Vol. 200 October 1, 2018 “Memories Are Made Of This” (apologies to Dean Martin)

October 1, 2018

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The man [or woman] with a clear conscience probably has a poor memory. ~Author Unknown

 

 

He said. She said. Which one has the correct memory? That’s a very good question . . . and there are a variety of answers.

Before the memory is made, of course, perception has to occur. As the police, lawyers, and judges know, perceptions of the same event can vary considerably between witnesses. Much has been written about the unreliability and inaccuracy of eyewitnesses to a crime. Extreme stress during a criminal act, presence of weapons, brief time durations, racial disparities, and lack of significant physical characteristics are some of the causes of much different perceptions. But some of it is due to how our brain works.

As an example of perceptual differences in viewing even non-stressful events click here and watch a video of an attentiveness test. It is a variation of the famous 1999 “Invisible Gorilla” perception test.

In the recent confirmation hearing of a Supreme Court judge dominating our current media only the two principals will be telling their story. Since he denies the event as described by her, and no eyewitness is available, we are back to the reliability of memories.

Memories are thought to be reconstructed like a puzzle rather than being played back like a videotape. Other people questioning the memory, challenging details, asking for repeated retelling (as in the “telephone” party game), or unintentionally giving non-verbal clues can actually alter how the puzzle is reconstructed. Police line-ups as a way of identifying criminals has long thought to be rife with such errors.

False memories have intentionally been created in experiments where researchers present to a number of adults four stories of their own early childhood. Three are true memories. The false story contains some true, irrelevant, but known to the reader, details provided by relatives. Each adult is asked to add any other details they can remember to the stories. In the end one-third of the adults believed that the false memory was true. In follow-up interviews 25% still felt that the false memory was true. This, of course, was a highly structured, experimental manipulation not easily mimicked in real life, but it shows that false memories can be created by outside influences.

Mitchell Garabedian, the lawyer that represented victims of Catholic clergy sexual abuse feels that victims often come forward because they feel obligated to for the sake of others. He also notes that both persons believe wholeheartedly that their memory is true, so that both will appear to be equally credible. (1)  This suggests that lie detector test results are irrelevant to characterizing memories as either true or false.

The debate about whether recovered memory in child abuse cases is false or true flared to a peak in the 1990’s. “Recent debates between differing schools of scientific thought, fueled by the media and by lay organizations with varied political agendas, have left the public confused and misinformed regarding the nature of traumatic memories” – ( this was writtenin in 1994!)  In an effort to reconcile the differences of scientific opinion of recovery memory in child abuse cases, a national symposium of all kinds of experts with all kinds of theories was convened in 2012. It did not produce a consensus, but it did produce a 255 page book that you are welcome to read.  (Full disclosure by my true memory: I did not read the whole thing)

“Emotional arousal appears to increase the likelihood of memory consolidation during the retention (storage) stage of memory (the process of creating a permanent record of information). A number of studies show that over time, memories for neutral stimuli decrease but memories for arousing stimuli remain the same or improve. Others have discovered that memory enhancements for emotional information tend to be greater after longer delays than after relatively short ones. This delayed effect is consistent with the proposal that emotionally arousing memories are more likely to be converted into a relatively permanent trace, whereas memories for non-arousing events are more vulnerable to disruption. Several studies have demonstrated that the presentation of emotionally arousing stimuli (compared to neutral stimuli) results in enhanced memory for central details (details central to the appearance or meaning of the emotional stimuli) and impaired memory for peripheral details.  A few studies have even found that emotionally arousing stimuli enhance memory only after a delay.”

We know from PTSD studies that traumatic memories can be either haunting or forgotten. Traumatic memories that are a single event, involve an adult victim, and receive validation and support are more apt to be retained as a “continuous memory”. (i.e.; a rape, assault) Trauma that is repetitive, involving a child victim, and is followed by denial and secrecy is more apt to produce “disassociation/amnesia” (i.e.; incest, abuse, torture).

