US Senate passes “milestone” bill to means-test Medicare, ration health care

Physician with older person Hospital

By Andre Damon
16 April 2015

The US Senate voted Tuesday to pass a health care “reform” bill that incentivizes care providers to cut services for Medicare patients and expands the means testing of the program, requiring recipients with higher incomes to pay more in premiums.

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 is a significant milestone in the ongoing drive to degrade and ultimately dismantle Medicare, the government health insurance program for the elderly and disabled.

The expansion of means testing is a move towards transforming Medicare into a poverty program, undermining political support and setting the stage for its de-funding and ultimate elimination.

Moreover, the bill will “create a new payment system with financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits,” according to the Associated Press, creating a significant financial incentive for care providers to ration care.

The claim that the shift in payment methods to doctors is aimed at improving the overall “value” of health care services is a fraud. In fact, the bill includes language specifically incentivizing or punishing doctors based on factors such as “resource use”—i.e., the frequency of tests or services. The aim is to force doctors to provide less care or face financial penalties.

The bill increases Medicare premiums through means testing by about $35 billion and cuts an estimated $37 billion in payments to hospitals and nursing homes. By some estimates, however, the program could cut Medicare funding by hundreds of billions of dollars over the longer term through the change in the compensation system for doctors. The bill also extends the Children’s Health Insurance Program for only two years.

With this reality in mind, Republican House speaker John Boehner, who drafted the bill along with Democratic House leader Nancy Pelosi, called it “The first real entitlement reform that we’ve seen in nearly two decades” and “a big win.”

Like the vote in the House last month, the Senate vote proceeded in bipartisan fashion. The measure passed 92-to-8, with only far-right Republicans voting against it. President Obama has indicated that he would sign it without delay.

Democratic Senator Ron Wyden called the bill “a milestone for the Medicare program,” declaring, “The Senate is voting to [eliminate] the outdated, inefficiency-rewarding, Medicare reimbursement system.”

Obama was likewise full of praise for the passage of the bill. On Tuesday, Obama declared, “I applaud the Members of Congress from both parties who came together” to pass the bill. He added that its passage was “a milestone.”

Obama declared, “This bill… creates incentives to encourage physicians to participate in new, innovative payment models that could further reduce the growth in Medicare spending.” In other words, the bill will facilitate the slashing of Medicare spending and effect a reduction of care for Medicare recipients.

The basic framework of the bill was originally introduced in the Obama administration’s 2016 budget released in February, in which the White House called for raising $66 billion over ten years by charging higher Medicare premiums to upper-income patients.

Significantly, the passage of the bill has been met with silence by the liberal and “left” organizations around the Democratic Party. Some Medicare advocates, have, however, voiced strong opposition to the bill.

Judith Stein, executive director of the Center for Medicare Advocacy, said that the bill “asks too much from beneficiaries—and nothing from the pharmaceutical or insurance industries.” Paying for the program should not “rely on increasing out-of-pocket health care costs for people with Medicare, jeopardizing access to needed care, and further diminishing the already tenuous economic circumstances facing many beneficiaries and their families.”

The far-right National Review, which favors the ultimate abolition of Medicare and Social Security in their current form, praised the measure as “a bill that actually reforms Medicare.” It declared in an April 13 article, written by Ryan Ellis of Americans for Tax Reform, that “conservatives should give their full support,” noting that the bill “not only would pay for itself but would result in large net savings to the Medicare program over time.”

Ellis writes that Medicare “Part A (which pays for hospital visits and is financed by the payroll tax we all pay) sees significant savings” under the bill. “The present value of future Part A benefits will decline by $387 billion, or just under 2 percent.”

He adds that the bill will lead to “hundreds of billions of dollars in reduced unfunded liabilities and debt from Medicare. All without a penny of tax increases. H.R. 2 is a conservative Medicare-reform bill.”

The real significance of the bill has largely been hidden from the American people by the media, which has presented the passage of the bill as a largely technocratic measure aimed at doing away with the necessity of the yearly passage of the so-called “doc-fix,” which adjusts Medicare reimbursements to care providers based on the growth of medical costs.

The current payment formula has been in place since 1997, tying reimbursements to doctors to the overall growth of the economy. Since health care costs have risen faster than economic growth, this formula would lead to significant cuts in reimbursements without regular adjustments that have been made by Congress. The “fix” ends the formula, but its real significance is the move to abolish the system of compensating doctors based on the services they provide to patients.

Within the private sector, there is already a significant move toward “value-based” care, which incentivizes care providers to skimp on providing services in order to maximize their profits. Forbes notes that “health insurance companies led by UnitedHealth Group, Anthem, Aetna and others are already shifting billions of dollars in payments to providers away from fee-for-service medicine to value-based care as well.”

The drive to slash Medicare spending and ultimately dismantle the program constitutes a significant element of the broader strategy of the ruling class, which is seeking to boost its wealth and profits by dragging back the living standards of the working class to those that existed in the 19th century.

The bipartisan unity with which both houses of Congress have passed this right-wing attack on Medicare expresses the fundamental fact that, for all the talk of “partisan gridlock,” there exists a unity within the political establishment when it comes to asserting the most fundamental social interests of the financial oligarchy that dominates political life in the United States.

Seeing Opportunity in Psychedelic Drugs

New research into LSD and psilocybin makes a powerful argument against prohibition.

