Wednesday, September 18, 2019

That Boy -- A Potential School Shooter

As a high school teacher, I have seen Him. He is the male student who has difficulty in establishing and maintaining friends. Typically depressed and dejected, He becomes an avoidant outcast who feels classmates and even teachers treat him unfairly. As a result, He turns to fantasy for companionship, often expressing his frustrations in his own violent artwork. Dealing with forces of bottled-up, internal anger, He dreams up plans for revenge, and He often exhibits his rage on social media. Hopeless and victimized, He walks the hallways of our school without a purpose, a simple step away from violence.

This "He" is the image of a young man in crisis. A victim of abuse? A dysfunctional teen? A child suffering with mental illness? Or, simply one of those so-called “strange kids”? In any case, this is the profile of a potential school shooter.

Of course, such a predictive profile can lead to something researchers call “the regression dilution effect" …

With the rationale of more is better, cases are aggregated on sometimes superficial and highly variable inclusion criteria. Most lethal violence in schools in recent decades has been committed by current and former students (“Violence from within”). So, to not re-create the error of regression dilution (aggregated analysis based upon superficial facts), we examine the 'violence from within' cases and search for certain common denominators. However, we must proceed cautiously as no predictive paradigm in behavioral science is perfect, especially 'profiling.'”

(George S. Everly, Jr. Ph.D., ABPP and O. Joseph Bienvenu, MD, PhD. "'Profiling' School Shooters.” Psychology Today. March 29, 2018.)

Yet, how can we be proactive and prevent senseless massacres in American schools unless we study the people who commit the atrocities? So, with a great deal of discretion, we must create a model – albeit imperfect – of those who commit, or attempt to commit, mass murder in schools. A place to begin is to analyze the “violence from within” school shooting cases that resemble the revenge-motivated pseudo-commando mass murderer.

The National Center for the Analysis of Violent Crime and Centers for Disease Control and Prevention has reviewed school shootings over the course of decades. Their model of a shooter is unique in that it is not only descriptive, but can directly lead to prescriptive actionable interventions – each factor can be used to facilitate direct supportive outreach and intervention with those who may be at high risk for committing school violence or their families, or both.

Here is the model:

1. So far, the vast majority of school shooters have been male and the vast majority of those (over 90 percent) were active or recent students at the school.
2. If there is one predominant theme in school shootings, it is anger and revenge.
  a. 75% of school shooters felt bullied or harassed by other students
  b. Sometimes shooters felt unfairly treated by teachers
  c. They seldom have specific targets, but kill randomly in order to inflict the most harm
3. School shooters tended to be socially awkward and avoidant, and often isolate themselves with few if any friends.
  a. They were sometimes described as “strange”
  b. They seemed to have a penchant for” retreat into fantasy,” especially when under stress
  c. Shooters exhibited an obsessive quality that often led to detailed planning, but ironically they seemed to lack an understanding of the consequences of their behavior and thus may have a history of adverse encounters with law enforcement
  d. The same obsessive quality drives the shooter to focus upon interpersonal rejection, unfair treatment, and elaborate plans for revenge
  e. They expressed fascination with violence, morbid media, death
  f. If the shooter does associate with others, it is likely to be with those who share preoccupations with the macabre
  g. Shooters may have a history of cruelty to animals (this is a low probability factor, but a significant one when present)
  h. There is often a sense of hopelessness that predicts their own death by the end of the incident
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4. The media contagion effect (copycat killings) may serve as an especially powerful motivator for those who already feel anger, frustration or loss.
5. Shooters tend to have experienced dysfunctional family situations or experience a lack of effective adult supervision, mentoring, or oversight.
6. 68% of shooters obtained weapons from their home or the home of a relative. (Yes, ease of availability to firearms does matter.)
7. Shooters tend to express their frustrations and anger using art and/or social media posts, thus monitoring of such media becomes an important tool in early identification of individuals at risk for committing violence.

It is commonly held that there's always a trail of what they're about to do. The signs can start at a fairly early age. Chances are these shooters “just don't know what they're on the earth for."" 

The accumulation and integration of recurring themes warrant consideration, not only by law enforcement, but by educators and mental health clinicians dedicated to primary prevention and school safety. Former FBI agent and ABC News contributor Brad Garrett says …

It's almost as if a seed gets planted into the individual, and unless somebody is there to intervene, to conduct some type of informal intervention over the course of that person's life, whether it's a parent or teacher or coach, that kid continues to move towards what could ultimately be an act of violence.”

(Emily Shapiro. “Dissecting the distinctive profile of school shooters: 'There's always a trail of what they're about to do.'” ABC News. February 22, 2018.)

Teachers know these at-risk students. They, quite frankly, interact with them every day. Teachers observe them, communicate with them, grade them, and, when necessary, discipline them. Any good teacher understands the need to establish a learning environment in which all students – from the “brains” to the “floaters” to the “loners” – can flourish. This is one of the most difficult parts of their job – to maintain a classroom “for all” and yet encourage diversity and individuality.

Profiling a student you identify with certain digressive characteristics as a “shooter” – an almost infinitesimal fraction of the characteristic inclusion – can be fraught with problems. In the pressure-cooker world of school society, there can be many reasons for “strange” and aberrant behaviors. Believe me, all teens get angry, depressed, upset, and even vengeful at times. So, addressing these issues are a daily concern.

But …

All of us teachers have also made this frightful consideration – that student just may be a young man who could bring a gun to school and unload a lethal barrage of revenge. 

And, of course, students, better than anyone else, know the workings of a school. They know exactly what's likely to go on. 

Therefore, in these times of increased gun violence, both teachers and students must report any such suspicions to proper school authorities – counselors and administrators charged with conducting further investigation. They, in turn, must take appropriate action. Is that profiling? Yes, it is. Is it necessary? Of course it is.

