Friends-Giving

With Thanksgiving now past we move into the core of the holiday season which actually concludes at Valentines Day in February. So for the next 10 weeks expect some sort of display, advertisement or article on how to stay sane/keep fit/find gifts and of course travel and do so despite rising costs of both travel and entertainment. Wow that sounds so fun!

I also will read numerous articles on loneliness and of course the rise in social isolation that has maintained since the onset of Covid in late 2019, when we thought it was just a simple virus and to be cautionary. Remember those holidays? No me either. I was still traveling between Nashville and Jersey and saw many travelers wearing masks as they were coming from Asia. I had been reading about the virus and knew instantly this was not something that will pass, little did I know how bad it would be. And then by the New Year it turned quickly to shit. Remember those fun pressers with Trump and the counterpoint Andrew Cuomo who would use their pulpit to bully and to coerce others into compliance and cooperation or sheer ignorance and little respect for others let alone their own health? Yeah and the rise of Fauci who retires next month and to never see him again either is fine with me. All three of these Stooges did little to assuage or comfort Americans with their endless polticizing, conflicting and contradicting messaging and of course the sheer bullshit that came out all of it from both sides of the political aisle. Not the first time I have seen a transmissible disease used as a political football, but hopefully the last. Nah, we had Monkeypox and that seems to have faded but that is fine as vaccines for diseases that are totally preventable are on the decline. Enjoy those pox/measles and the like at your holiday buffet and then when you have illnesses later thanks to the post affects of them, you can thank yourself and your family for their ignorance and lack of access to proper medical care. Folks few people have family Doctors and rely on Urgent Care and ER’s for their primary care which by then is now past the preventative stage. America, bringing back epidemics one at a time.

So with that we enter the phase of the moon where after three years of paranoia and hysteria we are to gather together and put all that aside to share a plate of food that may or may not cost more, taste any better or be worth all that time or travel to sit at a table and talk about what? Sports? TV? Movies? Books? Oh wait no one reads books they read Social Media that tells them about books. So they talk about I guess Book reports that they saw/heard on Tik Tok.

I go to a great deal of events of which I write about here, largely because this is self published and with that it is still considered published work and for that I can get some tax credits for the cost of doing so. I struggle keeping up the blog and was beginning another to draft fiction and see how to create work from what is ostensibly non fiction and turn it into fiction to avoid the whole concept of what is “creative non fiction” versus actual non fiction. Meaning that I can change names, situations and blur truth with well lies or made up shit isn’t that fiction, created non truths? Sometimes writing linear stories are boring and why most non fiction is not well read or sold other than a few bios that draw the eye and then the Author disappears back into the world to never have that kind of success again. The late Author, Julie Powell of Julia and Julie is a good example. She never had that kind of recognition and acclaim that began as what? A blog. From that drew attention and success which it evolved into a book and movie that was never replicated again in her brief time on earth. Or how about James Frey who wrote a creative non fiction book that was so beloved by Oprah, then it was discovered it was just that – creative fiction. His life ended in a similar fashion, once infamous now just sorta famous, a cultural footnote.

And that is the struggle for many who despite having had fame, fortune and success is finding a path that maintains this course of life and that the creative fuel or inspiration maintains. It ain’t easy. I can do small doses of inspired thought and then like any drug, it lasts for a moment and then back to real life. I get why people do drugs as they cannot handle the let down, the sense of high and with that the power it brings that makes one feel unique, special, loved. Read Modern Love in the New York Times or LA Affairs in the LA Times. These are the stories of the heart and head that talk about the success and failures of finding love and romance in the big city. I find them incredibly amusing, boring, sanctimonious, sad, or interesting. I don’t read them all the time but I do occasionally pass over them. I read one today, “When love calls, go.” My first thought, “Hang up the phone or don’t answer.” Honestly I did not get one word of that as it was a cultural story that one would have to understand the history behind the concept of race, identity, religion and belief in the institution and dogmas that are embedded into the belief of arranged marriage and its import to one’s family and history. But it continued to reinforce my belief that religion is the bane of all existence, especially to Women. Had that woman stayed in Hong Kong, had a thriving career, remained with her family and met someone on her own or not, what could have happened could have been equally if not more satisfying or joyous than meeting a dude and marrying him and moving across the globe to satisfy what appeared to be her family’s wishes, not her own. Wow. Just wow.

And in that same paper they had a story about a Breakup Bootcamp. It charges 4K to mend a broken heart. I knew in my heart I had potential to be a cult leader as I watch the Vow Season 2 on HBO and yet I also could not go through the charades and machinations to maintain such bullshit and duplicity. I mean once I cleared that first million I would be out of there and claiming that we must end this and go on our own journey to seek knowledge and freedom. Then I would immediately move to Switzerland.

I am not going to comment on any of that absurd bootcamp but it is about the same cost for some visits to Therapist over a brief period and add Yoga, a Sex Worker and a short vacation, it adds up so this is fine frankly if that is what you need to feel better. I am sure the ESP/NXIVM folks felt the same after their thousands of dollars dropped for bullshit jargon and coaching from ostensibly two white people that look like Middle School Teachers. Wow. Just wow.

But it is this pervasive FEAR of being alone. This has fueled many of the shooters who have no social ties and cite a lack of a “girlfriend” as their reasoning. The most current crop that shot up a Bus, a Walmart and a Gay Bar seem to have the most diverse reasoning or lack thereof as to why as one committed suicide (the Walmart employee) and the others “motives” at this point will either evolve or never fully be understood as again it is less about the why but more about the how. How they get a gun and ammo and feel compelled to act upon their rage in a manner that kills and harms people just living their lives is the only thing I care about. This is not about mental health as you are already crazy to start amassing guns, get tactical gear and ammo to then act on your rage. Yes, you are crazy. The end literally and towards people who had nothing to do with your rage or anger. The exception it appears is the Walmart crazy who while working their expressed paranoia, delusions and rage yet not one co-worker or supervisor felt compelled to listen to him and inform those around him that this is a problem. And that may explain his list and targets. We truly do not actively listen, we patronize, ignore or simply are that self involved to not. Almost all shooters have expressed similar anger prior to their acts and yet again and again we go “mental health” but hey its clear we have no fucking clue what defines mentally healthy.

And again we have this insatiable belief or idea that you must be partnered off, have a hand count of life long friends whom you rely to be that family of another kind. Great my family were nuts so would this be a sane family and what is sane. While I found my Parents challenging as parents they were not bad people so being their friend is not an issue and with that I accept their limitations and have moved on the therapy stage of blaming them for all my ills. What I did learn was independence and the ability to rely on myself which can be overwhelming and at times I would appreciate someone else to do the heavy lifting. I would actually really love someone to plan something and include me in a genuine offer of friendship. This would be inviting me to a play, a movie, a walk. An ACTUAL invite with the exchange being that they do the planning/organizing or get the tickets and I will pick up a meal, drink or something in the future in which to reciprocate. I can truly say that will never happen. The last time I was invited to something was in Nashville to a baseball game that I did not want to go but felt I could not say no as to not hurt their feelings and I dressed and was ready with a no show text about 20 minutes before. I knew it was a lie and was furious and it was then I decided to lie and fuck with that individuals head from that point on. But is that mentally healthy? No, but I found it by far more entertaining and when I left I finally did admit that I made it all up I could in fact write fiction! I was by far more creative when I put my mind to it but it also changed how I saw people and the limitations I could foresee as I moved forward in life. And that led to the policy of No Compromise. Since landing in Jersey City I have had two social encounters with two different Artists, one I went to Governor’s Island with (which turned out to be the longest and best thing of that) and another who I met for coffee and she drank none and we walked around Union Square for about an hour. It was boring and neither of them I have seen again nor even remember their names. But again effort made, it was stalled and I moved on. No harm no foul and no compromise.

And this weekend I read the below article in the Washington Post from of all things an Economist who is concerned about the concept of Social Isolation. What resulted was not a far reaching discussion on health, loneliness and the overall affects it can pose on mental or physical well being. This was about the issue of choice and of situation. Yes the rise of mental health issues and the like that can be serious when we speak of those who are alone, and wish to be otherwise. That is completely different when one chooses be alone and or is simply alone, and yes folks I was in a marriage of one so you can be in partnerships that are of that nature. I refer to my Parents who again were the role model of that which I duplicated to a tee, so yes I do now know that boundaries and interests and relationships do not need co-dependency in which to thrive. And yes folks that my Parents did not do things together, sleep together, socialize or have interests together they were utterly co-dependent on that dysfunction that I thought that was “normal” or “healthy” and today I find myself content with the idea that yes that works for me now. Irony I am back to where I started only now I can articulate that and am sure I do not want a partner to live with me or fuck me. I just want a great friend whom I can do things upon occasion and have trust and respect as the foundation of such. That will never be a Woman they are incapable of it. We women are an unhappy lot and I just look to the Karen who lives in 946 below me and that performance in my Apt. on October 10. Then last week to get on the elevator with me and act as if she had no clue who I was confirmed it, she is what? Crazy. Just not gunshot crazy. And that is what falls under the umbrella of a mental health disorder.

