Weekly Journal

Here's a compilation of everyday thoughts and articles I've written. Many have been published as part of my recurring columns in the News Messenger, the twice-weekly paper in Montgomery County, Virginia.

Wednesday
Apr112018

* * Anne Giles wants us to know about opioid use disorder

Blacksburg’s Anne Giles is on a mission to educate us on opioid use disorder. Anne is in recovery from addiction to alcohol and is acutely aware of the problems and stigmas associated with addiction.

Anne spent most of her formative years in Blacksburg, getting her bachelor's and master’s degrees at Tech. She left Blacksburg in 1983, earned a master's in counseling in Florida, and returned to Blacksburg in 2006 to spend more time with her mother during her final years.

In 2008, Anne started a technology company that proved not to be successful. Meanwhile, she began volunteering on the Board of the New River Valley Community Services. “I was so uplifted by their programming that I asked to work there,” she told me. “I was hired part-time as a counselor and I have been there for several years, and that’s what I’m doing now professionally.

“Opioid use disorder is one of many substance abuse disorders. It is one of the few that research shows that responds well to medication, to two in particular: methadone and buprenorphine. Methadone is only available at federally regulated clinics. However, buprenorphine is inexpensive and plentiful, but heavy regulation limits access to it.”

“We have declared that we have an opioid crisis across the nation, but the medicines known to treat it are essentially inaccessible. Most people with substance use disorders have experienced some sort of trauma. Physical trauma. Mental Trauma. Sexual trauma. Neglect. Violence. Loss. Death. All of it. Often someone is traumatized in childhood. Childhood trauma is correlated with mental illness in adulthood.

“Human beings have used substances for thousands of years. The beauty of being human is that we take risks, we adventure, we discover and explore. We desire, we long. 5000 years ago in Sumer, the Sumerians were ingesting beer. We have way more problems with alcohol than with opioids.

“Marijuana. Caffeine. We use substances for many purposes. When our use persists despite negative consequences, then it becomes a problem. That’s the definition of an addiction. Functionality in taking care of oneself. Functionality in maintenance of relationships. Functionality in citizenship or at work. When these functions are impaired, use has become a problem.”

Admitting to be virtually ignorant on the topic, I asked, “How big a problem is this?”

She said, “If death rate is what we care about, there are many more things that are causing pre-mature death than opioid use disorder. But basic humanity calls us to alleviate suffering. People with opioid addiction are suffering. Medications are denied them, and they are suffering. If you had diabetes, and you were not permitted access to insulin, I would be upset about it.

“Doctors have to be waivered to prescribe these medications. They have to go through training and are limited in the numbers of patients to whom they can prescribe.

“I would like for our citizens to speak to their representatives, their elected officials, to ask, ‘why can’t people have these medications?’

“I developed alcohol use disorder following the Virginia Tech shootings. Fifteen percent of people who experience violence develop PTSD (post traumatic stress disorder). Of those, 5% develop addiction. We live in a whole community affected by the event.”

“Why were the 15% different?” I asked.

“There are many pre-disposing factors to experiencing trauma in a way that develops into PTSD,” she said. “There are numerous research studies on known factors. It’s a social phenomenon (following these shootings). It happened at Columbine. It happened here. I’m sure it will happen in Parkland (Florida).

“The problem with substance use disorder is that it is perceived to be a moral and personal failing. The Surgeon General’s report that came out in 2016 disabuses us of that notion. It is a health condition. But the majority of people still think it’s a personal problem or failing. The research doesn’t support that. We’re having a national conversation on a number of fronts, and this is one of them. There’s a larger problem with Americans not valuing science and knowledge. Changing beliefs with knowledge is harder than I thought it would be. The problem with substance use disorder is that it can result in pre-mature death. It’s an emergency. We need to honor the facts.”

