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Buy viagra without prescription, Marvel how simple phrases mold consciousness: “Think globally, act locally,” “There is only one earth,” “Trend is not destiny,” “Optimism despite all.” These are Rene Dubos' words, the French-born American microbiologist (1901-1982) who was a leader in the development of antibiotics and became an important ideological source of the environmental movement of the Sixties.
Dubos' laboratory research isolated antibacterial substances from soil microorganisms. He led the discovery of antibiotics used against pneumonia and tuberculosis, and laboratory methods instrumental in Genetics. He is credited as the author of “the most imaginative and pioneering work on antibiotics.” Later in his long life and in more than a dozen books he described the influence and interaction of disease and our environment. Purchase viagra online, His research, publications, and other contributions helped make possible a knowledgeable challenge to the pharmaceutical, chemical, and nuclear industries as well as challenging the FDA and the EPA.
Those challenges, launched by others in the Sixties, failed to achieve any of their objectives, buy viagra without prescription. Nevertheless, buy viagra lowest price, Rene Dubos---the “Despairing Optimist” of The American Scholar--was part of the progressive movement of the Sixties.
His writings are part of what led to the April 22, 1970 “Earth Day” rallies in which millions participated as well as the vast, not always healthful “health propaganda” of the past forty years. Viagra from india, Unfortunately, Dubos also lent his name to some of the most conservative aspects of the environmental movement. You would have to include Dubos among the names of the many who articulated a conservative and pro-business view of any objectives that smacked of challenging industry or government regulatory agencies. Buy viagra without prescription, His career was intertwined with the pharmaceutical giants. He worked in the U.S. government on the army’s biological warfare projects during the Cold War. He was a favored speaker at 1976 Bicentennial events, cost viagra. The U.S. Information Agency then sent him on a round-the-world lecture tour, buy viagra without prescription. Imagine dozens of talks in his Maurice Chevalier accent, all of them of the optimistic: “adapt to the future, “the world as our garden, Cheap viagra online, ” type.
Dubos books or reading chapters from A Collection from His Writings edited by Gerald Piel (1990) will either fill you with admiration for his articulate care for the earth and his grand ethics of the environment or with dismay at his equivocations. Where does a man stand in your esteem who knew that we were Hans Brinker putting a finger in the dike while our technology and the earth’s natural responses overwhelmed our puny efforts intended to save us.
I believe that Rene Dubos died despairing. Buy viagra without prescription, He wrote:
If the goal of technological civilization is merely to do more and more of the same, bigger and faster, tomorrow will be but a horrendous extension of today and will almost inevitably lead us to disasters.
The equivocal “if,” and “will almost inevitably, viagra in australia,” and unnamed “disasters,” are typical of him. There is some denunciation of “palliative ad hoc measures” designed to disguise the “rape of nature” while “vast social unrest awaits us” because of our failure to respond appropriately. Yet he did not keep his denunciatory fires burning. Find cheap viagra, Most of his many words were palliative and officially acceptable.
Dubos understood that children could be trained to withstand most any form of “perversion.” As he said:
I feel sorrow and indignation at seeing the children of America being conditioned by noise, ugliness, and garbage in the streets, and therefore being conditioned to accept the public squalor as the normal state of affairs, buy viagra without prescription.
Reading just a few typical words---a famous lecture in the Rockefeller University Review (July-August, 1968) for instance---you come away with the mature, deeply pessimistic Dubos.
[Human being are so adaptable] that they can survive, function, discount viagra no rx, and multiply despite malnutrition, environmental pollution, excessive sensory stimuli, ugliness and boredom, No rx viagra, high population density, and its attendant regimentation. But while biological adaptability is an asset for survival….it undermines the attributes that make human life different from animal life.
Dubos’ lack of belief in politics is startling. Buy viagra without prescription, At great length and with some drama he would say that we “need” to save the Condors, the Salmon, and ourselves and then refuse to speak in behalf of a few Fish & Wildlife regulations and an enforced Clean Air Act. But what is a small “intrusion” on the “rights” of corporations compared to saving them and us. Why did Dubos tread so lightly on petty interests that progressive Acts of Congress might disrupt, viagra overnight delivery.
The ethical component of the environmental movement has always been high while the political component has been low, making it easily co-opted by corporate interests with the Rockefeller foundation in the lead. They made sure “The Good Earth” movement was acceptable, sure that “Earth Day” never really took off, Buy viagra us, sure that the “acceptable” environmental magazines were well-sponsored and never radical. They are responsible for the advertising-driven, trivial public consciousness of what environment means, the ease with which corporate congresspersons speak hypocrisies about the environment, the once radical Whole Earth Catalog coming to be all about composting toilets, and so on, buy viagra without prescription.
No one ever objected, in general, to trying to keep our environment free from poisons, our skies clear, our water healthful, cheap viagra. But the powers-that-be had strenuous, successful objection to a popular, unadvertised, politically radical environmental movement. Viagra for sale, Toward the end of his life, after his first wife died of a TB that was resistant to the best current antibiotics that he had helped develop, and suffering disabilities himself, he left microbiology recognizing that he was not up on the most current research. Rene Dubos turned his broad speculative intelligence to the subject of our earth, our health, find viagra, and our environment. Buy viagra without prescription, He taught general truths: diseases come and go, time and the good earth will take care of them sooner or later. In short, we live on Cold Comfort Farm.
He always emphasized that the earth will eventually regain its dominance, Free viagra, a very secular scientist’s way of saying “We are in the hands of God.” Here is the “optimism” that informed his views. It is a dark optimism:
There is no doubt that man’s own caprices and vagaries constitute the most insuperable obstacles to the achievement of the millennium and to the success of utopias (The Miracle of Health, 1959, p. 52)
Man is in the process of developing a new consciousness which, in spite of his apparent spiritual and moral captivity, cheap viagra internet, can eventually lift the human race above and beyond the fear, ignorance, and isolation which beset it today. (in the same place, p, buy viagra without prescription. 283)
[And in his public debate with Edward Abbey, Order cheap viagra, a militant environmentalist, Dubos said:] The earth is to be seen neither as an ecosystem to be preserved unchanged nor as a quarry to be exploited for selfish and short-range economic reasons . . . humankind and the earth are a symbiotic system undergoing adaptive changes that result in a continuous process of evolutionary creation. Buy viagra without prescription, [The Professor, p. 80]
These and many similar statements were the essential Dubos, best price for viagra. Fortunately his friends and colleagues were willing to go further:
In 1961 Walter Modell said bluntly:
Research is subordinated not to long-term social benefit but to immediate commercial profit. Currently, disease (not health) is one of the major sources of profit for the pharmaceutical industry, and the doctors are willing agents of those profits . Cheapest viagra online, . , buy viagra without prescription. .
When will they realize that there are too many drugs. No fewer than 150,000 preparations are now in use. About 15, viagra in uk,000 new mixtures and dosages hit the market each year while about 12,000 die off . . . We simply don't have enough diseases to go around. Order viagra cheap online, At the moment the most helpful contribution is the new drug to counteract the untoward effect of other new drugs (Time, May 26, 1961)
Drawing out the partial and implicit lessons from Dubos’ science and speculation on the future, the historian Thomas P. Hughes says that the final point should always be made:
Our vision for the future will be dissipated because new technologies will become subject to existing social forces, especially their profit motive, viagra online pharmacy. It will not reshape them, buy viagra without prescription. That is only a dream.
Many of those mentioned throughout this book of mine cite Dubos (Hughes, John Lech’s The First Miracle Drugs, Illich’s Medical Nemesis, Viagra online stores, and others). All point out, on this authority, that the profit motive is the greatest current threat to long-term public health.
When I compare Dubos to current progressive journalists---many of them thinking their ideas might magically turn into actions by the mere act of writing---I come down feeling warm toward Rene Dubos. Buy viagra without prescription, Yes, he is infuriating vague and general, never stating that conscious policies lead to dire health disparities between rich and poor, watching our longevity decline, seldom asking “who does it serve,” Dubos became one of those grand men sent out abroad as spokesmen for American empire. What a fate for an honorable microbiologist with a voice and a bent for vast perspective and lots of specific knowledge, buy cheap viagra online.
Why did Dubos not win the Nobel Prize. He was nominated many times. It is probably because his antibiotic discoveries were not the ones ultimately used on the market, and yet his research led to Wachsman’s Nobel and Monod, Order viagra in us, Jacob, and Lwoff’s Nobel. His research ended many painful, expensive, bad practices---the orthodox prolonged bed rest for early-treatment tuberculosis, for example, or the long-standing, common over-perscriptions of antibiotics, buy viagra without prescription.
But his popular titles (Mirage of Health, Dreams of Reason, So Human an Animal, A God Within, order viagra, The Wooing of the Earth, and Man Adapting) did not appeal to the European preferences of the Nobel committee. Or was it his work in the 1940s for the Army on biological weapons. Was it because microbiology, Buy generic viagra online, following WWII, had so many excellent candidates. Dubos had presented “The New Microbiology” in his Lowell lectures at Harvard. Buy viagra without prescription, His early biography of Pasteur was remarkable. From both his lab and his desk there was important work. The New England of Medicine and Lancet, and John P.S, viagra in us. Ioannidia and others made their justified high reputations reporting on routine medical industry malpractice. All of them are indebted to Dubos. And yet there was no Nobel, buy viagra without prescription.
During the Sixties, Dubos became general editor of the remarkable Time/Life Science Library, Buy viagra in canada, 26 individually authored, lavishly illustrated, popular volumes. They were sold into millions of American homes by mail-order subscription, so many millions that they are still widely available as used books. Dubos called upon colleagues and friends (all with scientific credentials but with a bent for popular science writing, get viagra, or science fiction, or philosophical speculation). He himself wrote the volume Health and Disease (1965). Buy viagra without prescription, In these circles capitalism is never mentioned in print. But the series included Walter Modell, Viagra no prescription, a radical, several anti-nuclear activists, the onetime screenwriter John Rowan Wilson (“Behind the Mask” about a drug addicted doctor), the remarkable Luna Leopold, and the author of Intern by “Doctor X,” and names like Arthur C, viagra prescription. Clarke and Carl Sagan. A Wikipedia’s site calls these volumes “ephemera of their time”; however, like much of Wikipedia’s Sixties coverage, it was written without reading much of anything. Viagra india, In his own volume, Dubos is particularly interested in showing the healthful physiological adaptability of man (or rather of children) to their environment. From the point of view of resistance to disease, he points out, “the easy life has certain drawbacks.”
Physicians, like generals, are always prepared to fight the last war, buy viagra without prescription. That war is already over. Out bodies and our minds respond best to challenges, which is why we have survived. Health is not a passive condition, sale viagra. (I am paraphrasing)
In essence, he says: Put not thy trust in medicine. Buy viagra without prescription, All the volumes, by Time/Life editorial decision, end optimistically (pictures of African nurses in training, Malaria being overcome, new seeds, more nutritious and effectively harvested fish, and above all pure water). But the text and pictures do not lie about disease, do not lie about the very high death rate among American men just retired, Buy viagra online without prescription, or our American pattern of life, “far from serene.”
We are odd beings, Dubos understands. We have goals which transcend biological purpose and which often run counter to our comfort, our health, and to medical sciences, viagra price. We are not a colony of social ants or bees or herds of cows, all stabilized by instincts. No medicine will give us permanently the health and happiness that these animals seem to symbolize for us. We are not them, buy viagra without prescription. With us new urges will always develop, Order no rx viagra, new problems, struggles, dangers. Yes, health and happiness is an objective, but to “reach our greater goals” is far more important to us than health, viagra pill. Usually our objectives bear no relation to biological necessity. That is our “higher adaptivility” you might say. Buy viagra without prescription, We scar our lives willingly. We will not be accountable to scientific laws. Volition is our thing. Compare viagra prices online, It is precious beyond words. We will continue to count and measure, of course, and that is enormously valuable, but our aspirations are beyond measure. We have not changed essentially since Pleistocene times and, paradoxically, we value much more than life itself, buy viagra without prescription.
We should not confuse medicine with life, canadian pharmacy viagra. Life is much greater, much stranger then anything medicine can comprehend. When these are the essential “carry away” lessons in reading Dubos, how can you deny him great credit.
All this is fair paraphrase of Rene Dubos at the conclusion of Miracle of Health (1959). Buy viagra without prescription, This Frenchman quotes Aristotle, Balzac, Dostoevsky, and others. Best of all, he quotes Katherine Mansfield’s Journal---how on earth did he come upon this?---saying:
Embrace your stresses and strains; disease is only a part of our struggles. There is no Garden of Eden. We were born for this fight.
I cannot but admire this fine scientist for whom making money was so far down in his list of priorities that he did not grasp what so many Americans were up to. He was a dangerous and a typical man of the Sixties, buy viagra without prescription.
In Dubos circles capitalism, as I said, is never mentioned. But all knew that when the powers-that-be wanted something to flourish (the drug industry, medical industry, the auto industry, the financial service industries, the Army and the NFL) they “socialized” it, made it tax-supported (with no tax-payer representation). The Life/Time volume The Physician (1967) by Russel V. Lee and Sarel Eimerl, and in the volume Drugs by Walter Modell and Alfred Lansing (1967), and in Dubos’ Health and Disease, and in other volumes, all put across that the profit motive is the greatest current threat to long-term American public health. They could reach no other conclusion.

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This essay acknowledges the founding group of Buy gold viagra without prescription, Our Bodies, Ourselves as a significant part of the trend of the Sixties. These are women friends and neighbors in the Boston area, so I will be brief. Some were from old CP backgrounds (“red diaper babies”), Gold viagra professional, some Maoists, some Trotskyite. The majority were committed SDS-type social democrats. Between 1969 and the breakup of SDS into various small groups in 1973, when the first full edition of Our Bodies, lowest price gold viagra, Ourselves was published, they recognized that what they had wrought was the first full American feminist manifesto for women.

The Scandinavian countries, where social medicine was an accepted tradition, had long since integrated women’s health issues into public discussion, But Our Bodies, Ourselves was a first for America, buy gold viagra without prescription. Being American, Gold viagra cheapest price, it went on to have a world-wide impact

From my wife I have learned the imperative African slogan “Nothing about us without us.” Our Bodies, Ourselves expressed that women’s slogan. There have been nine editions of the book in 25 languages. There are spin-off publications and interactive websites, workshops, gold viagra pharmacy online, and conferences. All of them reproduce the direct, visual, Buy gold viagra no prescription required, intimate, and well-studied approach created by the original founding group. Buy gold viagra without prescription, You cannot overstate the courage of these women. It may be that “OBOS” (the acronym) is a bad idea---the full name is so much better---and they may have made other minor mistakes. But that is no matter. Here is a paraphrase of their basic statement:

Until very recently pregnancies were all but inevitable, gold viagra medicine. Biology was our destiny. Because our bodies are designed to get pregnant, give birth, and lactate, that is what all or most of us did….When we first started talking to each other about this we found that old expectations had nudged most of us into a rigid role of wife-and-motherhood from the moment we were born females, buy gold viagra without prescription.

When we started in 1969 we found that the majority of us knew nothing of birth control and abortion, nothing of the laws governing birth control and abortion. Online gold viagra, And so we put this information together for each other. What does it mean to be female; how do we take away the compulsion and anxiety. We should control our destiny. Buy gold viagra without prescription, Poor sex education, the imperfection of available contraceptives, too highly priced and poorly administered health care, the notion that menstrual blood shameful and many insane legal restrictions on our life are unjust: these block our conscious decisions. We saw that body education is core education. As a consequence, order gold viagra from canada, our influence has gone around the world.

Theirs is a grand victory over reaction, over backlash, over a blind and disgusting hatred of women’s bodies. Buy no rx gold viagra, In retrospect it is a shame that our Sixties political organizations did not sponsor or support Our Bodies, Ourselves. That was a great mistake.

You can look up and attach some individual names, if that is your inclination, buy gold viagra without prescription. But Our Bodies, Ourselves was a pure product of the best of Second Wave feminism when women gathered in groups as collectives, gold viagra tablet. That was before feminist writing had become clotted with career striving for academic respectability, clotted with post-modernist fondness for obscurity and avoidance of anything discomforting. With these Our Bodies, Gold viagra buy drug, Ourselves women, we have a practical discussion of everything a woman should know about health, physician-relations, and sexuality, as learned with their feet in the stirrups, gold viagra approved. They covered all the health issues of great importance to women: birth, abortion, self-examination, Cheap gold viagra no rx, lesbianism, and how to demand answers to their intimate medical questions. Buy gold viagra without prescription, It is the most important book I know of that originated in a collective. Most collectives produced nothing of the sort.

How these twelve or fifteen women held together I have no idea. I have never asked, buy gold viagra on internet. Their unity gives some indication of the power inherent in a genuine collective from an era forty years ago that saw a great many collectives, the majority of which, as I say, Order cheap gold viagra online, left nothing behind for the benefit of us all. Every parent or friend of any woman should put Our Bodies, Ourselves in that woman’s hands, buy gold viagra without prescription.

Initially the book was directed toward supporting women facing male physicians. The physicians were routinely condescending, paternalistic, judgmental, buy gold viagra cheap, and uninformative. At first, the group called themselves “the doctors group” and simply shared experiences. Order gold viagra no prescription required, Perhaps this was how they overcame the sectarianism that was so common in those days, by making “subjective” experience a matter of importance whereas the normal power-leader sectarians (I know them well) banned everything that was not “objective.”

These women united around their focus and produced a book that has now benefited many millions in many languages as is told in the Preface to the 1973 edition:

When we gave the course we met in any available free space we could get: in day schools, in nursery schools, in churches, in our homes, order gold viagra from us. Buy gold viagra without prescription, We wanted the course to stimulate the same kind of talking and sharing that we who had prepared the course had experienced. We had something to say, but we had a lot to learn as well; we did not want a traditional teacher-student relationship. At the end of ten to twelve sessions, Gold viagra no rx, we found that many women felt both eager and competent to get together in small groups and share what they had learned with other women. We saw it as a never-ending process always involving more and more women.

That seems to be the way it was done. Oprah Winfrey has grasped and commercialized the power of this simple unity, buy gold viagra without prescription. To her credit she has at least done some things to sponsor clubs, “getting together, best price gold viagra,” and making little societies. Take this as a mass media endorsement of Our Bodies, Ourselves although it was always a bit too controversial for mass media.

Compare their work, Cheap gold viagra pharmacy, if you will, to nursing history articles in the academic journals of the period. Those lack the honesty and simplicity. They wander about with half-understood Derrida’s and Foucault’s suggestive phrases, sprouting three-syllable words in what amount to parody, gold viagra alternative, words aimed against comprehension and toward establishing intellectualist property boundaries. Buy gold viagra without prescription, Our Bodies, Ourselves resisted that contamination.

The Our Bodies, Ourselves people were educated, Where to buy gold viagra, mostly white, middle class women capable of reading textbooks and NEJM articles without concluding they must, somehow, imitate their way to respectability. They learned from some of the early nursing literature (although it was too confined, gold viagra canada, proper, inconclusive, and respectable). Find cheap gold viagra online, They remembered their Biology, going on to write about everything of deep concern to their sex.

Their sharing covered the onset of menstruation, self-examination, lesbian sex, buy cheapest gold viagra, abortion, pregnancy, and birth. And later they covered female cancer, buy gold viagra without prescription. Buy gold viagra online australia, Although their stories are not included here, I would urge you to read some medical novels---Cutting for Stone, for instance---only in order to acquaint yourself with the realities of the woman’s body. They knew and studied all this. It gave their book its authenticity, gold viagra malaysia.

They were very thorough, where for most of the world these were closed subjects. Thus the translations and international spread of Buy gold viagra without prescription, Our Bodies, Ourselves included common genital cutting and its consequences, effective starving of girl-children and in eutro infanticide, and other topics. Even in America there is more than one story of women-hating doctors excising the clitoris on whim, Gold viagra sale, what they referred to with their cynical colleagues as “gaming the system,” and other mistreatment.

Learning about our bodies is an exciting kind of learning, where information and feelings are allowed to interact. It makes the difference between rote memorization and relevant learning, find gold viagra no prescription required, between fragmented pieces of a puzzle and the integrated picture, between abstractions and real knowledge. We discovered that people don't learn very much when they are just passive recipients of information. We found that each individual's response to information about their body was valid and useful, and that by sharing our responses we saw that we could develop a base on which to be critical of what the experts tell us, buy gold viagra without prescription. Drug gold viagra, Whatever we need to learn now, in whatever area of our lives, we know more how to go about it.

A second important result of this kind of learning is that we are better prepared to evaluate the institutions that are supposed to meet our health needs---the hospitals, clinics, order gold viagra without prescription, doctors, medical schools, nursing schools, Cheap gold viagra from uk, public health departments, Medicaid bureaucracies and so on. For some of us it was the first time we had looked critically, and with strength, at the existing institutions serving us, price of gold viagra. The experience of learning just how little control we had over our lives and bodies, the coming together out of isolation to learn from each other in order to define what we needed, and the experience of supporting one another in demanding the changes that grew out of our developing critique, Discount gold viagra without prescription, all were crucial and formative political experiences for us. We have felt our potential power as a force for political and social change.

Buy gold viagra without prescription, This should have been the teaching of the nursing profession. Nurses did some of this work and should have done more. However, against the Nightingale tradition, they were wedded to their salaries and to the slow astonished pride they took in being somewhat regarded as professionals, gold viagra side effects. Nurses have yet to learn that they are the social medicine exemplars and the center of all this care as it is actually practiced for the great majority. It is too bad that professional nursing, by and large, Buy gold viagra pills, stood outside the circle of Our Bodies, Ourselves and outside the radicalism of the Sixties. They missed this period during which they might have made great contributions, buy gold viagra without prescription. Late Second Wave feminism---gender studies and so on---were a enormous distration for nursing literature. Those who have not already abandoned it should do so immediately.

Ignorance has been the bane of women, cheap price gold viagra, more even then male oppression and patriarchy and routine subordination. It is ignorance that keeps women down. Buy gold viagra without prescription, In many matriarchal societies---where the presence of a husband is an irrelevancy such as throughout the Middle East, Latin America, and Asia and where women grow and train their children while also providing essentials for the men---their backwardness, mirroring the common sad lack of development, is the society’s bane. That American nurses have failed to grasp these facts, Certified gold viagra, failed to spread widely throughout the world, and that is the curse of the nursing profession.

Nightingale foresaw this and devoted most of her energies in her last decades to India. But the example was not taken. By her lights and within her Victorian limitations, gold viagra in malaysia, nurses should look to the world. But Cold War nursing became a shame on nursing, a deep and costly politically failure, a scandal for their profession, buy gold viagra without prescription. They knew so much and shared so little. They kept their mouths shut. They perpetuated widespread ignorance while their ideological leaders wrote articles about “post-modernist feminist theory.” Ours is a poorer world for their failure to act.

Sooner or later the official nursing literature will have to begin to write about the contributions that took place outside their profession. They will have to break with their salaried isolation, They should think deeply about the contributions of Our Bodies, Ourselves.

Jim.

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Buy viagra super force without prescription, Among his friends, Ivan Illich was a story-teller. He made fun of what is and played with his many ideas for making this a better world. These ideas were based on a repudiation of everything existing (autos, suburbs, and all our service institutions with their teachers, cheap viagra super force overnight delivery, doctors, lawyers, judges, Tablet viagra super force, priests, and, in company, whatever had just been said by anyone else). The saving grace is that he did believe that everything was always up to us, buy viagra super force from canada.

Do not try to read Illich in tones of solemnity. Forget your awe of great learning and ignore the fact that he has been called “the greatest social critic of the twentieth century.” Enjoy this Jesuit priest---up above the world so high---always at the center of attention, buy viagra super force without prescription. He speaks in behalf of a world in perfect accord of the social gospel of Jesus Christ. Think of the Sixties Liberation priests and nuns---who also had their humor---those nuns and priests that the official and orthodox church condemned as it did Monsignor Ivan Ilich, Viagra super force online sales, S.J.

Ilich repudiated commercial medicine. He favored home nursing (and home schooling, and walking, and conviviality, viagra super force online review, and reading among the 12th century mystics who wanted us to understand God’s grace in order to grasp His gift of this beautiful planet that we now so misuse and our human society that we now so corrupt with bureaus and professions. Buy viagra super force without prescription, This essay attempts to fill you in on one of Illich’s lesser-known books, Medical Nemesis: The Expropriation of Health (1976). In Greek mythology, Nemesis, Viagra super force rx, is the goddess of retribution and vengeance against unlimited pride (hubris).

The more familiar book is probably Deschooling Society (1971) and his advocacy of home schooling in many public talks. We learn how we impoverish our culture in schools where the children are taught the mythology of industrial progress. In schools they learn to worship our counterproductive major institutions. Schools officially seize the young, who are avid to read, and they destroy that passion, right down to the ABCs, buy viagra super force without prescription. Soon children read only in the way a construction worker “reads” blueprints or a mechanic “reads” setup instructions, viagra super force online cheap.

If you are interested in city-planning, transportation, and oil depletion, Viagra super force overnight shipping, you should read Energy and Equity (1974) or, if your interest is feminism, the book Gender (1982) or Shadow Work (1981) or if is philosophy, the book Tools for Conviviality (1973). And there are remarkable books beyond these, viagra super force without rx. Although all the books invite exegesis, graduate schools do not offer seminars on Ivan Ilich. He aimed his arrows at the heart of their learned ignorance.*

But the best exegesis on Medical Nemesis Buy viagra super force without prescription, is by Illich himself in a speech given at a nursing conference in Hershey, Pennsylvania in 1994 devoted to qualitative health research.

There he remarks that his once shocking first sentence in Medical Nemesis (“The medical establishment has become a major threat to health.”) now seems trite.** Illich sets out to remedy any nurses’ misunderstanding. Order viagra super force on internet, He jokes that although the medical schools bought his book in bulk they did so only because of its major flaw. Here is his speech (made brief and in paraphrase):

My book was flawed. I meant it as an indictment of the medical profession but, because of the flaw, doctors were able to read it was a demonstration of how they can eat their cake and have it too, viagra super force from canada.

You nurses, on the other hand, are the learned watchdogs over the quality of Health Care, buy viagra super force without prescription. Some of you are after more, better, cheaper and less degrading services for more people. Lowest price for viagra super force, Others, cutting to the heart of the problem, want to do research on the pathogenic myths and false certainties that result from the financing and organization of health care rituals. Both groups need to understand that my book had a flaw.

I had studied 1970’s medicine and found it preoccupied with technique to the extent that it had become destructive of the health of persons, viagra super force no online prescription. Buy viagra super force without prescription, With the help of others, I documented clinical, social, and cultural iatrogenesis; that is, doctors were multiplying misery in order to sustain and enhance their profession and the profits from their professional monopoly.

However, I did not understand then how successfully the professional reduction of a person to “a life” could be.

I am still satisfied with the substance and rhetoric of Nemesis and its focus on counter productivity, Buy discount viagra super force, its focus on suffering. But I neglected the force of the technically engineered pursuit of happiness, the emerging epidemic of bioethics, and the idea of the total management of the “life” wherein the person would get totally out of touch with their own flesh.

The medical profession now has you thinking of yourself as a self-regulatory, cheap generic viagra super force, self-constructing “immune system” that only requires responsible management. You have become the patient, buy viagra super force without prescription. This will not change. It is altogether too profitable for the medical profession to allow it to change. Viagra super force free delivery, I smell that you nurses are on the point of being co-opted. You will try to remedy this technique-contaminated medicine but your will fail. Buy viagra super force without prescription, You cannot possibly spend as much as the AMA will spend on defeating a healthy medicine. Yes, there will be grants and papers and careers, but you will fail, viagra super force bangkok.

Most nurses I talk to do not want to spend your lives oiling the machinery, producing higher rates of client-perceived utility. Some of you want to decipher the machinery fearlessly. Low cost viagra super force, But just try deciphering any of our contemporary paradoxes. However your devotion to a dignified, meaningful, patient, loving, beautiful, resigned, and joyful embodiment of medicine, you will fail, buy viagra super force without prescription. You will loose your freedom. I know it.

Medicine has become “technique.” Mere health is a defeated concept. It has become self-abuse, real viagra super force without prescription, an arbitrary genetic event, or a crime. Buy viagra super force without prescription, There is no medical industry profit in true health.

You nurses are all on the dark side of the human condition where you must accept suffering and care for it. Order viagra super force in canada, The doctors will not do so.

I was wrong to define health as “the intensity of autonomous coping activity.” That played to the idea of a person as a ‘black box” where the “art of living” cannot be pursued.

