When I was growing up in that mythical land known as New York City, the Vietnam War was at its bloodiest, and had been escalated beyond anyone’s imagination. But every year they called for a Christmas cease-fire, which was of course, broken several times by both sides. When remains clear in my mind is that on Dec. 24, the news anchor would always declare that “it is already Christmas Day in Vietnam.” In my mind, I couldn’t figure that one out. How could it be Christmas Day in Vietnam, when we still had to wait until tomorrow here in NY?

A Christmas cease-fire is a rather double-edged sword. Christmas is supposed to be the time of peace and good will towards our fellow man (okay, I’m using the wrong word and not being politically correct). So in that vein, guns should be laid down on Christmas Day, and all men and women join hands and realize that we belong to the universal brotherhood/sisterhood–one giant family. But on the other hand, if it is possible to stop fighting on Christmas Day, then why resume a war? Why go back to killing, maiming and destroying? If you can stop for Christmas, well, then it is possible to stop, period.

The Christmas Truce of 1914

The most famous Christmas cease-fire occurred in 1914, just five months after World War I got into full swing. Ten million men would eventually die in that war, and an untold number of civilians. But during that first Christmas, English, Belgian, French and German soldiers, covered in mud and living in lice-infested trenches in Flanders, spontaneously laid down their arms, sang Christmas carols together, and even played soccer. They shared food, tobacco and souvenirs such as uniform buttons.

Whatever caused these men to snub their nose at the folly of war and decide to be friends. Well, as in many wars, conflict begins at the top. These young European men bore no animosity towards eachother, and hadn’t particularly wanted to go to war. But the first world war was a prime example of arrogance out of control, overinflated egos, and no clear cut reason for such a massive conflict. Unlike the second world war, where there were “designated bad guys,” the first one was the fault of all nations who took part in it. The heads of state and the generals fired blind patriotism into the young recruits, and sent them off to kill and be killed, all in the name of–nothing.

The Christmas cease-fire infuriated the generals. They wanted to instill hatred, not brotherly love. If it was up to the soldiers, the war probably would have ended right there on the Western front. But like most wars, those that instigate it are usually far out of harm’s way. And so the generals forced the war to continue, which it did for another four years.

The 1914 armistice began with a tentative cease fire, and ended with both sides singing carols together, the climax being “Silent Night”, in German and English. As one German soldier said, “It was a day of peace in war. It is only a pity that it was not a decisive peace.”

Wars have been fought since recorded human civilization. Right at this moment, a number of absolutely senseless wars are being fought. Iraq is probably the biggest folly that comes immediately to mind, but there are ongoing wars in the Congo and the Sudan which have left millions dead. Chechnya and Afghanistan, still hot spots.

But as the men on the Western Front nearly 100 years ago proved, it is possible to stop a war. We all just have to be willing to do so.

Yet another Christmas conspiracy, and this one involves Santa. The famous poem “Twas the Night Before Christmas or A Visit From St. Nicholas” has always been accredited to Clement Clarke Moore. It was believed that he wrote it in 1822 for his two daughters, Margaret and Charity, and later anonymously published it in the Troy, NY Sentinel on December 23, 1823.

However, Don Foster, in his book “Author Unknown: On the Trail of Anonymous” has demonstrated that Moore is not the author. Foster concluded that it was most probably written by Major Henry Livingston Jr (1748-1828), a soldier who fought in the Revolutionary War, and then went on to be a farmer, surveyor and Justice of the Peace in civilian life. And yes, he was also a writer of some note, with his work appearing in many of the prestigious journals of his day. But for whatever reason, Livingston published most of his poems and prose, anonymously or under the pseudonym of R. T. His most famous poem (now that his authorship has been determined) is considered to be Account of a Visit from St. Nicholas, commonly known as ‘Twas the Night Before Christmas.

So now that we got the author straight, here it is:

‘Twas the night before Christmas, when all through the house
Not a creature was stirring, not even a mouse;
The stockings were hung by the chimney with care,
In hopes that St. Nicholas soon would be there;

The children were nestled all snug in their beds,
While visions of sugar-plums danced in their heads;
And mamma in her ‘kerchief, and I in my cap,
Had just settled down for a long winter’s nap,

When out on the lawn there arose such a clatter,
I sprang from the bed to see what was the matter.
Away to the window I flew like a flash,
Tore open the shutters and threw up the sash.

The moon on the breast of the new-fallen snow
Gave the lustre of mid-day to objects below,
When, what to my wondering eyes should appear,
But a miniature sleigh, and eight tiny reindeer,

With a little old driver, so lively and quick,
I knew in a moment it must be St. Nick.
More rapid than eagles his coursers they came,
And he whistled, and shouted, and called them by name;

“Now, DASHER! now, DANCER! now, PRANCER and VIXEN!
On, COMET! on CUPID! on, DONDER and BLITZEN!
To the top of the porch! to the top of the wall!
Now dash away! dash away! dash away all!”

As dry leaves that before the wild hurricane fly,
When they meet with an obstacle, mount to the sky,
So up to the house-top the coursers they flew,
With the sleigh full of toys, and St. Nicholas too.

And then, in a twinkling, I heard on the roof
The prancing and pawing of each little hoof.
As I drew in my hand, and was turning around,
Down the chimney St. Nicholas came with a bound.

He was dressed all in fur, from his head to his foot,
And his clothes were all tarnished with ashes and soot;
A bundle of toys he had flung on his back,
And he looked like a peddler just opening his pack.

His eyes — how they twinkled! his dimples how merry!
His cheeks were like roses, his nose like a cherry!
His droll little mouth was drawn up like a bow,
And the beard of his chin was as white as the snow;

The stump of a pipe he held tight in his teeth,
And the smoke it encircled his head like a wreath;
He had a broad face and a little round belly,
That shook, when he laughed like a bowlful of jelly.

