Sometimes, There's More to Consider Than Just Gender

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Grace Annam, recently wrote a post ("It's not something I would do, but...") about her observations about interactions with others now that she has started the public transition process as a woman who is transgender. There were some aspects of her analyses that I'm not so sure about.

I can think of a lot of situations where it might be really bad idea to presume that the “I certainly support you in making this choice for yourself. It’s not something I would do, but...” response was a way of expressing the idea that transitioning is bizarre or incomprehensible. If I heard a friend who is transgender respond to someone with “Well, of course not. You’re cisgender” I’d be really, really disappointed for several reasons.

First of all, the comment assumes that the person is cisgender. After all, just as the person didn't know that my loved one is transgender, my loved one who is transgender may not be aware of the fact that the person they’re speaking to isn't cisgender. I can imagine that being mis-gendered by anyone can be incredibly hurtful, especially for those who are gender nonconformant. I’m cisgender, so I don’t know whether it feels the same. However, the idea of being mis-gendered by someone who is transgender makes me think about how awful and sickening it is to me when other mixed-race/mixed-ethnicity folks make assertions about what race they've decided that I belong to or when others within the queer community make assumptive assertions about my orientation.

Secondly, I’d be really upset about the “Well, of course not. You’re cisgender.” response because I feel like it betrays a certain lack of understanding about intersectionality. There are lots of other privilege issues involved in why a person could decide that transitioning certainly isn't anything they’d do.

I had a best friend in middle school. She came out to everyone. I totally supported her choice to do that, but it certainly wasn't something that I’d do and it had everything to do with privilege. As a person of color living in a white-dominated society, I already had my racial identity working against me. It’s damned hard to get a job when you’re competing against white people and most of the folks doing the hiring are white. My friend didn't have to worry about that. When you’re a black woman of color your femininity and womanhood is automatically denied. We are already seen as hypersexual or asexual and, as such, completely acceptable targets for sexualized violence. Now, couple that with being an “out” lesbian, with all of the stereotypes that go along with it, and see how long it takes before you are sexually assaulted. My friend didn't have to deal with that combination and never would.

I've known folks who will likely never transition to living as the gender that they are. I wish they lived in a world where they could, but they don’t. They can support those who do transition while recognizing that they wouldn't/won’t do it. It doesn't mean they’re cisgender or otherwise privileged relative to those who do transition. We don’t all pay the same cost for bucking the system. Some people just can’t afford to do it.

There’s also some real ablism in this post, but I think that might be best explained in a different comment.

So, the Retired Pope is Retreating Deeper into the Vatican

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I was reading about Pope Benedict the XVI's decision to live out the rest of his days at the Vatican now that he's stepping down from his position. People have noted that this decision will allow him to continue to avoid any legal repercussions associated with the sexual assault of children by Catholic clergy. In their justifiable bitterness and anger, I've seen comments where people wished that he would just die a horrible death, maybe even crucified. Then I saw a comment that said that dying would be too good for him.

I looked at the comment for a while and tried to figure out why I feel this way, too. I think it's because I think it's easy to die for your God. What's really difficult, is living...and I say that as someone who has spent over two decades of extreme sickness thanks to two progressive, incurable diseases and having dealt with a diagnosis of terminal illness (my bone cancer).

Dying is easy, a piece of cake, any fool can do it. It can be nasty and unpleasant, but it's usually brief and not too messy for the family to deal with. When you're dying, you'll get more kindness (from the folks who love you) than you know what to do with.

However, when you don't die, you have to face responsibility and accountability and an uncertain future. That, my friends, is what's difficult. This pope doesn't deserve the sweet dénouement of dying surrounded by friends and family doing what they can to ease you through the process. No, he deserves to live to be a thousand years and every day re-live the horrors that his actions caused.

Woman escorted from Vermont Medical Center at author Robert Whitaker's speaking event

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This blogger, who describes herself on her blog:

"My name is Jeanne and I'm a writer and artist living in VT. I worked as a peer supporter from 1995 til 2010. I survived psychiatric iatrogenic injuries and went on to sue for damages. I'm not a medical professional, if you want to taper from psych chemicals consult a professional. My dream is to have a small solar farm and to continue to be a pain in the neck to the arrogant everywhere."

Was Escorted out of the building when attempting to show support for ["support his work"] Robert Whitaker, author of 'Anatomy of an Epidemic' who was speaking at the Vermont Medical Center, in June 2012.

"She said it was private corporate property and I was trespassing. She said I was causing a disturbance. Then a Nancy T. showed up and got in my face about the situation. I had asked Ms. White for her last name and she was kind enough to tell me, but Ms. T. refused to tell me her name. I got out my handy iphone and asked if I could tape what they were saying to me. They said no. I was rolling up my posters when Ms. White yelled, “Call Security!”"


