#further evidence of adhd meds changing my life

[sizablelad]

actually amazed at myself for the fact that i got basically everything i needed to do done this week. it was hella busy and i'm EXHAUSTED, but i wrapped up my school work, prepped for going abroad for 3 months, packed up my entire room so my mom can move while i'm gone, mailed things i've been procrastinating on sending for a hella long time, got all the professional clothes i didn't have for the internship, and had time to vacation with my mom in mtl and spend time with my dad and do a whole passover in nj. everybody clap.

[iayhifbigyakwiltbsywps]

Fuckkk I had something really long written but my connection failed and now I can’t find it but this is important if you or someone you know has adhd and takes stimulant medications like methylphenidate. This will probably be weird because I wrote the original like 12 hours ago and I just got home so if the other one magically reappears then they will be really different.

Basically I wanted to make people aware that taking stimulant medications has the potential to do more harm than good. I have adhd and have drank concerta since the third grade and im currently in 11th. I have been noticing throughout the 2019-now time period that I really have lost all motivation and that I don’t really have interest in anything even getting up to eat. And I was like ‘well that’s not alright’ and so I did what every one does: I googled it. I asked google “can adhd medications cause brain damage and lessen motivation?” And honestly I was not really expecting an answer, kinda just hoping to see blankness and be relived that it was just something random I thought. Boy was I surprised.

I actually found this:

This is literally the answer I was too scared to find because a) it proved my suspicions correct and did kinda bring a different kind of relief in knowing I’m not just hysteric and b) this hit wayyy too close to home. The part in blue feels wayyy too familiar to me because all I do Is be on my bed on my phone most of tinge time and my parants keep getting concerned and like “go get a job, find a hobby, do something!” And I am honestly strangely alright with my situation, like I hate it but I still don’t try to change it because I can’t!

Forgot what else I could of said there on the fist draft, but onto the next peice of evidence!

This pretty much said that this meds were tested on rats and that the rats ended up losing all motivation to even react when they should be looking to escape a bad situation. That once the medication stops we no longer have drive to motivation.

This also states that the nucleus accumbens is the part of the brain that forms motivation into action and when you take these meds your actually risking it shrinking and leading to no motivational drive.

Also that there are other options if you are convinced you or your child needs help to lead a successful life then there are other options that are not stimulants!

I also found some videos but could only resurfaced one which I think is the most important: https://youtu.be/nif8TFPhjuI

This video basically talks about one of the beginning trails of adhd medications that ended up being a huge success after the recorded 14 months that this trial was conducted, but what most people who do their research probably don’t dig deep enough to check that after they took the pills away they came back 3 years later to see how they faired. Turns out that the my were actually worse and the adhd was too much or something. ( sorry I’m trying to remember what I wrote but I only slept like 10 minutes last night and it’s already 1am so my eyes are shutting)

I can’t remember much right nos but if I find the other articles or videos Ik re log or something.

Here are the links to the articles:

https://www.nytimes.com/roomfordebate/2012/06/09/fewer-prescriptions-for-adhd-less-drug-abuse/adhd-drugs-have-long-term-risks

https://www.leonardsax.com/stimulants.htm

There were more but I’m fighting To stay awake right now sorry.

Oh I just remembered something:

This is what happens when you give stimulants to a brain that is underdeveloped (brains aren’t yet developed until they are like 21) so if y’all need meds try taking non stimulants or else you’ll just cause growth problems for yourself

I really hope some people find this useful and that no one goes through what I am cuz it really kinda sucks and I hate it but I can’t do much to change it.

Also after hours trying to figure out a way to tell my mom I had finally told her and you know what she said? She said “if we take you of these meds will you promise to try to care about yourself more?” And like I didn’t say anything but sure mom I totally didn’t just work up the courage to try and tell you within the day I found this informants on when it would usually take me months to say things I think are important but yeah I totally need to try a bit more ugh!

Honestly I think it’s shit that I’m not even 18 yet and I already feel like all my fight has gone out of me. Like if it weren’t for my parents that actually care about me I would of let myself starve to death. And now there’s no way to thank them because I can barely move to get food much less show them my thanks. Mom dad I love you and I’m sorry my brain if fucked up.

Hi just a little edit here, I wanted to say that both articles are by the same person I just put the second one because the link didn’t work for me so I had to look for their actual page that was mentioned. But also I read further down on the second article and I saw there are more links to other related articles in the second link where this person wrote their actual research and citations

[jacobalderham]

Part II/Headlines

The following extract is from an early draft of Chapter 13 from Scattered Thoughts: The Story of a Kid Growing Up With ADHD by Jacob Ham. The following extract is unedited, unformatted, and will change before the final release.

Scattered Thoughts will be released August 24th 2021.

Real Life Events

These days it is hard to find a middle ground online. It seems that everyone has their own agenda. People attack others for supporting a different set of beliefs. Some people believe in God, and some assume that the Big Bang Theory is true. A few fixate on being part of an alien stimulation.

Social media is nothing but conspiracies and fake news.

If I made a political or scientific statement with hard cold evidence, people would still argue against it.

People these days can't stand being wrong.

People attack celebrities for something they did years ago, and they've already apologised for. These days you can't make a mistake.

But people change.

I know people who've changed after a traumatic experience, like a car accident that affects their ability to walk again. They think 's a miracle they're still alive. They used to cringe at the thought of their being a higher power, but now they go to church every weekend. Praying that one day they will play footy with the lads. People change. The older I get, the more I understand that.

The problem is people are caught up on having this persona. A persona behind a device. A persona behind an icon.

Social media has changed.

I can't scroll anymore without seeing negativity. I know drama gets more attention, but why does it have to be so toxic?

Why do we care so much about lives that are not ours? I wish I knew the answers.

I open my phone and see another bombing.

I scroll down and see another video from a protest about the environment.

I scroll a little more and see another status about a black guy getting shot by a cop in the street.

I scroll through the replies and see arguments over political views, forgetting we all bleed the same blood.

I scroll for another hour and see reports of another celebrity committing suicide. Harassed into ending their life because of some more clickbait.

People suddenly switch up their intentions and send prayers to the victim's family. They then get called out for being the ones who harassed the celebrity in question. Nothing is truly private anymore.

I scroll further and realise that my time could be spent better elsewhere.

I close my phone, and I am left wondering has the world always been this way?

I turn on the TV and see the same shit on the news.

The same bombing.

The same protest.

The same black guy getting shot by a cop.

The same footage, just without the comments and negativity.

I watch a little longer, and it starts to loop.

The same headlines as before.

The same adverts that cannot be skipped.

I keep flicking through the TV guide and cannot find anything worth my time.

I switch channels and hear more racism while watching Football. Everywhere I turn, I am reminded that the world is far from perfect.

I turn off the TV and attempt to sleep, but I'm wide awake wondering, maybe the world has always been this way.

Fictional Dreams/Dark Thoughts

I wake up the very next day, and my mind is racing. I feel agitated and annoyed about the world, but mainly towards the media. I hate how our lives are no longer private. Everything we do is traceable, permanent and backed up on our devices. Every part of our lives are public and used to build a profile of information, one that can be twisted against us if the time ever came.

That thought alone, has got me thinking about the worst-case scenario and if shit hit the fan, like what would happen if I grabbed a knife from the kitchen drawer and committed murder? Doing it with malice and intent. The motive of proving my point about the media. Imagine if that became a reality, and it was more than a fictional dream.  

My whole life would change instantly, no going back, and no do-overs.

It's permanent.

Do I go on the run? Or do I give myself up? It's hard to say because it would be a fight or flight decision. Maybe I'd finally have the guts to end it all.

Once I'm found guilty, it feels like the events that follow are far too easy to predict. Every single news corporation would use my name and my situation for clicks. They'd monetise off of my story, and someone else's miss fortune as that helps pay their bills.

They'd paint a picture of a boy who was troubled mentally and bullied growing up.

They'd name drop my diagnosis, and hint that maybe it was the medication I take, what pushed me over the edge.

