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Brain Science, Dangerous? Not So Fast, Says Poverty Expert

CommonHealth (WBUR) - Wed, 11/26/2014 - 2:04pm

Back in June, we wrote about a novel program in Boston that seeks to lift women and their families from poverty, in part by using the latest research in neuroscience. Specifically, the program (developed by the nonprofit Crittenton Women’s Union) takes into account recent studies that reveal how trauma, and poverty, can rewire the brain and potentially undermine executive function.

In an Op-Talk piece in this week’s New York Times headlined “Can Brain Science Be Dangerous?” writer Anna North cites our story, and then goes on to question whether this type of approach might be problematic. In the article, North refers to sociologist Susan Sered:

Dr. Sered…says that applying neuroscience to problems like poverty can sometimes lead to trouble: “Studies showing that trauma and poverty change people’s brains can too easily be read as scientific proof that poor people (albeit through no fault of their own) have inferior brains or that women who have been raped are now brain-damaged.”

She worries that neuroscience could be used to discount people’s experiences: “In settings where medical experts have a monopoly on determining and corroborating claims of abuse, what would happen when a brain scan doesn’t show the expected markers of trauma? Does that make the sufferer into a liar?”

[Watch on YouTube]

We asked Elisabeth Babock, president and chief executive officer of Crittenten Women’s Union, to respond to the Times piece. Here, lightly edited, is what she wrote:

Moving out of poverty in the U.S. today is an extremely complicated and challenging process. It involves trying to maintain a roof over your head when the minimum wage doesn’t cover the minimum rent; and trying to get a better paying job when almost all those jobs require education beyond high-school and the costs of that education, in both money and time, are well beyond the means of most low-wage workers. It involves trying to care for a family while filling in the gaps in what the minimum wage will buy with increasingly-frayed public supports. It involves a lot of juggling.

We at Crittenton Women’s Union (CWU) understand this process all too well because we work with hundreds of people trying to navigate their way out of poverty every day: homeless families living in our transitional housing and domestic violence shelters, and people who are living on the edge of homelessness, struggling to make ends meet. What we at CWU see is that the stress of this everyday struggle creates an additional set of monumental challenges for those we serve.

Our families often describe themselves as feeling “swamped” by their problems to the point that they can only think about how to deal with the crisis of the moment. And in those moments, they may not have the mental bandwidth to strategize about how to change their current circumstances or help them get ahead.

One of the most valuable things brain science research does for this struggle is that it validates what our families share about the way being in poverty affects them. Instead of saying that stress leaves people “irrevocably debilitated”, or worse still, that people should somehow rise above this crippling stress to “just move on” the science actually suggests something much more important. It calls upon all of us to understand that poverty, trauma, and discrimination are experiences whose cumulative effects impact our health, decision-making, and well-being in tangible and predictable ways, and because of this, we as a society can and must do our best to remediate it.

First, science shows us that people are highly “plastic” and respond to changes in the environment. If we reduce or remove stresses in the environment, the body and the mind respond positively and quickly. This holds true for both adults and children.

Second, the science shows that if in addition to removing stressors we also introduce better learning opportunities, both adults and children can improve the decision-making skills that will help them achieve their dreams for better lives.

At CWU, brain science has improved our understanding of the challenges our families face and has allowed us to create better ways to help them. We’ve built stronger environments, tools, and approaches designed to work with, not against, them, and we’ve built coaching models that strengthen their problem-solving and resilience. They are earning more, saving more, and graduating more than they did when our approaches were less informed. And when I say more, I mean at rates that are double, triple and quadruple what we were achieving in the past.

What I have learned through all this is that some people will use brain science to oversimplify the nature of poverty and blame the poor, but the real blame belongs on us as a society if we do not take full advantage of this promising new scientific lens to design better programs and policies to help them.

Categories: Health Care

Nearly Half A Million Select Obamacare Plans Through In First Week

Kaiser Health News - Wed, 11/26/2014 - 1:40pm

Federal officials said today that during the first week of open enrollment for the health law’s online marketplaces, 462,125 people selected health plans, with just over half of those return customers.

