do neurotypicals care about any of this? No. It’s their fate to fight each other to the end; because the “discussions” always end in violence. Words are the precursors to violence. The structure of a social pyramid of “worth” dictates failure to utilize the facts to solve problems. 

For anyone interested in all that information taxpayers pay the government to compile, the Census Bureau and National Vital Statistics System provide millions of “data” points with which to gain a perspective on American Life. 

 

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The Heritage Foundation / Poor? What poor?

http://www.heritage.org/research/reports/2007/08/how-poor-are-americas-poor-examining-the-plague-of-poverty-in-America

The Heritage Foundation Backgrounder #2064 on Poverty and Inequality

How Poor Are America’s Poor? Examining the “Plague” of Poverty in America

By Robert Rector 

“As a group, America’s poor are far from being chronically undernourished. The average consumption of protein, vitamins, and minerals is virtually the same for poor and middle-class children and, in most cases, is well above recommended norms. Poor children actually consume more meat than do higher-income children and have average protein intakes 100 percent above recommended levels. Most poor children today are, in fact, supernourished and grow up to be, on average, one inch taller and 10 pounds heavier than the GIs who stormed the beaches of Normandy in World War II.”

“While the poor are generally well nourished, some poor families do experience temporary food shortages. But even this condition is relatively rare; 89 percent of the poor report their families have “enough” food to eat, while only 2 percent say they “often” do not have enough to eat.”

“Overall, the typical American defined as poor by the government has a car, air conditioning, a refrigerator, a stove, a clothes washer and dryer, and a microwave. He (!!! most of the poor are women and children)  has two color televisions, cable or satellite TV reception, a VCR or DVD player, and a stereo. He is able to obtain medical care. His home is in good repair and is not overcrowded. By his own report, his family is not hungry and he had sufficient funds in the past year to meet his family’s essential needs. While this individual’s life is not opulent, it is equally far from the popular images of dire poverty conveyed by the press, liberal activists, and politicians.”

This document is quite long and filled with graphs and charts which “prove” that quality of life is determined by what one owns; at least these guys are honest about their low opinion of what constitutes a happy and secure life. The concept that underlies the conservative social pyramid is that supremacy of a select few is “the natural order” in which white males are pre-ordained as God’s elect.

I'm not inferring that His Mormoness has any ties to the Heritage Foundation

I’m not inferring that His Mormoness has any ties to the Heritage Foundation

The Heritage Foundation is an American conservative think tank based in Washington, D.C. Heritage’s stated mission is to “formulate and promote conservative public policies based on the principles of … Wikipedia

Founded: February 16, 1973

CEO: Edwin Feulner

Nonprofit category: Public, Society Benefit Research Institutes and/or Public Policy Analysis

Tax deductibility code: 501(c)(3)

Assets: 174.1 million USD (2011)

Founders: Paul Weyrich, Edwin Feulner, Joseph Coors

______________________________________________________________

 

Yellow World / Prose Wyoming

THE YELLOW WORLD is the high desert of southwestern Wyoming

The Yellow World is a source of sediment, a high spot on the continent that will be leveled in good time.

June

In the depths of a snaky arroyo that debouches into the Green River, there stands a cut bank I call the cobble wall, after the ovoid bodies of quartzite packed into a deep layer at its base. The appearance of the polished stones within the vast monotony of mud and sand is like that of a Roman mosaic discovered in a far flung mud brick town. The smooth substantive cobbles, which began as rough bits of rock broken from distant mountain exposures, were reduced to ovoid volumes in the welter of distal floods. Relict cross-bedding of the original sandstone, and the distorted pebbles of former conglomerates, are magical metamorphic fabrics that yield details of their geologic heritage.

Time’s beauty can be held in my hand: midwifed by ice wedging and snowmelt, the cobbles provide pleasure in my garden.

Above the cobble layer, sagebrush that have been undermined when a portion of the mud wall caved onto the arroyo floor hang upside down anchored by a taproot the thickness of a hangman’s rope. This trick can extend a life span, but not forever.

It’s a forest service road in a forest without trees: the shallow shifting channel demanded by the low flow of the Blacks Fork is flanked by a wide alkali flat salted with bunch grass, as if an old-fashioned chenille bedspread grows there. The surrounding bluffs and ridges deepen to charcoal blue under passing clouds and those traveling shadows tease one into contemplation of a desert life: a period waits at the end of each sentence. Keep writing, then.

July

July sidelines the winter worrier, cold anxiety soothed by Nature’s reassurance that we deserve to live in the sagebrush fields of Paradise. The earth’s rotation is our refresh icon: the Yellow World is restored by the arrant light of daybreak, but High Noon finds the gray chaparral and yellow escarpments white hot; the countryside is overexposed and uninviting. The reward for our endurance is the transition into twilight, when nature’s products, and man’s efforts as well, benefit from the long wavelengths of the sun’s farewell.

Clouds shed answers somewhere tonight, but not on the Yellow World, not on the drought-destroyed vitality of flowers in my garden, but theirs is a simple fatigue and no match for the weariness of consciousness, for the question of what to do with oneself.

Chance, that ruthless overseer, has designated Wyoming as the land of my exile. Its wide spaces are a fence made of distance where the temptations of civilized life cannot cross its wastes to find me.

We climb a pale road to meet night descending on one of the earth’s most simple places: Puccini instructs the silent hills what it means to be caught between obligation and desire. The red girl, as red tonight as cousin fox, vaults the acid snakeweed and blushing winged dock, her tail a feather that falls among those delicate beauties. She is unaware that a dark wild horse is grazing in the faint pooling light, cut from the dark sky when the full moon shatters the plateau rim. The west wind comes on strong: we just make it back to the truck, the hot sky flowing like taffy. A summer avalanche of dust pushes us down canyon, down home.

August

Coarse red weeds tangle like dredlocks on a piece of ground disfigured by man, over which the truck rolls toward the river, toward willow and birch that move like kelp in a tidal flow, adding grace of movement to a static landscape.

The red dog barks sharply at a distant passing vehicle and the puppy echoes her mousetrap behavior, causing me to question the size and shape of my psychic territory, which under scrutiny proves to be huge and somewhat comical. I used to dodge intimacy because I believed that it came with a blade and a burden, but the yellow world has shown me that it is my character that is double-edged.

An inexplicable happiness spreads across the land, evidence of the correspondence between the land and the land inside me. My existence has to this date shown no practical application, but loving the land is sufficient when so many don’t. The source of this benevolent function is unknown, but perhaps the Art Director of Life, upon noticing a dull spot in the universe, lured me to the Yellow World. 

November

A touchy starter delays our departure, but once warmed by the sun, the red truck shudders without complaint along our uncomfortable bladed roads, over two-track hard pan and sharp rolling rock, asking no more than to enter the wilderness with enough gas to get us home.

What a wonderfully mathematical landscape is our desert; the precision of its forms seduces one into the search for non-living intelligence. Hints lie about the gentle hills, concealed in the harsh places, floating atop the river of flashing fish. Desert secrets are filed within the digs of a surly badger and demonstrated in the strict sanity of the anthill.

Anxiety Disorders / Stress is bad; why do we promote stress?

Journal of the American Osteopathic Assoc., March 2004 vol.104 S2-S5

http://jaoa.org/article.aspx?articleid=2092999

Diagnosis and Management of Anxiety Disorders

Charles Shelton, Doctor of Osteopathy

Before posting the article, I think it’s important to at least try to explain the difference between an MD and a DO. There is info online, but it’s not very clear except to say that the two are genuine medical doctors, but osteopathy has a different “philosophy and practice” style than “allopathic” medical doctors.

Info from the article: This article was developed from a lecture presented by Dr Shelton at a symposium sponsored by Wyeth Pharmaceuticals at the 108th Annual AOA Convention and Scientific Seminar on October 15, 2003, in New Orleans, La. Dr Shelton is a national speaker on the visiting speakers bureau of Wyeth Pharmaceuticals. He is also on the speakers bureaus of GlaxoSmithKline; Pfizer Inc; Cephalon, Inc; and Bristol-Myers Squibb Company. Dr Shelton is also on the CNS advisory panels of Pfizer Inc and Elan Pharmaceuticals.

What is a DO? From The American Osteopathic Assoc.

“Doctors of Osteopathic Medicine, or DOs, are fully licensed physicians who practice in all areas of medicine. Emphasizing a whole-person approach to treatment and care, DOs are trained to listen and partner with their patients to help them get healthy and stay well. (Comment; the average person might think that all doctors had some training in patient interaction, but as many of know from experience, apparently not!)

DOs receive special training in the musculoskeletal system, your body’s interconnected system of nerves, muscles and bones. (Hence osteo-bone) By combining this knowledge with the latest advances in medical technology, they offer patients the most comprehensive care available in medicine today.

