Category Archives: Coffee Talk

No topic sacred, no rock left unturned, this is where editorial propriety meets the coffee table candid. Discuss, debate, ponder, whatever catches your fancy. New York Jew accent, optional.

On the Perils of Texting

I’ve been overwhelmed with all the sources of gratitude since moving home: thoughtful cousins, fresh air, helpful coworkers, exciting classroom moments, new books on Zen, an apartment two blocks from the library, quality Grandma time, dips in the ocean, lush green mountain backdrops, hilarity from my nieces and nephews, and so much more … apologies for the late blog!

Still, I’m no stranger to the stressors and challenges of daily life, especially while in transition.  There has been one in particular that got to me for prolonged period of time: a gaping hole where I felt communication should have been plentiful.  I was hoping for more texting, more emails, more Skyping – and yes, it was from a particular person.  So much suffering can stem from expectations!  Especially when they’re rooted in the actions of other people, and most especially when these actions are performed via modern mediums of communication.

And then I happened across an article and a video on this very topic … they certainly helped to put things into perspective for me.  I hope they’re of interest/entertainment value to you.  It’s hard to go wrong with Louis CK …



From Ira Israel on Elephant Journal:

I apologize in advance.

I could be wrong. I could be making a mistake. I’ve made mistakes before.

Maybe it’s my fault.

Maybe it’s me. Maybe I am reading too much into it. Maybe I am misguided. Maybe I don’t understand. Maybe I just don’t get it.

In the 1970s, if you told people that someday magnetized analog audio 8-track and cassette tapes would be replaced by digital ones and zeros pinging around inside a silicon microchip…

In the 1980s if you told the workers at Kodak that celluloid film would die a painful death at the hands of digital photo and video…

Or that facsimile machines would be replaced by PDF files cruising through high speed cable lines…

They would not have believed you.

All this to say that I believe that by the year 2040 people will look back on text messaging in the same manner that you and I look back on Morse Code.

Texting may seem wonderful for the occasional brief note to instantly reschedule a meeting in your crazy-busy life, but it actually often engenders ambiguity and confusion by failing to convey essential nuances such as disappointment, hope, irony, sadness, elation.

Text messaging is an absolutely terrible means of communicating emotions, WITH THE POSSIBLE EXCEPTION OF TEXTING ALL IN CAPITAL LETTERS (a.k.a. “shouting”)—LOL!— DUH!—sideways smiley faces and multiple exclamation points!!!!!!!!!!!!!!

I have witnessed the destruction of countless patients’ important relationships by miscommunications caused by texting and what I refer to as “subtexting.”

Subtexting is the tacit information given and the rampant misinterpretations of that information—namely the response time between text messages.

When you stand in front of a fellow human being and look into his or her eyes, you get a tremendous amount of information and you receive that information in real time; when you speak with someone on the telephone you can hear his or her breathing, you can feel the rhythm and tone of his or her voice, and get a general feeling of what that person’s current disposition or emotional state is.

Are they frantic, discombobulated, out-of-sorts, out-of-their-heads? Or are they serene, calm, composed, lucid, empathetic and thinking clearly?

All of this is completely lost while texting.

You have no idea if the other person is sitting on the toilet, driving furiously, smoking crack, gently massaging their wrists with a razor, having sex (yes, 25 percent of teenagers recently reported texting while having sex), throwing a tantrum, in a very important meeting, throwing a tantrum in a very important meeting or in a yoga class (yes, I watched an actress negotiate filming a nude scene via text message while in Virabhadrasana II—completely surreal yet somehow remotely acceptable at Maha Yoga).

And every second that passes as you wait for a response, your mind tries to assemble a scenario of the other person’s current reality from the blurry pixelated puzzle pieces of your text message conversation and the time it takes for them to respond.

You wonder,

“Is my wife really shopping at Whole Foods or is she screwing her tennis coach again? I thought that was over. Why is it taking her so long to text back?”

To my friends and recent girlfriends (too many of whom have ended our relationship via text message or what is known here as the “fade out,” which is when they slowly stop returning messages, and like a frog being boiled alive, you end up scalded by the silence): I have made very specific requests.

Please only text me for one of two reasons:

1. Egregious flirting. For example, “Ira, you’re super cool!” “You’re magic!” “You’re dreamy!” “You’re hugely gorgeous!” “You’re both dope, fresh and rad!” “I miss you!” “When can I see you again?”

