Follow Up on Do You Really Need a Mammogram

By MARIE MYUNG-OK LEEFEB. 14, 2014

I HAVE never had a mammogram. I’m almost 50 — nearly a decade into the age when the screening is recommended by the American Cancer Society. I’m college educated, adequately insured. And I am the bane of my health care providers. Once, my midwife went so far as to request that I never speak of my decision in any space where other patients might hear.

This week, I was vindicated. On Tuesday, a Canadian study, one of the largest ever done on mammograms, was published in the British Medical Journal. The study found that mammograms did not reduce breast cancerdeaths in women around my age compared to physical exams, and that one in five women screened was overdiagnosed, possibly leading to unnecessary surgery or radiation.

It seems astonishing, but it reinforced what smaller studies had told me, as someone with no family history of breast cancer: that getting a mammogram was unlikely to affect my chances of dying from the disease. What it would do is increase the probability of my mistakenly becoming a breast-cancer patient.

When I was in my late 30s, my midwife suggested I get a baseline mammogram, followed by annual screenings. I was ready to do it. I assumed my research into it would be mere due diligence.

This kind of research was a new habit of mine, born of necessity. When our son was 18 months old, he developed a devastating tumor on his spinal cord. We waited for the doctors to tell us what to do, but the diagnoses and suggestions were scattered — it’s cancer, it’s not cancer, it’s half cancerous, we need radiation, we don’t need radiation, it’s life-threatening, it’s benign. We opted for surgery, and it was deemed a success. Doctors waved us out of the hospital with balloons. But a few weeks later, we were urgently summoned back. The oncologists had decided that he needed another operation to make sure they had removed all of the tumor.

It made me realize that, despite the surety with which the medical professionals had presented things, it was all a best guess based on the available information. So I started doing my own research, to try to make the best decisions for our baby. I soon began to wonder why I didn’t study my own health care decisions as thoroughly as I did his.

So I started looking into mammograms. The more I found, the more I doubted. I was stunned by a 2001 Cochrane review — considered to be the gold standard for evidence-based studies — that concluded, “The currently available reliable evidence has not shown a survival benefit of mass screening for breast cancer.” Everywhere, I saw pink ribbons and the message that mammograms save lives. But no matter how many times I read the numbers, I wasn’t convinced that I should get one.

Over the years, my choice has spurred concern from health care practitioners as well as the person who is most worried about my health: my mother, who, in her 80s, is still a religious mammogrammer. She has described how nerve-racking the post-procedure waiting room is — you shiver in the cooled air until you’re sent home or get the ominous “The doctor needs to talk to you.” One day a few years ago, she was the one called to stay. They had found something “suspicious,” and she felt her world falling apart.

When my mother told me this, the first thing I thought of was the high rates of over- and misdiagnoses, and I told her so. But she still spent over a month in a panic — waiting for the follow-up, which then was somehow done incorrectly and had to be repeated one more time. Finally, multiple painful mammograms later, they concluded it had all been a mistake. And oddly, the false urgency has continued: She has been getting notices reminding her to make an appointment for another mammogram in six months because she is now “high-risk.”

Patients want reassurances. We feel we have to test, so we can find out if we’re sick. We rarely consider that the test itself might make us sick — perhaps through repeated exposure to radiation — or that there are health advantages for the nontester like me, who gains time, sheds stress and potentially dodges the harm of a false positive or unnecessary treatment.

This isn’t the answer for everyone. But as parents and patients, we have no choice but to try to become conversant in medicine, even if it makes some doctors bristle. Our medical experts are an invaluable resource, but in the end, it’s up to each of us how we want to proceed.

I now have a new primary care physician who still refers me to the mammography center, but when he hands me the slip, he smiles and says, “But I suspect you won’t do it,” and I get the feeling he respects my reasons. I wonder if, some day in the not too distant future, he’ll say, “This test actually seems to have more risks than rewards,” and stop handing out that slip at all.

Another excellent article found here:

You Can't Have It Both Ways - Oh, Wait, Yes You Can!

Josh Horwitz makes a good point that the "good guys" with guns want to keep the "bad guys" from having guns.  Which are you?  A good guy or a bad guy?  

And I wonder what would happen if one of these guys who thinks it's OK to hit your wife was suddenly face-to-face with the gun held by said wife who was saying, "I'm Standing My Ground, you hypocritical bastard!"

Josh Horwitz in The Huffington Post

The Double Standard of the Pro-Gun Movement

They hit you? Grin and bear it. You hit them? Prepare to die.

It was National Rifle Association (NRA) CEO Wayne LaPierre who famously intoned that "the guys with the guns make the rules" during the 2009 Conservative Political Action Conference. I don't think I had ever fully understood the sheer arrogance and hypocrisy behind this belief, however, until pro-gun activists brought it into sharp relief for me recently.

Late last month, the president of the radical pro-gun group Virginia Citizens Defense League (VCDL), Philip Van Cleave, made headlines when he told a WVTF reporter on Martin Luther King, Jr. Day that slapping around your wife was no big deal. Van Cleave was commenting on a bill, SB 510, that would prohibit individuals convicted of stalking, sexual battery, or assault/battery of a family member from possessing firearms for a period of five years following their convictions. "A slap?" Van Cleave asked reporter Sandy Hausman. "That's not a violent thing!" Van Cleave later reiterated this opinion during testimony before the Virginia Senate's Courts of Justice Committee. When asked by Senate Majority Leader Dick Saslaw, "So you think that if you go out and you slap your wife around and all it is is a misdemeanor [conviction], you shouldn't lose your weapon after that. Is that what you're telling me?" "Correct,"responded Van Cleave.

A couple days later, pro-gun activists on Twitter reminded us that George Zimmerman did the right thing by killing unarmed teenager Trayvon Martin because he was (theoretically) being punched at the time. So we decided to put a question to them:

"Do you think the punishment for punching someone should be death?"

"If you attack someone, you deal with what they choose to make you deal with," answered pro-gun activist Jordan of Atlanta, Georgia. "Yes."

"Yes I do!" replied pro-gun activist Dale Shroud of Boise, Idaho. "A punch hard enough in the head CAN KILL YOU ! I will STAND MY GROUND."

Hold on a second, I thought. Let me get this straight... It's OK for pro-gun activists to slap their wives around without losing their rights to own and purchase firearms, but if someone punches them, they have a right to execute that person on the spot -- no judge, no jury, no due process under the law?

What a sickening double-standard that is.

And lest you think it's merely a matter of a few isolated pro-gun activists engaging in such hypocrisy, let me assure you that that's not the case. The NRA practices what it preaches when it comes to its "the guys with the guns make the rules" philosophy. It was NRA Board Member and Congressman Don Young (R-AK) who took the lead in attempting to repeal the 1996 Lautenberg Amendment, which prohibits those convicted of misdemeanor crimes of domestic violence from owning and purchasing firearms. And who can forget these two classic quotes from NRA Board Member Wayne Anthony Ross: "If a guy can't rape his wife...who's he gonna rape?" and "There wouldn't be an issue with domestic violence if women would learn to keep their mouth shut." Finally, the NRA described the protections codified under "Stand Your Ground" laws as a "fundamental human right" after Zimmerman was acquitted of murder charges.