They'd claim to have inside information about what went wrong and ask questions about whether that morning I forgot to take my meds.

They'd ask my teachers and so-called friends, questions about whether they believed the rumours, and some would say they're shocked, and others would claim they expected it.

They'd twist the fact I have ADHD and create even more stigma for people like me, making it even harder to get jobs or live a normal life.

They'd completely ignore the fact that they're giving me the attention that all people with ADHD apparently crave.

They'd reference that I graduated with honours and was slowly starting to make ends meet, and I'm praying they'd name drop my business, so I can finally see my website at the top of Google.

They'd celebrate about all my awards, certificates, and personal achievements becoming worthless and null and void as companies distance themselves from my name.

They'd discuss how I was an advocate for mental health and wanted to be a champion for other people with similar problems. Because it creates a shock and gives readers more to nitpick.

They'd bring up my little sister and her disability, stating that maybe I had too much on my plate.

They'd bug my mam for a statement, and enquire about her M.S, but deep down they don't give a damn, they're only bothered about their story.

They'd most likely mention that I only got a few years behind bars for something I deserved life for.

They'd forget to highlight that maybe there are two sides to every story like we aren't told that for every argument growing up.

They'd essentially feed you the words to how you feel before you start forming your own opinion because that's how they keep you hooked.

Maybe now I've finished this fictional dream, the next time you read a headline, you can learn to form your own opinion before tweeting about it.

© 2021 Jacob Ham & AlderHam 

[heysawbones]

Congratulations, Me; You’re Slow

Surprise, me! You’re literally slow. As in, your processing speed - the rate at which your brain takes in stimuli and makes sense of it - is below average. Quantitatively. The average is 100. Yours is 94. 

Three years ago, I was given a cognitive battery. I’ve had an unusually high number of these in my life. Most people will never have even one. I’ve had four; one to assess for the Gifted and Talented program in kindergarten, one to reassess for the same when I changed school districts, one to assess for ADHD, and yet another, the latest, to assess for the same, as the prior records were lost. ADHD runs in my family, but I seem to have been one of those kids who compensated really, really well. Was I organized? Not even a little. Lose things? Constantly. I procrastinated like a motherfucker, too, but it was usually easy to make up the work in class before it was due. I would drive hard to complete the GT project-based assignments at the last minute, and always did fine. Better than fine, even. Sure, I used to obsessively braid yarn or draw in class, but nobody had any reason to suspect I would have issues with things like maintaining attention or executive function later on. If they did, I never heard about it. Even today, it’s not obvious; people associate a certain flightiness with ADHD and that isn’t me. People associate a lot of things with ADHD that aren’t me. This has been so much of an issue, in fact, that despite meeting diagnostic criteria over and over, as admitted by clinicians, people have been hesitant to give me the diagnosis. The argument deployed tends to be: you have all the symptoms, but you also have chronic depression, which has the same symptoms, so we’ll just go with that one. The underlying rationale, the unspoken answer to “why can’t it be both? they often co-occur” seems to be: you are too articulate and self-aware to have ADHD. It boils down to you’re too smart to be slow. 

This is unfair to me, and demonstrably untrue, besides. I recognized this long ago. I am the one who has to figure out some way to compensate for the symptoms. Yes, the symptoms of depression and ADHD overlap (especially if you are depressed for a long time), but the treatment of those symptoms is not the same. I have been in treatment for depression for over ten years. Am I better than I was? Unquestionably so. 

Do I function at a level sustainable for an adult not on disability? Can I get places on time? Can I catch a plane without showing up 14 hours early, lest I show up 14 hours late, or at the wrong airport entirely, instead? Do I remember things people told me yesterday? Can I go to Target without the possibility of getting caught up in a weird cognitive trap where I want bananas, but am too guilty to buy them unless I do the rest of my grocery shopping, which I don’t have the mental energy for? Do I remember enough of my meds when I go on trips? Can I stop persistently putting things in places that make no sense, and then having no idea that I’ve done it 15 seconds later? Can I manage an adult’s schedule? Can I remember to pay bills on time? Can I remember what I’ve spent money on in the last week? Can I remember what I ate this morning? Can I hold down a job that is, honestly, below my abilities in many ways?

The answer is, of course, sometimes yes. Distressingly frequently, it is no. Where travel is concerned, it is always no, and somehow, I have managed to show up at the wrong airport entirely more than once. 

Yes, I recognize that these are problems all people have, to some degree, at some time in their lives. If people are willing to act on the belief that I am too smart to be slow, why is it that when I account for my concerns and attempt to articulate the impact they have on my life, I am suddenly not self-aware anymore, and am only overreacting to what obviously MUST be the same degree of these problems that other reasonable adults experience? Why am I credible in other areas, but not this one? If I am so smart, why is it assumed that I’ve failed to account for my own emotional bias when gauging the difficulty I am experiencing? Why is it more satisfying to assume that I am not trying hard enough, then it is to accept that a smart, self-aware person may, in fact, have some kind of Brain Problem that, really, there is no logical contraindication to, and much evidence, for? When I do the responsible thing and insistently pursue all reasonable options to address my mental and neurological health, with the goal of being a functional contributor to society, why is this so persistently reduced to a fetish specifically for an ADHD diagnosis? I’m smart when it’s convenient for others, but not when it comes to the ability to draw cause and effect relationships from my own behavior, and make comparisons between those and the behavior of others? If I got treatment that worked, I wouldn’t care what the diagnosis was. Come the fuck on. I’m tired of this.

-----

Anyway. I sat down with the results of that three-year-old cognitive battery. I’ve read the summary before; it’s peppered with lines like

“There is also considerable other evidence in this testing consistent with a diagnosis of ADHD”

“In my experience, some individuals who are very bright are able to compensate for some of their disability”

“this distribution of index scores is very typical of individuals with ADHD”

“Many of the behaviors she describes are certainly typical of individuals who suffer from ADHD. Unfortunately, the coexisting history of chronic major depression and PTSD make that differential diagnosis based on history alone difficult” 

When I first read that last year, I was shocked because the therapist who requested the cognitive battery, only expressed surprise that I was “very smart” and said that my “scores were fine.” When I later confronted him after having read the summary myself, he merely admitted that some of my scores were “lower than others”. He never entertained the possibility that I had ADHD, which in an of itself, wouldn’t have been a problem if he’d been willing to just try the treatments for it, since clearly the two industrial-strength doses of antidepressants I was already on, were not cutting it. Alas, he was not, and it wasn’t until after he retired that the issue was addressed again.

Surprisingly, I was not the person who addressed it. When my therapist-MD retired, I needed at least a primary care provider to manage my medications. Since the appointment was for psych med management, I had to fill out a bunch of related intake forms - you likely know the kind. While looking them over, my new doctor peered up at me and asked, “Has anybody ever suggested that you might have ADHD?” I was taken aback by the question and wasn’t sure where to start. Them? Asking me? if I have ADHD? She asked me? 

I told her that I’d had two full cognitive batteries done, and that both of them concluded roughly the same thing: yes, all the symptoms are there, no, we do not know if it’s ADHD because there’s too much background noise from other psych issues. Without skipping a beat, she said the most amazing thing to me: 

Well, whatever it is, you have the symptoms, so let’s treat them.

God. Why didn’t someone say that years ago? Diagnoses are human constructs; we use them to group symptoms that tend to occur together, when they’re thought to have the same causes. Depression and ADHD have many (but not all) of the same symptoms, but the overlap doesn’t qualify as a diagnosis because the causes are assumed to be different. I think we often forget that diagnoses are containers for commonalities that we use to make talking about medicine easier, not necessarily biological phenomena unto themselves. If you remember that they are containers - a sort of conceptual shorthand - then it follows that if one treatment for a set of symptoms isn’t solving the problem, you ought to try a different treatment often used for the same symptoms, even if the minutiae of diagnosis means you aren’t sure you can apply the diagnosis typically associated with that second treatment*.

