Who knew?

In a perhaps not unrelated development, we also learn that while over the past eight years the National Review and Rush Limbaugh most surely did strive mightily to point out that the otherwise asskickingly awesome president George W. Bush was spending too much money, in retrospect they should have "screamed and caterwauled and hollered to high heaven" against such fiscal and ideological heresy.

There are two implicit premises in the foregoing: (a) the only reason the GOP is currently up a certain creek with a paddle rammed up its ass is that its leaders have failed to live up to goofball "big government" rhetoric; and (b) that this difficulty was compounded by a deficiency of right wing "caterwauling."

Neither of these premises will perhaps stand up to objective scrutiny. But then again, everyone at The Corner seems to be doing quite well out of the old orthodoxies, so why toss them aside just because they're nonsensical? It wasn't like the last Democratic administration was a bad time for this crowd, after all. Hell, Bill Clinton set lots of these nitwits up for life. Best thing that ever happened to them was 1992.

Think about it. Perhaps the most exciting thing to look forward to about an Obama presidency is that it will launch the career of the next Jonah Goldberg.

Kind of makes you feel all happy inside, don't it?

For almost two years, Metro police have had the option of calling for a needle loaded with a strong sedative to control the most unruly people they encounter on the street.

To compound the dangerous stupid, Versed's side effects include the same behavior the geniuses in Nashville seek to control.

Reactions such as agitation, involuntary movements, hyperactivity and combativeness have been reported in adult and pediatric patients. Should such reactions occur, caution should be exercised before continuing administration of midazolam.

In addition to making agitated patients more agitated, Versed can (and does) cause respiratory depression. What's respiratory depression - a case of the sighs? Nope - respiratory depression is the fancy doc talk for what happens when the nerve cells in our lizard brain get so sedated they forget to tell us to breathe - and we suffer severe brain damage, or even die. Because, amazingly enough, our brains require oxygen to survive.

Midazolam is a potent sedative agent that requires slow administration and individualization of dosage. Clinical experience has shown midazolam to be 3 to 4 times as potent per mg as diazepam. BECAUSE SERIOUS AND LIFE-THREATENING CARDIORESPIRATORY ADVERSE EVENTS HAVE BEEN REPORTED, PROVISION FOR MONITORING, DETECTION AND CORRECTION OF THESE REACTIONS MUST BE MADE FOR EVERY PATIENT TO WHOM MIDAZOLAM INJECTION IS ADMINISTERED, REGARDLESS OF AGE OR HEALTH STATUS. Excessive single doses or rapid or intravenous administration may result in respiratory depression, airway obstruction and/or arrest. The potential for these latter effects is increased in debilitated patients, those receiving concomitant medications capable of depressing the CNS, and patients without an endotracheal tube.

These deadly side-efects make Versed a drug that cannot be safely used without full capacity and opportunity to intubate the patient. In many teaching hospitals, use of Versed outside the ICU seting is restricted or prohibited: the risk of iatrogenic (treatment-caused) respiratory depression leading to brain damage or death is judged to be too great.

Of course, this concept may be lost on many whose co-workers insist that choke holds killed black people not because the victims couldn't breathe, but because of the victims' ethnicity.

In 1982, Chief Gates provoked an outcry from civil rights advocates when he said that blacks might be more likely to die from choke holds because their arteries do not open as fast as arteries do on "normal people."

The concept also may be lost on many whose co-workers insist that when people are hog-tied and placed face down (thus compressing airways), the resultant deaths have nothing to do with the hog-tying....so they keep using the hog-tying technique known to kill people.

The simple fact of the matter is that even if officers take precautions, hog-tied and prone restraint is inherently risky.

In other words, the concept that our brains actually need oxygen to survive appears to be lost on a significant fraction of those who work in law enforcement.

The Nashville cops try and justify setting themselves to forcibly administer powerful mind-altering drugs without judicial order (much less consent) by trundling out a local Emergency Services doc who tries to excuse away this insane practice by citing a diagnosis that doesn't even exist: "excited delirium".

...they are assessing the situation and saying, 'This person is not acting rationally. This is something I've been trained to recognize, this seems like excited delirium.' I don't view delirium in the field as a police function. It is a medical emergency. We're giving the drug Versed that's routinely used in thousands of health care settings across the country in the field by trained paramedics. I view what we're doing as the best possible medical practice to a medical emergency," Slovis said.

The phrases "excited delirium" and "agitated delirium" were pushed on the world by law enforcement and the people who sell them weapons -- like the nice folks from Taser. There is no such medical diagnosis.

