AlterNet.org: Personal Health

Is the Idea of an Intelligent Self-Help Book a Paradox?

Lisa Levy, Los Angeles Review of Books — Fri, 24 May 2013 13:49:00 -0700

Popular self-help book series from the 'School of Life' lacks depth and purpose.

This article first appeared in the Los Angeles Review of Books.

Is the very idea of an intelligent self-help book a paradox? It is certainly trying to serve two demanding masters: philosophical speculation and practical action. After all, readers don’t pick up self-help books just to ruminate on life’s dilemmas, but to be guided to solutions. The new series of self-help books published by the London-based School of Life, co-founded by the Swiss-born popular philosopher Alain de Botton, echoes the school’s lofty approach to problems, claiming to be “intelligent, rigorous, well-written new guides to everyday living.” Yet to peruse the School of Life’s calendar of classes is to fall into a vortex of jargon pitched somewhere between the banal banter of daytime talk shows and the schedule for a nightmarish New Age retreat: “How to Have Better Conversations,” “How to Realise Your Potential,” “Developing a Compassionate Mind: One Day Intensive,” “Philosophy Slam,” “Learning How to Say No,” “Getting Better at Online Dating,” “Resilience: One Day Workshop.” Before long, I was ready to sign up for “How to Stay Calm.”

De Botton himself is a divisive, if not easily dismissed, public intellectual. The author of bestselling books about many of the broad topics the School of Life curriculum covers — love, work, religion, happiness, and philosophy itself — de Botton is often accused of being a purveyor of Philosophy Lite (see, for example, Victoria Beale’s January 3, 2013, attack on him in The New Republic, “How to Be a Pseudo-Intellectual”). His works are securely aimed at the insecure middlebrow reader, the kind of person who knows that Proust can change her life but maybe would rather read about how Proust can change her life than slog through seven life-changing volumes. Indeed, there is something ersatz, if not quite fraudulent, about de Botton’s entire intellectual enterprise: he often seems like a grad student who shows up to seminar having done just enough of the reading to participate by jumping on other people’s comments, but who never makes an original observation of his own. He is constantly quoting and alluding to great figures — Jane Austen, John Stuart Mill, Stendhal, and Freud, among others, all get name-dropped in his self-help book, How To Think More About Sex (about which more below) — but he tends to meander and summarize after a quotation rather than using it to drive his own argument forward.

De Botton has, however, up until recently, been a great champion of philosophy as a way to work through life’s conundrums. His The Consolations of Philosophy (2000) is a charming and, in its own way, useful book that dissects the lives and ideas of major philosophers like Socrates and Nietzsche and applies them to everyday problems like “unpopularity” and “difficulties.” De Botton claims in Consolations that it is possible to “take on a task at once both profound and laughable: to become wise through philosophy.” In this he has positioned himself in a long line of thinkers about the care and maintenance of the self, such that the editing and writing of “intelligent self-help books” would not seem like such a stretch.

Yet the real issue with de Botton’s new book, and the others in the How To series, is not simply a lack of depth but one of purpose: they are certainly shallow in their philosophy, but they are not particularly useful either. The books are combination platters of soft science, anecdotal case studies (some real, some fictional), and exercises or suggestions about steps the reader could take to further his or her goal. Along with de Botton’s volume purporting to inspire more (but not deeper, note) thought about sex, the School of Life series includes How to Stay Sane, by Philippa Perry; How to Change the World, by John-Paul Flintoff; and How to Find Fulfilling Work, by Roman Krznaric. Krznaric’s volume is by far the most successful, perhaps because he is the only one of the authors who does not seem embarrassed by either his topic or the means of treating it. Perry, a psychotherapist, and Flintoff, a journalist, retain a tone like they should be doing their work by more highfalutin means. And de Botton’s book makes an enraging little study (all the books clock in at around 200 pages) of contemporary assumptions about sex, marriage, and relationships, regarded strictly from the point of view of a bored, married, middle-aged man who maybe dabbles in philosophy and fancies himself an intellectual. It’s like being hit on by a paunchy, balding European guy at an office party who tries to seduce you with, well, quotes from Jane Austen and Stendhal, and empty proclamations about the place of sex, marriage, and relationships in contemporary society.

The title of de Botton’s book, How to Think More About Sex, is actually a misnomer, or at least misleading, for he in fact advocates against thinking more about sex, at least if “more” here means “differently” or “better.” He certainly does not want anyone to interrogate the assumptions mainstream society currently holds about courtship and marriage (what a queer theorist might designate as “heteronormative practices”). He never explores any type of relationship outside of monogamous heterosexuality; even the idea of a marriage without children or with, say, a stay-at-home father and working mother seems to be outside of his imaginative purview.

So he’s not exactly Michel Foucault, but there is a historical dimension to de Botton’s thinking about sex. Sometime around the advent of space shuttles and bikinis, he states, “[s]ex came to be perceived as a […] pastime, a little like tennis — something that everyone should have as often as possible in order to relieve the stresses of modern life.” To do this, he cautions, is to take sex much too lightly, as

sex has a recurring tendency to wreak havoc across our lives: it leads us to destroy our relationships, threatens our productivity and compels us to stay up too late in nightclubs talking to people whom we don’t like but whose exposed midriffs we nevertheless strongly wish to touch.

It is an “inherently weird […] anarchic and reckless power,” with which the best we can hope for is “a respectful accommodation.” Given how frightened de Botton seems to be of sex, is it any wonder that his book utterly lacks imagination and a sense of curiosity?

This might in fact be the most boring book ever written about sex. In his (fictional) case studies, de Botton presents us with several boring couples in compromising positions: there is, for example, the “couple in a cafe on a Saturday night at eleven o’clock in a large city, eating ice cream after seeing a film together.” De Botton narrates their entire sexual encounter, with odd asides about their personal histories interrupting the action: “Soon enough he was dreaming of orgies and anal sex, obsessing about obtaining hardcore pornography and fantasizing about tying up and defiling his maths teacher. How could he still be a nice person?” As for the intercourse, it is utterly unerotic: “In a world in which fake enthusiasms are rife […] the wet vagina and the stiff penis function as unambiguous agents of sincerity.” Even the couple’s fetishes are dull: his is for “black, sensible loafers (of the sort often associated with librarians and schoolgirls, and in this instance manufactured by the Italian company Marni)”; hers is for men’s watches, like her father’s.

When de Botton finally gets the couple off, so to speak, he provides a profoundly unsexy definition of sexiness: “The more closely we analyze what we consider ‘sexy,’ the more clearly we will understand that eroticism is the feeling of excitement we experience at finding another human being who shares our values and our sense of the meaning of existence.” There are, of course, other kinds of eroticism, other ways to reach orgasm, not dreamt of in de Botton’s philosophy, but he confidently brands these “empty.” Thus, everything from masturbation (since it is performed alone) to bestiality (since it is nonconsensual) is considered a “betrayal of what sex should really be about”: a procreative couple in love sharing their values and their sense of the meaning of existence.

The only two real positions (no pun intended) that de Botton takes are an anti-pornography stance and a pro-adultery one. Neither, however, are at all radical, and both have a whiff of an acutely masculine frustration. How To Think More About Sex uses another fictional couple, the long-married and long-suffering Daisy and Jim, to illustrate these arguments. The story is timeworn: between work (though it is unclear whether Daisy works outside of the house), children, aging, and dwindling desire, Daisy and Jim’s sex life has all but disappeared. So Jim turns to the evils lurking in the family computer, which de Botton writes about with appalled strenuousness:

[P]erhaps as many as two hundred million man-hours annually that might have otherwise been devoted to starting companies, raising children, curing cancer, writing masterpieces or sorting out the attic, are instead spent ogling the mesmerizing pages of sites such as www.hotincest.comand www.spanksgalore.com.

In the name of productivity, then, de Botton advocates censorship of the internet, as “the entire internet is […] pornographic, a deliverer of constant excitement that we have no innate capacity to resist, a seducer that leads us down paths that for the most part do nothing to answer our real needs.” In the absence of government intervention, though, how can we resist the evils of the internet? Pray. Yes, really: de Botton suggests that religion, not philosophy, might provide guidelines to help individuals keep themselves in line. “A portion of our libido,” de Botton writes, “has to be forced underground for our own good; repression is not just for Catholics, Muslims and the Victorians, but for all of us and for eternity.” He urges readers to fall into line: “We cannot allow our sexual urges to express themselves without limit, online or otherwise; left to run free, they destroy us.” This interest in religion is not new: de Botton’s last book was Religion for Atheists. But the idea that it can solve problems instead of philosophy is a betrayal of de Botton’s earlier work. Apparently, rigorous thought is powerless against the seductions of the internet.

To proceed straight from this pious suggestion to one that long-term fidelity to a single partner might not work out after all would be galling in a writer who cared less about being provocative and more about being consistent, but coherency is not de Botton’s bag. He returns to poor frustrated Jim, sending him on a business trip where he runs into a comely young graphic designer, Rachel, who has done some freelance work for him. A glass of wine, a room at the Holiday Inn, and Jim and Rachel are off to the races.

There is, according to de Botton, nothing the matter with a little extramarital sex, as long as everyone is agreed that the bond between the partners is primary. “That a couple should be willing to watch their lives go by from within the cage of marriage, without acting on outside sexual impulses,” he writes, “is a miracle of civilization and kindness for which they ought both to feel grateful on a daily basis.” The “cage of marriage”? Eek. If you want to kill your libido and quash a budding relationship in one fell swoop, I have the perfect how-to book for you.

***

The School of Life books by de Botton’s epigones are also pretty dreadful. Substituting Philippa Perry’s How To Stay Sane for the rigors of psychotherapy is like insisting that running for the bus rather than going to the gym is sufficient exercise. “Exercise,” indeed, is a loaded word in Perry’s book, as she provides “exercises” for the reader to do in order to put her ideas into practice; these mostly involve lots of making lists and charts. The exercises are designed to increase self-awareness, help deepen relationships, and relieve stress, all elements in keeping life in perspective and thus remaining sane. Yet the most striking element of Perry’s text is her reluctance to be writing it at all: “This is a ‘how-to’ book and at this point I wish it was not, because as soon as we start to legislate relationships, we are already in danger of getting it wrong.” This is, hands down, the most honest moment in the book. Perry is the most hamstrung of these writers by the self-help form; her frustration bleeds through every page. After de Botton, it is a relief to read someone less pedantic and more pragmatic, but Perry’s reluctance to take a position on anything other than breathing and journaling makes her book utterly useless.

Equally maddening is John-Paul Flintoff’s How To Change the World, which offers a great deal of commonsensical advice about what could vaguely be called “making a difference.” Offering such pearls as “the personal is political” and “do what feels good,” the only engaging part of Flintoff’s book are the case studies he offers. Yet many of those have a familiar ring: all the usual world-changing suspects appear, from Gandhi to Rosa Parks to Mother Theresa to Martin Luther King Jr. Flintoff does cite a few lesser known figures, such as Richard Reynolds, who started a “guerrilla gardening” movement in London, and lawyer and environmentalist Polly Higgens, who is working to make “ecocide” (the destruction of ecosystems) a crime. Flintoff provides advice on how to change the world in small ways like reaching out to neighbors, volunteering, giving to charity, or just helping a friend. Overall, though, there is little here that a person with average intelligence could not figure out on her own with good intentions and a couple of Google searches.

After all of these failures, it’s a minor miracle that Roman Krznaric’s How to Find Fulfilling Work works as well as it does. Krznaric accomplishes what the other books do not by harmonizing a philosophical point of view with practical advice. The basic elements here are the same as in the other School of Life books: exercises, case studies, a pinch of philosophy. Yet Krznaric combines them in such a way that the reader is likely to actually feel both challenged and helped by his advice, perhaps because work is a topic you can be both philosophical and practical about without being overwrought. He focuses the book around two questions: first, what are the central elements of a rewarding career; and second, “how do we go about changing career and making the best possible decisions along the way?” It is in answering the second question that Krznaric’s book is most impressive. He notes that most people get bogged down in thinking about what kind of career might suit them, while the best way to figure out what job might be best for you is to try out as many things as possible. Most of his exercises are centered around figuring out how to take this approach which he calls “job dating”: whether it is confronting your fears about job change or writing a “personal job advertisement” which lists your skills and interests but does not mention any particular job you might be suited for. Krznaric then suggests emailing your advertisement to 10 friends in disparate jobs and asking them what you might try to do next. This is a book which is both clever and prescriptive without being preachy: it makes you think about work in a new way, as well as offering real exercises and solutions for people who are looking for more fulfilling work.

In The Consolations of Philosophy, de Botton writes, “It would scarcely be acceptable […] to ask in the course of an ordinary conversation what our society holds to be the purpose of work.” This is one of his throwaway lines, but a telling one: why couldn’t you ask such a question? What is so potentially frightening or offensive about where such a conversation might lead? In thinking back to the ludicrous list of School of Life classes, one could argue that the school — a word which, etymologically, refers to leisure time — is turning what are fundamentally leisure activities into work. Conversation, dating, thinking, feeling, and, alas, philosophy, which is supposed to be the pure love of wisdom, are all made into chores under the school’s rubric. The books the school has produced also turn philosophy into work, without much reward for our efforts: de Botton’s book on sex is too prudish and pedantic; Perry’s on sanity, too soft; and Flintoff’s on changing the world, too pedestrian. Given some of the most interesting topics there are, these writers flinch rather than engage.

How MDMA Can Take You on the Healing Path ... Even for a Former Nun

Ralph Metzner, AlterNet — Thu, 23 May 2013 15:16:00 -0700

Ralph Metzner re-examines uses and potentials of MDMA "Through the Gateway of the Heart."

The following is an excerpt from the book, "Through the Gateway of the Heart; Accounts of Experiences with MDMA and Other Emphathonic Substances," by Ralph Metzner. The first part of the text includes the Foreward to the 2012 edition, and following it, a first-hand experience by a former nun. (Four Trees Publications, 1986. 2012 Edition).

Ecstasy, empathy, openness, compassion, peace, acceptance, being, forgiveness, healing, re-birth, unity, emotional bonding, caring, celebration—these are some of the terms people use to describe their experiences with a class of substances, of which MDMA 3,4-methylenedioxy- amphetamine (also known as Adam, Molly, Ecstasy or XTC) has become the best known. Although related in a general way to the psychedelic “mind-manifesting” substances such as LSD, psilocybin and mescaline, these substances are different in that they do not usually produce visions, hallucinations, or altered perceptions of reality.

Even more importantly, these substances seem to consistently induce a positive affect and reduce or attenuate anxiety—in significant contrast to the classical psychedelics which can amplify and elaborate both positive and negative affects. Because of the high percentage of major positive insight experiences reported with these substances, and the relatively low incidence of undesirable side-effects, these drugs have attracted favorable attention from a number of psychotherapists, who regard them as facilitators of therapeutic insight and change. They have also been used by some teachers and practitioners of meditation, who see them as important amplifiers of emotional and sensory awareness, and as aids to spiritual practice.

The Use of MDMA in Overcoming Fear and Trauma

The book "Ecstasy: The Complete Guide," edited by Julie Holland, MD (Park Street Press, 2001) offers a comprehensive look at the risks and benefits of MDMA, as well as a summary of the pharmacological effects identified thus far. Jessica Malberg and Katherine Bonson in their chapter on “How MDMA works in the brain," summarize the effects the main brain neurotransmitters as follows:

"MDMA acts in the brain through three main neurochemical mechanisms: blockade of serotonin re-uptake, induction of serotonin release, and induction of dopamine release. With these actions, MDMA is essentially a combination of the effects of fluoxetine, a serotonin reuptake inhibitor and anti-depressant; a serotonin releaser and amphetamine, a dopamine releaser (op. cit. p. 29)."

More recent studies by Gillinder Bedi and others have used functional magnetic resonance imaging techniques to show that MDMA attenuated amygdala response to (pictures of) angry facial expressions, but did not affect amygdala response to fearful expressions. Responses to happy emotional expressions were enhanced with MDMA. Further studies done with recognition of emotions in facial expressions in photographs suggested to these authors that MDMA reduced the perception of fear in the images, leading to more “pro-social behavior.” Summaries and detailed descriptions of these and other studies may be found by consulting the MAPS website (www.maps.org), which maintains a comprehensive database of all published research on MDMA and other psychoactive drugs of potential value and interest.

