Tags for this video have been changed from 'Freedom of Speech, The Kids in the Hall, TKOTH, trouble, work, job, colleagues, company' to 'Freedom of Speech, The Kids in the Hall, KITH, trouble, work, job, colleagues, company' - edited by calvados

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
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Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

>> ^spoco2:

Does no one else find it a little sad that people find smoking weed so central to their lives that they feel compelled to cheer on people doing it in movies?
Surely once it gets to the point where one of the things you identify yourself as is a smoker of weed, you are letting it take up too much of your life?
Do people who drink really watching someone else on screen drink and go 'Fuck yeah man, he's drinking! I drink too! Fuck yeah, I LOVE him!'


I agree with the guy below you in that it has to do with the legality and the social perception of it. Look at any group that partakes in something that straddles the line of socially acceptable or legal and you'll find a group that feels a kinship toward each other. Particularly so if the person identifies themself as such outwardly.

I'd imagine people that say "yeah man smoke it up famous people" are people who willingly identify themselves as regular smokers or "pot heads" or "stoners." For such people this is popular culture and iconic scenes saying "yo man smoking is fine or fun or at least not some horribly illegal activity" to which they say "hell yeah I agree!"

Also for me I like the fact that it brings into question the perception that many people who are more radically against it hold. For many weed is just a lighter drug thats a step or two further than alcohol but for many it's a social cancer and the beginnings of harder crimes and drugs.

For me the common use of it in popular culture and on shows that tend to be on FX, Showtime, HBO, etc. just goes to show it for what it is...a fairly benign form of intoxication that is as close to large scale acceptability as anything besides alcohol has been. It shows it's not that different from people whom get intoxicated from alcohol on a semi-common basis. I would argue that many of my professional friends and colleagues have just as damaging results from their social drinking as I do from smoking and I'd be the first to say that my personal use is greater than theirs.

As a stoner, I'd be surprised to see these same attitudes and emotions surrounding it's use persist if it was legalized or decriminalized as that would take away the social aspect of "we chose to dismiss the law/society and partake in this activity we both enjoy" but it would take many years if not a generation or two for the old ideas to fall off.

The guy at 2:56 is a good friend/colleague.

>> ^scannex:

Certainly didn't take you long to resort to personal attacks. Sorry I annoy you.
Congratulations, you annoy me.
1. Your connection is ridiculous. I must somehow be privileged or sexist to have this view?
2. I guess I cannot figure out your point, since I only directly dealt with #3 in your post it sure sounded like "because she cannot turn off being fat, its nothing like smoking". Your other points are you soapboxing about how you want the world to be and are not something I am likely to convince you about.
3. She needs to binge eat in front of the camera to draw the conclusion that she overeats? I completely disagree with you that SHE is in a situation where being overweight is a necessity.
A point I will concede to: It is WILDLY more expensive to healthily than to eat garbage. Being on a local TV program however makes me think she is likely able to afford healthier choices.
3b. Please feel free to provide some hard numbers on the incidence of genetic obesity
4. I redefined behavior following you redefining behavior as essentially a state one can inhibit in the presence of others. Obesity is a behavioral problem. Feel free to use meriam webster if that link is insufficient for you.
5. I didn't ignore 1, and 2 of your post I just didn't reply to it. I don't agree with you. Period. It is tangential to our argument and while valid arguments will further take it off topic.I will say that you ascribe such heightened value to everything it makes me think you are on the brink of a nervous breakdown.
6. What do I care if what she said was not reprehensible? To be blunt, she cites this as a bullying event. It isn't. That is inaccurate. Its becoming the first warcry of those with hurt feelings. My main problem with it is that doing this has the effect of DEVALUING the term, and often when that happens people become desensitized to it. Not every statement is bullying. Not everyone who hears a negative utterance was bullied.
7. One said wasn't saying Shh. One side was privately making a statment. Voicing an opinion, however dickish. Was it his place? Nope. Was it nice? Nope. Was it his right? Yes if you live in any of the 50 states it is his right. A lot of assholes do things with words, like the westboro baptist church and gay soldiers funerals. When it reaches a point of bullying things need to be done (and in the westboro case something WAS done to stop them). That's a good thing. That differentiation between systemic hatred and one guy writing an email NEEDS to be made clear.
Last to your example of Chris Christie, people are BRUTAL to that guy. He gets his share of mail I assure you. People give him shit for the exact same reason of being int he public eye as well. The sexist/privelaged thing is just wild speculation on your part that only makes an angry situation seem angrier. That says a lot about you and your mindset, too.
>> ^hpqp:

Words



It's a fair point to call me out on making presumptions about you and linking your comments to those I've been reading elsewhere; my apologies for that.