I am now on Vyvanse. Does it magically solve my problems? No. Does it help? Yes. I am in a much better position to actually address the bad habits and coping mechanisms someone like me builds up over the years. The notable insomnia should wear off over time, and besides, as a person with an existing sleep disorder, having fucked up sleep isn’t new. It’s a price I’m willing to pay.

-----

Anyway. So I sat down with the results of that three-year-old cognitive battery, because I had to dig them up for my new therapist. Instead of reading the summary, I dug into the raw numbers: the related tests are the Weschler Adult Intelligence Scale IV (WAIS-IV), and the Weschler Memory Scale III (WMS-III). I couldn’t find sufficient guidance on interpreting the WMS-III, so I’ll stick with the WAIS-IV scores:

At first inspection, these scores do look “fine”. Anything within 10 points of 100 in either direction qualifies as “average”, even if 100 is “the average”. But on further reading, both in the summary and out: 

-Examination of these results reveals considerable significant variability between various functional capacities, with VCI of 141 a full 3 standard deviations above PSI of 94.** Problems with both working memory and processing speed impacted her overall IQ considerably, bringing her Full Scale IQ down to 120 (from 133). 

-A significant difference among subtest scores can suggest a problem in the particular skill being tested; this might underlie a learning disability. A significant difference among standard Index Scores might also indicate a learning disability, ADHD

-when I see a difference in IQ scores such that the verbal and nonverbal scores are far superior to the processing speed score, I try to discern what could be causing the discrepancy.

-LD diagnoses are also reliant on score discrepancies. On the WAIS, a gifted individual with ADHD may look like this.

Verbal comprehension - 132

Perceptual Reasoning - 129

Processing Speed - 97

Working memory - 101

Absolute scores aren’t the only diagnostic tool. Relative scores are also important. For example, average scores across the board wouldn’t be indicative of a working memory or processing speed issue, whereas great discrepancies between those parameters and others, is - even if the working memory and processing speed scores themselves are the same in both examples. What I’m saying is, it’s right there. It’s in the numbers. There’s no wiggle room. My old therapist saw these numbers, and not only did he choose not to act on the information, he pointedly refused to do so. If he hadn’t retired, I’d look into suing for malpractice. It’s in the god damn numbers, my dude. I don’t care what you want to call it, the deficit is right. there.

What did I ever do to him? Did he just... not believe ADHD is real? More to the point, did he think I somehow, without knowing the ins and outs of the WAIS-IV, faked the deficits or something? Really, guy, what the hell?

-----

Do I feel bad about being slow? Honestly, no. I might have if I found this out 10 years ago, or in circumstances wherein that reality didn’t perfectly explain aspects of my experience that other people have been prone to downplay, or dismiss entirely. Instead, it’s the closest I can get to scientific verification that I’m not just losing my shit over nothing over here; that something has, in fact, gone awry, and may always have been awry. I couldn’t compensate forever (though the ways I’ve done it are many, and in retrospect, interesting) and now I’m on the other end of it, trying to rebuild. I am, as I like to say, building an exoskeleton - something that will hold me up when my brain insists on faceplanting. I’m just grateful there’s someone out there who isn’t too caught up in the semantic navel-gazing of diagnosis, to help.

*There are obvious exceptions here, such as when the two diagnoses have causes whose treatment is contraindicated in the other diagnosis. This is not the case with depression and ADHD.

** You see that Percentile Rank of 34? That means I performed better than 34 percent of people my age, at least according to the test sample. That’s. Not great.

[lukecmurray]

What I Learned From Tony Robbins's "Unleash The Power Within” Event...And Why I Walked Out Anyway

I know that I want to spend a good chunk of my life encouraging and assisting others in accomplishing their goals, especially those groups with whom I have some common ground (i.e doctors, endurance athletes, entrepreneurs, musicians, etc). Actually, when someone asks me what I want to do professionally, I say I want to be a 'Tony Robbins for med students'. And while I've read a bunch of books about personal development, including many of his, I've never actually been to a Tony Robbins event.  

Then I saw I Am Not Your gGuru, a Netflix documentary that takes you inside one of Tony's week-long events (Date With Destiny). I was so floored that I booked a ticket to a four day event (Unleash The Power Within) as the films ending credits rolled.

And after the first day, I decided I'm not going back.

I want to clarify why, and to make tangible what I've accomplished instead of going to the last three days, but first, here's what I took from the first day.

1. Your 'state' is everything, and it's within your control pretty much all the time.

I have countless examples of this in my life, and they all go something like this:  There's something I don't want to do, but then I take a nap/shower/exercise/meditate/eat and BOOM, I'm ready and I crush the task both pleasurably and easily. During the event we spent a LOT of time (I'd easily say 25% of the 12 hours I was there) working on our state by what we did with our bodies. That is to say, we danced and clapped and rubbed the shoulders of our neighbors a lot.  Besides moving, resting, or fueling your body (our physiology) the other two ways we change our state are by what we focus on and the language we use to describe things ("this situation is terrible" vs "this situation is interesting").

2. Your perceived limits are based on beliefs you have, which might be build upon inaccurate data. They can be changed - both by focusing on past events and building upon future ones.

There are things I tell myself that hold me back and I believe them because I tie them to 'reference experiences' that "prove" to me that this belief about reality is accurate.  A good one for me is my ability to focus, to push past mental distractions for long periods of time. I believe this because I have been diagnosed with ADHD by a professional psychologist, I did poorly in medical school, I have been told by others "do you have ADHD or something?".  So, whenever I get distracted or tempted to distraction, I give up or give in by telling myself "I can't push myself past this mental fatigue barrier."  Acting on this belief (giving in to whatever distraction) also strengthens my "proof" that it is "true".

But there are other times in my life when I can point to incredible amounts of mental and physical endurance that would disprove this "fact". I ran an ironman. I've worked 15 hr days in a row selling books. Some of the days I studied in medical school I stayed extremely engaged and focused for long periods (12+ hrs). So what about those? They should at least cause me to question this "truth" about myself.  

But this begs the question: if I could have used evidence from real past experiences to justify belief A) "I can't focus for long periods of time, so I should probably quit when I get tired" or B) "I can focus for long periods of time, so I always try to push myself farther when I get tired" why did I choose the one that has the more negative consequences in my life? Two reasons.

The first is that it meets my needs. There are six of them, which I talk about in detail in a different post about how I implemented other lessons from Tony to quit being addicted to my email inbox, but the first one is certainty that you will avoid pain or gain pleasure. In this case, the belief that I can't focus helps me do both. I can experience the pleasure of doing something other than studying/focusing and avoid the pain of either the mentally strenuous activity or the failure to stay focused and ultimately getting distracted.

The second is that the negative events that I use to 'justify' the "I can't" belief were more emotionally powerful. Each bad test grade I got in medical school took something out of me. I got reviews from other physicians on medical school rotations that said "significantly behind his peers". The psychologist that diagnosed me, after spending an hour listening to my story, told me "You're either going to do really well or you're going to totally flame out in life". My parents have told me time and time again in a variety of settings since I was in 7th grade that I need to 'focus more'. So I've associated each of my failures to the cause of 'not being able to focus'. Successes were fewer and further between and not as powerful...and, as I mentioned, implied that I would need to push harder, which is much less comfortable than going and doing something more fun.

3. I already know what I need to do.

Have you ever been to a sermon or heard a TED talk whose ultimate message was "you should love people" and walked away blown away? You're floored about how powerful this insight has hit you, and then, an hour later, you realize: "Wait a minute. I already knew that. Actually, I've known that my entire life!"  Well, that's how I felt. Totally floored by the message about how important the fundamentals were. Fundamentals with which I was already deeply familiar.

So why did I leave?

