From Xico

More or less what you wanted to know about Hillary´s healthcare proposals' pros and cons

Don McCanne <[email protected]>	10:32 (hace 1 hora)
para Quote-of-the-D.

  

MedPage Today

March 15, 2016

Clinton's Health Plan Gets Mostly Passing Grades From Policy Experts (Mostly passing, say I, but lukewarm at best)

By Joyce Frieden

 

Democratic presidential candidate Hillary Clinton's ideas for improving the Affordable Care Act (ACA) drew cautious praise from health policy scholars, but they said they had no chance of enactment without a major change in Congressional attitudes.

 

"If we're really serious about getting to the general uninsured and getting costs down, and it's a choice between scratching everything and starting over [or] building on the Affordable Care Act ... I would build on what Clinton's talking about," Ken Thorpe, PhD, of Emory University in Atlanta, said in a phone interview.

 

Clinton's plan is "Very much a small adjustment to ACA, and in the climate we have, getting anything through [Congress] is a real challenge," said Paul Hughes-Cromwick, MA, of the Center for Sustainable Health Spending at the Altarum Institute, in Ann Arbor, Mich. "Most of what she's talking about is very small, and some things are already happening."

 

On her website, Clinton lists the following planks among those in her healthcare proposal:

 

*  Make premiums more affordable and lessen out-of-pocket expenses for consumers purchasing health insurance on the ACA exchanges. This would include a tax credit of up to $5,000 per family to offset a portion of out-of-pocket and premium costs above 5% of income.

 

*  Support new incentives to encourage all states to expand Medicaid. Clinton proposes allowing any state that signs up for the Medicaid expansion to receive a 100% match for the first 3 years.

 

*  Invest in navigators, advertising, and other outreach activities to make exchange enrollment easier. Today, as many as 16 million people or half of all those uninsured are eligible but not enrolled in Medicaid or an exchange plan. Clinton plans to invest $500 million per year in an aggressive enrollment campaign.

 

*  Expand access to affordable healthcare to families regardless of immigration status. Clinton "believes we should let families -- regardless of immigration status -- buy into the Affordable Care Act exchanges," according to her website.

 

*  Continue to support a "public option." Clinton wants states to be able to establish a public option under which people could buy into a publicly funded health insurance plan.

 

*  Defend the ACA. "Hillary will continue to defend the ACA against Republican efforts to repeal it," the website said. "She'll build on it to expand affordable coverage, slow the growth of overall health care costs (including prescription drugs), and make it possible for providers to deliver the very best care to patients."

 

*  Lower out-of-pocket costs like co-pays and deductibles. "Hillary believes that workers should share in slower growth of national healthcare spending through lower costs," according to the website.

 

*  Reduce the cost of prescription drugs. "Hillary believes we need to demand lower drug costs for hardworking families and seniors."

 

*  Transform our healthcare system to reward value and quality. "Hillary is committed to building on delivery system reforms in the Affordable Care Act that improve value and quality care for Americans."

 

Compared with the plan offered by Clinton's Democratic primary opponent, Sen. Bernie Sanders (I-Vt.), who wants to institute a single-payer "Medicare-for-all" program, hers is "definitely more realistic," said Michael Sparer, PhD, JD, of Columbia University in New York City, in an interview. However, "a lot depends on what happens to Congress as well [if she becomes President]. If something would change in Congressional makeup, I think she has a pretty clear fix-it agenda."

 

Even without such a change in Congress, "she will try to use whatever authority under ACA to encourage states to experiment," he added.

 

Similarly, Elbert Huang, MD, MPH, at the University of Chicago, said he was impressed by the level of specificity in Clinton's plan, especially compared with those of Sanders and Republican presidential candidate Donald Trump.

 

Jon Oberlander, PhD, of the University of North Carolina-Chapel Hill, agreed in an email that, overall, Clinton's plan is "more than realistic" -- "if we are to continue to make progress in reducing the uninsured population, making Obamacare more affordable for Americans with modest incomes is imperative. Politically, however, even these incremental measures are not so easy."