The figures were the first weekly snapshot promised by the Department of Health and Human Services to provide details about exchange enrollment.  The figures are preliminary and cover enrollment from Nov. 15 through Nov. 21 in the federal exchange, used by residents of 37 states.

The remaining states and the District of Columbia run their own marketplaces and their information was not included. The figures may fluctuate from week to week based on a variety of factors, such as consumers changing or canceling plans, officials said.

HHS Secretary Sylvia Burwell called the numbers “a solid start” but added the agency has “a lot of work to do every day between now and Feb. 15” when  open enrollment ends.

The first week’s tally was a dramatic improvement over last year’s, when‘s myriad computer problems caused the site to malfunction for millions of people. Some state exchanges also had problems, hindering enrollment efforts.

This KHN story can be republished for free (details).

During a call with reporters, HHS officials said now the website would be able to withstand peak demand periods, such as those predicted for Dec. 15, when consumers must sign up and pay their first month’s premium if they want their coverage to begin Jan. 1, and for Feb. 15 when the 2015 enrollment period ends.

Today’s report noted that the average wait time for the federal exchange call center was just over three minutes and that more than one million consumers had submitted applications for coverage.

HHS officials also announced new partnerships aimed at boosting enrollment. Deals with Westfield Shopping Centers, the National Community Pharmacists Association and the XO Group, which owns popular websites such as The Knot, are part of the agency’s efforts to reach more consumers and provide them with information about the health law.

Categories: Health Care

The Library of Congress: Magna Carta’s Home Away from Home

In Custodia Legis - Wed, 11/26/2014 - 9:00am

The following is a guest post by Susan Reyburn, writer-editor in the Library’s Publishing Office.

Seventy-five years ago this week, the Lincoln Cathedral Magna Carta (1215) made its first visit to the Library of Congress, something that had not been on its itinerary when it arrived in New York in April 1939 for the World’s Fair. Several months later, the outbreak of World War II and the end of the fair’s first season left the document stranded in the United States.  This happened as Lord Lothian, the British ambassador, put it, because “His Majesty’s Government feel[s] that it would not be proper for them to attempt to send Magna Carta back to England under existing conditions on the high seas.”

German U-boats, after all, were prowling those high seas.

In researching the Library’s unexpected custody of the document for the new book Magna Carta: Muse and Mentor (Thomson Reuters, 2014) and the exhibition of the same name, I came across lively correspondence in the Library’s central archives of British and American officials working to ensure both the visibility and the safety of the Great Charter. In shopping around for a high-profile sanctuary, Lord Lothian noted that his government had made certain guarantees to Lincoln Cathedral regarding Magna Carta’s safety, and “would feel an immense obligation to the Library if it could take charge of this precious document” during the war. Archibald MacLeish, the newly installed Librarian of Congress, was thrilled to help out, inviting the ambassador to the Library “to inspect the provisions made for the safeguarding here of the Declaration of Independence and the Constitution of the United States.”


Lord Lothian (right), British ambassador to the United States, transfers the Lincoln Magna Carta to Librarian of Congress Archibald MacLeish (left) for safekeeping during World War II, 1939. Prints and Photographs Division, Library of Congress.

On November 2, 1939, MacLeish wrote to then-president Franklin Roosevelt: “My dear Mr. President: I hate to fatten your mail, but a matter has come up which I’d like very much to tell you about. . . . I know your deep interest in the things Magna Carta symbolizes. . . .” Roosevelt was equally happy about the Great Charter finding refuge at the Library, gleefully telling MacLeish that “[t]here may a good many cartoons and ribald remarks in and out of the press about the surrender of the great British Magna Carta to the young stepchild that goes by the name of the United States.”


