Category Archives: Leading Causes of Death

Fact Check: Are there ‘more gun deaths by far’ in America than any other country? And what is the GOP going to do about IT?

Screen Shot 2019-08-26 at 9.19.29 PMThis is another very long post but gun violence and the solutions need to be center stage going forward. We in health care see the results of gun violence every day in our hospitals, ERs, and offices. Texan Beto O’Rourke joined nine other Democrats on stage in Detroit on Tuesday for the second round of debates in the Democratic presidential primary contest. All of the candidates made questionable statements — take a look at some fact-checking from the night — including O’Rourke, who was asked to respond to a comment about gun violence from Montana Gov. Steve Bullock.

Bullock said that Washington, D.C., “is captured by dark money” and political influence from the likes of the NRA and Koch Industries, making it hard for lawmakers to tackle issues like gun safety.

“That’s the way we’re actually going to make a change on this, Don, is by changing that system,” Bullock said, addressing moderator Don Lemon of CNN. “And most of the things that folks are talking about on this stage we’re not going to address until we kick dark money and the post-Citizens United corporate spending out of these elections.”

Lemon asked O’Rourke to respond to Bullock’s point.

“How else can we explain that we lose nearly 40,000 people in this country to gun violence, a number that no other country comes even close to, that we know what all the solutions are, and yet nothing has changed?” O’Rourke said. “It is because, in this country, money buys influence, access and, increasingly, outcomes.”

We assumed O’Rourke was talking about the number of gun deaths in the United States in the past year, a figure supported by federal data. But is O’Rourke right that no other country comes close to the number of deaths by gun violence in the United States? We took a look.

By Chris Nichols on Tuesday, August 6th, 2019 at 5:32 p.m.

Following the recent mass shootings in Gilroy, California and El Paso, Texas, and just hours before a separate mass shooting in Dayton, Ohio, California Democratic Sen. Dianne Feinstein made a sweeping statement about the number of guns and gun deaths in America.

“There are more guns in this country than people and more per capita than any other country in the world. And there are more gun deaths by far,” Feinstein, a strong advocate for gun control, said on Twitter on Aug. 3, 2019. “I continue to hope that opponents of commonsense gun reform laws will come to their senses and join the effort to save lives.”

Sen. Dianne Feinstein, D-CA, posted this tweet on Aug. 3, 2019.

As of early this week, 22 people were killed in the El Paso shooting, nine in Dayton and three in Gilroy. The suspected gunmen in Dayton and Gilroy also died.

We examined each part of Feinstein’s statement but found we couldn’t place a Truth-O-Meter rating on the first two parts because there’s no official count on the number of guns in America and there are competing estimates on how many exist.

We did place a rating on the last portion about America having “more gun deaths by far” than any other country.

We’ll provide analysis on each piece of Feinstein’s statement below.

Feinstein on guns

First, here’s some background on the senator. In 1994, she authored the Federal Assault Weapons Ban, which was signed by President Bill Clinton. It prohibited the manufacture of 19 specific kinds of military-style, semi-automatic firearms, often called assault weapons.

It also banned the manufacture and sale of gun magazines that hold more than 10 bullets.

The bill expired in 2004 after efforts to extend it failed in Congress.

Its restrictions did not apply to any semi-automatic weapons or magazines made before the ban’s effective date: Sept. 13, 1994.

Feinstein has remained an advocate for gun control. In February of this year, she introduced a bill that would pay for states to create their own extreme-risk protection laws, also known as red flag laws.

Those would allow family members to petition for a court order to “grant law enforcement the authority to temporarily take weapons from dangerous individuals who present a threat to themselves or others,” according to Feinstein’s office.

California, Maryland, and Florida have already enacted similar laws.

“There are more guns in this country than people” 

There are no official count of the number of firearms in the United States, only widely varying estimates, as PolitiFact has reported in the past.

As the Pew Research Center has observed: “Gun ownership is one of the hardest things for researchers to pin down.”

We found estimates as low as 265 million civilian guns in the U.S. in January 2015 — to as high as 393 million in a report last year.

Researchers say estimates can include guns that no longer work, leading to an overcount. Meanwhile, some survey respondents will understate the number of guns they own, leading to an undercount.

With no definitive tally, we decided not to place a rating on this portion of Feinstein’s statement.

“More (guns) per capita than any other country in the world”

This second part of the claim is generally on the right track, whether looking at the high estimates for guns in America or the lower ones. But again it relies on a topic for which there’s no settled data.

Taking the estimate of 393 million civilian firearms, there would be 120.5 guns for every 100 residents in the United States. As The Washington Post reported, that’s twice the per capita rate of the next-highest nation, Yemen, with just 52.8 guns per 100 residents.

Using the lower estimate of 265 million guns in 2015 would still produce about 83 guns for every 100 Americans that year.

While this part of Feinstein’s claim is likely more accurate, the per capita rate doesn’t mean all Americans own guns. Instead, gun ownership is concentrated among a minority of the US population — as surveys from the Pew Research Center and General Social Survey suggest, according to the Post.

“More gun deaths by far” in the United States?

This part of Feinstein’s statement is not supported. We found the United States experiences more firearm injury deaths than other countries of similar socioeconomic standing. But that’s not what Feinstein claimed. She suggested it had “more gun deaths by far” than any other country.

In 2017, Brazil had the most overall gun deaths of any country at 48,493, including homicides, suicides and unintentional gun deaths, according to a June 2018 report by the University of Washington’s Institute for Health Metrics and Evaluation.

The United States had the second most overall gun deaths at 40,229, though it had the highest suicide by a gun total of any nation, at nearly 25,000. Data from the report showed Brazil had the most overall gun deaths at least from 2015 through 2017.

“Yes, Brazil is highest by number” for overall gun deaths, the study’s author, Professor Moshen Naghavi, said by email.

“We believe 2018 and 2019 will be higher,” Naghavi said in a follow-up phone interview, citing decisions made by Brazil’s new president to make firearms more accessible.

Feinstein’s office did not respond to our request for information supporting this portion of her statement.

PolitiFact Texas fact-checked a similar claim last week by former Rep. Beto O’Rourke and rated it Mostly False. O’Rourke said at the Democratic presidential debate in Detroit that “we lose nearly 40,000 people in this country to gun violence, a number that no other country comes even close to.” It cited the University of Washington study and noted that more than a dozen countries had more firearm deaths per capita than the United States in 2016.

Our rating

Sen. Dianne Feinstein claimed, “There are more guns in this country than people and more per capita than any other country in the world. And there are more gun deaths by far.”

We could not place a rating on the first two parts because there are no official count of guns in America, only widely varying estimates.

The last part of her statement, however, is not supported. A recent study showed Brazil, not the United States, had the most overall gun deaths of any country over the last several years. America, however, had the highest total of suicides by firearm of any nation.

In the end, she was wrong that there are “more gun deaths by far” in the United States than any other country in the world.  Here are two charts/tables with data.

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We rate that portion of her claim False.

FALSE – The statement is not accurate.

America’s gun culture in charts

Two mass shootings within 24 hours, leaving 31 people dead, has once again brought the spotlight on gun ownership in the United States.

An attack on a Walmart store in El Paso, Texas on Saturday left 20 dead, while nine died in a shooting in Dayton, Ohio on Sunday.

But where does America stand on the right to bear arms and gun control?

What do young people think about gun control?

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When looking at the period before the Parkland school shooting in 2018, it is interesting to track how young people have felt about gun control.

Support for gun control over the protection of gun rights in America is highest among 18 to 29-year-olds, according to a study by the Pew Research Centre, with a spike after the Orlando nightclub shooting in 2016. The overall trend though suggests a slight decrease in support for gun control over gun rights since 2000.

Pew found that one-third of over-50s said they owned a gun. The rate of gun ownership was lower for younger adults – about 28%. White men are especially likely to own a gun.

How does the US compare with other countries?

I included two charts in the previous discussion and here are two more.

About 40% of Americans say they own a gun or live in a household with one, according to a 2017 survey, and the rate of murder or manslaughter by firearm is the highest in the developed world. There were almost 11,000 deaths as a result of murder or manslaughter involving a firearm in 2017.

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Homicides are taken here to include murder and manslaughter. The FBI separates statistics for what it calls justifiable homicide, which includes the killing of a criminal by a police officer or private citizen in certain circumstances, which are not included.

In about 13% of cases, the FBI does not have data on the weapon used. By removing these cases from the overall total of gun deaths in the US, the proportion of gun-related killings rises to 73% of homicides.

Who owns the world’s guns?

While it is difficult to know exactly how many guns civilians own around the world, by every estimate the US with more than 390 million is far out in front.

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Switzerland and Finland are two of the European countries with the most guns per person – they both have compulsory military service for all men over the age of 18. The Finnish interior ministry says about 60% of gun permits are granted for hunting – a popular pastime in Finland. Cyprus and Yemen also have military service.

How do US gun deaths break down?

There have been more than 110 mass shootings in the US since 1982, according to the investigative magazine Mother Jones.

Up until 2012, a mass shooting was defined as when an attacker had killed four or more victims in an indiscriminate rampage – and since 2013 the figures include attacks with three or more victims. The shootings do not include killings related to other crimes such as armed robbery or gang violence.

The overall number of people killed in mass shootings each year represents only a tiny percentage of the total number.