And when I read the article and the comments that followed they too confirmed the reality is that most people choose to be alone, they are bored, frustrated, exhausted. Some come to it from years of having to care take and be the primary care giver, have had tremendous loss and want to be alone and some manage to have a healthy relationship with their partner/family and feel no great urge to be the life of the party. I am a great advocate of the “random” where your path crosses for an hour or two and take great pleasure in that exchange and then move on. I finally accepted that and often do make an offer of a future time but I don’t mean it and I really do. That is being polite. Most often I don’t remember their names and make sure that I am appreciative and thankful but I am done with it. The nice man I met with his friend (and yes I do recall both their names they were delighful and deserve that respect) on my Birthday whom I had dinner I die offer to reciprocate. My first attempt was in that same week to meet by coming into the city and running errand and saying I was stopping for coffee so if he was around to let me know and left it there. His response, “I don’t drink coffee.” So I told him to have a nice day and keep in touch. He did and with that I have been deeply bored with the texting and after my disaster at the Brooklyn Academy of Music and the German Actor in Hamlet I realized I was truly done with plays and theater. I had my few tickets left and was going but not going to discuss or pursue any further drama, literally or figuratively. So this weekend I planned a trip to Baltimore in January to see the John Waters exhibit and attend their acclaimed Symphony. As I planned it I recalled that the Gentleman was coming to see Death of a Salesman again (where we all met) on the 13th but I simply dismissed it then moved on with my plans. And sure enough the very next day I got a text with all the tickets and theater he was planning on attending that weekend. It was packed and unless I attended one of them on the same day and time I could not possibly reciprocate with dinner. I was secretly relieved. But with that I responded. “Wow great choices, shame I don’t do Broadway anymore and with that schedule I doubt we would have a chance to get together anyway. Enjoy”. His response was Happy Thanksgiving anyway. Loved the deep inquiry into “What you don’t do Broadway anymore?” Yeah, like coffee. Again the lack of curiosity and interest said more than had he expressed as such. Even if I wasn’t going to Baltimore that weekend I am back Sunday morning, but with a short window and his lack of coffee I am not sure what he thought we could do. Have Breakfast? I actually don’t do breakfast. So with that I suspect it is done. I am relieved as we had nothing to talk about but the play. There is only so much to talk about there. I am not sure he thought we were to be anything more than friendly acquaintances but the inability to communicate and speak about things other than a single subject be that theater, politics or sports is a problem folks.

I find it fascinating that people find me so “intelligent” which is great but it is really that I simply read, retain and seek knowledge and experiences. It takes so little effort to find things to do that I like. I went to see the play, Piano Lesson, with a very star studded cast on Tuesday. I have been a fan of August Wilson as despite all his plays taking place in Baltimore where he once lived, he lived his later years in Seattle and it was from there is how I became familiar with his work and life. He lived a short distance from me in Mt. Baker and sadly our paths never crossed but I am sure he would have been a lively conversationalist. And with that I decided to stay in the City for the night as to avoid another drama at my home And at what had to be the best find of hotels in Manhattan, Public, in the LES. I have fond memories of that hood, often staying there when I would visit. It is still a mixed but thriving area and with that easy access to and from Midtown and the PATH exchanges. I had the best time at Public, from a room upgrade to a bottle of Prosecco on the house, I can not say enough good things about the service or the hotel. It is a must go to stay or just to dine, drink or visit. I am going to have to find another excuse in the future to stay despite my disinclination to attend Broadway in the future. Yes that much was true as there is nothing next season I plan on seeing unless I buy day of or lottery. It is not worth it. Two more to go with an Off Broadway show, Man of No Importance and the Musical 1776, my calendar is now full of Opera and some Cabaret. But theater is no longer my muse and with that we will always have our moments but it must be exceptional in every sense of the word.

And you do atttend Cabaret you can reserve a table or sit at a bar seat and with that I will never sit anywhere but a bar seat. I am seeing Sandra Bernhardt next month and Joe’s Pub to end the year and wisely will take the bar. I did Below 54 last week as well and they “upgraded” me to a table. I shared with a Mother, and a Daughter and another young woman who also joined the table. I knew after I was cut off mid sentence I had nothing more to say so I listened to their conversation progress and the best part was the Young Woman was originally from Nashville, confirming that I needed to keep my mouth firmly on my wine as flashbacks and reminisces were not on the menu. So I listened to the table next to me discuss their theater going and thanks to that convo again reminding me why it was time to forego it as they defined the “type” of NYC theater audience. Their discussion defined pretentious but while they trashed one production the irony was that next to them at another table was the Stage Manager of said production. Ah NYC folks it is a small town. I have come to the conclusion that yes I am smart and smart enough that small talk is being polite but silence is golden, like the Tony Awards.

So why are people alone? Read Bowling Alone a 20 year old book by Robert Putnam. It explains it and shows that little has changed but the methods in which we did connect and socialize have eroded and with it today’s Social Media is anything but a manner in which to meet and find others just like you. We are all now algorithms, and as in math, like finds like to solve the equation. Math is Hindu-Arabic, its own language and you read it right to left and we are Americans who suck at math. That may be why as we are also not bi-lingual and we assume that all of the rest will come to do as we do, as we do it. Yeah okay.

So embrace aloneness, do not confuse it with loneliness. If one suffers the one prospers and you must find the ways to those tiny relationships that can boost self esteem and self worth. My stay at the Public Hotel did that. With that I found out 946 was gone for the week, but I am glad I did stay regardless; I needed to treat myself to civility and dignity. And that is how you meet others in that orbit of positive energy that enables me to thrive and survive. I have let the thoughts of suicide pass over me and that is all they do – pass.

I spent Thanksgiving watching old movies. First was Blackboard Jungle (which irony had Sidney Pointier as the bad student which only decade later he would be taking on the redeeming Teacher role and my influencer in To Sir With Love) and folks there may be more closeness to reality than I imagined when I read this about a former Teacher at one of the many schools I subbed at in Nashville – Johnson. This was,the last stop before Jail and I knew this Teacher but the story was right out of the movie. That school had many problems, including that at one point Nashville Police quit as they did not feel safe there. Yeah no one did, it was literally a block away much like the other school in Jersey City Bright St which was, until this year and it explains why I subbed there as well, but not one moment did I feel safe. There was no learning, no security and frankly no point. So after that flashback, I then watched the original Boys in the Band from 1970; a film about a Birthday party but in reality a gay night of anger, rage and recrimination by a bunch of Queer friends who define the word in a dysfunctional way, not a fun “gay” way. Toxic friendships are just that toxic and with that it shows that even Men straight or gay have anger issues. Yikes, how perfect for the holidays to remind yourself maybe being alone is not that bad of an idea.

Opinion Americans are choosing to be alone. Here’s why we should reverse that.

By Bryce Ward

November 23, 2022. The Washington Post

Bryce Ward is an economist and the founder of ABMJ Consulting.

The covid-19 pandemic wreaked havoc on our social lives. Cancellations, closures and fear of a potentially deadly infection led us to hunker down and avoid acquaintances, co-workers and extended family. Time spent with friends went down. Time spent alone went up.

Thanksgiving was not spared. Americans spent 38 percent less time with friends and extended family over the Thanksgiving weekend in the past two years than they had a decade prior.

And now for the scarier news: Our social lives were withering dramatically before covid-19. Between 2014 and 2019, time spent with friends went down (and time spent alone went up) by more than it did during the pandemic.

According to the Census Bureau’s American Time Use Survey, the amount of time the averageAmerican spent with friends was stable, at 6½ hours per week, between 2010 and 2013. Then, in 2014, time spent with friends began to decline.

By 2019, the average American was spending only four hours per week with friends (a sharp, 37 percent decline from five years before). Social media, political polarization and new technologies all played a role in the drop. (It is notable that market penetration for smartphones crossed 50 percent in 2014.)

Covid then deepened this trend. During the pandemic, time with friends fell further — in 2021, the average American spent only two hours and 45 minutes a week with close friends (a 58 percent decline relative to 2010-2013).

Similar declines can be seen even when the definition of “friends” is expanded to include neighbors, co-workers and clients. The average American spent 15 hours per week with this broader group of friends a decade ago, 12 hours per week in 2019 and only 10 hours a week in 2021.

On average, Americans did not transfer that lost time to spouses, partners or children. Instead, they chose to be alone.

No single group drives this trend. Men and women, White and non-White, rich and poor, urban and rural, married and unmarried, parents and non-parents all saw proportionally similar declines in time spent with others. The pattern holds for both remote and in-person workers.

The percentage decline is also similar for the young and old; however, given how much time young people spend with friends, the absolute decline among Americans age 15 to 19 is staggering. Relative to 2010-2013, the average American teenager spent approximately 11 fewer hours with friends each week in 2021 (a 64 percent decline) and 12 additional hours alone (a 48 percent increase).

These new habits are startling— and a striking departure from the past.Just a decade ago, the average American spent roughly the same amount of time with friends as Americans in the 1960s or 1970s. But we have now begun to cast off our connections to each other.

It is too soon to know the long-term consequences of this shift, but it seems safe to assume that the decline of our social lives is a worrisome development. Spending less time with friends is not a best practice by most standards, and it might contribute to other troubling social trends — isolation, worsening mental health (particularly among adolescents), rising aggressive behavior and violent crime. Americans rate activities as more meaningful and joyful when friends are present. Friends and social connections build on themselves and produce memories and fellowship. They also boost health and lead to better economic outcomes.

