Pervasive Abusive Silence
Stephen Roberson says, "it would have been far better if [the surgeons
general] had shown the courage of their convictions while still in their posts
[...] the American people have a right to expect people in positions of
authority to speak the truth, even if these individuals have to risk
professional setbacks by doing so." ("The unhealthy silence of our surgeons
general," Letter, Boston Globe, July 13, 2007)
Why is this paradigm limited to surgeons general? Much of the cynicism
among voters derives from the failure of all public officials to reveal
wrongdoing by their colleagues for fear of losing their jobs. Fooling
journalists is the goal not keeping the public informed.
Six months after being elected the new Governor, the new Attorney General
and the Middlesex District Attorney remain silent about any wrongdoing by the
many local and state officials under their jurisdiction. Are they unaware of the
misconduct? If aware and keeping silent they have become part of the problem
that existed before they were elected. Business as usual is the dominant
paradigm in Massachusetts. Why is the Globe silent too?
Roy Bercaw, Editor ENOUGH ROOM
The unhealthy silence of our surgeons general
Letter
Boston Globe
July 13, 2007
WHILE IT is heartening to hear three former surgeons general -- Richard Carmona,
C. Everett Koop, and David Satcher -- finally speaking out about having been
censored by their respective administration officials, it would have been far
better if they had shown the courage of their convictions while still in their
posts (Ex-surgeon general accuses Bush officials of censorship," Page A2, July
11).
What would they have lost by speaking up when it mattered, over the president's
objections if necessary? Their jobs?
Whether we're listening to the secretary of state, the head of the CIA, or the
surgeon general, the American people have a right to expect people in positions
of authority to speak the truth, even if these individuals have to risk
professional setbacks by doing so. A private in the US Army risks more than that
every day; is it right that we expect so much less from our senior government
officials?
STEPHEN J. ROBERSON
Holliston
July 18, 2007
Media and Medical Bias
Media and Medical Bias
Comments by hospital PR flacks suggest that persons accused of psychiatric
illness are the cause of ERs being overwhelmed. (Liz Kowalczyk, "Psychiatric
patients feel strain," Boston Globe, July 15, 2007) More importantly this report
lacks any reference to the Rehabilitation Act of 1973, the Americans with
Disabilities Act of 1990, and Mass General Law Chapter 151 B (the state anti
discrimination statute). Many cities also have anti discrimination laws.
Do these medical professionals, and the editors at the Boston Globe believe
that persons accused of psychiatric illness are excluded from enjoying the
rights enumerated in the US and MA Constitutions? Janice Sullivan a Quincy PR
flack said safety overrules Constitutional Rights. Huh?
Kowalczyk notes, "the challenge of caring for sometimes-aggressive
psychiatric patients." Why are persons accused of psychiatric illness treated
differently? Are all "normal" patients passive? It appears that the Boston
Globe, the DPH, the DMH, and hospitals believe that a person accused of
psychiatric illness is violent and dangerous. Police and prosecutors share this
misguided belief. It is institutionalized in MA state courts.
Why are the training plans for ER employees not meant for all of their
patients? That in itself is discriminatory and unlawful. What is the legal
rationale for allowing "some psychiatric patients to keep on their clothes and
instead be frisked and scanned with a hand-held metal detector?" Why is this
proposed policy only applied to persons accused of psychiatric illness? That is
an unlawful proposal.
In Cambridge until I complained for three years the Cambridge Health
Alliance boasted that they delivered mental health care coordinated with the
Cambridge police. That is an outrageous admission. The comments in this report
suggest it is not just a Cambridge problem. A new perspective is needed. The DMH
and taxpayer funded attorneys whose mission is protect persons with disabilities
and their rights failed by intentionally negligently allowing institutions to
express their unlawful bias and abuse a class of vulnerable persons.
Few psychiatrists know the laws regarding persons with disabilities. They
believe that their feelings and personal opinions trump law. That needs to stop
immediately.
Roy Bercaw, Editor ENOUGH ROOM
Constance Surette, a Plymouth resident who has bipolar disorder, (left) and
Jill Judson participate in a discussion about patients' rights during an M-Power
meeting. (Globe Staff Photo / Evan richman)
The Boston Globe
Psychiatric patients feel strain
State investigates complaints at ERs
By Liz Kowalczyk,
Boston Globe Staff
July 15, 2007
The state investigated at least 21 complaints over the last 18 months that
emergency departments mistreated psychiatric patients, and officials cited
hospitals in half those cases for problems that included wrongly forcing
patients to undress, punching or hitting patients, and restraining others for
hours without proper monitoring.
One patient died while in restraints, and a patient's arm was broken as a nurse
forcibly removed his pants.
These cases are a sign of the growing strain on the state's overcrowded
emergency rooms, doctors, nurses, patients and state officials said, and also
reflect a shortage of services for the mentally ill, the challenge of caring for
sometimes-aggressive psychiatric patients, and inconsistent training of harried
ER staff.
Emergency rooms can be battlegrounds. They often are the last resort for
psychiatric patients in crisis -- some patients are so out of control and
aggressive that mental health facilities will not take them -- and ERs have
responded by creating "safe rooms" to handle such patients and on occasion
calling in police for help, according to inter views with 20 doctors, nurses,
patients, and hospital administrators.
ER staff give psychiatric medications but are not trained to provide
comprehensive psychiatric care, they said. And many of these patients stay in
ERs for days without proper treatment because of backlogs in psychiatric
facilities, creating potentially volatile situations for those patients, staff,
and other patients. Hospital officials said nurses, too, have been injured in
confrontations, and patients contend that they are humiliated by policies like
the one requiring them to undress.
Patients "will be in the ER from hours to days and they get absolutely no care,"
said Linda Condon, an emergency room nurse who has worked at four hospitals in
Southeastern Massachusetts. "You put a person with psychiatric problems in a
room with four walls and nothing to do, and there are going to be problems."
Documents from the Department of Public Health -- which conducts investigations
when patients or relatives complain or hospitals themselves report problems --
show that investigators cited 11 hospitals for a range of problems. Those cases
include:
A blind, disabled patient who went to Lawrence General Hospital in April because
he was suicidal. Hospital policy then required psychiatric patients to undress
so that staff could look for hidden drugs or weapons, but the patient wanted to
keep on his jeans. A male nurse "used excessive force" to remove them, the
health department found, breaking the patient's arm. The patient required
surgery and a three-week hospital stay.
