Rowman & Littlefield Publishing Group

Addicted to Addictions

By David J. Ley

A few weeks ago, a woman came up to me after a presentation I had given, on why I believed sex addiction was a dangerous myth. She was in tears, as she told me about her son whom she had lost about a decade ago to the ravages of alcoholism. She told me that near the end of his life, her son was in a very expensive private-pay treatment facility, and called her up to ask if he had ever been sexually abused.

As this mother told me this story, and disclosed this part, a look of anguish creased her face. “I told him that I didn’t think he ever was, and he told me that at the facility, therapists had told him that not only was he an alcoholic, but that he was a sex addict as well. And that his sex addiction must have come from being sexually abused.”

The lady’s son sadly died a few weeks after that, from complications related to his severe substance abuse. For a decade, this poor woman has lived with tremendous fear and guilt, guilt that her son might have been sexually abused, something she didn’t prevent, or even know about. She was anguished that the unknown abuse, and her apparent unknowing neglect, might  have contributed to her son’s tragic life and loss.

I was the first person this woman ever heard, who said that sex addiction was a myth, a moralizing and unsubstantiated label that people throw around callously and casually. I gave her some peace, she told me, because for the first time in a decade, she could see that her son probably hadn’t been abused, and wasn’t addicted to sex. These therapists were merely riding the train of sex addiction, throwing that diagnosis at anything they could lasso with it, regardless of the consequences. If they could convince her son that he wasn’t just an alcoholic, but a sex addict too, what did they get out of it? Who knows? Maybe money. Or maybe they just saw every problem in the young man’s life as a form of addiction, and threw that label around to impress themselves.

A few decades or so ago, therapists believed they could recover memories of abuse, uncover buried memories of sexual, physical and even satanic abuse, in their patients. Because they saw symptoms they thought were related to a history of abuse, it didn’t matter that the patient said “Hey, I wasn’t ever abused.” But it turned out the patients were right and the therapists wrong. Lives were ruined, people went to jail and families were devastated because of the therapist’s well-intended arrogance.

They thought they were helping. But hundreds of lawsuits and settlements have now shown that those therapists hurt people. The myth of sex addiction hurts people too. This is why I’m challenging it every chance I can get. To demand that these therapists be responsible with the power they wield over people’s lives and fears.

David J. Ley is a clinical psychologist in practice in Albuquerque, New Mexico. He provides clinical and consultative services in numerous other states. Dr. Ley currently serves as Executive Director of a large outpatient behavioral health agency in Albuquerque and maintains a current caseload of clients. He is the author of The Myth of Sex Addiction and   Insatiable Wives: Women Who Stray and the Men Who Love Them.

Religious Freedom and the Obama Contraceptive Mandate

By Stephen V. Monsma

An on-going controversy concerns the Obama administration’s attempt to mandate that under the new Affordable Care Act employers’ health insurance plans must include contraceptive coverage.  And contraceptive coverage is defined broadly enough to include sterilization procedures and what some consider abortifacients.  This has aroused the strong opposition of the Catholic Church—which has long opposed artificial birth control as a violation of its religious beliefs—and some evangelical Protestant groups, largely on the basis of the inclusion of what they consider abortifacients. 

Those who oppose the contraceptive mandate are claiming their religious freedom rights are being violated, since the mandate would require them to act in violation of their deeply-held religious beliefs.  Others claim that this a public health issue, not a religious freedom issue, since  assuring that contraceptives are readily available will protect women from unwanted pregnancies and reduce the number of abortions.  As a recent columnist in the New York Times wrote, “[T]he provision of preventive services without a co-pay does not interfere with a religious practice or ceremony.” 

This controversy—which has generated much heat and is likely to continue to do so throughout this election year—largely turns on one’s understanding of what constitutes a religious organization or a religious practice.   We all cringe at the thought of a government edict telling St. Patrick’s Cathedral in New York how it is to celebrate the mass or who may or may not officiate at the mass.  We all recognize this would be a violation of the religious freedom rights we all hold dear.  The organization in this example (St. Patrick’s Cathedral) is clearly accepted by all as a religious organization and the practice (the celebration of the mass) as a religious practice. 