Osteopathic physicians focus on prevention, tuning into how a patient’s lifestyle and environment can impact their wellbeing. DOs strive to help you be truly healthy in mind, body and spirit — not just free of symptoms. (See article for lists of pharmaceuticals “used for” each anxiety disorder)-

_____________

Abstract

Major anxiety disorders are more prevalent in women than in men. Although the tendency toward anxiety disorders appears familial, other factors such as environmental influences can play a role in the risk for anxiety. This clinical review focuses on the pathophysiologic basis for anxiety disorders. It provides brief overviews of panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. It also summarizes treatment options for patients with anxiety disorders. (Specific pharmaceuticals for each anxiety “type” may be informative IF you’ve been correctly diagnosed – a very big IF!)

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (Text Revision) (DSM-IV-TR)1 defines the five major anxiety disorders as social anxiety disorder (SAD), panic disorder (PD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Panic attacks, which represent an extreme form of anxiety, can occur in association with most of these anxiety disorders, though they are not typically associated with GAD. Lifetime prevalence rates of the major anxiety disorders range between approximately 3% (OCD) and 12% (SAD) and are approximately two times greater among women than among men.2,3

Pathophysiology of Anxiety Disorders

In the same way that behavioral traits are passed from parent to child, anxiety disorders tend to run through family structures. Studies comparing the risk of psychiatric illness in identical twins (who share 100% of their DNA) have found that in general, if one identical twin has a psychiatric condition, the risk that the other twin will have the same condition is approximately 50%.4 It therefore appears that nongenetic factors, including environmental influences occurring throughout the lifespan, must also contribute to the risk of developing an anxiety disorder.2,3

The human body attempts to maintain homeostasis at all times. Anything in the environment that disturbs homeostasis is defined as a stressor. Homeostatic balance is then reestablished by physiologic adaptations that occur in response to the stress response. (Comment: The dangerous American social belief that “superior humans” actually “thrive on more and more stress” is highly dysfunctional! The current idiotic belief is that the practice of increasing the stress that the average person must “deal with” every day, somehow (mystical natural selection) “improves” performance is abusive and a perversion of “survival of the fittest.” It’s DEADLY and accounts for the increase in poor health outcomes for Americans.  But if it increases profits – it “must be good”!

The stress response in humans involves a cascade of hormonal events, including the release of corticotropin-releasing factor (CRF), which, in turn, stimulates the release of corticotropin, leading to release of the stress hormones (glucocorticoids and epinephrine) from the adrenal cortex. The glucocorticoids typically exert negative feedback to the hypothalamus, thus decreasing the release of CRF.6

The stress response is hardwired into the brain of the typical mammal and is most often triggered when survival of the organism is threatened. The primate stress response, however, can be triggered not only by a physical challenge, but also by the mere anticipation of a homeostatic challenge. As a result, when humans chronically and erroneously believe that a homeostatic challenge is about to occur, they enter the realm of neurosis, anxiety, and paranoia. (Comment: This is not an “erroneous belief” – it is the purposeful and chronic state of the American social power structure to ensure that “homeostatic challenge” occurs 24/7. FEAR and conflict are promoted as the constant state of human reality by government and the media; by unstable employment and skewed presentations of threats from violence and crime via “news” programs and entertainment)

The amygdala is the primary modulator of the response to fear- or anxiety-inducing stimuli. It is central to registering the emotional significance of stressful stimuli and creating emotional memories.7 The amygdala receives input from neurons in the cortex. This information is mostly conscious and involves abstract associations. Being stuck in traffic, in a crowded shopping mall, or on an airplane may serve to trigger the anxiety response in a susceptible individual via this mechanism. (Comment: That’s almost every one; and “corporate policies” – ex. the airline industry – are pushing this stress to the MAX for passengers.)

The amygdala also receives sensory input that bypasses the cortex and thus tends to be subconscious. An example is that of a victim of sexual abuse who suddenly finds herself acutely anxious when interacting with a number of friendly people. It may take her a few moments to realize that characteristics of the individuals with whom she is interacting remind her of the person who abused her.

When activated, the amygdala stimulates regions of the midbrain and brain stem, causing autonomic hyperactivity, which can be correlated with the physical symptoms of anxiety. (You cannot “turn it off”) Thus, the stress response involves activation of the hypothalamic-pituitary-adrenal axis. This axis is hyperactive in depression and in anxiety disorders.8,9

Corticotropin-releasing factor, a 41 amino acid peptide, is a neurotransmitter within the central nervous system (CNS) that acts as a key mediator of autonomic, behavioral, immune, and endocrine stress responses. The peptide appears to be anxiogenic, depressogenic, and proinflammatory and leads to increased pain perception.10 γ-Aminobutyric acid (GABA) inhibits CRF release.6

Glucocorticoids activate the locus caeruleus, which sends a powerfully activating projection back to the amygdala using the neurotransmitter norepinephrine. The amygdala then sends out more CRF, which leads to more secretion of glucocorticoids, and a vicious circle of feedback between the mind (brain) and the body results.5 Repeated stimulation of the amygdala results in strengthened communication across its synapses with other regions of the brain (ie, long-term potentiation) (The damaging results of stress don’t go away, but are cumulative)

Prolonged exposure of the CNS to glucocorticoid hormones eventually depletes norepinephrine levels in the locus caeruleus. As norepinephrine is an important neurotransmitter involved in attention, vigilance, motivation, and activity, the onset of depression may subsequently occur. (Bad outcomes such as depression are PHYSICAL and not “hooky-spooky magic – psychology”)

Serotonin appears to be involved in the pathogenesis of anxiety disorders as well. Agents that enhance serotonin neurotransmission may stimulate hippocampal 5-HT1A receptors, thus promoting neuroprotection and neurogenesis and exerting an anxiolytic effect.11

GABA, the primary inhibitory neurotransmitter in the CNS, is another neurotransmitter believed to be inherently involved in the pathophysiology of anxiety disorders. Levels of GABA appear to be decreased in the cortex of patients with PD, compared with those in control subjects.12 Benzodiazepines facilitate GABA neurotransmission and therefore can improve anxiety. (Comment: This is where the “rubber meets the road” – the assumption that medication can “resolve” anxiety – it may effectively (or not) “mask symptoms” BUT pharmaceuticals “for brain pain” de facto create more problems in the form of side effects and changes to the brain – that’s  how they work. They change the brain; children’s’ brains are still developing! It’s a crap shoot for the individual taking the drug; it’s wildly uncontrolled testing on humans. Drugs do not REMOVE the source of stress that is causing anxiety! They OVERRIDE the brain-body alarm system, not only for “erroneous threats” but for actual threats such as toxic environments, unhealthy conflict-driven work environments, destructive relationships and anything that is “too stressful” in the person’s environment. They provide “negative adaptation” that allows for the damage to the person to continue. That said; in the immediate crisis of debilitating anxiety, benzodiazipines may be the only relief!) 

The remainder of the articles deals with the specific DSM disorders and “drug”  treatment …

 

 

Anxiety Disorders cont., / Panic Attacks, Panic Disorder

This is a continuation of post – Diagnosis and Management of Anxiety Disorders, by Charles Shelton, Doctor of Osteopathy. Dr Shelton is a national speaker on the visiting speakers bureau of Wyeth Pharmaceuticals. He is also on the speakers bureaus of GlaxoSmithKline; Pfizer Inc; Cephalon, Inc; and Bristol-Myers Squibb Company. Dr Shelton is also on the CNS advisory panels of Pfizer Inc and Elan Pharmaceuticals.

I’m using this article for reference because Dr. Shelton is obviously thoroughly embedded in the “Big Pharma” industry. I’m not concerned here with the wildly predatory “business” model of pharmaceuticals, but with the “drugs” that are “recommended” for treatment. Drug manufacturers are more conservative about which medications should – should not be prescribed for specific conditions than are many prescribers! Instructions and warnings are included with medications, which are so “legally protective” that reading them is often skipped – by prescribers! They go by what the drug sales rep. tells them; it’s an incredibly careless system; a crap shoot that depends on the integrity of your prescriber.

I’m not giving “medical advice” but clarifying some pitfalls in the “game” of American healthcare, based on a lifetime of experience with the “mental” healthcare system.

WARNING: Your prescriber may be ignorant of drug “chemistry” – side effects, conflicts between different drugs when taken together, or may simply be “pill happy” – the “try this” scenario of passing out pharmaceutical samples and adding more, more, more drugs. Do not trust a “randomly-assigned” prescriber – always read the side effects and other warnings: ask THE PHARMACIST about the drug’s potential for harm and any other concerns.