These findings of reduced fear-perception are consistent with anecdotal reports (including many of those in this book) that MDMA significantly attenuates interpersonal fear and anxiety. This is probably the basis for its marked therapeutic utility, especially in the treatment of PTSD, where the perceptual fixations on a real life-threatening situation blocks the normal processing of memories.

The potential applications of MDMA in the treatment of debilitating post-traumatic stress disorder (PTSD), which is now being researched by Michael Mithoefer and associates at the University of North Carolina, is exemplified in two of the accounts in this book, whose authors were able to confront the traumatic experience of rape. One is called “I Can Now Move through the Trauma.”

She wrote:

“There seemed to be some quality of the Adam that broke down the repressive/defensive network and took me back into the experience of the attack that was too much for my psyche to bear. Over a period of eight to twelve months I was able to re-experience fragments of the attack, thereby recreating and de-sensitizing me to the experience.”

The other account, by a school teacher, is titled “To Speak of What Was too Painful to Remember,” and she writes about realizing that a rape that had occurred eight years ago, had been,

“... hidden in the back of my mind… and all the little details that I had wanted to ignore were eating at me like a cancer…The suffering became more intense, but I still wanted to talk about it and I felt that I could deal with the pain, that this was a start to try to defeat this cancer.”

The potential value of using MDMA in the treatment of PTSD can hardly be overestimated, considering that there are some 350,000 veterans from US wars in Vietnam, Iraq and Afghanistan, who are suffering from this and who only receive palliative support, if any, from the usual prescriptions of SSRIs offered by the over-burdened Veterans health care system.

One of the people I (RM) worked with in MDMA-supported psychotherapy in the early 1980s was a Vietnam War veteran, who was able to release an enormous amount of war-related trauma in one intensive session, and subsequently turned his life completely around, becoming a dedicated peace activist and co-founder of the group Veterans for Peace, giving talks with fellow veterans on the realities of war to groups of high-school students (Ed Ellis & Ralph Metzner, From Traumatized Vet to Peacemaker Activist. MAPS Bulletin, Vol XXI, No. 1, 2011).

MDMA, Intimacy and Sexuality

Torsten Passie, MD, a research psychiatrist at the University of Hanover medical school in Germany, has done studies on the neurohormones released in the MDMA state and how this relates to the subjective effects. He states, on the basis of his studies, that MDMA deactivates the amygdala (the seat of fear-rage emotional reactivity) and reciprocally activates prefrontal brain circuits (which underlie calm thinking). This is the neurophysiological counterpart to the empathic understanding of self and others, reported by the patients. There is also a massive release of serotonin, the neurotransmitter associated with a non-depressive, non-fearful attitude. Passie’s research is described in a monograph published in 2012 by the Multi-disciplinary Association of Psychedelic Studies (MAPS): Healing with Entactogens: Therapist and Patient Perspectives on MDMA-Assisted Group Psychotherapy by Torsten Passie, M.D.

To my mind the most provocative of his findings is that MDMA results in a massive release of prolactin, the hormone associated with breast-feeding, as well as oxytocin, sometimes called the “cuddle hormone.” Both of these hormones are released during non-sexual post-orgasmic intimacy. As Dr. Passie points out, this release of non-sexual intimacy hormones correlates perfectly with the often-remarked subjective experience of MDMA-users— that they feel intimate with others, wanting to touch and be physically close, but not sexually aroused.

The experience of sensory and sensual intimacy without sexual activity or even desire is expressed in this book in the account titled “Desire Transcended by Being Fulfilled.” In this account the subject, a 48-year old male, reported an experiment of having a massage at the Esalen retreat center, on two occasions – once without MDMA and once with. The man reported that the second massage

“seemed longer and slower, and my body responses much deeper and more total. I felt blissful. I recalled my wanting and desiring the masseuse, from the first session, and realized I did not have that craving or desire now; instead I felt as if we were making love! The desire was transcended by being fulfilled, virtually (p.125)."

Even couples who were intimately involved have reported that with MDMA the sexual drive was often just not there. This effect is, in my opinion, one of the main reasons why MDMA has such unparalleled usefulness in enhancing psychotherapy: it facilitates the heart-felt, empathic, verbal and postural expression of emotional intimacy, without the slightest hint of sexual arousal or interest (which is often a confounding issue in therapist-patient interactions, as is well-known).

Entactogens vs. Empathogens

I want to say a word here about terminology. Torsten Passie, like most of the European researchers uses the word entactogen to describe the class of drugs like MDMA, whose primary neuropsychological action is a marked decrease of interpersonal and intrapsychic fear —thereby facilitating a seemingly effortless re-integration of previously defended and traumatic memories and perception. This is in marked contrast to the primary effect of the classical psychedelics (LSD, mescaline, psilocybin) which involve visual and affective amplification of all psychic contents and processes, including fear—thereby making difficult or “hellish” trips much more likely than with MDMA (where they are virtually absent). Entactogen means something like “touching within” or getting in touch with one’s own inner processes.

In a friendly debate which I had with a couple of my colleagues in the pages of the MAPS bulletin several years ago, I suggested that “touching within” doesn’t really distinguish the MDMA-type experience from the LSD-type experience. My own preferred term for these substances (and the experience they can facilitate) is empathogen—generating a state of empathy, both empathy for others and empathy with one’s own self in past or present conflict situations. This to me is the basis for the heightened affective understanding, the integration of emotion and reasoning, consequent upon the absence of fear and anxiety, that Dr. Passie’s study demonstrates.

The Use of MDMA in Alleviating Terminal Anxiety

A dramatic and powerful account of MDMA’s ability to attenuate fear and terminal anxiety is given in the book by Marilyn Howell "Honor Thy Daughter," also published by MAPS (2011). In this book, Howell relates how her 27-year old daughter who had colon cancer, struggled terribly to marshall her life-forces and resist the illness, in spite of the increasingly discouraging feedback from the medical professionals and increasingly painful side-effects of the chemotherapy drugs she was receiving. She fought for her life, using one extreme, technological method after another. She didn’t want to hear, think or talk about her possibly impending death. I think most researchers would agree that actually, for end-of-life palliative care the classical entheogens like LSD and psilocybin are better than MDMA at expanding awareness into the spiritual dimensions. But in the case of this young woman, since she was so relentlessly committed to fight for her life, and in denial about death, the turning point came when she could accept the possibility that the MDMA would ease her existing pain and anxiety, without thinking about death, the after-life or similar concerns. She was able to have a relatively peaceful and painless dying, in the company of her loved ones.

When MDMA first became known in therapists’ circles in the early 1970s, its possesion or use was not illegal—until the FDA, invoking emergency powers, placed it on Schedule I in July 1985, just around the time the first edition of this book was published. Because of the change in its legal status, and for obvious reasons of confidentiality, the individuals reporting, the therapists or group leaders facilitating, and the researcher who compiled and edited the accounts all chose to remain anonymous. Now, more than 20 years later, MDMA is still illegal, and listed on the FDA’s Schedule I (along with heroin, cocaine, LSD and marijuana) although researchers can obtain small amounts for their controlled and approved research studies. Such studies all have to be privately funded, since no pharmaceutical company can put its development resources behind it. In spite of the promising research studies demonstrating the relative safety of MDMA, and the positive anonymous self-reports published on the Erowid website—MDMA is no closer to being formally and legally available for any condition or purpose than it was in the 1980s. However the informal, underground distribution of Ecstasy at rave concerts, and in the context of small, anymous, secretive groups, has led some observers to estimate (though of course no hard statistics are available) that several million doses of Ecstasy are distributed and consumed every year—in the US, most European countries, as well as India, Japan, Australia, South Africa and possibly China.

The research with the classic psychedelic drugs (psilocybin, LSD etc) carried out during the 1960s had led to the hypothesis, widely accepted by workers in the field, that psychedelics are non-specific psychic amplifiers, and that the content of a psychedelic experience is primarily a function of the “set” (expectations, intention, attitude, personality) and the “setting” (physical and social context, presence and attitude of others, including the guide). This set-and-setting hypothesis is a useful model in coming to understand the experiences with MDMA also. The specific insights, feelings and resolutions of problems that occur are of course unique to the individual, although there is a commonality in the kinds of feeling states that are named, such as “empathy”, “ecstasy”. Individuals are often able, if their intention in taking the substance is serious and therapeutic, to use the state to resolve long-standing intrapsychic conflicts or interpersonal problems in relationships. One therapist has estimated that in five hours of one MDMA session clients could activate and process psychic material that would normally require five months of weekly therapy sessions.

Because of the importance of the set and setting variables, a brief description of the nature of the set and the setting was requested of each of the individuals whose accounts were included. These are shown at the bottom of the first page of each account; and one can obtain a pretty clear sense of the operation of this principle by comparing that statement with the content of the experience. In addition, the text lists as “catalyst” the precise identity and the amount of the particular substance used. In many of the sessions, an initial dose was followed after an hour or so by a “booster” of a lesser amount of MDMA, or with a related compound called 2-CB. Invented by Alexander Shulgin, the famous independent chemist who identified and synthesized hundreds of previously unknown psychoactive compounds (described in his booksTIHKAL and PIHKAL), 2-CB is in many ways analogous in its effects to MDMA, though much less research has been done on it, nor is it as widely available in the underground scene.

With all these empathogenic (or ‘entactogenic’) substances, the catalyst triggers a change of feeling state, in which insights and perceptions take place. These insights and perceptions, though they may appear ordinary and commonplace when they are afterwards heard or read by others, are felt with a depth and poignancy of emotion that was for most people unheard of in their lives before the time of that first experience.

None of this is meant to say or imply that similar or identical changes of consciousness could not be produced or arrived at without the use of these empathogenic substances. Obviously, many people have in the past, and continue to have, empathic and heart-opening experiences without the use of any external aid, pharmaceutical or other. For the people whose experiences are recounted in this volume, the heightened and deepened state of awareness facilitated by the drug served as a kind of preview, as it were, a taste of the possibilities that exist for much greater emotional openness and relatedness than they had imagined.

They are clearly aware, too, that the drug-experience is a temporary state, and one that can be converted into the ongoing reality of everyday consciousness only with continuing therapeutic and spiritual practice—and not with the continued use of the drug. Most people do not want to repeat the experience very often—it is felt to be too intense, too sacred. Although the possibility of becoming psychologically dependent on this, or any drug, cannot ever be ruled out, there is a fairly high degree of consensus that MDMA is not addicting, in the way that opiates are. None of this positive potential therapeutic work with MDMA discounts or denies the existence of patterns of extreme overuse of Ecstasy that have become associated with the international rave culture, nor do we intend to minimize the potential harm from such overuse.

Under favorable circumstances and with a supportive set and setting people feel that the MDMA experience has elicited true compassion, forgiveness, and understanding for those with whom they have important relationships; and most importantly, for themselves, for their ordinary, neurotic, childish, struggling persona or ego. The relative absence or attenuation of normal amounts of anxiety and fear in these states is perhaps the single most important feature in regard to their therapeutic value. People report being able to think about, talk about, and deal with inner or outer issues that are otherwise always avoided because of the anxiety levels normally associated with those issues.

The accounts presented in this book derive from about fifty individuals, of various ages, professions, and degrees of psychospiritual sophistication. They were apparently gathered from about twenty anonymous therapists, mostly, though not exclusively, from the West Coast of the United States. Some of the reports are from guided therapeutic sessions; others are from sessions with serious psychological or spiritual intention, where the “sitter” might be a trusted friend or partner, rather than a therapist. A considerable number are by individuals who are themselves therapists—which suggests that some of the most promising potentials of these substances may lie in the training of therapists – where the capacity for empathy is a highly-valued.

A smaller number of the reports are from group experiences, usually of a highly structured or ritualistic nature. Although the relatively unstructured, recreational use of Ecstasy in informal small groups of friends is probably more common, most people are agreed that the use of rituals similar to those of the Native American Church, or other shamanic traditions, is the preferred mode of operation when powerful sacramental substances are taken in a group context.

The editor of this volume, the writers of the Foreword and Guidelines, and the publishers, do not advocate the use of any illegal substance. Nor do they advocate that individuals attempt to treat their own medical or psychological problems with the use of this or any other substance. Nor do they recommend the use of these substances by individuals without the supervision and consultation of one’s physician. Given these obvious limitations on the use and accessibility of these drugs, the question might be raised as to the point of publishing these accounts since the experience with MDMA is now one that has become illegal. The answer to this question that the therapists and their clients using these substances would give, is that it is in the public’s interest to be aware of what is an extraordinarily promising new tool for the exploration of the human mind and for the improvement of human relations.

Perhaps greater public knowledge of these substances and their potential human benefits can lead to a considered re-examination of the social and legal framework with which our society deals with such matters, so that as other substances of similar import are discovered, their uses and potentials will not be wasted. Many of the individuals whose experience are recounted in this volume expressed the wish and hope that, given the gravity of the planetary crisis in which we find ourselves, aids to the evolution of consciousness such as these substances will be thoroughly explored, and applied to the solution of the immense human problems that confront us.

***

The following is another excerpt from "Through the Gateway of the Heart." This excerpt, titled, "I Was Resting in the Palm of His Hand," includes the experiences of an ex-nun during an MDMA treatment.

35 year-old former school teacher, ex-nun

Set: therapeutic, spiritual.

Setting: therapist’s office, with guide.

Catalyst: 150 mg MDMA plus 50 mg MDMA.

Perhaps the most obvious feeling for me at the beginning and throughout the session was the incredible sense of peace and release from the bondage that I felt. My body was no longer a trap, a prison, but instead became like a kaleidoscope, a mingling of different energies. I felt myself being several “I”s in a very strange way. Sometimes I felt myself very wise, sometimes I was the adult me (not so wise) and sometimes I was a child. I felt a deep friendship with the guide, as if I had known him for a long time. Certain other relationships came up and I saw them as equally lovable. I was able to detach from intense attachments that bring pain and was able to love gently and freely, a truly wonderful gift for me.

I found myself thinking of God the Father and felt that I was resting in the palm of His hand, just as Isaiah says in the Bible. I was being rocked in a large hand with darkness as universe all around me. It was incredibly soothing and loving. When the guide put on certain music, I felt romantic, and instead of being with God the Father, I was dancing with a very handsome man whom I don’t know. It was very peaceful, not passionate; very graceful and free. Then I was confused, and it became the figure of Jesus. I was amazed. I told the guide that Jesus was my brother whom I loved very deeply. The guide suggested that Jesus was also my lover and yes, I have felt that, though a bit guiltily. But love like that with a man is what I have sought…passion and gentleness together…peace. In my life both aspects have always been separate. A man is either passionate or gentle, and I love both, but they are separate.

I knew instantly what my life’s purpose was…to continue to seek the heart and mind union, to continue to remember the essence within which was so peaceful, in spite of worldly activities. Adam revealed a new potential which I knew was there, but was too afraid to experience alone. As far as my studies, I realized they were important, but they only mattered in the world. I saw that I was worrying too much about others’ opinions of my work. I realized that the intellectual work has been a saving grace for me…I truly love the work of the mind, I have always been an avid reader. But, now I can put it in perspective. I have been putting too much energy in concepts and theories that may change in ten years, whereas the eternal principles of love, truth, self-realization, etc., remain the same. Now I can, with the help of Adam, tap into the deeper resources which were always my goal. I am still a bit afraid of the future, of going back “into the world,” but after the session, I feel that the inner connection will guide me through and I will find my place. The place will definitely be working directly with love energies.

When the guide played Vangelis’ Odes I felt as if my soul had been called. I remembered my Greek heritage and I went back to ancient times in feeling and memory. I felt very, very old. I could have died at that point and not felt bad about leaving my loved ones. Somehow I felt that they would understand. Death was so natural, so peaceful.