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Figures from the Centers for Disease Control and Prevention show there were a total of more than 38,600 deaths from guns in 2016 – of which more than 22,900 were suicides. Suicide by firearm accounts for almost half of all suicides in the US, according to the CDC.

A 2016 study published in the American Journal of Public Health found there was a strong relationship between higher levels of gun ownership in a state and higher firearm suicide rates for both men and women.

Attacks in the US become deadlier

The Las Vegas attack in 2017 was the worst in recent US history – and eight of the shootings with the highest number of casualties happened within the past 10 years.

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What types of guns kill Americans?

Military-style assault-style weapons have been blamed for some of the major mass shootings such as the attack in an Orlando nightclub and at the Sandy Hook School in Connecticut.

Dozens of rifles were recovered from the scene of the Las Vegas shooting, police reported.

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A few US states have banned assault-style weapons, which were totally restricted for a decade until 2004.

However, most murders caused by guns involve handguns, according to FBI data.

How much do guns cost to buy?

For those from countries where guns are not widely owned, it can be a surprise to discover that they are relatively cheap to purchase in the US.

Among the arsenal of weapons recovered from the hotel room of Las Vegas shooter, Stephen Paddock were handguns, which can cost from as little $200 (£151) – comparable to a Chromebook laptop.

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Assault-style rifles, also recovered from Paddock’s room, can cost from around $1,500 (£1,132).

In addition to the 23 weapons at the hotel, a further 19 were recovered from Paddock’s home. It is estimated that he may have spent more than $70,000 (£52,800) on firearms and accessories such as tripods, scopes, ammunition, and cartridges.

Who supports gun control?

US public opinion on the banning of handguns has changed dramatically over the last 60 years. Support has shifted over time and now a significant majority opposes a ban on handguns, according to polling by Gallup.

But a majority of Americans say they are dissatisfied with US gun laws and policies, and most of those who are unhappy want stricter legislation.

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Some states have taken steps to ban or strictly regulate ownership of assault weapons. Laws vary by state but California, for example, has banned around 75 types and models of an assault weapon.

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Some controls are widely supported by people across the political divide – such as restricting the sale of guns to people who are mentally ill, or on “watch” lists.

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But Republicans and Democrats are much more divided over other policy proposals, such as whether to allow ordinary citizens increased rights to carry concealed weapons – according to a survey from Pew Research Center.

Who opposes gun control?

The National Rifle Association (NRA) campaigns against all forms of gun control in the US and argues that more guns make the country safer.

It is among the most powerful special interest lobby groups in the US, with a substantial budget to influence members of Congress on gun policy.

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In total, about one in five US gun owners say they are members of the NRA – and it has especially widespread support from Republican-leaning gun owners, according to Pew Research.

In terms of lobbying to influence gun policy, the NRA’s spending jumped from about $3m per year to more than $5m in 2017.

The chart shows only the recorded contributions to lawmakers published by the Senate Office of Public Records.

The NRA spends millions more elsewhere, such as on supporting the election campaigns of political candidates who oppose gun controls.

GOP Waits to See if Trump Will Protect It From the NRA Before Moving on Gun Laws

Sam Brodey Noted that just over a week since mass shootings in El Paso, Texas, and Dayton, Ohio, Senate Republicans are waiting to see if President Trump walks away from the issue again or forces their hand before trying to do anything about potentially expanding background checks for gun purchases.

He’s walked away before. Following the Parkland school massacre last year, the president promised that he was “going to be very strong on background checks,” only to retreat after holding private meetings with National Rifle Association officials at the White House. The NRA, a key ally of Trump’s, has spent big money lobbying against background-checks expansion legislation, and last week reminded him of its staunch opposition.

After the latest shootings, Trump told reporters that there is great “appetite” on the Hill to finally get something done on background checks but his GOP allies in the Senate are holding off, unwilling to burn political capital with the gun lobby and conservative-base voters on the issue if Trump isn’t going to burn some of his.

However, the president’s prior inaction, and the media coverage he incurred for it, may force him to make at least a slightly harder run at background checks this time around, even if only in his messaging and bluster. Two people who’ve spoken to the president in recent days say that he has referenced, during conversations about how he could possibly bend the NRA to his will in this case, his annoyance at media coverage of his post-Parkland about-face that suggested he was all talk and no action on the issue, and easily controlled by the NRA. One of the sources noted that Trump’s aversion to being seen as “controlled” by anyone or any organization makes it much more likely that the president will dwell on the issue for longer than he did last year.

Trump’s influence could well make or break legislation, since Republicans are unlikely to support anything without his blessing but will be just as hesitant to immediately reject a bill he puts his full support behind.

“Many Hill Republicans are waiting to see what Trump will get behind,” said a Senate GOP aide. “He gives them political cover. I don’t think you’re going to see any one bill or one proposal get any momentum until the President publicly endorses it.”

Senate Majority Leader Mitch McConnell (R-KY) said on Thursday that he and the president are actively discussing possible avenues for gun legislation. “He’s anxious to get an outcome and so am I,” said McConnell on a radio show in Kentucky.

The GOP leader stressed that the president was open to a discussion on gun legislation, from background checks to “red flag” bills: “Those are two items that for sure will be front and center as we see what we can come together on and pass.”

A spokesman for McConnell declined to elaborate on the Senate leader’s conversations with the president.

Democrats aren’t holding their breath, given that McConnell won’t call the Senate back from its recess for gun bills and that Trump has backtracked before on the issue after outcry from pro-gun factions of his base.

Democratic aides have been mindful of Sean Hannity’s reaction to the background checks push, since Trump’s position has been known to change based on the broadcasts or private counsel of Hannity and other top Fox personalities.

White House aides are similarly waiting on Trump, and talking up how he’s also been reaching out across the aisle to find a potential solution, even if nobody knows what that would look like yet. “The president has been actively talking to Republicans and Democrats on the matter of background checks, and just being able to have meaningful, measurable reforms that don’t confiscate law-abiding citizens’ firearms without due process, but at the same time keep those firearms out of people who have a propensity toward violence,” Kellyanne Conway, Trump’s White House counselor, said on this week’s Fox News Sunday.

One of those Democratic politicians, Sen. Joe Manchin (D-WV), said in a call with reporters on Wednesday he had spoken to the president twice since the shootings in Dayton and El Paso and that he was “committed to getting something done.”

While “everything is on the table,” Manchin said, Trump’s sign-off on any plan will be key to getting it through the Senate. The proposal introduced by Sen. Pat Toomey (R-PA) and Manchin in the months after the massacre at Sandy Hook elementary made modest adjustments to background check system by extending checks to gun shows and internet sales, but exempted gun transactions between friends and family members. It also provided additional funding to states to put critical information into the National Instant Criminal Background Check System in order to prevent people who should not have guns from obtaining them, and created a commission to study the causes of gun violence.

It’s a bill that’s failed twice, once in 2013 and again after the mass shooting in a San Bernardino office park in 2015. Both times it drew very limited support from Republican senators.

Asked what had changed since the last time the bill failed on the Senate floor, Manchin said, “The political will wasn’t there.”

Manchin said he was told by some colleagues who opposed the bill that they really didn’t object to the substance of the bill but they weren’t convinced the “Obama administration wouldn’t go further [and try] taking more of their guns away from them.”

Manchin said he tried to explain that would be unconstitutional, but to no avail.

Some Trump allies say that this president, given his record and rhetoric, might have just enough credibility among Second Amendment enthusiasts to drag them along, if he so chooses.

“If only Nixon could go to China, then maybe only Trump can address the chasm between gun owners and those who want gun control,” Michael Caputo, a former Trump campaign adviser, told The Daily Beast. “He’s so strong on the Second Amendment he can truly do something to make a change when it comes to these mass shootings.”

Caputo, who in 2013 and 2014 advised Trump on pro-gun voters and the NRA when the celebrity businessman was weighing a run for New York governor, said that even years ago, “We talked about mass shootings and what that means to the United States, and the importance [to voters] of the Second Amendment, and I know the president has been thinking about this issue for a long time: How you balance gun rights versus gun atrocities.”

Trump’s former adviser added, “If the president pursues broader background checks… perhaps it’s because he knows that is something only he can do. He may lose the support of some of the most pro-gun members of his base, but the vast majority of us understand there are some reasonable measures to be taken.”

I will be very interested to see what happens in D.C. when Congress comes back from their vacation. Will they all together come up with realistic guns laws without the concern for the NRA? That includes the President and yes, both parties in both houses!

Healthcare in 2018. Let’s Review!

48391556_1839791506150500_8003351817255649280_nAs the end of the year approaches I thought that I would try to review some of the progress, if I can find any. Probably the biggest invisible improvements the world sees year to year are essential indicators of overall global public health, like rates of infant mortality, maternal mortality, childhood stunting, and teen pregnancy. These are important, because they represent access the average person alive has to health-care professionals, facilities, medicine, and more. All of these rates have been falling in the past few decades, in some cases dramatically, and every single one fell again in 2018.

The Health of the World In 2018, By The Numbers

Reporter Susan Brink noted that at year’s end, global health numbers offer reason for both hope and despair.

There is one strong positive note. An overriding public health finding is that people are living longer. “If that’s not a bottom line reason for optimism,” says Dr. Ashish Jha, director of the Harvard Global Health Institute and the T.H. Chan School of Public Health, “I don’t know what is.”

