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McCamy Taylor

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Member since: Tue Nov 9, 2004, 06:05 PM
Number of posts: 14,481

About Me

Here is my fiction website: http://home.earthlink.net/~mccamytaylor/ My political cartoon site: http://www.grandtheftelectionohio.com/

Journal Archives

Life is a Crashing Plane, Peter Hammill's "Flight"

Warning! Long thread ahead! Travel at your own risk.

"No looking back on tomorrow...better think on today."

Peter Hammill from "Flight"/Black Box

If you choose to read this, please listen to the music at the following link simultaneously. And if you don't want to read this, please listen anyway. This song is about a million times better than what I am about to write.

Peter Hammill performs the song "Flight" from his album Black Box, this is a live solo version, Hammill doing vocals (duh) and accompanying himself on piano. Video is someone's compilation (not live).

Now, on to the topic, which is...

Mammon or muse?

"Mammon and Muse walk into a bar..."

Just kidding.

I have been listening to lots of Peter Hammill on You Tube recently. Which raises the question, where is the Peter Hammill Needs Money Police? You know, the folks who spend their time shutting down Internet bootleg? Apparently, Mr, Hammill is too busy writing, recording and performing to do it himself. Good for him. He survived his heart attack. May he live forever---meaning long enough---and keep writing and recording. Praise Gog.

And now, to the---no, not the, a ----as in one of many point(s), which is, how do we juggle the need to create art with the need to eat? This is an extremely loaded topic, right up with there with 1) Religion and 2) Politics on the list of Things Thou Shalt Not Talk About at the Thanksgiving Dinner Table Unless You Want a Food Fight.

I do not want to precipitate any food fights, so I am going to move this discussion to the far side of the Pacific Ocean. In Japan there is another term for mangaka. It is "richer than Croesus." Meaning that the people who create manga make a whole lot of money. Not like the US where DC and Marvel (now Disney) own your characters. That is why so many people create manga. So, consider two of the most successful mangaka, Rumiko Takahashi (Inuyasha) and Takehiko Inoue (Vagabond). It helps if you are familiar with their work. But if you are not, Rumiko's is sort of cutsie, shoujo-shonen-esque with so-so art, Takehiko's tends to be more mature, takes more risks, extremely inspired/technically competent art even by western standards. Now, Takehiko Inoue is on record as saying he does not care who posts his stuff on line and he even posts manga himself for free for fans (Buzzer Beater was an online manga). Rumiko Takahashi, on the other hand, has a rep as not tolerating any form of piracy--and that is saying a lot for a country that does not tolerate piracy. Keep in mind that both of them have more money than they will ever spend.

Where is this all going? The same place we are all going. No where. But, just to pass the time until we get there, I will step out on a limb and hazard a guess. I suspect that when Takehiko Inoue pens another chapter about swordsman Musashi learning universal truths from watching rice grow (Vagabond) or describing the struggles of wheelchair basketball players (REAL), he has a deep sense of personal satisfaction that makes the box office grosses ( I don't know if there is an equivalent term for this for manga) irrelevant. But when Rumiko Takahashi churns out another bit of Inuyasha clone, she is just going through the motions--in which case that royalty check is the carrot. But that could be----no, that probably is just my personal bias.

(And if you are not listening to Peter Hammill perform "Flight" please go click on the link.)

Now, for the counter argument. Think about Alan Moore, probably the most talented English language author alive today now that William Burroughs has gone off to the Western Land. Think about how the Comic Book Industry has used him. Think about Hermann Melville, whose Moby Dick, the greatest American novel of the 19th century was trashed by the British critics---who were not amused by the novel's themes of God-killing which is another form of anti-colonialism---and who therefore died in near obscurity. Think about William Blake, whose poetry was rescued by the merest chance---his Free Love agenda coincided with that of Victorian poet Algernon Swinburne. And no, I am not going to argue for a state subsidy for starving artists and poets. These writers received support----not financial support, moral support. They were and are the "Voice of honest indignation" (to quote Blake) which we so revere---

But you've gotta wonder. Worry and wonder. What Donnes labored and died in the cotton fields of Alabama, their words of beauty and wisdom lost forever, because it was illegal for slaves to learn to read and write? What Yeats are going unheard at this very moment, because they are too poor to afford a computer, and even if they had one, they don't have electricity in their third world hovel? All those rebels with a cause I mentioned above, those were and are all white guys with educations and good health and supportive families. When your life is a plane crash, how do you make yourself heard? What do you do if society does not give you a black box?