Back to the article:

“In general, individuals with PD may see up to ten practitioners before a correct diagnosis is made, have continuous increases in health care utilization spanning 10 years before diagnosis, and have a 5 to 8 times greater likelihood of being high users of health care.”

Now that’s a great confidence-producing set of statistics! What arrogance to claim that this dismal record indicates “expert” knowledge on the part of the psychology-psychiatry-therapy healthcare system.

Panic Attacks

Figure 1. Agents used in pharmacotherapy for panic disorder.

As discussed, panic attacks, defined as discrete periods of sudden symptom onset usually peaking in 10 minutes, can occur with most anxiety disorders.

The DSM-IV-TR criteria for panic attack are as follows: palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feeling of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or faint; derealization (feelings of unreality) or depersonalization (being detached); fear of losing control or going crazy; fear of dying; paresthesias; chills or hot flushes; one or more unexpected panic attacks. (?)

A “PA” is a single event; it may have one of many “causes” and occur only once or infrequently. To be a disorder, it must meet criteria below. One attack does not constitute a disorder. It is always a good idea to be checked out by a MEDICAL doctor first, to rule out a physical condition before consulting a “therapist” of unknown quality.

Panic disorder: at least 1 month of worry, including change in cognition or behavior;     presence or absence of agoraphobia; or attacks not accounted for by another mental disorder, or general medical condition. That’s pretty vague! It’s obvious HOW EASY it is for a “potential patient or client” to meet the requirements and to be diagnosed – a real profit bonus for “assembly line” type therapists and clinics!

Panic attacks must be differentiated from PD. Panic disorder as defined by the DSM-IV-TR includes: recurrent unexpected panic attacks; and at least one of the attacks has been followed by 1 month (or more) of one or more of the following:

persistent concern about having additional attacks; worry about the implications of the attacks or their consequences (eg, losing control, having a heart attack, going crazy); or a significant change in behavior related to the attacks.

In general, individuals with PD may see up to ten practitioners before a correct diagnosis is made, have continuous increases in health care utilization spanning 10 years before diagnosis, and have a 5 to 8 times greater likelihood of being high users of health care.

Now that’s a great confidence-producing set of statistics! What arrogance to claim that this dismal record indicates “expert” knowledge on the part of the healthcare system.

_______________________________________________

What really is a “panic attack”? It’s the activation of the “fight, flight or freeze” response. 

Myriad papers and articles about panic attacks are fairly repetitive:

1. There is no “real danger” present in the environment (at the time of that attack) that would justify the “extreme or “over” reaction.

2. Therefore, the PA is an abnormal event. The trigger is a memory of a prior experience with similar conditions (crowds, etc) that has “taken over” the response by the fight, flight freeze system. “Phobia”.

3. The PA is “illegitimate” given the benign circumstances that “actually” exist at the time of the PA.

4. The FFF system will shut down and return to “normal” in 10 minutes, so don’t “panic”!

5. Underlying these assumptions is the “belief” that the FFF response is an “animal thing” – that is, designed for wild environments and encounters between predator and prey. It’s “archaic” in essence; not suited to “modern life” but resurrected if a person is in “real danger” – a physical attack, natural disaster, an accident. Otherwise, the modern “environment” is safe, benign, non-threatening. HAH!

6. The descriptions are subtly judgmental: WOMEN are more likely to experience PA and anxiety than men, therefore the “cause” must be the unstable female psyche! (Hormones) Her system is “broken” – abnormal or damaged, which is a traditional view of “being female”.

Well! What does this indicate? Conditions that were “present” during a traumatic experience (example: a child being locked in a closet as punishment for “bad behavior” in a social situation) are not “imaginary” – confronting similar conditions (a crowded  event in which “good behavior” is a social requirement) are not imaginary: this is a normal fight, flight or freeze function. If a prey animal “survives” a predation event by the automatic physiological response of “OMG! I’m gonna die – run like Hell” OF COURSE it will “remember” the situation; it learns by the experience. If it simply “forgot” the experience, it probably would not survive for long. This is unconscious  processing: it’s the same in humans. These deep survival mechanisms did not go away because in our “imagination” we are no longer “truly animals” but live in wonderful cities and suburbs safe from natural consequences.

Why women? Because females are prey animals: females are “trapped” as the objects of sexual predation, violence and psychological imprisonment in “belief systems” that classify females as “lesser beings.” Females must repress “survival” behavior in order to survive.

Any child who has been traumatized by a single “life-threatening” event, or subjected to chronic abuse, is a candidate for ANXIETY which is the anticipation of both the horrible event reoccurring and the physical response of fight, flight or freeze, which is a frightening physical response. “Life and Death”

Telling a person who has a “panic attack” that it’s not real, or serious, or that it’s all in the mind, or that it will “go away” in ten minutes, or that they are being “a baby” or that they are weak, or are a “social embarrassment” is cruel. Saying these things in effect devalues the original trauma as “unimportant or imaginary” – telling him or her that they ARE CRAZY. This is stimulus for more anxiety and painful behavior.

Underlying the very high rates of “pathology” in American culture is the principle belief in, and unshakeable use of, punishment for any and all “social disobedience”  – from serious crime to the crime of simply being “a child.” Brutality, whether or not it’s physical or psychological, is held to be an “American Virtue”.

Researchers can fiddle with “the brain” AFTER THE FACT that the developing child brain has been compromised by maltreatment during pregnancy, premature birth, horrific medical intervention, abusive parents, malnourishment or neglect, or the prevalent (although denied) guidepost of spare the rod, spoil the child –  but this is madness: the origin of “disorder” is the diehard belief that brutality “toughens people” “produces superior individuals” especially males, and that life is a competition for “promoting one’s DNA”. This perversion means that only predators “win” –

Whoopee! More hypotheses, more studies, more verbiage, more funding, more denial that human on human predation causes damage to individuals, societies and the degeneration of Homo sapiens as a viable species.

A paper that flogs the obvious: Hyperventilation accompanies and exacerbates panic attacks.

Respir Physiol Neurobiol. 2009 May 30;167(1):133-43. doi: 10.1016/j.resp.2008.07.011. Epub 2008 Jul 25.

Panic disorder and control of breathing.

Abstract

Anxiety disorders, particularly panic disorder (PD), are associated with respiratory abnormalities. PD consists of unexpected panic attacks (PA) with anxiety, fear and many autonomic and respiratory symptoms. There is a substantial body of literature demonstrating that stimulation of respiration is a common event in panic disorder patients during PA. A number of abnormalities in respiration, such as enhanced CO(2) sensitivity, have been detected in PD patients. As a result, some investigators advanced that there is a fundamental abnormality in the physiological mechanisms that control breathing in PD. Studies indicate that PD patients with dominant respiratory symptoms are particularly sensitive to respiratory tests compared with those who do not manifest dominant respiratory symptoms, possibly representing a distinct subtype. Accumulated evidence suggests that respiratory physiology remains normal in PD patients and that their tendency to hyperventilate and to react with panic to respiratory stimulants like CO(2) represents the triggering of a hypersensitive fear network. However, some recent evidences support the presence of subclinical abnormalities in respiration and other functions related to body homeostasis. The fear network, composed by the hippocampus, the medial prefrontal cortex, the amygdala and its brainstem projections, may be abnormally sensitive in PD patients. This theory might explain why both medication and psychosocial therapies are clearly effective. The evidence of abnormalities in several neurochemical systems might be just the expression of the complex interactions among brain circuits. Our aim was to review the relationship between respiration and panic disorder, addressing the respiratory subtype of panic disorder, the hyperventilation syndrome, the respiratory challenge tests, the current mechanistic concepts and the pharmacological implications.

 

 

Thyroid Gland / Important Anatomy for Everyone

I’m currently interested in phony “psychological symptoms” that actually have a specific physical origin; that is, the symptoms are not “mental or emotional” and therefore can only be treated medically – psych mumbo-jumbo has no effect; psych “drugs” may actually exacerbate symptoms and cause further damage and side effects that add to, obscure, or complicate existing conditions. (How well I know this from experience!!) For Asperger and ASD people, this is extremely important: Anxiety is a major problem, but little is known about WHY this is so: anxiety is a pan-human reaction to “outside” social stimulus, environmental triggers, internalized trauma AND physiological “errors” or disease. We must know the origin of excessive anxiety in individuals in order to effectively reduce the debilitating levels many of us live with daily or episodically. 

From: endocrineweb.com 

How Your Thyroid Works

Controlling hormones essential to your metabolism

Your thyroid gland is a small gland, normally weighing less than one ounce, located in the front of the neck. It is made up of two halves, called lobes, that lie along the windpipe (trachea) and are joined together by a narrow band of thyroid tissue, known as the isthmus.