Wikimedia Commons

In a massive study published in the Journal of Psychopharmacology, scientists at the Norwegian University for Science and Technology at Trondheim concluded that there is no link between use of LSD and psilocybin (the active ingredient in magic mushrooms) and mental health problems. The study selected 135,000 participants at random—including 19,000 who had used psychedelic drugs—and found no evidence linking such drugs to the onset of mental disorders.

“Over 30 million U.S. adults have tried psychedelics and there just is not much evidence of health problems,” author and clinical psychologist Pål-Ørjan Johansen said.

Johanesen was careful to acknowledge that users of psychedelic drugs are not immune to bad trips, and are as susceptible as anyone else to mental health issues. But his findings negate a common perception that drugs like LSD put users directly in danger—a justification used in criminalization.

“This study assures us that there were not widespread ‘acid casualties‘ in the 1960s,” Charles Grob, a pediatric psychiatrist at UCLA, told Nature.

The study’s publication arrives at a time when interest in psychedelic drugs—or at least their scientific usefulness—is surging. In The New Yorker, the journalist Michael Pollan profiled scientists at New York University whose experiments with administering psilocybin has had largely positive results—particularly among participants stricken with terminal cancer. And in the U.K., 12 patients suffering from clinical depression will take magic mushrooms in a study next year at London’s Imperial College.

Most psychedelic drugs—including LSD and psilocybin—have been illegal in the United States since 1970, the year President Richard Nixon signed the Controlled Substances Act. The legislation classified LSD and mushrooms under Schedule 1, prohibiting not only their consumption and sale but also their use in medicine. Research into the therapeutic benefits of psychedelic drugs largely froze after decades of frenetic scientific investigation.

Despite a revival in scientific interest, a legislative reconsideration of LSD and mushrooms is not yet on the table, and may not be desirable. But a renewed enthusiasm for examining psychedelic substances hints, as with the gradual relaxing of marijuana laws across the country, at a more humane, rational approach to the criminalization of drugs.

MATT SCHIAVENZA is a contributing writer for The Atlantic. He is a former global-affairs writer for the International Business Times and Atlantic senior associate editor.


Curing the fear of death

How “tripping out” could change everything

A chemical called “psilocybin” shows remarkable therapeutic promise. Only problem? It comes from magic mushrooms


 Curing the fear of death: How "tripping out" could change everything

(Credit: stilikone, Objowl via Shutterstock/Salon)

The second time I ate psychedelic mushrooms I was at a log cabin on a lake in northern Maine, and afterwards I sat in a grove of spruce trees for three and a half hours, saying over and over, “There’s so much to see!”

The mushrooms converted my worldview from an uninspired blur to childlike wonderment at everything I glimpsed. And now, according to recent news, certain cancer patients are having the same experience. The active ingredient in psychedelic mushrooms, psilocybin, is being administered on a trial basis to certain participating cancer patients to help them cope with their terminal diagnosis and enjoy the final months of their lives. The provisional results show remarkable success, with implications that may be much, much bigger.

As Michael Pollan notes in a recent New Yorker piece, this research is still in its early stages. Psychedelic mushrooms are presently classified as a Schedule 1 drug, meaning, from the perspective of our federal government, they have no medical use and are prohibited. But the scientific community is taking some steps that – over time, and after much deliberation – could eventually change that.

Here’s how it works: In a controlled setting, cancer patients receive psilocybin plus coaching to help them make the most of the experience. Then they trip, an experience that puts ordinary life, including their cancer, in a new perspective. And that changed outlook stays with them over time. This last part might seem surprising, but at my desk I keep a picture of the spot where I had my own transcendental experience several years ago; it reminds me that my daily tribulations are not all there is to existence, nor are they what actually matter.

The preliminary research findings are convincing. You could even call them awe-inspiring. In one experiment, an astounding two-thirds of participants said the trip was “among the top five most spiritually significant experiences of their lives.” Pollan describes one cancer patient in detail, a man whose psilocybin session was followed by months that were “the happiest in his life” — even though they were also his last. Said the man’s wife: “[After his trip] it was about being with people, enjoying his sandwich and the walk on the promenade. It was as if we lived a lifetime in a year.”

Which made me do a fist pump for science: Great work, folks. Keep this up! Researchers point out that these studies are small and there’s plenty they don’t know. They also stress the difference between taking psilocybin in a clinical setting — one that’s structured and facilitated by experts — and taking the drug recreationally. (By a lake in Maine, say.) Pollan suggests that the only commonality between the two is the molecules being ingested. My (admittedly anecdotal) experience suggests matters aren’t quite that clear-cut. But even that distinction misses a larger point, which is the potential for this research to help a great many people, with cancer or without, to access a deeper sense of joy in their lives. The awe I felt by that lake in Maine — and the satisfaction and peacefulness that Pollan’s cancer patient felt while eating his sandwich and walking on the promenade — is typically absent from regular life. But that doesn’t mean it has to be.

The growing popularity of mindfulness and meditation suggests that many of us would like to inject a bit more wonder into our lives. As well we should. Not to be a damp towel or anything, but we’re all going to die. “We’re all terminal,” as one researcher said to Pollan. While it’s possible that you’ll live to be 100, and hit every item on your bucket list, life is and always will be uncertain. On any given day, disaster could strike. You could go out for some vigorous exercise and suffer a fatal heart attack, like my dad did. There’s just no way to know.

