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Tag Archives: Brenda Tobias

Dealing Prescription Drugs

03 Feb

Pill

Drug abuse has existed since the dawn of time (or at least since the first person ground a leaf into powder.) Just about any substance can be misused or abused. Many drugs lend themselves to misuse/abuse due to their mood altering effects. However in recent years antibiotics have become misused as well. As a culture we are not entirely comfortable with discussing prescription or over-the-counter (OTC) drug abuse. We know what drug abusers (a.k.a. junkies) look like; we’ve seen them in movies and magazine features. Surely the (pill taking) carpooling mom next door can’t be abusing drugs; look at her! Those honor students doing homework in the media room can’t be abusing A.D.H.D. medication; look at how well they’re doing! What adds a heavy opaque veil to the detection is that these drugs come from doctors. Doctors know a thing or two about the human body and what is good for us, no? In theory, yes.

Detecting drug abuse during a 3-5 minute office visit is not easy. There are those who live with people day in and day out and still have no knowledge of drug misuse/abuse. This is by no means to suggest that doctors shouldn’t prevent and detect misuse/abuse. Quite the contrary. We need to incentivize the doctors to limit prescription writing (kind of the way drug companies give incentives to write the prescriptions.) Primary doctors need to spend time asking pointed and probing questions and not merely relying upon questionnaires to make diagnoses for mood altering drugs. Doctors must know the signs of dependency and always err on the side of lower dosage. Doctors know the signs of mental illness and should be on alert for signs of self-medicating behavior. Doctors should refer patients to a mental health practitioner if there are any doubts about stability. The mental health practitioner and referring doctor must decide in concert what medication (if any) is best for the patient.

Pharmacies are already set up to detect prescription abuse. But there are gaps and it’s not considered abuse to fill legitimate prescriptions. We need to start with source (or ‘dealer’ as he/she is known on the street.) Doctors are not looking to get people ‘hooked’, not consciously anyway. For the most part they want their patients to be healthy and happy. They certainly don’t want to see their patients in pain, physical or psychic. Pain medication is tricky business and that’s why there are specialists and pain clinics. Managing pain and pain amelioration can’t happen in a 3-5 minute general practitioner’s office visit. General practice is not the place for treating a cognitive, behavioral or mood issue either. Psychologists and psychiatrists are trained to diagnose learning disorders, and behavior and mood disorders. Relying on general practitioners to treat all aspects of the human condition is quaint and ridiculously. No one person can possibly be up to date on all the medical developments of the 21st century.

We’ve become rather blasé about medicine; ironically as it’s become space age in its sophistication. But we are wrong to do so. Often times, dangerously wrong. Drugs are drugs; whether they come in a childproof bottle or a tiny ziploc bag. They can be life saving or ending, and should be treated as such.

 
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Posted by on February 3, 2013 in Cultural Critique, Well-Being

 

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A Health Care Reformation Proclamation

31 Jan

doctor

Medical Insurance (or as it’s less accurately known; health insurance) is on its way to reformation. It’s not clear if the results of the reform will render the; coverage, procedures and rights of the users any more decipherable than they are right now. But what is clear is that the more something is examined the more flaws are brought to light.

We can all probably agree that good medical care should be available to all. Whether insurance is the means to that end is highly questionable. But we seem to be stuck with that particular paradigm. Anyone who has ever sought treatment, payment or reimbursement would probably be happy to swear on a big towering stack of bibles that insurance companies seem to be in the business of making money not providing good healthcare. But as we established; we are stuck with this paradigm. In the interest of making lemonade out of the soul crushing demoralizing oligarchy of the paradigm, let’s consider how government involvement might improve things. (There will be no rolling of the eyes.)

The most obvious improvement will be filling gaps in the current usage of medical care. Insured people are presumably less likely to use emergency rooms as their general practitioner. This is good for both continuity of care and preventive efforts. It is also an enormous cost savings. Insured people are more likely to visit doctors before a condition become acute. They are also more likely to take the full dosage of their prescribed (co-pay) medicines, when not compelled to ration. In theory medical insurance for all will lead to medical care for all. Whether it’s ‘good’ medical care is another issue altogether (that was less of an eye roll and more of a ‘whatever’.)