With the South American jungle music, I felt very earthy and that felt threatening. I felt that I was going to be sacrificed, and my dream of running away over the mountain was remembered. Going into instinctual waters is very scary for me, I realized then. I felt the possibility of the mind gone wild, of no principles to live by, of evil sorcery and of life being worthless. Since then I have realized that I feel the same way about certain areas of the ghetto where I grew up. in fact, some were even called “the jungle.” There is a sense of being ripped open and apart. I have felt that passion does that, when it is purely egotistical desire without taking the beauty and dignity of the human being into account. In some ways, my quest for the spiritual was to purify myself from those threats. I have never seen that before. But I think I definitely have to face those instincts now, though I am afraid.

During the session I saw my mother’s life and realized that her suffering was hers, not mine. This has been a great release for me. I saw that, just as I could have died then and there and known it was right, that she also, at some level, perhaps had that feeling. I could see under the normal layers, in a way, and know that we all know the truth underneath. So too my mother may have known that someday I would understand and accept her death, without feelings of abandonment. This was a wonderful gift. When I thought of my father, I missed that sense of security and power that comes from the male (at least for me) but I was getting it from God the Father as energy and love. I was able to see my parents as earthly extensions of Divine parents and as such of course limited. But since I now felt the presence of Divine parents, it was O.K. I still hold that feeling to this day, though not as strongly as during the session.

I realized that I have a hard time receiving love, I mean, really experiencing it. I know that I am loved, but I feel shy and don’t seem to give it much importance. I felt a deep sense of self-love, a feeling of rightness about me, as I was. In loving freely, I want to give without expectations but also receive without judgment. I see this very clearly. It will be my life’s goal. I’m really excited about it. Life now becomes a mystery, but a good one. Before, it was always a problem. As a mystery, I am not judged if I am me, I am looking to see who that “me” is. And looking, in itself, is worthwhile. Another relief.

One of the most beautiful experiences of the session was the resolution of Christian and Buddhist compassion. This has been an inner question for me for many years. How could Buddha love and not feel sad; how could Jesus feel sad in loving and still be enlightened? Somehow, during the session, they came together. I saw that Jesus’s heart, sad with the ignorance of the world, was an expression of his life externally, but that internally, he was absolutely sure that he and the Father were one and so, his soul was at peace. Buddha’s external expression was mind, a peaceful, harmonious mind, but his internal experience was a deep sadness and heartfelt compassion for the suffering of the world. So he, too, gave his life to save others from suffering. For me, Jesus and Buddha, in front of whom I pray and meditate, became two sides of the same coin, two perspectives of one experience. That question is over and I am truly grateful, for I can cultivate both heart and mind, knowing that sadness and peace can be simultaneous emotions or feelings, and not judge them as separate. Also, that sadness and love are one aspect and that joy and love are also expressions of love. Love can and should also be practical.

Biblical Medicine? How Religious Corporations Are Gobbling Up Healthcare Facilities

Valerie Tarico, AlterNet — Thu, 23 May 2013 10:15:00 -0700

Catholic hospitals and healthcare corporations are becoming “health care ministries.”

When it comes to matters of individual conscience, Washington State voters have a don’t-mess-with-us attitude that makes Texans look like cattle—and it goes way back.

In 2012 Washington voters flexed their muscle by legalizing recreational marijuana use and marriage for same-sex couples. In 2008, death with dignity passed some counties by as much as 75 percent. In 2006, Washington lawmakers outlawed discrimination based on sexual orientation and gender identity. In 1991 a citizen initiative established that “every individual has the fundamental right to choose or refuse birth control” and “every woman has the fundamental right to choose or refuse abortion.” It also guaranteed an absolute right to privacy around mental health and reproductive issues for teens aged 13 and up. Washington state’s constitution includes an Equal Rights Amendment and (from the get-go) a stronger wall of separation between church and state than the U.S. Constitution.

In other words, west of Moscow, Idaho, and north of Portland, any bishops who want to control what they think of as their sacramental turf --birth, coming of age, sex, marriage, trippy transcendent experiences, and death—haven’t got a chance in hell at the ballot box. Washington even has extended statutes of limitations on child sex abuse—something Archbishop Timothy Dolan successfully fended off in New York and Pennsylvania. The Archdiocese of Spokane declared bankruptcy.

But the Vatican hasn’t survived for 1,500 years by being stupid. And as my devout family members like to say, “Where God closes a door, he opens a window.” The window the bishops found open in Washington takes the form of independent hospitals with financial problems.

Thanks to changes in healthcare delivery, more and more independent hospitals are being forced to merge with large healthcare corporations. The pressures include expensive equipment, complex electronic record keeping technologies, and an Obamacare-driven push for greater administrative efficiency. Rather like mom-and-pop hardware stores that survived by becoming Ace franchisees with standardized, streamlined supply and distribution systems, independent health facilities are surviving through acquisitions and mergers with other hospitals and healthcare corporations.

Of the largest healthcare corporations in the country, five of six are administered by the Catholic Church including the famously conservative Catholic Health Initiatives which operates the Franciscan brand and has $15 billion in assets. By the end of 2013, if all proposed mergers go through, 45 percent of Washington hospital beds will be religiously affiliated. In 10 counties, 100 percent of hospital facilities will be accountable to religious corporations, which are rapidly buying up outpatient clinics, laboratories and physician practices as well.

In the words of the U.S. Conference of Bishops, Catholic hospitals and healthcare corporations are “healthcare ministries” and “opportunities:”

New partnerships can be viewed as opportunities for Catholic healthcare institutions and services to witness to their religious and ethical commitments and so influence the healing profession. . . .For example, new partnerships can help to implement the Church’s social teaching.

Here is the diabolical stroke of genius. In any merger between a secular and Catholic care system, fiscal health comes with a poison pill. One condition of the merger is that the whole system becomes subject to a set of theological agreements call the “Ethical and Religious Directives for Catholic Health Care Services” or ERDs. Rather than care being dictated by medical science and patient preference, a set of religious doctrines place restrictions on what treatment options can be offered to (or even discussed with) patients.

Under these agreements, the patient-doctor relationship becomes a patient-doctor-church relationship: “The Church’s moral teaching on healthcare nurtures a truly interpersonal professional-patient relationship. This professional-patient relationship is never separated, then, from the Catholic identity of the healthcare institution.” Furthermore providers who work in these systems are required to sign binding contractual agreements to adhere to the religious directives, whether or not they are Catholic: “Catholic healthcare services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives . . . .”

The ERDs in full are readily available to public, but here are some key samples and implications:

Fertility Treatment: “Reproductive technologies that substitute for the marriage act are not consistent with human dignity.” This provision excludes in vitro fertilization and related treatments. It especially affects same-sex couples, who may rely on surrogacy or insemination for childbearing, but it also affects the 10 percent of American couples who have fertility problems.

Contraception: “Catholic health institutions may not promote or condone contraceptive practices.” . . . “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” While we don’t typically associate contraception with hospitals, state-of-the-art long acting methods like IUD’s increasingly are provided at the time of delivery, because postpartum insertion improves health outcomes. Under ERD guidelines, a woman who delivers a baby at a Catholic hospital and wants an IUD or to have her tubes tied has to have a second, separate procedure at a secular facility—if she can find one.

Abnormal Pregnancies: “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.” Catholic practice encourages the removal of the entire fallopian tube to end an ectopic pregnancy, rather than the standard practice which simply ablates the developing fetus. That is because the standard treatment is considered abortion, while in the invasive and fertility-destroying surgery, death of the embryo is simply a side effect. More broadly, Catholic “ethics” forbid abortion even to save the life of a mother carrying a nonviable fetus. The battle to save a young woman named Beatriz in El Salvador exemplifies this very situation.

Advance Directives: “A Catholic health care institution . . . will not honor an advance directive that is contrary to Catholic teaching.” Where patient directives and bishop directives conflict, the directives of the bishops take precedence regardless of a patient’s own religious or conscience obligations.

DNR: “The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.” Since this battle heated up, stories are emerging in which Catholic hospitals have force-fed incapacitated patients whose advance directives specifically forbid this.

Death with Dignity: “Catholic healthcare institutions may never condone or participate in [Death With Dignity] in any way.” Physicians are prohibited even from discussing options that exist in other institutions or making referrals.

To many non-Catholics, the most shocking statement in the ERDs is the suggested alternative to death with dignity: “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering."Redemptive suffering is a theological notion that derives from the crucifixion story—the idea that the blood sacrifice of a perfect being could redeem harm done. (Theories about how this works have varied over the course of Christian history.) By extension, suffering itself has redemptive value, which is why Mother Teresa’s order, for example, practiced self-flagellation and glorified suffering of the poor, ill and dying.

Given the clash between Washington State’s independence streak and the top-down approach of the Catholic bishops, Washington citizens are pushing back. After Catholic Peace Health got an exclusive contract near her home in the San Juan Islands, advocate Monica Harrington created a website, Catholicwatch.org to complement the efforts of the national Merger Watch. Merger Watch has been fighting the religious takeover of secular systems across the country for over a decade, and sometimes winning, but describes a recent surge that overwhelms their resources. The ACLU of Washington is ramping up and aggregating funds to fight for a state-wide solution, the first in the country, and is soliciting stories (confidentiality protected) from patients and providers anywhere in the U.S. who have experienced religious interference in medical decisions.

Even so, on May 20, the Seattle Times announced an affiliation agreement between the University of Washington system and Peace Health. Even within Catholic-controlled hospitals, less than five percent of revenues come from the Catholic Church. Most are tax payer funds in the form of Medicaid, Medicare and capital grants for public services—and insurance reimbursement. So, the thought of the bishops influencing a public owned and funded institution adds insult to injury. In response, Columnist Danny Westneat, of the Times, framed a pointed question. “Most of us aren’t Catholic, so I’m guessing we’d never go along with letting the creeds of that one faith run something as universal as education [even if ‘the Catholics have a good record of running quality schools’]. So why are we allowing it with healthcare?”

Why indeed.

How Corporations Are Subverting Attempts to Rein in Their Power

Thomas Mc Donagh, AlterNet — Thu, 23 May 2013 10:07:00 -0700

Citizens have won important policy victories only to be undermined by the growing web of international investment rules and arbitration courts.

In 2009, when the government of El Salvador refused to issue an environmental permit to a Canadian mining corporation, community activists in Las Cabañas rejoiced. For years they had been fighting a pitched battle against the efforts of the company, Pacific Rim, to mine for gold in their region - plans that included the dumping of toxic arsenic in their rivers. It was not a campaign without risk. Four Salvadoran anti-mining activists have been assassinated in the course of their courageous efforts. That victory, however, may well prove to carry a high cost for the people of El Salvador. In a legal assault filed in a World Bank trade court, Pacific Rim is now demanding $315 million in compensation payments from the Salvadoran government, an amount equal to one third of the country’s annual education budget.

That is just one example among many where citizens have fought for and won an important policy victory only to find that victory undermined by corporations using the growing web of international investment rules and arbitration courts. There are many others. Public health campaigners in Uruguay won a huge victory in 2010 when the national government passed new health laws to discourage tobacco consumption. Even though those new laws (including aggressive new warnings on cigarette packages) directly mirrored the guidelines of the World Health Organization, the U.S. corporate tobacco giant Philip Morris retaliated with a $2 billion legal action against the government.

Nowhere is this muscle-flexing by multinational corporations a greater threat than on issues related to sustainable development. The result is a little known but enormous legal obstacle planted directly in the policy path toward a sustainable future. The Democracy Center has just documented that threat in an important new report released this week: Unfair, Unsustainable and Under the Radar: How Corporations Use Global Investment Rules to Undermine a Sustainable Future.

For many this system of corporate-driven investment rules and “dispute resolution” burst into public view a decade ago when Bechtel, the San Francisco-based engineering conglomerate, sued the people of Bolivia for $50 million following the now-famous Cochabamba Water Revolt, after investing just $1 million in the country. A global citizen campaign aimed at the corporation ultimately forced Bechtel to drop that case for a token payment of 30 cents. Yet in the years since, the pile of corporate cases has only grown ever higher.

Another typical current case features dangerous exposure to lead in Peru. When the national government there revoked the operating license for a smelter plant in La Oroyo (operated by Doe Run Peru) in July 2010, the health of the local population and the surrounding environment got some badly needed respite. The village, located high in the Peruvian Andes, has been declared one of the most polluted sites on earth, and in 2007 99% of the children under seven in the neighborhood closest to the town’s smelter had dangerously high levels of lead in their blood. The government deemed that Doe Run Peru’s failure to meet environmental cleanup commitments at the site constituted a breach of the country’s environmental legal standards. However Doe Run’s parent company, the Renco group, has other ideas. The corporation, owned by US billionaire Ira Rennert, has hit back with an $800 million damages claim, enough money to pay the yearly salaries of almost 15,000 Peruvian school teachers (or nearly 6,000 Peruvian health workers).

The world today is covered by an expanding web of over three thousand bilateral and multilateral trade and investment agreements. These agreements grant rights to corporations and allow them to sue governments for policy initiatives that they claim interfere with their profits. The resulting legal cases, despite their far-reaching local consequences, are settled far away and behind closed doors by a small group of unaccountable private lawyers in international dispute arbitration tribunals. Flying in the face of democratic principles and judicial independence, these tribunals operate with little or no public scrutiny and where the communities directly affected are denied a voice.

The number of these investment cases has exploded in recent years, with 2012 breaking all records. By far the most popular tribunal system used by global corporations is the World Banks’ infamous International Center for the Settlement of Investment Disputes (ICISID). Corporations can use this and other tribunal systems to demand hundreds of millions of dollars in compensation from governments – not just for what they have actually invested in a country, but also vast amounts more for the profits they expected to earn into the future. The lawyers at these tribunals move seamlessly from the role of ‘independent’ arbiter to that of corporate attorney. Some have strong ties to multinational corporations and serious questions have been raised about their independence in an unaccountable system in which they have such a huge vested interest. Although previously used as a court of last resort by aggrieved investors, these tribunals have become the weapon of choice for corporations in their attempts to clear the path for profiting at the expense of public health and the environment.

The proliferation of these investor-state cases has three major impacts. First, in cases where the corporations win (as they often do) the result is a massive transfer of scarce public resources to wealthy private corporations. Second, even if governments are successful in mounting a legal defense, doing that comes at a cost of potentially millions of dollars in legal fees paid to one of the handful of high-priced law firms that specialise in such cases. Third, the net impact is a dangerous chilling effect on the willingness of policy makers to implement policies in the public interest for fear of costly international arbitration cases.

The international investment rules/tribunals system has been used to attack anti-nuclear efforts in Germany, public control of water in Argentina and Bolivia, anti-mining efforts across a host of nations, and today has new targets in its sights.

One new likely battleground is citizen and community efforts against oil and gas extraction by hydraulic fracturing or ‘fracking’. The proposed investment chapter of the Canada-EU free trade agreement, if approved, may give corporations the legal fire-power to challenge government regulation of this highly controversial practice. Efforts to curb the dumping of climate-changing carbon into the atmosphere are also at risk. The South Korean government has shelved a plan to introduce a low-carbon incentive system for the auto industry because of fears that the law would breach a provision in the US-South Korea free trade agreement. If the government were to move ahead with the measure it would risk landing itself before theseinternational trade and investment courts.

Today, just as communities in El Salvador and Peru have taken up the battle to protect their natural resources, a whole global movement is emerging to rethink the relationship between economic development and social and environmental well-being, and is pushing governments to take policy action in that urgent direction. This important shift, however, is in direct conflict with the interests of transnational corporations hard-wired to maximize short-term profit and pass on the environmental and social costs of their operations to others. The Democracy Center’s report puts a spotlight on how global corporations are using the investment rules system to undermine the policies essential to sustainable development and the democratic process essential to such policies.

Long an obscure interest of trade and investment lawyers, the system of international investment rules and tribunals has remained off the radar for most of the groups and communities that it affects. This is slowly beginning to change. As the number of controversial cases rises, the injustice of the current system is becoming increasingly clear.