Take a look at her posters on her blog. Outrageous, that she was removed from the building.

Whistleblowers and GSK's record $ 3 Billion dollar settlement: Paxil, Wellbutrin, Avandia

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via PR News Wire:

PRESS RELEASE
July 2, 2012, 10:42 a.m. EDT
Whistleblowers played major role in Glaxo case, leading to Glaxo's record settlement

WASHINGTON, July 2, 2012 /PRNewswire via COMTEX/ -- Two whistleblowers represented by Phillips & Cohen LLP provided the government with overwhelming evidence that was at the heart of the government's case against GlaxoSmithKline GSK +1.34% and the record-setting settlement announced today.

The whistleblowers - Thomas Gerahty, a former senior marketing development manager for Glaxo, and Matthew Burke, a former regional vice president -- provided invaluable insider information that Glaxo was engaging in corrupt nationwide schemes to push sales of Advair, Wellbutrin, Imitrex and other popular prescription drugs for "off-label" (unapproved) uses, that it used improper financial inducements to market its drugs, and that it misrepresented the safety and efficacy of those drugs. Glaxo's illegal practices caused Medicare, Tricare - the healthcare program for the military -- and Medicaid to incur huge losses.

The civil settlement of Gerahty and Burke's whistleblower case and a separate whistleblower lawsuit filed in Colorado total $1.017 billion out of total settlement. It is the largest civil, False Claims Act (whistleblower) settlement on record. (Two other whistleblower lawsuits that alleged another improper practice concerning Advair marketing settled for $25 million, for a total of $1.042 billion paid under the settlement agreement for the four whistleblower cases.)

Gerahty, Burke and Phillips & Cohen worked closely with the U.S. Attorney's Office in Boston and the Justice Department since they filed their "qui tam" (whistleblower) case in early 2003 in Boston's federal district court.

Gerahty and Burke gave the government new and detailed information about Glaxo's nationwide improper marketing practices, including the use of financial inducements to doctors to prescribe Glaxo's drugs and the promotion of Advair, Wellbutrin, Imitrex, Lamictal, Zofran and Valtrex for off-label, unapproved uses. Unapproved use of prescription drugs can create significant risks to patients, and drug manufacturers are prohibited by federal law from promoting their drugs for unapproved treatments.

As the government investigation progressed, the whistleblowers and their attorneys made a significant difference in particular in the government's case against Glaxo for its off-label marketing of Advair for mild asthma. Gerahty, Burke and Phillips & Cohen devoted substantial effort and time preparing the legal case that helped demonstrate Glaxo improperly marketed Advair as a first-line asthma treatment and for asthma patients previously treated with only a short-acting inhaler.

As a result, Glaxo paid $686 million out of the total settlement to resolve claims involving the off-label marketing of Advair to treat mild asthma - by far the largest amount Glaxo paid to settle any of the civil charges. (See the settlement agreement at www.glaxowhistleblowers.com .)

Kelton and Phillips & Cohen also represented the whistleblower whose qui tam lawsuit against Pfizer alleging the off-label marketing of the prescription painkiller, Bextra, helped the government recover $1.8 billion as part of a record-setting $2.3 billion settlement in 2009.

"The gravity of Glaxo's conduct cannot be overstated," Kelton said. "The company's improper marketing practices extended across a wide range of its prescription drug portfolio. Given what we saw with Glaxo, Pfizer and other pharma companies, it's fair to conclude there has been almost no limit to what pharma companies have done to sell their products."

Read the rest here

More on the massive GSK fine

Here GlaxoSmithKline to pay $3 billion for health fraud.

Here (Reuters) - GlaxoSmithKline Plc has agreed to plead guilty to misdemeanor criminal charges and pay $3 billion to settle the largest case of healthcare fraud in U.S. history.

The settlement includes $1 billion in criminal fines and $2 billion in civil fines in connection with the sale of the drug company's Paxil, Wellbutrin and Avandia products, according to filings in federal court on Monday.

Deputy U.S. Attorney General James Cole said at a news conference in Washington that the settlement "is unprecedented in both size and scope."

Also at Pharmagossip MONDAY, JULY 02, 2012--

GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data--
Largest Health Care Fraud Settlement in U.S. History
Global health care giant GlaxoSmithKline LLC (GSK) agreed to plead guilty and to pay $3 billion to resolve its criminal and civil liability arising from the company’s unlawful promotion of certain prescription drugs, its failure to report certain safety data, and its civil liability for alleged false price reporting practices, the Justice Department announced today. The resolution is the largest health care fraud settlement in U.S. history and the largest payment ever by a drug company.

And Pharmalot Biggest Deal Ever: Glaxo Pays $3B For Bad Behavior.



And Seroxat Sufferers Stand Up and Be Counted.

