Sex, Drugs, and Public Health

            Let’s begin at Lowe’s Hardware. I was wandering the alleyways they call “aisles,” squeezed in on both sides by walls packed solid with stuff that made me feel like I was back in New York City, lost among the skyscrapers. A kid wearing institutional orange approached me. His hair was neat, his face was clean and he was smiling. A very unusual-looking Lowe’s employee. Looked more like one of the young missionaries who I saw frequently cruising the streets of Latin American towns.

         Before I could ask him where they hide the doo-dads I was looking for, he beamed: “May I make you the best offer you’ll get all day?”

         He zipped thru an obviously rehearsed pitch, offering to come to my house, get a water sample, test it for free, and give me the results. I knew I was missing the most important information. “Why would you do that?” I prompted him.

         “Because most public water supplies have contaminants that you don’t know about. But we have water purification systems that an fix that!”

         I said thanks anyway because I know a fair amount about public water supplies. Also know enuf about scams to avoid them.

         If you’re wondering what this has to do with the title of this article, I promise to make the connection. Let’s begin with a quiz, answering the title’s question:

1. Because it’s the best Healthcare system in the world
2. Because of greedy physicians
3. Because of greedy Pharma
4. Because of greedy hospitals
5. Because that’s just the way it is
6. Other

         As the T V shows say, “Lock in your answer.”

1. We assess the quality of nations’ healthcare systems by outcome measurements. We usually compare the U.S. to other wealthy industrialized countries. As a group, these are called the Organization for Economic Co-operation and Development (OECD) countries, including mostly western European countries, Australia, Japan and Canada. I’ve gone over this in previous articles, but here’s a quick synopsis: *. Life Expectancy in the U.S. is four years lower than in OECD countries. * *. Maternal Deaths in the U.S. are three times higher than any in the OECD (a veritable Scandal!). *. Infant Mortality is one and a half times higher.

And for these (and other) dismal results, we pay a staggering cost of $14,855 per person per year. In the OECD countries, where outcomes are better, the average is just $5967 per person. (Kaiser Family Foundation – an excellent source on healthcare).

                  Hardly the best Healthcare in the world.

B. As for greedy physicians, although M.D.’s make more in the U.S. than almost anywhere else, the cost for physicians’ services is just 8.6 % of our entire Healthcare budget. In Canada, it’s 12 to 14%. In Sweden and Netherlands, 10 to 12% (NIH). So, not a major contributor to our  costs.

C. Regarding Pharma, U.S. costs were found to be 2.78 times higher than 33 OECD countries in a 2024 RAND Healthcare study. Here’s where the real problems begin to peek up at us from the murky waters of the healthcare swamp.

In the U.S., there’s a middleman between manufacturers and your pharmacy. These Pharmacy Benefits Managers control the list of drugs that Payers, like insurance companies, may approve for payment. Then, because these PBM’s control access to the massive markets of the Payers, they negotiate the lowest possible prices for drugs from the manufacturers. Next, because PBM’s process claims for drugs, they determine how much they will pay the pharmacies. Then they charge the insurance companies more than the pharmacies get paid, and keep the difference to add to their profit. I know this is murky (all swamps are) so I’m leaving out several twisting, confusing details. But this one is important: PBM’s are large monopolies – 80% of all prescriptions are managed by just 3 PBM’s (Federal Trade Commission). 

Result? A 2020 AARP  study of 943 commonly used drugs revealed that prices set by PBM’s were rising at a rate three times that of inflation. Worse, the agency administering both Medicare and MediCal saw a 26.8% rise in retail drug costs over the four year period of 2012 to 2016 (AMA study). The PBM’s operate inside both insurance companies and healthcare provider organizations, so they basically negotiate with themselves. 

     It’s a SCAM.

Do you know anyone who has lost their local pharmacy lately?

D. A significant number of hospitals have become corporate, for-profit institutions. By 2023, just five such corporations provided half of all hospital care in 42 states. (Families USA). Corporate hospitals make ten times the net income of independent hospitals. How? Studies have shown that they charged 282% more than Medicare allows, resulting in a $22 million profit for each corporate hospital per year. The federal government, which administers Medicare, controls how much they will pay hospitals for Medicare patients, no matter how much the hospitals bill. But those without Medicare are often stuck with sky-high bills.

The leading source of personal bankruptcy in the U.S. is – – – medical bills. Rural independent hospitals generate the least profit. 

              Corporate hospitals are a SCAM.

