Here’s a follow-up to the saga of my book The Healthy Prostate, which the publisher refuses to let go out of print, despite the fact that it has been selling less than 20 copies a year for several years now. (The book was originally published by John Wiley in 1996.) You can read the beginnings of the saga in the entries titles “Going Out of Print Would Be A Blessing, Cash-Flow Speaking” and “Going Out of Print – Part II” in the Contracts category.

I received another call from the editor, who told me that her boss had told her that I could buy my way out of the contract. That is, if I paid them a little over $4,000, they would put the book out of print. That would release me from my contractual obligation NOT to write a competing book, and allow me to accept more writing jobs. (And that, by the way, is the reason I originally asked them to put the book out of print – so I could accept a paying job to ghostwrite a different book on the prostate.)

How did the publisher come up with the $4,000-some dollar fee? That was how much my author account was in the red.

The publisher had given me an advance back in 1996 – an advance against royalties. Let’s say that the advance was $20,000, and the royalty was $1 a book. In a sense, they paid me in advance for the first 20,000 copies sold. My account began at negative $20,000, and every time a book was sold $1 was added to the account. When 20,000 copies were sold my account would be zero, and for every book sold after that they would give me an additional $1 in royalties.

Unfortunately, the book never “earned out its advance,” a common occurrence in publishing. (Most books do not earn out their advances; most are money losers. A relatively small percent of books are profitable, and a very few are mega-profitable.)

My book needed to sell a little over 4,000 more copies before it would earn back its advance and get my author account up to $0. Since there was no chance this would happen, not in my lifetime, the publisher was asking me to pay the difference.

That was the first time one of my publishers had refused to let a poorly-selling, out-of-date book go out of print.

Why? Is it just business, a straight-forward calculation that the book can still earn them a couple of hundred dollars, so there’s no incentive for them to act? Or are publishers going to play financial hardball with writers, using their books as hostages? (Remember, I can’t write another book on the prostate unless the original book is put out of print, and that won’t happen unless I pay the publisher $4,000-plus dollars.)

I don’t know the answer. Have any of you run into a similar situation?

Tuesday came and went, so I called the editor at John Wiley to ask what had happened.

She informed me that the publisher absolutely would not put The Healthy Prostate out of print, despite the fact that it had sold a net total of 13 copies in the just-ended 6-month period, and 4 in the period before that – that’s 17 for the year. And that’s an improvement, for it sold 12 in the previous year, 15 in the year before that, and 12 in the year before that. In fact, I had to look all the way back to royalty statements from the year 2000 to find a 12-month period in which the book had sold in the triple digits. I don’t think there’s any danger of this 13-year old book landing on the bestseller list any time soon.

Why does the publisher want to keep the book in print? There are no plans to mount a new media campaign to promote the book, or to issue a revised edition – in fact, the book has been put into “Print on Demand” status, which I understand to mean that they don’t even bother to print copies and send them out bookstores. Instead, they print copies one by one as orders arrive. I can’t imagine they’re making a lot of money on my book, but it will remain officially in print.

I don’t earn any royalties on the book, because it never earned out its advance. However, the fact that it remains in print means I can’t write a competing book on prostate health. I’m in a bind. A bind that I suspect is becoming more common thanks to modern technology that makes print-on-demand economically feasible for publishers. It doesn’t cost them any money to let a poorly-selling book’s page sit in their on-line catalog, and print-on-demand costs are low enough that they can apparently make a few bucks for every book ordered. And if no one orders a copy for a few years, well, it’s no skin off the publisher’s nose.

Unfortunately, my financial nose is being skinned by the contractual restriction not to write a competing book.

And double unfortunately, there is no “automatic reversion for dwindled sales” clause in my contract. This would be a clause saying that the book must sell a certain minimum number of copies in any six-month period, or else it will automatically be put out-of-print and rights to the book will revert back to the authors.

Alas, there is no such clause in my contract. To be honest, I didn’t think of such things when I signed the contract back in 1994, before the Internet and modern print-on-demand technology made it feasible to keep a book in print forever. In fact, back in the 1990s, when one of my books had outlived its sales life, I would call the publisher and ask them to put it out of print – so the rights would revert back to me and I could write again on the topic. Not anymore. From now on, I’ll have to consider the “automatic reversion for dwindled sales” and “competing books” clauses more carefully.

Indeed.

And no day reflects this evil like the darkest day of the year, Black Friday. Shopping malls turn to lands of desolation, lives are lost (literally) as warring factions set upon the dwindling resources of a forgotten age (bargains).

The question is….

WHY!

I mean what is it about this day that drives the hordes to pillage and plunder as they do?

I can see it from the retailer’s side, they want to make as much money as possible, but what about the consumer?

I guess the clue is in the word, isn’t it? Consumer. It’s Xmas, we have money in our pockets (bonuses) and we have to get little Johny the latest robot and Susy the latest doll. But if it is a question of getting a certain toy, why not order it from a catalog or online? You can do that from the safety of your own home.

But let us not forget the real victims:

Poor Gabe!

And he is right. Yes, store attendants can be snooty little brats who could find their heads in their own asses with both hands and a telescope but when you have to put up with shit like this:

You know what “the back” is? Is the space between the store walls and the actual walls of the mall. Cramped, smelly, cold and crawling with things that where old when the dinosaurs ruled the Earth. Trust me, this is maximum sale time. What you see is what you get. The store will not hold back anything. Who would even try to pull that off when you have the angriest/hungriest mobs this side of Attila the Hun devouring everything in sight? The aloof manner of the average teenage sales clerk is a defense mechanism, my friends! Jaded by countless hours of horror as reality is torn asunder in front of their very eyes (I know, I seen it, I SEEN IT!).Stuff that makes men out of boys, women out of girls and veterans of us all in a matter of minutes.

The greed, my god, the greed.

Of course, the media doesn’t help.

Oh no!

They hype this dark day for a month or so and then feast on the carcasses of the fallen (again literally fallen), the trampled, the dead (I wish I was making up that one, I really do) with stories of specials induced madness and blue light shock and awe.

And what about those vaunted Black Friday savings?

Buy one, get 50% of a second one? Really, that’s like 25% off (which it was the week before) and that’s only if you buy items of the same price.  Plus, factor in the sales tax which cuts into that percentage. On my desk I have a 25% coupon for Borders. It says, and I quote “list price of almost everything!”  Almost? Great!

On second thought….

But not everyone is compelled by this rush to the bottomless abyss of consumption. No, others wait, and wait and wait some more, while every show on radio and television tells us how many days are left till Xmas.

A countdown to another dark day!

Happy Holidays! And stay safe!

Now for some music by Armin van Buuren, Burned with Desire:

Back when I was in my tween/early teen years I was obsessed with all things military.  Part of that included being a huge fan of the TV series MASH.  Towards the later years of the show’s run it was both in syndication and producing new episodes allowing me to catch multiple viewings ever day.  My close proximity to both the New York and Philadelphia (and let’s not forget WWOR) television markets gave me access to three, four or even on some occasions FIVE episodes to watch every day (remember, this was pre-cable TV when we ‘only’ had 10 or so channels).  It didn’t matter that I had seen every episode dozens of times and new them so well that I became discriminating about which network I’d watch the show on since some would cut slightly more of some shows in order to cram in an extra commercial, I never got bored with the show.

Fortunately, that phase passed but I wasn’t aware of how much that show influenced me until much later.  It was then, years after I had first joined that I realized that I had unwittingly internalized some of the Hawkeye Pierce character.  The Quixotic stands, the pranks, thumbing my nose at authority all kind of fit.  Now, I don’t want to make this more than it is.  I always had an anti-authoritarian streak (which, oddly enough, goes away once I have the authority) and have been what my mother would describe (generously) as a ‘mischievous’ side but when the realization hit me (I think as I was in Bagram, listening to helicopters whirl around while lounging in my Hawaiian shirt).

Allow me to provide an example of what I’m talking about.

Back in 1989, I was a newly promoted E-5 (Sergeant) and I hated the army.  That was OK, however, because my enlistment was coming to an end.  I had been accepted to attend the finest university in the country so everything was good.

Then I got word that I had been selected to attend the Primary Leadership Development Course (PLDC).  It was required for all new non-commissioned officers and was 30 days of all-army stuff, all the time.  Quite frankly, I wasn’t too anxious to attend because it just seemed like a pain in the ass.  Besides, I wasn’t going to do this army thing very long so what was the point of sending me?  Slots to get into this school were fairly hard to get so it seemed to make sense to send someone who could actually get something out of going.

Finally, there was a regulation saying that you couldn’t attend a military school if, upon graduation, you had less than 180 days in your enlistment.  A quick calculation revealed that if I went to this ridiculous school I would have exactly 182 days until the end of my enlistment.  Surely, my chain of command would see all of this and realize that it was senseless to waste a spot in this class on me, right?

Well, no.  They said I had to go.

I said I didn’t want to and found out that there was actually a procedure (there’s one for everything) to decline a school.  Ah, brilliant!  So I walked into the orderly room and told them that I wanted to decline going to PLDC.

‘But, why?’ The sergeant behind the desk asked.

‘Because,’ I replied ‘I’m getting out of the Army and it’s a waste for me to go.’

‘Well, ok.’  He said.  ‘But, you know you’ll have to sign a Bar to Reenlistment.’  (Which means I wouldn’t be able to reenlist in the army).

‘So, if I say I don’t want to go to this school because I’m getting out of the army, you’re saying my punishment is not being able to stay in the army?’  I was beginning to feel like I was in an Abbott and Costello routine.

‘Well, I guess you could put it like that.’

‘Where do I sign?’

Now, I should have known it wouldn’t end there.  I went about my happy way and a few days later was told the First Sergeant wanted to see me.  Uh oh.

So, I had to explain my situation again while she tried to feed me the company line.  We were getting nowhere fast, going round and round.  I explaining that I was getting out of the army and her telling me that I was on the list to go to this school (We mustn’t change the list!).  Finally, in a fit of exasperation she said:

‘You can’t say with 100% certainty that you’re getting out of the army.’

To which I replied ‘First Sergeant, I’ll sell pencils on the street before I reenlist in the army.’

And with that, she knew she was defeated.  She let me go with a ‘You’re the worst NCO I’ve ever met in my career.’  I’m sure that wasn’t true.  I had only been in the army for 3 years by that point and I had met lots of NCOs worse than me.  But still, that seemed a bit harsh.  I wasn’t incompetent, after all, just a slacker.

