KMZ – KMZ Digest

For Many Disabled Patients, the Doctor Is Often Not In

KMZ — Fri, 16 Dec 2022 20:50:44 +0000

By Emma Yasinski

November 7, 2022

Ben Salentine, associate director of health sciences managed care at the University of Illinois Hospital and Health Sciences System, hasn’t been weighed in more than a decade. His doctors “just kind of guess,” his weight, he said, because they don’t have a wheelchair-accessible scale.

He’s far from alone. Many people with disabilities describe challenges in finding physicians prepared to care for them. “You would assume that medical spaces would be the most accessible places there are, and they’re not,” said Angel Miles, a rehabilitation program specialist with the Administration for Community Living, part of the U.S. Department of Health and Human Services.

Not only do clinics often lack the necessary equipment — such as scales that can accommodate people who use wheelchairs — but at least some physicians actively avoid patients with disabilities, using excuses such as “I’m not taking new patients,” or “you need a specialist,” according to a paper in the October 2022 issue of Health Affairs.

Ben Salentine’s experience is shared by many patients with disabilities who find physicians unprepared — or sometimes unwilling — to care for them.

Visual: Courtesy of Ben Salentine

The work, which analyzed focus group discussions with 22 physicians, adds context to a larger study published February 2021, also in Health Affairs, that showed only 56 percent of doctors strongly welcomed patients with disabilities into their practice. Less than half were confident or very confident that they could provide the same quality of care to people with disabilities as they could to other patients. The studies add to a larger body of research suggesting that patients with a variety of conditions that doctors may deem more difficult to treat often struggle to find quality care. The Americans with Disabilities Act of 1990, or ADA, theoretically protects the one in four adults in the United States with a disability from discrimination in public and private medical practice, but enforcing it is a challenge.

Laura VanPuymbrouck, an assistant professor in the Department of Occupational Therapy at Rush University, said the 2021 survey was “groundbreaking. It was the crack that broke the dam a little bit.” Now, researchers are hoping that medical schools, payers, and the group that accredits hospitals, the Joint Commission, will push health care providers for more equitable care.

Information about the health care of people with disabilities is limited, due in part to scant data, according to Tara Lagu, co-author of both the 2021 and 2022 papers and director of the Institute for Public Health and Medicine’s Center for Health Services & Outcomes Research at the Feinberg School of Medicine at Northwestern University. The few studies that have been done suggest that people with disabilities get less preventive care and have worse outcomes than their non-disabled counterparts.

Tara Lagu, co-author of both the 2021 and 2022 papers in Health Affairs, said that information on the health care of people with disabilities is limited, in part, by scant data. Visual: Courtesy of Tara Laguut a decade ago, Lagu was discharging a patient who was partially paralyzed and used a wheelchair. The patient’s discharge notes repeatedly recommended an appointment with a specialist, but it hadn’t happened. Lagu asked why. Eventually, the patient’s adult daughter told Lagu that she hadn’t been able to find a specialist who would see a patient in a wheelchair. Incredulous, Lagu started making calls. “I could not find that kind of doctor within 100 miles of her house who would see her unless she came in an ambulance and was transferred to an exam table by EMS,” she said, “which would have cost her family more than $1,000 out of pocket.”

Tara Lagu
Visual: Courtesy of Tara Lagu

“You would assume that medical spaces would be the most accessible places there are, and they’re not,” said Miles.

In recent years, studies have shown that even when patients with disabilities can see physicians, their doctors’ biases toward conditions like obesity, intellectual disabilities, and substance use disorders can have profound impacts on the care they receive. Physicians may assume an individual’s symptoms are caused by obesity and tell them to lose weight before considering tests.

For one patient, this meant a seriously delayed diagnosis of lung cancer. Patients with mobility or intellectual challenges are assumed to be celibate, so their providers skip any discussion of sexual health. Those in wheelchairs may not get weighed, even if they’re pregnant, a time when tracking one’s weight is especially important because gaining too little or too much weight can put the baby at risk of developmental delays or the mother at risk of complications during delivery.

These issues are well-known to Lisa Iezzoni, a health policy researcher at Massachusetts General Hospital and professor of medicine at Harvard Medical School. Over the past 25 years, Iezzoni has interviewed about 300 people with disabilities for her research into their health care experiences and outcomes, and she realized that “every single person with a disability tells me their doctors don’t respect them, has erroneous assumptions about them, or is clueless about how to provide care.” In 2016 she decided it was time to talk to doctors. Once the NIH funded the work, she and Lagu recruited the 714 physicians that took the survey for the work published in 2021 in Health Affairs.

Lizsa Iezzoni’s
Environmental Portrait
Visual: Jeffrey Andree/MGHDr.

Tara Lagu, co-author of both the 2021 and 2022 papers in Health Affairs, said that information on the health care of people with disabilities is limited, in part, by scant data.

Lisa Iezzoni has spent 25 years researching the health care experiences and outcomes of people with disabilities. Comments made by physicians in a recent focus group left her “completely shocked.”

Not only did many doctors report feeling incapable of properly caring for people with disabilities, but the vast majority held the false belief that those patients have a worse quality of life, which could lead to offering fewer treatment options.

During that study, Iezzoni’s team recorded three focus group discussions with 22 anonymous physicians. While the open-ended discussions weren’t included in the initial publication, Lagu said she was “completely shocked” by some of the comments. While some doctors in the focus groups welcomed the idea of additional education to help them better care for patients with disabilities, others said they were overburdened and that the typical 15-minutes allotted for office visits is not enough to provide the patients with proper care. Still others “started to describe that they felt these patients were a burden and that they would discharge patients with disability from their practice,” she said. “We had to write it up.”

The American Medical Association, which is the largest professional organization representing doctors, declined an interview request from Undark, and would not offer comments on the two Health Affairs studies. When asked about the organization’s policies on caring for patients with disabilities, a representative pointed to the AMA’s strategic plan, which includes a commitment to equity.

Patients with disabilities are supposed to be protected by law. Nearly 50 years ago, Congress passed Section 504 of the Rehabilitation Act of 1973, which prohibited any programs that receive federal funding, such as Medicare and Medicaid, from excluding or discriminating against individuals with disabilities. In 1990, the Americans with Disabilities Act extended these protections to include public and private institutions.