Because my heart told me to - There was a moment in the event where Tony was talking about how to deal with anxiety.  He took us through a meditation exercise where we put our hand over our hearts and led us through conscious breathing, connecting with ourselves, etc. until he ultimately ended with "What thing in your life is causing you the most anxiety? The answer to solving it is deep in your heart. You just have to listen to it. So do it. Finish this statement from deep inside your heart:  I know what I need to do make this anxiety go away, to totally change my life, and that thing is ____"

My answer "...leave."

So I did.

I realized that I 'got it'. I didn't need more information (and if I ever wanted it, I could save myself three days and could read through the booklet he gave us in a couple hours). I need to apply it. I walked on fire that night, which I was glad to say I did, but was pretty anti-climactic (which, in retrospect, I should have realized - you can't have 9,000 people do something that's actually risky), then ran for two miles through downtown LA at 1am to my cockroach-infested motel room...and woke up the next morning ready to crush it.

And what did I do instead?

I worked harder and for longer in a row than I had in months. I spent well over 10 hours each day getting my personal and business finances more in order than they ever have been. I finished a 30 blog post writing project that has been in limbo for over a year.  I finished a writeup of a medical device patent I've had in my head for four months. I finished a business plan and set up a meeting for a company that will consist of me doing adventures with interesting people. Wrote the website copy for a new kind of medical staffing company. Had breakfast with a dear friend in LA that helped me through one of the more difficult times of my life, and a double date with one of my closest friends and his soon-to-be fiance.

I'm sure I would have learned a lot from three more days of Tony, but the ultimate takeaway was that I didn't need more knowledge. I needed to double down on the fundamentals I already knew to be true, and Tony hit me with that truth hard enough in the first day that I don't regret spending the next three days executing on it.  

**Huge thank you to my friend Noah Kagan for writing about his experience at this same event (which he also walked out on). If I had not read his post before attending I don't know if I would have had the courage to listen closely to the deepest truth inside of me about staying vs. leaving. I appreciate your honesty about it PIIIIIIIIIIIIIMP!!!!

3/25/17 11:28 am-1153am

3/27/17 1121 AM...

3/28/17 6:19pm...

total time? at least 1 hr

published: 3/29/17

image credit: the lady next to me at the conference (go Tammy!)

[the-hyperactive-mind]

A Letter to My Parents

Dear Parents,  I think you both know by now I don’t know how to talk about the things I feel. I never have. You, Ma, know this better than anyone. Maybe its because of my reactive whatever disorder that you told me I have. Maybe its something else I don’t know myself truly why I do this. But what I do know my inability to express my thoughts and feelings regarding my behavior or choice of actions etc. has caused more than a fair share of problems from general concern and great frustration, to questioning if I have any true understanding of feelings or my actions to wondering if I actually feel anything at all. Well, to put it shortly I do feel and feel a hell of a lot more than I could begin to express. And being that I for some reason lack the ability to express myself confidently, sincerely and truthfully in words, I can write. While I know that both of you will probably never read this because I probably won’t show you, I’m thinking maybe this will be a step for me in beginning to force myself to tell you. Also please bare with me as Im sure this will be all over the place but I’m just spit balling everything out. Firstly, I’d like to try and put you at ease by telling you yes I do feel things. I have emotions. Don’t worry I’m not that messed up the head. I happen to feel very deeply to the point it might be unhealthy. I always have. I’m not sure if it is because I’m a thinker or because of the way my brain is wired. When I see someone else hurt, I feel for them even long after I see them. I hate for people to feel sad, I want people to feel happy. It’s been that way as long as I can remember. Maybe this seems hard to believe but its true. This is where the problem sorta comes in. We all know I have my issues. They’ve been with me forever and unfortunately they tend to cause me lots of problems. Before you go thinking that I am gonna blame the way I am on my ADHD I’m not. You know I hate using it as an excuse and never have. Hell, I refused my getting accommodation for years because I wanted to prove I could do things on my own even when it was clearly something I needed. The fact of the matter is that regardless of what I want to believe about myself a lot of myself is dictated by this. My impulsivity, reactiveness, my lack of focus, my hyper-focus, my constant struggle to to get my shit together no matter how hard I try, it will always follow me for as long as I live. I’ve known this forever but never accepted this. There was a period of time when I was much younger when I started to really understand this and I can’t even begin to explain to you how much it bothered me. I didn’t like the struggles I had. I wanted to be “normal” so badly I wished I could do anything to fix myself. Thats when the self loathing and beating myself but really began. I didn’t feel I deserved the love I was given or any good thing that happened to me because something was wrong with me. I wasn’t normal. With every impulsive move i made that caused problems or mistake, regardless of whether it was related to it or not, I took it beyond personally. I hated seeing the damage and frustration my actions caused to those around me as I didn’t want those I loved to suffer because of something I did. Yet, I had no idea how to control it or stop myself. I didn’t know how to cope with these feeling and thus sometimes when I would throw a fit it’d be in frustration with myself. Once I got a little older and understood that I could internalize what I felt, a whole new world opened. Maybe I couldn’t protect those I love from my actions but I could at the very least try and prevent them from worrying further about me from dealing with the way I truly felt. If I never cried no one would worry. I hate making people worry which is ironic because all I do is make people worry. I didn’t feel I deserved anything considering all the mistakes I made. Thats where the whole “shutting down” comes from. I stuck to it for years and got really go about it. But eventually it stopped working. As things got harder, you started to see it. At that point I had become so good as it that I didn’t know how not to do it anymore. I remember being on the couch at Dr.Evers and you asking me to please talk to you. To tell you what I was thinking. Why I did whatever the hell I did. You were practically pleading with me to say something. I was crying because I couldn’t hold it back anymore but I couldn’t speak. I could feel the words on the tip on my tounge. Part of me wanted them to come out but I just could not bring myself. I remember sitting there crying and hearing everything I wanted to say running through my head but couldn’t make my mouth move. We’d be in that position many more times after that just as before. I wanted to change so I did. I got better about talking. Not great but better. I started to open myself up and it was good. It was and still is only about the surface stuff but considering where I was it was a hell of a big improvement. Yet, I was still good at hiding the deeper stuff. Fast forward to Oak Knoll. I hate admitting it because it makes me weak but I have never felt so fucking useless. I was unhappy beyond belief but I remember Abuelita said that I shouldn’t make any trouble for you because you found someone who treasured you, a good man and that I better not try to do anything to ruin it. I mean I wanted to you to be happy. Despite it not sometimes being evident I knew you had been alone and that you did deserve someone who adored you the way you adored Pipsqueak and I. The last thing I wanted was to make you worry but of course in classic fashion I did. Each time you had to go a fight a battle for me. I felt I didn’t deserve any help. I wasn’t worth helping. I wasn’t cut out for any of this.  No matter what was a victory, it was overshadowed by the thought that I did it by luck. One step forward, three steps back. I screwed up so much that things I did right would be consumed by past mistakes. Maybe it was better to give up if I couldn’t get anything right anyway. I wouldn’t amount to anything. I wasn’t smart enough, I wasn’t athletic enough, I wasn’t able to be organized enough, I wasn’t outspoken enough, I wasn’t tall enough, I wasn’t clever enough, I wasn’t pretty enough, I wasn’t competitive enough, I wasn’t good enough and never would be. I was tired of feeling inadequate. I didn’t want to be a failure. It was frustrating because I had come this far and for what? To be told I didn’t quite make the mark. Thats when, what I later learned were panic attacks really started. I guess had them in middle school a few times but they were not this bad. It started during tests. I still remember the first time I really got a true one. It was during a math test. I didn’t know what the hell I was doing and felt an unreal amount of pressure because if I didn’t do well it would effect me forever. My heart started to race. I thought I was going to die it was beating so fast. I didn’t know what was happening to me. Everything around me started to melt. It felt like it was the end of the world. Every little sound became so loud it hurt. It got harder to breathe, I felt as if I was choking. I had no idea what was happening. It was so scary. I just got out of there as fast as possible. They started to happen more during school. I got them when I was alone and started to worry about my life and my future. Anytime I got too stressed out about anything or worry I would begin to feel that heaviness in my chest. So instead of asking you for help or want to make you or anyone worry I didn’t say anything. I started to not care about as much as I could in order to not feel stress. Obviously this is a terrible coping method as I neglected anything I felt would cause me too much stress. I’d rather have people think I was lazy then tell anyone what was experiencing. While this method did work it wasn’t perfect. I did that for two years. I cried more during those two years than I had in my entire life I’m pretty sure. I would go to the bathroom at school and cry. I would go to bed crying clinging onto Mocha. I somehow made it though. I was also really good at hiding it. I bet you didn’t know I felt this way during that time or at least to the extent I did. I was good at covering it up. I smiled at all the right times. I laughed. To tell you the truth other then the occasional squabble, I was happy at home. I enjoyed being with the family. I loved being home. Home was safe. There were times thing were good, but there were times things were bad. When I found out I wouldn’t have to go back to that place the panic attacks became almost nonexistent. I found hope that things would change and be good. Fast forward to going to Pomfret. I needed the change of view. Being away from the place I associated bad things with was good. I know you may have different thoughts about it but personally I think this was good. I have never been happier. I know you all could have been happier considering my fall mid term grades and frankly I needed that reality check but God I was happy. I hadn’t had friends in years. I was on my own. I was getting up and doing shit for myself. While there was room for improvement I was doing it. The biggest problem was that coping method I mentioned earlier. Teaching yourself not to care is not a good thing. The environment I was/am in was good. There was no need for that. So basically I had to try and reteach myself not to do that as it was doing more harm then good now. I shouldn’t have taught myself how to do that but I had to deal with that. I still am. I’ve spent this year fighting it. Its gonna be hard. But with this fight I found hope. I was actually excited for applying to college next year. I saw possiblities. I could maybe actually do this. The beginning of spring term i was amped.  I had found that spirit that I had lost 3 years ago. The fire was lit and I was amped. I took my meds, I got my work done, I went to class, I did practice, I was doing well. My grades were good. I had a new advisor. You guys were basically out of the loop. All you knew were the things I told you which was fine. No more calls in the middle of the day flipping out at me. You guys were at a distance. It felt good. I felt like I was becoming truly independent. But like I’ve learned when I go a while without messing up, its only a matter of time before I do. And of course it happened. The problem was, I think, that i wasn’t used to doing all of that so on task. It took a lot of effort. It was hard and I think I burned myself out. I got sloppy and with that mistakes happen. Now you all know about the incident with my homework. I’ve screwed up a lot in my life but never badly at school, not this badly. I have also never been so terrified. Things were going to well. Things were looking up and now all that I was working for could come crashing down. The night I went back to my room after finding out. I cried myself to sleep terrified about what would happen.It didn’t feel real.  I walked out of that meeting with my advisor and teacher about the situation in tears. I went back to my room and it all came to me at once. I screwed everything I was working toward up. Hell no good college was gonna take someone who had that on their record. And what were you guys gonna say. Everything was going so well. I might have just fucked up my future. I didn’t want to tell you. You and G both are dealing with your own shit. Serious shit. The last thing you needed to deal with was my dumbass that screwed up something so simple. I would tell you once I solved the problem because I didn’t want to worry. I completely skipped lacrosse practice that day and just sat on my floor and cried. That familiar heavy feeling in my chest came back soon after and wouldn’t stop. I felt like I was dying. I thought it would never end. I couldn’t breath. I wanted it to stop. I knew of only one way to make it stop other than wait for it to pass. Pain. One time when it was happening I was tying to crawl to my bed to the bathroom at night. When I went to lean on the bathtub to stand up my hand went straight on a razor that was on the edge of the tub. it was dark so I didn’t see it there but it hurt like hell. I almost scream it hurt so bad. But with that it the panic attack stopped. I needed it to stop this time. I couldn’t and didn’t want to wait for it to end. Theres still two small scars on my wrist from bringing myself back. I have never done that before. I’m not proud of it. I usually would have just let it pass but I was so overwhelmed at that point I couldn’t deal with it. But I felt better once I could breath normally. I just lay in my bed and kept crying and ended up falling asleep for a few hours. Since then the fire I had was gone. I haven’t really been able to get anything together since then. I keep dwelling on past things. Some days are better than others but I can’t find that fire I had before. Everything started to slip, like and ice cream that is melting and I’m desperately trying to hold it together. I know we are at the end of this school year and theres nothing that I can do. I might have just fucked up this year but I learned that in theory I can do it. I just gotta figure out how again. But the answer to your one of your questions earlier ma, am I on drugs? No I am not. The only drug I’m on I’ve been on for years and you’ve called and texted yelling at me to take when I forget. The answer to you other question: “whats wrong with me?”Well to put it frankly, I have no idea. Which is why I wrote this. I don’t really know if this will help. It seems like when I open up about shit like this I get yelled at or you worry about me I fear I might end up in a psych ward. Typically the later but I digress. I really hope you don’t put me on suicide watch or something after you read this, whenever you do. Because that not whats going on here. The self loathing and beating myself up has been going on forever. Its so normal now to me its not that big a deal. I just hope maybe this will give you a little insight to what was going through my head all these years. Theres probably a lot more I could say regarding my feelings but I’m getting tired of typing all this. Anyway I’m sorry. I’m so sorry. Clearly, I am a work in progress. I always will be. I don’t deserve how patient and loving you are to me. I love you both so much. And of course Pipsqueak and Mocha and Stumpy and Doggie too. Thank you for reading. <3