You nurses on the dark side hopefully will oppose demoralizing medicalization, the iatrogenic boomerang, and medical zed routine, viagra super force cost. More power to you, buy viagra super force without prescription. But, because of system ideology, you will not win. Viagra super force sales, Beware of whatever transmits system ideology. To see the patient ego as an immune system is deadly. The phrase “immune system” dates only from the middle 1970’s. Buy viagra super force without prescription, It is a market term. It is an object of belief, a misrepresentation of the self, viagra super force buy online. It is like the zygote---on the way to becoming a human subject because the Pope and his jurists say it is---along with a genome and cytoplasm and the whole zygote thing. Wonder of wonders. It replaces what we formerly called “a person, Discount viagra super force overnight delivery, ” a seeming bacteria competing for scarce oxygen that by necromancy becomes “a person.” I did not see this before.

You are a perfect audience, buy viagra super force without prescription. You care about bodies. Health is not simply a “coping” activity. I had ignored the corrupting influence of the system of medical management

From Limits to Medicine, he writes:

The threat which current medicine represents to the health of populations is analogous to the threat which the volume and intensity of traffic represent to mobility, cheap viagra super force no prescription. . . In each case a major institutional endeavor has turned counterproductive.

The details of his analysis are significant. Cheapest viagra super force prices, In the chapter “Political Transmission of Iatrogenic Disease” Illich analyzes the consequences of the medical monopoly. Well beyond any issue of mistakes, malpractice, or accidents---which are solvable real problems but widely used to excuse much more extensive iatrological disease---there are the political/social facts: excessive stress; disabling dependence; the creation of new painful needs; lowered levels of tolerance for discomfort; abolished self-care; and private homes made inhospitable to birth, sickness, canada viagra super force, and death. On top of this, there is the disabling industrial machine itself into which we are thrown and the whole drooling consumer life that we drive ourselves to when we are off the clock, as well as the endless “shadow work” we undertake (wasting, unpaid, unrewarding, and unhealthful shadow work that are part of being good consumers of products of the industrial machine), buy viagra super force without prescription.

He calls these ills “perversions,” perversions of a for-profit medical system that has crossed over to be a radical monopoly. Order viagra super force no rx, He points out that Marx showed at the beginning of Capital that radical monopolies paralyze the output of nonmarketable use-values. In the U.S. these use-values are gone. Buy viagra super force without prescription, In China modern medicine in rural districts was so scarce that budget increases have indeed contributed to increased health levels and equity. But even now---at the time Ilich is writing---the signs are that “Barefoot Medicine is losing its makeshift, semi-independent, buy viagra super force from us, grassroots character and being integrated into a unitary health-care technocracy.” And elsewhere (Latin America, Russia, England, Viagra super force discount, even Sweden) budget increases, turned over to medical professionals, are creating a monopoly as radical as that under America’s ruling capitalist oligarchy. The AMA and the pharmaceutical associations, and their equivalents elsewhere, buy viagra super force on line, become an obstacle to the distribution of resources to the sick and injured rather than to their self-appointed caretakers.

On the institutional shape healthcare has taken, Illich covers the phenomenal rise of health service costs, Viagra super force cheap, the growing incidence of prepayment (insurance), irrational planning, and the profit-drive toward always-new services over any rational concentration on providing old products more efficiently and cheaply. There is also the constant change in products due precisely to increased insurance coverage. (And he was writing before the advent of the “civil rights” for corporate “persons” that allows pharmaceutical corporations to market their nostrums on television, just as they now have been given an unlimited right to lobby the population, buy commentators, buy (“the Senator from Squib”) politicians, buy viagra super force without prescription.

Insurance becomes a self-reinforcing constant behind cost inflation, purchase viagra super force overnight delivery. It provides the providers (and the manufacturers) with ever more control of resources and, hence, for their wanton and irresponsible prescriptions, Buying viagra super force, unnecessary surgery and the laboratory analysis that always “indicates” new procedures, new technique, new products.

And, now, viagra super force, like most Review of Book essayists, I have paraphrased until I am out of breath. Best to end with other direct quotations:

Increasing and irreparable damage accompanies present industrial expansion of all sectors. Buy viagra super force without prescription, In medicine this damage is iatrogenesis. Viagra super force online without a prescription, Iatrogenesis is clinical when pain, sickness, and death result from medical care; it is social when health policies reinforce an industrial organization that generates ill-health; it is cultural and symbolic when medically sponsored behavior and delusions restrict the vital autonomy of people by undermining their competence in growing up, caring for each other, and aging, generic viagra super force cheap, or when medical intervention cripples personal responses to pain, disability, impairment, Order generic viagra super force, anguish, and death.

Under priests in the past epidemics came and went. The infection that prevailed at the outset of the industrial age illustrate how medicine came by its lofty reputation: tuberculosis, cholera, viagra super force for order, dysentery, and typhoid came and went losing much of the virulence and social important, just as scarlet fever, Viagra super force australia, diphtheria, whooping cough, and measles among children under 15 lost their virulence before antibiotics. Improved housing and especially better nutrition were the saving factors as their are in the third world, These and diarrhea and upper respiratory tract infections disappeared with the same measures, no matter how much or little medical care is provided. These declined as the modern epidemics—heart disease, emphysema, bronchitis, obesity, and diabetes---took over, buy viagra super force without prescription.

Two things are certain [writes Illich], the professional practice of physicians cannot be credited with elimination of the old forms of mortality . . . and alone should not be blamed for the new forms of suffering . . . The environment is the primary determinant of general health of any population.

His is an unusual condemnation of what is. For Ilich, exactly as for the deeply religious Florence Nightingale, “medicine is a moral enterprise and therefore inevitably gives content to good and evil”

When thinking of the health of peoples, there is this final Ilich quotation: “The trail beaten in the harvest is only a reminder of the greater damage done by the baron of the village that his hunt overruns.” [Illich, Medical Nemesis, (1995 edition) p. 40]***

Jim

* I learned at America: the National Catholic Weekly, that The International Journal of Illich Studies has recently been founded. The articles are, by and large, unimpressive, buy viagra super force without prescription. On Illich I recommend the collection of admiring essays The Challenges of Ivan Illich (2002) edited by Lee Hoinacki and Carl Mitcham

** If you doubt this “trite” judgment check out documents on the current web site of the U.S. Agency for Healthcare Research and Quality, or the iatogenic-focused articles in most any issue of the weekly New England Journal of Medicine, or see some shock-titled books by good medical journalists. I would recommend Laurie Garrett’s Betrayal of Trust (2000) because of her broad international perspective and careful documentation. There is also Code Green; Money-Driven Hospitals and the Dismantling of Nursing by Dana Beth Weinberg (2003) or Maggie Mahar’s Money-Driven Medicine (2006)], and many others. Buy viagra super force without prescription, In accord with my thesis, much of the best medical journalism dates from earlier. One example---and to test of the generalization---there are Morton Mintz’s By Prescription Only (2nd ed.1967) and The Pill: An Alarming Report (1970).

*** Ivan Illich was born in 1926 in Vienna and died of untreated cancer in Mexico in 2002. He refused ordinary medical treatment because it would disable him from trying to cope with the cancer through holistic health measures. As John Coleman, S.J., writes, “He lived as long and as productively as if he had let modern medicine take its course.” The good Father does say “arguably.”

.

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Buy viagra oral jelly without prescription, While we may occasionally hear of shortages of healthcare personnel, everyone knows that crisis is way overused in health journalism. Any evidence of shortage tends to be anecdotal, a local or regional issue. We know that over-production or under-production is an old story. Supply ebbs and flows with demographics and with national policy. Meanwhile, private interests encourage the government to tighten or loosen incentives, grants, regulations, and public payments, cheap viagra oral jelly from canada. The reasons are entirely those of the private interests, buy viagra oral jelly without prescription. These observations can make you feel like a cynic.

Health Care Personnel: Sixties to 2010

However, in the 60s the supply of medical personnel was an actual crisis. Retrospective statistics prove it. In the 60s healthcare expenditure was less than 5% of GDP. Buy viagra oral jelly without prescription, Now it is well over 20%. The new expenditures have served not only greed, not only drug and technology industry profits, but have also brought new and improved buildings, Viagra oral jelly us, new training schools, and staff additions. Back then there were roughly 150 physicians per 100,000 population; now there is twice that. Then there were roughly 430 nurses per 100,000. Now there are more than 850. These statistics are easy to find, buy viagra oral jelly without prescription.

Anyone can see the results. Back in the 60s people were aware of the aging of their few primary care physicians, the insufficiency of nurses, viagra oral jelly buy, and the genuinely long waiting times. A doctor’s office cartoon would show many people waiting for their turn. This reality was supported by a Carnegie Commission Report in 1970 (“the output of physicians ought to be increased by fifty per cent in the next decade”). Buy viagra oral jelly without prescription, And---not to forget---people were coming off a diet of emphatic TV: “Dr. Kildare,” “Ben Casey,” “The Nurses,” and “The Doctors.” The concern about the supply of doctors and nurses was real, no tint of cynicism. Purchase viagra oral jelly no rx, Nurses were striking for higher wages. Physicians were refusing to serve in rural or in urban slum areas (where rewards were smaller).* On their operative small business model, physicians were becoming “specialists” and attending to their professional equivalent of “billable hours.” Meanwhile the American Medical Association (AMA) was making chauvinist declarations that “men need income sufficient to support a family,” and that years and thousands spent on training (eight academic years plus three to eight years internship and residency) deserved recompense. As if nurses had floated without sacrifice to their degrees and certifications.

The majority of doctors had never been attracted to preventative, public, social medicine, or even primary care, buy viagra oral jelly without prescription. As doctors were absent or genuinely over-worked, an insufficient number of lowly nurses filled the gaps. Meanwhile, the professional bureaucracies of both the doctors (the AMA) and the American Nursing Association (ANA) were in turf battles over titles, control, cheap viagra oral jelly without prescription, and administrative or teaching slots.

No thanks to these bureaucracies, we soon saw changes. Federal expenditures and federal policies changed. Buy viagra oral jelly without prescription, Slowly new funding programs came into being. Also---again influenced by federal policy---we soon saw doctors and nurses trained in India, the Philippines, and Mexico coming into the countryside and the urban center hospitals. Both shortage and eventual response were real.**

“You girls are a couple of cynics, Cheapest generic viagra oral jelly, ” he said.
“We’re just tired of making those bastards rich while we do all the work.”
“There are some good ones,” I said
“Not where I trained,” she said. “All they knew how to do was count, one thousand dollars, two thousand dollars. , buy viagra oral jelly without prescription. .”
From the novel Forever Sad the Hearts (1984) by Patricia Walsh, CRNA.***

Henry Silver & Eugene Stead

Doctors Henry Silver and Eugene Stead, along with their nursing colleagues developed innovative advanced nursing programs in response to this 60s crisis, order viagra oral jelly overnight delivery.

First were Dr. Eugene Stead and his nursing colleague Thelma Ingles, who developed the “nurse-clinician” or “nurse practitioner” program at Duke University. He was chairman of the Dept. Buy viagra oral jelly without prescription, of Medicine at Duke, responding to pressure to improve health care delivery with a shortage of doctors in North Carolina. Thelma Ingles was supervisor of Med/Surg nursing at Duke Nursing School. This response began in 1957.

Second, entirely unrelated, Buy cheapest viagra oral jelly on line, were Dr. Henry Silver and his nurse-educator colleague Loretta Ford at the University of Colorado. In 1965 they developed a successful “Pediatric Nurse Practitioner” program, buy viagra oral jelly without prescription. The reality on the ground---as they say in the wars---had long accepted nurses functioning as providers of all pediatric services (diagnosis, testing, prescription, and treatment). But Silver knew that without an academic program, a title, and special certification more nurses would not come forward and flourish in responsible positions in social medicine.

For Silver and Ford, viagra oral jelly tablets, pediatric nursing segued into the “Pediatric Nurse Practitioner (PNP) and then a three-year “Physician’s Assistant” with a Masters. Silver was one of the first MDs to highlight child abuse and identify the syndromes of child neglect. Buy viagra oral jelly without prescription, To be brief, Silver first succeeded where Stead failed in the late 1950s to provide nurses with advanced clinical training and advanced certification.

In 1970 both the AMA and the ANA were still screaming against the idea of a new category for nurses, whatever it was called. Eventually both associations retreated from their opposition, but it required twenty years. That is a long time in health care terms. No credit is due either association. All credit is due the force of reality, buy viagra oral jelly without prescription. Buy viagra oral jelly once daily, Nurses were already doing all the work that the advanced certifications would license. Doctors wanted the work done. The doctors had a mature profession supported by billable procedures not patient care, but they were overworked. Someone had to represent social medicine and it was not going to be the busy specialist practitioner MDs of the AMA. Buy viagra oral jelly without prescription, Compromisers from the nursing associations talked of “the doctor-nurse team” and a “Unification Model,” but at some point nurses needed to dissociate themselves from doctors, that is, from their role as handmaidens who did something other than “medicine.” AMA leaders had exclaimed over and over that “Nursing care was not medical care.” The path forward was to develop the training necessary (and the degrees) for more comprehensive nursing practice, even though in many cases they were already practicing it.

Many nurses---never petty capitalists---thought all they needed was respect and fair compensation, more than independence. However, in a thoroughly sexist society such fine distinctions as respect and fairness exist only symbolically. Many nurses knew that in their bones, cost of viagra oral jelly. Therefore the only path forward was co-expansion and on toward higher salaried RNs: the Physician Assistant and the Nurse Practitioner. These positions provided something more than the mouth breathe the nurses were getting at their association meetings, buy viagra oral jelly without prescription.

Thus both Stead and Silver, along with their nursing colleagues, are important for persisting in their attempts to establish new categories and expanded responsibilities for nurses.

Stead

Eugene Stead’s initial “Physician’s Assistants” were male, mostly former military or from Emergency Medical Technician (EMT) jobs where they were largely free from the history of nurse submissiveness. They took to expanded responsibilities without hang-ups.

At first Stead was not a nurse advocate. Buy viagra oral jelly without prescription, He had condemned their “cookbook style” of learning medicine, their passivity, and their attachment to their families and the status quo. Buy generic viagra oral jelly, He was an old school “solo practitioner” by background---back when he knew his patients intimately---and had become a major medical school administrator. He soon understood that some of the passivity came from rigid hospital nursing administration. He advocated clinical rotations---on the MD model---and instruction not watered down for the weaker sex. He coerced med school professors to teach them.

He knew that nursing had grown up in the church and the military---highly authoritarian organizations---and he struggled through several efforts to respond to the shortage of doctors in the 1960s in the Carolinas always convinced that physician control of any nurse’s role was essential, buy viagra oral jelly without prescription. Therefore, in the no-man’s-land between nurses and doctors, he is ultimately responsible for establishing the title “Physician’s Assistant” (after flirting with “Nurse Practitioner,” “Extern,” and other titles) for the expanded nurse role.

Rapidly, viagra oral jelly without prescription, his graduates were providing “the best nursing care in North Carolina” But they had no special accreditation or title and soon the hospital administration and the director of nursing service put an end to the program. Stead could not recruit in these circumstances and he went on to attempt other innovations.

His nursing colleague, Thelma Ingles, was receiving wide publicity and had made a presentation to Congress on “nurse practitioners.” But she had her salary cut and she left Duke. Buy viagra oral jelly without prescription, There is a fine article by Natalie Holt---then a student, subsequently a MD anesthesiologist--- (“’Confusion’s Masterpiece’; The Development of the Physician Assistant Profession,” Bulletin of the History of Medicine, Vol. 72, No 2, Summer 1998) that gives a thorough history of Dr. Overnight viagra oral jelly, Stead’s efforts to respond to the shortage of doctors. Her piece includes interesting interview content and is not simply a hodgepodge of quotations from association speeches and annual reports.

I do not mean to suggest that nurses, lacking strong unions, did not need their associations and association loyalty. But these are a mixed blessing with associations prone to compromise and total capitulation, buy viagra oral jelly without prescription. Stead (and Silver also) made their accommodations to the formula of physician dominance/nurse submissiveness; but they appear to have understood that the real issue was actual performance, the day-to-day interactions, and service to patients. They recognized the history of nurse competence and contribution, and they understood that the national bureaucracies (AMA, buy cheap viagra oral jelly internet, ANA, and the HEW) were saboteurs of innovative efforts.

The upshot of these contradictions was a multiplicity of certifications and the current licensing on a state-by-state level. That is always a sad compromise since states vary enormously in their economy and political leadership while medical requirements are more or less uniform across the national population. Buy viagra oral jelly without prescription, As with education, community-by-community and state-by-state is a compromise formula and a failure of the federal role.

Silver

Henry Silver, responding to the need in Colorado with Loretta Ford developed a “nurse practitioner” program in the early sixties which failed. But with a clamorous and progressive wind at their back, they successfully developed a Physician Assistant program in Pediatrics. Buy viagra oral jelly online, Initially they called it a “nurse practitioner” program and Loretta Ford went on to become a major advocate/publicist of the Nurse Practitioner title.

Their initial “Physician’s Assistant” was accepted by the state medical review board in Pediatrics only, but this reflected the reality of physician dominance. Both Silver and Ford emphasized the independent nurse practitioner role and Silver’s initial PA program continued for nearly thirty years, buy viagra oral jelly without prescription. With his program came some national status, awards, and recognition that child care was a neglected aspect of social medicine.

Their work required stretching the great bureaucracies of accreditation, sponsorship, foundation and related agency grants, all under the “Physician’s Assistant” title, cheap viagra oral jelly from usa. The performance of graduates was measured again and again. Journals were founded. Buy viagra oral jelly without prescription, Careers were made.

The nurses second year was clinical work. It could not be called an “internship” because doctors had taken that taken. Titles, like insignia and uniforms in the military, are very important in the hierarchic, bureaucratized field of medicine. Viagra oral jelly pills, However, functionally, their PAs could diagnose and prescribe medications, many went on to hold doctoral degrees (which will be required, it is said, by 2015) and now Nurse Practitioners can act as “independent practitioners” (in 13 states), hang out their shingle, and are not required to collaborate with an MD or a DO. They diagnose and treat, but their focus (in accord with their nurse origins) is health promotion, preventative medicine, and education, buy viagra oral jelly without prescription. It rarely includes surgery.

In reality individual doctors across the country were all the while training men and women---some RNs, buy viagra oral jelly no rx, some not---to perform their health care responsibilities when they could not. In the small towns and slums this had always been the way. Accreditation and titles be damned. Buy viagra oral jelly without prescription, The work had to be done. Naturally, they did not pay commensurate salaries, but remember that they were only men running a small business that had to meet its profit goals.

Nurse anesthetists were considered incompetent in Denver or San Francisco but completely qualified to do anything and everything in the inner city slums or isolated small towns. Our competence was also related to the setting and rising of the sun. Online pharmacy viagra oral jelly, As the sun goes down, we become proportionately more capable of handling anything that comes along. By three AM we’re goddamned miracle workers, buy viagra oral jelly without prescription.
Patricia Walsh, CRNA, author of the novel Forever Sad the Hearts (1984).

Silver and Stead were in many ways heroic people, willing to go against the grain of convention and their professional bureaucracies to make their contribution to social medicine, and not alone for the salary and honors. Serious medical people do usually respond to people’s immediate needs regardless of professional association turf battles or power-influenced court decisions and legal threats. The simplest example, in this highly military nation, viagra oral jelly uk, is medical corpsmen and nurses responding and learning what is necessary to save lives.

From the Civil War, through WWI, WWII, Korean and Vietnam Wars we turned out hundreds of thousands of veterans with significant direct medical experience and training. Buy viagra oral jelly without prescription, They too created some of the pressure for change. Many did not want to be forced into jobs in the factories when they had experience and training that qualified them for high level work in hospitals.

The other side of it is that nurses must show loyalty to their unions, where they exist, Find viagra oral jelly on internet, their associations, and to the boundaries of their “certification.” Without that loyalty, a capitalist-based health care system would mercilessly exploit their labor. These are the two sides of the coin. Their associations---bureaucratic and slow as they are---do defend the living interests of social medicine workers. The nursing associations have lacked imagination, buy viagra oral jelly without prescription. Early on they tended to be dictatorial and ‘top-down.” They were turf-bound and not innovative. But ultimately they defend the interests of nursing.

The Nursing Narrative

As I have implied, nursing history tends to be written from records kept by the nursing associations. The better alternative would be an exhaustive examination of unconsolidated letters, cheap viagra oral jelly tablet, memoirs, and notes in professional journals, novels, etc. Buy viagra oral jelly without prescription, However, the narrative we have is the association narrative: who was the leader, speeches, dealings with government and competing associations, puffery from official annual statements, reviews of legal cases, etc. This is dull stuff and poor history.

A better narrative for nursing would be based on the fact of the grass roots origin of their health service practice. What knowledge did they actually possess and what work were they actually accomplishing “on the ground” and at various points in time. A quite different story.

That story may sound messy, but I believe there are narrative models from Europe where medicine is socialized---as it should be---and where national health programs have eliminated much of the gross income disparities along with the related excessive sensitivity to titles and rank, buy viagra oral jelly without prescription. Viagra oral jelly no rx required, This sort of narrative is also applicable world-wide where needs are grave. Dr. Paul Farmer’s Partners in Health, with its emphasis on the role and the training needed by community health workers (accompagnateurs), cannot be the only such community-based program. The formal scientific education of nurses, their actual practice, and new positions from which they can look after the staffing and training in rural and neighborhood American clinics---extending their kind of preventative medicine---is the kind of work for which nurses (and DOs) are famous and there should be more of it. Buy viagra oral jelly without prescription, The narrative might start with recognizing that the nursing profession was founded by Florence Nightingale whose initial cadre of nurses possessed, or the survivors soon acquired, “qualifications.” A number of them went on to lead their own nursing schools. Most followed Nightingale in recognizing that a rigid program of “Registration” would not be a good start for nursing.

Nightingale suffers a lot of uninformed snipping---the 1860s were not the 1960s and registration, order discount viagra oral jelly, certification, and licensing did become valuable and necessary with the enormous growth in numbers later on---but in her time registration would mark a cut-off point in training, which should never cease. It would inevitably lead to hierarchy. And it mirrored the small business path taken by physicians who then lost their interest in social medicine to focus increasingly on well-rewarded curative rather than preventative health care.

These random points about the nursing narrative are offered as a humble and unqualified opinion, but they serve to introduce the history of Certified Registered Nurse Anesthetics (CRNA) where I think the real narrative model is, buy viagra oral jelly without prescription. This profession rose from grass roots reality to what is now reportedly the highest salaried nursing position.

The CRNA

They came from the bottom up beginning in the Civil War. Piece by piece these nurses parlayed their learning and service into more and more recognition and respect, Viagra oral jelly order, higher salaries, and eventual certification.

Military nurses were the path breakers here. Buy viagra oral jelly without prescription, They did not make the precise, deep incisions or saw the bones back when amputation was the only way to deal with shattered and decomposing limbs, but they kept the patients alive through the ordeal. “Watchful Care” was their slogan, survival and a possible recovery was their responsibility and not that of the male surgeons.

Ether is our main anesthetic,” he said. “It’s cheap; it has a wide margin of safety; we can get it open drop when we don’t have any oxygen.” They hurried toward the screened-in poach, where Jean was trying to make room. The worst of them were put in there for triage, buying generic viagra oral jelly. The small room contained only two I.V, buy viagra oral jelly without prescription. poles and depended on the windows for light. They began working the hemorrhaging victims. The missing limbs and jagged pieces of bone jutting from torn flesh didn’t seem to bother them. I said, "What are you doing!” “It’s our tiny bit of morphine,” She replied. Buy viagra oral jelly without prescription, “You can’t give that to people in shock.” “So what; they’ll die happy. It’s all we have. They wouldn’t make it anyway.’ “There’ll be jaundice.” “So what?” But the ether still worried me, Viagra oral jelly non prescription, giving it right next to an electric suction. “The humidity’s too high here; we’ll not have an explosion.” “You know, we don’t have an anesthesiologist here.” “That’s okay; you’ll be able to teach them a few things back home. I’ve never seen one volunteer MD Anesthesiologist here. Fuck them; they prefer nicer climates.”
Adapted from Patricia Walsh, CRNA, author of the novel Forever Sad the Hearts (1984), buy viagra oral jelly without prescription.

Nurses had been administering the anesthesia since time immemorial and they finally triumphed over the opposition of the nursing associations---forcing the CRNA’s to develop their own effective association---and over the opposition of the MDs.

When, in the late thirties, the estimated revenue from anesthesia administered reached $50 to $70 million per year, physicians began arguing that physician-training should be required to administer anesthesia, no matter the history, viagra oral jelly in bangkok. No matter than since 1880s nurses and nursing sisters had been secreted bottles of chloroform in their pockets and were doing what was necessary for patient care. “Medical economics” now raised its ugly head. Buy viagra oral jelly without prescription, And excellent history exists for the CRNA and I will not retell it. That is Marianne Bankert’s Watchful Care; A History of America’s Nurse Anesthetists (2004). That is the book that introduced me to the Patricia Walsh’s novel quoted above, as well as to one of the few authoritative descriptions I have seen published making the important connection between the emergence of nursing the safety of hospitals (which were the first site of most late nineteenths century advances in medicine), and our modern medicine.

Bankert also introduces us to her predecessor Virginia Thatcher’s 1953 The History of Anesthesia With Emphasis on the Nurse Specialist whose research was able to establish the contribution of Catholic and Protestant nursing sisters: hospital Sisters from the Order of St. Francis in Springfield, Buy viagra oral jelly generic, the Lutheran sisters in Omaha (both at the turn of the century), and Alice Magaw working with the Mayo brothers a bit later. They and others provided the learning-in-practice---and were allowed to do a bit of publishing and even speaking to physicians---that established modern anesthetics, buy viagra oral jelly without prescription. There is, as you might expect, a Physician-Anesthetist Creation Myth (easily found in any encyclopedia or health web site), but Thatcher’s and Bankert’s research dispels it.

I am becoming fond of this history. Mark Twain said of the Mississippi, with its shifting sand bars, that you can drink it in, buy cheap viagra oral jelly, go on steamboat excursions, get baptized, or run aground. Many run aground on the title fetishism that afflicts the whole hierarchic medical profession. Buy viagra oral jelly without prescription, For instance, some get excited over the distinction between the Doctors of Osteopathic Medicine (DOs) and Medical Doctors (MDs) who are, presumably, Doctors of Allopathic Medicine. But MDs and DOs have the same scope of practice; they practice alongside each other; they are comparably trained and licensed (same 4+4 schooling, internships, residencies, etc.). Cheap viagra oral jelly on internet, The formal distinction probably should not exist. It is a hold-over from a time when MDs failed to recognize preventative health care and “the total person.” DOs had a training emphasis on primary care and the health of women and children (who were the last to be served in the bad old days of the MD medical profession). That is a sandbar. Likewise, somewhat like insisting on coche over carro, is the fetishism over who are médecins (in French) or médico (in Spanish) and who must be referred to as enfermera or auxiliar, buy viagra oral jelly without prescription. These are sandbars.

Real stories have their yin and yang. The real world abounds with stories of MD avoidance and nasty acts performed by arrogant doctors---mostly profit-oriented acts, but some just gratuitous nasty acts---especially in the stories of war and war’s aftermath. But doctors, too, have a history of heroism, buy viagra oral jelly, “doing what needed to be done to save the lives of patients.” But doctor heroism is over-storied and that of nurses is an after-thought. Buy viagra oral jelly without prescription, Our distorted perspective on MD prestige is not some accident. It is a sandbar. It was deliberately put in place largely by undermining the nurse and the role of nursing in history in order to justify a gross income disparity. I will outline that sandbar in another place. It is a story that would have to include the MD profession’s refusal to serve in WWII (short of the threat of trial for treason), their grand rewards and “internships” for a quick rotation in Korea, and the distortions of TV’s “M.A.S.H.” of Vietnam’s division-level tent hospitals. But also there was plenty of true heroism, the free sharing of knowledge and technique, contributions to problem-solving, and endless dramatic labor, buy viagra oral jelly without prescription. My concern here has been the nursing narrative. Cheapest generic viagra oral jelly online, History is drinking the water, swimming, excursions, and baptism. It should not serve running aground on sandbars of narrow commercial interests. Therefore the advance and narrative of the nursing profession is a delight as it appears before us. Buy viagra oral jelly without prescription, I am glad to add a voice.

