frequently asked questions about dr leigh’s belief system

By | February 2, 2010

Q: Does Dr Leigh believe in shots?

A: Dr Leigh believes that shots exist. She is sympathetic to folks who are leery about them. She does get shots herself. She can’t afford to buy them or give them.

Q: Does Dr Leigh believe in fibromyalgia?

A: Dr Leigh believes that fibromyalgia exists, helps care for many folks with it, and hopes it will soon have a better name. She would propose bringing back the term “neurasthenia” which is rather elegant. See also Dr Leigh’s campaign to rename another chronic illness at this link.

Q: Does Dr Leigh believe in mammograms?

A: Dr Leigh believes that mammograms exist. She is somewhat conservative about screening tests in general, and likes to closely assess a person’s risk factors, and carefully delineate what would happen in the event of a positive or negative test, before embarking. She can tell you a funny story about how she came to take this approach.

Q: Does Dr Leigh believe in medical marijuana?

A: Dr Leigh believes medical marijuana has existed in the State of Oregon for at least 11 years. She has noticed quite a few people improving from chronic and terminal illness, reducing their need for narcotics, antiseizure meds, migraine meds, and antispasmodics, and getting better glaucoma control, by using medical marijuana. She has also seen quite a few folks unable, by law or preference, to use it while driving, or during their workday. She believes that as the laws change, Oregon will become a research leader, out standing in this field (ha ha!). Her recent particular interest is that most pain patients, using this medicine, draw  a stronger distinction between pain and suffering, than do those using narcotics – they actually develop a different analysis of the nature of their pain.

Q: Does Dr Leigh believe in doctor-assisted suicide?

A: Dr Leigh has had her belief system too overcrowded with shots, fibromyalgia, mammograms, medical marijuana, and whether the city water is or is not fluoridated, to start adding doctor-assisted suicide to the mix, at this time.

Q: Does Dr Leigh believe in consumption of dessicated animal glands?
A: No.

Q: Does Dr Leigh believe, however, in fish oil?
A: Yes.

Q: Does Dr Leigh believe in home birth and breastfeeding, family bed, intact boys, and no hitting?
A: She not only believes, but she can totally prove, by indicating her own family, that these exist.

Q: Does Dr Leigh believe that family doctors have adequate training and resources to provide a full basket of services to a heterogeneous and often challenging all-ages population of insured, underinsured, and uninsured patients, in the context of a true medical home?

A: Yes. Plus: Like all primary-care physicians, Dr Leigh also gets by with a little help from her friends.

thanks for asking!

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mystery cures from the internets (and more!)

By | January 2, 2010

can you guess what these people are talking about?
real-life comments, from real live people on the internets, in italics below:

what is all the names of head treatments.

i am going to put mayonaise in my hair today will it work??

the ONLY thing that works is TEA TREE OIL SHAMPOO

the thing that works the best is mayonnaise.

Does it help if you have a little girl and you put her hair in braids.

We do the olive oil/saran wrap/comb treatment and it always works.

dip and wipe the comb with rubbing alcohol. go over head repeatedly.

Try 1/2 part mineral oil and 1/2 part white vinegar. Put it over head, wrap with plastic bag for one hr, then rinse.

what are we talking about?
that’s right… head lice!

nobody really likes them, but some people – including school officials -
just plain go crazy, when they find a child has head lice.

I had heard all of the horror stories and now we are dealing with our own horror of it… I feel like it has taken over our lives.

I am at my wits end and have broken down in the nurses offices twice.

I have used every shampoo, conditioner, apple cider vinegar, mayo, I’ve combed, picked, laundered, stuffed animals in bags, I’ve even gone so far as to have a little party with all the friends she hangs out with, so I could check their hair.

after picking out the varmints place them on a paper towel place another on top but damp and cook them in your microwave and viola.

I shaved both of my boys hair.

TAPE! Any kind of tape works, scotch tape or packing tape.

What if you have done all of this and they still will not stay away and the school is calling child protection services? They are also telling people not to let them go to the absent parent’s home for visitation.

rumors abound – people have some strange notions about these bugs.
here are some false ideas:

i heard that lice come from certain types of trees?

My mother in law says that we may have a nest of them in our house. Does anyone know if that is possible?

I looked up on the web and found that lice originates from dirty laundry that has been there for a very, very, very long period of time.

Lice like the cold! They can’t live over like 52 degrees or something!

I’ve heard they don’t like mint, lavender, coconut.

No one seems to know how it gets started in the first place!! Like for example how does the initial person get head lice??????

well, be mystified no more! here are…

dr. leigh’s true facts about head lice
~~ head lice are biting insects which are very tiny – about the size of a poppy seed.
~~ head lice can only live and reproduce on the scalp of a human – not in the eyebrows, eyelashes, body hair, hats, sheets, hairbrushes, or teddy bears of a human. they can not live on cats or dogs, chickens or rabbits, or anywhere else.
~~ they can not survive longer than a day away from the person’s scalp, and can not survive more than about 20 minutes of hot water or air (in a washer or dryer).
~~ they can not fly, jump, or burrow. they can only crawl around and cling to hairs.

~~ they spread by direct contact of one head touching another, or by sharing combs and brushes.
~~ the amount of blood they drink in a day is about 0.003 milliliters, or four hundredths of a drop. twenty-five headlice would, working together, drink one just drop of blood from a human, per 24 hours.
~~ when the mother gives birth to her eggs, she glues them to the strands of hair, where they look like tiny bumps, tiny grains of sand, or tiny pearls. they are called “nits.”
~~ the eggs can not hatch unless they are stuck to the hair near the person’s scalp. they need to be within 1/2 inch of the scalp – farther away, they’re unlikely to hatch. they can not hatch and grow on combs, hairbrushes, or hats.

~~ head lice do not spread diseases. they do not even spread blood borne infections or viruses.
~~ some people become more itchy than others, due to becoming allergic to the bites.
~~ it is normal to feel itchy when thinking about head lice. it is a psychological reaction. it does not mean you have head lice.

~~ pubic lice (“crabs”) are a different species! they can live in pubic and body hair (but not in head hair, teddy bears, dogs, chickens, etc.). otherwise, they are basically the same as head lice.
~~ body lice are completely different! they live on skin and in clothing, not hair. they can also be killed by hot water and hot air.
~~ head lice are nothing to be afraid of, or ashamed of, or revolted by. they are not dangerous. they are not dirty. they are just tiny bugs.

some folks end up with these big elaborate routines to try to get rid of them.
these really are not necessary. please do not put yourself through this much struggle:

Sit next to a window with the sun coming in, section hair into about 12 sections with tiny rubber bands, and go through each section in thin rows, using a white rat-tail comb against the back of the hair row you are checking to help you see the nits, and cut them out… It can take a few hours… This needs to be done about every other day… Do this and in about 1 1/2 months you should be lice free.

On day 1 of lice discovery: cover hair and scalp with olive oil… I used 1/4 cup of olive oil. I massaged the oil in for about 3 minutes… After oiling I put her in a shower cap (I pulled the shower cap tight and secured it with a large hair clip.) I put my daughter to bed and kept the oil on overnight. Ideally 8hr. On day 2 before I washed out the oil, and before she changed out of her pajamas, I ran the lice comb through her hair for approx 1/2 hour… Then I washed out the oil with regular shampoo (twice) and then applied cream rinse. Then I ran the lice comb through her hair again for about 5 minutes… I then helped my daughter change her clothes and we put everything in the wash. On day 4 we did the oil method again. And again on day 7 and again on day 10. Days 13, 16, 19, 22, and 25…

Everyone got their hair cut, and combed 2 times a day for 2 weeks. I took all linens off bed, and everyone slept in sleeping bags, I took then outdoors to frigid temp for the entire day, and brought them in at night. Every day cleaned pillow cases, as well as brushes and combs, hats, scarfs jackets were cleaned and or placed into the cold either all day or all night. All stuffed animals were either in freezer in plastic bags, or just outdoors in plastic bags…

what a hassle!

dr. leigh’s easy plan for dealing with head lice
1. teach your children (and their friends, and your friends, and their school) not to be afraid of, or worried about, head lice.
2. examine each itchy family member’s hair under bright light.
do you see tiny eggs (“nits”) stuck to the hair, close to the scalp, and live head lice that are crawling around?
if not – do nothing! check the hair again in a week.
3. if you do see head lice and nits…

~~ go buy a fine-toothed steel comb at the drugstore.
~~ apply olive oil, hair conditioner, or any other mild slippery stuff to the entire scalp, and comb the lice and nits out.
~~ give your family member something interesting to do while you are combing. be patient. use a bright light.
~~ after combing, wash and dry the hair as usual. you can use a vinegar or lemon rinse after washing (which might help melt the eggs), if you want.
~~ repeat every 3rd day, for a total of four sessions (takes about 10 days total).
~~ note: empty or dead eggs, which are pearly or colorless, will not hatch, and do not need to be removed.

4. if you can’t get or use a fine-toothed steel comb, or if you are in a hurry, you can use a shampoo or lotion that contains a pesticide (permethrin or pyrethin). buy it over the counter, and follow the directions on the box.
5. if you use the special shampoo, re-check the hair after about 10 days. you might need to repeat the treatment.
6. machine wash and dry hats, hoods, and pillowcases, and wash combs and brushes in hot water – or simply remove and don’t use them for a few days (lice and nits can’t survive away from the scalp).

please do not use harsh chemicals or your head or your child’s!
these are not good solutions:

I spray my daughters hair everyday with hair spray but she still got them.

Tried the listerine and vinegar with shower caps on both.

i read recently to use peroxide on your hair to rid the lice… it is a good alternative to using chemicals. [not true!]

Dogs flea shampoo is good.

USE SARGENTS FLEA AND TICK SHAMPOO FOR CATS ONLY… THE SHAMPOO SEEMS TO MAKE THE LICE GLOW [oh my goodness!]

some other solutions are probably non-toxic, but are bizarre, are not as effective,
and cost more than simpler treatments:

Try dawn dish detergent and baking soda the combination used EVERYDAY and BLOW DRY COMPLETELY!!!! …IT is 100 percent natural. [not true]

Peanut butter can be worked into the hair to kill lice. Leave it on for about an hour and then wash it out. [but you might need a plumber.]