In April 2006, a 49-year-old former nurse who arrived in the emergency room at
Melrose-Wakefield Hospital at 10:30 p.m., intoxicated and uncooperative. Staff
strapped down his arms and legs, gave him sedatives, and assigned a security
guard to watch him. After a nurse called the security guard away to help with
another violent patient, the first patient had a fatal cardiac arrest. The
hospital's internal investigation determined that the patient was not properly
monitored. Staff told state investigators that the ER was "very, very busy."
In June 2006, a male teen in the Merrimack Valley Hospital ER in Haverhill began
pulling medical equipment out of a wall, kicking furniture, and biting staff.
While he was biting a nurse, a staff member repeatedly punched him in the face.
State investigators said the hospital did not properly train staff on how to
restrain patients. Hospital staff said punching was a last resort because the
patient was severely injuring the nurse.
State documents released to the Globe omitted the names of patients and staff
for privacy reasons. When health officials find problems during investigations,
hospitals must implement plans to correct them.
The state public health and mental health departments have been so concerned
about the pattern of complaints that they sent a memo to hospital executives in
September, detailing 21 steps they should take to improve care of psychiatric
patients in ERs, including reducing waiting times, using trained mediators, and
further training staff in techniques to calm patients.
But patients and advocates for people with mental illness say problems remain
rampant. They are pushing legislators to increase the mental health department's
role in regulating ER care and to require the public health department to
develop "best practices" for treating psychiatric patients.
"When we get upset and don't want to take our clothes off, they think we're
going to flip out," said Constance Surette, 57, of Plymouth, who has bipolar
disorder and works with a group pushing for legislation. "But the way they treat
us, of course they're going to get that reaction. The ERs should use peer
mediators to talk to [psychiatric patients] because they are frightened of the
authority figures."
Surette filed a complaint with the health department last month, alleging that
city police officers at Quincy Medical Center sprayed one psychiatric patient
with mace and handcuffed another to a bench while she was in the ER. Hospital
spokeswoman Janice Sullivan said that she could not confirm Surette's account
but that the actions taken were appropriate "for the safety of everyone
involved."
Doctors and nurses say they have made improvements but are doing the best they
can in an impossible situation. They said the number of complaints statewide is
small considering the thousands of psychiatric patients who seek care in
Massachusetts ERs each year.
In 2005, ERs reported 168,000 visits by psychiatric patients, 10 percent more
than in 2003, according to the Massachusetts Health Data Consortium. And they
usually have to wait longer for care. The average ER stay for patients who are
eventually sent home or to another hospital is nearly three hours; it's nearly
six hours for psychiatric patients. And many of these patients wait two to three
days in the ER for an inpatient bed in a psychiatric facility to open.
"The emergency departments are overwhelmed," said Dr. Paul Bulat, medical
director of the emergency room at St. Luke's Hospital in New Bedford. "We are
seeing more violent patients and out-of-control patients. We're seeing mental
health problems much worse than we should be."
ER directors are reluctant to acknowledge that overcrowding hurts patient care.
But staff told the state health department that busyness was a factor in several
of the cases investigated, especially those that involved inadequate monitoring
of patients.
In the case of the former nurse who died at Melrose-Wakefield Hospital, not only
did the security guard leave the patient alone for about 20 minutes, but the
patient's condition was not checked every 15 minutes while he was restrained, as
required by hospital policy. Monitoring is especially crucial for intoxicated
patients who receive sedatives.
Hospital spokesman Richard Pozniak said he could not comment on the case because
of regulations requiring patient information to be kept confidential. State
investigators said in their report that 13 patients were in the ER when the man
arrived, and 20 other patients arrived before he died 4 1/2 hours later.
Public health investigators also found that lack of training is an issue,
including in cases where staff used excessive force. Better training in
techniques to calm patients is especially important as frustrated psychiatric
patients with no where else to go spend hours in the ER .
In the case of the patient whose arm was broken at Lawrence General Hospital,
investigators found a range of problems, including that the hospital's internal
investigation of the complaint did not include interviewing the patient.
Investigators also found no evidence that staff and security had been trained in
patient's rights. And they said the nurse should have explored the patient's
reasons for wanting to keep on his jeans before resorting to force.
Hospital spokeswoman Ellen Murphy Meehan said the hospital "expressed deep
regret to the patient" for what it considers an accident. She said Lawrence
General has since changed its policy to allow some psychiatric patients to keep
on their clothes and instead be frisked and scanned with a hand-held metal
detector.
Paul Dreyer, director of the state Division of Health Care Quality, said "a
culture change" is needed; he is organizing an educational summit for ER staff
in the fall, hoping hospitals will improve on their own, making legislation
unnecessary. Legislators expect to hold hearings this summer or in the fall.
We want "people to realize they don't have to call in security the first time
someone looks at them cross-eyed," Dreyer said. "The ERs are in a production
mode. Their aim is to process the patients as quickly as possible to get on to
the next patient. These patients may not take well to being treated that way.
They may act out."
A number of hospitals said they have improved care after serious encounters.
UMass Memorial Medical Center -- where campus police beat a psychiatric patient
with a baton in 2004, injuring him, and, several months later, threw a patient
against a wall and called her a "bitch," according to state reports -- said it
has made significant changes. These include creating a secured, quiet area for
psychiatric patients and training police to use calming techniques. Dr. Patrick
Smallwood, medical director for emergency mental health services, also joined
the hiring panel for campus police officers last year.
Dr. Bruce Auerbach, chief for emergency and ambulatory services at Sturdy
Memorial Hospital in Attleboro, said hospitals need more resources, not more
regulation. "When a patient who is having a behavioral health crisis is in my ER
for four days not getting the intervention he needs -- it's a travesty in our
healthcare system," he said.
Liz Kowalczyk can be reached at kowalczyk@globe.com.
Comments by hospital PR flacks suggest that persons accused of psychiatric
illness are the cause of ERs being overwhelmed. (Liz Kowalczyk, "Psychiatric
patients feel strain," Boston Globe, July 15, 2007) More importantly this report
lacks any reference to the Rehabilitation Act of 1973, the Americans with
Disabilities Act of 1990, and Mass General Law Chapter 151 B (the state anti
discrimination statute). Many cities also have anti discrimination laws.
Do these medical professionals, and the editors at the Boston Globe believe
that persons accused of psychiatric illness are excluded from enjoying the
rights enumerated in the US and MA Constitutions? Janice Sullivan a Quincy PR
flack said safety overrules Constitutional Rights. Huh?