 

However, Oberlander continued, "As for [Clinton's] public option ... its chances of enactment in the current Congressional environment are zero. Even if Democrats retake majorities in Congress in 2016, it would face an uphill path to enactment."

 

A federally run public option, he said, "is symbolic politics, something that liberal Democrats like that allows Clinton to counter Sanders' single-payer proposal."

 

Clinton's Medicaid expansion proposal "will be incredibly tricky to pull off politically," said David Becker, PhD, of the University of Alabama at Birmingham School of Public Health, in an email to MedPage Today.

 

"Even in a state like Louisiana where Medicaid expansion will take effect on July 1, it is somewhat unlikely that Republican senators and representatives would support expanding federal support. This proposal also assumes that states that have already expanded their programs will be happy to support the extension of funding without asking for something in return."

 

As to spending more money on navigators, "I'm not entirely sure this is money well spent," Becker said. "People that are eligible but not enrolled for public health insurance programs tend to be low-utilizers who re-enroll when they need care. Although marketing and outreach efforts have varied across the states, the benefits of increased spending on these efforts are not clear."

 

Clinton's proposal to lower out-of-pocket costs might work with plans on the insurance exchanges, said Alan Sager, PhD, at Boston University, but is incompatible with the economics of private insurance.

 

"For private employers it's very tough today, since employers and their benefits advisors think that higher out-of-pocket costs are the one tool they can wield to contain their healthcare costs," Sager said in an email. "Many economists fantasize that higher out-of-pocket costs will somehow shoehorn size 10 healthcare into size 5 free-market competition. And some reporters and 'consumer advocates' fantasize that better information about price and quality will make us healthcare super-shoppers."

 

Sager added, "Without real cost controls -- not widely supported politically by Americans -- out-of-pocket costs will continue to look to many people like the only game in town" for restraining overall costs.

 

He also dismissed the "reward value and quality" part of Clinton's plan, calling it "tough to do without torturing hospitals and doctors to make them give us still more data. And they control the data so they can game the measures of value/quality if they want."

 

David Howard, PhD, another Emory University scholar, told MedPage Today that he was troubled by Clinton's proposing of new spending without suggesting how the costs would be offset.

 

"Clinton promises new subsidies for people who buy insurance on the exchanges, new subsidies to help offset out-of-pocket costs, and additional funds to subsidize state Medicaid expansions," he wrote in an email. "At a time when the federal government is struggling to afford entitlements, it is irresponsible to promise new spending without offsetting spending reductions elsewhere."

 

Jan Carney, MD, MPH, at the University of Vermont in Burlington, said she is concerned about what's missing from all the candidates' proposals, including Clinton's.

 

"Public health issues such as infant mortality, obesity, HIV, injuries, homicides, and drug-related deaths all represent preventable contributors to health care costs," she said in an email. "These specific areas (where we do much worse than other countries) and other areas of public health, would make a strong addition to this national healthcare discussion."

 

Christopher Jones, PhD, of the Vermont Center for Clinical and Translational Science, in Burlington, named another topic of concern: biocybersecurity. “Health information has a longer shelf life than financial information and when both are sold on the black market, it is health information that commands a higher price,” he said in an email. “This will most assuredly be a concern for the Democratic candidate when s/he gets elected.”

 

http://www.medpagetoday.com/Washington-Watch/ElectionCoverage/56734

 

Comment by Don McCanne

 

Not a very exciting article. And that’s the point. When you read Hillary Clinton’s proposals, they all fall under the category of mere tweaks to our current dysfunctional system.

 

Tens of millions will remain uninsured; underinsurance will not be eliminated; Medicaid would be expanded without addressing its deficiencies in access; administrative excesses, including waste in marketing would increase; the undocumented would be allowed in without a way to pay for it; an ineffectual public option would continue to be offered through Section 1332 waivers; and so forth. Lower co-pays and deductibles along with a higher tax credit would be helpful, but to be effective, it would require significantly higher taxes when we have a Congress that continues to resist, on a bipartisan basis, any tax increases.