And then there are the million-plus cases of cholera in Yemen — deemed “a hideous milestone for the 21st century” by the International Committee of the Red Cross.

Note: Because of the way global numbers are gathered, it’s too soon to report on health statistics from the year now drawing to a close. There are only a few yet available for 2018 — polio cases, for example, and Ebola deaths in Democratic Republic of the Congo.

But there has been a constant stream of numbers released from the years just past. Unless otherwise noted, the numbers below represent the worldwide population.

7 Of Our Most Popular Global Health and Development Stories Of 2018

Life Expectancy

Worldwide life expectancy in 2016 was 72 years, up from 66.5 years in 2000.

The gain of 5.5 years in worldwide life expectancy between 2000 and 2016 was the fastest gain since the 1960s and reversed the declines of the 1990s caused by AIDS in Africa and the fall of the Soviet Union.

But life expectancy has been ticking down in the U.S. for three years: it was 78.9 in 2014; 78.8 in 2015; 78.7 in 2016; and 78.6 in 2017. An increase in deaths from opioids and from suicide is a possible reason for the trend.

Child mortality rates for children under five years of age have fallen from 216 deaths per 1,000 live births in 1950; to 93 deaths per 1,000 live births in 1990; to 40.5 deaths per 1,000 in 2016; and most recently to 39.1 deaths per 1,000 live births in 2017.

Health Care

3.6 million people died in 2016 because they had no access to health care.

5 million people, despite having access to health care, died in 2016 because the quality of care they received was poor.

In 2010, the year that the Affordable Care Act was signed into law, 49.9 million people in the United States, or 16.3 percent of the population under age 65, were without health insurance. In 2017, that number dropped to 28.9 million uninsured, or 10.7 percent of that segment of the population.

Yet also in 2017, the number of uninsured Americans increased by nearly half a million — the first increase since the Affordable Care Act was implemented.

HIV/AIDS

36.9 million people were living with HIV in 2017.

940,000 people died of AIDS-related illnesses in 2017.

35.4 million people have died from AIDS-related illnesses since the epidemic was identified in 1981.

Ebola

11,325 people died of Ebola in the epidemic of 2014-2016 in West Africa.

As of Dec. 23, there have been 347 confirmed deaths so far in the current Ebola outbreak in the Democratic Republic of Congo.

Air Quality

Pollution contributed to the deaths of some 9.9 million people in 2015 by causing diseases such cancer, heart disease and respiratory illnesses. That’s three times more deaths than the death toll from AIDS, tuberculosis and malaria combined.

Murder

Roughly 385,000 people were murdered around the world in 2017.

Hunger

Some 821 million people around the world did not get enough to eat in 2017. resulting in malnutrition, and about 151 million children under five experienced stunted growth due to malnutrition.

An estimated 1.9 billion adults were overweight or obese in 2016. 41 million children under five are overweight or obese.

Cholera

There were 1,207,596 suspected cases of cholera in Yemen between April 2017 and April 2018.

The total estimated number of cholera cases worldwide ranges from 1.4 million to 4 million.

Vaccinations

Global vaccination rates against childhood diseases in 2017: 85 percent. That number has stayed steady for several years.

In 2017, about 100,000 children in the U.S. under two, or 1.3 percent of children that age, had not been vaccinated against serious diseases like measles and whooping cough.

The percentage of unvaccinated U.S. children has quadrupled from 0.3 percent in 2001 — shortly after the circulation of erroneous and disproven reports that vaccines cause autism.

Polio

The number of cases of polio worldwide in 2018 as of Dec. 25 was 29, compared to 22 in 2017. There were an estimated 350,000 cases around the world in 1988.

A mysterious polio-like disease, called acute flaccid myelitis that can paralyze patients, mostly children, appeared in the U.S. in 2014 with 120 confirmed cases from August to December. There were 22 confirmed cases in 2015, 149 confirmed cases in 2016, 35 confirmed cases is 2017 and 182 cases as of Dec. 21, 2018.

Guinea Worm

In 1986, guinea worm disease, an incapacitating disease that creates painful lesions, affected some 3.5 million people in Africa and Asia. As of Oct. 1, 2018, there were 25 reported cases of guinea worm disease worldwide: 1 in Angola; 14 in Chad, and 10 in South Sudan. One obstacle to wiping it out entirely: The worm can circulate in dogs.

Mystery Disease

Number of cases of Disease X: Zero. But that doesn’t mean the World Health Organization isn’t worried about it. They use the term Disease X to refer to a pathogen “pathogen currently unknown to cause human disease” but that has the potential one day to trigger a deadly pandemic.

Healthcare in Congress for 2019: All Hat, No Cattle, Experts Say

News Editor, Joyce Frieden, in her end of the year report, noted that the work Congress does on healthcare next year — and even the year after — will be mostly for show without a lot of concrete results, experts said.

“Probably nothing is going to happen legislatively in the next 2 years around healthcare” in terms of legislation that is actually passed by both the House and Senate and signed by the president, said Chris Sloan, a director at Avalere, a healthcare consulting firm, in a phone interview. “I think the Democrats in the House are going to use this as an opportunity to showcase their policy priorities for 2020 — things like ‘Medicare for All’ or a Medicare buy-in, taking votes on those and nailing down some specifics.”

“You will also see Democrats in the House use their oversight power over [the Department of] Health and Human Services (HHS) — to hold hearings, and give pushback around things the administration is doing around the Affordable Care Act (ACA) like the expansion of association health plans and cuts in funding for marketing and outreach in the [health insurance] exchanges,” he said.

Sloan also expects a lot of activity to occur around drug pricing. “I’m not expecting a major piece of legislation around drug pricing coming out, but it’s a huge issue with a lot of traction on the right and the left… so I’d expect in the House and the Senate [to see] hearings on drug pricing,” he said. “There’s always a chance that the Democratic House and the Republican president will come together on some piece of drug pricing — like transparency reporting — but I think it’s unlikely. So the next 2 years won’t be stagnant for healthcare; there will be a lot of policy development but no major bills.”

Julius Hobson, Jr., JD, senior policy advisor at Polsinelli, a consulting firm here, was a little more optimistic — but only a little. “The first thing on my list is prescription drug pricing,” he said in a phone interview. “If there is an opportunity for Republicans and Democrats to work out something together — provided neither side tries to overreach — that will be the one thing that has the possibility of being enacted.” Possibilities for drug pricing legislation include bills supporting reimportation, pegging U.S. drug prices to those in Europe, or giving HHS the authority to negotiate drug prices under Medicare and Medicaid.

“After that, I can’t find a health issue at the moment that I think the two sides could work on,” Hobson said. “But I think we’ll see more hearings on the oversight of the ACA, especially in the House, as administration officials get dragged in to see what they’re doing.” A House floor vote on a ‘Medicare for All’ bill is also a possibility — although it won’t pass — along with more oversight on veterans’ healthcare, he added.

One area that gets little attention is healthcare costs at the Department of Defense, which is the fastest-growing portion of the budget, said Hobson. “Having been in wars for 17 years, our healthcare costs are going through the roof.” Both President George W. Bush and President Obama pushed for having military members pay more of their costs under the Tricare health insurance program for military families, “but Congress refused to do that.”

Instead of action in Congress, most of the activity on the healthcare front will probably be within the Trump administration, he continued. “There will be more attempts to get things done — things [the administration] can do that Congress is unable to do.” Expect more efforts to come from the Office of Regulatory Reform at the Centers for Medicare & Medicaid Services, “which is consistent with an executive order from last year to come up with lists of regulations they could do away with to make the system less burdensome,” Hobson predicted.

Rodney Whitlock, vice president for health policy at ML Strategies, a consulting firm here, said in a phone interview that he expected some effort to pass a bill related to Texas vs. the United States of America — the court case questioning the constitutionality of the ACA — “and I think there’s something that looks a little more like ACA stabilization in the works… [The question is] what is the difference between the things where they’re trying to make a point versus what might be actually statutorily possible.”

Bob Laszewski, president of Health Policy and Strategy Associates, a consulting firm in Alexandria, Va., agreed with the idea that both parties will be focused on the drug pricing issue. “This seems to be about the only bipartisan interest and it will be interesting to see if there is any real agreement between them,” he said in an email. “Trump’s reference pricing proposal could be an interesting spot — will he find more Democratic allies than Republicans?”

Healthcare-related taxes imposed by the ACA but not yet implemented — including taxes on “Cadillac” health insurance plans and medical devices — are another possible area of cooperation, he said. “These have only been postponed and will have to be dealt with. There does seem to be broad agreement they should not be restarted.” And the pharmaceutical industry will be pushing back against a proposal to have it pay a larger share of drug costs in the Medicare Part D “donut hole,” he added.

Finally, “Democrats will have as their top priority rubbing salt into the Republican wounds on pre-existing conditions and the recent Texas court case,” Laszewski said. “I don’t see any opportunity for bipartisan fixes. With the Supreme Court more than a year away in terms of any final decision, this will be a very dark cloud in 2019.”

Bookended by Obamacare, 2018 was the year of policy change

As Susannah Luthi points out in 2018 tith Congress’ attempt to repeal the Affordable Care Act dead by the end of 2017, any relief the law’s supporters felt were likely short-lived, as 2018 was the year the Trump administration began significantly remolding a law it fundamentally opposes.