Ok, now read the lyrics to Peter Hammill's song that I hope you have listened to at least once or twice by now. But do not read the lyrics unless you have listened to him sing them, because he is a singer-song writer not a poet and the delivery is three parts of the poetry. (In keeping with the four paragraph rule I'll post two stanzas, I urge you to go read the rest yourself, the lyrics are from the album version, the live version is a little different):

It was then that I knew I'd been thoughtless -
something had slipped my mind:
I'd strapped myself into the Fortress
but the Fortress was flying blind.
We got full clearance, so someone down there
ought to know the truth of our disappearance -
If even that still shows it accuses and blames me,
but nothing was quite what it seemed


No looking back from tomorrow,
no, there'll be no looking back on today;
better be looking on to tomorrow...
better think on today.


What the hell did any of that stuff about mammon and muse and voices of honest indignation have to do with Peter Hammill's 1981 version of a song about a plane crash as a metaphor for life? If we did not have people willing to do art for art's sake, then we would not have so many works of art waiting to touch that nerve that needs to be touched when the proper moment arrives. As we do our forensic investigation, read the tea leaves, examine the entrails and consult the stars for the answers that will keep something like this from ever happening again, I suggest that we also examine ourselves, because if we do not know ourselves we can not hope to know anything. And because life is so very fragile and so very fleeting and because so many people with such beautiful stories were not gifted with beautiful voices, I recommend that we take time to listen and then tell those stories. If every work of art strove to be Grapes of Wrath rather than---say---Twilight---think about what the world might be.

"I can't tell you nothin'. You got to go there." John Steinbeck The Grapes of Wrath
Posted by McCamy Taylor | Sun Mar 23, 2014, 04:15 PM (1 replies)

Poor Folks in the U.S. Can No Longer Afford Treatment for Pneumonia

Yes, this is a scary headline. Almost sounds sensational. It isn't. It is a cold hard fact. At this moment, if you are counting your pennies, trying to scrape up enough to pay for a $4 drug at Wal-Mart or Target, you can not afford an antibiotic that will treat your walking pneumonia---meaning that you could end up in the hospital saddled with tens of thousands of dollars in medical bills.

For years, doxycycline has been a valuable drug for physicians who treat the indigent --- unemployed or underemployed folks without insurance. A staple of $4 drug lists, it can be used to treat everything from bronchitis to "walking" pneumonia to urinary tract infections to skin infections to acne to venereal disease---and it covers some rarer infections like Lyme's and is sometimes used for malaria prevention, too.

For as long as I can remember--and I am pretty damn old---doxycycline, a twice a day form of tetracycline has been widely available and cheap as dirt.

And then, this winter, something surprising and very troubling happened. A patient with a list of medical problems longer than his arm and no income (he was still appealing a Social Security Disability denial) came down with bronchitis, possible early pneumonia--the two can be difficult to differentiate. I wrote him a prescription for doxycycline. He took it to the pharmacy. They wanted over $50 for it. He did not have over $50. He had $4. That was how much the drug used to cost at the same pharmacy.

He is not alone. Here is an LA Times Story about someone who had the same problem last year. Turns out that the difference can depend upon which generic drug manufacturer is making a specific medication at any given time. And apparently, right now, the one making doxycycline charges an arm and a leg for it.


A CVS pharmacist in Los Angeles, who asked that his name by withheld because of fear of retaliation by the company, shared with me the average wholesale price of different makers' doxycycline, as made available to pharmacists by the McKesson Connect online ordering system.

The system shows that the average wholesale price of 100 doxycycline pills made by Watson with a strength of 100 milligrams is $328.20. The same number of doxycycline pills at the same strength made by Mylan cost $1,314.83.

Mylan? Where have I heard that name before? Oh, yes. ALEC. As in "The Koch Brothers" and their corporate welfare mentality.


Where else have I heard of Mylan? Oh yes, the great lorazepam price fixing scandal.


The Federal Trade Commission approved a $100 million settlement with Mylan Laboratories, the largest monetary settlement in the commission’s history.

The agency had charged Mylan, of Pittsburgh, Pa., with conspiring to deny four competitors ingredients necessary to manufacture widely prescribed generic versions of anti-anxiety drugs. The practice resulted in a 3,000 percent boost in the price of the drugs, according to the FTC.

“Anti-competitive acts in the pharmaceutical industry potentially cost consumers millions of dollars in higher prescription prices,” says Richard Parker, director of the commissions’ bureau of competition.

Mylan is now the third largest generic drug manufacturer in the world since it acquired an Indian generic drug manufacturer--meaning that it is in great shape to corner the market on these all important key ingredients needed for drug manufacturing.


Not so long ago, the nation watched as patent drug manufacturers paid generic drug makers NOT to produce their product---keeping drug prices high. Keep that in mind as you ask yourself why a drug as popular as doxycycline is in short supply. This is not one of those orphan drugs that no one wants to make because almost no one needs it. This stuff sells itself. The more that is made, the more we will see it used. Why isn't supply attempting to keep up with demand? Where is the bottleneck in the so called "free market economy"?