Public views Magna Carta after it was deposited in Congressional Library. Washington, D.C., Nov. 28. Shortly after the historical Magna Carta was placed in the Congressional Library for safekeeping by British Ambassador Lord Lothian today the public was allowed to view it under the watchful eyes of library guards. November 28, 1939. Prints and Photographs Division. []

Magna Carta-related correspondence also covers efforts to send the document across the country on a proposed British war-relief campaign and a tour of American universities. (MacLeish nixed the first proposal because the Library, a government institution of an officially neutral nation, could not be involved in a “propaganda gesture”; Secretary of the Treasury Henry Morgenthau quashed the second out of travel and security concerns.) Several citizens wrote to the Library asking if it might purchase the Lincoln Magna Carta and thus keep it on permanent display. One even submitted a check for $1 to start a fund for that purpose. MacLeish replied that “Your project is altogether admirable” and thanked him for “the generosity that has prompted you to act,” but in returning his check, explained that the war made it difficult to discuss the issue with the charter’s owners. The Librarian closed by suggesting that “Perhaps when you are in or near Washington, you would be good enough to drop in to see me to talk about the whole matter.”

After the United States entered the war in December 1941, MacLeish, feeling the full burden of stewardship, sent the Library’s most valuable items to Fort Knox, repository of the nation’s gold reserves. Once the delivery was safely made, he wrote to Secretary Morgenthau of how the “responsibility had weighed heavily on me for many months, but never as heavily as the night when the shipment left the Library of Congress. . . . Here in one small group of containers was the documentary history of freedom in our world.” What was MacLeish was referring to? The list was impressive: Magna Carta, the Articles of Confederation, the Declaration of Independence, the Constitution, two copies of the Gettysburg Address in Lincoln’s hand, and Lincoln’s Second Inaugural Address, along with a Gutenberg Bible.

On October 1, 1944, these items returned from hiding and went back on display in the Library’s Great Hall. It was a remarkable but temporary assemblage. As MacLeish had once written to one of his correspondents, “I hope you will come up sometime when there isn’t a crowd around and look across the Gallery with the Magna Carta in front of you and the Constitution and Declaration of Independence on the other side. It gives you quite a thrill.”

The Library of Congress is commemorating the 800th anniversary of Magna Carta with an exhibition – Magna Carta: Muse and Mentor, a symposium, and a series of talks starting this year.  Running through January 19, 2015, the Lincoln Cathedral Magna Carta, one of four remaining originals from 1215 is on display along with other rare materials from the Library’s rich collections to tell the story of 800 years of its influence on the history of political liberty.  This post is adapted from an article in the November-December 2014 issue of the Library of Congress Magazine, available online.

Categories: Research & Litigation

Tax Extenders Package Is Fundamentally Flawed

Center on Budget and Policy Priorities - Tue, 11/25/2014 - 6:26pm
The emerging “tax extenders” package marks a significant step backward on several key issues facing the nation: long-term budget deficits, high levels of poverty (especially among children), and widening inequality.It would permanently enlarge budget deficits — and, by so doing, increase pressures to cut domestic programs more deeply — while favoring large corporations and leaving out millions of families that work for low or modest wages. At a cost …
Categories: Benefits, Poverty

Administration Warns Employers: Don’t Dump Sick Workers From Plans

Kaiser Health News - Tue, 11/25/2014 - 3:20pm

As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere.

Such a move would unlawfully discriminate against employees based on their health status, three federal agencies said in a bulletin issued this month.

Brokers and consultants have been offering to save large employers money by shifting workers with expensive conditions such as hepatitis or hemophilia into insurance marketplace exchanges established by the health law, Kaiser Health News reported in May.

The Affordable Care Act requires exchange plans to accept all applicants at pre-established prices, regardless of existing illness.

Because most large employers are self-insured, moving even one high-cost worker out of the company plan could save a company hundreds of thousands of dollars a year. That’s far more than the $10,000 or so it might give an employee to pay for an exchange plan’s premiums.