Led by HHS Secretary Alex Azar, who took the reins of the $1.2 trillion department last January, the administration charted an overarching strategy to lower drug prices and reduce spending on hospital care. Moreover, by the end of 2018, the entire Affordable Care Act was back in legal peril when a federal judge in Texas struck it down and blocked immediate appeal.

Here’s a look at the major healthcare political issues of 2018, a year when the public political drama slowed down, but activity aiming to overhaul the ACA sped up.

Drug prices

During Azar’s confirmation hearing last January, he faced skeptical Senate Democrats who argued his tenure as a top executive with pharmaceutical giant Eli Lilly & Co. could blunt the Trump administration’s promised plan to lower drug prices.

The skepticism didn’t abate when White House in May unveiled its blueprint. But as the policy bones gained muscle, Azar’s ideas have won over some doubters and drawn manufacturer ire.

“The biggest news item of the year is that the drug blueprint wasn’t hot air and that they’re really trying to do big things,” said Michael Adelberg, a healthcare consultant with the law firm Faegre Baker Daniels. “Like many others, I assumed it was mostly PR, but I think the administration deserves credit for taking this seriously.”

Among the most controversial policies: a mandatory international pricing index model for Part B physician-administered drugs to align prices with those in other countries.

Critics on the left who want Medicare to negotiate directly said the policy falls short. Investment analysts hope the proposal is a tactic to bring manufacturers to the negotiating table.

Critics on the right say it’s price-fixing.

“Proposing to effectively accept the pricing decisions of other countries, while having the chutzpah to brand the policy ‘market-based’ is beyond disappointing,” said Benedic Ippolito of the American Enterprise Institute.

Last month the administration also proposed a significant change to Medicare Part D that sparked outcry: room for price negotiation for drugs in protected classes, where Medicare costs are exceptionally high. Patient groups are fighting back over concerns about access, but the administration says Part D has substantial patient protections in place, and the chronically ill will always be able to get critical medications.

Site-neutral payments

HHS has also took action on site-neutral payments for Medicare, and despite pending litigation, analysts believe the political winds on the issue may have changed.

Last month the administration finalized a rule that will slash payments for office visits at hospital outpatient clinics to match the rate for independent physicians’ offices. In response, two powerful industry groups sued.

But nonpartisan experts have wanted to see this policy move—not only to address rising Medicare expenses but also consolidation and the rising costs that stem from that trend. “In an era of growing consolidation of providers and increasing physician employment by hospitals, site-neutral payments are critical on all dimensions,” said Paul Ginsberg, director of the USC-Brookings Schaeffer Initiative for Health Policy at the Brookings Institution.

Hospitals will keep fighting hard against them, Ginsberg added. But from his vantage point, analysts’ views on the issue have expanded to what’s at stake for the entire healthcare system in terms of this policy, and they are increasingly bipartisan.

“I’ve had the sense that (the administration) has long seen the issue of healthcare competition as something they can work with Democrats on,” he added. “And I think Democrats are much more comfortable using competition than they have been historically. So that’s a political dimension that makes it more promising that this policy could be sustained.”

340B program

The administration also trimmed reimbursement in the 340B drug discount program, which avoided congressional reforms despite Senate hearings and introduction of several House bills.

Hospitals had a key win late this year when HHS jumped ahead of its stated deadline and said it will start capping the prices manufacturers can charge providers for drugs. Regulation over ceiling prices for 340B has been delayed for years and early this fall hospitals sued over the latest postponement.

But litigation over the sweeping cuts to Part B drug reimbursements for 340B hospitals is still pending, and the administration has expanded those cuts to hospital systems’ off-campus facilities.

Affordable Care Act

A proposal to stabilize the individual market with a federal funding boost fell apart early in the year as a band of Republican-led states sued to overturn the law following the effective elimination of the individual mandate penalty for 2019.

Still, Obamacare may survive this attack. Sabrina Corlette, from Georgetown University’s Center on Health Insurance Reforms, said that in 2018 the law proved the doubters wrong. “It revealed remarkable resilience in the face of some pretty dramatic attempts to roll back or undo the law,” she said.

The individual market remains in a holding pattern. Shortly before open enrollment started this year, CMS Administrator Seema Verma touted the fact that premiums dropped for the first time since the law was implemented.

Premiums for benchmark silver plans on the federal individual market exchanges will drop in 2019, marking the first decrease since the Affordable Care Act was implemented, CMS Administrator Seema Verma announced on Thursday.

Verma attributed the 1.5% overall drop to looser regulations, the Trump administration’s market stabilization rule and the seven 1332 State Innovation Waiver approvals that launched reinsurance programs.

Tennessee will see the sharpest premium decline, as average monthly premiums for silver plans fell more than 26%, from more than $600 last year to $449. North Dakota had the greatest increase, with average premiums rising more than 20% from $312 per month to $375. Sixteen of the 39 states using the federal exchange will see declines, two states will have no change and the majority of the remaining states will face marginal, single-digit increases.

Verma dismissed the idea that President Donald Trump’s cut-off last year of the cost-sharing reduction payments hurt the market, although the action was followed by a nearly 40% jump in average premiums as insurers added the cost to benchmark silver plans in a move known as “silver loading.”

Analysts have credited the slim premium increases insurers have announced so far this year as a correction to excessive 2018 rate hikes.

But Verma defended the expansion of short-term, limited duration plans as an affordable option for people who can’t afford Obamacare plans. Potentially, they could appeal to the 20 million Americans who don’t have coverage, she added.

“The prediction was that the offering of short-term plans would have negative impact on the market and increase premiums, but we’re not seeing the impact on the market,” Verma said.

The administrator also announced the administration will be writing new guidance for 1332 waivers to allow states to broaden exchange plan design “to create more affordable options,” but said the new reinsurance programs are a key part of the overall drop in premiums.

Federal exchange states that launch reinsurance programs in 2019 will see decreases in premiums as expected, but prices will not fall to pre-2018 levels. Wisconsin, which had its 1332 waiver approved earlier this year, will see a drop in averages from $464 in 2018 to $440 for 2019. In 2017, average silver plan premiums in the state were just over $300. Maine’s average premiums will decline from $482 in 2018 to $446 in 2019, still more than $100 per month higher than the $316 in 2017.

New Jersey will see the sharpest decrease with its reinsurance waiver. In 2017, average silver premiums were $286 per month, rising to $339 per month this year. With reinsurance, they will settle in at $286 per month in 2019.

Last year, Alaska — which has the highest insurance premiums in the country — saw a drastic decline after implementation of its waiver. Average monthly premiums fell from $759 in 2017 to $595 in 2018. Next year they will drop again to $576.

The CMS hasn’t made enrollment projections for 2019 based on these new numbers, but Verma added that more people may opt for the federal exchanges “when we’re not seeing double-digit rate increases.”

Verma said the administration still wants changes to Obamacare’s exchange rules.

“For millions of people, the law needs to change,” she told reporters. ” While some have publicly been accusing us of sabotage, we have been doing everything we can to mitigate problems of Obamacare.”

The high cost of stabilization continues to trouble many. “ACA markets have stabilized at an unsatisfactory point,” said Douglas Holtz-Eakin, a conservative economist and former director of the Congressional Budget Office.

He said the deep cuts to marketing and other changes “all do matter at the margins” and that the slower enrollments noted this year have borne this out. “You have to decide what the administration’s objective is politically,” he added. “They don’t want to expand enrollment: they want it stabilizing,” but it’s coming at a high cost.

Adelberg said while plans aren’t “hemorrhaging money and going out of business” as they were in the early years, the exchange market still very much depends on subsidies and looks more like a tier of Medicaid.

“The exchange market is starting to look like Medicaid expansion-expansion,” he said.

The CMS has tweaked guidance for Section 1332 state innovation waivers, sparking criticism that the administration opened the door to trimming protections.

Potential actions from the administration take on extra weigh in light of the late-breaking court decision over Obamacare.

But even strong critics of the law doubt the administration would use the murky legal situation to cross statutory lines with waiver approvals in the meantime.

“No one wants to do anything in the interim, and both sides are waiting for the final, final decision,” said conservative policy analyst Chris Jacobs.

Medicaid public option

States this year started a serious push for their own form of the public option through Medicaid and some in Washington have started paying attention.

Minnesota, Nevada and New Mexico are some of the states that have forged ahead with studies on this policy. And with congressional activity on healthcare likely on hold until after the 2020 presidential election, advocates see this year’s progress on the state level with this policy as significant—even if the industry is on the alert about potential revenue hits.
Adelberg said he is tracking the discussion closely and is particularly interested in the option if it’s offered outside the Obamacare exchanges

I have previously stated and I will restate my opinion, that unless civility, maturity, and a dedication to do what is best for the voters, nothing will get done in healthcare in the next 2 years with the Democrats using the failure as one of many talking points to get elected. These will be depressing 2 or more years of frustration. But I will continue my discussion regarding the options for our healthcare system and hopefully offer what I believe is the best form of healthcare delivery for all in our wonderful country.

Happy New Year to All!!

 

 

Suicide Kills 47,000 Men, Women and Children a Year. Society shrugs, the Discussion We Need to have and Those Who Suffer the Most; an Association to Screen Time and Social Media?