The ADA outlines some guidelines for accessible buildings, such as requiring ramps, but does not specify details about medical equipment such as adjustable exam tables and wheel-chair accessible scales. While these items are necessary to provide adequate care for many people with disabilities, only 19.1 percent and 10.9 percent of doctors’ offices have them, respectively.

“Every single person with a disability tells me their doctors don’t respect them, has erroneous assumptions about them, or is clueless about how to provide care,” said Iezzoni.

Miles said she’s noticed an improvement in care since the ADA went into effect, but she still frequently experiences challenges in healthcare as a Black woman who uses a wheelchair. “We need to keep in mind the ADA is not a building code. It’s a civil rights law,” said Heidi Johnson-Wright, an ADA coordinator for Miami-Dade County in Florida, who was not speaking on behalf of the county. “If I don’t have access to a wellness check at a doctor’s office or treatment at a hospital then you’re basically denying me my civil rights.”

The ADA isn’t easy to enforce. There are no “ADA police” said Johnson-Wright, to check if doctor’s offices and hospitals are accessible. Instead, either a private citizen or the Department of Justice has to sue a business or institution believed to be in violation of the ADA. Lawyers have filed more than 10,000 ADA lawsuits each year since 2018. Sympathizing with businesses and doctors, some people accuse the plaintiffs of profiteering.

And it’s not just about accessible equipment. In 2018, the Justice Department sued a skilled nursing facility for violating the ADA, after the facility refused to treat a patient with substance use disorder who needed medication to help maintain sobriety. Since then, the department settled with eight other skilled nursing facilities for similar discrimination. “It is a violation of the ADA,” to deny someone care based on the medications they need, Sarah Wakeman, an addiction medicine specialist as Massachusetts General Hospital, wrote in an email, “and yet continues to happen.”

Indeed, in the focus groups by Lagu and Iezzoni, some of the doctors revealed that they view the ADA and the people it protects with contempt. One said people with disabilities were “an entitled population.” Another said that the ADA “works against physicians.”

The Department of Health and Human Services is aware of the issue. In a response to emailed questions, requested to be attributed to an HHS spokesperson, Rachel Klugman Seeger, a senior communications adviser for the department wrote that “[W]hile we recognize the progress of the ADA, important work remains to uphold the rights of people with disabilities.” The Office of Civil Rights, she continued, “has taken a number of important actions to ensure that health care providers do not deny health care to individuals on the basis of disability and to guarantee that people with disabilities have full access to reasonable accommodations when receiving health care and human services, free of discriminatory barriers and bias.”

Researchers and advocates told Undark that key to improving health care for those with disabilities is addressing it directly in medical education and training. “People with disabilities are probably one of the larger populations,” that physicians serve, Salentine said.

Ryan McGraw, a health/home and community based services community organizer with Access Living, helps provide education to medical schools in the Chicago on treating patients with disabilities. He regularly receives positive feedback from medical students but says the information needs to be embedded in the medical school curriculum so it’s not “one and done.” That’s difficult, however, as curriculums aren’t standardized across hundreds of medical schools in the U.S.

In one effort to address the issue, The Alliance for Disabilities in Health Care Education, a coalition of professionals and educators, of which McGraw is a member, has put together a list of 10 core competencies that should be included in a doctor’s education, such as considerations for accessibility, effective communication, and patient-centered decision making.

One of the simplest solutions might be hanging signs or providing accessible information on patients’ rights in exam rooms. “It’d be there for patients, but it’d be also there as a reminder to the providers. I think that’s a super easy thing to do,” said VanPuymbrouck. Miles said this could be a good start, but “it’s not enough to just give people a little pamphlet that tells you about your rights as a patient.” While all doctors should be willing and able to care for patients with disabilities, she thinks a registry that shows which providers take certain types of insurance, such as Medicaid, and also have disability accommodations such as wheelchair accessible equipment, would go a long way.

There are no “ADA police” said Johnson-Wright, to check if doctor’s offices and hospitals are accessible.

Some advocates have been calling on the Joint Commission to require disability accommodations for hospitals that want accreditation for more than 10 years. The step could be effective, because accreditation “is extremely important,” to hospitals, said Lagu.

On Jan. 1, 2023, new Joint Commission guidelines will require that hospitals create plans to identify and reduce at least one health care disparity among its patients. Improving outcomes for people with disabilities could be one such goal. But, Maureen Lyons, a spokesperson for the Joint Commission added, “if individuals circumvent the law, standards won’t be any more effective.”

Lastly, said Lagu, “we have to pay more when you are providing accommodations that take time or cost money. There’s got to be some accounting for that in the way we pay physicians.”

One of the most basic things people with disabilities are asking for is respect. The biggest finding in the 2021 survey, said Iezzoni, is that doctors didn’t realize that the proper way to determine what accommodations a facility needs for its patients with disabilities, according to the ADA, is to just ask the patients.

“I can’t tell you how many times I go to a doctor’s office and I’m talking but they’re not hearing anything,” said Salentine. “They’re ready to speak over me.”

UPDATE: A previous version of this piece included an outdated job title for Angel Miles. Formerly a community-based services policy analyst at Access Living, a disability rights advocacy group based in Chicago, she currently works as a rehabilitation program specialist with the Administration for Community Living, part of the U.S. Department of Health and Human Services.

Emma Yasinski is a freelance science journalist whose work has been published in The Scientist, Discover Magazine, and Kaiser Health News, among other publications.

The World Series of the Apocalypse?

KMZ — Thu, 25 Aug 2022 19:18:10 +0000

October 27, 2016

By Chris Lamb

In it, Al Tiller, the manager of the Chicago Cubs, is haunted by a prophetic dream that the world will end if the Cubs defeat the Los Angeles Dodgers to win the National League pennant. This puts Tiller in a bind: He must choose between momentary glory or the end of the world.

Those familiar with the short story may have braced themselves on Oct. 22, when the Cubs vanquished the Los Angeles Dodgers to win their first pennant since 1945.

The world didn’t end. Not yet anyway.

But if the Cubs defeat the Cleveland Indians to win their first World Series since 1908, it will end the longest period of futility in American sports – and forever put to rest the Curse of the Billy Goat.