If this were a fictional mystery, I would now tell you why doxycycline has gotten so expensive that poor folks can no longer afford it. Since this is real life, I don't know. If someone out there knows the answer, please tell me. Meanwhile, when a patient without money and without prescription drug coverage comes in which bronchitis/and or pneumonia, I am going to be hard pressed to get him treated with what is currently available on most $4 lists.
Posted by McCamy Taylor | Sun Mar 9, 2014, 05:23 PM (48 replies)

Managed Care Denies Coverage for Generic Albuterol, Will Only Cover----Name Brand Albuterol

I have blogged before about Managed Medicare abuses. About how a loophole in health care law allows the plans to bill their own internal Q&A as direct patient care. And about the massive number of medication denials which they issue, most of which are designed to create patient and doctor hassles rather than save the insurance plan money.

The latest target: albuterol inhalers, the inhalers that every asthmatic uses for asthma attacks now that all the competitors are gone. That's right. Albuterol is the only drug available in the U.S. for use as a rescue inhaler. There is nothing else that can take its place. And, because of reformulation issues, all of these inhalers are extremely expensive--too costly for a cash strapped senior or disabled person to buy his or her own, no matter how badly he or she is wheezing. So, how did I get not one but three Medicare Managed Care denials for generic albuterol inhalers in one day?

I wanted to know the answer to that one myself. So, once my medical assistant got a representative of the insurance plan on the phone and discovered that while the plan did not cover generic albuterol inhaler, the plan did cover Pro-Air--a name brand albuterol inhaler, I took the phone.

"Why?" I asked the young man at the other end of the line. "Does Medicare Advantage Plan C cover a name brand albuterol inhaler but not a generic albuterol inhaler? Why can't the participating pharmacy substitute Pro-Air for 'generic albuterol inhaler'?"


"This is the doctor. I really want to know why my patients can not get their asthma inhalers when they need them. Why do they have to do without their medication until their doctor can talk to an insurance rep? Can I talk to your supervisor?"

Ten minutes of holding and no supervisor came to the phone. While waiting for the supervisor that never appeared, I looked up the drugs in question. My drug handbook listed all the albuterol inhalers as being interchangeable. I gave up waiting and I called a pharmacist. "Are Pro-Air, Ventolin, Proventil Inhalers and generic albuterol inhalers all the same thing?"

"Yes, they are," said the pharmacist.

"If one was not in stock could you substitute another as long as the prescription did not specify name brand only?"

"Yes, I could."

Very strange indeed. So, basically, my asthmatic patients on Medicare had been forced to do without their rescue inhalers until their insurer could fax my office a worthless piece of paper that my nurse showed to me the next day that I was in the office--meaning potential refill delays of up to 72 hours. How does that keep my patients healthy? It doesn't. Instead, it scares them. Anyone who has asthma knows how bad it feels to need your inhaler and not have one.

In what kind of country is it legal for someone's insurance company to deny them a necessary medication for 72 hours for absolutely no reason? A crazy country. Why would an insurer want to do this? That's easy. Scare your sickest patients enough and they will drop off your Medicare plan and sign up for a different Medicare plan. Since Medicare Advantage plans are paid a flat fee by the federal government for each enrollee, they have an incentive to keep healthy people happy with bicycle socials and sick people scared by denying them their medications. And it is working. People with the biggest burden of chronic illness are the ones most likely to drop off a so called Medicare Advantage Plan and back onto traditional Medicare, meaning that the tax payer picks up their bills while the privates collect premiums--and then pay themselves for denying services and benefits (the Q&A loophole).

This is not an isolated incident and it is not confined to a single Medicare Advantage Plan. See my old diaries for other examples. This fragmented Medicare is ruining the best insurance plan in the country---and, in the process, making it even less likely that we will ever see a single payer insurance plan since the privates can point to the mess they have made of Medicare---siphoning all the money off and leaving all the debt for the public to pay---and say "See? See? Single payer is too expensive."
Posted by McCamy Taylor | Sat Mar 8, 2014, 05:55 PM (32 replies)

A Sleep Revolution is Coming in Public Health

In the 19th century, people knew that their water was clean. They could tell by looking at it. Sniffing it. Tasting. Then Louis Pasteur showed them what they could not see, smell or taste---microbes that caused disease. Once we became aware of the danger, we were willing to invest in sanitation services, sewage treatment, water filtration.

In the 21st century, people know that they get a good night's sleep. They go to bed at 11 pm. They set the alarm for 7 am. They lose consciousness for the next eight hours. They wake up feeling tired, achy and groggy, but that is just caffeine withdrawal kicking in. After a cup of java, they are good to go--for a couple of hours. Boy, age sure has crept on them. They sit at a desk all day, but they are always hungry. None of their old clothes fit. When they get home, they don't want to do the dishes. They don't even want to go out. They just want to pop a pizza in the microwave, fall asleep on the couch watching TV---and then go to bed at 11 pm, ready for that good night sleep that will make all the difference.

