Americans: How Fat, Loud, and Stupid are We?

I agree with every word printed in confirmation that you guys are fat, loud and stupid, but think that Canada, you know ? that National Park in the USA, just between Washington, Montana and Alaska, might have been a more appropriate reference than Somalia or Basuto...........

....nah, on second thought, you even got Somalia and Basuto right, and you might have achieved that level of success if only you'd tried a bit harder.

Thanks for your support, Don.  Actually, I steer clear of any mention of Canada, Canadians, or things or institutions Canadian--which might be misunderstood by Canadians--especially those of you with access to airplanes!  The funny thing is that, down here on the Gulf coast, we get a lot of Canadians with motor homes and travel trailers--along with folks from the northern U.S.  We and they call themselves "Winter Texans".  And they are some of the nicest people on Earth.  But that's not what is funny.  What's funny is that so many of them have accents like Sarah Palin!  I have never heard so many "Golly Gee"s and "Well, I tell ya, Fella"s in my life.  Of course I don't tell them they remind me of Sarah Palin, because they might know somebody back in Canada that can fly attack aircraft. 

Best regards,

Russ

I worked all last year in retail pharmacy Russ - let me just add "drug addled" to your list.  And I am speaking not of drugs for cholesterol, diabetes, hypertension, etc.  (That which is another issue entirely.)

Imma talkin' benzos and opioids - at doses, frequencies, and durations that are just unhealthy and meant more for gettin' high than anything else.  When I started the job I used to think "How can you get anything done on 4 Xanax a day?"  Then I realized they weren't getting anything done, because they didn't have to since they were living out of my pocket. And in fact, I was paying for their Xanax and Lortabs as well.  But there were plenty of workin' folks too - and the total number was a disturbingly high percentage of the population.  (Opioid drugs are know the number one abused drug in the USA, surpassing even alcohol.)

When I left the abusive world of USA chain retail pharmacy my thought was; Americans...fat, stupid, and drugged out.

And I just came back from a week in Italy, and yes, we are f***ing fat too.  The difference in the populace at large was incredible.  Hell, I felt fat and I am not even in the top 50% for obesity here.  Only when I got on my flight back to the USA did I again see the "typical" number of obese citizens I have come to accept as "normal."

I find this fact difficult to believe.  I am sure just about every adult has, at some point, abused alcohol (getting drunk) but I highly doubt the same can be said for prescription opiates.  Are you saying more people abuse rx opiates than abuse alcohol? Or are you saying there are more people addicted to rx opiates than alcoholics? Or the total instances of rx abuse exceeds the instances of alcohol abuse?

What qualifies you to determine the medications were for getting high?  Were you privy to their medical histories and diagnoses?  Are you suggesting physicians were prescribing these medications just so their patients could get high?  Perhaps you are unaware how debilitating panic disorders / chronic pain can be to those affected.  Btw, 4mg Xanax / day is within the therapeutic range.  Do you really believe an individuals so impacted as to require such high levels of medication would be leading highly productive lives in it's absence?

 There are probably millions of people who's lives are improved through structured use of 'benzos' and opiates.  Your anecdotal evidence is meaningless.

Go work in a pharmacy for a year - with even rudimentary training you would be able to see.  It's one of the banes of the job, being in a constant battle for drug seekers...sometimes you know damn well that's what they are doing, but you just are too tired and worn out to intercede.    We sued to joke about the "hydrocodone rush" in the last half hour the pharmacy was open, because they know you are tired, have been working for 12 hours with not even a meal break, and are worn out, less vigilant, and more apathetic about it all.  They are brilliant - if they put as much work into anything else as they do drug seeking, they'd be rich.

Yeah, my anecdotal evidence must be why we are constantly getting notices from the state board, why there are Continuing Education seminars in spotting drug seekers for pharmacists, why the pharmacy schools have classes on the topic, why we were instructed by the state board to not fill opioid C-II from FL or GA, why you get (numerous) phone calls asking "do you have the old Opana, the one shaped like a stop sign?" (because the newer formulation can't be modified for snorting or injection), why we had a rotation at a rehab clinic (which EVERY pharmacist and MD should be forced to see the absolute destruction drugs and alcohol cause...this was also where I was told that opioids are number one; and simply "getting drunk" is not considered a pattern of abuse, so therein may lie your confusion...they mean addiction), why you see a LOT of "doc shopping", why entire computer systems are being set up at great cost to combat it, why the states are passing ever more stringent controls on the distribution of these drugs, why when pharmacists meet, it's one of the main topics we talk about (because it comprises a far greater percentage of your job than you EVER thought it would), why they are increasing the penalties for MDs who are careless in prescribing of these meds, why the big chains (who will sell a pill to anyone for a buck) are even sending out notices on spotting drug seeking & how to combat it, why states are creating special tamper proof Rx pads (I just had to redesign our software to accommodate NY State...and Ohio is even crazier stringent requiring much customization of the pharmacy software), etc., etc., etc...

