Escalating Cost of Healthcare & Errors in Thinking

Recently, I read an article by Dr. Kenneth L. Davis, president and CEO of Mount Sinai Health System, on the reason that healthcare is bankrupting America. Although the article presents excellent points, there are elements which need to be further examined. There is a totality of America’s history which needs to be taken into account, as well as current micro-management of the system which actually forces healthcare professionals to perform tests which, based on clinical research, are not needed.

Lets start at the history leading to where we are. Over the last eighty years, we have invented and marketed everything from herbicides to medications which have only been marginally tested. Today, we are finding that these products have significantly contributed to the overall deterioration of the populations health. An example is Roundup which was flying off the store shelves during the 1970s through 2000. Despite the political and politic-economic pressures to state that it was harmless to humans, it has become increasingly clear that it is not. This is especially true when the combination of glyphosate with other substances is examined. Also during that time, the utilization of microwave technology and electromagnetic devises has increased, adding an additional form of pollution. I remember back during the late 1960s and early 1970s when Ralph Nader was warning of various problems which could occur. Even in the last episode of Michael Landon’s Highway to Heaven, warnings of our own hubrius in polluting our environment was put forth to help educate watchers on the dangers. Now, in 2019, we are being faced with the contributing damage the rush to making money on various products has had on our health. Since those who have the longest exposure to pollutants are likely to be affected, the increasing senior population in America is likely to continue to increase the costs of healthcare. Perhaps it is past time for the government and healthcare funders to demand a portion of the profits made by the manufactures of the products, which have caused people harm help pay for healthcare for the population they have impacted.

The unfortunate reality is that the strength of a country is in the development of their youth and the ability of older members to pass on knowledge based on lifetime’s of experience. There is significant evidence that many products which have impacted the environment, and continue to do so, are resulting in conditions ranging from learning disorders, to leaky gut syndrome, to cancers, to autism. As we continue down this course of putting profit first, we will find that our healthcare costs and the increasingly deteriorating healthcare in America will collapse from the overwhelming weight.

Although accountability is important, rules have been made requiring physicians to use x-rays and CT scans when clinically these techniques are unrevealing; when use of a MRI would be best. Our penny-smart pound-foolish thinking is costing us more than we can imagine. It is delaying proper care, and trade thorough treatment for “fast fixes” which frequently only allow the problems to get worse. Part of this is because frontline healthcare providers are having to deal with rules made by those with narrow or limited scope of clinical experience. In some cases, individuals with only healthcare administration knowledge are making decision which should only be made by the practicing healthcare provider whose license is on the line.

To give you an idea about the cost of fast fix or limited care, one only needs to examine the trial documents of the case of Kip Kinkel. The boy had been seen multiple time by various psychologists and professionals who each provided services which were limited to specific concerns (i.e., educational ability, mood problems, etc.). Due to the limits placed on the examinations, and the lack of an in depth assessment of need, he was expelled from school, killed his parents, killed two fellow students, and wounded 25 other students. The economizing on thorough assessment and care resulted in not only the loss of life, but months of legal costs, traumatization of a community and multiple families, and other residual effects.

The argument against “fee-for-service” healthcare is based on the premise that healthcare providers are taking advantage of their position. This is more likely the exception rather than the rule. The limitations of funding for healthcare is actually resulting in problems becoming bigger. We live in a very politically based system which does not put the well-being of the individual citizens first, despite the rhetoric.
What is interesting is that over the years there have been many attempts at passing laws and treatries to “hold harmless” corporations, including chemical manufacturers and pharmacological manufacturers, from any liability their products cause. Compare this, and the untethered promotion of potentially harmful products, against the current restrictions and limitations placed on healthcare. It results in putting the cost of this political dance in the laps of the American people who were the one’s harmed. The fact that lawsuits which are costly and place undue burden on individuals, such as the ones against Monsanto/Bayer, is unfortunate. If companies had to pay for any damages that their products caused, the quality assurance before marketing would be significantly higher. This is also part of preventative medicine.

Since we prohibited cigarette and alcohol advertisements on television, limited effort has taken place to limit the persuasive media aimed at unhealthy behaviors. Some pharmaceutical companies have included some of the risks of their medications in television advertisements.
We have slowly usurped the autonomy of individual healthcare professionals, blamed them for the increasing problems with healthcare delivery and cost, and forced them to treat more patients than is realistic if quality care is to be provided. With the politics as they are, the attraction of becoming physicians and other healthcare practitioners is reduced. Why would one elect to complete more than 10 years of education, multiple testing, and required supervised experience, if they can make the same living with a bachelor’s degree going into business or other fields? The need for medical care is like a freight train speeding down hill gaining speed with each second. It is too late to tout prevention without addressing other more pressing issues. If we are to address prevention of health problems, perhaps we need to examine the course industry has taken.

