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

______________________________________________________________

 

What Mormons Believe About Jesus Christ / By The Mormons

 

The “thing” about the Mormons is that they can SOUND RATIONAL about the most IRRATIONAL “things” !!!

Add this post to: Why Asperger’s say that neurotypicals are stupid…

from: http://mormonnewsroom.org

Check out: http://templestudy.com/tag/holyofholies

The following excerpts are taken from an address to the Harvard Divinity School (Puritans)  in March 2001 by Robert L. Millet, former dean of religious education at Brigham Young University. It is offered on Newsroom as a resource.

What Do We Believe About Jesus Christ?

Latter-day Saints are Christians on the basis of our doctrine, our defined relationship to Christ, our patterns of worship and our way of life.

What Do We Believe About Christ?

  • We believe Jesus is the Son of God, the Only Begotten Son in the flesh (John 3:16). We accept the prophetic declarations in the Old Testament that refer directly and powerfully to the coming of the Messiah, the Savior of all humankind. We believe that Jesus of Nazareth was and is the fulfillment of those prophecies.
  • We believe the accounts of Jesus’ life and ministry recorded in Matthew, Mark, Luke and John in the New Testament to be historical and truthful. For us the Jesus of history is indeed the Christ of faith. While we do not believe the Bible to be inerrant, complete or the final word of God, we accept the essential details of the Gospels and more particularly the divine witness of those men who walked and talked with Him or were mentored by His chosen apostles.
  • We believe that He was born of a virgin, Mary, in Bethlehem of Judea in what has come to be known as the meridian of time, the central point in salvation history. From His mother, Mary, Jesus inherited mortality, the capacity to feel the frustrations and ills of this world, including the capacity to die. We believe that Jesus was fully human in that He was subject to sickness, to pain and to temptation.
  • We believe Jesus is the Son of God the Father and as such inherited powers of godhood and divinity from His Father, including immortality, the capacity to live forever. While He walked the dusty road of Palestine as a man, He possessed the powers of a God and ministered as one having authority, including power over the elements and even power over life and death.
  • We believe Jesus performed miracles, including granting sight to the blind, hearing to the deaf, life to some who had died and forgiveness to those steeped in sin. We believe the New Testament accounts of healings and nature miracles and the cleansing of human souls to be authentic and real.
  • We believe Jesus taught His gospel — the glad tidings or good news that salvation had come to earth through Him — in order that people might more clearly understand both their relationship to God the Father and their responsibility to each other.
  • We believe Jesus selected leaders, invested them with authority and organized a church. We maintain that the Church of Jesus Christ was established, as the Apostle Paul later wrote, for the perfection and unity of the saints (Ephesians 4:11–14).
  • We believe that Jesus’ teachings and His own matchless and perfect life provide a pattern for men and women to live by and that we must emulate that pattern as best we can to find true happiness and fulfillment in this life.
  • We believe Jesus suffered in the Garden of Gethsemane and that He submitted to a cruel death on the cross of Calvary, all as a willing sacrifice, a substitutionary atonement for our sins. That offering is made efficacious as we exercise faith and trust in Him; repent of our sins; are baptized by immersion as a symbol of our acceptance of His death, burial and rise to newness of life; and receive the gift of the Holy Ghost (Acts 2:37–38; 3 Nephi 27:19–20). While no one of us can comprehend how and in what manner one person can take upon himself the effects of the sins of another or, even more mysteriously, the sins of all men and women — we accept and glory in the transcendent reality that Christ remits our sins through His suffering. We know it is true because we have experienced it personally. Further, we believe that He died, was buried and rose from the dead and that His resurrection was a physical reality. We believe that the effects of His rise from the tomb pass upon all men and women. “As in Adam all die, even so in Christ shall all be made alive” (Corinthians 15:22).
  • We do not believe that we can either overcome the flesh or gain eternal reward through our own unaided efforts. We must work to our limit and then rely upon the merits, mercy and grace of the Holy One of Israel to see us through the struggles of life and into life eternal (2 Nephi 31:19; Moroni 6:4). We believe that while human works are necessary— including exercising faith in Christ, repenting of our sins, receiving the sacraments or ordinances of salvation and rendering Christian service to our neighbors — they are not sufficient for salvation (2 Nephi 25:23; Moroni 10:32). We believe that our discipleship ought to be evident in the way we live our lives.

