Sex, Drugs, and Public Health

February 27, 2018

N R A vs Public Health (again)

Filed under: Uncategorized — cbmosher @ 11:12 am




There’s a reason that NRA-purchased politicians don’t want CDC to gather data on gun-related deaths. Doesn’t take a genius to figure it out. (see prior post, below). But there IS data on this Public Health epidemic. And that data points us toward WHAT WILL WORK as Treatment for this lethal disease.


Yes, gun-related deaths IS a disease. And the patient is the community – i.e. US. In Public Health, the Physical Examination is DATA and Treatment is PREVENTION. I assume that you are doing what I am – talking / confronting gun-loving friends and acquaintances. Thought I’d share some talking points.


DATA (the Physical Exam)


  1. Our patient (the U.S.) has a higher gun-related death rate (10.2 per 100,000) than Canada, Japan, Australia, South Korea and at least 19 European countries (they range from 4.8 to 0 per 100,000).


  1. Our patient has a higher number of mass shootings than those countries.


  1. Our patient has a higher Gun Density rate (89 guns per 100 people) than those same countries (range 46 to 1 / 100).


  1. Gun Laws in these countries vary, but are stricter than in the U.S. Canada, for example, has three categories of guns: Nonrestricted (e.g. hunting guns); Restricted (e.g. handguns); and Prohibited (automatic weapons).


  1. Within the U S, States that have stricter Gun Laws have lower rates of gun-related deaths. Examples: Hawaii, Mass, N Y, Conn all have laws on background checks, permits, difficult concealed weapon permitting, and no “stand your ground” laws. Their death rates range from 2.5 to 4.3 per 100,000. Arkansas, La, Miss, Ariz, Wy have either no laws or much more lax laws. Their rates range from 16.7 to 19.8.


  1. Moreover, states with higher Gun Density rates have higher gun-related death rates, mirroring the data from other countries.


  1. “Mental illness” is present in Canada, Australia, Japan, U K and all other countries, yet gun-related death rates are not as high as here.


  1. Schools are not the only sites where shootings take place. The worst mass shootings in the U.S. in the last 20 years took place in theatres, army bases, offices, churches, universities, nightclubs and outdoor music events. Moreover, 98 % of all gun deaths are NOT Mass Shootings. They are suicides, individual homicides, and accidental shootings (sometimes involving small children).


  1. Re Arming Teachers – Two points: Reagan was shot while surrounded by armed Secret Service guys; there WAS an armed officer on campus in Parkland, Fla. I could find no data on the efficacy of this policy.


  1. Re “taking away our rifles,” an AR-15 or AK-47 is NOT for sport. Here’s how a Florida physician described the injuries in Parkland:


                        I was looking at a CT scan of one of the victims of the shooting at Marjory Stoneman Douglas High School, who had been brought to the trauma center during my call shift. The organ looked like an overripe melon smashed by a sledgehammer, with extensive bleeding. How could a gunshot wound have caused this much damage?

….Routine handgun injuries leave entry and exit wounds and linear tracks through the victim’s body that are roughly the size of the bullet. If the bullet does not directly hit something crucial like the heart or the aorta, and they do not bleed to death before being transported to our care at a trauma center, chances are, we can save the victim. The bullets fired by an AR-15 are different; they travel at higher velocity and are far more lethal. The damage they cause is a function of the energy they impart as they pass through the body. 



  1. The N R A – originally founded in 1871 to promote marksmanship and safety, it was hijacked in 1975, becoming an intolerant vehicle for bullying politicians and citizens with a black vs. white vision of its one single cause: covering for gun manufacturers as they sell more guns. It’s become a fundamentalist Taliban-style crusade.




  1. The Second Amendment – you should really read it. It is only one sentence. Written in 1791 (no automatic weapons then) and (erroneously) interpreted by the Supreme Court in 2008. It clearly refers to “militia.”  Today, that is the military. Some have pointed out that it also refers to “the State” rather than “the Nation,” implying its purpose was to control slaves in the South.



