We in the medical and public-health enterprises give parents too little reason to trust what we say. In failing to show a caring and competent human face, we've given too many parents reason to spurn the valuable things we have to offer, sometimes with tragic results.

Friends & Colleagues,

We are writing to enlist your help in spreading the word about the deteriorating situation in Côte d'Ivoire and in pressing the United Nations to fulfill its mandate to protect civilians from imminent harm.

We collaborate closely with a team of doctors and researchers based in Abidjan, Côte d'Ivoire. This team provides medical care to over 10,000 HIV-infected individuals in that city, many through PEPfAR-related programs. Their excellent treatment services have improved the health of thousands; their pioneering research has saved the lives of even greater numbers throughout the developing world. These are brave men and women who have witnessed desperate humanitarian emergencies first-hand, who function with little support, and who are not the least bit prone to exaggeration.

Over the last few days, we have received increasingly dire reports from our colleagues. They describe the situation in Abidjan as "pre-genocidal." Several neighborhoods of the capital and outlying areas that are loyal to President-Elect Alassane Ouattara have now been fenced in by troops supporting ex-President Laurent Gbagbo. Civilians attempting to cross checkpoints have been robbed and killed. Gangs of militiamen conduct regular sweeps through neighborhood houses, ostensibly to maintain order but, in reality, to intimidate. Civilians in these neighborhoods are trapped, threatened in their own homes, terrified to leave, and not knowing where to turn for safety. For people with chronic conditions like HIV -- dependent on access to medications for their own health -- an already life-threatening situation is made even worse by the growing national drug shortage and the real danger of leaving one's home just to fill a prescription or to keep a medical appointment.

The political-military situation in Côte d'Ivoire was front-and-center in people's minds a few short weeks ago. But events in Egypt, in Libya, and in Japan have overtaken the headlines. Gbagbo has capitalized on our collective inattention to secure his illegal position and to terrorize the people. The UN needs to fulfill its mandate to protect civilians in Côte d'Ivoire. More than 400 people have been killed and some 400,000 persons displaced while UN troops have been on the ground.

Specific steps that can be taken immediately include: opening UN and French military bases to civilian refugees; establishing a humanitarian corridor to permit civilians to escape the violence and reach these bases; and jamming the state broadcasting system so that it can no longer incite violence.

Certain ways of describing suicide in the news contribute to what behavioral scientists call "suicide contagion" or "copycat" suicides.

Research suggests that inadvertently romanticizing suicide or idealizing those who take their own lives by portraying suicide as a heroic or romantic act may encourage others to identify with the victim.

Exposure to suicide method through media reports can encourage vulnerable individuals to imitate it. Clinicians believe the danger is even greater if there is a detailed description of the method. Research indicates that detailed descriptions or pictures of the location or site of a suicide encourage imitation.

Presenting suicide as the inexplicable act of an otherwise healthy or high-achieving person may encourage identification with the victim....

Dramatizing the impact of suicide through descriptions and pictures of grieving relatives, teachers or classmates or community expressions of grief may encourage potential victims to see suicide as a way of getting attention or as a form of retaliation against others.

Dear Harold,

As the day of your wedding approaches, I am prompted to write a few words of advice to the groom, not because they are necessary but rather because I tend to the verbose. We know that economic theory has made a mockery of Polonius's advice to Laertes, at least during inflationary periods. Nonetheless undaunted, I as a father who is perhaps none too wise, write these tiny gems for what they may be worth to his fledgling prior to the nuptial flight.

But hold on! Who am I to dare such foolery, at times a fallen sparrow myself, and a bearer of old wounds and unanswered questions.... Am I not the wrong man to attempt any dispensation of wisdom? I choose to ignore this question on the basis of pure ego and the belief that a fallen sparrow resurrected has something to chirp about.

What does one say about the joys and pitfalls? The joys are obvious, the pitfalls less so. There are differences between the sexes other than the obvious. Perhaps the most obvious is the male lack of intelligence. I use the word in the Ian Fleming sense. Men really don't, to a large extent, know what is going on. Women, in my experience anyway, know everything that's going on, sometimes before it happens. That's the way things are.

How did this happen to us, this lack of intelligence? The answer is: we read the wrong things. We read the sports page, the financial page, even the entire newspaper. We don't read the tone of a person's voice, and we often don't hear the sound of a person's ego being crushed. There's an entire war going on out there, and we don't even know that it's happening.