E. “Just the way it is.”  I have not yet met a person on Medicare who didn’t like it. It covers enuf of necessary costs to make physician and hospital care affordable to those on that system. The mechanism it uses is simple: it pays medical bills when submitted, on the Medicare schedule. The government administers it at a responsibly low administrative cost between 1 and 2 percent.

         However, the thing called “Medicare Advantage” is a very different beast. In spite of its name, “Medicare Advantage” (M-C Adv) is NOT Medicare. It is a healthcare Payer system provided by private, for-profit insurance companies. Here’s how it works:

1. Unlike traditional Medicare, it does not pay bills from the Medicare Trust Fund as they are submitted. Instead, the government gives the insurance company a year’s worth of funding for each person it enrolls, in a lump-sum out of the Medicare Trust Fund.
2. The insurance company decides which physicians, hospitals and pharmacies its enrollees may use.
3. Before your physician can order an expensive test or procedure, they must request approval from the Medicare Advantage insurance company. This is “Prior Authorization.”
4. The insurance company may deny such authorization. 
5. If the M-C Adv company denies the P A, it nevertheless keeps the money they were given upfront to provide care.
6. M-C Adv companies advertise heavily toward healthier people, those who will use fewer medical services, i.e., use less of the money the company has for the enrollee’s care.
7. M-C Adv companies negotiate with less expensive (lower quality) providers than traditional Medicare for the more intensive care like Cancer, Nursing and Home Health (Center for Economic and Policy Research).
8. To make their insurance look more attractive, they offer benefits not available under traditional Medicare such as gym memberships, dental and vision care. Studies reveal that most enrollees don’t us very much dental and vision benefits, so it’s not much of a cost to the companies.

         What is the impact of Medicare Advantage?

1. Health outcomes are no different from those people enrolled in traditional Medicare (KFF).
2. To maximize profits, M-C Adv Payers deny many Prior Authorizations (two million in 2021).
3. Per an AMA survey of physicians, the Prior Authorization process delays treatment. 80% said that the delays or denials led many patients to abandon treatment and 33% said serious adverse events resulted.
4. Comparing M-C Adv to the rest of the insurance market, M-CAdv companies made a profit of $1730 per enrollee in 2021; the figure for the others was $745 (CEPR).
5. The cost to taxpayers is rising. In 2011, M-C Adv cost the Medicare Trust Fund $ 124 Billion. In 2025 the number was $ 573 Billion (KFF).
6. M-C Adv is depleting the Medicare Trust Fund much faster than traditional Medicare costs. This causes ALL Medicare enrollees to pay higher premiums, even those not using M-C Adv.
7. If the Medicare agency could use the money wasted on profits for M-C Adv, it would be able to provide dental, vision and hearing to all enrollees (CEPR).

         “Medicare Advantage” is a SCAM.

         A Scam against taxpayers who fund the Medicare Trust Fund.

         A Scam that, together with corporate hospitals’ inflated bills and the PBM Scam on drugs, make us all pay more for healthcare than any other country. With inferior health results. Makes the daily Scams from Internet, phone, or hardware stores into small potatoes.

         What would be better?

All the data (there is a lot) shows that the systems in other OECD countries (including Australia, the UK, Canada, Scandinavian countries, New Zealand and Italy) work well, producing better health results at less than HALF the cost we pay into our system.

         This are NOT Socialized Medicine.

         These are Single Payer Systems: One entity administers the funds and private providers give the care.

         In the U.S., the Medicare system, administered by the government, uses only 1 to 2 percent for administrative costs. By comparison, all other U.S. insurance company Payers (including M-C Adv) average 12 to 18 percent for administration. And profit. In a prior article I gave you figures for the obscene benefit packages of insurance companies’ executives.

         If we could eliminate the waste from these three Healthcare Scams (M-C Adv, poorly regulated corporate hospitals, and PBM’s) we could save Billions for our Medicare Trust Fund. Then we could build a much better Healthcare system. Medicare is already up and running, popular with its enrollees and with most providers. A Single Payer System like Medicare For All is what we need.

         What can YOU do?  Find people running for congress who believe in the Single Payer System. And vote for them.

            In 1609 Galileo used his eyes and a crude telescope to watch what the sky was doing. To learn its truth. He saw that the sun did not revolve around the Earth. 

         The problem for him – and for all humanity– was that the Earth feels stable. Unmoving. (Somehow that 1037 MPH that we’re spinning feels like immobility). So, at the time, people believed Earth to be the center of the known universe. Everything else up there – including the sun – revolved around them.  And Society (which at the time was pretty much The Church) also believed that God created things that way. 