After reading this you may still be uncertain about who has the correct memory, as well as being undecided about whether the Senate Judicial Committee hearing was a kangaroo court or not. “A kangaroo court is a judicial tribunal or assembly that blatantly disregards recognized standards of law or justice, and often carries little or no official standing in the territory within which it resides. The term may also apply to a court held by a legitimate judicial authority who intentionally disregards the court’s legal or ethical obligations. A kangaroo court is often held to give the appearance of a fair and just trial, even though the verdict has in reality already been decided before the trial has begun. This could be because of the biases of the decision-maker, or because the structure and operation of the forum result in an inferior brand of adjudication.”

HAVE A NICE DAY! If you do, please make sure to remember it.

References:
1. Boston Globe, Sept 23, 2018, B2, Steve Annear

 

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Vol. 196 July 15, 2018 Consequences of Separating Children From Their Parents

July 15, 2018

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“Home Security and Family Values –
Is that an oxymoron?”

 

 

Hundreds of children in immigrant families wishing to enter the U.S. from Mexico have been separated from their parents by U.S. policy. The administration has not released the actual number, but the number of unaccompanied children held in U.S. detention centers jumped up by 20% from 8,000 to a little over 10,000 children after implementation of the “zero tolerance policy”.

In 2016 the Secretary of Home Security John Kelly began to talk about such a separation policy as a deterrent to families seeking entrance either illegally or even if legally seeking asylum on our Mexican border. In response to that proposed policy a coalition of pediatricians, psychiatrists, and social scientists published “Separating Families at the Border – Consequences for Children’s Health and Well-Being” in the New England Journal of Medicine (NEJM) June 15, 2017 and founded the Child Advisory Network   to advocate against the “zero tolerance policy”.

Now, nobody really believes that separating children from their parents, unless the children are being maltreated or abused, is good for the children. Our own legal system has a very high threshold for removing children from their parents. And maybe, administration policy makers were probably counting on this universal belief (in all languages, of course) to make their action an effective deterrent to immigration.

The NEJM article summarized the many studies that document the deleterious effects of separating children from parents; all based on the over-activation of the stress response system of the child’s brain and specific hormone producing organs. Proper balance of that system is necessary for normal physical growth, proper and appropriate regulation of emotions, and maintenance of good health. In fact, such stress and anxiety is apparently cumulative and can ever result in an earlier-than-expected death!

The high costs of separating and detaining the children, especially the costs of finding and supporting foster care for U.S.-citizen children of parents who have already been deported, was cited in this review. In many states the foster care system for American children is overwhelmed and an occasional source of horror stories of maltreatment by foster parents.

Perhaps you’re thinking that these are moot points after the announcement of the reversal of the “zero tolerance policy”, but NPR reported on July 12 that in a response to a court order deadline only 57 of the 100 under the age of 5 years had been reunited with their parents (49 other were not). NPR also reported that the total number of separated children is 3000. The next court order deadline in about two weeks calls for 2000 families to be reunited. Both court orders stem from suits brought by the ACLU against the U.S. Department of Home Security.

Reason cited by the Home Security Department for some “failures to reunite” include criminal charges against a parent(s), parent not available since already deported, and a lack of match between the child’s DNA and the parents’ DNA. Wow, talk about opening up another Pandora’s box for the U.S. border staff, Home Security Department, and our judicial system, already creaking under “zero tolerance policy” consequences. Resolution of those instances of DNA “mismatch” will become another nightmare for already stressed-out families and children who were seeking sanctuary from the stress of living in their own country in the first place; a uniquely modern negative consequence of political policy once again trumping science.


Vol. 192 May 1, 2018 Infections Going Viral

May 1, 2018

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“World conditions are ripe for a pandemic like the 1918 influenza epidemic, but we, the U.S. and the world, are not prepared to fight it.” – Bill Gates, April 27, 2018

Ten experts (three of them had British accents, so they were particularly believable) agreed with Bill Gates when he presented this warning in the 2018 Shattuck Lecture at the Massachusetts Medical Society Annual Meeting in Boston last week.