In essence, we declare that Jesus Christ is the head of the Church and the central figure in our theology.

How Are We Different?

Latter-day Saints do not accept the Christ that emerges from centuries of debates and councils and creeds. Over the years that followed the death and resurrection of the Lord, Christians sought to “earnestly contend for the faith which was once delivered unto the saints” (Jude 1:3). We believe that the epistles of Paul, Peter, Jude and John suggest that the apostasy or falling away of the first-century Christian church was well underway by the close of the first century. With the deaths of the apostles and the loss of the priesthood, the institutional power to perform and oversee saving sacraments or ordinances, learn the mind of God and interpret scripture was no longer on earth. To be sure, there were noble men and women throughout the earth during the centuries that followed, religious persons of good will, learned men who sought to hold the church together and to preserve holy writ. But we believe that these acted without prophetic authority. 

In an effort to satisfy the accusations of Jews who denounced the notion of three Gods (Father, Son and Holy Ghost) as polytheistic, and at the same time incorporate ancient but appealing Greek philosophical concepts of an all-powerful moving force in the universe, the Christian church began to redefine the Father, Son and Holy Spirit. One classic work describes the intersection of Christian theology and Greek philosophy: “It is impossible for any one, whether he be a student of history or no, to fail to notice a difference of both form and content between the sermons on the Mount and the Nicene Creed. … The one belongs to a world of Syrian peasants, the other to a world of Greek philosophers. … The religion which our Lord preached … took the Jewish conception of a Father in heaven, and gave it a new meaning.” In short, “Greek Christianity of the fourth century was rooted in Hellenism. The Greek minds which had been ripening for Christianity had absorbed new ideas and new motives.”[i]

What is the result? Such Platonic concepts as the immutability, impassibility and timelessness of God made their way into Christian theology. (Yes, this is all true, but it’s ALL neurotypical madness, so what’s the point?) As one group of Evangelical scholars has stated: “Many Christians experience an inconsistency between their beliefs about the nature of God and their religious practice. For example, people who believe that God cannot change his mind sometimes pray in ways that would require God to do exactly that. And Christians who make use of the free will defense for the problem of evil sometimes ask God to get them a job or a spouse, or keep them from being harmed, implying that God should override the free will of others in order to achieve these ends. …

“These inharmonious elements are the result of the coupling of biblical ideas about God with notions of the divine nature drawn from Greek thought. The inevitable encounter between biblical and classical thought in the early church generated many significant insights and helped Christianity evangelize pagan thought and culture. Along with the good, however, came a certain theological virus that infected the Christian doctrine of God, making it ill and creating the sorts of problems mentioned above. The virus so permeates Christian theology that some have come to take the illness for granted, attributing it to divine mystery, while others remain unaware of the infection altogether.”[ii]

Latter-day Saints believe that the simplest reading of the New Testament text produces the simplest conclusion — that the Father, the Son and the Holy Ghost are separate and distinct personages, that They are one in purpose. We feel that the sheer preponderance of references in the Bible would lead an uninformed reader to the understanding that God the Father, Jesus Christ and the Holy Ghost are separate beings. That is, one must look to the third- and fourth-century Christian church, not to the New Testament itself, to make a strong case for the Trinity. Sounds kind of sane, (for neurotypicals) n’est-ce-pas? 

Some Distinctive Contributions

What, then, can the Latter-day Saints contribute to the world’s understanding of Jesus Christ? What can we say that will make a difference in how men and women view and relate to the Savior?