2. Emergencies. For example, “Dude, I’ve lived in Los Angeles for 35 years and I still can’t calculate traffic into the equation. My GPS told me I would be there three months ago. I’m sorry I’m late. Dinner is on me.”

However, I have witnessed potential partners have entire one-sided passive-aggressive conversations and self-implode like Jon Favreau in “Swingers” via text message on my oh-so smart phone.

I have watched vacations in Paris spontaneously combust via text messaging on my oh-so smart phone. Worse, I have had imminent threesomes float off into the ether, never to be seen again, thanks to text messaging on my oh-so smart phone.

All joking aside, trying to communicate anything of note via text message equals one thing: fear of intimacy.

Anyone who can’t pick up the phone or look you in the eye when conveying vital information suffers from a dreadful fear of abandonment which manifests as a fear of intimacy. That’s why they like to keep everything vague—so that it appears more like Steve Jobs’ “Reality Distortion Field” than an outright lie, when they preemptively flake on you (before you can even think of flaking on or abandoning them).

After ten years and thousands of texts, I feel comfortable saying that the deficits outweigh the benefits regarding text messaging.

By now you’ve read or heard about Sonja Lyubormirsky’s book “The Myths of Happiness” so you know that most of the things you learned growing up in America will unequivocally not bring you happiness—right?

Once you are above the survival level, and if you are reading this article in your home or office and didn’t drag your pilfered three-wheel shopping cart from Venice Beach to the library this morning to shower in the bathroom sink, then you are probably doing better than just surviving.

The only thing that correlates strongly with happiness is the quality of intimate face-to-face relationships.

If you set your iPhone on the sink or toilet when you take a shower, then it is safe to say that technology is no longer your friend.

Facebooking and Tweeting delude people into believing they are engaging in relationships. But face it: nobody is ever going to receive a hug or pat on the back through a video screen. We need eye contact, we need to break bread with other human beings, we need touch, we need to practice the dying art of conversation, we need face-to-face empathy, love and compassion to get all of those mirror neurons firing again.

Oh, yeah, anyone notice the massive rise in depression, alienation and isolation, or the 100 million prescriptions for anti-depressants written every year in this country of 314 million people? I’m sure it’s just a coincidence.

All of the preceding is to explain why today I eliminated text messaging from my mobile telephone.

I want to rob people of the ability to reschedule via text message when I’m already sitting at the restaurant. I want to eliminate the possibility of a future girlfriend breaking up with me via text message or by fade out. It’s too easy. It’s too impersonal. It’s like assassinating someone by drone rather than knife and having his blood spurt all over you.

Horrendous improprieties and flagrantly inconsiderate behaviors have become tolerated due to text messaging and micro-scheduling. It is time that we realize that all of this multi-tasking—texting multiple people, while monitoring Tweets and Facebook feeds, while watching marathons of “Breaking Bad,” while eating Chipotle take-out, while paying credit card minimums online, while checking World of Warcraft scores, while skimming Youporn to see if you recognize anyone from Spring Break—isn’t making anyone happy.

Except possibly Time Warner Cable and their shareholders.

Most of you are too young to remember the famous line from Paddy Chayefsky’s “Network:”

“I’m as mad as hell and I’m not going to take this anymore!”

Well, you can call me Howard Beale if you like.

But you will no longer be able to text it to me. LOL!!!!!!!! :-)



Coffee Talk: Cultural Preservation

Macarons in their birth country!

Here in France 40% of the music on the radio must be French – whatever that means, considering the number of Beyonce and Lady Gaga remakes I’ve heard on this holiday!  The government puts significant funds into the proliferation of French culture, in particular the film industry, in addition to taxing French books at a much lower rate than foreign books.  Whether or not that means the book needs to be written by a French person,  in French and published by a French publishing company to meet the special taxation standards, I’m not exactly sure.  The Académie Française keeps close tabs on language, allowing new words to enter the French dictionary – like “smartphone” and “internet” – and disallowing other words whenever possible (amongst other responsibilities).

Though I respect the French for their staunch stand on cultural preservation, I can see how it might be interpreted as a touch pugnacious in an era  of globalization. Only time will tell in this grand experiment whether a national insistence on preservation will prove beneficial in future.  Giving priority to French creations sounds like heaven to the artist in me…

Sacre Coeur, Paris

It’s an interesting idea, one I wish the Native Hawaiians might have been more vigilant about during the mass invasion of British and American missionaries and tradesmen.  Too little focus on cultural preservation inevitably leads to a diluting of a region’s unique consciousness and practices.