Jim

Contemporary Notes:

* At present "about 20% of the population lives in rural areas but only 9% of physicians practice there.” H.K. Rabinowitz has studied this issue extensively. I have read some of his work and imagine him ringing his hands. Insufficient insurance payments in rural areas, pharmacy viagra oral jelly, administrative hassles tied to insurance claims, and rising cost of business and malpractice insurance expenses are among the most commonly cited reasons why rural medicine has lost its appeal among doctors. The United States has about 66 million people living in areas, both rural and urban, that the government recognizes as "underserved," according to the Department of Health, buy viagra oral jelly without prescription. The agency estimates that about 7,438 primary care physicians are needed to bridge this shortfall now in 2010. In addition, Rabinowitz said trends at medical schools are further exacerbating the rural medical care crisis. Fewer people from rural areas are applying to go to medical schools, he said, Order viagra oral jelly online, and about half of the students from rural areas don't want to go back to their communities to practice medicine. So every time a rural community loses one of its physicians, the impact is severe because these communities can't easily fill the doctor vacancy. Buy viagra oral jelly without prescription, ** Nothing here implies that currently there are too many doctors or nurses. The total population is expected to increase by 18 percent over the next 10 years; the population over the age of 65 will expand by 54 percent and older people require more health care. According to some estimates, the demand for doctors will rise to between 1.09 million and 1.17 million by 2020. That sounds to me like underestimation or old numbers. The shocker is that just a little more than a decade ago journalism talked of a doctor surplus. In 1996, a committee of the Institute of Medicine warned that the United States had a surfeit of doctors caused by foreign-trained physicians coming here to work, buy viagra oral jelly without prescription. They recommended freezing med-school class sizes and limiting first-year residency positions. One year later, order viagra oral jelly no prescription, Slate ran an article on alternative strategies for reducing the number of doctors approved by the federal Health Care Financing Administration. Under its Graduate Medical Education Demonstration Project, 41 teaching hospitals received 400 million federal dollars in exchange for not training between 20 and 25 percent of the medical residents they would otherwise have trained over the next six years. This is a fraught issue. Buy viagra oral jelly without prescription, Perhaps there is some truth behind this “strategy” of the Health Care Financing Administration. However, I do not have enough command of the numbers to test it.

*** This and the following quotations are from what was classed as a “Romance Novel,” published by Avon in paper in 1984. Buy discount viagra oral jelly online, It is powerful and authentic. The now-retired CRNA, Patricia Walsh then republished her novel (with some editing) as River City; A Nurse’s Year in Vietnam Memoir (2009, TOA Press; Bolder, CO). I recommend Forever Sad the Hearts especially if you ever thought that all Romance novels were schlock, buy viagra oral jelly without prescription.

**** Finally, here is a current run down, FYI, of the major contemporary nursing categories whose growth began from the 60s to date.

Licensed Practical Nurses (LPN): About 750, drug viagra oral jelly online purchase,000 jobs in 2008, with 50% working in hospitals or nursing home facilities. They hold at least AA degrees and rank above Nursing Aids. The number of LPN graduates has grown recently; however, with the decline of “team nursing,” the number of jobs has actually fallen. Buy viagra oral jelly without prescription, The response of corporate medicine to successful RN contracts has been to cut LPN positions. LPNs are if tremendous importance in Mississippi and similar impoverished states, in the few remaining terminal hospitals, Viagra oral jelly overnight, and in nursing homes.

Registered Nurses (RN). Here are 3.1 million. Their “scope of practice” is greater than LPN. Here, as above, they are still predominantly women, some with good unions, buy viagra oral jelly without prescription. RNs have BS degrees and often higher (nearly 50% with masters or doctorates by 2010). Both LPNs and Nurses are known for physical stamina and attentive care, but RNs perform almost every medical roles other than prescription and surgery, The 3.1 million is from a recent Health Resources and Services Administration report. Today a particular issue is that many (50%) are nearing retirement age. For comparison the AMA’s Physician Characteristics and Distribution in the U.S. Buy viagra oral jelly without prescription, counts 941,000 physicians (of which 61,000 hold DO degrees). About 30% of physicians are women. The numbers exclude students.

Physician Assistants (a category since the mid-sixties) numbered 80,000 in 2008. They still serve mainly in Pediatrics. As with all these classification the official “scope of practice” does vary by state as do certification requirements, buy viagra oral jelly without prescription.

Nurse Practitioners. There are 158,348 NPs reported by the HRSA study. The scope of practice is wide. They may diagnose and prescribe and in thirteen states hang up their own shingle. Buy viagra oral jelly without prescription, 90% are primary care providers; 27 % care for uninsured/indigent patients. As with PAs, all are RNs with advanced degrees, clinical practice, and some with med school training.

Certified Registered Nurse Anesthetist (CRNA). I include this as the oldest advanced practice nursing occupation. It dates back to the Civil War in practice and the CRNA back to 1954. The number is 44,000 (including student nurse anesthetists) and they account for nearly 100% of rural, military, and VA anesthetists. Their training is rigorous and extensive and they do the same work as MD anesthesiologists.

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Buy viagra plus without prescription, Dr. Frantz Fanon was focused on the effects of violent colonial oppression. He was born in Martinique, educated in the medical schools of France, Buy viagra plus low price, and spent most of his brief adult life in hospitals and clinics in northern Africa. At first he treated individual psychiatric patients as he had been taught but became increasingly dissatisfied with returning Arabic-speaking or Berber-speaking Black Algerians to their condition of colonial oppression (“adjusting” them to it). He turned to supporting the Front de Libération Nationale (FLN), working in the medical clinics they maintained just outside French Algeria, writing, viagra plus prices, and traveling for the FLN and the cause of independence.

He had no illusions, buy viagra plus without prescription. His books provide the earliest incisive description of “neo-colonialism” that I know. As an activist “native, Buy viagra plus canada, ” he was subject to several assassination attempts by organizations of the French settlers in Algeria. They, the French---some of them resident for generations in Algeria---were making their ultimately unsuccessful attempt to replicate South Africa for France: a source of wealth and opportunity for a white minority, oppressive poverty for the vast majority of “natives.”

As a doctor, intellectual, viagra plus drug, and child of his time (post WWII France, 1947-1952) Fanon had read Sartre, Heidegger, Buy viagra plus online cheap, Jaspers, Kierkegaard, Merleu-Ponty---as well as Hegel, Marx, and Freud---and also the literature of the French Communist Party and of Trotsky, order discount viagra plus online. Le Temps Modernes was his journal of opinion along with Presence Africaine with its focus on the continent of Africa and negritude. Buy viagra plus without prescription, He identified with the movements for independence throughout Africa and Latin America but it was the Algerian revolution with its mix of torture, terrorism, and intransigence that gave him his personal cause.

Most know Fanon for his most famous book, The Wretched of the Earth published in 1961, Viagra plus information, the year he died at thirty-six. No left activist I have known failed to read Fanon’s The Wretched of the Earth. It is a painful, great book. Whatever your specific orientation, viagra plus online sale, it shifts your mind.

At first, for Fanon as with many people who come from small islands, the question was one of escape, buy viagra plus without prescription. How do I go away from and on from here. How will my “degree of blackness” (and most Caribbean island people are Black) affect my struggle to make a better world for myself and others. Viagra plus internet, Many wanted to go to France for study. Would it be dentistry or medicine. Buy viagra plus without prescription, Fanon chose medicine.

He did his internship in Lyon and specialized in psychotherapy. He married and did not return to Martinique, which he knew as a stifling island not ready for rebellion, cheapest viagra plus, making his life in Algeria. He did his residency at St. Alban, Generic viagra plus, France and began his practice in Blida-Joinvill outside Algiers and in Tunis. He published a number of professional medical articles, buy viagra plus without prescription. You may say he did so for the sake of the health policy propaganda he could do there, but all published medical articles, all of them, contain such propaganda, buy viagra plus overnight delivery.

The theory under which he had studied beyond basic medical practice was “sociotherapy.” That was perfect for Fanon who became that field’s most famous and most thoroughly revolutionary practitioner.

In A Dying Colonialism (1959), Fanon reflects on medicine and colonialism. Find discount viagra plus, He recognizes the individual life-saving value of western clinical training, drugs, and technology, but points out that doctors who arrive or practice in an atmosphere of general conflict (Algeria in the fifties or any colonialized or occupied country such as today’s Afghanistan) are not “native” doctors whatever their origins. Buy viagra plus without prescription, The doctor belongs to the dominating society. He comes as fresh proof of the occupier’s hold on the country, viagra plus free sample. “What would you do without us?” is implicit in his attitude. Consequently, in the colony or foreign-occupied country there is a natural reluctance, Find no rx viagra plus, hesitancy, and distrust of these doctors.

A colony or occupation is always built on military conquest. The doctors arrive with the military, or the police, or the “Combined Forces.” Doctors bring their own “innovations” and attitudes and “experiments.” Naturally---rationally---such doctors are met with diffidence, even hostility, buy viagra plus without prescription. The doctors, unable to communicate, buy viagra plus in us, fall back on tests and clinical trials; and, if they are experienced cynics, prescribe pills or potions or regimes with no confidence whatsoever of their success. Buying viagra plus online, They become arrogant. Their attitude humiliates the patient. “They become veterinarians,” says Fanon. Buy viagra plus without prescription, When you combine the foreign doctor’s attitude with the reports of their “trials,” “experiments” and their participation in torture, and add to that their arrogant insistence that there is no divide between themselves and the whole complex and diverse structure of the colonialized world, the reason that regimens are not followed is plain. This has nothing to do with the common racist Western speculation that the patients are brutes, cheap viagra plus in uk, prone to violence, over-sexed, and inherently irrational. Viagra plus purchase, Yet the doctors demand to be honored as doctors. They say, “After all, we are doctors,” even though one day they are testing and blindly prescribing and the next day they are giving penicillin or vitamin B-12 shots so that the patient can recover for additional rounds of torture, viagra plus online without prescription.

Fanon says that when a doctor has decided “to exclude himself from the protective circle the principles and the values the medical profession has woven around him” he is worse than a veterinarian. He has become a criminal, buy viagra plus without prescription.

When Fanon and a group of male nurses failed after working for nearly a year with a large group of Algerian Muslim psychiatric patients---initially using electroshock and insulin coma therapy and other Western treatments---they left the hospital as a group. They concluded that the colonial system produces “a unique pathology” and they would no longer try to help patents adjust to the system. Purchase viagra plus, Fanon resigned his position of three years as medical director of Blida-Joinville (a psychiatric hospital in northern Algeria) and together, working outside the major hospitals, he and the nurses tried what is now known as group therapy. They tried “community psychiatry” and they tried day-care centers affiliated with hospitals. Buy viagra plus without prescription, Finally they went to work in the FLN refugee and health centers, knowing that what they were doing was, as is said, “joining the terrorists.” To them it was helping the revolution against French occupation.

In his letter of resignation to the Resident Minister, find viagra plus without prescription, Fanon outlined the Social Medicine issues that concerned them all: what can effort and devotion achieve “if everyday reality is a tissue of lies, of cowardice, of contempt for man”. Cheap viagra plus in canada, "Our tenacity is made into morbid perseverance when the Arab is permanently an alien in his own country and lives in a state of absolute depersonalization.”

What good, he asks, are medical intentions when accompanied by poverty of the heart, sterility of the mind, and hatred of the natives of this country, cheap viagra plus tablets. Yes, the worker in the commonwealth must cooperate in the social scheme of things. “But he must be convinced of the excellence of the society in which he lives. But here Arab labor has been “terrorized in their flesh and that of their families.” Irrational punishment is the norm, buy viagra plus without prescription. Discount viagra plus, Here “lawlessness, inequality, multi-daily murder are raised to the status of legislative principles.” There is no cure for systematized de-humanization except the process of opposing it.

This is brilliant. It closely abuts to what we call “Aid” in much of the world today, viagra plus medication. Where the social structure is hostile to any attempt to support health and aims at putting the individual "back where he belongs," no professional morality, no class solidarity, Approved viagra plus pharmacy, and no pseudo-national mystifications prevail over that prior reality. Buy viagra plus without prescription, In another letter, recovered by Mrs. Fanon, a letter to a Frenchman, he makes additional points with the force of poetry. After apologizing for the necessity of being harsh---since the Frenchman was once his friend---he reminds him of the Algerian reality he has decided to abandon after eight years of residence: “the country bristles, where to order viagra plus, the roads no longer safe, the wheat fields transformed into sheets of flame, the Arabs hostile.”

What will you say when you are asked, Discount viagra plus online, "What is going on in Algeria?" What will you answer. And yet no part of that enormous wound ever held you back in any way. You were free to discover yourself at last such as you are, concerned about Man but strangely not about the Arab. Oh, yes, you were worried, anguished, torn, buy viagra plus without prescription. For there is not a European who is not revolted, viagra plus generic, indignant, alarmed at everything, except at the fate to which the Arab is subjected. Buy viagra plus without prescription, Unperceived Arabs, ignored Arabs, Arabs passed over in silence, Arabs spirited away, dissimulated and daily denied, viagra plus cheap price. And you mingled with those who have never shaken hands with an Arab, never drunk coffee, never exchanged commonplaces about the weather. Lowest price viagra plus, By your side the Arabs; pushed aside the Arab. Buy viagra plus without prescription, Confined the Arabs. Without effort, rejected the Arabs. Native towns crushed. Towns of sleeping natives, best price for viagra plus. And you say ‘Nothing ever happens among the Arabs.’ All this is leprosy on your body.

You will leave, but these are the questions, buy viagra plus without prescription. What about the collective silence of 800,000 Frenchmen: this ignorant, Viagra plus overnight delivery, innocent silence. And 9,000,000 men and women living under this winding-sheet of silence. Millions of fellahs exploited, buy viagra plus online without prescription, cheated, robbed. Fellahs grabbed at four in the morning. Fellahs Buy viagra plus without prescription, gorged with water, gorged with leaves, gorged with old biscuit. Order discount viagra plus online, Fellah without land. Fellah without reason. But you don’t like it and you can just leave. Shacks full of children. Wrung-out fellah, buy viagra plus without prescription. And you say ‘What would they do without us, no rx viagra plus. A fine country this would be if we left. ‘Become a swamp in no time at all, yes!’

Fellah, Drug viagra plus, you face despair. In your belly is resignation. Fellah Buy viagra plus without prescription, , what does it matter if this your country is beautiful?

I took some liberties above to show you this Fanon writing, and I will leave you to explore his more typical, always lucid, always rational writing. I did not quote even once from The Wretched of the Earth.

Both letters are published in Toward the African Revolution (1964, translation 1967), viagra plus sales, a collection of Fanon’s essays, articles, and notes. It shows the growth of Fanon’s scientific recognition of the broken lives of the colonialized in 1952-1955 (as he was completing his medical studies) and his later grasp of “the great white error” and the “great black mirage.” There is a final essay on Patrice Lumumba’s assassination (which Fanon sees as the result of a U.S. decision that “Lumumba must go” because he cannot be bought). That is the year Fanon died, buy viagra plus without prescription.

Rereading Wretched of the Earth (Les Damnés de la Terre) and the essays in Toward the African Revolution reminds me of how cramped my own perspective was in the sixties, how overly proud we were to understanding a bit of the tragedy of neo-colonialism which Fanon and others intimately understood fifteen years earlier, how pa1e and desiccated is progressive journalism now, how passionless is all academic writing, and how enduringly valuable some sets of heated old words can be. All this is true. I just thought I would share that with you.

Jim
.

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Buy imitrex nasal spray without prescription, [This was originally posted April 2, 2007. I am retaining it because of the content, order discount imitrex nasal spray. Order no rx imitrex nasal spray, Please see the postscript.]

Out of their personal science bias or from their own reactionary politics, pop commentators like to present Einstein as if he had been an idealist vainly pursuing fantastic speculative goals, find imitrex nasal spray. Buy imitrex nasal spray no prescription required, We hear of his "Quixotic pursuit" for a "unified theory," his "Grand quest" for a "theory of everything, tablet imitrex nasal spray, No rx imitrex nasal spray, " That was not Einstein. He was a scientist and a socialist, imitrex nasal spray generic, Find discount imitrex nasal spray, not a speculator.

Likewise today editors at the NY Times labeled Paul Krugman's column "Distract and Disenfranchise" with the phrase "A unified theory of Bush scandals" as if it were a pull-out quote, buy imitrex nasal spray without prescription. Whoever did this hoped to suggest that Krugman was over-reaching, cheap imitrex nasal spray, Cheapest imitrex nasal spray, speculating, their coy way of belittling his straightforward economist observations, purchase imitrex nasal spray no rx. Imitrex nasal spray in bangkok,

Krugman links the Bush administration abuses of power to our rising income inequality. Here's how:

In 1980, buy cheapest imitrex nasal spray on line, Buy imitrex nasal spray pills, when Ronald Reagan came to power, we were a middle-class nation and at least white voters could reasonably believe that vast injustices and inequalities were behind us and, imitrex nasal spray cheap, Purchase imitrex nasal spray online, therefore, we no longer needed Big Government to remedy inequity through taxes and social programs as had been the case in FDR's time, imitrex nasal spray internet. Buy imitrex nasal spray internet, The Republican politics-for-the-rich was sold to the American people But look what happened:

Since then---since about 1976---we have again become deeply unequal society with an enormous and growing income gap between top and bottom, while the middle has been frozen in place for 30 years, order imitrex nasal spray in us, Buy imitrex nasal spray online australia, an entire generation. Buy imitrex nasal spray without prescription, The inequality is now at the level it was in the 1920s. The robber barons are back, order imitrex nasal spray from us, Price of imitrex nasal spray, thanks to 30 years of Reganite republicanism. Bush is only the 2000-2008 version, certified imitrex nasal spray. Cheap imitrex nasal spray no rx,

Republicans (a party of tax cuts for the rich, privatization, buy no rx imitrex nasal spray, Buying imitrex nasal spray online, and pro-corporate "supply side" economics) have had to rely or a narrowing set of tricks to win elections. They have relied on diversion: on 9/11, imitrex nasal spray online without prescription, Buy discount imitrex nasal spray, on a "war on terror," on a real war in Iraq (which, imitrex nasal spray no rx, Buy discount imitrex nasal spray online, BTW, the rich are not paying for, imitrex nasal spray, Find no rx imitrex nasal spray, see below), on security alarms and alerts, online imitrex nasal spray. And they have relied on disenfranchising those sections of the population who overwhelmingly vote Democratic: the poorest, minorities, immigrants, and all who have been in the hands of the justice system, buy imitrex nasal spray without prescription. Buy imitrex nasal spray without prescription,

Distract and disenfranchise, their formula for winning.  The most recent abuses to come to light is the Gonzales firings of federal attorneys who were investigating this disenfranchising, imitrex nasal spray us. Cheap price imitrex nasal spray,

After making these excellent points, Krugman, overnight imitrex nasal spray, Compare imitrex nasal spray prices online, as he often does, goes on to hope the Democratic Party can see the connections here and take advantage of them to win overwhelmingly in 2008.  Win they may, order imitrex nasal spray no prescription, Imitrex nasal spray in uk, but you have to ask why should we care.

The Democrats are only appearing to oppose the war while giving Bush an eighteen month window to continue it and voting more than all the money he has asked for. Restoring civil rights is not on their agenda, nor is making taxes more progressive (making the very rich pay a higher rate). Buy imitrex nasal spray without prescription, And the Democrats showed little energy when they were deprived of the votes of the poor and minorities in the last two presidential elections. They lost through electoral crimes in Florida, Georgia, Texas, Ohio, etc. Now it appears that fighting disenfranchisement is "off the table" for Democrats. In fact, if Clinton-era patterns hold true we can expect the whole topic of inequality will be dropped by the liberal and "left" liberal voices of the Democratic Party as soon as one of their own (most likely Ms. Clinton) is elected to highest office.

The graphic above is from the excellent Too Much site, buy imitrex nasal spray without prescription. Another of their graphics shows that the richest one percent are also not paying their share of the Iraq war costs. They paid:

Jim

Paul Krugman, the Too Much website, and the too liberal site Inequality.Org have continued their clarification of our extreme inequality. Barbara Ehrenreich is perhaps the best journalist writing of the consequences of our inequality (Nickel and Dimed, This Land Is Their Land, etc.). Her writing and other contemporary studies of inequality have made strides over the psychological emphasis in the Middletown studies in the Thirties, Sennett and Cole’s The Hidden Injuries of Class in 1972, and others. Buy imitrex nasal spray without prescription, Robert B. Reich's new book Aftershock) is a good addition to this literature because too few yet focus a the distinction between the existence of poverty and coefficient or rate of inequality. Reich takes a shot at it and reproduces the famous graphic from Piketty and Saez (essentially the first image above), explaining

They examined tax records extending back to 1913. They discovered an interesting pattern. The share of total income going to the richest 1 percent of Americans peaked in both 1928 and 2007, at over 23 percent. The same pattern held for the richest one-tenth of 1 percent (representing about thirteen thousand households in 2007. Their share of total income also peaked in 1928 and 2007, at over 11 percent. And the same pattern applies for the richest 10 percent, who in each of these peak years received almost half [of total income].

Reading the South African journalist Kevin Bloom's excellent book Ways of Staying, I find him saying what most South African intellectuals now understand: that it is the degree of inequality---not the existence of the poor, or poverty, or 'cultures of entitlement,' or 'deprivation'---that is the main fuel for social conflagration and violence. The fact is you cannot live off the fruits of 350 years of accumulated plunder without experiencing some of the consequences.


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Buy viagra professional without prescription, The only thing new in this world is the history you don’t know. (Attributed to Harry Truman)

Todos deben tener una unión. Everyone should have a union. Many have sacrificed their private convenience to keep the union idea alive over this Reagan Era, and certainly the sacrifice was not in vain, Where to order viagra professional, but neither was it a success. This era---which I pray is coming to an end---runs roughly from Ronald Reagan’s two terms as a solidly anti-union Governor of California until 2010.

After January 1975, Reagan ran for president on his Cold War celebrity and his anti-union credentials to eventually win two terms as the President of the Rich (1981-1989), buy viagra professional without prescription. He was followed in the presidency by three who equally deserved to be called scabs and strike-breakers. From the early nineteen seventies to 2009 the percentage of unionized private sector workers has fallen from about 24% to 7%, or from 15 million to about 7 million workers. Now that is dramatic, buy viagra professional low price.

Most of that span of years covers the work the great farmworker unionist Cesar Chavez. Buy viagra professional without prescription, Chavez is as important a name in our cultural history as any of the above presidents, as JFK, as MLK, and as others you may think of.

If you look as the statistics reflecting United Farm Workers, AFL-CIO accomplishments---although there were some undeniable accomplishments in sub-minimum wage increases and in still-inadequate health care---you may recoil at my saying Chavez was the “great farmworker unionist.” To be more accurate then, he was the greatest grassroots organizer American has yet brought forth. Order viagra professional no rx, Cesar Chavez was born near Yuma, Arizona on March 31, 1927, worked in the fields and organizing field workers and leading the United Farm Workers for five decades and died on April 23, 1993. Chavez possessed a focus on “union” so intense that some compared it to a flame, cheap viagra professional pharmacy, a focus that rivaled Florence Nightingale’s on health and sanitation, a focus so intense that many, as with Nightingale, could not accept Chavez’s refusal to be diverted by other worthy political causes away from “building the union.”

In spite of this intense “union” focus, Viagra professional alternative, Chavez belongs here in this “Social Medicine” category along with the other Nightingales. Our contemporary awareness of the health dangers of pesticides, of the absence of clinics for the poor---and farmworkers have always been kept poor---, of “organic” foods and “sustainable agriculture,” which are middle class hot topics right now, of fieldwork-related deaths, buy viagra professional once daily, injuries, and permanent harm, of groundwater contamination, and of other health issue all derive or owe a great deal to the work of Chavez. These health issues are the “normal” costs of capitalism in the farm fields,

Chavez is a familiar name about who most of us know nothing, buy viagra professional without prescription. Fda approved viagra professional, “Was he tall?” No. “Rhetorically powerful?” No. “Was he militant?” No, not in the sense you mean. He was Gandhian (non-violent, fasting, purchase viagra professional, do-unto-others-except-the- planters) “Successful?” Look at the statistics; the sad answer is no. Buy viagra professional without prescription, But the man believed in union organizing and taught the skills to his followers and all of us. They are simple, accessible skills: remain calm; listen carefully; sacrifice yourself; stay true to your class, to your objectives; never go over to the planters’ side; always remember “todos deben tener una unión.”

Tactically, Cost of viagra professional, Chavez was a master of sudden turns: demonstrations followed by picketing to support union recognition, by strikes for higher wage and better working conditions, by marches on the state capitol, by boycotting products nationally if the strike or the union failed, by mobilizing all possible supporters.

He knew that it could take many patient days to organize one man and that sometimes, discount viagra professional online, in an instant, dozens would come over to the union. For instance, an older woman on the picket line asks a young woman scab near the water truck for a drink of water; the young woman brings her a glass of water; noticing this a foreman kicks the glass out of the young woman’s hand; the young woman cries, Viagra professional prices, the older woman cries; soon all the women are crying. And then everyone walks off the field and joins the picket line. Work ceases and new union members are born, buy viagra professional without prescription.

Chavez knew that in the face of the extreme difficult of organizing politically (for Civil Rights, against the War in Vietnam, against the rich), anyone could support the passive, buy viagra professional canada, convenient act of a righteous boycott. He also used that knowledge well.

Chavez was picketing in 1946. By 1952, Viagra professional in us, when he and his wife were working apricots, he had the union concept but was wise enough not to use that hated word in the right-wing San Joaquin Valley, the great flatlands running from Redding to Bakersfield. Buy viagra professional without prescription, Notoriety as a grass-roots leader came to him even before January 1968 and the New York City grape boycott.

One of Chavez’s first experiences as a leader came during an onslaught of “investigations” by students from Stanford University among the California field workers. There were a swarm of them: bright kids nursed on John Steinbeck and progressive professors. They came also from Berkeley and San Jose State, cheap viagra professional in uk, all the private colleges, all interested in the worst “barrio,” the toughest slum. Of course they had picked Sal Si Puedes (Escape If You Can), Viagra professional online pharmacy, a Chavez barrio, and came with their questionnaires. “What do you eat?” “How often do you shower?” Endless shameless questions, buy viagra professional without prescription. Finally Chavez organized a tough reception party of barrio friends. The students got an introduction to Chavez and he asked “How would you like to meet twenty of my friends. “Wonderful,” they said, purchase viagra professional online. The plan was to listen and then, when Chavez shifted his cigarette to his left hand, the guys would become belligerent, provoke, Viagra professional side effects, and attack with words and, if they could drive the students to it, fists. Buy viagra professional without prescription, But the fight did not happen. Chavez got interested in what the students were trying to get at: the health and nutrition issues. He never shifted his cigarette. There was disappointment among the “toughs” but the health/nutrition conversation continued and it never ended, cheapest viagra professional online.

Chavez led the fight against gibberellins, the most widespread pesticide in commercial use on Thompson seedless table grape in California in 1962, then on strawberries (plump, perfectly colored, Viagra professional free delivery, tasteless), lettuce, etc. And parathion (another insecticide), on unprotected dry sulfur spraying, ground water contamination, and other struggles about which, hopefully, you are still hearing because victory is not yet, buy viagra professional without prescription. In 1986, twenty-five years later, Chavez led his “Wrath of Grapes” campaign against pesticide poisoning of farmworkers, viagra professional buy online, their children, and all the rest of us.

In the intensely Reaganite period, George Deukmejian was elected Governor of California with grower money in 1982 and the set-backs began. Buy viagra professional, But Chavez won the first industry-wide pay hike by 1992. His funeral in Delano---long the center of farmworker struggles---saw 40,000 mourners. Buy viagra professional without prescription, Strikes and marches continued into this last decade, always remembering Cesar Chavez.

In the early years of the late fifties and early sixties---before the great grape boycott of 1967-70 and the building of the UFW---Chavez organized for Civil Rights, voter registration, citizenship, discount viagra professional without prescription, barrio health, against the constant police brutality and murders, heat exposure deaths in the fields, and always for the union. Buy viagra professional online, By 1971 the UFW had about 80,000 members and was soon chartered as an independent affiliate by the AFL-CIO. By 1975 reportedly 17 million Americans were boycotting table grapes (and then lettuce, Gallo wine, and other scab products).

This is a very truncated sketch of Cesar Chavez and his world, lowest price for viagra professional. You can easily read about Chavez elsewhere, buy viagra professional without prescription. You can read the greatest of farmworker titles, John Steinbeck’s The Grapes of Wrath, or see the old video The Harvest of Shame, or read Truman Moore’s The Slaves We Rent or Fatal Sunshine, Viagra professional tablets, which I cannot locate, or Peter Matthiessen’s fine book Sal Si Puedes (Escape If You Can) even if you only read Chapter 10. And then there is an excellent Chavez speech (November 9, 1984) on the United Farm Workers website. He is no Kennedy, or MLK, buy no rx viagra professional, or Barack Obama; but the speech contains everything you should know about this heroic, practical man.

Finally, I want to point out that Chavez’s main work occurred during a period that can only be called “Backlash, Viagra professional price, ” the successful, concerted attack by the rich and their politicians to reverse the long period of wage gains (1938-1975), social benefit gains, middle class growth, and a greater measure of equality for most of us. Buy viagra professional without prescription, This period of intense Backlash has been given other names but, most simply, it is the period with and following Ronald Reagan through George W. Bush when contemporary American reached its present sorry pass, viagra professional no prescription. It is the period which saw the defeat of the cumulative effects of a thousand popular struggles during the recovery from the Great Depression of 1929, during and following the anti-fascist World War II, and from the work and inspiration of FDR. Chavez’s farmworker struggles were, Viagra professional without a prescription, you may say, a final part of that great progress.