The 1918 influenza virus first appeared in the U.S. in New York City and within just 5 weeks it had spread across the country to California resulting in 670,000 U.S. deaths. As you know, the flu virus changes every year and we can’t start making a vaccine until we recognize and identify “this year’s mutation”. It then takes months to produce, distribute, and administer a vaccine, so consequently our flu vaccine is always playing catch up. Since 1918 we have developed anti-viral medicines and a number of different antibiotics to combat influenza complications, so a repeat of such a lethal flu epidemic is today considered unlikely.

But it is the other viruses, the “novel viruses”, that concern the experts at this conference. For instance, 1000 “novel” viruses from different species which could potentially cross over to humans and cause significant disease have been identified over the past 8 years . Of these 1000 “novel” viruses, 891 are brand new, never before identified. Advances in genomic sequencing allow the specific identification of potentially pathogenic mutations, but as one speaker noted it has taken the U.S. Weather Service over 50 years to build a data base that allows “reasonably good” weather forecasts, so our ability to forecast the effects of new virus diseases is considered to be woefully rudimentary. (1)

We will probably receive the earliest warning signs of any new epidemic from mining the “digital exhaust” of our social networks, “flu near you” apps, crowd sourcing of symptom reporting, net-connected thermometers. upticks in certain prescriptions, volunteered Alexa conversations, Google search statistics, bot-driven AI, and locations of Uber-delivered medicines. (2)

The reasons the world is ripe for an infectious pandemic are: increasing population, increasing urbanization in developing countries, continued poverty that promotes inter-species living, routine rapid travel between countries, increasing frequency of natural disasters due to climate change, plus potential bioterrorism. Several speakers used a military preparedness metaphor, consciously using the verb “fight” and the noun “war”. For example, “If we knew our enemy was developing a new military weapon we would be throwing all sorts of resources at analyzing what the threat is, how to detect it at the earliest possible moment, how to defend against it, and how to deal with its effects if deployed. We should be doing the same for future infectious disease epidemics, and we are not.” (3)

Bill Gates was most impressive with his command of diverse, seemingly obscure facts like the per cent change of Uganda’s GDP, the identifying numbers of a new unnamed TB antibiotic, the three viruses that could mimic Ebola, and that in a recent study 4 almost random doses per year of the antibiotic zithromax reduced childhood mortality in developing countries by 50% in 2 years! He remains a man of vision as well , made it clear that the Bill & Melinda Gates Foundation would continue its support of innovative health and education efforts, and describes himself as an optimist. He nonchalantly reported that his foundation had just granted $12 million seed money to a group working with Glaxo (stock-pickers take notice) to develop a universal flu vaccine, one that would be effective against all flu virus mutations. (Such a universal flu vaccine was the #1 fervent wish of the Deputy Director of the CDC when asked for her hopes for the next ten years.(4))

 Our pandemic preparedness is not just a task for the medical/clinical sciences nor just for “new” technology.  The “old” technologies of anthropology and the fine art of negotiation were vital to a successful defense against Ebola. It was not until we recognized the cultural traditions of burial rituals of some African tribes, and persuaded them to change them, that we were able to contain the Ebola epidemic. (5)

Pandemic preparedness is not only a multi-disciplinary effort. It must also be political. Even as science advances, there must be the political will to deploy the resources before a pandemic attack . Of course, “urgent” often trumps even important “long term” needs in politics, but a pandemic is the equivalent of a war. By the time the battle is raging it can be too late to effectively marshal all the troops and equipment necessary to win. (3)

The consensus of the conference was: “The U.S. should continue to be the leader in global health security.”