 

Although the title of this article indicates that the health policy experts cited give her efforts a “passing grade,” they basically do not see much more than fine tuning of the status quo. There is no suggestion that we could achieve reform goals of universality, affordability, increased provider choice, greater access, greater administrative efficiency, and optimal equity in the financing of health care.

 

Many of the Clinton measures proposed would further increase health care spending while falling short on goals. That would be a shame when instead we could place effective controls on spending through a single payer national health program - an improved Medicare for all - while achieving all of the listed goals of reform.

 

 

Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office.

 

 

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More miniscule adventures

A couple of days ago we did NOT have a great deal of fun driving around Xalapa.  Xalapa has a LOT of traffic and it is often bumper-to-bumper on narrow streets which don't always go in straight lines, especially at certain hours.  Some of the hours include from 2 to 4 in the afternoon.  This is the still-frequently-taken lunchtime when I think people do their errands (Workers work at least eight hours a day, sometimes more. Often I don't mind the traffic because it gives me a chance to see the huge variety of tiendas and workshops that line the way. Anyway, we went in to try to buy a generic version of a medication I take and to go to Costco to see about hearing aids.  Costco is probably one of the best places to buy hearing aids.

So ANYWAY, of course we hit the 2-4 traffic, and it was cold and rainy and dreary.  On sunny days, Xalapa looks bright and busy and colorful.  This day, though, the sky was a dirty gray which seemed to drip onto everything and everyone.   

About medications here in our corner of Mexico:  There are lots of generics available and reputable places tend to have good generics, but some people (like me) may not respond well to generics available here so they end up paying non-generic prices.  Our wonderful doctor had found (he and we thought) a generic put out by the very company that makes the non-generic drug.  Unfortunately, according to the Pfizer salesman it required a prescription although the brand-name doesn´t and other generics don´t.  (Here a little explanation:  most drugs here don't require prescriptions.  The ones that always do are antibiotics, benzodiazapines like Xanax, and opioid pain medications like oxycodin. Antibiotics and narcotics, in other words.  There may be other classifications, but I haven't come across them.)  So anyway we went to one end of town to get the prescription which was limited to only twenty tabs for some reason, and then drove to the other end to find the pharmacy.  Need I tell you, they said they didn´t have it at either of the two stores.  These were discount pharmacies, ones who specialize in generics, with a long counter and shelves piled high with boxes of medicine.  Here most medications are packaged one pill to a bubble on a card of maybe ten, not in bottles.  Even prescription meds come this way so you often have to buy a bit more or a bit less than you want.  So we drove (sort of) a right angle to get to Costco.where I had to make an appointment for the hearing aid evaluation.  Groan.  I went to Xalapa with my friend Diane a couple of weeks ago by bus.  It is much, much pleasanter to go by bus, and we would have if we hadn't had to lurch such large distances in a relatively short time in the cold and rain. 

I now have the hearing aids.  They are the Kirkland brand and they are excellent.  The young technician was proficient and friendly and we got 19.22 on the dollar which was good for us but bad for Mexico (I think, but am not sure.)  The first shock I had happened when she opened the door to the littl soundproof room where hearing aid stuff is done.  With a whoosh, I was greeted by all kinds of sounds I guess I haven't heard in years.  Costco is NOISY!  Anyway, if you folks are finding yourself cupping your hand behind your ear to hear, leaning forward, maybe enjoying how soft everything sounds, maybe, just maybe a hearing aid evaluation at Costco would help.  Hearing aids have come a long way.

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The day before yesterday we took our dogs for a walk and went a bit further. It was not raining or misting, but it was chilly.  We usually let the two smaller dogs run free, which they do with glee.  Little Guy, the dachsund, can run as fast as Happy and as she is the alpha dog, she insists on being first. She is very cute as dachsunds are.  She is tiny, with floppy ears and limpid, doe-like eyes. She has learned to make wheedling sounds, soft beseeching sounds, coy sounds even. Often we are at her mercy. 