In the meantime, most of us are caught in the drudgery of to-do lists and unread emails. Responsibility makes us focus on the practical side of things — the rent isn’t going to pay itself, after all — while the force of routine makes it seem like there isn’t anything dazzling to experience anyhow. Even if we’d like to call carpe diem our motto, what we actually do is more along the lines of the quotidian: Work, commute, eat, and nod off to sleep.

With that for a backdrop, it’s not surprising that many of us experience angst about our life’s purpose, not to mention a deep-seated dread over the unavoidable fact of our mortality. It can be a wrenching experience, one that sometimes results in panic attacks or depression. We seek out remedies to ease the discomfort: Some people meditate, others drink. If you seek formal treatment, though, you’ll find that the medical establishment doesn’t necessarily consider existential dread to be a disorder. That’s because it’s normal for us to question our existence and fear our demise. In the case of debilitating angst, though, a doctor is likely to recommend the regimen for generalized anxiety — some combo of therapy and meds.

Both of these can be essential in certain cases, of course; meds tend to facilitate acceptance of the way things are, while therapy can help us, over a long stretch of time, change the things that we can to some degree control. But psychedelics are different from either of these. They seem to open a door to a different way of experiencing life. Pollan quotes one source, a longtime advocate for the therapeutic use of psilocybin, who identifies the drug’s potential for “the betterment of well people.” Psychedelics may help ordinary people, who are wrestling with ordinary angst about death and the meaning of life, to really key into, and treasure, the various experiences of their finite existence.

In other words, psychedelics could possibly help us to be more like kids.

Small children often view the world around them with mystic wonder — pushing aside blades of grass to inspect a tiny bug that’s hidden underneath, or perhaps looking wide-eyed at a bright yellow flower poking through a crack in the sidewalk. (Nothing but a common dandelion, says the adult.) Maybe the best description of psilocybin’s effect is a reversion to that childlike awe at the complexity of the world around us, to the point that we can actually relish our lives.

What’s just as remarkable is that we’re not talking about a drug that needs to be administered on a daily or weekly or even monthly basis in order to be effective. These studies gave psilocybin to cancer patients a single time. Then, for months afterward, or longer, the patients reaped enormous benefit.

(The fact that psychedelics only need to be administered once could actually make it less likely that the research will receive ample funding, because pharmaceutical companies don’t see dollar signs in a drug that’s dispensed so sparingly. But that’s another matter )

Of course, some skepticism may be warranted. Recreational use of psychedelics has been associated with psychotic episodes. That’s a good reason for caution. And a potential criticism here is that psilocybin is doing nothing more than playing a hoax on the brain — a hoax that conjures up a mystical experience and converts us into spellbound kids. You might reasonably ask, “do I even want to wander around awe-struck at a dandelion the same way a 3-year-old might?”

So caution is reasonably advised. But what the research demonstrates is nonetheless remarkable: the way the experience seems to shake something loose in participants’ consciousness, something that lets them see beyond the dull gray of routine, or the grimness of cancer, to the joy in being with loved ones, the sensory pleasure of a good meal, or the astounding pink visuals of the sunset.


Ten Years After Hunter S. Thompson’s Death, the Debate Over Suicide Rages On


February 20, 2015

Today, February 20, marks the tenth anniversary of Hunter S. Thompson killing himself with a .45-caliber handgun in his home in Woody Creek, Colorado. Since his suicide, the right-to-die movement has gained a stronger foothold in American consciousness—even if the country is just as divided as ever on whether doctors should be assisting patients in ending their own lives.

“Poling has always shown a majority of people believing that someone has a moral right to commit suicide under some circumstances, but that majority has been increasing over time,” says Matthew Wynia, Director of Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus. Wynia believes a chief factor in that change has been “more and more people say they’ve given a good deal of thought on this issue. And the more people tend to give thought to this issue, the more likely they are to say they are in favor of people having a moral right to commit suicide, under certain circumstances.”

The sticking point is what constitutes a justifiable reason to kill yourself or have a doctor do so for you. In Thompson’s case, he was suffering from intense physical discomfortdue to a back injury, broken leg, hip replacement surgery, and a lung infection. But his widow, Anita, says that while the injuries were significant, they did not justify his suicide.

“His pain was unbearable at times, but was by no means terminal,” Anita tells me via email. “That is the rub. If it were a terminal illness, the horrible aftermath would have been different for me and his loved ones. None of us minded caring for him.”

A mix of popular culture and legislative initiatives have shifted the terrain since then. When Thompson made his big exit in 2005, Jack Kevorkian was still incarcerated for helping his patients shuffle off their mortal coil. He was released in 2007, and shortly before his death a few years later, HBO chronicled his struggles to change public opinion of physician-assisted suicide in the film You Don’t Know Jack, starring Al Pacino.

Last year, suicide seemed to cross a threshold of legitimacy in America. When terminally ill 29-year-old Brittany Maynard appeared on the cover of People magazine next to the headline, “My Decision to Die,” the issue was thrust into the faces of every supermarket shopper in the US. Earlier in the year, the season finale of Girls closed with one of the main characters agreeing to help her geriatric employer end her life, only to have the woman back out after swallowing a fistfull of pills, shouting, “I don’t want to die!”

After the self-inflicted death of Robin Williams last summer, those with strong moral opposition to suicide used the tragedy as an illustration of how much taking your life hurts those around you. “I simply cannot understand how any parent could kill themselves,” Henry Rollins wrote in an editorial for LA Weekly. “I don’t care how well adjusted your kid might be—choosing to kill yourself, rather than to be there for that child, is every shade of awful, traumatic and confusing. I think as soon as you have children, you waive your right to take your own life… I no longer take this person seriously. Their life wasn’t cut short—it was purposely abandoned.”