Shortly thereafter, fate smiled upon me.  It was time for the NCO of the Quarter boards and I was submitted to compete by the agency I worked for (I was in a unit in Washington D.C. which had strange lines of command between who you worked for and who had responsibility for you otherwise).  And after some studying, I had the pleasure of receiving an award and certificate announcing that I was, in fact, the best NCO of my unit.  Mysteriously, my First Sergeant was away the day I was given the award, which was a shame but I was comforted in the fact that my name joined the honor roll of previous winners on the wall right outside her office.

heh…

Of course, five years later I did, in fact, rejoin the army (bars to reenlistment not being worth the paper they were printed on) and so it’s a lot less clear who has ultimate bragging rights in this conflict.  But, I’ll take it as a win.

Now, had I not watched so much MASH, I probably would have just gone to the stupid school and made everyone’s like just a bit easier.  So Mr. Alda, I hope your satisfied with yourself.  I am.

I’m reading “The Gardens of Kyoto” and have unconsciously been moving this scrap of notebook paper from one page to the next without really looking at it. I figured another library patron must have been using it as a bookmark.

I just now inspected it. In turquoise highlighter somebody wrote: “Anna’s page. Leave in book please.”

Anna, of the curlicue handwriting, you are bringing out the romantic in me, which is never far beneath the surface in any case. I’m so sorry I lost your place.

Why did you leave this note? Were you sharing reading this book with somebody and you were marking your spot? Did you run out of time, have to return the book and plan to go back, reborrow it, and pick up where you left off? Did you find a page with some writings that spoke to you?

You gave me an idea. I’m thinking everybody who borrows library books and who finds something they love in a book could write a little note, tuck it in the pertinent spot, and see if others agree with you. Pretty soon good books would be filled with little scraps of paper – a sort of old-fashioned offline book club. It appeals to my sentimental side.

If I were to take a little scrap of paper and mark it “Donna’s page. Leave in book please”, I’d probably pick the following page. Author Kate Walbert is a pretty evocative writer when it comes to love scenes, surpassed in ability only by yours truly. Here goes. (I’m telling my husband to read this page and pay attention).

Page 155: “I wake to find your father near me. Who has drawn back the curtains? The room is bright with moonlight, or very early morning. It is still quiet. He is on his knees and kissing my shoulder where the bone curves toward the neck, and I have never, quite truthfully, been kissed there, and his finger hooks my sweater like a fish hook, pulls it out of his way and he smells like something vaguely sweet, bourbon, and his head is outlined in light the way a shadow will be sometimes and he is too close to tell the color of his hair or whether his face is thin or round or what, exactly what he’s saying….”

Hah, hah. I guess I’m reading a chick book. What’s the appropriate antidote to equalize my hormone levels? A Winston Churchill biography perhaps?

Anyhow, enough of this. I have to go back to where I left off. Now where did I put that bookmark?

From the New York Times:

Researchers on Thursday announced the discovery of two World War II Japanese submarines, including one meant to carry aircraft for attacks on American cities and the Panama Canal, in deep water off Hawaii, where they were sunk 63 years ago.

Link

Our videographers have now posted some very sharply edited Youtube videos, in ten-minute increments, depicting our National Angel Summit panels!

For starters, here are the seven increments for the first panel. This panel was moderated by podcaster Frank Peters of thefrankpetersshow.com, with the participation of Permjot Valia, UK-based Angel investor and blogger, and Mike Volker, Managing Director of the Western Universities Technology Innovation Fund and VANTEC.

Click here for access to all Summit content.

I was 17 years old the first time I vividly encountered the impact of war upon a serviceman’s life. That was over 25 years ago. I was roughly the same age as my friend when he first went to Vietnam. Looking back I understood even then that I was having a rare opportunity to experience a piece of living history, to see first hand the effects of war upon a US Marine.

I don’t remember how or why we first started talking. I do remember we discovered common ground, despite our diverse backgrounds. My musical taste was stuck in the 60s, having been born 20 years too late! He too was stuck in the 60s, for different reasons; his experiences in Vietnam, his survivor guilt, and his appalling belief that the Mai Lai massacre had been the rule rather than the exception of the war. He had been part of that war.

Back in his room, he introduced me to Janis Joplin, Crosby Stills & Nash, and Rameses. He graciously listened to my adolescent angst and I witnessed the manifestation of some of his pain. I had never before seen a man cry; the way a man cries when he is taken back to a time when he saw his friends blown up in the vehicle in front of him, their body parts flying in all directions, All these experiences when he was just a lad.

He realised too young and too late that the military did not offer a career. Primarily it was about killing people, before they killed you and then spending the rest of your life trying to blot out the guilt that you had survived when your friends had not. And oh, the ways in which veterans blotted out their guilt; drugs, alcohol, failed relationships, and suicide afflicted Vietnam veterans at rates far higher than the general population.

As well as survivor guilt and a drug habit, my friend returned from Vietnam with another souvenir; post traumatic stress disorder (PTSD). It manifested itself in various ways. Once an old woman living in his block of flats found him shaking in a corner of the hallway, crying and yelling thinking he was being shelled. She understood. She’d seen similar after WWI and never imagined she’d have to see it again. He wasn’t someone that you’d want to pick a fight with after a few beers on a Saturday night either. He could find himself back in Vietnam thinking he was fighting for his life. Kill or be killed.

One of the saddest events he shared was the reaction of the American public when these brave boys returned home. Whilst many poor working class boys volunteered for Vietnam (many in the hope it would offer better prospects) their middle class peers led protests against the war. As a result, some veterans were spat on when returning home.

More veterans died by killing themselves after the war, than died during it. If you add to that the alcoholics, drug addicts, those with long term mental illness, those who have served prison sentences, the broken marriages and effects upon their children, the post Vietnam wreckage is vast. However, one thing the American’s learnt from Vietnam, is the significant impact of PTSD upon veterans’ lives. Now any US military personnel returning from action are assessed for PTSD. US military personnel also have free lifetime health care and are treated promptly in military facilities.

The contrast with the UK is significant, we have closed our last military hospital. Recent media reports cite incidents whereby Gulf war veterans treated in civilian hospitals are asked to remove their uniforms lest it offends, are discharged without being diagnosed with PTSD, or left on wards lacking security! Later many face long NHS waiting lists with no priority access to health care. Whatever the lack of morality of a war. Veterans should be treated like the brave men and women that they truly are, who follow orders. And in so doing, may loose their lives, or their minds. A job most of us would not or could not do.

Once whilst listening to my friend’s war stories, I recalled a story of my grandmother during the 1930s depression. Despite having 11 hungry children to feed, she always found something for the WWI veteran, an amputee reduced to begging with a tin tied around his neck whilst he balanced on crutches. This was his reward after serving in the trenches. And I wonder still what has changed when I read of the UK Government’s reluctance to recognise ‘Gulf War Syndrome’ from the first Gulf war, condemning sick veterans and their families to a life of relative poverty, in one of the richest countries in the world. And why more of those who fought in the Falklands war committed suicide, than actually were killed during the conflict.

Another time I recalled a story an aged aunt told me about the time her husband was on the beaches of Dunkirk, waiting to go home. She had no news of him. Then one sleepless night she swears she saw her younger brother Arthur who had died in childhood standing at the foot of her bed. He reassured her that her husband would return alive from Dunkirk. And indeed He did, weighing only 91 pounds. Terror has a way of literally frightening the life out of you.

Once I took a journalist to meet my friend. The idea being that he’d write and sell my friend’s story and we’d get a percentage cut! He arrived with a bottle of ‘Wild Turkey’, which I have no idea how he got of hold of, because it wasn’t sold in the UK then. They sat and drank whilst my friend told his stories. I watched. I didn’t drink as back then I had not developed my whiskey taste buds!

Without warning the journalist began to cry. Deep uncontrollable sobs. For our own different reasons my friend and I did not know how to comfort him. He said his tears were for the sadness of what he’d heard that night. For “the horror” that he had looked upon. I often wonder when I see people react this way whether they are really crying for themselves, or if what they have heard has unlocked their own deep reservoirs of pain?

That journalist never did write the article…

© Copyright 2007
All Rights Reserved
By Jules Aaron

It seemed like every big guy was called Moose just like all the radio operators on board were called “Sparks or Sparky”.  He was big, came in about 230 or so and that was much bigger than anyone else on the ship by far.  Moose played the violin and woe to the fellow who referred to it as a fiddle.  Moose  made it clear from day one that it was a violin not a fiddle played in some hayseed barn dance.   He had secretly shed a tear more than once in his bunk listening to him play, especially when it was Amazing Grace.  It just brought up too many strong emotions of better times and hopes yet unfulfilled.

His thoughts turned to his ports and his earlier voyages for something to fill in the time and tedium.  He liked New Orleans best but only because it was the closet one to home and he could hitch hike there in a day and have a few hours with his wife and the hitch rides back.  One of the few benefits of being in uniform as an enlisted man was that rides were easy to come by.  Almost everyone would stop to give a serviceman a lift on the highway.  Norfolk was just a busy place with industry and port activity everywhere.  In New York he got off the ship only long enough to spend an afternoon wandering around the city and saw Times Square.  The noise and rush of the place unsettled him a bit.  This was his fourth trip to somewhere.  He had already been to North Africa twice and England once.  Liverpool it was.  He thought it was a really grimey place and there wasn’t much to do except for the pubs which didn’t interest him because he didn’t drink.  The one memory that he did relish was a trip out in the country for a day with a shipmate to ride horses.  They had met the farmer in town waiting for a bus and he mentioned he lived out a few miles.  One comment led to another and soon they had a deal to have two horses to ride for 2 dollars for the afternoon.

Moose came into the watch station.  They only exchanged the comments about each other’s area of responsibility and went about their work in silence.   Moose’s size made the space more cramped and he had to move over to the railing.  The clouds were definitely clearing.  There was a clean break now in the eastern sky with only scattered clouds behind them.  He started practicing again his aircraft recognition procedure.  They first started drilling that into them at gunnery school in Virginia.  They would spend hours looking a flash cards with outlines and pictures of the various German aircraft the were likely to see.  The pictures were easy to identify in that setting.  He rarely missed and passed that easily.  He knew a Dornier from ME 109 or a Junkers 152 on sight.   It was very helpful but in reality it was much harder than he had every imagined.  When they first saw planes on that first convoy to Bizerte they were not much more than smudges in the sky–a dark cigar looking object and they didn’t hold still like the pictures did in the classroom back in Virginia.  When they were close enough to recognize either their guns were firing or the bombs were dropping.  The truth is they had to rely on whoever that mysterious person was that made the call that the aircraft were enemy and that all ships could open fire.  No one on any of his voyages so far had ever turned in a report of enemy aircraft; they just reported unidentified aircraft at such and such a location.