Now for the bat crap crazy stuff:

The First Vision

Joseph Smith’s First Vision represents the beginning of the revelation of God in our day. President Gordon B. Hinckley has observed: “To me it is a significant and marvelous thing that in establishing and opening this dispensation our Father did so with a revelation of himself and of his Son Jesus Christ, as if to say to all the world that he was weary of the attempts of men, earnest through these attempts might have been, to define and describe him. … The experience of Joseph Smith in a few moments in the grove on a spring day in 1820, brought more light and knowledge and understanding of the personality and reality and substance of God and his Beloved Son than men had arrived at during centuries of speculation.”[iii] By revelation Joseph Smith came to know that the Father, Son and Holy Ghost constitute the Godhead. From the beginning Joseph Smith taught that the members of the Godhead are one in purpose, one in mind, one in glory, one in attributes and powers, but separate persons.[iv]

There was reaffirmed in the First Vision the fundamental Christian teaching — that Jesus of Nazareth lived, died, was buried and rose from the tomb in glorious immortality. In the midst of that light that shone above the brightness of the sun stood the resurrected Lord Jesus in company with His Father. Joseph Smith knew from the time of the First Vision that death was not the end, that life continues after one’s physical demise, that another realm of existence — a postmortal sphere — does in fact exist.

The Book of Mormon

Through the Book of Mormon, translated by Joseph Smith, came additional insights concerning the person and powers of Jesus the Christ. We learn that He is the Holy One of Israel, the God of Abraham, Isaac and Jacob (1 Nephi 19:10) and that through an act of infinite condescension He left His throne divine and took a mortal body (1 Nephi 11; Mosiah 3:5). We learn from the teachings of the Book of Mormon prophets that He was a man but much more than man (Mosiah 3:7–9; Alma 34:11), that He had within Him the powers of the Father, the powers of the Spirit (2 Nephi 2:8; Helaman 5:11), the power to lay down His life and the power to take it back up again.

Another prophet, Alma, contributed the unfathomable doctrine that the Redeemer would not only suffer for our sins, but that His descent below all things would include His suffering for our pains, our sicknesses and our infirmities, thus allowing Him perfect empathy — “that his bowels may be filled with mercy, according to the flesh, that he may know according to the flesh how to succor his people according to their infirmities” (Alma 7:11–12). Truly, the Book of Mormon prophets bear repeated witness that the atonement of Christ is infinite and eternal in scope (2 Nephi 9:7; 25:16; Alma 34:11–12)

One could come away from a careful reading of the second half of the New Testament somewhat confused on the matter of grace and works, finding those places where Paul seems almost to defy any notion of works as a means of salvation (Romans 4:1–5; 10:1–4; Ephesians 2:8–10) but also those places where good works are clearly mentioned as imperative (Romans 2:6; James 2:14–20; Revelation 20:12–13). It is to the Book of Mormon that we turn to receive the balanced perspective on the mercy and grace of an infinite Savior on the one hand, and the labors and works of finite man on the other.

In the Book of Mormon, the sobering realization that no one of us can make it alone is balanced by a consistent statement that the works of men and women, including the receipt of the ordinances of salvation, the performance of duty and Christian acts of service — in short, being true to our part of the gospel covenant — though insufficient for salvation, are necessary. The prophets declared over and over that the day would come when people would be judged of their works, the works done “in their days of probation” (1 Nephi 15:32; 2 Nephi 9:44). That is, “all men shall reap a reward of their works, according to that which they have been — if they have been righteous they shall reap the salvation of their souls, according to the power and deliverance of Jesus Christ; and if they have been evil they shall reap the damnation of their souls, according to the power and captivation of the devil (Alma 9:28). In summary, the undergirding doctrine of the Book of Mormon is that we are saved by the grace of Christ “after all we can do” (2 Nephi 25:23), meaning above and beyond all we can do. As we come unto Christ by covenant, deny ourselves of ungodliness and love God with all our souls, His grace—His divine enabling power, not only to be saved in the ultimate sense but also to face the challenges of each day — is sufficient for us (Moroni 10:32).

The Book of Mormon has a high Christology; that is, the doctrine of Christ is thick and heavy on the pages of this scriptural record, and the testimony of the divinity of the Lord and Savior is powerful and direct. One cannot read the Book of Mormon and honestly come away wondering what the Latter-day Saints believe about the Divine Sonship. The Book of Mormon establishes clearly that “Jesus is the Christ, the Eternal God, manifesting himself to all nations” (Book of Mormon title page; 2 Nephi 26:12).