References:
1. Joanna Mazet, DVM, MPVM, PhD, Professor of Medicine, University of California, Davis
2. John Brownstein, PhD, Chief Innovation Officer, Professor of Medicine, Boston Children’s Hospital
3. Jeremy Farrar, OBE, FRCP, FRS, Director, Wellcome Trust
4. Anne Schuchat, MD, Principal Deputy director, CDC
5. Mark Gordon, Esq. Co-Founder Vantage Partners


Vol. 191 April 15, 2018 The Gun Violence Epidemic

April 15, 2018

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“EPIDEMIC” continues to be a common catch word for headlines. Apparently we have lots of epidemics; the flu, HIV, opioid, Zika, gun violence, etc. We spend a lot of tax money investigating and containing epidemics. . . . Oh, . . . all except for that last one: gun violence.

Why is that? In 1996 the Communicable Disease Center (CDC), our federal bulwark against harmful epidemics, was expressly instructed by Congress NOT to study anything related to guns, i.e. don’t give research grants, don’t establish data bases to track events, and don’t sic the EIS on the gun violence epidemic. In one of his rare Executive Orders President Obama instructed the CDC in 2012 to resume their gun violence research and asked Congress to allocate $10 million dollars for that purpose. Congress never did.

EIS stands for the Epidemic Intelligence Service, a division of the CDC. It has a stellar reputation for laser-focussed field analysis of incipient epidemics to guide early actions to contain them, to reduce any harm to people. Just last week the CDC launched an investigation into a cluster of 53 new HIV cases in Lowell, MA. (In 2007 Boston had a “cluster” of 92 gun-related homicides.) Ironically, the CDC remains hamstrung in any effort to collect and analyze data on the gun violence epidemic at a time when it is asking the general public to participate in identifying any other kind of potential epidemic via internet “crowd sourcing” .

The CDC does keep mortality statistics and issues an annual report of causes of death for each state. The difference of gun-related death rates  between states is huge, and  no one really knows why. Massachusetts had the lowest number of gun-related deaths in 2016: 3.4 deaths per 100,000 population, or 242 gun-related deaths in Massachusetts that year. Texas, Florida, and California had 3,353, 2,704, and 3,184 gun-related deaths respectively that same year. Those three states also had the most suicide deaths and the most accident-related deaths of all the states. That’s interesting, but those rates may not be related in any way to each other . Food for thought? Too bad the CDC can’t collect more data on gun deaths.

A gun is the harmful agent in this epidemic just as a virus is the harmful agent in the AIDS epidemic. True, human behavior is the cause for both of the epidemics spreading, but while we are developing a HIV vaccine we have implemented effective measures to contain the epidemic with “safe sex” campaigns, identification of risk factors, pre-natal treatment of HIV-positive pregnant women, early treatment of exposed newborns, and development of successful medical treatments. All of this was accomplished with the support of the CDC and NIH. Why not provide government support for similar interim steps to reduce the gun violence epidemic? Medical societies and many citizen groups have picked up the “safe gun” banner. Why hasn’t the federal government done so?

One answer is, of course, money. The NRA contributed money to 205 House members (189 Republicans and 16 Democrats) and 42 Senators (35 Republicans and 4 Democrats) in 2012. The Democratic Senator that got the most NRA money got less than the 41 Republicans above him or her on the list. 95 of the top 100 NRA money receivers in the House were Republicans. Most analysts actually consider this as “chump change” ($5,000-10,000 per Congressman) compared to the $18.6 million that the NRA spent on NRA-favorable candidates in the 2012 elections. Analysts speculate that the money buys “allegiance” rather than “influence” (whatever that means). We all know it buys lots of “thoughts and prayers.”

Another answer may be that there are more guns than people in the U.S. It is as if everyone had AIDS, or as if HIV- infected people considered it their constitutional right to do anything with it they wished to. We as a nation did a lot to reduce the harm of HIV without abolishing the HIV virus. Why can’t we take the same approach to gun violence? We could do quite a bit without abolishing guns if we could do research about how guns are spread, how they are used for harm (In fact, 50% of gun deaths are suicides), how we could reduce harmful use (electronic signatures, smart guns, trigger locks, no multiple cartridge magazine, etc.).