BUT in her own world which she enters as soon as she is off the leash, she is a hunter. In response to some smells she´ll roll in phantom remains, in response to others, she´ll dig frantically.  In response to fowl and other low-resting birds, she´ll catch them.  She takes off so fast she can´t be caught.  She doesn't  even acknowledge that anyone is shrieking at her to STOP while pounding after her.  And it seems she inevitably catches her prey.  We have been putting her on the leash long before we see a chicken, but the other day, she caught one yet again.  It was dead before she even turned around with it hanging limply from her mouth.  

Unfortunately, this chicken turned out to belong to friends of ours who refused to take any payment.  There I was, holding it by its legs, there my friend was saying, no, no, you don't have to pay while she looked mournfully at the bird.  Another friend made the suggestion that we buy her another live one.  I think we're going to try to do it.

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Last post I wrote about the miraculous healing of the dent in our front fender. So then we went to meet our ahijado to take the car to the man who was going to paint it.  We only remembered half the message: to meet him.  We didn´t remember the other half: to meet him at the painter's workshop.  So we went to his house.  I´m glad we did, though, because in spite of feeling a bit foolish when Doña J asked why we were there, we got to see the baby sheep Don A had bought.  The guy who works for Don A was grazing them on a rope outside their chicken pen and I have a picture for you.

I think the big one may be the mama.   But none of them are big.  I  have to confess I thought they were goats at first.  You'd think I'd know what goats looked like by now!

I really, really do not like Hillary Clinton

At a recent interventional cardiologist meeting recently Hillary gave her medical talking points.

The Fee-for-Service Debate

Edward Kulich, MD: "The political atmosphere regarding healthcare falls short in its attempt for a 'one-size-fits-all' approach. Hillary Clinton addressed a room full of interventional cardiologists, with an average salary of $400,000, while not addressing a room full of pediatricians, who earn, on average, $130,000. However, the medical school debt is the same for specialists and primary care doctors -- approaching $200,000."

Brian Flyer, MD: "Her comments suggest how out of touch she really is with healthcare. The problem with government intervention, is that they equate healthcare with insurance coverage. They miss the crux of the system, which is the doctor-patient relationship. The choices many specialists make to get by is really gaming the system. They make so little for their cognitive efforts, that they end up ordering unnecessary tests."

As I've said many times, here in Mexico we have fee for service medical care and doctors who do, when necessary, make home visits.  If we come to need sophisticated cancer treatment which really, really would improve our quality of life and not leave us lying on a hospital bed, then we might go to one of the cancer hospitals in the Land of the Free (my friend Susan's name for it).  

I really really really hope that Bernie Sanders, Elizabeth Warren, even Joe Biden can push Hillary out of running.  She hasn't shown any indication of using her time to really learn about the issues, how people feel about them, their history.  Her understanding of foreign places, especially Mexico which is saddled with the Merida Initiative remains limited to that which high placed diplomats and officials give her.  

Poverty in Mexico: The National Evaluation

It's no secret that there is poverty in Mexico.  The government itself measures it and analyzes it and publicizes it. The agency responsible is CONEVAL, the National Council of Evauation of Social Development Policies at www.coneval.gob.mx.  The measurement of poverty: methods, terms and results are laid out in excellent graphics here.

Today La Jornada presented a good summary of the results for 2012.  Below,from La Jornada, is a cart showing the states with the largest percentage of poor people.

(Mexico, whose official name is Estados Unidos Mexicanos, has 31 states and the Distrito Federal which is Mexico City.)

The government measures at least five markers: income; nutrition; health; social security (meaning pensions and payments of various sorts to workers -- I am not clear about this) and the government's health care system; educational levels, and housing situation.

The current statistics show a slight reduction from 46.1% in 2010 to 45.5% in 2012,or 53.3 million people.  People living in extreme porverty number 11.5 million or 9.8 percent. In te whole population, there are only 23.2 million people who are not vulnerable to falling into poverty. Our neighbors, as examples of vulnerability realized, were laid off (without any benefits) by Coca Cola.  One man finally got a job driving for a security company, the other after considerably longer, got a stock job at the new Bodega Aurrera in Coatepec. The extended family came together, but it was hard for everyone although they got income from a miscellany of sources: picking coffee, two small tiendas, temporary work as cleaning people and in neighborhood construction.   The government defines poverty as lacks in two of the markers; extreme poverty as lacks in 3 or more of the markers.Income for rural areas has to be at least 1490 pesos a month or 116.38 dollars a month.  In cities, the minimum income is 2329 pesos or 182.69 dollars at today's rate of exchange.  Where we live counts as rural.  We are the sole regular income for our gardener.  From us he gets between 960 pesos and 1440 pesos a month.  A friend gives him a grant of 150 pesos a month to help cover his son's medicine which Seguro Popular does not cover, though it treats his son.  He and his older boys pick coffee and they have some old-fashioned video games at the house that neighborhood kids pay to use.  