He was chubby and plump, a right jolly old elf,
And I laughed when I saw him, in spite of myself;
A wink of his eye and a twist of his head,
Soon gave me to know I had nothing to dread;

He spoke not a word, but went straight to his work,
And filled all the stockings; then turned with a jerk,
And laying his finger aside of his nose,
And giving a nod, up the chimney he rose;

He sprang to his sleigh, to his team gave a whistle,
And away they all flew like the down of a thistle.
But I heard him exclaim, ere he drove out of sight,
“HAPPY CHRISTMAS TO ALL, AND TO ALL A GOOD-NIGHT!”

Christmas is my very favorite holiday, and in fact, nothing else even comes close. So regardless of whether Christmas for you is a time to rejoice, a time to celebrate, a religious occasion, a time to be stressed and frazzled, or just a non-entity, it is not a time when people decide that life is not worth living. I really hate to see Christmas given an unjustified bad rap, and the idea that the suicide rate peaks is just a myth. An urban legend, perpetuated and nurtured by the media.

But myths and urban legends are slow to die, especially if no one is doing anything to kill them.

The Annenberg Public Policy Center at the University of Pennsylvania published a study in 2001 which ripped apart the suicide/Christmas link, and pointed out how despite no evidence to support this fallacy, the media still clings to this outdated Christmas tale of woe.

In an analysis of newspaper articles about suicide between Thanksgiving and Christmas in 1999, researchers found nearly half of them associated suicide with the winter holidays, despite receiving press releases warning journalists that such associations don’t seem to be warranted. Suicides actually drop during the winter months, according to the National Center for Health Statistics, and instead, tend to peak during the spring months.

So why does this myth persist? Does it make us feel good to think that people kill themselves more frequently during holiday festivities?

Annenberg researchers offer several reasons why reporters may find the myth appealing and continue to perpetuate it:

• Despite the fact that the majority of persons who commit suicide suffer from a mental disorder such as depression, making the winter holiday-suicide connection gives readers a different and more “sexy” explanation for the occurrence of suicide.

· The tendency on the part of journalists to cover the same story on an anniversary schedule may also institutionalize the tendency to repeat the story at each holiday.

Image courtesy of Freefoto.com

Writing about Dickens and Tim put me in the mood for another viewing of A Christmas Carol. I’ve only seen it three times already this Christmas season, and three different versions (I count the movie Scrooged with Bill Murray as a legitimate version). But you can never have too much Scrooge, at least in my mind.

My all time favorite version was made in 1984, starring the late and great George C. Scott as Ebenezer Scrooge. It is such a lush and meticulous version, and difficult to believe that it was a made-for-TV-movie. It was filmed on location in Shrewesbury, England, and I imagine that many of the buildings haven’t changed at all since Dickens’ time–other than to update the lighting and put in electricity. The supporting cast is excellent, and the story really sticks to the book.

There have been quite a number of filmed versions of the book; 1935, starring Seymour Hicks, 1938 starring Reginald Owen, 1951, starring Alastair Sim, 1984 starring George C. Scott, and 1999 starrng Patrick Stewart. I’ve probably omitted a few, but these are the main players. But out of all of these versions, the George C. Scott production is the only one that depicts Tiny Tim as a sick child. In the other productions, he is neither small nor sickly looking. In fact, in the 1951 movie, Tim is nearly the same height as his mother and certainly bigger than several of the other children in his family.

But here, Tim is tiny. He is frail looking and pale, with dark circles under his eyes. He looks well, like a child who “if these shadows remain unaltered by the future, none other of my race will find him here (to quote the ghost of Christmas present).” Tim looks like he may very well die, whereas in the other movies, particularly in the Patrick Stewart version (the absolute worst one of the lot), he looks like a healthy and robust child who injured himself sledding or playing soccer–thus the limp and the crutch.

The entire book is available online for free, as the copywrite has long expired. And if you wish to view a filmed version, my recommendation, hands down, is the 1984 with George C. Scott. Next in line would be the 1988 modernized version “Scrooged.” It is a wonderful and clever update of the story, very funny but yet uplifting all the same.

Next in line is the 1951 version with Alastair Sim. That one is a good movie, but certainly darker and somewhat more gritty, although that may have to do with the quality of the black and white tape. But the music is not uplifting, and the story has been highly embellished, with added storylines not present in the original book. Also disturbing is the fate of Scrooge’s old girlfriend. For some bizarre reason, they changed her name from Belle to Alice, and instead of her being happily married in the present, living comfortably with a fine husband and family, she is an old and lonely spinster, taking care of the poor and needy. While there is nothing wrong with that as a vocation, it distracts from Dickens’ message, and gives the impression that this woman ended her relationship with Scrooge because she enjoyed being poor.

And that’s all I recommend. The 1935 and 1938 versions seem sort of silly and watered down–Christmas Carol light, basically. Too many alterations in the story, and certainly, you have to wince at the somewhat portly version of Bob Cratchit in the 1938 movie (the guy barely had enough to eat), or the fact that they had curtains hanging in their home. Yeah, right.

The absolute worst, hands down, is the one starring Patrick Stewart. And this is really sad, being that it was made in 1999, so a lot could have been done with it, and Stewart is normally a great actor. This movie is so bad, that I dumped it into the trash as soon as we finished viewing it.

Happy viewing!

So now, let’s uncover the mystery. What we do know is that Tim Cratchit is small for his age (hence the nickname Tiny Tim); that he suffers from a crippling disease requiring the use of a crutch and metal braces on his legs; that he is weak and sickly and condemned to succumb to his illness in the near future. But whatever it was that ailed him was treatable in 19th century England.

The idea that Tim Cratchit may have suffered from a real illness is not as farfetched as it sounds. For starters, as I mentioned in my previous post, Dickens himself had a variety of health problems, experiencing symptoms which suggest that he may have been afflicted with migraines, gout, bronchial asthma, renal tuberculosis, and ischemic heart disease. The subject of Dickens’s own assorted ailments, along with Tim’s fictional illness, have been the topic of articles published in prestigious medical journals, doctoral dissertations, and scholarly newsletters.