As he viewed the eastern sky where things were clear enough to see something he wondered how effective the IFF signals were.  He thought that if you ask, Identify Friend or Foe, that they would answer if the latter with an attack and if the former they might not have heard the message anyway.   He supposed it made sense to try but he remembered the large flight of planes over the convoy as it left North Africa and the entire convoy and escorts opened fire on them.  The sky turned dark with the exploding shells broken by the streaking reds and yellows of the tracer rounds.  They took down some planes.  He saw a couple for sure going down but he was too frightened and busy to notice anything else except for momentary sense of relief and even elation at the sight of the “enemy” craft plunging.   Later they heard the skuttlebutt about how all those planes were friendlies.  That some big shot admiral was in deep trouble and an air force general for not working that out.  The Navy said they had no notice of friendlies flying over and the air force said they were incompetent not to recognize their own aircraft.  If it was true those were our guys it made him feel really bad.  They were just trying to get through all this same as he was and they got blown out of the sky by their own guys.  Of course they never were told anything official this was all just ship board rumor but he had a terrible feeling it might be true.  He remembered the command to open fire seemed hestitate and was given he suspected only because the other ships had already started firing.

Moose commented that he had just heard that an escort had picked up some survivors from the Uboat attack two nights before.  All they saw from their ships was a flash and billowing fire and smoke on the horizon.  Susuposedly the word was that two ships had gone down.  They had been repeatedly told they wouldn’t survive more than about 15 minutes in the water that cold and that is why they constantly practiced the abandon ship drill and the lowering of the lifeboats.  He hoped they did get some but the seas were pretty rough that night and finding them and then pulling them up the boat’s side would have been difficult.  Men that fell into the water were doomed.  They all knew that even the escorts could not and would not turn about to attempt a rescue with subs in the area.  At best you had one chance when they came by.  The convoy would not stop.  They moved slow enough as it was, making no more than 8 knots with the zig zagging and the full loads on most of the Liberty ships.  His thoughts were interrupted with the sight of a new flag and the PA address of enemy planes spotted.

to be continued….www.olcranky.wordpress.com

When he opened the hatch and stepped out the cold wind bit into his face but it was not as bad as he expected.  The spray from the waves was only a fine mist.  The ocean was pretty quiet compared to what it normally was, the swells were only about 3 or 4 feet and the wind was light.  He noticed how everything was gray.  Sometimes there was a contrast with the sky, sea and the ships in the convoy but today everything was gray.  The sky had high thin clouds and the sea itself was gray, no hint of green or blue.  The ship and everything afloat was gray.   The crew had added a fresh coat of paint in port just before they set sail two weeks ago from Norfolk.   That old adage he had heard from the salts was really true when there was nothing else to do they made them paint.  If it didn’t move, it got painted.  It didn’t matter if the paint was hardly dry from the last coating.  Where did the Navy get that much paint?  The supply seemed endless.

He locked the hatch back in place.  They did that everytime they came out even if the seas were relatively calm because they could change quickly and all the outer hatches had to remain watertight at all times.  He made his way along the railing toward the stern and his watch station.  It was near the number one gun on the afterdeck.  The watch was normal.  No high alert or battle stations which was better than having to sit with the gun and break out the ammo and prepare the ready room and gun.  He first went to check the gun as was his habit and job.  Sure enough the trigger was caked over with ice.  Albert forget to clear it from the last watch.  Damn!  It would get him in trouble if the Lieutenant saw that.  He got out the hammer and tapped the ice free and added solvent to keep it from freezing again, at least not right away.  He learned that trick himself on his first voyage from an older sailor.  He looked over the gun to make sure it was secure and no loose items were in the gun pit.  Then he made his way to his watch station.  It would be a longer, “normal” watch, since the weather was mild–in the mid twenties.  When it got much colder the watches were cut back to two hours.  It was great to get out of the weather but then it just messed up the schedule for trying to get some sleep because you had to go back on duty that much sooner.

As he settled in his watch post he checked the binoculars.  He wondered how much they cost.  They were very large and heavy and well made.  You could see all the way across the convoy  in clear weather and distinquish the men on deck and what they were wearing.  The convoy was in a “row” formation and stretched across several miles of sea even with the spacing of only a quarter mile between ships.  On the perimeter he could see the destroyer escorts.  He could only see one but assumed and hoped there were more than that.  They were told only what they needed to know to do their job.  Often he couldn’t see any escorts but was told they were there.  As usual he didn’t even know where they were going.  He assumed it was somewhere in England because they were so far north that surely they weren’t going to North Africa, at least not directly.  It took almost a week to go from Norfolk up to St. John’s where they had formed up with the rest of the convoy.  He had “been” to St. John’s three times now but it had never been more than a gray smudge on the horizon.   He wondered what that town was like having been so close but never seeing anything.  He thought it might be pretty big since so many ships went into port there.

His undershirt was chafing again on his neck.  As he idly watched his quarter of the sky and sea he wondered how he could get dressed quicker and easier for his watches.  It took almost fifteen minutes now to dress for watch.  They started with their skivies and then an extra undershirt and extra long johns.  Then came the pants and blouse as the Navy insisted on calling their shirt.  Then the overalls and last the parka jacket with hood and the sailor’s  wool cap–hell everything was wool, that was why it was always so itchy and chafed.  Then a scarf for those who had one and goggles were provided but you never could use them because you had to constantly be using the binocs so it was pointless with having to take them off every ten seconds.  Then they got the boots for outside.  They reminded him of those worn by the firemen back home in the real world.  He prided himself on being organized and efficient but he still hadn’t figured out how to reduce the time to dress for watch.  At least this was a morning watch.  Morning came about 5:30 at these latitudes in May.   He beat those dog watches in the middle of the night when you more often than not couldn’t see much beyond the bow of the ship anyway.   Silhouettes against a moon maybe of other ships.  With a blackout in force it was darker on cloudy moonless nights than anything he could imagine.  He really wondered why they had them out there on those nights because if they did see anything it would be too late to do anything.

The clouds were nice because it reduced the odds of enemy aircraft being around.  On the other hand it made it very difficult to see Uboats painted gray in the gray water and a gray background.  He had heard about others spotting periscopes in the seas by lookouts.  He had some doubts about those stories.  He found it hard to believe anyone even with the best eyesight could see one of those in the waves.  But maybe it did happen on occasion.  He heard one of the officers last night mention something about Iceland so he thought they must be near there and beginning to make the turn southward toward Scotland and England.  The skies were beginning to break some.  There was light streaming in low on the eastern horizon.  You might know it was dead in the middle of his watch quadrant so he would have to be looking that way all morning.  If the skies did clear then there was always the chance of planes.  He heard that they had air cover sometimes for the convoy but he had never seen any friendly planes or head anyone else on any ship he had been on talk about seeing them personally.  They were always reported by someone else from someone else.   He wondered if they would have beans and cheese sandwiches again for lunch.  He hoped for something else.  They usually had that in heavy seas when cookie couldn’t prepare anything much on the galley stove.

The klaxen sounded with its ear shattering screech and pitch and then he noticed the “sub in vicinity” flag being run up.  It was up most of every voyage.  The PA announced double watch.  So he would have company in a few minutes but at least it was not battle stations.  It would be Moose joining him.

to be continued…………..www.olcranky.wordpress.com

I wrote a book.

Seriously, that’s the most amazing thing of all, to me at least. I’m a sixty year-old engineer and business owner and along the way I’ve written a lot, though none of it is anything your readers would be the least bit interested in. Not unless they wanted to know about groundwater aeration and treatment systems. Ho Hum.

But I’ve also had a life-long interest in World War Two history. Why? I’m not sure. I didn’t fight in it, and neither did my father (washed out of the army with flat feet). Perhaps it was because WW2 was one of the most significant events in human history, claimed more than fifty million lives, and changed the balance of world power. Sounds pretty heavy doesn’t it. Well, at any rate, I’ve always been interested and read everything I could about this greatest of all human conflicts.

About fifteen or twenty years ago I read Herman Wouk’s The Winds of War. And a few years later, the sequel, War and Remembrance. Now that I thought is the way to write about history. Make it real, and visceral, make it directly impact someone we care about. Make it well documented, but do it in a way that even though we know how the war turns out we can’t put down the book because we absolutely must find out what happens to Natalie.

So, the right part of my brain began to poke through and I wanted to write something. I wanted to write something about the war. But what? What could I write that hadn’t already been written by Wouk, or Leon Uris, or Alan Furst, or historians like Stephen Ambrose. Then, a funny thing happened. My daughter married a young man from Belgium and moved to Europe, setting our family on a course that has forever changed our lives.

Over time, while traveling to Europe 2-3 times a year, we became very close friends with my son-in-law’s parents. They are wonderful, caring people who are several years older than we are. They were young children during the German occupation of Belgium, young, but old enough to remember. They didn’t talk about it at first, in fact they still don’t, its over, it happened a long time ago, and they survived. End of story. But gradually, as they realized I really wanted to know, they began to tell me the stories. They told me about living in the cellar while their city was being bombed, about German snipers shooting at children in the streets, about not having anything to eat for months on end, about my son-in-law’s grandfather being dragged away from the family home by the Gestapo in 1941. . . and returning five years later when he walked home from Germany.

It inspired me. It made it real.

And I spent the next five years writing Night of Flames: A Novel of World War Two.

Since the book was published, a lot of good things have happened. It has received many excellent reviews, it received the “Outstanding Achievement Award from the Wisconsin Library Association, and it has sold well, both here and in Europe. But what I find most gratifying is when someone who has read it comes up to me and says how much they loved one of the characters, like Anna, the college professor, or Jan, the cavalry officer, or Schmidt, the terrified German soldier. That makes it real. And that’s what it’s all about.

Douglas W. Jacobson is an engineer, business owner and World War Two history enthusiast. Doug has traveled extensively in Europe researching stories of the courage of common people caught up in extraordinary circumstances. His debut novel, Night of Flames: A Novel of World War Two was published in 2007 by McBooks Press, and was released in paperback in 2008. Night of Flames won the 2007 OUTSTANDING ACHIEVEMENT AWARD from the Wisconsin Library Association. Doug has also published articles on Belgium’s WW2 escape organization, the Comete Line; Poland’s 1st Armored Division; and the liberation of Antwerp. Doug has just completed his second novel set in Europe at the end of WW2. You can visit his blog at www.douglaswjacobson.blogspot.com.