Wednesday
Apr112018

* * The courage of convictions

“Just showing up isn’t that impressive; he works for those people,” deadpanned late night TV talk show host Stephen Colbert, speaking about Florida Senator Marco Rubio, who on Wednesday, February 21 held a town hall mass meeting, attended by about 7000 people, including many victims of the latest American massacre at the Marjory Stoneman Douglas High School. Maybe showing up isn’t that impressive to Colbert, but Rubio showed far more valor than our own congressman Morgan Griffith could muster the following night, as he was conspicuously absent at a similar, if far smaller, town hall meeting in Blacksburg.

To say that Rubio has a cozy relationship with the NRA is a massive understatement. As of last October, the NRA had bolstered Rubio’s campaign war chest by over $3.3 million. We can assume the NRA does not lavish that kind of money frivolously; they know what they’re buying.

I watched much of the event, and each speaker was more compelling than the one before. A teen boy whose best friend was annihilated openly wept as he implored the Senator to act. The father of a slain 14-year old daughter told the senator, “Your comments this week and those of our president have been pathetically weak.” A survivor of the shooting asked Rubio, “Can you tell me you won’t accept a single donation from the NRA?” Rubio, rather than giving a definitive answer, skirted around the issue and said, “People buy into my agenda and I do support the Second Amendment.” And then said it was fine if the NRA wants to flood him with donations, and he prefers to keep their money. Hey, a man’s got to win his elections, eh?

But here’s the thing; as hostile an audience as I’m sure Rubio expected and then got, he showed up. Apparently our own congressman is too much of a coward. In rejecting the local event organizers’ invitation, Griffith angrily called it a “political ambush.” In spite of his announced absence, the Blacksburg event, held in a hotel ballroom, was well attended. There were armed guards to keep the peace, but they weren’t needed. Speakers self-selected, coming to the front of the room to address the audience, a vacant chair set aside for the absent congressman, and three men, Anthony Flaccavento, Justin Santopietro, and Scott Blankenship, vying to face off against the congressman in November’s election. Attendees were giving bright red and bright green pieces of paper on which the words “disagree” and “agree” respectively, were printed. Speakers were impassioned but civil. The three designated topics were the recent tax bill passed by congress, the environment, and health care. Then there was an “open” session where people could speak about whatever they had in mind.

To anyone who’s spent much time following our national conversations lately, there were no surprises. There was much discontent expressed; otherwise why speak? On health care, people spoke about personal or familial situations where the ACA was a lifesaver for them, or how when visiting other, often poorer nations found far better and cheaper care ($250 MRIs, without a prescription, anyone?), and the insanely brutal prices of pharmaceuticals. On the environment, speakers with advanced degrees in environmental and ecological sciences spoke about the immense progress our country has had in cleaning up its air and water since the 1970s because of legislation like the Clean Air Act and Clean Water Act passed by a Republican congress and signed by a Republican president.

In the session on the tax bill, most speakers generally agreed that the plan was a brilliant ploy by the Republican-dominated congress to placate the masses with miniscule, temporary tax breaks while showering the overwhelming benefit of the savings to the richest citizens, all while adding $1.5 trillion or more to the deficit (which apparently is a problem to Republicans only when Democrats are in control).

True, if he’d bothered to attend, Griffith would have heard many things uncomfortable to him. But if he had the courage of his convictions, he’d want to defend his positions, and would feel confident he could actually win more votes by articulating them.

It seems to me, however, there’s more than cowardliness at play here. Griffith didn’t attend because in his political calculus, he feels he doesn’t need constituent approval to win. Our deadbeat congressman hasn’t sponsored or attended a constituent meeting in over 5 years and has zero legislative accomplishments of any value to 9th District communities or individuals since taking office. Nay, he doesn’t work for, nor does he rely on for sustenance, his constituents. He works for the nation’s most dominant corporations, political action committees, and special interest groups, and to them he owes his attention and allegiance. And it will remain that way unless and until voters prove otherwise and send him packing.

Wednesday
Apr112018

* * Keeping up with the Joneses, for three generations

Blasting through the woods at top speed on two wheels isn’t for everybody, but for Bob Jones, his two sons, and his grandson, it’s been part of the family for decades. It turns out that I had a part in their passion.