And, by the way, there is a counseling crisis in American schools. Many schools simply are not required to hire them. Only 31 states and the District of Columbia mandate school counselors, according to the American School Counselor Association. In 19 states, it’s not the law.

A nationwide investigation found one in four U.S. schools don’t have any counselors at all and nearly one in five school districts don’t have any district-wide, according to an analysis of the most recent U.S. Department of Education’s Civil Rights Data Collection from the 2015-2016 school year.

The American School Counselor Association recommends no more than 250 students to one counselor, but nearly 85 percent didn’t meet that standard in the 2015-16 school year.

But the lack of counselors is just part of the problem. Counselors spend much of their time not doing counseling duties. They do such work as patrolling the halls and making sure students are in class. Counselors often are assigned to bus or lunch duty.

Many counselors spend much of their time as college and career liaisons. They are basically academic facilitators. True, school counselors and other support personnel work with students on their mental health. But is it enough?

It is painfully evident that schools need more counselors to be more available and to deal with kids more quickly. That means each counselor should have a lighter load so as to devote more time to each student. Especially to the ones who appear to need it.

Tuesday, September 17, 2019

On Being a Hillbilly -- Definitions and Understandings

I have lived in 16 States
But of all I ever saw
There is no place like living
Down in old Arkansaw

They all wear homemade clothing
Both the men and females
While the children with dirty faces
All go in their shirttails

The men drink moonshine whiskey
The women chew and dip
And the big gals go barefooted
With tobacco on their lip….

All are free-hearted
And respect the moral law
Is the reason I love to live
Down in old Arkansaw.

Marion Hughes, Three Years in Arkansaw (1904)

I am a hillbilly. Born and raised in Appalachia, I have lived in the foothills of the Appalachians in Southern Ohio all of my life – now 68+ years. While existing among widespread stereotypes of Appalachian people as being backwards, ignorant, and lazy, I deny the derogatory portrayal of local residents as yokels, bumpkins, and rednecks.

Granted, having a sense of humor and being able to laugh about yourself are desirable character traits; however, embracing negativity can also lead to self-defeating behaviors. I claim no part of the clownish connotations of a hillbilly rube. My connection to the rural culture involves a deep commitment to preserving the wisdom of the resourceful people who pioneered this land.

Despite disproportionately adverse living conditions in severely distressed counties, Appalachians continue to embrace positive values such as self-reliance, faith, love of family, and humility. “Hillbilly” is a descriptive term penned to typecast residents of Appalachia, particularly those in the Southern region. Most of the negativity associated with the word is a product of published generalizations formulated to feed a colorful and wild American caricature.

The word hillbilly (noun, from hill + Billy/Billie, popular or pet form of William) has two early references believed to be the first in print. One appeared on July 1892:

I would hate to see some old railroad man come here and take my job, and then, I don't think it is right to hire some Hill Billy and give him the same right as I just because he was hired the same time I was.”

(The Railroad Trainmen's Journal," Vol. IX, July 1892.)

The journal article focused on the political importance and autonomy of mountain folk who happily accept free liquor and campaign payouts from one candidate only to vote for his rival. Clearly derogatory and accentuating the poverty and improper social behavior of its subject, it also suggests more admirable attributes of freedom, self-identity, and independence.

And, another reference appeared in 1900 in a New York Journal article describing the "hill-billie" as …

In short, a Hill-Billie is a free and untrammelled (sic meaning “not confined, limited, or impeded”) white citizen of Alabama, who lives in the hills, has no means to speak of, dresses as he can, talks as he pleases, drinks whiskey when he gets it, and fires of his revolver as the fancy takes him.

(New York Journal. April 23, 1900)

Starting as a regional label with a specific localized significance, the term and persona were soon spread by jokebook writers, professional linguists and, above all, the new mass medium of motion pictures. In hundreds of action shorts, directors such as D. W. Griffith (himself a Kentuckian) depicted a violent and lawless people whose feuds and drunkenness posed a serious threat to the “proper” late-Victorian social order.

By the mid 1910s, however, silent films and other popular culture media began to present a parallel but distinct interpretation of the mountaineer as a comical foil for bumbling urban naifs. Despite its evolving meaning, “hillbilly” remained a relatively uncommon and thoroughly ambiguous label throughout this era.

The "classic" hillbilly stereotype reached its current characterization during the years of the Great Depression, when many mountaineers left their homes to find work in other areas of the country. The period of Appalachian out-migration, roughly from the 1930s through the 1950s, saw many mountain residents moving north to the Midwestern industrial cities of Chicago, Cleveland, Akron, and Detroit.

In the 1930s, that icon was solidified through the hillbilly characters of Paul Webb's “Mountain Boys” cartoons in Esquire magazine, Al Capp's “Li'l Abner,” and Billy DeBeck's “Barney Google and Snuffy Smith.” These characters and their cartoon-world antics forever etched the hillbilly caricature into popular culture.

The origin of the term is disputed. Some etymologists cite the origins of the word hillbilly in a reference to Scottish and Ulster-Scottish (Scots-Irish) people whose songs and ballads dealt with William, Prince of Orange, who defeated the Catholic King James II of the Stuart family at the Battle of the Boyne, Ireland in 1690.

Others like Michael Montgomery, in From Ulster to America: The Scotch-Irish Heritage of American English, posit it was coined In Ulster to refer to followers of King William III and brought to America by early Ulster emmigrants.

Anthony Harkins, in Hillbilly: A Cultural History of an American Icon, states that the most credible theory of the term’s origin is that it derives from the linkage of two older Scottish expressions, “hill-folk” and “billie” which was a synonym for “fellow,” similar to “guy” or “bloke.”