At the heart of the doctrine restored through Joseph Smith is the doctrine of the Christ. “The fundamental principles of our religion,” he observed, “are the testimony of the Apostles and Prophets, concerning Jesus Christ, that he died, was buried, and rose again the third day, and ascended into heaven; and all other things which pertain to our religion are only appendages to it.”[v] The glorious news, the glad tidings is that Christ our Lord has come to earth, offered Himself as a ransom from sin and made available deliverance from death and hell. We rejoice in the message of redemption that fell from the lips of Old and New Testament prophets. More especially we exult in the realization that knowledge and truth and light and understanding concerning Jesus Christ — who He was, who He is and what marvels have come to pass through Him — have been delivered through additional scriptural records and modern prophetic utterances.

“Him Declare I Unto You”

One of the main reasons Latter-day Saints are often relegated to the category of cult of non-Christian is because we believe in scripture beyond the Bible. To be sure, we love the Bible. We cherish its sacred teachings and delight in reading and teaching it. We seek to conform our lives to its marvelous precepts. But we do not believe that the Bible contains all that God has spoken or will yet speak in the future.

Occasionally we hear certain Latter-day Saint teachings — like some of those concerning the Savior that I have detailed earlier — described as “unbiblical” or of a particular doctrine being “contradictory” to the Bible. Let’s be clear on this matter. The Bible is one of the books within our standard works, our scriptural canon, and thus our doctrines and practices are in harmony with the Bible. There are times, of course, when latter-day revelation provides clarification of additional information to the Bible. But addition to the canon is hardly the same as rejection of the canon. Supplementation is not the same as contradiction. All of the prophets, including the Savior Himself, brought new light and knowledge to the world; in many cases, new scripture came as a result of their ministry. That new scripture did not invalidate what went before nor did it close the door on subsequent revelation.

Most New Testament scholars believe that Mark was the first Gospel written and that Matthew and Luke drew upon Mark in the preparation of their Gospels. One tradition is that John the Beloved, aware of the teaching of the synoptics, prepared his Gospel in an effort to “fill in the gaps” and thus deal more with the great spiritual verities that his evangelistic colleagues chose not to include. How many people in the Christian tradition today would suggest that what Matthew or Luke did in adding to what Mark had written was illegal or inappropriate or irreverent? Do we suppose that anyone in the first century would have so felt?

Would anyone accuse Matthew or Luke or John of writing about or even worshipping a “different Jesus” because they were bold enough to add to what had been recorded already? Surely not. Why? Because Matthew and Luke and John were inspired for God, perhaps even divinely commissioned by the church to pen their testimonies.

If Luke (in the Gospel, as well as in Acts) or John chose to write of subsequent appearance of the Lord Jesus after His ascension into heaven, appearances not found in Mark or Matthew, are we prone to criticize, to cry foul? No, because these accounts are contained in the Christian canon, that collection of books that serves as the rule of faith and practice in the Christian world.

The authority of scripture is tied to its source. From our perspective, the living, breathing, ever-relevant nature of the word of God is linked not to written words, not even to the writing of Moses or Isaiah or Malachi, not to the four Gospels or the epistles of Paul, but rather to the spirit of prophecy and revelation that illuminated and empowered those who recorded them in the first place. The Bible does in fact contain much that can and should guide our walk and talk; it contains the word and will of the Lord to men and women in earlier ages, and its timeless truths have tremendous normative value for our day. But we do not derive authority to speak or act in the name of Deity on the basis of what God gave to His people in an earlier day.

Just how bold is the Latter-day Saint claim? In a letter to his uncle Silas, Joseph Smith wrote the following:

Why should it be thought a thing incredible that the Lord should be pleased to speak again in these last days for their salvation? Perhaps you may be surprised at this assertion that I should say ‘for the salvation of his creatures in these last days’ since we have already in our possession a vast volume of his word [the Bible] which he has previously given. But you will admit that the word spoken to Noah was not sufficient or Abraham. … Isaac, the promised seed, was not required to rest his hope upon the promises made to his father Abraham, but was privileged with the assurance of [God’s] approbation in the sight of heaven by the direct voice of the Lord to him. … I have no doubt but that the holy prophets and apostles and saints in the ancient days were saved in the kingdom of God. … I may believe that Enoch walked with God. I may believe that Abraham communed with God and conversed with angels. … And have I not an equal privilege with the ancient saints? And will not the Lord hear my prayers, and listen to my cries as soon [as] he ever did to theirs, if I come to him in the manner they did? Or is he a respecter of persons?[vi]