Second, Dickens had a keen interest in health and illness, evidenced by the number of characters in his books who suffer from various ailments. Despite his lack of medical training, doctors have frequently commended the accuracy of Dickens’s descriptions of illnesses, many of which have now been diagnosed and labeled by modern medical science, but which were unnamed and untreatable in his day.

And finally, Dickens often modeled his fictional characters on people who had passed in and out of his life. It is widely believed that his crippled nephew Harry Burnett, who died from tuberculosis at age nine, was his inspiration for Tiny Tim.

Theory I–TB

If Harry Burnett was Dickens’s role model for Tim, then tuberculosis would be the most likely diagnosis. Colonel Charles Callahan, chief of the Department of Pediatrics and Pediatric Pulmonology at Tripler Army Medical Center in Honolulu, ultimately arrived at that conclusion, after pondering which of several diseases may have been responsible for Tim’s symptoms.

Callahan was a pediatric pulmonology fellow when he was asked to write a textbook chapter on tuberculosis in children. That same December, after watching a movie version of A Christmas Carol, he began to muse, as many have, about Tiny Tim’s unnamed illness.

In his research, he was startled to find how prevalent TB was in England at that time. It is estimated that half of the population of England was infected with TB at that time, and it was the single most common disease and cause of death in the western world.

Tuberculosis is primarily a disease of the respiratory system, and is spread by coughing and sneezing. However, after infecting the lungs, it can manifest in other areas of the body, including the bones and joints. According to Callahan, Tiny Tim most probably suffered from Pott’s disease, also known as tuberculosis spondylitis or spinal tuberculosis. Dickens never mentions that Tim had any sort of respiratory disease, but it is very common for children not to exhibit the symptoms that would normally be seen in adults.

Pott’s disease most commonly occurs in children under the age of 10, which would fit Tiny Tim’s age range. The disease is crippling, causing deterioration of the spinal vertebrae. Children will often be in pain, and experience weight loss, fatigue, and fever. Left untreated, the disease can be fatal.

Callahan explored the possibility of other diseases which would produce similar symptoms, and these included bone infections such as septic arthritis and hematogenous osteomyelitis, as well as leukemia with metastasis to the skeleton. But all of these conditions would cause Tim to be far sicker than indicated in the book, Callahan concluded, and 19th century medicine was unable to effectively treat any of them, let alone provide a cure.

But could Scrooge’s benevolence save Tiny Tim from the ravages of tuberculosis? Yes, believes Callahan. While anti-tubercular drugs were not available, Scrooge’s money could have sent Tim to a sanatorium out in the countryside. Fresh air, good nutrition and rest, plus being custom fitted for a back brace, would have helped halt the progression of his disease or even put him into remission.

Tim’s diagnosis is also dependent on whether one believes that he was completely cured at the end of the story, or just merely survives. If you have read the book, Dickens simply says that “Tiny Tim did not die.” He did not say that Tim was cured and restored to perfect health. With tuberculosis, it’s likely that Tim may not have completely recovered, but could have survived with the spread of his illness halted.

Theory 2–KIdney Disease

In the best of the holiday spirit, Donald Lewis, an associate professor at Eastern Virginia Medical School, also set out to find a disease which was completely curable in 1843. He concluded that Tim may have suffered from a kidney disease called renal tubular acidosis or RTA.

Lewis’s interest in Tiny Tim arose when he was teaching medical students diagnostic techniques, and like Callahan, studied Tim’s symptoms and tried to fit them to a specific disorder. He then scoured pediatric textbooks from 1830 to 1850 to find out what illnesses were curable at the time.

Based on his symptoms, physicians would have treated Tim for tuberculosis, which was generically known as scrofula at that time. In fact, Lewis says, doctors treated everyone for scrofula if they had a crippling disease. It was believed that scrofula produced excessive acids in the body and patients would be treated with alkali substances such as bicarbonate. Prescribed “tonics” of the era generally contained combinations of belladonna, opium, sodium bicarbonate, sodium citrate, and potassium chloride.

In renal tubular acidosis, the body accumulates excess acids which in turn, interfere with bone metabolism. According to the kidney specialists Lewis conferred with, untreated RTA would produce symptoms similar to Tim’s, with short stature being one of the earliest signs of the disease. Eventually, the disorder can cause osteomalacia or softening of the bones, muscle weakness, and kidney failure with resulting death. The osteomalacia would also tend to affect one side more than the other, which would account for Tim’s use of a single crutch.

But most importantly, RTA was completely curable in 1843. And Lewis believes that this was what Dickens had in mind. A lot of people have suggested tuberculosis but the whole essence of the story is redemption and that Tiny Tim does not die. So that means that there’s something that physicians were able to do to correct his illness, and that’s in keeping with the theme of the story and the technology of the era, according to Lewis.

Lewis believes that you have to buy into the essence of the story. Something happens to Tim physiologically which heals him, and that is a parallel to Scrooge’s spiritual rebirth.

Rickets has also been suggested, a bone disease caused by a deficiency of vitamin D. Several doctors have favored the rickets diagnosis because of Tim’s probable poor diet and the lack of adequate sunlight in the foggy, heavily polluted London of the 1840s.

Both Callahan and Lewis, however, ruled out diseases such as rickets, because a nutritional deficiency would have affected all of the Cratchit children, and not singled out Tim. And by itself, rickets is not usually fatal.

Love and Redemption

In the end, is it really of any importance to diagnose Tiny Tim? Malcolm Andrews, a Dickens expert and professor of Victorian and Visual Studies at the University of Kent in the UK, believes the subject to be largely irrelevant.

“More important, though, is Tim’s role as victim of social neglect, a direct casualty of the brutal laissez-faire system to which the unreformed Scrooge subscribes wholeheartedly,” said Andrews, adding that Dickens was not concerned about being “clinically” specific and that Tim’s suffering is metaphorical.