Our current Great Recession is the “AfterShock” of the above period of reactionary “Backlash” against progressive initiatives. Backlash refers to the success of the rich in defeating union organizing, defeating progressive legislation, destroying the regulatory agencies originally set up to control capitalist greed, the period during which the rich decisively bought our Congress with contributions, lobbying, and PR organizations and instituted regressive tax policies to benefit the rich, buy viagra professional without prescription. In sum, it is a period of the shift of a very substantial portion of our wealth---the wealth created by our labor---into the sterile coffers of the rich. The current “Great Recession” is the Aftershock from this Backlash, buy viagra professional in canada.

Robert Reich’s new book is aptly titled AfterShock. He sees the current hard times as the consequences of the increasingly distorted distribution of income whereby the richest 1% won complete control of 24% of all income. Buy viagra professional without prescription, This is the greatest imbalance since 1928. Their long and vicious Backlash brought the rich nearly three times the share of the wealth they held in 1975.

1975 to 2010. Viagra professional information, How did we loose so much of the benefit of our national economy. It is like the growers’ victory over the farmworkers, their undeniable victory in spite of all that Chavez and his union were able to do to secure equitable wages. Farmworkers are still dirt poor, still lack health care and education, are still disrespected, brutalized, and poisoned, buy viagra professional without prescription. They still struggle and yet fail to gain the life for themselves that they deserve. And along with theirs, all of our incomes have also stagnated or fallen back since 1975, canadian pharmacy viagra professional. Yet we still hear that unemployment and poverty is“structural.”

“Structural Unemployment,” makes it sound as if the journalist or the academic using the phrase is saying something. They are not. Buy viagra professional without prescription, In their language, we have the “structural” rich, one percent of Americans or fewer, owning a quarter of all wealth and parking it permanently in “investment funds” benefiting only themselves. And we have the “structural” poor, Canada viagra professional, living below the government’s poverty line and their children suffering. For the farmworkers (Latino, Filipino, Black, Anglo) it is worse than that. They are the poorest of the poor, generic viagra professional online. And the big growers are the fattest of the fat, hoarding their money, not paying decent wages, shaving every penny off any benefit, Generic viagra professional, safety, or health care expense. That is called “structural” or, in an older idiom, a “class war” fought successfully by the rich, buy viagra professional without prescription.

And now we have the middle class facing layoffs and frightened, worried about the mortgage payments if not in foreclosure already, with credit card debt mounting. This is a middle class whose average annual income in real dollars has not improved since 1975, viagra professional from india, their hours have diminished, both husbands and wives must work, and their sons and daughters must go into deep debt in order to go to our public colleges. That is “structural.”

Back in 1968, Order viagra professional on internet, Chavez and his supporters participated in a movement to recall Governor Reagan (“This State is Temporarily Out of Order”). They failed. Buy viagra professional without prescription, They registered voters and got out the vote and were responsible for Bobby Kennedy’s California nomination victory. But then Kennedy, like his brother (also a farmworker supporter) was assassinated, just as was Martin Luther King (also a farmworker supporter).

Now numbering nearly 700, viagra professional in malaysia,000, California farmworkers or “crop workers” create an industry with revenue of $20 billion annually. You might think that they could influence California politics. Not so. This state is the Home of Backlash and of Reagan, a state that specializes in labor poverty and labor exploitation, a state that also specializes in celebrity politicians for the rich (Bob Mathias, Ronald Reagan, George Murphy, Shirley Temple, Arnold Schwarzenegger, to mention only a few), buy viagra professional without prescription. Low price viagra professional, California Backlash against the equality that was growing before 1975 was seen as a serious nation matter by the rich.

There is nothing irresponsible in looking at the parade of assassinations and murders nationally that accompanied Backlash. JFK, as you know, was killed in 1963. In 1964 the Civil Rights activists James Chaney, buy viagra professional from canada, Andrew Goodman and Michael Schwerner were murdered along with more than 100 others, by recent FBI analysis. Buy viagra professional without prescription, Malcolm X was assassinated in 1965, Robert Kennedy and Martin Luther King were assassinated in 1968, Fred Hampton---the exemplar of the Black Panther Party---was assassinated in 1969 along with numerous other Black Panther leaders. It is not unrelated that perhaps a million Vietnamese farmworkers died during these years as a result of defoliants, napalm, cluster, bunker, incendiary and other bombs and the American assassination teams that swarmed the Mekong Delta killing priests and leaders.

The cost of feeding the rich is very high.

I do wish to imply connection between the vicious opposition to the farmworker demand for social justice, opposition to Black America during the King years, opposition to our trade unions and decent wages and benefits, the Vietnam War against peasant workers, opposition to national liberation struggles elsewhere, and opposition to what were once growing benefits to middle class families, as well to any controls over the rich who clearly were intent on impoverishing all of us, keeping us shut up in our barrios, ghettos, and neighborhoods. This is a mouthful but also a real picture of years during which the rich won the ability to make their private wealth accumulation and to create this Great Recession. Chavez understood all these relationships, buy viagra professional without prescription. Read his speech from 1984. You will see.

As with every empire, our history will get simplified. Crowded, complex years will be collapsed into meaningless details and lying generalizations. Chavez and his people gained some ground but then they felt the Backlash. And we are feeling the Aftershock. We have all lost a great deal of ground and the time has come to regain it.

Jim
.

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Buy viagra soft tabs without prescription, In 1953 an Anglican priest, Chad Varah, noticed the substantial suicide rate in London. In response he founded The Samaritans to “befriend the suicidal and despairing.” By 1973 he had built a 17,000 volunteer member organization in the British Isles and begun to make a measurable social health impact preventing suicides by providing isolated people with a listener, a contact, a supportive voice. “You are not alone.” By diminishing the impact of isolation and opposing the ideology that saw suicide as the crime of “self-murder, Cheap viagra soft tabs tablet, ” his centers and telephone help lines flourished and spread.

Chad Varah---both are common Yorkshire names---led the central London branch of Samaritan until 1986 and founded and led Befrienders International (Samaritans Worldwide) from 1974 until 1986. He also built organizations encouraging sex education, fought against genital mutilation, and built a Mothers Union which supported the right to abortion. The Samaritans are best known for establishing the world’s first crisis hotline organization offering non-religious, non-bureaucratic telephone support to those contemplating suicide

The path to effect for The Samaritans was not easy, buy viagra soft tabs without prescription. It required nearly a ten year effort to persuade European church-based helping organizations to adopt the secular, non-judgmental, buy cheap viagra soft tabs online, non-proselytizing model of The Samaritans. Varah’s successful model spread to Asia and, to some extent, to Latin America. It has yet to win official approval in the United States. Viagra soft tabs professional, In the U.S. Buy viagra soft tabs without prescription, we have highly bureaucratized, federally contracted private corporations doing this work. Against the Samaritan model, they follow a coercive and/or proselytizing model of unsuccessful suicide prevention, one that rejects the tested Samaritan protocols and models of training. Here in the U.S., over the past ten years or so, fundamentalist organizations have become expert at floating private corporations and NGOs, buying viagra soft tabs, wining government contracts, and turning suicide hotlines and “Right to Life” and “Just Say No” hotlines into the dead ends we know them to be.

Yes, “if even one life is saved.” So sayeth the Philistines. You may have met one of that dogged, Cheap viagra soft tabs from uk, unenlightened breed, “opponents of the children of the light,” Matthew Arnold called them, remembering them as self-assured, young drunks bumping people off the sidewalks of German university towns. Philistines believe that “rich” equals “virtuous” and “what I say goes.” You may know the type, buy viagra soft tabs without prescription. They say: “Shut up. Don’t you know that if even one life is saved, buy viagra soft tabs in us. . .?” and so on. Buy viagra soft tabs without prescription, This is no small matter when Social Health is at issue. Suicide is one of the three most significant causes of death for our population. The World Health Organization reports around one million deaths per year and twenty million attempted suicides.

The evidence of the harm being done in American culture by right-wing fundamentalist ministers (and the pony politicians who ride them) accumulates. Viagra soft tabs cheap drug, It is reported every day. I want to give some history of steps taken toward health by this one eminently sane Anglican pastor, this Chad Varah, and his struggle to get the Samaritan protocol recognized worldwide, buy viagra soft tabs without prescription.

Facing him were Catholic, High Anglican, and fundamentalist opposition to love and honesty, opposition to women’s right to abortion, their right to the benefits of medical research, people’s right to oversight and health regulation, buy cheapest viagra soft tabs on line, to control of infectious diseases, to preservation of the broad environment, and to anything that may seem to impinge on private corporate rights and profits (which is an offense to politicized priests and parsons and their politicians alike).

Right-wing ideologues (Biblical literalists, “Rapture” and Armageddon people, Discount viagra soft tabs overnight delivery, salvation through faith alone people, anti-immigrant, America First, and racist people: the whole ugly ceremonial parade dripping down from the Papacy and the major churches onto the rural right-wing fundamentalists who flourished under Born Again President Bush during his two terms) were empowered to oppose important rights and undermine health alternatives. Varah and The Samaritans have faced all that. Concerning suicide in the U.S., these characters play the game of “professional” referral, order viagra soft tabs online, data collection, and legal and government agency involvement. Buy viagra soft tabs without prescription, They proselytize their narrow “Just say No!” false alternative and sponsor programs to combat the “threats” they see in any popular option. Popular options turn out to be whatever does not serve the interests of private enterprise. These characters, celebrities, Viagra soft tabs non prescription, and personalities are part of a capitalist front line and fifth column against public health. All rolled into one.

They have destroyed a significant health movement represented by the thousands of non-sectarian hot lines and phone consulting services for people in crisis. Originally, many of these services were founded by clergy (most notably under the influence of The Samaritans) dedicated to listening, to breaking the isolation, to non-sectarian services to whomever’s world has started to fall apart and who may need someone to call, buy viagra soft tabs without prescription. Contrary to this spirit of listening, fundamentalist doctrine has turned many such services into marketing opportunities for proselytizing and propaganda, turned them into their opposite. They also have become jobs for bureaucrats and opportunities for “professionals” to accumulate the data that validates the grants upon which their careers depend, find viagra soft tabs.

The UN Office of the High Commissioner for Human Rights has developed principles covering the protection of suicidal people through which the stigma of suicide is opposed, their rights respected, and effective interventions provided where needed or requested. Volunteer centers play an important role in making these principles meaningful. Buy viagra soft tabs without prescription, These UN guidelines are commonly violated in the United States by the bureaucratized federal grant-funded private corporations that run the 1-800-SUICIDE and 1-800-273-TALK hot lines.

Against them, Buy viagra soft tabs overnight delivery, through Father Varah’s work, the leading international centers of successful suicide prevention are Befrienders Worldwide (established by The Samaritans) serving mainly Europe, Asia, and Latin America), LifeLine International (mainly Asia and Africa), and the International Federation of Telephone Emergency Services (28 countries, mainly Europe), best price viagra soft tabs. These operate in partnership. Not surprising, then, that The Samaritans service about 2.5 million dialogue contacts per year and operate with tens of thousands trained listening volunteers at a volunteer time value of tens of millions of dollars. No volunteer serves without training and each must be immediately supported by a colleague or a leader.

The primary guideline is:

• Callers remain responsible for their lives and do not lose the right to make decisions even if that decision is to take their own life.

Secondary values are:

• The importance of having the opportunity to explore difficult feelings, buy viagra soft tabs without prescription. Viagra soft tabs free sample, • That being listened to, in confidence and accepted without prejudice, can alleviate despair and suicidal feelings.
• That everyone has the right to make fundamental decisions about their own life, including the decision to die by suicide.

In the United States this picture warps. Skipping some history, viagra soft tabs without rx, I note that in January 2005 the U.S. Buy viagra soft tabs without prescription, National Suicide Prevention Lifeline was launched with a grant from the Substance Abuse and Mental Health Services Administration. It operates a network of 120 crisis centers mainly in cities in the east. That is those 1-800 numbers.

They promulgate and enforce U.S. “Suicide Risk Assessment Standards” which accumulate data useful for further federally-sponsored research measuring “Crisis Intervention Outcomes.” The National Violent Death Reporting System mandates toxicology tests of the dead bodies (for alcohol, Viagra soft tabs online, cocaine, marijuana, amphetamines, etc.) and, as you might expect, gender-age-racial/ethnic and immigrant status data is also gathered.
Here we have the deaf, dumb, and blind version of epidemiology as practiced by American bureaucrats and academics, buy viagra soft tabs without prescription. I have read the detailed questionnaires and “training cards” for American volunteers, viagra soft tabs discount. I have surveyed the publications and conference reports. Against the background of what is being done in the U.K and Europe, the broad conclusion is inescapable. Publicly paid American officials and their hirelings do not care about human life. Buy viagra soft tabs without prescription, There is no mystery or unfairness in this judgment. Ours is a big country and the U.S. Viagra soft tabs malaysia, program is vast. No doubt some lives may have been saved and that is precious beyond money. However, I am concerned with the lives that were questioned, harassed, referred, subjected to proselytizing, generic viagra soft tabs cheap, and autopsied but not saved. Numerically---and it is a vast American accumulation of data---the number of “telephone dialogue contacts” (2009) in the U.K (under The Samaritan model) enormously exceeds those in the U.S, buy viagra soft tabs without prescription. The U.K. total population is 62 million; we are 307 badly served millions.

Imagine yourself a teenager or someone at the end of the tether of their addiction. (And you must know how information circulates among young people.) Would you call 1-800-SUICIDE. Buy viagra soft tabs without prescription, Suicide is the second leading cause of death among 25-34 year olds (CDC 2005) and the third leading cause among 15- to 24-year olds. Approved viagra soft tabs pharmacy, That is one death for every 100-200 attempts (or “gestures”). In the U.S., deaths by suicide exceed homicides by twice and enormously exceed deaths by AIDS.

The human cost of reactionary, anti-health ideology is substantial. Underreporting---for a variety of reasons---suggests, by the U.N.’s own assessment, find viagra soft tabs on internet, that U.N. publications catch 40% of the suicide phenomena, buy viagra soft tabs without prescription. Do these numbers matter for Americans. Our post-1976 rogue nation is not a signatory to a variety of Human Rights, Rights of the Child, and International Health declarations. Purchase viagra soft tabs no rx, Perhaps that, too, is beyond mattering

Samaritans provide confidential non-judgmental emotional support, 24 hours a day for people who are experiencing feelings of distress or despair, including those which could lead to suicide.

Whatever you're going through, whether it's big or small, viagra soft tabs vendors, don't bottle it up. Buy viagra soft tabs without prescription, We are here for you if you're worried about something, feel upset or confused, or just want to talk to someone.

Yet in the U.S. the 1-800 services proudly announced (on May 27, 2010) their 2 millionth call since their launch in January 1, 2005. Obviously, Buy viagra soft tabs on line, the U.S. government contract programs are doing something wrong and it is not difficult to discover what.

The 34,598 suicides/year reported recently is twice the number of homicides, as I said. There were 1.1 million suicides attempts in 2009, buy viagra soft tabs without prescription. Meanwhile $20,000 to $50, cheapest generic viagra soft tabs,000 stipends to U.S. call centers increased. I cannot trace the millions of dollars in private corporate contracts. One article suggests that these efforts “serviced” five million calls in 2009. Buy viagra soft tabs without prescription, Even rolling in the few Samaritan-based international centers in New York City and a few elsewhere, I am sure the number is misrepresentation.

On costs: the U.K. Buy viagra soft tabs no prescription required, and European Samaritans are said to operate at about 70% service delivery, the remainder of the expense is training (with more than 31,000 trained volunteers) and administrative costs. Compare this with the shocking U.S. ratio of service to “administrative costs” for our array of grant-fed researchers, NGOs, private for-profit contractors, price of viagra soft tabs, and a top-heavy administrative bureaucracy.

Basically the Samaritan do not operate in the U.S., but they do participate in conferences, buy viagra soft tabs without prescription. They submit data and always calmly promulgating their own guidelines. They document their results and quote the confirming U.N. documents. The weighted average of suicides annually worldwide is 19.5 per 100, Cheap viagra soft tabs pill, 000 population. Buy viagra soft tabs without prescription, That is about the U.S. average. It would be good to see that number reduced.

Commonly the U.S. call centers urge people to turn their lives over to answering detailed questions or to turn their lives over to Christ. How is that for listening, buy viagra soft tabs without prescription.

The fundamentalists and others now aim to use not only all call centers but all public schools for their ministry. They offer auditorium and classroom “programs, order cheap viagra soft tabs,” along the lines of “Say No to Drugs” and suicide prevention. Though it is illegal (Public Superintendents or Principles cannot collude with evangelicals to violate constitutional Church-State separation), it is common. Some brag of having reached every High School in their states. Buy viagra soft tabs without prescription, They seek the captive audience, those compelled to attend. And they disguise their pitch to avoid the letter and the spirit of the law. Buy cheapest viagra soft tabs, Chad Varah was an unusual man and he understood all this. You may be interested that he believed in reincarnation. Sarah Palin perhaps does not believe in reincarnation and I suspect she does not believe in anything. In the U.S, buy viagra soft tabs without prescription. media reincarnation makes Varah, but not Palin, a “freak.” Early on Varah was devoted to serious sex education for the young and accepted responsibility for starting “the permissive society.” The parson, his wife, order no rx viagra soft tabs, and supporters struggled through the early learning phase of several highly sensitive and unusual health services, developed their protocols and recruited volunteers. Then followed the explosive growth of their suicide help program based on the need for such a service. And then his decades of worldwide travel while building The Samaritans and Befrienders. All along his protocols were rejected by American experts who, Order discount viagra soft tabs, nevertheless, can incorporate fundamentalists proselytizing into their program. Buy viagra soft tabs without prescription, Varah wrote books covering their work in the 60s, 70s, and 80s. Befrienders was the name of the international organization because it translates easily and does not depend on a Biblical story. In addition, he and his wife developed protocols for abortion counseling and one of the first organizations against the genital mutilation of young women. He was bold, outrageously outspoken, viagra soft tabs generic, a believer in honesty with the young when honesty is sometimes shocking. He was dedicated to applying his intelligence in the most sensitive of places, where love has pitched its mansion.

In reading this history, remember that suicide was illegal in England, more or less, until 1961 and in the United States until 1976, more or less, buy viagra soft tabs without prescription. Since suicides continued at about the same level from Varah’s time to now these are not trivial matters. Sociologists and journalists may make no analysis of these facts. Viagra soft tabs canada, And yet all can singe the famous song “Suicide is Painless” (Johnny Mandel’s M.A.S.H. theme song) with its refrain “I can take it or leave it”). Buy viagra soft tabs without prescription, Well, whatever. The need continues for someone to say “You are not alone; I hear you.”

Suicide is preventable. As with every harm that besets us, it correlates with the quality and level of support available and the level of inequality. Some do find suicide a reasonable response to this life. About three thousand a day world wide do kill their selves (farmers in India, buy viagra soft tabs from india, employees of Foxconn in Shenzhen, but also thousand of American young people). And there are twenty times that number who attempt to do so, buy viagra soft tabs without prescription. In the U.S. recently the rate has nearly tripled among adolescents and young adults. By any measure the social cost is enormous. Cheap price viagra soft tabs, Dare I call it a hidden epidemic. Buy viagra soft tabs without prescription, Durkheim---and, of course. Marx---had shown that when we begin Bowling Alone suicide rates increase. The breakdown of “social integration” signals increased suicides among “social dependent” populations. That intelligence was more than 100 years ago. Current academic analysis has barely grasped the point yet And the trend is upward, especially among young men.

The WHO, which does grasp the point, made “prevention strategies” their focus in 1996 recognizing the move from 9.4 suicides per 100,000 in 1970 to 19.5 per 100,000 in 1990, buy viagra soft tabs without prescription. It has pretty much stayed at 19.5, purchase viagra soft tabs without prescription. There is international hope is to reduce the all-teen rate---already lower because of the inclusion of females---to 1.0 per 100,000. Meanwhile the U.S. bureaucrats and academics are looking to “screening” to achieve some reduction. Buy viagra soft tabs without prescription, God preserve us from their “screening”.

Jim

Addendum: All the major religious organizations oppose assisted suicide, Viagra soft tabs tablet, another issue entirely indicative of attitude and ideology. The propaganda groups, such as the “Nightingale Alliance” and others, tell their version of “Christ’s testimony” to captive school children and tell their version of reality on the hotlines, perverting the Samaritan’s tested listening/accepting protocol. But assisted suicide---statistically insignificant---is a “hot button issue” in the U.S. while suicide rates are ignored, viagra soft tabs us.

I also must mention that there is substantial academic literature that shows a correlation between Theism (religiosity in its many forms) and societal/economic dysfunction, buy viagra soft tabs without prescription. My story above would seem to confirm that correlation. But here is the twist in the current research: the U.S. is an outlier in to their statistical correlation. Outside the U.S., in the developed “First World” there is a perfect statistical correlation between social problem-solving and secularism and between religiosity and social dysfunction. Buy viagra soft tabs without prescription, I suspect the statistical anomaly is because our economic power, size, and apparent success fall outside the bound of their research formula. But I do not know.

On everybody else’s evidence the better you are at social harmony and measures of social satisfaction (happiness) the more secular you are. Theism (by measures like “prayer,” church attendance, belief in a magical deity, salaried parsons, etc.) correlates with high unhappiness measures and failure to solve social problems over, say, a generation. There is Gregory Paul’s study in 2009 of “The Chronic Dependence of Popular Religiosity upon Dysfunctional Psychosociological Conditions” (Evolutionary Psychology 7(3), 398-441), cited because of his own responsible citations both pro and con.

Anyway, the essence:

The U.S, buy viagra soft tabs without prescription. is exceptional in that, of all of Western Europe, only it shows some positive correlation between economic success and high levels of religiosity. All the rest of our peers in Europe show the opposite. They are not especially “religious” but they do solve their problems and are happy: the two statistical facts correlate. Other related statistical measures (health, longevity, infant mortality, decline in rates of suicide, etc.) confirm this. Buy viagra soft tabs without prescription, These results contradict the moral-creator socioeconomic hypothesis, including the thesis widely held in America that a democracy can combine libertarian economics with high levels of popular religion and charity to achieve socioeconomic success.

Conservative religious ideology is a probable contributing causal factor of societal dysfunction, in part because it opposes the modulation of free market capitalism with extensive government based assistance [which has] proven more effective in creating the exceptionally secure, equable and benevolent overall societal and economic condition.

I hope you see that this researcher and his colleagues have not solved the U.S. conundrum. They offer the conventional coda of most academic studies and government reports: “more funding for more studies is needed.” However, until they were shut down, they had an entire journal devoted to linking religiosity and social dysfunction over several past years. They should found a new journal under their own editorial control, buy viagra soft tabs without prescription. There surely must be some topic that will justify further exploration of Paul’s literature.

I have read only one of Chad Varah’s books (The Samaritans in the ‘70’s). There it is obvious that he understood all the difficult issues surrounding suicide. He did not---as is usual---run away and hide from them. Only such a man could have founded The Samaritans and seen the organization to its contemporary position of influence. He died November 8, 2007.

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Buy nexium without prescription, This introduces my reading notes on the topic of Social Medicine, a topic that should not be left to experts: the physicians, scientists, academics, and journalists---valuable as their work may be---who have given Social Medicine their professional attention.


Social Medicine emerged with Florence Nightingale, her colleagues Edwin Chadwick, William Farr, and others in the mid-nineteenth century. They recognized that medical services must go beyond the care of patients who seek the assistance of a doctor. The causes of TB, cholera, and typhoid cannot be treated effectively in individual patients. Private medicine, order nexium in canada, profit-driven enterprises, and philanthropy were unwilling to deal with the causes of these plagues. In fact, private enterprise was deeply implicated in people’s ill health and in the poisoned environment, Nexium overnight delivery, just as private enterprise was implicated in the continuation of slavery in the colonies, child labor in the mines, and filth in the working-class neighborhoods.


The Victorian sanitarians pushed government reforms and government regulation associated with clean water, clean housing, and fresh air. They recognized the intimate connection between poverty and ill health, buy nexium without prescription. They supported changing an ugly reality in behalf of greater human health through urging a more equitable distribution of society’s wealth.


The needed social measures were higher wages for labor, buy nexium online without prescription, taxing the richest and the relatively rich whose wealth derived from social labor and government favor, surcharges to support social welfare and sanitation, and intelligent philanthropy. Also the sanitarians opposed the idolization of doctors and the grand public expenditures (favored by doctors) spent on curative medicine. Buy generic nexium, These led to a neglect of preventive medicine and were of minimal benefit to individual patients.


In tracing this history, I try to see it as more than a simple class drama, a history of attempts to pry the practice of medicine from the clutches of profit-oriented and relatively petty private enterprise. I have wanted to see it as more than another sad story of kulaks vs. Buy nexium without prescription, landless peasants, colonialists vs. their backward subject peoples; enlightened managers and savvy entrepreneurs vs. dumb labor, cheap nexium without prescription. This, after all, is public health, an obvious and immediate matter of life and death.

I do not believe in "nature's noblemen" or labor as "the salt of the earth." These are fond fictions---often including my own fond fictions---that do not serve the long slog toward change. Find discount nexium online, Nightingale, above others, was not given to easy illusions. You may say that she and the others were simple reformers; however, they did grasp what it meant to prevent excessive early death and how persistent a reformer must be, buy nexium without prescription. That is a missing recognition in contemporary reformist writing and speaking. These Victorians based themselves on facts and were not afraid of statistics. That is a major difference between their 1850, nexium medicine, or even our own 1950s, a century later, and this Reagan Era, 1976-on and 2010.

Provide any large number today and minds blur. Nexium side effects, No one tests this strange weakness but I have seen it happen again and again. Buy nexium without prescription, Our mothers, sisters, and daughters today---where our hopes rest---are too much like Sunflowers, like Charlotte Douglas, like those for whom everything is a "choice" made in the ahistorical realm of commercial accumulation from the boutique or mall. And, no, I will not remove these literary alusions to Rebecca West, Joan Didion's A Book of Common Prayer, or the fine journalism of Susan Faludi.

Back then they were simple reformers who had grasped the essence of a public predicament, canadian nexium. They wanted to bring an end to excessive, preventable early death. That is why all true soldiers idolized Florence Nightingale; they were not afraid of death but they hated unnecessary, preventable death. Nexium vendors, We, in contrast, cannot seem to get our mind around our deplorable infant mortality statistics, our sorry longevity data, our widespread cancer damage, our dramatic rate of incarcerations (death in life), buy nexium once daily, our statistically useless drug dependence, our unnecessary wars for oil, or our phenomenal rate of child poverty whose consequences no one seems to grasp.

Their views and activities got support from such sources as Jeremy Bentham’s Utilitarianism (“the greatest happiness for the greatest number” etc.), from the Christian socialists and the social gospel of the Dissenting church, Buy nexium lowest price, from the inspiration of teachers such as Dugald Stewart and William Alison of Edinburgh University (somewhat unknown men who escaped the stigma of radicalism but who set many physicians such as Farr and Sutherland and public servants such as Chadwick on the path of reform, as well as the Whig aristocrats Palmerston, Russell, the Nightingale family, and others), and from the less direct influence of men like J.S, buy cheapest nexium online. Mill, the Chartist leaders, and Marx and Engels.

As you might expect, these progressive people faced vicious, dishonest opposition, buy nexium without prescription. By definition the opponents of equity, of health, and of sanitation make bad arguments. They have no other. Buy nexium on line, You can imagine trying to defend sickness forced on a whole population by the level of exploitation they face. Imagine trying to defend slavery and child labor. Buy nexium without prescription, And yet these have their defenders. So, the sanitarians, if they were intent on results and not just making happy talk, faced serious opposition: misrepresentation, find no rx nexium, slander, sophistry, lies, and pettifogging quibbles to obscure the central points they were making. Buying generic nexium, We do not have to be physicians to recognize their bad arguments. We do not have to be psychiatrists to recognize that the sanitarians, struggling for results against the odds, were not always humble and kindly people.