Hair gel… Dep can be found along with the shower caps at the Dollar Store. [and so on.]

dr leigh’s dos and don’ts for beautiful hair (and head lice)
don’t use pure essential oils (such as lavender, eucalyptus, or neem), which may be toxic when absorbed through the scalp.
don’t use mineral or motor oil, which dry out and can damage the scalp.
don’t use solvents such as alcohol, listerine, lysol, ammonia, “skin so soft” insect repellent, peroxide, or herbal tinctures, which are much too harsh.
don’t use hot or boiling water, a hot blow dryer, curling iron, hot comb or rollers, or any other electrical appliances, which can cause burns.
don’t use expensive enzymatic or other fancy remedies, which could cause an allergic reaction. simple, inexpensive treatments work just as well.

do be gentle with the fine toothed comb! do not worry about eggs that are stuck to the hair more than 1/2 inch from the surface of the scalp, because they are unlikely to hatch.
do use pure, plain kitchen ingredients: olive or coconut oil for combing through the hair (loosens up the bugs).
yes, you can use mayonnaise, though plain oil is cheaper and works just as well.
yes, you can use a plain vinegar or lemon rinse after washing (melts the eggs), if you protect the eyes with a washcloth.

please call your doctor if you are in doubt as to whether you, or someone you care for, truly has head lice.

two final words of great wisdom from the internets:

Do not blame the children its not like they invited them to their head or anything. Do you think they really want those things feeding off them.

Big arm length hugs (no head touching please) to those that are as aggravated at this as i am.

… … … … …

where did all this come from? quick bibliography:
harvard school of public health: http://www.hsph.harvard.edu/headlice.html
american academy of pediatrics: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;110/3/638.pdf
indian institute of technology, madras, india: http://www.biotech.iitm.ac.in/faculty/goda_head_lice.pdf
u.s. centers for disease control: http://www.cdc.gov/lice/index.html

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contagious conditions, canaries in coalmines

By | January 2, 2010

some folks (including prominent natural healers) whom i respect and esteem are still saying swine flu hasn’t been virulent, compared to seasonal flu. i continue to beg to differ… here’s an update.

you’ll recall that the centers for disease control (cdc) usually count seasonal flu deaths among kids under 18, rather than among older folks, because older folks might die from sepsis and pneumonia for lots of reasons, while with kids, it’s pretty clear when it’s flu. so the kids are our canaries in the coal mine:

2005 season: 41 pediatric deaths from seasonal flu
2006 season: 68 pediatric deaths from seasonal flu
2007 season: 83 pediatric deaths from seasonal flu
2008 season: 55 pediatric deaths from seasonal flu
[plus... a total of 7 infections with h1n1 "swine" flu had been confirmed when that last report was issued, last spring (april 18th). in the following 3 months, there were 25 child h1n1 deaths. three months after that, 70 more...]

h1n1, 2009:
[Since April 26th, 2009,] “243 deaths in children associated with 2009 influenza A (H1N1) virus infection have been reported to CDC.”
[compare to 2 deaths from seasonal influenza among kids, during the same timespan.]

the world health organization says that worldwide, from april through december, h1n1 caused “at least 12,220 deaths”, and add:

“…In the US… rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower than those observed during recent influenza seasons.” [emphasis added]

an oregon doctor (in the coalmine, as an infectious-disease specialist) writes about h1n1:
“A month ago all the ICU beds were full, most of the ventilators were in use and we were wondering how we were going to triage the next batch of patients who needed advanced life support and we had none to offer. Then, right as we reached maximum capacity and had no more wiggle room, the rates plummeted.

“…Oregon has had 1200 hospitalizations and 68 deaths. We had about 8 deaths from H1N1 in my hospital system. We would have had twice that number, but one of our hospitals is a trauma center and offers ECMO (Extra Corporeal Membrane Oxygenation) and we managed to save a number of people who would have died if they had been in a lesser hospital. The national statistics mirror our experience. None of the deaths were in the elderly.”

so now it’s seasonal-flu time (january-february), and if this year is like last year, the third wave of h1n1 will follow. but i think a lot more folks got shots, so the wave might not be quite so intense… ICUs, vents and ECMO? oh, my.

… … … … … …

so now you want to hear more about infectious disease? i am just the gal to get you tuned in! selected updates from the cdc’s “morbidity and mortality weekly report” – now with even more exclamation points:

cumulative numbers for the USA, year 2009
1,081,083 cases of chlamydia – use safe sex!
12,707 cases of syphilis – safe sex!
251 babies born with congenital syphilis – please!

28,707 new cases of lyme disease – watch out for ticks!
814 new cases acute hepatitis c – don’t share needles!

55 cases infant botulism – no honey for babies under one year old!
12 cases of tetanus – get your shots!
7 cases of plague – down with rats!
4 cases of rabies – stay away from bats!

…and furthermore:

“In 2008, a total of 12,898 tuberculosis (TB) cases were reported in the United States… [including] 125 cases of multidrug-resistant TB.” (brrrr!)

a little extra background from 2008:
“One in 100 Americans is behind bars in 2008, about 2.4 million people currently are incarcerated… Rates of positive or latent tuberculosis are 50 percent to 100 percent higher for inmates.”

plus, “While the number of men in State and federal prisons has grown 67% since 1990, the number of incarcerated women has increased by 92%” (1998 statistics). (there were 114,852 females in prison in 2008 (1,109 in oregon).

76 new cases of TB in oregon in 2009.

what about hiv?

the most recent “point estimate” data are, as usual, rather delayed:
42,655 cases reported in 2007 in 33 states* only (guess the remaining states don’t report?).

most recent death count: 14,997 “deaths in persons with AIDS” in 2006 alone, all states reporting; cumulative, 547,484 deaths since the start of the epidemic.

i just re-read randy shilts’ fine history of the early days, so i’ve had hiv on my mind. (did you know randy shilts started his writing career at UO in eugene? or that he died of – you guessed it – AIDS, the year after the HBO movie came out?)

remember “gay cancer”?
“GRID”?
“ARC”?
not to mention our friends, family members, and heroes, who died… well, anyway… 270 cases of “hiv-aids” were reported in oregon in 2009.

wear your hat! don’t forget your rubbers! baby, it’s cold outside.

*Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, New York, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. click here or even here, for an explanation of why the statistics are a huge mess.

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poverty, black friday, and the goose getting fat.

By | November 30, 2009

…please put a penny in the old man’s hat!
if you haven’t got a penny, then a half-penny will do…

Recession has plunged 2.6 million more Americans into poverty, wiped out the household income gains of an entire decade and pushed the number of people without health insurance up to 46.3 million.

11/3/0/9 – This is the last day, at least for now, that the federal government will subsidize COBRA premiums… COBRA premiums are unaffordable for many Americans without subsidies, as they average $1,069 per month.

brief review:
COBRA is the acronym for the Consolidated Omnibus Budget Reconciliation Act, a 1986 federal law that allows for the temporary extension of group health coverage to people whose health benefits otherwise would be terminated… You’ll pay the entire premium amount, including the portion of the premium that your employer used to contribute… [plus] a 2 percent administrative fee. [The subsidy, ending today, paid 65% of this cost.]

Less than 10 percent of the newly unemployed typically sign up for COBRA… More than half of those who lose their jobs go uninsured.

In 2007, the latest year for which data are available, the [richest] 1% increased their share of the country’s income to 23.5%, according to analysis of tax returns… The concentration of income earned by this top percentile now stands at its highest since 1928. Two-thirds of the country’s total gains in the five years to 2007 accrued to the top 1% .

the latest census dept poverty data was released last week.
a sampling:

worst case: in mississippi, 27.8% of all schoolkids*
(33.2% age 4 and under) live in poverty.
best case: in new hampshire, 7.8% of all schoolkids
(12.1% age 4 and under) live in poverty.

in oregon, 15.7% of all schoolkids (21.1% of 4 and under) live in poverty.

and here in lane county, oregon:
53,423 residents in poverty (15.7% of all residents).
7,230 schoolkids in poverty (14.7% of all schoolkids).
*schoolkid = age 5-17 years old

what is poverty?
The Census Bureau uses a set of money income thresholds that vary by family size and composition… If a family’s total income is less than the family’s threshold, then that family and every individual in it is considered in poverty. The official poverty thresholds do not vary geographically, but they are updated for inflation.

a sample of the official language:
“Unrelated individuals under 15 are excluded from the poverty universe; therefore there are 442,000 fewer children in the poverty universe than in the total population.”

click here to see if you, dear reader, would be eligible for food stamps, in the oregon “poverty universe”.
here is the 16-page application form.

Nearly half of all U.S. children and 90 percent of black youngsters will be on food stamps at some point during childhood… The current recession could push those numbers even higher… The analysis was released Monday in the November issue of Archives of Pediatrics and Adolescent Medicine. The authors say it’s a medical issue. [emphasis added by your personal physician]

joining the rest of the world (more emphasis-added action):
Forty-nine million people in American households – one in six – went hungry or had insufficient food at some point in 2008… [and] U.N. officials say 1 billion people – one in six globally – don’t get enough to eat.

6.6 percent of Oregon households… fall into a group technically called “very low food security,” but better known as “hunger”… Oregon is now among the five states with the highest hunger rate… Only Mississippi, at 7.4 percent, had a higher percentage than Oregon of hunger.
…It is important to note that the USDA numbers reflect the state of hunger in 2008. Since then, the economy has weakened significantly.

99 percent of all participating food banks reported a significant surge in demand for emergency food assistance over the past year… The survey showed an average increase of 30 percent in requests for emergency food assistance since July 2008.

A new study finds food waste per person has shot up 50 percent since 1974. Some 1,400 calories worth of food is discarded per person each day… About 40 percent of all the food produced in the United States is tossed out.

Black Friday this year seemed to fall into a gray area… Many shoppers seemed conflicted… Instead of the unbridled spending of past years, many people window-shopped and moved on, as if they’d come to the malls just to pretend happy days were here again.

A lot more Americans are feeling stressed out by debt this holiday season… Half of all those polled say they’re suffering at least some debt-related stress, and 22 percent say they’re feeling it greatly… Most people – 80 percent – say they’ll use mostly cash to pay for their holiday shopping… People carry an average of about $46,000 in debt – mortgages, credit cards, auto loans and other consumer debt. That’s a far bigger load than in the early 1980s… In 1982 per capita debt totaled about $14,000 in today’s dollars.