TAKE AWAYS (the Diagnosis)


  1. Gun Density is a major risk factor for a high gun-related death rate.


  1. Easy Gun Acquisition is also a risk factor. Strict laws are associated with lower death rates.


  1. Being in school is not a risk factor (less than 1 % of all gun deaths). Therefore, turning schools into virtual prisons will not stop the vast majority of shooting deaths.


  1. Mental Illness afflicts non-shooting populations world-wide, independent of gun deaths.


  1. Mass shooting deaths (even high-profile ones involving White kids) constitute only 2 % of gun-related deaths in U.S.


  1. Automatic / military style weapons ARE a MAJOR risk factor for mass shooting deaths.



PREVENTION   (the Treatment)


  1. Ban all automatic, semi-automatic (military style) weapons and devices which allow a weapon to fire multiple rounds quickly.


  1. Any politician-proposed action short of the above should be rejected as B S. This includes minor tweaking of background checks, raising the age to purchase guns and automatic / military style weapons, token increases in Mental Health funding. These are distractions, meant to quiet the outrage, with no data to support their effectiveness.


  1. Treat any politician-proposed action which is not objected to by the NRA as B S.


  1. If our current elected representatives won’t do it, elect politicians who will.


  1. Push voter registration of 17 year-olds. They’ll be electing new representatives soon.


  1. Lobby congress to direct the CDC to gather data and report annually on this epidemic. Repeal of the Dickey amendment needed.


  1. Treat the N R A for what it has become – a cover for the gun manufacturing industry (interesting read here about the man and the company that built the Parkland weapon) and an organized corruption machine which purchases our elected officials who sacrifice us for gun manufacturer profits. Pressure Amazon, Apple and other companies associated with the N R A to divorce themselves from this lethal parasite in the body of our patient – the people of the U.S.A.


  1. After achieving the above, move on to address the 98% of gun deaths which are not high-profile mass shootings.


  1. Sometime in the future, bring the Second Amendment back to the Supremes for another interpretation.



As a Public Health professional, a gun owner and a former member of the N R A, I’ve had enough. Even my gun-loving, hunter – buddy has admitted that there is no sporting use for automatic weapons.


The kids of Parkland are trying to ignite a movement like ours in the 1960’s that pushed back against an immoral war, disenfranchisement of Blacks at the voting booth, and the treatment of women as second class citizens. We know this scene. They will be attacked for their activism, just as we were. We need to have their backs. To rescue our kids and grandkids from this epidemic.








February 17, 2018

Public Health and the N R A

Filed under: Uncategorized — cbmosher @ 6:03 am

Filed under: Uncategorized — cbmosher @ 10:07 am Edit This

(Re-posted from July, 2016)


Well, they did it again.

Thursday (July 7) some Democratic and Independent congresspeople tried to get the Dickey amendment language removed from the 2017 Health spending budget. This would have allowed the CDC to fund research on firearm injury and death, so that we could have solid facts on this Public Health epidemic.

Dickey himself has reversed his position on his own eponymous amendment of 1996 and recommends that we allow the CDC to study this Public Health issue (see previous BLOG of June 19). But NRA-influenced congresspersons killed that effort. And, as more Americans are also killed, accurate data – also known as the truth – will be withheld from us all.



The horrific killings in Baton Rouge, Falcon Heights and Dallas this week scream from the headlines, skewing – again – our picture of gun violence. These high-profile killings, which are a symptom of something badly diseased in the body of our society, are not the only killings from guns that we suffer.

There are also incidents like Texas mom Christy Sheats gunning down her own daughters. Sheats is alleged to have written on her Facebook page: “it would be horribly tragic if my ability to protect myself or my family were to be taken away, but that’s exactly what Democrats are determined to do by banning semi-automatic handguns.”

This pre-Dallas (Houston area) tragedy is a stark example reinforcing the findings of the now-classic 1993 Public Health study which showed that households with firearms actually experience MORE homicides than gun-free households (see previous BLOG and original article for details).

That was the study that triggered the Dickey amendment.