         Thus, Galileo’s report of Heliocentric (sun-centered) orbiting caused an uproar among powerful people (the ones who made “official” interpretations of the Bible). 

         By 1615, his writings were being “examined” by the Inquisition and were declared to be heresy. Galileo was ordered to stop believing what his eyes revealed. Ultimately, they threatened him with torture to make him “tell the truth” (i.e. say what they wanted). He was imprisoned and his writings were banned.

         This was no empty threat. In 1600, the church had burned Giordano Bruno alive (not for long) for proposing that the Universe was infinite.

         Now we hit the Fast Forward button: Einstein called Galileo “the father  of modern physics.”

         Different years; another country: in 1846, Ignaz Semmelweis was a professor of Obstetrics in Vienna General Hospital (Austria). There were two different maternity wards there. The terror plaguing childbirth at the time was Puerperal Fever, a disease syndrome that occurred in women shortly after childbirth and frequently killed. This disease killed an average of 10% of all women delivering in the First ward, but only averaged 3 to 4% in the Second ward.

         And everyone knew it. Pregnant women begged, often on their knees, to be admitted to the Second ward.

         “Fever” is now a term describing a symptom of some disease – most often, an infection. But in Semmelweis’ day the term was the name of a disease itself. Sometimes “the Fever” was pneumonia. Puerperal Fever was sepsis – overwhelming infection spreading thru the bloodstream rapidly. But the Germ Theory was unknown in Austria at the time and antibiotics were decades away in the future.

         He examined several possible causes of Puerperal Fever, none of which explained or reversed the problem. Then One Day (as all stories say) a fellow (male) physician died. Autopsy showed hallmarks of Puerperal Fever. This physician had been accidentally cut by the scalpel of a medical student while they were dissecting a cadaver in the anatomy lab.

         Semmelweis made an epidemiologic discovery (although he didn’t use that term). The Second ward with the lower death rate was staffed by midwives. The First ward by medical students who would sometimes come directly from anatomy lab to examine women in labor. Something, Semmelweis postulated, was being transmitted from the cadavers to the women by the medical students’ hands. (Remember, still no awareness of bacteria there). He required that everyone wash their hands in chlorinated solution between autopsy work and examination of women in the Obstetrics ward. Deaths from Puerperal Fever on the ward fell from 18% to less than 2% (similar to the midwife ward), then to zero.

         How was Semmelweis rewarded for this monumental advance in medical care?  He was fired from the hospital and hounded by the medical community until he left town. He had confronted the accepted Belief system of Medicine at the time with a truth, and was punished for it.

         Before we start howling “what stupid doctors!” or “what stupid men!” or “what stupid non-Americans!” let’s be aware that this is a frequent behavior of humans.   People keep smoking in spite of widespread information about cancer, heart attack, and emphysema. People continue to support politicians who violate their promises and inact policies that hurt their voters. People eat meat yet profess to love animals.

         What is inside us that makes us do such insane stuff as rejecting – often violently – new discoveries or proven truths which should change our habits, actions, and beliefs for the better?

         Turns out someone has slapped a label on it, which actually helps us to understand the process better. And that can (should) lead to changing our reactions to new discoveries and truths. The term is Cognitive Dissonance, which we can translate to “internal stress due to information that is not consistent with our beliefs, values, attitudes or habits.”

         This stress makes us very uncomfortable because it de-stabilizes what has been working for us for a long time. The problem is that this tension is often subconscious, so we can’t deal with it directly. Honestly. But we need Relief ! What do we do?

         Way-all (Texas creeping in on me), there are a few ways we deal with Cognitive Dissonance. We can Rationalize the conflict away. For instance, Semmelweis’ colleagues probably functioned with “Illusory Superiority” bias (yeah, it’s an actual term used by Social Scientists). Basically, the colleagues believed themselves to be wiser, more knowledgeable than Semmelweis, so they could ignore his findings, get rid of him, and find inner peace by continuing to believe what they’d always believed.

         Or we can relieve the tension thru Denial. Galileo’s enemies just flat-out denied his findings because their interpretations of both the observed sky and the Bible were different. Dismiss his findings and the Dissonance goes away.

         It takes a lot of effort to pull off these tension-relieving justifications, so no wonder people react with anger.

         There is a better way to resolve Cognitive Dissonance. We can change our Behaviors. Or – – – we can change our Beliefs.

         Yeah, that means admitting mistakes. Or losing control. Or feeling a blow to our egos. Which probably explains why it doesn’t happen as often or as quickly as we wish (in others, usually).