-F.

[dinafbrownil]

Readers React: UVA Doctors Outraged Over Their Own Health System’s Billing Practices

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

First Do No Harm: When Financing Health Care Becomes Unethical

We attribute the oldest text of ethics in Western medical practice to Hippocrates (460-370 A.D.), a Greek physician whose oath instructs, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.” Most doctors, having pledged that oath upon entering the profession, recall best its later paraphrasing primum non nocere, first do no harm.

As physicians at UVA Health and educators at the University of Virginia, we were appalled by the revelations of the aggressive, pitiless billing and collections practices, first reported in The Washington Post based on an investigation by Kaiser Health News (“‘UVA Has Ruined Us’: Health System Sues Thousands Of Patients, Seizing Paychecks And Claiming Homes,” Sept. 10). We felt betrayed and we had, by extension, betrayed those who had relied on us. We had harmed.

When we began our positions at UVA, we did so with the understanding that, as clinicians at a public institution, we were privileged to care for all people, including those with limited ability to pay. Many of us chose academic medicine, and UVA specifically, so that we could partner with our patients to improve health and well-being thanks to the social contract specific to tax-exempt hospitals to provide low-cost care to people of all incomes. As we have learned recently about UVA and from stories reported from other states and institutions for more than a decade, avaricious billing and collections practices have broken the spirit, if not the letter, of that social contract (“UVA Doctors Decry Aggressive Billing Practices By Their Own Hospital,” Nov. 23).

The individual stories are heart-rending, and the extent of the collective impact is staggering. Indeed, based on an analysis by the Consumer Financial Protection Bureau in 2014, over half of all collections items in credit reports are associated with medical debt. A recent study of people with new diagnoses of cancer and a representative insurance mix, including the uniquely American categorization of people underinsured, found 42% had depleted their life savings 2½ years after their diagnosis. To be sure, academic medical centers must function within the competitive and revenue-driven environment of our country’s approach to health care, and some, like Hahnemann Hospital in Pennsylvania, have not survived. However, the survival of not-for-profit hospitals cannot be assured by the relentless pursuit of debt from the very patients for whom we are expected to be the safety net.

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) sent a letter on Oct. 17 to the UVA Health System’s acting executive vice president for Health Affairs that detailed questions about billing and collections practices at our institution. We have similar questions. While we applaud UVA for the rapidity with which it has announced reforms aimed at reducing the numbers of lawsuits and making more financial support available, we are uncertain how many future lawsuits will be prevented by restricting that punitive action to those with bills of more than $1,000, and why UVA cannot join other public hospitals that have effectively stopped suing patients altogether?