Today it is especially important to recognize bad argument and vicious ad homonym attack because most of what we are able to read concerning Social Medicine is opposition to it. I am sorry. I apologize, buy nexium without prescription. But this is true, cheap nexium pharmacy. In most ways, through most of the world, sickness is a direct expression and consequence of inequality. Inequality is the dominant feature of our world. Buy nexium in us, Most of what we can read about Public Health or Social Medicine is a defense of sickness, a defense of inequality. Buy nexium without prescription, It is disguised as concern and respectable convention. That is why it is important to read the sanitarians in their original words and not only their shallow contemporary critics. I do not want these notes to read like weak-hearted encyclopedia entries whose editor honors two sides to every bogus controversy. Health is not that kind of coin.*

These notes cannot be a review of the technical literature, the peer-reviewed research literature, purchase nexium no rx. But that is not necessarily my main inadequacy. I would remind you that research is expensive; it requires sponsors; careers and salaries are involved, buy nexium without prescription. Peer-reviewers are people too. They have their interests, ambitions, Cheapest nexium prices, and connections. Vast profits are to be made based on the outcome of research; corporations are actively interested in all medical research and pay for research with the "right" outcome. However deeply honest some researchers are, the majority of them in our society will sign up on the side that offers the greatest personal advantage. Buy nexium without prescription, Worse yet, they are expected to do that and accepted for doing that. Therefore, it is not a weakness to attend to those writers who are willing to write for a broad, certified nexium, non-specialist audience. All mixed in with the paid propagandists, they work as honorable combatants in the Social Medicine wars. With all of them we are able to judge the quality of their argument and see most clearly their position. Nexium information, The idea that science, in order to be true to itself, must be useless and must never descend from scientific formality in order to explain itself to the layman is an idea that deserves no respect.

Putting aside for the moment the world’s poor, who are much on my mind, we today in America face resurgent influenza and TB, various autoimmune diseases, nexium online review, and rampant cancer (a whole set of avoidable plagues that cannot be treated effectively in individual patients on the basis of who arrives fully insured at the doctor’s office). Plagues have again caught up with our cranky, post-Victorian, still predatory capitalism, buy nexium without prescription. Again the current government is entirely unable to deal with our modern health crisis. By opposing through quibble and inaction the extension of clean water, adequate nutrition, Lowest price nexium, decent housing, and a safe environment for all people, our government encourages these plagues and invites further preventable ones. Respectable voices may deny that there is any intention to bring about these ills, but the number of victims count more than that routine denial. Deaths are as real and more easily counted than the stench of London’s rivers and cesspools before 1850 when every polluter denied any intention to cause unpleasantness.

Social Medicine will collect notes and reviews and quotations from sanitarians writing during the famous Sixties, no rx nexium. Buy nexium without prescription, Let me explain why the Sixties. Social Medicine people are mainly reformers. Like the Victorian sanitarians and “gas and water” socialists of that bygone era, modern sanitarians made best headway with the winds of social protest at their backs. For the Victorians this wind was the rural rebellion of “the silent people” in 1830 (arson, Buy cheap nexium internet, violent assembly, machine smashing), the labor and socialist movements (marches, organizing, threat of revolution), the People’s Charter (to be forced on Parliament by mass demonstrations), nexium generic. Social protest and activism provided the wind behind England’s health and social welfare reforms. Likewise in the Sixties: the civil right movement, Black and Native American insurgency, urban rebellions, the anti-war, socialist, and openly communist agitations created the impulse behind some reforms sought by well-know people like Rachael Carson, Ralph Nader, and others, buy nexium without prescription. They, too, sought partial reforms. Nexium australia, They did not announce that they were setting out to overthrow the State of the Corporations. Perhaps they should have. They won some partial reforms from the powers-that-be, reforms offered up as appeasement and often substituted for substantive change. Buy nexium without prescription, Nevertheless, as in the earlier era’s victories for public sanitation, measures such as the Clean Air Act, Civil Rights guarantees, OSHA, a strengthened FDA and the EPA, an HEW with some responsible leadership, and funding for the United Nations' WHO were not insignificant gains however much they have been diminished during our subsequent Reagan era. The sixties are closest to us and were tremendously important preliminary years.

The condition of life of ordinary humanity is the point of departure of all social movements. In the human condition---exactly how ordinary people are living, nexium pills, are getting by---all social crimes are exposed. There we have numbers. There we have transparency. There the consequences of policy are not hidden, buy nexium without prescription. Today, Cheap price nexium, on the street, everyone may know that the rich are parasites and are, in fact, criminals. On the street everyone may know that fish rot from the head, that the government bears the central responsibility, nexium malaysia. But it is a long way from knowing to a social movement. Bright hopes and warm-hearted promises of “change you can believe in” are unsubstantial. Buy nexium without prescription, Therefore Social Medicine---concerned with the facts of infant mortality, longevity, population vitality, income distribution, nutrition, epidemic attacks, etc.---is the window on the future, a battle ground where we can see and measure the future. Revolutionary talk is easy, often futile and meaningless in the absence of a broad social movement, Low price nexium, in the absence of heroic organizers such we gave rise to in the 1840s and the 1960s. Social Medicine, as a topic, may help solve that lack, may help us move our lives off the nickel and the dime of cheap words.

Even our media, in their humble dishonesty---humble only because arrogance sells no products---reflect the importance of Social Medicine, cheap generic nexium. Our commercial media returns again and again to the subjects of Social Medicine to secure an audience. Timid journalism on the subject abounds, as do books, articles, Nexium free sample, and health websites. A few voices speak out, unafraid to be counted as radicals, buy nexium without prescription. And scattered through the professional scientific literature there are honest epidemiologists and sanitarians who present their research even now.

Here I will only attend to some older voices, back when writers had more wind at their back. Every one of them faced attacks. Rachael Carson, they said, nexium online without a prescription, was responsible for the deaths of millions in Africa because she initiated a campaign against DDT poisoning. The reformer Ralph Nader was stigmatized as a radical for advocating auto safety and arguing for labeling the chemical additives in the products we eat. Buy nexium without prescription, But we can say that, in essence, they were enemies of sickness. As a consequence, they were enemies of that mother of all sickness, Low cost nexium, wealth accumulation by the few. Ultimately they were enemies of capitalism itself. Excessive private wealth is a thing like the beasts and diseases that ravaged hunters and gatherers a thousand years ago. We do still care about our actual condition and that care has always driven progressive social movements. It will again.


Jim (written July 22, 2008, edited September 19, 2010)

***

One illustration of “controversy” from my reading: this week (July 18, 2008 NY Times) the government, for the second time in a year, announced cancellation of a major U.S, buy nexium without prescription. trial of an experimental HIV vaccine. Canceling an experimental vaccine trial is not a bad thing, nexium sales. They judged that the HIV virus was still too little understood (actually a virus never isolated) and the new vaccine’s interaction with the immune system was unknown and possibly harmful. As usual this news came with no background information, no mention that there are massive drug industry and AIDS-industry-funded trials and experimental treatments now taking place in Africa and India (at a direct cost against programs for clean water, nutrition, Where to buy nexium, and medical aid training), no mention of the Gates Foundation’s push for high-tech medicine in Africa, or the entire inadequacy of cause and result documentation in Africa, etc.

Also on July 18 my copy of a left-liberal magazine In These Times arrived with a Health column reiterating yet again the need for blind faith in the official HIV-AIDS theory that has dominated government science, the AIDS industry, and the media since AIDS emerged in the early 1980s, find discount nexium. Buy nexium without prescription, The journalist, Terry J. Allen, takes off against any suggestion that there might be something fishy about this HIV-AIDS orthodoxy. She seeks, again, Nexium approved, to repudiate Peter Duesberg and his colleagues, the so-called “AIDS denialists.” These people cast doubt on orthodoxy. That, she says, is not just irrational, it is murderous: “This dangerous nonsense has caused unfathomable death and misery.” If I follow her excuse for reasoning she is saying it is because doubts somehow might reduce the "unfathomable" billions already spent on AIDS research, drug treatments and vaccine trials. Of course (since it is a liberal magazine) she does not claim that the “Bush administration” has performed well against AIDS (“too little, too late”); but her main attack is against this “group of US-based AIDS denialists” who have “become a global menace” responsible for "unfathomable" suffering. She links any challenge to HIV-AIDS orthodoxy to the “conspiracy theories” of Rev. Jeremiah Wright (the old, quite casual suspicion that AIDS was invented by the US government to be used against Blacks, as at Tuskegee); she misrepresents South African President Mbeki’s thinking, as is common in this sort of piece, and fulminates against those who have influenced Mbeki, such as Duesberg (who will be one of the sanitarians I will review later in these notes).

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Buy viagra super active+ without prescription, Who hasn’t written about America’s divisiveness, its loss of community and cooperation. If civilization---in the post-Neolithic sense---began with human cooperation in taming the waters of the Tigris and the Euphrates and continued through the triumphs of tribes and vast extended families, viagra super active+ uk, Buy cheap viagra super active+ internet, on to building nations and organizing empires, then what about this recent American setback wherein we seem to be retreating into individualism, cheap viagra super active+ no rx, Buy discount viagra super active+, into each against all, apes rumbling in a capitalist jungle, overnight viagra super active+, Compare viagra super active+ prices online, and our current well-enforced, well-documented fragmentation?

The main metaphor for the collapse of American Community comes from Bowling Alone, find viagra super active+ no prescription required, Buy viagra super active+ cheap, the 2000 sociological classic by Robert E. Putnam, viagra super active+ sale, Viagra super active+ from canada, author initially of The Beliefs of Politicians: Ideology, Conflict, viagra super active+ australia, Cheap viagra super active+ internet, and Democracy in Britain and Italy (1973). I believe Putnam’s work had as great an impact on liberal opinion as Jane Jacobs’ The Death and Life of Great American Cities (1961) and David Riesman’s The Lonely Crowd (1950), buy cheapest viagra super active+ online. Viagra super active+ online sale,

Naturally, there is a vast, viagra super active+ online cheap, Viagra super active+ online review, contentious academic literature surrounding all of these books--- articles on which I have wasted much time while being cleansed and dried out, fluffed with derivative discussions of “social capital” vs, viagra super active+ no rx required. “social cohesion”---but I especially recommend reading Bowling Alone for its example of a fine sociologist in action.

Putnam established through membership records that most everything that matters socially went into decline during the last generation:

Television, two-career families, suburban sprawl, generational changes in values--these and other changes in American society have meant that fewer and fewer of us find that the League of Women Voters, or the United Way, or the Shriners, or the monthly bridge club, or even a Sunday picnic with friends fits the way we have come to live, buy viagra super active+ without prescription. Viagra super active+ in uk, Our growing social-capital deficit threatens educational performance, safe neighborhoods, order viagra super active+ without prescription, Viagra super active+ online without prescription, equitable tax collection, democratic responsiveness, discount viagra super active+, Buy viagra super active+ on internet, everyday honesty, and even our health and happiness.

Central to his analysis is the precipitous decline in labor union participation between 1975 and 1985, cheap viagra super active+ from usa. Order viagra super active+ from canada, The solidarity of the union hall is now gone, as with the Boy Scouts, viagra super active+ no rx, Cheap viagra super active+ overnight delivery, bowling leagues, serious volunteerism, viagra super active+ drug, Find discount viagra super active+, public meeting attendance, and even social evenings with neighbors.

Academics following on Putnam’s work are mainly decent enough people grinding out publish-or-perish articles and mucking up the waters of that simple thing “social capital.” They would have us fall into the washer & dryer of academic journalism and come out the worse for wear and be forgotten, viagra super active+ in bangkok. Viagra super active+ buy, I suggest that Bowling Alone and Putnam’s work in Italy---where he established that churchgoers are the least civic-minded of citizens, where good government is more a by-product of singing groups and social clubs than of prayer---are important to remember, compare viagra super active+ prices. Cheap generic viagra super active+, Always in Putnam’s original consciousness is the Police State, knowing that no number of police can enforce civility, find discount viagra super active+ online. Buy viagra super active+ without prescription, In the absence of social solidarity, we are given dramatic inequality and armed force as the only alternative.

Putnam documented all this, our American transformation following 1976 toward Bowling Alone and Ronald Reagan and corporate fascism.

As often with major academics (awards, invitations to testify, numerous honorary degrees, Council on Foreign Relations and National Security Council positions, Kennedy School dean, etc.) Robert Putnam gravitated increasingly toward work on “civic solutions.” We have lost the benefits of his considerable radical intelligence. Real viagra super active+ without prescription, He was no activist.

Since the federal government deals in “solutions” they need brilliant men to write copy for them. This is a sad outcome of so much valuable work and intelligence, cheap viagra super active+ in canada. Find no rx viagra super active+, I would have the government write its own fucking copy, do its own PR, cost viagra super active+. Viagra super active+ approved, But things do not happen that way. They recruit men and women from the top to write sop copy covering up their inadequate, corporate-friendly, unfunded legislation for them.

However, my private opinion should take nothing away from Putnam’s early work, buy viagra super active+ without prescription.

Putnam wrote with Social Medicine in mind and Social Medicine can be a bitter pill, buy generic viagra super active+ online. Viagra super active+, Everyone with whom I try to talk of Bowling Alone quibbles, contradicts, shallowly counter-indicates, or falls into hollow talk about solutions and alternatives. Maybe it is something about me, but I do not think so. I think Barbara Ehrenreich is correct in her new book, Bright-sided; How Positive Thinking is Undermining America. Buy viagra super active+ without prescription, We are so soused in American exceptionalism, drunk on cheap optimism, we have so internalized American Empire (while, of course, deploring our wars, genocide, the decimation of nations and cultures) that we refuse to experience the decline and fall of the American empire.

For most, beyond capitalism’s eternal “Now,” there seems to loom a science-fiction chasm or riff in time, a bottomless trench yawning over the frightening necessity of taking some action, over the fear of doing something about it. No one wants that necessity in their head, keeping them awake at night, making their skin crawl.

Hippies in the 60s and 70s, sensing what was taking place, depicted in their comics the burning of New York City, a vast conflagration, or some other timeless drama. Our nightmares are like that, using images from New Orleans, Afghanistan, our Gulf, or borrowing from Margaret Atwood and Philip K. Dick. This, too, is the trash of avoidance and denial.

I would like---in notes on a few of the many fine, moral, and progressive people who looked directly at the collapse of our social health in the 70s---to retain their picture of what was really happening. Robert Putnam in his early career was one of them.

Now Putnam’s books, articles, and editorials all end with: “To revitalize our democracy we shall need to begin by rebuilding social capital in our communities, by renewing our civic connections.” Okay, man, but your real contribution was pointing out the systematic destruction of social capital and saying a bit about “how did it happen.” There were yet miles to go before you rested in a bed of laurels. Why couldn’t you, as Jane Jacobs did, bring yourself to ignore that billboard reading “Shut Up!”?

.

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Buy yagara (herbal viagra) without prescription, All of you will have noticed the emergence of the multi-billion dollar market in “energy drinks,” those high-priced water/sugar/caffeine drinksboy2 with names like Red Bull (“It gives you wings”), Monster (“Unleash the Beast”), Vault (“The Taste, The Quench, The Kick”), Khaos, Cocaine Energy, SpikeShooter (“The caffeine of three Red Bulls”) and---naming just one more of many---Super Mario Brothers Energy Drink.  They are being marketed primarily to children with kid-oriented packaging, youth sports sponsorships, youth accessories (called Swag), youth celebrity endorsements, MySpace promotions, kiddy signage (“Reach Out--It's Yours”) and displays.  The corporations deny that they market to children and I have yet to see a journalist call them on this obvious lie. Primarily their youth marketing takes the form of aggressive product placement in aisles of greatest access for the young in all the key kid venues (7-Elevens, CVS, Cheap yagara (herbal viagra) without prescription, Walgreens).

Energy Drinks are the fastest growing segment of the beverage industry. The product belongs to an unregulated food industry segment called “functional foods” (AKA “dietary supplements”). Energy drinks are nutrition negative, health harmful, yagara (herbal viagra) pills, and untested.  Junk drinks.  Their initial success as a product depended on marketing lies and marketing placement.  But soon, via addiction, Yagara (herbal viagra) buy drug, the sugar-plus-caffeine jolt gained the product its traction.  Thus the push toward impressionable children, especially those kids made to feel they sleep too much or are not fast or bright or old enough, or that they lack their own cool vice, distinctiveness, yagara (herbal viagra) overnight, their own buzz.

Yes, it is a shame.  It is a shame that the victims of this aggressive private enterprise are the ones who get blamed (“Right, Yagara (herbal viagra) overnight shipping, another thing I’m doing wrong.”)  Yes, it is a shame that parental and child behavior change and enhanced health consciousness are the only solutions offered by the experts. It is a shame that teenagers are encouraged by advertising to imagine that drinking this stuff is a choice they have made and an exercise in freedom or control.  That is probably the most pervasive illusion among teenagers. No one teaches them about the power of advertising, which is to say the power of lies, buy yagara (herbal viagra) without prescription. It is also a shame that entry into this destructive industry is being offered to every brain-dead, find yagara (herbal viagra) online, amoral entrepreneur who wants to get in on the latest thing (franchising, distributorships, Buy generic yagara (herbal viagra), marketing from home, investment, new product entry opportunities).

What accounts for the energy drink emergence. First is the fact that the carbonated beverage market (the non-nutrient soda pop market) is a saturated market.  It has already reached every venue.  Brands like Coke and Pepsi are long established.  Their consumption peaked in 1997 at 56 gal./per person, cheapest generic yagara (herbal viagra) online, the prices have fallen. As much as 20% of the population already drink sodas for breakfast; more than 50% of all children drink them at school. Buying generic yagara (herbal viagra), They are sometimes provided to 2-3 years olds as near their first experience of adult foods.  The industry products are over-sold, a saturated market, closed to any essential profit-making growth.  As always growing profits---always growing---are the central and most irrational requirement of capitalism. Buy yagara (herbal viagra) without prescription, Therefore, new niches have to be created with new product lines.

The makings were already there. Hydrating fluids like Kool Aid and Gatorade and new-entry “healthy” beverages such as bottled tea and juice-like products had been modestly successful, yagara (herbal viagra) cheap. The beverage industry had already acquired, developed, Order yagara (herbal viagra), and manipulated the fruit juice and bottled water markets. Additionally, having created significant harm with its traditional carbonated beverages, it then milked the “Diet” and “Caffeine Free” markets, tablet yagara (herbal viagra). And not forgetting that the carbonated beverage industry had spent many years and hundreds of millions of dollars seeing that the so-called “regulatory environment” was open for a bottomless bath in soda pop.  It was an industry that was already selling everyone on water and sugar with caffeine for the narcotic/addictive effect. And Gatorade was widely used in sports and hospitals for hydration over water.

Being a vital private enterprise, the beverage industry looked ahead, buy yagara (herbal viagra) without prescription. All the components were in place for “Energy Drinks.” Brilliant!  These geniuses had figured out that if you can successfully prey on kids, Pharmacy yagara (herbal viagra), why within a generation the whole population will be your profitable victims. Had they not done it once with soda pop?  And now the regulatory environment was even more friendly.

Concerned doctors might have objected---without effect---to the way athletes are trained (excessive salt, stimulants, morphine and discomfort masking products, buy cheap yagara (herbal viagra), growth and strength accelerants legal and illegal), but that became water under the bridge. Online yagara (herbal viagra), There was some noise in 1996 when the FDA introduced the Functional Foods and Beverages category at the urging (and probably the drafting) of the beverage industry.  A wee bit of noise.  You can forget the rationale for that category since it was drafted to be acceptable. The long view was the industry's desire for a new, unregulated mass market category, and the junk food lobbyists got what they wanted so that now we have, find cheap yagara (herbal viagra) online, among other things, highly caffeinated, Canadian yagara (herbal viagra), intensely sugared drinks that go well beyond NoDoz, cold sweet milky specialties from Starbucks, and Coke's 10 teaspoons of sugar per 12 oz. can.

Buy yagara (herbal viagra) without prescription, Research in 2000 did not slow down the building of their business. The Government Accountability Office issued warnings about energy drinks and other product classed as functional foods but these were ignored, buy yagara (herbal viagra) pills. In 2002 the FDA was informed these products should be more accurately labeled “dysfunctional foods” and that their miscellaneous untested additives---so-called “dietary supplement ingredients”---were especially questionable. But that was only testimony which can be denied or contradicted always with opposing testimony bought from the academic shops that sell such testimory.  Worse comes to worst it can be handled as “a controversy.” No further scientific research was called for other than research sponsored by the industry, Yagara (herbal viagra) india, no order given to remove absurd health claims from labels, no special notification to the FDA required as new additives were tried out. When there were open violations of the lax law (as with Arizona Iced Tea and others) there was no prosecution. Thus, an industry notoriously indifferent to children's health was allowed, as they say, “to police itself.”

Concerning industry research, it comes in two varieties known to all researchers, buy yagara (herbal viagra) without prescription. There is the research the industry itself sponsors in order to use the results in their marketing.  There these is internal “trade secret” research wherein they discover exactly what is successfully addictive, buy yagara (herbal viagra) generic, what of the many forms of caffeine works best, and what quantities do not disrupt sales or brand reputation with embarrassments like the deaths of young athletes from “sudden onset death syndrome, Yagara (herbal viagra) prescription, ” etc. Those were isolated incidents. Naturally. There were predisposing conditions, yagara (herbal viagra) cost. There always are.

Buy yagara (herbal viagra) without prescription, Forget, too, the possibility of prosecuting an industry for criminal intent.  The tobacco industry has never been criminally prosecuted for jacking up the nicotine content of their “natural” and “safe” products nor for tweaking menthol content to accelerate adoption of smoking by the youth market. All this sort of evidence is protected by law as sacred trade secrets. Likewise the trade secrets of the soft drink industry are hidden from the public, Order yagara (herbal viagra) cheap online, although you must know that the industry did its homework and ran its tests. You can forget most research. The beverage industry sponsors more than 50% of all studies.  A Boston Childrens Hospital study found that industry sponsored studies of their own products were four to eight times more positive than government or independent research studies (See naturalnews.com).  Most of the researchers were doctors concerned about the effect of such products on children. The industry “questioned the conclusions,” as you might expect, but at least one researcher remarked---in that laconic way of concerned doctors overwhelmed by the crimes they witness---that industries only sponsor research to serve their marketing misrepresentations.

The doctors, fine as they make be, know that their own professional organization, the American Medical Association, is normally on the side of the industry criminals, its journal JAMA accepts advertising from them, and it promotes their irresponsible sponsored research, buy yagara (herbal viagra) without prescription. The AMA has blocked legislation to increase the tax on sugared soda sold in enormous quantities in all schools in spite of its proven association with obesity and diabetes, buy yagara (herbal viagra) internet. This tax was itself only a typical legislative avoidance making the drinks only slightly more expensive.  It highlights the AMA’s typical position (and unfortunately that of most nutrition journalism which repeats the AMA line of “moderation” and “a healthy life style”).

May I point out we are talking about children versus addiction, children versus non-nutrient, Yagara (herbal viagra) pill, untested, suspect substances. The illogical and irresponsible AMA advice that “concerned consumers” should avoid da da, da da amounts to no more than shilling for the beverage industry, get yagara (herbal viagra), as the AMA has historically done to our great harm for the pharmaceutical industry.

And, thus, Yagara (herbal viagra) online without a prescription, all the conditions were in place for the accelerated marketing of Enviga, Red Bull, Rockstar, Monster and others, yagara (herbal viagra) for order. First they would establish the product with young celebrities and give it a cool and risky image (Red Bull and vodka (“Wicked mega, double shots of caffeine”), Buying yagara (herbal viagra) online, for the teen give it a “Party!” image and a hot video game image. Buy yagara (herbal viagra) without prescription, Begin the massive displays of the product in every convenience store, CVS, and liquor store. And, concerning research, you can bet that CVS and others know exactly what they are contributing to the community beyond prescription drugs and cigarettes, find cheap yagara (herbal viagra), that they have measured out and done cost-benefit analysis of every foot of display space, of the returns on multiple displays of the latest cool things for kids, Yagara (herbal viagra) pharmacy online, the convenient high-priced, low value junk foods, the unsafe cosmetics, and the impulse buy trash.

Just as an aside, buy yagara (herbal viagra) no rx, they also know in detail that they are the community training grounds for middle and high school casual theft. They have the numbers. Online pharmacy yagara (herbal viagra), But all those numbers are “trade secrets.”  So why not gigantic center aisle canisters of Red Bull?

The idea that these corporations care about anything other than their bottom line is worse than laughable. This is private enterprise and they are quite willing to leave our children jangled, buzzed, addicted, order yagara (herbal viagra) no prescription, suffering headaches, anxiety, Buy yagara (herbal viagra) from us, depression, obesity, and diabetes as well as ADHD (Attention Deficit Hyperactivity Disorder).  I do not mean to exaggerate. The animal body---or at least the bodies of those who survive to reproduce---can handle lots of sugar, lots  of caffeine, lots of the other uninvestigated additives that you can discover by reading the side of a can of Monster, buy yagara (herbal viagra) without prescription. They can handle a lot of headaches and anxiety (“Get yourself a Tylenol, yagara (herbal viagra) for sale, honey; you’re a big girl now.”). Once there is no regulation at all the beverage manufacturers are unrestrained. Yagara (herbal viagra) purchase, Then here come their “energy drinks” and millions of to-some-extent damaged children, here comes the dramatic recent annual revenue growth and more to look forward to.

Okay, there is yet another factor in the emergence of this new thing: energy drinks for kids. And that is the weak, buy yagara (herbal viagra) lowest price, oblivious, ineffectual nature of the available health, Yagara (herbal viagra) bangkok, nutrition, and parenting journalism (newspapers, magazine articles, pamphlets, discount yagara (herbal viagra) no rx, “concerned” rneda, advertisements, information sheets and health pass-outs at the clinics and in the schools).  Much of it written and underwritten by the “functional” food and beverage industry. Buy yagara (herbal viagra) without prescription, Almost every one of these pieces of misinformation accepts the approach that “energy drinks” are a personal behavior issue, a choice made by children. The articles seem convinced that the corporations mean no harm, that they are acting within the law, that customer moderation is all that is called for, that there may be some little bit of controversy over some substances in some (excessive) quantities. This literature argues implicitly that there is little we can do about this harm deliberately done to children for private profit because free enterprise and free “choice” is a higher value, that corporations rule, that profit trumps health every time, that regulation is unnecessary. Self-policing is the American Way.

In 1942 the carbonated beverage industry got the U.S. War Board to declare soft drinks an “essential food” and they have been, the absence of controlling legislation and regulation, ever since.  Energy drinks are only spin off product, a new accelerating profit stream.  How do health journalists come to think they can responsibly address the health of our children without addressing the reality of private enterprise. It is as if our hunter/gatherer ancestors gave life to their children but never protected them against venomous snakes or predatory carnivorous beasts, buy yagara (herbal viagra) without prescription. The journalists must know that these industry profiteers will kill you.  Of course, our ancestors did more than plant a few warning signs in the grass for their illiterate kids to ignore. They did more or we would not be here now. All their children did not fall prey to the better adapted mature predators of the animal kingdom.

My advice to concerned parents is something the opposite of the AMA’s.  You cannot go to entrepreneurs for advice on how to keep your children healthy. You cannot go to the gods of plague for safety or a cure. The advice of “moderation” and “improved behavior” is pathetic.  Easily avoidable controls, taxes, or product labeling is not the answer.  For example, there is one energy drink that features dramatic, excessive, youth-oriented “Warnings” on its cans as a come-on, a way to create buzz.  Much of the health and nutrition advice (especially that in any way associated with a commercial product) is itself junk.  In the same way it was the advice of “doctors” that was first used to promote cigarette smoking as safe and healthy.  In the same way sugar-caffeine soda was promoted as “essential to the war effort.”  If you are going to defend your children’s health and see them grow to child-bearing age you are going to have to do it the way our hunter/gatherer ancestors did, by doing battle with the snakes and beasts that are killing them. Posting warning signs will not have much effect.

Jim (written August 6, 2008, edited August 17, 2010)

Health care posts do not appear in The Time of the Toad)

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Buy black cialis without prescription, Florence Nightingale was the founder of the profession of nursing  for the English-speaking world. That profession was inevitability growing toward some realization and she stamped it “F.N.” in ways more significant than many founders of nation-stateFN-Statues or religions could claim.

Many find something Marian in the way her founding spirit hovers over the secular profession of nursing. Because of Florence Nightingale, nurses have become respected for their their scientific training as well as for their honor, Black cialis no online prescription, labor, and service. Because of her they remain the guardians of our health. They are there for us.

In the unlikely event she had joined the Roman Catholic Church there would be a decree of beatification on the 100th anniversary of her death. That decree, I read, gives formal permission “to venerate one whose life is marked by the exercise of heroic virtue.”

She did not convert and was hardly Church of England, although very religious, buy black cialis without prescription. More like a Quaker or a rebel Mormon woman (if those categories are meaningful to you), cheap black cialis on internet. Such categories were not important to her. Most simply, she was one of those who have been called, Order black cialis in canada, one of the beautiful ones, one of those we have been waiting for.

In accord with her notion of Christ’s modesty, she wanted nothing but to be buried in an unmarked grave. Buy black cialis without prescription, If that proved impossible she wanted her grave marked only “F.N. Born 12 May 1820 Died 13 August 1910.” That wGrave-Wellowas done.

