The war on Ambien/Zolpidem

 There were 40 million prescriptions for Ambien in this country in 2012.   By 2020 that was down to 10 million.  The 30 million prescriptions withdrawn were for patients over 65 years old.  At the same time, 85% of patients on all sleep meds were on Ambien.
https://jabberwocking.com/health-update-21/

58 million Americans are above age 65.

My question is, if 40 million patients can get behind Ambien, why cannot -- why did not -- 30 million coalesce behind a "substitute"?  Perhaps because there is no specific substitute to satisfy their needs?!

I suspect that most prescription denial experiences include your primary physician offering a couple of, what I call "generic" alternates (eg., Trazodone) then fobbing you off to a sleep doctor -- who has no more idea of what might be a equivalent substitute than your primary.

Before your primary bumps you off the sleep med that has made your life livable for years, he or she should have a page of  14 questions to put to you -- to know what to switch to -- if there is any suitable alternate.  I suspect there is not a suitable substitute -- especially in the drug hang over department.  If 30 million patients had found a decent substitute, we would be hearing about it by now.

What is so unique about Ambien?  In my case I can cut a 10mg pill into three pieces: 5mg to go to sleep; two 2.5mgs to put me back to sleep when I wake up in the middle of the night.  Matches my sleep pattern exactly.  I feel no drug hangover even two hours after taking.  I call it 25-45-50 -- 25 minutes to reach max effect; 45 in deepest; 50 turning off.

I wake up next day bright eyed and bushy tailed.

The refreshing feeling I get after an Ambient sleep reminds me the feeling I got after my first sleep study for apnea.  I groaned being told I would only get 4-5 hours sleep which would be interrupted.  Instead, on the way home I felt more refreshed than I had felt for a long time -- finally had some deep refreshing sleep.

Just to make sure readers don't misunderstand "bright eyed and bushy tailed" as some kind of drug high.

Ambien makes you more likely to get into a traffic accident?  The drug makes you oblivious to driving mistakes while you are making them?  I would suggest that if you are half-way intelligent, you will recognize the mistakes after you make them and will know enough to get off that drug.

Half the elderly population may be being deprived of sleep or suffering hangover because the medical establishment is afraid we will slip in the bathtub.

I think that the manufacturers of Ambien should suggest to their former patients that they seek to get their prescriptions from DOs or psychiatrists -- who focus more on how people feel emotionally after treatment. I think they will have better luck.

Jimmy Hoffa’s wet dream – Jimmy Hoffa's worst nightmare

 First: Jimmy Hoffa’s medical labor market wet dream:
   a) cannot stop technical employees from organizing,
   b) demand is everywhere and ever growing
   c) bills paid automatically by insurance or government,
   d) bonus: once trained, employees can change location.

Jimmy Hoffa’s labor worst labor market nightmare – gouging physician residents:
   a) half the pay of physician assistants (PAs),
   b) full four years in medical school versus only three for PAs,
   c) perform more complicated diagnosing and procedures than PAs,
   d) 100 hour work week versus 40 for PAs,
   e) median pay $65,000 a year versus $75,000 for nurses!
                                                             
I’m not trying to make a big pitch for medical residents today.  I am just using their extreme plight as an example of remuneration lost when labor has no wherewithal to defend itself with.  Even trained medical doctors can be (will be) duped on payday if they lack bargaining punch.  What can the rest of we unorganized expect?

(I'm not sure why residents have no means to fight back – possibly feel trapped because that they suspend their education the moment they suspend their work – or perhaps stuck in the “social/cultural" calculus that they are in school and lucky to be getting paid any amount at all.  When confronted with such deep “social/philosophical” questions ask myself: What would Jimmy Hoffa say?  :-)

Labor unions effectively couple employees to paying customers in free market bargaining-- allowing them to calibrate their wage demands according to how much they think they can squeeze out of paying customers.  Walmart labor costs are 7% -- Imagine what the Teamsters Union could do with that.  Add 7% to the price of merchandise – even if sales dropped 7%, most employees would be far better off.

Walmart’s sales might go up if its pay raises were part of a nation wide movement to up lower wages, sending more dollars to retailers who serve lower income shoppers.

Quick and easy path to across-the-board unionization of America: federal legislation mandating regularly scheduled union cert/recert/decert elections at every private (non-gov) work place: https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/  

Fifty percent of American workers say they want to be in a union.  

Only 6% of non-government workers are union members.  The only thing standing in the way of starting a political wild fire of support for regularly scheduled union elections seems to me nobody thinks it possible to turn the labor market around that much, that quickly -- too good to be true – grandiosity insufficiency?  :-)

This essay seeks to make it seem impossible to work without a union.

Medical residents getting the very short end of the stick

 I've been passing around some thoughts I've had on (especially males) becoming nurses.  Seems median nurses pay in Illinois is $75,000 -- in New York is $100,000.