Something else, however, could be lost. Failure, melancholy and heartache – not joy and triumph – inspire drama and comedy, and no team in sports has inspired better literature than the hapless Cubs. Over the course of their long, storied history of losing, their failures have played out on the page.

The best that never was

Ring Lardner was one of the greatest sportswriters of the early 20th century. He also wrote short stories that captured the distinctive voice of baseball players, and he inspired F. Scott Fitzgerald, Ernest Hemingway, J.D. Salinger and Virginia Woolf. In “Alibi Ike,” Lardner’s protagonist is a Cubs player, Francis X. Farrell, who has an excuse for every error and every blunder.

In Bernard Malamud’s 1952 novel “The Natural,” 19-year-old baseball player Roy Hobbs vows that he will be the “best that ever was.” On his way to a tryout with the Cubs he meets the beautiful Harriet Bird. She invites him to her hotel room and then shoots him, leaving him critically injured, his dreams of greatness dashed.

The novel is based on the true story of Philadelphia Phillies first baseman Eddie Waitkus. In 1949, Waitkus, who once played for the Cubs, returned to Chicago for a game. An obsessed fan, Ruth Ann Steinhagan, invited Waitkus to her hotel room. Once Waitkus entered, she shot him in the stomach, nearly killing him.

A team of goats

For Cubs fans, legendary futility is the recurring punchline.

Chicago newspaper columnist Mike Royko has been dubbed the “poet laureate of Wrigley Field.” He helped perpetuate the story of the “Curse of the Billy Goat,” a spell cast on the team by the owner of the Billy Goat Tavern after being kicked out of Wrigley Field, along with his actual pet goat, during the 1945 World Series. (Fans had complained about the animal’s stench.)

Royko regularly pointed out in his columns that the Cubs failed to win not because a goat wasn’t allowed in Wrigley Field but because goats were allowed to play for the Cubs.

“The Cubs Reader” is a 1991 collection of essays that includes contributions from writers like Roger Angell, Roy Blount Jr., George Will and Ira Berkow. In Will’s essay, he admits that his gloomy conservative politics come from his decision to be a Cubs fans at age seven in 1948. “I plighted my troth to a baseball team destined to dash the cup of life’s joy from my lips,” he wrote.

In fact, the first joke I ever heard came from my father, a lifelong Cubs fan who is now 92:

“Will the mother who left her nine kids at Wrigley Field please come and get them,” the stadium’s public address announcer says one afternoon. “They’re beating the Cubs 7-2.”

Armageddon averted?

“The Last Pennant Before Armageddon” was included in a collection of W.P. Kinsella’s essays called “The Thrill of the Grass.” In the story, the backdrop for the Cubs’ season is the threat of nuclear war between the United States and the Soviet Union. In one of the manager’s dreams, God says, “I think you should know that when the Cubs next win the National League Championship, it will be the last pennant before Armageddon.”

Tiller finds himself in the decisive game with a fatigued starter. He can leave in his starter, which could cost his team the game but save the world, or he can bring in his closer and probably win the game – and destroy civilization.

“The Thrill of the Grass” was published in 1984 – the year the Cubs were one win away from winning the National League pennant. They ended up losing three straight to the San Diego Padres.

Armageddon averted

Almost 20 years later, before the 2003 National League Championship Series between the Cubs and the Florida Marlins, Kinsella was asked if he thought the world would end if the Cubs won the pennant.

“We’ll just have to wait and see,” he said.

The Cubs were five outs away from winning the pennant in 2003 when things fell spectacularly apart – not because of spectator Steve Bartman reaching for a foul ball, as too many Cubs fans want to believe – but because of poor fielding, poor pitching and poor managing.

If the Cubs do win the World Series, Kinsella won’t see it. He died on Sept. 16, a day after the Cubs clinched the National League’s Central Division.

*********************

The Cubs won in 7 games.-KMZ

The Trump Card

KMZ — Thu, 11 Aug 2022 20:19:06 +0000

Donald Trump takes the oath of office to be sworn in as the 45th president of the United States.
January 20, 2017

by Gene Myers

January 22, 2017

The following essay is not intended to either sway opinion, insult, or convert anyone to my thought process. It is simply an unfiltered opinion relating to recent national issues as analyzed by me. And who among humanity doesn’t want to hear my opinion? If not, read no further. Easy, huh?

So, here we are months after the presidential vote, and a new leader has been installed. Still, most of what I see and hear on television / radio news shows, NPR, and read in print has to do with sobbing, complaining, swearing, and hand-wringing over the results.

As much as I enjoy the asinine far left meltdown, come on, folks, grow up. Time to get over it and look ahead. The real irony is that the biggest whiners are the same people and organizations who finger-waggingly lectured that “Trump must accept the results of the election”. Well, guess what? He did! Now would you please have the same courtesy? More irony is that the same holier-than-thou sources looked the other way when the DNC rigged the Democrat primary in Clinton’s favor. Talk about galling hypocrites.

BTW, as much as I dislike name-calling, I do enjoy the “snowflake” label being applied to the protesting, hating whiners. It psychologically keeps them from being taken seriously. The DC rioters dressed ISIS-like, and destroyed property. Don’t they realize that kind of behavior wins moderate Democrats for Trump? I also found it amusing that the snowflakes smashed the windows of Bank of America and Starbucks, both big Hillary donors.

And the inauguration speech? According to news commentator, Greg Gutfeld, most politicians, including Obama, orate with the flavor of a Pina Colada, but Trump’s inauguration speech was like a shot of whiskey. If Gutfeld meant direct and not meaningless political-mumbo-jumbo-speak, I agree. Here’s an example of the latter, which is typical of inauguration and graduation speeches: “We must move forward, united for this great nation now and for generations to come. Today we…blah, blah, blah…zzz”

I do not wish our outgoing president anything but the best. However, he DID say during the campaign that repudiation of Hillary Clinton would be repudiation of his legacy. Unfortunately, the Clinton and Obama dynasties permitted their party, the party of FDR, Truman, and JFK, to be hijacked by the far left, which was a major factor in the election results. The original working man’s party is now the party of condescending academia and Hollywood elites. With that in mind, Obama’s legacy can be sadly described in two words: Donald Trump.