Latter-day Saints feel a deep allegiance to the Bible. It seems odd to us, however, to be accused of being irreverent or disloyal to the Bible when we suggest to the religious world that the God of heaven has chosen to speak again. Our challenge is hauntingly reminiscent of that faced by Peter, James, John or Paul when they declared to the religious establishment of their day that God had sent new truths and new revelations into the world, truths that supplemented and even clarified the Hebrew scripture. And what was the response of the Jews of the day? “Who do you think you are?” they essentially asked. “We have the Law and the Prophets. They are sufficient.” Any effort to add to or to take away from that collection of sacred writings was suspect and subject to scorn and ridicule. And so it is today.

A Willingness to Listen and Learn

A number of years ago a colleague and I traveled with two Evangelical Christian friends to another part of the country to meet with a well-known theologian, author and pastor/teacher in that area. We had read several of his books and had enjoyed his preaching over the years. As a part of an outreach effort to better understand those of other faiths (and to assist them to understand us a little better), we have visited such institutions as Notre Dame, Catholic University, Baylor, Wheaton College and various religious colleges and seminaries. We met this particular pastor and then attended his church services on both Sunday morning and Sunday evening and in both meetings were impressed with the depth and inspiration of his preaching.

The next day we met for lunch and had a wonderful two-hour doctrinal discussion. I explained that we had no set agenda, except that we had admired his writings and wanted to meet him. We added that we had several questions we wanted to pose in order to better understand Evangelical theology. I mentioned that as the dean of religious education (at that time), I oversaw the teaching of religion to some 30,000 young people at Brigham Young University and that I felt it would be wise for me to be able to articulate properly the beliefs of our brothers and sisters of other faiths. I hoped, as well, that they might make the effort to understand our beliefs so as to represent accurately what we teach.

Early in our conversation the minister said something like: “Look, anyone knows there are big difference between us. But I don’t want to focus on those differences. Let’s talk about Christ.” We then discussed the person of Jesus, justification by faith, baptism, sanctification, salvation, heaven, hell, agency and predestination, premortal existence and a number of other fascinating topics. We compared and contrasted, we asked questions and we answered questions. In thinking back on what proved to be one of the most stimulating and worthwhile learning experiences of our lives, the one thing that characterized our discussion, and the one thing that made the biggest difference, was the mood that existed there — a mood of openness, candor and a general lack of defensiveness. We knew what we believed, and we were all committed to our own religious tradition. But we were eager to learn where the other person was coming from. (Blah, blah, blah)

This experience says something to me about what can happen when men and women of good will come together in an attitude of openness and in a sincere effort to better understand and be understood. Given the challenges we face in our society — fatherless homes, child and spouse abuse, divorce, poverty, spreading crime and delinquency — it seems so foolish for men and women who believe in God, whose hearts and lives have been surrendered to that God, to allow doctrinal differences to prevent them from working together. Okay, you believe in a triune God, that the Almighty is a spirit and that He created all things ex nihilo. I believe that God is an exalted man, that He is a separate and distinct personage from the Son and the Holy Ghost. He believes in heaven, while she believes in nirvana. She believes that the Sabbath should be observed on Saturday, while her neighbor feels that the day of corporate worship should be on Friday. This one speaks in tongues, that one spends much of his time leading marches against social injustice, while a third believes that little children should be baptized. One good Baptist is a strict Calvinist, while another tends to take freedom of the will quite seriously. And so on, and so on.

Latter-day Saints do not believe that the answer to the world’s problems is ultimately to be found in more extravagant social programs or stronger legislation. Most or[S1] all of these ills have moral or spiritual roots. In the spirit of the brotherhood and sisterhood of humankind, is it not possible to lay aside theological differences long enough to address the staggering social issues in our troubled world? My recent interactions with men and women of various faiths have had a profound impact on me; they have broadened my horizons dramatically and reminded me — a sobering reminder we all need once in a while — that we are all sons and daughters of the same Eternal Father. We may never resolve our differences on the Godhead or the Trinity, on the spiritual or corporeal nature of Deity or on the sufficiency or inerrancy of the Bible, but we can agree that there is a God; that the ultimate transformation of society will come only through the application of moral and religious solutions to pressing issues; and that the regeneration of individual hearts and souls is foundational to the restoration of virtue in our communities and nations. One need not surrender cherished religious values or doctrines in order to be a better neighbor, a more caring citizen, a more involved municipal. (So rational! So Puritan!)