Speculation? The proof of usage offered in the journal articles previously cited stands as the published origins in America. The Dictionary of Smoky Mountain English says of the word hillbilly – “origin obscure, attested only since 1900” – which makes it a modern term. That, to me, is the origin that speaks volumes.

Middle-class Americans imagined hillbillies as an exotic race, akin to blacks and Indians, but still native and white, as opposed to the growing influx of immigrants in the first half of the 20th century. Crude caricatures of Southern mountaineers persisted long after similar ethnic and racial stereotypes had become socially unacceptable.

I am a hillbilly. I have a distinct hillbilly Southern accent. I live my hillbilly life in Southern Ohio, not in West Virginia or Arkansas. As a hillbilly, I have weathered all of the attempts of others to pigeonhole me into ambiguous Appalachian stereotypes.

As a hillbilly, I love my humble home and the hills of my natural environment. I am connected with my past. I am not like Jed Clampett or Li'l Abner – these hillbillies are products of somebody's income-seeking imagination. However, I don't deny my regional folk roots – they are full of stories and myths. Some are painful tales of the reality of living in an impoverished area where opportunities seldom come knocking. Others tell of the boundless spirit of poor people facing seemingly insurmountable obstacles.

Call me an American “hillbilly.” I like the term even though some still use it for derision and laughs. You see, I understand the origin of the word, and I also understand the false representations are misguided over-generalizations that encourage prejudice – prejudice based on a sensational ignorance meant to promote class structure.

The criticism of an entire culture, a group that has suffered from negative stereotypes seemingly forever is something to which we hillbillies have grown accustomed. You see, I live in the hills – not around them, not below them … and certainly not above them. Appalachia is a part of me, a fact of which I am exceedingly proud. If you are a hillbilly, I think you know exactly what I am saying.

I’m a hillbilly, a woman and a poet, and I understood early on that nobody was going to listen to anything I had to say anyway, so I might as well just say
what I want to.”

Irene McKinney, West Virginia Poet Laureate


Rudy Abramson and Jean Haskell, Editors. Excerpt: The Encyclopedia of Appalachia. National Public Radio

Anthony Harkins. Hillbilly: A Cultural History of an American Icon. 2005.

Dave Tabler.” The word ‘Hillbilly': Linguistic Mystery and Popular Culture Fixture.” March 5, 2012.

Monday, September 16, 2019

Girls Love Guys Who Smell Like Garlic

If you men are looking to impress a girl on the first date, here's a proven idea. Eat four cloves of garlic before you pick her up. She will love the way you smell. I am not kidding.

A recent study claims the health-boosting benefits of garlic positively affect a man’s body odor, “producing an olfactory marker of good health for the opposite sex to home in on.” In other words, men who eat garlic are more attractive to women.

The study, published in the journal Appetite, found that men who eat garlic smell much more pleasant and attractive to the opposite sex, and it has nothing to do with their breath, but rather, with their body odor.

The research, conducted by scientists at the University of Stirling, UK, tested the hypothesis by including three phases of the study: (1) A whole bunch of varied amounts of garlic were given to 42 male participants, (2) Over the span of 12 hours, the researchers collected their body odor with pads, and (3) the pads were then subsequently sniffed by 82 women who were asked to rate their pleasantness, attractiveness and intensity.

The takeaway? I am happy to report the research confirmed when the men's dosage of garlic reached 12g, or four cloves, the women judged their odor as significantly more pleasant and attractive. The researchers concluded that the men in the study needed to consume a lot of garlic, about 4 bulbs a day, in order to enjoy the effect of a pleasant body odor.

(Jitka Fialováab, S. Craig Roberts and Jan Havlíček. “Consumption of garlic positively affects hedonic perception of axillary body odour.” Appetite.
Volume 97, February 01, 2016.)

Study co-author Professor Craig Roberts explains to Forbes, “From an evolutionary perspective, formation of preferences for diet-associated body odors was possibly shaped by means of sexual selection. Previous research indicates that many animal species use diet-associated cues to select mates in good physical condition.”

Obviously, garlic negatively influences the individuals' breath on account of sulphur-containing gases, which does not seem to apply to the body odor,” the researchers added.

I know many are laughing, but wait just a minute. More people are eating the strong-smelling, pungent-tasting bulbs than ever before. Garlic consumption in the United States has tripled since the 1990’s. The average consumption of garlic in the U.S. is around three pounds a year, with about 75% of their consumption coming from the dehydrated variety.

And, this is not the first reference to garlic inflaming the passions. At times it was forbidden for Tibetan monks, widows, and adolescents to consume the stimulating herb.
Chinese doctors prescribed garlic for men with “intimacy problems.”

The Times of India reports the presence of a compound called allicin in garlic increases the blood flow to the sexual organs in both men and women. But, it doesn't work overnight. A minimal consumption of garlic on a daily basis for about a month can help people increase their libido. And I am sure that would also greatly increase that sweat appeal, too.  

Getting Your Garlic On

Herb? Spice? Vegetable? Garlic defies classification. For all intents and purposes, garlic is classified as a vegetable, but people will undoubtedly continue to debate this question.
Whatever you call it, there are about 600 varieties around the world. The two main types are hardneck (or topset) and softneck (artichoke garlic). Softneck (what is mostly found in grocery stores) produces more smaller cloves, while hardneck produces fewer larger cloves. Garlic flavors range from very mild (elephant garlic) to very strong (Romanian Red).

About 24,000 acres of garlic is planted in the U.S. annually, with total production of about 400 million pounds. California is the leading producer, with Oregon, Nevada, Washington and New York following in the distance.

Garlic, not unlike a human pregnancy carried to full term, requires nine months to grow. Harvest season in the U.S. runs from late June to early September.