Tim lives on at the end of the Carol, said Andrews, because Scrooge has reformed and becomes his second father. “It’s as simple as that. This is a fable, not a piece of social history.”

Perhaps Andrews has a point. The power of the story is really in the love which awakens in Scrooge after his redemption, and how that love is now able to transform the lives of those around him. After all, Dickens did say that Scrooge knew how to keep Christmas well, if any man alive possessed the knowledge.

And may that be truly said of us, and all of us! And so, as Tiny Tim observed, God Bless Us, Every One!

Charles Dickens was keenly aware of the plight of the poor in London, having once been there himself. When Dickens was 12 years old, his father was imprisoned for debt. Young Charles was put to work at Warren’s Blacking Factory, an experience which haunted him for the rest of his life. He became a lifelong humanitarian and champion of human rights, and Dickens’ novels were, among other things, works of social commentary. He was a fierce critic of the poverty and social stratification of Victorian society, and that is liberally reflected in his writings.

Dickens also appears to have a fascination with illness. Many of his characters suffer from illnesses which can be identified today. Dickens himself also appeared to suffer from a variety of disorders throughout his life, including clinical depression and asthma. His death on June 9, 1870 was due to a cerebral hemorrhage.

So it would not really be that far-fetched for Dickens to have been describing a real illness in Tiny Tim. He was a keen observer of the human condition, both in sickness and health, and well aware of the common maladies of his day. He also knew which diseases were treatable and curable, providing one had the economic resources to obtain medical help.

Two physicians, fascinated by Dickens saga of redemption and love, and discovering the true meaning of Christmas, embarked on a journey to discover the true story behind Tim’s illness.

To be continued….

Tight fisted, miserly, cold hearted Ebenezer Scrooge, and his alter-ego, the sickly, poor, but ever cheerful Tiny Tim, have become synonymous with the word Christmas. Like Santa Claus and his elves, mistletoe and holly, Scrooge and Tim have become firmly entrenched into our holiday traditions. Indeed, Dickens would undoubtedly be astonished by the longevity of his “ghostly little book,” and how it has become one of the most beloved classics of all time.

Every Christmas, the life of Tim Cratchit remains in peril. The ghost of Christmas Present states the case loud and clear, that “he sees a vacant seat…and a crutch without an owner.” The story is an allegory, brimming with events and characters who have multi-faceted symbolic meanings, with a central theme of sin and redemption. The visit of four ghosts on Christmas eve jolt Scrooge’s reality, and his cold heart reawakens as he rediscovers the magic of Christmas. Scrooge pries open his wallet and the doomed Tiny Tim is saved.

But what, exactly, ailed Tiny Tim? Did Charles Dickens merely create a sad character with a hypothetical illness that could be cured at the end of the story, by the mercy of Scrooge’s money? Or did Dickens have a real disease in mind, which was treatable by mid-19th century medicine?

Stay tuned for the answer…

It is the longest night of the year, and even though it won’t seem like it for a while (especially for those of us who live pretty far to the north), the days will begin to lengthen. In ancient days, the return of the sun was celebrated, although in places like Seattle, that may take a while (these gray rainy days are starting to get on my nerves). Or in Barrow, Alaska, where they will remain in complete darkness for a while longer.

No, this isn’t a picture of the soltice. It is Seattle, Jan. 6, 2004 during one of our rare snowfalls. I’m dreaming of a white Christmas as the days draws nearer. Doesn’t look like a white solstice is going to happen, but finger crossed that the snow will fall on Christmas Day.

How I yearn for a white Christmas. I know, I can move to Minneapolis or Fargo, and probably enjoy a white Easter as well. But some heavy snowfall in New Hampshire played a role in a rather convulated tale–and it is health related.

Reported in the Keene Sentinel, the region’s first real snowstorm of the year sent several vehicles sliding off roads and caused a handful of crashes, one of them a UPS truck.

Now this wasn’t just any UPS truck, but one that was on the way to deliver parts to Cheshire Medical Center in Keene. His van collided with two tractor-trailer trucks on Route 9, and the driver suffered a head injury. He was taken by ambulance to the very same hospital he was headed to, but they were unable to do one of the scans because the machine was broken. The article doesn’t say, but I’m assuming it was the CT scanner.

Ironically, the parts to fix it were sitting in his wrecked truck on the highway Route 9.

So they made an executive decision. Instead of sending the driver to Dartmouth-Hitchcock Medical Center in Lebanon, someone was sent to get the parts out of the truck. They were installed, and the machine was put to work, the driver had his tests. I don’t know whether it would have been quicker to transfer him to the other facility, but maybe due to the poor weather conditions, distances involved, and the fact that unnecessary movement may have caused further injury, they just decided to complete the job that the driver started out to do. As of this writing, he is alive and hopefully will recover.

There really isn’t too much to update since my last post, on how Governor Arnold (alias the Governator) has shown complete disregard for the health of California citizens. And attacked nurses, no less, considering the high regard that the public holds for the profession.

But an op-ed by Deborah Burger, RN, CNA President appeared in the Los Angeles Daily News on Sunday, December, 19, 2004, and it is a concise rehash of what exactly, Arnold Schwarzenegger is NOT doing for the average citizen of California. Contrary to popular belief, all Californians are not movie stars, are not movie moguls, and are not dripping in riches. The people are overwhelmingly average, and dealing with the same issues that affect the rest of the nation; no health insurance, poor health insurance, and dealing with a public health system that is being strangled by cost cutting and cutbacks.

WHEN Californians elected Arnold Schwarzenegger last year, it’s a good bet many voters were drawn to the image of a governor who would do battle with the special interests who hold sway in Sacramento. For Schwarzenegger it is, perhaps, a short leap from simulated violence on screen to a boast of stomping on a female-dominated profession. But from the calls we’ve received at the California Nurses Association, it’s clear that many people were less than enthused by an attack on the caregivers whom patients depend on when they are at their most frail and vulnerable in a hospital bed.