Much as the deregulation of financial markets encouraged by the banking sector helped lead to economic collapse, the system of international investment rules works pushed by multinational corporations is leading us toward environmental collapse. As we hurtle towards a number of ominous tipping points in terms of many of the earth’s natural systems, there has never been a more urgent time for activists, academics, development workers and others to understand the legal and political barriers that block us from changing course. This de facto privatized justice system for big business is a massive such barrier that urgently needs to be brought down.

In the Age of Social Media, People Say They Want More Real Friends

Jodie Gummow, AlterNet — Wed, 22 May 2013 18:05:00 -0700

An innovative study reveals that more than 75% of Americans are unhappy with their friendships.

Have you ever felt like your friendship is suffering from a prolonged period of stagnation? You’re not alone. According to Lifeboat co-founder Tim Walker, most Americans say they would prefer to have deeper friendships than more friends.

“People are feeling more insecure and unconfident about the quality of their friendships than ever before. That’s the experience of most adults across the country,” Walker told AlterNet.

Walker and co-founder Alia McKee, launched the very first "State of Friendship in America Report 2013," in response to their own independent, mid-life friendship slumps, with a view to discovering what friendship in adulthood really meant.

“We wanted to see if the friendship crisis in our own lives and in academic studies was taking a toll on the real lives of American people,” McKee told AlterNet.

Drawing upon academia, expert advice, philosophy and the assistance of two research teams on the quest to unlock the social science of friendship, McKee and Walker surveyed over 10,000 Americans across the country in search of finding answers.

Among the key findings in the study was that gen-Xers and baby boomers are hit hardest by the friendship crisis, exhibiting lower levels of satisfaction then millennials and seniors.

“Today’s generation is extremely busy and heavily invested in juggling a career and family and as a result these friendships have been sacrificed,” McKee explained.

The report also found that while women said they had access to more intimate friendships than men, they were not any happier than men with the state of their friendships. What’s more, the use of social media did not factor in the quality of one’s friendships or one’s overall friendship satisfaction.

“We have broader connections than ever before. However, social media isn’t helping us connect in terms of creating better friendships. The real gauge on whether people will be satisfied depends on the depth of the relationship you have created,” Walker said.

The good news for those of us who are suffering from "friendship inertia" is that there are a number of easy techniques we can use to spice up our old friendships or recreate deeper bonds. According to McKee, those seeking greater fulfillment from their friendships should invest more time and energy into the relationships they consider “close” -- with one of the primary predictors of friendship being "proximity."

“We’re not purposeful about who we choose as friends. Friendships happen to us through work, our daily lives and where we live. One of the joys of life is being introduced to new ideas, new professions and new ways of thinking. By purposefully seeking out people who are different from us, we can become more satisfied in relationships,” McKee told Alternet.

In addition to providing insight into the art of making and having friends, the study also revealed some quirky facts about friendships across various demographic groups in the United States:

Those who attend religious ceremonies once a week or more are twice as satisfied with their friendships then those who do not.
Conservatives are more satisfied in friendships than liberals.
Urban residents are happier with their friendships than those living in rural areas.
Most Americans don’t believe their close friends would bail them out of jail, lend them $500 or donate a kidney.

If you’re interested in how to become a better friend, Lifeboat has developed a list of Ten Simple And Powerful Practices of Amazing Friends to give people practical solutions on how to become an excellent friend. As Walker explained, “deep friendships give people greater meaning in life, higher levels of longevity, clear direction and a higher degree of empathy toward others.”

Austerity Kills: Crippling Economic Policies Causing Global Health Crisis

Amy Goodman, David Stuckler, Sanjay Basu , Democracy Now! — Tue, 21 May 2013 13:26:00 -0700

Economist David Stuckler and physician Sanjay Basu examine the health impacts of austerity across the globe in their new book.

The following is reprinted from the Democracy Now! interview,"Why Austerity Kills: From Greece to U.S., Crippling Economic Policies Causing Global Health Crisis."

In their new book, "The Body Economic: Why Austerity Kills," economist David Stuckler and physician Sanjay Basu examine the health impacts of austerity across the globe. The authors estimate there have been more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States since governments started introducing austerity programs in the aftermath of the economic crisis. For example, in Greece, where spending on public health has been slashed by 40 percent, HIV rates have jumped 200 percent, and the country has seen its first malaria outbreak since the 1970s. An economist and public health specialist, Stuckler is a senior research leader at Oxford University. Dr. Basu is a physician and epidemiologist who teaches at Stanford University. "Had austerity been organized like a clinical trial, it would’ve been discontinued given evidence of its deadly side effects," Stuckler says. "There is an alternative choice that we found in the historical data and through the present recessions: When we place people and their health at the center of economic recovery, it can help get our economy back on track faster and yield lasting dividends to our society."

Amy Goodman: "Early last month, a triple suicide was reported in the seaside town of Civitanova Marche, Italy. A married couple, Anna Maria Sopranzi, who was 68, and Romeo Dionisi, [who was] 62, had been struggling to live on her monthly pension of around 500 euros [around $650 a month], and had fallen behind on rent.

"Because the Italian government’s austerity budget had raised the retirement age, Mr. Dionisi, a former construction worker, became one of Italy’s esodati (exiled ones)—older workers plunged into poverty without a safety net. On April 5, he and his wife left a note on a neighbor’s car asking for forgiveness, then hanged themselves in a storage closet at home. When Ms. Sopranzi’s brother, Giuseppe [Sopranzi, who was] 73, heard the news, he drowned himself in the Adriatic."

Those are the opening lines to a startling recent article in The New York Times headlined "How Austerity Kills." The authors of the piece, David Stuckler and Dr. Sanjay Basu, have just published a new book looking at the health impacts of austerity across the globe. The authors estimate there have been more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States since governments started introducing austerity programs in the aftermath of the economic crisis. In Greece, where spending on public health has been slashed by 40 percent, HIV rates have jumped 200 percent, and Greece has seen its first outbreak in malaria since the 1970s.

David Stuckler is an economist and public health specialist. He’s a senior research leader at Oxford University. Dr. Sanjay Basu is a physician and epidemiologist. He teaches at Stanford University. Together, they’ve written this new book, out today, called The Body Economic: Why Austerity Kills—Recessions, Budget Battles, and the Politics of Life and Death.

We welcome you both to Democracy Now! I’m glad you could both be together in one place, being at Stanford and being at Oxford. David, let’s begin with you. Lay out the thesis of this book.

David Stuckler: We’ve been studying how recessions affect people’s health over the past decade, looking at the Great Depression through the East Asian financial crisis, right through to the present Great Recession. And what we found is that recessions hurt. Unemployment, job loss, foreclosure, unpayable debt are risks to health. But what ultimately matters is how politicians respond. And when they make large cuts to social supports, social protections, they can turn recessions into severe epidemics.

Amy Goodman: So, explain. Give us examples in countries. I mean, this horrific story I just described of this triple suicide, the couple and then her brother. Talk about what people—what happens when policies go one way or the other.

David Stuckler: Greece is in the middle of a public health disaster, as you mentioned. To meet budget deficit reduction targets set by the so-called troika—the International Monetary Fund, the European Central Bank and European Commission—Greece has cut its health sector by more than 40 percent. At a time when homelessness is escalating and austerity has further driven up youth unemployment, we’ve seen HIV infections jump, concentrated in injection drug users. The malaria outbreak was linked to the cut in mosquito-spraying prevention programs, creating an outbreak that’s much more costly to control than the short-term money saved by reducing the budget. Healthcare access has declined substantially. The majority of people who have lost access are pensioners who have contributed to the system their entire lives. And these are just a few of the many health effects seen in Greece, mirrored in Spain, Italy and, to some extent, the U.K. and the U.S.

Amy Goodman: We were just talking before the show about one of the suicides in Spain that became very well known. I wanted to turn to a clip. At the time, we were talking to a formerDemocracy Now! producer, María Carrión, about this case that occurred in Spain. The woman, David, was named?

David Stuckler: Amaia Egaña. It was a case of Spain’s eviction suicides. Spain has a system where when people’s homes are foreclosed, even if they default on their home, they’re still liable to pay back the debt. So people are plunged into poverty and arrears at the same time, without support. We’ve seen this trigger large rises in suicides. Spain, Italy and Greece are at the high end of increases in economic suicides.

Amy Goodman: So, Amaia Egaña was 53 years old. She jumped from a balcony to her death as she was about to be evicted. María Carrión appeared on the show to talk about Amaia’s suicide.

María Carrión: Amaia is a former city council member in a town—the town of Barakaldo in the Basque Country. And her case is especially tragic because she actually didn’t share just how bad off the situation was even with her husband. So, most people had no idea that there was a whole—there had been a repossession and an eviction process. She was so desperate and so ashamed of the situation that she jumped out of her balcony, her fourth floor apartment, as court employees came to evict her. This comes two weeks after police found a man dead in his apartment as they went in to evict him from his home after repossession.

And—but, you know, the movement to stop these evictions and repossessions has been working very hard on this for almost two years, and this is just the watershed. This has been the one situation that has actually forced government and the opposition and banks to come to the table and talk about real reform. Before this, you had these evictions taking place—500 orders every single day—silently. And thanks to the 15M movement—this is—was the Occupy movement in Spain just over a year ago—the platform against evictions was incredibly energized. And so, they have been able to stop hundreds of evictions.

But those are evictions of people who come to them and who say, you know, "My home is being repossessed. I’m facing eviction. Can you help me?" There are a lot of people like Amaia who did not do this, out of perhaps a sense of guilt or embarrassment. And so, her case is really representative and emblematic of what has gone wrong in Spain with, you know, thousands of people being left homeless after repossession and eviction.

Amy Goodman: David Stuckler, you were in Spain when Amaia killed herself.

David Stuckler: I was at a conference with the Barcelona Public Health Agency. The meeting got cut short as protests erupted onto the streets of Barcelona. People were outraged at the eviction-suicide of Amaia, at the hardship perpetuated by deep budget cuts under the Rajoy government in Spain.

Amy Goodman: On April 4, 2012, a 77-year-old retired Greek pharmacist named Dimitris Christoulas shot and killed himself near the Greek Parliament after writing a note that blamed his suicide on the economic crisis. His daughter Emi spoke at his funeral and said his act had been deeply political.

Emi Christoulas: [translated] You found it unacceptable that they were killing our freedom, our democracy, our dignity. You found it unacceptable as they tightened the harsh noose of economic austerity and apartheid around us, to the unacceptable act of surrendering our independence and the keys to the country. It was unacceptable to you that Greece did not acknowledge its children and its children did not recognize their own country. You found the bestiality of capitalism unacceptable, that it infiltrated our lives and no one tried to stop it. Then, you made your decision to become the fear, the death, the memory, the sorrow of our ruined lives.

Amy Goodman: Sanjay Basu, you have found more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States. Since when? How did you come up with these figures?

Dr. Sanjay Basu: Right. One of the major questions we asked here: Is this inevitable during a recession? Recessions are bad times. Could this just be the recession’s effects as opposed to austerity’s effects? And so, what we did is used so-called natural experiments. We compared regions and countries since the beginning of the recession, and even beforehand, to control for people’s pre-existing conditions, pre-existing mental health and alcoholism and so forth, and also compared areas that faced the same economic shock but had different policy responses. And looking at those as comparative cases, we could find that, in fact, during recessions, inevitably suicides or alcoholism didn’t increase, but rather, it was after austerity, in particular. And controlling for other factors that could statistically explain this, austerity consistently came up as a key trigger not just for suicides, but for alcohol, stress-related heart attacks and other major causes of death.

Amy Goodman: Now, this is the key point here, is the difference—I mean, people can say, "Well, hard times lead to, you know, very painful decisions that people make."

Dr. Sanjay Basu: Mm-hmm.

Amy Goodman: But that you’re saying that even in equally difficult situations, when countries opt for another solution, the public health of that community changes.

Dr. Sanjay Basu: Correct. We can look, for example, at Iceland as a contrast. Now, Greece and Iceland are very different socially, politically and economically, but Iceland serves as a nice case in point right now. They had faced a debt at 800 percent of GDP, the largest banking crisis in history compared to the size of the economy.

Amy Goodman: When their banks failed, their three top banks failed.

Dr. Sanjay Basu: Correct, all three major banks failed. And they had invested, of course, in U.S. mortgage-backed securities. After this, the Iceland politicians decided to do something truly unique as compared to the rest of Europe. They actually put the austerity plan to a public vote. And the public voted that instead of paying off bankers’ debts immediately through public cuts, they would instead do it gradually. They would still bail out their banks, but over the course of time and with great pace towards preserving their social safety net. And indeed what Iceland ended up doing was maintaining some of the healthiest standards in the world and the highest level of happiness.

Amy Goodman: We were just joined by the Icelandic Parliamentarian Birgitta Jónsdóttir onDemocracy Now! here in New York—she had just come in from Iceland—talking about how Iceland recovered from the collapse of its banking system. A part of what the country did, as you said, was to preserve its universal healthcare system.

Birgitta Jonsdottir: Actually, everybody has the same access to health and education. So even I, as an MP, ended up in a hospital in November, and I got exactly the same treatment as the woman working in the factory or in McDonald’s or Domino’s. And I like that. I love that. I think that is so important. And so, we pay just about the same amount of taxes as U.S. taxpayers. We don’t have to live in this insurance jungle. So we just, you know—and that was actually one of the first things they wanted to slash down, the IMF—no surprise.

Amy Goodman: They preserve their healthcare system.

Dr. Sanjay Basu: Mm-hmm. And indeed she highlights one of the key issues here, which is that there’s a great misunderstanding around debts and deficits. When we face a liquidities crisis, meaning that there’s a collapse in demand in the system, we actually find, quite robustly, through peer-reviewed journals and consistent with those of our colleagues, that stimulus early on does not actually produce higher, longer-term debts, but it generates the revenue and the building of the economic cycle that allows us to pay off those longer-term debts. By contrast, these short-term cuts end up so slowing the economic cycle that we find both economic and public health devastation as a result.

Amy Goodman: After break, I want to talk about the U.S., but, David Stuckler, you said you looked at the labor policies of places like Sweden and Finland in times of recession.

David Stuckler: It’s a remarkable case study. It alludes to what Sanjay mentioned earlier. Sweden faced a large banking crisis. Unemployment jumped by more than 10 percentage points. And yet suicides fell steadily. What we learned is that when politicians managed the consequences of unemployment well, they were able to prevent a mental health crisis. The specific programs we found are called active labor market programs. These help the newly unemployed link to caseworkers, develop an action plan and return into jobs. They treat unemployment like the pandemic it is. It not only saves money on healthcare bills, but even pays for itself by helping spur economic recovery.

Amy Goodman: We’re going to talk about what choices the United States is making, with David Stuckler and Sanjay Basu. Their book is called The Body Economic: Why Austerity Kills. Stay with us.

[break]

Amy Goodman: The Centers for Disease Control and Prevention recently revealed the suicide rate in people aged 35 to 64 rose by nearly 30 percent over the past decade, to 17.6 deaths per 100,000. The biggest increase was seen for men in their fifties, where the suicide rate increased 50 percent. Overall, suicides are now a greater cause of death in the United States than car accidents.CDC Director Thomas Frieden recently spoke to PBS NewsHour.

Dr. Thomas Frieden: We don’t know what specifically is causing it, but the trend has been consistent. And, if anything, our numbers would underestimate the gravity of the problem. And, of course, even one death from suicide is a terrible tragedy, and many of them are preventable. We know that in times of financial stress, there is generally an increase in suicides. We also know that this is a generation that grew up at a time when they expected more than some have been able to achieve in their lives, and also that they’re stressed with what their kids are going through and what their parents are going through. So it’s, in some ways, the sandwich generation.

Amy Goodman: That’s CDC Director Thomas Frieden on PBS. We’re joined by David Stuckler and Sanjay Basu. They are authors of The Body Economic: Why Austerity Kills. David Stuckler is a senior research leader at Oxford University, and Sanjay Basu is an assistant professor of medicine and epidemiologist at Stanford University. If you could respond, Dr. Basu, to Dr. Frieden’s comment?