I met Bob, now 65, at a local car dealership in the 1970s. He’d moved from Newport News and gotten a job as a car mechanic. I was 20 and had been a motorcycle enthusiast since around age 14. We hit it off and he bought a bike to ride with me. Eventually, I drifted away from dirt riding, but it stayed an obsession with him that has never worn off. Now my enthusiasm has returned as well, as I’ve recently bought another dirt bike.

Bob, sons Travis and Nathan, and grandson Trevor met me at Travis’ house on the edge of Blacksburg to talk about it.

Bob said, “I met you and became fascinated by dirt bikes in general. I’d been riding (road bikes) but was fascinated by your Penton, which was state of the art. I bought a 1970 Bultaco. I started motocrossing and trail riding. By 1977 I did woods racing. I’ve always been mechanically inclined and I worked my career as an automotive technician and in tool sales. Now I work for Travis at his store, Go Race (in Christiansburg), again as a mechanic.”

Son Travis, now 47, grew up in his dad’s tire tracks, so to speak. “I was growing up as dad was really getting into it, and it was natural for me to do the same. I was probably 4 when I rode for the first time and got my first bike when I was 6. I was involved in the environment and was stimulated by the machines and the people around them, working to understand how to make them go faster and how to ride faster. Dad taught me a lot and then I learned more on my own.

“We were racing constantly, hare scrambles, motocross and enduro.”

Terminology: motocross is done on a short dirt track with multiple obstacles, jumps, curves and the like. A lap takes a minute or two and a race is comprised of many laps. Hare scrambles are races through the woods on single-track trails that may take 20 to 30 minutes per lap. Enduro is a timed race with checkpoints for the riders.

 Bob said that even beyond the almost weekly racing and the constant mechanic work on the bikes after the races, there was training. “You have to be in good physical condition to race. Hare scrambles races are over 2 hours long and are grueling. To be competitive you have to be in good shape. We were racing together, wrenching together, learning together. I always thought it was a good family thing. We were close knit, enjoying the same activity.

Second son Nathan, 29, has also been a rider and racer for most of his life, and he’s now working on a Master’s degree in Mechanical Engineering at Virginia Tech. “I grew up going to the races with Dad and Trav. I worked my way up through the various age classes, which eventually led to a state championship in 2007. Many of the weekends we weren’t racing we were riding around here. I’m appreciative of the upbringing I got and think that racing builds confidence in other areas of life as well. We’ve always been close as a family in large part because of this shared passion.”

Bob and Travis have also won several state championships between them.

Racing was expensive, and to pay for it they bought a trailer and equipped it to be a mobile shop to take to races, offering mechanic services. On a typical weekend, they’d drive to the track on Friday, sell parts and services all day Saturday, often well into the evening, and race on Sunday. They did this for over ten years, learning the skills that eventually would lead Travis to establish Go Race Inc., which is located beside the Sheetz in Christiansburg. “One time,” Bob said, “Travis was doing suspension work until 4:00 a.m., got a couple hours of sleep, and then won the race at the Pro-Am level.”

Travis’ son Trevor is a high school junior, and he’s a rider as well, known for his near-endless wheelies and technical riding ability. Trevor said, “I don’t ever remember not riding motorcycles. I want to continue the Jones legacy of winning championships and eventually I want to be a world champion.”

“They’re all faster than me now,” Bob admitted. “I’m just trying not to hurt myself!”

I said, “I remember my first ride, how exciting it was. It either grabs you or it doesn’t. But it’s still thrilling for me today.”

Go Race, Inc. now employs several people and takes in suspension work from across the country and indeed worldwide. “Around 70% of my work is from beyond Virginia,” Travis claimed. He’s got all the work he can handle, including upgrading my new Beta. 

Travis said, “Motorcycles have been a successful and fulfilling way of life. I know we all thank Dad for sharing his passion with us; it’s been very rewarding, exciting and a whole lot of fun!”

