The Adjustments: Significant Changes

aloneLet me tell you about two recent experiences that have brought about significant changes in my life. They are, in fact, caused by important changes in the lives of two friends over which they had no control. The only thing I could do was to change my behavior and adapt to the new circumstances.

I met Wanda at a local craft show shortly after returning to Carrboro from the USVI’s. Typically Wanda and I would get together once a week. We’d hang out and have lunch together. Either I’d drive up to Hillsborough or she would come down to Carrboro. After I decided to stop driving, Wanda made the weekly trip to Carrboro and after lunch she would take me to Trader Joe’s to pick up the things I needed.

One day about a month ago, while she was driving in Hillsborough she passed out at the wheel and had an accident. Luckily no one was hurt. It is not clear what caused the problem. Wanda’s driver’s license was suspended for at least six months.

With me no longer driving that really changed things. Not only were we not able to get together on a weekly basis, I could no longer take advantage of the support she has provided. That has resulted in an important change in our socialization pattern and has required me to seek help elsewhere. Moreover, I could not drive to Hillsborough to give her a hand.

I have another friend, Sarah, whom I met at the Farmers Market. Sarah is a really fine, creative craftsperson. She is her family’s principal wage earner with a full-time job on the staff of Blue Cross-Blue Shield. She has three adult children, two of whom are married. They all live in the Portland, OR area. Two have medical issues. Last year when her son developed a life-threatening condition, Sarah went out to take care of him.

When he improved she came back to the area, only to learn that her ex-husband, who lived here on the property with her, developed medical issues as well. Amazingly, she has been able to perform her job and take care of all the problems as well. What she has had to put on the back burner was her passion — her art.

Before all this happened Sarah I hung out together at the Farmers Market every Saturday. We developed a really nice relationship. Not only do we have a common interest in art and craft, we have a special way of communicating with one another. From time to time we had lunch together. When Sarah invited me to her studio I’d jump into the MINI and off I’d go.

Understandably, Sarah has been overwhelmed by what has happened and I’ve barely seen her since. A couple of times we’ve been able to hang out briefly when we were both shopping at the Market.

With both Wanda and Sarah, the things that have happened in their lives have limited our time together. They were things that none of us had any control over. Our time together was and is very important to me. It is up to me to find ways to fill the gap that opens up when the help or services they provided are no longer available.

The new, current circumstances, over which I have no control, limit my independence, freedom and flexibility. They also make it more difficult for me to take care of myself. To accommodate to the new reality I am more reliant on others and have to make arrangements for their assistance. Some of my limited disposable time, energy, resources and funds (TERF) have to be used up to accommodate to the new conditions and to compensate those who provide assistance.

The thing that bothers me the most about these situations is that I can’t do what I really want to — namely, to jump into the MINI, hang out with my friends, and give them a hand. Not driving not only makes it harder for me to get the support and services I need, but makes it harder to me to support the people I care about. All I can do is adjust to the new circumstances as best I can. Which, trust me, is more difficult as we age.

The Rash of Anti-Abortion Legislation

heart-3846613_960_720As human beings we are largely all alike, 99.9  percent of our DNA is the same.  Despite the differences in gender, sexual orientation, appearance, our skin color and the shape of our eyes and nose, etc., we have far more in common than different. Nonetheless, each of us is different. We all have different combinations of genes, skills, strengths and weaknesses, background and experiences. Those differences make it possible for us each to make a unique contribution.

There has been a recent rash of anti-abortion legislation. Some States have made it illegal to have an abortion once the fetal heartbeat can be detected, which can occur before the woman even knows that she is pregnant. Let’s take a closer look at the consequences — on the woman, the child and society — of making it illegal for a woman to have an abortion when she would elect to have one.