People ask me all the time about my dad. I think because I write so much about my mother, most people just assume I don’t have much a relationship with my dad, but that’s just not the case. In fact, I think I have a more normal relationship with my dad than I ever had with my mother. Well, as normal as a relationship one can have when you’re a gay, recovering alcoholic/addict, only child. But he’s done his best, and really, what more can you ask for.

Several years ago, my dad and I went through a period of misunderstanding. He was an awesome dad when I was a little kid up through high school. My dad was my chief enabler. Buying me cars, getting me out of jail, paying for attorneys, college, apartments, vacations and treatments. During our time of misunderstanding, I worked with my sponsor on wanting a relationship with my dad where he would just call me up to talk, or invite me out to lunch. My sponsor at the time asked me to explain my dad’s relationship with his own father. “Did he have one? I mean…did he really have one? Because we can’t assume your dad has a road map for what that relationship you’re wanting looks like.” And he was right. But I think I allowed myself to become angry with my father for not doing all of the work, to which my sponsor asked, “what does your dad say when you ask him for that kind of relationship?” And that was the joke, because I had never asked for any kind of relationship. I had never set boundaries or told him what I wanted. And as most of us know, resentments are unfulfilled expectations.

So he and I worked on things, and they’re better. And I consider my dad and I very close. Especially when I need him to help me with anything medical, anything pertaining to my car or how to set up an IRA. My father is my forgotten soldier, always out at war, walking the fields for me, while I’m back at home, resting comfortably on my couch. I always feel a little safer just knowing he’s out there. And I think we all have forgotten soldiers out there, who make us feel safer, just knowing there around.

And so really, I don’t write much about him, because my dad is kind of a private person, unlike myself, and he is also a constant in my life. I also think it is much easier to write about people once they’re gone. If I knew my mother was reading over my shoulder half of the things I wrote, they would never make it to the page. She just wouldn’t have liked being exposed, no matter how much she was helping someone with her story. She never quite understood that in all her wisdom.

But maybe it’s time for me to give that soldier a badge of honor. Thanks dad; for everything. For cars and trips and treatment. For memories of skiing and laughter driving fast in your car. For a few drinks too many, and understanding now that I can’t have any. For my other mother, Debbie, more mother than step than anyone could ask for in a woman. For acceptance and tolerance, not in my being gay or being an addict, but in being crazy, demanding and overbearing. Thanks for all of it. A long, long time ago, driving back to your house one day, you apologized to me for leaving me alone with my mother. Well, thank you. For all of those times I was allowed to have with her. You have been released. Thank you for integrity and honesty, both qualities I learned from you because they were not inherent. But most of all, above all else…thank you for your humor. It has been God’s quiet reprieve from all that is dangerous and terrifying in this world to me. It is what most notice first about me, except from your wonderfully, azure eyes which women and men alike stare into daily. Your humor, although sometimes painful growing up, has been your greatest gift. Thank you for all of it…I love you!

When I was a little kid, my dad would drive his old Porsche up towards our sailboat in Michigan, 90 miles an hour in a fifty, fleeing the cops, cranking the music loud. I will always remember one of his favorites because he always warned it would us one day. And maybe, although I hate to admit the truth, he was right as he’s been so many times before…now, as I watch Harry Chapin sing “Cat’s in the Cradle” live, I’m reminded, like my mother has become famous for saying, we’re on borrowed time as it is…

(stackoverflow rep: 7576, Project Euler 83/257 complete)

In my band days we called it "Gaffer"

Reading Joel’s¹ Duct-Tape Programmer article this morning (in the interests of full disclosure I should admit without additional prevarication that I have a large roll of “Duck” tape in the second drawer of my desk as I type) one sentence smacked me metaphorically between the eyes:

“Shipping is a feature”

I was transported back a couple of decades to the time when the bank for whom I was then working discovered that it was building not one but two settlement systems (the things that ensure that what traders agree should happen actually does) in two locations: London and Zurich. In London we were targeting our DEC VAX/Oracle platform, while the Swiss were designing with their local Tandem Non-Stop installation. And we’d both have gotten away with it if it hadn’t been for that meddling CEO…

It was decreed that The Wise Men (external auditors) be appointed to review the two projects and pronounce which should live and which should consign its members to the dole queue.

The Wise Ones duly decamped to Zurich to spend a few weeks working through the cabinets of meticulously-detailed standards-compliant design documentation that had been lovingly crafted over the past several months, with coding about to start. Then they came to see us. It didn’t look so good.

dried-up and crusty now...

What documentation we had was months old (from a previous, aborted start of the waterfall) and coated in Tipp-Ex. Remember the white error-correction fluid we used all the time back in the 20th Century? When we still wrote “memos”? After a week of vagueness and frustration a set of presentations were scheduled for the Friday, at which we proposed to try to fill in the gaps.

Ing-er-land!

London won.

Yay us, but how? On most objective measurements we were deficient when compared with our continental rivals, even we agreed on that. But on that Friday afternoon, I got to stand up to summarise the differences, positive and negative between the two projects, as seen by the London team. I think what may have swung it was the part where I got to say “our system has been settling trades since 3 o’clock this morning”.

In about nine months, one team had done everything by the Book (don’t know the title, but I bet it had “Structured” in it) and had reached the point where they had, well, a book. Lots of books, in fact – they’d worked really hard. In the same time, we built a system and even better, shipped it. I don’t think anyone had written any Agile books by then – even if they had, we hadn’t read them.

Our team hadn’t done an awful job by any means, you understand: there’d been a few weeks of up-front requirement-gathering/scoping.  We had a massive data model that we Tipp-Exed down to the minimum needed. We had an outline architecture that, through luck or judgement, proved to be appropriate. Probably best of all, though, we sat with our users while we built their system. Better, as we built different features we moved around so we were always within speaking distance of our domain expert (I don’t think we’d done the whole “domain” thing then – we just called them “users”). So  we seldom got very far off track while stuff got built, and we were, with hindsight, feature-driven and relatively lowly-coupled/highly cohesive at the component level, all Good Things. Mostly written in COBOL, too.

Looking back, we were lucky: we didn’t manage to repeat the magic and fell back into time and cost overruns with the next couple of large projects. At least we were still being paid, unlike our erstwhile colleagues in Switzerland.

On several occasions he bravely stood on rooftops in London when German bombs rained down in world war two.

He lost more elections than any other Member of Parliament in Britain.

His had a very unhappy childhood, his father seldom spoke to him yet he always spoke kindly of his parents and he never blamed his childhood for anything.

A gold watch his father had given him slipped off his wrist and fell into a river when he was in the army, after attempts to dive down and find it proved unsuccessful, he hired 23 of his army mates to dig a new path for the river; he then drained the river with the hose from the local fire truck and found his watch.

He constantly battled against what he called his black dog (depression) yet he always bounced back and was renowned for his optimistic and resilient spirit.

At a time when leaders were not meant to cry he often wept openly when he walked through a bombed out London and talked to the people after the German blitz.

When staying in the White house in America he was once interrupted by a wheel chair bound President Roosevelt as he came out of the shower (bath); when Roosevelt hurriedly turned away, Churchill held out his hand and said “The Prime Minister of Great Britain has nothing to hide from the President of the United States.

“So there I was, sittin’ in a ditch for 47 hours straight. No food, only water was the morning dew, and my only weapon was a shank that I crafted from a leaf stalk and a shoe string – when BOOOOOM! Squirrel hits me square in the face! I’m talking dead-center-mess-you-up assault! So there I was, wrestlin’ this squirrel to the ground with my shank….”

“Count on Wesley to keep the water cooler entertained,” Betty smirked behind her coffee. “What was it last week? Suicidal bunny in Korea?”

“Actually, it was a bear. So there I was…”

Updated the Sources page with a couple of additional references (and corrected some typos).

Added some encouragement to take part in the various projects, and also come to my events in Off the Shelf in October, especially the drop-in workshop on Oct 15th.

Also, added to the Audio page some notes on how the call for contributions is progressing.

Every day this kind of thoughts rattle in my head. is there ever a time to wake up. please comment or maybe it is just me??
THIS WAS WRITTEN BY A SOLDIER IN IRAQ ,

Okay, I need to rant. I was just watching the news, and I caught part of a report on Michael Jackson. As we all know, Jackson died the other day. He was an entertainer who performed for decades. He made millions, he spent millions. He did a lot of things that make him a villain to many people. I understand that his death would affect a lot of people, and I respect those people who mourn his death, but that isn’t the point of my rant. Why is it that when ONE man dies, the whole of America loses their minds with grief. When a man dies whose only contribution to the country was to ENTERTAIN people, the American people find the need to flock to a memorial in Hollywood and even Congress sees the need to hold a “moment of silence” for his passing?
Am I missing something here? ONE man dies, and all of a sudden he’s a freaking martyr because he entertained us for a few decades? What about all those SOLDIERS who have died to give us freedom? All those Soldiers who, knowing that they would be asked to fight in a war, still raised their hands and swore to defend the Constitution and the United States of America. Where is there moment of silence? Where are the people flocking to their graves or memorials and mourning over them because they made the ultimate
sacrifice?
When did this country become so calloused to the sacrifice of GOOD MEN and WOMEN, that they can arbitrarily blow off their deaths, and instead, throw themselves into mourning for a “Pop Icon?”
I think that if they are going to hold a moment of silence IN CONGRESS for Michael Jackson, they need to hold a moment of silence for every service member killed in Iraq and Afghanistan. They need to PUBLICLY recognize every life that has been lost so that the American people can live their callous little lives in the luxury and freedom that WE, those that are living and those that have gone on, have provided for them.
But, wait, that would take too much time, because there have been so many willing to make that sacrifice.
After all, we will never make millions of dollars. We will never star in movies, or write hit songs that the world will listen too. We only shed our blood, sweat and tears so that people can enjoy what they have.
Sorry if I have offended, but I needed to say it. Feel free to pass this along if you want.
Remember these five words the next time you think of someone who is serving in the military;
“So that others may live…”

http://www.comcast.net/articles/news-national/20090909/US.Courthouse.Kickbacks/

ALLENTOWN, Pa. — Federal prosecutors have ratcheted up their pursuit of two former Pennsylvania judges accused of taking $2.8 million in kickbacks to place youth offenders in private detention centers.