~~
GSK Press Release: CEO Andrew Witty nearly apologizes, but doesn't--uses word "regret" and read to part that says it is not an admission of liability or wrongdoing regarding the sales of certain drugs listed in the lawsuit settlement:

GlaxoSmithKline concludes previously announced agreement in principle to resolve multiple investigations with US Government and numerous states

"Commenting on the agreement, GlaxoSmithKline CEO Sir Andrew Witty said: “Today brings to resolution difficult, long-standing matters for GSK. Whilst these originate in a different era for the company, they cannot and will not be ignored. On behalf of GSK, I want to express our regret and reiterate that we have learnt from the mistakes that were made.
“We are deeply committed to doing everything we can to live up to and exceed the expectations of those we work with and serve. Since I became CEO, we have had a clear priority to ingrain a culture of putting patients first, acting transparently, respecting people inside and outside the organisation and displaying integrity in everything we do.
“In the US, we have taken action at all levels in the company. We have fundamentally changed our procedures for compliance, marketing and selling. When necessary, we have removed employees who have engaged in misconduct. In the last two years, we have reformed the basis on which we pay our sales representatives and we have enhanced our ability to ‘claw back’ remuneration of our senior management.
“We have a vital role to play in bringing innovative medicines to patients and we understand how important it is that our medicines are appropriately promoted to healthcare professionals and that we adhere to the standards rightly expected by the US Government.”
Under the terms of the settlement, GSK will plead guilty to misdemeanor violations of the Federal Food, Drug, and Cosmetic Act related to certain aspects of the marketing of Paxil for paediatric use and of Wellbutrin for certain uses, and for failure to include information about the initiation or status of certain Avandia studies in Periodic and Annual Reports submitted to FDA.
The civil settlement reached with the Government does not constitute an admission of any liability or wrongdoing in the selling and marketing of Lamictal, Zofran, Imitrex, Lotronex, Flovent, Valtrex, Avandia or Advair products, nor in its nominal pricing practices. "

How does this work? part 2 Grassley's question number 6

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from page 13 of this document, that Dr Steve Balt placed on Twitter, in attempt to expose a colleague

Question 6

Have any of the prescribers identified to this Committee been referred to your state medical board?


Read the list of questions and ask yourself if Senator Grassley would be interested in the 2009 top 10 prescriber of Seroquel Dr Steve Balt, and his medical license being suspended (on probation) during the 2009 writing of over 1000 rx for Seroquel. Seroquel is known to be used off-label, and one must question the medical office setting where Balt worked at the time as being a player in the Medicaid, Medi-Cal fraud investigation. Were those patients rx'd Seroquel (antipsychotic) for indication use approved in 2009? or was it off-label? were the bulk of the recipients of the prescriptions Medicaid patients?

It's National VNA Week!

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The following is from an email I just sent to our fantastic staff:

This week, we celebrate National VNA Week and acknowledge and celebrate the invaluable work we do to keep patients home, where they most want to be. It’s even more special this year because we also are celebrating 125 years of providing excellent care for our community. We have a proud history and we can look forward to our future…. the VNA of Boston & Affiliates is more relevant now than ever before.

We are there at the start of life and we are there at the end of life providing compassionate care so that patients have the best quality of life they can with dignity and independence. Here is a sampling of some of the comments we receive from our patients:

“VNA of Boston is consistently excellent! VNA has improved my quality of life & sense of wellness!!!”

“I was treated with the greatest respect and courtesy.”

“They made me feel safe and secure in helping me get better and made a good recovery in regaining my health back.”

“We have had multiple experiences - OT's, PT's, nurses - all have been great.”

“I was very impressed with the professionalism of all who helped me. Thank you very much!”

“The care was excellent and I would highly recommend the VNA to anyone. Everyone was great.”

Thank you all – to all the clinicians in the field and the staff in the office who support their work – for your expertise, your passion and commitment, and your contribution to the future of the VNA of Boston & Affiliates.

Rey

"It's what we do... we are nurses..."

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For most of my career, I've been fortunate enough to work with clinicians who heal and who care.  Who bring skill and experience, and a frequently unquenchable compassion, into situations that many of the rest of us would do nearly anything to avoid.  I may be inclined to exit... while they rush in.

Meet Barbara, a nurse manager from the Visiting Nurse Association of Boston.  And here are a few of her photos of her native Haiti.  Idyllic and beautiful, as in the sunlit bay above.  Tragic and devastating, as in what follows.

Tuesday, January 12, 2010.  A catastrophic magnitude 7.0 earthquake with an epicenter only 25 kilometers west of capital city, Port-au-Prince.  Ultimately... 316,000 dead.  300,000 injured.  1,000,000 homeless.

And Barbara rushed in.