Women have intelligence. They know about this war. How do they do it? Well, they ask a lot of questions like: "Do you love me?" Or: "Does this dress look nice on me?" Now you may believe that love is a static condition. Women know that it's dynamic variable that can change state in a nanosecond. They are like radar, sending out periodic signals and analyzing the responses.... It's not really radar, and it's not really extra-sensory, but it's a sense that's very poorly developed in the typical human male.

Well, you're going to live permanently with a woman. What can you do to assure happiness? What should you avoid? ...The single gem I can offer is to avoid surprises. Now surprises come in various forms, such as "I'm leaving you to become a marine biologist," or "I'm leaving because you never pick up your socks." In both extreme cases, the man is completely surprised. The first guy must have seen the college catalogues and the scuba gear, but he never noticed the training sessions with Karl the diving instructor. The second guy heard so many grumblings that he began to ignore them, figuring them as part of the way he and his wife related to each other.

Don't get the wrong idea. Women are not strange malevolent monsters, waiting to be carried off by diving instructors, or necessarily neatness freaks. The point here is that a guy should be aware of what's happening. You should develop your own type of radar, and use it often if not all the time. You should ask questions and take the answers seriously within context that love can be a dynamic variable.

You don't always have to agree, but at least know what she's thinking and what she may object to. You should learn a mental list of her gripes, and your own gripes, and look for the most important ones. In fact, you should discuss these gripes, ranging from "You always have bits of cottage cheese in your teeth," to "I saw you looking at her(him) that way at that party." Talk about the serious things at a time when you can both focus on them in peace--not when one or both of you are tired or distracted. Talk also about those areas that are sacred to both of you. There are many areas where compromise is called for and necessary, but others where compromise should not be made.

When is compromise unwise? I think it is unwise when your own definition of self is at risk. Even though the lack of compromise can lead to confrontation, it's healthier for both people to hold their ground when the very definition of what they are is under fire. This is the hard part: deciding these areas that are so sacred to you that compromise is not to be made. Compromise to sacred areas of self will only explode into serious problems later on.

The question of compromise is interesting in itself. We often tend to compromise in areas that we consider unimportant, such as the selection of furniture or flatware. Leave it to her--it's not important enough to fight over. She may not even know that you have preferences other than her choices. This happens to many men who later find the chairs to be uncomfortable, or the fact that they live in a home at the sufferance of their wife--the mistress of it all. My advice is to take an interest in the home. Help with the choices. Learn what you like and what you don't. The house is also yours to live in. So own up to your responsibilities beyond taking out the garbage. On that topic, you could learn a little about cleaning and house maintenance so that you can be a partner in deed as well as spirit.

In a world where everything is in flux and people are redefining themselves all over the place, find stability in your marriage and in your home. In many ways we are all victims of other people's will. The marriage and the home can be a safe refuge....

In summation:
• Be aware of what is going on.
• Avoid surprises
• Talk to each other often in quiet times
• Make compromises that don't compromise self
• Take an interest in the home, and its furnishings
• Be a partner in household chores

Create a marriage that lasts because it is a happy one.

And....to thine own self be true.

Go fly my bird,

Dad

Dear Representatives John Boehner and Eric Cantor:

We are physicians and medical students who serve patients across America in all 50 states.

Every day, we see a broken health care system that is failing patients and health care providers.

That is why we stand behind the Affordable Care Act as an important first step in fixing our health care system.

We know that you have proposed to weaken or repeal the Affordable Care Act as one of your top priorities in the new Congress.

We believe repealing or weakening the Affordable Care Act will move our health care system backward - and we strongly urge against it. Instead, we ask you to work with us in building upon the Affordable Care Act, making it stronger, and ensuring that we can crate a health care system that works for all Americans.

The Affordable Care Act will cover 32 million more Americans that otherwise would fallen through the cracks of our health care system. It takes the biggest steps in history to improve the quality and reduce the cost of health care. It protects our children, our seniors and our sickest patients from the past abuses of the insurance industry. These are just a few of the reasons why so many doctors and patients support the Affordable Care Act.