[. . . ]

The indictment accused Ciavarella and Conahan of extorting kickbacks from the former co-owner of PA Child Care LLC and its sister facility, Western PA Child Care.

Conahan shut down Luzerne County’s existing juvenile detention facility in 2002, saying it was unsafe. In 2004, the county entered a 20-year, $58 million agreement with PA Child Care to lease its new Pittston Township facility.

The indictment said that Ciavarella, as juvenile court judge, sent youths to PA Child Care and later to its sister facility while he was accepting payments. To keep the prison beds full, Ciavarella routinely deprived young defendants of their right to counsel, ordered juveniles into detention even when probation officers didn’t recommend it, and pressured probation officials to change their recommendations, the indictment said.

[ . . . ]

Former PA Child Care owner Robert Powell, a lawyer, pleaded guilty July 1 to paying kickbacks to the judges. Prominent construction company owner Robert K. Mericle, who built the detention centers, pleaded guilty earlier this month to a charge of withholding information on a crime.

[etc.]

Former Pa. judges indicted in kids-for-cash scheme

By MICHAEL RUBINKAM, AP
3 hours ago

(from Associated Press)

http://www.comcast.net/articles/news-national/20090909/US.Courthouse.Kickbacks/

[And, there's the US health care system / prison for private profit / mental health and "behavioral" health modification systems / pharmaceutical based cooperation cocktails for behavior modification systems at work as it has been for the last thirty years - and they want to make that more pervasive, rather than less, rather than fixing it, rather than making it right? Apparently.]

***

My Note -

I listened to the President and the Congressional address about health care last night at least three times to hear it all. I listened to it carefully and it is obvious that both the President and the Legislature are overstepping the bounds of their authority. But, apparently -

They plan to extort a required tax against every living, breathing citizen of the United States, exempting illegal immigrants of course who gets to keep all of the money they make here. And, that tax will be put into the profit glut of every insurance company in America – that’s what it means to require every citizen to have health insurance. It denies the freedom of choice, it is unfair taxation going into private hands, it is illegal and it will require each and every citizen, business and child born into this country to pay to be alive in the United States of America.

At the same time, doctors and hospitals and pharmaceutical companies will be exempt from accountability when their all too typical malpractice occurs. And yet, we all must be registered with some health care insurance provider and pay each month for each member of our families, our children, ourselves and our businesses to be covered by their services without recourse, simply because we are alive and citizens of the United States. They may as well have just taken 50% of everyone’s income off the top in the first place and provided something in return for it. That would be less than the percentage we are paying now, to get virtually nothing but corruption and Nazi Germany style oppressions and tyrannies across virtually every state and every administration regardless of political party.

It seemed a little off to me that, the people in politics whose funding comes directly from the big insurance companies, health industries and pharmaceutical companies, would be pursuing “health care reform.” Well, now it is obvious that there is no reform in it. The only pursuit they have been making is to charge a tax per head extorted from the freedoms of our citizenship here in order to line the pockets of their campaign contributors.

Now, when any person gives birth to a child in the United States of America, they will be registered and stamped for citizenship with a required registration to a health insurance provider which will legally require those parents and that individual to pay to those insurance revenue streams for every day that they are alive in the United States of America or elsewhere as long as their membership as a citizen of the US is maintained.

And, there will be no recourse against a health system, doctors and industries that have been pervasively known for causing more harm than good on a regular basis, so consistently, in fact as to be unimaginable. Every day across America, health care industry professionals cause harms which were preventable and inexcusable. Nothing in this bill fixes that. The members of Congress and the Administration have no intention of fixing that.

Apparently, their only intention was to jeopardize our freedoms, our rights, our inalienable rights, our basis of freedom and our basis of citizenship. Also, apparently they don’t like the limitations of their power guaranteed by the Constitution to prevent their overstepping the bounds of that oath of office they took. It certainly overstepped those bounds when they decided to impose a privately profitable “tax” called “health care insurance” on every citizen and every business by virtue of their existence.

And then, it begs the question – just as with auto insurance which is required of every vehicle and driver but is no more than a tax on the right to drive in a world that demands personal transportation in order to work, to have a business, or to make a living – what happens when people don’t have the money to continue paying those health insurance premiums? Then do they lose the right of citizenship in the United States, despite being born here, taken the oath of citizenship here, being a consummated and valuable member of the citizens of the United States and despite being guaranteed that citizenship by the Constitution?

Will that be done in the same way the car insurance companies send license and personal information to the State Office of No Insurance to legally dismiss our drivers’ license, as is done now? Will they take away the rights to our own children and to our own citizenship, beyond what they’ve already been doing in that arena through health and human services / social services, simply because they are born without the required registrations and payments to the health insurance industries and we failed to “sign them up for it” and remit those payments to them?

How about this – what if we directly and immediately take to task those insurance companies as we should’ve done in the first place. They are the ones who have driven up the costs of health care beyond all measure. They are the ones who have tolerated shoddy health services, malpractice, incompetence, dispassionately destroyed the health of people for profit motives, paid themselves like kings and lobbied to get out of any accountability to the public and their customers. They are the ones that need to be changed. We sure don’t need to keep paying them to continue slaughtering us. They’ve done enough damage for several lifetimes and now they intend to further that profit machine to serve their own interests to an even greater and more oppressive extent. They are inherently evil – why give them even one more dime to use to do more damage?

- cricketdiane, 09-10-09

****

And, oh by the way, they plan on robbing over $500 Billion dollars from the social security system, Medicare and Medicaid funds that we have all paid into the government trusts for it, under the guise of this “health care reform.” That isn’t their money and is not free money, but every time they can find an excuse to get their hands on it – even paying the interest on the national debt out of it – there they go without anyone saying a word. And they are doing it again. It was written into the first bill and it will be found in the second one that will come to vote. Neither Congress nor the office of the President has any right given to them by the Constitution and by our laws, to levy a tax against every citizen for the right to be alive. And neither do they have the power offered to them which legislates health care to every person under their jurisdiction. It denies the fundamental rights and freedoms we are guaranteed.

Looking at how easily those judges in the story above, denied the rights and opportunities of those who were to be protected by them and did so with no more conscience about right and wrong than their insatiable desire for money could offer, I am horrified at the thought that more of that kind of power would be put into the hands of judges, insurance companies, government agency officials, states, health care businesses, prison for profit businesses, mental health agencies and industries or pharmaceutical companies / lawyers / academics / legislatures / state agencies / health and human services / hospitals / or in fact, anybody.

***

For the same reason that Congress could not legislate the salaries or bonuses of bankers and financiers, nor could limit or restrict them legally – they also cannot legally legislate health care. It is outside the authority of the President and the Congress, which constitutes a taking and assuming powers that do not legally belong to them. Anything they do in that process by exceeding their bounds of authority and doing it in that way will contest the foundation of authority they have been granted and break the validity of the legal and consensual premise of that authority.

***

It is a shame that so many shed their blood and gave their lives to insure our democracy, freedoms, individual rights and noble ideals when the real enemies of those tenets were in our businesses and seated in our own government all along, both of whom were so quick to disregard them, and found it painlessly easy to disavow the importance of those core foundations, then undermine them as a possibility guaranteed to everyone or, in fact, to anyone.

- cricketdiane

***

Medical malpractice cases from one law firm – these aren’t small negligence cases that are being pursued – it is obscene how far the health care system and health care industries have strayed away from offering health -

Notable Cases

• Sued Woodstock Residence Nursing Home on behalf of one patient who died as the possible result of a morphine overdose.^[3] The Illinois Department of Public Health found six mysterious deaths at the home and two employess face criminal charges.^{[4] [5]}
• $3 million awarded on behalf of woman who choked to death at a nursing home when her trachea tube got clogged. ^[6]
• $7.62 million verdict against an HMO doctor who ignored a mother’s complaints of postpartum bleeding, resulting in her bleeding to death.^[7]
• $10 million settlement on behalf of a 5-year-old boy who, while playing in an open fire hydrant, was struck by a City of Chicago Fire Department truck and ultimately lost his leg and half of his pelvis.^[8]
• $14 million verdict on behalf of a patient who’s diagnosis of lung cancer was delayed after doctors ignored abnormal chest x-ray results. ^[9]

http://en.wikipedia.org/wiki/Levin_&_Perconti

• Personal injury
• Nursing Home Abuse and Neglect/Elder Abuse
  • Bed sores, pressure sores, decubitus ulcers
  • Sepsis
  • Wandering and Elopement
  • Falls
  • Physical abuse and assault or Sexual abuse and assault
  • Physical restraints or Chemical restraints
  • Verbal abuse
  • Malnutrition and dehydration
  • Medication errors
  • Choking
  • Clogged breathing tubes
  • Burns
  • Elder financial exploitation
• Medical Malpractice
  • Missed or delayed diagnosis
  • Lack of informed consent
  • Birth injury
  • Doctor errors
  • Nursing errors
  • Hospital errors
  • Anesthesia errors
  • Surgical errors
  • Pharmaceutical errors
  • [Medical device#high risk devices | [Medical device errors]]
  • Misread x-rays, slides, and ultrasounds
  • HMO misconduct
  • Adverse drug reactions
  • Dental injuries
• Wrongful death
• Product liability
  • Machinery and tools
  • Medical devices
  • Medicine and drugs
  • Food and tobacco
  • Toxic chemicals and substances such as pesticides, asbestos, and mold
  • Firearms
  • Motor vehicles and automobile accessories such as tires, seatbelts, airbags, and child car seats
  • Household products and appliances
  • Toys and recreational equipment
  • Clothing and apparel
• Automobile Accidents
• Trucking Accidents
• Brain Injuries
• Burn Injuries
• Birth Injuries
  • Cerebral Palsy
  • Erb’s Palsy or Klumpke Palsy
  • Shoulder dystocia
  • Brachial plexus injuries
  • Breech birth complications
  • Birth hypoxia or brain damage
  • Fetal death occurring before or during birth
  • Death or trauma related to medication errors
• Spinal Cord Injuries
• Aviation Accidents
• Boating Accidents
• Bicycle Accidents
• Premises Liability
• Slip and Fall Accidents
• Pedestrian Accidents
• Construction Accidents
• Workers’ Compensation
• Jones Act and Maritime Law
• Asbestos and Mesothelioma
• Federal Tort Claims Act
• Injuries to Minors and Children
• Professional Malpractice

***

A 2004 study of medical malpractice claims in the United States examining primary care malpractice found that though incidence of negligence in hospitals produced a greater proportion of severe outcomes, the total number of errors and deaths due to errors were greater for outpatient settings. No single medical condition was associated with more than five percent of all negligence claims, and one-third of all claims were the result of misdiagnosis.^[6]

A recent study by Healthgrades found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially preventable medical errors. Researchers examined 37 million patient records and applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a study published in the Journal of the American Medical Association (JAMA) in October 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic.^[7] Some researchers questioned the accuracy of the 1999 IOM study, reporting both significant subjectivity in determining which deaths were “avoidable” or due to medical error and an erroneous assumption that 100% of patients would have survived if optimal care had been provided. A 2001 study in JAMA estimated that only 1 in 10,000 patients admitted to the hospital would have lived for 3 months or more had “optimal” care been provided.^[8]

A 2006 follow-up to the 1999 Institute of Medicine study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates. In 2000 alone, the extra medical costs incurred by preventable drug related injuries approximated $887 million – and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.^[9]

http://en.wikipedia.org/wiki/Medical_malpractice

Medical malpractice

From Wikipedia, the free encyclopedia

The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page.