However, the U.S. is the world’s largest importer of the vegetable, accounting for 339 million pounds of garlic in 2017. The garlic mostly comes from China, Argentina, and Mexico. Back in the early 90s, China accounted for only 2% of the garlic imported to the United States. By the year 2009, that number was up to about 50% and by 2012 it was about 66%.

The American market began a campaign to convince Americans that Chinese garlic was not only inferior in taste, but also toxic, as it was laced with hazardous pesticides and bleach applied by Chinese growers.

How are you to know which is which? American growers came up with a simple test. Garlic bulbs with roots scooped off the bottom are Chinese. The scooping, they say, is done to remove contaminated soil and lower shipping costs. (It’s also required by U.S. law.) American bulbs, on the other hand, come with roots attached.

Some Flavorful Garlic History

Garlic (Allium sativum) has been used for thousands of years for medicinal purposes. Sanskrit records show its medicinal use about 5,000 years ago, and it has been used for at least 3,000 years in Chinese medicine. The Egyptians, Babylonians, Greeks, and Romans used garlic for healing purposes.

Although there is some debate about it, the most recent theory based on molecular and biochemical research is that garlic (Allium sativum) was first developed from wild Allium longicuspis in Central Asia, about 5,000–6,000 years ago. Wild A. longicuspis is found in the Tien Shan (Celestial or Heavenly) mountains, on the border between China and Kyrgyzstan, and those mountains were home to the great horseback traders of the Bronze Age, the Steppe Societies, ca 3500–1200 BCE.

Garlic was likely traded out from central Asia into Mesopotamia where it was cultivated by the beginning of the 4th millennium BC. The earliest remains of garlic come from the Cave of the Treasure, near Ein Gedi, Israel, ca 4000 BCE (Middle Chalcolithic). By the Bronze Age, garlic was being consumed by people throughout the Mediterranean, including the Egyptians under the 3rd dynasty Old Kingdom pharaoh Cheops (~2589–2566 BCE).

The ancient Greek name for garlic was “scorodon.” According to Fulder and Blackwood, French physician Henri Leclerc derived this from “skaion rodon” which he translated as rose puante, or "stinking rose.”

Egyptian slaves were given a daily ration of garlic, as it was believed to ward off illness and to increase strength and endurance. As indicated in ancient Egyptian records, the pyramid builders were given beer, flatbread, raw garlic and onions as their meager food ration. It cost the Pharaoh today's equivalent of 2 million dollars to keep the Cheops pyramid builders supplied with garlic.

The bulb was so popular with those who toiled on the pyramids that garlic shortages caused work stoppages. A garlic crop failure, due to the Nile flooding, caused one of the only two recorded Egyptian slave revolts.

During the reign of King Tut, fifteen pounds of garlic would buy a healthy male slave. Indeed, when King Tut's tomb was excavated, there were bulbs of garlic found scattered throughout the rooms.

Roman soldiers ate garlic to inspire them and give them courage. Because the Roman generals believed that garlic gave their armies courage, they planted fields of garlic in the countries they conquered, believing that courage was transferred to the battlefield.


With a long, celebrated history, garlic is a formidable food. As far as its ability to make men more attractive to women, at least one study says “yes.” More males may now put garlic to the test, and I expect mixed results will follow. One last recommendation to those hearty souls who use the latest study to their advantage – the garlic “smell” can be avoided by eating some fresh raw parsley at the same time as consuming garlic. That may help with your breath. However, who knows what the parsley will do to your enticing sweat? At any rate – bon appetit!

Saturday, September 14, 2019

Purdue Pharma, the FDA, and the Sackler Family -- Players In an Evil Oxy Enterprise

New York state Attorney General Letitia James says the family that owns Purdue Pharma, maker of the opioid OxyContin, used Swiss bank accounts to transfer $1 billion from the company to itself.

The allegation, which came in court documents filed late Friday (September 13, 2019), indicates that the Sackler family is trying to keep its wealth free from potential liability in other court cases involving Purdue Pharma's role in
the opioid crisis.”

The death and destruction caused by Purdue and their prescription OxyContin devastate the nation. The company helped convince innocent Americans that opioid medications weren’t just for those in agony from cancer or major surgery – but that drugs like OxyContin, an opioid formula, could be used for much more manageable forms of short-term as well as chronic pain.

The corporation did this without credible research or secondary concern. Their actions of releasing and promoting the drug were reckless and criminally misleading. According to the Centers for Disease Control and Prevention, in as little as three to five days, exposure to opioids can start some people – like those genetically vulnerable – on a trajectory towards addiction. Purdue Pharma directed attempts to play down the dangers of the opioid painkiller while littering their campaign for OxyContin with biases and inaccurate characterizations.

This is a story of greed, unimaginable wealth, and corporate murder. In the face of facts, Purdue and the Sacklers … and even the Food and Drug Administration are responsible for the opioid epidemic.

Oxy Abuse

To accuse a pharmaceutical company and the government of being key players in the worst health epidemic in U.S. history may seem like a conspiracy theory; however, the reality is shockingly evil. All have played a major part, and overdose deaths have risen steadily, quadrupling in the U.S. since 1999 as prescriptions soared.

The opioid epidemic, and addiction more broadly, have become the defining public health crisis of our generation.”

-- Nora VolkowDirector, National Institute on Drug Abuse,
National Institutes of Health

In 1996 Purdue Pharma introduced their new drug, a time-released formulation of oxycodone they called OxyContin. Incredibly, the drug was touted as having a low risk of addiction. Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”

(Meier B. Pain Killer. Emmaus, PA: Rodale Press; 2003.)

Purdue backed OxyContin with an aggressive marketing campaign. Key components of this effort were pain-management and speaker-training conferences in sunshine states such as California and Florida, attended by more than 5,000 physicians, nurses and pharmacists, many of whom were recruited to serve on Purdue’s speakers' bureau.