The opinion of the pro-gun movement seems to be that the guy with the gun is always right, no matter what the facts of the case are; that gun possession makes you a super-citizen with enhanced rights to take life, avoid prosecution, and use lethal force in response to non-lethal force. Somehow, gun ownership increases your judgment and makes you smarter than other citizens.

But here's the reality. There are some really smart gun owners with excellent judgment who don't display their weapons in a prideful and dangerous manner, and there are also some slow-witted gun owners with terrible judgment who want to show off that they have the power to put you six feet under (think Michael David Dunn). The reason we need meaningful firearms regulation is not to stop truly law-abiding people with excellent judgment from getting guns, but rather to stop the reckless, dangerous individuals that exist in every society. The mere fact that you own a gun does not make you a "Good Guy." A good guy is someone who by measure of skill and temperament has been weeded out from the bad guys. That title is earned, not given.

I am not pointing out the pro-gun movement's double standard regarding the use of force merely to play a game of "gotcha." I am highlighting their hypocrisy because it has lethal consequences. The pro-gun movement is teaching young Americans that it is morally virtuous to shoot and kill someone who punches you. Is that really a message we want to be sending in an era of school shootings? One landmark study of school shootings found, "Almost three-quarters of [school shooters] felt persecuted, bullied, threatened, attacked or injured by others prior to the incident. In several cases, individual attackers had experienced bullying and harassment that was long-standing and severe." There are legitimate avenues to address this problem, but telling bullied kids that they are justified in opening fire? That's a recipe for disaster.

I am haunted by a quote from Sandy Hook Elementary shooter Adam Lanza that was recently unearthed by author Matthew Lysiak. Posting at the website Shocked Beyond Belief just a year before the shooting, Lanza wrote:

It goes without saying that an AK-47 and enough ammunition could do more good than a thousand "teachers," if one is truly interested in reforming the system. In short time the children will be brainwashed, pumped full of Xanax and told to conform, until they have been turned into the oppressors.

A clearer declaration of "the guys with the guns make the rules" has never been heard. It should be a wake-up call to all of us -- including gun owners -- to champion non-violent solutions to conflicts, rather than the use of deadly force. The preservation of human life should always be our highest priority in settling disputes, both personal and political.

Do You Really Need a Mammogram?

There are a number of news articles today that merit your time.  The first is an opinion piece from the NY Times by Charles Blow, who says, "the dreadful monotony and morbidity of the gun control discussion in this country has left me dispirited."  That's how I feel.  Read the entire article here:  

The second is an article by the editorial board of the NY Times, discussing the out-of-date practice of not allowing anyone who has commited a felony to vote ever again in their whole life.  Attorney General Eric Holder says this is a ridiculous plot devised years ago to keep newly freed blacks from voting.  Arizona was not a slave state during the Civil War, yet the laws here prevent any young person who makes a bad decision (and a lot of them do!) but serves his time, pays his fines, and does what is required of him, doesn't get reinstated to his pre-conviction status.  The Attorney General is urging legislatures to change these outdated laws and allow every citizen who has paid his debt to society to again be allowed to participate in this most basic privilege.  Here is the entire article. 

The longer I live the more studies show that a lot of previous studies turn out to be wrong.  I remember when doctors encouraged every menopausal woman to use "hormone replacement therapy."  I, too, tried it for a little while, but then I thought it through and came to the conclusion that Mother Nature probably knew what she was doing.  Females are meant to stop having babies when their bodies are growing old and not as capable of recovering from a pregnancy, or when biologically speaking they are approaching the end of life.  So, believing that millions of years on this planet counted for more than a few years of studies by people who were making millions of dollars on selling this idea, I stopped.  And guess what?  Soon thereafter, the longitudinal studies began to show the harmful side of HRT.  More cancer, more heart problems.  Now a recent study is claiming that all these millions of mammograms aren't having any effect on the mortality rate of women with cancer.  So if you skipped your last mammo, don't worry about it.  Do a self-exam.
Are Mammograms a Waste of Money?

Word of the Day: CONSEQUENCES

Word of the day:

CONSEQUENCES

This hasn't been my best week.  Maybe it's the phase of the moon, or something, but I have been feeling "marginalized," if that's the correct word. It sounds sort of ridiculous to say that different people in my life have made it clear that they believe they matter more than I do.  Should I say they want the upper hand, they want the power in the relationship?   That sounds so academic, but I don't know how else to describe how it makes me feel.  

The first instance was a repeat performance of a conversation that has taken place at least four times in the past two years between me and someone I have known for more than fifteen years.  We met in New Jersey when I owned a small consignment shop around the corner from her house.  She made a habit of coming by the store several times a week to pour her heart out about her abusive husband.  Eventually she divorced the abusive husband and began a relationship with another man.

Fourteen years ago, we moved from New Jersey to Arizona where our son and his family lived.  Our elder daughter and her young son moved with us.  Later on, the younger daughter with her husband and two babies joined the rest of us.  I am sure that my friend is right when she says I encouraged her to move to Arizona.  I was very happy with our brand-new house, my little grandchildren, and my job at the community college.  My enthusiasm must have been contagious.

After a failed attempt to relocate to Florida, she and her partner visited Arizona, liked it, bought a house 40 minutes from us, and went home to pack.  I had no idea what she was expecting when she made these decisions.

Now it is 14 years later, and I have gone from being 58 to being 72. My husband and I have both retired and are living on a greatly-reduced income, and we now baby-sit 4 days a week.

I called my one-time friend the other day to check in and see how she was doing.  The partner she was with dumped her in a suburb miles away from anything, moved her two sons out to live with her, went back to Jersey and has been lying to her for the past 8 years.  She made some really bad decisions because she believed his lies, and is now facing, guess what? - the CONSEQUENCES.

So, I called to say Hi.  After a few minutes, she announced in a flat voice, "I don't want to talk to you on the telephone."  This was after announcing a few weeks ago that she "doesn't do email and doesn't know how to text," so don't do that either.  She wants only face-to-face encounters.  She made it clear that she doesn't need another “acquaintance.”  She wants a "more intimate" relationship, like the one we had in New Jersey.  She remembers these heart-to-heart talks, visiting over tea and cookies, and the one time she was invited to my grandson’s birthday party.  She tells me that she thought she was moving to Arizona to be “near her best friend.”  That things have not turned out the way she imagined is just life, isn’t it?  

Now, I know what you're thinking.  Why should I get upset by someone basically saying she wants to see me more often?  Do people understand that if you want someone to like spending time with you, you have to have something to offer?  Both people should feel better after being together, not drained and glad to be leaving, which is how I always feel after being with her.  She is so negative, and has nothing to talk about except her latest catastrophe, her ungrateful kids, the man who betrayed her, and her failing business.  She is jealous of the time I spend with my family, because her two sons have no social life and never spend time with her.  Hummm? Wonder why?  She claims she is alone.  She's not.  She has her two children (30 and 23) living with her.  And even if she were alone, how is that my responsibility?

I finally ended up hanging up on her because the attack just wouldn't stop.  I find it difficult to tell her the truth - that she is a lot of work!  She drains every ounce of energy from me.  I told her that I thought she has Asperger’s Syndrome (which would explain why it’s so frustrating for everyone to deal with her) which she wouldn’t even consider.  Just went back to the old refrain - basically, I am not a “good enough” friend.

All I expect from people is the recognition that there are consequences from our behavior.  If she wants to be mean to me, attack me, and tell me how disappointed she is in me, there are consequences.  She expects the world to operate on her terms, or else what?   She will just see her world shrink smaller and smaller because she won't adapt.  Consequences.