Medical malpractice is professional negligence by act or omission by a health care provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. Standards and regulations for medical malpractice vary by country and jurisdiction within countries.

***

Medical error

From Wikipedia, the free encyclopedia

The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page.

Medical error is an inaccurate or incomplete diagnosis and/or treatment of a disease; injury; syndrome; behavior; infection or other ailment.

In the U.S., medical errors are estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year.^[1][2] One older extrapolation suggests ‘180,000 people die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every 2 days’.^[3] It is estimated that in a typical 100 to 300 bed hospital in the United States, excess costs of $1,000,000 to $3,000,000 attributable to prolonged stays and complications just due to medication errors occur yearly.

However, medical error definitions are subject to debate, as there are many types of medical error from minor to major,^[4] and causality is often poorly determined.^[5] The Health Grades study statistics, based on AHRQ MedPAR data, were based on administrative records, not clinical records, and largely overlooked multi-causality of outcomes.^[6]

Medical care is frequently compared adversely to aviation: while many of the factors which lead to errors in both fields are similar, aviation’s error management protocols are regarded as much more effective.^[7]

Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That’s more than die from motor vehicle accidents, breast cancer, or AIDS–three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems.

In 2000, The Institute of Medicine released “To Err Is Human”, which asserts that the problem in medical errors is not bad people in health care–it is that good people are working in bad systems that need to be made safer.[8]

http://en.wikipedia.org/wiki/Medical_error

***

Examples of errors

1. Misdiagnosis;
2. Giving the wrong drug or (wrong patient, wrong chemical, wrong dose, wrong time, wrong route);
3. Giving two or more drugs that interact unfavorably or cause poisonous metabolic byproducts;
4. Wrong-site surgery, such as amputating the wrong limb.
5. Gossypiboma, a surgical sponge left behind inside the patient after surgery.

Iatrogenesis

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Ancient Greek painting in a vase, showing a physician (iatros) bleeding a patient.

The terms iatrogenesis and iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, dentists, and others. Iatrogenesis is not restricted to conventional medicine and can also result from complementary and alternative medicine treatments.

Some iatrogenic artifacts are clearly defined and easily recognized, such as a complication following a surgical procedure. Some are less obvious and can require significant investigation to identify, such as complex drug interactions. And, some conditions have been described for which it is unknown, unproven or even controversial whether they be iatrogenic or not; this has been encountered particularly with regard to various psychological and chronic pain conditions. Research in these areas is ongoing.

Causes of iatrogenesis include medical error, negligence, and the adverse effects or interactions of prescription drugs. In the United States, from 120,000 to 225,000 deaths per year may be attributed in some part to iatrogenesis.^[1]

Contents 1 History 2 Sources of iatrogenesis 3 Causes and Consequences 3.1 Medical error and negligence 3.2 Adverse effects 3.3 Nosocomial infection 3.4 Psychology 3.5 Iatrogenic poverty 4 Incidence and importance 5 See also 6 Footnotes 7 References 8 External links

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History

In his 1861 book, Semmelweis presented evidence to demonstrate that the advent of pathological anatomy in Vienna in 1823 (left vertical line) was correlated to the incidence of fatal childbed fever there. Onset of chlorine handwash in 1847 marked by vertical line at far right. Rates for Dublin maternity hospital, which had no pathological anatomy, is shown for comparison (view rates).

Etymologically, the term means "brought forth by a healer" (iatros means healer in Greek); as such, in its earlier forms, it could refer to good or bad effects.

Since the time of Hippocrates, the potential damaging effect of a healer's actions has been recognized. The old mandate "first do no harm" (primum non nocere) is an important clause of medical ethics, and iatrogenic illness or death caused purposefully, or by avoidable error or negligence on the healer's part became a punishable offense in many civilizations.

The transfer of pathogens from the autopsy room to maternity patients, leading to shocking historical mortality rates of puerperal fever at maternity institutions in the 1800s, was a major iatrogenic catastrophe of that time. The infection mechanism was first identified by Ignaz Semmelweis.

With the development of scientific medicine in the 20th century, it could be expected that iatrogenic illness or death would be more easily avoided. Antiseptics, anesthesia, antibiotics, and better surgical techniques have been developed to decrease iatrogenic mortality.

Sources of iatrogenesis

Examples of iatrogenesis:

• medical error, poor prescription handwriting
• negligence
• faulty procedures, techniques, information, or methods
• prescription drug interaction
• adverse effects of prescription drugs
• over-use of drugs leading to antibiotic resistance in bacteria
• nosocomial infection
• blood transfusion
• harmful emotional distress from the ascription of mental pathology nomenclature for transient personal problems

Causes and Consequences

Medical error and negligence

Iatrogenic conditions do not necessarily result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic; for example, radiation therapy or chemotherapy, due to the needed aggressiveness of the therapeutic agents, frequent effects are hair loss, anemia, vomiting, nausea, brain damage etc. The loss of functions resulting from the required removal of a diseased organ is also considered iatrogenesis, e.g., iatrogenic diabetes brought on by removal of all or part of the pancreas.

In other situations, actual negligence or faulty procedures are involved, such as when drug prescriptions are handwritten by the pharmacotherapist. It has been proven that poor handwriting can lead a pharmacist to dispense the wrong drug, worsening a patient's condition.^{[citation needed]}

Adverse effects

A very common iatrogenic effect is caused by drug interaction, i.e., when pharmacotherapists fail to check for all medications a patient is taking and prescribe new ones which interact agonistically or antagonistically (potentiate or decrease the intended therapeutic effect). Significant morbidity and mortality is caused because of this. Adverse reactions, such as allergic reactions to drugs, even when unexpected by pharmacotherapists, are also classified as iatrogenic.

The evolution of antibiotic resistance in bacteria is iatrogenic as well.Finland M (1979). “Emergence of antibiotic resistance in hospitals, 1935-1975″. Rev. Infect. Dis. 1 (1): 4–22. PMID 45521. Bacteria strains resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs.

Certain drugs are toxic in their own right in therapeutic doses because of their mechanism of action. Alkylating antineoplastic agents, for example, cause DNA damage, which is more harmful to cancer cells than regular cells. However, alkylation causes severe side effects and is actually carcinogenic in its own right, potentially leading to the development of secondary tumors. Similarly arsenic-based medications like melarsoprol for trypanosomiasis cause arsenic poisoning.

Nosocomial infection

A related term is nosocomial, which refers to an iatrogenic illness due to or acquired during hospital care, such as an infection. Sometimes, hospital staff can be unwitting transmitters of nosocomial infections (in one of such instances, many hospitals have forbidden physicians to wear long ties, because they transmitted bacteria from bed to bed when the doctor swept the tie over the patients when bending over them).^{[citation needed]} The most common iatrogenic illness in this realm, however, are nosocomial infections caused by unclean or inadequately sterilized hypodermic needles, surgical instruments, and the use of ungloved hands to perform medical or dental procedures.^{[citation needed]} For example, a number of hepatitis B and C infections caused by dentists and surgeons on their patients have been documented.^{[citation needed]} One of the most horrid cases of massive death caused in recent times by iatrogenic infection has been reported on several bush hospitals in Zaire and Sudan, where the intensive reuse of poorly sterilized syringes and needles by nurses spread the Ebola virus, probably causing hundreds of deaths. ^[2]

Psychology

In psychology, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy^[3]).

Conditions hypothesized to be partially or completely iatrogenic include bipolar disorder,^[4] dissociative identity disorder,^[5][3] fibromyalgia,^[6] somatoform disorder,^[7] chronic fatigue syndrome,^[7] posttraumatic stress disorder,^[8] substance abuse,^[9] antisocial youths^[10] and others^[11] though research is equivocal for each condition. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial.

The over-diagnosis of psychological conditions is due to clinical dependence upon subjective criteria. The assignment of pathological nomenclature is rarely a benign process and can easily rise to the level of emotional iatrogenesis, especially when no alternatives outside of the diagnostic naming process have been considered.^{[citation needed]}

Iatrogenic poverty

Medical treatment does not only have an effect on the mind and body of patients but also on their wallet. Meessen et al used the term “Iatrogenic Poverty” to describe impoverishment induced by medical care^[12]. Impoverishment is described for households exposed to catastrophic health expenditure^[13] or to hardship financing^[14]. Every year, worldwide, over 100,000 households fall into poverty due to health care expenses. Especially in countries in economic transition, the willingness to pay for health care is increasing and the supply side does not stay behind and develops very fast. But, the regulatory and protective capacity in those countries is often lagging behind. Patients easily fall in a vicious circle of illness, ineffective therapies, consumption of savings, indebtedness, sale of productive assets and eventually poverty.

Incidence and importance

Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten were considered major, and in 2% of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications.^[15] In another study, the main factors leading to problems were inadequate patient evaluation, lack of monitoring and follow-up, and failure to perform necessary tests.^[16]

In the United State alone, recorded deaths per year (2000):

• 12,000—unnecessary surgery
• 7,000—medication errors in hospitals
• 20,000—other errors in hospitals
• 80,000—infections in hospitals
• 106,000—non-error, negative effects of drugs

Based on these figures, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Also, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).