Wednesday
Apr112018

* * A tale of two surgeries

My wife Jane and I both went under the knife in 2017. She had her right knee replaced and I had my gallbladder extracted. We’re fine now, thanks. But my bewilderment is off the charts. The way our national health care system works, as illustrated by these two surgeries, is maddeningly, astonishingly incoherent.

She’s a few year older than me and is on the uphill side of 65, thus qualifying for Medicare. I’m still streaking towards that magical number. Being self-employed and not covered by a company insurance plan, I have an individual plan on the Affordable Care Act “marketplace.”

My background: one night last summer, I went to bed on an otherwise uneventful evening. By midnight, I was in the emergency room, suffering from devilishly acute, floor-crawlingly intense pain. A failing gallbladder was diagnosed and I scheduled to have it removed. The surgery was a breeze, performed by a local surgeon at my neighborhood hospital, using a da Vinci surgical system, basically a surgeon-controlled robot. I was home within four hours and two days later walked three miles, over nine miles by the weekend.

Jane’s background: Through most of last year and especially on our vacation where she was standing and walking much of the day, she experienced considerable pain in her right knee. Her evaluation revealed diminishing cartilage that would cushion the knee. She was operated on at the same hospital by another local surgeon. She spent over a month in a rehabilitation facility before returning home where she continues to get routine therapy.

It goes without saying that everyone involved, from the doctors to the nurses to the therapist were absolutely top-notch, compassionate, professional, empathic, and attentive. The facilities were fantastic and both of us are having excellent outcomes. For that we are thankful.

However….! Costs are an entirely different beast. It appears that what the care providers charge can only be described as astoundingly arbitrary and capricious.

Breakdown:

On Medicare, Jane pays $108/month, taken from her Social Security. She also pays $163 for a Medicare Supplement. Her complete invoice “Charge” for the hospital, doctor, anesthesiologist and related services was $116,658 (which, by the way, is over half the median home value around here), but the “Allowed” amount was a mere $13,944.

My insurance cost, with the Affordable Care Act subsidy, was $420 per month. But it also carried a $3500 deductible. So I paid over $8500 for insurance last year. My surgery cost $33,782, negotiated to $6845 (a 5-fold difference).

As bizarre as that all is, here’s another story to throw into the mix. A friend of mine is a self-employed handyman. He had his gallbladder extracted a few years ago. When he explained to the hospital that he couldn’t afford to have it done, they did it anyway. For free. Yup, $0.00. He paid nothing.

Sorry to burden you with all that data, but I’m trying to illustrate this point: Healthcare is great when you can afford it, but the system we employ to fund its operation is an absolute, arbitrary mess. Healthcare is a for-profit industry, where a few people make millions off of sick people. They want to keep it that way, and as far as I can tell, they own Congress.

(Note that the Explanation of Benefits has three columns: “Charge”, “Allowed”, and “Difference.” As I understand it, “Allowed” is what the insurer is willing to pay, regardless of what the provider wants. So “Charge” is meaningless. There should be a disclaimer that says, “Warning to stupid people: do not pay this amount. Nobody does. Doing so will financially annihilate you.” How can a hospital ethically justify charging $116,658 for a service when they can stay in business while accepting $13,944 for the exact same thing? And then to beat all, they can offer that same service free to someone who cannot afford it.)

The ACA has become one of the most controversial laws in my lifetime. Personally, I think it’s a terrible system, yet still better than what it replaced. The problem with the “repeal and replace” efforts is they’re not providing a comprehensive solution, befitting our great nation. It is a moral imperative that good healthcare is provided to everybody funded by our national community, and in some ways we already do, as hospitals are legally required not to turn anybody in need away. But what we’ve got is inefficient, unfair, and expensive, relative to other industrialized nations, and we have worse health outcomes than most. We need a system that makes health care available to everybody, yet with incentives to spur talented people to enter the field and perform research to solve our vexing diseases.

Our failure to solve this has made people sick, miserable, poorer, and angry. Every other industrialized nation on earth has figured it out. Why can’t ours?