         So, with all that said, what’s on the Medical – Scientific  horizon that may trigger Cognitive Dissonance? And understanding the above, can we respond differently this time?

              *                         *                         *

         I learned, and am still learning, two distinct approaches to Medicine, to understanding the human body in health and illness. The first is Anatomy: where everything is and how it’s shaped from the biggest (the brain) to the smallest (a single cell). The second approach (which is much harder to learn) is Function: how things work. From the simple (a muscle) to the nearly incomprehensible (the brain again).

         We need to know how things work when everything is healthy and normal and how that function is disrupted by illness or chemicals (including drugs). We can’t experiment with people, so we’ve studied animals and hoped that we could extrapolate to humans. But just because a drug works a certain way in animals, or a disease attacks a certain way, or a therapy works in animals doesn’t guarantee a similar functional process in humans.

         So what could be a major advance in Medicine and Health would be to have human cells, tissues or organs to study such functioning without using living people. That’s where chimeras fit in.

         Chimeras are living beings that carry the cells of more than one individual. Like grafted plants.

         Here’s what chimeras are NOT: Unlike the mythical creature bearing this name, they are not hybrids. They are NOT half human and half animal. They are NOT made from HUMAN EMBRYOS.

         In fact, there are thousands of chimeras walking around among us. Some are Natural chimeras. In these cases, two ova (eggs) were fertilized and, very early in development, fused into one. What might have been twins ended up being one person. They lead normal lives and most are unaware that they carry two different sets of cells. One source estimates that this occurrence may be as common as 20% of all pregnancies (National Society of Genetic Counselors, Feb 2020). 

         Other chimeras among us were artificially created when they received a blood transfusion, bone marrow transplant, or organ transplant. They carry their cells and also the cells of the donors. Bone marrow transplant can change a person’s blood type.

         To better understand Function in humans when disease invades or when pharmaceuticals are used, animals can have human cells implanted and the living animal will grow human cells or tissues. Another massive potential benefit could be realized if the human cells are introduced early in development such that entire organs of human origin grow in the animal.

         Currently in the U. S., more than 100,000 people are on a list waiting to receive transplant organs because their own organs are failing. A new person needing an organ is added to the list every 8 minutes. But there are way fewer donors than people who need the organs, so 17 people die every day from failure to get a donor organ in time (National Institutes of Health).

         And even when a donor steps up to volunteer, the recipient and donor may not be compatible immunologically. Animals are not compatible – their genes dictate vastly different immunity from humans and, with rare exceptions, the recipient’s immune system would reject the organ (N I H).

         But organs which are human, although grown in animals, have the potential to save a lot of lives.

         There are serious ethical issues in addition to many scientific hurdles in developing animals to carry human cells – chimeras – and ethical guardrails will protect both humans and animals. But the potential for good, for advances in Medicine and Health, is great (Science Literacy Project Oct 2016).

         The important thing is for the public to learn the facts about this and not react to their Cognitive Dissonance with anger, denial or a dysfunctional clinging to “the way things have always been.” The potential benefit will be there for all of us, especially the people who need a new organ at the rate of one every 8 minutes.  

            California is crammed with the spectacular, the weird, the outrageous and the beautiful. But when, for the sixty-first day in a row, the weatherman says “tomorrow will be a gorgeous day,” I know we’re in for another boringly blue and empty sky.

         Not so, Texas.

         Above the flat and unimaginative land, the cloud performance varies over dramatically short timeframes.

1. An afternoon of whisps so vague that they change the sky from blue to aqua to mauve to purple with such subtlety that it’s impossible to pinpoint where the change occurs.

2. An unobstructed wind holds the ubiquitous flags as rigid and horizontal as the ubiquitous billboards. It stretches the clouds into threads.

3. Morning thunder, distant but approaching. Peal follows fast after peal. Gray pillows are heaped upon each other overhead, solid to the south, east and west. They stop to the north with a boundary as clean and sharp as if sliced by a scalpel.

4. Twelve minutes after observation # 3 above, a lightning flash, then torrential downpour. Rain so powerful it sounds like hail. It firehoses straight out from the downspout. Lakes materialize in minutes on the street.

5. Driving north to Fort Worth on the day described in 3 and 4, the sky is an ocean collapsing onto the freeway. The wipers are on turbo-overdrive, but the vehicle in front of me and another in my mirror are just blurred shadows, like sharks prowling at the edge of underwater vision.

6. After a rain. Night. There’s a partial moon up there somewhere, hidden behind clouds that have broken apart into faint ghosts the same color as the sky between them.