Kowalczyk notes, "the challenge of caring for sometimes-aggressive
psychiatric patients." Why are persons accused of psychiatric illness treated
differently? Are all "normal" patients passive? It appears that the Boston
Globe, the DPH, the DMH, and hospitals believe that a person accused of
psychiatric illness is violent and dangerous. Police and prosecutors share this
misguided belief. It is institutionalized in MA state courts.
Why are the training plans for ER employees not meant for all of their
patients? That in itself is discriminatory and unlawful. What is the legal
rationale for allowing "some psychiatric patients to keep on their clothes and
instead be frisked and scanned with a hand-held metal detector?" Why is this
proposed policy only applied to persons accused of psychiatric illness? That is
an unlawful proposal.
In Cambridge until I complained for three years the Cambridge Health
Alliance boasted that they delivered mental health care coordinated with the
Cambridge police. That is an outrageous admission. The comments in this report
suggest it is not just a Cambridge problem. A new perspective is needed. The DMH
and taxpayer funded attorneys whose mission is protect persons with disabilities
and their rights failed by intentionally negligently allowing institutions to
express their unlawful bias and abuse a class of vulnerable persons.
Few psychiatrists know the laws regarding persons with disabilities. They
believe that their feelings and personal opinions trump law. That needs to stop
immediately.
Roy Bercaw, Editor ENOUGH ROOM
Constance Surette, a Plymouth resident who has bipolar disorder, (left) and
Jill Judson participate in a discussion about patients' rights during an M-Power
meeting. (Globe Staff Photo / Evan richman)
The Boston Globe
Psychiatric patients feel strain
State investigates complaints at ERs
By Liz Kowalczyk,
Boston Globe Staff
July 15, 2007
The state investigated at least 21 complaints over the last 18 months that
emergency departments mistreated psychiatric patients, and officials cited
hospitals in half those cases for problems that included wrongly forcing
patients to undress, punching or hitting patients, and restraining others for
hours without proper monitoring.
One patient died while in restraints, and a patient's arm was broken as a nurse
forcibly removed his pants.
These cases are a sign of the growing strain on the state's overcrowded
emergency rooms, doctors, nurses, patients and state officials said, and also
reflect a shortage of services for the mentally ill, the challenge of caring for
sometimes-aggressive psychiatric patients, and inconsistent training of harried
ER staff.
Emergency rooms can be battlegrounds. They often are the last resort for
psychiatric patients in crisis -- some patients are so out of control and
aggressive that mental health facilities will not take them -- and ERs have
responded by creating "safe rooms" to handle such patients and on occasion
calling in police for help, according to inter views with 20 doctors, nurses,
patients, and hospital administrators.
ER staff give psychiatric medications but are not trained to provide
comprehensive psychiatric care, they said. And many of these patients stay in
ERs for days without proper treatment because of backlogs in psychiatric
facilities, creating potentially volatile situations for those patients, staff,
and other patients. Hospital officials said nurses, too, have been injured in
confrontations, and patients contend that they are humiliated by policies like
the one requiring them to undress.
Patients "will be in the ER from hours to days and they get absolutely no care,"
said Linda Condon, an emergency room nurse who has worked at four hospitals in
Southeastern Massachusetts. "You put a person with psychiatric problems in a
room with four walls and nothing to do, and there are going to be problems."
Documents from the Department of Public Health -- which conducts investigations
when patients or relatives complain or hospitals themselves report problems --
show that investigators cited 11 hospitals for a range of problems. Those cases
include:
A blind, disabled patient who went to Lawrence General Hospital in April because
he was suicidal. Hospital policy then required psychiatric patients to undress
so that staff could look for hidden drugs or weapons, but the patient wanted to
keep on his jeans. A male nurse "used excessive force" to remove them, the
health department found, breaking the patient's arm. The patient required
surgery and a three-week hospital stay.
In April 2006, a 49-year-old former nurse who arrived in the emergency room at
Melrose-Wakefield Hospital at 10:30 p.m., intoxicated and uncooperative. Staff
strapped down his arms and legs, gave him sedatives, and assigned a security
guard to watch him. After a nurse called the security guard away to help with
another violent patient, the first patient had a fatal cardiac arrest. The
hospital's internal investigation determined that the patient was not properly
monitored. Staff told state investigators that the ER was "very, very busy."
In June 2006, a male teen in the Merrimack Valley Hospital ER in Haverhill began
pulling medical equipment out of a wall, kicking furniture, and biting staff.
While he was biting a nurse, a staff member repeatedly punched him in the face.
State investigators said the hospital did not properly train staff on how to
restrain patients. Hospital staff said punching was a last resort because the
patient was severely injuring the nurse.
State documents released to the Globe omitted the names of patients and staff
for privacy reasons. When health officials find problems during investigations,
hospitals must implement plans to correct them.
The state public health and mental health departments have been so concerned
about the pattern of complaints that they sent a memo to hospital executives in
September, detailing 21 steps they should take to improve care of psychiatric
patients in ERs, including reducing waiting times, using trained mediators, and
further training staff in techniques to calm patients.
But patients and advocates for people with mental illness say problems remain
rampant. They are pushing legislators to increase the mental health department's
role in regulating ER care and to require the public health department to
develop "best practices" for treating psychiatric patients.
"When we get upset and don't want to take our clothes off, they think we're
going to flip out," said Constance Surette, 57, of Plymouth, who has bipolar
disorder and works with a group pushing for legislation. "But the way they treat
us, of course they're going to get that reaction. The ERs should use peer
mediators to talk to [psychiatric patients] because they are frightened of the
authority figures."
Surette filed a complaint with the health department last month, alleging that
city police officers at Quincy Medical Center sprayed one psychiatric patient
with mace and handcuffed another to a bench while she was in the ER. Hospital
spokeswoman Janice Sullivan said that she could not confirm Surette's account
but that the actions taken were appropriate "for the safety of everyone
involved."
Doctors and nurses say they have made improvements but are doing the best they
can in an impossible situation. They said the number of complaints statewide is
small considering the thousands of psychiatric patients who seek care in
Massachusetts ERs each year.
In 2005, ERs reported 168,000 visits by psychiatric patients, 10 percent more
than in 2003, according to the Massachusetts Health Data Consortium. And they
usually have to wait longer for care. The average ER stay for patients who are
eventually sent home or to another hospital is nearly three hours; it's nearly
six hours for psychiatric patients. And many of these patients wait two to three
days in the ER for an inpatient bed in a psychiatric facility to open.