Dr. Sanjay Basu:Yeah, I certainly agree with Dr. Frieden’s comment. And what we have found in our research is that these suicide rate spikes seem to correspond quite closely to state-level unemployment rates. And in particular, when we do these long-term studies that track individuals before the recession, during the recession and after, we can control for their pre-existing mental health statistically, and we find that it’s the new unemployment that seems to trigger new onset of depression and suicide, particularly among our most vulnerable, adults over 50, who, when they lose a job, are often discriminated against or have a very hard time finding new work. There’s a great deal of shame, and also it’s quite hard for our healthcare system to access those individuals, given the degree of barriers that they have, social barriers, to accessing mental healthcare.

Amy Goodman: I mean, the point for people to understand in this country is, what’s unusual for us, compared to other countries, is that when we lose our jobs, we lose our health insurance.

Dr. Sanjay Basu: Absolutely. And we do have some safety nets in the form of Medicaid, Medicare, but it’s quite true that there are some large holes in that system, as has been repeated time and time again.

Amy Goodman: During an interview on Fox News in February, Republican Senator Lindsey Graham of South Carolina suggested slashing healthcare to stop scheduled sequester cuts from, quote, "destroying the military."

Sen. Lindsey Graham: The commander-in-chief thought—came up with the idea of sequestration, destroying the military and putting a lot of good programs at risk. Here’s my belief. Let’s take "Obamacare" and put it on the table. You can make $86,000 a year in income and still get a government subsidy under "Obamacare." "Obamacare" is destroying healthcare in this country. People are leaving the private sector because their companies can’t afford to offer "Obamacare." If you want to look at ways to find $1.2 trillion in savings over the next decade, let’s look at "Obamacare." Let’s don’t destroy the military and just cut blindly across the board.

Amy Goodman: David Stuckler, can you respond to Senator Graham?

David Stuckler: Austerity in health is a false economy. The cliché, an ounce of prevention is worth a pound of cure, is really true. New York City officials learned this the hard way in the early 1990s, when they cut TB prevention programs by $120 million but ended up with a drug-resistant TB outbreak that cost more than $1.2 billion to control. What we found is that smart investments in public health can have a return on investment, for each dollar, of up to $3.

Amy Goodman: So, talk about the healthcare system, Dr. Sanjay Basu, how sequester fits in, and also just what Lindsey Graham was talking about, "Obamacare."

Dr. Sanjay Basu: So, I’m not a politician and—but I do analyze data. And I think, in looking comparatively among OECD countries, you see a lot of false claims about the U.S. health system. Why is it that we cost so much more and seem to be getting less? I think comparing our country to other OECD stations provides some sense of what—

Amy Goodman: You’re talking about European countries?

Dr. Sanjay Basu: European, as well as Japan, Australia and so forth. And you can see a lot of the myths by just looking at the data. So, what are the theories? The theory is, for example, maybe it’s just American obesity. Well, actually, the costs started well before American obesity and doesn’t seem to correspond actually statistically to obesity. Maybe it’s that we have an older population, but not so. Switzerland actually pays more in nursing home care. Japan has an older population, yet they still pay less while getting more in terms of health. Maybe it’s just technology. We do a lot of research and development. But, in fact, if you look at the Securities and Exchange Commission data, the R&D pharmaceutical industry, while making—

Amy Goodman: Research and development of the pharmaceutical companies.

Dr. Sanjay Basu: Sure. While they make a higher percent profit as a percentage of revenue than any other Fortune 500 industry at the moment, they actually spend almost double on marketing as compared to research and development. And while we do use more technology and we do tend to have some higher costs from technology, it doesn’t actually explain the majority of the bundle.

What you do see, on the other hand, if you just look at the raw data, is that we get more—we get more incentives in order to test the people who are covered, in order to bill more. And there’s a lot of companies making quite a bit of money on that margin. You can go to one hospital across town and be charged double or more of what another hospital has on a different side of town. But it’s not like a consumer market. If I’m in a car accident, I can’t say to the surgeon, "Hold my hand there for a moment before sewing it back on. I’m just going to go across town and compare prices for a minute."

So healthcare is a different kind of industry, in which we have what is classically called "market failure" by the Nobel Prize winner Kenneth Arrow back in the ’60s, but people ignored his work. I think what we really have is a system where we confuse inequality with choice. The majority of our costs come from common conditions in a small number of patients who have complications of diabetes, heart failure, hypertension. And we need more primary care prevention rather than paying for the ICU care.

Amy Goodman: I wanted to go back, and this is a theme you follow in The Body Economic, to the Depression. Going back to the Great Depression and the New Deal, this is President Franklin Delano Roosevelt speaking in 1933.

President Franklin Delano Roosevelt:It is three months, my friends, since I have talked with the people of this country about our national problems. But during this period, many things have happened. And I am glad to say that the major part of them have greatly helped the well-being of the average citizen.

In the short space of these few months, I am convinced that at least four million have been given employment, or saying it another way, 40 percent of those seeking work have found it. That does not mean, my friends, that I am satisfied or that you are satisfied that our work has ended. We have a long way to go, but we are on the way.

We come to the relief, for a moment, of those who are in danger of losing their farms or their homes. I have publicly asked that the foreclosure on farms and cattles and homes be delayed until every mortgagor in the country has had full opportunity to take advantage of federal credit. And I make the further request that if there is any family in the United States about to lose its home or its farm, that family should telegraph at once, either to the Farm Credit Administration or the Home Loan Corporation in Washington, requesting their help.

Amy Goodman: That was President Franklin Roosevelt in 1933. I think this is going to be very interesting for a lot of people listening and watching this today. David Stuckler, the choices made then and the choices being made today?

David Stuckler: Completely different. Roosevelt took bold steps, at a time when debt was 180 percent of GDP, to boost financial relief to the newly unemployed, to save Americans from homelessness. And we’ve studied the effects of his landmark program, the New Deal, on health. And what we found is that, comparing the states, the red and blue states, that pushed it to different degrees—the blue states tended to go further with the New Deal than the red states—led to a polarization in public health outcomes across the U.S. The greater relief spending implemented under the New Deal helped reduce suicides, reduced tuberculosis and pneumonias, and was in fact the biggest and one of the most effective public health programs on U.S. soil.

Amy Goodman: When you hear politicians today saying, "We’ve got to cut 'Obamacare.' We’ve got to cut healthcare in this country," talk about what you found, what it means for the economy to invest in public health.

David Stuckler: Investing in public health is a wise choice in good times and an urgent necessity in the worst of times. Had austerity been organized like a clinical trial, it would have been discontinued, given evidence of its deadly side effects. There is an alternative choice that we found in the historical data and through the present recessions, that when we place people and their health at the center of economic recovery, it can help get our economy back on track faster and yield lasting dividends to our society.

Amy Goodman: The issue of the West Nile outbreak, can you talk about that?

Dr. Sanjay Basu: Mm-hmm. Down in Bakersfield in California, there was a suspicion about why crows were dropping from the sky and people were also showing up in hospitals. A variety of theories were posited, ranging from polio to heat stroke, but in fact it amounted to a West Nile outbreak that, through a number of our colleagues’ research, it was found that the abandoned and foreclosed homes had stagnant water in old swimming pools and in other locations that were breeding mosquitoes. And this led to a rather large West Nile outbreak. Indeed, the reason why it was discovered was something called the California Encephalitis Project, a group of public system laboratories that work in concert with the CDC. And ironically, after helping to control that outbreak, they were closed due to budget cuts.

Amy Goodman: I want to turn to the issue of drug abuse. A recent film by Vice has brought renewed attention to the drug crisis in Greece, particularly the use of the new drug called sisa. This is Haralampos Poulopoulos, head of KETHEA, the main anti-drug center in Greece.

Dr. Haralampos Poulopoulos: Sisa is a form of crystal methamphetamine. They use amphetamines and some other liquids, sometimes battery liquids, to produce this drug. It’s very dangerous for the health of the users. I think the main reason for the increase of sisa is the changes of the attitudes of drug users during the crisis. They are more self-destructive. We have 27 percent unemployment, 62 percent the young people under 25. We didn’t finish yet with the crisis. We are in the middle of the crisis.

Amy Goodman: Haralampos Poulopoulos, head of the main anti-drug center in Greece. David Stuckler, talk about that, and also relate it to here, as we wrap up.

David Stuckler: This is a devastating situation we’re seeing in Greece with a drug crisis escalating at a time when drug prevention budgets are being cut. With gaping holes in social safety nets from austerity, people are becoming desperate, turning to the means of self-harm. We’ve seen drug use and infected needles spread HIV, creating rise of more than 200 percent, leading to an epicenter of HIV/AIDS spread in Europe.

What we can learn from these mistakes, and areas where we see successes in policy, is that recessions can hurt, but austerity kills. When politicians make smart choices to protect people during hard times, it doesn’t happen at expense of recovery but can help put our societies back on track to a happier, healthier future.

Amy Goodman: And here in the United States, how that translates into policy?

David Stuckler: Currently, we’re facing and implementing a large sequester in the U.S. While it’s too early to see the full health consequences, what we are seeing is the Women, Infants, Children’s health program, which provides nutritional subsidies to women, will be forced to reduce those subsidies from 600,000 pregnant women. And that program has been linked to reducing infant mortality. We’re also seeing large cuts to public housing budgets at a time when 1.4 million homes are still in foreclosure. We are concerned that, if done rapidly and indiscriminately, that budget cuts in the U.S. could create a repeat of the disasters that we’re seeing in Europe.

Amy Goodman: Final comment, what most shocked you in writing The Body [Economic], Sanjay Basu?

Dr. Sanjay Basu: You know, coming from the public health field, we have something called the "precautionary principle," which is that when a idea or policy is controversial, we should first do whatever protects people the most. And what we’re doing is entirely the opposite. We’ve essentially had a massive untested experiment. That experiment has failed, and it sounds like it’s quite deadly, given all the data through history.

Amy Goodman: I want to thank you both for being with us. Sanjay Basu is an epidemiologist at Stanford University. David Stuckler, Oxford University. Their new book, out today, The Body Economic: Why Austerity Kills—Recessions, Budget Battles, and the Politics of Life and Death.

Reprinted with permission from Democracy Now!.

How Coca-Cola's Ruthless Business Tactics Created a Despicable Global Powerhouse

Jill Richardson, AlterNet — Mon, 20 May 2013 11:27:00 -0700

Mark Pendergast's book, "For God, Country, and Coca-Cola" guides readers through decades of shrewd marketing campaigns and the company's ugly history.

For God, Country, and Coca-Cola by Mark Pendergast is the definitive history of the product so many see as a symbol of America itself. This impressive tome – recently released as a third edition with added new material – is not a critique of Coca-Cola, nor is it a fan’s tribute, as Pendergast reveals things the Coca-Cola Company doesn’t want you to know. (Yes, it used to contain cocaine.) He even reveals the drink’s original secret formula (which is less exciting than you might think).

Coca-Cola is not fascinating for what it is – colored sugar water with bubbles – but for what it represents. And that’s a point long known by the company’s marketers, with the exception of when they forgot it during the New Coke fiasco in the 1980s. Today, marketing students in business schools everywhere study that famous gaff.

Despite the decades-old slogan, “Delicious and Refreshing,” people do not drink Coca-Cola for the taste. They drink it because they associate it with positive things like friendship, fun, patriotism, and athleticism. Careful to market the drink to all people, everywhere, without alienating anyone, the ads are often vague. “Coke is It!” What is “it”? It’s whatever you want it to be, just as long as it makes you want to buy more Coke!

The book guides readers through the decades of marketing campaigns that built this image, most significantly during World War II, when Coca-Cola was made available to U.S. soldiers everywhere in the world, often at the government’s expense. When sales slumped, the answer was never changing the flagship product; it was a new ad campaign. Remind consumers that Coke = fun (or simpler times, or hope, or whatever feeling they crave) and they will drink more of it.

Because constant, never-ending growth is seen as essential, the other necessity is finding new channels to facilitate more Coke-drinking than ever before. Today, you can be 50 miles from nowhere in any country except Cuba and North Korea and if you crave an ice-cold Coca-Cola, you can get one. Even in places where few have clean drinking water or electricity, both needed to produce ice-cold Coke, some enterprising entrepreneur will have electricity and a cooler and plenty of Coke. The same cannot be said of nearly any other product.

The New Coke failure punctuates this strange phenomenon – that the world loves and guzzles an unhealthy beverage, but not for its good taste. Pepsi showed that in blind taste tests, more people prefer Pepsi over Coke. New Coke was tastier than both Coke and Pepsi in blind taste tests. Surely consumers would love it. Except, they didn’t. They wanted fun, hope, patriotism, and everything else they associated with good, old-fashioned Coca-Cola, not some new, better-tasting concoction.

Readers seeking the dirt on Coca-Cola’s sordid past with Columbian paramilitaries and Guatemalan death squads will find these episodes covered briefly in this book. But the completeness of the company’s history in this book paints a bigger picture, and Coca-Cola’s tangles with death squads fit in as just one piece.

This is a company devoted to, above all else, making as much money as possible and selling as much Coca-Cola as possible. Period. Nazis get thirsty, too, you know. In almost every case, the company tried to please everyone and sell to everyone, without taking sides, unless it had no choice.

It’s no good that Coca-Cola did business with a Guatemalan bottler who allegedly hired death squads to murder employees trying to unionize. But that is all part of a larger pattern, a larger scandal – although there’s no conspiracy at all. The drive to increase profits and sales and market share at all cost is the company’s story, plain and simple. It took us from a 6.5-ounce drink only available at soda fountains to one available everywhere in sizes as large as 64 ounces.

Coca-Cola told us it wanted to teach the world to sing, but it’s far more likely it is giving the world diabetes. Today, a small Coke at McDonalds is 16 ounces. Pendergast, ever the balanced journalist presenting both sides, fails to definitely state that Coca-Cola is unhealthy. He generously points out that Coca-Cola creates jobs and donates to charity, even though he notes the company’s policy of “strategic philanthropy” – i.e. using “charitable” donations to gain access to valuable markets, particularly children.

The book is a long and somewhat exhausting read, but it’s also a captivating history of the development of America’s consumer culture (and terrible dietary habits) and it contains fascinating profiles of the men (yes, mostly men) behind the company, making readers wonder what a psychologist might have to say about these often tyrannical, driven workaholics.

Here are some answers Pendergast gave about his book and the company he wrote about.

Jill Richardson: Why did you choose the title For God, Country, and Coca-Cola?

Mark Pendergast: Coca-Cola has been a kind of religion to many people, including the inventor, John Pemberton, who died two years after he came up with it, and Asa Candler, who took it over and used to lead the singing of "Onward Christian Soldiers" at his sales meetings.

These were days when the drink was under attack for having cocaine in it and even afterwards for its caffeine content. So they felt like early Christian martyrs in a way, fighting for a just cause. Candler called Coca-Cola "a boon to mankind." Coke employees have always joked that they have Coca-Cola syrup flowing in their veins.

The drink has also become a kind of religion for consumers, a symbol of the American way of life as well. During World War II the drink was deemed an "essential morale booster" for the troops, and it was served in lieu of communion wine during the Battle of the Bulge. When New Coke was introduced in 1985, people wrote anguished letters as if they had killed God. Here is an actual letter I quoted in the book: "There are only two things in my life: God and Coca-Cola. Now you have taken one of those things away from me." I could go on....

JR: Can you explain Coca-Cola's relationship with the two ingredients in its name, coca and kola nuts? How much cocaine was initially in the product and when was it removed?

MP: Coca-Cola was named for its two principal drug ingredients. Coca leaf from Peru contained cocaine. Kola nut from Ghana contained caffeine. Original Coca-Cola had a very small amount of cocaine in a six-ounce drink, about 4.3 milligrams. The company took out all but a minuscule amount of cocaine in 1903 and the final amount in 1928.

JR: You imply in the book that it's attempted to sugarcoat (no pun intended) this part of its past, saying at some points that the product never contained cocaine. Is that true? Can you elaborate?