Aside from the death statistics related to guns (mortality rates), there’s the issue of non-fatal serious injury (morbidity). In the absence of CDC compiled data, we still have some idea of the scope of this issue. From 2010 through 2013, an average of 76,164 people went to hospitals annually for treatment of gunshot injuries. That’s 208 seriously injured people each day, more than eight every hour.

That, folks, is an epidemic.



If killings and injuries are the SYMPTOMS of this disease in the body of our society, how is the body’s “immune system” responding? Of course, our individual bodies’ immune systems are defenseless against bullets, but society’s body has responded:

1. congressfolks who profit from lobbying by the NRA have responded by maintaining the Dickey amendment, in hopes of keeping us in the dark about this epidemic;

2. investors in gun manufacturing have responded by profiting from the value of firearm stocks. In the few hours between stock market close on Thursday and the opening bell on Friday, the Dallas shooting occurred. Friday morning, Smith and Wesson stock and Ruger stock both INCREASED by 3 to 5%.

If that’s society’s immune system at work, we need a new immune system.

Skewed impressions about gun violence – which are produced in this data void of the Dickey amendment – lead us to react with overheated emotion, anger, and finger-pointing. Almost always, in my experience, fingers point away from the true cause of the disease under these circumstances.

If we want to do something that may actually work (because it’s based on logic and reason, not emotion), we need to utilize the same problem-solving process we use in Medicine every time we see a patient:

1. Examine the patient (in Public Health, we need accurate data to do this)

2. Diagnose the disease (for P.H., it’s a community-wide disease, not just one individual)

3. Treat the disease (P.H.’s main treatment is Prevention).

But we’re not doing that. So, on the day that headlines scream “First Death from Zika in the U.S. !!!” there were (an estimated) 208 serious injuries and 82 deaths from firearms.

You know what to do.


References: Agency for Healthcare Research and Quality, CDC, New England Journal of Medicine, Daily Kos, New York Daily News.

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January 16, 2018

Cuba, Número Uno

Filed under: Uncategorized — cbmosher @ 7:11 am






“That Hijo de Puta Raul Castro,” blurted our dreadlocked taxi driver. “We need someone younger to lead this country.” His words of insult and passion spewed, incongruously, from a wide smile.


Everyone’s Friend, on the seat next to him, ventured “are you allowed to talk like that here in Cuba? We ” – he indicated this Invisible Observer in the backseat – “don’t want to go to jail with you.”


Taxi Man removed his hands from the wheel to adopt the position of the Cuban shrug: elbows pulled against his sides, palms outstretched, facing forward. “Como no. why not?” he laughed.


So, even before the Havana airport had receded in the taxi’s decades-old rear-view mirror, we were into politics.


Everyone’s Friend prodded him on with his chortling Spanish. Horse-drawn wooden wagons and smoke-belching motorcycles passed us on the other side of the divided highway.


“We’re a different generation,” Taxi Man continued. “The Revolution was already over when I was born. We need to elect new leaders – younger leaders. We want more freedom, a better economy.”


“Who owns this taxi?”


“Me. With the earnings, I can feed my family more than just what I buy with the ration card.”



How Capitalistic of you, I.O. thought in the back seat. A billboard filled with Che’s iconic face flowed by, flanked by tall palms and a stray horse who chewed the lush grass. But mental gymnastics attempting to link that face with Taxi entrepreneurship were interrupted by the word “Trump” from within E. F.’s effusive Spanish.


Taxi Man’s reaction was swift “Está loco ! Completely crazy,” he mixed his languages. “Obama, he was opening things up. Now this Loco comes in and, for us, it’s four more years of Bloqueo.”


He swerved his rattling taxi down city streets, avoiding small lakes that were disguising large potholes. He let us out in front of a decades-old colonial style house. Paint peeled from it, as it did from most of the neighboring buildings. Our two companions waited inside for us.



“We are poor, Taxi Man smiled his parting words to us. His white teeth glittered against his black skin. “And you can see things are crumbling. But you will be safe in the streets. We like Americans. The Bloqueo and Trump? – this is just politics.”



