People are sick. Sick, and strange.

First, the strange:

Story 1: At www.cbc.ca/cp/Oddities/070215/K021515AU.html
we learn that a California man reported to his wife (and to police) that two men held him at gunpoint and forced him to drive them to Santa Rosa, California, and he escaped by purposefully driving into a wall. His wife was happy to know he was safe, even if her brand new 2007 Ford Focus was crashed in the escape.

Happy, that is, until she learned that he'd lied about the kidnapping. He'd apparently crashed her car en route to a casino, and made up the story about the kidnapping because he feared her reaction.

So, police are considering laying charges for filing a false complaint. And I can see their point. But I'm kinda thinking... if the guy was so worried about telling his wife about the accident that he went so far as to make up a story about being kidnapped, and reported this to the police... I'm thinking he's already being punished... by his WIFE, and in a far more effective manner than society could ever impose!

Story two: I hear voices... coming from the urinal!
www.cbc.ca/cp/Oddities/070215/K021525AU.html
New Mexico purchased 500 talking urinal cakes as part of an effort to... increase sales of schizophrenia meds? decrease sales of hallucinogenic illegal substances? No... to decrease drinking and driving, of course! Because what better method of keeping people from driving drunk than utilizing talking urinal cakes!

Seriously, now: these cakes, costing $21 US each, are motion-sensitive and have a woman's voice saying "Hey, big guy. Having a few drinks? Think you had one too many? Then it's time to call a cab or call a sober friend for a ride home" and end with the woman saying "your future is in your hand."

(Actually, I think it's ... well... something else... a brain, maybe... but not really a FUTURE, given that the future of THAT particular piece of anatomy will eventually require Viagra to work... which I hear tell is kinda depressing... so maybe not what you want people to think on when they're already drunk, given that alcohol is a depressant....)

Apparently these cakes have already been used in Long Island (New York), Colorado, Pennsylvania (picture the poor Amish guy who only stopped in the bar to use the washroom!), and across the seas in Australia. And they seem to be a good idea.

But I have a few thoughts (apart from the picture of the poor Amish guy ...):

a. drunk people aren't entirely logical. I'm thinking, at some point, we're going to have people falling on their knees and bowing before the Great Urinal who has broken His silence to show them the error of their ways. To say nothing of the risk of injuries (and the MESS!) when startled men jump back... bang into things... attack the demonic urinal... etc.

b. these cakes are going to be stolen. Some at Turtle Mountain Co. bar and restaurant have already been stolen, and the owner managed with a straight face to express surprise. I'm surprised he can spell the name of his restaurant, 'cause uhm... talking urinal cakes... being stolen... DUH!!! You better chain those things down, 'cause people stupid enough to drive drunk are gonna be stupid enough to just looooooove a talking urinal cake and stupid enough to STEAL the unsanitary thing. Again, all together now: DUUUUUUUH!!!!!

c. I read this in the "diversions" section. Not everyone knows about this. So who's gonna warn the doctors as men start trickling in (sorry, couldn't resist... shoulda, but couldn't....) talking about hearing voices in the washrooms... how many people will be diagnosed with late-onset schizophrenia... or just heavily medicated... before knowledge of talking urinal cakes becomes widespread?


So I suggest an alternative to the talking urinal cakes as a means of cutting down on drinking and driving: breathalizer-controlled bathroom doors. You can walk in, but unless you exhale under the limit, you can't walk out. They'd have to be connected to the fire alarm system so that people weren't trapped in the bathroom during an emergency, and you'd want little plastic disposable caps to put on the mouthpiece for hygienic reasons (although again, people that drunk likely wouldn't care...). If you want to get REALLY hi-tech, if someone blew over the legal limit you could have a bed pop out of the wall and a voice cheerily inform them that they are spending the night. People who were drinking and NOT driving could be handed a little button or something when they turn over their car keys to their designated driver and then use the button to get themselves out of the bathroom.

I admit, the plan needs a bit of work. But seriously; how many urinals are in a typical men's bathroom, and how many cakes are used per year? I'm sure a breathalizer would pay for itself in a few years, without the risk of theft... or religious conversions....


Story 3: On a more serious note, the poor (annual income less than $39000) receive different treatment for heart attacks than do richer individuals (annual income greater than $63000), as written at
www.cbc.ca/health/story/2007/02/13/heart.html

The article makes several points:
a. people with lower incomes go to emergency for heart attacks more often than do those with higher incomes, but have a higher mortality rate,
b. rates of invasive surgery are lower for those with lower incomes and death at one-year follow-up was higher,
c. people with lower income were more likely to be older, have higher rates of diabetes, hypertension, and elevated cholesterol levels,
d. and people with lower income were more likely to use emergency services in lieu of a regular doctor, less likely to HAVE a regular doctor, and more likely to postpone seeking medical treatment because they "are so focused on making ends meet."

I'd like to add a few points.
a. an important reason why people of lower income are less likely to get invasive surgery is because doctors are less willing to provide it if they know the person has no access to post-operative care. That doesn't just mean immediately-after-the-surgery care, though that too is decreasing in general with hospitals turfing patients sooner and making more surgeries into "day treatments." Post-operative care also means someone to help during recouperation, ensuring that the patient is eating properly, getting exercise (after invasive surgery, even walking can be hazardous), taking medications as scheduled... those with lower incomes are less likely to have someone available for home care to supervise and assist with their recovery. So doctors are less likely to perform the surgery in the first place.
b. I do take a bit of issue with the comment that people of lower income are less likely to seek medical coverage because of their focus on "making ends meet." It could be that, and likely is for many people. But there's more to the story.