7. After a downpour and lightning, bolls of cotton clump overhead, polka-dotting the blue sky. But approaching the horizon, the white puffs develop gray underbellies, and beyond, they fuse into striations of gray down to the horizon.

8. A day where, above me is an M.C. Escher scene of cloud ships lazy in a Caribbean sky.

9. A day of feeble drizzles has morphed, by late afternoon, into sunny and heating up. It ends with two separate clouds in the west. The first is a curtain from sky to horizon, glowing yellow-orange as the sun descends in front of it. The face of the sun is eclipsed by the second – an elongated stretch of dark blue lumpiness that is darkening into gray. Reminds me of a fart trailing from some diesel truck with a worn-out engine.

10.  Blue Norther. A quasi-mythical entity I’ve heard of a few times over the years. It’s unique to Texas and named as if it were a phrase from Cowboy Poetry. Yesterday it was sunny, 85 degrees, breezy and humid. Did a few things outdoors and was beaded with sweat. Back indoors, perspiration oozed over my whole body. Skin sticky like chewed bubblegum. Ultimately, I broke down and turned on the A / C.

         This morning, dawn brought light with a deep grey filter and no visible sun. Stepped outside into gusting wind so cold I went in for my down parka. Wind was now coming from the north, 180 degrees from yesterday. Thermometer at 45. Mashed together clouds of dark blue filled the sky.

          Went out to hunt wildflowers. Periodic bursts of rain, no sun, no warming up. Fields of early Spring flowers, but not a single bee. In the evening, lumpy clouds the color of bruises were still bunched together overhead. To the south, where Gulf of Mexico air pushes in, the northern clouds were turning into streaks that curved from horizontal toward the land as if someone had pulled a comb thru the clouds with one big curving sweep.

When I was finally old enuf to count, I counted years. “Wow,” I thought, “I may see the 1900’s become the 2000’s. We’ll learn so much more by then.” But then another thought hit me. “That’s 50 years. A half century. Heck, I’ll be dead by then.”

            And so it is that the words “wisdom” and “children” are seldom used together.

            Over time, experience brings knowledge that can sometimes grow into wisdom. We add to that knowledge by sharing experiences. Schools do this.      And so it is that, in Med School, the professors discussed Pain. It’s subjective, they said. Some writhe and whimper from slivers or stubbed toes. Others shrug at cuts or when they hit a fingernail with a hammer. It’s difficult to know which drugs to use to relieve “pain.”

            How, I wondered, can a powder in a capsule make pain go away? Ice decreased the soreness of bruises. Aspirin evaporated my headaches. But I never had enuf pain to test other analgesics – pain relieving drugs. Then one day (as the story tellers say) I had a serious injury in South America. I sliced open my hand, severing the main nerve that allows fingers to feel and operates the muscles in the hand.

            As I lay in the hospital bed, my bandaged hand suspended above my head and the rest of me and my glitching brainstem writhing in unrelenting pain, they injected something into the IV line. Then they moved me onto a gurney. I recall the lights in the hallway ceiling flowing past like marching soldiers. I became aware of a strange feeling: I was relaxed for the first time in three days.

            I looked at my bandaged hand. The pain was still there. All of it. My hand was in a vice, being slowly crushed. My fingers were being ripped away from each other like drumsticks from a cooked turkey. A blowtorch was blasting against my palm. Everything was the same since leaving South America.

            “That’s a lot of pain,” I thought. “I bet it must hurt.”

            But it didn’t.

            Not gone, like some headache after aspirin. I still felt the pain, but it was no longer – – – mine.

            I leaned over to vomit. Small price to pay for such relief.

            Learned a lot from that experience about the connection between Pharmacology (the study of how various drugs – including herbal extracts – effect the body) and Neurology (the study of how the brain and nerves function). More than I could ever learn from a textbook.

            Other experiences added to the knowledge. Judges in Mariposa asked me to evaluate people arrested for offenses related to the use of illegal drugs. The drugs that these folks were using were often different. Some used opioids (known medically as “narcotics” from the Greek meaning “to make numb”). Some used meth or “speed” (stimulants, not narcotics). Others used benzodiazepines (sedatives, drugs that  decrease awareness and response to stimulation). Not surprisingly, each person described both the effect of their drugs and the reason for using it very differently.

            And over the years, many patients I’ve treated have been dealing with a complicated relationship between the pain of their problems in life (some, but not all, medical problems) and their use of drugs, both legal and illegal.