In addition, we can have lively and provocative discussion on our differences, and such interactions need not be threatening, offensive or damaging to our relationships. What we cannot afford to do, if we are to communicate and cooperate, is to misrepresent one another or ascribe ulterior motives. Such measures are divisive and do not partake of that Spirit that strengthens, binds and reinforces. President Gordon B. Hinckley said of the Latter-day Saints:

We want to be good neighbors; we want to be good friends. We feel we can differ theologically with people without being disagreeable in any sense. We hope they feel the same way toward us. We have many friends and many associations with people who are not of our faith, with whom we deal constantly, and we have a wonderful relationship. It disturbs me when I hear about any antagonisms. … I don’t think they are necessary. I hope that we can overcome them.[vii]

There is, to be sure, a risk associated with learning something new about someone else. New insights always affect old perspectives, and thus some rethinking, rearranging and restructuring of our worldview are inevitable. When we look beyond a man or a woman’s color or ethnic group or social circle or church or synagogue or mosque or creed or statement of belief, when we try our best to see them for who and what they are, children of the same God, something good and worthwhile happens to us, and we are thereby drawn into a closer union with the God of us all. (Okay, okay! Just stop!)

Conclusion

Jesus Christ is the central figure in the doctrine and practice of The Church of Jesus Christ of Latter-day Saints. He is the Redeemer.[viii] He is the prototype of all saved beings, the standard of salvation.[ix] Jesus explained that “no man cometh unto the Father, but by me” (John 14:6). We acknowledge Jesus Christ as the source of truth and redemption, as the light and life of the world, as the way to the Father (John 14:6; 2 Nephi 25:29; 3 Nephi 11:11). We worship Him in that we look to Him for deliverance and redemption and seek to emulate His matchless life (D&C 93:12–20). Truly, as one Book of Mormon prophet proclaimed, “We talk of Christ, we rejoice in Christ, we preach of Christ, … that our children may know to what source they may look for a remission of their sins” (2 Nephi 25:26).

As to whether we worship a “different Jesus,” we say again: We accept and endorse the testimony of the New Testament writers. Jesus is the promised Messiah, the resurrection and the life (John 11:25), literally the light of the world (John 8:12). Everything that testifies of His divine birth, His goodness, His transforming power and His godhood, we embrace enthusiastically. But we also rejoice in the additional knowledge latter-day prophets have provided about our Lord and Savior. President Brigham Young thus declared that

we, the Latter-day Saints, take the liberty of believing more than our Christian brethren: we not only believe … the Bible, but … the whole of the plan of salvation that Jesus has given to us. Do we differ from others who believe in the Lord Jesus Christ? No, only in believing more.[x]

It is the “more” that makes many in the Christian world very nervous and usually suspicious of us. But it is the “more” that allows us to make a significant contribution in the religious world. Elder Boyd K. Packer observed: “We do not claim that others have no truth. … Converts to the Church may bring with them all the truth they possess and have it added upon.”[xi]

Knowing what I know, feeling what I feel and having experienced what I have in regard to the person and power of the Savior, it is difficult for me to be patient and loving toward those who denounce me as a non-Christian. But I am constrained to do so in the spirit of Him who also was misunderstood and misrepresented. While it would be a wonderful thing to have others acknowledge our Christianity, we do not court favor nor will we compromise our distinctiveness.

We acknowledge and value the good that is done by so many to bring the message of Jesus from the New Testament to a world that desperately needs it.