There are many orthopedic problems associated with the holiday shopping spree. Many of these are associated with prolonged hours on your feet, prolonged walking on hard surfaces and general muscle fatigue… Many of us are guilty of trying to carry too many bags and putting one more thing into an already overloaded bag. This adds stress to the entire body… [and so on.]

The new first couple told People magazine last year that they don’t personally give Christmas gifts to their daughters, but there’s always something under the tree from Santa Claus. President Barack Obama said they want to teach the kids limits.

buy-nothing holiday gift ideas, excerpted, from angela of “my year without spending”:
Mix CD… Herb garden: “A few herbs in a pretty pot”… Jam/ jelly/ marmalade… Baked goods… Knit hats or scarves… Board games: “I once made a time-travel board game for my brother that involved meeting famous people in history and curing diseases, that type of thing”… Ornaments… [and so on]

and from a writer at ruby glen:
~~Personalised Recipe Book… if one of your recipients is a vegetarian or has a penchant for curry, loves anything with tomatoes in or is a sucker for chocolate, make use of the fact by making a personalised recipe book.
~~Dress Up Box For Kids… browse round the charity shops and pick up cheap hats, scarves, veils, tutus, jewellery, gloves and small size dresses or jackets.
~~Hand Decorated Ceramics… a set of plain white ceramic egg cups, tea cups or plain glasses which are extremely inexpensive. Using a bottle of ceramic paint decorate by hand or stencil or stamp on each
~~Flavoured Cooking Oil… Half fill with peanut or olive oil. Add twigs of Rosemary, Thyme, Basil, Oregano, Parsley etc. If desired also add some peppercorns for decoration and further flavour and then fill bottle with more oil.
~~A Set Of Fridge Magnets… make small squares or circles out of cardboard and stick photos onto the card. Finish by attaching small magnets to the backs.
~~Home Made Honey Bath Oil… a cup of light baby or olive oil with 1/2 cup honey, 1/2 cup liquid soap, and a drop of your favourite essential oil… decant into a pretty squirt bottle.

and from the gang at buy-nothing christmas (excerpted):
~~Books on tape… it only costs time!
~~A calendar for the family with everyone’s photos and birthdays
~~Give Linux for Christmas! It’s free and it works like a charm! These days, distributions include not only the operation system that runs your computer, but applications such as word processing, spreadsheets, picture and sound editing, etc. And give a hand installing it.
~~Look through your (and your kids’) old clothes, cut out squares of fabrics they will remember, and make a little wall hanging or pillow or stuffed toy or whatever.
~~My parents always recorded a tape of me singing christmas carols and/or reading stories for my grandparents and other family that lived far away.
~~I started to make little comics for my friends, that were about us and things we had done, always with an added twist and some inside humour.
~~Make a small drawing of your select person’s living room or other room in their house and give it to them.
~~Buy a used book and in the inside cover explain why you chose the book for that person.
~~For the elderly people in your life, research newspaper and magazine articles from their youth and present in a creative fashion.
~~Create coupons for a massage, spring cleaning, child-minding, manicure, etc.
~~Babysitting coupons for the new parents.

but in the meantime…
The economy has taken a toll on a New York tradition: the “Sidewalk Santas” who collected money for the poor on Manhattan’s Fifth Avenue. The 107-year-old program has gone online for the second year in a row… It doesn’t have the money to manage and pay formerly homeless men to play Santa and gather donations. Spokeswoman Rachel Weinstein said Saturday that many are elderly and in fragile health.

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i hate [name of overpriced fizzy sugar drink deleted]!

By | November 22, 2009

overpriced fizzy sugar drink? what is it that dr leigh hates? is it pepsi? red bull? hard cider? is she against all sweet and fizzy things?

nope – guess again. i hate the overpriced fizzy sugar drink that pretends to be medicine.

i just can’t help it – i hate “emergen-c.” i hope they don’t sue me for saying this, but it just kills me when people who have NO MONEY for birth control or heart medicine, still drop their hard-earned cash on emergen-c.

i hate its imitators and distant cousins, too.

don’t get me wrong! i pester people to take particular vitamins, and support use of medicinal herbs, and send people to an accupuncturist, and so on, when i think it’s appropriate. i’m a vegetarian. but really, above all, i’m a cheapskate, and the wild popularity of expensive junk like emergen-c just gets under my flinty skin.

what is emergen-c? it’s an individually packaged “fizzy” “energy drink” that is widely rumored to treat colds and flu. taken as directed (2 packets a day), it is roughly equivalent to a chewable vitamin c supplement plus one-half of a flintstones chewable vitamin per day (most of the vitamins in a packet of emergen-c are 25% the recommended daily amounts).

it contains a little extra vitamin b12 and b6 – and so what?! there’s no evidence that extra does anything for you. they certainly don’t give you “energy” – only the 6 grams of sugar in each packet would do that (about the same amount you’d get from half a cup of fruit loops or a fun-sized snicker bar).

also note: when you take higher dosages of water-soluble vitamins (like vitamin c and b vitamins) than you can absorb, you just get very expensive pee.

emergen-c, low online price, $9 for 36 packets, an 18-day supply if taken as directed by the manufacturer: fifty cents a day.
generic children’s chewable, one and a half cents per day, PLUS generic chewable vitamin c, twelve cents per day. (multi: $3/100, 200 days’ worth; vit c: $6/100, 50 days’ worth.)

total cost for 18-day supply of chewables: less than $2.50 – about a quarter of the cost of emergen-c.
(fun-sized snicker bars not included – chewable vitamins have plenty of sugar by themselves! the whole price tag is maybe half as much, not to mention lower-calorie, if you simply buy ones you swallow.)

stories like this just bug me:
“And so I began the regimen: One Emergen-C at 5 am. Another once I woke up (again) at 8. Another when I got to work, two more after lunch. In all, I think I must have had six or seven packets of that goodness yesterday… Those, plus the 11 hours of sleep I got last night, are what I’m crediting with my slow return to health today.”
i would propose that the sleep, indeed, and the extra “six or seven” glasses of water, as well as the simple passage of time, had more to do with any “slow return to health.”

note: if you take emergen-c at that dosage – for, say, 6 days, the length of your average bad cold or mild flu – the cost for emergen-c would be more like $1.50/day – twice the cost of, for example, a whole month’s worth of birth control pills, blood pressure medicine, glaucoma drops, antidepressants, or any of the other meds* somebody might “postpone” getting, even while they’re shelling out for emergen-c.
*(at discount-store prices, $4/month.)

should i even get into the amount of paper products necessitated by these individually packaged powders? (if it were necessary to obtain special nutrients by means of excessive gimmicky packaging, i’d be the first to defend it; it’s not.)
or the obvious scam value of adding insignificant amounts of overprocessed herbal ingredients? (tiny amount by actual weight – GIANT AMOUNTS by size of lettering on each packet.) people, if you want to benefit from hibiscus flower, make some dang tea! use real flowers! 1/10 of one gram of hibiscus “extract” in emergen-c? please!

and yes, my science-based medicine friends, i am aware there’s no evidence that high doses of vitamin c do a blessed thing for viral infections!

i tell ya.

call me old fashioned, but if you’re going to blow $9 when you’re feeling crummy, why not just do it this way?

Consider the Flu Shot, a drink on the menu at Drop Off Service, a bar on Avenue A in Manhattan. It’s a mixture of garlic-infused honey, jalapeño-infused tequila, orange-lemon-ginger purée and a few drops of liquid echinacea…
The Throat Coat [has] honey-and-pepper-infused vodka and B&B, a French liqueur… combined in a snifter with a spoonful of honey.

…[A] Chinatown bar, Apotheke, specializes in pharmaceutically themed cocktails, has been busy formulating new drinks for the current flu season. One involves yellow Chartreuse, thyme, lavender and a stick of cinnamon “for the throat”; another involves warm rum, hibiscus and rosehips.
At the Harrison, on Greenwich Street, the beverage director, Adam Petronzio, has been prescribing a drink called the Western Smash… Lemon balm, which infuses a syrup that Mr. Petronzio mixes with whiskey and mint, is the medicinal ingredient.

~

Boston’s Tamo bar just launched the Baby Tylenoltini – a blend of Absolut Pears, ginger, lemon, honey, Grenadine and pink lemonade made to taste like the childhood curative…
San Diego’s Odysea bar serves up the Siren, a sizzling hot combination of Fortaleza Tequila, Gabriel Boudier Crème de Cassis, red jalapeños, lime and ginger beer…
The Oliver Lounge at the Sports Club/LA-Beverly Hills has concocted a low-carb martini with soy vodka, fresh wheatgrass (which has, like, six tons of vitamin C per ounce) and ginger reductions.

~

also:
Cold-Eeze and Brandy: Cold-Eeze lozenges, honey, honey-pepper vodka, Benedictine and brandy
The Pomegranate Emergen-C Martini: pomegranate Emergen-C [speak of the devil...], pomegranate-infused vodka, pomegranate liqueur, lime, pomegranate seeds
Ricola Whiskey Soda: Ricola cough drops, Benedictine and brandy, soda, Fernet, orange wedge

~

Over at Casita in Shoreditch Will Foster was pouring his Swine Flu Shot: 1/2 shot Arette blanco tequila, 1/2 shot Pink grapefruit juice (pink for pigs!), Tabasco to taste (one drop thoroughly permeates an entire shot, so proceed judiciously), Tiny dash agave syrup, Squeeze lime wedge. Shake and strain.

~

this one really sounds bland, by comparison:
Flu Cocktail: Stir (without ice): 2 oz rye, 1/4 oz ginger brandy, 1/4 oz rock candy syrup, 1 pinch Jamaica Ginger, 1/2 oz fresh lemon juice

…until you really get down to brass tacks:
You know, every year my late father looks more and more intelligent. When he used to get a cold, he’d take a shot of blackberry brandy, sometimes two or three! Did it cure or slow down the cold? No. But after two or three shots of blackberry brandy… you pretty much didn’t care.

as a physician, i can’t formally endorse that approach – other than to say it would be a lot cheaper than, and probably as effective as, emergen-c.

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health news roundup: focus on D R U G S

By | November 16, 2009

The average premium [Medicare beneficiaries] pay for stand-alone drug plans will rise 11% to $38.94 a month in 2010… Changes are even greater for seniors receiving drug coverage as part of Medicare Advantage… The average monthly premium for those beneficiaries will rise by an average of 32%, to $48 a month… Advantage plans cost the federal government 14% more on average per beneficiary than traditional Medicare. [for details, tips, and links, including rx drug coverage search engine, see here and here.]