A decade earlier, Rollins’s comments might have gone unnoticed. As might have Fox News’ Shepard Smith when he referred to Williams as “such a coward” for abandoning his children. Of course, both received a good lashing in the court of public opinion for being so dismissive toward someone suffering from depression. “To the core of my being, I regret it,” Smith apologized in a statement. Rollins followed suit, saying, “I should have known better, but I obviously did not.”

A 2013 Pew Research Poll found that 38 percent of Americans believed that a person has a moral right to commit suicide if “living has become a burden.” But if the person is described as “suffering great pain and have no hope of improvement,” the number increased to 62 percent, a seven-point jump from the way Americans felt about the issue in 1990.

“Psychic suffering is as important as physical suffering when determining if a person should have help to die.”

Still, only 47 percent of Americans in a Pew poll last October said that a doctor should be allowed to facilitate a suicide, barely different from numbers at the time of Thompson’s death. Wynia believes an enduring factor here this is the public’s fear that assisted suicide will be applied as a cost-cutting measure to an already overburdened healthcare system.

“There is worry that insurance companies will cover medication to end your life, but they won’t cover treatments that allow you to extend your life,” he says. “And then the family is stuck with either ponying up the money to extend that person’s life, or they could commit suicide. That puts a lot of pressure on both the family and the individual. Also, there is the issue of the doctor being seen as a double agent who isn’t solely looking out for their best interest.”

As with abortion before Roe v. Wade, when determined citizens are denied medical assistance and left to their own devices, the results can sometimes be disastrous. “There are people who try and fail at suicide, and sometimes they end up in much worse positions than they started,” Wynia adds. “I’ve cared for someone who tried to commit suicide by drinking Drano; that’s a good way to burn out your entire esophagus, and if you survive it, you’re in very bad shape afterward.”

A 2014 Gallup poll showed considerably more support for doctors’ involvement in ending a patient’s life. When asked if physicians should be allowed to “legally end a patient’s life by some painless means,” 69 percent of Americans said they were in favor of such a procedure. But when the question is whether physicians should be able to “assist the patient to commit suicide,” support dropped to 58 percent. This has lead many advocacy groups to adopt the term “aid in dying” as opposed to “assisted suicide.”

A statement on the Compassion and Choices website states: “It is wrong to equate ‘suicide,’ which about 30,000 Americans, suffering from mental illness, tragically resort to each year, with the death-with-dignity option utilized by only 160 terminally ill, but mentally competent, patients in Oregon and Washington last year.”

According to Oregon’s Death With Dignity Act—which permitted Brittany Maynard to be prescribed a lethal dose of drugs from her physician—a patient must be over 18 years old, of sound mind, and diagnosed with a terminal illness with less than six months to live in order to be given life-ending care. Currently, four other states have bills similar to Oregon’s, while 39 states have laws banning physician-assisted suicide. Earlier this month, legislators in Colorado attempted to pass their own version of an assisted suicide bill, but it failed in committee.

In 1995, Australia’s Northern Territory briefly legalized euthanasia through the Rights of the Terminally Ill Act. Dr. Philip Nitschke was the first doctor to administer a voluntary lethal injection to a patient, followed by three more before the law was overturned by the Australian Parliament in 1997. Nitschke retired from medicine that year and began working to educate the public on how to administer their own life-ending procedure without medical supervision or assistance. Last summer, the Australian Medical Board suspended his medical registration, a decision which he is appealing.

Nitschke says two states in Australia currently offer life in prison as a penalty for anyone assisting in another’s suicide, and that he’s been contacted by the British police, who say he may be in violation of the United Kingdom’s assisted suicide laws for hosting workshops educating Brits on how to kill themselves. Unlike more moderate groups like Compassion and Choices, Nitschke’s Exit International doesn’t shy away from words like “suicide,” and feels that the right to die should be expanded dramatically.

A proponent of both left-wing social justice and right-wing rhetoric about personal freedoms, Thompson had very strong feelings about the role of government in our daily lives, particularly when it came to what we were allowed to do with our own bodies.

Laws in most countries that allow physician-assisted suicide under specific circumstances do not consider psychological ailments like depression a justifiable reason for ending your life. Nitschke sees a circular hypocrisy in this, arguing that everyone should be granted the right to end their own life regardless of health, and that those suffering a mental illness are still able to give informed consent.

“Psychic suffering is as important as physical suffering when determining if a person should have help to die,” Nitschke tells me. “The prevailing medical board [in Australia] views almost any psychiatric illness as a reason why one cannot give consent—but the catch-22 is that anyone contemplating suicide, for whatever reason, must be suffering psychiatric illness.”

These days, Nitschke is avoiding criminal prosecution by merely providing information on effective suicide techniques. So long as he doesn’t physically administer a death agent to anyone—the crime that resulted in Kevorkian being hit with a second-degree murder conviction and eight years in prison—he’ll most likely steer clear of jail time.

Philip Nitschke’s euthanasia machine. Photo via Wikimedia Commons

“I think our society is very confused about liberty,” Andrew Solomon, author of The Noonday Demon: An Atlas of Depression, wrote in 2012. “I don’t think it makes sense to force women to carry children they don’t want, and I don’t think it makes sense to prevent people who wish to die from doing so. Just as my marrying my husband doesn’t damage the marriages of straight people, so people who end their lives with assistance do not threaten the lives or decisions of other people.”