47430587_1812958915500426_7411626721117470720_nLet us first remember Pearl Harbor Day and the men and women who lost their lives and the battles that followed. Now, let’s continue with the second edition of the suicide post. I am interested in the discussion of the epidemic and those who are left behind to suffer who someone commits suicide. The Editorial Board at USA TODAY noted that though suicide is the 10th leading cause of death, efforts to understand and prevent it falls short. But this could be changing.

If a killer roaming America left 47,000 men, women and children die each year, you can bet society would be demanding something be done to end the scourge.

Well, such a killer exists. It’s called suicide, and the rate of it has steadily risen.

Yet the national response has been little more than a shrug, apart from raised awareness whenever celebrities — fashion designer Kate Spade and renowned chef Anthony Bourdain, to name two this year — are tragically found dead by their own hand.

USA TODAY’s comprehensive look at this public health crisis and its ripple effect, published Wednesday, includes a daughter’s heart-wrenching narrative of losing a mother to suicide, as told by former Cincinnati Enquirer Managing Editor Laura Trujillo.

Although suicide is the 10th leading cause of death in America, efforts to understand and prevent it fall dismally short. The National Institutes of Health, by far the world’s largest underwriter of biomedical study, spent $68 million last year on suicide — a relatively small amount compared with NIH funds devoted to other leading killers.

NIH and NIMH: We’re deeply committed to reducing suicide

Kidney disease leaves about as many dead, yet it receives nine times the research funding. Indeed, the NIH spent more than twice the suicide research sum to better understand inflammatory bowel syndrome and even more on dietary supplements.

Suicide rates across the U.S. (Photo: USA TODAY)

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The NIH says that it spends billions on mental health research and that this indirectly prevents suicide, but that’s misleading: Millions of Americans suffer emotional problems and relatively few resorts to suicide. Society needs to know why this is, and only further study can answer the question.

Federal government priorities often mirror what matters to politicians and, ultimately, the general public, which for too long has seemed mired in complacency about suicide. There have been no concerted campaigns similar to those targeting leading killers such as HIV or breast and prostate cancers.

This could be changing.

A new survey funded by the American Foundation for Suicide Prevention shows that 94 percent of Americans believe that suicide is preventable, and the foundation is advocating an increase in NIH suicide funding, to $150 million.

“The public is starting to get it,” says foundation CEO Robert Gebbia.

Even limited investments have borne fruit:

►The military and the Department of Veterans Affairs invested hundreds of millions of dollars after suicide rates tripled in the Army during recent wars, then kept climbing among a generation of young veterans. The VA has developed an algorithm to identify the most at-risk patients as a way to focus more intensive care. Preliminary results have been encouraging, with lower mortality rates.

►Studies show that reducing access to lethal means saves lives, and states with stronger gun control laws now see reduced rates of suicide. Construction began this year on a massive, stainless steel net slung under the Golden Gate Bridge to end that San Francisco landmark’s dark history as a prime site for suicide.

►With proven benefits of intervention, President Donald Trump this year signed a bill to examine the feasibility of creating a 911-style, three-digit emergency number for more easy access to the National Suicide Prevention Lifeline (1-800-273-8255).

Scientists have established that the self-destructive urge is often fleeting. Where counseling, better coping skills and reduced access to a lethal means help the distraught to endure this moment, people can survive. It’s one of the reasons why nine out of 10 people who attempt suicide, studies show, do not ultimately kill themselves.

Where there is life, there is hope.

We need to talk about suicide more

USA TODAY has published an extensive story by Laura Trujillo on her mother’s suicide. Editor Nicole Carroll explains why and the precautions are taken.

I called Laura the minute I heard.

We had worked together in Phoenix for more than a decade, and she had recently moved to Cincinnati.

She answered, sobbing.

“Oh, Laura, I’m so sorry.”

My heart was broken for Laura, her mom, her family. And over the following years, I watched as Laura tried to absorb, understand and even explain her mother’s suicide. She began writing about it in spurts on Facebook.

“It can feel impossible to understand,” she once posted. “And you can’t until you can. Until you, too, have felt alone in a way so overwhelmingly strong that you would do anything to escape it. It can be gone and return, consuming you. But sometimes there is luck. Good doctors and medicine. Time, people and faith.”

Laura and I talked about how someday when she was ready, she should share her story more widely.

Because every time Laura told her story, others would tell theirs.

And we need to talk about suicide.

On average, there are 129 suicides each day, according to new data from the Centers for Disease Control and Prevention. And for every person who dies, about 29 more attempt it. It’s the 10th leading cause of death in the United States.

We all know someone touched by suicide. Myself included.

I lived with my grandparents until I was 2. I stayed close to my grandfather; he never stopped looking out for me, even as I started college, work, a family. Then, in 2001, he killed himself. It wasn’t a secret, but no one ever talked about it.

That was 17 years ago. And still today, we just don’t talk about suicide.

The media rarely share stories of suicide, in part because we don’t want to make things worse. The practice in newspapers for decades was not to write about suicide at all unless it was done in public or was a public figure.

When the media cover high-profile suicides, especially when they include specific details of the death, the exposure can lead to suicide contagion. In the months after Robin Williams’ death in 2014, suicides rose 10 percent higher than expected, according to a Columbia University study.

But the answer can’t be to ignore suicide and the effect it has on so many. In addition to Laura’s personal essay, we felt it important to explore suicide as a broader public health problem. In our reporting, we learned that while suicide rates are up 33 percent over the past 18 years in the USA, funding for it lags behind that of all other top causes of death, leaving suicide research well behind the nation’s other top killers.

There is much about suicide we don’t know. And in an effort to protect people, news organizations have allowed misconceptions to persist, including the belief that there’s nothing you can do to help someone who is contemplating suicide.

So we know we need to report on suicide, but we must do it carefully. Because when we write about suicide responsibly, we can help save lives.

We’ve talked about this – constantly – in the writing and editing of Laura’s story.

We shared the story with two psychologists who study suicide. They advised us on language to avoid, details to omit and ways to offer support. Stories of survival help, they said. Make sure to include the suicide lifeline number with every story. Talk about warning signs.plans.

Not all psychologists agree on exactly how we should or shouldn’t write about suicide. And we didn’t do everything those experts suggested. We felt it was unrealistic to avoid talking about how Laura’s mother killed herself and to avoid every detail of where it took place. We did, however, avoid descriptions of the method in our other reported stories on suicide. Our intent is to inform, not to sensationalize, and we felt these stories were compelling without them.

We discussed language to use on social media if vulnerable readers reached out to us and how to keep the conversation going after this story published.

We then shared the story with Kelly McBride, senior vice president at the Poynter Institute and an expert on responsible media coverage of suicide. She reviewed the story, headlines, and photos, giving further advice on sensitive phrasing, and suggestions for more details of Laura’s personal journey that could help.

Because the goal of Laura’s story is to help.

Help those who’ve been touched by suicide.

Those who’ve considered suicide.

And those who are worried – right now – that someone they love is thinking about suicide.

So let’s not be afraid. Let’s find ways to share our stories.

Let’s talk.

After a suicide, here’s what happens to the people left behind

To me, this is the most important part of this post. I consider suicide a loser’s way to solve their problems and I have been through it with fellow physicians and friends who have lost family members. The people who suffer are those left behind to wonder what they did wrong or what they could have done to prevent the suicide.

Loss survivors – the close family and friends left behind after a suicide – number six to 32 for each death, according to the Centers for Disease Control and Prevention, meaning that in 2017 alone, as many as 1.5 million people unwillingly became part of this group.

They are forced to cope with the loss of a loved one and navigate uncertain futures, often caring for confused children as they struggle to accept they may never know “why.”

Suicide can affect a wider community of individuals, including members of a person’s church or school. One study estimates roughly 425 people are exposed to each suicide in this way.

After a loved one’s death, those left behind face an increased risk of suicide themselves. According to a report in 2015 from the Action Alliance for Suicide Prevention:

  • Losing any first-degree relative to suicide increased the mourner’s chance of suicide by about threefold.
  • Young people appear to be particularly vulnerable after the suicide of a peer, which can lead to a phenomenon sometimes referred to as suicide clusters or contagion.
  • Men who have a spouse die by suicide have a 46-fold increase in their chances of dying by suicide. Women have a 16-fold increase.

Kim Ruocco, whose husband, Marine Corps Maj. John Ruocco, died by suicide in 2005, said she never seriously considered killing herself, but she often wondered how she would make it through each day.

“After his death, I cannot say that I was suicidal, but I can remember being in so much emotional pain that I would think, ‘I really don’t want to wake up,'” Ruocco said. “Because you can’t figure out how to live your life with this kind of grief.”

‘My whole world turned upside down’

When Ruocco’s husband died, she said, she lost her sense of reality.

“My whole world was turned upside down,” she said. “What I thought I knew to be true may not have been true. … It made me question everything in my life, from my spirituality to my instincts, to my decision-making, to my marriage, to my family relationships.”

Grief, she learned, was not linear. Some days were terrible. Some were OK, even good. She had to learn, she said, to embrace it all.

“It’s not one feeling, it’s a whole bunch of feelings, and I think the advice for anybody who’s experiencing grief is that whatever you are feeling, it’s OK, it’s normal, and it’s going to come,” she said. “I let it come, I look at it, I feel it, I express it, and then I try to let it go.”