MP: Every time I go to the World of Coca-Cola museum in Atlanta, I ask the guides if Coca-Cola ever contained cocaine. They assure me that it did not. The official company line seems to be that Coca-Cola never contained added cocaine -- i.e., they didn't add white powdered cocaine, which is true. But it did contain fluid extract of coca leaf, which contains cocaine. For years, the company line has also been that the name "Coca-Cola" is just a "euphonious combination of words" -- i.e., it sounds nice. True, but the drink was also named for its two principal drug sources.

JR: How did Coca-Cola use World War II to establish its dominance abroad? And what impact did its role in the war have for their market at home?

Robert Woodruff, the head of Coca-Cola, declared shortly after the attack on Pearl Harbor that, "We will see that every man in uniform gets a bottle of Coca-Cola for five cents, wherever he is and whatever it costs our company." Coke was subsequently declared an essential product and Coke men called Technical Observers were sent overseas in army uniforms at government expense to establish 64 bottling plants behind the lines. As a result, Coca-Cola was put in position for global expansion in the postwar world.

American soldiers came home with an overwhelming preference for Coca-Cola. In a 1948 poll of veterans, conducted by American Legion Magazine, 63.67 percent specified Coca-Cola as their preferred soft drink, with Pepsi receiving a lame 7.78 percent of the vote. In the same year, Coke’s gross profit on sales reached a whopping $126 million, as opposed to Pepsi’s $25 million; the contrast in net after-tax income was even more telling, with Coke’s $35.6 million towering over Pepsi’s pathetic $3.2 million.

Soon after the war, when the Army quizzed 650 recruits, 21 had never drunk milk, but only one soldier had never sampled a Coke. As the company’s unpublished history stated, the wartime program “made friends and customers for home consumption of 11,000,000 GIs [and] did [a] sampling and expansion job abroad which would [otherwise] have taken 25 years and millions of dollars.” The war was over, and it appeared, at least for the moment, that Coca-Cola had won it.

JR: The impact when Coca-Cola entered new markets was increased sales for all beverages, not just Coca-Cola -- and less consumption of water and milk. Can you explain that?

Yes. As Coca-Cola and subsequently other competing soda companies increased marketing and other campaigns to out-do one another, that's what expanded the total soda market. When the market for soft drinks expanded, it helped competitors such as Pepsi, and when people are paying attention to the cola wars, they are less focused on water or milk.

JR: Coca-Cola's history practically reads like a marketing textbook. Can you tell us about its revelation of the little girl's Pooh bear? Why do Coke-drinkers love Coke so much?

Archie Lee, who was the ad man behind "The Pause That Refreshes" slogan during the Depression, noticed during a beach vacation, that his four-year-old daughter lavished such attention on her Pooh bear that other children fought over it, though other toys appeared more attractive. Lee took the incident as a parable. “It isn’t what a product is,” he wrote to Robert Woodruff, “but what it does that interests us”—and set out to plant the proper thoughts about Coca-Cola, which he wanted to make as popular and well-loved as the Pooh bear.

Coke lovers care so much about the drink for many reasons -- not least the ubiquitous, effective advertising that associates the drink with youth, energy, happiness. But many people also really do associate the drink with some of the best times in their lives.

JR: How has soda consumption changed in the U.S. from the drink's introduction over a century ago, back when a serving was 6.5 ounces? Was there ever a "turning point" when Americans switched from more modest per capita soda consumption to the amount they drink today, or has it been a gradual change over time?

MP: Amazingly, Coca-Cola was served in 6.5 ounce bottles for a nickel until 1955, when King-Size Coke was finally introduced. (“King-Size” drinks were 10 and 12 ounces, smaller than a McDonald’s small today.) Since then, the sizes grew steadily larger, and PET bottles meant they wouldn't break and weren't too heavy. Super-size me, indeed. But over the last decade, concern over the obesity epidemic has made Coca-Cola back off a bit, and now the company has introduced smaller mini-cans, along with the huge containers.

JR: Over the years, Coca-Cola has dealt with Nazis, dictators, South Africa's apartheid government, and even allegedly Guatemalan death squads. Should consumers hold Coke accountable for this dark part of its history, or is it all water under the bridge? Do you agree with Coke's position that it doesn't play politics, it just sells soda?

MP: Of course, the company, like any other business, should be held accountable for its actions, although as you suggest, many of these episodes are safely in the past. The Guatemalan death squads were in the late 1970s. Paramilitaries in Colombia killed union employees in similar fashion in Coke bottling plants in the 1990s.

Quite recently, human rights violations have once again occurred against Guatemalan bottling employees. The Coca-Cola Company has usually attempted to distance itself from such violence, saying that it doesn't control its bottlers, but that seems disingenuous, since the bottlers rely on Coca-Cola syrup from Big Coke.

On the other hand, let me point out that while Coke did business inside South Africa during the apartheid regime, it left the country for a while and then was very instrumental in helping to ease a peaceful transition to black rule under Nelson Mandela.

JR: The past decade has ushered in an enormous change in Coca-Cola's product portfolio. How has it changed and why? Do you think the day will come when Coca-Cola's flagship product is no longer its top seller?

MP: Coca-Cola has diversified in the face of increased competition from other types of beverages and in response to concern over the obesity epidemic. It purchased Glaceau, maker of Vitaminwater, for $4.1 billion, for instance, in 2007. Today the Coca-Cola Company sells 3,500 beverages worldwide, and about a quarter of them are low- or no-calorie.

The future is hard to predict, but I don't think that Coca-Cola will lose its place as the flagship product in the foreseeable future -- but I do predict that the combined sales of Diet Coke and Coca-Cola Zero will eventually surpass sales of regular sugary Coca-Cola.

Bill Moyers: 12 Ways You Can Avoid Toxic Chemicals

Lauren Feeney, Bill Moyers — Sun, 19 May 2013 12:29:00 -0700

Lead, flame retardants, and BPA are everywhere, but you can limit your exposure.

After watching this week’s interview with Gerald Markowitz and David Rosner, you’ll probably be wondering what you can do to protect yourself and your family from toxic chemicals. Perhaps the most important thing you can do is become politically involved – join the fight against both chemicals in our environment and money in our political system. In today’s world, it’s virtually impossible to avoid dangerous chemicals, even in your own home, but here are a few simple steps you can take to limit your exposure to known toxins like lead, flame retardants and BPA.

Lead

If you think that lead poisoning is a problem of the past, or one that only affects the urban poor, think again. While it’s true that lead paint has been illegal since the 70s and leaded gasoline was phased out in the 80s, the highly toxic substance still lurks in old homes, parking lots, water pipes, and in products imported from countries that don’t have the same regulations. And while lead poisoning no longer the killer it once was, miniscule amounts of lead can cause neurological damage and behavioral problems in children. According to the CDC, there are currently half a million children with elevated levels of lead in their blood. Here’s what you can do to protect your family from lead poisoning:

1) Find out if there’s lead in your water. A good place to start is with your local government. website. At NYC.gov, for example, you can order a free testing kit. You can also try contacting your local water company, your landlord or a private lab. You may also want to install an NSF-certified water filter on your water tap. Though the EPA has mandated that water systems be tested for lead since 1991, your home’s own internal plumbing could still contain lead, particularly if you live in an older building.

2) Replace old windows. Though lead paint has been illegal since 1978 and has largely been removed from old buildings, in some cases, it was seen as too costly to replace the windows. To have your windows replaced (or to do any sort of renovation on a building that may still contain lead paint), contact an EPA-certified renovator who has been trained to follow lead safety practices. In some cases, your local government may cover the costs.

3) Throw out colorfully-painted toys that were made outside the U.S. or Europe. They may look innocent, but toys, crayons, ceramic and jewelry, particularly those manufactured in China or Mexico, may contain lead, and as any parent knows, children are likely to put these things in their mouths.

4) Dust or vacuum regularly. Even without any obvious source of lead in your home, there may still be lead in the air, particularly if you live in an industrial area or if a neighbor has been renovating an old home. Dust particles containing lead are especially dangerous to babies who crawl around on the floor. It’s also important to keep toys and hands clean.

5) Test the soil. Urban and suburban yards can still contain contaminants from the days when lead paint and gasoline were widespread. Before planting a garden or even letting your kids run around in the yard, make sure the soil is lead-free. Your local public health department may offer free testing; you can also contact a private or university-run lab.

Flame Retardants

The hazards of flame retardants have been known for some time — brominated tris was banned from children’s pajamas back in 1977. And yet, similar chemicals can still be found in everything from couch cushions to television sets. Studies have linked one group of flame retardants, polybrominated diphenyl ethers, or PBDEs, to lower IQs, behavioral problems, early puberty and fertility issues. And the fire-safety benefits of these chemicals are debatable. Here’s what you can to keep toxic flame retardants out of your home:

1) Check the labels on your furniture. The California Furniture Flammability Standard essentially requires that cushioned furniture, children’s car seats, diaper-changing tables and other products containing polyurethane foam are dipped in toxic chemicals. (Don’t breathe a sigh of relief just because you live in one of the other 49 states — because of California’s size, most mass-produced furniture is designed to meet California’s standard). Check the tags for the familiar notice: This article meets the flammability requirements of California Bureau of Home Furnishings Technical Bulletin 117. (The tag is not required though, so just because you don’t see it doesn’t mean it’s safe.) Fortunately, California has proposed changing the rule; until that happens, you can look for products made with wool, cotton or polyester filling instead of polyurethane foam. And if you can’t afford all new eco-friendly furniture, be sure to dust, vacuum and wash your hands regularly — most of the toxins enter the body by swallowing contaminated dust.

2) Check the labels on electronics, too. Flame retardants have long been used in electronic equipment like computers and television sets. Thankfully, that’s slowly changing. As of 2008, the following companies had committed to phasing out all brominated flame retardants: Acer, Apple, Eizo Nanao, LG Electronics, Lenovo, Matsushita, Microsoft, Nokia, Phillips, Samsung, Sharp, Sony-Ericsson, and Toshiba. To find flame retardant-free versions of everything from refrigerators to nose-hair clippers, check this list created by ChemSec, an environmental non-profit based in Sweden.

3) Beware of fleece pajamas. Though one flame retardant, brominated tris, was banned from children’s pajamas, some sleepwear is still treated with another flame retardant called PROBAN which has been linked to genetic abnormalities and cancer. Check the label — children’s pajamas that DO NOT contain flame retardants must have a tag that reads: “For child’s safety, garment should fit snugly” (the snug fit limits the flow of oxygen in order to prevent fire from spreading, an approved alternative to chemical flame retardants). Cotton and polyester products rarely contain flame retardants, but look out for those cozy fleece footed pajamas — they usually do.

BPA

Bisphenol A, or BPA, has been linked to cancer,asthma, obesity and reproductive issues. And yet, until recently, the chemical was found in, among other things, baby bottles. The FDA finally banned the use of BPA in baby bottles and children’s sippy cups in 2012 — three years after major manufacturers had voluntarily stopped using it. But BPA is still found in other hard plastic containers, the lining of metal cans and the paper that receipts are printed on. It’s difficult to completely avoid BPA — 90 percent of Americans have traces of the chemical in their urine. But here are some things you can do to limit your exposure:

1) When purchasing plastic products — particularly those that come into contact with your food, such as food storage containers, plastic plates and cups, look for those that are clearly marked BPA free. Thanks to vocal consumers, many companies are now manufacturing BPA-free products and marketing them as such.

2) Avoid food containers marked with recycling codes 3 or 7, which may be made with BPA. If your food does come in a container marked 3 or 7, don’t microwave it in that container – chemicals are more likely to leak into your food at high temperatures.

3) Limit your consumption of canned foods, or look for cans marked BPA free — they are rare, but do exist. Eden Organic cans have been BPA free since 1999.

4) BPA is often used in the thermal paper that receipts are printed on. Since it’s impossible to know whether or the receipt you’re being handed has contains BPA, don’t take receipts that you don’t need. If you operate a business that uses receipts, switch to a BPA-free paper manufacturer, such as Appleton Paper, which went BPA-free in 2006.

Bill Moyers: Our Media Is Polluted by Toxic Lies About the Risks Posed by Lead

Bill Moyers, David Rosner, Gerald Markowitz, BillMoyers.com — Fri, 17 May 2013 14:43:00 -0700

There’s no safe level of exposure to this dangerous toxin still lurking in millions of homes, but that truth is consistently under attack from industry-funded public relations excecutives.

From BillMoyers.com:

INTRO:Science can be a battleground — witness the politics of climate change, the teaching of evolution, the uncharted terrain of genetic modification and stem cell research, among other contentious issues. But when industries release untested chemicals into our environment — putting profits before public health — our children are the first to suffer. Nowhere is this more troubling than in the ongoing story of lead poisoning.

Bill talks with David Rosner and Gerald Markowitz, public health historians who’ve been taking on the chemical industry for years — writing about the hazards of industrial pollution and the neglect of worker safety — despite industry efforts to undermine them. Their latest book, Lead Wars: The Politics of Science and the Fate of America’s Children, is the culmination of 20 years of research. Markowitz and Rosner warn that, for young children, there’s no safe level of exposure to this dangerous toxin still lurking in millions of homes.

The authors discuss thwarted efforts to hold the lead industry accountable, failed attempts to find cheap solutions, and the cost to the future of our children. As long as the chemical industry and its powerful lobbies prevail in blocking efforts to reform outdated laws, Markowitz and Rosner say, we will continue to float in a soup of toxins — inhaling, drinking, and absorbing chemicals that we may learn, years later, have put us all in harm’s way.

***

BILL MOYERS: At the end of a week that reminded us to be ever vigilant about the dangers of government overreaching its authority, whether by the long arm of the IRS or the Justice Department, let’s pause to think about another threat, from too much private power over public policy.

All too often, instead of acting as a brake, government becomes the enabler of corporate power and greed, undermining the very rules and regulations intended to keep us safe.

Think of inadequate inspections of food and those infections which kill 3,000 Americans each year and make many millions sick. Think of the 85,000 industrial chemicals available today. Only a handful have been tested for safety. Think of the explosion of perhaps as much as half a million pounds of ammonium nitrate in that Texas fertilizer plant. People can die when government winks at bad corporate practices.

As long as there are insufficient checks and balances on big business and its powerful lobbies, you and I are at their mercy. Which is why their ability to buy off public officials is an assault on democracy and a threat to our lives and health. Keep that in mind as I introduce you to David Rosner and Gerald Markowitz.

Some years ago, their book, Deceit and Denial, told how the chemical industry tried to conceal the truth about untested and unregulated chemicals in our food, water, and air. Twenty companies responded with a vicious campaign to smear their reputations. That proved hard to do, actually, impossible.

Gerald Markowitz is a distinguished professor of history at both John Jay College of Criminal Justice and the City University of New York’s Graduate Center. David Rosner is co-director of the Center for the History and Ethics of Public Health at Columbia University where he also teaches science and history.

This is their new book, which revisits a chemical menace you might have thought was behind us, but isn’t: Lead Wars: The Politics of Science and the Fate of America’s Children.

BILL MOYERS: Gerald Markowitz, David Rosner, welcome.

DAVID ROSNER: Thank you.

GERALD MARKOWITZ: Thank you.

BILL MOYERS: Your book concludes that after all these years, lead is still a problem.

GERALD MARKOWITZ: Absolutely. You know, in some ways the story of lead is a great success. We’ve reduced the amount of lead in children's blood and we've gotten lead out of gasoline and we've gotten lead out of paint. But there are still children who have too much lead in their blood. And it is endangering their life chances, endangering their futures.

BILL MOYERS: Does it kill?

DAVID ROSNER: It doesn't kill anymore. It used to send kids into convulsions, into comas and into paroxysms and ultimately killed them up until the 1980s. But we've gotten lead levels down to the point where we're now discovering new, even in some sense, more troubling problems.

BILL MOYERS: What's the most important thing you've discovered about lead since we last talked?

DAVID ROSNER: Well, that in what we would once have considered miniscule amounts lead in children can cause neurological damage, causes behavioral problems, attention deficit disorders, dyslexia. Studies show that children who are exposed in utero can have permanent neurological changes that put them at risk later in life for learning disabilities that lead to failure in school and IQ loss. There are a whole series of problems that we never even thought about in the old days, so to speak.