Some things have improved, notably health care, with the expansion of Seguro Popular, or health insurance for everyone.  This does meet basic needs, but often people don't have enough money to pay for medicines.

Schooling, via television, is available to all the kids in our Colonia.  Most go through secondaria which ends at the equivalent of ninth grade.  Those who drop out often do so to go to work for their families.  We also have a Telebachillerato, the equivalent of high school.  Kids who show some interest and aptitude for academic work continue in this.  The woman who cleans for us has three daughters, two of whom are now in University.  One is studying pedagogy, the other, business administration. This is quite a burden for the family although the husband is a well-respected house builder and construction worker and makes a good income when he has jobs.  The woman makes 1360 in a four-week month with us, occasionally more when we need more.  By itself, the round trip bus trip to the University for each girl is about 720 pesos a month.  There are no bus passes.

Most living places in our colonia are adequate.  Some people have benefitted from new houses built by the government (basic cinderblock construction), by a program to replace dirt floors with concrete, and from a program to replace interior wood-burning stoves with efficient wood-burning stoves with chimneys.

Generally, it is agreed that there has to be economic reform which enables people to make a living wage without moving to factories (which can only hire so many people anyway) in distant locations.  NAFTA did away especially with much local farming and animal production.

Nutrition is an interesting issue.  Mexico has been overrun with junk food which is sometimes cheaper than the good stuff people used to eat.  Soda is often cheaper than bottled water.  As a result, though health care is more accessible, rates of obesity and diabetes are increasing.  

 

 

 

 

 

 

 

 

 

Crime in Mexico, Oh No!

Indeed, how safe IS Mexico?  Click on this link. I really would like to know what ideas you up there in the north have about Mexico.  How big do you think it is?  What do you know about its government, its culture, where do you get most of your information about Mexico?  What do you know about Mexican schools and universities?  Why do we go to Mexican doctors?  What, are we crazy?  Are they all witch doctors? Etc,etc.  

Why does it matter? Because US policy towards Mexico is really ignorant and because I wish my kids would visit.

Medicare, Medical Treatment and Coverage in Mexico Plus Some Photos of Our Hotel and Hospital Art (Mostly)

Jim had surgery for his glaucoma in Mexico City last week.  It seems to have gone well and yes, it was reasonably priced even at a very fancy hospital.  We had hoped Medicare would cover some of the cost since the hospital had said they could accept Medicare.  But Medicare won't. This seems both foolish and unfair since excellent care is available at a MUCH lower cost here, and since Jim and I have paid into Medicare our whole working lives.  Obamacare may change this, but according to Mexconnect, not in the near future since (groan) all the rules and regs have to be written, and they might never be.  Mexconnect also has some good information on health care in Mexico and insurance companies that will cover us old folks, including IMSS.  So we are going to look into the private insurance possibilities and are very glad we keep up our IMSS coverage.  IMSS can be slow, but it is generally good, especially for (oddly) routine coverage and emergency coverage, although we do know of some notable exceptions.  I do think it is worth thinking about these things!

Here are some photos from the Hotel Camino Real del Pedregal and the Hospital Angeles del Pedregal.  the hotel is next to the hospital and is fancy but you can find Deals, especially close to check-in.

Hotel conceirge desk in the very high-ceilinged lobby.

Huge geometric sculpture suspended from ceiling of mezzanine level of hotel as seen from main floor

Dancer (sort of) sculpture in lobby.  