You cannot dissociate my first 2 points above from the third: you do not go telling strangers, even in a passive-aggressive way, that they are unfit to be in the public eye. For someone so quick to see personal attacks in comments about you, you seem rather impervious to those in the letter you defend (then again, 'tis true that I'm not very subtle when pissed). The real tangent, one I should probably not have given so much weight to, is whether or not obesity is something one can show/not show and induce simply by showing it (my argument remains valid, btw, it's just not so important as to repeat it all over, and your strawmen are so obvious as to no longer require pointing out).

Your point as I understand it is twofold: the letter-writer has a right to send the anchor his personal criticism and is right to do so. I only agree with the first part; he has a right to do so ((so long) as it is not harassment/threats), but she is also right to call him out for it, and point out that such behaviour is wrong, and that it participates in a culture that tolerates bullying, by letting people think it's fine to say whatever they think to whomever without questioning whether it might be hurtful or not. And nobody's saying that something like this is as bad as WBC-style bullying or systemic racist bs, just like nobody would argue that a female politician being meowed in a session by a colleague is as bad a case of sexism/misogyny as a continually harassed or beaten wife, for example. They are, however, on a spectrum with a unifying underlying belief, namely "I can and should voice my opinions/(dis)tastes about others without taking how it affects them into consideration (and society has nothing to say about it)".

The reason I projected the whole sexism/privilege thing on your comments is because they contain the same "it's harmless/no big deal" and "just poor me self-victimisation" and "what's with making a private event/exchange public?" and "you're trampling his rights!" dismissals. It was wrong of me to do so, but at least now you can understand why I did.

Speaking of projection, presumption and personal attacks, you sure are quick to jump to (and stick to) the conclusion that the anchor is overweight because she has poor lifestyle choices (the same assumptions behind the letter), which is why I (and @bmacs27) went on the tangent of "there's-more-to-obesity-than-being-a-lazy-junkfood-gobler". The assumption that an overweight person is that way because s/he choses so is insulting and ignorant in and of itself, the same way the GOP's "poor people are that way cuz they're lazy moochers who don't pull themselves up by the bootstraps" is.

As for Chris Christie, I refer to point 1) of my comment above: public denunciation all 'round!

I hope that has clarified my argument. Otherwise, I refer you to @Thumper's comments, less contentious than mine and with which I wholly agree.

>> ^scannex:

So your counter to the point of it being a behavior, is that it is term applied as the result of a series of behaviors which is a combination of over-eating and lack of exercise?
You must be kidding.
And sorry I have to put words in your mouth above, because aside from divine intervention I am not sure what mysterious factors cause one to be obese unless you are referring to genetic disorders/thyroid problems. Have fun finding a source on what % of obese Americans that covers.
It is behavioral, and its remedy is behavioral. I certainly will not say its an EASY behavior to modify (see previous arguments on leptin/dopamine), but you need to deal with it.
Also regarding what is impressionable you are simply incorrect. If you believe a child with two overweight parents that is the result of those parents having an idle lifestyle and providing garbage food for their kids isnt impactful youre dead wrong.
But here you go, some backup for that concept. From the AACAP
No one is advocating mocking is the right thing to do. And if you think this guys letter came from a place of hate or mockery I suggest you reread it. There really is no indication of that to me. It comes from a place of concern, even if that is misguided. You want to crucify this guy for trying to (perhaps poorly) encourage this woman to lose weight and that really isn't the right ethic either.