In the 19th century, people did not know that what they could not see, smell or taste could kill them. That's because they could only see it with a microscope. In the 21st century, people do not know what happens when they are unconscious can kill them. That's because it only happens when they are unconscious.

By now some of you know that I am talking about sleep disorders. More of you know that I am writing about sleep disorders than members of the average population would know if forced to read this. You are reading this because it has the words "public health" in it, and therefore you have an interest in health. Since those reading this have an interest in health, 100% of you should know all about sleep disorders, one of the most common chronic medical conditions in our society today. 100% of you should know how you sleep, whether you snore or stop breathing, whether you grind your teeth, whether you kick all night, because you will have made a point of asking friends and family---it is very important that we know how we sleep.

Sadly, more of you probably know your ldl cholesterol than know about your own sleep. More of you have probably asked your significant other "Are there any funny looking moles on my back that might be cancerous?" than have asked "Do I show signs of restless leg syndrome?"

Sleep disorders are one of those tricky medical conditions that do not announce themselves with a great big billboard, the way that--say--angina from coronary artery disease does. When you are carrying the groceries in the house and suddenly a bull elephant is sitting on your chest and you have been transported from sea level to the top of Mount Everest and your head is swimming and you feel like puking---when all that happens, you listen.

Sleep disorders are more like high blood pressure. Sometimes you get symptoms, more often you don't. Once upon a time, no one knew their blood pressure. Now, you can get it checked in the grocery store. Almost every adult knows that blood pressure is important. So is cholesterol. So is blood sugar. So is not smoking. If you want to avoid a heart attack, you pay attention to these things---and heart disease is the number one killer in this country right now.

Pop quiz. Name another independent risk factor for heart disease. You said obesity, didn't you? Close. Sleep apnea. Name a risk for car wreck--besides DUI. Blindness? I guess so. But most blind people know not to drive. People who are sleep deprived do not know that they are sleep deprived, because they were unconscious when their body was failing to get restful, restorative sleep.

Our current insurance system, which offers many of us essentially no insurance between the ages of 40 and 65---too many pre-existing conditions to get individual policies and not yet old enough for Medicare---has contributed to the sleep apnea crisis. When folks reach 40 and the sleep disorder they inherited from Mom kicks in, they do not know that they have a sleep disorder. They know that they have high blood pressure, depression, fibromyalgia, erectile dysfunction, low back pain, migraine headaches---and they can no longer perform the necessary functions of their jobs so they make mistakes and get fired.

Once they start working as a cashier at Quickee Mart, they no longer have health insurance, so even if they begin to suspect that there is something wrong with their sleep, they can not see a doctor and get tested. But most of them do not suspect. They know that they can not work and so they file for Social Security Disability. They are turned down because high blood pressure, depression, fibromyalgia, erectile dysfunction, low back pain, migraine headaches can not keep a person from working--the judge knows this. If the people appealing their disability denial could bring in the results of a pulse oximetry test done overnight or a sleep study showing that they stop breathing 60 times an hour, the judge would exclaim "You have sleep apnea! No wonder you can't work! Here's your Medicare. Get that treated!"

No, this is not a fairy tale. I have lost track of the number of patients whom I treat at a public health clinic for the uninsured who lost their jobs and insurance due to a sleep disorder that their old doctors never suspected and who are able to successfully appeal their disability denial and get Medicare---insurance!---once they prove to the judge that there really is something wrong with them. I have lost count of the number of people who think that I am psychic, because I look over their medical record and ask "Do you snore or stop breathing at night?" No, I am not psychic. I just have first hand experience with what it is like to have an unrecognized sleep disorder that costs you your career in the prime of your life.

Now, on to the revolution. This is not how it should be. People who develop sleep disorders in middle age should not lose their memory, their energy, their concentration and finally their jobs because doctors are so bad at diagnosing sleep disorders. This should be one the first things that their doctor screens them for when they first go in saying "I can't remember things. My driving sucks. I can't get an erection. I hurt all over." They should not go into their doctor's office unaware of their own snoring, apnea, restless leg jerks and bruxism, since---being educated professionals---they keep track of their own health. They should not be forced out of the professional job market and into the hourly minimum wage job market just when their professional skills are at their best. They should not have to leave the job market altogether---in effect, retire---in order to get their sleep disorder treated. If they and their doctors recognized the first clues about a sleep disorder and started treatment while the patient was still employed with insurance and did not carry the stigma of long term unemployment, a big chunk of the American workforce would continue to be productive beyond Medicare retirement age---and we would never have to worry about Medicare and Social Security going bankrupt.

Ten percent of Americans over 40 have a sleep disorder. 80% of them do not know it. Among them are professionals like me, a family physician. Society lost ten years of my medical skills, because neither I nor my doctors knew what was wrong with me for years after I retired. And then, after I figured it out and got treatment, I had to scramble to find a way to get back into a workforce that does not trust those who have been out of it, it would rather see you stay on disability and Medicare, just to be safe.

