But... but... as the Capitalist says: "where's the money in THAT?"

Notice how the Western health system is designed to not solve health/mental problems and drug companies rarely want to take out the root causes, they mostly treat (i.e. suppress) just enough of your symptoms so you can get whatever problems (and/or some others) you have again down the road. Most pills don't help build your system to fight, just buying you time.

And addressing trauma? forgettabouit! The society-at-large have painted a largely negative imagine to psychologists & mental health professions, and associated victim shaming, most people don't even want to seek help?

What say you to those who grow their own food, produce their own power with microhydro, solar, and or wind, (or only buy renewable energy, possible in California) and drive electric vehicles or bicycles when they drive?

What about those who still pollute, but offset their carbon usage by buying credits/planting trees?

Can they blame the problem on the companies who supply destructive products and the junk science that tricks gullible ignoramuses into believing they aren't destructive...or do those companies get to continue to abdicate their responsibility, pawning it off on their customers?

I mean, your position seems to be if you assholes wouldn't buy the lead painted products, we wouldn't be selling it to toy companies and producing studies claiming it's safe....so it's your fault your child is brain damaged....or the same argument over opioids, your fault you listened to your doctor and got addicted, then turned to heroin, not your doctor who told you the pills weren't addictive, certainly not the drug company who told your doctor they were safe, right?
Fortunately, courts don't think that way, just ask Johnson and Johnson.

Yes, customers bear some responsibility for what they buy, but not nearly as much as the sellers, especially true when the sellers advertise by lying about the dangers. When companies lie about their products dangers, they make themselves 100% responsible for their damages.

Okay, the whole last statement is Bullshit.
"Americans are subsidizing the cost of drugs for the rest of the world." "The reason drugs are so expensive in the US, is becuase they are cheaper everywhere else."

BULL
Talk about shifting the blame.
The reason the drugs are so expensive is because the Drug companies are "for Profit" private companies, and they know people will die without their product so they also know there is an urgency for people to have the drugs. So they jack up the price for bigger profits. Stock owners want better return on their investments, so the board and CEO do everything they can/get away with to get as much as they think they can without breaking the bank. AKA, the consumer - of course, there is an acceptable death rate that they factor in, which they feel is safe to shield them from backlash, staying as close to that line as possible.

As always follow the money - see what these companies make in a year.

<iframe src='//players.brightcove.net/2111767321001/default_default/index.html?videoId=6007817856001' allowfullscreen frameborder=0></iframe>
http://players.brightcove.net/2111767321001/default_default/index.html?videoId=6007817856001


"As a result, even with major R&D spending, pharmaceutical companies remain highly profitable. They have the tenth highest average after-tax profit levels of more than 100 different industries. And according to figures from Axios, while drug companies bring in 23% of health care’s U.S. revenue, they make 63% of the total profits."

Congratulations! Your video, How drug companies make you buy more medicine than you need, has reached the #1 spot in the current Top 15 New Videos listing. This is a very difficult thing to accomplish but you managed to pull it off. For your contribution you have been awarded 2 Power Points.

This achievement has earned you your "Golden One" Level 146 Badge!

Your video, How drug companies make you buy more medicine than you need, has made it into the Top 15 New Videos listing. Congratulations on your achievement. For your contribution you have been awarded 1 Power Point.

Revenue from drug companies plays a major role in why the media doesn't even try to cover many stories, especially those that may shed a bad light on the products. There is no excuse for this schlock, and the "some people might need anti-depressants" nonsense in this video is sickening considering the extreme levels of over-prescription.

There are not "two sides" to this story. There are drug pushers, and they have money. The public is getting screwed left,right, and center on this issue.

Damn you VS for making me sign in.

@Jinx
@enoch
@VoodooV

Fair point on acceptance, I guess seeing people on TV smoke it and continue to be productive members of society has its benefits in dispelling the fear around it. Not the best comparison but kind of like how the Cosby Show, Eddie Murphy in 48 Hrs helped bridge racial tolerance in the 80s by exposing whites to black people on TV and in movies.