The lack of adequate healthcare is seen throughout the nation. It is difficult for those living in metropolitan areas to realize the extreme limitations which face many American communities. For example, although it was estimated a years ago that there were approximately 28,000 psychiatrists in the USA, many counties and communities do not have a psychiatrist. Even with the utilization of Psychiatric Nurse Practitioners, the demand has far overwhelmed the availability. Left untreated, individuals have turned to self medicating with alcohol, THC, and other drugs. We readily acknowledge the presence of dual diagnosis where individuals with psychiatric issues also have a substance abuse problem. We spend a significant amount on law enforcement and the prison system, but we have failed to see the connection between adequate healthcare and these expenses. Select members of the psychological community have elected to complete training, obtain supervised experience, and the vetting in psychopharmacology and related medical sciences to help, but acceptance of these specialists and inclusion for prescriptive privileges has been limited.

We need to change our thinking about healthcare if we ever expect to solve this problem.

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Why I Keep Bugging People To Study History: The Art of Business

Rory Fleming Richardson, Ph.D., ABMP, TEP

My father worked in international trade for 42 years. As part of his job, he would go to different countries and help local business persons set up factories, set up trade agreements, and arrange the details of doing business. He was more closely involved with the people doing the work, than the people simply moving money around. He was respected by the business persons and the workers. This was not something that was appreciated by other service managers who were more involved in the politics. He worked on principles of fairness, respect, and honesty.

Two thousand years ago one of my great…grandfathers was also involved in international trade. He was known as Nobilis Decurio, or noble provider. He lived in the South part of Israel and had ships which he sailed throughout the then Roman Empire and beyond. One of the locations he would go to was to the area known now as Wales and Cornwall; gathering tin and metals for trade. These areas were outside of the Roman Empire. Eventually, he and others would move to the island nation settling in the area known as Glastonbury, where King Aviragus gave them 12 hides of land which was not to be taxed. His name was Joseph of Arimathea.

Despite a functional international trade, Rome eventually elected to invade Britain and attempt to make it a “client nation”. Why? The answer was control and power. Was this necessary? The answer is “No”. It was simply a way of a few individuals, in the Roman Empire, having more control to increase financial gain and control without having to earn it. Joseph’s skill in international trade gained him the respect of the Roman Empire, with the title Nobilis Decurio, and garnered him the respect of the people Britannia, which was demonstrated by the granting of him 12 hides of land.

When a business person or a community is free to trade and interact on the basis of mutual benefit, the interaction is more likely to be fair and sensitive to the needs of each party. When this is controlled by more detached, less involved parties, people are taken advantage of and placed in positions of inequality.

In many cities in the USA during the 1930s, individuals who were nothing more than thugs would extort “protection money” from local merchants. The protection that was provided was most likely to protect them from reprisal of the thugs who collected the money. What is the difference between that and a government which purposely interferes in international trade to force the development of cartels, which promote themselves, as necessary for international trade?

As problems develop in the world, we have been lulled into believing that additional levels of administration are needed to solve problems. To give the appearance that the interests of the everyday person is being met, meetings of “stakeholders” are held. Unfortunately, the input from those meetings is rarely of significant influence on those commissioned with solving the problems. Many times the interests of an elite few, who are the gathers of power and control, end up being the deciding point.

Perhaps it is time we start to peel off the layers of government, and get back to creating on environment where fair, honest trade can occur.

 

Geophagia: A Spoonful of Dirt to Your Health in Our Changing World

During my childhood, I remember my father asking me if I had eaten my “spoonful of dirt today”. At the time, I took this to mean that some of the dirt I had gotten into had ended up in my mouth. As I grew up, I learned this was not only a metaphor, but also literal. As psychologists, we normally refer to geophagia as Pica. Metaphorically, it means “have you had your dose of life experiences today”. When I started to learn about medical anthropology, I found that the literal meaning stems back to Hippocrates and the practice of eating earth. Hippocrates of Kos (460-377 BC) wrote of the pregnant women wanting to eat earth. “Earth eating” was also noted by A Cornelius Celsus during the reign of Emperor Tiberius (14-37 AD), Aetius of Amida during the Byzantine era, and Gaius Plinius Secundus (23-79 AD). Although some found this to be an odd practice (or pathology), the Ebers Papyrus (approximately 1550 BC) referenced use of medicinal clay for intestinal complaints, as well as for external use on wounds. Records of the ingestion of clay tablets, as anit-inflammatory agents and antiseptics, go back to 2500 BC in Mesopotamia.

