[cross-posted to filkhaven, shadowriderhope, stilyagiaircorp and penguicon]

The Third "Acorn Music and Verse" housefilk will be held this Saturday, July 12 from 1:00 pm into the evening at the Great Oak Cohousing Common House, 500 Little Lake Drive, Ann Arbor, MI 48103. (Please park at the side of Little Lake Drive, and not in the parking lot - there is very limited parking available for residents).

This is the direct descendant of the "Fen and Filk" house sings at Glimmerglass house, and they are always a good time. Let me know ASAP if you need crashspace, so I can make sure there is space is available!

It's a fun, inviting get-together where you will always get a turn to sing, recite a poem, or ...? (and you can pass if you want), and new people are welcome and encouraged. :) You can show up any time during the event, and leave at any time. Our schedule is to arrive at 1:00, get singing by 2:00, break for pizza around 5:00, and then sing till usually 8:00-ish. Often there is a musical jam that continues well after the 'end' of the event, so feel free to stick around if you're interested!

It's a friendy, non-judgemental place to start singing, playing, or reciting in front of people, and a fine spot to test out your new songs. We welcome instrumental musicians and spoken word performance as well. There is a kid-friendly play room next to the dining hall where we play, and kid-friendly play equipment outside if the weather is nice.

Hosted by shadowriderhope and nubianamy.
Supported by qnvhrtz & peteralway.

Come prepared to participate - song or word....... ! Bring friends....

Bring a snack, a dish to share, etc.....what food & drink we have is whatever we bring. There is most likely going to be a pizza order.

We hope to arrange a group call to Tom Smith filkertom to wish him well and sing him a song, as he can't be there with us physically - he's recuperating in a rehab facility after a badly torn quad at a Christine Lavin concert.

There's a great Tom Smith Fundraiser album that's being put together by Rob Balder and DJ Particle and many others - I encourage you to check it out and help out this fine master filker and friend. :)

Details are here.

Sometimes, volunteering in the ED is a little surreal.

It was nice getting back there today - I'd had to miss three consecutive Fridays, between the car accident, food poisoning, and the trip to CMU - and I was a little surprised to see how happy people were to see me. As in, they missed me. :) I like feeling like a part of the organism that cares for people there - there are a lot of really wonderful people there.

I started my shift like I usually do - in the waiting room, checking the blanket warmer and seeing if anyone needs a blanket or anything else that I, in my lowly volunteer-ness, can provide. Then I progressed to the main ER and started working my way around the perimeter. Lively bunch tonight - nearly all the hall beds are full. I handed out a few blankets, and then turned the corner to find a disheveled middle-aged man curled up on a hall bed. I asked him if he'd like a warm blanket, and he asked me "do you pray?"

I said I do (and I do - in my own fashion), and moved in closer to listen.

... (to be continued after I get sleep. And no, I did not accept the marriage proposal. ;)

An absolutely frightening tale...

El Salvador ... has not only a total ban on abortion but also an active law-enforcement apparatus - the police, investigators, medical spies, forensic vagina inspectors and a special division of the prosecutor's office responsible for Crimes Against Minors and Women, a unit charged with capturing, trying and incarcerating an unusual kind of criminal.

Today, Article 1 of El Salvador's constitution declares that the prime directive of government is to protect life from the "very moment of conception." The penal code detailing the Crimes Against the Life of Human Beings in the First Stages of Development provides stiff penalties: the abortion provider, whether a medical doctor or a back-alley practitioner, faces 6 to 12 years in prison. The woman herself can get 2 to 8 years. Anyone who helps her can get 2 to 5 years. Additionally, judges have ruled that if the fetus was viable, a charge of aggravated homicide can be brought, and the penalty for the woman can be 30 to 50 years in prison.

This article tells a tale of women's vaginas being searched for 'evidence of crime,' of the state prosecuting women in comas from infection of their perforated uteruses from botched back-alley abortions, and women recovering from illegal abortions in hospitals being handcuffed to their beds. As in the United States, women with money have the means to fly away to another country and have a safe and legal abortion, but for the mass of women in El Salvador, the spectre of an unplanned pregnancy is a terrifying one.

This sort of draconian policy makes women slaves to their biology - a simple ectopic pregnancy can be a near death sentence in this case, where an abortion can not even be performed to save the life of the mother. Even in cases of rape or incest, women can be forced to bear children against their will.

It's simply chilling. I can't capture enough of it to express it.