Stories of hope:

  • Stepping back from the ledge
  • Suicide never entered his mind. Then 9/11 happened.
  • Young, transgender and fighting a years-long battle against suicidal thoughts
  • She worked in suicide prevention. Then one day she had to save herself.

When Debbie Baird lost her 29-year-old son, Matthew, to suicide in 2009, she didn’t think she would ever let go of her grief.

Debbie Baird said she didn’t think she would ever recover from the grief over her son Matthew’s suicide. (Photo: Debbie Baird)

“If you had told me in the early days that I would feel better again, I would never have believed you,” she said.

She went to counseling, found a support group and journaled for years, which the Suicide Prevention Lifeline recommends as a way to process things you weren’t able to say before your loved one’s death. Slowly, Baird said, she began to heal. She could see it in the pages.

“I kept thinking if I could write a letter to him, maybe he’d write back to me. Maybe he’d let me know the reason why this happened. I felt like I needed to find a way to connect with him,” she said. “It went from wanting to know why, and how hurt and sad I felt and how my heart was broken and all the physical pain that I was going through and my depression and how I was feeling too, ‘Hey, Jen’s going to have another baby.’ I could see my life changing.”

Baird is now a community educator and support specialist for loss survivors at the National Alliance on Mental Illness.

The American Psychological Association said that after a suicide, it’s important for survivors to:

  • Accept your emotions.
  • Not worry about what you “should” feel or do. There’s no standard timeline for grieving and no single right way to cope.
  • Care for yourself. Do your best to get enough sleep and eat regular, healthy meals. Taking care of your physical self can improve your mood and give you the strength to cope.
  • Draw on support systems.
  • Talk to someone. There is often stigma around suicide, and many loss survivors suffer in silence. Speaking about your feelings can help.
  • Join a group.
  • Talk to a professional.

How to help

The bereaved can heal, suicide prevention experts said, but their pain is often underestimated. The stigma around suicide creates an additional burden. Loss survivors commonly experience a range of emotions as they grieve, including shock, fear, shame, and anger. As they work to cope with these feelings, many simultaneously deal with the pressure to keep their loved one’s suicide a secret or with the mistaken belief that they did something to cause their loved one’s death.

Thomas Joiner, who lost his father to suicide and went on to become a leading suicide researcher, wrote in his book “Why People Die by Suicide” that some people’s inability to intellectually make sense of suicide kept them from showing sympathy after his dad’s death.

“To some people … understanding didn’t matter and wasn’t a barrier to acting with a real generosity of spirit,” he wrote. “To others, the lack of understanding seemed an insurmountable barrier, so that instincts toward compassion were short-circuited.”

According to the American Association of Suicidology and the National Suicide Prevention Lifeline, people can help loss survivors by:

  • Listening without judgment
  • Using the lost loved one’s name to show that person is not forgotten
  • Accepting the loss survivor’s feelings, which can include shock, shame, and abandonment
  • Avoiding phrases such as “I know how you feel,” unless you, too, are a loss survivor
  • Avoiding telling them how they should act or feel
  • Being sensitive during holidays and anniversaries

“People need the education to understand that it is OK to talk about their loved one,” Baird said. “It is OK to mention their name. It is OK to say, ‘I’m sorry.’ ”

Loss survivors should be encouraged to get help for themselves. Grief counselors, faith leaders, social workers, and doctors may be trained in how to respond to suicide.

Ruocco became vice president of suicide prevention and postvention at the Tragedy Assistance Program for Survivors (TAPS) after her husband’s death. “Postvention” describes efforts to prevent suicide among loss survivors and help them heal. Ruocco said postvention doesn’t just decrease risk, it can help survivors find a new purpose.

“They can really have post-traumatic growth and make meaning out of this kind of loss,” Ruocco said.

It’s impossible for survivors to return to the way things were before their loved one’s death. Ruocco said she misses her husband every day, but she’s managed to build a life for herself that, although not what she imagined is full of joy.

“You look at the world in a different way,” she said. “Not only did I have meaning in my life because of his death, but I also cherished the world in a different way. My relationships with my children were more intense, more purposeful. I was more present and connected to the outside world, whether that’s nature or other people. I found joy in little things and appreciated little things and moments with people that I may not have discovered prior to my husband’s death, and I was able to honor his life lived by telling other people about him and preventing suicide in honor of him.”

Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or night or chat online.

If you have lost a loved one to suicide, visit Alliance of Hope to find support resources.

If you are grieving the death of a loved one who served, you can contact the Tragedy Assistance Program for Survivors (TAPS) at 800-959-8277.

‘Screen time’ causing, exacerbating childhood psychiatric disorders

U.S. teens now spend 6 hours, 40 minutes per day using screens for entertainment. Fifty percent report they feel “addicted” to their devices.

Working in the world of child and adolescent psychiatry as an advanced practice nurse, I frequently hear about symptoms of irritability, anger, isolation and poor sleep from my patients. These symptoms are common to many childhood psychiatric disorders. These disruptive symptoms baffle parents, teachers and clinicians alike, and can lead to incorrect diagnoses for these children with dysregulated moods.

I have been a steadfast believer in the importance of good diet, exercise and adequate sleep as being elementary steps one can take to improve moods. I now also consider the fourth tenet for youth mood regulation to be limited electronic screen exposure.

Excessive screen time stresses the brain, and electronic devices of all types have taken over our modern everyday life by storm in an insidious manner. The typical U.S. teen now spends 6 hours, 40 minutes per day using screens for entertainment. Fifty percent of U.S. teens say they feel “addicted” to their devices.

Recently, I saw a 12-year-old male in my office who presented with symptoms of isolation, nightmares, anxiety, anger, academic decline and poor sleep. What followed my evaluation was a discussion about how electronic devices tend to produce mood disturbances. Excessive screen time can disrupt the production of melatonin, which helps to regulate sleep-wake cycles. Light at night has been linked to depression and/or suicide in numerous studies.

Typical gaming and social media interfaces induce stress reactions with hyperarousal, provoking a “wired and tired” state. Gaming interfaces desensitize the brain’s reward system and release the “feel-good” chemical dopamine. Dopamine is critical in regulating focus and moods. Brain scans have shown that those playing video games are similar to those using cocaine.

Screen time overloads the senses

Screen time overloads the senses, fractures attention and depletes mental reserves. Emotional meltdowns can then become a coping mechanism. And lastly, excessive screen time reduces a time for “green time” — physical activity outdoors in a natural setting, which can reduce stress and restore attention.

“Pervasive design” is the practice of combining psychology and technology to change behavior. The pervasive design is increasingly employed by social media and video gaming companies to pull users onto their sites and keep them there for as long as possible. Several Google and Facebook executives have voiced their concerns about social media sites negatively affecting human psychology.

Utilizing an “electronic fast” for children in my practice has shown drastic improvement in psychiatric symptoms. I suspect those without underlying psychiatric disorders may show an even more marked improvement. As parents/guardians of children, please consider the negative impact screen time may be impacting your child.

And it is my impression after reviewing all the data that this increased screen time and social media may be the reason for this increase in suicide rates. Whether you believe President’s Trump’s tweets and outlandish suggestions that the media lies, kids and adults are measuring themselves to impossible comparisons in behavior, aesthetics, levels of social measures etc.

 

Suicide Rate Up 33% in Less than 20 years, Yet Funding Lags Behind Other Top Killers!

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First let us all take a minute to remember Past President 41, George H.W. Bush, probably one of the most respected past presidents. is experience, knowledge, and experience was amazing and so welcomed and useful to run a country. This former president has inspired us all with his toughness mixed with judiciousness and kindness. We could all learn much from 41! Now a moment of silence…………………..

Suicide rates are up 33% in the U.S., yet funding lags behind that of all other top causes of death — leaving suicide research in its “infancy.”

More than 47,000 Americans killed themselves in 2017, the Centers for Disease Control and Prevention reported Thursday, contributing to an overall decline in U.S. life expectancy. Since 1999, the suicide rate has climbed 33 percent.

Americans are more than twice as likely to die by their own hands, of their own will, than by someone else’s. But while homicides spark vigils and protests, entering into headlines, presidential speeches, and police budgets, suicides don’t. Still shrouded in stigma, many suicides go unacknowledged save for the celebrities – Robin Williams, Kate Spade, Anthony Bourdain – punctuating the unrelenting rise in suicide deaths with a brief public outcry.

And research suggests our ways of living may be partly to blame, in ways that don’t bode well for the future.

Alcohol and substance abuse are risk factors, and both are increasing. Isolationraises the risk, and nearly half of Americans say they sometimes or always feel alone. Increasing smartphone use has been linked to suicidal thoughts in teens. Even climate change has been found to have roughly the same effect on increasing suicides as an economic recession.

The leading causes of death have declined since 1999

The Suicide rate has increased more the 33%

Screen Shot 2018-12-01 at 10.16.49 PM“We’re trying to reduce suicide death rates in the face of a culture that’s ever more fascinated with violence, that has a bunch of opiates around left and right, where family structure isn’t getting more cohesive and neither is community structure,” said Thomas Joiner, a leading suicide researcher. “That’s a lot to fight against.”

Suicide is the 10th leading cause of death in the U.S. and is often called a public health emergency.