We can hope, as covid-related barriers recede, that people will change course.Time with friends did increase in 2021 after the vaccine rolled out; however, at the end of 2021, it was still an hour below the 2019 level. Furthermore, a Pew Research Center survey made public in August suggests that covid might have changed us permanently — 35 percent of Americans say that participating in large gatherings, going out and socializing in-person have become less important since the pandemic.

The potential harms of these trends are sufficient to demand that Americans devote some resources to understanding and reversing them.

You can help reverse these trends today without waiting for the researchers and policymakers to figure it all out. It’s the holidays: Don’t skip Thanksgiving with your family. Go to that holiday party (or throw one yourself). Go hang out with friends for coffee, or a hike, or in a museum, or a concert — whatever. You will feel better, create memories, boost your health, stumble across valuable information — and so will your companions.

Put effort into building relationships that you can count on in good times and bad because, as the song goes, that’s what friends are for. Besides, you just might have a good time.

White Coats White Care

As we take to the streets or our screens we have to realize that systemic racism and sexism dominates most of the larger institutions established in our country. And none other is as large as the medical industrial complex, and the emphasis on complex has truly come to fruition with the Coronavirus and the exposures with regards to the failings of public health. We have for years found a lack of funding for public enterprises, from housing, to education and lastly to health care has lent itself to major disparities of equity when it comes to the working poor. And no group composes the working poor more than faces of color.

There is some roots in this vested in racsim but it is also with regards to gender and now sexuality identity. The AIDS crisis exposed again how the system failed when it came to helping those who identified as Gay and had contracted that disease. It was labeled the “Gay disease” and much like Covid today, contributed to a genocide of those who were not part of the acceptable mainstream aka White/Male/Christian. Women’s rights so fought for in the 70’s and ultimately leading to the failure of the ERA, also plays a factor as men in leadership roles found that by having women enter the workplace they may have expectations reagarding rights and privileges that were largely the domain of men. We finally saw that come to head with #MeToo and again with Covid the rights of Trans folks shows again another marginalized group shoved aside when it comes to crime, violence, and of course health care.

Below are two articles, one about the failings of the MIC to properly treat, diagnose and care for faces brown and black and that implied if not overt bias dominates the field when it comes to finding medical care. The next is on reproductive rights and how the BLM group do not see this as an issue. Well then remind me why again I am not to support you, a woman, a face of color and with the genitalia we share, with the same reproductive rights issues and needs regardless of the shade of our skin. Of all groups most affected again by denial of access to abortion it has also led to closures of clinics that do more than provide abortion and in turn provide pre and post natal care, two issues of import that again largely affect faces of color. When you take away one right you have a domino affect that leads to a reduction of rights across the spectrum. Again, we have the right to care and because of the complext needs of Trans folks the access to proper medical care is essential. Got tits? Well welcome to breast cancer and the ability to screed for that or any other cancer is again a reproductive sexual right. Safe sex is informed sex and these clinics again provide essential information and education to eliminate the transmission of sexually transmitted diseases and the necessary vaccine to prevent cervical cancer.

So agai you say you don’t have time for this? Okay then don’t ask me for any time to spend on your issue. As clearly you have one where your sexuality is not a part of your identity and your identity is more than skin color.

Racism in care leads to health disparities, doctors and other experts say as they push for change

 

The Washington Post

By Tonya Russell
July 11, 2020 at 10:00 a.m. EDT

The protests over the deaths of black men and women at the hands of police have turned attention to other American institutions, including health care, where some members of the profession are calling for transformation of a system they say results in poorer health for black Americans because of deep-rooted racism.

“Racism is a public health emergency of global concern,” a recent editorial in the Lancet said. “It is the root cause of continued disparities in death and disease between Black and white people in the USA.”

A New England Journal of Medicine editorial puts it this way: “Slavery has produced a legacy of racism, injustice, and brutality that runs from 1619 to the present, and that legacy infects medicine as it does all social institutions.”

The novel coronavirus has provided the most recent reminder of the disparities, with black Americans falling ill and dying from covid-19 at higher rates than whites. Even so, the NEJM editorial noted, “when physicians describing its manifestations have presented images of dermatologic effects, black skin has not been included. The ‘covid toes’ have all been pink and white.”

Black Americans die younger than white Americans and they have higher rates of death from a string of diseases including heart diseases, stroke, cancer, asthma and diabetes.

By one measure, they are worse off than in the time of slavery. The black infant mortality rate (babies who die before their first birthday) is more than two times higher than for whites — 11.4 deaths per 1,000 live births for blacks compared with 4.9 for whites. Historians estimate that in 1850 it was 1.6 times higher for blacks — 340 per 1,000 vs. 217 for whites.

Medical professionals describe the effects of racism across specialties and illnesses. Tina Douroudian, an optometrist in Sterling, Va., has observed differences in the severity of her patients with diabetes, as well as their management plans.

“Black folks have higher rates of diabetes and often worse outcomes. It’s universally understood that nutrition counseling is the key factor for proper control, and this goes beyond telling patients to lose weight and cut carbs,” Douroudian says.

“I ask all of my diabetic patients if they have ever seen a registered dietitian,” she says. “The answer is an overwhelming ‘yes’ from my white patients, and an overwhelming ‘no’ from my black patients. Is there any wonder why they struggle more with their blood sugar, or why some studies cite a fourfold greater risk of visual loss from diabetes complications in black people?”

Douroudian’s patients who have never met with a dietitian in most cases have also never even heard of a dietitian, she says, and she is unsure why they don’t have this information.

Her remedy is teaching her patients how to advocate for themselves:

“I tell my diabetic patients to demand a referral from their [primary care physician] or endocrinologist. If for some reason that doctor declines, I tell them to ask to see where they documented in their medical record that the patient is struggling to control their blood sugar and the doctor is declining to provide the referral. Hint: You’ll get your referral real fast.”

Black women are facing a childbirth mortality crisis. Doulas are trying to help.

Jameta Barlow, a community health psychologist at George Washington University, says that the infant mortality rate is a reflection of how black women and their pain are ignored. Brushing aside pain can mean ignoring important warning signs.

“Centering black women and their full humanity in their medical encounters should be a clinical imperative,” she says. “Instead, their humanity is often erased and replaced with stereotypes and institutionalized practices masked as medical procedure.”

Black women are more than three times as likely as white women to die of childbirth-related causes, according to the Centers for Disease Control and Prevention, (40.8 per 100,000 births vs. 12.7). Experts blame the high rate on untreated chronic conditions and lack of good health care. The CDC says that early and regular prenatal care can help prevent complications and death.

Barlow says that the high mortality rate, and many other poor health outcomes, are a result of a “failure to understand the institutionalization of racism in medicine with respect to how the medical field views patients, their needs, wants and pain thresholds. The foundation of medicine is severely cracked and it will never adequately serve black people, especially black women, until we begin to decolonize approaches and ways of doing medicine.”

Barlow’s research centers on black women’s health, and her own great-grandmother died while giving birth to her grandmother in 1924. “In the past, black women were being blamed for the maternal mortality rate, without considering the impact of living conditions due to poverty and slavery then,” she says. “The same can be said of black women today.”

Natalie DiCenzo, an OB/GYN who is set to begin her practice in New Jersey this fall, says she hopes to find ways to close the infant mortality gap. Awareness of racism is necessary for change, she says.

“I realize that fighting for health equity is often in opposition to what is valued in medicine,” she says. “As a white physician treating black patients within a racist health-care system, where only 5 percent of physicians identify as black, I recognize that I have benefited from white privilege, and I now benefit from the power inherent to the white coat. It is my responsibility to do the continuous work of dismantling both, and to check myself daily.

“That work begins with being an outspoken advocate for black patients and reproductive justice,” she says. “This means listening to black patients and centering their lived experiences — holding my patients’ expertise over their own bodies in equal or higher power to my expertise as a physician — and letting that guide my decisions and actions. This means recognizing and highlighting the strength and resilience of black birthing parents.”

DiCenzo blames the racist history of the United States for the disparities in health care. “I’m not surprised that the states with the strictest abortion laws also have the worst pregnancy-related mortality. For black LGBTQIA+ patients, all of these disparities are amplified by additional discrimination. Black, American Indian and Alaska Native women are at least two to four times more likely to die of pregnancy-related causes than white women, regardless of level of education and income,” she says.

As for covid-19, although black people are dying at a rate of 92.3 per 100,000, patients admitted to the hospital were most likely to be white, and they die at a rate of 45.2 per 100,000.

The CDC says that racial discrimination puts blacks at risk for a number of reasons, including historic practices such as redlining that segregate them in densely populated areas, where they often must travel to get food or visit a doctor.

“For many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick,” the CDC says.

The CDC is urging health-care providers to follow a standard protocol with all patients, and to “[i]dentify and address implicit bias that could hinder patient-provider interactions and communication.”

In her 16 years in medicine, internist Jen Tang has provided care for mid- to upper-class Princeton residents as well as residents of inner city Trenton, N.J. She has seen privatization of medicine adversely affect people of color who may be insured by government-run programs that medical organizations refuse to accept. Some doctors complain that the fees they are paid are too low.

And that can make referrals to specialists difficult.

“Often my hands are tied,” says Tang, who now works part time at a federally qualified health center in California. “I try to give my patients the same level of care that I gave my patients in Princeton, but a lot of my patients have the free Los Angeles County insurance, so to get your patient to see a specialist is difficult. You have to work harder as a clinician, and it takes extremely long.”