Totally with you guys on the hypocrisy of policy, and the libertarian argument.

I don't know how much pharmaceuticals actually care about pot legalization. I mean at this point the likes of Pfizer don't do that much actual research. They buy up other drug companies (Allergan is the recent big example) as well as benefiting from government funded basic research.

If anything what they've become specialized in is getting the drugs approved and adhering to regulation (which they probably helped draft and make complicated to keep their advantage). So if anything they should be well placed to be the first to sell pot based drugs in scale when they get fully legalized.

Prisons and law enforcement is a different issue, they do lose out a lot.

On published research:

'Well, here’s a medical expert. For 20 years, she had a front-row seat that very few doctors or researchers ever occupy. Thousands of medical studies arrived at her desk. She was a “queen of judgment.”

She is Dr. Marcia Angell. She was the editor of the most prestigious medical journal in the world, The New England Journal of Medicine.

On January 15, 2009, the NY Review of Books published Dr. Angell’s devastating assessment of medical literature:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” —(Marcia Angell, MD, “Drug Companies and Doctors: A story of Corruption.” NY Review of Books, Jan. 15, 2009.)'

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.
Related

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.

I can see that taser companies get rich by selling equipment to the cops, but wouldn't the US government and various drug companies stand to make MORE money if they legalised (and then taxed) recreational drugs?

I'm not sure if you're serious or not, but there was a study at MIT that showed more expensive placebos were more effective than less expensive placebos. That is, there was a reliable effect of the cost of the sugar pill. I know... depressing right? That's just what we need to tell the drug companies. "You don't even need to do research... just mark up the sugar until it starts working."

>> ^dag:

Yes, but you need to pay until it hurts for the placebo effect to work.>> ^eric3579:
I hope at some point I'm taking sugar pills that work. I'm guessing they are a hell of a lot cheaper.

>> ^ChaosEngine:
Bollocks, ip doesn't stifle innovation, it encourages it. Take pharmaceuticals for instance, without patent protection companies simply couldn't afford the millions required to research new drugs (yes, drug companies are evil, etc, but theyre still kinda important).
As for the difference between physical property and intellectual property, are you really saying that a sculptor deserves compensation for their work, but a writer/musician/programmer doesn't?
That kind of attitude is why idiotic laws like this get written in the first place.


If I want to own your statue I need the physical artifact itself (until 3d printing technology matures...), if I want to listen to your CD I never need to touch the thing. These are real distinctions. This is not a question of what you deserve; it's reality. You cannot cry about it and try to oppose the basic operation of the universe because you want to make your living by singing once into a box. Do gigs, sell tshirts, update your business model and stop crying.

---

Ug hits a couple of rocks together and makes a spark, the spark starts a fire. He shows his innovation off to the rest of his tribe, everyone's very impressed. Soon they learn to copy his technique, now they can eat a wider variety of food, stay warm in winter, keep the god damn flies away - they flourish. Other tribes take notice, so on, pretty soon everyone is using fire.

Ug hits a couple of rocks together and makes a spark, the spark starts a fire. He knows fire is now his intellectual property. He makes a comfortable living starting fires for people, but only if they agree to turn away while he does it. He gets the biggest share of the food, which he never has to bother to hunt for, never mind how hungry the others are. Anyone who accidentally observes his method keeps it to themselves because they know Ug owns the patent to fire, and they're not allowed to know how to make it without his permission. Ug dies. No one is using fire any more.

>> ^gorillaman:

>> ^ChaosEngine:
First up, read my original post. I do not, in any way shape or form support SOPA or PIPA. In fact, I abhor them. So you can leave the childish "government thugs" line out of it.
As to the rest of your arguments, I'm not going to pay you to take a dump, because I don't want your dump. If I did want your "output", I would expect to pay you for it.
As for "extracting the tribute I'm owed", I don't believe I'm owed a damn thing, until you use what I've created, in which case, pay me. If you don't want to use it, fine. But it's still my ip that I worked hard on. It's not "imaginary" property, it is intellectual property and the principal has been around for longer than you would believe (look up the story of Colm Cille copying art works in medieval Ireland).
The quality of the work is irrelevant. If Transformers or CoD or whatever is so shit, don't watch/play it.
As for these posts, I'm pretty sure that when you signed up to this site, we agreed that posts were made under creative commons, or are the property of siftbot or whatever. The point is that there is no expectation of remuneration here. I have no problem with people sharing their content or whatever, but it's still their decision to make.