            And so it is that I’ve learned three major things thru all these experiences:

• – just because a drug is legal does not mean it’s free of hazards; conversely, just because a drug is illegal does not mean it is hazardous;
• – each drug – legal or not – has a very different effect on the human body;
• – the way some drugs are used can cause harm.

When we say (or hear) “drugs,” many folks have a powerful emotional reaction. This may be due to some tragic personal experience with a loved one or maybe is just integrated into a belief system. We think of the psycho-active chemicals, often, those purchased on the street. We don’t think of medications. But in addition to the drugs called Antibiotics, Blood Pressure modulators, Hormones etc. there is a long list of psycho-active drugs available to physicians. 

            All these can do positive things – otherwise, no one would use them. But they also have potential to harm if used incorrectly. And a couple of them are notorious.

• – Blood-borne Diseases. Hepatitis, AIDS, and bacterial sepsis can result from injecting with dirty needles. These are devastating diseases and the reason that some jurisdictions have needle exchange programs for those who use IV injection of drugs.
• – Social Destruction. Loss of family, loss of job, and the cost to society of medical and psychological care can be extreme.
• – Crime. Because several of the psycho-active drugs are illegal, criminals get involved. Violence has ripped thru more than one country because of the money. Reminds us of the Prohibition era (1920 to 1933). Thousands are imprisoned , often for mere possession.
• – Death by Overdose. Those who obtain their opioids from pharmacies rarely overdose. They know exactly how many milligrams of morphine or hydrocodone they are getting, and the drug is “clean” of contaminants. Thus folks like healthcare workers or patients who are addicted can function for years without detection. But those who use street opioids never know the exact dosage, and often the heroin (a drug that is prescribed in Britain) is contaminated with fentanyl (a very powerful synthetic opioid) or with benzodiazepines. So  you can see how easy it would be to overdose accidentally.

Drugs other than opioids that can kill by overdose include alcohol (a sad consequence of “hazing” at some colleges) and Tylenol. CDC reports six alcohol overdose deaths per day and 500 Tylenol / acetaminophen deaths a year.

If a person wants to avoid the harm, why don’t they just quit?

In 1875, the medical syndrome of addiction was described, associated

 with morphine. Addiction has these characteristics:

• – an overwhelming urge to use the drug, in spite of the risk of harm
• – the phenomenon of Tolerance, whereby the patient uses increasing doses to get the same effect. Often, people use doses that would be lethal to others.
• – Physical Dependance where the body incorporates the drug into its normal chemical balance.
• – Withdrawal symptoms when the drug is stopped – a very painful and sometimes fatal process.

Several legal drugs can cause addiction, which increases the likelihood of harm. Alcohol is notorious for a withdrawal syndrome that can be lethal. Even without the withdrawals, alcohol kills 140,000 a year in the U.S. (CDC). Tobacco is extremely hard to quit because of addiction to nicotine. This drug kills 480,000 a year (CDC). Caffeine, when daily users (like me) stop for a few days often punishes us with headaches that are a withdrawal symptom.

But it is the opioids (morphine, heroin, codeine, fentanyl) – the classical drugs of addiction – that has grown into a horrendous epidemic. Even if the initial doses were prescribed by a physician, patients, once addicted, have a much bigger problem than pain (physical or psychological). Snagged by the claws of addiction, they have fallen into a catastrophic quagmire of harm or accidental death. Just how extreme this can be is exemplified by James Fisher, a man who, like me, rode a gurney to an O R. But for very different surgery.

James had become addicted to opioids a decade earlier and tried to escape its clutches multiple times. He had been yanked back from the brink of death from contaminated drugs several times and had tried every addiction therapy available. He always relapsed. Desperate times, desperate measures.

And so it was that a neuro-surgeon implanted electrodes into a very specific part of James’ brain and attached these to a pacemaker-like electronic stimulator implanted under his skin. This artificial modification of his brain has allowed him, so far, to remain off opioids. This case shows how desperate people can be to escape the clutches of opioid addiction.

Here in the U.S., the response to this major Public Health epidemic was to make certain drugs illegal. This approach grew into the War on Drugs. “War” requires a military, and that’s where tens of BILLIONS of your tax dollars have gone in the attempt to cut down the supply of drugs. More money was poured into the law-enforcement / judicial system, chasing after those who possessed the illegal drugs. A small, inadequate amount went to treatment of addiction.

How well has this “War” worked out since 1971?