I have had breast cancer twice. I am a private practice physician. I see patients every day like me. I do not have health insurance (although I might have been approved for the PA health option that was offered to people with pre-existing conditions), because of my breast cancer history. I have paid into the system for 35 years.... I am appalled each time I hear some one with insurance saying they want to repeal the healthcare bill, especially those who enjoy the benefit of excellent healthcare as a result of our taxpayer dollars. I welcome Mr. Boehner and Mr. Cantor to go without healthcare for one year, then pray each and every day that they or one of their loved ones don't get sick.

I have seen patients avoid going to the emergency room or getting their prescriptions due to lack of insurance. They have died or gone into heart failure.

An adolescent female of our clinic was having heavy periods which had been controlled my medications. When her mother's insurance (and subsequently her insurance) interrupted due to cumbersome paperwork and provisions of her health insurance, they worked for two months to get insurance so they could afford the medication again. In that time, the patient bled enough that she had to be hospitalized for blood transfusions....

My niece, age 25, is likely to die in 6 months or less, of metastic adenocarcinoma of the esophagus despite heroic treatment at a major university hospital. Living alone, with a bare minimum wage income she ignored here symptom until she had almost complete esophgeal obstruction because she did not have health care insurance and made too much money to qualify for Medicaid. Without insurance, she could not get an appointment with a physician.

I am a pediatric oncologist. All of my patients have a catastrophic illness. Patients who are uninsured experience delays in diagnosis and gaps in care that jeopardize their chances of cure. Adolescents who have to leave school because of cancer and its treatment will lose their health coverage from their parents' insurance because they are not students. They too be at risk of delays in care that are potentially life-threatening.

Our clinic's population is primarily insured through Medicaid. Our patient population has grown significantly since the economic downturn. These are people whose lives are already difficult due to poverty and chronic stress. Please, before you dare assume what the American people truly want, come speak to the American people served at our clinic.

Representative Cantor- I look forward to driving up the Shenandoah Valley to be in Virginia once again in the house my mother and father have lived in for four decades... I am a doctor who takes care of children with cancer and with hemophilia, a bleeding disorder that costs on average $100,000-300,000/year for drug costs alone... I am deeply upset by the refusal to take part in the legislative process that so many in our government cynically display as a badge of honor. It is my request that you put your considerable energy and influence into moving the country forward.

All of my patients depend on health insurance to see me, from the disabled schizophrenic to the anxious architect. Since Massachusetts guaranteed health insurance for all, it has become possible for well-trained psychiatrists like myself to "do well by doing good" and forego cash-only practices.... One need only look at how Massachusetts has weathered the storm of the recession to see that our healthcare plan is both morally and economically the right thing to do.

I take care of college and university students at Yale. A recent graduate noticed a lump in his testicle about a month after he had graduated and his student health insurance had expired. He was working a menial job in NYC to pay his bills and had no health insurance. It was heartbreaking to see that I could only offer him my services and exam gratis, but could not do the Ultrasound or labs that he needed desperately to rule out a cancer.

I have a patient who can't get the medicine she needs and is now suicidal...

A Saturday morning free clinic where I work, even in a town full of doctors, has difficulty getting primary care providers or specialty services for patients and the demand grows every week.

I recently saw a young woman who was denied insurance coverage for her thyroid disease. She is a successful entrepreneur in Atlanta who has been creating new small businesses and hiring hundreds of Atlantans despite the economy. Yet insurance companies would not cover her only medical problem. This is a crime. The Affordable Care Act fixes gross immoral actions such as these for patients like mine....

Every time I have a patient who defers a screening test because of concerns over the cost of the copay, I can't wait for the ACA provision to take effect. Every time I get a call from a patient who is having trouble obtaining new insurance because of a pre-existing condition, I am thankful for the ACA....

Not only do patients struggle to get into the system, but as a provider, I had struggled to navigate the most vulnerable patients through the system once they are "in". It would be a shameful act to relinguish the government's duty to provide a standard of health care as stated in the Universal Declaration of Human Rights. I hope that politicians put politics and profits aside to ensure that lives are not jeopardized.

One of my patients who was admitted to the hospital with sepsis looked at me and my resident with utter desperation when we told her she was not yet stable for discharge home. She said, "I made $16,000 last year. I have no insurance. I can't stay in the hospital. I'm sorry, I have to be able to eat." We convinced her to stay, but we just spent her annual salary on a 2-day hospital stay.