Sculpture over reception desk (which is under overhang)

Traffic on Periférico Sur seen from top floor of hotel

Apartment building seen from top floor of hotel.

Reflection of Jim taking photo of sphere outside of side hotel entrance.

Hospital Angeles from top floor of hotel.

Lobby art in hospital

 

Hospital information desk with art composed of trees and abstract mural behind it.

 

 

 

Sex Ed

Recently we were talking with our friend the doctor about the success Mexico has had reducing its birthrate from something like 7 or 8 children per woman during her childbearing years to slightly over 2 children per woman in her childbearing years.  He said indeed attitudes towards birth control have changed dramatically with each new generation and that now, with this generation of child-bearing women, birth control has become almost universally accepted with a few exceptions.  Jim asked if perhaps people in rural areas were resistant.  Our friend said no, acceptance was high in most rural areas. I´ve mentioned before that sex ed materials in the public schools are direct and very informative. There are, however, a couple of states, notably Guanajuato, where resistance remains high to anything deviating from the teachings of the Church.

I think before I mentioned that in our local pharmacies, educational promotional materials from (of course) drug companies were prominently placed.  Now there is prominently placed

information on the "day after" pill.  I asked the pharmacist if you needed a prescription for birth control pills of this sort, or just regular birth control pills. She looked at me as if I was nuts.  "Why would you need a prescription," she asked.  

Here are the first three pages of the little brochure on the day after pill, with some translation (by me).

THIS page says, Okay, you know a lot about sex...Do you know about contraception?  PILDORA for the next day.

 

THIS says:

Plan

decide

act

and

live

 

I like the graphic.  Very interesting

 

 

This says

 

 This says,

In contraception there are man options.....eve for the emergencies such as the day after pill ....Ask your doctor.

What contraceptive methods exist?

The contraceptives can be divided into temporary and permanent depending on whether you want to have children in the future or whether not to have them is a permanent decision.....

The brochure, which as I said, is available on the counters of local drugstores and repeats information available in schools.

Abortion is a different issue.  Abortion is legal in Mexico City.  I am not sure about other states.  Here people are not violent when the issue is brought up, but seem reluctant to pursue it when a woman gets pregnant, although clearly some do.  One does not hear about backroom abortions.  I assume, perhaps incorrectly, that obgyn's perform them, but do not publicize them.  In our colonia there has been a rash of young "marriages" recently due to pregnance.  I put "marriages" in quotes because civil and church weddings are very expensive so people often set up households and consider themselves married without official blessings.  Families accept these.

In my next blog, I will give you a rather opposite example from the state of Guanajuato which I've mentioned before and which seems to pride itself on being the most conservative state in Mexico.  As Carlos Fuentes pointed out in "Buenas Conciencias", conservative religion does not appear to have much to do with holiness, more to do with power and getting along with the society.

 

 

Yet again, NAFTA and the Mexican Diet

NAFTA (The North American Free Trade Agreement or El Tratado de Libre Comercio de  America del Norte in Spanish) has been deadly for many ordinary Mexicans who depend[ed] on their farms for their livelihoods.  I have been a small voice among many talking about this over the years.  Today in La Jornada there is an article on NAFTA's effects on traditional food and on the growth of the junk food market here in Mexico.  I often wish I could beg the owners of the tiendas in our colonia to stop selling soda and chips and all the other crap that has so affected the health of my neighbors, but then they'd be done out of much of the small income they get as would the delivery men and line workers at places like Coca Cola.  I do know that at least on special occasions, one of the shop owners sells home-made syrup for jamaica, the delicious local agua made from a local flower.

The translation of the article below is mine and is kind of loose to make it flow (I hope).

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The North American Free Trade Treaty (with the US and Canada) has distorted Mexican eating habits. The use of transgenics and the importation of "junk food" [chatarra in Spanish] in local cooking and eating represents a danger to the national cuisine which is included in the list of the Non-material Cultural Patrimony of Humanity of Unesco noted Gloria López Morales, ex-official of the United Nations Organization for Food and Agriculture (FAO).