In 1986 and again in the 1990’s, the government contracted with the RAND corporation to look at that question. RAND reported that the “armed forces had little to no effect” on drug supply except to increase prices. They recommended moving billions from law enforcement to treatment which they assessed as “23 times more effective.” In 2001 the National Research Council reported that the “War” had shown no evidence of success. The journals “Foreign Policy” and “Journal of Crime and Justice” deemed the War on Drugs “a failure.”

On the human side, there are an estimated 21 million people addicted in the U.S. per the Association of American Medical Colleges. The Federal Bureau of Prisons reported that 45.3% of all criminal charges were drug-related. And thru all this, the opioid death rate has kept climbing. It hit an all-time high in 2021 at 108,000 deaths, up 15% from 2020 and 53% from 2019. (CDC).

These disappointing results should not be a surprise. We’ve done this before. Prohibition made alcohol illegal between 1920 and 1933 and the result was a dramatic rise in crime (remember Al Capone?), the creation of illegal speakeasies (an estimated 100,000 in New York alone), increased harm from bad moonshine (blindness) and an increase in the price of alcohol. If, as a kid, I was wrong about what we would learn over 50 years, this failure to learn over the course of a century speaks poorly of human wisdom.

Isn’t it about time we looked at this Public Health epidemic from a different angle?  Shouldn’t we invest the money wasted on the “War on Drugs” into Treatment of the victims of these drugs (legal and illegal) and Prevention measures against future addiction? 

            But it’s not your fault.

            Oh, oh, I just wrote the punch line. So what’s left to write? Ah, well, the Middle, of course.

            Giddy with the joys of Spring, of my daughter, of my egg-hunting grand-daughter and of days of playing with a six year-old (made me feel – and act – like a kid), I experienced a sudden, nauseating hit in my gut. It wasn’t the jelly beans. It was the news that a political appointee in Florida had just yanked the “Health” out of Public Health. And my flight home was the next day.

            Knowing that the latest variant, Omicron BA-2, was jeopardizing the supply chain of Air Fryers and Christmas Toys (lock-down in China), and had hopped from South Africa to New England in just eight weeks, I wore my N-95. But only one third of the passengers did.

            For the other two thirds, it was like exercising “freedom” from their seat belts just before merging into the truck traffic on 99.

            I take my guidance from multiple studies and a couple of case reports in particular. Case # 1 was a man who sat thru a flight from China to Toronto and was diagnosed with Covid after he landed. They tested 25 people near him on the plane. No one was infected. He and everyone on the plane had worn masks. Case # 2 involved a couple of hairdressers in Missouri who were diagnosed. But all 140 customers they exposed during their infectious period were negative because everyone in the salon was required to mask up.

            Question # 1: what are the most accurate Public Health data points? We all know that conspiracy mongers have tried to convince us that people who were reported as Covid deaths did not die from that cause. If you swallow that, it may lead you to believe Covid is a mild disease (or a non-existent disease if you want to go that far). So let’s ignore the cause of death and just look at the numbers of deaths.

            Births and deaths are the most solid data we use in Public Health. Pretty binary. From as far back as at least 2010, Average Daily Deaths (from any cause) in the U S have fluctuated between 7,000 in summer and 9,000 in Winter. Like a baby roller coaster, up and down; up and down for over a decade. But suddenly, in 2020 and 2021, the roller coaster graph became erratic. It burst out of its seasonal pattern with spikes as high as 12,000 deaths a day. Even tho these were “All Causes” deaths – that is, no cause reported – it’s pretty clear what was responsible for these “excess deaths,” as they’re called.

            But many folks are not concerned about the possibility of death from lung failure. However, a large number of survivors – over 18 million in the U S (the exact number can’t be counted at this point) end up with Long Covid. Months of profound fatigue, shortness of breath, brain fog and / or insomnia. Investigators believe this is either persistent infection or an auto-immune syndrome where a patient’s immune system attacks the body itself. Similar to Rheumatoid Arthritis, Crohn’s Disease, Lupus and other auto-immune diseases.

            You know by now what “Pandemic” means. We’ve studied this new virus enuf so far to see that the constant parade of variants means that it’s become “Endemic” here in the U S. That is, it’ll be with us for a long time.

            So what do we do about this Public Health crisis?

1. Wear a respirator-mask in crowded, enclosed areas. And make it an N-95, not a cloth mask or paper surgical mask. Oh, and cover your nose, too.
2. Get / remain fully vaccinated. Studies from Israel and the U K show that this greatly reduces the likelihood of Long Covid. Immunity from this vaccine wanes over time, so stay boosted.

            Question # 2: What is the safest age group for humans?