But money to research and combat suicide continues to lag behind other leading killers and even non-fatal conditions. The National Institutes of Health, the largest public funder of biomedical research in the world, spent $68 million on suicide last year. It spent nearly five times that studying sleep and 10 times more on breast cancer, which killed fewer people in 2016.

“What I’m just painfully aware of is that all of the areas where the top 10 causes of death in the United States have gone down have received significantly more attention,” said John Draper, director of the National Suicide Prevention Lifeline. “There’s been so much more put into every one of those causes of death than suicide. … If you didn’t do anything for heart disease and you didn’t do anything for cancer, then you’d see those rates rise, too.”

NIH officials say they do not expressly budget by disease, and research funding in other categories could affect suicide without being suicide-specific. The NIH spent $2.7 billion on mental health, for example.

“A large portion of the research is not disease-oriented but based on human biology. For instance, if we’re studying brain function, it might be pertinent to suicide, but we might not necessarily categorize it as suicide,” said Michael Lauer, NIH deputy director for extramural research. “Same with depression, which obviously is linked to suicide.”

Still, many in the field wish for dedicated spending. Jill Harkavy-Friedman, vice president of research for the American Foundation for Suicide Prevention, advocates for $150 million a year for suicide research, still far less than the $592 million the NIH allocated to fight kidney disease, the nation’s No. 9 killer.

“We are happy that other health conditions are getting the money. … It’s not an either/or,” Harkavy-Friedman said. But “the cost of suicide is enormous, and people don’t realize it.”

The cost — in dollars, in suffering, in science

Suicides and suicide attempts cost $93.5 billion a year, most of it in lost productivity, a 2016 study estimated. And that’s nothing compared with the cost in human lives and suffering.

Joiner recognized the human toll 30 years ago – even before his own father died by suicide.

As a graduate student in psychology in 1990, Joiner had begun focusing on depression. That summer, his father, a former Marine sergeant turned software pioneer, took his own life.

“He was a successful, visionary, ambitious, intelligent man,” Joiner said. “And he had an illness that ended up being fatal. That’s how I see him.”

Joiner, now a psychology professor and clinician at Florida State University, said his father’s death helped persuade him to make studying suicide his life’s work.

“I’d already inclined toward that decision, and this only made it starker. I already knew this was a problem,” he said. “It was a misery for the bereaved, and that’s not to mention the even more acute suffering suicidal people go through in the hours, days, months before their death – just a lot of suffering all around. And it wasn’t being studied then.”

It’s studied now, but given the size of the problem, we still know surprisingly little about it.

“I think that we’ve told the public that we know more about suicide than we know,” said April Foreman, a clinician on the American Association of Suicidology board of directors.

When someone dies by suicide, people and the media trot out a series of “maybes,” she said: Maybe it was mental illness. Maybe it was losing a job or getting divorced.

“Maybe it was not getting a phone call at just the right moment. Maybe. But maybe something was happening in their brains that in 20 years we’ll understand,” she said. “We tell stories about bullying or sadness like it’s a fairy tale. There’s probably real science there, and we just haven’t decided to treat it like that. … We’re telling stories about why people kill themselves that isn’t scientifically based, that are very inaccurate, and are just the easier stories to tell because it’s much harder to say we don’t know.”

Joiner compares suicide research today to “cancer research about 100 years ago.”

“People were so scared of the topic they wouldn’t even say the word,” but cancer research has since made great strides, he said. “I think the same thing will happen with suicide research, but that’s decades in the future. Right now we’re in our infancy.”

Suicide studies reflect the broad sweep of the current science. Some focus on genetic factors involved in maintaining brain circuits and neurotransmitters, biomarkers of at-risk populations, brain PET imaging and medications; others focus on psychotherapies, preventing substance abuse and school nurse interventions.

The effectiveness of prevention efforts has been difficult to determine as suicide rates increase, said Andrew Sperling, director of legislative affairs for the National Alliance on Mental Illness.

“The challenge is there are various suicide prevention programs, and we’re still learning a lot about what works and doesn’t work,” Sperling said. “There’s not a lot of evidence we’ve been very effective at it.”

Scientific knowledge is limited. Public knowledge is wrong.

Even key discoveries that enjoy broad support among researchers have yet to percolate into the public consciousness. 

Public health experts say: Suicide is preventable.

People think: Suicide is inevitable.

Consciously or unconsciously, many Americans write off those who seriously consider killing themselves as hopeless causes, unreachable. A study in 2017 showed that people are skeptical of a suicidal person’s ability to recover – the idea that even if we stop the person today, we won’t tomorrow.

“If you think once someone’s suicidal that they’re just going to die, then it doesn’t make sense to invest money in that,” Joiner said of a common point of “ignorance.”

Science tells us that isn’t true. So does common sense. Survivors of suicide attempts themselves are walking proof.

In 2016, nearly 45,000 died by suicide, but the number who attempted is almost 29 times that — meaning more than one and a quarter-million survived. Though a previous suicide attempt makes the risk of dying by suicide higher, it is just one of many risk factors. Nine out of 10 people who survive a suicide attempt will not go on to die by suicide later, according to studies that have tracked survivors over decades.

Cliff Bauman, a National Guardsman who struggles with post-traumatic stress disorder, attempted suicide once, but when he faced a crisis again he was able to get through it by using learned coping skills, including being aware of his triggers and having people he can trust.

“I made the conscious decision (after my attempt) to go back into counseling,” he said. “(I) was opening up about why I did what I did and how it got to that point, and I felt suddenly … the darkness doesn’t seem so dark.”

Another misconception is that suicidal ideation is rare. But one in 33 American adults seriously thought about suicide in 2016, the commonness of the thoughts belied by how rarely they’re discussed.

“Suicide is reflective of other issues that we don’t want to talk about,” said Adam Swanson, a senior prevention specialist at the Suicide Prevention Resource Center. “We don’t want to talk about the fact that people can’t afford to pay electric bills. … We don’t want to talk about the … pain people carry.”

Survivors are often the first to distinguish that it’s not a desire to die that drove their attempt but a desire to escape the pain. It’s something Shelby Rowe, a PTSD and suicide attempt survivor who works in suicide prevention knows firsthand.

“If I could go back to talk to myself that night when all I could hear in my head was ‘You can’t live like this anymore, you can’t live like this anymore’ … I would have said: ‘It’s OK, you’re right. It is really awful right now, and you can’t live like this anymore, but please live, because there is another way. There is another beautiful life waiting for you.'”

Mental and emotional pain is less acknowledged – both by doctors and the public – than physical pain, Foreman noted.

“It is OK for someone to suffer from wanting to kill themselves and to suffer from trying to kill themselves or even die that way, but it’s not OK to feel sick with the flu for a few days,” she said.

Stymied by stigma

The lack of compassion people feel for those who die by suicide is reflected in the lack of funding. Stigma goes beyond misconceptions.

“Stigma is about fear, and suicide is associated with our most primal fears – fear of death … fears of traumatic loss and our fears of mental illness,” Draper said.

Fear and discomfort also can be expressed as anger.

Retired California Highway Patrol officer Kevin Briggs said he has heard drivers shout “Go ahead and jump!” to people contemplating suicide on the Golden Gate Bridge.

The taunts reflect a disdain some people feel toward those who attempt suicide, whom they see as “weak” or “crazy,” a 2017 study found. Though mental illness is a risk factor for suicide, not everyone who is mentally ill has suicidal thoughts, and not everyone who attempts suicide is mentally ill.

But even statistics on the relationship between mental illness and suicide are incomplete “because we’re not funding it,” Harkavy-Friedman said.

“Every year we go to (Capitol) Hill and we advocate at the state level for fully funding the National Violent Death Reporting System,” she said.

The tracking system, now in place in just 40 states, helps health experts and law enforcement officials identify common circumstances associated with specific types of death, including suicide. Suicide can be especially hard to track without a strong system in place because family members may try to cover it up or pressure officials not to enter “suicide” into records.

In the past, even in clear cases of suicide, families were “not telling anybody for years because they thought they would be blamed or stigmatized,” Harkavy-Friedman said.

Stigma is not only an obstacle to accurate reporting, but it also has made politicians shy away. It’s part of why suicide wasn’t seriously studied or even discussed until the past few decades.

“Twenty years ago when I worked on (Capitol) Hill, you wouldn’t find suicide prevention on federal documents. It wasn’t talked about in the Department of Defense or in the general public. There were no researchers. There was no national strategy for suicide prevention,” said Jerry Reed, a doctor on the executive committee for the National Action Alliance for Suicide Prevention.

That changed in 1998 when Congress declared suicide a national problem, Reed said.

“Since then, the country has caught up to the significance of this issue, but it still has a long way to go.”

Congressional support is key because it affects the overall NIH budget. Congress also can pass special provisions regarding certain issues, as it has for Alzheimer’s and opioid abuse.

“Congress has made that a clear priority,” Lauer said.

Where’s the hope? A little bit in a lot of places

Despite challenges, experts agree our understanding of suicide is light-years ahead of where it was just a generation ago. And suicide prevention is at “unprecedented” levels, the Substance Abuse and Mental Health Services Administration reports.

Therapy

Through interventions, including medication and therapy, Joiner says he sees suicidal patients at his clinic go from “pretty desperate, pretty intent to die” to “turn(ing) a corner – and usually it’s shockingly quick.”