"The emergency departments are overwhelmed," said Dr. Paul Bulat, medical
director of the emergency room at St. Luke's Hospital in New Bedford. "We are
seeing more violent patients and out-of-control patients. We're seeing mental
health problems much worse than we should be."
ER directors are reluctant to acknowledge that overcrowding hurts patient care.
But staff told the state health department that busyness was a factor in several
of the cases investigated, especially those that involved inadequate monitoring
of patients.
In the case of the former nurse who died at Melrose-Wakefield Hospital, not only
did the security guard leave the patient alone for about 20 minutes, but the
patient's condition was not checked every 15 minutes while he was restrained, as
required by hospital policy. Monitoring is especially crucial for intoxicated
patients who receive sedatives.
Hospital spokesman Richard Pozniak said he could not comment on the case because
of regulations requiring patient information to be kept confidential. State
investigators said in their report that 13 patients were in the ER when the man
arrived, and 20 other patients arrived before he died 4 1/2 hours later.
Public health investigators also found that lack of training is an issue,
including in cases where staff used excessive force. Better training in
techniques to calm patients is especially important as frustrated psychiatric
patients with no where else to go spend hours in the ER .
In the case of the patient whose arm was broken at Lawrence General Hospital,
investigators found a range of problems, including that the hospital's internal
investigation of the complaint did not include interviewing the patient.
Investigators also found no evidence that staff and security had been trained in
patient's rights. And they said the nurse should have explored the patient's
reasons for wanting to keep on his jeans before resorting to force.
Hospital spokeswoman Ellen Murphy Meehan said the hospital "expressed deep
regret to the patient" for what it considers an accident. She said Lawrence
General has since changed its policy to allow some psychiatric patients to keep
on their clothes and instead be frisked and scanned with a hand-held metal
detector.
Paul Dreyer, director of the state Division of Health Care Quality, said "a
culture change" is needed; he is organizing an educational summit for ER staff
in the fall, hoping hospitals will improve on their own, making legislation
unnecessary. Legislators expect to hold hearings this summer or in the fall.
We want "people to realize they don't have to call in security the first time
someone looks at them cross-eyed," Dreyer said. "The ERs are in a production
mode. Their aim is to process the patients as quickly as possible to get on to
the next patient. These patients may not take well to being treated that way.
They may act out."
A number of hospitals said they have improved care after serious encounters.
UMass Memorial Medical Center -- where campus police beat a psychiatric patient
with a baton in 2004, injuring him, and, several months later, threw a patient
against a wall and called her a "bitch," according to state reports -- said it
has made significant changes. These include creating a secured, quiet area for
psychiatric patients and training police to use calming techniques. Dr. Patrick
Smallwood, medical director for emergency mental health services, also joined
the hiring panel for campus police officers last year.
Dr. Bruce Auerbach, chief for emergency and ambulatory services at Sturdy
Memorial Hospital in Attleboro, said hospitals need more resources, not more
regulation. "When a patient who is having a behavioral health crisis is in my ER
for four days not getting the intervention he needs -- it's a travesty in our
healthcare system," he said.
Liz Kowalczyk can be reached at kowalczyk@globe.com.
Only Black Women Have Feelings?
Only Black Women Have Feelings?
This essay raises serious credibility questions. (Madeline Drexler, "How
racism hurts -- literally," Boston Sunday Globe, July 15, 2007) Are black women
different from white men when it comes to reacting to stress? Are black women
different from white men in reacting to discrimination? Are black women's
reaction to racism different from white men's reaction to discrimination based
upon sexual preference? Or disability? Were any studies done on the effects of
discrimination against white men who are accused of psychiatric illness? I don't
think so.
Why does the Globe continue to prioritize one form of discrimination
over others when many kinds of bias are equally unlawful and offensive? The
Globe discriminates in its focus on discrimination. See, e.g., how differently
the Globe reported on outrageous unlawful discrimination in access to health
care for persons with disabilities in Liz Kowalczyk, "Psychiatric patients feel
strain,"
Boston Globe, July 15, 2007.
This essay cherry picks ignoring the income and class of black people. Do
multi millionaire athletes and celebrities get worse medical care than poor
white men? I don't think so.
Most importantly psychiatrists say that you cannot control what another
person thinks or says about you. But you can control how you react to what they
say or do. These anecdotes suggest that black people are incapable of ignoring
what others say and do. Do black people have no control over their emotions and
thoughts?
Roy Bercaw, Editor ENOUGH ROOM
How racism hurts -- literally
Boston Sunday Globe
By Madeline Drexler
July 15, 2007
FOUR YEARS AGO, researchers identified a surprising price for being a black
woman in America. The study of 334 midlife women, published in the journal
Health Psychology, examined links between different kinds of stress and risk
factors for heart disease and stroke. Black women who pointed to racism as a
source of stress in their lives, the researchers found, developed more plaque in
their carotid arteries -- an early sign of heart disease -- than black women who
didn't. The difference was small but important -- making the report the first to
link hardening of the arteries to racial discrimination.
The study was just one in a fast-growing field of research documenting how
racism literally hurts the body. More than 100 studies -- most published since
2000 -- now document the effects of racial discrimination on physical health.
Some link blood pressure to recollected encounters with bigotry. Others record
the cardiovascular reactions of volunteers subjected to racist imagery in a lab.
Forthcoming research will even peek into the workings of the brain during
exposure to racist provocations.
Scientists caution that the research is preliminary, and some of it is quite
controversial, but they say the findings could profoundly change the way we look
at both racism and health. It could unmask racism as a bona fide public health
problem -- just as reframing child abuse and marital violence as public health
concerns transformed the way we thought about these ubiquitous but often secret
sources of suffering. Viewing racial discrimination as a health risk could open
the door to understanding how other climates of chronic mistreatment or fear
seep into the body -- why, for instance, pregnant women in California with
Arabic names were suddenly more likely than any other group to deliver low
birth-weight babies in the six months after 9/11.
Most striking, researchers note, is how consistent the findings have been across
a wide range of studies. The task now, they say, is to discover why.
"We don't know all the internal processes," said James Jackson, director of the
Institute for Social Research at the University of Michigan. "But we can observe
an effect, and we need to find out what's going on."
The burgeoning research comes at a time when lawmakers and government officials
are increasingly focused on the problem of racial disparities in health.
African-Americans today, despite a half century of economic and social progress
since the civil rights movement, face a higher risk than any other racial group
of dying from heart disease, diabetes, stroke, and hypertension. In the United
States, affluent blacks suffer, on average, more health problems than the
poorest whites. Spurred by statistics like these, dozens of states and cities
have been passing legislation intended to eliminate racial and ethnic
disparities in health.