Thyroid has two lobes and an isthmus.

The thyroid is situated just below your “Adams apple” or larynx. During development (inside the womb) the thyroid gland originates in the back of the tongue, but it normally migrates to the front of the neck before birth. Sometimes it fails to migrate properly and is located high in the neck or even in the back of the tongue (lingual thyroid). This is very rare. At other times it may migrate too far and ends up in the chest (this is also rare).

Iodine + Tyrosine=T3 and T4.

The function of the thyroid gland is to take iodine, found in many foods, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine. These cells combine iodine and the amino acid tyrosine to make T3 and T4. T3 and T4 are then released into the blood stream and are transported throughout the body where they control metabolism (conversion of oxygen and calories to energy).

Every cell in the body depends upon thyroid hormones for regulation of their metabolism. The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone “strength” as T4.

/hypothalamus secretes TRH, Pituitary secretes TSH, Thyroid secretes T3 and T4.The thyroid gland is under the control of the pituitary gland, a small gland the size of a peanut at the base of the brain (shown here in orange). When the level of thyroid hormones (T3 & T4) drops too low, the pituitary gland produces Thyroid Stimulating Hormone (TSH) which stimulates the thyroid gland to produce more hormones. Under the influence of TSH, the thyroid will manufacture and secrete T3 and T4 thereby raising their blood levels.

The pituitary senses this and responds by decreasing its TSH production. One can imagine the thyroid gland as a furnace and the pituitary gland as the thermostat.

Thyroid hormones are like heat. When the heat gets back to the thermostat, (awkward!) it turns the thermostat off. As the room cools (the thyroid hormone levels drop), the thermostat turns back on (TSH increases) and the furnace produces more heat (thyroid hormones). The pituitary gland itself is regulated by another gland, known as the hypothalamus (shown in the picture above in light blue). The hypothalamus is part of the brain and produces TSH Releasing Hormone (TRH) which tells the pituitary gland to stimulate the thyroid gland (release TSH). One might imagine the hypothalamus as the person who regulates the thermostat since it tells the pituitary gland at what level the thyroid should be set.

The thyroid’s hormones regulate vital body functions, including:

  • Breathing
  • Heart rate
  • Central and peripheral nervous systems
  • Body weight
  • Muscle strength
  • Menstrual cycles
  • Body temperature
  • Cholesterol levels
  • Much more!

Thyroid Anatomy Tour: click here to access 2nd article

How the Thyroid Gland Works
The thyroid is part of the endocrine system, which is made up of glands that produce, store, and release hormones into the bloodstream so the hormones can reach the body’s cells. The thyroid gland uses iodine from the foods you eat to make two main hormones:

  • Triiodothyronine (T3)
  • Thyroxine (T4)
It is important that T3 and T4 levels are neither too high nor too low. Two glands in the brain—the hypothalamus and the pituitary communicate to maintain T3 and T4 balance.

The hypothalamus produces TSH Releasing Hormone (TRH) that signals the pituitary to tell the thyroid gland to produce more or less of T3 and T4 by either increasing or decreasing the release of a hormone called thyroid stimulating hormone (TSH).

  • When T3 and T4 levels are low in the blood, the pituitary gland releases more TSH to tell the thyroid gland to produce more thyroid hormones.
  • If T3 and T4 levels are high, the pituitary gland releases less TSH to the thyroid gland to slow production of these hormones.

Why You Need a Thyroid Gland
T3 and T4 travel in your bloodstream to reach almost every cell in the body. The hormones regulate the speed with which the cells/metabolism work. For example, T3 and T4 regulate your heart rate and how fast your intestines process food. So if T3 and T4 levels are low, your heart rate may be slower than normal, and you may have constipation/weight gain. If T3 and T4 levels are high, you may have a rapid heart rate and diarrhea/weight loss.

Listed below are other symptoms of too much T3 and T4 in your body (hyperthyroidism):

  • Anxiety
  • Irritability or moodiness
  • Nervousness, hyperactivity
  • Sweating or sensitivity to high temperatures
  • Hand trembling (shaking)
  • Hair loss
  • Missed or light menstrual periods

The following is other symptoms of too little T3 and T4 in your body (hypothyroidism):

  • Trouble sleeping
  • Tiredness and fatigue
  • Difficulty concentrating
  • Dry skin and hair
  • Depression
  • Sensitivity to cold temperature
  • Frequent, heavy periods
  • Joint and muscle pain

Thyroid Hormones / Brain Development

Endocrine System > Thyroid and Parathyroid Glands

Thyroid Hormones: Pregnancy and Fetal Development

Thyroid hormones are critical for development of the fetal and neonatal brain, as well as for many other aspects of pregnancy and fetal growth. Hypothyroidism in either the mother or fetus frequently results in fetal disease; in humans, this includes a high incidence of mental retardation.

Maternal Thyroid Function During Pregnancy

Normal pregnancy entails substantial changes in thyroid function in all animals. These phenomena have been studied most extensively in humans, but probably are similar in all mammals. Major alterations in the thyroid system during pregnancy include:

  • Increased blood concentrations of T4-binding globulin: TBG is one of several proteins that transport thyroid hormones in blood, and has the highest affinity for T4 (thyroxine) of the group. Estrogens stimulate expression of TBG in liver, and the normal rise in estrogen during pregnancy induces roughly a doubling in serum TBG concentratrations.
  • Increased levels of TBG lead to lowered free T4 concentrations, which results in elevated TSH secretion by the pituitary and, consequently, enhanced production and secretion of thyroid hormones. The net effect of elevated TBG synthesis is to force a new equilibrium between free and bound thyroid hormones and thus a significant increase in total T4 and T3 levels. The increased demand for thyroid hormones is reached by about 20 weeks of gestation and persists until term.
  • Increased demand for iodine: This results from a significant pregnancy-associated increase in iodide clearance by the kidney (due to increased glomerular filtration rate), and siphoning of maternal iodide by the fetus. The World Health Organization recommends increasing iodine intake from the standard 100 to 150 ug/day to at least 200 ug/day during pregnancy.
  • Thyroid stimulation by chorionic gonadotropin: The placentae of humans and other primates secrete huge amounts of a hormone called chorionic gonadotropin (in the case of humans, human chorionic gonadotropin or hCG) which is very closely related to luteinizing hormone. TSH and hCG are similar enough that hCG can bind and transduce signalling from the TSH receptor on thyroid epithelial cells. Toward the end of the first trimester of pregnancy in humans, when hCG levels are highest, a significant fraction of the thyroid-stimulating activity is from hCG. During this time, blood levels of TSH often are suppressed, as depicted in the figure to the right. The thyroid-stimulating activity of hCG actually causes some women to develop transient hyperthyroidism.

The net effect of pregnancy is an increased demand on the thyroid gland. In the normal individuals, this does not appear to represent much of a load to the thyroid gland, but in females with subclinical hypothyroidism, the extra demands of pregnancy can precipitate clinicial disease.

Thyroid Hormones and Fetal Brain Development

In 1888 the Clinical Society of London issued a report underlining the importance of normal thyroid function on development of the brain. Since that time, numerous studies with rats, sheep and humans have reinforced this concept, usually by study of the effects of fetal and/or maternal thyroid deficiency. Thyroid hormones appear to have their most profound effects on the terminal stages of brain differentiation, including synaptogenesis, growth of dendrites and axons, myelination and neuronal migration.

Thyroid hormones act by binding to nuclear receptors and modulating transcription of responsive genes. Thyroid hormone receptors are widely distributed in the fetal brain, and present prior to the time the fetus is able to synthesize thyroid hormones. It has proven surprisingly difficult to identify the molecular targets for thyroid hormone action in the developing brain, but some progress has been made. For example, the promoter of the myelin basic protein gene is directly responsive to thyroid hormones and contains the expected hormone response element. This fits with the observation that induced hypothyroidism in rats leads to diminished synthesis of mRNAs for several myelin-associated proteins.

It seems clear that there is a great deal more to learn about the molecular mechanisms by which thyroid hormones support normal development of the brain.

Thyroid Deficiency in the Fetus and Neonate

The fetus has two potential sources of thyroid hormones – it’s own thyroid and the thyroid of it’s mother. Human fetuses acquire the ability to synthesize thyroid hormones at roughly 12 weeks of gestation, and fetuses from other species at developmentally similar times. Current evidence from several species indicates that there is substantial transfer of maternal thyroid hormones across the placenta. Additionally, the placenta contains deiodinases that can convert T4 to T3.