I had had no idea my "anecdotal evidence" was so compelling as to place all this in motion.  Thanks for pointing out the power that I wield.

I personally was not prepared for the level of the problem despite much of the above training.  I guess despite it all, I thought that it couldn't be as prevalent as it turned out to be.  And since you can be implicated in the problem and lose your license if you are not diligent enough, you're damn right we pay attention to it.  But rarely do you intervene, because you have to be damn sure; although we did arrange for 2 arrests in the 8 months I was at one pharmacy.  (Person picked up their meds and was greeted by po-po at the end of the aisle on their way out.)

And funny how someone can be on their high horse and still be in over their head.  If my information is anecdotal, yours is negligible.

Russ, your posts are priceless.

I would agree with everything you say…except the "culinary capital of the Universe" has to be Tokyo, or more precisely Japanese food. The French have outstanding food, the Italians consistently better though…but honestly, not a patch on Japanese food. Not only more tasty, more healthy but more available at a lower price...and better served by people who have the utmost respect for the cook, the food and the eater.

You don't tip for your food in Japan because they are paid properly...it is considered rude.

Jason.

In a nutshell, yes!

I am sure you have good doctors and nurses who can put bad things right. And assuming you have the money or the insurance, you will have access to these professionals. Even with basic medical aid you no doubt get some sort of treatment for your poor condition.

In Europe, I think we put more emphasis and effort into preventative medicine. We still have good doctors and nurses who can put bad things right and the NHS provides very good access to these professionals on a "needs" basis - free at the point of delivery. Additionally you can pay for private access to some professionals either directly or through insurance schemes.

So, overall, I don't think the US has the absolute best health care on the planet. The main failing is "prevention". Which, as we all know, is better than "cure"

Don: With respect, I don't think you understand the depth of the problem.  I shall assume without knowing that in England and in much of Europe where such preventative care is more widely available, that your somewhat longer life-expectancies are due to the fact that patients actually listen to the advice given them.  However, in my own country, I am trying to imagine the reaction of any preventative care provider to the flood of cheesy, bloated, waddling patients invading his or her waiting room, seated in the wide-load chairs that would be required--coming in for visit after visit, stepping on the cattle scales that would be required, and showing a significant weight gain each and every time!  Such a health care professional would no doubt end up committing suicide.  And in any case, in the U.S., insurance policies would have to include donuts in the waiting room to get people to sign up for preventative care.

Do you realize, my friend, that we have had more than one reality TV series about people who are so fat they can't get out of bed?  And people who have to be buried in piano crates because no coffin will hold them.  OK--I could be wrong--this may actually have been in Europe--but I remember a few years ago, they tried to cremate someone who had so much body fat that it set the crematorium on fire.  I mean, Jesus Christ! 

Wallah: How right you are in your observation that space aliens would equate civilization with armaments.  That is why I am currently urging all the Representatives and Senators from Texas to develop more effective laser weapons to shoot the bastards (in this one instance I am using that word to denote the space aliens, as opposed to members of Congress) out of the stratosphere before they have an opportunity to land and say: "Take me to your leader." 

Which necessitates a brief aside: I have it on good authority that a flying saucer once came to earth in the United States and landed in a gas station (read that as "petrol", you Brits).  A little green man emerged, walked up to the pump and said: "Take me to your leader."  Of course, the pump did not reply.  This occurred twice more, whereupon the little green man climbed back into his spacecraft and returned to his base on Planet Xenon-X24.  He went before his own leader who asked: "What are these Americans like?"  The little green man replied: "Master, they are all morons.  All they do all day is stand outside with their pricks in their ears."

But where was I?  Oh, yes, I wanted to tell you, Don, that, while I appreciate your kind words, I would never, ever, EVER eat Japanese food again.  Oh, sure it is tasty, but my problem is that, for whatever reason, they eat raw fish, for Crissake.  I can only assume that, in building their bicycle-sized Toyotas and Hondas, since they have to import all their fuel, (thereby raising the price of the gasoline we put into our American Sport Utility Vehicles) , fuel is a commodity that is in too short supply for them to cook their food.  And I have it on good authority that eating raw fish  (crawling as it always is with parasitic worms) will rot your insides out.  Physicians deny this and tell me that my anecdotal evidence is meaningless, but I have no desire to eat a batch of sushi, then go to my doctor's to give a stool sample that ends up looking back at me.