Regardless of the circumstances that led to the pregnancy, making it illegal for a woman to have an abortion puts her in a very difficult position. Because the decision is forced on her, this changes her life, lifestyle and her life path. It places her decision in the hands of others. She and the child bear the consequences and the burdens of the unwanted pregnancy. Typically, she receives little or no additional support or help adjust to the decision that was forced upon her. Much of the time the man, who is also responsible for the pregnancy, is not held accountable for the results of his actions.

The unwanted pregnancy also has important additional consequences. Each of us, as adults, is responsible for taking care of ourselves on a daily basis. That obviously becomes more difficult for a woman in the case of an unwanted pregnancy. That responsibility is present regardless of her age and marital status. It is even more difficult to fulfill when she is single, a teenager, or the victim of rape or incest. If she elects not to put the child up for adoption, that added burden of raising a child she didn’t plan on having, continues until both are adults. Under any of those circumstances not allowing her to have an abortion when she wants one, clearly, places an additional burden on her and the child.

Continue reading “The Rash of Anti-Abortion Legislation”

A Memo to Pro-Lifers

Rather than take an adversarial position, those who are Pro-Life could adopt a more proactive approach, one that would advance their cause. Their understanding is that life begins at conception. Consequently, from their perspective any induced abortion constitutes murder and is illegal.

It follows that the first thing to do, is to do everything possible to prevent an unwanted pregnancy. Therefore, the first step in the Pro-Life agenda would be to promote the use of contraceptives. Make all forms of them available to those women who at this stage in their lives do not want to have a child.

One important way for Pro-Life advocates to accomplish that would be to set up and fund clinics to help women (and men) who do not want to have a child to get whatever form of contraceptive they prefer and to provide the funds necessary to accomplish that objective. In that way, Pro-Lifers would significantly help. Fewer women would be placed in a position where they would choose abortion as their best option.

Since that would not prevent all unwanted pregnancies, the next step would be to provide counseling at the clinics. It would inform pregnant woman about the costs and benefits of various procedures, including one which the clinic provides: to assist her through all stages of the pregnancy and the birth and to make arrangements for the infant’s adoption once it has been successful delivered. All costs, including the support of the woman during the pregnancy, would be covered by the Pro-Life group.

The group’s objective would have been met. Once the child is born it would be placed in a family that wanted it. An induced abortion would not have happened. This Pro-Life approach would have prevented that from happening. Moreover, the pregnant woman would be less likely to be placed in a position where she would consider an abortion as her best option and she would be fully supported during her pregnancy. Along with that she would know that the child would be well taken care of. It has the additional advantage that a family that wanted and would otherwise not have a child, has one. In addition, the Pro-Life advocates were instrumental in making that happen.

It will lead to fewer women who consider abortion as their best option. Moreover, whatever time, energy, resources and funds (TERF) that the anti-abortion advocates commit to the program will further their primary objective. Furthermore, they are less likely to cause resentment and hostility and to alienate others in the process.

Should I Enter a Clinical Trial–Part Four

What to Consider Before Deciding

choiceIntervention is frequently based on the medical and public perception and assumption that doing something is better than doing nothing. That is not always the case. There are times when the net benefits of all interventions are negative — that is, anything you do will make you worse off.  Rather than starting with the underlying philosophy, “You/We should be able to do something that will fix it” begin by asking what are the likely benefits and costs of each of the alternatives. Then chose the one where the net benefits — the benefits minus the costs — are likely to be the greatest. Take no action when that provides the best results.