There are three types or combinations of thyroid deficiency states known to impact fetal development:

Isolated maternal hypothyroidism: Overt maternal hypothyroidism typically is not a significant cause of fetal disease because it usually is associated with infertility. (How does this affect infertile women who become pregnant using donor embryo implantation?) When pregnancy does occur, there is increased risk of intrauterine fetal death and gestational hypertension. Subclincial hypothyroidism is increasingly being recognized as a cause of developmental disease – this is a rather scary situation. Several investigators have found that mild maternal hypothyroidism, diagnosed only retrospectively from banked serum, may adversely affect the fetus, leading in children to such effects as slightly lower performance on IQ tests and difficulties with schoolwork. The most common cause of subclinical hypothyroidism is autoimmune disease, and it is known that anti-thyroid antibodies cross the human placenta. Thus, the cause of this disorder may be a passive immune attack on the fetal thyroid gland.

Isolated fetal hypothyroidism: This condition is also known as sporadic congenital hypothyroidism. It is due to failure of the fetal thyroid gland to produce adequate amounts of thyroid hormone. Most children with this disorder are normal at birth, because maternal thyroid hormones are transported across the placenta during gestation. What is absolutely critical is to identify and treat this condition very shortly after birth. If treatment is not instituted quickly, the child will become permanently mentally and growth retarded – a disorder called cretinism. This problem has largely disappeared in the US and many other countries due to large scale screening programs to detect hypothyroid infants.

Iodine deficiency – Combined maternal and fetal hypothyroidism: Iodine deficiency is, by a large margin, the most common preventable cause of mental retardation in the world. Without adequate maternal iodine intake, both the fetus and mother are hypothyroid, and if supplemental iodine is not provided, the child may well develop cretinism, with mental retardation, deaf-mutism and spasticity.

The World Health Organization estimated in 1990 that 20 million people had some degree of brain damage due to iodine deficiency experienced in fetal life. Endemic iodine deficiency remains a substantial public health problem in many parts of the world, including many areas in Europe, Asia, Africa and South America. In areas of severe deficiency, a large fraction of the adult population may show goiters. In such settings, overt cretinism may occur in 5 to 10 percent of offspring, and perhaps five times that many children will have mild mental retardation. This is a serious, tragic and, most importantly, a preventable problem.

The effects of mild maternal hypothyroidism on cognitive function of children has been evaluated in several studies, including some in which mothers will low levels of T4 or high levels of TSH were treated prophylactically with thyroid supplementation. The results of these studies are somewhat divergent, and the benefit of routinely testing pregnant women and treating those with suspected thyroid deficiency remains unsettled.

The fetus of an iodine-deficient mother can be successfully treated if iodine supplementation is given during the first or second trimester. Treatment during the third trimester or after birth will not prevent the mental defects.

Iodine deficiency can also be a sigificant problem in animal populations. The most common manifestation in sheep, cattle, pigs and horses is a high incidence of stillbirths and birth of small, weak offspring.

Hyperthyroidism in Pregnancy

Gestational hyperthyroidism is associated with increased risk of several adverse outcomes, including preeclampisa, premature labor, fetal or perinatal death and low birth weight. In humans, hyperthyroidism usually is the result of Grave’s disease, which involves development of autoantibodies against the TSH receptor that stimulate the thyroid gland.

From the Archives / Essay on Social Petri Dish

One “fun” result of getting a new computer (with a CD drawer, no less) is being able to go back through all those CD back ups that I should have thrown away years ago, but kept. This dates to ca. 2006…

 

Early One Morning in the Universe

Humanity may be stuck on a wheel of incarnation (repeating the same mistakes, generation after generation), but the individual need not be

What if the form and content of human belief come down to a design preference, with the majority of people preferring a hierarchical plan, based on the family: a design fated to bog down in jealousy and unfair treatment: a system based on parental rage – life in a social petri dish that breeds implacable tragedy from which the individual cannot escape, even in death?

At the other end of the spectrum of ideas, and so far, a neglected alternative, is something clean and random and spontaneous: a scheme based on experience, which does not require supernatural affirmation of our collective and primeval family delusions. The fact that the body will die, permanently and forever, opens the imagination to that which lies beyond human control, and frees the individual from bondage to the group, because it is my body, not theirs.

Society tells its children that a glow worm, or some larval stage of development, was inserted into each of their bodies at conception, or at birth, or baptism, or when the sex hormones turn on, depending on the cultural context they were born into and that this ghostly thing was activated by the supernatural, thus causing the child to be alive. In actual practice, we proceed through life guided by infinitely more ancient and practical instructions called DNA. The results are not perfect, certainly. In Homo sapiens, it is apparent that the code results in a brain of dubious reliability. It is painful to admit, but necessary.

The claim is that this supernatural thing will leave my body when it perishes; a thing which is held by the majority of people in my culture to be my true identity, but which is alien to me – unknowable, in fact. A temporary resident that has no particular form or substance, but which is locked in combat with an inherently evil physical body – a body that for as long as I may live, never really belongs to me. This is put forth as a stupendous delusion: I am expected to believe that my real self is on loan from a supernatural source, and my individual abilities and pursuits discarded as worthless except in reference to this source: my status is that of a puppet activated by magic.

Creation stories, devised by primeval tribes and salvaged or scavenged or embroidered by civilizations of size and material sophistication, fail the pure design test, which requires consonance with Nature. These schemes begin by naming and claiming pieces of existence, an approach to conceptualizing the environment that is understandable in primitive circumstances, hatched by the need for power in the childhood of humankind. The leap our ancestors made to magical connections between objects and ideas is significant in animal evolution, but faulty. Our ancestors had to be satisfied with what their brains could do constructively, which is to make analogies.

Many of these early connections are elegant, while other myths are positively stupefying, perhaps because the original symbolism is lost to us. Many stories that have come down to us betray the weaknesses in human memory, just as each copy of an image is farther removed from the original and loses its distinction. What we have is a cultural junk drawer jammed by absurdities, which have been patented by repetition and fanciful interpretation, which served our species in their time, but we now hoard these errors at terrific cost; cultural ideas have not kept pace with technology. Mythology has become an end in itself. Reality is lost.

Like the genetic code itself, human culture is both repetitive and additive. Genetic information is not thrown away; unnecessary bits are instead stashed in great unused collections of instructions, which is why most of our DNA matches that of both extinct and existing species; why the human fetus recapitulates evolution, why each of us is a portable portion of an ancient sea. Nature is conservative, and yet favors the workable mutation and the turning on and off of old switches.

By means of language and technology, human beings also gather vast amounts of information. Certain knowledge remains active in a culture, some lies dormant: certainly, not all information is of equal value. The results are a mixed affair. An advance in technology may be valued because it can be used in war, while its peaceful uses are ignored, or eventually borrowed and put to a different use.  An idea may be valued because it sanctions the rights of ruthless rulers. A war may be fought because it appears to be motivated by moral good, but which in reality merely exploit greed. There is no way to judge cultures as a whole any more than we can judge DNA, or the results of evolution.  And yet, we do, because we can, because we have a brain built to contrast and compare; ideas are a product of human thought, but most ideas are  not at all helpful to survival.

Our peril to ourselves and to the life of the planet lies in obsessing over and hoarding bits of cramped opinion that will never produce a picture of existence that is new in any way. The picture that mankind persists in using as its model of the universe was created by ignorant and fearful minds that were driven by the necessity of wresting control from a powerful environment, but we are mature and ought to have learned something from the history of our species. Our current picture is as jumbled as those clots of discarded DNA; useful, not useful.

We are perfectly capable of accepting the totality of the universe in an attitude of respectful silence, in recognition of what we do not know, and with a comprehensive view that doesn’t require a beginning and ending point in us. We are the sole creature to arise on earth (as far as we know) to have the ability to view the many threads of existence. Throughout life, each of us will perceive these mysteries in changed ways, even if we are not aware of it. That is, we learn.

For our species, the universe of mind is whatever we make of it. Despite this creative attribute, physical reality does exist, and we are ultimately powerless when faced with this truth. From deep within us great fear arises, causing us to cast our theories, dreams, imaginings, fears, and limitations onto a sublime unknown. We write our own story, one that explains how it was all meant to be, but these ‘meant-to-be’ stories are wishes designed to soothe our nerves and explain our cruelty. Why do we need to deflect ownership of our perpetual violence, cruelty, and destruction when this is actual behavior?

We respond to beauty as strongly as to food or sex. Beauty is inherent in physical reality: contrary to what one might assume, mathematicians and physicists understand this best, since mathematics is the language of physical reality. What could be more beautiful and concise than E=mc2? We are a product of physical reality, therefore beauty is built into us. Beauty is the motivation for civilized and sane behavior, for kindness and for learning. Why paint animals in the deep recesses of a cave, why labor for decades to erect temples, why undertake near-fatal journeys just to collect fantastic and beautiful materials from around the earth, if not to participate in a beauty that is also within us? What we desire from beauty is fusion with the universe.