Cuba, Número Dos

Filed under: Uncategorized — cbmosher @ 7:10 am


Mildew gnawed at the houses. Wires overhead drooped, entangled each other, some dangling like amputated jungle vines. Tree roots heaved up fractured chunks of sidewalk. Residual puddles from yet another hurricane-driven ocean surge festered with algae in front yards, basements and flooded garages. The street had more potholes than a California freeway.


As I said, the flavor of dark and dingy.




Russians, of course, had been here. They of the Block-of-Cement school of architecture. But this was Vedado – reputed to be the snazziest neighborhood in Havana. It had been a dense forest left untouched as a barrier to pirates until the late 1800’s. Then, over the first five decades of the 1900’s, Vedado had spawned houses for the wealthy and casino-brothels for U.S.- based gangsters. This house was no decaying Russian box. It was a decaying home of some long-gone wealthy Cuban, its Art Deco exterior slowly evolving into a laboratory culture plate.




The Russian contribution to all this was their withdrawal from Cuba in 1991 leaving fewer resources for Public Works.


We’ll see if the people are as beaten down as their infrastructure.


Tita, beside her husband, welcomed us at the threshold with a broad smile and flashing Castillian eyes.


IMG_0630 (1)


Inside: tile floors, high ceilings, thick walls. What the well-to-do in Latin America demanded to combat the heat. Everything, though old, was clean. Furnishings were sparse.


Our room: two beds with sparkling clean sheets, a tiled bathroom, and the best feature – a modern air conditioner.


“Do you manage this house for the government?” the Invisible Observer asked Tita.


Her black eyes flashed. “This is my house. You are my guests. Breakfast will be ready en seguida,” she smiled.


Her son, Alberto, in white shoes, sox, pants, shirt and cap, headed to the kitchen.


He takes his role as chef seriously. Sartorially.




Our travelling partners, Dr. Robot and Flyboy, joined us for fruit, pastries and coffee. They caught us up on their previous twelve hours on the Socialist Island. Tita had directed them to a restaurant a couple of blocks away which they described as “great.”


Turns out that, seven years prior, a policy change in Cuba allowed small to medium sized self-employment enterprises like Tita’s “casa particular,” Taxi Man’s business, and paladares such as where our friends had enjoyed a dinner “as good as any in the States.” There are several hundred such categories including hairdresser and auto mechanic.




Abel, Tita’s husband, smiled as we ate, then settled into a stuffed chair to watch TV. Official news flickered, focusing on stories with very different slants from those seen in the U.S.


Still puzzled by Taxi Man’s dissent, I.O. asked Tita about her parents and the Revolution.


“I come from Camaguey,” she straightened a little with pride. “Where we speak the best lexicon in Cuba. I was born in the 1960’s – after Fidel’s conquest – but both my parents supported the Revolution. And so do I. Did you have enough to eat?”


Our tour guide knocked at the door. “Your car for the day,” she flourished her arm toward a pristine blue and white De Soto. If any of us were disappointed that it wasn’t a convertible, we kept it to ourselves. Perhaps we were too busy breathing. The air was so thick, that inhaling felt more like sucking. It was only nine A M but our shirts were soaked with sweat and our skin as sticky as chewed bubble gum.




De Soto Man had retro-fitted air conditioning into his 1950’s engine compartment. Ah-h-h. Forget convertibles.




We would learn in the coming days that several things we’d seen were not as they appeared. Many of the 1940’s and 50’s era cars no longer drank gasoline. People were subverting the T V propaganda dished out by official channels, and Alberto’s white clothing (which we would see on many others) had nothing to do with the kitchen or his role as breakfast chef.


But on this muggy De Soto-ed morning, we set off to discover historic Havana, music and the 200 year-old ghosts that haunt Cuba to this day. Even older ghosts awaited us in Cuba’s mountains.




Cuba, Número Tres

Filed under: Uncategorized — cbmosher @ 7:02 am


De Soto, a fluffed-out peacock, struts onto the Malecón. Potential mates drive by, chrome gleaming and whitewalls spinning, flaring their erogenous zones with colors both bold and pastel.

