Author Archives: Tom

The shameful state of the Incarceration Nation

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mentally ill prisoners The troubling U.S. incarceration rate ñ a direct result of the governmental policy of overcriminalization ñ has been a frequent topic on this blog (here, here, here, here, here,here, here, here, here, here and here).

In this post from last fall, Scott Henson notes that Kings College in London now has available here its latest "World Prison Population List" that reflects that the United States remains a world leader in incarceration rate by a large margin:

The United States has the highest prison population rate in the world, 756 per 100,000 of the national population, followed by Russia (629), Rwanda (604), St Kitts & Nevis (588), Cuba (c.531), U.S. Virgin Is. (512), British Virgin Is. (488), Palau (478), Belarus (468), Belize (455), Bahamas (422), Georgia (415), American Samoa (410), Grenada (408) and Anguilla (401).

Americaís dubious drug prohibition policy is one of the reasons for the high incarceration rate. However, as this Houston Politics/Chronicle blog post notes, this National Sheriffsí Association survey (H/T Doug Berman) reports that the United States imprisons many more mentally ill citizens than treating them in hospitals. This press release on the survey summarizes the sad story:

Americans with severe mental illnesses are three times more likely to be in jail or prison than in a psychiatric hospital, according to "More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States," a new report by the Treatment Advocacy Center and the National Sheriffs’ Association.

"America’s jails and prisons have once again become our mental hospitals," said James Pavle, executive director of the Treatment Advocacy Center, a nonprofit dedicated to removing barriers to timely and effective treatment of severe mental illnesses. "With minimal exception, incarceration has replaced hospitalization for thousands of individuals in every single state."

The odds of a seriously mentally ill individual being imprisoned rather than hospitalized are 3.2 to 1, state data shows. The report compares statistics from the U.S. Department of Health and Human Services and the Bureau of Justice Statistics collected during 2004 and 2005, respectively. The report also found a very strong correlation between those states that have more mentally ill persons in jails and prisons and those states that are spending less money on mental health services.

Severely mentally ill individuals suffering from diseases of the brain, such as schizophrenia and bipolar disorder, often do not receive the treatment they need in a hospital or outpatient setting. The consequences can be devastating ñ homelessness, victimization, incarceration, repeated hospitalization, and death.

"The present situation, whereby individuals with serious mental illnesses are being put into jails and prisons rather than into hospitals, is a disgrace to American medicine and to common decency and fairness," said study author E. Fuller Torrey, M.D., a research psychiatrist and founder of the Treatment Advocacy Center. "If societies are judged by how they treat their most disabled members, our society will be judged harshly indeed."

Recent studies suggest that at least 16 percent of inmates in jails and prisons have a serious mental illness. According to author and National Sheriffs’ Association Executive Director Aaron Kennard, "Jails and prisons are not designed for treating patients, and law enforcement officials are not trained to be mental health professionals."

Ratios of imprisonment versus hospitalization vary from state to state, as the report indicates. On the low end, North Dakota has an equal number of mentally ill individuals in hospitals as in jails or prisons. By contrast, Arizona and Nevada have 10 times as many mentally ill individuals in prisons and jails than in hospitals.

Among the study’s recommended solutions are for states to adopt effective assisted outpatient treatment laws to keep individuals with untreated brain disorders out of the criminal justice system and in treatment. Assisted outpatient treatment is a viable alternative to inpatient hospitalization because it allows courts to order certain individuals with brain disorders to comply with treatment while living in the community. Studies show assisted outpatient treatment drastically reduces hospitalization, homelessness, arrest, and incarceration among people with severe psychiatric disorders, while increasing adherence to treatment and overall quality of life.  .   .   .

More evidence of the myth of American exceptionalism?

Robert Furst’s nightmare ends

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Furst_3.jpg

So, after seven years, the Department of Justice finally rolled over with nary a whimper and agreed to end the absurdly unjust prosecution of former Merrill Lynch banker Robert Furst. As usual, the deal to dismiss all charges against Furst will receive a small fraction of the publicity that the mainstream media trumpeted for his tainted conviction. The deferred prosecution agreement is below.

Although surely a relief, the agreement must be bittersweet for Furst. His business career is badly damaged and has been effectively put on hold for the better part of a decade. And for what purpose?

Thatís the question that we should be asking as we get ready for yet another round of the same type of senseless prosecutions than ensnared Furst.

UH Law Professor Geraldine Szott Moohr reminded us this week in the context of Jeff Skilling’s pending Supreme Court appeal of the foreboding nature of the government’s overwhelming prosecutorial power. As Sir Thomas More teaches us, “when the last law was down, and the Devil turned ’round on you, where would you hide, the laws all being flat? . . . do you really thing you could stand upright in the winds that would blow then?”

