June 2010

AMC has been running Clint Eastwood’s classic western, Unforgiven. It won Best Picture in 1992, and another look at it reminded me of why it’s one of Eastwood’s best movies.

It was a timely showing, too, since Unforgiven strikes a chord in people who like to talk about gun control. I thought about this on Monday when the U.S. Supreme Court voided Chicago’s gun control law – just one week after the city was rocked by 40 separate shootings over the weekend of June 19-20.

Big Whiskey, Wyoming, had its own gun ban and it was brutally enforced, as gunslinger English Bob (Richard Harris) discovered when he ignored it. Sheriff Little Bill Daggett (Gene Hackman) found out that Bob was armed and surrounded him with armed deputies. He forced Bob to give up his guns and then proceeded to beat him bloody in the street.

Why am I comparing the Wild West’s Big Whiskey, Wyoming, to Chicago? Well, in both cases the bans were ineffective in limiting violence. The 40-shooting weekend occurred in Chicago while the gun ban was in full force.

And Big Whiskey was awash in brutality, despite the ban. In fact, Clint Eastwood’s character William Munny ends the movie in an orgy of violence.

From what I’ve read, by the way, Eastwood is not anti-gun control, and Unforgiven was not a gun control commentary, pro or con. I think his focus was more on the violence that seems baked into the American culture.

Now we return to Chicago. The gun control decision will undoubtedly have both sides in the debate locked and loaded on Fox News and MSNBC. Second Amendment advocates and the National Rifle Association will of course be whooping for joy; gun controllers will warn of dire consequences.

But it looks to me like much ado about nothing. Chicagoans who really wanted a gun probably had one already. A few more legally cautious people may end up owning a weapon, but I’d be willing to bet that the net change will be negligible.

No, the real issue is the violence built into the American psyche. So don’t look for any changes despite what the Supreme Court says, or how City of Chicago officials try to regulate gun ownership now that the ban has been lifted.

And maybe that’s the message of Sheriff Bill Daggett, English Bob and William Munny.

Image: Unforgiven movie poster, Warner Brothers

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It can be tough when you have a long-held opinion about someone that gets turned on its ear by events. That’s what happened when I found myself agreeing with the Supreme Court justice who had the guts to dissent on a major mental health care decision last month – Clarence Thomas.

Well, heck. As they say, even a stopped clock is right twice a day. So I suppose I shouldn’t get too shaken up about it. And sure, I may even pay more attention once in a while to what the justice has to say. What have I got to lose, other than a little self-respect?

So many, many bad decisions by Thomas.

But in this case I refer to the May 17 U.S. v. Comstock ruling in which the court decided that sexual offenders can be civilly committed beyond their prison sentence for reasons of public safety.

The case centered on five people convicted of sexual offenses under federal jurisdiction who were committed to institutions following completion of their sentences. The question was whether this was in within the scope of congressional authority to enact such an outcome.

Writing for the majority, Justice Stephen Breyer said that it was, noting that the federal government has long been involved in the civil commitment process when mental illness was involved.

Yes and what a long and shining history this has been.

But there are really two issues here. The first is the broader one that, if the federal government decides you are a danger to society, it has a right to keep you off the street. You may find it difficult to imagine this becoming a problem with a sexual offense, but think of that as just a starting point.

Federal prosecutors would never use the heavy hammer of civil incarceration as an excuse to stifle the basic gift of expression. No, no, no. Never.

Still, you can’t help wondering whether the decision, as Thomas says, “…comes perilously close to transforming the [constitutional] Necessary and Proper Clause into a basis for the federal police power….”

Additionally, the American Psychiatric Association publication, Psychiatric News, worries that since the court has now equated sexual offenses with mental illness, it has basically put its stamp of approval on civil commitment over public safety concerns due to mental illness.

“The Court has thoroughly bought into the notion that people who are sexually dangerous are mentally ill,” APA past president and forensic psychiatrist Paul Appelbaum told the publication.

Psychiatric News drills home the point when it adds: “More fundamentally, the ruling gives the Supreme Court’s approval to a practice that very likely has little to do with treating people—mentally ill or not—and more to do with keeping people perceived to be a public menace off the streets.”