Arnold certainly came across as being a new kind of Republican, one who believed that business and the general public could work together for the benefit of all. But alas, he has shown his true colors in the handling of healthcare. To date, in the short time he has been in office, his policies have effectively worked to destroy the health of millions of people in the state. You know, the ones who live beyond the borders of Bel-Aire and Beverly Hills; the ones who avoid seeing the doctor because the co-pay is too high and since they have to pay out of pocket to fill a prescription (at the current inflated prices that Americans are charged), what’s the point in going?

Equally telling is who this governor considers “special interests” — nurses — and who he does not — in this case some of the state’s largest corporations, which donated up to $250,000 each to sponsor the conference and were rewarded with corporate logos adorning the hall and private photo sessions with the governor.

In his first year in office, Schwarzenegger accepted $26.6 million in corporate contributions, according to the records of his political team. The donors were rewarded with an outspoken champion for corporate interests. Nowhere has that been more evident than in health care policy.

A man of the people? Maybe we’ll all be better off if Arnold goes back to hunting for the elusive John Connor and keeps his hands off of California’s healthcare system. For in addition to his support of postponing the expansion of the nurse to patient ratio, a less publicized Arnold act was leading the campaign to oppose a ballot measure that would have extended health insurance coverage to over 1 million uninsured Californians. What a guy.

According to Burger’s article, Schwarzenegger’s health care vetoes include:

More notice prior to hospital and emergency-room closures and assistance to local communities that want to keep open private hospitals facing closure.

Assistance for Californians and California agencies that seek to import lower-cost prescription drugs from Canada at a time when high drug costs are a national scandal.

Help for families faced with financial ruin due to exorbitant hospital bills.

Requiring health plans to pay for maternity care (so much for family values).

Expansion of nursing education slots in community colleges.

Requiring hospitals to have policies to reduce crippling back injuries for RNs and other caregivers.

For all of you Terminator movie fans; in the last few movies, Arnold keeps saying that, “I am an obsolete model.” Well, I think that applies right now. Arnold is fast wearing out his welcome. Many of his supporters are increasingly becoming disillusioned, especially when they can no longer afford their prescription drugs, or face financial ruin because the uncovered cost of their cancer treatment has wiped out every penny they have.

I’ve had to temporarily close the comment form on nabeepchen.com, due to unwelcome and overwhelming SPAM. It’s tiring having to spend time deleting it, so for now, I’ve had to block off access until the spammers get weary of my site and move on to new victims.

I don’t know, do they think if they jam up my comment box with ads for online poker and larger breasts, that I’m going to be so happy that I’ll rush out and buy their stuff? No, it just strengthens my resolve to find ways of keeping them out. I even have two email addresses, one that I use commercially and therefore, gets the bulk of spam, and my personal/professional one, which receives relatively little of the trash.

Five years ago, Dr. Joseph Mercola, who runs a popular website about natural and holistic health, issued a warning about Vioxx and other drugs like it.

You will see much in the media throughout the next few weeks about this new brand of drugs, COX-2 inhibitors. However, taking these new drugs might be a matter of exchanging a gastrointestinal risk from one painkiller to a cardiovascular risk for another. Though the cardiovascular risk may be much more significant.

I would strongly advise against using these drugs. I suspect there is a high likelihood that they will be pulled from the market when the increased cardiac deaths are recognized.

Also at that same time, a report in Proceedings of the National Academy of Science,stated that Celebrex may increase the risk of heart attack, stroke and blood clotting disorders. In the four years since these drugs have come on the market, there have been several reports and articles linking their use to an increase in cardiovascular events.

But did the FDA do anything to infringe on the huge windfall fortunes of these drugs? No, not a thing.

This whole Vioxx scandal also brings up the laxity of the FDA in monitoring drugs after approval. Some drug effects are not immediately apparent, as in the case of Vioxx, which took about 18 months to work its evil magic. The FDA needs to be carefully tracking new drugs for at least five years.

And who is to blame for this travesty? There are dozens of civil lawsuits being filed, but money payments only go so far. When responsible people start going to prison, then maybe we may start seeing some real regulatory action. Who at the FDA turned their back on this? Who ignored the data that was seeping in? Who delayed the recall of the drug?

Same goes for the manufacturer. I don’t know if this was the case with Vioxx, but oftentimes drug companies do not publish results of studies that show less than stellar results. This issue was highlighted when the connection between teen suicide and antidepressants was being examined. So was data on Vioxx suppressed? Did the data go through some statistical “engineering” to make it look good and play down side effects? Did they also cover-up information once the drug was on the market, that it may be dangerous?

Someone is responsible, but unfortunately, it seems like the FDA is being quietly acquitted of any wrong doing, and while Merck may have to make a few cash payouts, I doubt that there will be any criminal prosecution. What a shame.

It seems that nurses are fair game all over the world. Not news to those of us familiar with the problems nurses face around the globe, but perhaps an eye-opener to those who don’t realize how vulnerable healthcare workers are to physical abuse.

Two nurses in France were murdered in a very grisly fashion. The decapitated head of one of them had been left on top of a television set. The other had her throat cut.

Union leaders at the hospital have complained that recent staff cuts left them more vulnerable to attack. Now doesn’t that sound familar, although I can’t imagine that staffing cuts in France could be worse than they are here.

No one has been arrested thus far, but psychiatric units and emergency departments would be asked to establish hotlines to the police. Now that’s something that needs to be done here. I don’t know how many stories I read of workers (docs included) being attacked in the ER. Yet security is often lax, cutbacks have dramatically decreased the number of personnel, so the health workers are often just sitting ducks. A crime waiting to happen.

The full story about the French nurses can be read on the BBC.