Wednesday
Apr112018

* * The lost art of the town hall meeting

Who of us in the bifocal set doesn’t love the artwork of Norman Rockwell? During his long and prolific career throughout most of the early 20th Century, Rockwell was among America’s most famous and successful artists and illustrators.

Hold that thought for a moment.

One of the foundational ideas of our American system is that all of us have the right and responsibility to participate. Our Founding Fathers decreed that our nation would not be a monarchy. There would be no kings or queens. Those who rule us would come from us, with their powers granted by our consent. For legislators to know what we want and need, they must hear from us. Thus, town hall meetings emerged in the 19th Century, modeled after New England town meetings of the 17th Century, to allow interaction between political leaders and citizens. In these meetings, participants don’t actually vote or making legally binding decisions. Instead, they provide an equal exchange of ideas. One by one, a citizen express his or her concerns, opinions, and wishes, and the legislator reacts and comments on it.

Local governance, for example our town council and county board of supervisor meetings, are generally open to the public and habitually offer citizen input. Thus, town hall meetings are more useful for state and national level politicians whose work, in our case, is done in Richmond or Washington, and are more appropriate for state senators and delegates to the former and U.S. Senators and congressmen to the latter.

President Franklin Roosevelt was well into his four-term tenure as President of the United States when on January 6, 1941, he delivered one of the most powerful and memorable State of the Union addresses in history. Adolph Hitler’s Nazis had already established concentration camps and his armies were already marching through Europe when Roosevelt proposed four fundamental freedoms that in his view should be enjoyed by people not just in his own country but across the world. Everyone, Roosevelt declared, should have the freedom of speech and of worship, and freedom from want or fear.

To honor and promote these ideals, in 1943, Norman Rockwell released a series of four oil paintings, each illustrating one of Roosevelt’s visions. Rockwell chose a scene from a fictitious town hall meeting to illustrate the Freedom of Speech. It has become one of the truly iconic portraits in American history, especially considering it includes no recognizable subject.

It remains strongly symbolic and timeless. Its main character is a handsome but otherwise undistinguished dark haired commoner. He is of the working class; he wears no tie or jewelry, merely a flannel shirt and worn, frayed jacket. His hands, resting on a wooden railing, are darker and rougher than the bystander to his right, who is bestowing upon him a look of respect, anticipation and earnestness. The speaker is clearly no elitist; he’s merely a devoted citizen speaking his mind to an unseen legislator.

What has made the town hall format so effective and enduring? For one thing, there is an unspoken relationship between the citizen and the legislator, that they are of the same stature. For another, citizens feel empowered because they’re being heard. When a complex issue is raised, speakers not only educate the legislators to their concerns but also educate fellow citizens as to how these issues may affect them. Even though no specific rules or guidelines govern town hall meetings – organizers are free to establish their own – it is implied that give-and-take is an essential part of the process. It is a way for legislators to hear from citizens on upcoming issues, legislation, or regulation.

Recently, several local politicians have purposefully withdrawn from invitations to these events. Why? There may be several reasons; I can only guess. One may be that they can be a locus for protest, often turning heatedly vitriolic. Some have even turned violent. Maybe it’s too much trouble to attend. Sorry to be cynical, but maybe they don’t care what constituents think.

Local congressmen Morgan Griffith and Bob Goodlatte have sworn off these events. Goodlatte is retiring after this term, but Griffith is up for re-election. He hasn’t participated in a town hall meeting since 2011, arguing that carefully orchestrated telephone “meetings” serve the same purpose. You decide whether that’s a compelling point or whether Griffith refuses to directly encounter his constituents.

The local activist group, NRV Indivisible, is hosting a town hall meeting in Blacksburg on February 22, 2018. Griffith and three Democratic potential challengers have been invited. Organizers and many local citizens including myself implore the congressman to attend. I’ll be in the audience, seeing in my mind’s eye the ghost of Norman Rockwell’s fictitious speaker, expressing his fundamental freedom of speech.