Sketch artists and encyclopediasts, black cialis medication, in their anonymity and vast audience, fail to convey Florence Nightingale’s many qualities and contributions. They leave her as an icon: “The Lady of the Lamp, Low cost black cialis, ” “The Angel of the Crimea.” Nevertheless, she has had fine biographers making contributions toward more fully understanding her: Sir Edward Cook in 1913; Ida O’Malley in 1931; Cecil Woodham-Smith in 1950, Gillian Gill in 2004; and Mark Bostridge in 2008. And there have been many other biographies and contributions. Several selections from Nightingale’s letters are works of some scholarship and care: Martha Vicinus in 1989; Sue Goldie in 1990; Mary C, cheapest black cialis. Sullivan in 1999, and others, buy black cialis without prescription. There are several fine studies of Nightingale’s contributions to public health, administration, and religious thought. Black cialis internet,

Now a Collected Works of Florence Nightingale is underway (the first volume of a planned 16 was published in 2001) under Lynn McDonald of the University of Guelph by the Wilfrid Laurier University Press in Waterloo, Ontario. Finally having her Collected Works will improve all new Nightingale writing. McDonald’s text, introductions, order black cialis no prescription required, and annotations are very fine: generous and always scholarly.

Buy black cialis without prescription, All the products of this Nightingale industry—scholarly and, for the most part, responsible work—have and probably will continue to have a touch of imagination, of speculation, of wonderment about them.  Not surprising that sketch artists fail.

We grope for a full understanding of Nightingale as if knowing would throw a switch somehow illuminating a great deal that concerns us. Or---with the nurses who always learn something from her---we turn her light onto contemporary issues and benefit from what it reveals.

No surprise that some have fought hard to diminish her, as if to keep their privilege, Order cheap black cialis online, property, and preconceptions hidden. She has never been an easy woman.

Mark Bostridge in the most recent full biography chooses an apt head-note quotation from Nightingale’s close friend Mary Mohl (”Clarkey”)

I study Flo as if she were a language and as she is a deep one I have not mastered it by any means.

One thing can be said with certainty: there was a great force behind Nightingale’s association with others well beyond her extended family. Although she put considerable practical effort into conciliating her family and into diverting all credit for shared accomplishments onto men like Edwin Chadwick (the great sanitarian and Director of the Poor Laws Commission), cheap black cialis in usa, William Farr (founder of the discipline of medical statistics), John Sutherland (colleague in War Office reorganization and something like “Surgeon General” of the UK), Sidney Herbert (repeatedly Secretary at War in the cabinet and her main ally in government), Cheap black cialis from canada, Benjamin Jowett (preeminent Oxford classicist), and many, many others, all owe a significant part of their reputations to their work with her. Herbert, Farr, Sutherland, the poet Arthur Hugh Clough, Jowett, and—excepting in Jowett’s case—their wives literally gave significant years of their lives over to Nightingale, buy black cialis without prescription. Along with them were the resolute Bracebridges, buy discount black cialis online, the Shore aunts, the Smith, Bonham Carter, Purchase black cialis overnight delivery, and Nicholson cousins, and others. From her twenties into her seventies she played life-defining, career-making, or influential roles in many additional lives, no prescription black cialis. Many were eminent Victorians.

When reading even the most generous biographies or studies, I am always convinced that not enough has been said. I do not mean that I want to take away her intense personal privacy.  But I do want more said that applies to major public events and issues, Black cialis cheapest price, that sheds more of her light.

For instance, in likelihood, Nightingale did not go to the Crimea as a result of Billy Russell’s newspaper reports on the criminal conditions facing the troops (inadequate supplies, disease, no medical services, cheapest black cialis prices, French superiority in health care through their nursing nuns). Buy black cialis without prescription, Nor did she go at the initiative of the Secretary at War. She had read the newspapers from before the Battle of Alma, knew the conditions from her correspondence, Buy black cialis us, and herself initiated the Times’ reportage of the lack of medical services (through her military contacts, Ambassador Stratford de Redcliffe and Lady Stratford, young Thomas Chenery who actually wrote the first reports as a stringer for the Times, and Times editor Thomas Delane). The reportage had a powerful impact on the British public because of the new telegraph connection between the Crimea and London, black cialis cheap price. More than likely she herself---in immediate days before spent investigating medical conditions among the poor with Sydney Herbert---initiated the plan for a team of nurses to be sent to the Crimea.

Again, in likelihood, Nightingale was mainly responsible for the weakening and fall of the Aberdeen government in 1855 and for the reform of the British War Department following the Crimean War, Black cialis pharmacy, as well as the reforms brought about through Royal Commissions she urged to life, especially the Commission on India, and the performance of Indian Viceroys. There was much else.

Not much good can come from pandering to celebrity culture—with its powerful underwriters in publicity and marketing—nor from pushing a Great Man theory of history.  And Nightingale herself teaches us what cooperation, colleague, buy black cialis without prescription, and collaborator mean.  However, there was such a force and pertinence about her that it weakens my reluctance to emphasize.

Her name should be associated with the dissolution of the British East India Company (a primary agency of Great Britain’s colonial depredations). Her name should be significantly associated with the whole course of English reform legislation (she had learned from Chadwick’s painful experiences), buy black cialis without prescription. Her name should be associated with the founding and successes of the British Social Science Association---as it was known---and the London Epidemiological Society.

And there are many smaller matters. Cheap black cialis no prescription, Nightingale’s family is never mentioned in history in connection with Adolphe Quetelet’s invitation to England and the consequent founding of what became the Royal Statistical Society (Malthus was there, Babbage was there). There is the significance of her use of statistics in Parliament (through her MP allies) and in statistical graphics. The anthropologist/eugenicist/coiner of words Sir Francis Galton (1822-1911) figures more prominently in the history of science than does Nightingale who was tutored by the great James Sylvester and with Quetelet her “dear comrade.” And so forth. There are many historical oversights and injustices.

Buy black cialis without prescription, I expect to discover much more about her accomplishments. For instance, order black cialis overnight delivery, the history of epidemiology—that foundation of social medicine—does not yet have a historian who will speak a single word about the significance of Nightingale’s fight against the primacy of graft---in the form of misused grants and funds, position, and privilege, Certified black cialis, as well as common trade in medicine-for-profit---in the history of their science. They avoid she who avoided nothing.

Also her name should be significantly associated with the novelist careers of major Victorian novelists. Nightingale felt that some of their most important accomplishments was work she might have and perhaps should have done. She was often conflicted about the use of her resources. However---true to form---she used the thought of writing great novels the way actors use the joke “I could have done that,” to keep her head on straight, buy black cialis without prescription. She knew full well a great writer when she read one and knew that her devotion lay elsewhere.

If Nightingale and English literary history seems a stretch consider that to leave her out is exactly like imagining that Nightingale—massive correspondent, where to buy black cialis, activist, reader of everything, reformer, Cheap black cialis tablets, an office/residence in London just off Hyde Park, burner of midnight oil and candles at both ends—had no contact with the revolutionary struggles for social change beyond  the boundaries of gentry-acceptable reform politics. There too she is left out.

Sometimes you have to wonder about history writing. For instance, in behalf of historical business-as-usual there is a great underestimation of the Elizabethan license-to-power for women in the early sixteen hundreds, cheap black cialis. And the continuity of that license. Buy black cialis without prescription, Historian get stuck on the well-documented legalities and the formalities of conservative gender relations and ignore the living reality. Also, way too often, Cheap black cialis online, historians ignore or understate the power which deep and intimate learning (classical and scientific) conferred on women when they possessed it. As if to talk of such learning is to admit you yourself do not possess anything like it. That is an obvious truth and therefore a closed subject.

Also, very often, our own twentieth century class preoccupation with the home gets read back into Victorian culture where that preoccupation was only in its infancy, black cialis online sales. Dozens of studies tell history hind side to. Yes, the Victorians were giving rise to the middle class culture we know so well.  But it is we, not they, and especially not Nightingale, who indulges all the limitations of that particular class phenomena.  And as for her “invalid” status, a society that honors exercise over accomplishment, idle socializing over influence, and advertising above all is in no position to judge Nightingale’s great energy and precious time and space.

You should also know that most prominent Victorians were censors, concerned with privacy, careful of reputations and of the feelings of others, buy black cialis without prescription. Nightingale destroyed many reams of paper in her own fire and often ordered letters and papers to be destroyed. Undoubtedly her family and first biographer (a family friend) continued the practice on their own. Black cialis medicine, The British Museum holds 15,000 Nightingale letters, spoken of as a great number. Yet that is far fewer than a letter a day over her 60 active years while we know that she wrote constantly, day long and into the night, drug black cialis online purchase, exercising her influence by correspondence. Buy black cialis without prescription, Yet only 15,000 or so letters remain.

Even these generations later critics deliberately neglect or actively suppress aspects of Nightingale’s life for no more reason than their inability to provide their version of scholarly annotation. I suspect they sometimes have darker reasons of their own. “How small a thing is woman.” Even such a woman.

Therefore, Black cialis without prescription, with Nightingale, may we not stretch the boundaries of propriety somewhat. Whole dramas could be composed of scenes of great interest. For instance, an aggressive, free black cialis, brilliant child interrupting her father and their neighbor Lord Palmerston at their weekend chess to demand answers to her incisive questions on British political issues; her meeting with Frederick Engels in Hyde Park and their inevitable discussion of The Conditions of the Working Class in England in 1844 and their own diverse aspirations; private conversations with the Brontë sisters; Nightingale on a horse at night in the rain overlooking a Crimean battlefield with a favorite officer—one of the many who became life-long friends and supporters—in discussion of the war.

We still lack even a developed scene in which she attempts to mesmerize a tame bear in the Oxford apartment of a friend, accompanied by her would-be fiancé, R, buy black cialis without prescription. Milne, who was the first biographer of Keats and himself an extraordinarily accomplished strange duck, Black cialis order, an MP, Lord, and life-long supporter of her causes.  Clearly they all had a bit too much wine.

We do have many invented scenes from her childhood, necessary in the very numerous popular biographies of the Lady of the Lamp, black cialis rx, but they are lame by comparison.

These are only poor illustrations.

Although she was a woman of machinations, angers, and lament—or as Sutherland said, Order black cialis from us, “a woman sprinkling sawdust and iron filings”—Nightingale could also be an amusing woman, occasionally a comedian, mimic, and a scandalous delight for her sister, cousins, cheapest black cialis price, and close friends. Her humor was most often informed by her knowledge of the inadequacies of her nation, its BrokenColumn leadership, Find black cialis without prescription, and its culture. Replying to a friend’s question “What Is To Be Done?” she said, “Perhaps we should advertise for the answer.” Describing a defense of inadequate statistics, she said “He claimed there were even uglier bonnets in the store.” When the Crimean brass could not grasp the differences between a Latin or Greek cross or a Crescent for a Turkish cemetery monument at Scutari, she wrote that she had proposed Themistocles’ broken column, black cialis online stores, “only nobody could see the sentiment of it.”

If Nightingale had converted to Catholicism---which she seriously considered---that would have made Cardinal Manning’s career. Buy black cialis without prescription, He was a former beau and close friend, fellow reformer, and a most famous English convert. But far more than Manning’s career, her conversion would have changed the course of religious history in England and would have answered “The Irish Question.” Her Crimean experience lay ahead. Order black cialis in us, For a considerable time she was the most famous woman in the world. Nightingale’s sense of religion was enormously radical. Religious caterpillars, as she called them, categorize too easily, order generic black cialis, as if religion were a bug or butterfly that you catch and that Science must give a scientific name.

Any woman knows what it is to be belittled. Nightingale does not allow it, buy black cialis without prescription. There are now six million trained nurses in the English-speaking world. Every one of them knows something of Florence Nightingale.

Concerning getting a reform accomplished, Nightingale once said “I shall eat straight through England.” They will think they are in a forest of Nightingales.

She was a great tree of a woman and the scaffolding that made the profession of nursing possible. As a great tree does, she left behind a forest of leaves. As from such a solid scaffolding, schools of nursing throughout the world will celebrate the 100th anniversary of her death this August, 2010.

A note on her leaves follows. Also, I may append some of the many moving anecdotes.  For one instance, when Japanese nurses---after days of horrors following the Hiroshima atomic bombing and in real danger of suiciding themselves or running home---repeated together each day the Nightingale Pledge, and then stayed there in Hiroshima working at their profession.

When I can locate it, I will append a list of the many nicknames (some quite overwrought) by which Florence Nightingale was known in her time.

Jim (written in 2007, edited August 16, 2010)

.

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Buy cialis without prescription, This continues the draft novel, "Nightingale At Large." The form is e-mail correspondence, notes, and other documents exchanged between two brothers along with others about a film project based on Florence Nightingale’s life. One brother, Robin Landsman, is a Florence Nightingale enthusiast and a part-time instructor at the American University in Beirut and elsewhere. The other, Richard Landsman,is an A-list Hollywood director. A third party, introduced here, is Richard’s wife Rachael Landsman who is responsible for bringing the two long-separated brothers together on this project.

Robin to Richard 

Rich, here is something of the Nightingale childhood settings---Lea Hurst and Embley---to go along with the photos sent.

I meant for you to throw those lame photocopies from encyclopedias and the life-sketches away after reading. I am suggesting that we do not employ any of the child-is-father-to-the-man clichés used about this famous reformer and the founder of modern nursing: binding the broken leg of the gardener's dog Spot, or whatever; arranging her dolls in rows in the closet, sale cialis, their appendages wrapped in scraps of muslin; running pell-mell to any relative who sneezes. I hope to see none of this.

And yet some dress rehearsal for a life is necessary and I hope I can provide useful suggestions, buy cialis without prescription. We cannot just have the public woman---Bam!---like that. First there has to be the spindly five-year-old in a dusty play smock, the grotesque and dirty shoes, tearing around the grounds of Lea Hurst and hiding behind the great tree, Flo and Pop and governess at hide-and-seek.  Or we see her stamping her feet with impatience as she is dressed and combed by a nurse in the children’s austere bedroom. Or as little Miss Dutiful, counting silver in the pantry, or attempting to report properly to her mother---the graceful and aristocratic Fanny, née Shore, Nightingale---on that week’s calling cards.

Later there may be an onyx drop necklace, Cialis in australia, hardly worn, never her favorite, thrown into the corner in a snit. That necklace might have been rough mined in Africa, polished in Amsterdam, set by a jeweler in Haddon Garden---and she may well have known all this---but it was a string of useless baubles to young Miss Nightingale.

Here are some ideas of events in the settings I described earlier.

Flo and Pop’s charity visits to cottages in the village with their mother were routine. Buy cialis without prescription, The servants—Flo will address the oldest by name—will show they know what is to take place beforehand and have set aside what is needed. Again we have Fanny Nightingale’s managerial mother manner---lots of presence and formality---as she instructs the girls, who show by fetching and placing this and that into the worn charity baskets before being ordered to do so that no instruction was needed. Flo, in particular, operates just at the little girl edge of discourtesy. This is not new.

We see Flo’s avidness as well as her tendency to obedient disobedience, a child already living the two lives of supplying the required courtesy while attaining her own ends, buy cialis online cheap. We will also see a touch of this cruel village world, one without welfare beyond the occasional philanthropy, this parish care. The teeth are poor, complexions bad, an ill-set bone, imperfect drainage abound the cottages, buy cialis without prescription. At the cottages we will see that the folks are used to caring for themselves, moving to and fro at their routine tasks around the ladies. Even so, the occasional largesse from “the House” is welcome and they are not indifferent, yet not obsequious.

There is a scene in the Miramax “Emma” where Paltrow and “Miss Smith” do a similar visit, mainly used to show Miss Smith as an inexperienced bumbler. I mention this in case you want to do visual “quotes” from other Victorian setting films?

With the Nightingales visiting the cottages, we see Flo touching a goiter or a scar. Buy cialis online australia, We should see the poverty, the thin children in the corners attentive and clearly hungry, the smoking fire, all that. Buy cialis without prescription, And this is one of William Nightingale’s villages, a relatively generous landlord, but one where the lead mines have closed down, agriculture is uncertain, and Nightingale’s money is now invested elsewhere.

The village near Lea Hurst will soon be a mill town.  There is an old factory there---if you want to mess with chronology---which still operates. Mainly for tourists.  Still operating in the Midlands and the North you will find small tucked-away mills, foundries, and dye works. Lots of images of the late nineteenth century. Mainly for tourists. 

In a subsequent “Sisters” scene (if, for instance, the childhood scenes are done as flashbacks) Flo and Pop will talk of this local economy and of their charity visits with Flo indicating---even at a quite young age, you be the judge---that she sees their occasional, incidental philanthropy is as near as you can get to nothing, cialis cheap price. without actually being nothing.

I didn’t say that it was nothing, Pop. [Imitating Fanny’s voice] “Our Christian duty” is nothing next to what they do for themselves every day of their lives, buy cialis without prescription. We shouldn’t make ourselves big. We are little.”

“But we are little,” says Pop.

“What we do is little.”

Even as a child, she always knows her proportions.

You remember our trips to Nicaragua, our liberal bit of building outside Matagalpa, off and on for a few weeks. Of course you do. 35,000 good liberals went that year: picking coffee, Purchase cialis overnight delivery, doing whitewash, roofing, bits of painting and not representing one hundredth of one percent of the country’s own efforts carried on without any aid from Oxfam volunteers. Buy cialis without prescription, I’m thinking of that lecture we got from that hard-nosed Sandinista. “So, thanks in advance for your testimony that we are not godless communist terrorists bent on invading Texas. And also, thanks for your bit of work.” Por nada.

Rich, here is another scene:

EXT. Mother and daughters are in the carriage for charity calls at a set of poor cottages in the parish. There is game and fruit in baskets, a few sheets of elevating prayers for mock reading to the households (”mock” because the Nightingale ladies had them by heart and most of those they visited were illiterate). There were also meals in special wrap from the Nightingale kitchen and some oils and tea.  Also old linen and muslin stripped of its hemming, pieces folded for whatever use, all in the well-used charity baskets, buy cialis without prescription. There are also several bottles of port and, well hidden, cialis malaysia, Flo has tucked away with Cook’s connivance a bottle of brandy that she intends to give to Mrs. Garrett who was dying.  There is a bit of jostling and words between the sisters about who sits shotgun on the cottage-side of the open rig.

Pop, dear, change with your sister, please

Mum, may we visit Mrs. Garrett today?

Her injury is so unpleasant, dear, and we do it no good.

It eases her to have me touch it. And she must need jam just as well as others.

No, Florence, Generic cialis cheap, not again this week.

Their weeks are seven days, just as ours are.

Did you fail to hear me, Florence?

…Mamma, why do so many people have things wrong with them?

We are bringing comfort to our parish. It is our Christian duty.

Buy cialis without prescription, Mum, how many people are there here?

You know that, dear, all the cottages, perhaps twenty or thirty.

Twenty houses times five or six. Or thirty. This week and last and when I came down with George on Wednesday, I counted seventeen people who have something wrong with them, limbs and fingers missing or deformities or scars.

Scars don’t count. [Says Pop. They have been over this ground.]

They do too. The boys are always getting beaten, buy cialis without prescription. And I did not count small scars.

Florence, you are to be silent this minute. This work is the Christian charity that God makes possible for us and I will not have you deny Him with your, fda approved cialis. . . You are to sit quietly and remain so.

Seventeen people of 100 or 180.

Buy cialis without prescription, [And Florence is seen slipping the brandy to Mrs. Garrett, who is dying in the smoky corner of her cottage. And touching her enormous goiter or tumor. Pop is hesitant. And Fanny is the kind lady, a bit imperious. And, remember, no bread or vegetables should be brought, buy cialis without prescription. I didn’t like that in “Emma.” These people do, after all, have a life in spite of their scars, Cialis overnight, smoke, and need.  They have bread and vegetables.  William Nightingale is not a monster.

From:landsman@landsmanla.com"
Sent: Saturday, June 09, 2007 10:48 Pm
To: alandsman%aub.edu.lb
Subject: Re: Childhood

I get it. Doug McGrath’s charity scene in “Emma” was totally for comedy. The whole thing was Austin irony. I don’t do movie “quotes,” visual or otherwise, as you must know. Buy cialis without prescription, And whole minutes for a fucking carriage ride. What’s with that?

From: alandsman%aub.edu.lb
Sent: Saturday, June 09, 2007 11:21 Pm
To: landsman%landsmanla.com
Subject: Childhood

Fuck you too, Bobby, buy cialis once daily. Assigning minutes to the charity visit scene is unfair. You know I mean all this Childhood establishing stuff to be very brief. Anything can be sheered away. I just need to know how to proceed.  How to be useful.

He asks how to proceed.

Robert, just open your heart.  Surely everything is useful and certainly encouragemetn is useful to your brother.  Just pile up his notes, read them at a sitting, don’t always e-mail back, but frequently just a comment back.  I will explain to NNN and I’ll be the emancuensus for both bothers, keeping everything, ready to sort of shufflewhy not pile up my notes and read them at a sitting rather than e-mailing back counting minutes.

From: alandsman%aub.edu.lb
Sent: Wednesday, June 13, 2007 3:28 Pm
To: landsman%landsmanla.com

Subject: Re: Continue childhood

From: Rachael Landsman
Sent: Monday, June 11, 2007 1:18 Am
To: landsman%landsmanla.com
Subject: On Arni

From: Rachael Landsman
Sent: Monday, June 11, 2007 1:18 Am
To: landsman%landsmanla.com
Subject: On Arni

From: alandsman%landsmanla.com
Sent: Saturday, June 09, 2007 11:51 Pm
To: Rache
Subject: On Arni
Attachments: England, Childhood

Honey, I’ll call at your 10 PM tomorrow, buy cialis without prescription. If Arni is not cc-ing you all his e-mails I’m attaching some here. And to follow. He’s still an irritating ass.  Still, how glad am I we had that day. Any normal pitch, I would have been outta there. Buy cialis without prescription, Now we have my brother and I talking. A relationship. Nightingale is like an unconsummated affair for him—a bit like the way he looks at you—someone incomplete contemplating a very complete woman. Cialis order, Love, R

From: Rachael Landsman
Sent: Monday, June 11, 2007 1:18 Am
To: landsman%landsmanla.com
Subject: On Arni

They came. Get the office to clump related mail and forward it to me to this address, not my handheld. Robert, remember; don’t be too hard on him, buy cialis without prescription. It is great simply that he is writing. A lost sheep found. That you may really want to do the film is just frosting. Missed your call. Buy cialis without prescription, Tonight. Love, Rache

From: landsman%landsmanla.com
Sent: Monday, June 11, order discount cialis online, 2007 11:31 Pm
To: alandsman%aub.edu.lb
Subject: Continue childhood

Where are my installments, my night-reading. Just imagine the awful the scripts I read and pass on. Looking forward. Robert

From: alandsman%aub.edu.lb
Sent: Wednesday, June 13, 2007 3:28 Pm
To: landsman%landsmanla.com
Subject: Re: Continue childhood

All right, I understand, forthcoming. I have a need to convey that Nightingale was more than a “clever child,” which is cliché, buy cialis without prescription. She felt she must become one. That’s a different thing. Buy cialis lowest price, Never to be the cipher, never “dull” (which in her grandmother’s blunt Derbyshire talk meant both blind and foolish). In the live time of such minds between plunging awake and giving in to sleep she was determined to make her impression even on the air.

At times at home she would wake early, four or five AM, to steal some plus time for her own purposes before maid and governess arrived, before duties—counting linen and silver, list-making, watchful eyes peeled for imperfections, before lessons and the required exercises they called “arms”—before the calls, visiting, entertaining, and the laborious transcribing into a special journal copies of Francis Nightingale’s social notes; before the precious time with father who offered up trunks of wealth from Athens, Rome, cialis pharmacy, Alexandria, and Cathay to be picked over. If you had the keys!

Buy cialis without prescription, Florence wrote an autobiography, La Vie de Florence Rossignol, at eleven. Even it is not childish. I hate that mockery of life you find in soft memoirs and biographies with their little childhood scenes. The dear pets: old Muff, pour Bismarck, all the birds, and the insect corpses. “Watch Florence Nightingale promote advances in Veterinary Science and sublimated love while taking a hard look at the thing called life.”

I want childhood scenes, however they are used, to describe the struggle that is growth when the child was called “Emergency Man” and “Stage Manager.” When you heard a visiting Lady’s child, Purchase cialis, years beyond Flo’s age, whine, “Mamma, I don’t want to play with the bossy girl.” When that child would soon be known as “Pope of the Wards,” “Mother of the Coldstreams,” and—with no sense of exaggeration—”Chief.”

“A Privileged Victorian Childhood” chapter in Gillian Gill’s biography gives more breadth and detail than I can. I’ll send you a copy.

But here are scenes:

—EXT, buy cialis without prescription. Two girls are formally burying a dead frog in the garden at Lea Hurst; and, a year later, a cat; and later, a dog. No. No. I’m just being pissy, cheap price cialis.

Real scenes:

Buy cialis without prescription, —INT. Lea Hurst. Children’s bedroom. Austere, board floor with small worn oriental, furniture of Shaker aspect. This seen in panning to corner wall where 13 children’s dolls are laid out in a perfect row, clearly a tiny hospital ward. Some of the dolls wear bandages.

—INT, buy cialis without prescription. Children’s bedroom. Florence ill with flu, turpentine dampened flannel scarf wrapped round her neck, rises, Compare cialis prices, secures a doll and a small bottle of turpentine secreted from under the bed, dampens a small cloth, makes a face tasting the turpentine, and wraps the cloth securely around the doll’s neck.

I like this one. Alternative version:

—INT. In the Quaker-seeming large bedroom lit by the moon the girls are sleeping. Buy cialis without prescription, The younger of the two, Florence, is feverish, glowing with perspiration. She wakes, rises, locates matches hidden in a near closet and lights a candle. Returns matches. She collects a number of dolls lying about the room and removes the heavy flannel cloth that is wrapped round her neck. Grimacing at the taste, she uses her teeth to tear small strips from the end of the wrap each of which she wraps around the neck of a doll, cialis online. She places the dolls on the floor in a neat row of sick dolls, buy cialis without prescription. She rewraps the remaining flannel about her own neck, wets two fingers in her mouth, grimaces, pinches out the candle, and returns to bed and to sleep.

—EXT. Embley, rear, lower kitchen entrance. Florence hugs the cook as cook hands the child some rolls of flannelette bandages torn from old sheets, prepared and set aside for her. Child runs off through the back garden with armload of “bandages” flying.

—EXT. Buy cialis without prescription, Embley, rear garden. Buy cialis, Tall WEN stands waiting as Florence leads a troop of groundskeeper and village children up the lawn some distance to the garden. They are bandaged elaborately—arms in slings, splints, heads wrapped, boys limping and embarrassed on home-made crutches. Generous use has been made of berry stain. WEN greets this war theater, this pageant, with a wave and grand smile, and then makes a stern formal bow. He asks, “Victory or defeat.” The child answers: “Father, Both will produce wounded.”

—INT Embley, withdrawing room, Florence and Parthe seated at sunny window seat, no cushions, doing their Cicero with stern, serious WEN, buy cialis without prescription. Or the girls reciting their Euripides. Parthe concludes her recitation with a down turning “I realize that wasn’t very good” look; Florence stands and recites with feeling and gesture. We can almost imagine the scene from “Iphigenia in Tauris.”

—INT Embley, cheap cialis pharmacy, sewing room scene: picture, brightly lighted, Fanny, Pop and Flo, doing needlepoint as Fanny reads to them. Flo impatiently jams the needle and plunges up from her chair: “I cannot stand being read to. It is like lying on your back and having water poured down your throat.”

Buy cialis without prescription, —EXT Embley villages. young Florence concentrating intensely on a bloody birth. She holds steaming water in a pan with cloth-wrapped hands. Or she is ready in the same way with hot water at the lancing of a boil.

—EXT village. Florence somewhat older walking a dark road lined with barely lit village cottages, a heavy basket with cloth packages and bottles of Port or Brandy showing.

No offense, Buy cialis online cheap, Robert, but thinking of the way of some movies work the above scenes might be followed by child-is-father-to-the-man jump cuts to:

—EXT. Kaiserswerth Hospital outbuilding, buy cialis without prescription. The woman Florence in rough Protestant nursing uniform is closely and intensely attending an autopsy being explained in German.

—INT. Assembly room in London. Banner reads “Royal Statistical Society of London.” Florence is delivering a paper with the same tone of angry drama and same gestures as when reciting Euripides for her father.

—EXT. Scutari Hospital. Buy cialis without prescription, Florence, on her knees as with the dolls above, removing a rotten bandage from a common soldier’s amputation—eyes and voice are with the soldier for these clearly routine motions—then, with intense eyes on the wound, she presses her thumb into a nerve in his shoulder then clears the wound of maggots with a short-handled wooden spoon she has taken from her corpsman’s shoulder bag and applies a fluid also from the bag. Finally, eyes and voice to the soldier again, she expertly applies a fresh bandage.