The question remains, is the converse true as well?  Are nations on the far end of the protective spectrum – like Bhutan or North Korea – setting themselves up for a regressive kind of isolation?

Clearly France is nowhere near those two extremes, but it’s an interesting debate, one that was had over delicious food and a few glasses of rose.  A perfect setting for such things, voila.

To the NCCAM

Today I’m grateful for the National Center for Complementary and Alternative Medicine, providing grant money for research utilizing healing practices that are not within the scope of the Western biomedical model.  They also provide training for medical professionals interested in these kinds of healing modalities, research,  and health information for the public.
This was their Facebook page post today:
It is Yoga Week here in D.C. Check out our resources on the science of yoga, including our video “Scientific Results of Yoga for Health and Well-Being”:
It’s good to see aspects of the wisdom of yoga infiltrating government departments.  Although it’s clearly already infiltrated the White House Lawn 🙂


If you have a research project you require funding for, the center is currently favoring the following kinds of investigations:

Although a wide range of research topics are of interest to NCCAM, studies focusing on CAM interventions used frequently by the American public, and on the conditions for which they are most frequently used are particularly encouraged. These would include, but not be limited to, investigations of the impact of CAM modalities in alleviating chronic pain syndromes and inflammatory processes, and improving health and wellness. Among all types of studies, attention to a range of endpoints meaningful to improved health, well-being, and quality of life is strongly encouraged.

Now . . . I wonder how closely the NCCAM works with the FDA . . . ?

Drugs: The Portuguese Approach

Should drug abuse policy be *primarily* approached as a public health concern instead of an issue of criminality?


To check out the concept it greater detail: The Effects of Decriminalization of Drug Use in Portugal[529Kb PDF].

Cheers, Spiegel, for a refreshing dose of perspective (below) …


03/27/2013 11:32 AM

‘This Is Working’

Portugal, 12 Years after Decriminalizing Drugs

By Wiebke Hollersen

Twelve years ago, Portugal eliminated criminal penalties for drug users. Since then, those caught with small amounts of marijuana, cocaine or heroin go unindicted and possession is a misdemeanor on par with illegal parking. Experts are pleased with the results.

Before he got involved in the global war on drugs, João Goulão was a family physician with his own practice in Faro, on Portugal’s Algarve coast. Arriving in his small office in Lisbon, the 58-year-old tosses his jacket aside, leaving his shirt collar crooked. He looks a little tired from the many trips he’s taken lately — the world wants to know exactly how the experiment in Portugal is going. Goulão is no longer able to accept all the invitations he receives. He adds his latest piece of mail to the mountain of papers on his desk.

From this office, where the air conditioning stopped working this morning, Goulão keeps watch over one of the world’s largest experiments in drug policy.

One gram of heroin, two grams of cocaine, 25 grams of marijuana leaves or five grams of hashish: These are the drug quantities one can legally purchase and possess in Portugal, carrying them through the streets of Lisbon in a pants pocket, say, without fear of repercussion. MDMA — the active ingredient in ecstasy — and amphetamines — including speed and meth — can also be possessed in amounts up to one gram. That’s roughly enough of each of these drugs to last 10 days.

These are the amounts listed in a table appended to Portugal’s Law 30/2000. Goulão participated in creating this law, which has put his country at the forefront of experimental approaches to drug control. Portugal paved a new path when it decided to decriminalize drugs of all kinds.

“We figured perhaps this way we would be better able get things under control,” Goulão explains. “Criminalization certainly wasn’t working all that well.”

Much the Same as a Parking Violation

As part of its war on drugs, Portugal has stopped prosecuting users. The substances listed in the Law 30/2000 table are still illegal in Portugal — “Otherwise we would have gotten into trouble with the UN,” Goulão explains — but using these drugs is nothing more than a misdemeanor, much the same as a parking violation.

Why set the limits on these drugs at 10 days’ worth of use, though?

“Well, it’s a limit, which by its nature is arbitrary,” Goulão says. Now the head of Portugal’s national anti-drug program and an important figure in Portuguese health policy, he still talks like an easygoing family doctor. Arrayed on Goulão’s windowsill are photographs, including one of him with Richard Branson, the British billionaire and hot air balloon operator. Another shows Goulão with the king of Spain. Both these men have received personal briefings on Portugal’s new drug program from Goulão.