IMG_2216 copy


The Gulf splashes against the seawall, but not, at the moment, onto the street. A diorama flows by as if De Soto were a slow camera. Tour Guide Lady chats, mixing English and Spanish.


Invisible Observer: “Is this your full-time job?”


“No,” she interrupts her diorama comments. “I work at a hospital. I’m a dermatologist. Now over here you see – ”


“Wait. If you’re a physician, why do you guide tours?”


“I want for that the world sees,” she smiles, “how beautiful are the people of Cuba. Also, I need the money.”


From Vedado we cruise past Central Havana – the most color-less and run-down section of the city. Paralleling the sea, we curve slowly to the right where centuries-old fortresses guard the harbor’s entrance.



Close your eyes. See the Conquistadores in Peru surrounded by hundreds of magnificent gold sculptures. See them melt these into bricks. See them load the bricks onto their ships (well, honestly, the Conquistadores don’t do the work. The local residents such as the Inca’s people do the hard work because they love the Spanish so much that – z-z-z-t! Wrong record.)


See these gold-laden ships make their last stop here in Havana before crossing the ocean to feed the rapacious Siglo de Oro of Spain. See the English, Dutch and French pirates drooling over the gold.






“Here we have Havana Vieja,” Tour Guide Lady-Doctor announces. De Soto disgorges us onto the street. We walk. Our phones take pictures. Quickly we discover that “Old Havana” is two places: first, it is el número uno tourist trap. Also, it’s a sclerotic but dignified City of Ghosts.


First, the Tourist thing because it is the more distracting and you have to get beyond it: cheap cigars hawked in the street; three-peso “Che” coins for only $5 (worth 12 cents at the bank); Hemingway’s bar #1; cigar-smoking ladies in colonial dress available for photos and tips; The Best Mojito in Cuba! ; hawkers for restaurants; Hemingway’s bar #2; music (don’t need to hear “Guantanamera” again); The Best Mojito in World!



City of Ghosts:

           Within a couple of decades of Columbus claiming Cuba for Spain, this satellite Madrid began to grow. With the help of indigenous residents (who proved to be of “weak constitution” for slavery, and were therefore banished early to extinction) and of imported Africans, they used local materials to build streets of wood – – –



And buildings of fossil- bearing stone.




Here, gold played out quickly. They established sugar plantations on the backs of slaves.


473 miles to the east, Spain set up a second capital at Santiago. African slaves in this “oriente” region worked themselves to death growing tobacco, sugar and coffee which were sold by Spaniards and Criollos (those born in Cuba with white skin). Thus were created the two wealthy classes of Cuba: Spanish loyalist land-and-slave owners in the west (Havana) and Criollo land-and-slave owners predominantly in the oriente east. Also was born the far more populous Poor class that worked the flat valleys.




Remember this geography. It will haunt Cuba over four centuries.


Cuba’s Tea Party:

So, while feisty white-skinned English speakers started a revolution in “The Colonies” 90 miles north, feisty white-skinned Spanish speakers on the island revolted against Spain’s Tobacco Levy. Common cause trade between the two colonies began, and grew both economies. Sugar, coffee, slaves.


By 1841 there were 1.5 million African slaves in Cuba. On a subsequent visit to the sugar fields, a Cuban woman showed us around a long-deserted mansion and plantation. “Only men were kept here,” she synopsized her own ancestry. “Their life expectancy was 25 years. Women were kept on breeding farms somewhere else.”


She also gave us a dramatic insight into post-Revolution Cuba. But that’s for later.


Two things Latin America has in abundance are statues of long-dead people and various public streets and parks named for long-dead people. Ghosts whose faces you can see and names you can hear.


Ghost # 1:



This is Céspedes. “Father of the Country.” He owned a plantation in the east. Got tired of the Spaniards telling him (and other Criollos) what to do. Of course, he told his slaves what to do, but that was different.

He was different. In the same decade that the U.S. proclaimed the Emancipation of its slaves, Céspedes freed his own slaves and started a revolution. Somewhat successful for a while. Got himself installed as president of the country. Spain didn’t recognize him, but it recognized his son, Oscar. They captured Oscar.