If society wants to keep sexual offenders out of circulation – and that’s a worthy goal – it ought impose longer prison sentences, not use the weaselly outlet of civil commitment.

As Thomas wrote: “To be sure, protecting society from violent sexual offenders is certainly an important end. But the Constitution does not vest in Congress the authority to protect society from every bad act that might befall it….

“The fact that the Federal government has the authority to imprison a person for the purpose of punishing him for a federal crime—sexual-related or otherwise—does not provide the government with the additional power to exercise indefinite civil control over that person.”

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After my rant about the uncivilized society last week I couldn’t help gasping in amazement when I saw this headline in The Chicago Tribune yesterday: “At least 40 shot across city over the weekend.”

It appeared that most of the people were just standing around on the street, and someone popped them as they were driving by. For example, a 31-year-old man was waiting for a bus at 5 p.m. on Sunday afternoon when he was shot in the buttocks.

Two people were shot sitting in their vehicles in traffic. Nobody was in custody for any of the shootings, half of which police said were gang related.

Half. Which means of course that half were not.

Curious, I checked some of the other major markets to see what kind of carnage took place over this first weekend of a very hot summer bubbling over with chronic urban unemployment.

Los Angeles: Two shot on Friday evening in two separate incidents in South L.A. This in addition to the Sunday massacre at a taco restaurant in San Bernadino when a 56-year-old man opened fire on his step-daughter’s family, killing two and then himself.

Newark, New Jersey: One woman killed on Saturday after gunfire broke out at a block party around 9:30. “Bullets started flying” during the cookout, according to the Star-Ledger. Another man was wounded.

The paper added: “The shooting capped a violent five hours in Newark during which two separate shootings left two people dead.” A few hours earlier, a man had been approached from behind while walking down the street and was shot in the back.

Chattanooga, Tennessee: A 20-year-old man was shot twice late Saturday night in a housing development by “unknown suspects.”

St. Louis: Four separate shootings, including a 56-year-old man who was “shot in the rear end” on Saturday night; a 21-year-old woman shot in the foot; a couple shot in the leg by some people firing from a car; and a 43-year-old man shot multiple times in the wee hours of Sunday morning.

And so on.

I’d stop short of calling it an epidemic of violence, since a few weekend shootings are typical for any big city in the summer. Nevertheless, the Chicago blood bath should give us pause.

Sky-high unemployment, heat, flaring tempers and an attitude of everyone being out for themselves. A frayed social fabric stretched to the breaking point. Ingredients for the prototypical long hot summer.

Photo: Chicago: http://www.flickr.com/photos/bdesham/1124223314/

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I wasn’t terribly impressed by a study last month showing a lack of empathy among college students and graduates since 2000. I have an inherent dislike and distrust of anything that tries to pit age group against age group.

But I have to admit I thought of it yesterday when I spotted this unsettling scene: A woman was trying to cross a busy street in a power chair. A twenty-something driver was approaching and refused to slow down – he didn’t even take his foot off the gas – as she hurried across the road. She said something and I couldn’t hear exactly what, but the tone was exasperation.

Now, I understand that the driver figured he had the whole thing timed out properly, that as long as the woman kept moving at her current pace, he’d avoid a collision. But had her chair quit, or sputtered, in mid-road, the consequences would have been disastrous.

“Many people see the current group of college students – sometimes called ‘Generation Me’ – as one of the most self-centered, narcissistic, competitive, confident and individualistic in recent history,” said Sara Konrath, a researcher at the University of Michigan’s Institute for Social Research who presented the study at a conference in Boston.

Her argument: “Compared to 30 years ago, the average American now is exposed to three times as much nonwork-related information. In terms of media content, this generation of college students grew up with video games, and a growing body of research, including work done by my colleagues at Michigan, is establishing that exposure to violent media numbs people to the pain of others.”

My view is based on personal observation, not scientific study. But I don’t believe that the lack of empathy is strictly a condition of youth. Rather, it seems to be spreading through the culture at large to the rich, the poor, the young and old.