Tang has also encountered what medical experts say is another effect of long-term racism: skepticism about the health-care system.

“Some patients don’t trust doctors because they haven’t had access to quality health care,” she says. “They are also extremely vulnerable.”

American history is rife with examples of how medicine has used people of color badly. In Puerto Rico, women were sterilized in the name of population control. From the 1930s to the 1970s, one-third of Puerto Rican mothers of childbearing age were sterilized.

As a result of the Family Planning Services and Population Research Act of 1970, close to 25 percent of Native American women were also sterilized. California, Virginia and North Carolina performed the most sterilizations.

The Tuskegee experiments from 1932 to 1972, which were government-sanctioned, also ruined the lives of many black families. Men recruited for the syphilis study were not given informed consent, and they were not given adequate treatment, despite the study leading to the discovery that penicillin was effective.

Though modern discrimination isn’t as apparent, it is still insidious, Barlow says, citing myths that lead to inadequate treatment, such as one that black people don’t feel pain.

“We must decolonize science,” Barlow says, by which she means examining practices that developed out of bias but are accepted because they have always been done that way. “For example, race is a social construct and not clinically useful in knowing a patient, understanding a patient’s disease, or creating a treatment plan,” she says, but it still informs patient treatment.

She calls upon fellow researchers to question research, data collection, methodologies and interpretations.

Like Douroudian, she recommends self-advocacy for patients. This can mean asking as many questions as needed to get clarification, and if feasible, getting a second opinion. Bring a friend along to the doctor, and record conversations with your doctor for later reflection.

“I tell every woman this when doctors recommend a drug or procedure that you have reservations about: ‘Is this drug or procedure medically necessary?’ If they answer yes, then have them put it in your medical chart,” Barlow says. “If they say it is not necessary to do that, then be sure to get another doctor’s opinion on the recommendation. Black women have always had to look out for themselves, even in the most vulnerable medical situations such as giving birth.”

Medicine’s relationship with black people has advanced beyond keeping slaves healthy enough to perform their tasks. Barlow says, however, that more work needs to be done to regain trust, and uproot the bias that runs over 400 years deep.

“This medical industrial complex will only improve,” she says, “when it is dismantled and reimagined.”

Can’t Focus on Abortion Access if My People Are Dying’

Some Gen Z and millennial women said they viewed abortion rights as important but less urgent than other social justice causes. Others said racial disparities in reproductive health must be a focus.

Emma Goldman|| The New York Times

Like many young Americans, Brea Baker experienced her first moment of political outrage after the killing of a Black man. She was 18 when Trayvon Martin was shot. When she saw his photo on the news, she thought of her younger brother, and the boundary between her politics and her sense of survival collapsed.

In college she volunteered for the N.A.A.C.P. and as a national organizer for the Women’s March. But when conversations among campus activists turned to abortion access, she didn’t feel the same sense of personal rage.

“A lot of the language I heard was about protecting Roe v. Wade,” Ms. Baker, 26, said. “It felt grounded in the ’70s feminist movement. And it felt like, I can’t focus on abortion access if my people are dying. The narrative around abortion access wasn’t made for people from the hood.”

Ms. Baker has attended protests against police brutality in Atlanta in recent weeks, but the looming Supreme Court decision on reproductive health, June Medical Services v. Russo, felt more distant. As she learned more about the case and other legal threats to abortion access, she wished that advocates would talk about the issue in a way that felt urgent to members of Generation Z and young millennials like her.

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“It’s not that young people don’t care about abortion, it’s that they don’t think it applies to them,” she said. Language about “protecting Roe” feels “antiquated,” she added. “If I’m a high school student who got activated by March for Our Lives, I’m not hip to Supreme Court cases that happened before my time.”

Her question, as she kept her eyes on the court, was: “How can we reframe it so it feels like a young woman’s fight?”

On Monday the Supreme Court ruled on the case, striking down a Louisiana law that required abortion clinics to have admitting privileges at local hospitals, four years after deciding that an effectively identical Texas requirement was unconstitutional because it placed an “undue burden” on safe abortion access. The Guttmacher Institute had estimated that 15 states could potentially put similarly restrictive laws on the books if the Supreme Court upheld the Louisiana law.

The leaders of reproductive rights organizations celebrated their victory with caution. At least 16 cases that would restrict access to legal abortion remain in lower courts, and 25 abortion bans have been enacted in more than a dozen states in the last year.

“The fight is far from over,” said Alexis McGill Johnson, the president of Planned Parenthood. “Our vigilance continues, knowing the makeup of the court as well as the federal judiciary is not in our favor.

Continue reading the main story

Interviews with more than a dozen young women who have taken to the streets for racial justice in recent weeks, though, reflected some ambivalence about their role in the movement for reproductive rights.

These young women recognized that while some American women can now gain easy access to abortion, millions more cannot; at least five states have only one abortion clinic.

But some, raised in a post-Roe world, do not feel the same urgency toward abortion as they do for other social justice causes; others want to ensure that the fight is broadly defined, with an emphasis on racial disparities in reproductive health.

Members of Gen Z and millennials are more progressive than older generations; they’ve also been politically active, whether organizing a global climate strike or mass marches against gun violence in schools.

While Gen Z women ranked abortion as very important to them in a 2019 survey from Ignite, a nonpartisan group focused on young women’s political education, mass shootings, climate change, education and racial inequality all edged it out. On the right, meanwhile, researchers say that opposition to abortion has become more central to young people’s political beliefs.

Melissa Deckman, a professor of political science at Washington College who studies young women’s political beliefs, said that Gen Z women predominantly believe in reproductive freedom but that some believe it is less pressing because they see it as a “given,” having grown up in a world of legalized abortion.

“Myself and other activists in my community are focused on issues that feel like immediate life or death, like the environment,” said Kaitlin Ahern, 19, who was raised in Scranton, Pa., in a community where air quality was low because of proximity to a landfill. “It’s easier to disassociate from abortion rights.”

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Fatimata Cham, 19, an ambassador for the anti-gun violence advocacy group Youth Over Guns, agreed that the fight for reproductive rights felt less personal. “For many activists, we have a calling, a realm of work we want to pursue because of our own personal experiences,” Ms. Cham said. “Growing up, abortion never came to mind as an issue I needed to work on.”

Some young women said that they considered reproductive rights an important factor in determining how they vote, but they struggled to see how their activism on the issue could have an effect.

When Ms. Baker helped coordinate local walkouts against gun violence, she sensed that young people no longer needed to wait for “permission” to demand change. With abortion advocacy, she said, organizers seem focused on waiting for decisions from the highest courts.

And even as those decisions move through the courts, the possibility of a future without legal abortion can feel implausible. “I know we have a lot to lose, but it’s hard to imagine us going backward,” said Alliyah Logan, 18, a recent high school graduate from the Bronx. “Is it possible to go that far back?”

Then she added: “Of course in this administration, anything is possible.”

For many women in the 1970s and ’80s, fighting for legal abortion was an essential aspect of being a feminist activist. A 1989 march for reproductive rights drew crowds larger than most protests since the Vietnam War, with more than half a million women rallying in Washington, D.C.

Today, young women who define themselves as progressive and politically active do not always consider the issue central to their identities, said Johanna Schoen, a professor of history at Rutgers and the author of “Abortion After Roe.”

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“Women in the ’70s understood very clearly that having control over reproduction is central to women’s ability to determine their own futures, to get the education they want, to have careers,” Dr. Schoen said. “As people got used to having access to abortion — and there’s a false sense that we’ve achieved a measure of equality — that radicalism women had in the early years got lost.”

Some millennial women who can easily and safely get abortions do not connect the experience to their political activism. Cynthia Gutierrez, 30, a community organizer in California, got a medication abortion in 2013. Because she did not struggle with medical access or insurance, the experience did not immediately propel her toward advocacy.

“I had no idea about the political landscape around it,” she said. “I had no idea that other people had challenges with access or finding a clinic or being able to afford an abortion.”

Around that time, Ms. Gutierrez began working at a criminal justice reform organization. “I wasn’t thinking, let me go to the next pro-choice rally,” she said. “The racial justice and criminal justice work I did felt more relevant because I had people in my life who had gone through the prison industrial complex, and I experienced discrimination.”

Other young women said they felt less drawn to reproductive rights messaging that is focused strictly on legal abortion access, and more drawn to messaging about racial and socioeconomic disparities in access to abortion, widely referred to as reproductive justice.

Deja Foxx, 20, a college student from Tucson, Ariz., became involved in reproductive justice advocacy when she confronted former Senator Jeff Flake, Republican of Arizona, at a town hall event over his push to defund Planned Parenthood.

But abortion access is not what initially drew her to the movement. She wanted to fight for coverage of contraceptives, as someone who was then homeless and uninsured, and for comprehensive sex education, since her high school’s curriculum did not mention the word consent.

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“There’s a need to protect the wins of the generation before us,” Ms. Foxx said. But she believes the conversations that engage members of her generation look different. “My story is about birth control access as a young person who didn’t have access to insurance,” she said.

The generational shift is evident at national gatherings for abortion providers. Ms. Schoen has attended the National Abortion Federation’s annual conference each year from 2003 to 2019. In recent years, she said, its attendees have grown more racially diverse and the agenda has shifted, from calls to keep abortion “safe, legal and rare” to an emphasis on racial equity in abortion access.