I have had several student patients who were able to get coverage through their parents plan because of the expansion to age 26. This has been an enormous relief/benefit both to the parents and the students.

My patient is on dialysis waiting for a kidney transplant for many years. He was generously approached by a friend who expressed a willingness to donate her kidney... One of the potential "complications" of donation is the inability to get insurance subsequent to donating her kidney (she would have the "pre-existing condition" of a nephrectomy - one kidney removal). The potential donor was very concerned about the ramifications to her of this policy.

I am a physician, and the patient story I share is about myself. I have Common Variable Immune Deficiency and my IV's and meds cost more than $6000/month. I have a $200,000 lifetime maximum coverage which will soon run out. If that happens, I cannot possibly pay for the medication.... With the health reform, my lifetime maximum will be eliminated and I will be able to continue to work in a medically underserved community.

President Obama's new health care law takes more than $500 billion from Medicare and spends it all to start a new entitlement program for the nonelderly. The most severe cuts affect Medicare Advantage....

Seniors aren't fooled. These cuts will have a direct impact on their health care. Costs will go up, and quality and availability will go down.

The problem begins with double counting. The Congressional Budget Office estimates that the health law will reduce Medicare spending by about $450 billion over 10 years. But all of those savings, plus massive tax increases, are used in the new law to pay for an expansion of Medicaid and a new entitlement program to subsidize insurance premiums for low-income households.

...the Hospital Insurance (HI) Trust Fund is now expected to remain solvent until 2029, 12 years longer than was projected last year, and the 75-year HI financial shortfall has been reduced to 0.66 percent of taxable payroll from 3.88 percent in last year's report. Nearly all of this improvement in HI finances is due to the ACA.

What's needed is a new vision for Medicare. Instead of micromanaging prices, the federal government should provide oversight of a marketplace in which cost-conscious seniors choose among competing insurance and delivery system options. That's how the new drug benefit works, and costs have come in much lower than expected because genuine price competition drives down costs much more than any payment regulation can.

So how many suicides are associated with the recession? Nobody knows, not yet. The statistics lag about three years, so the official Center for Disease Control numbers still predate the financial crisis. Right now, therefore, the reports remain anecdotal.


But looking at individual counties' or cities' data, there are ominous signs of a real spike. Some counties show no change. Others show dramatic climbs. In rural Elkhart County, Ind., where the unemployment rate is 13.7 percent, there were nearly 40 percent more suicides in 2009 than in a normal year. In Macomb County, Mich., where the unemployment rate is also 13.7 percent, an average of 81 people per year committed suicide between 1979 and 2006. That climbed to 104 in 2008 and to more than 180 in 2009.

The suicide prevention hotlines also show signs of stress. In Jan. 2007, as the recession started, there were 13,423 calls to the National Suicide Prevention Lifeline, a nationwide toll-free hotline. A year later, there were 39,467. In Aug. 2009, the call volume peaked at 57,625.

Pollack cites the Wall Street Journal (circulation 2 million), Fox News (the highest rated basic cable channel in primetime), and Investor's Business Daily (circulation 210,000) as a few examples of the "bad journalism" which peddled the worst kinds of healthcare miseducation nonsense. He's absolutely correct that these forums engaged in shoddy journalism, but their low-quality gutter-dredging techniques successfully brainwashed millions of readers and viewers. That's a big "FAIL" for the state of journalism right there. The worst journalmalism reached the most people.

The reason Pollack believes healthcare is "the best-covered news story, ever" is because a select group could seek out very accurate information if they had the right tools to do so.. Even Pollack acknowledges that only a small part of the population could do this ("I concede that one needed to know where to find this information"). This hypothetical person would first need to be aware that the mainstream media was lying to them. Then, they would need access to the internet (and specifically probably broadband internet). Then, they would need to know where to look for accurate information that delves deeper than 99.9% of the healthcare coverage, which obsessed with the horse race aspects of reform (who's up, who's down, who's mad at Nancy Pelosi this week, blah, blah, blah...)

Yes, it's very cool that people could read the health care bill online, but how many Americans actually did that? We'll probably never know, but it seems likely that far more people tuned in for Fox "death panel" propaganda than sat down to read the health care bill. For people who work two jobs and/or have five kids, it's just easier to turn on the teevee.