As for me, I’ve decided to trust the system (executive, legislative, and judicial branches) of our government to be an effective check-and-balance, and to err on the side of the American people as they administrate our Republic under law of the Constitution. No, folks the US was not formed to be a democracy, and personally I’m tired of hearing politicians and media describe our system that way. Democracy is mob rule where the squeaky wheel always gets the grease, and eventually falls under its own consequence. I’m not suggesting that we’re not morphing in that direction what with all the self-interest groups and lobbyists trying to sway public opinion; and for the most part, it’s working. Sad to watch. Jefferson said once we make that turn, we’ve maybe 50 years left.

Meanwhile, I intend to hope Trump is successful, and trust what’s left of the system. Recall Obama had both houses of the legislature for two years, and was reined-in still. it will be the same for Trump because his party is not in lockstep with him—not at all. In fact, I consider him a third-party candidate. (Of course, there is the reality that congress consists of an enigmatic and ineffective herd of humanity. Now I’ve depressed myself.)

The biggest con foisted upon us (for years) is that political experience by people who have political science and law degrees is somehow paramount to running a country. What a load of fiction that is. The only thing experience in politics gains one is experience in being a politician—not in getting anything done. See, the idea is: Once you’re “in”; to get reelected, which is what they spend their time doing. Until we mandate term limits for congress, nothing will change. It wasn’t always that way. People in government used to have “real” jobs before running for office, and returned to the private sector once they went home.

Now this “in” crowd NEVER leaves. If they don’t hang around for years (voting themselves new perks), they become lobbyists. Our so-called Republic is becoming a falling body. Want more proof? Take a hard look at the House of Representatives’ top Democrat, the vacuous Nancy Pelosi. Then there’s the GOP’s top Senator, the oblivious Mitch McConnell. I’m surprised that either has the ability to form words. Warning: A “hard look” requires you to be objective, and check your emotions at the door. Can you do that? Do you have intellectual honesty? Many of you with an “us vs. them” attitude will probably have difficulty; and are therefore, responsible for putting the country in the present day Kafka-esque mess we “enjoy”. The only reasonable solution is to bring in a total outsider; one who understands a republic system of government under law of a constitution.

So, with that in mind, I’ve decided to give Trump a chance to succeed. The law in a republic is specifically intended to limit the power of government over people. The Democrats (and I suspect most Republicans) want bigger, more-intrusive government, not restricted government. Nuff said.

As a Truman / JFK advocate, it pains me to see that the far left has become the mainstream of the Democratic Party. I categorically do not believe the leftwing bomb-throwers’ campaign exaggerated rhetoric about Trump; and all one has to do is look at the makeup of his business empire, and ask his people how they’re treated. Plus, I do want open borders closed, and illegals who commit crimes removed—and I don’t care how. In addition, I want Islamic terrorists eliminated. How is that racist?

For those Hillary supporters who do believe their party’s acerbic verbosity, recall what the Wikileak’s hack into the DNC revealed. Mainly, that venerable DNC staffers’ communiques were replete with anti-gay, sexist, and racist remarks. Then there is Bill Clinton’s ongoing history with women. Those of you who remember the man getting caught with his hand-in-the-cookie-jar during his term will also recall what his supporters and the media lectured us, to wit: CHARACTER DOESN’T MATTER! Then there is Ted Kennedy drowning a young lady, and not mentioning it until the next day; the same Ted Kennedy and Chris Dodd bragging about their “waitress sandwiches”; and Joe Biden twice getting busted for plagiarism.

I am not suggesting Trump is a knight in shining armor, but Democrats CANNOT have it both ways no matter how often the self-serving media looks the other way. That, and the unrelenting name-calling of ALL Trump supporters, is what irritated voters and got a guy like Trump elected. Geez, folks, learn from it for crying out loud! Still, they persist…(sigh)

I prefer to consider Trump’s assets since he’s going to be around for a while. No matter what one thinks of the guy, he is an astute businessman. He knows what a balance sheet is and how to run an organization by interpreting the numbers. He also knows how to make a deal, and administrate assets and people. Since World War I, and maybe before, the US is renowned in the international community for being terrible at diplomacy. My tenth grade history teacher even taught us, through examples, how our country has been snookered time and again at the international bargaining table. The Europeans, in particular, have been laughing up their sleeves at us for years. John “Lerch” Kerry, Hillary Clinton, and most of their Secretary of State predecessors have been inept, and that’s being kind. The only respected and adequate Secretary of State I can recall in my lifetime is Henry Kissinger, and he was lumbered with Tricky Dick Nixon. (Aside: Hey, do any of you remember when Nixon ran against JFK that people would intentionally put Nixon bumper stickers upside down on their cars so it read, NOXIN?)

Therefore, I intend to look at the new president’s positive attributes, and totally and completely ignore the allegations of his opponents. They have zero credibility in my world.

As Hillary Clinton infamously said, “Besides, at this point, what difference does it make?”

Your working boy, Yosemite Sam, a registered and disappointed Democrat.

How Back-to-School Shopping Is Like Modern Politics

KMZ — Fri, 22 Jul 2022 19:27:43 +0000

Gary M. Galles
August 21, 2019

As 2019’s campaign unpleasantness has accelerated (OMG—there’s still way over a year to go), many Americans have been going through another sometimes-unpleasant experience: back-to-school shopping. Seemingly overlooked, however, is that the frequent parent-child conflict of back-to-school shopping illustrates why politics expands Americans’ disunity.

Parents and Children Have Different Values

Parents and children value back to school items differently. And the difference is often large. That is because parents’ more practical considerations can be way out of line with children’s “where will this put me on the social pecking order at school?” concerns. And when their valuations differ substantially, requiring them to make decisions jointly can cause serious disagreements.

There is also often a large difference in the relevant costs facing parents and children. A parent footing the back-to-school bill weighs the value they perceive against each item’s price because they must pay it. But children do not pay the bill. Given that decision-makers will want more of things when the cost to them is lower and less of things when the cost is higher (which economists call the law of demand), this, too, causes disagreements.

That is also why modern politics heightens Americans’ disunity. Americans’ preferences for what they want government to do are very different.

In sum, back-to-school shopping often involves strident confrontations due to large gaps between the values parents and children place on the items in question and the very different costs that they must bear to get them because those decisions must be jointly made.