Where things potentially get exciting and sane is the possibility of payment parity. Currently medical insurance is sold in two sizes; individual and family. The individual plan is discreet and self-explanatory. The family-size is an unlimited free for all. There is nothing equitable about this framework. A two-person family is paying the same rate as a ten person family. A parent with one child is in essence subsidizing larger families. Two options of coverage (individual and family) only benefits large families (and no doubt insurance companies.) There is no other insurance plan (of which I’m aware) that operates this way. You don’t buy homeowner insurance for either one home or an unlimited amount of homes. You don’t purchase auto or life insurance in this manner either. You purchase insurance plans for each entity that needs coverage.

I would like to think that as the thinkologists are drawing up this new way of doing medical care business, they will take note of this inequity. (Can’t really see my eye rolling behind these rose colored glasses, can you?) Perhaps when all people (not covered by employers) have to purchase insurance they will balk at the two sizes fits all framework. People probably don’t spend a lot of time scrutinizing each pay-stub and considering their pre-tax contributions. But it’s hard to ignore being overcharged when you are writing the check.

Sometime during the last four decades or so we’ve convinced ourselves that medical insurance is mandatory and good. It is not a coincidence that healthcare costs have skyrocketed as we succumbed to this thinking. There are too many bad medical practices and less than good doctors hiding behind insurance. There is far too much money and time spent trying to keep costs down versus caring for people. Good care that focuses on what’s best for the patient is what we need. We’re on our way to medical insurance for all. Now how about some actual health care reform?

 
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Posted by on January 31, 2013 in Cultural Critique

 

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Hazardous Insulation

30 Jan

Aleichem

Anyone even remotely familiar with ultra-conservative enclaves might not be surprised to learn that there are insiders who see it as their mission to keep things just so. It stands to reason that the more insular a community is, the more self-regulating it is as well. This dynamic is not unique to religious groups. There are many small (and not so small) towns where outsiders (defined as anyone living there less than 25 years) are noticed and suspect, and locals are watched for deviation from the community norm. In some more traditional communities there may even be groups or committees of older families who consider themselves the keepers of the status quo. They may give their groups names that include the words “civic” or “betterment.” They may even host annual events (on their own behalf.)

Knowing this (or at least suspecting this) means we shouldn’t find it the least bit remarkable that such undertakings occur in America’s melting pot; New York City. This is a city made up of any and every ethnic and religious group. It is also a city that is much more a conglomerate of many small towns than one grand entity. One of those small towns is Hasidic and in Brooklyn. For Hasidim almost everything about their lives hinges upon being insular. Many of their customs stem from a way of life centuries old. You can only imagine (if you are not Hasidic) the level of vigilance needed to keep the modern world at bay in the 21st century. If you’ve been in almost any house of worship in the past few years you’ve no doubt seen someone texting? Yeah, that doesn’t happen in a Hassidic synagogue. I’m guessing you know of a parent trying to limit their offspring’s television and video game consumption? Yeah, not so much with the Hasidim. It’s a different world for them. For outsiders the Hasidim are probably more similar to characters from Sholem Aleichem’s Tevye the milkman stories than anyone they actually know. And that doesn’t happen without some community effort and oversight.

There is a group of keepers of very specific “do’s” and “don’ts” of a Hasidic community in Brooklyn going by the name; modesty committee. This ‘group’ considers it their duty to temper tantalization. Some of their (reported) activities are far from benign. Open threats, theft, violence are committed by people calling themselves members of a modesty committee. Modesty infractions range from the bizarre; fully dressed mannequins in a shop window, to (possibly) relatable; excessive cell phone usage with the opposite sex. Mostly there’s a lot of bullying involved. People in power pushing people without power around. No surprises there. It’s what lies at the heart of the committee’s furor that is most remarkable. The modesty that is being policed is for the benefit of young (and presumably not so young) men in the community. That’s right. Ultra-religous men could potentially grow wild with lust from viewing a clothed mannequin. If the material on a girl’s tights is not opaque enough a teenage boy could be sent ’round the bend. (I got news for you; a breeze could send a teenage boy ’round the bend.) All in all, this policing is about controlling the (presumably) uncontrollable impulses of men and boys. So the rigid dogma doesn’t do that, nor does the rigid and insulated daily life? Even with the most dire of social (and spiritual) consequences the only thing separating a decent man/boy and an uncontrollable bundle of sexual id is the fiber content of black tights? Well that’s not very flattering is it?