The cause of death only appears where police are involved in restraining individuals.[2][3] The term has no formal medical recognition and is not recognized in the Diagnostic and Statistical Manual of Mental Disorders. There may also be a controversial link between "excited delirium" deaths and the use of Tasers to subdue agitated people.[4]

Am I relying on the Wiki? Nope -- for years, delirium was a big part of how I made my living. Over years as a consultation-liaison psychiatrist responsible for organ transplant recipients and many oncology patients in a major UC teaching hospital, I diagnosed and treated delirium just about every week, and most days in most weeks. Why? Delirium is very common in patients so severely ill as to require hospitalization in major university teaching hospitals. By some estimates up to one-third of patients in major med centers on any given day will meet diagnostic criteria for delirium. Most will be quiet, so the delirium is often missed. A few will be disinhibited ("agitated") as a symptom of the delirium. "Agitation" is no more a diagnostic category for brain disease than "chest pain" is a diagnostic category for heart disease. Both are symptoms, not diagnoses.

Duh.

Delirium is characterized by a fluctuating (waxing and waning) impairment in orientation (accurate knowledge of self, time, location, and situation). Yep - on any given day, up to one third of acutely ill patients won't quite know what day it is -- and many won't give an accurate answer about their location and/or situation. Over the course of the day, the level of disorientation waxes and wanes. Who cares? Well, in hospital patients, persistent delirium is one factor predicting an increased risk of death. Yet the delirium is very seldom the factor that causes death.

Delirium is simply an obvious indication of impaired brain function. In medical patients it may reflect other disease states (infection and/or major cardiac, pulmonary, liver, or kidney disease), medication side effects, or even prolonged sleep disturbance. Among these causes, the underlying disease is almost always what causes the delirium-associated deaths.

In people on the street, delirium may sometimes reflect medical illness, but is far more often simply a reflection of acute (and hence self limiting) intoxication with alcohol or other substances. In other words, on the street, delirium fortunately seldom indicates the patient has an acute medical illness -- and far more commonly simply indicates acute intoxication.

Who cares? Well, the above facts explain why Dr Slovis' excuse for forcibly giving Versed to delirious people on the street is bogus

I don't view delirium in the field as a police function. It is a medical emergency.

Though some acutely intoxicated folks on the street do perish as a result of their confusion, the vast majority don't. If they did, every Sunday morning college campuses across America would be littered with the bodies of those who got so wasted the night before they couldn't find their way home.

To justify an insane policy, Nashville's emergency service doc cites a spurious emergency from a non-existent diagnosis.

Of course, my "colleague" who attempts to defend having Officer Friendly direct EMS personnel to forcibly adminster Versed is the same doc presiding over use of a deadly drug with side effects that look exactly like the "symptoms" the Nashville PD presume to treat in the first place.

Nashville: home of country music and Gulag medicine. No wonder Johnny Cash gave 'em the finger.

Scotty, if I ever end up drunk in Nashville, beam me outta there. Stat.

[photo: Virany]

Regulation Needs Teeth. - Photo by Sharon Beals

"Regulation is always bad for business."

How do I know this? Why the think tanks who are supported by Business tell me that. The CEOs and PR firms who work for the businesses tell me that. The conservative talk radio hosts who work for advertiser dollars tell me that.

Who comes out and says that regulation is GOOD for business? Who comes out and says that we NEED government to keep an eye on things? Hardly anyone. And when they do, they are ATTACKED. Who attacks them? The think tanks, the talk radio hosts, the people who make money in an unregulated environment.

The corporations will ALWAYS push for what they can get, it is their nature. Someone should push back. Because when there is no one to push back they will win. Who is on our side? Who pays when the whole thing falls apart? We do.

Think-tankers are WRONG about the need for regulation and they know it, but that doesn't stop them from pushing. Suggesting that regulation is a good for business usually brings up a knee jerk reaction in conservatives. "Ack! Regulation is always bad for business! Deregulation is better. If deregulation fails it is because it wasn't done right." Or, to paraphrase Digby on conservatism, "Deregulation can never fail, it can only be failed."

We can rub conservative's noses in the failures -- but that isn't very satisfying because they always have an excuse for why they failed. Why bother suggesting it?

Because, like a child who is testing the limits, conservatives need someone to push back and I'll bet they are secretly happy when they lose a regulation battle, because the smart ones understand that they really need regulation, though they still cry just to save face. Recently the airline execs sent out a letter pleading with people to help them get stronger regulation (pdf link). Of course they want regulation on the OTHER guy, those dirty oil speculators, but it shows that smart businesses understand about the critical need for regulatory limits in some areas.