That is also why modern politics heightens Americans’ disunity. Americans’ preferences for what they want government to do are very different, and various groups are always lobbying to use the government to expand their to-do lists out of others’ pockets. Many desires are also mutually inconsistent (e.g., if I want “A” and you want “not A,” we cannot both get what we want) in areas ranging from taxation and regulation to health care, education, and the environment.

Further, different people face vastly different tax and regulatory price tags for what government chooses to do, as when particular property owners are forced to bear virtually the entire cost of preserving an endangered species habitat, making that preservation free to others, or when some pay disproportionate shares of the tax burden (including future taxes, when deficit financing is used or other unfunded liabilities are created by current programs) for government expenditures.

Conflict in Elections

In fact, electoral conflict is like back-to-school conflict, except that the disagreements are worsened when they concern what the government is to do. The government decides who will be treated as “children,” including what and how much they will be given and who it will force to bear the “parent’s” tab. Every added government freebie expands American discord. Consequently, every proposal promising more handouts benefits politicians by expanding their power to be the distributors of costs and benefits, but this creates more disunity among citizens.

One common means of reducing back-to-school disagreements also illustrates part of the problem with our current redistributionist state. That is to give children back-to-school budgets for clothing, and let them choose what to buy. Unfortunately, American politics has trended away from freedom, with an ever-expanding array of redistribution that forces them to compare the value they see represented by each dollar spent on each item with the value offered by alternatives they could pick instead. And a beneficial byproduct is dramatically reduced conflicts.

Such a back-to-school approach to government would increase each American’s freedom to make their own choices with their own resources by reducing government dictation in areas where our preferences and circumstances differ widely (i.e., almost everywhere). Our disunity (which ironically seems inversely proportional with candidates’ claims they will be unifiers) would be reduced. Unfortunately, American politics has trended (and not just on Twitter) in the opposite direction, with an ever-expanding array of redistribution backed by what we recognize as theft when government is not involved. That is a major reason we are now so divided and why so many electoral promises can only divide us more.

Gary M. Galles is a Professor of Economics at Pepperdine University and a member of the Foundation for Economic Education faculty network.

In addition to his new book, Pathways to Policy Failures (2020), his books include Lines of Liberty (2016), Faulty Premises, Faulty Policies (2014), and Apostle of Peace (2013).

How Seinfeld (Hilariously) Exposed the Creepy Authoritarianism of Aggressive Do-Gooders

KMZ — Wed, 20 Jul 2022 20:56:56 +0000

Jon Miltimore
(@miltimore79)
October 3, 2021

The writers of Seinfeld saw how the human instinct to do good can breed a fanaticism that is anything but funny.

If you asked me what my favorite Seinfeld episode is, I’d have a hard time answering. There are just too many winners.

Many would say the best ever is “The Contest,” the Emmy Award-winning episode where Jerry and company compete to see who is “master of their domain.” And who can forget “The Soup Nazi” or “The Merv Griffin Show” or Kenny Rogers chicken (“The Chicken Roaster”)?

Personally, I’ve always been a fan of “The Race,” the one where Elaine is dating a communist—Ned Isakoff—who feeds Kramer a bunch of socialist propaganda that ends up getting Kramer and his side-kick Mickey fired from their Santa/Elf gig at Coleman’s department store.

All of these are worthy of discussion for belonging in the Seinfeld pantheon; I bust a gut laughing at each one. But one of the most instructive scenes—one fitting for our times—comes in “The Sponge,” when Kramer decides to participate in an AIDS walk to support charity.

‘You Have to Wear an AIDS Ribbon’

Like a good Samaritan, Kramer shows up to walk to support the cause: AIDS awareness. Things take a turn, however, when he declines to wear an AIDS ribbon.

VOLUNTEER: You’re checked in. Here’s your AIDS ribbon.

KRAMER: Ah, no thanks.

VOLUNTEER: You don’t want to wear an AIDS ribbon?

KRAMER: No, no.

VOLUNTEER: But you have to wear an AIDS ribbon.

KRAMER: I have to?

VOLUNTEER: Yes.

KRAMER: Yeah, see, that’s why I don’t want to.

VOLUNTEER: But everyone wears the ribbon. You must wear the ribbon!

KRAMER: You know what you are? You’re a ribbon bully (walks away).

VOLUNTEER: Hey! Hey you! Come back here! Come back here and put this on!

The peer pressure Kramer receives is funny because it’s strange but also relatable. You don’t have to be a hard-nosed libertarian immersed in Rothbard and Mises to see there is a human tendency to fanatically push conformity, even in matters of symbolism (perhaps especially so).

The story doesn’t end there, however. The writers explore just how intense the impulse to make others conform can be as Kramer begins his charity walk in a scene that is simultaneously dark and hilarious.

WALKER 1: Hey, where’s your ribbon?

KRAMER: I don’t wear one.

WALKER 2: You don’t wear the ribbon? Aren’t you against AIDS?

KRAMER: Yeah, I’m against AIDS. I’m walking, aren’t I? I just don’t wear the ribbon.

WALKER 3: Who do you think you are?

WALKER 4: Put the ribbon on!

WALKER 2: Hey, Cedric, Bob. This guy won’t wear a ribbon.

BOB: Who? Who will not wear the ribbon?

The scene is a great example of mob mentality. Kramer, who is walking in support of AIDS awareness, is browbeaten by his peers despite his support of the cause. The ribbon bullies don’t care Kramer is walking in support of the same cause they are; all they can see is he’s not wearing the ribbon.

The scene ends with the ribbon-wearing walkers beating Kramer up in an alley.

The Pandemic and Stone Throwers

Watching Kramer get beaten up in an alley for not wearing a ribbon is funny because it’s Seinfeld. But the writers of the show are also revealing a dark side of human nature that is very real.

The great American individualist Ralph Waldo Emerson once observed how humanity treats those who don’t conform to the collective.

“For nonconformity the world whips you with its displeasure,” Emerson wrote.

Emerson may have been echoing Voltaire, who saw “our wretched species is so made that those who walk on the well-trodden path always throw stones at those who are showing a new road.”

This is true even in the best of times, but in the worst of times the behavior gets even uglier.

Perhaps, then, it’s no surprise that the pandemic has unleashed a level of anger and hostility against those who choose to follow his or her own conscience instead of the decrees of the collective.