_{I realised why your comments annoyed me so much: they remind me of those MRA-holes who try to defend the missteps and/or bile of privileged/sexist people and then see them as being persecuted or "witchhunted". I can only hope I am wrong in seeing a connection.}

To the substance: you completely miss my point, go after strawmen, and then try to defend the unethical while falsely accusing the anchor and myself of persecuting a person (instead of criticising a... you guessed it, behaviour).

Yes, certain behaviour causes and/or aggravates obesity, but do you see her glamourously binge-eating junkfood while telling the news? Unlike a meth addict, there are plenty of overweight people who are overweight of no fault of their own. In fact, the example you give about obese parents having a higher chance of having obese children supports my point, not yours. Children of obese parents have a higher risk of being obese genetically, as well as environmentally, and that has nothing to do with imitating the parents' behaviour (but it's their fault, right? They should just exercise and not eat what their parents feed them, right?). Of course the parents who feed their children junkfood are responsible for their child's obesity, but what does that have to do with an overweight woman being on TV? Not to mention that even that can be more complex, since there are socio-economic factors, what with the US's terrible education system and the fact that its cheapest high-calorie food (i.e. what poor/hungry people will buy) is 98% corn-syrup (yes, I made that stat up, but the point remains). Finally, obesity can be a side-product of mental health issues / eating disorders (but then maybe you're the kind of ignorant douche who'd tell people with depression to just stop wallowing in self-pity and be happy; I hope not).

You go on in your second comment to, on your own admission, redefine what a behaviour is so it can suit your argument. Say the following phrase, out loud if need be, to realise how ridiculous your argument is:

"The woman on the TV is behaving/being overweight/fat/obese". See what I mean?

Finally, you accuse her of "wanting to crucify the guy". Did you even read my points 1) & 2) above (you know, the ones you ignored in your answer)? The "guy" is not being attacked (you'll note he has been left anonymous), what he is saying/doing is. His letter is being taken as an example to call out a certain kind of behaviour, one which is rampant in our society, and doing much harm. Whether his letter is a well-intentioned yet ignorant expression of misplaced concern (at best, and highly unlikely) or a surreptitious piece of condescending shaming (much more likely*) is irrelevant. It's anti-bullying month, and she's saying "people, don't do this, and here's why".

Your more recent comment is a perfect example of why what she's doing is of utmost importance:

the spectacle this woman made of herself for someone writing her a private communique over the internet does not warrant ANYWHERE near this attention.
She chose to shine a spotlight on something perfectly hidden, for the purpose of, I don't know... you tell me? To stop imaginary bullying (in her case explicitly here)? To not feel bad about being overweight? I really don't know anymore. Its a bizarre reaction to wantonly make a spectacle of someone suggesting you lose weight.

If what he said was not reprehensible, who cares if it's made public (note once again that no names are named)? Shaming people or projecting one's narrowmindedness on them is all fine, but shhh, don't shed light on it! It's just a private message on the internet, it does no harm! (because we all know that there is no bullying, shaming, sexism, etc. on the internet. Nuh-uh)

When only one side of an exchange says "shhh, don't tell anyone about this, it's private" you usually have a bad situation; and the fact that you would defend the letter-writer and his "right" to not have his error called out does not suggest anything good about your own mindset, either.

In conclusion, it is all the more to this woman's (and her husband's/colleagues') credit that she/they took a "seemingly" (to the thickest out there) innocent letter to expose this form of abuse; a harmful remark need not be shocking or particularly vulgar to leave its mark, and it can even come from good intentions. Maybe some people watching will realise that the words they themselves speak/write are harmful, even if not intentionally, and will be more aware of it in future, while others might realise that the words they heard/read were not so innocent after all, and that they should stop beating themselves up for feeling guilt/shame/self-hate when in fact they've been being worn down by ignorant and/or hurtful attacks.

_{*It would be quite easy to analyse just how ignorant and condescending this letter is, not to mention borderline sexist (try imagining this person writing the same letter to Chris Christie, for example, replacing "girls" with "boys"). Analysis starter kit for you: "choice/habit/lifestyle", and the cornerstone phrase "Surely you don't..."}

I am appalled at some of the responses to this here on the Sift: "she should just take it and shut up", "yeah what's wrong telling someone they're fat" and @scannex's craptacular line of argumentation. This discussion took such a bizarro turn that even bobknight33 has more sense in his comment than a good half of the commenters!

