I would be more comfortable — and supportive — if marijuana were the basis of numerous drugs currently used as medicine. Or if it had a long history of medical use, and its effects and applications were well-known to medical science. Or if it were widely available and already legally grown in this country, by farms and garderers alike.

None of this is true of marijuana – but is true of another plant: Papaver somniferum, also known as the Breadseed or Opium Poppy.

For whatever reason, marijuana legalization is a very popular topic on Change.org, at least among the membership. This means that a number of the site’s causes and petitions focus on some aspect of marijuana legalization or medicalization. With that in in mind, I wrote this post partly just to yank some chains, so there’s that. But I actually do find it intensely frustrating that the government has these absurd rules on this particular plant. It would be immensely gratifying if one consequence of the broader legalization movement would be that I could grow and use the poppy without fear of a felony conviction.

Before I get to that, I want to clear my tabs in this last post of the year. First, you should read Bob Herbert’s op-ed about the Senate’s plan to fund health care by taxing “Cadillac” insurance plans. I was indifferent to this proposal, but Herbert makes a very good case for why it is wrong, and so I am now against it. We can only hope the mechanism is abandoned in the reconciliation process.

Next, this article from Tony Judt, about what it’s like to live with ALS is striking and moving – and especially resonates when he says, “it is hard to resist the thought that even the best-meaning and most generously thoughtful friend or relative cannot hope to understand the sense of isolation and imprisonment that this disease imposes upon its victims.” I have often thought the same of Crohn’s, and I am sure it’s true of a great many other illnesses.

Lastly, back to Alien: I happened on Dan O’Bannon’s obituary in the NY Times over the holiday. O’Bannon wrote the screenplay for Alien, as well as several other horror and science fiction films. O’Bannon also had Crohn’s disease – in fact, the obit quotes him as saying, “the idead for the the monster in ‘Alien’ originally came from a stomachache I had.” I’ve seen Alien a half-dozen times, and now it makes perfect sense: how I’ve wished the monster gnawing at my guts would just kill me and/or scamper away.

Of course, most doctors will tell you that Crohn’s is incurable but not terminal – so it’s notable that the obit states, “the cause [of death] was Crohn’s disease.” That could mean any number of things, from surgical complications to sepsis to self-assisted euthanasia – there are a lot of ways to die from Crohn’s disease. But the fact that you might identify a proximate cause of death in no way changes the underlying cause of death; so when doctors say Crohn’s isn’t terminal, what they mean is that in theory you could live a normal lifespan, if you can just avoid all the different ways people with Crohn’s disease die prematurely. Props to whomever named Mr. O’Bannon’s cause of death for what it was.

Sad though Mr. O’Bannon’s passing is, I am at least grateful I can finally claim a movie for my disease. People with AIDS have Philadelphia, and people with ALD have Lorenzo’s Oil – but those of us with Crohn’s? We have frickin’ Alien – and that’s a pretty badass movie to have.

That’s it for 2009. See you in the new year.

For starters, the Senate bill never had a strong public option. Then they dropped even what they had, in favor of a weaker compromise. Then it dropped the compromise substitute for the public option – apparently, due to the influence of Sen. Joe Lieberman (I-FU). (When I was a younger man, and Lieberman was running for Vice President, the two of us shook hands on a runway in Orlando; nowadays, my skin crawls whenever I think about that day.) If health reform fails, Joe Lieberman will bear much of the blame.

Which isn’t to say that all hope is lost. The House bill is still good, and the Senate bill still has some incredibly valuable language. Even if the Senate text was all that became law, it would still be better than the current system – which shows you how bad things are, if even milquetoast legislation is a substantial improvement. For more on this theme,  Ezra Klein has had a few compelling posts about what the Senate bill might accomplish – this one, for example. It’s also worth considering Nate Silver’s 20 Questions for liberals who are clamoring to kill the bill, and Jon Cohn’s response to the same activists.

Obviously, I’m not advocating killing the bill. But at the same time, I’m not spending a lot of my energy advocating for the bill. I say it’s acceptable, but it’s also tremendously disappointing. The public option was important – it was already a compromise from single payer or similar government-intensive reform; Jacob Hacker has a helpful post about what we’ve lost there. Moreover, I am mostly convinced at this point that the Obama administration never intended to deliver comprehensive health care reform, and what they do plan to deliver is a giant new pool of money for insurance companies – in which case, Joe Lieberman is not so much arch villain, as eager henchman in this story.

Assuming the Senate bill makes it through without further amputations, the bottom line for sick people is that it should be a good deal easier to obtain and keep health insurance. It might still be relatively expensive, but folks with lower incomes will get subsidies to help them buy that insurance. The insurance companies can’t eject you arbitrarily, or refuse to pay claims for pre-existing conditions, but they can impose an annual or lifetime limit on your care. There may be some changes that help to improve the quality of health care, but no obvious means by which to contain costs.