What has happened to mankind that our cultures are so out of balance with the physical world? Beauty and light did not leave our world, but are abandoned by the mass of human beings for various dreary versions of existence, in which every living thing is worthless when compared to profit. These plodding schemes are crowded and disorganized and not beautiful at all because they do away with possibility. Tangled loops of anti-knowledge go around and around in the minds of those who are stuck on limits within the brain. But the universe does not stop evolving in order to satisfy their need for a finite answer, and yet the mass of humans dwell on the tired details of texts and rituals that ignore common experience. We think that the universe will become whatever we want it to be, but whatever it may be, it exists ‘as is’ and we merely constrain our knowledge with beliefs, preferences, and delusions.

I feel more free as a body that will die, than believing that something unnatural will leave my body, to proceed onward and upward into a supernatural domain. Most of it seems a design preference. There is something clean and spontaneous in a design that is not required to house itself in levels of existence freed only for a time from the great overseeing One. I fear I am a renegade soul out to proceed on my way alone.

 

 

 

 

Abuse of the Elderly is a CRIMINAL Social Activity

Prescription Abuse Seen In U.S. Nursing Homes With Updates 2011 and 2016 – Nothing Changes –

It takes a dedicated social structure to perpetuate human rights abuses, especially by those at the top of the hierarchy who profit from that abuse. 

********

Powerful Antipsychotics Used to Subdue Elderly; Huge Medicaid Expense

By Lucette Lagnado / Updated Dec. 4, 2007 WALL STREET JOURNAL

In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals — including antibiotics, AIDS drugs or medicine to treat high-blood pressure. One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer’s disease and other forms of dementia. ______________________________________________________________________________

Seroquel had global sales of $3.4 billion last year (2006), making it one of the industry’s blockbusters. U.S. sales were $2.5 billion. For the past two years, Seroquel has been the No. 1 drug purchased by Medicaid. ______________________________________________________________________________

The use of atypical antipsychotic drugs in nursing homes continues despite scientific papers that question the benefits of using them on dementia sufferers in light of the risks. Earlier this year, the federal Agency for Health Care Research and Quality reviewed existing research and noted the drugs can trigger strokes, induce body tremors, fuel weight gain and affect an elderly person’s gait, increasing their chances of falling.

‘Black Box’ Warning The Food and Drug Administration issued a “black box” warning on using the drugs for dementia patients in 2005. But the FDA stopped short of banning such use; officials say they give physicians the leeway to prescribe the drugs if they think it will help this difficult-to-treat population. Some doctors are now switching back to older, cheaper antipsychotics, such as Haldol, the FDA says. The older drugs had fallen into disuse, but don’t have a black-box warning. Now, the FDA says it’s weighing putting a black-box warning on those drugs, too.

The wonders of modern medicine will keep you alive long enough to live your last years in HELL.

The wonders of modern medicine will keep you alive long enough to live your last years in HELL.

In Massapequa, N.Y, a nursing home was recently fined by the state for injecting 90 doses of Haldol into a 96-year-old Alzheimer’s patient. The woman, identified only as Resident #2, enjoyed listening to music and getting her nails polished, according to a state report. But when agitated, she banged her hand on the table and sometimes yelled. One aide found it was possible to calm her by offering ice cream and chatting with her, the report said. But other staff gave her the drug Haldol. Between August 2006 to February of this year, she received 90 doses of injectable Haldol, the report said. The facility, Parkview Care and Rehabilitation Center, paid a $2,000 fine for medication misuse.

“It is a unique situation,” says Steve Seltzer, Parkview’s administrator. “I know that this is not the nature of this facility.” (The social hierarchy functions on lies, no matter who it hurts, which of course, means the most vulnerable human beings.)

He described Resident #2 as an especially difficult case, who reverted to her native European language, making it hard to communicate. As a result of the state’s action, “staffing changes were made,” he says. The woman was later given a teddy bear as both a way to calm her down and to provide a cushion so she wouldn’t hurt herself.

 

______________________________________________Update, 2011
Introduction and Discussion (Attorney Toby Edelman’s testimony at the Senate Aging Committee on Nov. 30, 2011)

In May 2011, the Inspector General of the Department of Health and Human Services issued a report indicating that

  • 304,983 elderly nursing home residents (14%) received atypical antipsychotic drugs between January 1 and June 30, 2007, at a cost of hundreds of millions of dollars for the six-month period;
  • 83% of the claims were for off-label conditions, including 88% for conditions specified in the black-box warning given to antipsychotic drugs by the Food and Drug Administration (FDA).[1]

The Inspector General’s report actually understates the inappropriate use of antipsychotic drugs with nursing home residents because it does not evaluate the inappropriate use of conventional antipsychotics drugs, which are still used in nursing facilities.  Nursing facilities’ self-reported data, publicly reported by the Centers for Medicare & Medicaid Services (CMS), indicate that in the third quarter of 2010, 26.2% of residents received an antipsychotic drug in the previous seven days.[2]  Facilities reported to CMS that they gave antipsychotic drugs to many residents who did not have a psychosis or related condition, including 39.4% of residents at “high risk” of receiving antipsychotic drugs because of “behavior problems.”[3]

As Inspector General Daniel Levinson wrote in a May 9, 2011 statement, “Too many [nursing homes] fail to comply with federal regulations designed to prevent overmedication, giving nursing home patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use.”[4]  He concluded, “Government, taxpayers, nursing home residents, as well as their families and caregivers should be outraged – and seek solutions.”[5]

We agree with General Levinson that the misuse of antipsychotic drugs with nursing home residents who suffer from dementia is outrageous.  But what is even more shocking is that this problem is not new.  More than twenty years ago, this Committee held a Workshop on “Reducing the Use of Chemical Restraints in Nursing Homes” that identified the same issues we are discussing today.[6]  Several months later, in February 1992, in the preamble to proposed regulations that would have given residents new protections from chemical restraints, the Health Care Financing Administration (HCFA) (predecessor agency to CMS) described the long-standing and “significant public health problem in many, but not all of this nation’s long-term care facilities.”[7]  The problem described by HCFA was, even then, more than 15 years old:

For many years, there have been allegations of misuse of psychoactive drugs in these facilities.  In 1975, the Special Committee on Aging of the U.S. Senate held hearings on this public health problem and made reference to “chemical straight jackets” in nursing homes.  In 1980, the House Select Committee on Aging held hearings on the same subject.  They entitled their report, “Drug Abuse in Nursing Homes.”  Most recently, articles that deal with the subject have appeared in a number of medical journals.  These papers generally question the extent of the use of psychopharmacologic drugs in nursing homes and question whether adequate monitoring of the use of these drugs exists.[8]

Since at least 1975, we have been on notice as a country that nursing home residents have been overmedicated with antipsychotic drugs. Yet the problem persists.  It is long past time to change this shameful record.

The Nursing Home Reform Law prohibits the antipsychotic drug practices that we see in too many nursing homes

The federal Nursing Home Reform Law, enacted in 1987, limits the use of psychopharmacologic drugs.  The law expressly provides:

Psychopharmacologic drugs may be administered only on the orders of a physician and only as part of a plan (included in the written plan of care described in paragraph (2)) designed to eliminate or modify the symptoms for which the drugs are prescribed and only if, at least annually, an independent, external consultant reviews the appropriateness of the drug plan of each resident receiving such drugs.[9]

Implementing regulations explicitly limit the use of antipsychotic drugs (under a subsection of the regulations entitled Unnecessary Drugs):

(2) Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that—

(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and

(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.[10]

The federal regulations also require monthly review of each resident’s entire drug regimen by a pharmacist, who must report “irregularities”:

(c) Drug regimen review. (1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.

(2) The pharmacist must report any irregularities to the attending physician and the director of nursing, and these reports must be acted upon.[11]

CMS guidance to surveyors in the State Operations Manual[12] encourages facilities to use non-pharmacological alternatives, identifies situations where antipsychotic medications are not indicated,[13] and provides an investigative protocol for unnecessary drugs, including antipsychotic drugs.

Despite these strong provisions, antipsychotic drug use remains a serious concern, in part because the law, regulations, and surveyor guidance are inadequately and ineffectively enforced.  Stronger enforcement of these standards would make an enormous difference.

Changing current practice is an important goal of residents’ advocates, as demonstrated by the Resolution passed this month by members of the National Consumer Voice for Quality Long-Term Care (Consumer Voice).  (The resolution is attached to my testimony.)