The company also used a bonus system to incentivize its pharmaceutical representatives to increase OxyContin sales. The average bonus exceeded the representatives’ annual salaries.

In 1998, as Purdue hawked OxyContin for conditions such as arthritis and back pain, it decided to "increase communications" with patients, company records show. Their goal was stated as a strategy to "convince patients and their families to actively pursue effective pain treatment. The importance of the patient assessing their own pain and communicating the status to the health care giver will be stressed."

"Fear should not stand in the way of relief of your pain," a pivotal marketing brochure said. The OxyContin slogan in 1999 was: “The One to Start With and the One to Stay With.”

The New York Times reports that according to a court filing, Richard Sackler, the son of a company founder, said sales representatives should advise doctors to prescribe the highest dosage of the powerful drug because it was the most profitable.

In one email (2001), Richard Sackler suggested blaming addicts when the growing problem of opioid abuse became apparent in the early 2000s."We have to hammer on abusers in every way possible," he wrote when he was president of Purdue Pharma. "They are the culprits and the problem. They are reckless criminals."

Kaiser Health News (August 17, 2018) reports on Purdue and what the New York attorney general's office called operating a "public nuisance" in it sales tactics and marketing of opioids …

Purdue's six-page pamphlet for patients, provided to the Florida attorney general, was titled 'OxyContin: A Guide to Your New Pain Medicine.' 'Your health care team is there to help, but they need your help, too,' the pamphlet says. It says OxyContin is for treating 'pain like yours that is moderate to severe and lasting for more than a few days.'

To patients or family members worried about addiction, Purdue's pamphlet said: 'Drug addiction means using a drug to get “high” rather than to relieve pain. You are taking opioid pain medication for medical purposes. The medical purposes are clear and the effects are beneficial, not harmful.'"

Dr. G. Caleb Alexander, a physician at the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health, said the sales pitch was "simply not true" and called it "a smoking gun" for Purdue's role in the opioid epidemic.

Of course, Purdue's marketing and promotion amplified the prescription sales and availability of opioids. The extraordinary amount of money spent in promoting a sustained-release opioid was unprecedented.

During OxyContin's first 6 years on the market, Purdue spent approximately 6 to 12 times more on promoting it than the company had spent on promoting MS Contin, or than Janssen Pharmaceutical Products LP had spent on Duragesic, one of OxyContin's competitors.

(“Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem.” Washington, DC: General Accounting Office; December 2003.)

As early as 2001, pressured by Big Pharma and pain sufferers, the Food and Drug Administration made a fateful decision and, with no new science to back it up, expanded the use of Oxycontin to just about anyone with chronic ailments like arthritis and back pain. A small label change allowed the industry to sell more pills at higher doses.

"There are no studies on the safety or efficacy of opioids for long-term use."
Ed Thompson, 60 Minutes
Since then, the FDA has approved other opioids for wide prescribing even as evidence mounted that the drugs were addictive, open to abuse, and often not effective for long-term use. The administration has been accused of being complicit in the epidemic by failing to use its powers to protect the public as the death toll escalated.

Nationally, the increasing availability of OxyContin has been associated with higher rates of abuse as it became the most prevalent abused prescription opioid by 2004. Individuals of all ages abuse OxyContin – by 2013, the National Institute on Drug Abuse (NIDA) reported 6,973,000 people aged 12 and up have used OxyContin nonmedically in their lifetimes.

(Cicero T, Inciardi J, Munoz A. “Trends in abuse of OxyContin and other opioid analgesics in the United States: 2002–2004.” J Pain. 2005;6:662–67.)

Finally, in the middle of the deadly Opioid Epidemic, the FDA specified that strong painkillers like OxyContin should only be used for severe, chronic pain from conditions like arthritis and cancer. The damage had been done, and the fallout continues.

"We have learned the hard way that many patients develop opioid [addiction] when using these medicines as prescribed," says Dr. Alexander.

Yet, many critics claim the FDA has not learned from its mistakes. Just consider that the division that approves new opioid drugs receives 75% of its funding from the industry. This puts the FDA in the posture of a business partner of Big Pharma rather than a regulator.

Anesthesiologist Raeford Brown puts it like this:

I think that the FDA has learned nothing. The modus operandi of the agency is that they talk a good game and then nothing happens. Working directly with the agency for the last five years, as I sit and listen to them in meetings, all I can think about is the clock ticking and how many people are dying every moment that they’re not doing anything. The lack of insight that continues to be exhibited by the agency is in many ways a willful blindness that borders on the criminal.”


What remains? Today enough opioid prescriptions are written each year in the U.S. to give every adult American his or her own one-month supply. Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. Past misuse of prescription opioids is the strongest risk factor for starting heroin use, especially among people who became dependent upon or abused prescription opioids in the past year.

(Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. “Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic reviewand data synthesis.” Pain. 2015.)

So …

Since 1999, more than 700,000 people in the US have died of drug overdoses, mostly driven by an increase in opioid-related deaths. That’s comparable to the number of people who currently live in big cities like Denver and Washington, DC.

Every day, more than 130 people in the United States die after overdosing on opioids. The misuse of and addiction to opioids – including prescription pain relievers, heroin, and synthetic opioids such as fentanyl – is a serious national crisis that affects public health as well as social and economic welfare. Some estimates predict that hundreds of thousands more could die in the next decade of opioid overdoses alone.

The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

Holding Purdue Accountable

Payback? Nothing can bring back the innocent lives lost to the opioid crisis. Nothing can compensate for the misery. The AMA Journal of Ethics explains the damage in one year:

In 2010, 16,651 Americans died from prescription opioid overdoses. For each death there were 15 drug-treatment center admissions, 26 prescription opioid-related emergency room visits, 115 people who met criteria for prescription opioid abuse or addiction, and 733 people who used these medications nonmedically (that is, for the feeling that the drug provided).”