GERALD MARKOWITZ: It's shocking that we know that children can be prevented from any kind of lead poisoning if they are, live in a home that is lead free. And this is no longer, you know, a priority of the country. We still have many homes millions of homes that contain lead that are endangering our children.

BILL MOYERS: Is it the cost of getting rid of the lead from homes that are already established and we're living in, is that the main barrier?

DAVID ROSNER: For some it is. But the history of public health, and that's what we are, historians, is rife with examples of decisions that are very costly that we decided are necessary for the population as a whole.

But somehow because we have in some sense accepted a definition of what the problem is and who the victims are and we've devalued their lives, we decided not to address this issue because it's quote, “too costly.”

GERALD MARKOWITZ: We really made a morally bankrupt calculation that it is less costly to endanger the health and futures of our children rather than to protect them by paying to remove lead from their homes.

DAVID ROSNER: The message really should be is we need to really think of lead as one symbol, one symptom of this much larger problem of the pollution of our children, pollution of their lives, the pollution of all of us from a whole host of toxic materials that we are, we've grown accustomed to using and tend to put out of our consciousness.

BILL MOYERS: When I first met you, people were saying, scientists were saying, that the smaller the dose of lead, the exposure to lead, the safer it would be.

GERALD MARKOWITZ: Scientists now say that it is very likely there is no safe level of lead, that any amount of lead in a child's body, in a child's blood, you know, causes a variety of neurological and intellectual problems. So this is really a sea-change in our understanding of what, the amount of a toxin that causes a problem for children.

DAVID ROSNER: We no longer have children convulsing and going into comas. In other parts of the world they still are from lead exposures. In Africa, in Nigeria, children still are exposed to huge amounts of lead from a variety of sources. And a recent article indicates that we're still selling lead paint, for example, to other countries despite the fact that we in this country no longer use it on our walls. But if you look at where lead poisoning is most prevalent, when you look at the communities that are most affected by lead they're usually communities, poor communities, working class communities, parts of the cities that are more run down because the lead that is dangerous is the lead that comes off of walls of old buildings. And walls of old buildings that are not maintained give off more lead than walls of old buildings that have been recently renovated. It's hard to believe how much lead there is in an old home. I mean, we often think of paint as just a lot of liquid with a little bit of color. But in fact, when you looked at lead paint and you lifted it in your grandfather's garage or, you know, my grandfather's garage, it was very, very heavy. And that's because about, in that can of paint there was 15 pounds of lead. And that was being painted on walls, three coats on each wall, every five to ten years, whatever the renovation took. We were putting literally hundreds and hundreds of pounds of lead, a deadly toxin at that point, that a small fingernail's worth could actually cause convulsions, into the children's environment.

BILL MOYERS: Well, there were ads actually promoting lead paint as the right paint for your home.

DAVID ROSNER: They said that lead paint was a friend of the child and that it could be spread on any surface and it could be fun to do. And they showed these ads in which children are painting their toys, painting their cabinets, painting their walls, painting their furniture with a poison. At the same time when all these cases are appearing in the medical press about lead poisoned children, at the same time when in their own internal documents they're saying, we have these examples, we have, we're being attacked because children and babies are getting poisoned by lead on their cribs.

And so you see this kind of progression of this problem from the 1930s when it once killed children and sent them into comas straight through the early 2000s and now when the CDC says there are a half million children, I mean half million children at risk, a half million children with elevated blood lead levels. This would be a national epidemic, I mean, if this were meningitis, if this were polio. I mean, could you imagine the reaction of the society?

GERALD MARKOWITZ: And the industry said over 50 years ago that this was an insoluble problem, it was a problem of, caused by slums, it was a problem caused by who they called uneducable parents. And so that they washed their hands of the problem and they have still washed their hands of the problem. Parents have played, excuse me, paid the cost of lead poisoning. Landlords have even paid the cost of lead poisoning. The government has paid the cost of lead poisoning. The industry has not paid to get that lead off the walls so future generations of children can be protected.

BILL MOYERS: What your critics say is, look, it's like gasoline in cars. We didn't intend harmful effects to come from a product that was fueling America's economy. We found out later and we're trying to cut back on emissions.

This applies as well to lead and other toxins in our environment. Nobody intended it, it proved to be a consequence of, as even you say in here, the enormous amount of material we've taken out of the earth and turned into the engine of our prosperity.

GERALD MARKOWITZ: Well, unfortunately they didn't give them the information about the dangers of lead that they had. They knew that lead was killing children in the 1930s. They knew that researchers were uncovering lead and they were fighting those, the diagnoses of lead poisoning in children. They, even into the 1970s and '80s, they went after researchers like Herbert Needleman who were uncovering the low levels of lead that were damaging children. They were not innocent purveyors of a product. They were actively involved in the political dialog attempting to increase their profits at the expense of public health.

BILL MOYERS: I interviewed Herbert Needleman some years ago for a documentary on Kids and Chemicals. Let's take a look.

BILL MOYERS in Kids and Chemicals: In the late 1970s Dr. Needleman studied the baby teeth of healthy schoolchildren in two Boston suburbs […]

DR. HERBERT NEEDLEMAN in Kids and Chemicals: When we looked at the data, we found that children who had high lead in their teeth, but who had never been identified as having any problems with lead, had lower IQ scores, poorer language function, and poorer attention.

BILL MOYERS in Kids and Chemicals: It was a stunning discovery, and no one knew it better than the lead industry. Leaded gasoline was the single greatest source of lead exposure, and as a result of Needleman’s work the Environmental Protection Agency sped up efforts to ban it. The lead industry fought back, denying Needleman’s science.

JEROME COLE in Kids and Chemicals: Lead has been used in gasoline for over 60 years. There’s simply no evidence that anyone in the general public has ever been harmed by this usage […]

DR. PHILIP LANDRIGAN in Kids and Chemicals: The lead industry attacked it viciously and they attacked Dr. Needleman himself. They accused him of scientific misconduct and they actually filed charges against him at his university and at the National Institutes of Health.

DR. HERBERT NEEDLEMAN in Kids and Chemicals: It’s like a death sentence. If you’re found guilty of scientific misconduct you’re out of business; your reputation is ruined; you’re through.[…]

BILL MOYERS in Kids and Chemicals: The assault went on for three years. For three years, Dr. Needleman stood his ground.

DR. PHILIP LANDRIGAN in Kids and Chemicals: Those were tough years in Dr. Needleman’s life. Eventually those charges were shown to be baseless and the people that brought them forward who had portrayed themselves as neutral scientists were, in fact, revealed as consultants to the lead industry. It took several years for the truth to out. But he triumphed.

DR. HERBERT NEEDLEMAN in Kids and Chemicals: I knew I was right. I mean, I knew that the work was good. I knew that my colleagues who worked with me on it were honest people. But I realized that science is not always the polite intellectual activity that it appears to be; that environmental science sometimes becomes something closer to warfare.

BILL MOYERS: So that's why you called this Lead Wars, I assume?

DAVID ROSNER: That's right.

GERALD MARKOWITZ: Yes.

DAVID ROSNER: That's where the title comes from. This is one of the, you know, tactics of this industry, of these industries to essentially control the regulators, to find ways of both undermining, in Herb Needleman's case, the integrity or the scientific integrity of the researcher by trying to attack his personality or his research, his data, but also trying to find ways of getting the regulatory agencies in government to see anyone who in any way cast doubt on their product as biased as opposed to a neutral observer. But it wasn't only lead. The more industries we look at, the more like other industries the lead story is.

BILL MOYERS: How so?

DAVID ROSNER: Well, you look at the asbestos story. Our homes are still, you know, covered with asbestos. It's on, in old homes, it's on the shingles that, you know, we use, it's in the floor coverings that, the vinyl that we use, it’s on the roofs. It's on our boil, older boilers still, but when you look at the history of asbestos the knowledge about that product goes back literally decades and decades and decades.

Then you look at the silica industry, the, when you look at the vinyl chloride industry, when you look at the PCB story. And the same unfortunate, the same unfolding of, what can you say but corporate greed.

GERALD MARKOWITZ: And in addition to the corporate greed there is their war on science. The attacks on global warming. There is a war on bisphenol A, which is in a wide variety of products, it is virtually in every human being in the United States--

BILL MOYERS: What is it?

GERALD MARKOWITZ: It is basically an ingredient in plastic that is in the linings of cans, it's even in receipts that we get every day from a clerk at a store, the credit card receipt. And we take that and that has bisphenol A on it. And we end up absorbing that.

There's been a tremendous amount of research that shows that it is an endocrine disruptor, that it causes a disruption of the endocrine system that can affect reproduction, that can affect development of the fetus. But it's also a carcinogen. And so this is a real problem that the industry has been fighting to cast doubt on really amazing science that has been done by a wide variety of people.

BILL MOYERS: Just this April California's Environmental Protection Agency put it on its toxins list. The American Chemistry Council is suing California to keep this off of that list of dangerous substances.

GERALD MARKOWITZ: And they are supporting research that, as David said creates doubt about the independent scientists who are finding these variety of subtle and not so subtle effects. And they are determined, as they did, as we talked about in tobacco, in global warming, in lead, in asbestos, to make people not be convinced. And if they're not convinced, if they have a question in their mind, then they can continue to sell their chemical.

BILL MOYERS: You two have been yourselves the subject of harassment, legal suits, attacks, efforts to discredit you, right?

GERALD MARKOWITZ: Absolutely.

DAVID ROSNER: There was an article in a legal journal that kind of warned us about what was going to happen. It talked about the title of our book--

GERALD MARKOWITZ: Which was Deadly Dust.

DAVID ROSNER: --which was called Deadly Dust. And it said, you know, we could let Rosner and Markowitz play by themselves in their own little play yard of historians, but they, their book has appeared in lawsuits against the industry. And it has become the dominant narrative or it's becoming the dominant narrative of how silicosis is understood. Therefore we have to do something about them. They didn't quite say it in those words, but that was the implication.

GERALD MARKOWITZ: Well, they said, you know, be an academic and talk only to academics. But when you talk to the public that's dangerous.

DAVID ROSNER: And then very shortly afterwards we found Deceit and Denial, the next book we did came under enormous attack. They actually subpoenaed the press, they subpoenaed the foundation that supported us, the Milbank Foundation.

GERALD MARKOWITZ: They subpoenaed the peer reviewers of the book for a university press.

DAVID ROSNER: And then they hired a historian to call us unethical, lousy historians, to attack minor footnotes in the book that weren't wrong, but he claimed were wrong. It was quite an attack. And I think the biggest thing they do, though, is try to introduce doubt. One of the issues that they constantly are raising is you don't have definitive, you don't have definitive proof that in 60 years, for example, children might develop cancer from exposure to bisphenol A, right. You don't have the long term studies that we think are really essential.

But you introduce doubt about the data and then you find other people to introduce studies that raise questions about it. So you introduce, it's really the production of uncertainty. Produce uncertainty about the issue and we as an industry have no obligation to prevent disease. And it's completely antithetical to everything that public health could, public health's supposed to be about preventing disease and you always work on imperfect data. You never have the long term 60-year study that tells you you're going to have damage 60 years from now. So that's one of the tactics, it's just to keep saying there's a question, there's a question.

GERALD MARKOWITZ: And to attack people like Herbert Needleman, and to create the kind of uncertainty that gives parents pause. Should I act or should I not act? And that is probably the, as David says, the most dangerous thing they do.

BILL MOYERS: But it's consistent with what you have learned as historians this industry and others have done over the years to whistleblowers, to truth tellers, to neutral scientists and journalists who are just simply trying to report what the public should know.

GERALD MARKOWITZ: But if you can't contest the message then you go after the messenger. But think about all the younger academics who are deciding what they're going to study, what they're going to work on. And for those people it is a real decision. Are they going to go up against powerful industries or are they going to do something safe? And our fear is that more and more younger scholars and younger scientists will end up doing something safe rather than something that could really make a difference in the public arena.

BILL MOYERS: Both of you were witnesses in that big case in Rhode Island. Can you summarize that and what happened?

GERALD MARKOWITZ: Well, this was the longest civil trial in Rhode Island history, or at least up to that point. And it was a remarkable effort by the attorney general of the state of Rhode Island to prevent future damages for lead’s harm to the children of Rhode Island. It was really a public health lawsuit, an amazing public health lawsuit.

BILL MOYERS: As I understand it Senator Whitehouse whom I have met had this problem before he was a senator. He had inadvertently exposed his own children to lead when he renovated his house. And then he became attorney general and brought this suit to try to hold the industry accountable.

GERALD MARKOWITZ: It took, unfortunately, his personal tragedy to get him to take this extraordinarily important action. And we were asked to testify in that case to provide the historical evidence of what the lead industry knew about the dangers and what did they do with that knowledge, which basically was to deny that there was a problem, to say that this was a public relations problem for them rather than a public health problem.

Our documents showed that they had been, they'd known about what they were creating, they'd known that children would be poisoned, they were discussing children dying as early as the 1920s and '30s, and yet they had created this huge environmental mess of millions and millions of pounds on the walls of Rhode Island, all of which was waiting to poison future generations.

DAVID ROSNER: And that they had done nothing about it, they continued to market. And that really, I think, enraged the jury.

GERALD MARKOWITZ And we were thrilled, just thrilled when at the end of this trial the jury came back and for the first time in lead industry lawsuits they held three lead companies responsible for cleaning up the mess, in the form of lead paint on the walls of houses throughout Rhode Island.

BILL MOYERS: So the jury said the industry has to clean up and pay for it?

GERALD MARKOWITZ: Absolutely.

BILL MOYERS: For the first time?

GERALD MARKOWITZ: First time.

DAVID ROSNER: This was the high point of our professional careers, the idea that we could use history and we could use the legal system really prevent disease for the future, not just pay back for the damages already done that were irreversible to children, but to actually prevent future generations. This was a suit that actually was going to demand somewhere between $1 billion and $4 billion from the companies to clean up the mess they had created. The low point of our lives, our professional lives, came two years later when the Supreme Court in Rhode Island overturned the decision.

BILL MOYERS: And what was the basis for them taking it back?

GERALD MARKOWITZ: Basically, they said that the lawsuit was filed under the wrong law, that it was filed under public nuisance law rather than under liability law.

DAVID ROSNER: What's interesting now is that there's another suit coming up in California. And there was fear that the California suit would not go forward because they thought the precedent of the Rhode Island Supreme Court denying the legitimacy of the suit would undermine that case. The Court in California rejected the arguments of the Supreme Court in Rhode Island. The Supreme Court of Rhode Island had said this can't go under, there is no standing in future generations to get damages from these companies because they haven't been damaged yet. Until the kids are damaged you can't actually sue. And California has said that absolutely, public health law is all based upon preventing disease. All regulations are in order to prevent future damage, therefore it can go forward in California. So we're quite excited because in June this court is, this case is going to be heard by a California jury.

BILL MOYERS: Tell me about the Baltimore case that you write about.

DAVID ROSNER: In the 1980s, researchers at Hopkins wanted to find a way of remedying the conditions of Baltimore's housing, which lead was all over the place. And they were trying to find a way of doing it cheaply. So what they did is they set up three kinds of housing, one of which has been renovated to $1,650 worth of renovation, another to $3,500 and the last to $7,000 worth of renovation.

And then they recruited mothers, young mothers with children between the ages of six months to five years to live in these different houses, knowing that each house had lead exposures, but that if they could find which was the cheapest and which was the most effective way of lowering the blood lead level, not actually eliminating lead but lowering it a little bit.

GERALD MARKOWITZ: And perhaps the most troubling part of the experiment was that we've seen the consent forms and the consent forms do not tell parents that living in these homes may cause their children to be lead poisoned.

And as a result they ended up exposing 100 kids to less than fully abated homes expecting that most of those blood lead levels of those children would go down. And in fact, for most of the children their blood lead levels did go down. But some of the children, their blood lead levels went up.

DAVID ROSNER: What the court says is they were using children as human guinea pigs, as canaries in the mine so to speak, they were using them to measure the effectiveness of each one of their methods of abating lead. You know, this is young women, single mothers by and large with children, young children. And--

GERALD MARKOWITZ: Overwhelmingly African American.