Regulation. Good for Business. Good for Americans.

It always behooves the people who don't want regulation to tell stories of too much regulation. Are there sometimes cases of too much regulation? Yes.

Are there many, many more cases of too little or NO regulation? YES. 1000 times yes.

I saw first-hand the consequences of little or no regulation during the tainted pet food crisis last year. Did you know that thousands of pets died? The FDA kept reporting the official number "at least 16 deaths" because they didn't have the resources to confirm the thousands of dead.

Did you ever wonder what happened to the recalled pet food? Because there was no regulation on disposal of the tainted food, some was fed to 20 million chickens and 56,000 hogs. Gee, I wonder if the same stuff that killed and sickened thousands of puppies and kitties might make chickens and hogs sick? What would happen to us if we ate them? Don't worry, the FDA and USDA did a "risk analysis" that declared the chickens and hogs safe, but I was always curious why they wouldn't release the name of the company that processed them. Could Big Chicken and Big Pig have put pressure on the FDA and the USDA to get a quick safety ruling to ensure they wouldn't have to cull their chickens and hogs? Did they request (demand?) that their names never be mentioned to the media? We'll never know, especially in a world where the industries being "regulated" really rule the roost.

Should we promote these cases of too little regulation or regulation abuse, make the people go to jail, and extract our money back from these people so that this won't easily happen again? Yes.

Dear Enron: I want my money back, you lying jerks. -- Signed California

I'm sick of being told how terrible regulation is when I can point to major crisis after crisis that could have been nipped in the bud with regulation or enforcement of existing laws.

Regulation. Good for Business. Good for Americans.

If you disagree with the importance of regulation let me ask you who you work for and who funds you. Has your industry benefited from regulation? Have you ever benefited from regulation? Before you answer no, consider the car you sit in, the chemicals in your home, the food you eat, the hard hat you wear, the water you drink and the air you breathe. I'll bet 200 quatloos that you have benefited from regulation.

Yet businesses and neocons still fight regulation. Hot-shot CEOs don't want to follow government rules, only Wall Street's. They know they can buy off the government. Yet they want the other guy to follow the government rules. I can't tell you how many CEOs I've met who say, "All I want is an unfair advantage." If they looked at the big picture they would realize that regulation is GOOD for them, their industry and the country.

The U.S. benefits when we have regulation, but of course the U.S. isn't who corporations want to help. And if there are no consequences for bad behavior, they will keep doing it again and again. We've lost the stick on the side of regulations and the law and they still get carrots for bad behavior.

"I fail and I'll take all of you with me! Ya shoulda stopped me sooner, I'm too important to fail now!" -Current logic used to obtain corporate bailouts

Businesses won't fund studies about how GREAT regulation is for everyone and how the desire to destroy and circumvent regulation is bad for business, bad for America and bad for the economy. But if anyone does such a study, look for the findings to be destroyed by the knee-jerk, right-wing think-tankers and conservative media machine.

The current banking crisis is the latest example of the need for oversight that oversees, regulation that regulates, government that governs. Now we need consequences and regulations put back into place with funding, enforcement and teeth. Why? Because as I've said:

Regulation. Good for Business. Good for Americans.

What We Could Have Done With The Money

Rob Simpson, author of What We Could Have Done With The Money, has asked what the US could have had for that trillion dollars if it hadn't spent it on war. Some of his answers are sad (pay every Iraqi 3X their average income to stay peaceful), some are tragic (rebuild and protect New Orleans for only 213 billion), others are comic. But they all put into perspective that was lost wasn't just lives, it was opportunity. Money used to kill people, drive up the price of oil, violate human rights and destroy the US's international reputation could have bought a heck of a lot. And Simpson has been conservative, he puts the cost at a trillion, but when you take into account deferred costs (like looking after Vets who are amputees) economist Joseph Stiglitz put the cost of the Iraq war at 2 trillion.

And Stiglitz doesn't add in certain other costs. For example, military hardware is obsolesced very quickly by warfare, because enemies get to see how it works and what its weakness is. The Abrams was once thought invincible but today foreign governments and guerillas alike know how to defeat them. A generation of military hardware will have to be replaced if the US wants to keep its edge.