The healthy person who declines to wear a mask in a grocery store is treated much like Cosmo Kramer.

“You don’t want to wear a mask?

“But you have to wear a mask!”

“Who do you think you are?”

“Put the mask on!”

Interestingly, not wearing a mask is not an actual sin. We saw celebrities and politicians galore flout this supposedly necessary medical precaution, with nary a peep from the mask police who insist children must wear them in schools. And we routinely see our leaders remove them when they believe the cameras have stopped. Saying masks are not necessary or suggesting healthy individuals should decide for themselves whether to wear one is the true heresy, which invites shame and ridicule.

Choosing to not get vaccinated carries an even greater risk of social stigma and shame. Kramer received a beating for not wearing the AIDS ribbon, but many have suggested the unvaccinated deserve much worse.

TV host Jimmy Kimmel recently said unvaccinated patients should not be treated if they fall ill, while a Florida doctor recently came right out and said she won’t treat unvaccinated patients, as did a physician in Alabama.

The reasons a person chooses to not get vaccinated—perhaps she already had COVID, or is trying to get pregnant, or is a young, healthy person with little to fear from COVID—don’t really seem to matter. Like the AIDS walkers who attack Kramer because all they can see is he’s not wearing a ribbon, many see one thing alone: an unvaccinated person, a threat.

The pandemic may have fueled our tribal instincts that seek to browbeat those who stray into conformity, but it’s important to understand it existed beforehand and infects people of all parties, ideologies, and persuasions. (Conservatives who doubt this need only look back at the fury presidential candidate Barack Obama caused when he stopped wearing an American flag pin.)

Extremism can take many forms, but it’s important to understand that Seinfeld’s ribbon enforcers and the COVID bullies share a common trait. Both groups are absolutely convinced that what they are doing is good.

The problem is, good intentions mean very little. The 20th century was the bloodiest century in human history, largely because many humans sought to create a better world by instituting an economic system they believed would solve human problems: socialism.

The allure to enforce that which is seen as good is a powerful one, but an evil one; and it’s why the French philosopher Bertrand De Jouvenel said tyranny lurks in the womb of every Utopia.

The great economist, philosopher, and FEE founder Leonard Read understood this, which is why he believed “a hard look” at ends and means was necessary to determine whether any action was right or wrong.

“Ends, goals, aims are but the hope for things to come,” Read observed. “Many of the most monstrous deeds in human history have been perpetrated in the name of doing good—in pursuit of some ‘noble’ goal. They illustrate the fallacy that the end justifies the means. Examine carefully the means employed, judging them in terms of right and wrong, and the end will take care of itself.”

Wanting to do good—through a charity walk or encouraging people to take medical precautions—is a noble human instinct. But the instinct ceases to be noble and good when we begin to use aggression and coercion to make others do what we think is right.

The writers of Seinfeld saw how the line between the two could be blurred, and how the human instinct to do good can breed a fanaticism that is anything but funny.

Jon Miltimore

Jonathan Miltimore is the Managing Editor of FEE.org. His writing/reporting has been the subject of articles in TIME magazine, The Wall Street Journal, CNN, Forbes, Fox News, and the Star Tribune.

Bylines: Newsweek, The Washington Times, MSN.com, The Washington Examiner, The Daily Caller, The Federalist, the Epoch Times

Why do holes horrify me?

KMZ — Wed, 20 Jul 2022 20:37:21 +0000

Trypophobia is the fear of clusters of holes and cracks. Its origin may be evolutionary but as awareness spreads online, is it becoming a social contagion?

Julia was around 11 the first time it happened. She let herself into her dad’s apartment in Malmö, Sweden, dropped her schoolbag and flopped on to the sofa.

She switched on the TV and turned to her favourite channel in time for the cartoons.

The screen filled up with a cartoon man with a huge head. On his chin, in place of skin or a beard were huge cracks.

Suddenly, she felt like she was going to throw up in disgust. She screwed up her eyes and fumbled for the button to turn off the TV.

Every three or four months or so she’d see something that she just couldn’t stand. Something that made her feel utterly disgusted and terrified. Sometimes it was cracks, but other times it was patterns of holes or dots, or scenes from underwater nature programmes showing things like groups of barnacles. She’d shake, pour with sweat and end up lying on the floor in tears.

One time she was chatting on the phone when she saw something so awful she threw her mobile across the room. No one else she knew seemed to have this strange reaction. What was going on?

Then one day, when she was living in London in her early 20s, her then-boyfriend came bursting through the front door after work.

“Julia!” he shouted. “I know what you have!”

And why for the affected people are holes – of all things – the cause of utter te

Trypophobia is an aversion to clusters of holes or cracks that’s associated with feelings of fear and disgust.

You might not have heard of it. But don’t worry: you won’t be able to forget it now.© Cait McEniff for Mosaic

Psychologists recognise a number of phobias that can have a huge negative impact on people’s lives. The new kid on the block, trypophobia, is not yet widely accepted as one of them.

There is even debate about whether it is a phobia at all. That’s because while most phobias are synonymous with abject terror, a number seemingly provoke disgust as well as fear. Some researchers think that trypophobia is based only in disgust.

Asked what first triggered their trypophobia, people describe everything from a Christmas bauble to a picture of a wasps’ nest, pitted bricks in a wall, bubbles in cake batter, the way water beaded on their shoulder after a shower.

As well as such triggering objects in real life, many people with trypophobia describe images as being particularly problematic. Pictures involving lotus seed pods are often cited as initial triggers. If you haven’t seen one, the lotus plant produces large green seed heads that look almost like a shower head, with many large seeds. The “lotus boob” meme, a fake image and story about an infected breast, caused quite the stir when it started circulating on email back in 2003.

There is limited research into trypophobia, but one study might help explain why that meme (debunked by Snopes) spread so far and wide – it found that trypophobia is more powerful when holes are shown on skin than on non-animal objects like rocks. The disgust is greater when holes are superimposed on faces.

Of course, the lotus boob meme wouldn’t have gone anywhere without the internet. The world wide web has been linked to the rise of other conditions that have physical or behavioural symptoms but, many believe, have their origin in the mind – so-called psychogenic conditions.