“The political questions and demands that the younger generation raises are very different,” she said. “There’s more of a focus on health inequalities and lack of access that Black and brown women have to abortion.”

Amid the coronavirus outbreak, even the most fundamental legal access to abortion seemed in question in some states. At least nine states took steps to temporarily ban abortions, deeming them elective or not medically necessary, although all the bans were challenged in court.

Research from the Kaiser Family Foundation found that the pandemic led to various new legal and logistical hurdles. In South Dakota, abortion providers have been unable to travel to their clinics from out of state. In Arkansas, women could receive abortions only with a negative Covid-19 swab within 72 hours of the procedure, and some have struggled to get tested.

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Alliyah Logan, a recent high school graduate, near her home in the Bronx. “I know we have a lot to lose, but it’s hard to imagine us going backward,” she said.Credit…Hiroko Masuike/The New York Times

But in spite of the threats, for some young women the calls to action feel sharpest when they go beyond defending rights they were raised with.

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“Right now, in a lot of social justice movements we’re seeing language about the future,” said Molly Brodsky, 25. “I hear ‘protect Roe v. Wade,’ and it feels like there needs to be another clause about the future we’re going to build. What other changes do we need? We can’t be complacent with past wins.”

Hands Up!

Seriously touch nothing until you get home and wash your hands well and then after clean your face and change clothes if you spent anytime outside.

The reality is that half of these mor-fucking-ons wearing masks are not wearing gloves that can be either washed or disposed of. The reality is that again they are disposable NOT ON THE STREET.  Gee we don’t want to handle your fucking medical waste. Another law for littering which in the case of med waste should be higher, along with fuckwits congregating in public places so that we the good people can go out in the parks to walk, exercise and de-stress.

First up is that closing parks does more harm than good as congestion on streets gets worse so we are packed in with the joggers, bikers, strollers and the walkers.   So the droplets fly as they zoom past me hence I wear a washable hoodie when I get home it goes straight into the laundry, with my face mask and I toss the gloves.  I wear rubber gloves in my home to then clean locks, keys and handles once inside.   And wash my hand AGAIN to ensure that nothing transmits from the endless routine.

Our moronic Governor has closed all parks state wide and the equally idiotic Mayor of Jersey City did that weeks ago which has made it near to impossible to keep socially/physically distant from anyone.  So go figure why we haven’t spike and all the endless mask ordinances are doing little to change that but more shops and restaurants are closing as they cannot keep up with them so they just close.  Hence why Wells Fargo shuttered all its branches other than ones that already had plexiglass screens to protect the tellers from robbery but who knew that it would work.   Hey why not use the down time to in fact alter and fix that in a nearby branch and once that is changed open for business with the capacity limit enforced by bank security.  You know those idiots that are there to protect from the robbery thing again!  FUCK’ SAKE!

So as the insanity continues with no clear end in site here is where we are, nowhere. We are in perpetual lockdown looking at each neighbor as some crime suspect and try desperately to avoid human contact unless you have a cell mate who by now you hate and are seriously considering how to end that when all else is over.  Or you will fuck them in some incest bullshit.  The repercussion of this will be immense, drug/alcohol addiction, spousal abuse, child abuse, idiocy (already a problem but now in spades), small businesses will collapse and of course well nothing will improve in quality of life from health care to education as that affects the mass and the mass is nothing without the square root a much smaller number.  For you the math idiotic it means the rich will be fine.

I love reading Facebook as there the stupidity flows like a river that I can see from my apartment but cannot walk along. Okay then. See reading shit makes you smart.  I am going for a walk, masked, gloved and covered head to toe. I call it my Virus Hunter outfit… soon to be a show on Discovery.

Keep parks open. The benefits of fresh air outweigh the risks of infection.
Some simple strategies can help keep you healthy. Remember to wear a mask.

The Washington Post
William “Ned” Friedman,
Joseph G. Allen and
Marc Lipsitch
April 13, 2020

In the midst of a pandemic, urban life goes on. People are mourning the loss of a spouse, battling cancer and dealing with anxieties and stress from everyday life on top of new anxieties and stress from the coronavirus, all of which is often made worse by economic insecurity and extended duties of caring for children and elderly relatives.

What public-health and well-being policies can help alleviate some of the extraordinary stressors that urbanites are feeling across the nation right now? Part of the answer is baked into every city in the country. It is our public green spaces, our parks, botanical gardens and arboreta right outside our doors or down the street.

Regrettably, though, many public green spaces across the country have been closed. Yes, in most cases, there have been good reasons for the specific closings: overcrowding with parking lots jammed, egregious disregard for proper social distancing and respect for others, and the prospect of drawing people from afar who would be better off spending time in nature closer to their front doors.

But closing parks and public gardens should be a temporary, last-resort measure for disease control. lf visitors persist in violating physical distancing, officials could employ capacity controls like those now in use in supermarkets, timed entry or other measures to reduce crowding, such as limiting parking, extending hours, or putting up signs and enforcing limits. Maintaining the benefits of public green spaces is critical as we also make our best efforts to restrict covid-19 transmission. Public parks (though not playgrounds or sports facilities, which are much harder for maintaining social distancing while using), botanical gardens and arboreta are essential to the public health and well-being of the more than 80 percent of Americans who live in urban areas.

Don’t cancel the outdoors. We need them to stay sane.

The science could not be clearer: The benefits of getting outside vastly outweigh the risk of getting infected in a park.

Study after study has shown that time spent in contact with nature has important and positive psychological, indeed neurological, effects on the mind — decreased rumination and negative thoughts in adults, reduced symptoms of ADD and ADHD in children, improved cognitive development. The amount of green space around a school is associated with decreased stress, better attention capacity and reduced mental fatigue and aggression. Those are the exact types of benefits kids need while coping with this crisis, especially with their access to green space missing with most schools shut down. And no one needs a scientific study to envision the benefits to a family’s well-being of just being together in a beautiful green space surrounded by nature.

Anxiety is understandably high, and many might be fearful of heading out to a public green space. But before you hesitate to visit a park, botanical garden or arboretum, it’s worth looking at the science to disentangle real from perceived risk.

There are simple strategies you can take to head outside with confidence. First and foremost, maintain physical distancing. That means staying at least six feet away from others for the vast majority of time. But walking past someone should not induce fear or panic — these short walk-bys are low risk for transmission of the coronavirus.

Everyone in community green space — cyclists, runners and pedestrians — should wear a facial covering. Even a homemade cloth mask can help prevent you from infecting others, which can happen if you have the coronavirus even with no symptoms, and it also provides some protection for you from others. Perhaps equally important, wearing a facial covering is a clear social signal that you take your community role in minimizing risk to others seriously. This simple courtesy can help others relax when outdoors in a common space.

If you’re a runner, be mindful that you eject more aerosols while exercising due to heavy breathing and exertion, with most of it trailing behind you, so give others a larger buffer than six feet as you approach or pass. If you’re running with others, the best way to do this is to run side-by-side, separated by six feet. If you’re behind another runner, give yourself more than six feet and stagger your alignment so you’re not directly behind their plume. Outdoors, the virus quickly disperses in the air, so others should not be anxious if a runner goes by — even if they pass within six feet. Such fleeting exposure, especially if you and the runner are wearing masks, is low-risk.

The virus can survive on surfaces, but it diminishes over time. Try to minimize how many surfaces you touch while outside, don’t touch your face, and wash your hands when you get home. Some have worried about tracking the virus home on their shoes, but this is not a concern. Still, it’s good public-health practice in general to take your shoes off at the door.

Frederick Law Olmsted is remembered as the creator of great urban public spaces such as Central Park and Prospect Park in New York, the Emerald Necklace (including the Arnold Arboretum of Harvard University) in Boston and the U.S. Capitol grounds in Washington. Perhaps less well-known is that during the Civil War, he headed the U.S. Sanitary Commission. Olmsted knew a thing or two about contagious diseases when he designed these great urban public spaces.

Here in Boston, where we live and work, and also across the nation — in New York, Washington, Atlanta, Chicago, Denver, Los Angeles — during this pandemic, Olmsted’s words still ring true: “The occasional contemplation of natural scenes of an impressive character, particularly if this contemplation occurs in connection with relief from ordinary cares, change of air, and change of habits, is favorable to health and vigor.”

Parks, botanical gardens and arboreta and other urban green spaces are not just pretty places to jog or stroll, they are also central to our health and well-being in the urban built environment. Especially now.

And all of this is enforceable by the State Troopers and Park Rangers on site as they have been before lockdown. Cite the fuckers, kick them out and let the good folks do what they will do, walk, bike, run, sit read, and leave.

As for wearing the bandit face protection gear I do and despite the debate over the issue, I wear simple cotton ones I have found on Etsy.  I wear a three ply one to the store and on transit as there are larger risks in these confined spaces than in the general public.  I also bring two sets of gloves to wear  as I shop and then remove, hand sanitize and replace with another pair.  A third if I ride transit and touch anything although a plain white handkerchief is a great grabbing aid and is not used for coughing or sneezing. I use kleenex as that gets tossed immediately.  I have more fucking hand creams and face creams than any human at this point they are essential. And yes I wash everything every two days.  It is the thing I have stressed repeatedly – PERSONAL RESPONSIBILITY,  I care for myself and in turn care for others in that same way.  But we have learned that Americans are Sweden and don’t give a shit.  I was so in love with Alexander Skaarsgaard, that is over bitch!