From: alandsman%aub.edu.lb
Sent: Monday, June 19, 2007 04:11 Pm
To: landsman%landsmanla.com
Subject: Childhood

Thank you Robert. I have left out the childhood wounds, its battles and rages, cialis tablets, the throwing of jewelry, inarticulate frustration, bitter withdrawal, vicious needlework, bedside prayers in tears, slapping a servant, pleading forgiveness on her knees, exhausting and articulate private self-recriminations, as well as the counting silver, taking notes, making lists, Buy cialis overnight delivery, catalogs, and the endless reading. And, okay, I’ll not send any books!

I realize I’m putting off the Crimea and the struggle for reform. Maybe a few adult scenes with family and friends first, how about that?

To tell the truth, I approach the Crimea on my own frost-bitten, bloody feet. Maybe I’m sick to death with my own brucellosis—her probable recurrent malaria-like disease—contracted in my own wars.

And God never said a word to me.

Not to mention Vietnam, our current “Crimea” now approaches its million dead, needless dead.  On top of the second English-speaking empire’s other crimes, buy cialis without prescription. Here one hundred and fifty years from Florence Nightingale. I hear her quoting Horace.

Time’s canker sore enlarges.
Parents more vile than their parents
Raise up our shoddy selves
While we set forth our own base offspring,
Worse yet, approved cialis pharmacy.

From: landsman%landsmanla.com
Sent: Monday, June 18, 2007 11:03 Pm
To: alandsman%aub.edu.lb
Subject: Re: Childhood

Okay, you’ve got “Blues on Monday.” What about me. Buy cialis without prescription, Looking forward, Bob

From: alandsman%aub.edu.lb
Sent: Tuesday, June 19, 2007 04:28 Pm
To: landsman%landsmanla.com
Subject: Childhood

Robert,

Here’s a passage from one of Mrs. Elizabeth Gaskell’s contemporary letters describing one of her stays with the Nightingales at Lea Hurst. Maybe for Props, part of our team.

High as Lea Hurst is, one seems on the pinnacle, with the clouds careering round one. Down below is a garden with stone terraces and flights of steps—the planes of these terraces being perfectly gorgeous with masses of hollyhocks, dahlias, Cialis australia, nasturtiums, geraniums, etc. Then a sloping meadow losing itself in a steep wooded descent (such tints over the wood!) to the river Derwent, the rocks on the other side of which form the first distance, and are of a red colour streaked with misty purple. Beyond this, interlacing hills, forming three ranges of distance; the first, deep brown with decaying heather; the next, in some purple shadow, and the last catching some pale watery sunlight, buy cialis without prescription.

And another:

I am left alone established high up, in two rooms, opening one out of the other—the old nurseries. It is curious how simple it is. The old carpet doesn’t cover the floor. No easy chair, no sofa, order cialis no rx, a little curtainless bed, a small glass. Buy cialis without prescription, In the outer room—the former day nursery—Miss Florence’s room when she is at home, everything is equally simple; now, of course, the bed is reconverted into a sofa; two small tables, a few bookshelves, a drab carpet only partially covering the clean boards, and stone-coloured walls—as cold in colouring as need be, but with one low window on one side, trellised over with Virginian creeper as gorgeous as can be; and the opposite one, by which I am writing, looking over such country.

As needed I’ll send other clips from this novelist and friend of the family although not particularly intimate with Florence. Letters and her biography of Charlotte Bronte are good sources as well as Bronte’s novels; she was also an acquaintance living not 30 miles away in a familiar culture.

From:landsman%lansmanla.com
Sent: Tuesday, June 19, 2007 11:53 Pm
To: alandsman%aub.edu.lb
Subject: Re: Childhood

It is Set Design. Props do not get creative input. The Mrs. Gaskell and whoever stuff is okay to send, but better what you have seen or thought, buy cialis without prescription. We’ll buy professional literalism as we need it. Now we’re on for the woman and her story. Get that right and we can cut Design budget significantly. Drug cialis, No groping around for the right “look.” Carry on. Buy cialis without prescription, Love, Bob

From: alandsman%aub.edu.lb
Sent: Thursday, June 21, 2007 5:15 Pm
To: landsman%landsmanla.com
Subject: Later, but the Sisters

Robert,

There is another Sister Conversation much later, post-Crimea. These conversations can be a recurrent visual “theme” in the film. I mean cinematographically established as recurring such that they do not require set up or explanation or being placed in context. The audience says, “Ah, the sisters privately together again for a ‘heart felt.’”

[This is Parthenope, concerned about a suitor or Parthenope about to be married, 17 July 1858, at 40 to Sir Harry Verney who is 57, four children by his previous marriage and already, as Liberal member of Parliament from Buckinghamshire and a pioneer in rural housing issues, he has become one of “Florence’s men” in reform work. FN is much embroiled in politics and other work at this time and impatient with Parthenope but is prevailed upon to walk, order cialis without prescription. Parthenope is weeping.]

You are not a true sister, buy cialis without prescription. We never talk. You don’t care about my fears.

Parthe, you and Mama lay about telling each other not to get too tired by putting flowers into water. You would ask me twelve questions an hour if I’d allow it. You tinker with the hotel accounts overcharging me at random and I am supposed to take it up with you, discuss the bloody accounts endlessly. Buy cialis without prescription, And go walking with you. Parthe, I am totally exhausted. . .

Cruel. [still crying]

Pop, Cialis from canada, dear Pop, what is the matter with you. I am under the empire of work day long, buy cialis without prescription. And now this clatter of pots and pans among my family. Since the past fifteen years—at least!—there has never been any question where my life was going; and, still, the same old demands. Even now. Admit it. You are enjoying my popularity while I hate it…

Buy cialis without prescription, . . . I answer your correspondence; I write endless condolences, we entertain for you, sort your mail, buy cialis in canada, and make possible all the friends…

Who want only to be among the Nightingales.

…We… And you never talk to me. And now I am about to be married…  I hope you find time to attend.

Dear Parthe, my love, don’t you be cruel. I hate it that you and Mama pursue “excitements” and myself as an “excitement” now after years of opposing my doing anything, buy cialis without prescription. You make an excitement of my labors and can’t wait for the next opportunity. It is madness. Remember I have been in Hanwell with the lunatics. Some conceive themselves to be tea-pots and others have 30,000 men fighting in their insides or think themselves to be Christ resurrected. Buy cialis without prescription, They are not more mad then you people, trying to live by excitements while spending the day on the sofa persuading yourselves and others that you are the victims of devotion, devotion to another who is heedless of your trials. Meanwhile that other is dying from over-work.

But I am about to be married. . Find cheap cialis, . Please talk to me, Flo. Say something to put my mind at rest.

Pop, buy cialis without prescription. . . So be it. But take it for a measure of my love for you, a full and overflowing measure.

[Florence continues] You know that I loved Monckton. Buy cialis without prescription, We would entertain each other. His pleasure was that I should emerge from one of our conversations flushed, swollen, and fairly dripping. And he would know, somehow, cialis in malaysia, and feel himself to be the man. My pleasure was that, never having been at university, never having participated in those funny, lewd and learned conversations that were so much a part of their social life, never having had the least touch of those experiences which they could buy several evenings a week for the cost of a carriage ride. It was an acting-out of passion and release upon each other which the boys enjoyed commonly. And that was at least as exercising as using my learning in some other way.

[Florence, in more somber tone, continues] Parthe, if this kind of thing, this excitement, leads to anything worthwhile it leads directly to companionship, buy cialis without prescription. Whatever else, it is companionship that you will most enjoy with Harry who is a fine man. And, I believe, Cheapest generic cialis, companionship also with his children who are a benefit to your new marriage. They must to some extent reflect Harry’s fine qualities.

Yes, I see

As for Monckton, with whom else could I talk Horace and Plautus and Terrence and retell old stories and bat about quotations and pretend innocent ignorance of the full implications. Father was a total failure at protecting me from those passages that I could easily translate in my mind but never commit to paper.

But why talk of Latin?

Companionship is the thing, dear Pop. Buy cialis without prescription, But it is no good denying we have bodies. Didn’t you know or can’t you imagine Mama becoming warm in front of the Donatello in her father’s collection. She so loved art. And the Shore’s home. I can still see her standing there in the Uffizi en grande tenue holding her note card and newly invented prize pencil, becoming warm. Harry Verney is a handsome man, as still and tall as a tree, so imagine your companionship and mother’s with father, buy cialis without prescription. Doesn’t matter, Latin or Donatello or only our proud, lowest price cialis, thin Papa taking Mama’s hand on a walk that I know you to have seen many times., Fanny was once a new wife and perhaps more warm than I have ever been or you may be, having greater experience and opportunity than ours.

Flo, don’t you have a suggestion?

Dear, I suggest you remember to touch you husband frequently and not only when both of you are in front of guests receiving, not just at Malvern. It will bring you closer.

Flo, did you and Monckton have sex?

No, dear, we had what I have described.

I mean to ask…

We did not have intercourse. Only “intercourse.” We did not make the beast with two backs. Order discount cialis, In the literal sense we did not horse around, Pop. I remember flouncing my skirt outrageously and being in heat…

Florence!

Buy cialis without prescription, …Nothing for someone who’s spent her entire life hot under the collar. [pause, walking] And here we are like those two sister cows licking each other about the neck and waddle [landscape background shot of exactly that.].

Parthe, I am admitting to you that I approached our conversations with some gaiety. It was my body thinking, as it has a perfect right to do. And remember, I actually loved the man, so to say. But we did not conclude, however exciting some days may have been…the words…and the flouncing of skirts. If we had been children, yes, we might have had a look see, given the man’s current interests, although I doubt it, buy cialis without prescription. We would have compared any more profound activity to poking each other with sticks, cialis prices. And beneath us. We were thinking of ourselves both as sacred persons, temples, confusing the highest with the lowest. [Remembering her audience] But love’s mansion is the mind and the sentiments. Buy cialis without prescription, [Back, wanting to complete the thought] Horace could make a joke of the unity of higher and lower. And Ovid could make it a comic religion: Me miserum. certas habuit puer ille sagittas. Uror, et in vacuo pectore regnat Amor.

Not the Latin…please.

No, I was never poor in Latin. So, Cheapest generic cialis online, you have had the story. Children and flouncing skirts and years passing until adult is on us and responsibilities are taken up, buy cialis without prescription. And the essence of it, Parthe, is companionship. Less than and greater than excitement….but to pursue genuine companionship at every opportunity. As with me, you will find there are too few opportunities for companionship. But that only serves to make a person more calm and the opportunities more precious.

Flo, you know what they say about Monckton?

Of course I know and I discharge what they say and so should you. Buy cialis without prescription, … Still, you are fortunate that such stories never circulated about your husband and never will.

Certainly not!

Pop, companionship and friendship. As for Monckton, a frivolous gift is still a gift. A friend should remain a friend. And he has proven over the last several years that reform can triumph over a joke with an old Cambridge companion, buy generic cialis. And, sometimes, over a suspect hobby. I expect him to continue as a valuable ally and have told him so, buy cialis without prescription. If a time comes to England when reform cannot triumph over boy’s indulgences, you will have fakery for reform and thoroughgoing irresponsibility for a hobby. Those will be the kind of men I cannot care for. I can still care for Monckton.

I love you, dear sister.

And I you. And, if it is not too silly to say, you have my blessing.

From: alandsman%aub.edu.lb
Sent: Friday, Cheapest cialis online, June 22, 2007 1:51 Am
To: landsman%landsmanla.com
Subject: Re: Later, but the Sisters

On and on. Clearly we can forget about a thwarted love affair.

From: alandsman%aub.edu.lb
Buy cialis without prescription, Sent: Friday, June 22, 2007 05:01 Pm
To: landsman%landsmanla.com
Subject: Re: Later, but the Sisters

That was about 1,000 words. Depending on the talents of the actors I can imagine it being reduced to 10-20% of that. The eyes can have it.

I’ve forgotten the title but do you remember Meryl Streep in a comedy hiding just outside the door to a trailer in which others are holding a revealing conversation. We can’t hear what they are saying, only occasional words and mum-mum-mum rumbling man talk. What we see is her face in a long sustained set of reactions to the inaudible conversation.

From: alandsman%aub.edu.lb
Sent: Friday, June 22, 2007 10:29 Pm
To: landsman%landsmanla.com
Subject: Re: Later, but the Sisters

Forget it. We can’t have Meryl Streep, buy cialis without prescription. The title was “Postcards from the Edge.” I meant you should continue on.

From: alandsman%aub.edu.lb
Sent: Sunday, June 24, 2007 10:44 Am
To: landsman%landsmanla.com
Subject: Another Side

Another Side of the Milne Relationship

[About 1844. He proposed first in 1842 and got his final refusal in 1849 following which she said “I know that since I refused him not one day has passed without my thinking of him, that life is desolate without his sympathy.” But likewise “I could not bear his life…nailed to a continuation, an exaggeration of my present life without hope of another…voluntarily to put it out of my power ever to be able to seize a chance of forming for myself a true and rich life would seem to me like suicide.” She subsequently often praised marriage as an alternative for others—both as the possibly perfect companionship and also, for many, as the best practical accommodation to circumstances—but only after she had absolutely rejected it for herself.]

Nearing the village they come upon a rundown building and she asks a man with a barrow, “Sir, what sort of place is this.” He downs the barrow, removes cap, and answers “A sleeping barrack for the miners, Ma’am, a-for the lead mines closed down.”

“I want to see the inside.” [But she can’t budge the door.]

[Milne puts a boot to the door and pushes.] “Allow me.”

“Ma’am…” says the local warningly.

[Milne enters and immediately retreats out with a handkerchief at his nose indicating ‘that’s enough of that,” but she steps around him and enters.]

“Flo!”

It is dark, about 18 feet long and 12 wide with wooden berths as on shipboard, one above another. It will sleep about 50. There is no opening above for the escape of foul air. Buy cialis without prescription, Light is provided from the doorway and cracks between and wallboards. She exits, wiping cobwebs from her dress and hair.

“Thank you, sir. Would you close it back for me?” and takes Milne’s’ arm.

“Perhaps not as bad as an American slave ship but no better than those doing the transporting to Australia.” As they proceed, “It must have housed the lead miners brought in to supplement the local men. Imagine the place on a hot summer night after 12 hours in the mines.”

Milne: “Yes.”

“Or coming to it in winter, sweating from the climb up the ladders.” They continue on.

“The Swedish life tables—everyone respects their accuracy—give their workers an average of 57 and a half years. What would you say for these miners?

“You know your villages better than I, Flo.”

“Ten less years of life, I judge. Taken from them for a cheaper lead.”

“’Old before they are young,’ is the coal miners’ saying.”

They continue on.

From: alandsman%aub.edu.lb
Sent: Monday, June 25, 2007 10:45 Pm
To: landsman%landsmanla.com
Subject: Arni, notice this!

Sorry about the stumbling around on the phone yesterday, buy cialis without prescription. Essence was you’ll be back at your base today or tomorrow and a couple of people will call for meetings with you. Expect them to come to you once a time is arranged. They are from North West Vision in Manchester and/or Northern Film and Media. They do location, crew, facilities, etc. Buy cialis without prescription, We have nothing specific to give at this time; our names will be enough. The meetings will get us on their schedules for some time in 2009 better than a phone call from here. And a contact. Pick the two most Nightingale appropriate seasons—one as sunny as possible, one winter, both 2009. You are an associate producer, my brother, looking around in a preliminary way. Bob

.

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Do you smell stink of pitch in that remark?  The non-apologists point out that “a lot of these kids are not getting any other mental health services.”

We are talking schizophrenia, buy cialis jelly pills, Buy cialis jelly cheap, autism, and bipolar disorder, cialis jelly online cheap. All of these diagnostic categories are questionable; even the related more minor diagnoses (attention deficit, hyperactivity, persistent defiance, etc.) are included when Medicaid, with its big bucks, is involved, buy cialis jelly without prescription. Find cialis jelly no prescription required, .

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I wanted to share this with you, a piece of everyday intelligence.

Jim

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Buy cialis professional without prescription, Below are a series of quotations from doctors taken from the transcript of a recent a PBS documentary film. Each thought from these doctors is more or less separate. The quotations are unified only by the doctors' willingness to be interviewed in a PBS documentary titled "Money-Driven Medicine." Please assume the necessary quotation marks. Then I have some remarks of my own and a "Solution," which is also a quotation, this time from the widely endorsed, 17,000-member Physicians for a National Health Program, essentially a "Medicare-for-all" solution, discount cialis professional online. My thought was that reading these quotations takes little time, far less than watching the PBS documentary (Bill Moyers Journal, August 28, 2009) and is far superior to the YouTube clips. I seldom clip content, so forgive me this one time, buy cialis professional without prescription. Quotations follow:

If you look at the way we pay for care in the country and say, "Well, what is the underlying theme here?" We pay for doing things. Price of cialis professional, A piece of surgery, performing a test, doing a procedure. Even a visit is a thing. So specialties or medical practices that do a lot of things, a lot of tests, a lot of surgeries, a lot of procedures; They'll tend to be the higher income earning specialties.

It is, I guess, real cialis professional without prescription, politically correct, widely believed, that to say that American health care is the best in the world. Buy cialis professional without prescription, It's not. There's a much more complicated story there. For some kinds of care, [call it] rescue care, yes, Cialis professional cheap drug, we're the best in the world. If you need very complex cardiac surgery or very advanced chemotherapy for your cancer or some audacious intervention with organ transplantation, you're pretty lucky to be in America.

You'll get it faster and you'll probably get it better than in at least most other countries. We’re great at Rescue Care. But most health care isn't that, buy cialis professional without prescription. Most health care is getting people with diabetes through their illness over years or controlling the pain of someone with arthritis or just answering a question for someone who is worried or preventing them from getting into trouble in the first place. And on those scores: Chronic disease care, community-based care, primary care, preventive care, low price cialis professional. No, no, we're nowhere near the best. It's reflected in our outcomes.

We're something like the…we're not the best health care system in the world in infant mortality rates. Buy cialis professional without prescription, We're like number 23. There is an index that is used in rating health care systems, which is the rate of mortality that could have been prevented by health care. There are at least a dozen countries with lower rates of preventable mortalities than the United States and not one of those countries spends 60 percent of what we do on health care.

Our whole system of medical care is deformed by this great drive for profits.

In Albany Med's Internal Medicine residency this year, Buy discount cialis professional online, I believe, none of them are going to primary care. They're all going to sub specialize in cardiology, gastroenterology, endocrinology, etc. I believe it's none are going into primary care. If the dollars to dollars ratio were even vaguely similar to specialty and primary care, I'd choose it again every time, buy cialis professional without prescription. I like the variety. I like doing different things, find discount cialis professional online. I wouldn't like doing the same thing all day long. And I'm willing to take an income hit to be primary care, but it's affected the quality of primary… the ability to deliver quality primary care in this country, because not enough people are going into it and, makes it harder to put together an integrated system. Buy cialis professional without prescription, And everyone pretty much acknowledges that if someone doesn't have a primary care doctor they go to multiple specialists, there is more duplication of services at higher total health care cost.

We're now treating medicine as if it were an industrial product. Through put. How many units of care can you deliver. Buying cialis professional, The idea that you are going to see a patient on average for between 12 and 15 minutes, no matter what their condition or how many kinds of problems they have or how complicated their diagnoses or how much reassurance they might need is an idea that you can treat medicine like a production line product and you can turn out patients in the same way like we produce widgets. That's a commercialization and an industrialization of the relationship. So this is a system which is fundamentally broken in terms of the kind of conflicts it raises in the minds of physicians and, also, in the minds of the patients.

You can't just fix things in medicine, buy cialis professional without prescription. Medicine is a process. It's a duration of treatments that occurs over the course of somebody's lifetime. Yeah, there are things that we do that are very systematic and very matter of fact, so to speak, where you fix and "boom" they're are on their way, online cialis professional, but it's just not a good way to develop a relationship. You need a rapport, you need trust.

The thing I miss most is being able to sit in a room and talk to a patient for an hour. Buy cialis professional without prescription, But, you know, you get on the assembly line. Just get hooked up and the chain keeps moving.

The insurance companies, you know, are clearly in the room with us. You know, Drug cialis professional online purchase, employers are in the room with us. You know, you get into these issues of out of network, in network; we're only going to pay 20 percent of your hospital visit versus 50 percent if you go to this hospital. These are all brokered deals and negotiated contracts and things like that, that in larger insurance companies have with specific hospitals, which specific testing centers. You know, so you're dealing with a lot of things that, you know, this is not stuff that's taught at medical school, this is not stuff that, you know, your partners are familiar with other than being exposed to it, buy cialis professional without prescription. You know, and we've kind of turned the blind eye or done the ostrich thing with, cialis professional online sale, you know, burying our heads in the sand saying, "You know what, we're just doctors we want to just deal with what we do." But all of those other entities now live in our bed, in our bedroom with us. You know, you can't just pay attention to your wife and go to sleep at night. Cialis professional medicine, You're sleeping with six or seven other people that are trying to break your marriage up. That's a big problem. That's a big problem.

Buy cialis professional without prescription, You know, if you're a hammer, everything looks like a nail.  I'm an interventional cardiologist and what I do for a living is I fix blockages. Does the hospital like you doing lots of procedures. Sure, you know, these procedures are reimbursed, fairly substantially. You know, even within your own group there is a component of productivity, find cialis professional online. You wish things would just be about taking care of patients and doing the right things but, you know, are there external pressures. Absolutely, buy cialis professional without prescription. Absolutely.  But, at the end of the day, if you just remember the fundamental principle that you have to have done something for that patient in order to make them feel better, live longer, Cialis professional buy online, you know, engage in a lifestyle that they weren't able to engage in before, and if you stick to those principles, it allows you not to, kind of, drift from what you know is right and fall in to this arena where, you know, you're just slamming a stint in every blockage that you see. Because if you did that, order cialis professional from canada, then clearly it becomes… I would hate to use the term immoral, but it becomes an issue where you are doing things just to do them, not because it's the right thing to do.

I'd like to suggest that if we looked at the population of people with a problem: Back pain. And said how many MRI's do you think we need to do as a nation. We could probably cut the number in half and not have hurt anybody. Buy cialis professional without prescription, Yet we keep opening more and more MRI machines and do more and more pictures. They're beautiful, they're incredible -- incredible technology. Order cialis professional on internet, But then that causes somebody to have to make a decision about a back surgery that maybe they didn't need.

I think the main driver, the difference between our costs and other countries costs, health care systems as good or better than ours, is supply-driven care. It's this work that Elliot Fisher and Jack Wennberg have explored at Dartmouth.  It's that we overbuild and, therefore, we use, and there's no limits, there's no cap, cialis professional no online prescription, there's no control. And so we just spin the wheel.

What's truly staggering is how much waste there is in our health care system. Up to one out of every three of the more than two trillion dollars that we spend is wasted on ineffective, often unproven procedures, overpriced drugs and devices that are no better than the drugs and devices that they're replacing, buy cialis professional without prescription. Unnecessary hospitalizations, unnecessary tests. Now this may seem like an overstatement. I mean, how can it be that 1/3 of the money is wasted. Buy cheapest cialis professional, We actually have close to three decades of research done by doctors at Dartmouth University  proving how much waste there is in the system. What the Dartmouth research Buy cialis professional without prescription, ended up doing was looking at health care all across the country and what they discovered is that in some high treatment states, like New Jersey, Medicare was spending 20 percent more per patient than the average. And in other low treatment states, like Iowa, Medicare was spending 25 percent less than average. They tended to focus in on what happened to patients during their final two years of life.

So in that way you're comparing apples to apples, pretty sick patients, and they began looking at sick patients who had the same disease, etcetera -- finding these enormous differences in what Medicare spent. Some people said, sale cialis professional, "Well maybe patients in New Jersey are simply more demanding than the stoic citizens of Iowa." But, in fact, very few people demand a chance to spend more days in the hospital during their final two years of life. Very few people cry out for a chance to die in an ICU or to have that fourth procedure or to be poked and prodded by eleven or twelve specialists during your final six months of life. In the states where Medicare spends more, these are the things that happen to people.

They're getting more aggressive, intensive, and expensive care, buy cialis professional without prescription. And here's the stunner: The outcomes are no better. Often they are worse on average in states like New Jersey or New York or California than they are in low treating states like Iowa or North Dakota.

The fact of the matter is that insurance companies tried saying no in the 90s, in that era of manage care, Buy cheapest cialis professional on line, when the great many HMOs would say, "No, we're not going to pay for that." The problem is that HMOs made their decisions on what they are going to pay for based, too often, simply on cost. If something was too pricy, they would say no. But they weren't looking at the quality of the procedure. Buy cialis professional without prescription, They weren't asking, "Well, would it really benefit the patient?" They were simply saying, "Well, where does it fit on our schedule of costs?" So, sometimes, they denied ineffective, unnecessary, expensive care and sometimes they denied very good, effective, expensive care.

There was a backlash, needless to say, in the media, on the part of patients, on the part of doctors, so by the late 90s HMOs began to say, "Okay, okay, we won't try to manage care. By and large, buy cialis professional no prescription required, we will pay for whatever Medicare pays for. Medicare tends to pay for whatever the FDA approves. We'll just pass the cost along to you in the form of higher premiums." And that's why, since 1998-99, premiums have just skyrocketed.

  • In fact the average total premium for a family of four last year topped ten grand.
  • Doctors here in Boston say they're seeing an increasing number of patients who cannot afford the most basic preventative health measures, like a blood test.
  • 72 million Americans had trouble paying for medical care last year, buy cialis professional without prescription. Cheap cialis professional online,
  • Hospital bills are now a leading cause of personal bankruptcy.

I think it's interesting that a country that has a 12-trillion dollar budget spends a sixth of it on health care. And our work would suggest that we're not spending it wisely.  The Dartmouth slogan is Vox clamantis in deserto, which is that voice crying out in the wilderness, and I thought it was a good analogy for me because I came here because I heard another voice, Jack Lindberg, talking about the disparities in the delivery of our health care system and the irrationality of its utilization.

We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices, cialis professional online pharmacy. Buy cialis professional without prescription, They pick more efficient choices than the health care system does. Wonderful work of a researcher named Annette O'Connor studied patient shared decision-making with respect to surgery. What she found across a range of studies was when patients actually got to participate in the decision, surgery rates fell by almost 25 percent. And satisfaction in outcomes improved. So an activated patient is really engaged. I'm not talking about payment here, buy cialis professional without prescription. I'm not talking about shifting burden of cost. Just engaged with knowledge and shared decision-making. Cialis professional no rx required, Better outcomes, lower cost, higher satisfaction. You know, what more could you want?

[Another doctor recalls a call he made] to a hospital in Texas and said, "We've heard you have a very good procedure for treating a particular disease. Buy cialis professional without prescription, We'd like to learn more about your protocol so other hospitals can use it." And the hospital said, "We can't tell you that. It's a competitive advantage in our market that we're better at treating this disease and it is very lucrative. So this is proprietary information."

[Another describes Nashville’s “Marilyn Way”]  “Marilyn Way is a center road of Marilyn Farms. Marilyn Farms is a huge complex, cost cialis professional. The predominant business in here is health care corporations of one sort or another. This goes on and on for over a mile here and this is not called for-profit hospital row, or anything like that, but this, this is …, buy cialis professional without prescription. titled "The Nashville Health Care Industry, The Family Tree 2006." Every little square here is a health care business industry or spin-off. We have 3 mother corporations here: HCA, which is the Hospital Corporation of America, spun off all of these. Hospital Affiliates, Cialis professional cost, which is a spin-off of HCA, spun off all of these. And Health Trust, which is a spin of Hospital Affiliates and HCA, spun off all of these. Buy cialis professional without prescription, So this is a massive, industrial health complex that's headquartered here in Nashville.”

I've heard it said that the official bird of health care is a crane. Look around at any hospital in your community there's a crane on top adding rooms. You know, we just, we overbuilt it, cialis professional no prescription. And then, having overbuilt it, we use it and then we think using it is necessary. It's a spiral.

[Rashi Fein says:  “We live in a society not just in an economy…. Well, we spend more than any other country and we spend a higher percentage of our gross domestic product and our gross domestic product is larger than most other countries', buy cialis professional without prescription. So we are spending per capita one heck of a lot more than anybody else, which ought to be disturbing, if only because there are lots of other things we could be doing with money. Buy discount cialis professional, We could have more money for education or more money for infrastructure or more money for bridges and transportation or we could put money into high- speed trains or we could have tax cuts.  On the other hand somebody could say, "Well, we have chosen to spend money on health care and that's also a good thing." True. But interestingly, disturbingly, frighteningly, pick your own word, we spend more money and we are not healthier. We don't live longer, cialis professional vendors. We don't seem to be getting as much value for money.”]

Buy cialis professional without prescription, It shouldn't be any surprise that there is a huge disconnect between the amount of dollars that actually poured into health care and the health indicators of a population because this system was not designed to serve this end. That's a fundamental realization that we need to come to. And until we do I think, you know, we'll still be trying to tinker with the market in some kind of funny way. Just a little tweak or adjustment to make it work better, but it was never designed, actually, Cheapest cialis professional, to meet health care needs.