“At the point when we designed the law, we had hardly any data to draw on,” Goulão relates. “We weren’t the least bit certain this would work.”

The question at stake: How can a government keep its citizens from taking dangerous drugs? One way is to crack down on those who provide the drugs — the cartels, the middle men and the street dealers. Another approach is to focus on the customers — arresting them, trying them and imprisoning them. Legal prosecution — as both a control mechanism and a deterrent — is the chosen approach for most governments.

Giving Up on the Idea of a Drug-Free World

“It’s important that we prevent people from buying drugs, and taking drugs, using every method at our disposal,” says Manuel Pinto Coelho, 64, the last great opponent of Goulão’s experiment. Pinto Coelho wants his country to return to normalcy, in the form of the tough war on drugs that much of the rest of the world conducts.

Pinto Coelho is a doctor too. He has run rehab centers and written books about addiction. Now he’s at odds with former colleagues and with “the system,” as he says.

His greatest concern is that his country has given up on the idea of a drug-free world. How, Pinto Coelho asks, is it possible to keep young people away from drugs, when everyone knows exactly how many pills can legally be carried around? He still believes deterrents are the best form of prevention and that cold turkey withdrawal is the best treatment method. He is also fighting the extensive methadone program Portugal began as part of its drug policy reform, which now provides tens of thousands of heroin addicts with this substitute drug.

These days, Pinto Coelho earns his living running diet clinics, but he spends his evenings writing letters and drafting presentations on his country’s “absurd drug experiment.” He travels to symposiums to warn the rest of the world of its dangers. At home in Portugal, his critical perspective has made him an outsider, but he says he’s been well received abroad. As if offering proof, he shows a fact sheet issued by the United States Office of National Drug Control Policy, a brief and skeptically worded report on the Portuguese experiment.

The Freedom that Overwhelmed the Country

When João Goulão wants to explain why it is Portugal in particular that came up with the idea to stop prosecuting drug users, he starts with the country’s Carnation Revolution.

In 1974, Portugal broke free from nearly 50 years of military dictatorship, a political shift symbolized by the carnations soldiers stuck in the muzzles of their rifles.”Suddenly, the drugs were there,” Goulão says, as Portuguese returning from the country’s overseas colonies brought marijuana with them. Goulão, too, says he smoked pot back then. He was in his early twenties and “drugs promised us freedom.”

But it was a freedom that soon overwhelmed the country. When Goulão established his doctor’s practice in Faro, he soon found himself approached by parents whose children were no longer just smoking joints, but had moved on to heroin. Sometimes the children came to him as well, and Goulão had no idea how to treat them. When the first state-run rehab clinic opened in Lisbon, Goulão attended a training course there.

At that point, he says, the heroin epidemic was just beginning.

In the 1980s, cheap heroin from Afghanistan and Pakistan began flooding Europe. Portugal was not the only country affected, but Goulão says his nation was hit particularly hard, because people here had little idea how to handle drugs. “We were naïve,” he says.

The number of people taking illegal drugs in Portugal was low compared with other countries, but of those who did consume drugs, an unusually high number of them fell into the category that specialists in this field refer to as “problem drug users.”

From the pile of papers on his desk, Goulão unearths a copy of a speech he recently gave in Paris. Flipping through it, he finds the figure he’s looking for: 100,000. This is the number of severely drug-addicted people in Portugal at the height of the epidemic, in the mid-1990s. Portugal’s total population at the time was just under 10 million. The number of drug addicts who became infected with HIV was also considerably higher than in most other countries.

A drug slum formed in Lisbon, at the edge of a neighborhood known as Casal Ventoso. Here junkies slept in shacks or in the garbage, in extremely poor conditions. “They shot up on the street, and they died on the street,” Goulão says. Anyone in Portugal could observe this phenomenon — on TV, in newspaper pictures or even from the nearby highway.

‘Drug Users Aren’t Criminals, They’re Sick’

These were the conditions in the country at the point when the Portuguese government convened an anti-drug commission composed of 11 experts, including Goulão. Most of the members of the commission were not politicians. “Drug users aren’t criminals, they’re sick,” Goulão says. Not everyone agrees — Pinto Coelho, for example. But the anti-drug commission quickly agreed on this position, which formed the basis for Portugal’s experiment in dealing with drug users without dealing in deterrents. Goulão repeats that statement often, as do members of his staff within the anti-drug program, as well as doctors at state-run drug clinics. More surprising is that a Lisbon police commissioner, whose officers spend their days searching for drugs, says it too.