Gun Report One Year Later

Joe Nocera of the New York Times began working with Jennifer Mascia right after the Newtown shootings last year.  What a grueling task they set themselves!  It must be difficult to read day after day of deaths that occur all over our country.  No state is exempt.  And yet, after all these numbers have been compiled, evidence that cannot be contradicted, absolutely nothing has been done by our Congress.  Years from now, when history looks back at this time in America, I cannot imagine what people will think of our Barbarian society.


Joe Nocera   FEB. 3, 2014
It has been a year since my assistant, Jennifer Mascia, and I started publishing The Gun Report, an effort to use my blog to aggregate daily gun violence in America. Our methodology is pretty simple: We do a Google News search each weekday morning for the previous day’s shootings and then list them. Most days, we have been finding between 20 and 30 shootings; on Mondays, when we also add the weekend’s violence, the number is usually well over 100.

From the start, we knew we were missing a lot more incidents than we found. The Centers for Disease Control and Prevention, after all, says that nearly 32,000 people are killed by guns each year. Slate, the online magazine, which tried to tally every gun death in the year after the tragedy in Newtown, Conn., arrived at a number of 12,042, far higher than ours. (We include gun injuries as well as gun deaths.)

Part of the issue, as Slate has noted, is that it is impossible to track suicides using news media accounts — and suicides, according to the C.D.C., account for some 60 percent of gun deaths. But it was also obvious that a Google News search was bound to miss plenty of examples; that’s just the nature of the beast. Comprehensiveness was never really the point, though. Mostly we were trying to get a feel for the scale and scope of gun violence in America. A year later, it seems like a good time to take stock.

First, the biggest surprise, especially early on, was how frequently either a child accidentally shot another child — using a loaded gun that happened to be lying around — or an adult accidentally shot a child while handling a loaded gun. I have written about this before, mainly because these incidents seem so preventable. Gun owners simply need to keep their guns locked away. Indeed, one pro-gun reader, Malcolm Smith, told me that after reading “about the death toll, especially to children” in The Gun Report, he had come to believe that some gun regulation was necessary. He now thinks gun owners should be licensed and “should have to learn how to store guns safely.” No doubt he’ll be drummed out of the National Rifle Association for expressing such thoughts.

Second, the N.R.A. shibboleth that having a gun in one’s house makes you safer is demonstrably untrue. After The Gun Report had been up and running for a while, several Second Amendment advocates complained that we rarely published items that showed how guns were used to prevent a crime. The reason was not that we were biased against crime prevention; it was that it didn’t happen very often. (When we found such examples, we put them in The Gun Report.) More to the point, there are an increasing number of gun deaths that are the result of an argument — often fueled by alcohol — among friends, neighbors and family members. Sadly, cases like the recent shooting in a Florida movie theater — when one man killed someone who was texting during the previews — are not all that uncommon.

Third, gang shootings are everywhere. You see it in the big cities, like Chicago, Detroit and Miami, and you see it in smaller cities in economic decline like Flint, Mich., and Fort Wayne, Ind. Drive-by shootings are prevalent in California, especially Los Angeles and Fresno. As often as gang members shoot each other, they kill innocent victims, often children who happen to be in the wrong place at the wrong time.

Among the readers who post daily comments to The Gun Report are a number of gun rights advocates. What has been astonishing to me is the degree to which they tend to dismiss inner-city violence, as if to say that such killings are unavoidable. The code word they often use is “demographics.”

It is unquestionably true that the most gun homicides occur in the inner cities — the anecdotes we collect in The Gun Report are confirmed by such studies as a May 2013 Bureau of Justice Statistics report. And, yes, plenty of them are the result of gang violence. But why should that make them any less lamentable, or preventable?

There are an estimated 300 million guns in America, and that’s not going to change anytime soon. But to read The Gun Report is to be struck anew at the reality that most of the people who die from guns would still be alive if we just had fewer of them. The guys in the movie theater would have had a fistfight instead of a shooting. The momentary flush of anger would pass. The suicidal person might have taken a pause if taking one’s life were more difficult. And on, and on. The idea that guns, on balance, save lives — which is one of the most common sentiments expressed in the pro-gun comments posted to The Gun Report — is ludicrous.

On the contrary: The clearest message The Gun Report sends is the most obvious. Guns make killing way too easy.

CDC Classifies Overdoses From Opiates and Heroin As An Epidemic

It is amazing to me that in the President's State of the Union address, in Jon Stewart's interview with Nancy Pelosi, or in any of the other political coverage recently, not one mention has been made of what I consider to be two of the greatest challenges facing our country today: the number of children and adults who are killed by guns every day, and the heroin epidemic sweeping the country.  I can't understand how our elected officials can keep arguing about everything else and ignore this.

To the Editor:

Philip Seymour Hoffman’s tragic death puts a very public face on an epidemic health condition that is ravaging families across New York and the United States (“Actor’s Heroin Points to Surge in Grim Trade,” front page, Feb. 4).

The Centers for Disease Control and Prevention has classified overdoses associated with prescription opiates and heroin as an epidemic. The loss of life and the impact on communities across the country have been front-page news. There is little debate that there is a significant cause for alarm.

Unfortunately, state legislatures and policy makers have failed to address this public health crisis with prevention, treatment and recovery supports adequate to reverse its impact.

We will make progress only when there is increased prevention and education targeting at-risk populations, widespread availability of Naloxone to reverse the symptoms of an overdose, treatment on demand and services to help people in recovery to stay in recovery. Gov. Peter Shumlin of Vermont is to be praised for his leadership on this issue. We need others to join him.

JOHN J. COPPOLA
Executive Director
Alcoholism and Substance Abuse
Providers of New York State
Albany, Feb. 4, 2014

Can We Genetically Modify Poppies?

Within 48 hours of Philip Seymour Hoffman's death, the police arrested four people with more than 350 bags of heroin.  Is it probable that, prior to Hoffman's death, the police knew nothing about this dealer a mile away from Hoffman's apartment? If a dealer with this much heroin can operate without the police's knowledge, then we are doing a poor job of trying to find and put away drug dealers.  If authorities find the dealer than sold the heroin to Hoffman, he/she should be tried for first-degree murder.  I am so sick of the cops locking up the 19-year-old victim for being caught with a piece of tin foil, and not doing anything about the dealer that is selling to multiple victims. 

Perhaps scientists can develop a genetically-modified poppy seed that will destroy the plant's ability to destroy our children! 

By J. DAVID GOODMAN and EMMA G. FITZSIMMONSFEB. 4, 2014

Four people were arrested in Lower Manhattan on Tuesday evening with more than 350 bags of heroin as part of the investigation into the death of the actor Philip Seymour Hoffman, a law enforcement official said.

Narcotics investigators executed search warrants in three apartments in a building at 302 Mott Street on Tuesday evening, the official said. Three men and a woman were arrested, and the investigators recovered the bags of heroin inside the apartments.

Information stemming from the investigation into Mr. Hoffman’s death led them to the building, the official said. Mr. Hoffman, widely considered one of the best actors of his generation, died on Sunday in an apparent heroin overdose.

He was found dead with a needle in his arm in a West Village apartment, about a mile from where the arrests took place. Near Mr. Hoffman’s body, the police found dozens of packages of heroin, some branded with the label “Ace of Spades” or with an ace of hearts.