The significant reduction of auto accidents deaths was accomplished by multiple means (seat belts, car seat regulations, air bags, electronic sensors, changes in car manufacture, speed limit regulations, etc,) and not by abolishing cars or drivers’ licenses. With better data perhaps we could take effective action to reduce the gun death epidemic.

Claritin:gun cartoon


Vol. 178 October 1, 2017 What is Single-Payer Health Insurance?

October 1, 2017

Now that Bernie Sanders is again firing up the discussion about single-payer health insurance, it might be a good idea to review this complex issue. So, here’s a short self-test for you to gauge your understanding of what Bernie, and a lot of other people, are talking about.  The correct answers are supplied right away, so you won’t stay confused for long. Since this is an internet-based test, YOUR ANSWERS, of course, WILL BE COMPLETELY ANONYMOUS. Nothing will  be recorded by NSA , Equifax, or the Russians.

 

“Single-payer” means:

  1. socialized medicine
  2. 100% of health care costs are paid for with taxes
  3. Pop-Pop picks up the dinner bill for everyone
  4. none of the above

Answer: 4. none of the above – In socialized medicine health care facilities and providers are owned by the government. “Socialized medicine” is a pejorative term which is now irrelevant since at least 70% of U.S. healthcare costs are already met by tax dollars  from Medicare, Medicaid, or the Veterans Administration. “Single-payer” is just an insurance scheme for public or privately owned services. In countries with universal health care insurance 77%-87% of costs are met by taxes. In the U.K. private insurance pays for about 13%. Pop-Pop gladly picks up the dinner bill for his children, but health insurance is still on them.

The number of countries with universal health insurance are:

  1.  1
  2.  2
  3.  3
  4. 58

Answer: 4. 58 – Germany in 1883, France in 1945, UK in 1946, Australia in 1975, Canada in 1984, Israel in 1995.

A basic tenet of single-payer insurance is that everyone will be covered without regard to income level:

  1. true
  2. false
  3. true, but …

Answer: 3. True, but … it will take years to bring everyone in the U.S. under “Medicare For All”.  Each year or so another decade of ages will be added to the coverage. States will need to coordinate their income-based Medicaid programs with “Medicare For All”.  Some states could request and receive waivers from the national program. Etc., etc., as incrementally we always go.

Universal health care insurance in other countries is administered:

  1. nationally
  2. regionally
  3. locally (municipalities)
  4. all of the above

Answer: 4. all of the above – Germany has 1100 public and private “sickness funds” with a national standard level of coverage. In the Netherlands health insurance is administered by municipalities that levy local taxes to pay the costs. This  apparently enhances transparency and both taxpayer and patient satisfaction. Conclusion: If you have seen one system of universal health coverage, you have seen ONE. By the way, isn’t “sickness fund” a much more honest name for insurance which pays for medical care and does not necessarily buy “health”. (Leave it to the Germans to say it like it is).

Universal health insurance is based on which basic insurance principles:

  1. spread the risk over the greatest number of people
  2. use education and regulation (i.e.. fire laws) to reduce the highest risks of loss
  3. if you win (stay healthy), you “lose” (your premiums). If you “lose” (get sick), you win (care is paid for)
  4. use excess premium revenue to build fancy office buildings and pay for expensive lobbyists .

Answer: 1-3 (see subsequent question for further information on #4)

Single payer health insurance will cost less to administer than our present system:

  1. true
  2. false
  3. true, but …

Answer: 3. true, but… maybe not as much reduction as we hope. Administrative costs for the individual provider will probably remain the same because “meaningful criteria” compliance, complex diagnostic coding, need for medical necessity justification, and need for data showing that quality is not being eroded will continue to require significant personnel time and computer capability. Remember also that Medicare is currently administered in large part by “fiscal intermediaries” like Blue Cross. That probably won’t change. Some predict that because of continued pressure on a single-payer to reduce costs, it may, if fact,  get even more complicated for providers to get paid for their services. Of course, the huge consumer advertising, employer marketing, and lobbying expenses of private health insurance companies will be greatly reduced when the market share of private insurance is reduced to 10-15% as has occurred in other countries. If only we could get Visa to run Medicare’s fraud protection system!

