Madeline Perez, victim – 24, actress, 5’-10”, 120 lbs., blond hair, blue eyes, right-handed, lives alone in an apartment in Hollywood, CA.

Charlie Robinson – 30, male, unemployed, 5’-8”, 180 lbs., left-handed, lives with his mother in the same apartment building as Madeline. Charlie is mentally disabled and obsessed with Madeline.

Desmond Howard – 30, male, actor, 6’-1”, 178 lbs., right-handed, lives alone in a house just outside Hollywood. Desmond is dating Madeline, but is not as successful in his acting career.

(Click on the image for the full-size version)

I am very much bothered by the fact that the prescription drugs we produce in this country come at a premium. It seems so asinine to me that identical scripts are available for a cut rate just across our borders. While I do understand that we are subsidizing first class research here in the States, I cannot fathom a good reason to continue to pass this cost onto the consumer at the retail counter. Does this not fuel the volume of people seeking alternate routes of abstaining prescription drugs? It seems to me that this path will inevitably increase the amount of diversion to the black markets and increase individuals’ risks of obtaining dangerous counterfeit goods from less scrupulous pharmacies (including Internet pharmacies).

Moore’s Sicko also stirred up some aggravation and some thoughts about the medical care in our country.  For those that have not seen the documentary, it is rather compelling.  While I have mixed feelings about Moore - he hit the nail on the head with this one (with his usual embellishments).  However, Moore wasn’t completely right in his assessment of the US health care system.
It hit me on the way home that we do have socialized medicine in our country - something that is overlooked quite often.  Forensic medicine is available to every citizen in need and is funded at the municipal, state, and federal levels.  The glamor of CSI and similar pop forensic television has placed a lot of stress on the autopsy/medical examiners - but many other aspects of the discipline enrich our daily lives (via the public health and criminal justice services they provide).

Now if we can translate this model to other realms of medicine is another story.  But surely our medical examiners and forensic nurses are paid decently and live comfortably, have say over the way they handle their “practices,” and are free to work where ever they please.  All of these were arguments for not pursuing socialized medicine.  Seems to me that there has to be a compromise between the privately ran options we are currently engaged in and the models available in England, Canada, and France.

For those that have seen Sicko - the Cuba bit was rich!  Here’s Moore on Nightline - decide for yourself and chime in.

I am particularly worried about the impacts this will have on pain management in our health care system. Plenty of extant research shows that we undertreat patients’ pain - from acute to chronic - partially due to the stigma attached to our more potent pharmaceuticals as well as some of the regulations and monitoring protocol required for particular narcotics. Some physicians avoid giving out narcotic prescriptions - especially when some doctors are being prosecuted for just this reason. Take, for example, the most recent major case - that of William Hurwitz. While there may be some malfeasance on Dr Hurwitz’s behalf in this case, the conviction of a physician in this manner will definitely send shockwaves through the pain management community.
As someone who has had two family members in hospice care in the last decade, I have seen firsthand how difficult it can be to begin and maintain a sufficient pain management regiment. Even at the behest of the patient and his/her family, receiving enough pain relief can be an uphill battle.

The reason why I bring this up is that two colleagues of mine are working on a manuscript on OxyContin abuse in the United States - in particular, they find that the increased availability and popularity of OxyContin has lead to an increase in the diversion of this product to the gray and black markets, which in turn has lead to increased abuse. My initial reaction to their piece in progress was to be careful of the policy implications - if increased availability means increased abuse, then the commonsense thing to do is to reduce availability. This has been done with plenty of other dangerous medicinal products in the past - some to the point of extinction.

My argument is that there is not enough of this product as well as its narcotic kin being legitimately prescribed to patients in need. It seems to me that we are in dire need to fund research that will help us solve this conundrum - how can we reduce levels of licit drug abuse when in fact we already under-prescribe narcotics to our patient population in many cases/circumstances?

– Dave Khey

Over the past couple of months there has been a movie and radio/ television shows discussing the Zodiac killer from the San Francisco Bay area. My questions to you are … 1) Is the Zodiac killer still alive? 2) What would be your psychological profile of this individual?