Current U.S. Food and Drug Administration regulations require that any mention of a drug’s benefits must also reveal its risks… But drug makers and Web companies attending a two-day hearing this week on online marketing of medical products said the rule hampers them… [They] are proposing new types of ads – ones that would carry links to detailed drug information [rather than the drug information itself, thus leaving more room, suggests dr leigh, for bigger photos of women looking sad and men in bathtubs].

A new study shows that drug ads are not doing a good job at helping consumers improve decisions about their health… “American television viewers see as many as 16 hours of prescription drug advertisements each year…” The study authors also suggest getting rid of video and audio distractions.

Pharma Will Fight House Health Reform Bill… The Senate version includes an $80 billion discount drugmakers agreed with the White House would be offered; the House version says that should be $140 billion. Brennan says the industry will fight if the House version survives. ["discount" means price controls on drugs covered by government health programs, which might reduce drug company profits by the amounts mentioned.]

The health care reform bill passed by the House would force drugmakers to disclose how much they spend on continuing medical education classes for docs, although the Senate version doesn’t include such a requirement.

Eli Lilly’s publication of a registry revealing all payments to doctors has opened up an overdue conversation. Is it ethical for a doctor to become a member of a drug company speaker’s bureau? Or is it inherently deceptive for a doctor to pose as being an independent source of information while at the same time being under contract to speak for specific drugs?

from the registry, jan-june 2009:
one drug company, one state (oregon), one 6-month period: how much doctors were paid to promote lilly drugs (in economically distressed communities), individual amounts:
portland/beaverton (11.7% official september unemployment rate, vs. 9.8% nationwide*): $32,025 – $27,125 – $27,150 – $18,450 – $16,450 – $15,050 – $13,350 – $12,638 – $12,150 – $11,063 – $8,750 – $5,813 – $5,550 – $5,400 – $4,450 – $4,800 – $3,000 – $2,500 – $675 – $638 – $188
eugene (12.2% official unemployment rate): $19,900 – $9,400 – $3,600 – $3,300
bend (15.9%): $35,113 – $29,269
salem (11.6%): $1,800
corvallis (7.6%): $16,950 – $5,700
ashland (11.5%): $525
*sept unemployment rates from oregon employment dept
[note: to date, lilly is the only company that publishes their 'speaker's bureau' list.]

The Food and Drug Administration on Friday took the first step toward banning alcoholic beverages that contain caffeine, sending letters to nearly 30 manufacturers of such products giving them a month to prove that the products are safe… The caffeine in the drinks tends to mask the impairment produced by alcohol.

Stainless steel fragments, non-latex rubber and fiber-like material have been found in some drugs made by Genzyme Corp… Viral contamination forced the company to close its Allston Landing plant in Boston in June.

[The Food and Drug Administration] is considering “outsourcing” the efficacy analyses of older marketed antibiotics to a nonprofit standards-setting group ["CLSI"], whose 2,000 members include numerous drugmakers.
…The FDA said it is facing the enormous task of ensuring that drug labeling for older antibiotics, which are mostly made by generic manufacturers, many of them foreign firms, is updated… Many antibiotics have become resistant to certain bugs, but the product labeling does not reflect that information.
…The FDA is facing a choice of requiring generic drugmakers to conduct clinical trials to establish the current efficacy of the older antibiotics in combating pathogens – which regulators have expressed is an unfeasible option, given the expense to do so – or force the drugs off the market, which also would not be feasible given the need for the drugs. The other option is to use the data already collected and analyzed by CLSI or another standards group.
…But Diana Zuckerman, president of the National Research Center for Women & Families, who testified at the October advisory meeting, argued that the FDA should evaluate antibiotic resistance using “the gold standard” of clinical trials.
[let me get this straight: what "outsourcing" means, is that the FDA is funded too poorly to test generic antibiotics to see if they still work, or is too spineless to require generic manufacturers to do the testing, so they plan to just buy data compiled by drug manufacturers in the past? that's "outsourcing"?]

U.S. Senator Benjamin L. Cardin (D-MD) today [11/10/09] sent a letter to Defense Secretary Robert Gates requesting an accounting of how many troops serving in Iraq and Afghanistan have been prescribed antidepressant medications while deployed. Senator Cardin expressed his concern that there may be a connection between the reported use of such prescription medications and the record high suicide rate among active-duty soldiers.

Antidepressants get to work immediately to lift mood, contrary to current belief, UK researchers say… The action is rapid, beginning within hours of taking the drugs, and changes negative thoughts, according to the Oxford University researchers… [One author] said: “We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively… Over time, this will affect our mood and how we feel because we are receiving more positive information.”

A regular antidepressant combined with an intensive treadmill training program can help people with partial spinal injuries walk better and faster, a study by the Rehabilitation Institute of Chicago found.

A new analysis of a dozen studies in The New England Journal of Medicine examined possible new uses for [Neurontin, a.k.a. gabapentin,] and found the published results were often fudged, indicating the pill worked better than internal company documents showed. In essence, when the primary finding of a company-funded study wasn’t favorable, the study authors usually buried the result and found something else positive to highlight, without disclosing the change… The analysis comes two months after Pfizer was fined a record $2.3 billion, including an unprecedented $1.2 billion criminal fine, for illegally marketing other drugs.

Eight prescription drug-making companies are paying Iowa $4.3 million to settle allegations that they purposefully reported false and inflated drug prices which serve as the basis for Medicaid reimbursements paid by taxpayers. Medicaid is the state-federal health care program for the poor… The suit alleged that the price for drugs paid by the State, based on fraudulently-reported Average Wholesale Prices… can exceed 40-50%, 100%, 200% or even 1000% or more of the real prices.

headlines at a glance:
A drug for people with a form of leukemia holds promise as a possible treatment for ovarian cancer.
A drug used to treat pneumonia might serve as an effective treatment against a type of muscular dystrophy.
Two drugs used to treat breast cancer and osteoporosis eliminated cervical cancer in mice.
Birth Control Pill May Reduce Asthma Symptoms
German Company Develops Female Viagra
Researchers are now inching closer to discovering a contraceptive pill for men. Men will soon have the options of a daily oral pill, a patch or gel to be applied to the skin, an injection given every three months or an implant placed under the skin every 12 months as birth control methods.

Since 1997, the American Medical Association has taken a hard line against [medical marijuana], endorsing its classification as a Schedule 1 controlled substance – the most restrictive category – and asserting its lack of medical value… [But] at its annual meeting Tuesday, the country’s largest physicians’ organization adopted a policy that urges the federal government to reclassify, or “reschedule,” the drug.

11/4/9 – Voters approved a referendum making Maine the fifth state to allow retail pot dispensaries… California, Colorado, New Mexico and Rhode Island allow for places where medical marijuana patients can legally buy pot… Fourteen states have laws allowing some use of marijuana for medical purposes.

The Cannabis Cafe in Portland, Oregon, is the first to give certified medical marijuana users a place to get hold of the drug and smoke it – as long as they are out of public view.

Police raided four large marijuana-growing operations in Eugene and West Linn [Oregon] this week that were tied to a registered medical marijuana grower whose crop far exceeded legal limits… [and who] is registered as a legal grower for one patient under the Oregon Medical Marijuana Program. He is permitted to possess only six mature marijuana plants [and] 18 seedlings… In all, police seized 1,127 marijuana plants.

Abusing prescription drugs is an alarming new trend… National statistics show teens are three times more likely to overdose on prescription pills rather than illegal ’street’ drugs… In a national survey, 64 percent of teens 12-17 say they didn’t have to look farther than their own home, often getting pills from their own medicine cabinet, or from friends and relatives. [dr leigh's opinion: the most dangerous drug overdose: calcium-channel blockers (for high blood pressure). next most dangerous: tylenol. next most dangerous, but most prevalent: alcohol. estimated number of teenagers who overdose yearly, on plain old marijuana: zero.]

A few weeks ago I walked into the pharmacy of one of those “we sell everything and cheaper” places to fill a 14-pill prescription for a cancer patient… I asked the pharmacist what the price would be without the insurance. She looked at me and smiled and said in a very low voice, “$4,100.” “Excuse me. Did I hear four thousand one hundred dollars for 14 pills – almost $300 for one?” my voice becoming shriller with each word. “Yes,” she replied at an even lower decibel, glancing nervously over at the line of customers waiting to be served.

For more than a few minutes I was utterly incoherent… The patient took me by the arm and led me out of the store and said smilingly, “They don’t leave much alternative do they? Either one can afford them or one can’t…” When I related the story of the 14 pills to a congressman the other morning at a press breakfast, he was stunned for only a second and then began the standard defense about how much it took the pharmaceutical companies to research and produce such special medicine. He said nothing about how many billions in profits these companies have made over the years, or the fact that very few new medicines are being produced, or that stockholder demands that the research costs be recaptured quickly are a problem.

Some of my colleagues stopped me after the meeting to ask what kind of pills they were and who was the person who needed them? My daughter, I replied, for a brain tumor. “Wow!” one of them said. “Yeah, wow!” I replied.

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the deal with medicare

By | November 7, 2009

On Friday, Oct. 30, the Centers for Medicare and Medicaid Services (CMS) put the final rule on the 2010 Medicare physician fee schedule on display… In the final rule, CMS estimates that family physicians will experience a 4 percent increase in their Medicare allowed charges in 2010 as a result of the rule… [However,] under current law, the Medicare conversion factor, which translates Medicare’s relative value units into payment allowances, is scheduled to decrease 21.2 percent on Jan. 1, 2010, which would more than wipe out the potential gains… –Kent Moore

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

On Monday, reporting on a conference call with aides to Senate Majority Leader Harry Reid, I wrote that there would be a vote this week to eliminate the mandated 21.5 percent reduction in Medicare reimbursement to physicians that is scheduled to go into effect on 1 January 2010… On Wednesday, the measure (S.1776) was defeated in a roll call vote 53 – 47.

…That got me wondering how much in dollar figures physicians are reimbursed by Medicare. Good luck finding it online. I couldn’t… But what I do have in my personal possession are three years of records… Here is an example of one charge from a visit at this time last year… The total paid [by Medicare/Medigap] for a $104 visit was $59.85 or about 57 percent of what was billed, and the physician eats the difference… Next year my doctor’s office will be paid only $47.28 for the same visit.