Boston's Disparities Project, launched in 2005 by Mayor Menino's office and the
Boston Public Health Commission, is one of the most progressive blueprints for
change. It includes partnerships with medical institutions, detailed public
reports tracking progress, and community grants to tackle such entrenched
problems as street violence and lack of access to fresh produce. In May,
lawmakers on Beacon Hill held a hearing on proposed legislation that would
reverse the root causes of health inequities. The bill would establish a state
office of health equity, among other measures.
Critics of the new research tying racism directly to disease have charged that
it is flawed because one cannot objectively measure "racial discrimination." But
the science has grown more sophisticated, allowing investigators to measure
people's experiences with prejudice more precisely. And its proponents argue
that the sheer breadth of the work suggests the conclusions are important. Most
of the investigations have been done in the United States, but a growing body of
literature originates elsewhere -- from Finland and Ireland to South Africa and
New Zealand. These studies have found connections between racism and physical
health in populations ranging from Brazil's African-descended citizens to black
women in the Netherlands who had immigrated from the former Dutch colony of
Suriname.
"Across multiple societies, you're finding similar kinds of relationships," said
David Williams, a sociologist at the Harvard School of Public Health. "There is
a phenomenon here that is quite robust."
For decades, experts have agreed that racial disparities in health spring from
pervasive social and institutional forces. The scientific literature has linked
higher rates of death and disease in American blacks to such "social
determinants" as residential segregation, environmental waste, joblessness,
unsafe housing, targeted marketing of alcohol and cigarettes, and other
inequities.
But the new work draws on a different vein of research. In the early 1980s, Duke
University social psychologist Sherman James, introduced his now-classic "John
Henryism" hypothesis. The name comes from the legendary 19th-century
"steel-driving" railroad worker who competed against a mechanical steam drill
and won -- only to drop dead from what today would probably be diagnosed as a
massive stroke or heart attack. In James's work, people who churn out prodigious
physical and mental effort to cope with chronic life stresses are said to score
high on John Henryism. James showed that blacks with high John Henryism but low
socioeconomic position pay a physical price, with higher rates of blood pressure
and hypertension.
Racism, other research suggests, acts as a classic chronic stressor, setting off
the same physiological train wreck as job strain or marital conflict: higher
blood pressure, elevated heart rate, increases in the stress hormone cortisol,
suppressed immunity. Chronic stress is also known to encourage unhealthy
behaviors, such as smoking and eating too much, that themselves raise the risk
of disease.
In the 1990s, Harvard School of Public Health social epidemiologist Nancy
Krieger pushed the hypothesis further. She confirmed that experiences of
race-based discrimination were associated with higher blood pressure, and that
an internalized response -- not talking to others about the experience or not
taking action against the inequity -- raised blood pressure even more. A
controversial finding at the time, it has since been replicated by other
investigators: The suppressed inner turmoil after a racist encounter can set off
a cascade of ill effects.
Jules Harrell, a Howard University professor of psychology, said he was moved
this spring by a photo of the Rutgers University women's college basketball
team, sitting together with dignified expressions, after radio talk show host
Don Imus had labeled them with a racist epithet.
"The expressions on their faces," said Harrell. "All I could think was, 'Good
God, I'd hate to see their cortisol levels.' "
Collectively, these studies of the racism-health link have tied experiences of
discrimination to poorer self-reported health, smoking, low-birth-weight
deliveries, depressive symptoms, and especially to cardiovascular effects. In
the mid-1980s scientists began to take advantage of the controlled conditions of
the laboratory. When African-American volunteers are hooked up to blood-pressure
monitors, for example, and then exposed to a racially provocative vignette on
tape or TV -- such as a white store clerk calling a black customer a racist
epithet -- the volunteers' blood pressures rise, their heart rates jump, and
they take longer than normal to recover from both reactions. Perhaps, scientists
reasoned, the effort of a lifetime of bracing for such threats prolongs the
effect.
More recently, the lab has moved out into the real world. Several investigations
have linked blood pressure to real-time experiences of stress and discrimination
as recorded in electronic diaries. In one yet-to-be-published study, Elizabeth
Brondolo, a psychologist at St. John's University, found that daytime
experiences of racism led to elevated nighttime blood pressure, suggesting that
the body couldn't turn off its stress response.
Despite these suggestive findings, the field remains beset by unknowns. One of
the biggest problems is that researchers don't share a concrete, agreed-upon
definition of racial discrimination -- partly because such prejudice takes
myriad forms. They also don't know if more exposure to racism produces more
disease or if, instead, disease sets in only after a threshold has been passed.
They don't know if exposures during certain periods of life are more risky than
others. And they don't know why some victims cope better than others.
Skeptics distrust people's own accounts of racial discrimination, because the
experiences can't be objectively documented and because the victim can't always
know the motives of the perpetrator.
"You have to read these studies very carefully and see how they define
'discrimination.' What exactly are they measuring?" said Dr. Sally Satel, a
resident scholar at the American Enterprise Institute, a conservative
think-tank. "Typically, it comes down to an individual's perception of how he
was regarded by another person or by a system -- which is not the same thing as
being unfavorably dealt with on the basis of race."
The field's proponents counter that perception is precisely the issue. Studies
of depression, anger, and post-traumatic stress disorder also rely on the
patient's perceptions of events in their lives, they say -- not on objectively
verified facts. Why should research on discrimination be held to a different
standard?
Researchers have also refined the questionnaires and interview methods they use,
allowing them to tease out the effects of depression or hostility -- mood states
that can encourage a person to see discrimination where it's not. The questions
posed have also grown more subtle and indirect, enabling study participants to
talk openly about experiences they might otherwise deny or minimize.
Methods gauging changes in the body have likewise become more accurate. Stress
researchers have gone beyond such straightforward approaches as taking
blood-pressure readings or asking individuals to rate their own health. Now,
with noninvasive diagnostic equipment, they can look directly at coronary
blockages, levels of stress hormone, and the functioning of the immune system.
These measurements help scientists zero in on the mechanisms by which racial
discrimination may ultimately cause damage.
At the University of California, Los Angeles, psychologist Vickie Mays, director
of the Center on Minority Health Disparities, is taking a futuristic angle on
racism's bodily toll: peering into the brain itself. In a forthcoming study,
Mays will record what happens in the brain's circuits and structures during
laboratory conditions of discrimination and whether people vary in their brain
responses based on their lifelong exposure to racial prejudice.