 

The bags that were found during the arrests on Tuesday did not have those types of labels, the official said. The investigation was continuing, police officials said.

Earlier Tuesday, police officials said that the heroin found in Mr. Hoffman’s apartment did not contain fentanyl, a powerful additive that has been tied to 22 recent fatal overdoses in Pennsylvania. The city medical examiner had not yet reached a definitive cause of death for the actor.

Preliminary tests of the heroin found “no traces of fentanyl,” said Stephen Davis, the department’s top spokesman, adding that investigators had taken a representative sample of the substances found in the apartment in reaching that conclusion.

As the investigation into the actor’s death continued, Mr. Hoffman’s family released a statement outlining plans for a private funeral service for “the family and close friends.”

The statement said “plans were also underway for a memorial service later in the month also to be held in New York,” though no details were provided.

When Are We Going to Start Doing Something About This Epidemic?

By J. DAVID GOODMANFEB. 3, 2014

Detectives found dozens of small packages in the West Village apartment where Philip Seymour Hoffman, the actor, died on Sunday. Most were branded, some with purple letters spelling out Ace of Spades, others bearing the mark of an ace of hearts. At least five were empty, and in the trash.

Each of the packages, which can sell for as little as $6 on the street, offered a grim window into Mr. Hoffman’s personal struggle with a resurgent addiction that ultimately, the police said, proved fatal. And the names and logos reflect a fevered underground marketing effort in a city that is awash in cheap heroin.

 

Heroin seizures in New York State are up 67 percent over the last four years, the federal Drug Enforcement Administration said. Last year, the agency’s New York office seized 144 kilograms of heroin, nearly 20 percent of its seizures nationwide, valued at roughly $43 million. One recent raid, in the Bronx last week, netted 33 pounds of heroin and hundreds of thousands of branded bags, some stamped “N.F.L.,” a timely nod to the Super Bowl.

From 2010 to 2012, after several years of decline, heroin-related overdose deaths increased 84 percent in New York City to 382, according to the Health Department statistics. Staten Island, where prescription drug addiction has been especially virulent, has the city’s highest rate of heroin overdoses, though a connection has not been established.

Bags bearing different stamps turn up in raids of large-scale heroin mills around the city.

They are named for popular celebrities or luxury products, or the very thoroughfares along which the drugs travel: Lady Gaga. Gucci. I-95. They reflect an increasingly young and middle-class clientele, who often move from prescription pills to needles: Twilight. MySpace. And they often indicate little about the quality or purity of the product, which is diluted with baking soda or, in some cases, infant laxatives, officials said.

To be sure, there is variety, especially in potency and reliability. Recently, 22 people died in and around Pittsburgh after overdosing from a batch of heroin mixed with fentanyl, a powerful opiate usually found in patches given to cancer patients. Heroin containing fentanyl, which gives a more intense but potentially more dangerous high, has begun to appear in New York City, said Kati Cornell, a spokeswoman for Bridget G. Brennan, the special narcotics prosecutor for the city. An undercover officer bought fentanyl-laced heroin on Jan. 14 from a dealer in the Bronx, she said. The dealer did not warn of the mixture, which is not apparent to the user; subsequent testing revealed it. (The patches themselves had turned up in drug seizures in the city before, she said.)

Ultimately, users have no way to be sure what they’re buying. “There’s no F.D.A. approval; it’s made however they decide to make it that day,” Ms. Brennan said. The same shipment of heroin may be packaged under several different labels, she said. “At the big mills, we’ll seize 20 stamps. It’s all the same.”

Far from plaguing only big cities, heroin has emerged as a grave concern in places like Vermont, where last month the governor devoted his entire State of the State message to what he said was “a full-blown heroin crisis”there.

But almost as long as there has been heroin in the United States, New York City has been its hub. Certainly much has changed since the 1970s, when addicts flooded shooting galleries and flashy drug traffickers like Nicky Barnes, known as Mr. Untouchable, became household names. The drug is still smuggled into the country from faraway poppy fields, still cut from kilo-size quantities in hothouse operations secreted around the city, still diluted in coffee grinders and still sold to needy consumers.

Various brands, too, have been around for decades. “There always have been markings going back as far as Nicky Barnes,” said James J. Hunt, the acting head of the Drug Enforcement Administration’s New York office. “Now the difference is that the addicts you see a lot are young suburban kids starting on prescription drugs, and they graduate to heroin.”

The trade has become more organized, officials said, from the top to the bottom. Delivery services abound for those who can afford a dealer who arrives at the door with a grab bag of drugs. Highly organized mills have been found in middle-class city areas like Riverdale, in the Bronx, and Fort Lee, N.J., or, in one case, in a Midtown Manhattan apartment near the Lincoln Tunnel. Such locations draw less scrutiny from potential robbers, and often provide ready access to major roads for deliveries up and down the Eastern corridor.

“It’s like somebody setting up a big production factory in China and the product is going to go out through to the world,” Ms. Brennan said. “That’s how I look at these production mills that we’re seeing in New York. Some will stay here in the city, but it’s mostly intended for distribution.” (A $6 bag in the city could fetch as much as $30 or $40 in parts of New England, authorities have said.)

Some officials fear that efforts to drive down abuse of prescription medications could be contributing to rising heroin use in New York City, as it has in places like Maine.

“What we’re seeing, as pills become more difficult to access, is a shift to the black market and heroin,” said Dr. Andrew Kolodny, the chief medical officer at the Phoenix House Foundation, a drug-treatment center, and president of Physicians for Responsible Opioid Prescribing. “It’s not easy to get the opioid genie back into the bottle.”

It is a cycle that friends of Mr. Hoffman, who was 46, said may have recently taken hold in his life as well.

Last year, he checked into a rehabilitation program for about 10 days, a move that came after a reliance on prescription pills led to a return to heroin, after what he said had been a clean period spanning two decades.

The Police Department on Monday said detectives were working to track down the origin of the substances Mr. Hoffman used, though a police official conceded it could be difficult to determine. “Just because it’s a name brand doesn’t mean that anyone has an exclusive on that name,” the official said. “Ace of Spades; I would venture to say that someone else has used that name.”

The ace of hearts logo has appeared in at least one case in the city, the police said.

The Drug Enforcement Administration said it had seen “Ace of Spades” branding in a 2009 drug case on Long Island. It has been seen in photographs of heroin packages at least as far back as 2005.

Investigators will also test the paraphernalia found near Mr. Hoffman, as well as the syringe found in his left arm, to determine whether the mixture he consumed had been adulterated in any way, the official said. Results from those tests were expected sooner than the toxicology tests by the city medical examiner.

For law enforcement officials, Mr. Hoffman’s death was a stark reminder of the dangers inherent in a highly addictive drug that ravaged urban communities in the 1970s.

“People who study drug trends talk about generational amnesia,” said Ms. Brennan, the special narcotics prosecutor. “We’re now 40 years out from our last major heroin epidemic and I think people have lost their memory of that drug’s devastation.”

Indeed, she said, some of the most common heroin brands suggest as much: Grim Reaper; a skull and crossbones; D.O.A.