Why antipsychotic drugs are inappropriately prescribed for nursing home residents

There are many reasons why antipsychotic drugs are inappropriately prescribed for nursing home residents who have dementia, despite the strong statutory and regulatory protections against such use.[14]  I offer several additional reasons here.

Nursing facilities have insufficient numbers of appropriately trained staff

The most significant cause of the inappropriate use of antipsychotic drugs is the serious understaffing in nursing facilities.[15]  Most facilities do not have enough staff and enough staff with specialized and professional training to meet the needs of their residents who have dementia.

This point was bluntly made by the American Society of Consultant Pharmacists (ASCP).  In a Policy Statement about “Use of Antipsychotic Medications in Nursing Facility Residents,” issued in response to the Inspector General’s May 2011 report, ASCP acknowledges that “non-pharmacological approaches are generally preferred as initial therapy when possible,” but then states:

Nursing homes have evolved to the point where the vast majority of residents have one or more mental health problems, yet few nursing homes have staff with specialized training in psychology or behavior management.  The result is that medications have become the dominant approach to management of BPSD [Behavioral and Psychological Symptoms of Dementia].[16]

Jonathan Evans, M.D., incoming president of the American Medical Directors Association, has called for “a different paradigm” – a recognition that “behavior is communication, . . . not a disease.”[17]  He urges that caregiving staff learn new methods to figure out the meaning of residents’ behaviors and to address the behaviors creatively, without drugs.

Two additional staffing issues – the enormous turnover in staff and lack of consistent assignment of staff to residents – both contribute to the inappropriate medication of residents with antipsychotic drugs in order to address behavior issues.  When staff do not know the residents they are caring for, they are less able to recognize and understand residents’ non-verbal communications or changes in condition that could warrant a care intervention.

Physical restraints are used less often

General recognition that physical restraints are not appropriate has led nursing facilities to use drugs as an alternative way to deal with residents with behavior issues.  When the 1987 Nursing Home Reform Law was implemented in 1990, the federal government made a strong effort through the survey and certification system to reduce the use of physical restraints.  Strong federal regulations and guidance were supported by residents’ advocates’ and nursing facilities’ recognizing the dangers of physical restraints and promoting alternative methods of care.  While physical restraints are still used far more widely than they should be, they are less common than they were 20 years ago.  But physical restraints have been replaced by less visible chemical restraints.

Some drug companies have engaged in illegal off-label marketing of antipsychotic drugs for nursing home residents

The aggressive off-label marketing of antipsychotic drugs, especially the atypical antipsychotic drugs that were promoted as having fewer side effects than conventional antipsychotic drugs, led to their expanded use after a brief period of declining use.[18]  To cite one example: In January 2009, the Eli Lilly Company settled civil and criminal charges under the federal False Claims Act,  paying $1.45 billion in civil and criminal fines.[19]  The United States alleged that between September 1999 and March 31, 2001, the company engaged in off-label promotion of Zyprexa “as treatment for dementia, including Alzheimer’s dementia.”[20]  Eli Lilly had trained its long-term care sales force to promote Zyprexa for the treatment of dementia, depression, anxiety and sleep problems in nursing home and assisted living residents.

  Consultant pharmacists often work for long-term care pharmacies

Consultant pharmacists, who are critical to implementing the federal provisions governing drug regimen review, have not been independent.

One example: In January 2010, the United States sued drug manufacturer Johnson & Johnson for paying kickbacks to Omnicare, the nation’s largest nursing home pharmacy, so that Omnicare’s pharmacists would recommend Johnson & Johnson’s drugs, including Risperdal, for use by nursing home residents.  The Justice Department’s January 2010 press release described the government’s allegations:

In its complaint against J&J, the United States alleges that the company paid kickbacks to Omnicare to induce the nursing home pharmacy company to purchase and recommend J&J drugs, including the anti-psychotic drug Risperdal, for use in nursing homes. According to the complaint, J&J understood that Omnicare’s pharmacists reviewed nursing home patients’ charts at least monthly and made recommendations to physicians on what drugs should be prescribed for those patients. The government further alleges that J&J knew that physicians accepted the Omnicare pharmacists’ recommendations more than 80 percent of the time, and that J&J viewed such pharmacists as an “extension of [J&J’s] sales force.”[21]

Two months earlier, in November 2009, the government had settled a False Claims Act case with Omnicare.  Under the settlement, Omnicare paid $98 million and the drug manufacturer IVAX Pharmaceuticals agreed to pay $14 million to the United States to resolve allegations involving kickbacks paid to Omnicare by Johnson & Johnson in exchange for Omnicare’s consultant pharmacists’ recommending the antipsychotic drug Risperdal for nursing home residents.[22]

Although these False Claims Act cases arose prior to implementation of Medicare Part D, problems with drug regimen reviews continue under Part D.  Long-term care pharmacies often provide consultant pharmacist services to nursing facilities, at low or no cost.  Long-term care pharmacies receive rebates from drug manufacturers, leading to “‘a very strong incentive to promote utilization of drugs for which they receive rebates.’”[23]  In a study of antipsychotic drug use in nursing facilities between May 2010 and June 2011, the California Department of Public Health found that consultant pharmacists failed to identify inappropriate antipsychotic use in 18 of 20 facilities (90%).[24]

Antipsychotic drugs are a protected class under Medicare Part D

The Inspector General recently reported that the utilization control mechanism of prior authorization is prohibited “in most instances” for drugs that are protected classes under Part D, including antipsychotic drugs.[25]  Post-payment strategies for utilization control “do not focus on medically accepted indications” for drug use.  Psychoactive drugs, once prescribed, face little scrutiny from Part D prescription drug plans.

The high costs of using antipsychotic drugs

Antipsychotic drugs are expensive.  They are the top-selling class of drugs in the United States, generating annual revenues of $14.6 billion.[26]  While all of these drugs are not used with nursing home residents,[27] a significant portion is.  Drastically reducing the use of these drugs with residents for whom they are not appropriate would not only result in better care for the residents; it would also save the health care system billions of dollars.

But the costs of inappropriately using antipsychotic drugs extend far beyond the costs of the drugs themselves.  Residents who are inappropriately given antipsychotic drugs experience a number of bad health outcomes that are expensive to try to correct.  There is a high financial cost to the inappropriate use of antipsychotic drugs with nursing home residents.

Twenty years ago, efforts were made to quantify the “hidden costs” of antipsychotic drug use.  David Sherman described research documenting that “elderly long-term care residents receiving antipsychotic drug therapy are two to three times more likely to experience a fractured hip than residents not receiving these medications.”[28]  He identified increased urinary incontinence resulting from use of antipsychotic drugs[29] as well as an increase in falls and hip fractures.[30]

More than 20 years ago, the Senate Labor and Human Resources’ Subcommittee on Aging issued a staff report that identified the high cost of poor care and quantified the costs, citing research literature.  The report quantified $3.26 billion to pay for incontinence care; $746.5 million for hip fractures for 18,500 residents ($40,000 per person); and nearly $1 billion for hospitalizations – all poor outcomes of care caused, in part, by antipsychotic drugs.[31]

A new report issued in April 2011 by Consumer Voice provides additional research-based data on the high costs of poor care.[32]  Consumer Voice cites reports by the Centers for Disease Control and Prevention (CDC) that falls and fractures in older people account for $31 billion in costs to the health care system (although not all of these costs, of course, reflect nursing home residents).[33]  CDC also reports that in 2004, 8% of nursing home residents nationwide – 123,600 individuals – had an emergency department (ED) visit in the prior 90 days and that 40% of the ED visits, involving 50,300 residents, were preventable.[34]  The leading cause of residents’ potentially avoidable ED visits was injuries from falls.

Solutions

BLAH, BLAH, BLAH –

A problem as far-reaching as the chemical restraint of nursing home residents cannot be resolved by a single solution.  Many solutions, simultaneously implemented, are necessary.  Residents’ advocates do not recommend an absolute prohibition against prescribing antipsychotic drugs for residents who have dementia, but no diagnosis of psychosis or related conditions.  However, the fact that off-label use of drugs may be appropriate under some circumstances does not provide wholesale justification for the extensive use of antipsychotic drugs with residents who have dementia.  The FDA’s black box warnings on antipsychotic drugs should call into question most off-label use of antipsychotic drugs with such residents.

What we recommend is implementing what virtually all commenters on all sides of this issue agree on – that non-pharmacologic approaches should be tried first.  To achieve that end, we recommend a number of approaches that would call prescribers’ attention to the issue of antipsychotic drug use, slow down the process of prescribing antipsychotic drugs, teach better non-drug alternatives, and create and impose stronger sanctions for inappropriate antipsychotic drug use.