Why eat earth or clay? This made more sense when I learned about primitive tribal medicine men who performed brain surgeries and their patients lived. The reason attributed to this was that the patient had been exposed to the local flora and bacteria to a point that he/she had developed an immunity to them. Thus, when the skulls were examined, there was evidence that the cuts in the skull had healed, and that the patient had survived.

In ancient times, the earth contained not only essential minerals and nutrients, but also provided exposure to indigenous bacteria and microbes, which forced our immune systems to develop. Today, we would be hard pressed to find earth that does not contain a significant amount of toxins which are far from helpful. Over the years, we have exposed the earth to various compounds, from pesticides and herbicides, to the excretion of antibiotics, and various medicinal preparations from our bodies. Our almost obsessional preoccupation with avoiding germs has resulted in increasingly deadlier strains of pathogens to develop.

In an attempt to control weather, we have exposed the world to geoengineering, which carries with it other risks, throwing the balance of this planet farther off, to the point that we find our air and land polluted with aluminum, barium, strontium, and other dangerous heavy metals.

Since the 1950’s, various defoliants, herbicides and pesticides, have been used to the point that identified build-up in the environment, and in animals (including humans), is being identified. Some of these chemicals include: organophosphate, carbamate and glyphosate, which are well documented to having a profound impact on the health of individuals and the developmental processes.

We are faced with additional challenges. Humankind’s attempt to create more sources of consumable electricity has resulted in increasingly costly damage to the planet. A good example of this is nuclear power facilities, which produce more waste than is justified for the amount of energy produced. In addition, they carry with them risks of events like Chernobyl and Fukushima which toxify the world, killing off not only the surrounding area; but in the case of Fukushima, impacting life in the world’s oceans and beyond. There are exceptions such as the wolves of Chernobyl who have, by the Grace of God, adapted and survived, but this Grace has not extended to most other life forms impacted by nuclear accidents. At this point, radiation from the Fukushima accident and others is being found in remote locations, including the mountains of Tibet.

The more toxic the world becomes, the more desperate individuals become to find ways of detoxifying themselves and their environment. What is interesting is that some of these detoxification solutions come from the earth. Zeolite has long been a filtering agent to remove contaminates in industry and agriculture. Recently, a consumable form of Zeolite has been used by humans to help celeate heavy metals from the body tissues. Zeolite is a crystalline nano-particle structure which traps contaminates, including radioactive particles, allowing them to be released from the body through the urine.

Studies by Falkinham et al, on the red clays from Jordan, have supported that antibiotic-producing bacteria within the clay were effective to fight off E-coli. Bentonite has also been studied for detoxification properties.

Shilajit, another detoxifier, has been used in India and the Himalaya region. Shilajit is a tar-like organic substance, which comes out from between the rocks in the Himalayan mountain region, which contains minerals in ionic forms; humic acid and fulvic acid.

It would appear that in addition to considering filtering our water from pollutants, excessive fluoride, and harmful chemicals, we will have to make sure, if we are to continue to practice any form of geophagia, the need to do the same for the earth, at least until we find a way of making amends for the harm that we have done her.

Parenting In A Mine Field

Being a parent is many times a frustrating experience. We want the best for our children. In attempts to pass on our knowledge and experience, we can create friction with our children which is perceived not as assistance, but rather, as nagging and attempts to “tell them what to do”. It is like the beginning cook who has never cooked with grease. If a grease fire occurs, the beginning cook may attempt to put it out with water, only to find that this causes disaster. The perception of our children dictates the manner which advice and suggestions are given. When our children repeatedly ignore our advice, we become frustrated. This frustration is perceived as anger. From the child’s perception, the input of the parent is interpreted, at best, as “nagging”, and, at worse, verbal abuse and confirmation that the parent thinks the child is stupid.