Acting Can Be Dangerous to Your Health

It was with great sadness that I read about the death of one of my favorite actors, Philip Seymour Hoffman.  His ability to transform himself into other "characters" (people) may have been what lead to his death.  I have long suspected that playing toxic roles poisons an actor's brain, but until now I have never seen any suggestions in the media that my idea might be correct.  Not that I saw anything like this doctor's conclusions in the news reports about Hoffman; I found this blog by Googling "Actors and Reality."  Of course, I don't want to make generalizations.  Not every entertainer who has died from alcohol or drug overdose had performed in dark and/or disturbing roles.  But two others come to mind: James Gandolfini, who played Tony Soprano, and Nancy Marchand, who played his mother.  For six seasons, Gandolfini portrayed Tony Soprano's painful anxiety attacks and very dark depression.  And Marchand's character, Livia, had narcissistic personality disorder - a fancy term for someone who is evil and wicked.  Is it too much of a stretch to believe that playing these roles could have had a real physical effect on the actors?  I don't think so.  

"A source close to the actor revealed that Hoffman was spending $10,000 a month on heroin and the prescription drug, Oxycontin."  (Examiner.com)

Is There a Blir Between Acting and Reality?

Dr. Masha Godkin (Online Therapy with Dr. Masha Blog)

One of the various explanations for why actors often struggle with problems such as anxiety, depression and substance abuse could be connected to the nature of the acting profession. Could there be a confusion between what is reality and what is acting, on  a subconscious level?

Acting ”As If”

There’s a famous expression called “fake it til you make it.” In Cognitive Behavioral Therapy (CBT), this is called acting “as if.” So for example someone dealing with depression is instructed to act in a cheerful manner ( i.e. pretending to be self-confident by walking with shoulders back, or smiling even when the inclination may be to frown.)

What happens when an actor must dive into a difficult role? Perhaps the character has an addiction or a mental disorder.  A great deal of time is spent filming. During this time, the actor must get into the characters shoes. The actor feels all of the intense emotions of the character. Once filming of the movie finishes, then what?  Is it easy to let go of the emotions accessed for the part? The actor can of course, on a rational level, understand that it was just a role, and not who they are in real life. But what occurs on the subconscious level?  Can the brain become rewired?

Cells That Fire Together Wire Together

Hebb’s rule in neuroscience explains this rewiring. The rule is that cells that fire together, wire together. So if an individual continually tells him or herself that he/she is not a worthwile person,  that will at one point turn into an automatic thought. Or if an individual repeatedly experiences the emotions connected to certain states of minds, those emotions will be felt without conscious awareness eventually.  In other words, act depressed on a consistent basis, feel the emotions of hurt, sadness, etc. time and time again, and a habit can be formed. Those negative emotions will come up without trying. Emotions are a product of thoughts.  An actor may think back to past frustrations, traumas and  disappointments  in order to get into a depressed state of mind. The thoughts that trigger these emotions could include something like : ” I don’t deserve good things, I’m not a lovable person, I’m just going to be abandoned in the end etc.” "What the Bleep Do We Know"

It’s not simple to change thoughts and emotional states.An emotional state can be addictive! It requires consistent effort. I like to use an analogy: an actor may be required to gain a significant amount of weight for a part. Once filming is over, is the weight lost immediately? Or does it require  some effort to lose it with a plan that might include diet and exercise? “Rewiring” brain cells takes just as much hard work.

The Highs and Lows of Being a Perfomer

Performing can be exciting and fulfilling. It can be a great “high” to receive praise for a role well-played. But what happens if it’s not all praise? Or what about when it ends? It isn’t possible to be in the spotlight all the time.  Performers are very creative individuals. They possess a gift. However, with that gift, there frequently comes a price- a level of vulnerability, a sensitvity level that is elevated. A performer may deal with issues related to self-esteem. Being an entertainer involves facing multiple stressors. And for many in the industry, the  maladaptive coping mechanism becomes turning to drugs,alcohol or other addictive behavior.

I welcome any thoughts you may have on this topic.

12-Step Program or Medications?

I have spoken with various people who have been encouraged to attend AA meetings, and more than a few of them say that they need the support but that they do not believe in "God" and can't sign on to a program that is so fundamentally spiritual.  They believe, as do I, that they are not powerless over their addiction; that, in fact, it is totally in their control, not in some "higher power's" control.  So, for those people, there is no place to turn.  There are few, if any, programs that are not 12-step based.  See what you think after reading this article which appeared on Slate.


Alcoholics Anonymous is, by far, the largest and most venerable addiction recovery group in the world. Founded nearly 80 years ago, AA now boasts 2.1 million worldwide members, many of whom attribute their very survival to the organization. In the United States, where the 12-step program originated, AA is viewed by many as a national treasure of sorts. Social workers send patients to AA meetings. Judges condition people’s freedom on meeting attendance. Desperate spouses condition marriages on it. Everyone loves Alcoholics Anonymous. Or almost everyone.

Many patients and doctors have grumbled for years about the religion inherent in the Alcoholics Anonymous process: Half of the 12 steps involve God or “a Power greater than ourselves.”

In recent years, however, the complaints have turned scientific. Some doctors who specialize in treating alcoholism have leveled a pair of accusations against the organization. First, they claim that AA has obstructed the spread of medications to treat alcoholism. Second, they claim that the group stubbornly resists evidence that some alcoholics are better suited to a life of moderate drinking than to complete abstinence.

Read entire article

Not Quite Ready for College - Here's an Idea

I am fully aware of how much my travel experiences have changed me (and for the better, I might add) and helped me understand so much more about the world.  At home it has helped, too, because I learned that there is not just one way to do things.  I no longer insist that my way is the best way.  I know that those who volunteer with the Peace Corps value that experience for the rest of their lives, and I believe that taking a Gap Year might also be a life-long benefit.  See what you think.  This article appeared in Slate.

This article originally appeared in Inside Higher Ed.

Over the next few weeks, students around the country will receive offers of admission to colleges and universities. But before students jump online and accept an offer, I have one piece of advice for them: They might be better off not going to college next year.

Instead, they should think about taking a gap year, to defer college for a year to live and volunteer in a developing country.

In the traditional sort of gap year, students immerse themselves in a developing community to volunteer with a nonprofit organization by teaching, working with local youth, or assuming some other community role.

Gap years have been rising in popularity in the United States, the United Kingdom, Australia, and elsewhere. I’ve spent the last few years researching what happens to young people when they have such an immersive experience in a community radically different from their own.

The answer, in short, is that gap years can help change students in ways the world needs.

The challenges of our time demand an educational system that can help young people become citizens of the world. We need our students to be smart, critical, and innovative thinkers but also people of character who use their talents to help others. Gap years help young adults understand themselves, their relationships, and the world around them, which deepens capacities and perspectives crucial for effective citizenship. They help students become better thinkers and scholars, filled with passion, purpose, and perspective.

How do people learn from gap years?

One principal lesson is clear: We often develop most when our understandings of ourselves and the world around us are challenged—when we engage with people and ideas that are different. Despite this insight, we often prioritize comfort and self-segregate into groups of sameness. We tend to surround ourselves with people who think, talk, and look similar to us.

The treadmill from high school to college makes it hard for students to see alternative paths.

Taking a gap year speeds our development by upsetting these patterns. Trying to occupy another person's way of life in a different culture—living with a new family, speaking the language, integrating into a community, perhaps working with local youth, for instance—these are valuable experiences that help young people understand themselves, develop empathy and virtue, and expand their capacity to see the world from others' perspectives.