My interest was piqued during lecture when Prof. Rhodes mentioned a case in which parents of an anencephalic infant fled Florida (where life is defined by heartbeat) for Georgia (where defined by brain function) so they could donate organs from the child. They were sentenced & imprisoned. I've spent a lot of time searching, but can't find this particular case, but I did find the case of Baby Theresa - Theresa Ann Campo Pearson - in 1992.

Laura Campo and Justin Pearson, found out 4 weeks before Laura's due date that her baby was anencephalic, and they decided to proceed with the pregnancy in the hopes that they might donate the child's organs so that some good might come of what was otherwise a very bad situation. But when they attempted to get their baby declared legally brain dead so that her organs could be donated before they deteriorated with her natural death, the Florida courts refused. Florida defines dead as "irreversible cessation of all functions of the entire brain, including the brain stem," and because Baby Theresa had a beating heart and brain stem activity, she was still alive.

I've been struggling with this issue ever since I first heard of it. The utilitarian part of me wants to think that some good could be salvaged from an otherwise disastrous situation by allowing the infant's organs to be transplanted - after all, it is commonly held that anencephaly is "medically incompatible with life." These babies rarely survive long enough to be born, and those that do rarely live more than a few days or weeks. Baby Theresa died after 9 days, and her organs died with her.

That pragmatic part of me, though, blanches when it considers the reality of the proposal: taking a living human child and cutting out its organs for the benefit of another. This is where Kant's statement that we must treat everyone as an end in themselves, and not a means to an end. To kill one to save another, even one gravely impaired and incapable of ever having a life in the sense that we understand it, can never be right.

I finally happened across this article, and the conclusion which rang true with me:

Dead Complicated
10.01.1992
by Elisabeth Rosenthal

Although science and logic say these patients are dead, emotion shouts, no, they’re alive! When I touch them, they’re warm. When I place a stethoscope on their rising chests, I hear air moving and the vibrant beating of their hearts. George Annas, a lawyer at the Boston University School of Public Health, argues for a commonsense solution. Dead is when you’d bury someone, he says. To me the way to resolve the issue is to decide whether you’d bury someone with a beating heart. And the answer is no. In our society, being buried alive is the ultimate fear.

I have to agree. I just can’t see putting people whose hearts are still beating and whose lungs are still breathing six feet under in a box-- no matter how hopelessly comatose they may be. And with only a brain stem, those feats can in some fashion be performed.

So, reluctantly, I conclude that baby Theresa was alive and had to be allowed to die. Too bad we lost her organs.

Indeed, it was a terrible tragedy, but I can't see any way we can do anything different with a clean conscience.

Other articles consulted include:

Legal Definition of Death Is Questioned in Florida Infant Case"
New York Times
By SABRA CHARTRAND
Published: March 29, 1992

Donating Organs of Anencephalic Babies Is Backed
Taking a stand on one of today's most contentious ethical issues, an expert committee of the American Medical Association says it should be permissible to take organs from anencephalic babies while they are alive.
By GINA KOLATA
Published: May 24, 1995

A BABY'S LOST LIFE AN UNWINNABLE BATTLE
Miami Herald, The (FL)
March 29, 1992
JIM HANER And CHRISTINE EVANS Herald Staff Writers

Infants with Anencephaly as Organ Sources: Ethical Considerations
American Academy of Pediatrics.
POLICY STATEMENT
Committee on Bioethics

Use of anencephalic newborns as organ donors
Bioethics Committee, Canadian Paediatric Society (CPS)
Paediatrics & Child Health 2005; 10(6): 335-337
Reference No. B05-01
Reaffirmed February 2008

By ALEX BERENSON
Published: December 18, 2006

Eli Lilly encouraged primary care physicians to use Zyprexa, a powerful drug for schizophrenia and bipolar disorder, in patients who did not have either condition, according to internal Lilly marketing materials.

Doctors are allowed to prescribe medications for off-label purposes - I was on Lamictal (an anticonvulsant) for a good long while before it was approved for use as a bipolar mood stabilizer. However, federal laws prohibit drug companies from promoting medications for off-label conditions that they have not been approved for. In this case, Eli Lilly was promoting Zyprexa in its "Viva Zyprexa" campaign for use with dementia and dementia-related psychosis - despite the fact that it "is not approved to treat dementia or dementia-related psychosis, and in fact carries a prominent warning from the F.D.A. that it increases the risk of death in older patients with dementia-related psychosis." Furthermore, Zyprexa carries some significant side effects - significant weight gain, and it's been implicated in causing diabetes. Zyprexa is Lilly's top-selling medication, bringing in $4.2 billion in sales in 2005, 30% of its overall revenues.