Finally occurred to me that medical residents with four years of medical school and who work 100 hours a week get only $65,000.  Physicians assistants in Illinois average $135,000 a year. Residents do more complicated procedures than PAs -- for 100 hours (!) a week compared to 40 hours.  If the excuse is that residents are getting an free education (as it were) -- I remember a PA in an urgent care clinic telling me that PAs get their residency on the job.

Nothing could be easier to sell to the public that inherent unfairness here -- wildly so.  Physicians pretax earnings are only 10% of the medical costs so paying residents what they are worth should hardly cause any strain.

Cite articles like these:
"Officials say the 5 1/2-year contract gives nurses an immediate $16,000 raise in the first year and over $5,500 in the second year. The increase will bring salaries for nurses up to par with those at private facilities."
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjT7KroqIuDAxWqtokEHWWBDsUQFnoECA0QAw&url=https%3A%2F%2Fbronx.news12.com%2Fnyc-health-hospitals-nurses-to-receive-major-pay-bump-following-new-contract&usg=AOvVaw2wDtggAOn8m4FMDxfZdOSd&opi=89978449

"The Teamsters union reached an agreement with UPS that secured a total compensation package of $170,000 for UPS drivers ..."
https://www.yahoo.com/news/ups-drivers-video-breaking-down-185543274.html

What I've been passing around:
https://ontodayspage.blogspot.com/2023/08/jimmy-hoffas-wet-dream-strong-squaws.html

(I was in Teamster 804 back in 1970 when it was Gimble's furniture warehouse.)

How to sell mandatory union elections -- to progressives

https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/

When I was 16 (1960), I got more new customers than any other NY Post paper delivery boy (out of 700) by getting past a "psychological quirk."

I wanted to offer a free week to everybody on my paper route -- there were several reasons to believe a third might take the paper permanently -- did pay for itself.  But I knew nobody would want to get involved with some kid at the front door.

So I brain stormed it (learned from Reader Digest).  I came up with printing coupons.  Now, when you opened the door (nobody was afraid to open their door in those days) I slapped a coupon in your hand, saying "This coupon entitles you to one free week of the NY Post delivered."

Now you had a different psychology -- now you had money to spend, and only one place to spend it.  Doubled my route temporarily -- one-third stayed.
  * * * * * *
The only reason I get from progressives for not going after regularly scheduled, cert-recert-decert elections is that it "must" be impossible to turn the whole country around just like that. Can't be done.

So, let's reformulate the pitch:
Unions couple labor directly to the paying customer.  Not face to face, setting product prices; but having the power to set wage demands based on what we think the consumer will tolerate.  Without that, ownership will be in effect, selling labor for the deepest discount possible.

Setting up a three way tug-of-war -- instead of today's two way.

Now, it looks impossible NOT to have a union -- switching "impossibilities."

 P.S.  Mandatory, periodic union elections would be the perfect issue – really the only issue – that can bring back Obama-Trump voters to the political fold where they belong, in droves.  

“[P]inning Mrs. Clinton’s loss on low black turnout would probably be a mistake. Mr. Obama would have easily won both his elections with this level of black turnout and support. (He would have won Michigan, Ohio and Wisconsin each time even if Detroit, Cleveland and Milwaukee had been severed from their states and cast adrift into the Great Lakes.)”
https://www.nytimes.com/2016/12/23/upshot/how-the-obama-coalition-crumbled-leaving-an-opening-for-trump.html

What argument could Republicans possibly foist to oppose re-raising American workers to their should-have-been-accustomed-to level of economic – and political – power?!  Hillary lost because Democrats didn’t do enough for our lost souls during their span in the White House; not so they could see their lot seriously improving.  

Welcome back to the Democratic Party, working America.

Unions couple labor directly to consumers in the free market

 Labor unions effectively couple employees directly to paying customers – bargaining for the maximum amount consumers are willing to part with.  In the same light, non-union businesses sell the labor component of their products at the cheapest possible discount.

Both union and management are busy racing after the same customers’ pocketbooks.  What American labor needs is to regain equality at the starting blocks.
    
Fifty percent of American workers reportedly want to join a union.  Only 6%of private sector workers have been able to -- thanks to ownership’s overwhelming, illegal resistance.  Stepped up law enforcement –- no matter how determined –- is never going to deliver truly free market starting blocks to the majority of workers.  

Only practicable way to guarantee that all workers, who want to organize, can organize: federally mandated, regularly scheduled, labor union cert/recert/decert elections at every private workplace.  
https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/

Mandatory, periodic union elections would be the perfect issue – really is the only issue – that can bring back Obama-Trump voters to the political fold where they belong, in droves.  