 But this agreement breaks down and the controversy explodes when the organization is not a religious congregation in the traditional sense and the practice does not involve a religious ritual or ceremony.  What about a nonprofit spouse abuse program that was begun by an evangelical Protestant church, is still largely supported by church members, and explicitly states that it is providing services in obedience to Jesus Christ and in his name?  Is it a religious organization?  And are the volunteers and staff who counsel with and offer help to women who have been abused and preyed upon engaging in a religious act? Or what about a Catholic college that takes its religious commitment seriously and seeks to understand the world within the context of historic Catholic thought and reflection?  Is it a religious organization?  And is a professor who seeks to apply Catholic social teaching in her sociology course engaged in a religious act?

As I explain in my book, Pluralism and Freedom: Faith-Based Organizations in a Democratic Society, for historic reasons Americans, and especially the educated elite, tend to exclude as religious organizations and religious practices organizations and practices outside of religious congregations and their core religious rituals and ceremonies.  But such a narrow view of religion is untenable.  It is inaccurate to say that when the Rev. Martin Luther King, Jr., led African American demonstrators out of their churches and into the streets in defense of racial justice he changed from a religious leader to a secular leader.  An official statement the National Association of Evangelicals testifies to its belief that its faith not only encompasses acts of love and mercy but demands them: “Jesus said that those who do not care for the needy and the imprisoned will depart eternally from the living God.”  The nature of religion as extending beyond the confines of church and synagogue was clearly summarized by Robert Bellah and his associates in their classic, Habits of the Heart, when they wrote:  “Yet religion, and certainly biblical religion, is concerned with the whole of life—with social, economic, and political matters as well as with private and personal ones.” 

To me, this means that when a governmental edict clashes with faith-based organizations’ thought-out, long-held, religiously-based beliefs and practices, our public policies should do all they can to accommodate those beliefs and practices.  This is what protects the pluralism and diversity to which we as a society claim to aspire.

Coming back to the current controversy over the contraceptive mandate, this means no church should seek to force its view of contraceptives onto all of society; no government mandate should seek to force faith-based organizations to provide contraceptives in violation of their religious beliefs.  Religious liberty and religious freedom rights are indeed at stake here.  We as a people have long lived together with our deepest differences by each group respecting those with whom it does not agree and allowing them, to the fullest extent possible in keeping with public health and safety, to follow their beliefs.  My book mentioned earlier suggests that we need to renew this commitment and broaden it to include the host of educational, health, and social service faith-based organizations that continue to contribute much to our life together.

 

About the author:

Stephen V. Monsma is a senior research fellow at the Henry Institute at Calvin College and professor of political science emeritus at Pepperdine University. He is the author of numerous works for faith-based organizations and church and state relations, including Faith, Hope, and Jobs and Putting Faith in Partnerships.

DUST: the Inside Story of Its Role in the September 11th Aftermath

By Paul J. Lioy

Memorial Day 2011 has just passed, and during the Spring of 2011 another page in the fight against terrorism and the need to be prepared for the unknown. Tom Kean, who has commented widely about preparedness, is still correct because even with the death of Osama Bin Laden threats remain high against our country’s people and infrastructure, and his words should be a reminder that being prepared for terrorist events is an important part of our country’s responsibility to protect and defend. The 10th Anniversary of the deadly attacks on the WTC, United flight 93, and the Pentagon is also just around the corner. They will be solemn occasions that will provide an opportunity to educate those who were too young to remember or are part of the next generation. Since the publication of Dust: the Inside Story of Its role in Role in the September 11th Aftermath, I have talked to many individuals and groups, and recorded interviews, about the reasons for writing the book. In my discussions, it became clear that people wanted to know how the results of our analyses of the dust were used to understand exposure and health response relationships. In reviewing what has been written since publication of my book, the actual health effects experienced by the workers/volunteers remain highly correlated with the time of a person’s arrival at Ground Zero, and whether or not he or she was wearing a respirator during their completion of Ground Zero related activities over time. Based upon all my conversations with physicians and other environmental health professionals, my hypotheses remain consistent: the unknown or unquantifiable gases released during the jet fuel fires were part of the etiology of the diseases derived from the aerosol that contained the WTC Dust and inhaled by the workers/volunteers during the first days after the collapse of the towers. However, they cannot be realistically reconstructed in toxicological tests because they would have to include both the WTC Dust and combustion gases released by “uncontrolled” fires caused by the burning jet fuel.