Interviewed at the Mesoamerican Food Summit, she said that "the changes in food are a secondary effect [of NAFTA] on the availability of affordable local ingredients.  The real danger for the Mexican kitchen is that they are losing these ingredients.  There are a series of such products which, without adecuate farm policies, can be lost. This is going to mean we will have to give up a traditional balanced diet: varieties of corn and beans, many kinds of quelites [I think this is amaranth and related plants]. and wild and culivated greens and herbs.

Also the former director of the regional office for culure of Unesco for Latin American and the Carbbean, López Morales warned of the "enormous fragility" of the products of the milpa. [The milpa is the indigenous/traditional and effective small-scale method of farming corn, beans and squash together.  The link is in Spanish but you can use google translate if you need help.]

"Everything has been distorted by the foodstuffs of the free market, and we import junk food, transgenic maize, all that is deterimental to the cultivation of our own products." Studies have been called for from biological and anthropological perspectives so that policies in defense of local products can be developed.

Sooner or later, she affirmed, governments are going to have to develop adequate policies for the preservation of our food system, "first, because we've already lost self-sufficiency and sovereignty and second, because we have already won the championship in obesity and diabetes. [These "championships"] also hit us hard in something that matters a great deal: our pocketbooks.

We are learning that we have to spend too much of our public budget to treat illnesses caused by malnutrition."

During the current transition [from the presidency of Calderón to that of Peña Nieto] the promoter of Mexican gastronomy suggested that citizen actions should be undertaken to attract the attention of the new government to the country's food problems.

At the gathering which took place in Mexico Ciy from the 25th to the 28th of July Guadalupe Latapi, promoter of organic products through her business Aires del Campo, emphasized that in Mexico the consumption of organic food has increased twenty percent (in the US it grew this past year by 9 percent) since more and more people are worried about health, flavor, the environment, the well-being of animals and the sustainability of the agricultural economy.

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Me speaking again: the government takes a much more active approach in advertising issues of health and nutrition here than the US government does.

 

 

 

 

 

Depression: Some Good Thoughts About

Some cogent points on the value of antidepressants by Maura Kelly in the Atlantic, some cogent points on the value of antidepressants. 

"[G]ood therapy is often very expensive--far more expensive than most people can afford, particularly because so many health insurance plans provide little or no coverage for it--whereas less-than-excellent therapy can contribute to a sense that one's problems are intractable, that things will never change. (I speak from experience.) Perhaps it's also worth noting that if developing a fitness habit were easy for the average person, then the obesity epidemic wouldn't be the most serious and costly health problem facing our country right now. And many seriously depressed people have a difficult time getting out of bed, to say nothing of going for a thirty-minute jog--though for some of us, like myself, our mental illness happens to come with a degree of obsessive-compulsiveness that often manifests itself at the gym."

And quoting Daniel Carlat, former author of The Carlat Psychiatry Blog and anything but a pill pusher:

Carlat, an associate clinical professor of psychiatry at Tufts University School of Medicine, wrote in to agree that "psychiatrists often overdiagnose disorders of questionable scientific validity, they have become overly fixated on medication solutions to life's problems, and many have accepted a steady flow of drug industry money, creating so many conflicts of interest that it is impossible to know who we can trust." But he also noted that "missing from her review is an unequivocal if perplexing truth about psychiatric drugs--on the whole, they work." (Carlat, let us remember, had no axe to grind; Angell had written favorably about his book.) 

(HT to Andrew Sullivan)..

Of course it's important to realize--VERY important--that if you're a bit down you shouldn't simply go to your family practitioner for ten minutes and accept a prescription for antidepressants with no real examination of your symptoms.

Also check out one of Andrews Quote for the Day items here.

On Rick Santorum et al, Abortion, Birth Control, Bronx Primitive and Morality

The current political battle over women’s use of contraceptives and abortion is ludicrous, incredible.  The positions of Santorum and the Catholic bishops should be laughed out of town.  I am horrified that in all the brouhaha I have only heard faint hints of the importance of contraception in enabling healthy mothers and healthy babies.  Where’s outcry about maternal deaths in childbirth: about the terrible physical burden on too-young bodies from bearing children  and from mothers bearing too many children throughout their reproductive years?   Where is the outrage on behalf of children who are too many to feed adequately, to provide decent health care to? Where is the outrage over babies ending up in dumpsters because their mothers can’t deal with them?  Where is the outcry about abusiveness bred in the cramped hardship of large families trying to exist in tiny apartments on filthy streets? And how about some compassion for mother who should not have to bear to term terribly damaged fetuses? Anencephalic babies, for instance.