A truly civil society would find a better way.

Robert Furst Deferred Prosecution Deal

The War on Drugs goes viral

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drug-war The perverse damage that federal and state drug prohibition policies impose on American citizens and our neighbors has been a frequent topic on this blog over the years.

In this must-read Reason.com article, Radley Balko reviews how Americaís drug prohibition policies are increasingly being used as a basis for conducting Gestapo-like raids on American citizens:

Last week, a Columbia, Missouri, drug raid captured on video went viral. As of this morning, the video had garnered 950,000 views on YouTube. It has lit up message boards, blogs, and discussion groups around the Web, unleashing anger, resentment and even, regrettably, calls for violence against the police officers who conducted the raid.

I’ve been writing about and researching these raids for about five years, including raids that claimed the lives of innocent children, grandmothers, college students, and bystanders. Innocent families have been terrorized by cops who raided on bad information, or who raided the wrong home due to some careless mistake. There’s never been a reaction like this one.

But despite all the anger the raid has inspired, the only thing unusual thing here is that the raid was captured on video, and that the video was subsequently released to the press. Everything else was routine. Save for the outrage coming from Columbia residents themselves, therefore, the mass anger directed at the Columbia Police Department over the last week is misdirected.

Raids just like the one captured in the video happen 100-150 times every day in America. Those angered by that video should probably look to their own communities. Odds are pretty good that your local police department is doing the same thing.

Meanwhile, after suggesting on the campaign trail that drug prohibition policies needed to be changed, President Obama has cynically and hypocritically retreated and now supports the federal governmentís drug prohibition policy. Meanwhile, the enormous costs of the dubious policy continue to pile up.

Americaís War on Drugs is lost. It is way past time that we require our leaders to acknowledge that and end it. Their war has now become a war on us.

Update: Scott Henson has more.

The truly interesting question about Tiger Woods

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Tiger-Woods.jpgIs not how and when he is going to settle up with Elin. Or even when he is going to play again.

No, the most interesting question about Tiger is this — What has happened to his golf swing?

As noted earlier here, I haven’t been comfortable with the public flogging that Woods has taken and continues to take as a result of his personal indiscretions. Seemingly without any true friends and receiving more than his fair share of bad advice, I find it quite easy to have compassion for Woods.

But putting the less interesting personal issues aside. The swing — what has happened?

Because Woods is the best golfer of our time, his swing has been heavily scrutinized over the years. Butch Harmon successfully refined the young Woods’ upright stance and steep swing plane during Woods’ early years on the PGA Tour. But Woods eventually grew tired of the outspoken Harmon and ended up with Hank Haney at the recommendation of Woods’ pal, Mark O’Meara.

Haney teaches a one-plane swing, so Woods’ swing became flatter and more around his body under Haney. Although Woods never has been the ball-striker of a Ben Hogan, after some initial questions (see also here), the Woods-Haney partnership took off when Woods won the Masters in 2005. Woods went on to win an incredible 51% of his PGA Tour starts from July 2006 through last year (32 wins total).

Woods captured six majors over that span, including the 2008 U.S. Open over Rocco Mediate that he somehow won playing on a broken leg and torn ACL. Even though I expressed concern about Woods’ misguided training regimen at the time, it appeared that it was only a matter of time before Woods would break Jack Nicklaus’ record of 18 major championships.

Haney then helped Woods return from reconstructive knee surgery in 2009 to win seven times, but none of them were major championships. Nevertheless, this season looked to be a good one for Woods as Pebble Beach and St. Andrews were in the rotation for major championships.

But then Woods personal life blew up and everything changed. Woods put his golf game on ice and missed the first three months of the season. Woods somehow tied for fourth at the Masters in his first start of the season, but he was clearly not sharp in doing so.

The last couple of weeks have been pretty ugly, what with the missed cut at Quail Hollow and a withdrawal at the Players Championship because of a sore neck. In the meantime, Woods had lost so much confidence in his swing that he was at the bottom of the both tournaments in terms of driving distance and accuracy.

To add insult to injury, Woods main competitor — Masters champion Phil Mickelson — is poised to overtake Woods as No. 1 in the World Rankings soon.

And now Haney is gone. So, what’s going on?