This totals 225,000 deaths per year from iatrogenic causes. In interpreting these numbers, note the following:

• most data were derived from studies in hospitalized patients.
• the estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.
• the estimates of death due to error are lower than those in the IOM report. If higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.^[1]

See also

• Adverse drug reaction
• Adverse effect (medicine)
• Bedsore
• Bioethics
• Complication (medicine)
• Fatal Care: Survive in the U.S. Health System (book)
• Journal of Negative Results in Biomedicine
• Medical error
• Nocebo
• Patient safety
• Placebo
• Polypharmacy

Footnotes

1. ^ ^{a b} Starfield B (2000). “Is US health really the best in the world?”. JAMA 284 (4): 483–5. doi:10.1001/jama.284.4.483. PMID 10904513.
2. ^ Fisher-Hoch SP (2005). “Lessons from nosocomial viral haemorrhagic fever outbreaks”. Br. Med. Bull. 73-74: 123–37. doi:10.1093/bmb/ldh054. PMID 16373655.
3. ^ ^{a b} Spanos, Nicholas P. (1996). Multiple Identities & False Memories: A Sociocognitive Perspective. American Psychological Association (APA). ISBN 1-55798-340-2.
4. ^ Pruett Jr, John R.; Luby, Joan L. (2004). “Recent Advances in Prepubertal Mood Disorders: Phenomenology and Treatment“. Curr Opin Psychiatry 17 (1): 31–36. doi:10.1097/00001504-200401000-00006. http://www.medscape.com/viewarticle/466375_print. Retrieved 2008-05-04.
5. ^ Braun, B.G. (1989). Dissociation: Vol. 2, No. 2, p. 066-069: Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD (Morose Parasitic Dynamism). https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1425/1/Diss_2_2_3_OCR.pdf. Retrieved 2008-05-04.
6. ^ Hadler, N.M. (1997). “Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients?“. Postgrad Med 102 (6): 43. http://www.ncbi.nlm.nih.gov/pubmed/9270707. Retrieved 2008-05-04.
7. ^ ^{a b} Abbey, S.E. (1993). “Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome“. Ciba Found Symp 173: 238–52. http://www.ncbi.nlm.nih.gov/pubmed/8491101. Retrieved 2008-05-04.
8. ^ Boscarino, JA (2004). Evaluation of the Iatrogenic Effects of Studying Persons Recently Exposed to a Mass Urban Disaster. http://mailer.fsu.edu/~cfigley/IatrogenicEffectsfinal3p1.pdf. Retrieved 2008-05-04.
9. ^ Moos, R.H. (2005). “Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence , predictors, prevention” (abstract). Addiction 100 (5): 595–604. doi:10.1111/j.1360-0443.2005.01073.x. http://pt.wkhealth.com/pt/re/addi/abstract.00008514-200505000-00006.htm;jsessionid=LpCb6sF6cx1sMvkMlc5h62MCCWh1Gj5vyLBz0ydpfn36tl31Y8Kn!1379360954!181195629!8091!-1.
10. ^ Weiss, B.; Caron, A.; Ball, S.; Tapp, J.; Johnson, M.; Weisz, J.R. (2005). “Iatrogenic effects of group treatment for antisocial youths“. Journal of Consulting and Clinical Psychology 73 (6): 1036–1044. doi:10.1037/0022-006X.73.6.1036. http://eric.ed.gov:80/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ734173&ERICExtSearch_SearchType_0=no&accno=EJ734173. Retrieved 2008-05-04.
11. ^ Kouyanou, K; Pither, CE; Wessely, S (01 Nov 1997). “Iatrogenic factors and chronic pain” (abstract). Psychosomatic Medicine 59 (6): 597–604. PMID 9407578. http://www.psychosomaticmedicine.org/cgi/content/abstract/59/6/597. Retrieved 2008-05-04.
12. ^ Meessen,B., Zhenzhong,Z., Van Damme,W., Devadasan,N., Criel,B., Bloom,G. (2003). “Iatrogenic poverty.”. Tropical Medicine & International Health 8 (7): 581-4.
13. ^ Xu et al. (2007). “Protecting Households from Catastrophic Health Spending”. Health Affairs 26 (4): 972-83. doi:10.1377/hlthaff.26.4.972.
14. ^ Kruk et al. (2009). “Borrowing And Selling To Pay For Health Care In Low- And Middle-Income Countries”. Health Affairs 28 (4): 10056-66. doi:10.1377/hlthaff.28.4.1056.
15. ^ Steel K, Gertman PM, Crescenzi C, Anderson J (1981). “Iatrogenic illness on a general medical service at a university hospital”. N. Engl. J. Med. 304 (11): 638–42. PMID 7453741.
16. ^ Weingart SN, Ship AN, Aronson MD (2000). “Confidential clinician-reported surveillance of adverse events among medical inpatients”. J Gen Intern Med 15 (7): 470–7. doi:10.1046/j.1525-1497.2000.06269.x. PMID 10940133.

References

• Valenstein, Elliot S. (1986). Great and desperate cures: the rise and decline of psychosurgery and other radical treatments for mental illness. New York: Basic Books. ISBN 0465027105.

External links

• Patient Safety Network

Retrieved from “http://en.wikipedia.org/wiki/Iatrogenesis“

Categories: Medical ethics | Healthcare quality | Medical error

http://en.wikipedia.org/wiki/Iatrogenesis

***

My Note -

In medical journals and other statistical analysis portals / academics / study / dissemination – the terms can be Iatrogenesis, as above, or medical error, or pharmaceutical error or who knows how many other things. It seems to be divided up rather than placed in the same category by the same terms where an overview of the problem and of the pervasiveness of the problems would be self-evident.

cricketdiane, 2009

***

Adverse drug reaction

From Wikipedia, the free encyclopedia

An adverse drug reaction (abbreviated ADR) is an expression that describes harm associated with the use of given medications at a normal dose^[1]. The meaning of this expression differs from the meaning of “side effect”, as this last expression might also imply that the effects can be beneficial.^[2] The study of ADRs is the concern of the field known as pharmacovigilance.

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[edit] Classification

ADRs may be classified by e.g. cause and severity.

[edit] Cause

• Type A: Augmented pharmacologic effects – dose dependent and predictable
• Type B: Bizarre effects (or idiosyncratic) – dose independent and unpredictable
• Type C: Chronic effects
• Type D: Delayed effects
• Type E: End-of-treatment effects
• Type F: Failure of therapy

Types A and B were proposed in the 1970s,^[3] and the other types were proposed subsequently when the first two proved insufficient to classify ADRs.^[4]

[edit] Seriousness and Severity

The American Food and Drug Administration defines a serious adverse event as one when the patient outcome is one of the following:^[5]

• Death
• Life-Threatening
• Hospitalization (initial or prolonged)
• Disability – significant, persistent, or permanent change, impairment, damage or disruption in the patient’s body function/structure, physical activities or quality of life.
• Congenital Anomaly
• Requires Intervention to Prevent Permanent Impairment or Damage

Severity is a point on an arbitrary scale of intensity of the adverse event in question. The terms “severe” and “serious” when applied to adverse events are technically very different. They are easily confused but can not be used interchangeably, require care in usage.

A headache is severe, if it causes intense pain. There are scales like “visual analog scale” that help us assess the severity. On the other hand, a headache can hardly ever be serious, unless it also satisfies the criteria for seriousness listed above.

[edit] Overall Drug Risk

While no official scale exists yet to communicate overall drug risk, the iGuard Drug Risk Rating System is a five color rating scale similar to the Homeland Security Advisory System:^[6]

• Red (High Risk)
• Orange (Elevated Risk)
• Yellow (Guarded Risk)
• Blue (General Risk)
• Green (Low Risk)

[edit] Location

Adverse effects may be local, i.e. limited to a certain location, or systemic, where a medication has caused adverse effects throughout the systemic circulation.

For instance, some ocular antihypertensives cause systemic effects^[7], although they are administered locally as eye drops, since a fraction escapes to the systemic circulation.

Mechanisms

As research better explains the biochemistry of drug use, fewer ADRs are Type B and more are Type A. Common mechanisms are:

• Abnormal pharmacokinetics due to
  • genetic factors
  • comorbid disease states
• Synergistic effects between either
  • a drug and a disease
  • two drugs

Interactions with other drugs

The risk of drug interactions is increased with polypharmacy.

**

Abnormal pharmacokinetics

Comorbid disease states

Various diseases, especially those that cause renal or hepatic insufficiency, may alter drug metabolism. Resources are available that report changes in a drug’s metabolism due to disease states.^[8]

Genetic factors

Abnormal drug metabolism may be due to inherited factors of either Phase I oxidation or Phase II conjugation.^[9][10] Pharmacogenomics is the study of the inherited basis for abnormal drug reactions.

http://en.wikipedia.org/wiki/Adverse_drug_reaction

Monitoring bodies

Many countries have official bodies that monitor drug safety and reactions. On an international level, the WHO runs the Uppsala Monitoring Centre, and the European Union runs the European Medicines Agency (EMEA). In the United States, the Food and Drug Administration (FDA) is responsible for monitoring post-marketing studies.

Examples of adverse effects associated with specific medications

• Abortion, miscarriage or uterine hemorrhage associated with misoprostol (Cytotec), a labor-inducing drug (this is a case where the adverse effect has been used legally and illegally for performing abortions)
• Addiction to many sedatives and analgesics such as diazepam, morphine, etc.
• Birth defects associated with Thalidomide and Accutane.
• Bleeding of the intestine associated with aspirin therapy
• Cardiovascular disease associated with COX-2 inhibitors (i.e. Vioxx)
• Deafness and kidney failure associated with gentamicin (an antibiotic)
• Death, following sedation in children using propofol (Diprivan)
• Dementia associated with heart bypass surgery
• Depression or hepatic injury caused by interferon
• Diabetes caused by atypical antipsychotic medications (neuroleptic psychiatric drugs)
• Diarrhea caused by the use of orlistat (Xenical)
• Erectile dysfunction associated with many drugs, such as antidepressants
• Fever associated with vaccination (in the past, imperfectly manufactured vaccines, such as BCG and poliomyelitis, have caused the very disease they intended to fight).
• Glaucoma associated with corticosteroid-based eye drops
• Hair loss and anemia may be caused by chemotherapy against cancer, leukemia, etc.
• Headache following spinal anesthesia
• Hypertension in ephedrine users, which prompted FDA to remove the status of dietary supplement of ephedra extracts
• Insomnia caused by stimulants, Ritalin, Adderall, etc.
• Lactic acidosis associated with the use of stavudine (Zerit, for anti-HIV therapy) or metformin (for diabetes)
• Liver damage from paracetamol
• Melasma and thrombosis associated with use of estrogen-containing hormonal contraception such as the combined oral contraceptive pill
• Irreversible Peripheral neuropathy associated with the use of fluoroquinolone medications ^[17][18][19]
• Rhabdomyolysis associated with statins (anti-cholesterol drugs)
• Seizures caused by withdrawal from benzodiazepine
• Drowsiness or increase in appetite due to antihistamine use. Some antihistamines are used in sleep aids explicitly because they cause drowsiness.
• Stroke or heart attack associated with sildenafil (Viagra) when used with nitroglycerine
• Suicide, increased tendency associated to the use of fluoxetine and other SSRI antidepressants
• Tardive dyskinesia associated with long-term use of metoclopramide and many antipsychotic medications
• Spontaneous Tendon rupture associated with fluoroquinolone drugs ^[20] even occurring as late as 6 months after treatment had been terminated.^[21]

See also

• EudraVigilance (European Union)
• Iatrogenesis
• Paradoxical reaction
• Polypharmacy
• Toxicology
• The Medical Letter on Drugs and Therapeutics
• Yellow Card Scheme (UK)

References

• The Adverse Drug Reaction Electronic System United States

Medical Errors Costing U.S. Billions

Wednesday, April 9, 2008; 12:00 AM

TUESDAY, April 8 (HealthDay News) — From 2004 through 2006, patient safety errors resulted in 238,337 potentially preventable deaths of U.S. Medicare patients and cost the Medicare program $8.8 billion, according to the fifth annual Patient Safety in American Hospitals Study.