There are several important issues at stake here:

1) Unethical behaviour should be called out, as done here, not silenced/ignored, no matter how "petty" it may seem. Silence (often enforced by shaming and/or interiorised guilt) is one of the main contributors to a culture of abuse of privilege, of bullying, humiliating, harassing, etc etc. I just wish stuff like this (the video) happened more often on TV and in the media in general. The more this kind of behaviour (be it sexist, ableist, bigoted, etc.) is called out as socially unacceptable, the less it will spread over the next generations.

2) Privilege: this guy thinks it is his place to tell a perfect stranger that she's too fat for TV, as if his small-minded opinion was worth anything. Even if it hadn't been so disgustingly condescending, he should know (lets hope that's now the case) that it's not his place to make those remarks. Even if he's a doctor, nutritionist, you name it. He's not her doctor, nor friend, and you have to be pretty fucking stupid to think you're illuminating someone on their hitherto unnoticed BMI, and even more fucking stupid to defend that as "doing her a favour".

3) Obesity is not like smoking. Yes, they are both health problems, but unlike smoking, being obese is not a behaviour. It can be caused/aggravated by certain behaviour, among many other factors. But while a behaviour can be inhibited while in front of others (e.g. not smoking in front of kids/a camera), you cannot "stop being obese". This brings out another distinction, namely that, while seeing people smoke can entice impressionable minds to do the same, seeing someone who is fat will not make one want to be fat as well. Seeing an overweight person on TV having a job or living a normal life might, on the other hand, give hope to people who are mocked and discriminated against for their weight issues, something which does not undermine in the slightest the struggle against obesity.

I could go on, but I've ranted enough as is. Suffice it to say that I fully *support what this woman and her colleagues have taken the courage to do, and hope it is a situation we will see more of in future. We can't (and shouldn't) outlaw douchebaggery, but we sure as hell can make it socially stigmatising, and we damn well should. (and unlike obesity for some, douchebaggery and hateful/hurtful ignorance is something anyone can be cured of)

/rant

The Philadelphia police officer who was captured on video punching a woman in the face will be fired.

Police Commmissioner Charles H. Ramsey said today that he had issued a direct-action dismissal, an immediate step that commissioners can take if they have evidence that an officer has violated departmental policies or the law.

Lt. Jonathan Josey, 39, is a decorated 19-year veteran of the department who has been praised by some colleagues even after the video emerged. He declined to comment. As of Thursday, he is suspended for a month with the intent to dismiss.

Ramsey had previously said he was "deeply troubled" by the now-notorious video.

"From what I saw, it's difficult to justify the actions that took place," Ramsey said Tuesday.

Josey's punch to the woman's head, which knocked her to the ground and bloodied her face, appeared to be a case of excessive force being used to make an arrest, Ramsey said.

The woman, Aida Guzman of Chester, was arrested Sunday for disorderly conduct at a celebration in North Philadelphia following the city's Puerto Rican Day parade. Police said they thought she was throwing liquid at a group of officers, which led Josey to target her.

District Attorney Seth Williams said today that charges against Guzman have been dropped.

Ramsey said police still have not been able to interview Guzman, despite several attempts. He made a public request that she speak to police in order to help move the investigation forward.



Philly officer who sucker-punched woman will be fired

A colleague would totally want this with the cat ears.

oh the last one was the best. the look on the guy's face and then his colleague's reaction were great.

that and the black girl with the gigantic boobies.

Being an Englishman living in America, man did I get funny looks from my colleagues when I used the phrase "cock up" in a training seminar. Everyone thought I'd said the rudest thing in the history of mankind, while I was all, "what?">> ^Quboid:

>> ^spoco2:
Ahh, "It'll be alright on the night", that was a great show that I remember from my childhood.
On the topic of the particular video though... how could they not have actually demonstrated to him how he was supposed to use the carton before going on tv to demonstrate? Ineptitude

This was great stuff. Especially pleasing to hear crusty old English gentlemen say "cock up". That's a phrase that needs to come back.