(Gary M. Reisfield, MD. “OxyContin, the FDA, and Drug Control.”
AMA Journal of Ethics. April 2014.)

Still, Purdue and the Sacklers should pay and pay heavily for their greedy handiwork. As German Lopez, Senior Correspondent for Vox states:

The rise in opioid misuse, addiction, and overdose originally began with the proliferation of prescription painkillers – which were overprescribed by doctors, allowing the drugs to flow not just to patients but to the friends and family of patients, teens rummaging through parents’ medicine cabinets, and the black market.”

Although Purdue Pharma has secured support from 23 states and thousands of local governments for a multibillion-dollar deal that could enable the drugmaker to resolve much of the opioid litigation it faces through a planned bankruptcy restructuring, 25 states and the District of Columbia oppose the deal, in part because they believe it will not yield as much as projected, and because some feel the Sackler family is not contributing enough of its personal wealth to the total.

The New York AG's office, which is among the plaintiffs opposing the deal, also alleged that Mortimer Sackler hid his ownership of an Upper Eastside townhouse in Manhattan through a shell corporation and that he failed to disclose its existence in the litigation.

If the Sacklers, with their ill-gotten billions, continue to lowball victims, hide their assets, and skirt responsible settlements, they should be forced to give until they bleed. More power to New York in their drive to get a much larger settlement.

And, not just settlements from Purdue and the Sacklers – it's time for the government to own up to its part in the carnage and pay back. Purdue must think so. The company says the Physicians for Responsible Opioid Prescribing tried to get the FDA to regulate Oxycontin in 2012 but failed. Purdue claims it “was” and “is” simply following FDA guidelines in how it markets the deadly opioid.

The FDA rejected these proposed restrictions,” claims Purdue.

Still, the FDA – in all its so-called “wisdom” and actions like approving new and more potent opioids – says that making painkillers less likely to be abused is a “public health priority.” Have things changed?

Dr. Sidney Wolfe, a former member of the FDA’s drug safety committee and a founder of the Public Citizen Health Research Group, said the FDA had been given every opportunity to act but “can no longer be trusted” because it is heavily swayed by the drug industry which provides the bulk of the funding for the FDA’s drug approval division. And he believes the agency’s “dangerously deficient oversight” is continuing to fuel the opioid epidemic.

Without a doubt, it is clear that the greedy pharmaceutical industry has been built off the backs of helpless, “legalized” addict-patients. There is plenty of righteous blame pointed directly at agencies and industries that scratch each other's evil itch for maximum profits.

Friday, September 13, 2019

Bad Guys and Traditional Masculinity

Toxic masculinity is used in psychology and media discussions of masculinity to refer to certain cultural norms that are associated with harm to society and to men themselves. Traditional stereotypes of men as socially dominant, along with related traits such as misogyny and homophobia, can be considered "toxic" due in part to their promotion of violence, including sexual assault and domestic violence.

A recently released American Psychological Association’s first-ever guidelines for working with boys and men does not directly refer to toxic masculinity but instead to traditional masculinity. The report suggests traditional masculinity is associated with a variety of (mostly negative) outcomes such as anti-femininity, risk, adventure, achievement, violence, and avoidance of appearing weak.

Regardless of disagreement about the proper classification and definition, masculine norms such as overemphasizing power/dominance, restricting emotionality, and having multiple sexual partners may be responsible for the negative associations between masculinity and well-being.

It appears that traditional masculinity is often toxic and harmful. To be fair, such a view can be stereotypical. It creates a binary around an imaginary “good man” vs “bad man” that isn’t altogether useful. Just as not all men perpetrate acts of masculinity, not all fit a standard mold of manhood. And, of course, both men and women can be victims as well as victimizers.

Not all standards of manliness are negative. Traditional norms include winning and well-being. Such traits encourage males to strive toward success and accomplishment, and they may enhance a positive sense of mastery and competence.

But how about the “bad guys” – aberrations and deviations who use their maleness in abuse of power, possession, aggression, and entitlement?

We live in a society that advertises increased testosterone as treatment for every red-blooded man, not to mention pills for penis enlargement to help those who feel anxiety with regards to the size of their member.

Aggression can result when a man experiences stress deriving from self-perceived failure to live up to masculine expectations (discrepancy) or when he maintains normative masculine expectations (dysfunction). Both may result in a man’s expression of negative idealized characteristics of masculinity, such as violence towards others.

My view is that violence as it relates to traditional masculinity, hyper behavior, and the male heart is out of control.

Violence pervades this culture. Every day, 100 Americans are killed with guns and hundreds more are shot and injured. According to the United Nations Office on Drugs and Crime Global Study on Homicide in 2013, an astonishing 95 percent of homicide perpetrators and 79 percent of homicide victims were male. According to the National Coalition Against Domestic Violence, nearly 20 people per minute are physically abused by an intimate partner in the United States. During one year, this adds up to more than 10 million women and men.

Not only do American males engage in violence, also they are entertained by it. Children and youth are exposed to violence daily in television, social media, and video games. When a child becomes a legal adult, he or she will have seen 16,000 assassinations and 200,000 acts of violence on television. I know many authorities deny that such exposure accounts for violent youth; however, children become numbed to all the violence and, certainly, some traditional males accept it as a means to solve problems.

Some scientist's also point to men's evolutionary tendency toward risk and violent behavior. 17th-century thinker Thomas Hobbes famously described the lives of humans in their “natural condition” prior to the development of civil society as “nasty, brutish, and short.” Men in particular bear the marks of “an evolutionary history of violent male-male competition.” You and I know these toxic 21st century attitudes all too well:

When I bleed, I don’t cry. I’m no sissy.”
Women are conquests. Men are threats.”
There’s power in my stride, intensity in my stare and furor in my fists.”
I carry an emotion-proof veneer with distant abandon.”
I must hide the hollow fear and lonely isolation destroying me from within.”