At the end of the day does anyone really care about what goes on in groups that opt out of the larger community? Maybe not, but they should. If you are going to live anywhere on the grid, there really is no such thing as total isolation. Enclave behavior affects outsiders either overtly or passively. We all share many of the same resources and we should (and need to) care how people are treated. It is a safe assumption that the primary targets of modesty committees are most often women and girls. The women and girls are seen as existing solely in terms of how they impact men and boys. This country has gotten to a point where we’re not comfortable with women relegated to the role of accessory to men’s lives. No doubt there are positive things to find in any insular society. There is most probably a strong sense of support and care for many members. But there is also a great deal of protection for members who abuse their power. Human rights violations and civil rights erosion sometimes happen slowly and undramatically. But they can only happen when enough people turn their heads.

 
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Posted by on January 30, 2013 in Cultural Critique

 

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Step Into The Sun, Step Into The Light

28 Jan

emerald city

It’s been four weeks since we; stubbed out our last cigarette, scarfed our last overgrown cupcake, corked the bottle, and put on sneakers. How are we doing? Have there been some slips? Have there been any results? Well there’s some bad news and some good news. Bad first? Well, three weeks is when a new activity really loses its aura of novelty. The excitement of starting something has ebbed. Now it’s just doing the activity. If you haven’t seen immediate or significant results you might just be thinking; “one donut never hurt anyone.” You may have started a convincing inner dialogue of “Ya know four weeks is a long time. I showed I could do it if I put my mind to it. This is just a bad time for me. I’ll pick it up again when…” And you’d be right. January is a dumb time to change physical behavior. So are you ready for the good news? A new behavior becomes habit at five weeks. That’s right, you are almost at the sweet spot. This doesn’t mean that in one week you will awaken to a svelte non-craving new self. It means that it will no longer feel like a virtual living hell on earth to engage in your resolution behavior.

Instead of simply enduring this last week of drudge, let’s use it to tweak ourselves.

If it’s tobacco that you are trying to excise from your life, do you have proper support? Have you seen a doctor (who might suggest nicotine patches/gums?) Do you have a (smoke-free) buddy you can talk to/hang with? Have you cleaned and made uncomfortable all your smoking spots? Have you eliminated or altered smoking triggers (that after dinner coffee, those work breaks, the commuting)? Are you putting your cigarette money somewhere visible? Have you earmarked your new wealth for something? In just one week you are going to feel incredibly proud of yourself! You’ve made real and considerable strides in prolonging and improving the quality of your life. And your skin is going to look so much better.

If comfort foods have made you much too comfortable you may be questioning your resolve right about now. It’s January! A long dark month quite simply designed for massive doses of carbohydrates. But we’re four weeks in, so dammit it’s full steam ahead. If you’re interested in losing more than 20% of your body weight, you’ve seen a doctor, yes? Have you banished all processed/sugar infused/empty calorie food and beverage from your home/bag/car/desk/pockets/nightstand/locker? Good. Do you write down any and everything that passes your lips? You must. Food amnesia is the single biggest weight loss sabotage. You may be eating/drinking at times and not considering the calories. That overpriced latte? It’s not coffee it’s a hot milkshake. The glass of wine (or two or three) after work/with dinner total real calories. The birthday/retirement/fertility office party cake? Eating with people you don’t particularly care for does not burn calories. There’s nothing wrong with overpriced coffee, wine or cake. There’s only something wrong with mindless eating. It will get you. Now have you found a nice substitution for the afternoon snack/wine? Perhaps some flavored teas? Maybe lighting a scented candle is all the sensory comfort you need. The only way permanent behavior change works is if it doesn’t feel punitive. Consider adopting one or two new (or forgotten) behaviors that would feel rewarding.