The reader response to other important aspects of my story has come as sort of a surprise. Many were associated with the content of Chapter 12 which deals with the lessons learned and the lessons that still need to be learned from 9-11. These are linked specifically to the 5 Rs + 1: Rescue, Re-entry, Recovery, Restoration and Rehabitation. The Plus 1 is Resilience. Because of the natural events that have occurred since 9-11 (e.g. earthquake and Tsunami in Japan), and military actions overseas, I have had opportunities to describe the levels of completion or success using the 5 Rs for some of those incidents. As a member of the general public you can use my 5Rs to grade us all on the actions and the outcomes of those actions that can and do occur in natural and terrorist events.

Paul J. Lioy is a Professor and Vice Chair, Department of Environmental and Occupational Medicine at UMDNJ-Robert Wood Johnson Medical School. He is Deputy Director for Government Relations and Director of Exposure Science at the Environmental and Occupational Health Sciences Institute of Rutgers University and RWJMS-UMDNJ. Dr. Lioy is the author of Dust: The Inside Story of its Role in the September 11th Aftermath.

Relapse Prevention: It’s The “How” That Counts

By Deborah Serani

A recent study from the University of Toronto suggests how you process information determines if you’re at risk for a depressive relapse. More specifically, researchers learned via the use of fMRI technology that how the brain responded to a sad event was a predicting factor.

In this study, depressed participants were shown a series of sad clips of movies. Individuals who ruminated about the sadness they experienced fell into another depressive state as opposed to those who were able to feel and accept their emotional experience. It’s been long-known that patterns of negative thinking put a person’s mental health at risk. Like treading water, negative thinking gets you nowhere fast, leaves you fatigued and overwhelmed. Before you know it, you’re unable to problem-solve, and depression sets in. In this study, individuals who experienced the depth of their sadness and accepted the limits &/or hardships continued with their recovery intact. So, when it comes to keeping your depression from relapsing, it’s all about “how” you move through your experiences.

Taking the “how” to a scientific level, fMRI data showed that frontal brain activity resulted in ruminating behavior whereas brain activity in the rear part of the brain signaled acceptance. This is of great interest not only to researchers, but also to therapists who specialize in depression treatment. This study supports the aims of psychotherapy and medication, where interrupting a negative rumination style is the targeted goal of treatment. For those who live with depression, learning how to problem-solve, visualize and work toward acceptance of what one can change and what one cannot, can help inoculate against relapse.

“Part of what makes depression such a devastating disease is the high rate of relapse,” says Norman Farb, a PhD psychology student and lead researcher. “This study suggests that there are important differences in how formerly depressed people respond to emotional challenges that predict future well-being.”

Reference:

Farb, N.A.; Anderson, A.K.; Bloch, R.T. & Segal, Z.V. (2011). Mood-linked responses in medial prefrontal cortex predict relapse in patients with recurrent unipolar depression. Biological Psychiatry, DOI: 10.1016/j.biopsych.2011.03.009

Deborah Serani is a psychologist in private practice in New York and the author of Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing.

Shopping for an Organ Transplant?: The Pitfalls of Medical Tourism

By Katrina A. Bramstedt

In the US, thousands of patients are waiting for a kidney or liver transplant. Sometimes, they get so desperate, they contemplate traveling to a foreign country to buy an organ. In their desperation, patients often don’t think about the pitfalls and ethical problems of organ tourism, and there are many. Some organs are known to come from prisoners who did not give informed consent. Some organs are taken from women who are forced by their husbands to “donate” a kidney or liver tissue to pay a debt. Is this the setting for ethical medical care?

Other problems with organ tourism are issues such as the lack of medical records, or records which are written in a foreign language and unhelpful upon return to the US. Organs are sometimes also contaminated with viruses such as HIV and hepatitis. And what about these medical complications? Who pays for the treatment? What if there is malpractice? Can the patient obtain any recourse? The complexity of organ tourism is immense, clinically, ethically, and legally. So is there another option for patients who need a kidney or liver transplant?