I’m not sure why, but I’m pretty certain that it has nothing to do with video games.

It is part and parcel of another social disorder I and many others have observed: uncivil discourse. It’s been unfolding for the better part of three decades and the seeds planted way back when – whatever they were – are starting to bear some pretty ugly fruit.

Check the battery level in your power chair and watch your back.

Photo: http://www.flickr.com/photos/niffyat/3905208112/

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Another day, another report on the country’s dysfunctional health care system.

This one, issued by the American Medical Association Monday, examines just one of the many busted pieces, finding that one in five health insurance claims are incorrectly processed. The inaccuracies cost the health care system $15.5 billion a year, money that could be spent on actually delivering services.

Even a 1 percent improvement would save $776 million, according to the AMA’s National Health Insurer Report Card.

Here’s another shocking statistic: Up to $210 billion is spent every year on claims processing, and doctors spend the equivalent of five weeks annually trying to cut through insurer red tape.

“Each insurer uses different rules for processing and paying medical claims, which cause complexity, confusion and waste,” said AMA Immediate Past President Nancy Nielsen. “Creating a single transparent set of processing and payment rules for the health insurance industry would create system wide savings and allow physicians to direct time and resources to patient care and away from excessive paperwork.”

From the consumer’s side, denials usually cause the most angst. And here’s where it gets very interesting. The percentage of claims denied varies widely, from Cigna at .67 percent to Anthem at 4.5 percent.

In 2008, Aetna denied 6.8 percent of its claims, reduced it to 1.81 percent last year, and came in with 2.57 percent in the 2010 AMA report.

What were the reasons for the denials? “Expenses incurred after coverage terminated” topped the list at several companies. At Aetna, this was a quarter of all denials; almost half – 45.6 percent, at Coventry.

At Anthem, a lack of complete information was the largest factor, making up one out of every five denials. Cigna listed “Non-covered charges” at 27 percent; and in the same category, Humana was at 40.8 percent.

As anyone who has ever filed a health insurance claim knows, every year one thing or another is denied, requiring hours on the phone with a claims rep, and your physician’s office, to sort it out. Sometimes there is a problem with the way a claim was submitted, but it often seems that insurers are looking for a loophole they can crawl through in order to deny a claim.

I wonder how much insurers save every year on claims denials simply because busy network members give up. There’s a limit to how much time you can spend on an issue.

But the real problem is a top-heavy system that wastes billions of dollars by forcing everyone, medical service providers as well as customers and human resources people, to jump through hoops in order to settle a medical claim.

At the very least, the AMA has a legitimate point on standardizing the claims process, and this should be one of the fixes to the reform law once Congress begins tinkering with it next year.

Photo: http://www.flickr.com/photos/infomofo/102321549/

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There’s one type of research that I find particularly galling. That’s analyzing certain physical characteristics and then concluding that people who have them are more prone to heart disease.

And here’s another one freshly published in the June 8 European Heart Journal: “Short Stature is associated with coronary heart disease.” It’s based on a review of 52 previous papers on heart disease and height factors in 3 million men and women.

Although the issue of height was relative – the definition of “short” varied from country to country – the researchers found that the shortest people within a population were 50 percent more likely to have heart problems than tall people.

On average, though, short people were defined as being under 5-feet 3-inches, and tall people were more than 5-feet 9-inches.

“The relationship between short stature and [cardiovascular disease] appears to be a real one,” the researchers concluded.

So, for height-deprived folks who already weren’t real happy about it, here’s another pie in the face, thank you very much. But they shouldn’t feel alone.

Men who have a diagonal crease in their earlobes also have a higher risk of dying from heart disease. This is based on a University of Chicago study released in 1991. A group of 108 patients were followed for 10 years, and those with earlobe creases had higher heart-related death rates than those who didn’t.

So. You follow a healthy diet, exercise like crazy. Then one day you’re looking at yourself in the mirror while shaving and notice THE CREASE. You feel you’ve been duped. All those salads, all that tofu. For nothing.