Joiner theorizes that suicide results from a combination of factors: feeling like a burden, isolation, and having lethal means and a lack of normal fear of death.

Short-circuit one of that – isolation, for instance – and you might stop someone from hurting himself.

“It stands to reason if you reconnect a little bit then risk should abate, so we just arrange within the context of people’s day-to-day lives small increased doses of social connection,” Joiner said. “It’s a very simple behavioral idea, but it seems to work if people do it.”

Asking a friend to lunch would be a great example, Joiner said, but some patients don’t have a friend. They might start simply with “show up to this community event and stay for 10 minutes.”

Of course, some people are chronically suicidal, but Joiner and others note that they can also feel relief through targeted therapy.

Shear Avory, a transgender person who sees a therapist (not associated with Joiner), has lived with daily suicidal ideation and continues to hold on to hope.

“For so long I’ve been stuck in just wanting everything to disappear, from wanting the trauma to go away,” said Avory, whose traumatic childhood included foster homes and conversion therapy. “I’m still alive. I’m still here. That feels like an accomplishment. … Healing is not a linear experience.”

Low-cost changes to health care

With unlimited funding, Joiner said he’d put resources toward practical things proven to work, such as “means safety” – which can include everything from putting pedestrian barriers on bridges to locking up guns and medicine cabinets – and training doctors to identify at-risk patients.

Training primary care doctors and other medical staff is the foundation of the Zero Suicide program.

Zero Suicide founder Mike Hogan said that though suicide is incredibly complex, determining who is at risk can actually be very simple: Once patients are in a health care setting, ask them. Studies have shown that asking people if they’re thinking about suicide does not plant the idea in their heads.

“If people are asked, they often really want to get it off their chest, and they want some help, and it opens the door to help,” Hogan said. “A little bit does a lot: asking, safety planning, reducing lethal means and reaching out … turns out to be quite powerful.”

A 2014 study found that 83% of those who die by suicide saw a health care provider in the year before their death. That’s particularly true for older white men, who account for most suicides.

“We can’t predict when they’ll die, just like we can’t predict when someone might die of a heart attack,” Hogan said. “But we can predict who needs a little help just like someone might need help because their lipid levels are high.”

Hogan said two nonprofit organizations that offer mental health treatments – Centerstone, which spans multiple states, and the Institute for Family Health in upstate New York – saw roughly 60 percent reductions in suicides after adopting Zero Suicide.

Becky Stoll, vice president for crisis and disaster management at Centerstone, said one of the biggest improvements has been the methodical approach to plugging holes in care. For instance, coordination between the suicide prevention committee and their IT department resulted in a program that changed the font color of high-risk patients if they missed appointments, which would then alert them to start calling the patient. If the patient didn’t answer, they’d start calling their friends and family. It was a simple change and it saved lives. In one case, a man’s wife called him after she had received calls from Centerstone. He had been standing on a bridge at the time.

“I’ve been in the field since the late ’80s, and I’ve not seen the enthusiasm the results that we’re seeing now,” Stoll said. “We don’t win every time, but we win a lot. When we know better, we have to do better. And embedding these frameworks into systems of care … it really does seem like we can have an impact. It seems like that’s catching wildfire across the U.S. … (We need to) make people feel they have lives worth living.”

Colorado has embraced Zero Suicide as one tool in its fight. But advocates are more closely watching the newly formed Colorado-National Collaborative, a partnership aimed at reducing suicides thereby 20percent by 2024.

Through a combination of funding from state and federal sources and the American Foundation for Suicide Prevention, Colorado’s Office of Suicide Prevention went from an annual budget of $536,000 about 18 months ago to $2.6 million as of Sept. 30. If the partnership between scientists and public health professionals proves effective in the state with the eighth-worst suicide rate in the country, it could be adopted nationwide.

Removing the means

Colorado and other states also have joined the Gun Shop Project, in which gun store owners and firing range instructors distribute suicide prevention materials as part of an effort to reach people who might be looking for a tool to commit suicide.

Guns were used in 23,000 of the 45,000 suicide deaths in 2016.

These interventions focus on the “means,” or how suicides are completed.

“We may not understand suicidality very well … (but) we know people don’t die of feeling suicidal – they die from a gunshot wound, they die from a medication overdose. Just like you don’t die by (a driver) having poor depth perception, you die from them striking the car and your head hitting the windshield,” Foreman said.

‘On the cusp’?

Many in the suicide research and prevention field describe it as being on a precipice – the science is not where it needs to be, but it shows promise; the funding is not where it needs to be, but it has increased. On the other side, they hope, are the results: a nation in which fewer lives are lost to suicide or tormented by suicidal thoughts.

“With suicide, I hope that we’re on a cusp of a movement,” Foreman said. “Where the people who have survived suicide attempts, the people who live with chronic suicidality, the families, the loved ones, the people who are left, that they get up and say: This suffering is the same as someone who has died by HIV … or cancer. It deserves the same quality science.”

Suicide, at a 50-year peak, pushes down US life expectancy

Mike Stobbe wrote that Suicides and drug overdoses pushed up U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.

Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago.

The increase partly reflects the nation’s growing and aging population. But it’s deaths in younger age groups—particularly middle-aged people—that have had the largest impact on calculations of life expectancy, experts said.

“These sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable,” Dr. Robert Redfield, the CDC’s director, said in a statement.

The suicide death rate last year was the highest it’s been in at least 50 years, according to U.S. government records. There were more than 47,000 suicides, up from a little under 45,000 the year before.

A GENERAL DECLINE

For decades, U.S. life expectancy was on the upswing, rising a few months nearly every year. Now it’s trending the other way: It fell in 2015, stayed level in 2016, and declined again last year, the CDC said.

The nation is in the longest period of a generally declining life expectancy since the late 1910s, when World War I and the worst flu pandemic in modern history combined to kill nearly 1 million Americans. Life expectancy in 1918 was 39.

Aside from that, “we’ve never really seen anything like this,” said Robert Anderson, who oversees CDC death statistics.

In the nation’s 10 leading causes of death, only the cancer death rate fell in 2017. Meanwhile, there were increases in seven others—suicide, stroke, diabetes, Alzheimer’s, flu/pneumonia, chronic lower respiratory diseases, and unintentional injuries.

An underlying factor is that the death rate for heart disease—the nation’s No. 1 killer—has stopped falling. In years past, declines in heart disease deaths were enough to offset increases in some other kinds of death, but no longer, Anderson said.

(The CDC’s numbers do sometimes change. This week, CDC officials said they had revised their life expectancy estimate for 2016 after some additional data came in.)

WHAT’S DRIVING IT?

CDC officials did not speculate about what’s behind declining life expectancy, but Dr. William Dietz, a disease prevention expert at George Washington University, sees a sense of hopelessness.

Financial struggles, a widening income gap, and divisive politics are all casting a pall over many Americans, he suggested. “I really do believe that people are increasingly hopeless and that that leads to drug use, it leads potentially to suicide,” he said.

VoteCast, a wide-ranging survey of the electorate conducted by The Associated Press, found voters expressing pessimistic views about the future: About half of voters nationwide said they expect life in America for the next generation to be worse than it is today. Nearly a quarter said life would be better and about as many said it would be the same. VoteCast surveyed more than 115,000 voters nationwide as Americans cast ballots in this year’s midterm elections.

Drug overdose deaths also continued to climb, surpassing 70,000 last year, in the midst of the deadliest drug overdose epidemic in U.S. history. The death rate rose 10 percent from the previous year, smaller than the 21 percent jump seen between 2016 and 2017.

That’s not quite cause for celebration, said Dr. John Rowe, a professor of health policy and aging at Columbia University.

“Maybe it’s starting to slow down, but it hasn’t turned around yet,” Rowe said. “I think it will take several years.”

Accidental drug overdoses account for more than a third of the unintentional injury deaths, and intentional drug overdoses account for about a tenth of the suicides, said Dr. Holly Hedegaard, a CDC injury researcher.

OTHER FINDINGS

The CDC figures are based mainly on a review of 2017 death certificates. The life expectancy figure is based on current death trends and other factors.

The agency also said:

—A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average. An American born in 2015 or 2016 was expected to live about a month longer, and one born in 2014 about two months longer than that.

—The suicide rate was 14 deaths per 100,000 people. That’s the highest since at least 1975.

—Montana had the highest suicide rate, and New York the lowest. Suicide rates were nearly twice as high in rural counties than in urban ones.

—The percentage of suicides due to drug overdose has been inching downward.

—Deaths from flu and pneumonia rose by about 6 percent. The 2017-2018 flu season was one of the worst in more than a decade, and some of the deaths from early in that season appeared in the new death dates.

—West Virginia was once again the state with the highest rate of drug overdose deaths. The CDC did not release state rates for suicides.

—Death rates for heroin, methadone, and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017.

—Gun deaths rose for the third year in a row, to nearly 40,000. That’s about 1,000 more than in 2016. They had been hovering around 33,500 deaths until a few years ago.

Like in other years, most gun deaths were suicides. Earlier CDC reports have noted increasing rates of suicide by gun. In 2017, it about 60 percent of them were by gun.

More next week as I discuss the discussion that we need to have and those who are left behind and suffer the most.

Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or night or chat online.