It would be hard to ignore all of the fervor lately, over the drug Vioxx. But it seems to be business as usual with the FDA, and they are following their usual pattern of muzzling dissent within their ranks. Dr. David Graham, associate director in the FDA’s Office of Drug Safety, called the FDA’s approval of arthritis drug Vioxx, “The single greatest drug safety catastrophe in the history of this country or the history of this world.” Graham went on to cite the following statistic: A staggering 88,000 to 139,000 Americans suffered heart attacks and strokes as a result of taking Vioxx. He also pointed out that this number far exceeds earlier disasters such as the 100 children killed in the United States by an elixir of sulfanilamide in the 1930s and the 5000 to 10 000 children born in the 1960s with birth defects related to thalidomide.

He is the whistleblower. He is the person who is carrying out the function of the FDA, and doing the job that the agency is supposed to be doing.

So what happens? Tom Devine, Dr. Graham’s lawyer, stated that Graham would be exiled from his duties of reviewing drugs and placed in the office of the commissioner. Devine described this position as “filling space under the scrutinizing watch of a babysitter.”

Two good links to the story: USA Today, British Medical Journal

The BMJ article states that the approval of rofecoxib (Vioxx) by the US Food and Drug Administration has led to the “single greatest drug safety catastrophe in the history of this country or the history of the world,” charged one of the agency’s own experts, Dr David Graham, in US Senate hearings last Thursday

Dr. Graham also pointed out that sweeping changes were needed again because the FDA “as currently configured is incapable of protecting America against another Vioxx.” In response to questioning, Dr Graham indicated that five other drugs currently on the market may be endangering patients, including another cyclo-oxygenase-2 inhibitor, valdecoxib (Bextra; made by Pfizer), the weight loss drug sibutramine (sold as Reductil in Britain and Meridia in the United States), the lipid lowering drug rosuvastatin (Crestor; made by AstraZeneca), the acne drug isotretinoin (Roaccutane; Roche), and the asthma drug salmeterol (Serevent; A&H).

So in thanks for saving the public from yet more loss of life, Dr. Graham has been essentially demoted, and shuttered away inside of the commissioner’s office. Safe inside the commissioner’s office, he will be watched and kept out of mischief.

This is not a first for the FDA. When Dr. Mosholder was scheduled to speak out against the use of antidepressants in teenagers, and present some very thorough and damning evidence, he, too, was effectivly muzzled.

Although I don’t have the facts offhand, I can recall yet another story from a few years back, when a statistician was canned because his figures showed that a drug awaiting approval had basically no benefit. I believe it was one of those flu remedies, but he was summarily fired for his efforts.

Now we are hearing all kinds of nasty reports filtering in about the wonder drug Celebrex, which some experts have said is no more effective than the pain relievers you can buy over the counter at a tiny fraction of the cost.

If anyone has been following the sordid history of the FDA, somewhere along the way, they changed from the regulatory watchdog they were designed to be, into an agency designed to protect the financial health and welfare of the pharmaceutical industry. So who cares if a few people die from Vioxx? Better to cover it up so the manufacturer doesn’t lose any money, and stock prices don’t drop.

One of my favorite columnists, Maureen Dowd at the New York Times, has done a terrific job of the perennial “what if?” What if I had never been born? Better yet, what if Donald Rumsfield had never been born? It’s a clever take on the old Frank Capra film “It’s a Wonderful Life,” in which the Jimmy Stewart character, on the brink of suicide, is shown how different the world would have been if he had never been born. In Stewart’s case, the little town of Bedford Falls would have fallen victim to the unscrupulous hands of the evil Mr. Potter, and the sweet all-American town (sweet as apple pie) would have turned into a venerable den of inequity.

But not so for the Rummy. As Dowd demonstrates, the world would truly be a better place if Donald Rumsfield had never been conceived and born, and with her usual sarcastic humor, she makes a darn good case.

So can we undo Rummy? Unfortunately not. But maybe a miracle will occur, and he will be visited by his own angel Clarence. Or maybe he’ll have a Dickensonian visit a la Scrooge, and be haunted by three spirits along with the thousands of ghosts whose time on earth was cut short as a direct cause of his devastating policies. Maybe that will be enough to scare that smirk off his ugly face.

Reap the rewards! Screw the old geezers and come out smelling like a multi-million dollar rose.

That is precisely the case with Rep. Billy Tauzin. From the NY Times: House’s Author of Drug Benefit Joins Lobbyists.

Representative Billy Tauzin, a principal author of the new Medicare drug law, will become president of the Pharmaceutical Research and Manufacturers of America, the chief lobby for brand-name drug companies, the trade group announced Wednesday.

So the scumbag waited a year, is now retiring from Congress, and will reap the rewards of screwing the public. It is astounding that this is legal. Entirely so. I highly doubt that Mr. Tauzin labored on that Medicare bill, and then out of the blue, after he announced his retirement from Congress, the pharm organization politely asked if he would be their new boss.

“This industry understands that it’s got a problem,” Mr. Tauzin, a Louisiana lawmaker who is retiring from Congress, said in an interview. “It has to earn the trust and confidence of consumers again.”

Hey no kidding. And your action isn’t doing much to further instill confidence. If anything, it is having the opposite effect, especially among older Americans who were royally betrayed with the Medicare bill.

Drug makers said that the job was not a reward for Mr. Tauzin’s work on the Medicare bill, which followed the industry’s specifications in many respects. The law was signed by President Bush on Dec. 8, 2003, a few weeks before a lawyer for Mr. Tauzin began talks with the drug trade group.

Yes, of course. And anyone believes that also believes that the tooth fairy is leaving a pot of gold under their pillow, and that Elvis is alive and well and gives concerts in Antarctica.

Mr. Tauzin wrote large parts of the new Medicare law as chairman of the Energy and Commerce Committee and as a member of the conference committee that hashed out differences between the House and the Senate in four months of intense negotiations last year. The law steers clear of price controls and price regulation, which are anathema to drug companies. The law forbids the government to negotiate with drug manufacturers to secure lower prices for Medicare beneficiaries.

Can it be any clearer than that? Bush say the law’s main beneficiaries are Medicare recipients, not the industry. Uh, has he read the law? How can forbidding the government from securing lower prices for Medicare patients be beneficial to them? Has it slipped his mind that Medicare doesn’t cover drug costs once a patient is out of the hospital?