But don't get me wrong--I would love French food if I didn't have to mortgage my family's ranch to obtain portions large enough to enable me to do justice to the three-foot-wide chairs in the waiting room of my diabetes specialist.  In the early days of my first marriage, after being served frozen pot pies three times in one week, I bought Julia Child's French cookbook and began preparing meals for myself.  I found that I had to stop buying butter at the grocery store and have it sent in by the truck load.  Cheese was another problem--and I found that there was not enough time in the day to separate out enough egg yolks in order to maximize the level of bad cholesterol that the recipes called for.  After a year of preparing and eating her dishes, I visited the doctor and when he listened to my heart through his stethoscope, he reared back and dropped in on the floor, claiming that the sound of my coronary arteries slamming shut had damaged his ear drums.

But enough of that--what I really started out to say is that, anecdotal or not, drug abuse is, as Dr. Mark points out, a huge problem in the U.S.  And since insurance companies won't pay for preventative care, then we need to make them pay for unneeded opiates and speed-related stuff.  Back in the 'sixties, in what is now the People's Republic of Austin, there was a Hippie writer and comic-book illustrator named Gilbert Shelton.  In his series titled The Famous Furry Freak Brothers, the motto of the three heroes of the strips' motto was:

"Drugs will get you through times of no money better than money will get you through times of no drugs."

Best regards,

Russ

Hey Russ.

It's obvious that you know "sweet fcuk all" about Canadians.

BBM

I don't have to work in a pharmacy to know that these drugs are abused.  Your initial post was to characterize Americans as drug addled.  I am sure you see some number of people engaging in illegal "drug seeking".  However you indicated that this behavior is found in a disturbingly high percentage of the population.  What's your understanding of that percentage? .1% - 1% of the adult population?

Russ, I am sure you write these posts just give that old grey matter some exercise.

Contrary to belief, Sushi and Sashimi are but a tiny proportion of Japanese cuisine, you are more likely to come across other forms of Japanese food on the high street.

Parasites live in all fish and meat, some are more dangerous than others, Salmon being one of the worse fish that can be eaten raw, not all fish is suitable for eating raw though...That's the reason why we cook food, but, if you prepare it right, then you will not get stomach problems with raw fish. The Japanese understood for centuries that freezing salmon, for example, in the snow for a couple days makes it edible without any chance of stomach problems. Recent scientific studies concluded that all parasites linked to sushi can be killed off by freezing it at a temperature of -20 degrees Celsius (-4 degrees Fahrenheit) for 24 hours.

Nothing tastes better than a pre-frozen fresh sashimi, but freeze treatment is often used on other fishes used for sashimi and sushi just to be extra safe about parasites. The good news is that most seafood have to be frozen anyway when they are transported. The question to ask is at what temperature and how long?

I suspect, one is more likely to get sick from being cooked/served food from underpaid sick staff in restaurants where health insurance is so expensive that waiters would rather endure a day at work because they can't afford to stay at home or receive medical attention.

Some physicians also say that the enormous fresh food diet is one of the reasons why the Japanese live to a ripe old age whilst simultaneously working all hours god sends.

Now, compare Sushi with those bowel cancer inducing rare Texan 'T' Bones.......

Jason.

p.s. I saw some interesting figures regarding illness and restaurant workers somewhere on the beast commonly known as the web, but now I can't find them.......shame.

Gents, I have to say this is one of the most refreshing posts I have read in a while.

I have always thought that it would make for interesting TV if they "picked" a handful of people from different countries to discuss there lives, schools, salaries, diet....well you get the idea.

Thank you for your honesty and well presented posts.

More please!

When you have 40/45 mins to spare go onto  www.youtube.com

In the search box type walmart customers.

Loadsa clips of their punters fat/thin/blokes in dresses & heels,weirdos,you name it walmart gets just about everything.

Mista h

You did not read my post properly...freeze the fish for 24 hours @ -20 c and your choice for eating it is greatly increased as well as your health plan

Why go down the republican route on food aswell, have some faith!

Jason

No - I would say it is significantly higher than that.  But let's see what the people who study these things say:

"More than 22 million Americans age 12 and older - nearly 9% of the U.S. population - use illegal drugs, according to the government’s 2010 National Survey on Drug Use & Health."

That would be between 9 to 90 times greater than your estimates...and just because someone is a "high functioning addict" (saw a few of those in my rehab rotation) doesn't make them not a danger to themselves and those around them. That is a pretty sad percentage of our US population...and doesn't speak well of our society.  (But it may speak volumes about it.)