“Rather than eliminating coverage for all employees, some employers … have considered paying high-cost claimants relatively large amounts if they will waive coverage under the employer’s plan,” Lockton Companies, a large brokerage, said in a recent memo to clients.

The trend concerns consumer advocates because it threatens to erode employer-based coverage and drive up costs and premiums in the marketplace plans, which would absorb the expense of the sick employees.  The burden would fall on consumers buying the plans and taxpayers subsidizing them.

This KHN story can be republished for free (details).

Administration officials approached independent lawyers about the practice in May, saying, “We don’t like this, but how can we address this?” said Christopher Condeluci, principal at CC Law & Policy, a legal firm. This month’s guidance, he said, “is the first time that they’ve come out explaining how and why the administration believes it violates the law.”

The Affordable Care Act itself doesn’t block companies from paying sick workers to find coverage elsewhere, lawyers said. But other laws do, including the Health Insurance Portability and Accountability Act and the Public Health Service Act, according to three federal agencies.

Specifically, paying a sick worker to leave the company plan violates those statutes’ restrictions on discriminating against employees based on medical status, the departments said in their bulletin.

“If you were to cherry-pick your high-cost individuals and offer them money to send them over to the exchange … this would be a violation of HIPAA,” according to the regulators, said Amy Gordon, a benefits lawyer with McDermott Will & Emery.

The agencies publishing the guidance were the departments of Labor, Treasury and Health and Human Services.

Starting next year, the health law requires large employers to provide medical insurance to most workers or face fines.

How many companies have offered to pay workers with chronic conditions to find coverage elsewhere is unclear.

“I know there are some brokers out there that were pushing this, but it was a limited number that I had heard about,” Condeluci said. Even so, he added, the attitude of the administration was: “We don’t want it to become widespread. Let’s nip it in the bud now.”

Categories: Health Care

Quadruple Amputee Gains New Arms, From Donor Who ‘Gave Best Hugs’

CommonHealth (WBUR) - Tue, 11/25/2014 - 2:55pm
[Watch on YouTube]

Will Lautzenheiser looked down at his rosy, fleshy new arm at a Brigham and Women’s Hospital news conference today and exclaimed, “It’s the most beautiful arm!”

For three years, Lautzenheiser — a quadruple amputee in the wake of a virulent bacterial infection in 2011 — had lived without arms. Now, he and his Brigham and Women’s Hospital transplant team have just revealed, he has two new ones, the gifts of an anonymous donor. A medical team of 35, including 13 surgeons, operated on him for nine hours last month.

Lautzenheiser, 40, spoke with us last year in the video above about his “sit-down” comedy career: “Did You Hear The One About The Comedian With No Arms And Legs?” That armless footage is now outdated.

Physicians surgically connect the donor arm during the transplant operation. (Lightchaser Photography, courtesy of Brigham and Women’s Hospital)

It will take months for the new arms and hands to gain sensation and function, but Lautzenheiser, a former film professor at Boston University, says he’s already putting them to good use, hugging his partner, Angel Gonzalez. “To be able to hold my love in my arms again is really the best,” he said.

The late donor put those arms to similar use, as described in a message from his family that New England Organ Bank President Richard Luskin read aloud to Lautzenheiser: “Our son gave the best hugs. We pray that you make a wonderful recovery and that your loved ones will be able to enjoy your warm embrace.”

Thus far, Lautzenheiser says, his new arms have little sensation, mainly just a bit of feeling in the skin right below where they’re joined to his own body. As for moving them, “If I really focus, I can occasionally move my thumb just a little bit, a few millimeters. It bends. I can pronate and supinate my wrist on my right arm. I have a little bit of wrist motion, a little bit of forearm motion.”

He’s now commuting every weekday from home to the hospital for intensive rehabilitation and continuing medical care, and doing additional exercises throughout the day.

The whole process has been surprisingly painless, he said.

It generally takes months and up to a couple of years for a patient’s nerves to grow into a transplanted limb, said Dr. Matthew Carty, director of lower extremity transplantation at Brigham and Women’s.