As we move closer to the goal of Cradle to Grave Insurance for all of us, those who pay the bills will have an incentive to keep us healthy. As it stands, Blue Cross would just as soon see your sleep apnea go untreated--if it means you lose your job and your insurance. If Blue Cross is going to pay your medical bills whether you can work or not, Blue Cross wants you as healthy as possible---because people with undiagnosed sleep disorders accumulate thousands of dollars a year in unnecessary medical tests and treatments, and if you have Cradle to Grave insurance, Blue Cross will have to pick up that bill. Blue Cross (and United and Aetna and Medicaid and Medicare) will realize that increasing physician and public awareness of sleep disorders will keep you healthier and save them money.

Eventually, you will see pamphlets like the ones that the American Cancer Society used to hand out with the 10 warning signs of cancer. Yes, once upon a time, people did not know that rectal bleeding could be a sign of cancer that could be treated and cured if found early. One day, they will know that snoring can be a sign of a serious medical condition that is treatable--if found before you die in a car wreck or of a stroke. Eventually, High School Health classes will teach sleep hygiene. Eventually, no one would dream of NOT telling you "You snored and stopped breathing last night" anymore than they would dream of NOT telling you "Don't eat that potato salad. It was left out all night. There is no telling what kind of bacteria are growing on it."

Raise sleep medicine awareness. Keep our roads safer. Keep middle aged workers at their jobs longer. Reduce the strain on Social Security and Medicare. It's gonna happen. The only variable to the equation is when.

And, as before, if you want a free Word document copy of "Life After CPAP" send me an email at McCamyTaylor@earthlink.net
Posted by McCamy Taylor | Wed Feb 12, 2014, 04:38 PM (10 replies)

Damaged Care Redux: "They're Back!"

In 1999, under my maiden name I published a short book about so called managed care---"Damaged Care" as it was sometimes called at the time. HMOs or Managed Care failed due to physician and patient concern that they were damaging the doctor-patient relationship and leading to poor quality care. In particular the idea of paying doctors NOT to provide care or to turn away SICK people did not set well with many people---including doctors. Laws were passed to prevent HMO abuses. Most people dumped their HMO for a PPO--a plan that provided better payment for in network providers but had an out of network option as well.

Well, don't look now, but the economic forces that lead to the creation of HMOs are in play again. Insurers now must take all comers, regardless of pre-existing conditions. They can no longer "cherry pick" healthy people in the individual markets. If your aunt on dialysis wants to sign up for United Health, she can. If your brother who is on a liver transplant list decides to pick Blue Cross, Blue Cross is stuck with him.

Since insurers make money in only one way---by collecting more in premiums than they pay out in benefits--the ACA puts them at tremendous risk. And risk is something that the health insurance industry does not want. In order to cut its losses, the industry will try to do what it did in the 1990s---limit care, drive away the sick, make it difficult for doctors to care for those who need care the most. Their goal is to make all the sick people abandon ship while keeping the healthy members happy. Their ultimate goal is to force all the "sick" people on government funded Medicare and Medicaid while collecting federal payments for healthy people. How do they hope to accomplish this? The same way they did it back in the 1990s.

Some things have changed from the 1990s, but some are all too familiar. People who are trying to use their shiny, new silver plated insurance for the first time are discovering that their specialists are NOT on their plan (they were promised that they would be). If they belonged to an HMO in the 1990s and if they had read my book back then, they would not be surprised, because they would know that "Member Services Always Lies." They are beginning to realize that finding doctors and providers on their new insurance can be difficult if not impossible. There are new rules and regulations that make so sense. Barriers to care are thrown up that seem to serve no purpose except to frustrate and frighten patients--and that is exactly what they are trying to do. Scare away "sick" people while keeping the "healthy" folks happy. Insurers have found new ways to reward doctors for treating only the healthiest patients--they call it "Pay for performance". And since "poor" often equals "sick" in this country, one way they can limit their liability is by having only a limited number of doctors and providers that serve in poor or minority areas.

After reading about some early bad experiences that people are having in California, I decided to revise and update "Damaged Care" for the 21st century. Some parts are left out. Some are modified. New sections have been added to address issues that are unique to the ACA. The book, "Damaged Care Redux" is now available in electronic form now for FREE at Amazon at http://www.amazon.com/...

If you do not have a Kindle and can not download Kindle books on your computer, send me an email at McCamyTaylor@earthlink.net and I will send you a Word manuscript at no charge. If you want a copy of "Life After CPAP" I can send that, too.

I am a family physician with a Master's Public Health. I work in a public clinic for the uninsured but I see a lot of so called Medicare Advantage Plan patients too, because their insurance does not have enough doctors to meet their needs. Pretty sad when someone with insurance has to rely on a clinic for the uninsured to get care.