While support for laws banning physician-assisted suicide typically come from conservative religious groups and those mistrustful of government-run healthcare, the idea that the government has a role in deciding your end of life care is rooted in a left-leaning philosophy.

“The theory used to be that the state has an interest in the health and wellbeing of its citizens,” acccording to Wynia, “and therefore you as a citizen do not have a right to kill yourself, because you are, in essence, a property of the state.”

This conflicted greatly with the philosophy of Hunter S. Thompson. A proponent of both left-wing social justice and right-wing rhetoric about personal freedoms, Thompson had very strong feelings about the role of government in our daily lives, particularly when it came to what we were allowed to do with our own bodies.

“He once said to me, ‘I’d feel real trapped in this life, Ralph, if I didn’t know I could commit suicide at any moment,'” remembered friend and longtime collaborator Ralph Steadman in a recent interview with Esquire.

Sitting in a New York hotel room while writing the introduction to The Great Shark Hunt, a collection of his essays and journalism published in 1979, Thompson described feeling an existential angst when reflecting on the body of work. “I feel like I might as well be sitting up here carving the words for my own tombstone… and when I finish, the only fitting exit will be right straight off this fucking terrace and into The Fountain, 28 stories below and at least 200 yards out into the air and across Fifth Avenue… The only way I can deal with this eerie situation at all is to make conscious decision that I have already lived and finished the life I planned to live—(13 years longer, in fact).”

Thompson’s widow, Anita, was on the phone with her husband when he took his life. To this day, she feels that the situation was far from hopeless, that his injuries weren’t beyond repair, and that he still had plenty of years left in him.

“He was about to have back surgery again, which meant that the problem would soon be fixed and he could commence his recovery,” she tells me. “My belief is that supporting somebody’s ‘freedom’ to commit suicide because he or she is in some pain or depressed is much different than a chronic or terminal illness. Although I’ve healed from the tragedy, the fact that his personal decision was actually hurried by a series of events and people that later admitted they supported his decision, still haunts me today.”

In September 2005, Rolling Stone published what has come to be known as Hunter Thompson’s suicide note. Despite being written four days beforehand, the brief message does contain the weighty despair of a man unable to inspire in himself the will to go on:

No More Games. No More Bombs. No More Walking. No More Fun. No More Swimming. 67. That is 17 years past 50. 17 more than I needed or wanted. Boring. I am always bitchy. No Fun — for anybody. 67. You are getting Greedy. Act your old age. Relax—This won’t hurt.

Seeing as he lived his life as an undefinable political anomaly—he was an icon of the the hedonism of the 60s and 70s, and also a card-carrying member of the NRA—it’s only fitting that Thompson’s exit from this earth was through the most divisive and controversial doorway possible.

“The fundamental beliefs that underlie our nation are sometimes in conflict with each other—and these issues get at some of the basic tensions in what we value as Americans,” says Wynia. “We value our individual liberties, we value our right to make decisions for ourselves, but we also are a religious community, and we are mistrustful of authority. When you talk about giving the power to doctors or anyone else to help you commit suicide, it makes a lot of people nervous. Even though we also have a libertarian streak that believes, ‘I should be allowed to do this, and I should be allowed to ask my doctor to help me.’ I think this is bound to be a contentious issue for some time to come.”

If you are feeling hopeless of suicidal, there are people you can talk to. Please call the Suicide Prevention Lifeline at 1-800-273-8255.

Follow Josiah M. Hesse on Twitter.

Are America’s High Rates of Mental Illness Actually Based on Sham Science?


The real purpose behind many of these statistics is to change our attitudes and political positions.

About one in five American adults (18.6%) has a mental illness in any given year, according to recent statistics from the National Institute of Mental Health. This statistic has been widely reported with alarm and concern. It’s been used to back up demands for more mental health screening in schools, more legislation to forcibly treat the unwilling, more workplace psychiatric interventions, and more funding for the mental health system. And of course, personally, whenever we or someone we know is having an emotional or psychological problem, we now wonder, is it a mental illness requiring treatment? If one in five of us have one….

But what NIMH quietly made disappear from its website is the fact that this number actually represented a dramatic drop. “An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year,” the NIMH website can still be found to say in’s Wayback Machine. Way back, that is, in 2013.

A reduction in the prevalence of an illness by eight percent of America’s population—25 million fewer victims in one year—is extremely significant. So isn’t that the real story? And isn’t it also important that India recently reported that mental illnesses affect 6.5% of its population, a mere one-third the US rate?

And that would be the real story, if any of these statistics were even remotely scientifically accurate or valid. But they aren’t. They’re nothing more than manipulative political propaganda.

Pharmaceutical companies fund the tests

First, that 18.6% is comprised of a smaller group who have “serious” mental illness and are functionally impaired (4.1%), and a much larger group who are “mildly to moderately” mentally ill and not functionally impaired by it­. Already, we have to wonder how significant a lot of these “mental illnesses” are, if they don’t at all impair someone’s functioning.

NIMH also doesn’t say how long these illnesses last. We only know that, sometime in the year, 18.6% of us met criteria for a mental illness of some duration. But if some depressions or anxieties ­last only a week or month, then it’s possible that at any time as few as 1-2% of the population are mentally ill. That’s a much less eye-popping number that, critics like Australian psychiatrist Jon Jureidini argue, is more accurate.