Representative Henry A. Waxman, a California Democrat who has focused on health policy for 30 years, did not question the legality of Mr. Tauzin’s move. But Mr. Waxman said: “The appearance is terrible. A chief architect of the Medicare prescription drug legislation is now going to represent the chief beneficiary of the bill. This will only reinforce the public’s disillusionment with Congress.”

Yes, Henry, you’ve got it right. Tauzin is only prohibited from directly lobbying Congress for one year. After that, the sky’s the limit. And even during the “forbidden” year, he can make campaign contributions, schmooze all he wants on an informal basis, and “consult” with others on how to lobby.

This is a sad day in the ever continuing saga of American healthcare. Tauzin himself is no stranger to the healthcare system, having been afflicted with intestinal cancer this year. But I’m sure that none of the problems that the average American is dealing with ever crossed his golden path. His cancer was cured (at least for the time being) by a new drug called Avastin, which costs about $4,400 a month, and is typically used for 10 or 11 months. Do you think an uninsured person with the same disease can afford this kind of care? Does Medicare cover it?

Do tell, Joe Tauzin. Tell us if from your new position, you are going to fight for the right of all patients to receive the same care you did. Or will you be battling instead, for the financial health of the industry that you will soon represent–an industry whose coffers grow more robust with each passing day.

After posting all of these depressing stories about workplace abuse, I thought I really needed to return to the Christmas spirit. As you can see, Pixie is still the only one who will wear her Santa hat. The other two are such Scrooges!

Rather coincidental that as soon as I post about workplace abuse, and the lagging efforts–on everyone’s part–to put an end to it, a rather disturbing thread appeared on a nursing bulletin board. At allnurses.com, a nursing student wrote that during her clinical rotation, a patient whacked her in the face. She is now sporting a blackeye, bruised cheek, and a bruised nose.

No, to answer the next question, the patient was not mentally incompetent. He wasn’t a crazy in a locked psych unit. The man wanted a narcotic, and when the student refused (and even if she wanted to give it to him she can’t, by virtue of her being an unlicensed student nurse), he socked her in the face. With blood gushing out of her nose, she fled the room.

So now what do you think happened? Did everyone rally around this poor student, call the police, and have this man arrested? Make sure that as soon as he left the hospital, he would stand trial for assault and battery? Did the hospital administration bend over backwards, trying to make amends to this poor student (remember, there’s supposed to be a nursing shortage so they surely would like this girl to come and work for them when she finishes school), and do whatever they can to investigate, and send up a contingency plan should a similar incident ever recur?

No, of course not. If you read her post at allnurses, it will make you sick to your stomach. An incident report was filled out, and it seems that the student’s instructor made a weak little attempt at requesting the police be called. But the hospital administration responded with blackmail–if the student/teacher dared so much as to report this horrendous incident, then the school will not be permitted to return for clinicals for the rest of the semester.

So of course, the scared student wimped out. Since this would affect about 2/3 of her class, and because she wants to graduate, she chose to be the good nurse and not do anything.

This is great training for the nurse. She is learning that she must take whatever abuse comes her way, that it’s the “right” and martyish thing to do. Afterall, nurses must do what is best for the hospital, and it certainly would not look good to have their fair name blackened. Of course, a man who belts a student nurse in the face because she won’t give him a narcotic obviously has violent tendencies as well as an addiction problem, and should not be released on society without an investigation. Perhaps he has already committed violent crimes, injured people, maybe even murdered. The hospital’s cover-up is not only appalling for the nurses, but they are trying to protect a potentially dangerous man.

It was comforting to see that the vast majority of posters told her to call the police. Now. Immediately. Call the local news, one person said. Let’s see how the hospital likes having its name plastered all over the news reports, that not only did they do nothing after a student nurse was assaulted, but that they threatened retribution if anyone dared speak up.

However, equally discomforting was that one or two posters thought she did the right thing, in trying to “preserve” her education, and not screw things up for her fellow students. The idea that nurses do not fight back, do not demand justice, do not have rights, and are just things to be used by the hospital until they are worn out and can be discarded is alive and well. And this idea is held by nurses, as demonstrated by a few of the reactions.

How can anyone think this is okay? Perhaps when the hospital CEO is mugged by this same man, and beaten to a pulp, then there might be a change of heart. But as long as it’s a nurse, it doesn’t matter.

I don’t know what hospital this is, or who the poster is. Everyone on allnurses.com is anonymous, and most do not mention where they work. But believe me, if I was that student, not only would the police have been called, but so would every news organization in a 100 mile radius. And I’d make sure that everyone knew how the hospital threatened to refuse to allow nursing students to continue their clinical rotation. Imagine that, in a time of an acute nursing shortage, they would be denying nursing students the right to continue their education.

It is sad that the student was cornered and threatened. Even sadder is that her instructor is such a stupid spineless wimp.

The hospital itself, had committed a serious crime by trying to keep someone from talking to the police. It can probably prosecuted for obstruction of justice, or something like that. There are so many factors involved in this case, and the hospital has dug itself into a deep hole. But what they are counting on is the usual nursing response–and they got it.

Obnoxious doctors have been stereotyped, and even glorified on television shows. Especially surgeons, who have garnered a reputation as prima donnas and total assholes, who may think nothing of throwing a tantrum during open heart surgery and then bashing a nurse over the head with an IV pole.

Truth and fiction both, I would say. Many surgeons are warm, wonderful people who would never step on an ant, let alone physically strike a co-worker. Others fall right into the first category mentioned above. Abusive assholes. And the sad thing is that most of the lowly co-workers say not a word and silently put up with the abuse. Nurses are notorious for their locker room gossip and their boardroom silence.

An interesting story appeared in a local newspaper, in which a plastic surgeon in western Kentucky apparently threw a tizzy fit because he couldn’t find the equipment he needed in the emergency room. After the nurse brought him the equipment, he then thanked her by hitting her in the back.