Have you noticed that your workout clothes aren’t being washed as much as they were a few weeks ago? Is all the treadmill/stair-master/soul cycling very dull? Does real life get in the way? You’re not a failure; you’re just not a hamster who is perfectly enthralled with walking to nowhere. It’s time to find what makes you happy. No really. There was probably once a time you enjoyed playing/moving. Did you love to dance? Was it double-dutch that made your heart sing? Figure it out! Find the adult 21st century equivalent and do it. No one is watching and no one cares. The only way this is going to work (and it will work) is if you enjoy what you’re doing. Maybe you love learning new things? Use that to your fitness advantage. Take on new and complicated activities on a regular basis. Fitness is not a chore it’s time for yourself and a wonderful way to feel (and stay) alive.

Changing behavior in any real and lasting way is not easy. (If it were the world would be a much nicer place.) We all want (in our heart of hearts) to be our best selves. Often our best intentions are stymied by the pesky existence of others. But we do have complete control over how we treat our bodies. Physical behavior change that will lead to a healthier (and perhaps happier) you is attainable and within reach.

 
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Posted by on January 28, 2013 in Well-Being

 

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Not Ready To Wear

25 Jan

Audrey

Once the daytime temperature high dips below 25 (and stays there for days) all style bets are off. If your entire exposure to the out of doors consists of the 10-20 steps from your front door to your car to your office door, your appearance still suffers. Even if you don’t have hat hair (and for g-d’s sake you could die from being that vain!) your hair is dried & fried. Your nose is beet red and running and so are your eyes. No one looks good when it’s this cold. In fact it’s a minor miracle that the northern states repopulate. It’s no wonder that fashion magazines and websites are filled with spring apparel. Clothes stores turn up the thermostat to help with cognitive dissonance and faltering sales. As we start to sweat in our sweaters and coats purchasing a sleeveless shift (in January) seems almost reasonable. Perusing open-toed shoes is a delightful diversion and a beacon of hope for our unvarnished neglected ice-cold toes. Just the idea that our feet may someday see the light of day again can be enough to help us soldier on.

It can dampen the spirits just a wee bit when the fashion being pitched isn’t exactly the golden ticket one hoped for. While I’m sure there are women (over the age of 8) who can rock pastels, it’s probably a very small percentage. Easter eggs seemed to have shared a special hug and created multiple lines of shoes and accessories this season. Pastel green? Really? It’s hard to even find a reason for that color to exist let alone find its way onto leather goods. Okay, so maybe this won’t be the season to purchase a new pair of shoes (did you hear that? and angel just lost its wings.) That leaves a whole lot of fashion/merchandise to drool/swoon over, right? Not so fast. There seems to be a trend (trend: a nice word for all manufacturers take their cues from one or two designers) of unflattering shapes and cuts. Granted the cropped pant has been around for a few seasons, but it’s really in its glory this spring. It is simply everywhere. In fact, you’d probably be hard pressed to find many full-length pants for sale. Now with all due respect to Gilligan, cropped pants are simply unflattering if you are under 5’10”. Making the leg line shorter (or stumpier) is simply not a sensible silhouette goal. Adding to the stumpy effect is the addition of high waists (with pleats!) and drawstrings and/or peplum; adding volume, volume and more volume. A perfectly normal proportioned person now looks like a balloon animal. To top off this squatty look are voluminous/tiered/ruffled blouses and tops. The entire ensemble sending the distinct message; “I’m in here somewhere.”

Now not many of us enter early springtime at our fighting weight. So there is something to say for some strategic camouflaging. But strategic camouflage rarely involves adding volume and making things look bigger. A little extra middle is best hidden with a tailored top or jacket. A little extra hip or bottom is best served by a pant that fits perfectly on the hip and bottom (probably tailored at the waist) and has a full (not oversized) leg. But these are really four season rules. Whatever are we to do about finding our light at the end of our 25-degree tunnel? Flipping to the back of the magazine to the home and garden section can work. Images of lush blooming flowers and greenery fill the heart and head with hope. Gorgeous photo spreads of salads, mixed grills and sangria can save you from a full-blown sweats on, pizza ordered, “I’ve lost all hope” 48 hour bender. Before we know it the temperature will rise and we’ll be able to smell the earth once more. We will be inexplicably surprised when we see the first sign of emerging crocuses. In just a matter of (several) weeks the ground will be dotted with tiny brave flowers in the most stunning shades of purple and yellow, which incidentally would look fabulous in a shoe.

 
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Posted by on January 25, 2013 in Style

 

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