You head out for a well-deserved cheeseburger with a double order of fries.

And yet another delightful study: Male pattern baldness is associated with a greater risk for heart disease. The more hair loss, the greater the risk, according to the Harvard Medical School study, which came out in 2000.

Pattern baldness, by the way, is the kind of hair loss that starts up at the crown of the head and spreads from there. Guys with receding hairlines – even if they’ve receded all the way back to their ankles – are apparently safe.

But if you’re dealing with the pattern baldness AND have high blood pressure, you’re like a walking time bomb. Men who are also short and have an earlobe crease should have 911 programmed into their cell phone speed dial.

What’s the point of these studies? Well, the idea is that if you have these uncontrollable risk factors you should take extra care to tow the line on all the other fronts, like diet and exercise.

But it’s hard to escape the conclusion that if you’re tall, with a full head of hair and no earlobe crease, having that extra slab of prime rib and skipping your workout may not be such a bad thing. And that’s my definition of galling.

Photo: Consolation prize – eat up! (http://www.flickr.com/photos/hellochris/202508906/)

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Admittedly, I’m behind the curve sometimes when it comes to technology. Yes I do all the social networking for my freelance writing business, and keep in touch with what family members are doing on Facebook.

But there are many places where I have not ventured. I use only a portion of the features on my cell phone, for example. There is a slew of interactive websites of which I know little.

Which brings us to the topic of something called advergames. When my daughter was little, and we went into a chain restaurant, the hostess would often give her a placemat and a set of crayons. On the placemat was a little game that usually featured a character or situation that involved promotion of the franchise.

But now companies are reaching right into people’s homes to find kids interested in playing interactive web games that promote their products.

There’s even a website that has assembled these games for easy access – advergames.com. Kids can pick out games that strike their fancy, or they can build their own personalized page of favorites by creating an account. Some of the companies sponsoring the advergames include Frito-Lay, Coca-Cola and 7-Eleven.

Advertising to children has always been the subject of debate. And now a study by the University of California at Davis contends that the new medium is being used to sell high-fat, high-sugar foods and beverages to kids. Researchers, who published their findings in the May issue of the Journal of Nutrition Education and Behavior, would like food companies that target kids to come up with some content standards.

“We knew based on our previous research that food advertising on television programming for children is dominated by high-fat quick-service restaurant options and high-sugar cereals and candy,” said Diana Cassady, senior author of the study and an associate professor of public health sciences. “At the same time, we noticed a lot of that TV advertising included corporate websites, and we wanted to find out how these sites were being used to communicate about food to kids.”

Cassady and her colleagues analyzed beverage and food websites advertised on the Cartoon Network and on Nickelodeon in 2006 and 2007. They found that 84 percent of these sites included advergames.

“I was astounded by how often logos or actual food products were integrated into the games,” said co-author Jennifer Culp. “For example, some games used candy or cereal as game pieces. In others, a special code that was only available by purchasing a particular cereal was necessary to advance to higher game levels.”

The researchers aren’t attacking the concept of advergames. But they’d like companies to self-regulate by including nutritional and physical exercise information.

Advertising works, which is why there’s so much of it on TV, radio, in print and on the Internet. Kids are particularly susceptible. The UC Davis study is a reminder that new advertising vehicles are being created all the time, and we need to carefully consider their impact.

Photo: http://www.flickr.com/photos/ejk/417437288/

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The American health care system is disjointed, top-heavy in administration, and politically contentious. Delivery of actual services seems almost incidental. And the costs keep going up, up and away.

All this we know. But there are a few pioneers who are thinking about the real root of the problem, which is how to get more health care services out to people of all stripes. The obvious starting point is to give people more low-cost options.

And that’s exactly what they’re doing in Mississippi with the Mississippi Health House Network, an idea that makes so much sense it’s almost shocking to see it proposed in a country obsessed with high-priced pharmaceuticals, medical tests and quick-fix therapies.

A Health House is just what it sounds like – it’s in a house or other building staffed by people from that community who get basic training as Community Health Workers. They do very basic things like screen people for signs of diabetes, putting the patient back on the road to a compliant diet, taking blood pressure, or counseling people on how to deal with asthma.