That said, we are now at the point where only the most die-hard ideologues can object to this bill. If you’ve been on the fence – perhaps you were suspicious of a “government take-over”- the ball is now yours: this bill changes a lot of things, but it is nowhere near a government take-over of health care. So if you haven’t yet called your Senators to voice your support for reform, now is your chance. Those of us who favored more comprehensive reform have already made our voices heard; it’s your turn. Read a little, think a little, and then call or email.

We’re pretty close to the end of this road, and though it didn’t lead where I wanted it to, we can at least make sure it doesn’t lead us back to where we started.

I agree that people should be paid for sick time but I am concerned that some employees will abuse the situation.

Second:

My other concern would be the paperwork that comes with this. I had a patient that missed 4 days for the flu. I received a 4 page form to complete on why he could not work. That was ridiculous.

The second problem is, of course, the direct consequence of the first. Somewhere, someone decided to demand employees’ doctors complete a four-page form in order to qualify for sick leave, lest they otherwise take advantage of their sick leave and “abuse the situation”. The employer wants to guarantee that their workers only miss work if they are sick enough to see a doctor – which is dumb, because there are plenty of perfectly awful communicable illnesses that don’t necessarily require a doctor’s visit, e.g. rotavirus in adults. If my employer forced me to choose between seeing a doctor for rotavirus and going to work sick… well, best wash your hands, and don’t touch my desk.

The employer’s concern – and Stargirl65′s – are a deeply American mindset. As a society, we are terrified that someone, somewhere, might be getting away with something – this paranoia is the basis of our social welfare system. See for example this Street Sense article about applying for Medicaid: the author has a Stanford degree, and still has trouble wrestling through the forms and questions he has to answer to get his mom the care she needs. I’ve heard from friends that Social Security disability is much the same experience.

Ostensibly the forms weed out the unworthy, but the practical consequence is that a lot of people who need and deserve our help end up excluded as well. A single fraud against these programs is newsworthy, but we never hear about the thousands or millions who are wrongly denied entry into these programs.

Back to sick leave: yes, some people will abuse the situation. That’s a problem. But it’s not a big enough problem to justify denying millions of working people the relief they need when they’re sick. It’s not even a big enough problem to justify four pages of paperwork.

If we’re going to help people, we ought to help them – and trust that the good we are doing outweighs the harm done by anyone who might abuse our generosity.

The film is based on the life story of Richard Pimentel, a talented public speaker who was deafened by injuries he received in Vietnam. His experiences turned him into an advocate for disabled veterans, and he was a driving force in the events that led to the Americans with Disabilities Act.

The movie is – inevitably – a bit syrupy, but also has a sharper wit to it than most films in the genre. The depictions of discrimination and prejudice against disabled people are almost surreal, but accurate as far as I can tell. There really were such things as “Ugly Laws“, which made it against the law for people with unsightly disabilities or disfigurement to appear in public.

One of the things I had not considered before I saw the film and read a little more about the story was the extent to which disabled veterans worked to change society in a way that benefited all disabled people. From what I understand, Vietnam produced an unusual number of disabled veterans, compared the previous wars – apparently because previously fatal injuries were made survivable my advances in battlefield medicine. And those disabled vets were returned to a society that had no real use for them.

Richard Pimentel, along with others, helped changed all of that. He made this country a better place – not just for disabled veterans, but for all sick and disabled people.

Your Representative needs to hear from you today. Even if you have never called before – especially – today is the day. You can look up your Rep. here, if you’re not sure who it is. Or, you can just call the Capitol switchboard at 202-224-3121, and ask to be connected.

It’s important this strong version of health reform pass the House, because anything the Senate passes will be much weaker. Having a strong bill going into conference committee – where the Senate and House versions get combined – helps ensure that whatever comes out of conference will still be reasonably good.

Call today.  Call now. Tell your friends.

For those of us still suffering from Pinkness envy, Slate has an Explainer on how to get our pet causes declared National Months, Weeks, or Days. I am looking forward to National Patient Blogger Awareness Fortnight, which should start any day now.

Via Movin’ Meat and Kevin, MD, comes this LA Times article about funding for “prayer healing”. Apparently the Christian Scientists want their prayer healers to be reimbursed as if they were real doctors, and they somehow convinced a few legislators to slip a provision to that effect into the Senate’s version of the health reform bill.