Survey

  • CMS should revise the federal survey protocol and the new Quality Indicator Survey to require surveyors to include residents using antipsychotic drugs in the resident sample in every survey.
  • CMS should require its Regional Offices to focus the federal surveys they undertake as part of their oversight function on facilities with high rates of antipsychotic drug use.

Training and education

  • CMS should issue a Survey & Certification Letter, outlining the importance of surveyors’ determining compliance with CMS’s regulations and guidance on the use of antipsychotic drugs.  The Letter could highlight the recent decision in Washington Christian Village v. CMS, Docket Nos. C-10-456 and C010-602, Decision No. CR2403 (July 27, 2011), which sustained an unnecessary drug deficiency for antipsychotic drugs.
  • CMS should conduct a Satellite broadcast and in-person trainings on CMS’s existing (and new) regulations on antipsychotic drugs.  More than twenty years ago, surveyor training on physical restraints presented the importance of the issue and information on how to provide care without physical restraints. Similar training should be provided on chemical restraints.

New legislation and regulations

  • The Prescription Drug Cost Reduction Act, S. 1699, §7, introduced by Senator Kohl on October 12, 2011, requires physician certification that off-label prescription of an antipsychotic drug with a nursing home resident “is for a medically accepted indication.”[35]  This is an excellent legislative proposal that we strongly encourage Congress to enact.
  • CMS recently proposed amending the consultant pharmacist regulations, 42 C.F.R. §483.60(b) to require that consultant pharmacists be independent and have no conflict of interest; prohibit rebates, kickbacks, bonuses, fee arrangements, and gain-sharing.  76 Federal Register 63018, 63038-63041 (Oct. 11, 2011).  This is an excellent proposal that we strongly encourage CMS to adopt.
  • CMS should adopt the 1992 proposed rules on chemical restraints.  These regulations require that residents or their legal representatives give specific written informed consent for antipsychotic drug use.  They also require that physician orders specify “the dose, duration and reason for the use of the drug;” that a psychopharmacologic drug “not be used unless it can be justified in the clinical record that the potential beneficial effects of the drug clearly outweigh its potential harmful effect;” that residents taking psychopharmacologic drugs “be monitored closely;” that drugs “be gradually withdrawn at least semi-annually in a carefully monitored program conducted in conjunction with the interdisciplinary team;” and that residents’ drugs “be reviewed at least annually by a physician who has training or experience in geriatrics and psychopharmacology.”  Proposed 42 C.F.R. §483.13(a)(2).
  • CMS should amend the Requirements of Participation for nursing facilities to require Medical Directors, Quality Assurance Committees, Administrators, and Pharmacists to certify that they have reviewed the facility’s use of antipsychotic drugs and that the use is in compliance with 42 C.F.R. §483.25(l) (unnecessary drugs) and §483.60 (pharmacy services and drug regimen review).

Transparency

  • CMS should post facility rates of antipsychotic drug use on Nursing Home Compare.
  • CMS should develop a quality measure on antipsychotic drug use in nursing facilities.

Medicare Part A

  • CMS needs to explore ways to prevent the prescribing of antipsychotic drugs during nursing home residents’ Medicare Part A stays.  Depending on how prescriptions are physically transmitted to pharmacists, a program in a Boston hospital establishing a computerized warning system might provide a useful model.[36]  Under the authority of section 6114 of the Affordable Care Act, a demonstration could test a computerized order entry warning system for antipsychotic drugs in nursing facilities.

Medicare Part D

  • CMS needs to consider utilization control mechanisms that would establish greater oversight of the use of antipsychotic drugs before they are prescribed and given to residents.

Stronger enforcement of federal law, regulations, and guidance

  • Stronger enforcement of limitations on antipsychotic drug use can be effective in ensuring compliance with the requirements of law and regulations.  Following both the federal FDA’s 2005 warning about the death risks resulting from antipsychotic prescriptions in nursing homes and CMS’s 2007 revised surveyor guidance on drug use, the state of Minnesota “responded with training for inspectors on how to spot cases of unnecessary medication and for nursing home administrators on how to prevent them.”[37]  In 2007, Minnesota cited 53% of nursing homes in the state for unnecessary medications.  As a result of the deficiencies and enforcement, Minnesota nursing facilities’ use of antipsychotic drugs with nursing home residents who do not have a diagnosis of psychosis declined between 2005 and 2008.

What can eliminating antipsychotic drugs mean for residents?

A researcher working in New York State to translate the research literature about the dangers of antipsychotic drugs into practice at nursing facilities wrote me about a small facility whose Director of Nursing had heard her speak about how to provided care to residents without using antipsychotic drugs.

This young DON heard me speak and said that will never be possible, but decided to give it a go, and got her medical director involved and consultant pharmacist on board, and they now have 2 residents only on antipsychotics and they have schizophrenia diagnosis.  . . . one man they found had severe back pain from a spinal injury from a car accident years ago that was never addressed, but his dementia prevented his communicating the pain and they had him in a deep seated Geri chair which only exacerbated the pain, poor man, so he had behavior issues and was on antipsychotic meds, couldn’t communicate or feed himself.  He now eats lunch in the dining room and converses with his wife, participates in activities, etc. They have taken away the antipsychotic and replaced with pain medication.  . . . one story makes it all worth it.

But the story this researcher told could be replicated hundreds of thousands of times in nursing homes across the country.  Drastically reducing the use of antipsychotic drugs with nursing home residents would vastly improve the lives of hundreds of thousands of residents and would save hundreds of millions, if not billions, of dollars.  After 35 years of studies, reports, and hearings, it is time to eliminate the epidemic use of antipsychotic drugs in nursing homes.

Articles and updates 2016

CMS does not describe enforcement of federal rules about antipsychotic drugs as part of its antipsychotic drug agenda.  In a June 3, 2016 report on its five-year old National Partnership to Improve Dementia Care in Nursing Homes, CMS never once mentions the imposition of sanctions as a method of reducing the inappropriate administration of antipsychotic drugs to nursing home residents.[23]  Instead, CMS focuses on training, state coalitions, partnerships, awarding a grant to the Eden Alternative for a project entitled “Creating a Culture of Person-Directed Dementia Care,” posting of resources about antipsychotic drugs on the website of Advancing Excellence, publicly reporting antipsychotic drug rates on its website Nursing Home Compare, and developing and testing of a Focused Dementia Care Survey.

Conclusion

The misuse of antipsychotic drugs with nursing home residents who have dementia should be recognized as elder abuse.  This abuse could be dramatically reduced if nursing facilities employed sufficient numbers of nursing staff and if federal and state regulatory agencies enforced the Nursing Home Reform Law.

BLAH, BLAH, BLAH

 

 

 

Magical Thinking / Failed Drug Policy

The War on Dugs: result – an exponential increase in drug use, drug trafficking, drug-related crime, drug-related incarceration, prescription drug abuse by doctors and patients.

ondcp-infographicv2

Drug Reform Policy demonstrates the disaster of magical thinking: The above policy statements belong to the supernatural dimension, that is, they are concepts devoid of concrete direction and application and rely on the belief that words create reality. These statements of policy are not new; we have heard these pronouncements over and over, handed down like the Ten Commandments by an elite ruling class who are convinced that their abstractions have the weight of divine power. In fact, the reliance on meaningless verbiage has resulted in catastrophe.

To begin with, the basis for policy is unproven.

1. Drug use is caused by a lack of education. Really? Schools have been inundated with information about drugs for 40 years. How’s that working?

2. Expand access to treatment? Establish more rehab programs like the ones that we already have, which create a profitable cycle of failure and return to rehab for the addict? Or the default ‘treatment program’ of incarceration?

3. Reform the Criminal Justice system? This is outrageous. The Criminal Justice system is one of the primary vehicles of social engineering in the U.S. Why would the elite who profit from selective application of ‘justice’ wish to change it?

4. Support? With money, a pat on the back, a brochure, a poster, a speech, a photo op? Lift the stigma? Words, words, words. Support is one of those words that is popular because it’s a vague substitute for concrete action.

money-war-drugs-infographic-11-30

change-in-us-incarceration-rate

The most popular  drug “treatment” program in the U.S. is incarceration.

What is going on with policymakers?

1. The ‘policymakers’ suffer from magical thinking, which is in this case, the belief that INTENT is sufficient to produce a result. It’s the Abracadabra effect. Words communicate intent, therefore words create real results.

2. The policymakers are cynical. They don’t believe in what they are saying, and write nice progressive policy while laughing at dumb citizens.

3. The War on Drugs is big business: individuals, corporations, lobbyists, consultants and contractors are sharing a boatload of cash: 15.6 billion dollars / year. Why would anyone involved want to end the war?

The war on poverty is the perfect partner in social engineering, and like the war on drugs, policy has created a permanent poverty class.

 aclu-imprisonment