"We know about [racism's] outcome -- but in many ways we don't know what makes
up the experience of racism," she said. "Is it processing in the part of the
brain responsible for emotions? Or in the part of the brain responsible for
fear?"
Racism remains challenging to explore scientifically, researchers say, partly
because it is difficult to get funding and partly because of institutional
reluctance to take on a potentially polarizing issue. In 2006, Harvard's David
Williams and a colleague submitted a grant proposal to the National Institutes
of Health to study whether perceived ethnic discrimination, coupled with
inequities in medical care, delayed stroke recovery in Latinos. As one reviewer
wrote back, "It is not a good investment of NIH dollars to study racism, because
even if we fund something, there is nothing we can do about it."
It's the kind of remark many scientists in the field have heard. These comments
are frustrating, they say, because they see the research as a crucial first step
toward a more clinical, less charged, discussion of the place of racism in
American society.
"The first step is validating that these effects could be real," said Tené
Lewis, a health psychologist at the Yale School of Public Health. "Once we have
a body of literature, we can say: 'OK, can we please talk about this?' "
Boston-based journalist and author Madeline Drexler, a former Globe Magazine
medical columnist, holds a visiting appointment at the Harvard School of Public
Health.
This essay raises serious credibility questions. (Madeline Drexler, "How
racism hurts -- literally," Boston Sunday Globe, July 15, 2007) Are black women
different from white men when it comes to reacting to stress? Are black women
different from white men in reacting to discrimination? Are black women's
reaction to racism different from white men's reaction to discrimination based
upon sexual preference? Or disability? Were any studies done on the effects of
discrimination against white men who are accused of psychiatric illness? I don't
think so.
Why does the Globe continue to prioritize one form of discrimination
over others when many kinds of bias are equally unlawful and offensive? The
Globe discriminates in its focus on discrimination. See, e.g., how differently
the Globe reported on outrageous unlawful discrimination in access to health
care for persons with disabilities in Liz Kowalczyk, "Psychiatric patients feel
strain,"
Boston Globe, July 15, 2007.
This essay cherry picks ignoring the income and class of black people. Do
multi millionaire athletes and celebrities get worse medical care than poor
white men? I don't think so.
Most importantly psychiatrists say that you cannot control what another
person thinks or says about you. But you can control how you react to what they
say or do. These anecdotes suggest that black people are incapable of ignoring
what others say and do. Do black people have no control over their emotions and
thoughts?
Roy Bercaw, Editor ENOUGH ROOM
How racism hurts -- literally
Boston Sunday Globe
By Madeline Drexler
July 15, 2007
FOUR YEARS AGO, researchers identified a surprising price for being a black
woman in America. The study of 334 midlife women, published in the journal
Health Psychology, examined links between different kinds of stress and risk
factors for heart disease and stroke. Black women who pointed to racism as a
source of stress in their lives, the researchers found, developed more plaque in
their carotid arteries -- an early sign of heart disease -- than black women who
didn't. The difference was small but important -- making the report the first to
link hardening of the arteries to racial discrimination.
The study was just one in a fast-growing field of research documenting how
racism literally hurts the body. More than 100 studies -- most published since
2000 -- now document the effects of racial discrimination on physical health.
Some link blood pressure to recollected encounters with bigotry. Others record
the cardiovascular reactions of volunteers subjected to racist imagery in a lab.
Forthcoming research will even peek into the workings of the brain during
exposure to racist provocations.
Scientists caution that the research is preliminary, and some of it is quite
controversial, but they say the findings could profoundly change the way we look
at both racism and health. It could unmask racism as a bona fide public health
problem -- just as reframing child abuse and marital violence as public health
concerns transformed the way we thought about these ubiquitous but often secret
sources of suffering. Viewing racial discrimination as a health risk could open
the door to understanding how other climates of chronic mistreatment or fear
seep into the body -- why, for instance, pregnant women in California with
Arabic names were suddenly more likely than any other group to deliver low
birth-weight babies in the six months after 9/11.
Most striking, researchers note, is how consistent the findings have been across
a wide range of studies. The task now, they say, is to discover why.
"We don't know all the internal processes," said James Jackson, director of the
Institute for Social Research at the University of Michigan. "But we can observe
an effect, and we need to find out what's going on."
The burgeoning research comes at a time when lawmakers and government officials
are increasingly focused on the problem of racial disparities in health.
African-Americans today, despite a half century of economic and social progress
since the civil rights movement, face a higher risk than any other racial group
of dying from heart disease, diabetes, stroke, and hypertension. In the United
States, affluent blacks suffer, on average, more health problems than the
poorest whites. Spurred by statistics like these, dozens of states and cities
have been passing legislation intended to eliminate racial and ethnic
disparities in health.
Boston's Disparities Project, launched in 2005 by Mayor Menino's office and the
Boston Public Health Commission, is one of the most progressive blueprints for
change. It includes partnerships with medical institutions, detailed public
reports tracking progress, and community grants to tackle such entrenched
problems as street violence and lack of access to fresh produce. In May,
lawmakers on Beacon Hill held a hearing on proposed legislation that would
reverse the root causes of health inequities. The bill would establish a state
office of health equity, among other measures.
Critics of the new research tying racism directly to disease have charged that
it is flawed because one cannot objectively measure "racial discrimination." But
the science has grown more sophisticated, allowing investigators to measure
people's experiences with prejudice more precisely. And its proponents argue
that the sheer breadth of the work suggests the conclusions are important. Most
of the investigations have been done in the United States, but a growing body of
literature originates elsewhere -- from Finland and Ireland to South Africa and
New Zealand. These studies have found connections between racism and physical
health in populations ranging from Brazil's African-descended citizens to black
women in the Netherlands who had immigrated from the former Dutch colony of
Suriname.
"Across multiple societies, you're finding similar kinds of relationships," said
David Williams, a sociologist at the Harvard School of Public Health. "There is
a phenomenon here that is quite robust."
For decades, experts have agreed that racial disparities in health spring from
pervasive social and institutional forces. The scientific literature has linked
higher rates of death and disease in American blacks to such "social
determinants" as residential segregation, environmental waste, joblessness,
unsafe housing, targeted marketing of alcohol and cigarettes, and other
inequities.