            If people get thru their first year of life, the period of lowest mortality is from there to age 19.

            Then they start to drive.

            Question # 3:  what’s the leading cause of death in children aged 1 to 19 in the U. S. ?

            Not anymore. It USED TO BE motor vehicle accidents. For years. But in 2020 that changed. That year, 4357 kids were killed by firearms. That was the year when gun-related deaths first eclipsed deaths from MVA’s in that age group. 

            Know what else happened in 2020? Gun sales (per the FBI) hit an all-time high at 21 million.

            What can we do about Public Health crisis number 2?

            Lobby legislators, both local and federal, for sensible gun control laws.

            Question # 4: How many Earths do we need to maintain our current rate of resource use and destructive emissions?

            Answer: 1.75.  Obviously, more than we’ve got.

            “Earth provides enuf to satisfy everyone’s needs, but not everyone’s greed.” (Gandhi)

            There’s BIG GREED and LITTLE GREED. The Big one is corporate. The Little one is what each of us has. But both need to be dealt with because the Quality of Life on this planet is so much more important than uncontrolled economic growth.

            This requires VISION.

            “As human beings we base our conception of time on our life-span. This is unfortunate when it comes to planning for what industrialization is doing to make earth inhospitable to life in our children’s lifetimes let alone 1,000’s of years from now.” (source forgotten). 

            Many of us (me included) will be gone before it gets really bad. But do we want to take our last breaths realizing that we fiddled like Nero and left an un-fixable catastrophe of fires, droughts, floods, crop failures, new Infectious Diseases, and worse of all, possible human extinction to our kids and grandkids?

            What can we do right now about Public Health crisis # 3?

1. Lobby the politicians. Local and federal.
2. Use our feet or bicycles rather than cars when possible
3. Go solar. Don’t waste electricity (check out Ohm Connect). Insulate.
4. Move toward much more plant-based food (60% of Ag land is for grazing animals, which releases tons of methane into the atmosphere).
5. Shop locally to avoid transportation of food. Grow your own. Farmer’s Market.
6. Don’t waste food (currently 30 to 40% is wasted).
7. Adjust what you wear. The Fashion industry causes 8 to 10% of CO2 emissions. Recycle. Repair.
8. Plant trees. They eat CO2 for lunch.
9. Invest intelligently. Avoid carbon polluters.

            Question # 5: How’s the Mental Health of our descendants doing?

            “I love my students at school. But I want to be child-free. People are envious of us. We’ve had people confide and say ‘You guys are so lucky’.” (A 30-something teacher).

            Fertility rates in the U S have been falling since the mid 60’s. From 110 births per 1000 women aged 15 – 44 down to 58.3 by 2019. Counter-intuitively, they fell even more during the Covid Pandemic. 44% of non-parents say it’s unlikely that they will have children. Reasons? “Medical,” “Financial,” “State of the World” and “Climate Crisis.” (Pew Research).

            More globally, from a survey of 2100 people aged 18 to 29, done by Harvard:

1. 51% feel “down, depressed, hopeless”
2. 25% have had thoughts of self-harm
3. 56% say Climate Crisis is already impacting or will impact future decisions
4. 52% say “Democracy is “in trouble” or “failing”

            And now this: a 93 year-old veteran of International Politics recently said “We’re approaching the most dangerous point in human history.”

            When I was in Junior High, I lived in a fallout shelter. Dad obtained a lead-lined door from the Radiology Department and built a room of cement blocks in the cellar. Seemed like a natural extension from the “Duck and Cover” drills we had in grade school. I’d almost forgotten those days of cowering under our school desks until Putin declared “Any country that interferes (with his invasion) will face consequences greater than you have faced in history.”

            Big issues. And real. But we can’t ignore them. That wouldn’t help the kids. So, on top of the Public Health crisis of war (see Gazette of March 3) we have a generation with serious Mental Health issues.

            What can we do about Public Health crisis # 4?

1. Check in with the kids (and adults) to be sure they’re not hiding depression
2. Don’t dismiss signs of depression. In others, or yourself. There are specialists who can help.
3. Stay connected. In person, by phone, e-mail or even that quaint (but frequently appreciated) ink-on-paper. 
4. Stay physically active and include others.
5. Do what you’re good at.
6. Find ways to serve others.
7. Fight for Democracy. Everyone, especially the kids, must have a voice and a vote that gets counted. We can teach the kids techniques we learned in earlier struggles.

            We need to remind ourselves that these big issues are not our fault. But there’s a lot we can do to start fixing stuff.