The logical extension of this statement is that people who are not criminals should not be treated as criminals. They should not be arrested, put on trial or thrown in jail. The punishment for drug possession in Portugal prior to decriminalization was up to a year in prison.

The Portuguese experiment has been in action since Law 30/2000 went into effect nearly 12 years ago, and Goulão’s staff is currently calculating how much money the country’s judicial system has saved, in its courts and prisons, now that it no longer has to process individuals the police catch with a few grams of drugs.

“The police still search people for drugs,” Goulão points out. Hashish, cocaine, ecstasy — Portuguese police still seize and destroy all these substances.

Before doing so, though, they first weigh the drugs and consult the official table with the list of 10-day limits. Anyone possessing drugs in excess of these amounts is treated as a dealer and charged in court. Anyone with less than the limit is told to report to a body known as a “warning commission on drug addiction” within the next 72 hours.

The Second Time Brings Consequences

In Lisbon, for example, the local drug addiction commission is housed on the first floor of an unremarkable office building. The idea is that no one should feel uncomfortable about being seen here. A 19-year-old in a white polo shirt waits in one room. Police caught him over the weekend with about a gram of hashish. A social worker has already questioned him for half an hour and learned that he attended vocational training at an agricultural school, lives with his parents and smokes pot now and then. This was the first time he was caught in possession of drugs.

“Social user, no risk factors present,” the social worker notes.

Next, a psychologist and a lawyer speak to the young man. They want to know if he’s aware of the dangers of cannabis.

“Yeah, yeah, from school,” he says. “We had a class on prevention.”

As long as he isn’t caught again within the next three months, his case will be closed. “We won’t inform anyone that you were here and this won’t go on your record,” the lawyer explains. “But if it happens a second time, there are serious consequences.”

But later, asked to explain these consequences in more detail, nothing comes to her mind that sounds particularly serious. A couple days of community service, perhaps. The commission can also impose fines, but the lawyer says it doesn’t like to do so for teenagers. The fines are likewise not intended for people the commission determines to be addicts — they’re already paying to maintain their habit. “Our most important duty is to invite people to participate in rehab,” she explains. Lisbon police send around 1,500 people to the commission each year, which averages out to less than five a day. Seventy percent of these cases concern marijuana. Those who fail to turn up receive a couple of reminders, but coercion is not an intended part of this system.

Decriminalization, Not Legalization

Warnings, reminders and invitations to rehab — it seems Portugal’s war on drugs is a gentle one. “Humanistic and pragmatic” is how João Goulão describes the new program. It is based on decriminalization, which should not be confused with legalization. Portugal considered that path too, but ultimately decided not to take things quite that far.

When Portugal’s parliament was debating the proposed Law 30/2000, representatives of right-wing parties declared that planes would start arriving in the country daily, full of people looking for an easy opportunity to pump themselves full of drugs. Our entire country will become a drug-ridden slum, these parties said. The left-wing parties in parliament held a majority, though.

Goulão sits in his office and pages through charts, tables and graphs that are just some of the great quantity of data his team has collected over the years.

The data show, among other things, that the number of adults in Portugal who have at some point taken illegal drugs is rising. At the same time, though, the number of teenagers who have at some point taken illegal drugs is falling. The number of drug addicts who have undergone rehab has also increased dramatically, while the number of drug addicts who have become infected with HIV has fallen significantly. What, though, do these numbers mean? With what exactly can they be compared? There isn’t a great deal of data from before the experiment began. And, for example, the number of adults who have tried illegal drugs at some point in their lives is increasing in most other countries throughout Europe as well.

Running Out of Money

“We haven’t found some miracle cure,” Goulão says. Still, taking stock after nearly 12 years, his conclusion is, “Decriminalization hasn’t made the problem worse.”

At the moment, Goulão’s greatest concern is the Portuguese government’s austerity policies in the wake of the euro crisis. Decriminalization is pointless, he says, without being accompanied by prevention programs, drug clinics and social work conducted directly on the streets. Before the euro crisis, Portugal spent €75 million ($98 million) annually on its anti-drug programs. So far, Goulão has only seen a couple million cut from his programs, but if the crisis in the country grows worse, at some point there may no longer be enough money.