Enter the Good Samaritan. These are people, right here in USA, who are ready and willing to give an organ to a stranger. They have no goal other than “to help”. Their organ gifts are “no strings attached” and often, they never even meet the person who receives their organ. For the Good Samaritan, all that matters is that they have something extra and they want to share it with someone who needs it. In the new book, The Organ Donor Experience: Good Samaritans and the Meaning of Altruism, 22 donors were extensively studied to learn their personalities and motivations for organ donation. In general, these givers are normal, everyday folk, of average means, with a genuine desire to serve their community. Often, they have a lengthy history of volunteerism and their parents did as well. They originate from all fields, law, law enforcement, health care, education, you-name-it. A Good Samaritan could be your neighbor down the street, the clerk at the grocery store, a local taxi driver, or even your bank teller. These people want to give, and with medical, surgical, and psychosocial screenings, they can be lifesavers.

References:

• Bramstedt K.A., Xu J. Checklist: passport, plane ticket, organ transplant. Am J Transplant. 2007 Jul;7(7):1698-701.
• Bramstedt K.A. Ethical minefields in medical tourism. Sonoma Medicine 2011.
• Bramstedt K.A. Steering clear of organ tourism. Kidney Review 2007.

Dr. Katrina A. Bramstedt is a noted medical ethicist associated with California Transplant Donor Network in Oakland, California. She also has a private practice in Marin County where she has performed over 800 ethics consultations and published over 75 articles in medical and bioethics journals. She lectures nationally and internationally and has made numerous appearances on television and radio discussing transplantation and donation. She is the co-author of The Organ Donor Experience: Good Samaritans and the Meaning of Altruism.

Mental Illness Does Not Erase Your Dreams: The Little Metal Box

By Randye Kaye (parts first published on Ben Behind His Voices blog)

Mental illness makes news. Usually sensational news. CNN reports that Jared Lee Loughner is unfit to stand trial. Last month, Catherine Zeta-Jones spoke openly about her bipolar diagnosis. Charlie Sheen? Anybody’s guess. (But I say: get that man into treatment, stat!)

But what about the people who don’t make the news? What about the large proportion of consumers who are managing their lives somehow, or trying to, without shooting anyone or landing on the cover of People? Those who have been diagnosed with mental illness deserve respect - and help. Their courage is enormous, the obstacles often beyond comprehension for those who don't understand.

My son, Ben, earned another six college credits this semester, and is still on the Dean's list. Plus - in the past two months - a new job, and a move to his own small apartment. All this after seven hospitalizations, seven years in a group home, eight years unemployed. Amazing! He's getting his life back in small steps. But there’s no news coverage for people like Ben.

Why did it take so long? Ben has paranoid schizophrenia. That kind of messes up your path to maturity. Never, never compare his progress to someone else his age whose brain functions without illness. There are other yardsticks to use.

Ben spent lots of time dealing with an illness whose onset confused us all, and then lots of time learning to recover. He’s still learning to recover. But years ago, when all was in confusion and chaos, he’d still had dreams, which he wrote down and kept in a little metal box. I discovered these seven years after his fifth trip to the Emergency Room for psychiatric admission.

When I cleaned out Ben’s last apartment seven years ago, I’d found a little metal box. At that time, I peeked at its contents: more scraps of paper, obviously precious enough to be stored in this place of honor. I couldn’t bring myself to open these papers then. What crazy ideas would I find written on them? He was so desperately ill, his schizophrenia so in charge of his mind at that time. I’d seen enough; I’d heard enough. I threw the box in with the rest of his “desk supplies” and stored it away with more evidence of his disastrous attempt to live on his own that year.

Recently, I rediscovered that old metal box in a storage bin in Ben’s childhood bedroom. It had originally held mints: “Organic Cinnamon Snaps! Over 100 snaps per box,” reads the cover. The hinges are covered in duct tape now; the picture of forests and volcanoes under the words has faded. Ben’s little treasure box, now seven years old.