Why not “Medicaid For All”;  could individual states institute universal health insurance so that we wouldn’t have to wait for a national consensus?

  1. no
  2. yes
  3. yes, but…

Answer: 3. Yes, but … the hallmark of universal health insurance in other countries is a consistent standard of coverage for all residents. Medicaid programs are state-specific and coverage is extremely variable, as is provider payments. If you see one, you have seen one. Attempts to waive the Obamacare national standards by those wishing to repeal it spotlighted the potential glaring inequities. But, Massachusetts has done it for 90% of its population, and there are bills in its legislature to do it for all. California is attempting to do it. Most California families and businesses, a University of Massachusetts study has said, would pay less for health care than they do now, even with the new taxes, because they would no longer pay premiums, deductibles or co-pays. As Samantha Bee recently noted: “You don’t have to be racist anymore to believe in States’ Rights .”

Why is a single-payer sometimes described as a “double-edged sword”?

  1.  a single-payer could have much greater negotiating leverage with both suppliers (drug companies) and providers (doctors and hospitals)
  2. a single-payer would be perched on the sharpest edge of the cost-quality equation
  3. the standardization of payments by a single-payer could dampen innovation and hamper medical progress
  4. all of the above

Answer: 4. all of the above – More leverage against the drug companies is “good”. More leverage against the providers could be “bad”.  Despite studies that show that good quality care is less costly, many still see a dichotomy between cost and quality. Concern about hampering innovation (“new ways of doing things”) with excessive standardization (“the old ways”) was one reason Obamacare created a Center for Innovation within Medicare as part of the ACA .

Who is in favor of single-payer health insurance?

  1. 60% of those polled
  2. 38% of those polled
  3. depends on the nature of the poll
  4.  all of the above

Answer: 4. all of the above – The 60% in favor of single-payer health insurance dropped to 38% when the question was tied to one about increased taxes. The most recent Harris-Harvard poll (9/17/17) showed that 52% were in favor of single-payer insurance. 69% believe that it would provide more coverage, including 54% of Republicans. . Most of the other questions about a governmental single-payer were 50/50 pro and con. Some physicians, hospitals, and other providers are in favor of single-payer insurance.

What are some of the barriers to implementing single-payer, universal health insurance in the U.S.?:

What does President Trump think?:

 


Vol. 175 August 1, 2017 Trump Turmoil From a Medical Perspective

August 1, 2017

President Trump is not my patient.
I am not President Trump’s doctor.

Neither is Leonard L. Glass, MD, MPH, Board Certified psychiatrist and psychoanalyst, Associate Professor of Psychiatry Harvard Medical School, McLean Hospital Senior Attending Physician , medical ethicist, and Distinguished Life Fellow of the American Psychiatric Association (APA).

After clearly making those two statements above, Dr. Glass resigned his 40+ year membership in the APA because the APA recently reaffirmed and expanded its statement that it is unethical for any psychiatrist to make any statement about the mental state of public figures who they have NOT examined in person, i.e. who are not their “patient”.  It is called the Goldwater Rule and was  implemented by the APA Ethics Committee in 1964 after FACT Magazine lost a libel suit over their published poll of psychiatrists of the “mental state” of Senator Barry Goldwater as a candidate for president.  “Superimposing the time-honored doctor-patient relationship onto public, political discourse, where there is no doctor-patient relationship is intrusive, improper, and self-defeating”. (1)

HIPPA regulations about patient confidentiality aside for the moment, Dr. Glass feels that since orthopedic surgeons can explain to us the mechanics of an ACL tear and its treatment in a Patriots linebacker, and radiation therapists can give us chapter and verse about Senator Ted Kennedy’s positron treatment for brain cancer, forbidding an experienced professional observer of behavior to comment on the observed behavior of a public figure is ridiculous. He makes no pretense of “making a diagnosis”, and explicitly refrains from that.