I am proud that the nurse is pressing charges against this asshole (yes, I am overusing that word because it best describes this type of doctor). I don’t care how frustrated you get at work, you just don’t take it out on the people you are working with. What if I decided to hit a doctor? Or whack him over the head with a patient file, as I once saw one do to a nurse? Do you think I’d keep my job? Do you think that the doc would whimper, “Oh that’s okay, I understand that she’s frustrated. It’s been a long day.”

Not on your life.

So the good news is that the nurse has some backbone. The bad news is that the Kentucky doctor was suspended for harassment. Uh, these people need to define their terminology. Hitting someone is not harrassment, it is assault. He faces a misdemeanor charge which carries a penalty of up to 90 days in jail and a $250 fine if convicted. And no doubt, his sentence will be suspended.

Hospitals definitely do not support their nurses, and I would not be surprised if this nurse loses her job because the doctor assaulted her and she reported it. And oddly enough, many nurses do not support their co-workers in taking real action against this abuse, which is one of the primary reasons that it continues on.

The Sacred Abuser

One incident of a nurse sticking up for herself took place in the operating room of a facility that shall remain unnamed. An egotistical surgeon, famous for throwing instruments around (yes, some of them still think they’re toddlers and that mommy will think it’s cute), hit a nurse with the blunt end of a clamp. As soon as she was able to, she left the room and called police. She was smart as she did not waste time notifying the nursing supervisor, who would have tried to tell her to “just write up an incident report” that would be buried in a drawer somewhere, and not to do anything more about it.

So when Dr. Nasty emerged from the OR, the police were waiting for him. He was arrested for assault and battery, not harrassment, and he did serve time in jail plus paid the nurse a sum of money. Did he learn his lesson? I don’t know. But the nurse, while not fired, was basically forced to quit because the atmosphere was so hostile against her. It reminds me of countries where women are blamed for being raped, and then thrown out of their homes or even killed.

I’ve never been hit by a doctor, and I’ve never tolerated any sort of abusive behavior. Sorry, but I’m just not that kind of nurse. When a nurse once told me how a doctor had thrown a tray at her and hit her in the chest with it, I asked if she had called the police and pressed charges against him. She, along with several other nurses who were standing nearby, looked at me like I was crazy.

“Well,” she finally said, “I did get him to apologize in private.”

“Great,” I told her. “Glad he apologized in private. If he had done that to me, that sucker would be sitting in prison right now, and I’d also be filing a civil suit against him as well.”

Turns out this wasn’t the first time that doctor had thrown anything. I then told her and the rest of the little group that if they didn’t have the balls to defend themselves, then they got what they deserved. If you stand up for yourself, the chances are, you get respect. You get abuse if your inaction tells the doctor that his (or her) behavior is okay.

Taming Andre

Another story, this one personal. Andre was a neonatologist who was part of a medical group that took care of the NICU where I was working. He was a good doctor, but notorious for losing his temper during a critical admission, and for throwing equipment around. He didn’t throw it at people, but let’s put it this way, he didn’t go out of his way to avoid them. His hands went wild, and the debris flew, and if you didn’t get out of the way, well, too bad.

One night, when we were really short-staffed, we got a critical admit. A really sick baby. Andre was on-call, and he showed up in his full glory. I was fairly new to the job, and hadn’t worked with him before. He started shouting, cursing, and tossing stuff around. I want this, I want that…you get the picture. He yelled at me, the other nurse, the respiratory therapist. Stamped his foot, and then threw a syringe off the table. It landed near my feet.

I told Andre that if he didn’t shut up and control his temper, and start acting like a professional, I was leaving. He could admit this kid by himself. I was in charge that night, and I told him he could take over that job as well.

He was stunned. He tried to defend his actions, telling me that he “got a little excited” but I cut him off at the pass. If he raised his voice one more time at anyone in this room, and if he even so much as threw a scrap of paper on the floor, he was on his own. I didn’t care what other people put up with, I didn’t tolerate this sort of juvenile behavior.

“Act like a doctor, Andre,” I told him, “And we’ll get along just fine.”

And so he did. He behaved like an angel that night, and every other time I worked with him. The other nurses were totally baffled why Andre was a perfect gentleman with me, but still threw tantrums with them. Just tell him, I said. Assert yourself and demand to be treated as a professional.

If any of you are MASH fans, then you remember the infamous nurse Major Margaret Houlihan. On one episode, someone asked her what she wanted.

“Respect,” she said without hesitating. “Nothing more, nothing less.”

Image courtesy of the Nation Library of Medicine

What was I saying about the flu vaccine? Suddenly the shortage is over and there’s a surplus. According to an AP story, now everyone is worried that there will be leftover doses because no one is rushing to get their shots. Public health officials are now wringing their hands, no longer worried about the sick and infirm dying from lack of vaccine. Now they’re worried about that tens of thousands of doses could go to waste, and they are considering easing the restrictions.

It turns out that the furor over the vaccine shortage and the government’s response have had an unintended effect: More than half of all elderly or chronically ill adults have not even tried to get flu shots because they figured they would not be able to get one, the Centers for Disease Control and Prevention said Thursday.

So how does this translate? What about the disease itself? We are now deep into cold and flu season, with people crowding into overheated stores, coughing into eachother’s faces, spreading germs like there’s no tomorrow. But I haven’t heard a thing about people dying in droves from this year’s flu, or that the vaccine shortage has caused an increase in the death rate, or that more people are getting sick…nothing. Nada.

The CDC study found that as of last month, only about 35 percent of high-risk adults, mainly senior citizens, had gotten a flu shot. Another CDC study released Thursday found that people at high risk often do not get vaccinated for various reasons, including a misperception that the shot causes influenza and the belief that it would not be easy for them to get the vaccine.

That tells us nothing. Just the same canned response. Are there consequences because of this? Is this percentage of people getting vaccinated really that much lower than previous years?

It would be nice to get a full story on this, but it doesn’t seem likely any time soon.