The documents also show that Lilly encouraged primary care doctors to treat the symptoms and behaviors of schizophrenia and bipolar disorder even if the doctors had not actually diagnosed those diseases in their patients. Lilly’s market research had found that many primary care doctors did not consider themselves qualified to treat people with schizophrenia or severe bipolar disorder.

Patients have to trust their physicians. They are at the mercy of their doctors, who are influenced by a multi-billiion dollar industry intent on selling drugs. Patients have to expect veracity from their doctors, who get their information on new medications from a variety of sources, including the drug companies. No one - except the drug company - is served by these dangerous off-label prescriptions, and many may be harmed. I'm glad that they caught Lilly in this case, but it's not at all uncommon - according to the article, nearly every drug company is under either civil or criminal investigation for alleged efforts to promote use of their drugs beyond the conditions for which they've been approved.

From NPR's Talk of the Nation, August 18, 2005
Racial Disparities in Health Care Persist.

Three new major studies on racial disparities in health care conclude that African Americans continue to receive inferior care when compared to white patients. The results show that, with a few exceptions, little has changed since racial disparities in health care came to light more than a decade ago.

Some advances have been made, especially in low-cost treatments like beta blockers, but for higher-priced care such as back surgery and CAT scans, things are still much the same as they have been. Even when corrected for socioeconomic status, minorities still fare much worse. And stunningly, most doctors - including minorities - don't recognize or admit to racial disparity.

In many cases it came down to condescension - with a white patient needing surgery for abdominal bleeding, for instance, he was told he needed a surgery because he was bleeding internally. With a black man, he was simply told he needed the surgery 'to save his life.'

We haven't come very far.

A friend tipped me off to this interesting issue...

"The International Olympic Committe thinks female ski jumpers that they are too fragile to compete. Apparently the shock of jumping is too much for women's delicate inner organs."

Seriously. I'm not making this up.

One woman ski jumper was given this flimsy reason for women being barred from ski jumping:

"Ski jumping is just too dangerous for women. Don't forget, [the landing] it's like jumping down from, let's say, about two meters to the ground about a thousand times a year, which seems not to be appropriate for ladies from a medical point of view."

And when she pressed for more details, she was told:

"... that it's too 'dangerous' for girls... that it would damage our ovaries and uterus and we won't be able to have children, even though that's not true. It's so outdated, it's kind of funny in a way. And then it's not."

This seems about as preposterous as the admonitions I got against sitting on cold park benches from the old Russian ladies during my semester in St Petersburg - "you'll freeze your ovaries," they warned.

Athletes take risks. Many, if not most, of the Olympic sports entail some moderate risk of injury - they're pressing themselves to the limit, after all. This needless medical paternalism is soaked in sexism and is completely inappropriate in this century.

One of the things that bothered me in the wake of the Virginia Tech shootings was this: the underscoring of Cho's "history of antidepressant use" and references to goverment databases that keep track of such things.

Well, this blog post written by an MD friend of mine delved a little more deeply into it, and it *is* a rather Big Brother sort of tale...

Big Brother is Watching Your Rx

From ABC News' article, Killer's Note: 'You Caused Me to Do This':

Some news accounts have suggested that Cho had a history of antidepressant use, but senior federal officials tell ABC News that they can find no record of him in the governments files on controlled substances. This does not completely rule out prescription drug use, including samples from a physician, drugs obtained through illegal Internet sources, or a gap in computer databases, but the sources say theirs is a reasonably complete search.

This article has apparently undergone a few revisions since it's original posting:

(NOTE: Some readers may have inferred from an earlier edition of this story that the federal government keeps a comprehensive record of all prescriptions. The Drug Enforcement Agency says it does track prescriptions of so-called controlled substances -- including some mood-altering medications -- but not all prescriptions made in the United States.)

Some additional research, though, shows that there are an increasing number of federal and
state programs to track not only controlled substances, but drugs with limited to no abuse potential, such as common antidepressants. With the stigma that still persists against those with mental illnesses, it's rather frightening that our prescriptions are being recorded. And even more distressing that such an effort could actually dissuade people from seeking out treatment.

I wrote this in response to a thread on a friend's blog regarding the use of physical restraints in a health-care context, and it was lengthy enough and meaningful enough to me that I thought I'd share it with here.

Her original post....

And my response. (Also behind the cut below)

Yeah. I have mixed feelings, but mainly because I've had a very nasty run-in with this.