We simply cannot accept one-off solutions. Over half of all hospitals in the U.S. are not-for-profits, and the regulations that govern billing and collections practices vary by state and fail to offer adequate protection in most. Continued identification of egregious practices at individual institutions is essential, and we are grateful for the work of health care journalists and of members of Congress who have prioritized these issues in the national discourse. Public pressure placed on hospitals has frequently resulted in forgiveness of debt and, in some cases, changes in billing practices. Yet, until we achieve a truly universal health system modeled after other countries with similarly vast monetary wealth but more concrete social moorings, we must pursue an immediate solution to address health care pricing and billing. Such a solution must ensure transparency, as Sen. Grassley rightly highlights in his requests of UVA, and therefore allows for honest conversations about how we, as a country, hope to continue to provide excellent care to all Americans. The National Consumer Law Center’s Model Medical Debt Protection Act could serve as an important starting point.

To be clear, we are outraged. We stand with those that have been financially injured, whose bank accounts have been looted, whose homes have been swallowed as if they were built on quicksand, whose credit scores were ruined and whose mental health and energy were spent in a courtroom or in anxious conversations with lawyers — all as a result of having sought our care. We commit to working at UVA, our beloved professional home, to advocate for leaders of high moral integrity, to regain the trust of our patients and to repair to the greatest extent possible the damage that has been done. We call on our community, and especially our fellow clinicians, to demand that the precious resource of our public, not-for-profit hospitals protect our ethical responsibility to first do no harm.

— Drs. Scott K. Heysell, Michael D. Williams and Rebecca A. Dillingham, University of Virginia, Charlottesville, Va.

It’s good news that predatory hospital billing and collection practices are being questioned (this time at a location we get care from): https://t.co/rT2MlRdnZo

— Jan Oldenburg (@janoldenburg) October 18, 2019

— Jan Oldenburg, Richmond, Va.

The Slippery Slope Of Preventing Falls

I commend Kaiser Health News for shining a light on the dangers of senior falls ― the most common cause of nonfatal trauma-related hospital admissions (“‘Fear Of Falling’: How Hospitals Do Even More Harm By Keeping Patients In Bed,” Oct. 17).

Fears over patient falls are warranted; however, steps should be taken to provide patients with access to physical therapy while in the hospital to prevent loss of strength and mobility. Further, access to physical therapy can help reduce the steep costs associated with falls, which total roughly $50 billion annually.

In the outpatient setting, physical therapists are uniquely qualified to improve a patient’s functional ability and recommend the home modifications necessary to allow them to remain independent.

Whether inside the hospital or in the outpatient setting, patients need to be allowed and encouraged to move and walk under the supervision of a physical therapist. Promoting access to physical therapy will ultimately keep our seniors independent, prevent adverse events and drive down health care costs.

― Nikesh Patel, PT, DPT, executive director of the Alliance for Physical Therapy Quality & Innovation, Washington, D.C.

Another poorly thought through CMS regulation. Quality healthcare cannot be reduced to yes or no questions. ‘Fear Of Falling’: How Hospitals Do Even More Harm By Keeping Patients In Bed https://t.co/GTO1xLTDU6 via @khnews

— Cat Shah (@CatherineShah8) October 22, 2019

— Catherine Shah, Charlotte, N.C.

Kaiser Permanente Therapists Sing The Blues

I’ve been a Kaiser Permanente psychologist for over 25 years. I have seen many changes with Kaiser and I am tired of having to shortchange my patients of much-needed treatment services (“Bruising Labor Battles Put Kaiser Permanente’s Reputation On The Line,” Nov. 8). I wrote this song on behalf of my therapist colleagues in protest for better working conditions for patient care in the Department of Psychiatry at Kaiser. I recorded it with another colleague, Matt Torres, and two musician friends who are Kaiser members and sympathetic to the NUHW cause.

― Eugenie Hsu, Oakland, Calif.

Not Either/Or, But Sometimes Both

The article “Meth Trip Or Mental Illness? Police Who Need To Know Often Can’t Tell” (Nov. 1) failed to delve into how often individuals whom police interact with are experiencing mental health or behavioral problems in conjunction with substance use disorders.

The police in this article said they need to know whether they’re dealing with a mental health issue or drugs in order to respond appropriately. In Substance Abuse and Mental Health Services Administration’s 2018 report “Key Substance Use and Mental Health Indicators in the United States,” the percentages of adults who used illicit drugs in the past year were higher among those with serious mental illness (49.4%) and adults with any mental illness (36.7%), compared with those without any mental illness (15.7%).

Since there is such a high chance that people with mental illness are also using substances that can alter their clinical presentation, the police should be trained to prepare for modalities that can accommodate that, keeping themselves and those they serve safe.

― Xi Lucy Shi, Pittsburgh

Standing By Drug Treatment For ADHD

I am a child psychiatrist with a research and clinical focus on treatment of attention deficit hyperactivity disorder. I recently submitted a grant to the National Institute of Mental Health examining the evidence for and against stimulant treatment. The individuals quoted in the article “Pediatricians Stand By Meds For ADHD, But Some Say Therapy Should Come First” (Sept. 30), arguing that behavioral interventions are effective enough to be considered the first choice in ADHD treatment, aren’t correct.

Repeated, large-scale, well-controlled double-blind studies have shown that, with the exception of preschool/kindergarten children: (1) Medication for ADHD is shown to be significantly more effective than behavioral interventions, with behavioral treatments for ADHD only mildly effective or not effective at all. (2) Medication improves long-term outcomes, such as reduction of motor vehicle accidents, accidental physical injury and delayed educational progression. (3) Untreated ADHD is associated with increases in suicide risk, legal issues, divorce rate, job loss, substance use, motor vehicle accidents and self-esteem issues.

While the 6-year-old child in this article has tantrums (which might improve with only behavioral interventions), a school-aged or older child with ADHD would have problems with attention and concentration in school ― hurting his/her early learning. Symptoms of attention and concentration are particularly poorly responsive to behavioral interventions.

Behavioral treatment is not the first choice because delaying treatment can quickly have consequences, while medication treatment is very low-risk, yet dramatically effective.

― Dr. Ryan S. Sultan, New York City

Modifying classroom instruction and using behavioral supports should be first. Then meds if they are needed at the lowest effective dose along with modification and behavioral support. Jeez

— Terri Lewis, PhD 和平抵抗 (@tal7291) October 1, 2019

— Terri Lewis, Silver Point, Tenn.

On Astronomical Air Ambulance Costs

Your recent story about the cost of air ambulance services (“Bill of the Month: The Air Ambulance Billed More Than His Surgeon Did For A Lung Transplant,” Nov. 6) failed to paint the full picture. Recently, my wife had a Type A aortic dissection. She was transported to emergency surgery via helicopter air ambulance for a six-hour-long heart operation that saved her life. Our bill for the air ambulance was over $81,000 for the hour-long flight. What I learned from this incident is that there are only four hospitals in all of California where this operation is performed. Without the air ambulance, I would have likely been planning a funeral instead of dealing with over $750,000 in medical bills. The highly trained crews of these operations save lives every day. Most fly a helicopter, which costs $6,000,000 before it is equipped as a flying ICU. Most fly between one and three flights in a 24-hour period, on average. They are manned 24/7, equipped to fly in the clouds and equipped with night-vision capability. Nearly all are single-pilot crews (to keep costs lower) and have at least one flight nurse (most have two). All have training and qualification maintenance costs for the equipment and personnel. In consideration of all of these costs (note: I did not include facility or insurance costs), I think their cost to the patient is not out of line with other medical costs today.

I noted there was no talk of using a ground ambulance in the article. Was it time-critical for the patient? In other words, would it have had a similar outcome if a ground ambulance been used? In our case, the two extra hours a ground ambulance would have consumed would have likely concluded in a fatality.