But the new work draws on a different vein of research. In the early 1980s, Duke
University social psychologist Sherman James, introduced his now-classic "John
Henryism" hypothesis. The name comes from the legendary 19th-century
"steel-driving" railroad worker who competed against a mechanical steam drill
and won -- only to drop dead from what today would probably be diagnosed as a
massive stroke or heart attack. In James's work, people who churn out prodigious
physical and mental effort to cope with chronic life stresses are said to score
high on John Henryism. James showed that blacks with high John Henryism but low
socioeconomic position pay a physical price, with higher rates of blood pressure
and hypertension.
Racism, other research suggests, acts as a classic chronic stressor, setting off
the same physiological train wreck as job strain or marital conflict: higher
blood pressure, elevated heart rate, increases in the stress hormone cortisol,
suppressed immunity. Chronic stress is also known to encourage unhealthy
behaviors, such as smoking and eating too much, that themselves raise the risk
of disease.
In the 1990s, Harvard School of Public Health social epidemiologist Nancy
Krieger pushed the hypothesis further. She confirmed that experiences of
race-based discrimination were associated with higher blood pressure, and that
an internalized response -- not talking to others about the experience or not
taking action against the inequity -- raised blood pressure even more. A
controversial finding at the time, it has since been replicated by other
investigators: The suppressed inner turmoil after a racist encounter can set off
a cascade of ill effects.
Jules Harrell, a Howard University professor of psychology, said he was moved
this spring by a photo of the Rutgers University women's college basketball
team, sitting together with dignified expressions, after radio talk show host
Don Imus had labeled them with a racist epithet.
"The expressions on their faces," said Harrell. "All I could think was, 'Good
God, I'd hate to see their cortisol levels.' "
Collectively, these studies of the racism-health link have tied experiences of
discrimination to poorer self-reported health, smoking, low-birth-weight
deliveries, depressive symptoms, and especially to cardiovascular effects. In
the mid-1980s scientists began to take advantage of the controlled conditions of
the laboratory. When African-American volunteers are hooked up to blood-pressure
monitors, for example, and then exposed to a racially provocative vignette on
tape or TV -- such as a white store clerk calling a black customer a racist
epithet -- the volunteers' blood pressures rise, their heart rates jump, and
they take longer than normal to recover from both reactions. Perhaps, scientists
reasoned, the effort of a lifetime of bracing for such threats prolongs the
effect.
More recently, the lab has moved out into the real world. Several investigations
have linked blood pressure to real-time experiences of stress and discrimination
as recorded in electronic diaries. In one yet-to-be-published study, Elizabeth
Brondolo, a psychologist at St. John's University, found that daytime
experiences of racism led to elevated nighttime blood pressure, suggesting that
the body couldn't turn off its stress response.
Despite these suggestive findings, the field remains beset by unknowns. One of
the biggest problems is that researchers don't share a concrete, agreed-upon
definition of racial discrimination -- partly because such prejudice takes
myriad forms. They also don't know if more exposure to racism produces more
disease or if, instead, disease sets in only after a threshold has been passed.
They don't know if exposures during certain periods of life are more risky than
others. And they don't know why some victims cope better than others.
Skeptics distrust people's own accounts of racial discrimination, because the
experiences can't be objectively documented and because the victim can't always
know the motives of the perpetrator.
"You have to read these studies very carefully and see how they define
'discrimination.' What exactly are they measuring?" said Dr. Sally Satel, a
resident scholar at the American Enterprise Institute, a conservative
think-tank. "Typically, it comes down to an individual's perception of how he
was regarded by another person or by a system -- which is not the same thing as
being unfavorably dealt with on the basis of race."
The field's proponents counter that perception is precisely the issue. Studies
of depression, anger, and post-traumatic stress disorder also rely on the
patient's perceptions of events in their lives, they say -- not on objectively
verified facts. Why should research on discrimination be held to a different
standard?
Researchers have also refined the questionnaires and interview methods they use,
allowing them to tease out the effects of depression or hostility -- mood states
that can encourage a person to see discrimination where it's not. The questions
posed have also grown more subtle and indirect, enabling study participants to
talk openly about experiences they might otherwise deny or minimize.
Methods gauging changes in the body have likewise become more accurate. Stress
researchers have gone beyond such straightforward approaches as taking
blood-pressure readings or asking individuals to rate their own health. Now,
with noninvasive diagnostic equipment, they can look directly at coronary
blockages, levels of stress hormone, and the functioning of the immune system.
These measurements help scientists zero in on the mechanisms by which racial
discrimination may ultimately cause damage.
At the University of California, Los Angeles, psychologist Vickie Mays, director
of the Center on Minority Health Disparities, is taking a futuristic angle on
racism's bodily toll: peering into the brain itself. In a forthcoming study,
Mays will record what happens in the brain's circuits and structures during
laboratory conditions of discrimination and whether people vary in their brain
responses based on their lifelong exposure to racial prejudice.
"We know about [racism's] outcome -- but in many ways we don't know what makes
up the experience of racism," she said. "Is it processing in the part of the
brain responsible for emotions? Or in the part of the brain responsible for
fear?"
Racism remains challenging to explore scientifically, researchers say, partly
because it is difficult to get funding and partly because of institutional
reluctance to take on a potentially polarizing issue. In 2006, Harvard's David
Williams and a colleague submitted a grant proposal to the National Institutes
of Health to study whether perceived ethnic discrimination, coupled with
inequities in medical care, delayed stroke recovery in Latinos. As one reviewer
wrote back, "It is not a good investment of NIH dollars to study racism, because
even if we fund something, there is nothing we can do about it."
It's the kind of remark many scientists in the field have heard. These comments
are frustrating, they say, because they see the research as a crucial first step
toward a more clinical, less charged, discussion of the place of racism in
American society.
"The first step is validating that these effects could be real," said Tené
Lewis, a health psychologist at the Yale School of Public Health. "Once we have
a body of literature, we can say: 'OK, can we please talk about this?' "
Boston-based journalist and author Madeline Drexler, a former Globe Magazine
medical columnist, holds a visiting appointment at the Harvard School of Public
Health.
July 10, 2007
Biker Abuses
Biker Abuses
My favorite biker abuse is when they come up on pedestrians on sidewalks
and yell, "On your right," or "On your left." (From the Editor, Weekly Dig, July
4, 2007, page 3) Is this a carry-over from car-on-car traffic? Do car drivers
approach cars from behind and yell "On your left," and expect the car in front to make way for the yelling driver? What are these morons thinking?
Roy Bercaw, Editor ENOUGH ROOM
My favorite biker abuse is when they come up on pedestrians on sidewalks
and yell, "On your right," or "On your left." (From the Editor, Weekly Dig, July
4, 2007, page 3) Is this a carry-over from car-on-car traffic? Do car drivers
approach cars from behind and yell "On your left," and expect the car in front to make way for the yelling driver? What are these morons thinking?