It's the lives not lived, the paths not followed that make us weep the most. Rob's book invites us to imagine some very different worlds, not just worlds without the war, but worlds with what the Iraq war cost us, such as:

• Pay off every American's credit card debt. And hey, still have a couple hundred billion left for a night on the town.
• Pay off those Bush tax cuts. Nope. But you could pay, er, pay the interest on their cost for about 10 years.
• A solar power build out big enough to generate enough energy for two-thirds of all American homes.
• $10,000 subsidy on hybrid cars, leading to 40% of the US auto fleet being hybrid, and reducing gas use by 56 billion gallons a year.
• Give every single American a full $600 makeover. Because aren't you all just stressed out dahllling?
• The World Sings As One! Stage 40,000 3 day music festivals each with 125 acts on 9 stages.
• Send 5 years worth of high school students to university, with fully paid tuition.
• Clean up and revitalize 667 rivers.
• Mass Transit! Create 6,667 miles of monorail or subway systems (about New York to Tokyo, or 60 miles in each major city).
• Pave every highway with 23.5-Karat gold leaf!

As Rob writes at the end of his book, the US could have done amazing things with that money. Instead it chose not to, to pour the money into a hole in the desert. And in a democracy that means that everyone failed, not just the politicians. This is a book that drives that point home, in plain figures and cold facts. It is, I think, the perfect gift for the Republican friend who's beginning to have a few doubts, because it's non-partisan, even-handed, and it's just the facts, ma'am.

And hey, the roads really could have been paved with gold!

I was only able to watch for a little while -- heard Erik Erickson of Red State and Michael Steele talk, and watched the nostalgic Ronald Reagan videos they ran in between segments to help boost what clearly were some flagging spirits -- before they realized I didn't have the requisite green tag and booted me out.

I was polite and well-behaved (I even opened the doors for a handicapped woman who was having trouble pushing through as all the young conservative men stood and watched her struggle) but, well, they clearly did not want interlopers. I was hoping to have been in there long enough to hear Michelle Malkin, but the Unhinged One was late arriving and they kept finding ways to stall the crowd, and soon enough my time ran out.

But there were some notable differences with Netroots Nation:

-- I stood out like a sore thumb because I was wearing shorts and a Hawaiian shirt, fairly typical NN/DFH wear. All the male Pubbies, young and old, were neatly dressed out either in chinos and golf shirts or suits and ties.

-- It was very, very, very white there.

-- There were only speakers; no question-and-answer periods. Everybody seemed happy to just be talked to, not to talk back.

-- The speakers were uniformly, uh, subdued about their prospects for the 2008 elections. I think a hari-kiri booth in the exhibit area would have been popular.

-- And there were, well, a lot fewer people. A LOT. You can see the crowd shot above, as it were. I guesstimated (generously) the crowd to be between 200 and 300 people. Below, just for the sake of comparison, is a typical NN crowd -- where the numbers are upwards of 3,000.

That says all I think you need to say about the state of the conservative movement vs. the state of the progressive movement.

Last night I was very inspired by the story of Granny D, a progressive 94 year old in New Hampshire who ran against glad handing Bush rubber stamp Judd Gregg. I posted the 90 minute documentary at DWT and I want to recommend that everyone watch it when they have some time.

This past Tuesday, Regina Thomas lost her race against another glad handing Bush rubber stamp, John Barrow, who paid $21 for every vote he got. It will remain to be seen if the scare Regina gave him will make him a better member of Congress. As she said in the note she sent me on election night, she'll be watching to see if he's more responsive to the needs of the district's working families. She also told me she has some money that's coming in from ActBlue and asked that Blue America make some suggestions about which worthy candidates she should send some of it to? Any suggestions from the community that helped her get her race going?

And while you're thinking about that, if you missed our action against the extremist group Freedom's Watch, please take a look at the video and consider helping us pay for the several hundred thousand calls we're making to defend Steve Kagen (D-WI), Chris Murphy (D-CT), Linda Stender (D-NJ), John Adler (D-NJ), and Tom Allen (D-ME). These Neocon Bush billionaires are trying to blame them for high gas prices. And Mike Farrell sets the record straight:

Why?

She's a weak Speaker with a serious internal challenge to her authority from the Maryland conservative Majority Leader Steny Hoyer, who is very popular among House Dems. He's there for them and he's a very able manager. He staffs their offices and raises money for them religiously.

Better to run out the clock and talk about "expanding our universe" (whuh?) than acknowledge the knives at your back and the fact that Democrats in the House do not believe as we, or the majorities of people in the country, do.

The shortest solution is an organizing solution, and it sounds like the long road. . . but it's the short road. We need to get better at grassroots candidate recruitment and training, starting this November.