There’s no impediment to this first “Level 1” step of health care because it’s free. This removes the most important barrier to getting people to begin to address health issues. They may or may not go on to the next level, which is a community health care clinic staffed either by a nurse practitioner, a physician or both.

The Health House Network is still under construction, as you’ll see from its website.

One of its main promoters is Dr. Aaron Shirley, a Mississippi community health care pioneer who converted an empty shopping center in Jackson into a medical mall for the poor.

But the idea originally comes from rural Iran, which has more than 1,000 health houses staffed by trained health care workers. Shirley, and a partner in the Mississippi program, James Miller, visited Iran in May 2009, looked at what they were doing and came back impressed.

Despite Iran’s negative image in the U.S., Shirley and Miller convinced officials in Greenwood, Miss. to open the first Mississippi Health House in an abandoned new car showroom. They sold it as a health care system for the masses, similar to the Volkswagen Beetle.

Their website notes: “It was developed in the ‘30s by the Germans as part of their national socialist agenda, but later, when our country needed a well-built, inexpensive car that was simple to operate, it was imported and proved to be a great success for people who didn’t have much money to spend on transportation.

“Our healthcare health house model is just like the Beetle – developed for the masses in a country not too popular in the world right now (Iran), but designed to be inexpensive, efficient, and made for people who don’t have much money to spend.”

Initially, Health Houses will be located in six Mississippi Delta locations.

Necessity is the mother invention, and nowhere is this kind of a system more needed than Mississippi. It has the country’s highest levels of childhood obesity, hypertension and teen pregnancy, but more than 20 percent of state residents are uninsured.

Basic care is in demand in urban areas, too, and I hope this idea gains some traction. No, it’s not the solution to the U.S. health care crisis, but it’s a very reasonable, practical and doable step in the right direction.

Photo: Classic Volkswagen Beetle, http://www.flickr.com/photos/doctor_keats/244376112/

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Everyone wants airport security to be as thorough as possible. Taking off your shoes, scanning your carry-on or laptop, is common sense. And if you get pulled out of line randomly for a little additional attention, that’s also fine.

Now, the Transportation Security Administration plans to do a full body scan of two out of every three passengers by the end of 2011. This is a low power X-ray and the assumption is that it can’t do any physical damage at such minimal strength.

But recently a group of biochemists from the University of California at San Francisco sent a “letter of concern” to John Holdren, assistant to President Obama for science and technology. They wrote to express their reservations about “the potential serious health risks” of X-ray airport security scanners.

They argue that although the scanners are indeed used at low doseage, the energy they deliver is concentrated in the skin and the tissue immediately beneath it.

“Thus, while the dose would be safe if it were distributed throughout the volume of the entire body, the dose to the skin may be dangerously high.”

The approach lacks safety data, the scientists say. They would like an independent panel to investigate to assess potential risks to various segments of the public.

About 5 percent of the population is particularly sensitive to X-rays, and people over the age of 65 may be at particular risk. Passengers with HIV and other compromising health issues may also be susceptible to X-ray damage, they argue.

“The risk of radiation emission to children and adolescents does not appear to have been fully evaluated,” according to the letter, which was signed by four UCSF faculty members.

Well, it may not be terribly surprising that federal officials have scoffed at the suggestion.

“The risk is so low it’s almost negligible,” Alexander Garza, chief medical officer for the Department of Homeland Security, told The Los Angeles Times.

Almost negligible.

Fine, but who among us puts full faith and credibility in medical opinions offered by the federal government?

As Garza points out, passengers may opt for a “full body” search. But most people won’t want to go through the bother and will accept the word of the TSA that a scan is harmless. And it may well be.

But as the UCSF professors point out, not all risk is equal. On top of that, there are people who fly constantly, at least several times a week.

Safety is a top priority, but we ought to understand definitively what we’re getting ourselves into – not fly by the seat of our pants.

Photo: Airport security line via Flickr: http://www.flickr.com/photos/hyku/427400947/

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