When the patient/consumer is not paying for the service, he/she is placed in the position of not having to consider what they are giving up when having the procedure. When that happens they are more likely to elect to have more services than they would if they had to pay for them. Historically, that goes under the name “Moral hazard”. Moreover, the prescribing practitioner and the PhysicianFirm almost always benefit from the additional revenue they receive from providing those services. Often it is someone else, like an insurance company or the government, who ends up paying the bill. Continue reading “Should I Enter a Clinical Trial–Part Four”

Should I Enter a Clinical Trial–Part Three

An Example of What Happened

We would like to provide a concrete example about the consequences of participating in a clinical trial. It is based on Amanda Bennett’s The Cost of Hope. She is a fine journalist and currently Executive Editor of Projects and Investigations at Bloomberg News. The book documents her husband, Terence Foley’s, seven year bout with kidney cancer. Initially, Foley was diagnosed with an atypical and aggressive form — collecting duct kidney cancer. It was spotted in December 2000 during the operation to remove his intestines to treat his ulcerative colitis. There were only 50 known cases of it worldwide at the time. This alone makes questionable whether his participation in the clinical trial contributes to our understanding of the potential benefits for future patients. In January 2001 when it was diagnosed, the prognosis was that he had a few months to live. [Bennett, p. 66] He died of it seven years later in December 2007. Continue reading “Should I Enter a Clinical Trial–Part Three”

Should I Enter a Clinical Trial–Part Two–The Beneficiaries

The Beneficiaries

It is at best uncertain whether you or anyone else currently in your condition will benefit from your participation in a clinical trial. If the trial is successful — and as we have mentioned earlier not all of them are — and the drug or appliance is cleared for marketing, some of those who get a similar condition in the future may benefit from it. Your participation is your legacy to them. But the important question is, “Who benefits now?” That is particularly relevant since large amounts of time, effort and money go into clinical trials. Someone must believe the investment is worthwhile. Let’s take a look at each of the stakeholders.

The stakeholders

Those conducting trials are stakeholders in it. They benefit from it. They include:

  • The doctors and other practitioners involved.
  • The organizations and institutions they are a part of and represent– the Medical Centers, Hospitals, Universities and PhysicianFirms.
  • The pharmaceutical and medical equipment companies whose products are being tested and who sponsor the trial whose self-interest is definitely connected to the success of the project.

The principal investigators — a.k.a., the lead doctors — have their reputation on the line. The study is based on their hypothesis. If the clinical trial turns out favorably, they can say, “See I was right!“ Not only is that a boost to their ego, it enhances their reputation and all that goes along with it. If successful, they get to publish the results and present the findings at national meetings. Moreover, it enables them to test out their ideas, to get funds for their projects and it increases their income as well. Those personal benefits contribute to their wanting you to participate and, perhaps, inadvertently encourage you to do so. That is particularly true when the number of possible candidates for the clinical trial is limited, and the lack of participants threatens the validity of the results or even makes it impossible to conduct the trial. In fact, the possibility of being pressured to enroll has led to the requirement that in order to participate in a clinical trial you must sign a form indicating that you are giving your informed consent. Continue reading “Should I Enter a Clinical Trial–Part Two–The Beneficiaries”

Should I Enter a Clinical Trial–Part One

I — The Issues

Clinical_trials_LGWith few exceptions, every prescription and over-the-counter (OTC) drug and medical device marketed in the U.S. has to be approved by the Food and Drug Administration (FDA) for efficacy and safety. That is where clinical trials come into play. They provide the information required for clearance.  It is critically important to realize that for any drug or device in a clinical trial it is impossible to know beforehand what the outcomes of the intervention — both favorable and unfavorable — will be. No one — not even the best informed minds — know that. That is the reason for having a clinical trial. The trial is based on an hypothesis — a.k.a,, a guess. Sometimes it is correct, sometimes not. If the outcomes, or the range within which they fall were understood, there would be no reason for the trial.

Not all clinical trials are successful. Some drugs do not even make it through Phase I (which determines if the drug is safe and the dosage levels). Others are withdrawn before they complete Phase II (which tests for efficacy and safety). They can be withdrawn because they are ineffective, unsafe or have damaging side effects or considered to be non-profitable. Still others may not offer a significant improvement over current therapy represented by the control group. Only some of the ones that get through those hurdles are ultimately cleared for marketing by the FDA.

Continue reading “Should I Enter a Clinical Trial–Part One”