It is simply by chance that the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) has its headquarters in Lisbon. Frank Zobel works here, analyzing various approaches to combating drugs, and he says he can observe “the greatest innovation in this field” right outside his office door.

No drug policy, Zobel says, can genuinely prevent people from taking drugs — at least, he is not familiar with any model that works this way. As for Portugal, Zobel says, “This is working. Drug consumption has not increased severely. There is no mass chaos. For me as an evaluator, that’s a very good outcome.”

Translated from the German by Ella Ornstein


All Rights Reserved
Reproduction only allowed with the permission of SPIEGELnet GmbH

Obamacare: Explained

Cheers to the Atlantic for posting this gem for those of us out there who are a little fuzzy on just what Obamacare means (myths busted at the NYTimes) … are you ready for it (Mother Jones sure is)?




What Is Obamacare?
By James Hamblin

Only 37 percent of Americans say they’re in favor of the 2010 health-care law. When you describe specific changes happening under the law, though, closer to 70 percent are on board with them. That’s among data from Kaiser Family Foundation that was highlighted on All Things Considered this weekend. Also of note: 50 percent think the law gives health-care subsidies to undocumented immigrants, 80 percent don’t know if their state will expand Medicaid, and 40 percent think the law sets up “death panels.”

Even though the law passed three years ago, there’s still a lot of misunderstanding out there about the basics of what it is/does. So hopefully some people will find this of use. I totally relate to situations where everyone is talking about something for a while, and you never really got it, and then before you know it everything you try to read is beyond comprehension because it assumes everyone already knows the basics. So you just nod passively when people bring it up and try to change the subject and continue not to know about it. I’m that way with Syria and food trucks.

If you consider yourself conversationally fluent in Affordable Care Act banter, then what I write here will bore you. Detailed discussion is at — and also like, everywhere else.

Obamacare … okay to call it that?

Yes. The name used to have a negative vibe, but the President has since owned it.

Patient Protection and Affordable Care Act = PPACA = ACA = Obamacare = “the health-care law”

None of these in particular imply that you love or hate Barack Obama or intend to support or subvert the law.

What does it do for people?

SHARK300200.jpgObamacare does not mandate that anyone bend over. This is a playful sodomy reference. (RebeccaCook/Reuters)


The stated purpose is to “increase the number of Americans covered by health insurance and decrease the cost of health care.” The most widely relevant and talked-about parts are that no one will be excludedfrom getting insurance, and everyone will have to get insurance.

Insurance companies can’t refuse to cover people like they used to, and they can’t revoke coverage when people get sick. People won’t be forced to pay extra for insurance because of pre-existing conditions. There will be a limit on how much insurance companies can legally profit, and they will eventually have to cover all kinds of preventive care.

Those things, among other measures aimed at containing U.S. health care spending, which was $2.6 trillion last year …


This law passed three years ago. It doesn’t feel like much has changed.

Changes are rolling out over a ten-year period. So far, things have mostly affected insurance companies and the industry side. Increases in health care spending have (coincidentally?) slowed since 2010.

The most disputed part of the law — the “individual mandate” that requires “most Americans to have “minimum essential health insurance coverage” (the part that drove the ACA to the Supreme Court last Spring, where it was upheld) — goes into effect in January 2014.

45 million Americans don’t have health insurance, though. How are so many people supposed to get it by 2014?

First, state and federal governments are setting up exchanges. That will start in October.

What are exchanges?

Exchanges are markets where small businesses and people can shop for insurance and compare prices and benefits. They’ll be on web sites.

Well, what if people still can’t afford it?

People with “moderate” incomes can get money/discounts from the federal government to help pay for insurance. People with “low” incomes will get their care from Medicaid. More people than ever before will qualify for Medicaid. People who make less than $15,856 (or $26,951 for a family of three) will qualify. As you’ve heard, Medicaid is expanding, but the federal government is leaving it up to states to decide whether to accept that expansion. The Supreme Court upheld the ACA, but it limited the federal government’s ability to enforce expansion, so it’s up to states.

Is my state expanding Medicaid?

Here is where we stand as of last week.

States_continue_to_weigh_the_Medicaid_expansion_decision.jpgWhere the States StandThe Advisory Board Company

What about undocumented immigrants?

Not eligible for Medicaid or for buying coverage through an exchange

What are death panels?

Not a thing

Why do 40 percent of people think they are a thing, then?