“We would expect Will to essentially, over time, have an ascending level of sensation down his limb, which is pretty amazing to behold,” he said. “A couple months from now he’ll be able to feel things at a point further down each of his arms than what he can feel right now, and eventually we hope all the way to the tips of his fingers.”

Wearing splints, Lautzenheiser can now use a spoon, and a stylus for electronics, though he can’t type on a keyboard because his fingers cannot exert pressure. One big advance: He can now use his elbow to get up from bed independently. “This is major for me,” he said.

The operation was not a major medical first, Brigham and Women surgeons said, though they called it the first above-the-elbow transplant done in Boston.

“There have been about 70 hand transplants in about 50 patients around the world,” said Dr. Simon Talbot, director of the Brigham’s upper extremity transplantation. “This is certainly becoming more common. There are aspects of it that may be a first, but for the most part, this is, for us, becoming an operation that we are comfortable with.”

So now that Will Lautzenheiser has new arms, will new legs be next? Possibly, but not soon. First come the many months of arm rehab. Dr. Carty says that ideally, leg transplant recipients can use their arms to help during leg rehabilitation.

“So it’s going to be critically important that Will achieves at least a minimum level of motion and stability in his arms, before we’d even consider his legs,” he said. “That’s our perspective. From his perspective, I’d imagine he’s a little tired and may want a bit of a break. But we look forward to continuing these discussions with him over the future.”

For now, Lautzenheiser says he’s looking forward to a quiet Thanksgiving with his family. He offered special thanks to the donor and his family, saying he wanted to “acknowledge, and to honor, the memory of the man whose arms I have so gratefully received. This person, who’s anonymous to me, will always be as close to me as my own skin now, and it’s really an incredible gift.”

So his new arms function well enough to carve a Thanksgiving turkey?

Definitely not, Lautzenheiser said. But he does love to cook, and may be up to giving a bit of a stir to the whipped cream…

Categories: Health Care

In Custodia Legis Named One of the ABA Journal’s Blawg 100

In Custodia Legis - Tue, 11/25/2014 - 2:14pm

On Monday, I learned the Law Library’s blog, In Custodia Legis, has earned a spot in the 2014 ABA Journal’s Blawg 100, the annual list of “the best in blogs about lawyers and the law.” We have reviewed the ABA nominations list in the past for possible blawgs to include in our archive.  Being nominated, especially as a government blog, is very meaningful to us.  Our goal since the launch of In Custodia Legis four years ago has been to provide a window into our unique part of the government, working for Congress and the public at the Law Library of Congress.  

In Custodia Legis is authored by a terrific team composed of Barbara BavisRobert BrammerKelly BuchananJeanine CaliKurt CarrollJennifer DavisNathan DornClare Feikert-AhaltTina GheenHanibal GoitomRuth LevushBetty LupinacciFrancisco MacíasDonna SokolAndrew WeberMargaret Wood, and Laney Zhang.  Kimberly Allen also does a wonderful job editing our posts.  In addition, we have had a number of other people contribute over 230 guest posts.

“No longer to be confused as a fad or the realm of the tech-savvy, law blogs are rooted in the legal media landscape,” Allen Pusey, ABA Journal Editor and Publisher, said. “While traditional media sources often break news, law blogs dive deeper to offer insight into what the news means for clients, the legal profession and the public. They are sometimes-irreverent watchdogs of the bench and bar. And the ones on our list are well-written and, more often than not, entertaining.”

I was also pleased to see The Third Branch News included with us, too.  Our two blogs are the only .gov blogs listed in the 2014 Blawg 100.  I didn’t see any .gov blogs on the more recent 2013 Blawg 1002012 Blawg 100, or 2011 Blawg 100 lists.

The blogs are organized into 13 categories, and In Custodia Legis can be found under the Legal Research/Legal Writing category.  Now go vote!

And if you haven’t already, you can subscribe to In Custodia Legis by RSS and email.

Categories: Research & Litigation


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