I won’t spend too much time denigrating Christian Scientist beliefs – I leave that to Mark Twain – but I knew a kid in high school who was a Christian Scientist. The kid had extreme ADHD, but his parents refused to treat him with actual medicine. So the kid was a total jerk, disruptive, mean, utterly obnoxious, and apparently nobody could do anything about it because those were his beliefs. I’m all for faith, but if your beliefs can’t help you be any less than a complete asshole, it’s time for some soul searching.

I am a practicing Christian, and I do think prayer is important and helpful. But it’s not a substitute for medicine. I worry that my fellow faithful often get confused on this point, with the result of much avoidable suffering.

For example, I had a church friend in college who struggled with depression, to the point he drove his car off an embankment and nearly killed himself. He had somehow come to believe that God would cure him of his depression, if only he was a good enough Christian, if only he prayed enough. On the one hand, sure – that’s one way to read the Bible. But on the other hand, nowhere does it say “thou shalt not take your meds”.

God knows what diseases there are, and what medicines are available; if the point were unmitigated suffering, you would have gotten something untreatable. But you didn’t, and the fact that you take your meds doesn’t make you any less faithful or God any less powerful. If you brush twice a day, does it mean you don’t trust God to save your teeth? Is wearing a seatbelt a sin?

It’s bad enough that they hold out prayer as a panacea, but even more galling is that Christian Scientists ask to be paid for their prayer ‘treatments’ – by the government. This proposal strikes me as less about helping people than a way for the Church of Christ, Scientist to enrich itself at taxpayer expense – and once that happens, you know the Scientologists will want billing codes for auditing, and all manner of quacks, hacks, and wacks will be right behind them.

Point being, I join the chorus of people who think this proposal is a bad idea. I hope it gets stripped out in the conference between Senate and House versions of the bill.

And meanwhile, if you feel like you need a prayer, let me know; I’ll do it, and I won’t expect to get paid.

Last week, about midway through my bout with the flu, I woke up to an empty cupboard. Well, not “empty” exactly – but out of breakfast foods. And since I didn’t have the energy to comb my hair, much less fry pancakes, I was forced out into the wild. Fortunately, “the wild” includes a Dunkin’ Donuts an easy walk from my house, where I could get a bagel or two.

The fact that I live here is not entirely due to chance. I live where I live because it has good access to public transit, it’s within an easy walk of a pharmacy, groceries, a few restaurants, and other necessary shops. I can take the bus to work – in fact, I usually due. Our neighborhood is also due to get light rail service in the not-too-distant future, an extra bonus. Last week’s flu helped remind me what a big difference the built environment makes when you’re sick.

Lots of places – I’ve lived in some of them – are not so easy on ill people. I used to have a 45-minute commute to work – by car, because my job wasn’t reachable via transit. At one point I developed a bad stricture in my terminal ileum (in the small intestine), which would cause massive cramping every now and then. A few times, “now” meant while I was driving home, so I would be bent over doubling, hurtling down the Interstate at 65 miles an hour. It wasn’t worth pulling over, because the cramps could go on for hours at a time, and I didn’t want to be stuck. If you’re thinking “not safe”, you’re probably right.

I’ve also had to drive while in the throes of steroid-induced psychosis, as well as high on narcotic pain relievers. These drugs help me feel a lot better, but they make me an unreliable driver. And though I try to avoid driving while taking them, in a lot of places it just can’t be helped. If you can’t drive, you can’t go anywhere on your own.

A while back I decided I simply had to live in a walkable neighborhood with good public transit – which means one of maybe a dozen cities in the US. It’s not that I like living in cities on the merits, but these are the only places where I can get around safely and conveniently without relying on a car. I don’t even like to drive anymore, and I usually support just about any transportation project that makes people less dependent on driving – light rail, high-speed rail, pedestrian pathways, buses.

To revisit a theme, this is a pretty good example of illness as a socially-constructed problem, rather than merely a clinical diagnosis. Not every developed country in the world makes it so hard for sick people to get around; say what you will about Britain’s health care, but their train system makes ours look third-world. But in this country, we put all our eggs into automobiles, and don’t spend a lot of time thinking about the consequences for sick people.

(Photo by Flickr User VeloBusDriver by CC license)

What stands out in this article is that no one method is a silver bullet for the problem. A few of the approaches are attractive in principle, but likely difficult in practice. Still, if you want to evince any sophistication at all in the debate over health reform and medical malpractice, you simply must know that damages caps are not the only and certainly not the best answer.

One important thing to remember, and this is specific to the last sentence in the article: when a patient who has been injured by their provider are unable to recoup the costs of those injuries, we’re not ‘saving’ any money. Insurers are saving money, doctors might be saving money, but society as a whole still pays the same costs. They just get shifted, mostly onto the patient – and if the patient can’t bear those costs, the rest of us will have to. If we want our court system to be any kind of approximation to justice, we have to bear that in mind.