Having stated that he disagrees with the APA Goldwater Rule, Dr. Glass goes on to give his insightful views of the observed behaviors, nay the copiously observed videotape and real-time audio behaviors, of a prominent public figure, President Trump. (Please notice the respect I am showing by not referring to him as “the Donald”.)

Dr. Glass first cites the US Army’s Field Manual for Leadership’s list of “criteria for leadership” as an objective means to evaluate capacity for effective leadership. The criteria are:
Trust
Discipline
Self-control
Judgment
Critical thinking
Self-awareness
Empathy.

Dr. Glass’s then offers his “plausible ways of understanding Trump’s aberrant behavior.”

  • “Trump’s continual boasting and proclamation of great confidence in his ability to solve complex problems suggest bluster and posturing to disguise insecurity.”
  • “His inability to tolerate divergent opinions and his lashing out impulsively at those who differ from him demonstrate an impulsivity that could interfere with processing important new data that runs contrary to his prior opinions.”
  • “His vindictiveness and ridicule of vulnerable groups [and individuals] point to a lack of empathy and compulsive need to prop up his self-worth at the expense of others.”
  • “His assertions of strength and power, paired with repeated complaints of being victimized, suggest fears of exposure as small and inadequate.”
  • “His numerous self-contradictions and shifts of position without acknowledgement of prior misjudgments betoken an erratic, unstable, and unreliable mind-set in which chaotic emotional needs are constantly swamping his capacity for deliberative, thoughtful problem-solving.”

Dr. Glass finishes with “These are psychological hypotheses aimed at helping us make sense of mercurial and aberrant behavior without getting into diagnosis .”

Now if you don’t consider President Trump’s behavior as aberrant, or at least as unusual, for a President, then you stopped reading this blog a while back.

One of the reasons I think that President Trump is so unusual was recently clarified for me by a couple of linguists interviewed on radio. They who have been studying his speeches for some time. “He speaks like people ordinarily do.” They mean that he is a bit rambling, sometimes quickly changes subjects, repeatedly emphases favorite or strongly held thoughts, and even injects profanity for effect. They go on to say that “ordinary language” is meant to be spoken, not read. It doesn’t necessarily read well as the written word. Understanding it often depends a lot on physical cues like voice modulation, facial expression, and body language. The linguists noted that his speech pattern is one way Trump has such an appeal for some. “He doesn’t talk like a politician.”

I am no fan of politick-speak, and I don’t consider myself to be an elitist (though at least one of my children would tell me that as a relatively affluent older white male, I fit the definition). But I do expect Presidents to speak like a President; with some eloquence, with some consistency of content and syntax, and hopefully with a greater vision than I have, so I can be inspired or challenged.

My late, sweet, gentle, very-short Irish Catholic mother-in-law’s most damning and infrequently-used dismissal of a person was “They’re ordinary”. I never thought that I would ever quote her in a blog, BUT ….

References:
1. “Let psychiatrists talk about Trump’s mental state,” Leonard L. Glass, Boston Globe, July 31, 2017, pg.A9.


Vol. 174 July 15, 2017 Dumb Government and Smart Guns

July 15, 2017

Gun violence injuries and deaths in the U.S. is a public health crisis.”   – AMA

Gun violence kills roughly 30,000 Americans each year, about as many people as car accidents. The federal government has been restricted in gathering and analyzing gun violence data since 1996 when a CDC study linked the presence of a gun in the house with an increased risk of homicide. The NRA responded with a successful lobbying effort to pass the restriction that the CDC may not use any money allocated to it for “activities that advocate or promote gun control.” It stripped $2.6 million from the CDC budget for firearm injury research. After the Newton School shooting in 2012 Obama issued an Executive Order (one of his relatively few) commanding the CDC to renew their research into gun violence and requested Congress to allocate $10 million for that. Congress never did, and research never resumed.