But even that number may be overblown. That’s because these national-level statistics come from surveys of the general population using mental health screening questionnaires that produce extremely high “false positive” rates.

Virtually all of the screening tools have been designed by people, institutions or companies that profit from providing mental health treatments. The Kutcher Adolescent Depression Scale, for example, will “find” mental illnesses wrongly about seven times as often as it finds them correctly. The screening tool’s author, psychiatrist Stan Kutcher, has taken money from over a dozen pharmaceutical companies. He also co-authored the massively influential study that promoted the antidepressant Paxil as safe and effective for depression in children – a study which, according to a $3 billion US Justice Department settlement with GlaxoSmithKlin­e, had actually secretly found that Paxil was ineffective and unsafe for children. ­Similarly, t­he widely used PHQ-9 and GAD-7 adult mental health questionnaires were created by the pharmaceutical company Pfizer.

This year’s NIMH numbers came from population surveys conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and National Survey on Drug Use, which included the Kessler-6 screening tool as a central component — the author of which, Ronald C. Kessler, has received funding from numerous pharmaceutical companies. How misleading is the Kessler-6? It has just six questions. “During the past 30 days, about how often did you feel: 1) nervous, 2) worthless, 3) hopeless, 4) restless or fidgety, 5) that nothing could cheer you up, or 6) that everything was an effort?” For each, responses range from “none of the time” to “all of the time.” If you answer that for “some of the time” over the past month you felt five of those six emotions, then that’s typically enough for a score of 15 and a diagnosis of mild to moderate mental illness. That may sound like the Kessler-6 is a fast way to diagnose as “mentally ill” a lot of ordinary people who are really just occasionally restless, nervous, despairing about the state of the world, and somewhat loose in how they define “some of the time” in a phone survey.

And indeed, that’s exactly what it is.

How 80% accuracy leads to 20 times as much mental illness

Under optimal conditions, the best mental health screening tools like the Kessler-6 have sometimes been rated at a sensitivity of 90% and specificity of 80%. Sensitivity is the rate at which people who have a disease are correctly identified as ill. Specificity is the rate at which people who don’t have a disease are correctly identified as disease-free. Many people assume 90% sensitivity and 80% specificity mean that a test will be wrong around 10-20% of the time. But the accuracy depends on the prevalence of the illness being screened for. So for example if you’re trying to find a few needles in a big haystack, and you can distinguish needles from hay with 90% accuracy, how many stalks of hay will you wrongly identify as needles?

The answer is: A lot of hay. With a 10% prevalence rate of mental illnesses among 1,000 people, any online screening tool calculator can be used to help show that of the 100 who are mentally ill, we will identify 90 of them. Not too bad. However, at 80% specificity, of the 900 who are well, 180 will be wrongly identified as mentally ill. Ultimately, then, our test will determine that 270 people out of 1,000 are mentally ill, nearly tripling the mental illness rates we started with to 27%. And if mental illnesses are less prevalent, the performance of the test is mathematically worse: ­When only 10 in 1,000 are mentally ill, our test will determine that over twenty times that many are.

Mental illness diagnosing is a scientific bottomless pit

This is a common problem with most medical screening tests. They are typically calibrated to miss as few ill people as possible, but consequently they also then scoop up a lot of healthy people who become anxious or ­depressed while getting subjected to lots of increasingly invasive follow-up tests or unnecessary, dangerous treatments. That’s why even comparably much more reliable tests like mammography, cholesterol measuring, annual “physicals,” and many other screening programs are coming under increasing criticism.

The designers of mental health screening tools acknowledge all this in the scientific literature, if not often openly to the general public. As explained deep in their report, SAMHSA tried to compensate for the Kessler-6’s false positive rates; however, the main method they used was to give a sub-sample of their participa­nts a Standard Clinical Interview for DSM Disorders (SCID).

SCID is the “gold standard” for diagnosing mental illnesses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, SAMHSA stated. In fact, SCID simply employs a much larger number of highly subjective questions designed to divide people into more specific diagnoses. For example, the SCID asks if there’s ever been “anything that you have been afraid to do or felt uncomfortable doing in front of other people, like speaking, eating, or writing.” Answering “yes” puts you on a fast path to having anxiety disorder with social phobia. Have you ever felt “like checking something several times to make sure that you’d done it right?” You’re on your way to an obsessive compulsive disorder diagnosis.

That’s why SCID actually isn’t any more reliable than the Kessler-6, according to Ronald Kessler. He should know; Harvard University’s Kessler is author of the Kessler-6 and co-author of the World Health Organization’s popular screening survey, the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). In their scientific report on the development of the WMH-CIDI, Kessler’s team explained that they simply abandoned the whole idea of trying to create a mental health screening tool that was “valid” or “accurate.”

The underlying problem, they wrote, is that, unlike with cancer, there’s no scientific way to definitively determine the absence of any mental illnesses and thereby verify the accuracy of a screening tool. “As no clinical gold standard assessment is available,” Kessler et al wrote, “we adopted the goal of calibration rather than validation; that is, we asked whether WMH-CIDI diagnoses are ‘consistent’ with diagnoses based on a state-of-the-art clinical research diagnostic interview [the SCID], rather than whether they are ‘correct’.” Essentially, creating an impression of scientific consensus between common screening and diagnostic tools was considered to be more important than achieving scientific accuracy with any one of them.