When discussions turn to rationing care — for example, not spending millions of dollars to keep a 145-year-old person in a coma on life support indefinitely; and, instead, using that money to provide basic preventive care to thousands of underprivileged kids — someone will bring up the term “death panels.” That is, if we are not going to always keep everyone alive at all costs, who decides how care should be rationed? An important question, but “death panels” are fiction.

The law did create an independent nonprofit organization called the Patient-Centered Outcomes Research Institute (PCORI) that compares treatments and tries to figure out which options make the most sense for particular people. That’s the closest thing to what someone could somehow call a death panel. But it’s actually a body to help make sure more of the decisions made by doctors are supported by evidence.

I get it. How many death panels will Obamacare create? How many astronauts per death panel?

[No response]

Can I still have bacon and giant sodas under Obamacare?

Yes. The only thing in that realm you might care about is that chain restaurants have to list calories on their menus.

Also tanning beds, right? Obama wants to disassemble the free market?

There is a tax on tanning salons. UV rays cause skin cancer, which costs the system money. If you object to taxing things, you could think of it this way: Tanning salons are paying for the costs they create.


I trust and love my family doctor. Under the Affordable Care Act, is there a chance she will be replaced by a drone?


But drones are everywhere. At least robot doctors are in the works? They are. I saw it on the cover of The Atlantic magazine.

If the Affordable Care Act leads to less money wasted on inefficiently providing health care, then more could be invested in tech. So this is not an insane inference. Tech won’t replace doctors, though.

I remain unconvinced and am pretty sure there’s fine print somewhere that gives undocumented immigrants access to my kids’ medical records and whatnot.

You can read the entire act here. It’s 955 pages, though.

And also join the ongoing discussions about health reform everywhere, dinner parties to angry Internet comment threads. I hope this helped a little in getting someone somewhere somewhat more comfortable with that.

This article available online at:

Coffee Talk: Gadgets and Health

Clearly there are ways technology aids in starting or maintaining a healthy lifestyle: the step counter, the scales, the BBC News Health App 🙂

But do we *need* gadgets and technology to be healthy?  Could they, in actual practice, be more distracting than helpful?


Today I’m grateful for the infiltration of the “health market” in the Consumer Electronics Show in Vegas.  Hey, if we can get gamers off the couch for some actual engaged embodiment, there’s hope yet!

Check out this article from a newspaper that’s kept me surprisingly awake at many a mid-morning brunch, The Guardian

The HAPIfork … vibrates when you eat too fast.

The Consumer Electronics Show, an annual innovation showcase which brings over 100,000 industry professionals to Las Vegas and fills 172,000 square metres of convention floor space, is traditionally a cornucopia of gadget prototypes for couch potatoes. At this year’s CES, alongside the usual array of computers, robots and giant televisions, about a quarter of the exhibits were related to health and fitness, selling the idea that technology is the key to mental and physical wellbeing.

It does not sound a promising combination: geeks tend to neglect health and fitness; Sin City discourages moderation and sense; and conferences are graveyards of diet and exercise. Yet companies and developers unveiled a parade of apps, accessories and gizmos to help lose weight, eat properly, exercise regularly, prevent disease, manage illness and banish infirmity. Believe the hype and it is a mystery how our species survived this long without technology.

“Everybody could benefit from this,” says Philippe Monteiro de Rocha, an engineer with the French company Hapilabs, holding a fork. And it’s not just any fork but a prototype HAPIfork, a piece of smart cutlery to help you slim. “It has a capacity sensor in the handle which monitors the speed you eat,” he explains. Eat too fast and the fork vibrates, reminding you to slow down. People feel full after 20 minutes of eating so if you eat less during that time, you’re on your way to a thinner you. An unexpected hit at the expo – “We’ve been covered by [journalists from] 62 countries in the past 48 hours,” marvels Hapilabs’ Renee Blodgett – the forks are due to go on sale in the US this summer for $99 (£60) and in the UK later in the year.

Metria wearable sensors.
Among the thousands of products ranging from daft to useful to ingenious, the connecting thread is wireless technology – using smartphones and tablets to collect data about your body in real time. “Everybody is trying to leverage this technology into the field of wellness,” says Ryan Hruska, an engineer with Vancive, a Chicago-based medical technology company exhibiting a wearable sensor called Metria. You put the small patch on your chest for seven days, during which it measures heartbeat, skin hydration, breathing, steps taken and sleep patterns, recording the duration and quality of sleep (poor, good, excellent) on the basis of how much you tossed and turned.