We can't not do it.

I'm sitting here waiting for the "Ask The Speaker" session to start. Exhibit Hall 4 of the Austin Convention Center is totally packed and buzzing and Code Pink is in the house. Already I've heard several people say, "this could get pretty rowdy." We'll soon find out.

I'm hearing rumors of a surprise guest, but nothing confirmed yet.

I'll be liveblogging the event in comments. FDLers everywhere. Spencer, Pach, Marcy and Watertiger are also in the house.

UPDATE

Spencer reports that the Goracle will the special guest today.

First, from Elizabeth Edwards:

...Last week—when Tony was still alive and I was not so afraid—I rode my bicycle in a small Fourth of July parade at the beach to which we have gone for close to two decades. When I got to the celebration and stepped off the bicycle, an older man approached me. I hope you are doing well, he said, and then he added—oddly, it is more often the case that people do feel obliged to confess the gap between us—"although we don't agree on much of anything." I thanked him for his good wishes and then I added—as I often do—"and I suspect we agree on more than you think." He smiled, I smiled, and that was that. And then Tony died. And I thought more about the things on which we agree and the things on which we disagree. And as with my parade companion, I suspect Tony and I agreed on more things that we might have guessed. 

We each chose to reach for something larger than the life and body with which we were saddled when we kept our course after the last diagnoses. We did it because we thought it was important and because (although it is chic to say that one detests politics) we actually loved the give and take it, the struggle to find what you think is right and the imperative to make others understand and agree. But what, in the end, does it tell us about what we each found to be really important? I am guessing it is not school vouchers or the expensing of stock options or class action lawsuits about salacious material in video games. It was that woman who stood with him years before and promised to love him in sickness and in health; it was those children, whose births marked the very best days of his life. And it isn't so different for any of us, is it? Not for the rich man or the poor man, for the Ethopian or the Thai or the Oregonian. So why do we have such trouble turning what we have in common into common cause? There will always be fault lines where we just disagree, but can't we find—maybe in our founding documents—the things on which we do agree and work from there instead of starting always, always perched as soldiers along those fault lines?...

And further, this from dday:

...My dad's in his fifth day of radiation treatments right now. He got the same type of cancer his father got, which is the same cancer his father's brother got, and I suspect it'll be the same cancer I'll get someday. There isn't an insurance agent, conservative activist or Republican politician alive who can tell me that they disagree with the imperative of keeping alive those who we have the ability to treat. It's an argument without a rebuttal, at least without one that is cruel or evil. And when we reach out, even to those political opponents, through common experience, and common cause - that's actually how we become a more progressive nation. We have a tremendous empathy deficit in America - the inability to stand in the shoes of our brothers and sisters. Edwards' expression of empathy is an object lesson. 

When you face a conservative movement that is wholly dedicated to putting up roadblocks and turning off the spigot of empathy, making this a cruel and angry and paranoid and fearful nation, it can be hard not to fight back in the same manner. But I think, while engaging in the fight is fundamental to the survival of this democracy, occasionally we have to step back and recognize the human truths. Elizabeth Edwards is heroically battling on the front lines for reforming our broken health care system. But she hasn't forgotten that the issue goes beyond spreadsheets and mandates - it's about fathers dying young, sons without treatment for their ills, mothers who can't afford their pills. It's about healing. And you can only be on one side of that debate.

There's no calculation in these remarks. They are simply truths. It so happens that these truths, and the courage and bravery exhibited in saying them, are unquestionably progressive.

Now, beyond the obvious best wishes for both Elizabeth Edwards and dday and their family and friends and, frankly, for every one of our readers and writers who are also facing family and/or personal health battles, there looms a universal truth that doesn't get nearly enough discussion, and that is this: 

At its roots, human behavior can come from a lot of motivations and end games.  But we are all at our best when we remember to be humane.  Because at its heart, compassion calls to the best in all of us.

We are strongest where we find common ground, rooted in the best of who we ought to be. And we don't spend nearly enough time contemplating ways to do just that. Perhaps that's because we all get so caught up in the day to day battles that we forget to look up and contemplate what we really, truly want the end result to be. But in order to get where we want to go in the end, we need to think about the end game -- and how we get there together.

So, let's talk a little compassion this morning, and try standing in someone else's shoes for a change. You might find the view a little enlightening. Pull up a chair...

(H/T to Digby. YouTube is a classic Coca-Cola commercial.)

Tokyo Police Club - Your English is Good

What's on your mind tonight?