…78 million baby boomers start becoming eligible for Medicare in little more than a year, 2011. –Ronni Bennett

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

here is the doctor’s-eye view of the happens with medicare. (please bear in mind that medicaid and other public insurances for adults and kids under 65 are even worse – from a small-business perspective.)

currently, payment to a doctor for a service usually begins with this medicare formula:

payment = RVUs x conversion factor

not only medicare uses this formula; private insurance companies use it, too; large medical practices use it to determine salaries for their doctor-employees, and independent doctors use it to set their fees.

what are RVUs? they’re “relative value units,” the number of “units” Medicare decides a particular medical service is “worth,” relative to all other medical services in the world. they were invented in 1992, to make medicine less surgical and more preventive. as you’ll see, they haven’t done this. one reason might be that RVUs are assigned by a committee of 29 AMA members, only 5 of which are primary care doctors (one each from family, internal medicine, geriatrics, pediatrics, and osteopathy). the remainder are surgeons and specialists. “values” are assigned by a 2/3 majority of the committee.

each RVU is made up of three elements: “physician work,” “practice expense,” and “malpractice risk.” “work” means how much time, effort, and ingenuity is required to provide the service. note the differential between some common physician “work” RVUs:

in the land of specialists:
removal of prostate, 19.62 RVUs
cesarean section, 18.26 RVUs
removal of uterus, 17.21 RVUs
lower back surgery, 13.03 RVUs
cataract surgery, 10.20 RVUs

in the land of primary care:
office visit, multiple health issues, 1.42 RVUs
well baby visit, 1.02 RVUs
hospice care supervision, 1.10 RVUs
counseling/planning for risk reduction, 0.98 RVUs
diabetes group visit, 0.25 RVUs

the “malpractice risk” RVU elements are different, as you’d expect:
specialist: cesarean section, 4.13 RVUs for malpractice (high risk! expensive malpractice insurance.)
family doc: office visit, multiple health issues, 0.05 RVUs for malpractice (low risk, cheaper malpractive insurance.)

as you guessed, “practice expense,” the presumed cost to a physician of providing a service, follows the same pattern: cesarean section (lots of sutures and knives and things), 6.49 RVUs; office visit (paper, computer time, headache medicine for billing and coding), 1.10 RVUs.

to arrive at the “value”of a doctor’s services, each of these RVU elements is adjusted by a number representing the cost of living (or the cost of practicing) in the specific geographical area. this number is called the GCPI. some parts of the nation are cheap to live and practice in; some are expensive.
for example, if you are a doctor in washington DC, your “work,” “expense,” and “malpractice” GCPIs are 1.047, 1.218, 1.032 – mostly more than 1 (more spendy). but in alabama, they are 1.000, 0.853, 0.496 – mostly less than 1 (cheaper).

so let’s run some numbers.
first, let’s go to alabama.
in alabama, more than 2/3 of adults and 1/3 of teens are obese or overweight, about a quarter are smokers, and there’s a high rate of diabetes, and of death from heart disease.
now, pretend you’re a cardiologist (or rather, a chest surgeon) in alabama, and you’re going to do a two-vessel coronary bypass operation on somebody who had a heart attack.
what is this medical service “worth”?
2-vessel bypass =
{work 38.34(1.000) + expense 15.20(0.853) + malpractice 4.56(0.496)}
= 54 RVUs.

but what if you moved to washington, DC?
(DC is thinner, doesn’t smoke as much, and has much less diabetes, but still has more heart disease death than alabama does.
while alabama has the 5th-lowest income in the US – only 4 states are poorer – DC has the 12th highest.)
now what is your work “worth”?
2-vessel bypass =
{38.34(1.047) + 15.20(1.218) + 4.56(1.032)}
= 63 RVUs.
the work itself the same, but its “value” is 18% more in washington, DC.

hmmmmm.

the geographical differential may help explain why DC has the highest number of physicians per capita in the nation, 8.6. alabama is 9th from the bottom at 2.5.
DC also has the highest number of primary-care doctors per capita, at 2.8. alabama’s second from the bottom, at 1.

now, pretend you’re a family doctor instead of a surgeon, working with a patient who has multiple health problems, to prevent their having a heart attack.
you help them quit smoking.
you help them lose weight and get their cholesterol under control.
you help them with their depression and anxiety.
you see them in the office. you talk to them on the phone.
you review their old office and hospital records. you talk to consultants and to their family members on the phone and by email.
you probably send them written explanations, reminders, and copies of their care plan.
how much is this service “worth”?

in alabama, 2 RVUs.
in DC, 3 RVUs.
(you can check my math, if you want to, with all the numbers i already gave you.)

again, bypass operation: 54-63 RVUs. preventive primary care: 2-3 RVUs.
now you can see why the american academy of family physicians is very pleased that medicare plans to increase primary-care RVUs this year, although 4% is not very much.

how do RVUs translate into dollars? hang onto your hat!
to arrive at dollar figures, the RVUs for any given service are multiplied by the medicare “conversion factor” – a dollar amount written into law by congress.
in 2009, the conversion factor was $36.0666 per RVU. this was a 5.3% decrease from the previous year. this means…

the alabama and DC surgeons’ work is “worth” $1,932 and $2285, respectively.
(note that these amounts are for the bypass surgery only, not the initial evaluation and testing, leg-vein harvesting, hospital admission, and other additional payments.)

the family doctors’ work is “worth” $86 and $104 this year in alabama and DC.
(note that these amounts are for the office visit only. family doctors are not reimbursed for hunting down and reviewing records, writing and mailing care plans, or taking phone calls/emails from patients, families, insurances, consultants, etc., etc.)

the plot thickens: in january of 2010, as noted above, the conversion factor is planned to decrease 21.2%. (new conversion factor, around $28.42.)

then the alabama and DC family docs’ work will be “worth” $68 and $82. (the cardiologists will be cut down to $1522 and $1801 each.) however, in real life, as in the example we started with, $47.28, for 45 minutes, might be closer to the truth.

this tells you why, here in Oregon (when last studied in 2006), one-quarter of family doctors do not take medicare patients at all.

if you add in the docs who limit the number of medicare private insurance patients they see (those who have medicare and also a medicare plan run by a private insurance corporation), it’s 46%, nearly half of all family doctors.
(and those figures are actually from 2006, the good old days, when the medicare conversion factor was $37.8975 – one-third higher than it will be two months from now.)

dropping medicare patients is very painful, especially for the patients. it’s getting harder and harder to find a new doctor. it’s also painful for the doctor, who entered the underappreciated field of family medicine in order to help and care for people of every age and income, and who often has extra training in geriatrics and chronic conditions. many of these family docs have already dropped obstetrics, in which they are trained, due to malpractice hikes, and have also stopped seeing babies and kids, because they can’t afford to buy or store vaccines. they feel increasingly forced to give up sophisticated skills they worked very hard to acquire, in order to pay the nurses and the office people who rely on them, and keep up with the rent and insurance, and pay for the medication, equipment, and supplies, and still take home enough to pay the mortgage. primary care doctors are not high rollers. they don’t usually even have nice cars. they’re kind of like, well… moms.

most family docs do not find this out until they enter practice. i merely remark.

although dropping medicare and other publicly insured patients can reduce some of the financial distress in a primary care practice, it will not eliminate it. why? because the RVU system, controlled by specialists, completely permeates american health care.

private insurance companies almost always base their reimbursements on the medicare rate – usually 100-150% of medicare. thus, an independent family doc in alabama might be paid $86-130 for a typical visit, without taking any medicare.
(since in most cases this includes the patient’s cash co-pay and co-insurance, not to mention deductible, the insurance company itself usually pays from zero to half of the bill, but that’s another rant.)

doctors who work in large “corporate” groups receive salaries based on how many RVUs they “produce.” a family doctor who mainly takes histories, does exams, and makes individualized care plans, will “produce” (and therefore earn) nowhere near as much as the family doctor next door who biopsies a lot of moles, does a lot of EKGs and stress tests, and injects a lot of joints. office procedures – many of which are quick and cheap to perform – are worth about twice as many RVUs per hour.

it begs the question: is it really more “productive” to do a stress test, than to help a patient quit smoking? is it more “productive” to place an IUD, than to counsel a woman on sexual and menstrual issues? who says so, and why?
(note: the examples i am choosing – IUDs, joint injections, stress tests, etc. – are office procedures that family doctors are constantly exhorted to incorporate into our practices, to “boost your bottom line.”)

it begs another question: how many procedures are performed without much discussion, simply because they reimburse well? example: newborn male circumcision, with no medical indication whatsoever*, is still uncontroversial. in alabama, it’s “worth” 3.95051 RVUs, or $143 at rock-bottom medicare-level rates (in DC, $171). a family doctor can do about three or four of them in an hour. compare this to the RVUs for counseling about the risks of this procedure (since there aren’t any benefits): zero. this may be one reason why the only counseling most parents receive is in the context of being handed a consent form. * dr leigh is skeptical of studies claiming lower transmission of hiv.

it begs the biggest question of all: if primary care is treated as so “unproductive,” and therefore is so poorly reimbursed, how will we ever persuade young doctors to enter the field in the first place, and to see medicare, medicaid, schip, uninsured and under-insured patients, once they’re in it?

we already have a severe primary-care doctor shortage, worse by the year, and worse in some places than others (alabama loses, DC wins). we have an even worse shortage of primary doctors who can afford to sign contracts with public insurances.

what will happen when our national movement toward “universal coverage” succeeds? what if we get a “public option”? who’s going to see all those patients, for $47.28 each?
[note: in oregon, medicaid - for people under retirement age - reimburses physicians at 78% of the medicare rate.
11% of oregon residents are on medicaid (26% of all kids).
17% have no insurance (12% of all kids).]

if you can think of a way that dr. leigh could afford to see patients who are on public insurance, while still providing the same standard of care her other patients receive (no 10-minute appointments, please, and she’s not going hire any employees, either), do comment. please keep in mind that she lives in a state with a “real” unemployment rate of more than 20%, and has no rich patients who can subsidize the poor ones!