Much violence is familial. Everytown for Gun Safety (2018) found that in mass shootings, in which “mass shooting” is defined as a situation in which at least four people are killed with guns, 54% were committed by intimate partners or family. In other words, domestic violence plays a pivotal role in over half of those cases.

The overwhelming victims of domestic violence are women. The Violence Policy Center reports 85% of domestic violence victims are female, and 15% are male. Today, an average of three women are killed every day. More often than not, women are shot. Over half of all women killed by intimate partners between 2001 to 2012 were killed using a gun. The firearm is a convenient tool for extreme male violence.

In their comprehensive study of homicides, leading evolutionary psychologists Martin Daly and Margo Wilson note that most homicides between men originate from what is known as “trivial altercations.” A typical homicide in real life is not premeditated, well planned, and nearly perfectly executed by a meticulous and intelligent murderer. Instead, it begins as a fight about trivial matters of honor, status, and reputation between men (such as when one man insults another or makes moves on another’s girlfriend).

Fights escalate because neither is willing to back down, until they become violent and one of the men ends up dead. And, because women prefer to mate with men of high status and good reputation, a man’s status and reputation directly correlates with his reproductive success; the higher the status and the better the reputation of the man, the more reproductively successful he is.

There’s not a sense of accountability. So they settle a fight with a gun because it doesn’t matter if they get caught because they’re not worried about the penalties,” Chicago police spokesman Guglielmi said. Often the dispute is mindless:

A Calumet Heights man allegedly shot and killed his good buddy in the chest for touching his Cadillac. “Let that motherf----- die,” the shooter said.
An Englewood man shot and killed a guy who cheated at a dice game.

Men are therefore highly motivated (albeit unconsciously) to protect their honor, and often go to extreme lengths to do so. Daly and Wilson explain these homicides between men in terms of their (largely unconscious) desire to protect their status and reputation in their attempt to gain reproductive access to women.

(Martin Daly & Margo Wilson. “Crime and Conflict: Homicide in Evolutionary Psychological Perspective.” Crime & Justice, 22. 1992.)

l impact of White Supremacy. To learn more about Frank visit
Statistics show that males are responsible for 90% of the violence that occurs. This includes both male on male violence, and male on female violence.

Frank Blaney, author at the Good Man Project, says, “Men are intimates of the demon of violence.” He asks, “Does it not seem strange to you that 90% of the perpetrators of a particular crime would come from one gender, who only makes up about 50% of the global population?”

We love it (violence). Within the atmosphere of violence, we American males “live, and move, and have our being,” (to cop a line from Paul the Apostle.) Why do we love it? Because, within the American context, violence is the overarching paradigm for defining masculinity and self-respect. A man unwilling to use violence to defend their home, family, and nation, is emasculated. They are less than men. Worse than “faggots,” as many of the far-right, gun toting, “pro-American” White racists males would say.”

Frank Blaney, Creative Director at Less is More Press

Where and when did this obsession with violence begin? Can we simply blame evolution? I am sure we must also blame toxicity on traditional masculinity as it readily serves those “bad guys” who abuse its well-established traits. These males exhibit hyper-aggression, hyper-violence and criminal sexual objectification.

History should also be considered in the blame. After all, the United States is a very young nation with a very violent past …

A nation (of people) whose influence and economic power is based upon three centuries of state and economic violence against kidnapped Africans violently forced into labor, the extermination of Indigenous people for their life-giving lands, and the exploitation of war – has no alternative other than to become infected with an adoration (conscious or unconscious) with violence.”

Frank Blaney

Perhaps, saddest of all, most men do not believe they’ve been sociologically conditioned, and the first step towards rehabilitation is awareness. A traditional ignorance that fosters toxicity? It well could be. An Irish survey on men’s attitudes towards domestic violence (SAFE Ireland, 2013) shows Irish men are less conscious of the prevalence of domestic abuse than Irish women. That seems unrealistic, yet consider once more that concept of traditional masculinity.

With great pride, tradition instructs a male – young or old – to be tough, not to show any emotions, to be the breadwinner, to always be in control, to have many sexual partners, and … to use violence to solve problems. This “holy” guy seems to have gotten the message loud and clear …

My penis was chiseled out of marble by the hand of God himself.”

Thursday, September 12, 2019

Gun Violence Suicide -- Men, Gendered Behavior, and Available Guns

When we speak of gun violence, few think of the horrible toll of suicide by firearm. Though most people who attempt suicide are struggling with mental illness, suicide attempts are usually impulsive responses to acute crises. Those who reach for guns in these times of trouble seldom survive. These lethal weapons are responsible for over 50% of suicide deaths. Our country’s suicide problem is also a gun violence problem.

Most people who attempt suicide without a gun survive in both the short and long term – 90% of survivors do not die by suicide. For example, attempts using cuts or poisoning are only fatal 6 to 7 percent of the time. Also, a literature review of 90 studies (2002) showed that nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date.

But those who reach for a gun rarely have a second chance. A study by Dr. J. Michael Bostiwck, a psychiatrist at the Mayo Clinic, showed that the odds of successfully committing suicide are 140 times greater when a gun is used than for any other method.

Of course, mental illness increases the risk for suicide. Some ignore the instrument of destruction as being any part of the problem by saying the firearm, an inanimate object, “doesn't pull the trigger.” However, if a gun is readily available, a temporary crisis often becomes a permanent loss. Consider these frightening recent statistics:

* Nearly two-thirds of all gun deaths in the US are suicides, resulting in an average of 61 deaths a day.