[etc.]

Of the 270,491 deaths that occurred among patients who experienced one or more patient safety incidents, 238,337 were potentially preventable, the researchers said.If all hospitals performed at the level of the top-ranked hospitals, about 220,106 patient safety incidents and 37,214 patient deaths could have been avoided, and about $2 billion could have been saved.

[ . . . ]

Starting Oct. 1, the federal Centers for Medicare and Medicaid Services will stop reimbursing hospitals for the treatment of eight major preventable errors, including objects left in the body after surgery and certain kinds of post-surgical infections.

***

My Note -

The health care reform being legislated currently only includes preventing people from suing doctors, hospitals, pharmaceuticals and to legally require every citizen to have health insurance which amounts to a tax per head levied and extorted from every American in order to exist anywhere in this country. Not only is it not going to solve the health care crisis in this country, it will continue to contribute to the problems we already endure and allow them to get worse. Medicine and profits are not compatible by any sensibilities of conscience and good health.

- cricketdiane, 09-13-09

***

In this project so far, I’ve had several interesting and useful contributions from other poets and artists. However, I’d like quite a few more, if I can get them. You might like to do any (or all) of the following:

- send me a line or two for the audio installation

- if you’re a designer or visual artist, offer to create the planned poetry objects (I’ve a small fund to pay for this work)

- add something to the collaborative poem on this site

- send me you personal or family stories of war that might stimulate the writing.

Alternatively, if you’d like something back from me, contact me about a free workshop or reading. I’m happy to come to any local writing or community group, in or near Sheffield, S Yorks or Derbyshire.

I mean, why wouldn’t you?

Here at Counterforce, we have three simple rules for dealing with all life:

1. Jai Alai is fucking stupid.

2. Funny, sad, tragic, or fitting, death is always weird, no matter where you go or who the hell you are.

and

3. No sailors. No way.

That said, ruminate on last night’s episode of Mad Men, “The Arrangements.” Normally August Bravo would be here to join me, but, well, he didn’t heed Peggy’s mom’s warning and moved to Manhattan. And he got raped.

Somewhere out there in the ether there’s a t-shirt waiting to be dreamt up: I Moved To Manhattan, Got Raped, And All I Got Was This Lousy Fucking T-Shirt. Oh, And A New TV. I’d wear it, but only to classy parties.

Last week I mentioned that Sally Draper was becoming one of my favorite characters and this week, if you didn’t agree with me, let’s face it, that shit was all over your face. Little Kiernan Shipka acted her way nicely (and, yes, adorably) out of the damp paper bag that was the Grandpa Gene storyline (which I respect so much more now, because Gene Hofstadt was a real grandfather, crazy warts and all), and did so marvelously. And she fits so perfectly into the scheme of the show that it hurts.

Oh, and interestingly enough, for a show that’s all about the multi-faceted horridness of 1960s masculinity, I have to say that Bobby Draper, you’re just not cutting it. You’re just there, kid, taking up space, and taking dead men’s helmets. If you’re not careful, you might go upstairs one day, and like the little sister on Family Matters, just never come back down again…

Families are tough, man. And this was an amazing episode about seeking out familial approval, and how you’re never going to get it. Not really. You may always get their love, but they’ll never really understand you. Not in the way you need to be understood.

And the same for the previous generation. You’ll ache to see out their approval, but it’s not coming. And right now, it really feels like that’s what so much of this show is about, at least this year: Looking to the people older than you for understanding and approval and guidance. And finding nothing. Only more confusion.

It’s not their fault. The older generation of America at this time didn’t know how to love. Maybe they still don’t. But back then they didn’t know how to get past the horrors they’d seen within and without and to connect with another human being.

And saddest of all, they haven’t realized that the world changed around them when they weren’t looking and now they’re hopeless to catch up. They don’t even know they’ve been left behind, much like Roger in last week’s episode.

Though it doesn’t say much in credit of the younger generation when they have nicknames like Ho Ho and think that jai alai is the future. And in color! On all three networks!

Poor Betty Draper. As much as I want to root for her, she keeps falling into the category of the precious sad victim. And as much as I want to feel bad for her, I can’t. This woman is terrified of intimacy, of anything outside a perfect world that hasn’t existed in a long, long time, and even when it did, it may have only been in the revisionist history of her pretty little head. In fact, Betty and Ho Ho have a lot in common in that their parents meant the best for them, but know that their kids are unprepared for the world.

Betty Draper = Worst Mother Of The Year, 1963.

Instead, the Mad Men housewife I do actually feel real remorse for is, of course, Sal’s poor wife, Kitty. Her husband’s a commercial director now, ripping off the finest for ad work, but with a little luck, Kitty’s realized something powerful there about the man she loves. And hopefully it’s not that everyone just wants photographs.

She doesn’t need a lot, Sal. But she does need… tending.

And the saddest part of all? On this show, they’re easily the most functioning couple. The truth may be kept at arm’s length, but there is a closeness there. And more importantly, there’s a mutual respect in their bedroom.

I love that Don Draper operates by a certain set of rules that he holds dear. They may not be the same as society’s, not the surface of what society says anyway, but they’re his rules. He’s a man of few words, and they’re sharp, cutting, to the point when they have to be. Surgical strikes, dripping with wit (particularly the line about the guy going off to direct a feature in Hollywood).  And he has no problem taking money from that guy, Horace, for his stupid jai alai campaign, but he’s going to seek out the approval of his elders, and he’s going to at least warn the guy that he’s a moron.

Question for you: Pete’s line about his father and money: “This is his kind of investment.” Is he just playing the account man, trying to line up the sweet deal, or is this his subtle acknowledge of his father’s own financial failures?

Warning sign #1, Ho Ho: If you have to pitch your idea to the ad men, your idea’s crap. If it’s good, they’re just going to sell it right back to you to get your cash.

I think Pepsi certainly learned their lesson there with the Patio commercial. But like Don says there, even a failure can mean reaching a new plateau. Or, to use the parlance of today’s television lingo, reaching a new “game changer.”

“Game changer” is the buzzword/phrase, I hope, that killed “jumping the shark.” All TV jumped the shark five or six years ago, and now we’re all praying for game changers.

Speaking of Patio, you had to adore Peggy’s satisfied grin as she walked out of that meeting. She was right. Maybe she wasn’t right for the her own reasons, but still, she was on the winning side, no matter what was in or out of her toolbox.

And I think I love Peggy’s new roommate. So much so that I want them to have their own spin off. And it shall be called I Love To Have… Fun!

And Joan, Joan, Joan. The Tex Avery girl brought to life. We saw a little bit of it last season when dealing with Harry Crane and the television scripts, but Joan is clearly meant for more than just being a secretary and house mother figure to a bunch of confused young ladies with” stupid looks on their faces.” Her spicing up of Peggy’s ad was perfect. No more stage directions from an Ibsen play here! Just look at the catch it nabbed Peggy. Just don’t forget, Peggy: A door should only be closed for one thing. You know what we’re talking about.

I have to say it again: Poor Sally Draper. Her path, at least through the rest of this season and, one presumes, next season as well, is going to be an interesting one. Her mother can’t acknowledge her sadness because she’s too busy trying to ignore her own. Her father is doing the best he can but he doesn’t know who he is. And she’s growing up without that guidance or nurturing in a confusing and confused world, raised by people unprepared for the social forces about to knock them down. The pope is dead and monks are lighting themselves on fire.

Before long, she’ll stop mixing Tom Collins for her parents and just making them for herself.

Since celebrated writer Walter Dean Myers celebrated his birthday this month (August 12, actually) I’ve been asking several staff members which Myers books they’ve read.  Of course this lead to a discussion of favorites, and in honor of Mr. Myers‘ birthday we thought we’d share them with you.  Here are our staff’s most loved books by one of the most revolutionary children’s authors of our time:

Dope Sick
Myers blurs the fine line between reality and surreality in his latest.  Lil J has gotten caught up in a drug deal he never intended to be a part of.  In fact, his intentions for the day were to get a real job to help support his mom.  Chased into a run down apartment building, he runs into a strange man who seems to know way more about Lil J than he should.  This novel is fast-paced, strikingly rich, and important.
-reviewed by Emily

Monster
This innovative, award-winning novel straddles the fence between movie script, noir fiction, and sociological thriller. If you want your pre-teen/teen to turn off those television cop dramas that are so ubiquitous in our lives, Walter Dean Myers’ book is the answer to your prayers. A great read.
-reviewed by Brian C.

Sunrise Over Fallujah
Walter Dean Myers is a fearless writer – in Sunset Over Fallujah, he takes his readers to war. As a soldier in a Civil Affairs unit, Robin Perry has chosen to serve his country, but at the same time feels conflicted about the purpose of the Iraq war. Like many of Myers’ characters, Robin is reflective and self-aware; he is understated but in constant contact with his powerful emotions. He is also courageously honest.  But this is not primarily a story of war – it’s the transformation of a boy into a man, and the development of relationships – some life-changing and some short-lived – all of which is achingly true to life.
-reviewed by Beth