The other side of this conversation revolves around how patients are billed and how our current system works to be the most expensive system in the world with only mediocre results. Nearly all billing is reduced by some amount by the insurance ― often called a discount. Because doctors and hospitals know they will receive only between half and three-quarters of what they bill, they inflate the billing so they get what the need to cover most costs. The big loser is the patient, who is underinsured or not insured at all.

The article as written is a very incomplete picture of the air ambulance world and a disservice to your readers.

― Dennis Lyons, Paso Robles, Calif.

Just read your article about helicopter charges. Why not educate the public that they can purchase helicopter insurance, which is very cheap? I highly recommend it to friends who live in rural areas with hospitals that do not offer a full range of services or who need transportation to receive a higher level of trauma care. A bigger problem: the huge health care systems ― whether privately managed or government-run ― that have associates with these rural hospitals or own them. They want patients to stay in their system and will bypass other hospitals that are closer and offer the same services. Choices of care are not always given to patients, or when they are given, they are brief and come in a moment of crisis when patients and families can’t take it all in. How about educating the public on what really is happening and how we continue to waste health care dollars and how they can protect themselves in advance? Call the air transport company and learn about their insurance.

― Nina Jeffords, Miramar Beach, Fla.

The associated "fact sheet" was equally bizarre and rather incoherent..this is a far cry from the normal professional and policy-oriented communications we expect from HHS.

— Dr. Cheryl Phillips (@phillic58) October 4, 2019

— Dr. Cheryl Phillips, Washington, D.C.

Don’t Let Fact Check Undermine Facts

Shefali Luthra did an excellent point-for-point takedown of President Donald Trump’s speech at a conservative retirement community in Florida, which amounted to a cynical gambit of frightening Caucasian seniors into believing that their long-cherished Medicare was under attack from the Democratic “socialist” and the freeloading communities they represent (“KHN & PolitiFact HealthCheck: Trump Speech Offers Dizzying Preview Of His Health Care Campaign Strategy,” Oct. 3).

One critical point that she and others, including the Democratic candidates for president, however, have failed to give sufficient emphasis to, is the degree that household income will actually increase in response to a “Medicare for All” plan. Trump stated in this speech, with no evidence, that household income will go down $17,000 a year with Medicare for all. Although there will be a tax increase to fund this program, the increase will pale in comparison to what we are already paying in premiums and deductibles to a predatory insurance industry. Ms. Luthra only went so far as to question the accuracy of that absurd assertion. Failure to drive this point home will invariably allow the masses to revert to the default mode of “socialized equals a tax increase ― end of story,” and put its long-overdue implementation at risk.

― Samantha Derrick, Berkeley, Calif.

Good, in-story fact check.But could context that current efforts aimed at serious reducing protections through ACA and #GOP has never offered any legitimate alternative > Trump Speech Offers Dizzying Preview Of His Health Care Campaign Strategy https://t.co/8waboBoT1B via @khnews

— jerrymberger (@jerrymberger) October 4, 2019

— Jerry M. Berger, Boston

Under Pressure To Treat Lymphedema

Great story about a little-known expense patients have for compression garments (“Compression Garments Can Ease Lymphedema. Covering Costs? Not So Easy,” Oct. 23). I had to purchase some to wear for a short time for lupus-related swelling and I was shocked at how much they cost. They definitely make a big difference in comfort, and I really think insurers should pay. As they also help to prevent infection, it may make coverage cost-effective in the long run. Is there a petition I can sign to support legislation? I will call my Congress members as well. Thanks for the article!

― Kristan Thompson, Savannah, Ga.

Penalties Run Afoul

In response to Jordan Rau’s article on Medscape.com (“New Round of Medicare Readmission Penalties Hits 2,583 Hospitals,” Oct. 1): If the hospital does not want to be penalized for readmission, well, the hospital staff can just let the patient die. On the contrary, the hospital should be rewarded for saving the life of the patient, and that is all that should concern Medicare. The hospital should be penalized for any patient deaths, period! Because the way around that penalty from Medicare is to just let the patient die in the hospital. It should be that the hospital is recognized for giving treatment to the best quality care that the hospital can provide! Someone should look into Medicare’s revolting penalty system.

― Lois Greene, Sacramento, Calif.

Wow! 2,583 hospitals were penalized for heart failure readmissions in 2020, including @BrighamWomens, @MassGeneralNews, and @BIDMChealth. If everyone is penalized, is the program actually effective? @kejoynt @rkwadhera https://t.co/KAIELu819A

— Aaron Paul Kithcart (@APKithcartMDPhD) October 2, 2019

— Dr. Aaron Paul Kithcart, Boston

Entrenched Stigma

The cumulative effect of “experts” telling the public there is a stigma to mental illnesses (“Taking The Cops Out Of Mental Health-Related 911 Rescues,” Oct. 11) ought to draw considerably more attention.

― Harold A. Maio, Fort Myers, Fla., former editor of Boston University’s Psychiatric Rehabilitation Journal

I had injured/panicked bipolar client strapped on board call me frm accident scene bc cops on the way. She was afraid they’d shoot her. I get there, find Fire Capt next 2 her ready 2 protect her. Taking The Cops Out Of Mental Health-Related 911 Rescues – https://t.co/6f7k9Ehdf7

— R. Ruth Linden, PhD (@TOLHlthAdvocate) October 21, 2019

― R. Ruth Linden, San Francisco

Nurse Practitioners Answer The Call

Your Oct. 9 article “They Enrolled In Medical School To Practice Rural Medicine. What Happened?” underscores the growing primary care provider crisis in rural America. Nationwide, the demand and need for primary care, especially in rural areas, leaves patients without care.

According to the U.S. Department of Health and Human Services, 80 million Americans lack access to primary care, with the most significant shortages in rural areas. By 2030, the country is expected to face shortages of more than 120,000 primary care physicians.

The nation’s 270,000 nurse practitioners (NPs) can address the shortage. In fact, a study in Health Affairs found NPs now represent 1 out of 4 health care providers in rural health practices. NPs assess patients, order and interpret tests, develop treatment plans and prescribe medications in all 50 states ― yet outdated state laws stand in the way.

Forty percent of states authorize full practice authority (FPA) for NPs, ensuring patients full and direct access to NP care. The remaining states limit NPs from practicing to the top of their education and training.

NPs can meet the demand for high-quality primary care nationwide. It’s time the remaining states update their laws so that all patients can access the care they deserve.

― Sophia L. Thomas, president of the American Association of Nurse Practitioners, Austin, Texas

The Plus Side Of 3D Mammograms

As a clinical researcher and diagnostic radiologist who reads thousands of mammograms each year, I was dismayed to read the KHN investigation “A Million-Dollar Marketing Juggernaut Pushes 3D Mammograms” (Oct. 22), which stated “there’s no evidence they are more effective than traditional screenings.” Hundreds of peer-reviewed scientific articles substantiate improved recall rates and cancer detection rates associated with 3D mammography. This article fails to present this information to readers and causes significant confusion in patients and physicians nationwide.

Recalls ― or “callbacks” — from screening mammography impose a tremendous psychosocial and economic burden on patients. Not only do patients and their families experience fear and anxiety due to a potential cancer diagnosis, but recalls also lead to downstream noncompliance with future screening recommendations and, on average, a 13-month delay to returning to screening mammography. Experiencing a recall or false positive increases the risk of late-stage diagnosis, when breast cancers are larger and harder to treat.

The experience of radiologists reading thousands of mammograms is not anecdotal. It is rooted in evidence-based medicine and data. These are not my opinions, they are facts.

― Dr. Nila H. Alsheik, chair of breast imaging, Advocate Aurora Health Care, Chicago

How High Is High?

The article “Employers Are Scaling Back Their Dependence On High-Deductible Health Plans” (Oct. 29) did not provide enough detail to confirm whether the cost to the employer of the PPO options was the same, more or less than the cost of the “high”-deductible health option. For example, it wasn’t clear whether the employer was making a contribution to the Health Savings Account or Health Reimbursement Account for the high-deductible health option.