Remember, an informed consumer is a healthier consumer.
Posted by McCamy Taylor | Tue Feb 11, 2014, 07:33 PM (0 replies)

"Life After CPAP" A physician's experience with OSA, e-book available free.

Hi, longtime, no see, DU. I am not writing political journals very much, now that we no longer have our Selected President Bush. I spend my days practicing medicine and writing an occasional piece about health disparities along with a lot of fiction, which is what I prefer to write (when we do not have a Supreme Court coup).

Below is a link to the e-book I Just wrote, "Life After CPAP: A physician's experience with Obstructive Sleep Apnea, the Most Commonly Missed Common Diagnosis in the U.S." I am a family physician working at a large urban public clinic. I also have a Master's Public Health in the area of health education. I wrote this book as first person narrative, because I think that many readers will recognize themselves, and health ed messages are more effective if the target/reader thinks "This applies to me!"

I was disabled for ten years, unable to work as a physician, because it took three years for my doctors to figure out that I had sleep apnea. And they only solved the mystery after my husband (not a doctor) made the diagnosis. It took me several more years to get my OSA under control.

The e-book is free for Kindle for five days, then I will have to start charging for it as per Amazon policy. If you don't have a Kindle and are broke because you can't work because you don't know that you have OSA or can't get it treated without insurance but you do have a computer---which probably applies to everyone here---I can also send a free word document to anyone who e-mails me at McCamyTaylor@earthlink. net. This is intended to be a health resource, not a money making venture. This is NOT a screed against CPAP. CPAP works great in about a quarter to a half of the people with OSA. It didn't work for me---and in the book I spell out exactly why it did not work for me and I go over a lot of other treatment options that work. I have done research (physician surveys) about why primary care doctors are so bad at diagnosing sleep disorders. I have a few suggestions for how we can improve our doctors' diagnostic skills. Most of them involved increased public awareness--which is another reason I have written this. This book is also an attempt to make the initial diagnosis easier, because if you don't know you have sleep apnea, you will go around chasing your tail treating all the complications. Sleep apnea is now a particular area of interest of mine in practice, since so many of the disabled uninsured that we see got that way because when they had insurance, their doctors did not notice that they had a sleep disorder, and the complications of untreated sleep apnea got them fired. If they had only known about their health condition, they could have kept their jobs by getting treatment and taking advantage of special laws that protect the disabled until their OSA improved. I also see a lot of people who qualify for Social Security disability but who keep getting turned down, because they do not know that they have OSA--a condition which the government considers disabling if it is severe enough. If you get Social Security, you (eventually) get Medicare--and then you get treatment and get back to being your own self and maybe even back to work, the way that I did.

If you have fibromyalgia, migraine headaches, hard to control BP, ED, nocturnal angina and mini-strokes, depression that does not respond to medication, poor driving skills, memory loss, over 40 sudden onset "ADD" and doctors can not tell you what is wrong with you, there is a very high chance that you have an undiagnosed sleep disorder. OSA--obstructive sleep apnea--is the most common of these.

Posted by McCamy Taylor | Wed Jan 15, 2014, 02:25 PM (3 replies)

The Tea Party's Big FU to Its Middle Class Base

When the Tea Party decreed that no self respecting red state would be caught dead expanding Medicaid, its middle class base agreed. Poor folks don't deserve to be coddled. Poor people are poor because God hates them and He wants them to suffer. The Tea Party's middle class base was not about to spend any of its heard earned tax dollars paying for mammograms and blood pressure medications for people who were better off seeking (uncompensated) care at the local ER for metastatic cancer or massive stroke. Anyone who dares to draw a breath while poor deserves what he or she reaps.

Well, now the Tea Party has taken things one step further. It has decreed that none of its wealthiest members' hard earned tax dollars should be spent paying for the middle class's mammograms or blood pressure medications. According to the fat cats who finance and run the Tea Party, Middle Class America is better off seeking (uncompensated) care in the ER for its own metastatic cancer and massive stroke. Any middle class American who dares to draw a breath while middle class deserves what he or she gets.

Sound far fetched? Here is the link:


In case you can't read the link, the same lawyer who denied the poor health care in red states is now attempting the deny the middle class health care, too. He is arguing that anyone who signs up on one of the federal exchanges (as opposed to a state exchange) is not eligible for federal subsidies. And many states do not have their own exchange. Many Red states.

Who, you ask, is this lawyer who seems intent upon giving the Tea Party's Middle Class base the big Kiss Off? Meet Michael Carvin:


Mike Carvin focuses on constitutional, appellate, civil rights, and civil litigation against the federal government. He has argued numerous cases in the United States Supreme Court and in virtually every federal appeals court. These cases include the recent constitutional challenge to the Affordable Care Act and the decisions invalidating Sarbanes-Oxley's accounting board, preventing the Justice Department from obtaining monetary relief against the tobacco industry under RICO, overturning the federal government's plan to statistically adjust the census, limiting the Justice Department's ability to create "majority-minority" districts, and upholding Proposition 209's ban on racial preferences in California.