And again in the ever changing Covid landscape even the issues about masks has evolved. Like Gay Marriage and Gays in the Military.  Funny how that works and of course the conflicting bullshit that endlessly is never brought up and when it is overblown like we are bad children annoying Daddy!

Should Healthy People Wear Masks to Prevent Coronavirus? The Answer May Be Changing

TIME
By Mandy Oaklander
Updated: April 6, 2020

If you have no symptoms of the coronavirus, should you wear a mask? It’s one of the most-asked questions during this pandemic, and until recently, one of the most easily answered—if you follow the guidance of the U.S. Centers for Disease Control and Prevention. The CDC’s answer, up until April 3? No. According to its initial guidelines, outside of health care settings, face masks should only be worn by people who are sick or who are caring for someone who is sick (when the person who is sick can’t wear a mask). A mask helps capture some of an ill person’s cough particles that might otherwise spread to other people.

But federal guidance around masks has changed. On April 3, President Trump announced that the CDC now recommends that the general population wear non-medical masks—meaning fabric that covers one’s nose and mouth, like bandanas or cut T-shirts—when they must leave their homes to go to places like the grocery store. The measure is voluntary. The mayors of Los Angeles and New York City have already made similar recommendations. In other parts of the country, it’s not voluntary: for example, officials in Laredo, Texas have said they can fine people up to $1,000 when residents do not wear a face covering in public.

In other parts of the world, governments have given different answers to this question from the start. During the current coronavirus outbreak, China’s national guidelines recommend different types of face masks for people in the general public based on their health risks and occupations. But the U.S. government’s initial anti-mask messaging was so strong that the U.S. Surgeon General, Dr. Jerome Adams, tweeted on Feb. 29, “Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

In the next few weeks, experts’ tones became more equivocal, suggesting that a supply shortage, not necessarily a complete lack of efficacy, may have partly driven the U.S. government agencies’ earlier guidance. In a March 26 interview with basketball star Stephen Curry, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, “When we say you don’t need to wear a mask, what we’re really saying is make sure you prioritize it first to the people who need the mask. In a perfect world, if you had all the masks you wanted, then somebody walking in the street with a mask doesn’t bother me—you can get some degree of protection.”

So, do masks really help protect the healthy public after all? Will a T-shirt actually prevent you from getting sick? The answers are controversial and not fully known. Here’s what physicians and face-mask researchers say.

Scientists now know that people who are infected with the new coronavirus can spread it even when they don’t have symptoms. (This was not known in the early days of the current pandemic.) Up to 25% of infected people may not show symptoms, said CDC director Dr. Robert Redfield in a recent NPR interview. They’ve also learned that people who are symptomatic shed the virus up to two days before showing symptoms. “This helps explain how rapidly this virus continues to spread across the country,” Redfield said.

This silent spread also bolsters the case for people in the general population to always wear masks when in public, since anyone could be sick. “Now with the realization that there are individuals who are asymptomatic, and those asymptomatic individuals can spread infection, it’s hard to make the recommendation that only ill individuals wear masks in the community setting for protection, because it’s not clear who is ill and who is not,” says Allison Aiello, a professor of epidemiology at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, who has researched the efficacy of masks.

So should everyone wear a mask?

Both ideologies—that everyone in the general population should wear a mask, and that they should not be used widely—have fervent supporters. People in the first camp point to the scientific studies finding that masks can help protect healthy people from symptoms of influenza-like illnesses, at least a little bit, and note that masks can help protect against asymptomatic spread. If everyone wears a mask when they leave their house, then people who have the virus but who don’t have symptoms will be wearing a physical barrier that can catch infected droplets that escape their mouth or nose. That helps protect everyone.

People in the second camp believe that the available scientific evidence does not show that masks are effective enough in public settings to warrant a mass recommendation, and that wearing one may give people a false sense of protection and embolden them to ignore recommendations that are actually effective, like staying away from other people. They also believe that wearing a mask can inadvertently encourage people to touch their face more.

“There are some very strong opinions on both sides,” says Dr. Isaac Bogoch, a physician and scientist in infectious diseases in Canada. Bogoch says he lands somewhere in the middle. “If we look at the public health side—in western countries, not in Asia—lots of the messaging reflects that these masks aren’t going to help you,” he says. “I think we need to be a bit more honest and transparent that there is some data that would demonstrate some potential benefit of masks, but of course there are large caveats. The data supporting this is not strong, but I think it’s hard to be dogmatic and overly dismissive of the data.”

On the other hand, “it is very clear that many people wearing masks are negating any benefit from this by wearing the wrong mask, or touching their face to adjust the mask, and aren’t appreciating that if you’re practicing physical distancing and truly are separate from other people by six feet, mask wearing is unlikely to provide incremental benefit,” Bogoch says.
A severe mask shortage

What’s not up for dispute is that the U.S. is in the midst of a mask shortage. Health care workers can’t get the personal protective equipment (PPE) that they need to take care of coronavirus patients, including N95 respirators (tight-fitting facial devices that filter out small particles from the air) and surgical masks (loose-fitting, disposable masks designed to block splashes and large-particle droplets that contain viruses and bacteria, but which don’t filter or block very small particles in the air transmitted by coughs or sneezes).

“We know that there’s probably greater risk [of infection] in healthcare settings just because of the nature of the work that’s being done and the patients who are here,” says Dr. Erica Shenoy, associate chief of the infection control unit at Massachusetts General Hospital. Masks—when used with handwashing, eye protection, gloves and gowns—can help protect health care workers as they have sustained interactions with people infected with COVID-19. In response to the growing knowledge that even people without symptoms can spread the virus, in late March, Shenoy’s hospital and others in Boston implemented a universal masking policy in which staffers wear surgical masks throughout their shifts in clinical or common areas. “You can’t really social distance when you’re taking care of patients or when you’re working side by side with your colleagues,” Shenoy says.

Because of the shortage, the new federal recommendations about masks for the general public aren’t about N95 respirators or surgical masks, but about homemade ones.

Still, if the shortage resolves and the general population can eventually get access to surgical masks, it’s worth knowing if they can help protect the healthy public.
What the science says about masks

There are several studies testing how well surgical masks help tamp down on the spread of respiratory viruses and protect healthy people from getting sick. “Across these studies, it’s quite consistent that there’s some small effect and there’s no risk associated with wearing masks,” says Aiello, who co-wrote a 2010 review article evaluating studies on the subject. In one of Aiello’s studies, in which healthy college students wore masks on campus during flu season, researchers didn’t see much of a reduction in flu-like illness, except when masked students also sanitized their hands regularly.

In another trial published in 2009, an Australian team of researchers looked at families of children who had influenza-like illnesses. Family members who diligently wore masks when they were caring for the sick child were more protected against getting sick, they concluded.

“If you look at [the research] together, you don’t see these really strong effects,” Aiello says, adding that while the effects may be greater in a real-life pandemic, there’s no way to know. However, “we are at a time now where it seems pretty clear that there are no major risks to wearing masks and they may provide a benefit. I think for those reasons, it seems like it would be prudent to recommend some kind of face covering at this point to protect individuals.”
What about homemade masks?

The CDC currently recommends that, when medical-grade face masks are unavailable, health care personnel use homemade masks—their examples include bandanas and scarves. “However, homemade masks are not considered PPE, since their capability to protect [health care personnel] is unknown,” the guidance reads. “Caution should be exercised when considering this option.”

The evidence supporting homemade masks for both health care workers and the general public is scant. “There’s not a large body of research on this topic,” says Aiello. One of the only studies testing whether or not homemade masks are effective was published in 2013. Researchers tested household materials—including cotton T-shirts, scarves, tea towels, pillowcases and vacuum cleaner bags—to see how good they were at blocking bacterial and viral aerosols, and how realistically the material could be used as a mask. The researchers found that the most suitable materials were pillowcases and 100% cotton T-shirts, though the shirt’s stretchy composition made the mask fit better. Volunteers made their own T-shirt masks (here’s how) and then coughed wearing their homemade mask, a surgical mask and no mask. T-shirt masks were about a third as effective as surgical masks at filtering small infectious particles. “We basically found that it was okay at blocking,” says Anna Davies, a research coordinator at the University of Cambridge and one of the authors of the study. “It’s better than nothing.” To some extent, the homemade mask acted as a barrier to keep droplets in.

Now, about seven people a day email Davies to ask if their idea for a homemade mask would work. It’s impossible to know. “There’s so much inherent variability in a homemade mask,” Davies says. We’d have a much clearer idea, she adds, “if somebody could do some slightly better quality research that said this is a good pattern, this is the right sort of fabric to use, this is how long you should wear one for, how you should decontaminate it.” The list of unknowns is long.

In addition, there is some evidence that homemade masks can backfire. “We’ve tested the efficacy of cloth masks and found they can actually increase the risk of infection,” says Raina MacIntyre, a professor at the University of New South Wales in Sydney (who also co-authored the Australian mask study). She speculates that people in the study didn’t clean their masks as often as they said. “We know they get very damp and moist,” she says. “Moisture will breed pathogens, and if people don’t wash it well enough or regularly, that could increase the risk of infection.” If people decide to make their own, MacIntyre suspects that a mask with more than one layer of fabric will be more effective, as will fabric that repels water.