DAVID ROSNER: And this is the, one of the most prestigious medical institutions in the country, Johns Hopkins.

BILL MOYERS: Weren't they trying to figure out how little could be spent to protect children in the short term? And wasn't that the wrong question altogether, don’t we need to solve these problem for the long run?

GERALD MARKOWITZ: Absolutely. And the lead researchers understood that the only way to solve the problem of lead poisoning in children was to get rid of all the lead from the walls. But they didn't think that there would be the political will to do that.

BILL MOYERS: Why don't we have that political will?

GERALD MARKOWITZ: Basically the industry has bought that political system.

DAVID ROSNER: For the past 40 years really we've been living under this set of assumptions about the scarcity in our society, how we can't afford anything and how government can't do anything. Government is the problem, not the answer. That's diametrically opposed to virtually all principles of course of public health which sees government as something that really could do something good. And but we've been taught over and over again that it's too expensive and government is the problem. And therefore we're incapacitated.

BILL MOYERS: With millions, billions of dollars at stake in profits aren't they following a kind of logic of capitalism?

GERALD MARKOWITZ: They absolutely are following the logic of capitalism. But we are all research subjects in a grand experiment where we are being exposed to literally thousands of chemicals that we have no data about. And do we want to know in ten, 20, 30 years that these are going to be either making us gravely ill or killing us?

Do we want our grandchildren to be exposed to this toxic soup of chemicals and only to find out when they're in their 30s and 40s that this is endangering their lives? And there really is a way that we can handle that problem. There is legislation in Congress now, the “Safe Chemicals Act,” which would require the EPA to test all existing and, existing chemicals and the 700 chemicals that are introduced every year and to not allow those that are dangerous to continue.

BILL MOYERS: But Jerry, you know that, as you write in here about the politics of science, that the industry went to Congress in 2005 and got fracking, even before it had come to full blossom, got fracking exempted from the Safe Drinking Water Act. And you think, and you have hope for any kind of legislation such as you just described?

GERALD MARKOWITZ: Well, I have hope that there were actually 29 senators who were willing to cosponsor this piece of legislation, but no, I don't have hope that it's going to pass. I think only if environmental groups all around the country, and there are hundreds of environmental groups around the country, really mobilize a mass movement to demand that Congress protect our health, we really care about our health, but we are not doing the political mobilizing that is necessary in order to put that caring about health into legislative action.

BILL MOYERS: So how is the politics of science affecting the fate of America's children?

GERALD MARKOWITZ: You know, in our lifetime we have seen the abandonment of the commitment to try to help those who are most vulnerable in our society. And instead of that commitment today we ask how much does it cost. And by that we mean how many dollars does it cost. We don't ask what does it cost in terms of the health of our children, what does it cost in terms of the futures of our children and of our society.

Hospitals Should be Care Providers not Loan Sharks

Deborah Burger, AlterNet — Fri, 17 May 2013 10:38:00 -0700

Predatory pricing practices can be found nearly everywhere in healthcare.

If there is one problem that symbolizes the ongoing national healthcare emergency, it is the rampant price gouging in the healthcare industry that continues to price too many Americans out of access to care and into financial ruin. Not only is the problem not solved by the Affordable Care Act, but it is a likely reason many will continue to demand more effective reform, as in expanding and extending Medicare to cover everyone.

Predatory pricing practices can be found nearly everywhere in healthcare, by the drug companies, insurance companies, medical suppliers, outpatient clinics, boutique medical services, and many others as chronicled this spring in Time magazine.

U.S. hospitals are among the biggest abusers, as illuminated in recent datareleased by Medicare on hospital charges for a variety of common procedures as well as brand new findings by the Institute for Health and Socio-Economic Policy, the research arm of the National Nurses United, based on Medicare cost reports.

The nurses’ data augments the Medicare findings, and goes the next step, illustrating a trend of rising high hospital charges while providing context to a very ugly picture and the deplorable impact on anyone who needs healthcare.

Here’s the sobering numbers:

· U.S. hospitals charge on average $331 dollars for every $100 of their total costs, in statistical terms a 331 percent charge to cost ratio.
· While hospital charges over costs have been climbing steadily over the past 15 years – the charges took their biggest leap ever in 2011– a 22 point vault.
· From 2009 to 2011 (the most recent year for which the data is available), hospital charges lunged upward by 16 percent, while hospital costs only increased by 2 percent.
· U.S. hospital profits, pushed upward by the high charges, hit a record $53.2 billion, while nurses see more and more hospitals cutting patient services and limiting access to care.
· One case study is California where hospitals soared past the national average with a charge to cost ratio of 451 percent, or $451 for every $100 of costs.

That similar pricing practices occur elsewhere in the healthcare industry is hardly an excuse for the private hospitals to act more like Wall Street corporations than responsible, community based institutions. It should be no shock that the lowest charges are by government-run hospitals that operate in public, not in secret, and have far more accountability and transparency.

Hospitals ought to act as responsible providers of needed medical care, not loan sharks. Piling up profits in large part by jacking up prices is at sharp odds with the glossy feel good ads from hospitals we see so often on our TV screens, newspaper pullouts, sponsorship of sports teams, and on mass transit placards.

Hospital lobbyists have tried for years to convince us all that predatory pricing policies don’t matter. These are just “list” prices that few people actually pay, they claim, and it is a random phenomenon that two hospitals in the same city, or even on the same block, might have widely varying prices for similar patient services.

But the grotesque reality tells a different story.

We’re not the only ones who think so. As Glenn Melnick, a USC health economist, told a reporter, "If (hospital prices are) meaningless how come hospitals spend all this money on consultants to raise them? Why haven't they stayed flat for the past 15 years? Why do hospitals keep raising them if they have no impact?"

While it is true that major payers seldom pay the list price, hospitals typically bargain with insurance companies over reimbursements. Anyone who has ever bought a car knows that the higher the list price, the more you end up paying. That’s true with hospital charges as well.

The inevitable result is insurance companies respond by ratcheting up their charges to employers and individuals. In California, for example, since 2002, premiums have risen 170% -- more than five times the inflation rate, as noted in a California Healthcare Foundation survey last month.

An alarming, if predictable ripple effect follows. As the CHF survey noted, in the past decade, the percentage of California employers providing health coverage dropped from 71 to 60 percent; 21 percent said they’d increased workers’ co-insurance premiums while 17 percent said they had reduced benefits or increased other out of pocket costs. More than one-fourth of workers in small firms have deductibles of $1,000 or more on their health plan.

Then there’s the uninsured who do not have the collective clout to bargain down the list price. Hospitals say they write off a lot of those bills, but clearly not all of them. How many distressing stories have we all heard about patients staggered by $50,000 or $100,000 un-payable medical bills while being hounded by the hospitals or bill collection agencies to pay up?

Patients and families, even those paying for insurance, have a stark choice. Use your health coverage and get socked with huge out of pocket costs that may mean choosing between medical bills, housing costs, food, or other necessities, or facing financial calamity, or forgo needed care.

As the Washington Post recently noted, the Affordable Care Act has not ended the deplorable story of medical bills accounting for more than half of all personal bankruptcies in the U.S.

Even many of those now paying for health insurance either through their employer or as individuals, or who will be required to buy insurance under the ACA, choose not to use it because of the high co-insurance, deductibles, co-pays, and all the add ins that get thrown in by the hospitals, such as professional fees, facility fees, pathology fees, anesthesia fees, and so on.

A 2011 Commonwealth Fund study found that the U.S. stands out among high income countries with as many 42 percent of Americans skipping doctors’ visits, recommended care, or not filling prescriptions due to cost.

Consequently, people end up in emergency rooms for medical problems that should have been resolved earlier at far less cost and pain. It is also why two recent reports disclosed that the U.S. has the lowest life expectancies and the highest first day infant death rate among major industrial countries.

It’s long past time to fix this nightmare, and sadly the ACA won’t meet that test. At a minimum we need to crack down on price gouging by all the corporations that control our health, with real penalties for lack of compliance.

But a longer vision is needed. Replace our profit focused health care system with one based on patient need and quality care as all those other countries with national or single payer systems that surpass us in access, quality, and cost, have long figured out.

Why You Can't Sleep: The Science of Insomnia

Joseph Bennington-Castro, io9 — Thu, 16 May 2013 11:35:00 -0700

Is your anxiety about falling asleep keeping you awake? Or are your neurons to blame?

We've all experienced a sleepless night or two, and for some people that's actually the norm. But why do we experience insomnia at all? What is going on in our minds and bodies, to cause this awful condition? Here's what scientists know so far.

The prevalence of insomnia in adults varies widely, depending on how the condition is defined. Most broadly, someone has insomnia if he or she simply suffers from difficulty falling asleep, waking up over and over during the night, or nonrestorative sleep — and according to that definition, up to 50 percent of adults experience insomnia. But only around 20 percent of the population deals with insomnia, if we're going by the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, where insomnia is considered a sleeping disorder (pdf) that lasts at least a month and causes daytime distress.

In any case, our understanding of insomnia is constantly evolving. For many years, insomnia was considered just a symptom of other issues, including depression, anxiety and schizophrenia. The prevailing thought was that if you treated the dominant condition, insomnia would subside as well. Insomnia is now known to be a syndrome in its own right, one that occurs alongside (is comorbid with) other disorders. So if you suffer from depression and insomnia, both issues should be treated at the same time — rather than just treating your depression alone.

To doctors, this type of insomnia, which is not caused by other medical issues or medicines, is called primary insomnia (as opposed to its sibling, secondary insomnia). They further describe the condition by how long it lasts — acute insomnia occurs for days or weeks, while chronic insomnia goes on for a month or more.

The basic models

In the past few decades, scientists have proposed a number of models to describe how chronic primary insomnia arises. One of the foundational paradigms was the "3-P model," referring to the supposed Predisposing, Precipitating and Perpetuating factors of the condition.

The model says that certain attributes, including being highly anxious or a perfectionist, may first make you more susceptible to insomnia. Then, some precipitating event, such as a death in the family or a new job, throws your sleep out of balance, causing acute insomnia. Finally, poor attitudes and perceptions perpetuate insomnia — these can include heightened uneasiness and tension regarding sleep, or poor sleep hygiene.

Over the years, other models have come along, some of which adapted concepts of the 3-P model. For example, the cognitive model, proposed a little over a decade ago, explains that insomniacs are overly worried about sleep and about what happens if they don't get enough of it. These negative thoughts trigger arousal and emotional distress, which essentially plunges people into an anxious state, causing them to actively monitor themselves and the environment for sleep-related threats (noises, body sensations and the like). Of course, this only exacerbates sleeplessness.

But insomnia (and the models to explain it) isn't limited to the psychological realm. Theneurocognitive model explains that people with insomnia show more high-frequency electrical activity in the brain (EEG) when they're going to sleep compared with normal sleepers. This cortical arousal suggests that insomniacs have enhanced sensory or information processing and long-term memory formation during a time when normal sleepers do not, which could ultimately affect sleep. For example, the enhanced sensory processing may make insomniacs more sensitive to and aware of what's going on in the environment.

Hyperarousal?

A common theme in these models and others is this idea of arousal. In fact, many researchers now consider insomnia to be a state of 24-hour hyperarousal, brought on by the interplay between psychological and physiological factors.

Current models suggest insomnia is caused by an interaction between behavioral and neurobiological factors. Courtesy of Elsevier.

On the psychological side of things, we have some of what we've already discussed. One useful cognitive model called the AIE (attention–intention-effort) pathway says that people with insomnia focus their attention on sleep, which leads to an active intention and effort to fall asleep.

The idea here is that normal sleep is automatic and involuntary — it's the result of a de-arousal process that allows homeostatic and circadian factors to engage sleep. But by actively trying to engage sleep themselves, insomniacs are impeding these natural processes and actually maintaining a state of arousal.

Interestingly, scientists have seen evidence of AIE even in the daytime naps of insomniacs. Numerous studies have looked at the Multiple Sleep Latency Test, which involves four or five 20-minute nap opportunities set two hours apart. If someone has gotten poor sleep because of insomnia, it stands to reason that they would be able to fall asleep quicker than someone who slept well the night before — but test after test has shown just the opposite. Some researchers are now speculating that the increased nap latency of insomniacs is due to the demands of the test, which directly asks participants to attempt to sleep at that very moment (insomniacs have basically conditioned themselves to enter a state of arousal when they make a conscious effort to sleep).

This induced arousal, at night and during naptime, has several lines of supporting physiological evidence. For example, studies have shown that insomniacs have higher whole-body metabolic rates — measured by looking at oxygen consumption at periodic intervals throughout the day — than normal sleepers.

Using PET scans, researchers have also investigated brain metabolism differences between insomniacs and normal sleepers. They saw similar results: insomnia patients had elevated global brain metabolism, both asleep and awake. Moreover, the study showed that insomniacs had smaller metabolism declines in wake-promoting regions of the brain when going from waking to non-REM sleep. In addition to this, a recent study found that insomnia patients have increased waking EEG.

Scientists have also examined the body temperatures, galvanic skin responses and heart rates of insomniac patients (all of which are physiological indicators of arousal). The results are not entirely conclusive, but suggest insomniacs have elevated electrodermal activity during the day, and may have elevated heart rates and altered heart rate variability during sleep; also, elderly insomnia patients have elevated core body temperatures at night (given the inconsistencies in the research, we can't say much else about other insomniacs).

Studies on hormone levels have also yielded interesting results, supporting the hyperarousal theory. Patients with primary insomnia apparently secrete less nighttime melatonin, which is known to regulate sleep and wake cycles. On the other hand, norepinephrine, which helps mediate wakefulness, is increased in insomnia patients, even at night. Stress hormones, including cortisol and ACTH (adrenocorticotropic hormone) may also be elevated in insomniacswhen compared with controls.

Flip-flopping

Scientists' understanding of insomnia points to the condition being a state of hyperarousal, which is mediated by cognitive and physiological factors. But the exact mechanisms behind the arousal are not clear.

Some research suggests that the neurobiology of sleep-wake regulation may provide some answers. To put it simply, the tendency to sleep is regulated by a balance between sleep-promoting neurotransmitter systems and wake-promoting neurotransmitter systems. To facilitate sleep, a group of neurons in the hypothalamus called the ventrolateral preoptic nucleus (VLPO) release the inhibitory neurotransmitters galanin and GABA to shut off the arousal (wake) system. So a faulty VLPO flip-flop switch may prevent the brain from de-arousing.

At the same time, however, other evidence suggests that sleep arises from bottom-up processes. In this sense, sleep may be a local process, an intrinsic property of individual neurons or group of neurons. This concept of local sleep would suggest that hyperarousal is not something that happens globally in the brain — it may instead be a "use-dependent dysfunction" in specific neural circuits.

Future research will no doubt tease out these finer details. And other work may elucidate the role that genetics play in chronic primary insomnia. But the ultimate goal of insomnia research, of course, is to find an effective way to stop the condition in its tracks. Given that insomnia apparently costs us billions of dollars each year, curing the syndrome could have a huge positive impact in a lot of areas.

AlterNet.org: Personal Health

Is the Idea of an Intelligent Self-Help Book a Paradox?

Related Stories

How MDMA Can Take You on the Healing Path ... Even for a Former Nun

Related Stories

Biblical Medicine? How Religious Corporations Are Gobbling Up Healthcare Facilities

Related Stories

How Corporations Are Subverting Attempts to Rein in Their Power

Related Stories

In the Age of Social Media, People Say They Want More Real Friends

Related Stories

Austerity Kills: Crippling Economic Policies Causing Global Health Crisis

Related Stories

How Coca-Cola's Ruthless Business Tactics Created a Despicable Global Powerhouse

Related Stories

Bill Moyers: 12 Ways You Can Avoid Toxic Chemicals

Related Stories

Bill Moyers: Our Media Is Polluted by Toxic Lies About the Risks Posed by Lead

Related Stories

Hospitals Should be Care Providers not Loan Sharks

Related Stories

Why You Can't Sleep: The Science of Insomnia

Related Stories