From Strasbourg’s dancing plague of 1518 to the 2011 case of twitching teenage girls in a small town in New York state, mass psychogenic illnesses are nothing new. They’re part of the fabric of being human. But with the internet and its virtually instantaneous global avalanche of information, billions of us can be exposed to potential triggers wherever we are in the world. And anyone with a device and an internet connection is a potential agent of spread.

Online communities have emerged around things like Morgellons disease (an unexplained skin condition) and people who believe they are “targeted individuals”, being stalked, surveilled or experimented on by the establishment. So, is trypophobia another of these odd conditions? Is it a product of the digital world, or simply disseminated through it?

Julia’s boyfriend grabbed his laptop and typed furiously into a search engine. He picked a video from the results and clicked play.

She lasted 10 seconds before bursting into tears and running out of the room.

The video was one of many you can find today that ‘tests’ if you have trypophobia. They tend to be a series of triggering images – everything from lotus flower seeds to washing-up sponges.

Once she’d had time to calm down, Julia thought about what this moment meant. “I was really surprised but also kind of happy,” she says. “It felt kind of comforting that other people had the same thing.”

There was just one catch. She couldn’t search online for more information because the first thing you see when you search “trypophobia” is triggering images.

Hence her boyfriend became her designated Googler, reading aloud anything he could find on the condition. This was also how Julia discovered and joined one of the two main Facebook groups for people with trypophobia.

Skimming through the groups, it doesn’t take long to realise that trypophobia creeps into all aspects of life. People affected live in constant fear of being accidentally or deliberately triggered by any number of seemingly innocuous pictures or objects. From crumpets to brake-lights.

A massage therapist tells me: “I can’t look at certain things… I have to send some clients away if they have triggering skin issues.”

“The hairs on my arms rise whenever I see MANY holes,” writes another. “I would come to think that I’m gonna die if I keep on looking…” They’re also troubled by anything with “hairy spikes”.

Talking about Facebook, one person says they’re “always wondering if I’m about to get slammed in the eyes with pods, or holes in rocks…” They go on to describe watching TV or movies. “There are costume and make-up artists that love the effect for depth on screen. We’ll spend the rest of our viewing time knotted up…”

One user describes himself as a “6ft 4 big guy” who was “absolutely flattened” by one picture.

Online and in real life, trypophobic people say they are also deliberately shown triggering pictures by people looking to elicit a reaction. “It’s never going to be funny to surprise me with a photo of tiny holes etc,” writes one. “Making me panic is just cruel.”

For these people, trypophobia is a question that no one wants to have to answer:

What is in those holes?

The patient is gowned up. A dotted black felt-tip line marks the boundaries of the bump. The doctor chooses her weapon. Ready? she asks. Knife to skin. A disembodied gloved hand hovers nearby, holding gauze.

Nearly. Nearly. Nearly.

Then it happens. A huge jet of oatmealy pus rises out of a shoulder cyst. A blackhead yields to the forces applied to it, dead skin gunk snaking and coiling its way out of the pore like butter being squished through a cream cracker.

It’s gross and mesmerising.

I am weirdly fascinated by US dermatologist Sandra Lee, aka Dr Pimple Popper. She has 3.5 million followers on Instagram, 5.4 million on her YouTube channel SLMD and a TV series. So I am clearly not alone.

I can’t stop watching her videos once I start. I get a taste in my mouth – thick, slightly metallic saliva. The headrush of anticipation, impatience, tension building up before the release.

If you’re not au fait, then pimple popping is the trend for filming, up close and personal, the act of popping, squeezing or otherwise removing blackheads, cysts and other dermatological dementors.

It is disgusting. It’s also ambivalent, not in the sense of indecision or ambiguity but rather a strong tension between opposing forces – something that researchers in the field say is “equally capable of helping and harming, making laugh and making angry”.

For me, pimple popping is gross, but it’s also compelling. Try a video on your nearest and dearest! (Mother-in-law: loves it; colleague who sits dangerously near to my desk: not so much.) Anecdotally, pimple popping seems to divide the trypophobia community down the middle too.

“They are actually surprisingly satisfying. I don’t know why,” says Julia, who is partial to the occasional popping video despite her trypophobia.

Does she find them triggering? “A little bit, but only on the level that it’s still kind of nice. It’s a super weird mix, like doing something you know that’s a bit dangerous but you kind of like it.”

What is in those holes?

Pus, blood, gunk.

Gross, but familiar. And being dealt with.

Think of the last time you were disgusted, I-need-to-bleach-my-brain-and-wash-my-hands-forever disgusted.

Whenever it was, and whatever was behind it, we have something in common. The face that you would have made (and that you are probably making now, remembering) is the same as mine when I last stepped in warm cat sick.

Your eyebrows contract, your eyes narrow, your nose wrinkles and your upper lip curls. That disgusted snarl is controlled by a muscle called the levator labii superioris – the movement of which is seen as the unique facial expression for disgust.

Researchers suggest that we have evolved disgust to help us avoid pathogens – things that can cause disease – found in everything from spoiled food to poisonous plants, from vomit to dead bodies.

Faced with things we associate with disease or decay, we instinctively screw up our faces, to try and stop them entering our bodies through our mouth, nose and eyes. We retch, say “yuck”, and back off to protect ourselves from exposure to them and their disease-laden possibilities.

This pathogen avoidance reaction is now being seen as a key part of what’s called the behavioural immune system. This describes our thought processes and behaviours when we try to avoid parasites and infectious diseases.

Tom Kupfer, an emotions researcher at Vrije Universiteit in Amsterdam, thinks that trypophobia is linked to our evolutionary adaptations to avoid parasites that live on our skin – things like head lice and sand fleas. (Is it me, or is anyone else feeling itchy?)

Just as the typical disgust response evolved to stop us consuming things that could make us ill, skin-based responses like feeling itchy or that our skin is crawling may have evolved to protect us from these ectoparasites.

In other words, our urge to scratch that itch is no different from a cow covered in flies swishing its tail, or a flea-ridden cat grooming itself.

A study co-led by Kupfer suggests that you don’t need to feel parasites on your skin to get that response. “It looks like just those images [of parasites] can trigger the skin-protective response, even though that would normally be triggered by something actually crawling on your skin,” he says.

While people without trypophobia were grossed out by disease-related images such as ticks clustered on a dog’s ear but not by images of innocuous thing like holes in bread, people with trypophobia reacted in exactly the same way to both sets of images.