This information is sent via Bluetooth and can be instantly tracked on a phone or tablet, meaning you can be on the other side of the world and check up on Grandma’s precise medical condition, says Hruska. “A lot of elderly people live on their own. This way you can make sure they’re OK.”

The disposable patch, which lasts seven days and can be worn in the shower, is due to go on sale this year for between $30-$40. The US air force is considering it to monitor pilots. Drug companies could use it to observe subjects’ adherence during drug trials. Insurance companies could, in theory, use it to verify medical conditions. “It will become more difficult to lie to insurance companies but it cuts both ways. If you’re taking medication as you should you’d be able to prove it,” says Tim Ensor, a product developer with Cambridge Consultants. The British firm’s wares include an algorithm which uses a bike, Bluetooth and smartphone to calculate and adjust the gear for optimal efficiency.

Fitness straps, which can record medical data in real time.Exhibitors hammered the message that smartphones and tablets could now help liberate us by processing medical data instantly and precisely. “Some diabetics need to test their blood sugar six to 12 times a day,” says Joseph Martorano, of iHealth, a California firm which has developed an app to record and store such information using one of the increasingly ubiquitous “cloud” services. Dozens of other companies such as Fitbit, Fitbug and BodyMedia vied to show “wearable” fitness devices you can strap around your wrist or ankle to record, it seems, every pore that opens.

If information management alone could deliver health and fitness then soon we would all be athletes. Sadly there is no app for willpower. There is, however, a gadget you can strap around your head to harness your brainwaves. “You just have to concentrate,” says Steve Castellotti, the founder of PuzzleBox, snapping a black band around my head. A sensor node rests on my forehead, a device is clipped to my ear. Castellotti taps on a computer. “Ready.”

My brow furrows, my eyes squint and hey presto, a toy helicopter buzzes upwards, controlled by my thoughts. The device works by measuring brainwave electroencephalogram and heartbeat electrocardiography. Seconds later the helicopter plunges – I lost concentration.

The point of the software, says Andrea Shukis of NeuroSky, which has partnered with PuzzleBox on the brain-controlled helicopter, is to teach the value of concentration and focus. They also had on display furry cat ears with sensors that swivel, prick and droop according to what you’re thinking. “You can use it to teach children and to help adults keep their brains active.”

Who would have thought: Las Vegas, the temple of indulgence, showing us how to eat less, monitor health and exercise willpower.


I spent quite a bit of my day leafing through books on Hawaiian psychology, ancient family traditions, lomi lomi (intentional Hawaiian healing massage), ho’oponopono (the Hawaiian process of reconciliation and forgiveness) and la’au lapa’au (Hawaiian herbal medicine) – all thanks to the Hawaii & Pacific section at the Hawaii State Public Library (pictured above).

The public library in Brooklyn is pretty sweet from the outside as well, even if their actual physical collection is not quite as impressive.  Which isn’t to say I’m complaining!  I couldn’t be more grateful for the books they do have, as well as the free workshops they provide on business plans, language acquisition and talks with reputable authors.  What they may lack in book selection, they make up for with their online offerings, ranging from standardized test preparation to the latest in academic journal publications.  Having a membership there is a real blessing.

When I was younger, I always frequented the Ewa Beach library, partial inspiration for a blog I wrote during my last trip home.  The smell of the books, the infinite possibilities that lay within that small air conditioned structure – it was the perfect remedy to hot sweaty days on the fenced elementary school playground.

In fact, public libraries (with books in English!) were a big reason I decided to move back to the states!

It’s obvious to say it, but I will anyway: libraries are damn good for communities.  They offer invaluable opportunities for people to come together and share in their knowledge and wisdom, it levels the educational playing ground (no $100k debt after a library education!), to socialize, to explore the fictions and facts of any worlds they choose, to find a job, or to simply use a computer.  And for the less liberal-minded (or more linear thinkers?) out there, a Florida study found that public libraries return $6.54 for every $1.00 invested (the link includes quite a few studies proving the ROI of libraries)The bottom line is libraries rock.

“There is not such a cradle of democracy upon the earth as the Free Public Library, this republic of letters, where neither rank, office, nor wealth receives the slightest consideration.”  ~Andrew Carnegie

What do you say, are libraries important investments for our future?