[Mahar says: “A physician takes an oath to put his patient's interests ahead of his own. A corporation is legally bound to put its shareholders' interests first. And this is part of the inherent conflict between health care as a business, part of our economy, and health care as a public good and part of our society, buy cialis professional without prescription. Health care has become a growth industry. That means higher health care bills. That means more and more middle class people cannot afford health care in this country.”]

[Finally---and this ends my quotations from the PBS transcript---from PNHP’s Dr. Uwe Reinhardt]  “We have 900 billing clerks at Duke (medical system and  900 bed hospital).  I’m not sure we have a nurse per each bed, but we have a billing clerk per bed.  It’s obscene.”]

THE MUDDLE IN THE MIDDLE

And now, in the middle and all in a muddle, you will find most everything you may hear or read in the major media.  Any look will show you they are in bed with the insurance and pharmaceutical corporations.  Those giant corporations have arm twisted, cialis professional non prescription, bribed, and lied against single-payer national health care for more than fifty years. Buy cialis professional without prescription, Given that obvious big fact, the scandal of Congress and the Administration---both candidates, staffers, and serving---who are in that same bed is hardly worth mentioning.  As for the thirty or forty thousand ordinary-uninformed who have been mobilized by those same giant for-profit corporations, I don’t know what to say.  I only know that we must talk to them. 

We must explain, first of all, that Medicare (with 44,831,390 beneficiaries) as well as the nationwide system of 155 VA hospitals (and over a thousand clinics, centers, and homes as well as---don’t forget to mention this---responsiblity for all or some of the training of two-thirds of our physicians) are “government-run” programs.  And their health outcome statistics are superior (by most measures) to for-profit medicine.

The ordinary-uninformed will have heard---and you should reinforce---that compared to all other nations in any way comparable to ours we Americans are poorly served by our profit-driven health care system.  By most measures we are not even average among comparable nations.  I’ll post on that next.  We are #1 only in advanced cancer treatment and other high tech procedures.  In longevity, survival after hospitalization, infant mortality, recovery after procedures, drug-independent lives, most years of life lost due to circulatory diseases, respiratory diseases, and diabetes, we are not even close to #1.

Surveying this list of failures, it is easy to say “Oh, that can’t be!”  But it is.  And we should take no comfort from comparisons with health care in Myanmar, Sierra Leone, the Congo, or Nigeria. Isn't that obvious. The scarlet thread that runs through all of what we should be talking about is the red of blood, our blood. That we pay way too much for this list of failures is a secondary question.

THE SOLUTION

[Here I turn for a quotation to the 17,000 physician-members---Marcia Angell et al---of Physicians for a National Health Program, Cheap cialis professional from canada, their web site, and this following summary of their much more detailed proposal, essentially a “Medicare for all” proposal:]

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet over 39 million Americans have no health insurance whatsoever, and most others are underinsured, in the sense that they lack adequate coverage for all contingencies (e.g., long-term care and prescription drug costs).

Why is the U.S. so different, buy cialis professional without prescription. The short answer is that we alone treat health care as a commodity distributed according to the ability to pay, cialis professional prescription, rather than as a social service to be distributed according to medical need. In our market-driven system, investor-owned firms compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs, which, Order cialis professional from us, along with profits, divert resources from clinical care to the demands of business. Buy cialis professional without prescription, In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar.

We endorse a fundamental change in America’s health care - the creation of a comprehensive National Health Insurance (NHI) Program. Such a program - which in essence would be an expanded and improved version of Medicare - would cover every American for all necessary medical care. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Investor-owned facilities would be converted to not-for-profit status, and their former owners compensated for past investments. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, cheap cialis professional overnight delivery, hospitals or clinics.

A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules - often rules designed to avoid payment, buy cialis professional without prescription. During the transition to an NHI, the savings on administration and profits would fully offset the costs of expanded and improved coverage. NHI would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run.

A National Health Insurance Program is the only affordable option for universal, comprehensive coverage. Cialis professional pharmacy online, Under the current system, expanding access to health care inevitably means increasing costs, and reducing costs inevitably means limiting access. But an NHI could both expand access and reduce costs. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine.

Buy cialis professional without prescription, The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 45.7 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, buy cialis professional canada, enough to provide comprehensive, high-quality coverage for all Americans.

Finally, note that in spite of bias, battering, and distortion the polls still show that the majority of Americans want health care reform along the line of Medicare-for-all.  More significantly, nearly three-fourths of all physicians and a even higher percentage of nurses want that. Not all of them, Cialis professional free sample, true, but a substantial majority. They live their lives up close and personal to the issue and want Medicare-for-all.

You might also want to see Unions for Single Payer Health Care, moving toward 1,000 locals and labor organization who endorse H.R, buy cialis professional without prescription. 676, the John Conyers Bill. That bill, I believe, now has about 70 co-signers.  Other sites---not hidden---record thousands of states, cities. towns, cheap cialis professional without prescription, and community organizations who have passed resolutions supporting single payer health care, “Medicare for all.”         

__________________________________

Source for the doctors’ comments is the transcript of a Bill Moyers PBS program based on Maggie Mahar’s book Money-Driven Medicine (2006), updated by the film of that title (2009), and her PBS blog.

The three most recent editors of the New England Journal of Medicine (oldest, most prestigious, largest circulation medical journal) offer very valuable additions to these doctor’s comments:

  • Dr. Buy cialis professional without prescription, Jerome P. Generic cialis professional, Kassirer (On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health, 2004)

  • Dr. Marcia Angell (The Truth About the Drug Companies: How They Deceive Us and What to Do About It, 2004)

  • Dr. Jeffrey M. Drazen (NEJM’s weblog on healthcare reform, his doing, is very fine)

The reference to Fisher is Dr. Elliott S. Fisher.  I believe he is one of the initiators of the Dartmouth Health Atlas.  See also the reference to Anette M. Cormier O’Connor (RN, M.Sc.N, Ph.D).

Rashi Fein served on Truman’s health commission when he was pushing for universal coverage, with JFK fighting for Medicare that LBJ signed into law, with Carter (one of the co-author’s with Fein of The Health Care Mess, 2005, 2007), and he has sought, with no apparent success at least during this term, to influence Obama.  His new book, Learning Lessons: Medicine, Economics, and Public Policy, will appear in November.

Jim

.

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Buy cialis soft tabs without prescription, For my infrequent audience: First, I love you. Cialis soft tabs rx, Being able to say these things is very important to me (other than when dog walking on the street; other than when collaring a friend on the phone or in a drive-by; other than when, on an occasion we’ve forgotten, buy cialis soft tabs from india, Purchase cialis soft tabs without prescription, we are each holding something to drink).

Thank you, cialis soft tabs approved. Cialis soft tabs without rx, I am grateful. And what you have to say to me is often more valuable than what I have written, cialis soft tabs for sale. Quite often it is, buy cialis soft tabs without prescription. Order cialis soft tabs in canada, Nevertheless, I must have my own say in writing, order generic cialis soft tabs. Order cialis soft tabs, That is why this weblog exists.

  • California is at 12% unemployment. At 20% in LA county.
  • California schools are 47th in the nation.
  • Many state parks are being closed, cheap generic cialis soft tabs. Cialis soft tabs in bangkok, And public swimming pools.
  • Mortgages of one in four Californians are in default by formal definition.
  • California is now the 8th largest economy in the world.
  • RNs to 1,000 population ratios are low; in Contra Costa County and Santa Cruz are the lowest anywhere in the nation.
  • California public policy remains tightfisted, cialis soft tabs buy drug, Tablet cialis soft tabs, money buried in the crotch of the very rich.
  • In California a 2/3rds majority is needed for a tax increase to pass.
  • California’s time is up.
  • California needs a constitutional convention.
  • California’s middle class does not have a clue where its interests lie.
  • Obama’s identification with the interests of Wall Street, NYC is complete.
  • If “our very own Weimar moment” comes, cialis soft tabs professional, Cialis soft tabs overnight shipping, it will come first in California.

Please read my The United States of California, although it is overlong.  Thanks

Jim

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Buy cialis super active+ without prescription, These highlights are for those who would hear a bit more about health in California but do not wish to wander, as I’ve been doing, through the valuable and actively maintained web sites of the 86,000 nationwide membership California Nurses Association http://www.calnurses.org/ and the 17,000 member Physicians for a National Health Program http://www.pnhp.org/

Public health policy---thus far written to please or pacify insurance and pharmaceutical corporations---leaves 43 million without regular health coverage and bankrupts and diminishes the quality of life of millions of “successful” middle class Americans. Meanwhile, where to buy cialis super active+, Cialis super active+ tablet, the spiraling profit cost of health-as-a-commodity threatens the entire economy.

This vast shifting of wealth from all of us to the pharmaceutical and insurance corporations and to private for-profit hospitals and medical groups has made an American shame of the ideal of social medicine, social medicine even in the modest sense commonly practiced and honored by all other wealthy nations, best price for cialis super active+. Canada cialis super active+, I am not talking grand ideals here.  Nothing radical.  National Health Care is within our doing.

According to the courageous California Nurses Association, buy cheap cialis super active+ online, Order no rx cialis super active+, California patient severity-of-illness levels have been rising steadily. Full-time RN staffing ratios have worsened---not that they have not fought the good fight against Governor Schwarzenegger---and are one of the worse in the nation, get cialis super active+. The steady decline in number of staffed beds (growth in patients per staffed hospital bed prove), prove for anyone who can respond to numbers that medicine in California focuses almost entirely on revenue, buy cialis super active+ without prescription. Buy cialis super active+ online australia, The CNA shows the correlation in great detail.

We are first in the world only in high-tech cancer treatment. That is not nothing as I well know; but do not hold up any giant foam “We’re #1” gloves, cialis super active+ without a prescription. Cialis super active+ no rx, Everywhere else---from infant mortality, mortality before six, cheap cialis super active+ from usa, Cialis super active+ alternative, vaccination rate, on and on---we are woeful and toward the bottom of all successful and civilized nations, compare cialis super active+ prices online. Order cialis super active+ no prescription, America might have been first and proud of it.

About 34% of spending on health care in California goes to administrative costs, according to a study by the Institute of Health Policy Studies at UC San Francisco, cialis super active+ sale. Buy cialis super active+ without prescription, Of that figure, 21% goes to private insurance billing-related tasks including health plan profits. Cialis super active+ information, In my direct experience you cannot find a “Billing Office is the clinics, pharmacies, cialis super active+ uk, Find cialis super active+ without prescription, or hospitals of Canada, England, buy no rx cialis super active+, Cheap cialis super active+ in usa, Cuba, or Venezuela, best price cialis super active+. Cialis super active+ without prescription, In California the overall percentage of adults with employer-based coverage declined from 61% to 58%. The percentage of California full-time workers making $9–$11 an hour with employer based coverage dropped from more than 59% to 46%, cialis super active+ online stores, Buy cheap cialis super active+ internet, compared to a national decline from 64% to 58% (UC Berkeley Labor Research and Education study.

Some California insurers sell policies that require members to go to Mexico for care where costs are 40% lower. Some 160, cialis super active+ pills, Online pharmacy cialis super active+, 000 only have cross-the-border coverage, mainly Mexicans legally employed in the United States in agriculture, cialis super active+, Where to order cialis super active+, hotels, retail, cialis super active+ canada, Buy cialis super active+ low price, and local government. Health insurance premiums in California rose 61% from 2000 to 2004, buy cialis super active+ without prescription. California families pay $1, buy cialis super active+ without prescription, Cialis super active+ online sales, 500 more per year than the national average. Yes, cheap cialis super active+ tablet, Cialis super active+ overnight delivery, I could have updated these numbers. Want to bet which way the trend is going?

All this is the result of class war in California, overnight cialis super active+, Discount cialis super active+ overnight delivery, not of any “Ponzi scheme.” People came to California for jobs with good pay and benefits, which meant union jobs, cheapest cialis super active+ prices. Cialis super active+ pill, They left Iowa and Minnesota and Kansas in order to leave behind the non-union work and the run down, beat up, lowest price for cialis super active+, Cialis super active+ purchase, winterized housing stock they had inherited. Buy cialis super active+ without prescription, Now they face lay-off and forclosure. They are angry and they listen to Republican politicians and right-wing radio and TV as it denounces union “special interests” and “big government.” They bleat about “pulling the plug.”  Class war is a serious and paid-for reality not some voluntary, transcendental listening to a different drummer of your choice. Reactionary opinion and lies dominate for-profit media.

The California Nurses Association is one of the few places in the nation where they clarify in numbers and stories that the class war fought by the insurance industry against single-payer national health is actually murdering people.

Could it be that our nation’s President Hamlet and the flock off-stage who rallied to his “Hope” cannot decide whose side they are on. Obviously, they are not about “to take up arms against this sea of troubles, and, by opposing, end them.” Meanwhile the national chorus is being led by those for whom the greed never stops: the pharmaceutical corporations, the insurance industry, and the medical establishment. They are “#1” in dishonesty and misrepresentation. All this has the makings of continuing tragedy.

This needs a better dramatist than I. It needs more than a handful of progressive-minded comedians plying their small venues. It needs the influence of a House of Representatives to advance single-payer national health legislation rather than that committee of six ancient Senators from unpopulated states, at least half of them dedicated right-wing Republicans.  Anyone can call the House, write letters, donate, and march.

You yourself should perhaps see the excellent web sites mentioned above and follow some of where they lead.

Jim

.

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clip_image002 Buy female cialis without prescription, Golden California, our most populated state, was once widely admired. Now you hear of lay-offs and foreclosures and there are wild cries of “fiscal crisis,” “bankruptcy,” and “bail-out.” In fact the current state deficits ($24 billion) are less than under Governor Schwarzenegger in 2004 and substantially less then he decried during his earlier run to replace recalled Governor Gray Davis ($38 billion), low cost female cialis. Davis’s sin was being one of the first to oppose Enron’s crimes.

Exaggerated debt projections are normal capitalist publicity. All the better to fight public service wage increases, Buy female cialis online, my dear. All the better to argue for cuts in social benefits. And heaven forbid anyone think of raising taxes on the richest 2%, buy female cialis without prescription. Normal capitalist publicity becomes very emphatic in a state with intact, strong unions quite capable of putting up a fight for progressive solutions to the state’s real ills (SEIU State Council, buy female cialis from canada, California Nurses Association).

Solutions will be offered for California, Order female cialis online, be assured. Mostly they will reflect that the rich, once again, are trying to shift the costs of the economic recession they created onto the backs of the people of California and the nation.

july06_california For decades, find discount female cialis, California has been a model of capitalism-in-action and much of California publicity and politics are expressions of class war. You may deny the reality of class war; however, Cheap female cialis tablets, as someone said, reality is the sort of thing still there even if you do not believe in it.

California inequality is extreme. Buy female cialis without prescription, The top one tenths of one percent in family income (the 14,588 American families, each with annual income exceeding $11.5 million) are disproportionately Californians. [* Saez http://elsa.berkeley.edu/~saez/saez-UStopincomes-2007.pdf. ] By population, buy female cialis internet, California’s very rich would appear at 12% of the national rich but substantially exceeds that. A quarter of the “Forbes 400 Richest Americans” routinely are California residents.

No matter the corporate lies and those of a bought press, Order female cialis cheap online, California does provides lavishly for unearned wealth: inadequately taxed real property, state and local taxes that do not match those of the Northeast, capital gains exemptions on invested wealth (on which federal tax is only 15%), bank generosity about loan rollovers, female cialis buy, etc. There are plentiful accounting and legal services designed for the rich and the state provides inordinate propaganda and decision-making influence, Buying generic female cialis, important because this is not passive, eastern, “old money.”

California also provides a near-magic invisibility and forgiveness for the rich, as if all excesses were Hollywood smoke and mirrors there for our entertainment, order female cialis in us. Larry Ellison, Charles Schwab, Summer Redstone, the Bechtel, Walton, and Murdock, and many other billionaire families residing in California are “celebrities.”

The annual gains from invested wealth in California are skyrockets in the sky, buy female cialis without prescription. Comparatively the super salary incomes of corporate CEOs are sparklers (a New York minute thing) even though they are a favored subject of lazy journalists. Maintaining California’s stark income inequality---once again I say---are dramatic tax law loopholes, Buy female cialis on line, corporate exemptions and giveaways, special deregulations, property tax “relief,” speculation-enhancing loan rollovers, find cheap female cialis online, and overseas “protections” rivaling Florida’s. There are also “legal” protections for those who would cut wages below the legal minimum, Female cialis online without prescription, raid pension funds, and cut legislated social services. The extraordinary corporate salaries and bonuses are a minor add-on.

Buy female cialis without prescription, For decades, California has been the model of the class war state. Manufacturing is exported, female cialis in uk, employment stands at 11.2% in this high cost, high productivity state over the U.S. Female cialis cheap, average of 8.5%. True, the state government’s fiscal problems are partially the consequence of its Ponzi scheme financing---based on pretending that state population and in-migration would automatically grow forever. But when journalists ask “Do we want to bail-out California again?” and the answer is a resounding “No!” you must expect that will happen anyway, cheap female cialis, or to the extent it is not fought and the journalists know this.

If California were a nation, it would be the 10th largest in the world, Cheapest female cialis price, clearly “too big to fail.”

clip_image006This state is a leading (perhaps the leading) model of capitalist income inequality, a fat favored male child at the family table who gets the attention and two deserts.

Because the economic, political and social drivers are the same---inequality, deregulation, female cialis from india, union busting, health and social service cuts, Buying generic female cialis, welfare for the rich---what is happening in California will happen in the nation. Hence, “The U.S, buy female cialis without prescription. of California.”

Recent California history follows California’s capitalist 19th century, a typical capitalist 19th century, when amoral, female cialis overnight, antisocial opportunist entrepreneurs---Collis Huntington, Charles Crocker, Female cialis approved, Mark Hopkins and Leland Stanford---revolutionized transportation and corporate agriculture using cheap public land and stolen ranches. Nor did they mourn at the graves of legions of Chinese and Irish labor, paid just as little as possible. Richard Rayner’s The Associates describes them well, order cheap female cialis.

More recently, the free-market price gouging by Enron and Reliant Energy, Cheap price female cialis, which followed on California’s energy deregulation, produced the “crisis” of 2000 and cost the people of California $70 billion in inflated energy bills. Buy female cialis without prescription, Then the nation’s taxpayers also bailed out all the other corrupt deregulated private utilities in the years following. All of them modeled themselves on Enron.

Enron was the top revenue private energy company in the 2000 Fortune magazine’s “100 Best Companies” (as well as “Most Innovative,” “Best to Work For, female cialis information,” and the top for “Quality Management”). By late 2001, Female cialis no rx required, it was bankrupt and soon a few criminal senior officers found themselves indicted, guilty, and imprisoned. None of Enron’s publicists or politicians were indicted.

With that real crisis, female cialis without prescription, don’t you know, speculative investors had to shift their investments elsewhere. Buy no rx female cialis, Thus, the high-tech bubble. Then the housing bubble, buy female cialis without prescription. Now the commercial real estate bubble. Just follow the money; they are all connected, no prescription female cialis. California’s rich led the way, all the way. Female cialis pills, Now California’s native Bank of America, the US's largest bank has received its taxpayer bailout ($20 billion in government aid and $118 billion of guarantees against bad assets). Buy female cialis without prescription, More to come.

This is not rocket science. Since the rich do not pay any fair share of taxes and seldom have any real interest in socially valuable activities without a tax-avoidance value, female cialis pharmacy, they must find something unfair and useless to do with their ever- accumulating wealth. Conspicuous consumption requires only a small portion of their wealth. Female cialis rx, They speculate on energy and food futures, on dot-com startups, on mortgage-backed securities, on commercial real estate, female cialis online cheap, whatever. Who pays the price when these speculative bubbles burst, buy female cialis without prescription. You know the answer.

This private, Female cialis pill, highly concentrated California wealth originally depended on the labor of 38 million ordinary Californians (their labor once accounted for 19% of Gross Domestic Product). However, when you now go to beautiful California be prepared for a state whose service economy dominates, an state that is an economic as well as a geologic anomaly; be prepared for the anomalies both in its formation years ago and in its faults, female cialis cheapest price, financial manipulations, and worn infrastructure that may destroy it in the future.

In line with all the above features, Buy female cialis cheap, California gave us Ronald Reagan (Republican, Governor, and President from 1966 to 1989) and, by political inheritance, buy discount female cialis online, his protégé and Vice President George Bush, Senior (President from 1981 to 1998) and his son and protégé George Bush, Generic female cialis, Junior (President from 1995 to 2009. Bill Clinton (a compromising centrist President from 1993 to 2001) did nothing to oppose or moderate this Republican onslaught or its culture of noise and lies.

Ronald Reagan adored the rich. Buy female cialis without prescription, His protégés were rich. Together they broke up or weakened unions, find no rx female cialis, fought minimum wage increases, and firmly establishing the Republican politics of no taxes and little regulation while running grand federal deficits in behalf of their patrons. Price of female cialis, The state furnishes endless particular marvels of Republican greed and ruthlessness in the face of which its remaining unionized labor force fights heroically for their own and California’s benefit.

Historically the state’s promoters have stood aside from misery (and California has more than its share of the poorest communities in America). They described California’s glories and big statistics, ignored the conditions of life of its minority and immigrant labor force and blamed them and the unions for each “fiscal crisis.” This is the class war model. Ted Kennedy’s question to the Republicans was merely rhetorical: “What is it about working men and women that you find so offensive?”

In-migration to California peaked at least two years ago and some of the coast is experiencing out-migration for the first time in more than a decade. Infrastructure and environment are deteriorating, state and local governments are viciously pruning schools, teachers, and social services.

California health by objective public health measures is as poor as the poorest states. The California Nurses Association---long an advocate of single-payer national health care (“Medicare for all”)---finds California health care quality correlates directly to income not to need. As the nurses know the abandonment of public health amounts to murder. Many thousand of Californians are today taking their place beside the bodies of thousands of California’s 19th century Chinese and Irish laborers, victims of the ultra rich “Associates” of California.

Jim

.

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Buy tramadol without prescription, A policy-enforced disparity between the health of the rich and the poor is evident in any major urban hospital. All the staff is aware of it. Drug tramadol online purchase, As you proceed from the worried well to the barely ambulatory, from brief physical examination to technologically sophisticated costly medical diagnostics, from scant to full staffing, buy tramadol overnight delivery, from simple to thorough lab tests, Order tramadol in us, from wards to the single rooms with adjoining kitchens and accommodations for family---nice views, hospital-supplied flowers, comfortable seats, find cheap tramadol, etc. Cheapest tramadol prices, ---so you proceed from health care for the rich to health care for the middle-class.

Meanwhile, outside on the streets and in the poorer schools the majority population is served only in emergency. Outside on the streets drugs for relief of symptoms are available at Walgreens and CVS, order generic tramadol. Essential eyeglasses, trusses, crutches, and other comforts come from these same stores were you can also buy vitamin supplements for $14 a bottle if you are able to recognize them among the arrays of herbal remedies promising wonders, buy tramadol without prescription. Beyond these simple over-the-counter patent medicines even the most common antibiotics are available only with insurance, Tramadol online sale, an MD visit, and a fee. Little wonder that on the streets of America it is not difficult to recognize the signs of malnutrition and ill health, tramadol online review, as easy as on any London street 150 years ago.

As in Florence Nightingale’s London 150 years ago, Tramadol internet, the observant see not just a single crude separation between the health of the rich and the sickness of the poor but graduated discriminations, degrees of separation, between the two, cheapest tramadol. The shocking thing about health disparity is that it so perfectly matches the level of income inequality. Tramadol bangkok, Nationally, at the bottom, the majority are already spending 10 percent of their income on health care and cannot be expected to come up with more, tramadol cheap price. Buy tramadol without prescription, At the top the rich are spending well less than one tenth of one percent of their income for far superior health care. And---this shocks my recognition, Buy generic tramadol, as I say---nicely graduated all between.

This is a fascinating feature of our democracy. The existence of the truly poor means little to most (they will “always be with us” sayeth John 2:8).  Just imagine, the founders of our Republic were truly worried about a threat from the poor, cheap tramadol no rx, fear that they would never accept such inequality, Tramadol price, would rise up against the minor wealth disparity of that time as enjoyed by Jefferson and Madison. The fools!  Now here we are with full acceptance of far greater disparity and all neatly gradated to income quartiles.

About the health care levels of inequality I hope you recognize that President Obama’s new $634 billion proposed expenditure on health care, while very welcome, tramadol discount, is inadequate. Buy tramadol online without prescription, And it is inadequate before it will be, as some general once said, “nibbled to death by pissants” in behalf of tax advantages for rich clients and industries and cut down to reduce the grand social deficit they have run up while George Bush was president.

No, compare tramadol prices, it cannot be said that health care is a policy priority in the U.S. The most important recognition is not that the poor die earlier but that all our health is harmed in proportion to the size of the gap between rich and poor, buy tramadol without prescription. Tramadol in australia, As with this death-AJPH-1rate chart here, so with all other health indicators. The absolute level of the great wealth of our total society is irrelevant ("We are a rich nation, order tramadol no prescription required," as all say). Cheapest generic tramadol online, The shame of allowing so many to live below the poverty level is also irrelevant ("What else is new?" as all ask). These matter less than the exact gap between the rich and the rest of us at each income level. Buy tramadol without prescription, This can be measured in relative health. Public policy has established and the government defends these levels of income inequality and that impacts everyone’s health, tramadol medicine. Once more: the greater the inequality in the distribution of income the poorer the health of the vast majority, Purchase tramadol no rx, by any measure and at every level. Okay.

A LIST

We see the inequality in the death rate in the poor graphic here, cheap tramadol in canada. Another graphic could show you that states with greater inequality in the distribution of income also show a higher death rate.  And at each income level in those states.  We can also see child mortality following the pattern of the graphic here.  And low birth weight, malnutrition, influenza, diabetes, cervical cancer and on and on, buy tramadol without prescription. And, Tramadol cheap drug, likewise and closely related, inequality in the distribution of income correlates to a higher rate of unemployment (now at 8% moving like a plague toward 12%), of incarcerations, find tramadol on internet, of absence of medical insurance, Cheap tramadol without prescription, of higher rate of homicide and violent crime, of a greater number unable to work because of disabilities, a higher proportion using tobacco, tramadol for order, a higher proportion who are sedentary, Tramadol prices, less spent per child on education (fewer books in public schools, poorer educational performance, which is to say worse reading skill, where to order tramadol, worse math skill, Lowest price tramadol, all that), even size of residence moves with the degree of income inequality regardless of "class" or income quartiles. Oh, discount tramadol overnight delivery, and of course, Buy discount tramadol, lower rate of high school completion. Forget higher education. That, canadian tramadol, too, Tramadol canada, is expensive.  It excludes the poor as well as much of the so-called middle class all of whom it burdens with debt, their punishment for presumption and for trying to follow the model of generations past.

You can bury this factual information in thousands of minor articles on inside pages of local newspapers, or miss it in fleetingly references within noble TV programs or on NPR, tramadol online, but the facts are still there. Buy tramadol without prescription, Our health impoverishment as a nation is a direct consequence of the degree of inequality in income distribution. Tablet tramadol, Pick your own slice of the wealth pie (lower, middle, upper middle class, find discount tramadol, whatever) and the health in your slice can be measured by the national or state or metropolitan area income distribution disparity. Tramadol without a prescription, Pick your state or metropolitan area. Once more: relative to others your health will be better or worse in accord with the measurable level of inequality.

That is not what the politicians and media personalities mean when they say this is "a rich country, order tramadol overnight delivery," but that is what it does mean. Wealth is concentrated most unevenly and health varies in accord with the degree of unevenness, richest to poorest, buy tramadol without prescription. Use Search on this site for “inequality” to find my 2008 posts on this subject if my insistent repetition does satisfy you.

Via our cowardly and irrelevant media the fact becomes a sing-song of false concern for “the poor.” And that concern is usually expressed in the low media genre called “human interest.”  It is never correlated to the public policy that makes our nation’s extreme inequality the reality it is.

When I bring up this fact here and there I often receive a helpless shrug. However, American levels of inequality is impoverishing all of our lives and killing our children.  That is the fact. “What else is new?” is not an appropriate response.  However, I may not yet have a good handle this issue. I will keep trying.

Jim

*  The widely-used graphic above originally appeared in the American Journal of Public Health.  That was ten years ago during an upsurge of research following---and attempting to measure---the broad social harm caused by the Reagan presidency (tax breaks and other government largesse for the very rich, and for the rest of us wage cuts and union busting, deficits, living expense increases, and attacks on social welfare programs).  I am hoping for new research covering 2000-2008 and a new, improved graphic appropriate to George Bush.  He was a letter-perfect Reaganite.

.

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