Yeah, I'm surrounded by colleagues who get all squishy over the latest gizmo. I always tell them "I don't care if you can point your phone at somebody and have it scan their features and somehow call up their birth certificate online and project it as a hologram in mid-air, complete with the 3D embossed county seal. I'd still say big fucking deal, show me something useful".

>> ^mintbbb:

>> ^ant:
news laws blocked
I wonder if she knows about this. Conan should have her come to her show!

CHAGRIN FALLS, Ohio — A local police officer has become an instant celebrity all because of who she looks like. Chagrin Falls Police Sgt. Amber Dacek recently went Hollywood thanks to an interview on FOX 8.
Dacek was featured on the Conan O’Brien show earlier this week. O’Brien showed video from a FOX 8 story where Dacek was being interviewed. The sergeant has a lot of features that resemble the late-night talk show host.
“There is a resemblance, definitely. We both have big foreheads and red hair,” Dacek said by phone.
This isn’t the first time Sgt. Dacek has been told she looks like Conan O’ Brien.
“The kids in town used to call me that all the time,” said Dacek. “I think they thought they could make me cry, or something, try and pick on me.”
The video clip aired on Conan O’ Brien’s show earlier this week. Sgt. Dacek didn’t see the show live, but caught a recording of it a day later when her colleagues brought it to her attention.
“I thought the clip was funny. I am not much of an attention seeker,” she said.
Dacek has watched O’ Brien’s shows before, but admits she doesn’t watch it regularly, because she is either sleeping or working when the show is on the air.
“It didn’t necessarily excite me to see myself on national TV, but I do think it’s funny, and it’s all in good fun, I guess,” Dacek said.
The celebrity status didn’t end with Conan O’ Brien. Sgt. Dacek was featured on FOX 8 News in the Morning on Friday with Kenny and Wayne.
“I’m surprised that there is such a to-do about just the fact that I look like somebody,” she said.
Not just anybody, but a well-known Hollywood Celebrity.
Dacek said she has not been contacted by Conan O’ Brien’s staff to make any appearances on the show.
(http://fox8.com/2012/06/08/local-police-sergeant-conan-doppelganger/)< br>

Thanks.

>> ^ant:

news laws blocked
I wonder if she knows about this. Conan should have her come to her show!


CHAGRIN FALLS, Ohio — A local police officer has become an instant celebrity all because of who she looks like. Chagrin Falls Police Sgt. Amber Dacek recently went Hollywood thanks to an interview on FOX 8.

Dacek was featured on the Conan O’Brien show earlier this week. O’Brien showed video from a FOX 8 story where Dacek was being interviewed. The sergeant has a lot of features that resemble the late-night talk show host.

“There is a resemblance, definitely. We both have big foreheads and red hair,” Dacek said by phone.

This isn’t the first time Sgt. Dacek has been told she looks like Conan O’ Brien.

“The kids in town used to call me that all the time,” said Dacek. “I think they thought they could make me cry, or something, try and pick on me.”

The video clip aired on Conan O’ Brien’s show earlier this week. Sgt. Dacek didn’t see the show live, but caught a recording of it a day later when her colleagues brought it to her attention.

“I thought the clip was funny. I am not much of an attention seeker,” she said.

Dacek has watched O’ Brien’s shows before, but admits she doesn’t watch it regularly, because she is either sleeping or working when the show is on the air.

“It didn’t necessarily excite me to see myself on national TV, but I do think it’s funny, and it’s all in good fun, I guess,” Dacek said.

The celebrity status didn’t end with Conan O’ Brien. Sgt. Dacek was featured on FOX 8 News in the Morning on Friday with Kenny and Wayne.

“I’m surprised that there is such a to-do about just the fact that I look like somebody,” she said.

Not just anybody, but a well-known Hollywood Celebrity.

Dacek said she has not been contacted by Conan O’ Brien’s staff to make any appearances on the show.

(http://fox8.com/2012/06/08/local-police-sergeant-conan-doppelganger/)

Aw, sweet! Also mentions my old classmate and colleague, Steven Barnes.
Thanks!
In reply to this comment by oritteropo:
Hello, and a belated happy Canada day :

I liked this one, you might too:

http://videosift.com/video/Hide-and-Seek