And that percentage doesn't even include those who get their "stuff" fully legally with insurance paying for it, but are no less addicts, so bump the overall drug user percentage even higher than the 9%. (Not to mention the 9% includes the children 11 and under, so the percentage of the population 12 and over is higher still.)

Check, and Mate.

Look at table 1.87B - non medical use of pain killers adults 18 and over

They estimate use in past month at 2.0%, past year 4.7%

table 1.86B for adults 26 and over the percentage drops to 1.5% and 3.5%

also table 1.1B illicit drugs - marijuana past month =  3.6%

Table 5.14b - Substance dependence or abuse by age group - total for all groups

Non medical use of pain killers = .6%, 'benzos'  = .1%

Alcohol = 3.3%

So they estimate .7% of the population is abusing the rx medications from your initial post while 3.3% of all Americans aged 12+ are Dependent/abusing alcohol.

I tried to only include adults as I suspect you would not fill a rx for a minor.

Are non medical pain killers 4.7%, or 0.6%?  Your stats are all over.

Define "non-medical use" - does that mean the guy who got 3 Rx's from 3 docs filled at 3 pharmacies is being tracked? Because those were legitimate scripts from legitimate MDs filled at legitimate pharmacies.  And what of the sales right in the parking lot of the pharmacy, 5 minutes after they are picked up?  (We had complaints from customers about it...like I'm able to do something about it.)

Many of these people have "legitimate" prescriptions for their 120 pills a month, and you can bet your @ss they will be right on time for the next round, if not trying to get them early.  (Watch them flip out when you say "Sorry, you're 2 days early and have to wait until the 16th.")  And then they'll have a zolpidem Rx for sleep after that...WTF are you needing a zolpidem for sleep after taking 4 x 1 mg of alprazolam all day?  Sorry sir/madam, you have a drug problem...it's called "chemical dependence."  I think their definition of non-medical use is why the numbers are so low.  Just because your MD gives it to you doesn't make you not a drug abuser.

Oh - another fave tactic - been to the ED, got a RX for levofloxacin (an antibiotic or ABX for short) and vicodin.  "Just fill the pain pills, I don't want the antibiotic."  If they are on one Rx sheet, I'd tell them that if they want the one, they have to get them both.  But if the doc wrote two different Rx's (separate pieces of paper), then there's nothing I can really do about it...so he gets his opioids and the ABX goes unfilled.

Or a guy gets Lortab on Monday, then he's back 2 days later for some more with a different Rx.  "Sorry, we can't fill that, you just got hydrocodone 2 days ago."  "Oh but that was for my shoulder, this is for my low back." Riiiiiight - each pill knows exactly where to target it's analgesic effect, so you need both of these.  Sorry, that's not going to happen.  "We'll just keep this on hold for you."  "No, I want it back."  So now my tech and I have to call all the other pharmacies in the area to tell them about this guy so they don't fill it...which is something I really have time for when I am supposed to fill 300+ a day with insufficient help.

The way every pharmacy I have been in flies through bottles of alprazolam, lorazepam, & diazepam (those are the "big 3" - and ALWAYS in the "Fast Movers" section of every pharmacy), and then the lesser clonazepam & chlordiazepoxide, and temazepam a distant last - there is NO WAY it is only 0.1% - not a prayer.  And I doubt the pharmacies in which I have worked (2 CVS, 2 Rite Aids, 2 K-Marts, and one independent) are vastly different than most others - they weren't all one as bad as the other, but on average it was pretty grim.  And the opioids (especially the C-III's) were even more - much more.

If the problem is as insignificant as you say it is, why is as much money being poured into it by both governmental as well as private industry?  Literally millions being spent to try to stem the tide on the problem, which is getting worse each year.  Just think where it would be without the efforts at hand?  If benzos and opiates were as insignificant an issue as you indicate, there is no way the expenditure would be made.  NY is considering (If they haven't already) making hydrocodone-APAP products C-II, because there is so much abuse - this in a state with very tough regulation on it already.  (I have a classmate who is up there in Long Island, he says the extra work is a nightmare for him to keep compliant.)

It's fully half the reason I quit retail pharmacy, because I wasn't doing what I went to school for (to help people manage their illnesses) and was dealing with opioid/benzodiazepine/amphetamine (and pseudephedrine too) abusers a 20-25% of my day. I felt like I was part of something dirty.  And it was EVERY day; not some days, not most days, but EVERY day.  It got tiring.