Traditionally, U.S. higher education has championed the idea of liberal arts as a way of getting students to engage with difference, to expand their worldview beyond their known universe by (in the words of a Harvard research committee on education) “questioning assumptions, by inducing self-reflection … by encounters with radically different historical moments and cultural formations.”

However, formal classroom education alone cannot accomplish this aim. The classroom is limited in its ability to engage students with difference and contribute to their development as able citizens. We also need new experiences that inspire critical self-reflection to cultivate the right moral feelings and dispositions.

What’s important here is the productive dissonance that these long-term, immersive gap year experiences provide. It's unlikely that a young person staying in America—or even traveling overseas for a short time—would have assumptions about herself and the world around her challenged with the same intensity, frequency, and breadth as in a gap year in a developing community.

It's interesting that spending time in developing communities can help young people appreciate ways of living that we need more of—such as a more active and intimate sense of community. Going overseas also helps cultivate a type of independence and self-confidence that staying close to home in a familiar environment probably does not.

Furthermore, taking the traditional kind of gap year after high school helps students take full advantage of their time in college. One telling observation is that many students who take gap years end up changing their intended major after returning. During college, their gap year experiences enrich their courses, strengthen co-curricular endeavors, and animate undergraduate research and creative projects.

To be clear: Though these gap year students are working in partnership with a community organization and aim to make some positive impact, the students typically, at least in the short term, gain more than they are able to give. But this empowers them to bring new perspectives to bear in other personal, professional, and civic efforts. Gap years, borrowing a line from the Rhodes Scholarship Trust, can help create leaders for the world’s future.

Despite the benefits of these kinds of gap year experiences, too few Americans take gap years and too few colleges encourage them. The treadmill from high school to college makes it hard for students to see alternative paths. But that is changing. More people and organizations are beginning to see gap years for the formative experiences they can be, given with the proper training, support, and community work. In fact, all the Ivy League universities now endorse gap years for interested students. And they’re right to do so.

Many parents and students are nervous about the idea of spending an extended period in a developing country. But these experiences, especially through structured gap year programs like Global Citizen Year, are generally very safe and supported. Are there some risks? Of course, there are risks with any travel or change—but the risks are worth taking. The investment in taking a gap year will pay dividends throughout one’s college career and beyond as society and one’s life are enriched.

However, one central challenge that remains is how to finance gap years for students from lower-income families. This is also beginning to change. The University of North Carolina and Princeton University, for instance, have both begun to subsidize gap years for incoming students. Other organizations, such as Omprakash, now offer low-cost volunteer placements as well as scholarships to those with need. And with the help of crowdfunding sites, students are able to raise money for these experiences with greater ease. Despite these efforts, if gap years are to really expand, we’ll need more institutions or governments to offset the costs.

Higher education is society’s last mass effort to really shape the character and trajectories of our young people. Let’s help them take more advantage of the precious time in college by taking a gap year beforehand.

Joe O'Shea is the author of Gap Year: How Delaying College Changes People in Ways the World Needs.

Unlawful Search? Or, Rape By Police?

This is THE most outrageous story I have ever read.  I doubt you will even believe it.  It seems most like a story from a repressive regime in the Soviet Union, or some horrible story about torture by a crazy person.  But it's our police force - doing, or forcing doctors to do - totally unconstitutional acts and continuing them in the face of a man's innocence.  What are we going to do about this?  Yes, the victim in this case received compensation for the abuse he suffered, but why did it happen in the first place?

SundayReview|OP-ED COLUMNIST

3 Enemas Later, Still No Drugs

Nicholas Kristof  JAN. 25, 2014

IF you think that protests about overzealous law enforcement are over the top, listen to what unfolded when the police suspected that David Eckert, 54, was hiding drugs in his rectum.

Eckert is a shy junk dealer struggling to get by in Hidalgo County, N.M. He lives a working-class life, drives a 16-year-old pickup and was convicted in 2008 of methamphetamine possession.

Police officers, suspecting he might still be involved in drugs, asked him to step out of his pickup early last year after stopping him for a supposed traffic violation. No drugs or weapons were found on Eckert or in his truck, but a police dog showed interest in the vehicle and an officer wrote that Eckert’s posture was “erect and he kept his legs together.”

That led the police to speculate that he might be hiding drugs internally, so they took him in handcuffs to a nearby hospital emergency room and asked the doctor, Adam Ash, to conduct a forcible search of his rectum. Dr. Ash refused, saying it would be unethical.

“I was pretty sure it was the wrong thing to do,” Dr. Ash told me. “It was not medically indicated.”

Eckert, protesting all the while, says he asked to make a phone call but was told that he had no right to do so because he hadn’t actually been arrested. The police then drove Eckert 50 miles to the emergency room of the Gila Regional Medical Center, where doctors took X-rays of Eckert’s abdomen and performed a rectal examination. No drugs were found, so doctors performed a second rectal exam, again unavailing.

Doctors then gave Eckert an enema and forced him to have a bowel movement in the presence of a nurse and policeman, according to a lawsuit that Eckert filed. When no narcotics were found, a second enema was administered. Then a third.

The police left the privacy curtain open, so that Eckert’s searches were public, the lawsuit says.

After hours of fruitless searches, police and doctors arranged another X-ray and finally anesthetized Eckert and performed a colonoscopy.

“Nothing was found inside of Mr. Eckert,” the police report notes. So after he woke up, he was released — after 13 hours, two rectal exams, three enemas, two X-rays and a colonoscopy.

The hospital ended up billing Eckert $6,000.

When I came across this case, it seemed far-fetched to me — more like rape than law enforcement. But the authorities, hospital and doctors all refused to comment, and, a few days ago, the city and county settled the lawsuit by paying Eckert $1.6 million.

This wasn’t a unique case. A few months earlier, a man named Timothy Young who lives nearby says that police officers pulled him over, forcibly strip-searched him in a parking lot and then took him to a hospital for a forced X-ray and rectal examination while he was handcuffed. Nothing was found, so he was released — only to receive a hospital bill.

And a few weeks before Eckert’s ordeal, a 54-year-old American woman crossing from Mexico into El Paso was strip-searched and taken to the University Medical Center of El Paso. She says in a lawsuit that, over six hours, she was shackled to an examination table and subjected to rectal and vaginal examinations — with the door open to compound her humiliation. After a final X-ray and CT scan, all of which turned up nothing, she was released — and billed for the procedures.

Joseph P. Kennedy, Eckert’s lawyer, notes that such abuses are not random but are disproportionately directed at those on the bottom rungs of society. “It’s a socioeconomic issue,” he said. “It’s the indignities forced on people who are not articulate, not educated and don’t have access to legal services.”

Police are caught in a difficult balancing act, and obviously the abuse of Eckert isn’t representative. But it is emblematic of something much larger in America, a kind of inequality that isn’t economic and that we don’t much talk about.

It’s the kind of inequality that lies behind police stops for “driving while black,” or unequal implementation of stop-and-frisk policies, or “zero tolerance” school discipline codes that lead many low-income children to be suspended.

This inequality has a racial element to it, but it is also about social class (Eckert is white but struggling financially). This is about Americans living in different worlds. If you’re a middle-class reader, you probably see the justice system as protective. If you’re a young man of color, you may see it as threatening.

So as we discuss inequality in America, let’s remember that the divide is measured in more than dollars. It’s also about something as fundamental as our dignity, our humanity and our access to justice; it’s about the right of working stiffs not to endure forced colonoscopies.