The NRA has also successfully limited the federal government’s ability to trace guns involved in crimes, “crime gun-tracing”. Some states have developed data bases of crime-gun tracing to identify sources of and reduce illegal gun trafficking. Massachusetts established crime-gun tracing in 2014, but has not published a meaningful analysis of the data which might lead to some action. The 2017 Massachusetts legislature has inserted into their budget proposal a request that the governor produce such an analytical report.

Doctors, particularly pediatricians, are keenly aware of the dangers of having guns in the  house. 90% of accidental gun injuries to children happen in a home with a gun. The American Academy of Pediatrics has explicitly recommended that pediatricians routinely ask gun-safety questions during health and wellness visits. But in 2011, Florida passed a “Privacy of Firearm Owners” law levying $10,000 fines and loss of medical license to any pediatrician that inquired about the presence of firearms in the house. The law was upheld by a Florida state court in 2014 based on “2nd Amendment infringement”. The law was just struck down this year by a Federal Appeals Court that ruled that “there was no evidence that the law infringed on the Second Amendment.” By the way, the Affordable Care Act (aka Obamacare… remember Obamacare?) specifically prohibits physicians from keeping records on gun ownership. an assurance to any paranoid, conspiracy-theory-believing gun owner that docs were now not in league with big government. (see “Docs vs. Glocks”, Scientific American, August 2015. pg. 10)

The solutions to gun violence deaths are mostly focussed on mass shootings including either/or/and:
1. eliminate mental illness,
2. eliminate terrorists,
3. eliminate humane treatment (put water boarding video of terrorists on You Tube),
4. eliminate Muslims,
5. eliminate political correctness  (utter the words “Radical Islam Terrorists” which Obama refused to say (sic.) (1)

The truth is that “mass shootings”, though a big part of media attention, are a small part of the  30,000 annual gun death toll. 62% of  gun deaths are due to suicides committed with guns that DO NOT BELONG to the victim (particularly among the young). Criminals steal about 250,000 guns per year. 1.7 million children live in homes with unlocked, loaded firearms. (2)

The NRA consistently raises the spectrum of the need for the home owner to have a means of self-defense, but a gun is 22 times more likely to be used in a criminal assault, an accidental death or injury, a suicide attempt, or a homicide than it is for self-defense. 61% of gun homicides are by people who know each other.(3)

Making a gun as smart as an iPhone is one way to prevent to a large portion of gun injuries and deaths. Previous attempts to develop such a smart gun have been fraught with problems, have been actively boycotted by gun manufacturers, and have been opposed by gun advocates and the NRA. Kai Kloepfer, a 15-year-old high school student in Colorado, in response to the Aurora theater shooting near his home, started a science project in 2015  to design a pistol that will only fire when a sensor in the grip recognizes the fingerprint of the owner. His project won awards, and Kloepfer delayed his entrance to MIT for a year when he got a grant to develop a working model of such a smart gun. By 2017 he successfully built and demonstrated a smart pistol. The gun takes 1 second to unlock, its battery lasts a year, a light indicates the battery status, and a second light indicates it is unlocked and ready to fire. Neither a child nor a thief can fire the gun. The owner may store up to 10 “authorized user” fingerprints (like for a spouse or domestic partner ). The smart gun is smart enough to NOT  connect with the internet, so it can not be hacked or hijacked.

The NRA response has been predictable: “NRA does not oppose new technological developments in firearms; however, we are opposed to government mandates that require the use of expensive, unreliable features, such as grips that would read your fingerprints before the gun will fire.”(2)

Hey, at least the NRA didn’t evoke the 2nd Amendment argument. That is progress!  Technology can deal with “expensive” and “unreliable”. Technology is far faster to upgrade than the Constitution.

References:
1. “A Nation Captive To The Gun”, Garry Wills, Boston Globe 6/15/2016
2. “The Future of Everything”, Wall Street Journal, 2017, Geoffrey Fowler
3. Journal of Trauma and Acute Care Surgery, 1998

 

 


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