( Herein be dragons, or at least personal demons. )

.. but all that said, I know that both the physical and chemical restraints were what I needed, in that time and space and situation.

But I wish they'd left the light on, and given me back my glasses sooner, and used comfier restraints. And for heaven's sake, taken the restraints off the bed after 24 hours had passed....

I was diagnosed with type I bipolar affective disorder in the fall of 2000, during a massive breakdown. My mother also has bipolar, so I wasn't entirely shocked, but it forced me to reevaluate some long-held biases I'd had. When growing up with my mom, I often thought "I never want to take drugs to 'make me sane - I'd rather die." The irony, of course, is that not taking the drugs could be nearly a death sentence - the rate of suicide in untreated bipolar patients is nearly 20%.

I had managed without medications until I was 26 - so why was I now looking at a future life of daily cocktails of drugs?

It wasn't until after I had some time, and some perspective, that I recognized patterns from my past - my severe depression, which was likely a breakdown, in the fall of my freshman year at the School of Music, which led me to drop out and abandon a career involving music; incidences of self-harm from high school and beyond; many erratic and unwise errors of judgement over the years that had hurt me, my partners, and in some cases, my friends. And it wasn't until probably a year after I initially started on Depakote that I realized I could still be "me" on the medications; that they didn't make me into a different person, but they allowed me to be a healthy, happy me.

There were trade-offs, however: along with the improved stability of mood came some hair loss, a fine tremor, and about 50 pounds of weight gain, which didn't help my diabetes. But both my diabetologist and psychiatrist agreed that it was better for me to be a bit heavier and stable than lighter and not. Because while diabetes can kill slowly, over a lifetime, untreated bipolar can kill in an instant.

In 2005, my insurance restricted the number of visits it would allow for mental health to only cases where there were severe symptoms being experienced and a treatment plan had to be worked out with number of expected visits neatly laid out. I had been seeing my therapist for quite a while to help me manage my bipolar disorder, and it's generally considered a good idea for people with bipolar to maintain a relationship with a therapist, not just a psychiatrist. But I had been doing well for some time - I wasn't having any over symptoms of either mania or depression - so I didn't really qualify for therapy coverage.

My therapist expressed willingness to fudge the documents to make me look sicker than I really was, but that wasn't something I was willing to live with. So I quit therapy.

Whatever happened to preventive care? We know that preventive care is critical in managing serious mental illnesses - medications alone are not the answer - and yet coverage is cut leaving patients on their own.

I've managed OK, but there have been scary times. Because things can change quickly, it's hard to get therapy sessions set up quickly if my symptoms *do* change for the worse.

They're starting to learn that preventive care works for things like diabetes and heart disease - hopefully someday soon they'll recognize the value of preventive care for mental illness as well. It's just another step to getting to a point where mental health is viewed on par with physical health. Someday we'll get there.

In '04, I decided it was time to confront some of my personal demons from my experience as an inpatient psychiatric patient during my breakdown in '00. I approached the medical records office of the hospital and asked for my full medical record -- and was surprised to get two sheets, basically a discharge summary.

I went back to figure out what was wrong, and it took a fair bit of wrangling to get the full record, but I ultimately did get it - all 100+ pages of it, including the notes from group therapy sessions, consents for medications, and the full narrative of my psych ER experience.

It was a jarring experience, reading the story of those floridly colorful two weeks in hard black and white. It filled in a lot of holes in my memory from the psych ER visit, and lent an interesting perspective, but there were some parts that I almost wished I had not seen.

Were they trying to protect me from this knowledge by keeping the full record from me? Or protect themselves against potential litigation that might come from knowing the details of my treatment? Or was it simply a routine bureaucratic maneuver? It's hard to say for sure. It was, on the one hand, an annoyance, but perhaps the additional hurdle was a good thing, in making me think twice whether I really wanted that bit from the tree of knowledge.

A new way to extract money from unwitting consumers emerges.

This is a fascinating article on one of the latest health scams - ultrasound screening by a company called Life Line Screening which offers "Preventive Health Screening Services That Can Help Save Your Life" (from their website).

Thing is, these screenings aren't proven to be effective at all, and are far more likely to cause undue worry, expense, and possibly unnecessary surgery or other treatments.

In particular, the author notes: What is unethical is withholding information that the average reasonable person would like to know before making a decision. If Life Line informed their customers that the tests are not recommended by any medical authority and explained why, then the customers could give informed consent to the screening. Instead, customers are only told the tests can help them avoid a stroke or save their lives.