“It’s still unclear,” Aiello says. “But to the extent that any material provides some protection against the droplet spread, then in theory, you should find having that barrier there could prevent some spread in some scenarios.”

The bottom line

Wearing a mask probably won’t hurt—as long as you wear it properly, clean it often, wash your hands, continue to not touch your face and physically distance yourself from other people. There’s just not a strong body of evidence that wearing one, especially one you make yourself, will protect you from getting sick. “If you want to wear a mask, go for it,” Bogoch says. “But just be mindful of what the possible benefits are and what the possible limitations are. And be realistic.”

Even with new federal guidance, the issue is far from settled. Much more research is needed. “Just because it’s a policy,” Bogoch says, “it doesn’t necessarily suggest that these scientific questions are truly answered.”

—With reporting by Hillary Leung

Lies and More Lies Mean More Money

The immense amount of conflict of interest and bias emerges with the increasing number of individuals imprisoned for largely misdemeanor victimless crimes relating to drug or alcohol abuse.

Today the New York Times had the second in a series of a new drug treatment drug called “buprenorphine”  that has its own set of problems with regards to the Doctors administering it and monitoring those in need.  In other words, the Doctor was doing what he was prescribing.  Sounds great.  The article neglected to mention who was funding his work but I suspect that aside from private insurance, I believe that the good Doctor was treating largely Medicare patients.  We supported not one but two addictions. But Big Pharma still wins big.

Then we have the whole debate on the new statin issue and of course there is concern that the sudden uptick in demand may be biased by race and gender and again who is responsible for payment.  More fraud more bias. The article about that is here.

Then I found an article in NCBI that discusses the fraud and duplicity with regards to drug and alcohol assessments and educational programs. Remember “Just Say No”? The idea is that the very programs set in place to prevent those from early use are simply using it to fund their programs.   There is a great deal of concern right now with privacy rights and student access and now to find a decade old study that shows many of these facilities are simply in it for profit actual prevention and education, not so much.   SHOCKING I KNOW.

So when anyone is required to be drug screened or alcohol screened be sure that there will be a diagnosis that of course allows the participant to partake in expensive and likely unnecessary programs and treatments. And that does what exactly?  Oh it keeps the bottom line going but does nothing to actually help people recover, rebuild or simply move forward.

Corrupt, venal and incompetent is our current state of America.  A state of chaos united.

Conflict of Interest in the Evaluation and Dissemination of “Model” School-based Drug and Violence Prevention Programs

Dennis M. Gorman and Eugenia Conde

1.1 Evaluation of Drug Prevention Programs

One-and-a half decades ago, Joel Moskowitz (1993) published a paper in this journal that raised serious questions about the quality of outcome research conducted in the field of drug prevention program evaluation. He concluded that the shortcomings present in the design, implementation and data analysis of evaluations was not simply the result of limitations of resources but rather stemmed from the broader structural and institutional context within which research was conducted. Among the institutional pressures, Moskowitz included conflicts of interest, noting that:

“Unfortunately, much of the drug abuse prevention research conducted to date suffers from real or apparent conflicts of interest. Evaluations are often conducted to prove that a program merits funding or to market the program on a broader scale. Many investigators evaluate programs that they, or their institutions, have developed and intend to market. Thus, the financial interests of the investigators and their institutions may be directly affected by the outcomes of the research, increasing the likelihood of bias in reporting methods and results” (Moskowitz, 1993, p. 7).

Since the publication of Moskowitz’s paper, the types of drug education programs he discussed have become the mainstay of prevention policy in the United States (National Institute on Drug Abuse, 2003; Schinke, Brounstein & Gardner, 2002). While concerns about the quality of evaluations of these programs continue to be raised , these are never mentioned in reviews of the literature written by program developers  or in documents that describe so-called “model” or “research-based” programs  Indeed, drug prevention evaluation has become a field of research in which critical debate about issues pertaining to the design, implementation and analysis of the most widely advocated programs is almost entirely absent. It is therefore hardly surprising that the issue of conflict of interest is almost never raised in the drug prevention literature.

1.2 Conflict of Interest

As Tobin (2003) observes, the term “conflict of interest” refers to “a set of conditions in which professional judgment concerning a primary interest, such as the validity of research, might be influenced by a secondary interest, such as financial gain” . Tobin further draws a distinction between conflict of interest and bias. The latter occurs when a researcher’s judgment concerning his/her primary interest (i.e., the production of objective knowledge) has been clearly influenced by some secondary and competing interest. In contrast, a conflict of interest exists irrespective of whether the researcher’s judgment and behavior can be demonstrated to have been adversely influenced – that is, it exists simply as a condition of the researcher having two competing interests.

The competing interest that has received most attention in the literature addressing the prevalence and effects of such conflicts on the practice of empirical research has been that of financial relationships between investigators and research sponsors. The primary focus of studies that have addressed this issue has been on the scope and influence of the pharmaceutical industry’s funding of biomedical research. These studies show that financial relationships between the pharmaceutical industry and researchers are widespread (about 25% of researchers have industry affiliations) and that there exists a systematic bias in the reporting of study outcomes favoring the products of those companies sponsoring the research. Industry sponsorship has also been found to be associated with the use of inappropriate study designs, irregular data analysis and reporting practices (e.g., selective reporting among numerous outcome variables, multiple subgroup analysis), and publication delay.

Recently these types of analyses have been extended beyond the examination of biomedical research. Cosgrove and colleagues (2006), for example, assessed the pharmaceutical industry’s relationship with members of the advisory panels that recommend changes in the Diagnostic and Statistical Manual of Mental Disorders, and found that 56% of these individuals had financial ties with drug companies. And although the literature is less comprehensive, studies have also been conducted that examine the influence of other large industries on the quality of empirical research that they sponsor, notably the tobacco and food industries.

1.3 The Institute of Medicine’s Open Systems Model of Conflict of Interest

It is easy to be skeptical about research funded by multinational industries whose profit motive clearly outweighs concern for public health. However, from a purely fiscal standpoint there is nothing unique to the industries mentioned above when it comes to having a vested interest in the outcome of studies into the effectiveness of their products. As Tobin (2003) observes, the primary obligation of any manufacturer is to deliver a sound financial return on an investment, and hence there is an inevitable vested interest in the products that are manufactured being perceived as effectively performing the functions for which they were intended with minimal adverse side effects. This is as true of a school-based prevention curriculum as it is of a pharmaceutical pain-killer, a soft drink or a cigarette. It is this interest in the success of the product that is fundamentally at odds with the disinterested orientation that is so basic to the norms of the practice of science

The divergence between these two norms and their influence upon the practice of research can best be understood using the open-systems model employed in the Institute of Medicine’s (2002) recent report on research integrity. The model highlights the fact that conflict of interest typically occurs within a complex organizational system that has a structure and culture, requires inputs of financial and human resources in order to function, and exists in order to produce outputs in the form of goods, products, services, and activities. Using this model, we argue that the following basic differences exit between the organizational culture of the typical institution that functions solely to develop drug and violence prevention intervention programs and the organizational culture of the typical institution that functions solely to evaluate such programs.¹

Program Developer Organizational Culture

• Mission: develop and disseminate programs
• Audience: consumers, practitioners, policy-makers
• Commitment to belief system and/or financial return from product
• Culture: advocacy and promoting of products
• Norms: interest, commitment, belief

Program Evaluator Organizational Culture

• Mission: produce and disseminate knowledge
• Audience: researchers, scientists, scholars, practitioners, policy-makers
• Commitment to science, objectivity, “truth”
• Norms: skeptical, critical, rational, inquisitorial

It can be seen that while there is some overlap in the audience to which their work is targeted, there are also fundamental differences between the two organizational cultures. Specifically, the researcher’s skepticism and commitment to unearthing the truth is likely to conflict, at least on some occasions, with the programs developer’s belief in, and advocacy of, his/her program. Indeed, if one accepts the principle of equipoise (that is, that evaluations should only be conducted when there is genuine doubt about the efficacy of an intervention) then one would expect the results of an evaluation to conflict with the developer’s positive expectations in about half of the studies conducted. Thus, given the context within which the evaluation occurs, the potential for conflicts of interest to occur is high when either the program evaluator and program developer are employed by the same organizationor when the program developer and program evaluator are one and the same person

The present study examined the relationship between program developers and program evaluators using a sample of “model” school-based drug and violence prevention interventions. Specifically, we addressed the following two questions. First, what is the nature of the relationship between the developers of these “model” programs and the organizations that distribute them? Second, what proportions of evaluations of these programs that have been published in peer-reviewed journals have been conducted by the developers of the programs compared to independent evaluation teams?

2.1 Sample of School-Based Drug Prevention Programs

The sample of “model” drug and violence prevention programs used in the analysis was taken from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Effective and Promising Programs (NREPP). We chose the NREPP list as this is the most comprehensive of the best practice drug prevention lists available and has been influential within the field given its sponsoring agency. The research reported here is part of a larger study designed to assess the types of data analysis and presentation practices used in drug prevention research that commenced in late 2005. Thus, the NREPP model program list used in this study was the one available on the SAMHSA website at this point in time. While the NREPP rating criteria and selection procedure have subsequently been revised (Substance Abuse and Mental Health Services Administration, 2006), the list of 66 model programs used in our larger study is still accessible on the SAMHSA website, as are the materials (such as program fact-sheets) produced for each.