Do we really have to go over the differences between physical property and indefinitely replicable information?
If you create something, create it for yourself and be satisfied. If I like it, I'm going to use it. That's how our culture advances.
Do you realise how devastating it would have been to human progress if IP had always been around stifling the propagation of new ideas and technologies? I wonder if we'd have made it to the bronze age yet.


Bollocks, ip doesn't stifle innovation, it encourages it. Take pharmaceuticals for instance, without patent protection companies simply couldn't afford the millions required to research new drugs (yes, drug companies are evil, etc, but theyre still kinda important).

As for the difference between physical property and intellectual property, are you really saying that a sculptor deserves compensation for their work, but a writer/musician/programmer doesn't?

That kind of attitude is why idiotic laws like this get written in the first place.

The 'terminally ill' do still qualify for small and large clinical trials, but the severity and complication of their illness will effect their acceptance to a study group. The best study subjects are going to be young, otherwise healthy individuals with a supportive family, close proximity to the research hospital, and a upbeat attitude in the face of the challenges ahead!

Here's a decent read about clinical trials in general: http://clinicaltrials.gov/ct2/info/understand
You might be interested in the 'Phases' part, describing the size of participant pools. You might also be interested in seeing some of the recently approved devices/procedures (they include scans of the letters sent out, which I always find interesting): http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm241143.htm

One last thing to note; you can follow products funded by the government (http://grants.nih.gov/grants/funding/sbir.htm for instance) as they progress by digging through the interwebs. Private companies can get a peak at their publicly funded competition sometimes, which,... well, is actually usually not as useful as you'd think.

>> ^quantumushroom:

Common sense would dictate that drug companies be allowed to offer deals to terminally ill patients, perhaps in exchange for paying for their care. But the FDA is there to make sure common sense is kept locked away.

Common sense would dictate that drug companies be allowed to offer deals to terminally ill patients, perhaps in exchange for paying for their care. But the FDA is there to make sure common sense is kept locked away.

Everything you've stated is true, and the fadeouts of these potential 'cures' certainly don't sell papers like hype does.



>> ^bamdrew:

These are costly and typically slow-moving ventures. A lot of waiting for approvals, signing up and weeding through subjects, processing collected data, etc.. Many promising ideas get lost in the ~4-8 years from rodent animal model to large human trials (researchers leave the project following new ideas, funding dries up, etc.).
One trick you'll often see if you look for it is the country the initial human data is collected in; Portugal (and Scandinavian countries to an extent) has laws with a higher tolerance for experimental use of clinically approved devices and devices shown to be biocompatible than the US, so you'll see a group from Purdue in the middle of Indiana gathering data with surgical staff and subjects who are in Portugal.
The study you cite is also surgically invasive, and the obese subjects are not going to be the healthiest people out there... the fear of random health complications can keep project leaders up at night, and can quietly kill a project if they're bad enough. Related to the study you cite, I'm aware of vagal nerve stimulation being researched for treating depression... in other words, systems in the body that seem straightforward often reveal themselves to be a part of complex, intertwined feedback loops.

>> ^quantumushroom:
While far from a conspiracy nut, I notice that fat-reducing products that have great potential (and even actual results) are never seen nor heard from again. In America alone the 'diet industry' is 40 billion a year.

Two I remember:

Intra-abdominal vagal blocking (VBLOC therapy): clinical results with a new implantable medical device
http://www.ncbi.nlm.nih.gov/pubmed/18549888


There was also a pill that mimicked exercise (stuck at the mouse phase).
Both of these items are from 2007-2008.