Well, there certainly is no poverty of opinions. As a student of the golf swing, my sense is that Woods has lost confidence in his swing of the longer clubs, such as his driver, 3-metal and hybrids. He seems much more comfortable swinging his “control” clubs (mid and short irons). But for whatever reason, Woods’ arms have become disconnected from his upper body during his swings with the longer clubs, which has resulted in a large number of mishits. As the mishits mounted and Woods’ confidence waned, he also lost distance off the tee, which only aggravated Woods’ frustration.

Jeff Ritter — who is one of America’s top young golf instructors — does a very good job below of analyzing Woods’ swing with the driver while comparing it to the swing of one of the best ball-strikers of all-time, Sam Snead.

Woods will probably rebound to the top levels of the game once he sorts out his personal life and straightens out his swing. But Woods’ body is increasingly breaking down under the strain of high-level golf and a needlessly brutal training regimen, so regaining his physical health may be an even bigger problem than regaining some sense of emotional stability in his quest to top Nicklaus’ record.

The Medicaid Contagion

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Medicaid_June 2009-thumb-320x240 (1) This earlier post decried the failure of the Obama Administrationís reform of the U.S. health care finance system to address one of the fundamental problems with the system ñ the over-reliance on third-party payor of health care expenses.

Take Medicaid, which is the foundation of Obamacareís insurance-for-all principle. As the Happy Hospitalist explains, Medicaid is a particularly shaky foundation:

Not accepting Medicaid used to be the in thing for primary care.  Only one internist out of thirty in Happy’s town accepts new Medicaid patients.  That’s nothing new.

However, this Medicaid contagion has now spread to subspecialty care. In a first of its kind for Happy’s community, I learned that some subspecialty surgeons are no longer accepting Medicaid for outpatient evaluations.    Cash is king.  If they are forced to care for a Medicaid patient during ER call, they don’t even bill Medicaid for the care.  The hassle factor outweighs the payment received.

Going to the ER does not guarantee you’ll get a hospital admission which would mandate the physician to see you.  If you aren’t sick enough to get admitted, you may get referred back to the subspecialist doctor  from the ER for an outpatient evaluation.  And the  front desk at the office will tell you  they don’t accept Medicaid and will ask for a cash payment up front for a clinic evaluation.  They may be required to see you.  They aren’t required to accept your insurance.

If a Medicaid patient shows up in the clinic as an outpatient referral from a primary care doctor’s office, the patient is told they do not accept Medicaid and cash is necessary for an evaluation.  There is no where for the patient to go, except to the University Hospital 60 miles away.  The surgical clinic doesn’t  offer cab vouchers like Happy’s hospital does.  This is the current reality of Medicaid.  This is ObamaCare’s cure to health care finance reform. 

Medicaid is not a solution. It’s pollution.  Medicaid is an insult to physicians everywhere. [.  .  .]

A nation of disgruntled patients with all the insurance in the world, and no where to go.  Take it up with your Congressman I would say.  They are the ones that destroyed it.

Yes, but everyone will still have health insurance.

For whatever thatís worth.

My favorite Mayor

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Oscar Goodman Is unquestionably Las Vegasí Oscar Goodman:

Q: Prior to politics, you represented accused organized crime figures. Whatís the biggest difference between politics and the mob?

A: My clients gave me their word, and their word was their bond. They always paid me. They always thanked me at the end of the day.

In the political world, none of that happens. A politicianís word usually doesnít mean a damn. His word is for the moment.

The MD Anderson – Anticancer Research Venture

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mdanderson This David Agus/TEDlecture from awhile back emphasized the need for new ideas and approaches in cancer research.

Along those lines, David Servan-Schreiber in the video below announces that he has teamed up with Houstonís MD Anderson Cancer Center in a new research project aimed at enhancing and bolstering cancer research and care. Dr. Servan-Schreiberís website about the project is here.

Dr. Servan-Schreiber is the author of the best-selling book, Anticancer, A New Way of Life (Viking 2009). While serving as a clinical professor of psychiatry at the University of Pittsburgh School of Medicine, Servan-Schreiber underwent chemotherapy and surgery twice for brain cancer. After the second bout, Servan-Schreiber spent years researching a mass of scientific data on natural defenses against cancer. His book is the result of this experience and research.

As this Abigal Zuger/NY Times review notes, there is skepticism in the clinical research community regarding Servan-Schreiberís conclusions and recommendations. So, M.D. Andersonís interest in Servan-Schreiberís approach is somewhat surprising.

Nevertheless, as Dr. Agus notes in his TED lecture, perhaps Servan-Schreiberís ideas are the type that are needed to spur clinical research into better treatment protocols and innovative care procedures for cancer patients.

Passenger Side

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One of the all-time great road songs, Passenger Side by Wilco.