1. As a person whose income is on the borderline, I can tell you that getting to a doctor isn't easy when you're working in a job at the lower-income-level. Such positions are less likely to allow you to take time from work to see a doctor. And apart from doctors working in walk-in clinics and emergency centres, they aren't really available outside regular business hours. So if you can't get off work, your only access to doctors is through walk-in clinics and emergency rooms. I spent over a year working with an "official" in-town doctor whom I could rarely see. He was always overbooked and running at least an hour behind, so he wouldn't book appointments past 4 pm. However, you couldn't book a 4 pm appointment and then show up at 5: if you weren't in his waiting room at the time of your appointment, you lost your appointment. You had to be there, and wait. But when I moved to that town, he was the only doctor taking new patients... likely 'cause everyone else had changed doctors in frustration!
2. Which is another issue; the difficulty of even GETTING a doctor! I spent four years of grad school rarely seeing the same doctor twice. I relied soley on walk-in clinics because no doctor in town would take university students as clients. It's not considered 'sound' business practice to take too many university students as clients because they keep leaving town for summer terms and when done their studies, so you don't have a consistent number of clients seeking your services, and thus you don't have a consistent income.
3. And accessing specialists is even harder! I've been trying to see an asthma specialist for two months, in a city an hour away. He doesn't see patients past 5:00, I don't get off work until 4:30, and he doesn't work Saturdays. I'm waiting for March break; a time that I will have off and he won't. I'm also supposed to a doctor every two weeks for medication monitoring. He also works an hour away. (Don't move to small towns; the doctors are always Elsewhere.) This doctor does work late twice a week, but those prized appointments are literally booked 6 weeks in advance, and you can only book one appointment at a time. So I see him every 6 weeks. Anyone else see a problem? The last time I got to see a "regular" doctor was during my Christmas holiday, when I wasn't working and he was.

Again, it isn't just a "focus on making ends meet:" I know my health is important, and I'm taking steps to improve it. But my job doesn't permit me to take time off to see doctors on a regular basis. They aren't being mean: they need me there. My duties don't allow for the hiring of substitute/replacement staff. If I'm not there, the work doesn't get done.

Now, in defense of my workplace, they might let me leave a bit early once every 4 weeks, but I'm reluctant to ask because I risk looking 'unhealthy,' and I'm new and don't want to seem like a 'bad hire'. Which brings me to the next story:

Story 4: Everyone has it, but nobody wants to talk about it....

Well, not EVERYONE. But quite a few people. 11% of Canadians, to be exact, with possibly another 20% going undiagnosed. And the dirty little secret is... depression.

Though 90% of people polled in a recent survey by Ipsos-Reid believe that depression is caused by a chemical imbalance in the brain (that is, not the fault of the person who has depression, but rather a medical condition that is outside of their control, kinda like the flu, cancer, and the need for chocolate), 80% of people diagnosed with depression feel their careers would be hurt if their employers learned of the diagnosis. I've worked in mental health, and unfortunately, those fears are not unfounded. Come on; who wants to hire someone who can't always work at their peak, who periodically or regularly struggles with lethargy, mood swings, increased risk of illness (because of somatizations and weaker immune systems)? It doesn't make good business sense, especially because depression doesn't have a predictable recovery time as do other illnesses. Depression is an illness that can take years or even a lifetime to overcome. And without the media hype and societal support that you find with other illnesses, there's little fear of retribution for the adminstration that chooses not to promote or give permanent contracts to individuals who have disclosed their diagnosis.

The irony, of course, and this explains why I include these last two articles together, is that people with depression often can't access the medical services they need to conquer the depression. The best treatment for depression is a combination of medication and counselling, and the best counselling method is cognitive-behavioural therapy. However:

1. Antidepressants are depressingly expensive and could cost upwards of $100/month, so if you don't have a drug plan, you may not be able to afford medication.
2. Symptoms need to be closely-monitored to determine the best drug and drug dosage, because there is a wide variety of medications and everyone has a different "best fit." But if you are relying on walk-in clinics or emergency services, you won't get the monitoring you need. (Quick story: I was feeling really tired and went to a walk-in clinic because I thought I should have my meds changed, dosage increased or something. The doctor said we should run a blood test, Just In Case. Turns out I had a mild case of mono. I doubt previous doctors would have caught it, because that's the only time I've had my blood checked before changing meds.) By the way: I'm told that symptoms are 'best' monitored by a psychiatrist, someone who has specialized training in the medical treatment of psychological issues. But I've been dealing with depression off and on for over 13 years. I've never seen a psychiatrist because there's never been one available.
3. Mental Health services are stretched to the limit in many communities, so unless you can afford private counselling, sufficient counselling may be hard to come by. And health plans rarely (if ever) cover enough counselling sessions. If you are diagnosed with depression you can likely get counselling through your mental health clinic, but sessions may be few and far between, unless you're in an emotional crisis. And if you have symptoms of depression but aren't in an actual DSM-IV-R depressive episode, many mental health agencies can't take you because they just don't have the staff to offer services to people with such 'mild' issues. I'm not saying don't ask; I'm just pointing out the challenge.

So to sum, then: there are reasons why people of lower income have poorer outcomes when health issues arise. It's the health care system itself that is sick.