And where that “consensus” lies has shifted over time. Until the 1950s, it wasn’t uncommon to see studies finding that up to 80% of Americans were mentally ill. Throughout the ’90s, NIMH routinely assessed that 10% of Americans were mildly to seriously mentally ill. In 2000, the US Surgeon General’s report declared that the number was 20%, and the NIMH that year doubled its reported prevalence rates, too. In recent years, NIMH was steadily pushing its rate up to a high of 26.2%, but changed it several months ago to 18.6% to match the latest SAMHSA rate.

Suicide and mental illness and other influential sham statistics

Yet as a society we don’t seem to care that there’s a scientific bottomless pit at the heart of all mental illness statistics and diagnosing. One example which highlights how ridiculously overblown and yet influential such epidemiological statistics have become is the claim that, “Over 90% of people who commit suicide are mentally ill.” This number is frequently pumped by the National Alliance on Mental Illness, American Foundation for Suicide Prevention, American Psychiatric Association, and the National Institute of Mental Health, and it has dominated public policy discussions about suicide prevention for years.

The statistic comes from “psychological autopsy” studies. Psychological autopies involve getting friends or relatives of people who committed suicide to complete common mental health screening questionnaires on behalf of the dead people.

As researchers in the journal Death Studies in 2012 exhaustively detailed, psychological autopsies are even less reliable than mental health screening tests administered under normal conditions. Researchers doing psychological autopsies typically don’t factor in false positive rates. They don’t account for the fact that the questions about someone’s feelings and thoughts in the weeks leading up to suicide couldn’t possibly be reliably answered by someone else, and they ignore the extreme biases that would certainly exist in such answers coming from grieving friends and family. Finally, the studies often include suicidal thinking as itself a heavily weighted sign of mental illness—making these studies’ conclusions rarely more than tautology: “Suicidal thinking is a strong sign of mental illness, therefore people who committed suicide have a strong likelihood of having been mentally ill.”

Unfortunately, there is immense political significance to framing suicidal feelings and other psychological challenges this way, if not any substantive scientific significance. These alleged high rates of mental illness are becoming increasingly influential when we discuss policy questions with respect to issues as diverse as prison populations, troubled kids, pregnant and postpartum women, the homeless, gun violence, and the supposed vast numbers of untreated mentally ill. They draw attention, funding and resources into mental health services and treatments at the expense of many other, arguably more important factors in people’s overall psychological wellness that we could be working on, such as poverty, social services, fragmented communities, and declining opportunities for involvement with nature, the arts, or self-actualizing work. At the individual level, we all become more inclined to suspect we might need a therapist or pill for our troubles, where before we might have organized with others for political change.

And that reveals what the real purpose behind many of these statistics is: To change our attitudes and political positions. They are public relations efforts coming from extremely biased sources.

The politics of “mental illness”

Why is 18.6% the going rate of mental illnesses in America? SAMHSA’s report takes many pages to explain all the adjustments they made to arrive at the numbers they did. However, it’s easy to imagine why they’d avoid going much higher or lower. If SAMHSA scored 90% of us as mentally ill, how seriously would we take them? Conversely, imagine if they went with a cut-off score that determined only 0.3% were mentally ill, while the rest of us were just sometimes really, really upset. How would that affect public narratives on America’s mental health “crisis” and debates about the importance of expanding mental health programs?

However well-meaning, the professional mental health sector develops such statistics to create public concern and support for their positions, to steer people towards their services, and to coax money out of public coffers. These statistics are bluffs in a national game of political poker. The major players are always pushing the rates as high as possible, while being careful not to push them so high that others skeptically demand to see the cards they’re holding. This year, 18.6% is the bet.

Obama’s budget proposal cuts $50 million from immunization funding


By Kevin Martinez

16 February 2015

As part of the 2016 budget proposal, the Obama White House announced that it will cut $50 million, or 8 percent, from $611 million for the Department of Health and Human Services’ “317 program.” The 317 Program provides free vaccinations to children with and without insurance, as well as insured adults in response to outbreaks and disaster relief. It also funds the infrastructure needed for high immunization coverage. The announcement comes at a time when the measles has now spread to 14 states with over 120 confirmed cases.

The budget proposal also calls for $128 million to be added to the Vaccines for Children program, an entitlement program that covers insured, uninsured, and Medicaid-eligible children for vaccines. The Obama Administration has argued that through the Affordable Care Act (ACA) access to immunizations will be expanded, decreasing the need for the 317 program.

L.J. Tan, chief strategy officer for the Immunization Action Coalition, told CNN that despite the ACA now covering many children who were previously covered by the 317 program, the budget cuts will be a setback. “The program funds a lot of the states’ infrastructure for vaccine delivery,” he said. The program is also critical in monitoring the spread of the disease and interviewing those who have come in contact with it.

The announcement that the federal immunization program will be cut is in direct contrast to President Obama’s statement to NBC: “There is every reason to get vaccinated, but there aren’t reasons to not,” adding, “You should get your get kids vaccinated.”

While the Affordable Care Act requires insurance providers to pay for vaccines without cost-sharing, it does not cancel out the function of the 317 program, which acts as a safety net for Americans with and without insurance. It also provides for insured children and adults during a major outbreak such as when 317 program vaccines were used to immunize privately-insured children during 2012-13 when pediatricians did not buy enough pediatric influenza vaccines, according to the Centers for Disease Control and Prevention.