For children with special needs or with communication impairments (such as autistic children), this can lay the groundwork for perceived abuse and trauma. Children with any obsessive tendencies are likely to ruminate on these experiences feeding into a self-concept of “not being good enough”, or being “broken”, or being “stupid”. Imagine what it is like for a person with obsessive thoughts continuously having this running through their mind. It is easy to see that even the most well intended input, by a parent or others, can be used to feed into this mantra of negative self-talk.

If we are lucky enough to gather this knowledge of perceptual variations early in the child’s life, parents can work on using positive reinforcement methods helping the child to ingrain the concept of being loved, being believed in, and being supported. Learning to communicate is key. One of the first things that we as parents need to understand is that when children bring us their problems, they do not always want us to help them fix them or to tell them what to do. Listening and being supportive is many times much more important. As parents, we need to learn when our input is desired, when to give it (even if it is not desired), how to draw the options out without being misperceived, and when to just be lovingly supportive.

These are some of the reasons that parents of special needs children need the help and support of not only professionals, but also a support group, which can help to ease the frustration. The unfortunate reality is that parents are in a specific role which can preclude the ability to assist the child, no matter the age, in resolving some problems. If the interactive events of the past have resulted in a perceived trauma, the child will need the help of a therapist to work through these feelings; assuring they do not do more harm in the current and future communication with the parents and others. Parents are simply in the wrong role to do this. Even the attempt to correct the perception, and communicate that there was no harm intended, is likely to be perceived by the child as further “scolding” and “abuse”.

This situation is, by its very nature, also traumatizing to the parent. Although it will take time to work through the feelings and learn to perceive issues differently, it is possible. The first step is getting help.

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Dr. Rory Richardson is a clinical psychologist & neuropsychologist consultant at the SIM Child Heart & Children’s Clinic in Penang (04-655-4058).

Mentoring the Future of Psychology: Promoting Competence

I recently had the opportunity to observe the patterns of declaring specializations in psychology, which occur in developing countries, and the political dynamics of inclusion of professionals from other countries. In countries where psychology has developed, the minimal training as a clinical psychologist required a doctorate, two years of supervised experience, passing national examinations, and vetting by the local regulatory board. Some psychologists declared specializations during this process, which required additional training and supervision, while others would complete their professional training after the doctorate was completed. Traditionally, individuals who wished to practice psychotherapy were required to complete a minimum of two years of additional training, supervised practice, personal therapy, and other requirements.
These traditions have been minimized over the years within some developed countries, but the minimal requirements for psychologists in developing countries have reduced to omission of doctoral training, and minimal clinical supervision (many times by a psychologist who is not a seasoned practitioner or adequately trained). As for personal therapy being required as part of the preparation to be a psychotherapist, this has been almost fully eliminated.
What are the dangers of reducing the standards? The psychotherapeutic technique of role-play can be learned in a weekend, but knowing and practising the technique of “deroling” is rarely used. For example, the patient and another group member act out the conflict the patient is experiencing with his lover. After the roleplay is completed, the patient and the individual playing the lover have developed a closer connection artificially. To reduce the risk of these two individuals proceeding to develop an intimacy based on this temporary role within a therapy session, the therapist would “derole” the person playing the lover by: (1) helping them symbolically shedding the role of lover, and (2) making sure that both the patient and the individual assisting are clear as to the real relationship. The therapist would then monitor to make sure that the patient has not maintained transference issues with the person playing the lover, and vice-a-verse-a.
As a health psychologist, helping a patient to stop smoking is common. A seasoned practitioner would also know that this affects the internal biochemistry and the patient’s reaction to some medications. For example, Olanzapine levels are altered by the patient’s smoking. Communication with the prescribing psychiatrist and primary care physician is essential to avoid problems. In addition, the health psychologist may be in the best position to monitor for adverse reactions brought about by smoking cessation.
As a professional, minimizing the importance of adequate training and post-degree clinical supervision is concerning. In some parts of the world, practitioners at the masters level are touting themselves as health psychologists or psychotherapists without the adequate preparation. As a medical and health psychologist, I understand the value of completing medical classes (i.e., anatomy and physiology, biochemistry, clinical neurosciences, pathophysiology, psychopharmacology, psychoneuroendocrinology, pathophysiology and others) as essential for fully understanding the scope of the field and the patient’s needs. When you add to this the limited number of seasoned professionals, who have clinical experience to provide supervision, this poses two significant dangers. The first is that the patients do not get adequate, professional care. The second is that it introduces a significantly lesser image of health and/or medical psychology to the public. Also, there is a difference between health psychology and medical psychology, as far as further specialization which requires additional training and experience. Besides the dangers this poses to the patients, it demeans the profession and undermines the perception of properly trained professionals.
Although there is a desire to provide for the increasing need for psychological services, reducing the requirements to allow for more providers is harmful. It would be much better to help clarify the gradation of training, and clinically supervised experience by guarding the titles, and providing grades of psychologist: psychological intern, psychologist associate (masters level psychologist), clinical psychologist, and the various specializations.
Even within the specialization of health psychologist, some areas of specialty require even further training and vetting. For example, in the area of treating eating disorders the psychologist must establish competence. Without this standard, results could result in the death of a patient.
Due to the limited number of psychologists in some countries, it is sometimes very difficult to find seasoned specialists. This means that specialists from outside of the country would have to be enticed to work in these lesser developed countries. This is, unfortunately, threatening to practitioners who have established themselves in a country where standards have not been established from the beginning. As international relocation has increased for work, or for other reasons, it is essential that incumbent local practitioners find ways of including specialists in clinical supervision, specialty training programs, and ways of sharing their knowledge and years of experience.
As psychologists, regardless of level of training, we need to find ways of supporting the standards of preparation, while at the same time finding ways of mentoring developing professionals, in achieving the highest level of expertise required.