"The World Is Better Than It Has Ever Been"

Twenty years ago, I was staunchly a member of Team Steve, and thought that members of Team Bill were evil, wicked, dishonest, thieves, and greedy, self-centered monopolists.  Much to my surprise, Bill and Melinda Gates have established a foundation to address many of the world's most pressing problems, and, because they are not government operated, they have had tremendous success.  I am publicly congratulating Bill and Melinda for their work to make the world a better place, and for their "Giving Project."  This letter should be mandatory reading for every American, especially for those pessimists who think the world is getting worse all the time.  Read this and read P.J. O'Rourke's new book, The Baby Boom, and go to bed happy because you are living at a time when the world is better off than it's ever been.

Introduction to the Annual Letter of the Bill and Melinda Gates Foundation:

"By almost any measure, the world is better than it has ever been. People are living longer, healthier lives. Many nations that were aid recipients are now self-sufficient. You might think that such striking progress would be widely celebrated, but in fact, Melinda and I are struck by how many people think the world is getting worse. The belief that the world can’t solve extreme poverty and disease isn’t just mistaken. It is harmful. That’s why in this year’s letter we take apart some of the myths that slow down the work. The next time you hear these myths, we hope you will do the same. 

- Bill Gates"

Read the entire letter

Fail Better

Congratulations to Stan Wawrinka for persevering and finally winning against Novak Djokovic at the Australian Open.  You can say you don't believe in affirmations or in visualization, but everyone is talking about Stan's "code."

This is what is tattooed on his left arm (right where he can see it at a glance):

                      "Ever tried. Ever failed. No matter. Try again. Fail again. Fail Better."

                                                                            Samuel Becket

It's Just Common Sense

If you pay attention to the posts that show up on Facebook and in other media, it seems there are three issues that beg for government attention, but that don't seem to get any.  First is gun violence, of course.  The second is the heroin epidemic.  And third, increasing income inequality.  And it's not for lack of solutions.  There are solutions that work - in other places.  This writer specifies one way to address the heroin problem, but so far, it's not widespread.  Is it that there is too much money in treating addicts as criminals?  What do you think?


To the Editor NYTimes:
Re “In Annual Speech, Vermont Governor Shifts Focus to Drug Abuse” (news article, Jan. 9):

Gov. Peter Shumlin’s State of the State Message about addiction brought deserved attention to this national public health crisis. We agree that greater access to treatment, instead of criminal penalties, will save lives and money.

The most effective treatment for opioid addiction entails the use of medications, specifically, methadone or buprenorphine. While New York City has many methadone programs and buprenorphine prescribers, medication-assisted treatment remains stigmatized and is still not at the scale needed.
Furthermore, because opioid painkillers most frequently originate with prescriptions, the New York City Department of Health and Mental Hygiene’s safe opioid prescribing guidelines help prescribers prevent new cases of addiction.

The crisis of opioid addiction and overdose is one we can address. Effective addiction treatment that is integrated into mainstream health care, along with policies that promote treatment and not punishment, can reverse the problem in New York City and across the country.

THOMAS FARLEY
New York, Jan. 17, 2014

The writer is the departing health commissioner for New York City.

Love those Beekman Boys!

A Contrarian's Non-Lessons for Life | Chicago Ideas Week

Drug Abuse is Bad; The Drug War is Worse

The Feds Have Failed; Help the States Instead

Glenn E. Martin

Recently, Attorney General Eric Holder announced major shifts in federal sentencing policy, including limiting the use of mandatory minimum sentencing for low level drug cases and allowing more drug cases to be processed in state courts. The federal government should go even further and get out of the business of drug law enforcement altogether. Instead they should provide incentives for states to focus sensible drug policies and scarce public safety resources on prevention and treatment.

Encourage states to focus drug policies and scarce public safety resources on prevention and treatment, not punishment.

After 40 years, $1 trillion and 45 million arrests, the United States remains embroiled in a war that costs more than all the rest combined: the drug war. With the federal government helping to set the pace, this decades-old war has failed practically, morally and economically, with drugs more widely available and inexpensive than ever before. Moreover, even though racial groups use drugs at approximately equal rates, black people are 10 times more likely to be sent to prison for drug offenses. Today, black Americans represent 56 percent of those incarcerated for drug crimes, even though they comprise only 13 percent of the U.S. population.

Yet, while even conservative states are increasingly adopting evidence-based approaches to drug addiction, with many trending away from incarceration and repealing mandatory minimums, the Obama administration recently requested $25.6 billion in federal spending for drug law enforcement. The result of this repeated investment in heavy-handed drug law enforcement is that over half of the federal prison population was already incarcerated for drug offenses in 2010, according to the Bureau of Justice Statistics.

Perhaps the rehabilitative outcomes justify the investment? No such luck! No other industry would continue to operate with the failure rate experienced by our Federal Bureau of Prisons, with 60 percent of people released returning to prison within three years. The bureau has produced these abysmal outcomes for decades, but has continued to operate without meaningful course correction and has even grown unabated.

Why? Because our federal domestic drug control policy, launched decades ago and heavily focused on law enforcement, continues to operate on full throttle, ignoring the mounting public health evidence that strongly recommends alternative approaches.

Getting the federal government out of the domestic drug law enforcement business is not a solution to our country’s addiction to mass incarceration, but it would signal a major shift in policy. It could also encourage states to continue to create more humane, cost-effective approaches to drug use, including reducing inflexible mandatory minimum penalties for drug offenses and giving judges discretion to avoid harsh sentences. 

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 NYTimes: The Gun Report January 10, 2014

NYTimes: The Weekend Gun Report January 10-12, 2014

NYTimes: The Gun Report January 14, 2014

American Parents Have Got It All Backwards

I watch my children's friends and see them systematically making sure that their own children will not be able to cope with life when they are adults.  These parents intervene in every little squabble so that little Tommy doesn't have to learn how to settle disagreements with another on his own.  I see them deciding what little Susie will order at the restaurant, never paying attention to the fact that in a few short years little Susie will have to decide what to prepare for dinner for her own family.  How is she ever going to learn anything about healthy eating if she never has to choose for herself?

Worse, I see the children of divorced parents being treated like little princes and given big, expensive bribes so that they won't like the other parent better.  Parents are no longer parents - they are just big, rich friends.

We all talk about helicopter Moms, but it's not just Moms.  It's a whole generation of parents who are raising their children to believe the world is a dangerous place, someone is always waiting to grab you if your Mom's not watching, and worse, that you (the child) can't be trusted to make decisions and take the consequences.   When every child gets a trophy, there is no motivation to work hard and win.  Imagine their surprise when they get a job and find out that someone actually expects them to do something!

I want to read Christine Gross-Loh's book on parenting.  I may end up giving it as Christmas presents to a few people.

Christine Gross-Loh

Author, Parenting Without Borders: Surprising Lessons Parents Around
the World Can Teach Us

Have American Parents Got It All Backwards?

The eager new mom offering her insouciant toddler an array of carefully arranged
healthy snacks from an ice cube tray?

That was me.

The always-on-top-of-her-child's-play parent intervening during play dates
at the first sign of discord?

That was me too.

We hold some basic truths as self-evident when it comes to good parenting.
Our job is to keep our children safe, enable them to fulfill their potential
and make sure they're healthy and happy and thriving.