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h1n1: don’t make me go there… again

By | November 3, 2009

…oh, all right, i’ll go there one more time. i can’t even believe how many questions i get about the h1n1 flu shot. (and how few questions i get about the h1n1 flu disease – or the “regular” flu. i hate flu!)

last night one of those celebrity-worshipping tv shows delivered a halfhearted retraction about a video of theirs that had been recast on youtube*. the video showed a woman who developed neurological-motor problems after getting a flu shot (not h1n1, but “regular” flu). [the re-cast said 'you should worry' about getting shots, and the show said that what they meant was, 'you shouldn't worry'.] (beware of the remix!)

post hoc, ergo propter hoc: it happened after the thing; therefore, it happened because of the thing: a well-known logical fallacy. the classic example is, roosters crow before the sun comes up – therefore, roosters make the sun rise. but we know this is not true, however true it looks… correlation is not causation.

however, having something dreadful happen post hoc, can certainly give us the feeling that propter hoc! the real question is, how many so-called side effects can be expected to occur even in the absence of hoc? in other words, what are the odds of developing a neurological-motor problem (or a conversion disorder) even without getting a flu shot? this was the subject of an article reposted by kevinmd.com, concerning “background events” or illness/disability/disaster occurring at the usual “background” rates:

“Overall, 3.58 cases of Guillain-Barre syndrome would be expected as background events within seven days per 10 million individuals vaccinated and 21.50 per 10 million within six weeks.”

this means basically that there is a certain rate of people getting guillain-barre (“gee-yan bar-ray”) paralysis, even without getting a flu shot. it means that you can’t blame guillain-barre on the flu shot, in this certain number of people. see? even if you, or your auntie, or your neighbor’s teenage child, is one of them, and is real sick, and just got a flu shot the previous week. it’s almost certainly a coincidence.

“…Coincident sudden death [yikes!] would be expected to strike 0.98 people per 10 million vaccinated people within seven days of vaccination and 5.75 cases would be expected to occur within six weeks as background events.

“Among women, 14.40 cases of optic neuritis [sudden blindness!!] would be expected for every 10 million vaccinated within seven days and 86.30 could be expected for the same population within six weeks.

“For pregnant women, 397 spontaneous abortions [aaaa!] within one day of vaccination would occur as coincidental, background events for every 1 million vaccinated.”

it gets worse: the authors also discuss the problem of “temporal and geographical clustering” – the phenomenon that such illnesses/disabilities/disasters are not spread out evenly across time and space, but may clump up, so that a bunch of things appear to be happening in one specific place or time.

“For example, about 2% of [medical] practices will likely have a seemingly elevated rate – more than two standard deviations above average [that's high!] - of postvaccination spontaneous abortion, based on the normal distribution.” (“the normal distribution” is the “bell curve” of how events naturally spread out across large populations.)

what this means is that even a big cluster of illnesses/disabilities/disasters occurring in one place, after a vaccination campaign, may not have anything to do with the vaccinations themselves – any more than the sun can be raised by even by many, many, many roosters all crowing at once. it also means that you can’t take the figure “4 cases of guillain-barre per 10,000,000 shots” and turn it into “1 case per 2.5 million,” and then claim that 2 cases per 2.5 million is an elevated rate – except “on average.” if you see what i mean.

how much is 2.5 million? to get a sense of scale, note that the government/ taxpayers have purchased 100 times that many doses of h1n1 flu vaccine. or consider that 2 million is the number of folks, in oregon alone, who are considered high-risk first candidates to get the shot (though only a tenth of that many doses have been delivered so far, which is the real news story, if you ask me – the shortage.)

we realize, of course, that every medication (and supplement, and food, and activity) may have unintended risks. so how can we tell true side effects from post-hoc, apparent ones? due to tons and tons of public concern and the current ubiquity of high technology, the cdc is tracking “adverse event reporting” better than ever.

“…In the U.S., the voluntary Vaccine Adverse Event Reporting System has beefed up outreach efforts, and a new Web-based active surveillance system has been implemented along with population-based, computerized database monitoring… The CDC’s Frank DeStefano, MD, MPH, and Jerome Tokars, MD, MPH, wrote that other countries have mounted similarly intensive monitoring for the safety of the H1N1 vaccine, which should serve as a model for tracking safety of all vaccines in the future.”

so very shortly we will know more about the h1n1 shot, flu shots in general, and all shots in general.

but beware: from science-based medicine: “The Vaccine Adverse Event Reporting System is a voluntary reporting system that accepts all reports of symptoms or illnesses that occurred after vaccination. It even accepted a fraudulent report claiming that a man had been turned into The Hulk by his influenza vaccine.” (emphasis added)

dr leigh does not provide medical advice over the internets, unless you are her private patient communicating with her over secure channels. please do not ask her for diagnosis or treatment as a result of reading this article!

*for more, see here.

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flu!

By | October 14, 2009

how are you? are you feeling ok? because a lot of folks are getting the flu.

it turns out that h1n1 is not the same as, or milder than, “regular” flu! it is spreading a lot faster than usual, and making healthy, strong people much sicker than usual.

here are some oregon stats:
– last year in oregon, during the 2008 flu season, there were 105 hospitalizations for flu, total, all year. (“regular” flu.)
– this summer alone, from April to September, 116 hospitalizations and 12 deaths (all h1n1, as far as we can tell).
– since Sept 1 – a little more than a month ago – 84 hospitalizations and 3 deaths.
– since Sept 1 in Lane county alone, 11 hospitalizations and 1 death.
(this summer, in total, from April to Sept, there were 18 hospitalizations and 1 death in Lane county.)
– median age of patients hospitalized for flu in oregon, 28 years old.

people in Oregon, going to a doctor’s office (one of 21 offices statewide that report their numbers), with fever + cough/sore throat:
507 three weeks ago > 653 two weeks ago > 1075 last week.
(that’s an average of 51 per office, in a single week!)

testimony from the blogosphere:

When it first started, I had that sick, achy feeling – you know, when you have those momentary chills, your joints hurt, you feel kind of heavy, and you just know something is coming around the corner for you… I had a sore throat, so sore I couldn’t swallow. I tried to sleep, but I had the worst chills. Just couldn’t get warm. And then I’d wake up in a full-body sweat, just sweltering hot. My body ached so bad… I lost eight pounds.

My nephew came to my house with flu-like symptoms and was here for at most 10 minutes… He did not sneeze or cough while I was in the room either. He was in search of medicine and I gave him some…. It was that easy to catch this flu.

This was the worst flu I ever had. My fever did not get below 102 even with double-doses of extra-strength tylenol, and lasted over 5 days straight… After that, the fever came and went depending on how many meds I could keep pumped into my system without going toxic. My cough was so bad, it morphed into a mild case of pneumonia after about 3 weeks. Al in all, it took me over a month to really feel even 85%. It was definitely the worst flu or sickness I ever had.

[note: PLEASE never take "double-doses of extra strength tylenol." that would be 2000 mg/dose, enough to poison yourself, if you did it over and over.]

You feel extreme exhaustion. Your fever has you burning up. You ache and hurt all over like you ran headlong into a bulldozer. Your head throbs and feels like it is going to explode. It isn’t at all uncommon for you to experience discomfort in your chest…Then to top things off, you develop what starts out to be a small, non-productive cough that may become very harsh and severe enough to keep you awake at night, depriving you of your desperately needed rest.

“Emily”, who is 27, is feeling fine. She is attending a birthday party, having dinner with friends… The day before her symptoms appear, Emily is already contagious.

…Today, Emily woke up feeling miserable. She is now running a fever, has a cough and a sore throat… Emily also has asthma, which puts her at higher risk for complications from this flu… She needs to call her health care provider to ask if she needs to start taking Tamiflu. Unfortunately, Emily does not have health insurance or a primary care physician. She decides to wait.

…In her second day with H1N1 swine flu, Emily was up most of the night coughing and her fast-acting inhaler didn’t help much with her asthma symptoms… She goes to a walk-in urgent care clinic… The healthcare provider who sees her does not prescribe her any antiviral medication and sends her home with cough medication instead.

…On her third day with H1N1 swine flu symptoms, Emily is still feeling exhausted, her throat is hurting and she still has a fever. Her cough is not really improving… She decides to go to a different walk-in clinic where she is finally prescribed an antiviral medication, Relenza… It is an inhaled medication and is not recommended for people with asthma.

…On Emily’s fourth day with H1N1 swine flu, her cough still isn’t getting any better… She calls the clinic where she was seen yesterday and finally speaks with someone who agrees that she should be taking Tamiflu instead of Relenza because of her asthma. Unfortunately, the pharmacy does not have any Tamiflu in stock.

…On day 5 of her H1N1 swine flu infection, the pharmacy calls to let Emily know that her Tamiflu is finally ready. Unfortunately, it is likely too late in the illness for it to make a difference… and because it is quite expensive and she does not have health insurance, Emily decides not to get the medication.

…On her sixth day with H1N1 swine flu, Emily is still feeling tired but she is breathing easier and her fever is gone. She decides that she wants to get back into her routine and goes out for a jog. Her body isn’t fully recovered from the virus though, so she doesn’t make it far before she has to come back home.

…When Emily wakes up on day 7 of her H1N1 swine flu infection she is feeling well. She goes to visit her family… Later in the evening, she starts to feel run down and then develops another high fever and starts vomiting. She is also experiencing chest pain and her cough returns.

…On Emily’s eighth day with H1N1 swine flu, she is experiencing a painful cough and a fever… After another few days with the cough, fever and vomiting, Emily makes a trip to the emergency room because she just can’t take it anymore. She is diagnosed with lobar pneumonia after x-rays are taken. She is given a prescription for antibiotics and sent home. She finally starts to feel better after another two to three days.

summary:
2 weeks illness (approx $950 pre-tax income lost, at Lane county median female income)
2 visits to urgent care and 1 to emergency room (approx $1000 if un- or under-insured)
1 chest x-ray, 1 antiviral medicine and 1 antibiotic (approx $150)
total: $2100!

It came on very suddenly. I had gone to bed feeling oddly thirsty… Just after lunch came the first bout of diarrhea… By teatime, as I sat watching Dumbo with the children, I realized that I couldn’t really lift my head. Shooting pains were assailing my arms and chest… And I was hot, really hot. Except actually I was cold, really cold. Brrr, shivery cold. Or was I hot? I had absolutely no idea.
…I took my first Tamiflu at around 6pm. After about an hour, I became dimly aware of a strange foreboding in my stomach… I barely made it to the bathroom before my body unceremoniously ejected the Tamiflu… The night passed relatively uneventfully between dizzying trips to the bathroom and sweat-soaked sheets.
On day three… my tonsils were so swollen that I couldn’t open my mouth more than half an inch. Yesterday it was announced that a six-year-old girl who died after becoming infected with swine flu suffered septic shock as a result of tonsillitis… The doctor called back. “Mm’ve gnot tnonsllitis,” I said, sounding like I was trying to swallow a large dumpling. “Plnease gnan I hnave…” “Don’t say another word,” she said, “…And the Tamiflu?” “Tnen tnimes wnorse,” I mumbled. “Ah,” she said, “So sorry. Everyone thinks that it’s this big Holy Grail and it’s not. Sadly, though, it’s all we’ve got.”