And as I indicated, I walked into it with no preconceived notion that this was how it was.  I was nothing short of stunned by the problem, even with the training and warnings and a rotation in a rehab.  And upset by the amount of public money that was going towards it in the form of Medicaid, which means there is less for people who really need help for real medical issues.

And I can promise you, the problem is not only bad, it's getting worse.  And it is a reflection of the increasing dysfunction of American society.  You can sit in your armchair all you want - get out in the trenches and you will see.

I dated a GP many years ago, and her experience matches yours. She would be put under immense pressure every day, by a significant portion of her patients, to prescribe opiates for non-existent or imaginary illnesses. Maintaining an ethical stance and not just prescribing simply to get them out of her surgery was tiring, especially that she knew they would simply try doctor after  doctor until they found one that would acquiesce.

I am not at all competent to address any of the issues that people with professional experience are discussing here, but I have gradually come to agree, on another thread, with those who advocate the legalization of drugs--and I am thinking here, just damned well any drugs.  I have always subscribed to the notion that we need to protect ourselves by making a statement--by means of judicial punishment for drug use.  But, (typical of my other conservative views), I have decided to impose the standard of personal responsibility on those who are stupid or careless enough to poison themselves.  I suppose we should concentrate on keeping them out of the hands of our children, but after that, harsh as it may sound, let them kill themselves.  And I regretfully now believe that the best way to minimize the harm drugs do--not only to the bodies of users, but to the economy, the police forces, and damned near every other element of our society--is to legalize them and let the Devil take the hindmost.  Hell, our kids are killing themselves as it is.  Places like Detroit, Chicago and Houston have turned into cesspools of drug use and murder.  I say, take the premium away from the "added value" that attaches to the distribution of illegal drugs and see what happens.

Best regards,

Russ

These are not my stats.  These are from the study you quoted.

The first stats are % of population that has taken a rx painkiller for "non-medical" use in past time period [1m, 1year] (2% and 4.7%)

The stats from Table 5.14b - are % of population that are either Dependent or Abusing painkillers / 'benzos' / Alcohol. 

 pain killers = .6%, 'benzos'  = .1%, Alcohol = 3.3%

I am not sure how they define "non-medical" use.  I do not believe it matters in the context of this discussion.  I am confident that the 2% > max % of population actively abusing rx pain killers.

You used this study as proof of rampant addiction/abuse of painkillers/'Benzos' in the American population.  Additionally, you indicated that prescription rx addiction/abuse has a higher incidence in the American population than found with alcohol.   According to this study, alcohol dependence/abuse afflicts a much greater % of the population than opiate + 'benzo' rx meds.

This study easily refutes your claims. 

However, I do not doubt your perception.  You have to deal with that % of people everyday.  It must be an awful burden.

"Non-medical use" definition has everything to do with the discussion, because the discussion is about people abusing opioids and other available by prescription drugs - whether or not a MD gave them the RX or not.  Just because you go running for the shelter of your mother's little helpers doesn't mean you aren't a drug abuser.  As winky indicated from his MD friend, and when I go to my GP we also "talk shop" - it becomes a real issue trying to slow these people down, and if it were 1% or less, then we wouldn't be seeing it multiple times every day in every pharmacy and probably most MD clinics.  In fact, I spoke to a pharmacist friend this morning about this discussion, and that was his first comment re "medically necessary" because he was dealing with it in a Walgreen's.  Now he works in a closed pharmacy supplying drugs for people in financial need, and he doesn't have to do controls, and even though he took a big pay cut, he's happier now that he's not dealing with the public.

My doc says he tries to keep things under control, and sometimes he knows there is about a 95% chance they are lying, but they wear you down so bad, and he knows sometimes he is giving them to someone who is really not in need, but wants them for abuse or sale.

I also have a friend who is a nurse in the ED at Parkland Hospital in Dallas (you may know it as the place where JFK was taken after he was shot) and he says over 50% of what he sees is seekers.  You are correct especially in that case because it's the "free" hospital so the clientele will tend towards those who are more prone to bend the rules and try to take advantage of the situation.  He laughingly tells me that it's amazing how many people in pain who come in there are allegedly allergic to tramadol (which is the "opioid-oid" you give when you want to give them something but it won't give them the "kick" they want.)

No way it's less than 1% Kevin, no way.  I am betting more at 10 +/- 1-2%...with a good half of it in stealth mode.

And re opioids over alcohol, the folks at the rehab had whatever study they had from which they were quoting; I didn't see it but since they were treating both types of addiction there I'm sure they weren't making it up.  It's what they do for a living.  (And in an ironic touch, the "drug" addicts at times kind of looked down their noses at the others who "only" were alcohol addicts...strange pecking order, init?)