Most of the 317 program provides for state and local health officials to purchase vaccines, educate immunization providers, prepare and respond to outbreaks, and have infrastructure in place. The program was cut $51.5 million last year, eliminating $37.5 million for vaccine purchases. Program operations, which include public awareness and immunization provider education, were cut by $14 million.

Despite the proposed $128 million increase for the Vaccines for Children Program, millions of Americans still rely on the 317 program’s vaccines. According to the Kaiser Family Foundation, more than 41 million non-elderly Americans did not have health insurance in 2013. This did not include the underinsured, whose health plans do not cover all vaccines.

Another strain on the country’s immunization system is that fewer physicians are providing the full host of vaccines to insured patients, while vaccines costs more and more and insurance reimbursement rates decline. This means that local public health providers have to pick up those who fall through the cracks.

The National Vaccine Advisory Committee, in its report to Health and Human Services wrote, “As we have learned over the years, insurance coverage alone is not enough to ensure disease control or high vaccination coverage rates. … Current vaccine financing strategies, including those offered now by the ACA, do not address the fundamental resource needs to support the immunization infrastructure.”

Even if the additional funds are going toward vaccine purchases, the ability of local health departments to prepare and respond to outbreaks has been diminished by the cuts. Chris Aldridge, senior director for infectious disease at the National Association of County and City Health Officials told theWashington Post, “When we’re looking at an outbreak, such as with measles, sometimes the concern is less about, ‘Is that person insured,’ than it is really about getting the vaccine out there and distributing it. There is still a need for vaccine purchasing and making sure we can get out there.”

Meanwhile, the measles outbreak, which began last December in Disneyland, has spread to 17 states and has affected at least 125 people. This year’s outbreak is on track to surpass last year’s total of 644 cases, the highest number since the disease was thought to be eradicated in 2000.

A private Christian school in Port Angeles, Washington, was quarantined after a 5-year-old kindergartner was diagnosed with measles. Students at Olympic Christian school who cannot show proof of immunity were told to stay home, avoid public places, and have no contact with anyone susceptible to measles until February 27, according to the county health department. According to the state health records, of the 115 students at the school, nearly 16 percent were exempted from the required vaccinations, meaning that some 18 students could be affected by the quarantine.

Three new cases of measles were also reported in Toronto, Canada, bringing the total in that country to 22. Health officials there confirmed an unvaccinated 14-year-old girl from the Niagara region was infected. Two more cases were also confirmed in Cook County, Illinois, bring the total there to 13 cases statewide. At least 12 of those cases have been tied to a suburban daycare center in Palatine, mostly occurring in children too young to be vaccinated.

In California, where the disease was thought to have first appeared, two new cases were reported in Ventura County, bringing the county total to 14, and the statewide total to 110. At least one of the cases involved a person who visited Disneyland last December. The amusement park has asked California health officials to reassure the public that the park is safe to attend.

Lawyer Says He Has Fool-Proof Method for Dealing With DUI Checkpoints

Warren Redlich says keep your windows up and remain silent when stopped.

A Florida criminal defense attorney has gone to war against DUI checkpoints, saying the compulsory traffic stops by police violate state laws and civil rights.

Attorney Warren Redlich, a former Libertarian candidate for New York governor, says drivers are not required to roll down their windows at checkpoints to talk to police. Redlich says drivers open themselves up to problems when the police have direct access to them.

Redlich posted a YouTube video on New Year’s Day, which has received nearly 2.4 million views. It has spawned several copycat videos by supporters who have filmed police officers after they were stopped at checkpoints in various states.

In the video, Redlich identifies a DUI checkpoint run by the Florida Highway Patrol and Levy County Sheriff’s department and drives to it. Attached to the door is a flyer that Redlich says spells out his rights: I WILL REMAIN SILENT/I WANT MY LAWYER/NO SEARCHES, it begins. The flyer also contains his valid registration and insurance information along with a clear pocket for his driver’s license.

Redlich says it is important not to open the window, because then the police can say they smell alcohol or drugs. He also says it’s important to remain silent, because otherwise the police can claim your speech is slurred. Even if you’re innocent, Redlich says, it makes it more difficult for an attorney to mount a defense at a trial.

“I’ve seen innocent people who plead guilty because they couldn’t fight or afford an attorney,” Redlich told a Florida ABC News affiliate.

The YouTube video shows three drivers who approach police checkpoints. When the first driver approaches the checkpoint with the doors locked and the windows rolled up, the police examine his flyer quizzically before letting him go. The second and third drivers are also allowed to proceed.

Redlich cautions that the Fair DUI flyer and the procedures used by the drivers are specific to Florida laws. He has published custom flyers and information for other 10 other states on his site Fair DUI. Redlich also published a book by the same in 2013.

“This is not about helping drunks,” says Redlich. “This is about helping innocent people. If some drunk person along the way gets help because of this, I’m perfectly okay with that. I’m a criminal defense attorney.”

Redlich says following his directions, being patient and remaining silent are important, so the flyers probably wouldn’t help impaired drivers.

See Redlich’s video:

Cliff Weathers is a senior editor at AlterNet, covering environmental and consumer issues. He is a former deputy editor at Consumer Reports. His work has also appeared in Salon, Car and Driver, Playboy, Raw Story and Detroit Monthly among other publications. Follow him on Twitter @cliffweathers and on his Facebook page.