Mike was one of the lead lawyers, and argued before the Florida Supreme Court, on behalf of George W. Bush in the 2000 election Florida recount controversy. He also has represented state governments, financial institutions, telecommunications, and energy companies in "takings," First Amendment, civil rights, and statutory challenges to federal government actions.

Which states will get the shaft? Here is a map:


Everyone in a dark green state---relax. You are getting federally subsidized health care. If you have a big family and your wife stays home meaning that you have to live off a single $50-$60 k income---you know, traditional right wing Christian family values---in a Blue state like New York or California, your kids will have health insurance next year. You wife will be able to get a biopsy of that breast lump. They will catch the cancer early. She will have a lump-ectomy and survive to raise your kids into adulthood. Your blood pressure will be controlled and you will not leave your kids orphaned due to a massive stroke.

If you live in one of the light green states where the feds and states are running exchanges together--keep your ears open. Or better yet, contact an elected official and suggest that they relabel their exchange "state run". Blue state officials in places like Illinois and Michigan may listen to your pleas.

Now, check out this map:


This one is important. Note that in those states that have chosen to exclude the poor, a relatively small number of people stand to benefit from the health care law. These are the working class. Working stiffs. Working stiffs in states where working stiffs tend to vote Red, because the GOP knows that they are better than Black folks and Poor White trash and Hispanics.

Oh, sorry. Did I say that working class voters in Red states stand to benefit. I meant to say they stood to benefit.

Listen up you 30-40% of folks in the South who thought that you would be getting insurance while the Black folks on the other side of the track and the poor White Trash in the trailer parks and the Hispanics who work at the mill would have to do without----you are not going to like this. You don't get insurance either. Not unless you are willing to fork over the entire premium yourself. Now, if you have lupus or a bad heart, I am sure that you will find a way to make that premium payment. But if your health has been good up until now, ask yourself, which is more important? Making the car payment or buying insurance without any subsidy? And if only the people who are sick sick sick sign up in your state, you know what that is going to do to health insurance premiums in your state, don't you?

And the best part? If you don't spend ten thousand dollars out of your own pocket for insurance, you get to pay a $1000 fine. Like Christmas in April!

So, kiss your hopes of health insurance goodbye, working folks in Texas, Alabama, Mississippi, Georgia, Florida etc. You will have the unique privilege of paying for health insurance for all the folks who live in Blue states---and traitorous Red states like Kentucky--- while you will get nothing. Jesus will be so proud of you! You are almost assured admittance to Heaven--where you will be heading a little bit earlier than planned thanks to that metastatic cancer and that massive stroke.
Posted by McCamy Taylor | Sat Oct 26, 2013, 07:18 PM (2 replies)

Prepare to Cry.

We all know that lack of access to health care has condemned millions of children and adults in this country to jail. Kids whose parents can not afford to get them inpatient treatment for diseases like schizophrenia and bipolar disorder are told to have the courts declare them truant or unruly. Once they are locked up, the families are told, their child will be eligible for "free" mental health. They hear the same story when it comes to a suicidal brother or aunt or neighbor. "Let the criminal justice system take care of it."

We all know that the mental health services offered to these people while in custody are poor. Sometimes, there is no mental health care at all. Getting any type of medical care while in prison requires a clear head and perseverance. If you are a bright prisoner with a bad heart, you can probably get your state penitentiary to refer you to a cardiologist by threatening to sue them if they do not. But if you are not even sure who you are or where you are or what is wrong with you, then you can never hope to jump through the hoops the criminal justice system will set between you and the medical care you need.

We all know this. But a story at ABC allows us to feel what it is like to be mentally ill in a country that is more willing to incarcerate than it is to offer medical treatment.

Stephen Slevin, 59, was depressed in 2005 when he decided to drive across the country, with no particular goal or destination in mind, his lawyer Matt Coyte told ABCNews.com. After being pulled over in Dona Ana County, N.M., on Aug. 24 2005, Slevin was arrested on aggravated DWI charges, and for driving a vehicle that he did not own. He was brought into the Dona Ana County Detention Center.

From there, his long nightmare began.

"To find out what happened was difficult," Coyte said. "His mental health was so compromised from his time in jail, he had very little memory of his stay there."


Jail officials, recognizing that the patient suffered from mental illness, decided that looking him up in solitary for two years would be an adequate treatment. He was allowed access to mental health treatment for a couple of weeks in those two years, immediately got better---and then was forced back into solitary as he was awaiting his trial.