The parent I used to be and the parent I am now both have the same goal:
to raise self-reliant, self-assured, successful children. But 12 years of
parenting, over five years of living on and off in Japan, two years of
research, investigative trips to Europe and Asia and dozens of interviews
with psychologists, child development experts, sociologists, educators,
administrators and parents in Japan, Korea, China, Finland, Germany,
Sweden, France, Spain, Brazil and elsewhere have taught me that though
parents around the world have the same goals, American parents like me
(despite our very best intentions) have gotten it all backwards.

Why?

We need to let 3-year-olds climb trees and 5-year-olds use
knives.

Imagine my surprise when I came across a kindergartener in the German
forest whittling away on a stick with a penknife. His teacher, Wolfgang,
lightheartedly dismissed my concern: "No one's ever lost a finger!"

Similarly, Brittany, an American mom, was stunned when she moved her
young family to Sweden and saw 3- and 4-year-olds with no adult
supervision bicycling down the street, climbing the roofs of playhouses and
scaling tall trees with no adult supervision. The first time she saw a 3-yearold
high up in a tree at preschool, she started searching for the teacher to
let her know. Then she saw another parent stop and chat with one of the
little tree occupants, completely unfazed. It was clear that no one but
Brittany was concerned.

"I think of myself as an open-minded parent," she confided to me, "and yet
here I was, wanting to tell a child to come down from a tree."

Why it's better: Ellen Hansen Sandseter, a Norwegian researcher at
Queen Maud University in Norway, has found in her research that the
relaxed approach to risk-taking and safety actually keeps our children safer
by honing their judgment about what they're capable of. Children are
drawn to the things we parents fear: high places, water, wandering far
away, dangerous sharp tools. Our instinct is to keep them safe by
childproofing their lives. But "the most important safety protection you can
give a child," Sandseter explained when we talked, "is to let them take...
risks."

Consider the facts to back up her assertion: Sweden, where children are
given this kind of ample freedom to explore (while at the same time
benefitting from comprehensive laws that protect their rights and safety),
has the lowest rates of child injury in the world.

Children can go hungry from time-to-time.

In Korea, eating is taught to children as a life skill and as in most cultures,
children are taught it is important to wait out their hunger until it is time
for the whole family to sit down together and eat. Koreans do not believe
it's healthy to graze or eat alone, and they don't tend to excuse bad behavior
(like I do) by blaming it on low blood sugar. Instead, children are taught
that food is best enjoyed as a shared experience. All children eat the same
things that adults do, just like they do in most countries in the world with
robust food cultures. (Ever wonder why ethnic restaurants don't have kids'
menus?). The result? Korean children are incredible eaters. They sit down
to tables filled with vegetables of all sorts, broiled fish, meats, spicy pickled
cabbage and healthy grains and soups at every meal.

Why it's better: In stark contrast to our growing child overweight/obesity
levels, South Koreans enjoy the lowest obesity rates in the developed world.
A closely similar-by-body index country in the world is Japan, where
parents have a similar approach to food.

Instead of keeping children satisfied, we need to fuel their
feelings of frustration.

The French, as well as many others, believe that routinely giving your child
a chance to feel frustration gives him a chance to practice the art of waiting
and developing self-control. Gilles, a French father of two young boys, told
me that frustrating kids is good for them because it teaches them the value
of delaying gratification and not always expecting (or worse, demanding)
that their needs be met right now.

Why it's better: Studies show that children who exhibit self-control and
the ability to delay gratification enjoy greater future success. Anecdotally,
we know that children who don't think they're the center of the universe are
a pleasure to be around. Alice Sedar, Ph.D., a former journalist for Le
Figaro and a professor of French Culture at Northeastern University,
agrees. "Living in a group is a skill," she declares, and it's one that the
French assiduously cultivate in their kids.

Children should spend less time in school.

Children in Finland go outside to play frequently all day long. "How can you
teach when the children are going outside every 45 minutes?" a recent
American Fulbright grant recipient in Finland, who was astonished by how
little time the Finns were spending in school, inquired curiously of a
teacher at one of the schools she visited. The teacher in turn was astonished
by the question. "I could not teach unless the children went outside every
45 minutes!"

The Finnish model of education includes a late start to academics (children
do not begin any formal academics until they are 7 years old), frequent
breaks for outdoor time, shorter school hours and more variety of classes
than in the US. Equity, not high achievement, is the guiding principle of the
Finnish education system.

While we in America preach the mantra of early intervention, shave time off
recess to teach more formal academics and cut funding to non-academic
subjects like art and music, Finnish educators emphasize that learning art,
music, home economics and life skills is essential.

Why it's better: American school children score in the middle of the heap
on international measures of achievement, especially in science and
mathematics. Finnish children, with their truncated time in school,
frequently rank among the best in the world.

Thou shalt spoil thy baby.

Tomo, a 10-year-old boy in our neighborhood in Japan, was incredibly
independent. He had walked to school on his own since he was 6 years old,
just like all Japanese 6-year-olds do. He always took meticulous care of his
belongings when he came to visit us, arranging his shoes just so when he
took them off, and he taught my son how to ride the city bus. Tomo was so
helpful and responsible that when he'd come over for dinner, he offered to
run out to fetch ingredients I needed, helped make the salad and stir-fried
noodles. Yet every night this competent, self-reliant child went home, took
his bath and fell asleep next to his aunt, who was helping raise him.

In Japan, where co-sleeping with babies and kids is common, people are
incredulous that there are countries where parents routinely put their
newborns to sleep in a separate room. The Japanese respond to their babies
immediately and hold them constantly.

While we think of this as spoiling, the Japanese think that when babies get
their needs met and are loved unconditionally as infants, they more easily
become independent and self-assured as they grow.

Why it's better: Meret Keller, a professor at UC Irvine, agrees that there
is an intriguing connection between co sleeping and independent behavior.
"Many people throw the word "independence" around without thinking
conceptually about what it actually means," she explained.

We're anxious for our babies to become independent and hurry them along,
starting with independent sleep, but Keller's research has found that cosleeping
children later became more independent and self-reliant than
solitary sleepers, dressing themselves or working out problems with their
playmates on their own.

Children need to feel obligated.

In America, as our kids become adolescents, we believe it's time to start
letting them go and giving them their freedom. We want to help them be
out in the world more and we don't want to burden them with family
responsibilities. In China, parents do the opposite: the older children get,
the more parents remind them of their obligations.

Eva Pomerantz of the University of Illinois at Urbana Champaign has found
through multiple studies that in China, the cultural ideal of not letting
adolescents go but of reminding them of their responsibility to the family
and the expectation that their hard work in school is one way to pay back a
little for all they have received, helps their motivation and their
achievement.

Even more surprising: She's found that the same holds for Western
students here in the US: adolescents who feel responsible to their families
tend to do better in school.

The lesson for us: if you want to help your adolescent do well in school
make them feel obligated.

I parent differently than I used to. I'm still an American mom -- we struggle
with all-day snacking, and the kids could use more practice being patient.
But 3-year-old Anna stands on a stool next to me in the kitchen using a
knife to cut apples. I am not even in earshot when 6-year-old Mia scales as
high in the beech in our yard as she feels comfortable. And I trust now that
my boys (Daniel, 10, and Benjamin, 12) learn as much out of school as they
do in the classroom.