The First Presidency of the Church in 1907 made the following declaration: “Our motives are not selfish; our purposes not petty and earth-bound; we contemplate the human race, past, present and yet to come, as immortal beings, for whose salvation it is our mission to labor; and to this work, broad as eternity and deep as the love of God, we devote ourselves, now, and forever.”[xii]

Actually, it’s not some “Trinity doctrine thing” that “other Christians” care about (or know about) it’s the whacko “archaeology” of Mormon history and beliefs that put them at the top of the list of Bizarre Cult Fantasies, over and beyond those of New Age Cults and “Ancient Aliens”

Google: “Mormon Archaeology”

 

From the Edge of the Mormon Empire / PBS Video

Hmmm….. speaking of Puritans, few people realize that the Mormons are “renegade descendants” of those money-loving, east coast Chosen Ones: God loves Money more than he loves People! Mormons are above all, about business $$$ today. Social typicals love bat crap crazy “Money Men”

And yes, I live at the edge of the Mormon Empire…

From the Archives / Superstition, Mass Murder, Psychosis

Why am I “exposing” my thinking from many years ago? Because the frustration of “dealing with” social humans was so debilitating, that I turned to a “new” asset – writing, in order to make my unconscious internal conflict something that I could “analyze” in terms of the social structure that mystified me.

That is, I discovered that nature had equipped me with thinking skills that could unlock the prison of human self-created misery. It’s ironic, I suppose, that finally “finding” that Asperger people, by whatever “name” one calls them, do exist, and that I am one of them, has actually “softened” my opinion of social typicals; modern humans are products of their brain type and obsessive social orientation, due to “evolutionary” trends and directions that they cannot control. The same can be said for neurodiverse and neurocomplex Homo sapiens: adaptation is guided by the environment; adaptations can be temporarily positive, but fundamentally self-destructive. “Being” Asperger, and exploring what that entails, has gradually allowed me to “be myself” – and to gain insight into the advantages of cognitive detachment in understanding “humanity” – which contrary to psychologists, REQUIRES empathy – empathy that is learned and discovered by experience, and not by “magic”.  

___________________________________________________________________________________________

From the archives:

Nature exists with or without us.

The Supernatural Domain is delusional projection; therefore, it is prudent to assume that any and all human ideas and assumptions are incorrect until proven otherwise! 

The supernatural realm is a product of the human mind – and most of its contents have no correlation with physical reality. As for the content that does correspond, mathematics supplies the descriptive language that makes it possible for us to predict events and create technology that actually works. Whatever jump-started human brain power, the results have been spectacular – from hand axes to planetary probes, from clay pots to cluster bombs. Designing simple tools is fairly easy; a thrown spear either travels true or it doesn’t. Improvements can be made and easily tested until “it works.”

Human beings not only learn from each other, but we observe and copy the behavior of other animals. Useful knowledge can be extracted from nonliving sources, such as the ability of water to do work.

Responses to the environment that belong to the category of conscious thought, and which are expressed by means of language (words and symbols), I would identify as The Supernatural Realm – a kind of warehouse or holding area for ideas waiting to be tested in the physical environment. Problems arise when we fail to test ideas! 

The ability to imagine objects that simply cannot exist, such as human bodies with functional wings attached, is remarkable as a source of useful imagination and dangerous mistakes. Ideas that produce aqueducts, sanitation, medical treatments, or aircraft correlate to conditions of physical reality, and therefore move out of fantasy and into a body of real knowledge. This system of observation, along with trial and error, and the building of a catalogue of useful environmental skills is what has made human adaptation to nearly all environments on earth possible. Each generation has capitalized on the real world techniques of the ancestors, but what about the content of the supernatural that has no value as a description of reality and which if tested, fails miserably?

Ironically this lack of correlation to reality may be what makes some ideas impossible to pry loose from the majority of human minds. Some supernatural ideas can easily piggyback onto acts of force: the religion of the conqueror needs no explanation nor justification. It is imposed and brutally enforced. The fact that the human brain can accommodate mutually impossible universes leads to fantastic possibilities and enormous problems. Without self-awareness and discipline, the result is a continual battle over ideas that are utterly insubstantial, but which are pursued with the furor of blind emotion.

There is widespread belief in the supernatural as an actual place in the sky, under the earth, or all around us, existing in a dimension in which none of the familiar parameters of reality exist, and that it is inhabited by powerful beings that magically take on the physical form of people, ghosts, animals, space aliens, meddlers, mind readers, winged messengers, law givers, deliverers of punishment – who stage car wrecks (then pick and choose who will be injured or die in them), killer tornados, and volcanic eruptions. These spirits prefer to communicate via secret signs and codes which have become the obsession of many. These disembodied beings monitor and punish bad thoughts, hand out winning lottery tickets to those who pray for them, but alternately refuse “wins” to those who are equally needy and prayerful. They demand offerings of flowers, food, blood, and money and millions of lives sacrificed in wars.  