Assuming the PPOs and the high-deductible health option all use an 80%-20% coinsurance formula after the deductible up to the same out-of-pocket expense maximum, the employee contributions you quoted give the appearance that the PPO options are much more attractive to almost every employee. For that result to occur, the cost to the employer for the PPO options would have to be substantially greater than the cost to the employer of the high-deductible health option.

― Jack Towarnicky, Powell, Ohio

from Updates By Dina https://khn.org/news/readers-tweeters-letters-to-editor-uva-doctors-outraged-over-their-health-systems-billing-practices/

[greenlifestylemarket]

World Famous Psychiatrist Says: More Psychiatric Drug Treatment Means More Shootings Will Happen

(Natural Blaze by Jon Rappoport) Listen to this man. You’d better listen.

His name is Peter Breggin. He is a world famous psychiatrist. He has been called the conscience of his profession.

Here is an excerpt from his bio:

“Peter R. Breggin MD is a Harvard-trained psychiatrist and former Consultant at NIMH [National Institute of Mental Health] who has been called ‘The Conscience of Psychiatry’ for his many decades of successful efforts to reform the mental health field. His work provides the foundation for modern criticism of psychiatric diagnoses and drugs, and leads the way in promoting more caring and effective therapies. His research and educational projects have brought about major changes in the FDA-approved Full Prescribing Information or labels for dozens of antipsychotic and antidepressant drugs. He continues to education the public and professions about the tragic psychiatric drugging of America’s children.”

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“Dr. Breggin has authored dozens of scientific articles and more than twenty books, including medical books and the bestsellers Toxic Psychiatry and Talking Back to Prozac. Two more recent books are Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families.”

“Dr. Breggin has unprecedented and unique knowledge about how the pharmaceutical industry too often commits fraud in researching and marketing psychiatric drugs. He has testified many times in malpractice, product liability and criminal cases, often in relation to adverse drug effects…”

Here is an explosive excerpt from Dr. Breggin’s recent column at Mad In America: “Psychiatrist Says: More Psychiatry Means More Shootings”:

“In the early 1990s, a federal court-appointed me to be the scientific expert for all of the combined product liability cases that were brought against Eli Lilly throughout the country concerning Prozac-induced violence, suicide and crime. Since then I have been involved in many cases in which judges and juries, and even prosecuting attorneys, have determined that psychiatric drugs have caused or substantially contributed to violence. For a lengthy list, see the Legal Section on my website [www.breggin.com].”

“In 2003/2004, I wrote a scientific review article about antidepressant-induced suicide, violence and mania which the FDA distributed to all its advisory committee members. This took place as the FDA Advisory Committee members prepared to review new warnings to be put in the Full Prescribing Information for all antidepressants.”

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“In my peer-reviewed paper [about the effects of antidepressants], I wrote: ‘Mania with psychosis is the extreme end of a stimulant continuum that often begins with lesser degrees of insomnia, nervousness, anxiety, hyperactivity and irritability and then progresses toward more severe agitation, aggression, and varying degrees of mania.”

“In words very close to and sometimes identical to mine, the FDA one year later required the manufacturers of every antidepressant to put the following observations in the Warnings section of the Full Prescribing Information:”

“’All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric’.”

“These adverse drug effects—including agitation, irritability, hostility, aggressiveness, akathisia, and impulsivity—are an obvious prescription for violence. Akathisia, which I also described in my article, is a psychomotor agitation that is strongly associated with violence.”

“The FDA Medication Guide for antidepressants warns clinicians, patients and families to be on the alert for the following:

acting on dangerous impulses

acting aggressive or violent

feeling agitated, restless, angry or irritable

other unusual changes in behavior or mood”

“This list (above) of antidepressant adverse effects from the Medication Guide should make clear that antidepressants can cause violence.”

“The FDA also acknowledges the risk of both psychosis and aggression from the stimulant drugs used to treat ADHD…”

“In the study of violence reports to the FDA, any predisposition toward violence in the patients themselves was largely ruled out because some of the most violence-inducing drugs were not psychiatric drugs, and were being given to a more general population. Some of the violence-inducing drugs were antibiotics, including Lariam (Mefloquine), which Sgt. Robert Bales was taking when he slaughtered 16 helpless, innocent villagers in Afghanistan.”

“[The authorities] do not foresee that the psychiatric strategy for treatment will sometimes lead to tragic outcomes like the school shootings. Nor do they realize that the overall evidence of harm from psychiatric drugs is infinitely greater than the evidence for good effects, as scientist Peter Gøtzsche has confirmed in Deadly Psychiatry and Organized Denial.”

“Calling for more spending on mental health and on psychiatry will make matters worse, probably causing many more shootings than it prevents.”

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“Not only do psychiatric drugs add to the risk of violence, but psychiatric treatment lulls the various authorities and the family into believing that the patient is now ‘under control’ and ‘less of a risk.’ Even the patient may think the drugs are helping, and continue to take them right up to the moment of violence.”

“Even when some of their patients signal with all their might that they are dangerous and need to be stopped, mental health providers are likely to give drugs, adding fuel to the heat of violent impulses, while assuming that their violence-inducing drugs will reduce the risk of serious aggression.”

NOTE: DR. BREGGIN ISSUES THIS WARNING: “Most psychiatric drugs can cause withdrawal reactions, including life-threatening emotional and physical reactions. So it is not only dangerous to start psychiatric drugs, it can also be dangerous to stop them. Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision. Methods for safely withdrawing from psychiatric drugs are discussed in Dr. Breggin’s book: Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families.”

My comments: The tragedy of many mass shootings—many more than are highlighted by the press—is mirrored by the tragedy of psychiatric drug treatment.

Overwhelmingly, psychiatrists bury their heads in the sand, as they continue to dose patients with compounds that cause horrendous effects, including violence.

The psychiatric solution to mass shootings—more diagnosis and more drugs—becomes the cause for increased shootings.

Many mainstream reporters are aware of this, but they are constrained from telling the whole truth. Their media outlets are relying on pharmaceutical advertising for their very existence.

Legal authorities make it very difficult, if not impossible, to obtain information about which psychiatric drugs shooters were taking before they went on their rampages. Case in point, Sandy Hook, 2012—the (purported) killer, Adam Lanza, had been under psychiatric treatment. But an assistant attorney general for the state of Connecticut stated that the list of Lanza’s meds would not be disclosed, because that “can cause a lot of people to stop taking their medications.” Better for patients to keep taking those drugs—and then some of them will violently go off on innocent persons.

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In conversations with attorneys over the years, I’ve been told that judges, police officers, and prosecutors avoid the “psychiatric drug issue.” They don’t want to touch it. After all, friendly psychiatrists are part of the legal system. They often testify at trials. Further, “medical experts” will lash out and go on the attack against law enforcement if an attempt is made to link a violent crime to the effects of psychiatric drugs. (Dr. Breggin has managed to break through this code of silence. He is one of the only psychiatrists who has been able to testify in court about the true effects of psychiatric drugs.)

At the federal level, lobbyists for drug companies are crawling all over Washington DC. They exert an astonishing level of influence on law makers and bureaucrats. The issue of psychiatric drug-induced murder is obviously not on the list of permitted issues for open and extensive discussion.

Then there is the FDA. This is the agency tasked with approving every medical drug as safe and effective before it can be released for public use. The FDA will never admit its decisions have been fueling mass shootings across America. The Agency views the pharmaceutical industry as its partner. Placing warnings on informational drug inserts (as described above by Dr. Breggin) easily escapes the attention of psychiatric patients. Doctors who prescribe the drugs may or may not read those warnings. Even if they do read them, the drugs are THE solution to “mental disorders.” Very few doctors will seek other means of treatment.

The public is in the middle of a psychiatric plague. Learning the truth is the first step forward.

After that, we MUST preserve the right to refuse medication.

Freedom and life itself hang in the balance.

(To read about Jon’s mega-collection, The Matrix Revealed, click here.)