I open it. Inside are pages ripped from a small spiral notebook, carefully folded to fit. I hesitate. I do – and I don’t - want to open these.

What will I find? What secrets has he kept in here? I hold the box in my hand, a key to the things my son considered sacred when he was 20 years old.

I take out the first paper and unfold it. I expect to see what I have found before in his writings from that period: grandiose ideas, poetic phrases, delusions that guide my son when his symptoms flare up.

But I’m wrong. It’s only a list of phone numbers, readable, organized. His friends, our family, his most recent employers. At the bottom of the list, the names of some old friends – from high school days – with no numbers listed.

People he hoped to get in touch with again, I think. I’d almost forgotten how many friends he used to have. So many friends. Would they even talk to him now?

I open the next paper. It’s another list, with “Stuff” written across the top, then: candles, lawn chair, blank tapes, phone card, origami paper. The list goes on; it’s a “want” list, or a shopping list. Things he’d like to have for his birthday, perhaps. The simplicity of these small desires touches me.

The next sheet is a to-do list. Again, the handwriting is legible and the columns organized. There are about seventy-five items on this list. Most are written in blue ink, a few in green, black or red. I stare at this for a long time.

Among the plans he’d made:

• Write letters (with a list of over twenty people, including me, Ali, other family, old friends, our rabbi, his old therapist – what had he wanted to say?)
• Write play
• Write animal language dictionary
• Make gifts: Mom pillow, Dream Catchers, Ali cookbook (for his sister)
• Compose college essay
• Build a drum
• Make chess set

More lists: movies he wanted to see, videos he wanted to rent, books he wanted to read, CDs he wanted to buy.

I’d almost forgotten that he used to have dreams. So many dreams, such simple ones. Any dreams at all. It’s not fair! He had all of these plans. Will he ever get to do them?

At the bottom of the pile is a last piece of folded paper. This one is messier, but I can still read what it says. It is full of quotes, ideas, and plans that are more internal. Written here are ideals Ben wants to live by, almost like New Year’s Resolutions:

• Listen a lot.
• Blow nothing up out of proportion.
• Simplify, don’t be hypersensitive.
• Don’t judge people.
• Don’t use your muscles, use your mind.
• Don’t use big words.
• Think before I speak or act.
• Don’t try to control others, let them be.
• Reach out to people, lovingly.
• Hear and consider others’ points of view.
• …and the list continues.

I’d had no idea Ben was trying to change himself all the time I was desperately trying to change him.

Plans for his life - a life at a standstill for so many years. A life worth living; a life worth saving; a life stolen from him. Will he – will we -ever get it back? My boy, my precious boy. I know you’re still in there. Come back to us. Come back to you.

I wipe my eyes, carefully refold the papers and put them back in the little metal box. I wish I could sleep with it under my pillow, like a lost baby tooth, and have my wishes – and Ben’s – come true.

Randye Kaye is an actress, broadcaster, voice talent, and speaker. She is the author of Ben Behind His Voices: One Family's Journey from the Chaos of Schizophrenia to Hope.

Swine Flu Media Pandemic Scare: A Lesson from History?

By Debra E. Blakely

In light of the recent Swine Flu pandemic scare, several important trends emerged that demonstrate we haven’t come as far as the technology used to report it. In other words, while instant news stories popped up on major news wire services, Internet sites and social media outlets around the world, the narrative discourse, arbiters and resulting public health policies resorted to old frames created during the deadly 1918 Spanish Flu Pandemic. Even though the death rate for Swine Flu has been extremely low, and influenza is an expected annual pesky visitor, reportage reflected the same intense public anxiety as was reported when millions were actually dying during the 1918 pandemic.

Media coverage in the USA began around April 22, when Swine Flu was detected in several people in San Diego County, California. Public health officials speculated that since this was a strain that had not been seen recently, and that a vaccine was not available, health officials should be on their guard. A couple of days later, a link was made to a recent Swine Flu epidemic in Mexico, where 60 deaths had occurred, from this report news and Internet stories went viral, with thousands of stories being published, tweeted and blogged around the world. In fact, the media coverage spread faster than the actual flu!