Here’s the deal, Spain said (probably with that annoying lisp). Renounth your prethidency and your thon retunth to you. Famously, mythically, Céspedes is reputed to have said “I do not have just one son. All Cubans are my children.”

At this point in the story you hear a fusillade of executioners’ rifles.



Invisible Ghosts:

There are no statues of slaves. Shocker.

There were to be many slave rebellions, however, in addition to the repeated attempts at revolution against the European colonizer (Spain) by Criollo patriots.



Ghost # 2:

Replica of the statue of Jose Marti arrives in Havana


Name is Martí. This guy lived for a while in the U.S. – Cuba’s major trading partner. Somewhere between Cuba and the U.S. he caught independence fever in 1892 and formed the Cuban Revolutionary party.

Martí’s rebels brought Revolutionary War from the oriente (see the geographical pattern?) right into Havana. Spain was pissed. And militarily stronger. It launched a “War of Extermination” and drove the rebels back to the east. But Martí’s writings inspired many, right down to the 1950’s.



Ghost # 3:



Battleship Maine. No photos; it sunk. U.S. excuse for intervention into the Cuban War for Independence. America destroyed the Spanish fleet and got control of Cuba. Also, took ownership of Puerto Rico, the Philippines, and Guam.



Skipping details, next comes a period of U.S. military occupation, a new Cuban constitution with an amendment demanded by the U.S. allowing us to intervene in Cuban affairs at will, a series of corrupt presidents, large sugar companies displacing Cuban farmers, and another uprising by Blacks and Mulattos.


The pattern of a handful of rich dudes and millions of poor, continues into the twentieth century.


Ghost # 4:

Remember Vedado? It grew during the Boom Era of sumptuous homes built along the Malecón in the 1920’s by U.S. capitalists (they controlled 70% of Cuba’s sugar and much of its infrastructure), by corrupt Cuban politicians, and by colorful gangsters like Meyer Lansky who built hotels, casinos and prostitution rings.




Here’s a Cuban description of those halcyon days, translated by someone with a poetic eye but a tenuous grasp of English: for thousands nine hundreds were built great villas, amazing and rich palaces – – – and new population nuclei formed thus fashionable. Very beaten to the sea it receives from this all his light and magic. Along the Malecón you enjoy near the sea how the sun is lost in the water after the horizon – – – the progressive light dimming.


The 20’s, 30’s and 40’s were lots of fun for American tourists. Wonder if Jay Gatsby still haunts the opulent halls of the gangster-era Hotel Nacional?


The 1920’s also brings the birth of the University Student Movement. Restless, naïve kids fighting injustice. Oh, oh.


Ghost # 5:



Fulgencio Batista. Military dictator who undermined an uprising by soldiers, students, and workers. And who took over, by military coup, the government in the wealthy post-WW II era. Supported by the U.S. which was, as usual, protecting its financial interests.


Out of these University student movements comes, in 1953, a young lawyer. Name is Fidel, of whom we’ll hear more –

               Hey! What’s this?



His wife and daughter wait as Carburetor Man does a re-build on the street. He and wife are perfectly happy to allow a photo. Their teenager daughter sits in the back seat displaying an age-appropriate sulk.



During the entire morning we’ve seen no police and no signs of street-living Homeless.

I. O. turns to Tour Guide / Dermatologist: “Does the government keep the Homeless off the streets in tourist zones?” he inquires, thinking Santa Barbara or Miami.


She stops walking Havana Vieja to explain in English for us. “In the evenings, comes through Social Workers. Anyone they discover with no dinner or bed they offer a place to sleep and a few pesos for ration-card food. To those people with mental illness, they offer care. If they refuse, at least they get food.”


“So, they can get medical care?”


“Everyone can get medical care. No cost.”


I. O. has heard about this for years. But how is the quality? “Please, I would like to see a clinic, a Centro de Salúd. I would like to speak with physicians, if it is allowed.”


“Of course,” our Dermatologist smiles. “I will arrange it.”


We finish the day, back in Vedado, enjoying how the sun, all his light and magic, is lost in the water, after the horizon, the progressive light dimming.



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