Let´s mention, just for a moment, the seemingly sunny solution of adoption for kids a family can´t afford: I couldn’t bear to give up a kid. Even more important, where is the rush of families willing to adopt someone else’s kid?

And let’s talk about sex for a minute.  How naïve is rick Santorum?  Does he think that every married couple that falls into bed for a romp in the sheets without inending to conceive a child is composed of a man and a woman both giving in to their excessive urges?  Hasn’t he heard of women whose husbands won’t take no for an answer?  Maybe that’s how he got eight kids. The women may hate the sex.  Why should they have to bear a child as well?

The variety of sexual experiences for people, married, single, straight, gay, is enormous as I’m sure most adults are aware.  Obviously many of the experiences are exciting, ecstatic, and represent a momentary loss of self.   What’s wrong with this?  What’s wrong with eating chocolate bars with almonds sometimes?  And one of the most important functions of sex between loving partners is the nourishing of that love.  So why are we giving Santorum and the bishops the time of day?

All this fuss reminded me of a book called Bronx Primitive by Kate Simon.  I think it was published in the 1980s.  Currently it is not available as an e-book so I can’t download it to refer to it.  My father bought it when it came out in the 1980s. 

When my mother was spending her four years comatose in a New Jersey hospital in the 1980s, I travelled east several times a year to help my father with bills (which he kept in paper bags), his lawn, his house maintenance, his shopping, and various other things he wandered around trying to do.  Sometimes we talked.  He had spent his childhood with Kate Simon in the same Jewish Bronx neighborhood, a lower middle class enclave not far from where I spent my first years.  He really shocked me one evening by asking me what I thought of the idea of his getting in touch with her.  I think at one point when they were much younger my parents had been friends with both Bob and Kate Simon and I think in fact it may have been Kate who introduced my father to my mother.  She and my mother both worked at the Book-of-the-Month Club in the late 1930s if my memory serves me. (I have increasing doubts about my memory serving me).  At any rate, my father appeared, after a major stroke and a few TIAs to be entertaining romantic thoughts.  He brought out Bronx Primitive for me to read as he talked with great fondness about Kate.

So now we can return to Rick Santorum, et. al.

In Bronx Primitive there was a chapter not simply on childbirth, but on abortion.  In the days Simon was writing about, during the second decade of the twentieth century and maybe into the 1920s in that Jewish community, men took their wives whenever they wanted. The only time they didn’t want to was when women were menstruating. There was no thought given to birth control because basically, it didn’t exist.  Large families were pretty much the norm.  My grandmother had five children, one, a blue baby, died as an infant, another died in a tragic fire. 

Women weaken after having a lot of children; they wear out, they get sick, they die young.  And so Kate Simon described the neighborhood saint, The Abortionist.  A woman would send for him before her husband knew she was pregnant, while the husband was at work.  After he came, she would spend a day or so in bed, simply saying she was ill-disposed.  The Abortionist was apparently a very kind and gentle man, revered in the neighborhood among the women.  They considered themselves fortunate not to have to resort to the dangerous methods so common elsewhere.

So I would say to those stirring the flames of hate against women most of whom have good reason for using birth control and abortion service  that it is very easy to adopt a cruel morality when you can afford it, maybe when you have no sex drive, when you live amongst people who support you no matter what you believe, like the Puritans did (you ought to look up Roger Williams, by the way).

And finally I would say, doesn’t the Bible talk about who should throw the first stone?  Isn’t it God who is supposed to be the judge, not us? If a Catholic University, say, doesn’t have to itself provide payment for birth control, who is so arrogant to say that independent contractors can’t provide it?

And again, why are we talking about this at all while the near east is in flames and the world is heating up?