However, Swine Flu reportage was preceded with several reasonably calm stories as early as March 28, 2009. The United News of India reported that a Swine Influenza outbreak in Mexico and the USA had been identified and declared a public health emergency of international concern by the World Health Organization. Given a gap of nearly a month between a real alarm and the media frenzy, one must ask, “How could this happen?” A logical exploration might turn out further investigation by asking: Was it the rampant use of technology that helped to fuel the explosion of Swine Flu reportage? Simply put, the answer would be yes and no. Yes, technology has definitely made it much easier for information, be it rumor or fact, to spread at rapid-viral speeds, (hence the phrase, going viral). However, it wasn’t technology, per se, that fueled the media coverage, but in fact it was the media coverage itself.

With initial media stories focusing their narratives on death rates and a virus with no vaccine, the next wave of influenza stories picked up on the analogy to the Spanish Influenza pandemic of 1918 and the 20 to 50 million deaths it caused worldwide. Stories speculated on infection rates and containment issues, and public health authorities obliged by putting into place quarantine orders and travel advisories. As infections popped up and were reported around the world, schools closed and public health officials scrambled for a vaccine. When Mexico decided to close down to contain their epidemic, the media coverage soared and business continuity plans with essential worker policies began to emerge as a new topic of conversation.

Perhaps, if reporters had made the analogical jump to the two subsequent pandemics, (the Asian Flu Pandemic of 1957 and the Hong Kong Flu Pandemic of 1968), they would have drawn more appropriate analogies, such as when deaths rates are low, and a vaccine is not available, one should focus on practical concerns, such as individual health practices and the natural course of nature. In time, and as time has shown, the virus will run its course.

While influenza remains an annual public health threat, and there is a chance that a deadly virus could possibly wreck havoc and destruction, the World Health Organization declared May 8th, that the world was better prepared to deal with an influenza pandemic. Are we, really?

Debra E. Blakely is assistant professor of communication at the University of Houston–Clear Lake and the author of Mass Mediated Disease: A Case Study Analysis of Three Flu Pandemics and Public Health Policy.

The New (and Stupid) Math of Health Care

By Carey Kriz

I just opened a letter from my health insurer and, for one of the few times in my recorded history, I actually read the fine print. To say that I am upset with the system we have created is an understatement. We have built a foundation of insider-dealing that demands a rethinking and analysis of every nail in the building.

This is what I read:

First the global charge. According to my insurer, the “price” was $296.00 for a procedure that may have taken 5 minutes of time in the clinic to perform. For those of you not part of the inner circle, a “procedure” is one of the golden nuggets of the industry and generally (and economically) means a way to make exorbitant amounts of money for doing very little. Forgetting what may have been its noble heritage, the average procedure has evolved into the financial equivalent of bank robbery. The list here is big and getting bigger with each technical innovation we introduce to make the system better adding costs to an already overly-expensive business.

Next came the strange part – what the insurance company had agreed to pay, or $108.25. Talk about discounts? Imagine getting more than 60% off your bill the next time you buy a car or purchase groceries at the store. I bet Home Depot would laugh at you if you asked for it – and even the over-priced coffee chains tend to stay firm on their charges. So how did this price get set?

This is where I can help. I used to run a network of clinics and was involved in figuring out these prices for a living. Basically, you have a negotiation between the “big” insurance company and your “little” business where the group collectively sets a price that you (the clinic) can live with and they (the insurance provider) are willing to pay. This discount is what most of us in the business use to calculate how much we need to cover our costs and make some small profit. But this “pricing ” exercise and the haggling over full retail and actual charges causes problems.

The worst part is that if you do not have any insurance we, the clinics and hospitals, will charge the full rate – whatever that is and as high as it may have gone. So if you did not have the luxury of having an insurance plan you would have gotten a bill for $290.00 – not the $108.25 the insurance company wound up paying. And guess who does not have insurance and gets hit with these higher bills? The young and a whole bunch of people that are down on their luck and can’t afford to get insurance in the first place.