According to the fact-sheets that appear on the SAMHSA webpage for each program, eight were designated “treatment”. Of the remaining 58 prevention programs, 34 were designated “school-based” or “school-based/community” (hereafter referred to as “school-based”) and 16 were designated just “community” on their fact sheets. Of the remaining eight programs, three were designated “environmental”, four “workplace”, and one was a secondary prevention program targeted at heavy drinking college students. Here we focused on the 34 school-based interventions since these are the most extensively evaluated group of programs and the ones most often packaged in a form that can be sold commercially (typically as curricula).

2.2 Data Collection: Identification of Evaluation Studies

Two types of data pertaining to the 34 school-based NREPP programs were collected for the present study. First we sought to identify all evaluations of the programs that had been published in peer reviewed journals. The initial step in this process was to conduct a literature search using the general search engine of the Texas A&M University library system, which searches the following databases: the University’s Library catalog; the Medical Sciences Library Catalog; Academic Search Premier (EBSCO); Academic Search Premier(EBSCO); MLA Bibliography (EBSCO); PsycINFO 1872-current (CSA); Science Direct; ERIC (EBSCO); and CAB Abstracts (Ovid). The name of the program was first searched for by itself, followed by the name of the program developer. In the next step in identifying appropriate publications to review, the abstracts obtained through step 1 were reviewed by one of the authors (DMG) to ensure that the publication directly pertained to the NREPP program. The lists that resulted from this process (which included journal articles, book chapters and books) were then sent to the program developers, who were informed that we were interested in the material that had been used in establishing the program as a NREPP model intervention. Since it was difficult to establish exactly when this status had been conferred, we sent each developer the complete list of evaluation papers that we had identified through steps 1 and 2 described above. We asked each to review the list and amend it as necessary. Thirty-two of the program developers agreed to review the list and make appropriate edits, one refused, and one stated that she thought we had missed some relevant papers upon her initial review but failed to provide additional information upon subsequent requests.

For the present analysis, we limited our focus to publications that had appeared in peer reviewed journals. The revised lists that we received from the program developers (along with the two lists that were not reviewed by the developers) were further reviewed to ensure that the publication described an evaluation of the program. In order to be included as an “evaluation”, the publication had to include a description of the study design and data pertaining to a process or implementation evaluation and/or an outcome evaluation (including studies focused just on mediational analysis or cost-effectiveness data). The definition was broad in the sense that it set no restrictions on the type of study design, type of data reported, or the length of follow-up. Multiple reports from a single study were also included. Review articles summarizing findings from a series of published evaluations were excluded, as were those publications that only described the conceptual basis of the program or its development and components. Those that just described the design of the evaluation study or that used study data to test etiological models were also excluded.

2.3 Data Collection: Program Developer-Program Distributor Relations

The second type of data we collected pertained to the relationship between the program developer and program distributor. Each SAMHSA fact-sheet lists the program developer and either this or the SAMHSA website states how the program can be obtained. In many cases it was clear as to the type of institution or agency that distributed the program (for example, a university). In those instances in which it was not clear, we searched ReferenceUSA and LexisNexis using the program’s name in order to obtain more details. Finally, for those programs that were distributed by a third party (i.e., not by an organization that the developer owned or directed, or by which he/she was employed), we reviewed publications to identify disclosure statements that specified the type of financial relationship between the developer and distributor. In those instances where this information could not be found in the public domain, we contacted the developer to ask the type of a financial arrangement he/she had with the distributor (e.g., licensing agreement, royalty payment).

3.1 Distribution of Programs

Table 1 presents details of the relationships between the developers of the 34 school-based NREPP model programs and the distributors of the programs. We grouped the relationships into five broad categories (rows a-e), with two of the programs being placed in two categories (row f) since the developers both directed companies that provided training in the use of the program and distributed the programs through a publishing company. Two additional points should also be noted. First, one developer had three programs on the list (all of which were distributed by the university at which he worked) and another had two (each of which was distributed by a publishing company). Second, the relationships described in the table are those that existed in late 2006. This is especially important in the case of those programs that are distributed by a third party, as most of these relationships were some time after the program was initially developed (indeed, in some instances many years). Publishers typically purchase and distribute established programs that have been evaluated in one or more studies. Thus, the distribution mechanisms for some programs may well have changed over time (e.g., from a university to a publishing company).

The most direct financial relationships between the program developer and distributor exist in those cases where the former owns or directs the company that distributes the program (or provides training in it) or receives remuneration from a third party (typically a publishing company) that sells the program. The distribution of 17 of the 34 programs involved such relationships. The majority of the remaining programs (15) were distributed by the organization for which the developer worked either as an employee or a consultant. Nine of these were universities (row d) and six were private companies (row c). The remaining two programs were distributed by a third party from whom the developers received no royalty payment. In one case this was a charitable foundation and in the other a voluntary health organization.

3.2 Evaluation of Programs

The search procedures described in the methods section produced a total of 246 evaluation studies. For two of the programs (both in the category Developer Employed by Private Company that Distributes Program) there were no evaluations published in peer reviewed journals. In addition, there was one other program that was part of a multi-component intervention that was also on the NREPP list. These two programs (both in the category Developer Distributes Program through Third Party with which he/she has a Financial Relationship) were treated as one in the present analysis, since we did not want to double count the two papers that pertained to both programs. The range of published evaluations across the remaining 31 programs was 1 to 37.

The majority (193/246) of the published evaluation reports included the program developer as an author. Only 27 of the 246 publications were totally independent in the sense that the program developer was not one of its authors. These 27 publications came from evaluations of just nine of the programs. In the case of the remaining 26 publications, while the program developer was not an author on these there was some association between him/her and the authors. Specifically, the developer had either published previously with at least one of the authors of the publication, or worked in the same organization as the author(s), or was a co-investigator on the project from which the publication came, or was acknowledged by the authors in the publication for contributions to the project.

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4. Discussion

This examination of the 34 school-based programs that appear on the NREPP list of model drug prevention programs suggests that little has been done to address Moskowitz’s concern that “much of the drug abuse prevention research conducted to date suffers from real or apparent conflicts of interest” The data presented indicate that there are relatively few published evaluations of these programs that do not involve program developers and that there are few instances in which there is complete separation between the program developer and program distributor.

With regard to the first of these issues, it was argued in the introduction that given the difference between the organizational culture of an agency that develops intervention programs and one that evaluates these, separation of the roles of program developer and program evaluator is preferable in the assessment of the effectiveness of interventions, at least if one’s primary goal is to limit conflicts of interest and reduce the potential for bias or distortion that can result from advocacy of the intervention. Examples from the drug prevention field of such separation of roles include most of the evaluations of the DARE program  and the Hutchinson Smoking Prevention Project. These studies produced little evidence of program effectiveness. This is consistent with other areas of evaluation research which show that studies in which program evaluators were significantly involved in program delivery report substantially larger effect sizes than independent evaluations

Lipsey (2005) argues that the most plausible explanation of the association between developer involvement in an evaluation and increased effect size is implementation integrity; program developers are likely to ensure that the program is delivered in the appropriate manner and with sufficient intensity. He contrasts this idea with a “cynical view” that attributes this finding to biasing or “wish fulfilling” emanating from the developer’s vested interest in the outcome of the evaluation. This is clearly an area that requires further study, and we hope to be able to shed some light on this issue in our larger study by examining the types of data analysis and presentation practices used in evaluations that include program developers and those that are conducted by independent evaluation teams.

As for the relationship between program developers and program distributors we found that in 32 of 34 cases the developer had a financial relationship with the distributor. The nature of this relationship varied: in some cases the developer owned the distribution company, in some he/she received royalty or consulting payments from the distributor, and in some he/she was the distributor’s employee. The latter case included developers who distribute their programs through a university. We did not examine the nature of the financial relationships here, for example if the revenue goes into salary savings or other discretionary accounts of the developer. In addition, even when there is no financial conflict in such relationships, there is the potential for what might be termed “ideological conflicts of interest” that arises from a different set of institutional pressures. This type of conflict is especially relevant to the evaluation of intervention policies and programs intended to prevent undesirable behaviors such as drug use, and results from adherence to a specific set of beliefs, values or theories that are resistant to rejection or modification when faced with conflicting evidence. A number of the programs on the NREPP list are part of a much broader theoretical or conceptual model that the developer/evaluator has also developed and built a research career upon. This type of potential conflict is probably unavoidable, since it is desirable that interventions are theory-based and researchers who are knowledgeable about drug use are likely to produce a better intervention than those who know little or nothing about this behavior. However, psychological theories are at times very resistant to modification, and so independent evaluations of all prevention programs – not just those for which there exists a financial conflict of interest – is desirable.

The analysis described herein is exploratory in nature and limited by its focus on just 34 programs and 246 publications. Since conflict of interest is an important issue it deserves further empirical analysis, especially in light of the emphasis now placed on the identification and dissemination of evidenced-based interventions in the field of drug and violence prevention. While the organizations that develop and disseminate these programs obviously have a different mission to businesses such as the food and pharmaceutical industries, it is likely that many of the same institutional pressures will arise as the marketplace for these interventions becomes more lucrative. As noted in one of the independent evaluations that we reviewed: “In 21^st century America, education materials are a significant business.  However, psychological theories are at times very resistant to modification , and so independent evaluations of all prevention programs – not just those for which there exists a financial conflict of interest – is desirable.