…so that’s how it feels to get the flu. click here for a handout with instructions on taking care of yourself if you’ve got it.

you will note that i, a vegetarian, recommend hot chicken soup – or a reasonable facsimile thereof (hot-sour soup and kimchee ramen are good vegetable alternatives) – see here for scientific evidence base. see here for medicinal chicken-soup recipe, with garlic, red chilies, ginger root, and plenty of vegetables.

old wives, like old scientists, say that sickness is likely to be worse if you
– can’t get enough sleep
– are under too much stress
– get chilled
– or are deficient in vitamin d.
(all right, old wives aren’t that specific about vitamin d. but it is becoming clear now that many of us here in the northern hemisphere, who spend a lot of time indoors, are deficient in this important immune-modulating vitamin.)

as you recall, antiviral medicine (tamiflu, relenza) is not that great to begin with (only shortens the course by a little bit) and isn’t very effective at all if started more than 48 hours after symptom onset. antiviral medicine is reserved for those who get the flu and…
– develop bronchitis or pneumonia
– suddenly get much worse
– have higher risk of complications: younger than 2, older than 64, pregnant women
– have a chronic lung disease (asthma, COPD, etc)
– have other chronic conditions (diabetes, heart failure, kidney failure, hepatitis, etc)
– have severe obesity (body mass index 40+)
– have a neuromuscular condition that could interfere with clearing secretions (seizure disorder, MS, parkinson’s, etc)
– have a weakened immune system (taking steroids, taking immune suppresant medicine, living with HIV, etc)
– are 18 or younger, on long-term aspirin therapy (Reye syndrome risk from viruses)

please call me if you or your loved one have these signs of the flu:
temperature 100+ by mouth (if you measured inside the ear or rectally, subtract 0.5 degree; if you measured under the arm, add 0.5 degree) and/or shaking chills,
and cough or sore throat.
other symptoms: headache, chest pain or pressure, difficulty breathing, shortness of breath, diarrhea, vomiting, severe body aches, extreme tiredness, dizziness, confusion, or flu symptoms that go away and then come right back.

danger signs in children:
if you are worried, call me. if you are very worried, go to the emergency room!

details about the h1n1 flu shot:
– the injected shot contains killed virus.
– single-dose syringes contain no mercury. multi-dose bottles do contain mercury preservative.
– the nose-spray shot contains weakened live virus.
– no h1n1 flu shots in the united states contain any squalene or any other adjuvant.
– the shot has not been fully tested – any more than any other flu shot is tested… which is to say, laboratories plan ahead for what strains will be needed, and make the vaccines at least 6 months in advance. clinical trials of shots given to 4500 people nationwide (including elderly, kids, pregnant, immune-suppressed, and people with lung conditions) started in august, and no safety “red flags” have been found yet.
– the shot is made by the same “recipe”, in the same labs, and by the same manufacturers, as every year’s flu shot. it’s neither a new kind of vaccine, nor similar to the vaccine made 33 years ago.
– the shot can make your arm sore, and the immune reaction can make you feel crummy for a day or so, but this is not the same as having the flu (it’s not a viral infection).
– if you already had h1n1 flu earlier this year, you may be immune without a shot – unless the virus mutates. it hasn’t done so yet!
– right now at least 90% of all flu in the u.s. is h1n1. the “regular” flu season hasn’t really started yet.

a concerned reader wrote to me, reporting that her own primary care doctor, and the specialists she sees, do not intend to get the h1n1 shot. i found this surprising, since almost all the primary-care docs whom i know plan to get it – mainly because they are exposed to a lot of flu, and would be unavailable to their sick patients for many days, if they got sick. (and, of course, they’d make their patients sick, too.) my reader wondered if i am associated with vaccine manufacturers in any way.

please allow me to reassure her, and you, that not only do i neither buy nor sell vaccines at this time (they’re very expensive!), i also do not accept visits, invitations, phone calls, presents, free lunches, drug samples, or surveys, from drug companies or their representatives. none of my family members or personal friends work for drug companies, either. my interest in vaccines stems purely from a personal interest in – believe it or not – natural healing, and the body’s own resilience and tendency toward good health. does this mean i’ll “make you” get a shot? it does not. i’m going to get one, though.

so… how are you feeling?

please call me if you get sick!

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no-hitting newshour

By | September 29, 2009

r-e-s-p-e-c-t
find out what it means to me
r-e-s-p-e-c-t
take care, t.c.b.
oh!

Situation: Your child has just run out into traffic. Or: thrown a golf ball at the picture window. Or: stolen a toy from a store. Or: peed on the couch. Or: spit at their brother. Or: turned up the tv, after you told them to turn it off. Or: hidden their eggplant casserole in their napkin and tried to sneak away to the bathroom to flush it, then told a preposterous lie to blame it on someone else. Or: thrown a violent screaming tantrum, possibly involving swear words or throwing things, in the candy aisle of the grocery store, in the doorway of the preschool, in the church parking lot, and/or in the waiting room at the doctor’s office. How do you respond?

a) pull out your cell phone and take a photo.
b) pull out your cell phone and dial 911.
c) point out to them that their behavior is highly illogical.
d) hit them.

hitting kids is in the news these days, all over the world. my personal suspicion is that the past decade’s worsening levels of warfare and economic meltdown have been stressing out the world in general, leading both to more family violence and to more concern about it. here are some recent newsbites:

Researcher Murray Straus found that younger children who were spanked scored an average of five points lower on their IQs, compared to children in their age group whose parents did not believe in corporal punishment… This was the third major U.S. study released this year showing a correlation between physical discipline and a child’s intelligence. “To put it in a nutshell, corporal punishment slows down the rate of development of mental ability,” Straus said in a telephone interview from San Diego. “All the kids got smarter because they got older, but the ones who were spanked, less so.”

Published in this month’s issue of the journal Child Development, [a] study of 2,573 toddlers enrolled in Head Start found that… early and frequent spanking – by the age of 1 – is not only very common, but it also makes their behavior at age 2 more aggressive and by age 3 appears to have slowed their socio-emotional development. They also found that a low-income mother is most likely to start spanking a very fussy, irritable baby by the age of 1, and more likely still if the mother is depressed. Boys were spanked and yelled at more often than girls.

…The American Academy of Pediatrics in 1998 issued a recommendation that parents find means to correct children’s behavior other than corporal punishment. A large body of evidence suggests the practice is seldom effective and may have negative effects.

A Cincinnati woman has been charged with assault for spanking a two-year-old that was not her child. Police say Gloria Ballard encountered the young boy and his mother Dannay Jones at a Salvation Army store. Jones says her son was misbehaving and talking back to her when Ballard approached and told the mother to silence the child. When an angered Jones responded, Ballard is accused of grabbing the child, bending him over her leg and spanking him up to four times.

After being arraigned, Ballard told reporters outside the courtroom that she only tapped the child on the behind… Claiming that she gave the child love, affection and attention, Ballard then put a bear hug on a reporter and tapped him on the rear to show what she had done.

A Gwinnett County [Georgia] man is in custody accused of slapping a stranger’s crying toddler in a Stone Mountain Wal-Mart on Monday. Sonya Mathews, the mother of the 2-year-old child, told police that both were walking in the aisles of the Rockbridge Road store when Roger Stephens, 61, approached and said “If you don’t shut that baby up, I will shut her up for you.” …Stephens was charged with felony cruelty to children.

The Ohio Legislature is close to passing a law that would make it legal to spank other people’s children. “Well, it’s obvious the parents aren’t going to do it,” said state Sen. Harold Shotmeyer, R-Canton.

A 27-year-old Pine Bluff woman who allegedly used a cord to spank her son got a stern lecture from a Jefferson County circuit judge Wednesday, as well as the possibility of felony charges… Judge Berlin Jones [said]… “The concern this court has is that there were some welts in the child’s face that should not have been there.” Jones ruled that prosecutors had probable cause to charge [the mother] with second-degree domestic battery.

A study released Tuesday [8/19/08] by doctors at the University of North Carolina-Chapel Hill finds that… parents are much more likely to beat, burn or shake their children if they spank frequently… “Parents get angry when they’re spanking and it’s not working,” said Adam Zolotor, lead author of the study and a pediatrician at the UNC-CH’s Department of Family Health. “If a child gets spanked so often, they just don’t care anymore and will misbehave anyway.”

…12 percent of [parents] who spanked 50 or more times in the last year admitted abuse such as beating, burning, shaking or hitting the child with an object about their body… “People want to change behavior immediately, and they think spanking is the way to go,” said Tom Vitaglione, a child advocate from Raleigh-based Action for Children who has pushed for the statewide ban on spanking in schools. “Down the line, though, these children do far worse. That relationship of trust is broken.”

An outraged mother said she plans to press criminal charges against the public school official she claimed beat her daughter leaving her with several bruises… Her 15-year-old daughter… said she had been hit on the neck, back, arm and buttocks by an administrator. The teen claimed the school official beat her with a metal rod wrapped in black tape because she thought she was skipping class.

More than 200,000 U.S. schoolchildren were subjected to corporal punishment during the 2006-2007 school year, [a] study shows… Paddlings in school are still legal in 20 states… In the saddest finding of the ACLU study, children with disabilities, especially autism, drew corporal punishment at a far higher rate than others, the study found. Children with autism were often punished for behaviors linked to the condition, because teachers lacked the knowledge, training or patience to use other methods of behavior control.

A former Perry Township [Indana] teacher accused of twice striking a disabled student asked a judge Monday to dismiss his felony battery charges. Thomas E. Cripe’s attorneys cited Indiana’s corporal punishment protections for educators. …Cripe’s student was a 20-year-old man with autism and severe mental retardation.

The Decatur County [Georgia] Board of Education has opted to keep its existing corporal punishment policy, ending a seven-month suspension of the practice in local public schools… after a Feb. 6 incident in which an assistant principal was judged to have used excessive force in disciplining a student.