You caught that last part, right. He was awaiting trial. He was never convicted of anything. Prosecutors decided not to press charges, because he was not fit to stand trial. But he was considered fit to spend two years locked in a box where his mental status and health deteriorated.

This story does not have a happy ending. While he got a $15 million settlement, he is now dying of lung cancer. Would that cancer have been caught early enough to treat if he has not sent two years locked in a box? Probably not. The US denies all health care, not just mental health care to its uninsured citizens. But maybe his last few years of life would have been better if he could have seen a psychiatrist and gotten treatment rather than seeing a policeman and getting solitary confinement instead.

Posted by McCamy Taylor | Thu Mar 7, 2013, 07:23 PM (0 replies)

How Citizens United Encourages Corporations to Break the Law Like Enron

Surprise, Surprise, Sheldon Adelson's lawyers just admitted what we have known all along. His company used illegal bribes to get its Macau casino built.


The Las Vegas Sands Corporation, an international gambling empire controlled by the billionaire Sheldon G. Adelson, has informed the Securities and Exchange Commission that it likely violated a federal law against bribing foreign officials.
In its annual regulatory report published by the commission on Friday, the Sands reported that its audit committee and independent accountants had determined that “there were likely violations of the books and records and internal controls provisions” of the Foreign Corrupt Practices Act.

Last year, Adelson spent a measly $60 million of his $25 billion fortune attempting to unseat Obama and install a Republican---any Republican in the White House. In retrospect, it probably seemed like a good deal to him and his accountants. Remember what happen to Siemens? They settled their foreign bribery case for $1.34 billion. A gambling man, Adelson must have reasoned that $60 million spent to save $1 billion was a good bet. And though he lost the crap shoot, chances are if he had it to do over again---the bribes, the campaign donations--- he would. Because the Supreme Court has made it very profitable to ignore federal law.

Imagine what would have happened to Enron if Citizens United was already the law of the land in 2000. Ken Lay, Karl Rove and Antonin Scalia managed to get Bush selected. Their party controlled the House. However, the GOP had only a razor thin margin of the control in the Senate, and they lost that when one Republican turned Independent. Because the Senate was in Democratic hands, the bill which the House wrote and the White House endorsed to give Enron a huge infusion of taxpayer money in the wake of 9-11 was not passed. Enron's house of cards collapsed, much like the war that was lost for the want of a horseshoe nail in the nursery rhyme. Had Ken Lay been free to spend sixty million dollars shoring up the Senate in 2000, he would still be the head of the world's "biggest" company---

That is what Citizen United is all about. Giving corporate criminals like Ken Lay the ability to buy elections so that their crimes go unpunished and their debts get paid by you and me. The Supreme Court ruled the way they did in Citizens United because five of the Justices never, ever want to see any of their rich business buddies dragged through the mud again. Jail is for poor folks and minorities. The rich are different. If they sin, they buy a papal pardon. If they break the law, they buy a politician and get a bailout. It is the Neo Conservative American Way.

Posted by McCamy Taylor | Sun Mar 3, 2013, 03:06 AM (1 replies)

Kids of the Working Poor to Remain Uninsured Under "Health Care Reform"

Looks like the working poor just got screwed again. A portion of the new law which was supposed to limit the out of pocket for a family's employer sponsored insurance to less that 9.5% (a huge chunk if you are skating on the edge of poverty) is now being interpreted by the IRS as limiting the family's out of pocket to 9.5% of the income for the worker's insurance only. This is a big win/win for both health insurers (who like to insure workers, because, hey, they are healthy enough to work, so there can't be much wrong with them) and employers (who want their employees to get well as fast as possible so they can get back to work). However, it means that if your employer offers family coverage that will eat up 20% of your paycheck and you think you can't live off 80% of what you used to bring home, the government is not going to help your spouse or kids get insurance. In some cases, it will mean that the kids will no longer be eligible for SCHIP--meaning that the new law is costing them insurance.

The IRS has graciously decided not to charge the children of the working poor a penalty for being unable to afford insurance. Aw, how sweet of them.

At the risk of offending administration supporters, I smell a big, fat carrot/rat. As in health care is still being used as a carrot to get voters to the polls. The working poor (whose kids will be unable to get check ups, get asthma treatment etc.) will be told "It isn't our fault. Our hands are tied. Congress has to fix this loophole in the law. But the Republican House won't."

Which begs the question, if the IRS can unilaterally decide not to tax the kids who can not afford insurance, why can't the IRS decide that the 9.5% was supposed to cover both workers and their kids?

30 million people will remain uninsured in 2016---and many of them will be children. Stop playing politics with the health of our kids! Declare a national healthcare emergency, open Medicare up to all children. Then stand back and watch how quickly the privates drop their rates for coverage of children.

Posted by McCamy Taylor | Thu Jan 31, 2013, 05:50 PM (10 replies)
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