Roy Bercaw, Editor ENOUGH ROOM
Only In New York?
Only In New York?
[This letter was published in The New York Post on Tuesday July 10, 2007]
Are the abuses of police powers by Governor Spitzer unique to New York?
("Abuse of Power?" Editorial, New York Post, July 5, 2007, page 26) At least in
Albany there are some powerful Republicans like Joe Bruno to fight back. In some
places e.g., Massachusetts there is one-party rule. Similar police abuses
are customary with no Republican Party to oppose them.
As in Albany, the new Massachusetts Governor promised change and he is
doing business as usual. Is this something that is common to all politicians? Or
is it something in the New York water?
--
Roy Bercaw, Editor ENOUGH ROOM
AN ABUSE OF POWER?
New York Post
Editorial
July 5, 2007 -- So now comes word that the New York State Police, at the direction of Gov. Spitzer's office, undertook a detailed surveillance of Senate Majority Leader Joseph Bruno.
The surveillance appears to have culminated in a selectively leaked story published in an upstate newspaper meant clearly to undermine Bruno in his on-going battles with Spitzer.
Which it clearly has done.
Post State Editor Fredric U. Dicker reports this morning that detailed State Police records have been kept of Bruno's travels around the city. It was those records that apparently served as the basis for the newspaper story - which appeared last Sunday in the Albany Times-Union.
No such records have been kept on the travels of Spitzer and Lt. Gov. David Paterson.
It hardly needs to be said that the application of police powers to serve political ends is antithetical to American traditions, values and law.
If, in fact, Spitzer sicced troopers on Bruno, the governor's effectiveness will be significantly constrained. As it is, the boorishness that has characterized his administration almost from the beginning has all but hamstrung state government, rendering the governor's ambitious reform agenda moot.
In May, at the height of the governor's battles with Bruno, troopers began keeping records of the majority leader's use of a state helicopter and ground transportation for a number of trips he made - but not that of any other state officials. The cops say they have no separate documentation of any trips by Paterson or Spitzer himself - although Spitzer acknowledges having used state aircraft and vehicles.
Yesterday, gubernatorial spokesman Darren Dopp said Bruno got special attention after Conservative Party Chairman Michael Long - often at ideological loggerheads with Bruno - said that the lawmaker was bringing armed troopers to fund-raising events.
Long flatly denied that.
Obviously, somebody is not telling the truth.
Where the story goes from here is anybody's guess. To term the entire matter bizarre would be to understate the case.
What seems clear, however, is that Spitzer & Co. ordered the police to track Bruno's travel methods and compile records - and then suggested that the Times-Union request those records, which it did under the Freedom of Information Law - resulting in the paper's story Sunday.
If Bruno did nothing wrong - and from what's on the record now, it appears that he did not - then the dust-up over the trips pales before the larger question:
Did Eliot Spitzer, or someone acting at his direction, in fact order state troopers to undertake a surveillance of Joe Bruno in an effort to gain political advantage?
Parallels with other abuses of police power by politicians spring to mind. If Spitzer wants to avoid spending the coming months - if not years - attempting to govern under such a cloud, he would do well to commission an independent investigation of the facts already on the record, and of those which might come later.
This is an extraordinarily serious matter. It must be attended to forthwith.
[This letter was published in The New York Post on Tuesday July 10, 2007]
Are the abuses of police powers by Governor Spitzer unique to New York?
("Abuse of Power?" Editorial, New York Post, July 5, 2007, page 26) At least in
Albany there are some powerful Republicans like Joe Bruno to fight back. In some
places e.g., Massachusetts there is one-party rule. Similar police abuses
are customary with no Republican Party to oppose them.
As in Albany, the new Massachusetts Governor promised change and he is
doing business as usual. Is this something that is common to all politicians? Or
is it something in the New York water?
--
Roy Bercaw, Editor ENOUGH ROOM
AN ABUSE OF POWER?
New York Post
Editorial
July 5, 2007 -- So now comes word that the New York State Police, at the direction of Gov. Spitzer's office, undertook a detailed surveillance of Senate Majority Leader Joseph Bruno.
The surveillance appears to have culminated in a selectively leaked story published in an upstate newspaper meant clearly to undermine Bruno in his on-going battles with Spitzer.
Which it clearly has done.
Post State Editor Fredric U. Dicker reports this morning that detailed State Police records have been kept of Bruno's travels around the city. It was those records that apparently served as the basis for the newspaper story - which appeared last Sunday in the Albany Times-Union.
No such records have been kept on the travels of Spitzer and Lt. Gov. David Paterson.
It hardly needs to be said that the application of police powers to serve political ends is antithetical to American traditions, values and law.
If, in fact, Spitzer sicced troopers on Bruno, the governor's effectiveness will be significantly constrained. As it is, the boorishness that has characterized his administration almost from the beginning has all but hamstrung state government, rendering the governor's ambitious reform agenda moot.
In May, at the height of the governor's battles with Bruno, troopers began keeping records of the majority leader's use of a state helicopter and ground transportation for a number of trips he made - but not that of any other state officials. The cops say they have no separate documentation of any trips by Paterson or Spitzer himself - although Spitzer acknowledges having used state aircraft and vehicles.
Yesterday, gubernatorial spokesman Darren Dopp said Bruno got special attention after Conservative Party Chairman Michael Long - often at ideological loggerheads with Bruno - said that the lawmaker was bringing armed troopers to fund-raising events.
Long flatly denied that.
Obviously, somebody is not telling the truth.
Where the story goes from here is anybody's guess. To term the entire matter bizarre would be to understate the case.
What seems clear, however, is that Spitzer & Co. ordered the police to track Bruno's travel methods and compile records - and then suggested that the Times-Union request those records, which it did under the Freedom of Information Law - resulting in the paper's story Sunday.
If Bruno did nothing wrong - and from what's on the record now, it appears that he did not - then the dust-up over the trips pales before the larger question:
Did Eliot Spitzer, or someone acting at his direction, in fact order state troopers to undertake a surveillance of Joe Bruno in an effort to gain political advantage?
Parallels with other abuses of police power by politicians spring to mind. If Spitzer wants to avoid spending the coming months - if not years - attempting to govern under such a cloud, he would do well to commission an independent investigation of the facts already on the record, and of those which might come later.
This is an extraordinarily serious matter. It must be attended to forthwith.
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