At least 818 Chicago Public School students, since 2003… allege being battered by a teacher or an aide, coach, security guard, or even a principal. In most of those cases – 568 of them – Chicago Public School investigators determined the children were telling the truth… Investigators found reports of students beaten with broomsticks, whipped with belts, yard sticks, struck with staplers, choked, stomped on and pushed down stairs… Of the 568 verified cases, only 24 led to [teacher] termination.

A teacher in Thailand was captured on film beating a 14-year-old student and bashing his head against a blackboard, sparking national outrage… “I won’t do it anymore,” the boy screamed after the teacher slammed his head at least four times against the blackboard as his classmates watched, occasionally giggling.

Parental consent or even request for corporal punishment of students for misconduct has no law-binding basis therefore the act of punishment will still be considered illegal, said Taipei County [Taiwan] department of education (DOE) yesterday.

The Terre des Hommes children’s rights organisation has called for more public debate in Switzerland on the issue of children and corporal punishment… pointing out that Switzerland was not among the 19 European countries that have completely banned the practice.
“If you beat a dog it is mistreatment, if you beat an adult it is a criminal offence but if you beat a child it’s considered in the family as being for the child’s own good,” noted Elda Moreno from the Council of Europe’s Children’s Rights Committee. “We want to get rid of this perverse idea.”

The three [Filipino] House panels on revision of laws, welfare of children and appropriations, unanimously approved House Bill 6699 or the so-called Anti Corporal Punishment Act of 2009… HB 6699 prohibits all corporal punishment and all other forms of humiliating or degrading punishment of children in homes, schools and other places.

Outdated language used to justify corporal punishment of children is set to be removed from new translations of the Christian Bible in Norway. Church leaders… [will] replace the word “chastisement” with more appropriate language reflecting its original and intended meaning. Ombudsman Reidar Hjermann found that children subjected to physical harm, who had contacted his office, believed violence may be authorised by the Bible.

Thirteen countries have abolished all corporal punishment of children – Sweden (1979), Finland (1983), Denmark (1986), Norway (1987), Austria (1989), Cyprus (1994), Latvia (1998), Croatia (1999), Israel (2000), Germany (2000), Iceland (2003) and, most recently, Ukraine (2004) and Romania (2004).

oregon law: An individual who is a teacher, administrator, school employee or school volunteer may use reasonable physical force upon a student when and to the extent the individual reasonably believes it necessary to maintain order in the school or classroom or at a school activity or event, whether or not it is held on school property… The authority to discipline a student does not authorize the infliction of corporal punishment… “Corporal punishment” means the willful infliction of, or willfully causing the infliction of, physical pain on a student.

more oregon law: A parent, guardian or other person entrusted with the care and supervision of a minor or an incompetent person may use reasonable physical force upon such minor or incompetent person when and to the extent the person reasonably believes it necessary to maintain discipline or to promote the welfare of the minor or incompetent person.

A northwestern Oregon man who used a shock collar for dogs on his young children has been sentenced to three years of supervised probation… He also is barred from using corporal punishment and participating in physical play with children. Investigators say Marcum used the electronic collar to shock his four children – ages 3 to 9 – last spring because he thought it was funny.

Half a Dozen Reasons Not to Hit* Kids
1. If you don’t hit them, you can teach them not to hit other people themselves, and they’ll listen.
2. If you don’t hit them, you can teach them to be sorry for their mistakes, instead of angry at you.
2. If you don’t hit them, you preserve your home as a safe place for kids.
3. If you don’t hit them, you don’t risk unintentionally injuring them.
4. If you don’t hit them, you don’t send their stress level – or yours – out of control.
5. If you don’t hit them, you don’t trigger your own sad/ mad/ bad memories of childhood.
6. If you don’t hit them, you can set a good example of smart, creative, and fair conflict resolution.

(when i say “hit,” i also mean swat, paddle, tap, slap, pinch, switch, spank, strike, punch, shake, shove, drag, choke, tie up, tape down, threaten, menace, curse, hold hostage, or otherwise treat a child in any way that would be against the law, if it were done to an adult or to an animal.)

however… as you know… kids misbehave.

our original example was drawn straight from real life:
Your child has just run out into traffic.
Or: stolen a toy from a store.
Or: thrown a golf ball at the picture window.
Or: peed on the couch.
Or: spit at their brother in the back seat.
Or: turned up the tv, after you told them to turn it off.
Or: hidden their eggplant casserole in their napkin and tried to sneak away to the bathroom to flush it, then told a preposterous lie blaming it on someone else.
Or: thrown a violent screaming tantrum, possibly involving swear words and/or throwing things, in the candy aisle of the grocery store, the hallway of the preschool, the lobby of the church, and/or the waiting line at the doctor’s office.
What do you do?

here is my advice.

you need a two-step approach: first step, in the heat of the moment. second step, after the dust settles.

In the heat of the moment:
1. Count to ten. Literally count to ten. Relax your shoulders. Do not flip out.
2. If anyone is in immediate physical danger:

• Calmly, swiftly, pick up your child in your arms and carry them away from the scene. Do not shout at them, drag them, or otherwise enable violent behavior during the removal.
• If they are yelling and thrashing on the ground/floor, ensure their safety (so nothing will fall on them), quietly sit down within arm’s reach, and let them tantrum until they stop.
• If they are running away from you or otherwise making it impossible to ensure their safety, wrap your arms around them and hold them on your lap (immobilize their arms and legs) until they stop. (Be prepared to avoid head-butting and biting, since your child is not thinking rationally at this time.)

3. If the problem is naughty behavior:

• First, calmly state what you see happening. “I see you colored on my computer screen.” “I see you have a bike that does not belong to you.” “I see you put salsa on the cat.”
• Then, calmly make them observe the result of their actions. “Look at this mess. It is gross.” “Look at Rashan. He’s crying because it hurt when you bit him.” “Look at my jewelry box. It won’t close because the lid is broken now.”
• Finally, teach them how to fix the damage or make amends immediately. You can offer to help. “That sounded like a lie. I want you to tell me the truth now.” “That was a mean thing to say. Take it back.” “That’s Pema’s hat. Give it back to her and say ‘I’m sorry I took your hat.’ I’ll come with you.” “You tore up Grandma’s picture. I want you to write a letter to her right now, telling her you’re sorry. We can mail it together.” If they are too upset to follow instructions, go over it again with them after they’ve calmed down.

To summarize: In the heat of the moment,
1. Count to ten. Calm down.
2. Ensure safety.
3. State what you see.
4. Make them observe the result of their actions.
5. Teach them how to fix the damage or make amends.

Debriefing – when the dust has settled:
Take a few minutes by yourself to think. Why did your child act out in that way – in that place – at that time? If you can figure this out, and especially if you see a pattern of behavior, maybe you can make a plan that will reduce problems in the future.

Here are some common issues:

Is the child stressed out?
Diet: Too much junk food/sugar/artificial colors and flavors? Solution: reevaluate diet, and change shopping list as needed.
Sleep: Not enough? Overtired? Bad dreams? Scared of the dark? Solution: adjust sleep arrangements.
Attention: Not enough? Less “one-on-one” time with you lately? Consider: Do you read to your child? Do you color with them? Play in the bath with them? Solution: set aside one or two times daily when you will provide one-on-one attention to the child.
Violence: Recent violent games, shows, or movies? Has the child been bullied at home, at school, or with other caregivers? Have they witnessed abuse and violence? Your child is very unlikely to tell you about this! Solution: Restrict or eliminate violent television and games. Ask your child, often, how they are treated by others. Supervise, observe, and monitor. Do not behave or speak violently yourself.

Is the environment a problem?
Hazards: Reduce them! Is the environment baby- and child-proofed for safety?
Chaos: Reduce it! Is the house quiet after bedtime? Do you eat meals together as a family, with no arguments allowed? Does each family member have a private space of their own, large or small, that is respected? Do all family members follow the same “House Rules”?
Temptations: Reduce them! Can you prevent misbehavior by storing pens and pencils, cellphones, television/stereo/ computer controls, makeup/hair products/ jewelry, etc, where the child can’t see them or reach them? Keep items that cannot be shared out of sight (example, older siblings’ private property).

Is the child behaving normally?
Imitation: Is the child trying to act like a grownup or older child? This is normal learning behavior. Solution: Provide better role models for your child (friends, movies, stories); restrict or eliminate contact with poor role models (friends, movies,stories). Explain the reasons why you disapprove of specific bad behavior, and why you approve of specific good behavior.
Experimentation: Is the child trying something new, risky, or interesting, without realizing it will cause trouble? This is normal creative behavior. Solution: Explain, in terms the child can understand, what were the unexpected results of their behavior.
Protest: Is the child reacting against activities/foods/clothing they hate? This is normal self-respecting behavior. Solution: Analyze the situation: how important is the activity/food/clothing? If it’s not very important (for example, string beans), is there a choice you could reasonably offer the child (would you rather have string beans or carrots)? If it is very important (for example, going to the babysitter), can you make a compromise (we have to go to Mrs. Grundy’s house now, but you can pick 2 toys to bring with you)? Try to offer a fair deal that your child can understand. Note: your child will expect the right to reject your offer, just as you have that right when they try to bargain with you. That’s just how bargaining works. Kids have a strong sense of fairness.

You will notice that all of these approaches involve a lot of explaining. As a wise fella once said, “Kids don’t have any ear-lids, so you can just keep telling them what you want them to learn.”

It’s always a good idea to make a plan, write down your plan, and know how you will tell if your plan has succeeded.

I also recommend having a short set of simple “House Rules” that apply to everyone, that each family member understands and can remember. For example:

1) No Hitting. 2) No Threats. 3) Put Your Dishes in the Dishwasher.

…Or whatever works for your family.

The reality is that kids do not want to be in trouble, any more than adults want to be jerks. Kids want to be respected and admired and loved – to “feel right” in the world. Imitation, experimentation, and protest are the natural parts of their learning. Unless they have serious developmental or psychological challenges to deal with, they will try to play by the unwritten rules as they understand them. Unfortunately, sometimes the unwritten rules seem to say “Might makes right” and “Look out for Number One,” instead of “Treat others as you’d want to be treated” and “We’re all in this together.”

The good news is, when you start out by figuring out why children misbehave, there are a million ways to resolve conflicts. When you start out by hitting, there’s only one – and it doesn’t even work!

Good luck.

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