More people believe in a universe where nothing works, or can possibly work, except through the temperamental will of unseen inflated humans, than understand the simple principle of cause and effect. This failure, in a time of space probes that successfully navigate the solar system, indicates that something is functionally delusional in the human brain. The ability of our big brain to investigate the world, to imagine possible action, and to test ideas for working results is remarkable, but our inability to discard concepts that do not reflect how the world works, is bizarre and dangerous. Powerful technologies are applied without understanding how they work. The dire consequences are real. Superstition is the mistaken assignment of cause and effect. The election of leaders who are automated by supernatural ideas, and our frustration when they cannot produce results, is a disaster. The physical processes that drive reality trump all human belief. The destructive power of the richest nation on earth is handed over to a leader without a technical or science-based education, on the claim that his intentions are good and those of the enemy are evil. Does this not seem inadequate?

In the supernatural state of mind, intent guarantees results: Cause, effect, and consequences are nowhere to be seen.

Just where does sanity exist? is a question that still awaits a functional answer. As ideas are vetted and removed to a rational catalogue, which in the U.S. has become the domain of science and engineering, the supernatural realm becomes enriched in fantasy.

Unless children are taught to distinguish between the two, they merely add to a population that is increasingly unable to function. Countries that we arrogantly label as backward embrace science and engineering education. Why is that?

 

From the Archives / Quotes about Women

Having loaded old files into the new PC, I’m going through them, eliminating those not currently relevant. These random quotes are a good reminder of what female Homo sapiens have put up with…

 

What is (wo)man?

The torment that so many young women know, bound hand and foot by love and motherhood, without having forgotten their former dreams.  ~Simone de Beauvoir

Men at most differ as Heaven and Earth, but women, worst and best, as Heaven and Hell.  ~Alfred Lord Tennyson

I would rather trust a woman’s instinct than a man’s reason.  ~Stanley Baldwin

The supply of good women far exceeds that of the men who deserve them.  ~Robert Graves

Brains are an asset, if you hide them.  ~Mae West


Women are like dogs really.  They love like dogs, a little insistently.  And they like to fetch and carry and come back wistfully after hard words, and learn rather easily to carry a basket.  ~Mary Roberts Rinehart

A husband only worries about a particular Other Man; a wife distrusts her whole species.  ~Mignon McLaughlin, The Second Neurotic’s Notebook

What men desire is a virgin who is a whore~Edward Dahlbert

Women have very little idea of how much men hate them.  And… Is it too much to ask that women be spared the daily struggle for superhuman beauty in order to offer it to the caresses of a subhumanly ugly mate?  ~Germaine Greer, The Female Eunuch


Nature has given women so much power that the law has very wisely given them little.  ~Samuel Johnson

When a woman has scholarly inclinations there is usually something wrong with her sexualityFriedrich Nietzsche 

Once a woman is made man’s equal, she becomes his superior. ~ Margaret Thatcher   

I agree today that a man has no business trying to tell women what their characteristics are, which ones are inborn, which are more admirable, which will be best utilized by what occupations. ~ Benjamin Spock 

If I were asked … to what the singular prosperity and growing strength of Americans ought mainly to be attributed, I should reply: To the superiority of their women. ~ Alexis De Tocqueville

There are only two types of women: goddesses and doormats. Pablo Picasso

The only question left to be settled now is: Are women persons?  And… No man is good enough to govern any woman without her consent.~ Susan B Anthony

One is not born, but rather becomes, a woman. ~ Virginia Woolf, Second Sex

Women are never so strong as after their defeat. ~ Alexandre Dumas

Because man and woman are the complement of one another, we need woman’s thought in national affairs to make a safe and stable government. ~ Elizabeth Cady Stanton 

Women speak two languages – one of which is verbal.  ~William Shakespeare

Fighting is essentially a masculine idea; a woman’s weapon is her tongue.  ~Hermione Gingold

 

 



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)-

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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.

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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.

 

 

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. 

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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