In my clinics we used compassion and would discount the charges from our published retail price to a more reasonable level. But we were not the norm – and were definitely not one of the large hospital systems that almost never provide this much generosity. I will never forget listening to a public discussion on this issue last year in which an “expert” hospital administrator defended these higher charges as necessary to keep the system afloat. His argument was complete hogwash but unfortunately represented the groupthink that permeates the health industry.

As someone who is also in the industry, I know the reality: we do not have to charge this higher amount to anyone ever to run a good business. It is time to stop confusing people about the charges and costs of health care – and start telling them the truth on where the money is going and what our pricing system means. The bad news is that I have little hope that the health industry will fix its own mess, given the amount of money the people and companies inside the tent are used to making.

But I do think American business, combined with some gutsy politicians, can fix it. They are ultimately the ones being hurt by this out-of-control health care industry and will eventually force a change. For this part of it, I thank God we have a pure capitalist society and are at a point where change is not a question of if but when (and probably now). And finally we have the ultimate change agent – you and me.

It’s time to let our neighbors and friends know we have a problem with how our economy prices health care services and that an increasing number of our fellow citizens are being hurt by our silence. Given the chance, Americans are the most compassionate people on the planet – and the most resourceful.

I can’t wait for them to rise to this occasion. Is anyone in the health care industry listening? They better pay attention to this dialog.

Carey Kriz is the author of The Patient Will See You Now: How Advances in Science, Medicine, and Technology Will Lead to a Personalized Health Care System (Rowman & Littlefield).

Where Did the Compassion of Health Care Go?

by Carey Kriz

Anna is an 87-year-old woman, living with her husband in a Boston suburb. She has lived in the same house for more than sixty years with the only husband she has ever known. Her town is in one of those places that reminds you of the 1950s stories of neighbors that know each other and help each other when needed.
But one part of her life is definitely in the twenty-first century. It is how she is treated by our health care system.

The story for Anna started about nine months ago. It was then that Anna’s husband was diagnosed with a severe form of stomach cancer. His life, and hers, became a series of doctor visits, hospital stays, and treatments that spanned from surgery to chemical therapies. Stomach cancer is a sometimes painful and often deadly disease.

And when it became the worst—which was when I went to visit her last week—she had a husband that was dying in their home, and Anna had the new job of taking care of him. Anna was told that she would be the one giving her husband of over sixty years his daily injections of medications with names she couldn’t pronounce. She had used her allotment of home health care visits and was now on her own according to her health care “benefits” coordinator.

Anna is 87, has never had medical training, and has never given a shot to anyone. She is also getting more confused every day, which is something you would expect given her age and the loss she knows is about to happen.

It is a tough thing to lose a partner of over sixty years. It is even tougher knowing that you are being asked to take on a job that you don’t understand. How do you become a doctor or nurse in one day?

While her husband is a victim of disease, Anna is victim of a system that has turned medicine into a business. Today we measure our health care system by percentages, dollar amounts, and reimbursement rates. If you have commercial insurance, you can expect to see one set of care providers and be allowed to take another set of drugs. If you come into a hospital with Medicaid or without insurance, God help you. Be prepared for heartaches, crummy service, and possible bankruptcy.

We have a mess of contradictions and inequities. Where did the compassion go?

Maybe it saves money. Having a nurse or other health care professional visit Anna’s house would have cost money. So having someone visit her husband and helping him manage these last days of his life would add more dollars to a system that everyone knows has gotten overly expensive.

Maybe it moves responsibility back to the family. If you and I were forced to manage the health care mess we created, maybe we would have better health habits and take better care of ourselves. Anna should, with this thinking, be prepared to care for someone close to her.

But something is wrong with this story. Why do we seem to forget that health care is ultimately about human relationships? Taking care of people should mean exactly that—helping them when they are down or lost or sad or can’t take care of themselves.

Medicine should not be a business that asks an 87-year-old woman to become a health care provider for a dying husband. In this era of unending complexity and anywhere/anytime information, the calling of medicine is in danger of losing its heart and soul.

It’s time to take control of the system again. Know where we can find some good leaders?

Carey Kriz is the author of The Patient Will See You Now: How Advances in Science, Medicine, and Technology Will Lead to a Personalized Health Care System (Rowman & Littlefield).