Here's her story... from the beginning.

Barbara grew up in Carrefour, a suburb of Port-au-Prince, with her mom, a teacher, and dad, an owner of an auto repair business, and brother and sister.  It was a happy, largely uneventful time... until her father became sick.  Among his ailments, Barbara's father also suffered from decubitius skin ulcers, which then (and even still today in Haiti) were poorly understood.  Barbara, then 13 years old, remembers being angry when her father, a proud man who resisted family pressure to move to the United States, told her "not to worry" and that he would be around for "another ten years".  Unfortunately, that was not to be the case.

At the age of 16, Barbara and her remaining family members moved to Florida and then eventually to Cambridge, Massachusetts.  Barbara and her sister, Beatrice, held a variety of jobs and when Barbara decided she wanted to become a nurse, Beatrice, then a medical assistant, helped her to pay for the training.  When Barbara completed nursing school, she began working and then helped to finance Beatrice's nursing education.  Barbara continued on to earn her bachelor's degree and is now studying for a master's in health care administration.

Barbara remembers well that day in January, 2010.  Reports of an earthquake began surfacing, with no one fully aware of its magnitude or impact.  Beatrice called Barbara and gave her an update.  It was far worse than expected.  Far worse.

Barbara recalls: "We were looking at the news.  We couldn't believe it.  Nobody knew what was happening.  We started calling our family there but no lines were open.  We were so worried.  We couldn't sleep.  We tried calling the UN but couldn't get through.  We just didn't know what to do.  I was desperate..."

The overwhelming emotion was helplessness.  "People there were dying and I thought, I'm a nurse.  I have to help."  Partners in Health, an organization dedicated to improving the quality and access to health care services in poor and developing areas, called Beatrice on Saturday and asked to deploy her to Haiti on the following Monday.  A month later, Barbara's call came.

It was a two week assignment.  The lead time was limited.  According to Barbara, "you just pack your bag and go."

She recalls departing the airport in Haiti.  She remembers looking around at the rubble, the devastation, the places where buildings once stood.  "It was tough to see a country you left and is no longer there."

Barbara was stationed at the General Hospital in Port-au-Prince.  "Once you got there, the gate was closed and you couldn't leave."  And once there, she and her companions worked for 10 days straight, during 7PM to 7AM shifts.  Barbara remembers being struck when she saw the former sight of a nursing school next to the hospital which she had seen as a child.  "It was no longer there.  It was completely flat.  I wondered how many people were trapped underneath."

After a quick orientation from the physician-in-charge, Barbara was given a brief tour and was immediately "put to work."  She described the first day as "one of the worst days of my life.  There were 300 to 400 patients there all needing care... from TB to fractures to missing limbs to wounds... to people who were just dying.  Just name it - it was right there looking at you..."

When asked how she responded to that, Barbara describes: "You start to work.  Your forget about everything else.  You just tried to save everyone you could.  You just do whatever you can."

She remembers one young girl at the hospital.  She had lost nine members of her family in the tragedy.  "She was so thin.  You could see only bones.  She would not eat or drink... and she never spoke... except at night, she would scream out the names of her family who were now lost to her.  I remember seeing a lady who stayed with her.  She was from the local church and she slept on the floor, giving the girl a sip of water."  Despite their efforts, the patient passed away.

Another patient, a 27 year old woman with renal failure and high blood pressure, was experiencing significant physical and emotional stress.  Barbara knew the patient needed oxygen and fast, so she ran down the hall looking for a tank.  A simple tank of oxygen.  Plentiful in every hospital where Barbara has worked, but scarce in Port-au-Prince's General Hospital.  Barbara called out: "This girl's going to die, her heart's going to give out soon... "... and remembers seeing the desperate look in the woman's eyes.  The patient said to Barbara: "Please don't leave me.  If you leave me, they're going to let me die."  Barbara knew she was right.

The patient eventually received the oxygen and the vital dialysis she required and lived.

There was also an older woman patient who "could have been my mother."  She had two wounds in her lower legs; "it looked to be a diabetic ulcer".  Barbara watched this patient fade from an amiable, even joking, favorite among the nurses, to one who became more and more ill and despondent.  At one point, she had no clothing or even sheets, leaving one of the nurses to donate some of her own clothing to the patient.  The patient died, alone and in pain.  Per Barbara, "there was no reason for her to die that way..."

Barbara looks back at the experience and feels that: "We didn't do enough.  There's so much more to do there.  And it's not over there.  It's terrible what's happening in the tent cities there now.  It's just horrible still... but I want to go back."

When asked why she wants to return, Barbara lowered her eyes and said, simply and solemnly: "It's what we do... we are nurses..."

If you're interested in learning more about Partners in Health, please click here.

If you'd like to help, click here.

 

Posted by Rey