Rory Fleming Richardson, Ph.D., ABMP, TEP
Dr. Richardson is a Board-Certified Medical Psychologist who is registered as a Clinical, Counselling and Health Psychologist Practitioner in the UK, licensed in Oregon (USA), vetted eating disorders specialist, and experienced Neuropsychologist who has worked with children, adolescents and adults. He has been in the field since 1975 when he obtained his certification as a Trainer/Educator/Practitioner by the American Board of Examiners in Psychodrama, Sociometry and Group Psychotherapy (ABEPSGP). He has served as an onsite examiner for the ABEPSGP, served as the Chairperson of the Oregon Board for Counselors and Therapists, and on the Education Committee of the International Association of Eating Disorders Professionals.

The Big Picture

I was asked how can I focus on the poisoning of people with pesticides, struggles with learning disabilities, coping with psychiatric issues, and helping people with challenges of life when there is so much corruption and evil in the world. The answer is simple. I know that “good wins”. I can not fix the evils of the world or undo the corruption, but I can help my brothers and sisters to live, grow and find hope. In doing this, I have hope. And I am reminded that the big battle…the war…has already been won. I just need to have faith and be thankful. If we remember that we have already won, we have. The actions between are simply the dramatic story line.

Bulimic Education: The Neutralization of Humanity Towards Robots

Many systems of education have deteriorated, over the years, to a point of destroying the learner’s opportunity to develop. This is a radical, extreme statement, but it has been an observation that I have made over at least 50 years of my 62 years of life. Today, we practice a form of bulimia-style learning where students will binge on facts before an examination and then regurgitate them. Unfortunately, retaining these facts is not always present. This does exercise “left brain” activity, but the “right brain” is ignored. The value of music, art, drama, and other humanities have been devalued, as “not profitable” directions. The question of developing reasoning, imagination, critical thinking, and other aspects were discussed in a recent meeting I attended. There is minimal attention placed on these. We have the minimized the value of history, and on the individual life stories people have. I remember hearing about a “classical education”, there becoming versed in a range of classical knowledge was required. Over the years, I have sought to develop this, and have found that it contains the essence of surviving in this world. The classical works of Plato, various literature, Greek plays, fine arts, music, and the stories of elders, have provided the basis for understanding a repeating pattern. It provides the valuing of history and looking beyond the immediate stress and struggles of the acquisition of money and material possessions.

We are faced with an end of some mythologies relating to the value of money and finding that the things of value, are not found in a computer or in technology. Based on theoretical sciences, we are faced with having to deal with multiple dimensions which sound very much like the stories of the spirit world and the battle of good against evil. In this realm, the rote memorization of facts, which can prove that we are “good producers” and “effective consumers”, are of little value.

In these areas, music, arts, philosophy, valuing ancient writing, and finding value in faith, are all of much more value in seeing the connections between this reality and what is yet to be discovered.

Is rote memorization and “regurgitation” of value? The answer is yes, but only to a point which provides basic information to understand other more important concepts. The secret to education is balance between different materials and learning styles which promotes not only recalling data, but also to reason and make humane decisions.