The company is simply out to make a profit by fearmongering. They could be making a real difference by offering screenings that *are* recommended - blood pressure, for instance, or counseling people to quit smoking. But then, that would assume that they actually have our health - not their bottom line - at heart.

Another good one from the Science-Based Medicine blog...

An excerpt:
"The Amen Clinics, founded by Daniel G. Amen, MD, offer SPECT (single photon emission computed tomography) scans to help diagnose and manage conditions such as attention deficit disorders (ADD), mood disorders, anxiety and panic disorders, autistic spectrum disorders, obsessive compulsive disorder (OCD), substance abuse, toxic exposure, brain trauma, memory problems, temper problems, and relationship and marital struggles.

...SPECT depicts blood flow or chemical reactions in different areas of the brain. It is invasive and potentially harmful: it requires the injection of a radioactive tracer. Areas of low blood flow show up as apparent “holes” on colored pictures of the brain, giving a moth-eaten appearance. Amen says that when patients improve clinically, the appearance of their follow-up scan typically improves."

This is another case where the public is being sold a bill of goods (costing $3250 up front) - brain imaging which may be useful for diagnosis and treatment in some cases, but clearly not for the wide range of disorders that Dr. Amen is claiming. It does, however, offer rather impressive 'pretty pictures' that the doctors can show patients.

In fact, it's very questionable as to whether any of his patients can be giving truly 'informed consent' ~

"[the] informed consent form is misleading: it does not divulge that the American Psychiatric Association has spoken out against SPECT scanning for these purposes and has warned of potential harm - especially to children, who are more susceptible to the effects of radiation."

This is an invasive procedure with considerable risks involved, and rather than being offered as an experimental, unproven technique, its proponents praise its diagnostic powers.

A hospital in the Republic of Ireland has admitted removing the wrong kidney from a sick child.

The mistake, that led to a healthy kidney being removed, was described by Our Lady's Children's Hospital in Crumlin as an "unprecedented error".

In this case, a healthy kidney was removed from a child at Our Lady's Children's Hospital in Crumlin, Irelan, and the child now faces regular dialysis unless a donor kidney is found. The hospital described it as "as a 'significant and regrettable medical error'".

In this case, Francoeur's prima facie ethical principles of non-maleficence and beneficence were clearly violated.

It does appear that the hospital and providers are doing their best to 'make good' and uphold their veracity to the patient and family, though --

The Dublin hospital said it had given its sincere apologies to the family.... [the hospital] said the family was continuing to receive full support by the hospital staff and were happy to remain there for follow-up care.

Also, the hospital's board of directors is investigating the case to determine if any action is needed to prevent any future problems of this nature.

In such an investigation, though, there are potential issues of breach of confidentiality, as the Labor Party is calling for the for the findings of the inquiry to be made public. A delicate balance between sharing information for the greater good of all and protection private medical information needs to be found.

Irish Health Minister Mary Harney has indicated there may need to be an outside enquiry, even though she said she had total confidence in the internal review.

She said that unfortunately clinical errors occur in the best healthcare systems

The Labour Party said the findings of the hospital inquiry must be made public.

The party's Jan O'Sullivan said: "While I would accept that private aspects of this case must remain private, any findings of an investigation that indicates that there may have been systems failures or other shortcomings, should be published.

"The parents of this child, as well as parents of other children who are being treated for similar conditions in the hospital, need reassurance that this kind of incident does not recur."

Indeed, this "unfortunate clinical error" is nothing short of a tragedy for the child and her parents.

BBC News, 08:05 GMT, Tuesday, 22 April 2008 09:05 UK


A drug widely used to treat cancer may cause brain damage, with the effects lasting for years after the end of treatment, research suggests.

Tests on mice showed it destroys vital cells in the brain that help to keep nerves functioning properly.

The researchers say their findings could explain some of the neurological side effects associated with chemotherapy - a phenomenon often known as "chemo brain".

These include memory loss, poor concentration, and in more extreme cases, seizures, impaired vision and even dementia.



It must be remembered that this drug can offer significant benefits for people who need it which far outweigh the changes which some patients report
-- Martin Ledwick, Cancer Research UK


When is the cure worse than the illness? I've seen far too many friends and relatives die of cancer, and I don't doubt that chemotherapy can, in some cases, cure or at least ease some symptoms of cancer. It troubles me, though, that people who might survive the cancer would be stuck with neurological deficits potentially for the rest of their lives. This points to the importance of continued testing of drugs even after they've been approved by the FDA - often some drugs are rushed to market, and the subtler side effects may evade notice until later research brings it to light.