Kupfer suggests they could be overreacting in response to things that resemble pathogens or parasites but that are, in fact, harmless. Like someone scared of snakes getting a fright when they see a garden hose out of the corner of their eye.

As with pimple popping, there’s an ambivalence within trypophobia. Some online support groups ban the posting of images that could trigger people, but over on Reddit, the subreddit for trypophobia is quite the opposite.

As “ratterstinkle” told another user: “So the way it works in this sub is that people post pictures that trigger trypophobia.” This was in a thread called “That’ll do it”. Below was an image of a phone screengrab showing a man with ragged, holey skin on his face.

Could clusters of holes actually appeal to some people? Just as there are tarantula owners as well as arachnophobes; skydivers as well as people too terrified to climb up a stepladder? Perhaps. On Reddit there is a “trypophilia” subreddit, where one user asks, apparently rhetorically: “So, this is basically a mirror of /r/trypophobia with different captions? am i missing something?”

On one of the two main trypophobia Facebook groups, one user explains their own love–hate relationship with trypophobic material:

“Since I realized I wasn’t alone I tried to desensitize myself to the images that affect me horribly. In trying to do that i came across a YouTube video of a vet clinic in Gambia. Now I’ve become obsessed with watching their videos of a specific condition. I’m not exaggerating when I say I’m obsessed; it’s one of the first things I watch when I wake up. I have to watch it several times throughout the day.”

Another writes: “I almost feel drawn to look at the images of it because maybe my brain is telling me that if I look at it enough it will stop bothering me.”

There is a fair bit of discussion about this kind of exposure therapy in the online groups, especially given that forms of it are used to treat psychiatric issues including phobias, post-traumatic stress disorder and obsessive–compulsive disorder. However, there doesn’t seem to be any published research on its success or not in treating trypophobia.

Some trypophobic people seek solace in another internet trend: autonomous sensory meridian response. ASMR has taken off big time on YouTube. There are a reported 13 million videos dedicated to it, designed to give viewers ‘brain tingles’.

Fans of ASMR say it relaxes them and it can even beat insomnia. In April 2019, a New York hotel announced it was making in-room ASMR videos available for its guests. Classic ASMR fodder includes people eating, whispering, brushing hair, paper-crinkling, tapping and – somewhat curiously – the painting videos of an American artist called Bob Ross.

Whether it’s trypophobia or ASMR, there is an aspect of social contagion to these online communities, says Adrienne Massanari, associate professor in communication at the University of Illinois at Chicago. “You can easily share videos and gifs really quickly and have this conversation that sort of takes you out of a sense of a solitary understanding of watching that video.”

With a couple of swipes and taps, the sender makes their experience of that little chunk of the internet a communal event.

The sharing of such experiences is something Massanari calls “profoundly human”. We can feel this sense of connection even if the thing we’re sharing is something that seems revolting at first glance.

Julia doesn’t go online much, for fear of seeing something triggering. “It takes a long time to let go of it afterwards,” she says.

She’s careful about triggers offline too. She loves TV and movies but will avoid anything that has underwater scenes in case she sees barnacles or animals with patterns of dots that look like holes. She doesn’t swim in the sea for the same reason – she stayed put on the boat during a family holiday in Egypt, while her siblings enjoyed the water. She once made a friend change a jumper because it was full of holes and she couldn’t look at him.

She’s a visual communication student and has the stunning Instagram you might expect. Photos of skyscrapers, skylights, staircases. She even makes shopping trolleys and umbrellas beautiful – all stark angles, refraction and reflection, light and shadow.

Some images show holes but they’re regular, clean, clinical. Like the inside of her washing machine and round windows on the front of a building. It’s precise. Contained. There are no cracks.

I ask if her course interacts with her trypophobia. “So far, not yet,” she says. “It’s a mix of theoretical and practical, and we’re taking photos of what we want to take photos of.”

I say her pictures look very linear. “I’ve never actually thought about it,” she says. “I love structure in the pictures. Maybe it’s about control.”

Have you had any treatment? I ask.

“Is there one?” she asks, surprised.

I stumble an answer about talking therapies.

Massanari tells me how some people with anxiety use things like pimple popping, ASMR and miniature food (Google it – it’s fascinating) to self-soothe.

“If you’re using these videos as a way of release and as a way of managing [anxiety] that can be both a really wonderful thing, but it’s also a really sad state of affairs,” says Massanari. “This is what people are doing because they may not have a lot of other outlets for professional support.”

For now, Julia will carry on as she has been, trying to avoid what she can’t stand.

But even in sleep she’s not safe. Sometimes when dropping off, she sees pictures of holes, which jolt her awake.

Are they images you’ve seen before? I ask her.

“No,” she says. “This is just my head making up holes.”

Once you know about trypophobia, whether you have it or not, you start to spot potential triggers everywhere.

You start talking about it, too. In the pub, at work, in conversation with my mum, I am like Julia’s boyfriend or those Reddit posters, quickly pulling up a screen full of lotus seed pods, Surinam toads and honeycomb, reading the person’s facial responses.

For many, it sounds too strange to be true. Just another socially contagious internet non-disease. Media coverage plays up populist angles – a Kardashian who goes “public with her trypophobia battle”, a celebrity chef who posts trypophobia-inducing images of beef Wellingtons, or the student too scared of bubbles to do the washing-up.

What you don’t see – unless you go looking – is the debilitating power of one picture to ruin someone’s day or week. A compulsion to look at images that make you feel sick or panicky. Having to vet the movie you want to see with your child, the new boxset you’ve downloaded, the adverts on the bus, just in case something holey terrifying is waiting there.

Regardless of whether or not it’s officially recognised as a phobia or another kind of condition, trypophobia is real for the people experiencing it.

But as the internet plays its part in spreading these fearful images, it also facilitates connection. People from different continents who would never otherwise meet are online now discussing things like how upsetting a scene in the Wreck-it Ralph movie is.

In an online world that seems increasingly divided, emerging sub-cultures like the ones based around trypophobia, ASMR and pimple popping have one thing important in common. They remind us of our human-ness. Skin and bone. Flesh and blood.

Whether with pleasure or digust, or a bit of both, we’re feeling.

We’re alive.