* The problem is getting worse: Over the past decade, the US firearm suicide rate has increased by 19 percent.

* Suicides by firearms claim the lives of over 22,000 Americans every year, including over 1,000 children and teens

* The trend has been of particular concern for children and teens, whose firearm suicide rate has increased by 82 percent over the past 10 years; and for veterans, who have a firearm suicide rate 1.5 times higher than non-veteran adults
    (Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Children and teens defined as aged 0 to 19.)
The U.S. suicide rate by firearms is 10 times that of other high-income countries. A recent poll, 16 percent of respondents – or roughly 40 million American adults – reported that someone they care for attempted or died by suicide with a gun.

    (Survey USA Market Research Study. Data collected from December 7, 2018 to December 11, 2018.
States with higher rates of gun ownership have higher suicide rates than states with low gun ownership, whereas non–firearm suicide rates are comparable, indicating that firearm access drives overall suicide rates.

(“Reducing Suicides By Firearms.” Policy Number: 20184. American Public Health Association. November 13, 2018.)

There is evidence that gun control can reduce suicide rates. A buyback program that wound up taking a fifth of Australia’s guns off the street wound up reducing firearm suicides by 74 percent without affecting non-firearm suicides.

(Andrew Leigh and Christine Neill. “Do Gun Buybacks Save Lives? Evidence from Panel Data.” American Law and Economics Review, Vol. 12, No. 2. Fall 2010.)

When the Israeli Defense Forces stopped letting soldiers bring their guns home over the weekend, suicides fell 40 percent, primarily due to a drop in firearm suicides committed on weekends.

(Gad Lubin, MD, Nomi Werbeloff, PhD, Demian Halperin, MD, Mordechai Shmushkevitch, MD, Mark Weiser, MD, and Haim Y. Knobler, MD. “Decrease in Suicide Rates After a Change of Policy Reducing Access to Firearms in Adolescents: A Naturalistic Epidemiological Study.” Suicide and Life-Threatening Behavior 40(5). November 2010)

A study in California found that the rate of suicide among new gun owners in the first week after buying a gun was 57 times higher than the state’s population as a whole. Policies and practices that disrupt the easy and immediate acquisition of firearms may save lives. This begins at the point of sale, with strong background check and permitting laws.

(Wintemute GJ, Parham CA, Beaumont JJ, Wright MA, Drake C.
Mortality among recent purchasers of handguns.”
The New England Journal of Medicine. 1999.)

By state or region…for every age, for both genders, where there are more guns, there are more total suicides.”

Dr. David Hemenway, National Academy of Sciences

Firearm suicides are less common in U.S. states that check if potential gun purchasers are mentally ill or criminal fugitives. By strengthening our existing background checks system, we can keep more deadly weapons from falling into the wrong hands, preventing shootings before they happen and saving lives.

In homes with firearms, 86 percent of the suicides used the firearms. In the homes without firearms, only 6 percent of the suicides used a firearm.”
    Dr. David Hemenway, National Academy of Sciences
We must understand that keeping guns out of the hands of individuals with a high risk of committing violence – convicted felons, domestic abusers, and those experiencing a mental health crisis – is crucial to preventing deadly shootings.

Yet …

In November 2018, the NRA issued a tweet advising physicians to stay away from the issue of guns: "Someone should tell self-important anti-gun doctors to stay in their lane."
The NRA pushes for laws that restrict how federal money can be spent to study gun violence, which makes it difficult for lawmakers to figure out how to reduce gun deaths.

Of particular concern, the gun lobby has successfully backed legislation specifically aimed at restricting doctors’ ability to discuss firearms with their patients. In 2011, Florida passed a law to prohibit doctors from discussing firearms with their patients, and Montana and Missouri followed with their own laws that interfere with the doctor-patient relationship. While the Florida prohibition has since been struck down, the clear intent of these laws is to discourage doctor counseling on gun safety.

By asking their patients about firearm access and counseling about firearm suicide risk, medical professionals may help prevent these deaths.

Elaine Frank, with the Harvard Injury Control Research Center and the New Hampshire Firearm Safety Coalition, leads a program called Counseling on Access to Lethal Means, or C.A.L.M. This program trains medical professionals on how to explain the differing lethality of various suicide methods, and to “help clients at risk for suicide and their families reduce access to lethal means, particularly firearms.”

America's gun problem is much bigger than mass shootings. Women are more likely to attempt suicide, nearly twice as likely according to some research. But men are two to four times more likely to carry it out … and, men who employ firearms are overwhelmingly successful in their attempts.

The Center for Disease Control’s recent analysis of factors contributing to the increase in suicide rates in the U.S., released June 7, 2018, reads like a list of disproportionately masculine traits:

Mental health problems (often untreated or undiagnosed);

Alcohol or drug use (higher for men than women and often a solace for failed manhood);

Social or personal problems (for which men are not supposed to seek help); and

Access to firearms (again, mostly men).

Promundo, with support from Axe, carried out a survey of 1,500 young men aged 18–30. Which young men were more likely to think about suicide? Those who believed in a version of manhood associated with being tough, not talking about their problems, and bottling up their emotions were twice as likely to have considered suicide.

Perhaps, the association between manhood and gun ownership is a problem in itself. After all, the suicide crisis is not occurring primarily because modern males are being deprived of their traditional masculine roles. In fact, women still struggle mightily with being “breadwinners” and attaining executive positions. Rather the anxiety of males seems to be linked with toughness, stoicism, and yes with toxic masculinity – aggression and violence with the expectation that using these behaviors is the correct way of being a man.

It appears that when people who partake of the gun culture experience
a stress or a loss of significance. They turn to guns as a tool to restore
their sense of mattering and importance.”

Psychologist Arie Kruglanski who surveyed gun owners both before and immediately after the 2016 Orlando nightclub shooting