“[P]inning Mrs. Clinton’s loss on low black turnout would probably be a mistake. Mr. Obama would have easily won both his elections with this level of black turnout and support. (He would have won Michigan, Ohio and Wisconsin each time even if Detroit, Cleveland and Milwaukee had been severed from their states and cast adrift into the Great Lakes.)”
https://www.nytimes.com/2016/12/23/upshot/how-the-obama-coalition-crumbled-leaving-an-opening-for-trump.html

What argument could Republicans possibly foist to oppose re-raising American workers to their should-have-been-accustomed-to level of economic – and political – power?!  Hillary lost because Democrats didn’t do enough for our lost souls during their span in the White House; not so they could see their lot seriously improving.  

Welcome back to the Democratic Party, working America. 

Unionize America sea to shining sea -- do away with the biggest threat to democracy -- with one easy federal labor law stroke

Let’s conjure up a labor market where all businesses are family owned and family operated -- where no outside labor is hired and where prices of goods and services are set at the highest amount families (producers) can squeeze out of other families (consumers).

Let’s say that that the incomes of all families are twice what it would take to live at the merely subsistence level (leaves out a lot of complication for the simple math point made here).

With 0%, outside (non-family) labor supply – only family workers -- let's say every family worker earns 20 dollars an hour.

Then, let’s say 10% outside workers are brought in to replace family workers who emigrated, which outside workers are paid subsistence incomes (half what family workers earn).

Let’s say for every 100 workers, 10 outsiders earn only 10 dollars an hour – and the left over 100 dollars are distributed among the 90 family workers -- yielding (approx) 1.1 extra dollars an hour (100/90) for the family laborers.

For every 20 outside (non family) workers: 200 dollars are divided among 80 family workers = yielding 2.5 more dollars an hour for each family laborer.
30 outside:  300 divided among 70 = 4.2.
40 outside:  400 divided among 60 = 6.6.
50 outside:  500 divided among 50 = 10.
60 outside:  600 divided among 40 = 15.
70 outside:  700 divided among 30 = 23.
80 outside:  800 divided among 20 = 40.
90 outside:  900 divided among 10 = 90.

Ninety-four percent is the number that represents the labor union desert in the private (non gov) American labor market -- 6% labor union density, though “density” seems hardly the word.

Fifty percent of American workers say they want to be unionized.  6% are unionized (and going down).  SEIU council Andrew Strom has dreamed up a way that could spring American labor into more like universal bargaining coverage: legally mandated, periodic, cert-recert-decert union elections.  
https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/

Union bargaining power makes for a more moral market because the consumer can be forced to pay the producer as much as the consumer judges the product is really worth.  

Walmart (an admittedly extreme example) has 7% labor costs (most businesses run more like 12-15% costs – fast food, 25%).  Imagine what the Teamsters Union could do with 7% (double-triple paychecks?).  But, employees have to have a way to bring unionization to a vote.

Mandatory cert-recert-decert union elections would be the perfect issue to bring back Obama-Trump voters.  

“But pinning Mrs. Clinton’s loss on low black turnout would probably be a mistake. Mr. Obama would have easily won both his elections with this level of black turnout and support. (He would have won Michigan, Ohio and Wisconsin each time even if Detroit, Cleveland and Milwaukee had been severed from their states and cast adrift into the Great Lakes.)”
https://www.nytimes.com/2016/12/23/upshot/how-the-obama-coalition-crumbled-leaving-an-opening-for-trump.html

So what are we waiting for?  Let’s return the American labor movement to its former, effective place – while guarding democracy against the MAGA-man – all in one federal labor law stroke.

Jimmy Hoffa's wet dream -- strong squaws

 I encourage young guys to go into nursing.

I tell them that the medical labor market is Jimmy Hoffa's wet dream (hopefully some of them know who Jimmy was).

I tell them that nobody can stop nurses from organizing because they are they are technical.  Can't go out on the street and hire 100 replacement nurses.  Can't even go out on the street and hire 100 high school teachers -- or management would have done so a very long time ago.

The demand for medical care is everywhere and always growing.

The bills are paid automatically by government or insurance.

As an extra bonus you can work anywhere -- this year in Florida; next year in Portland (or Montreal) if you wish.

It's perfect.
 * * * * * *

I just spent three days in the hospital.  You know how the American Indian wanted a strong squaw?  I just spent three days watching strong squaws run all over the place, from demanding task to demanding task.

Working in hospitals you might end up hooking up with your favorite strong squaw.

How will they feel if they are making $40,000-$50,000 for a 40 hour week, or $75,000 for a 70 hour week -- and their strong squaw is earning $75,000 a year for 40 hours a week -- because that's the median (not average) nurse's salary in Chicago; $100,000 in New York City?
  * * * * * *

[late note]  https://www.nysna.org/press/2023/nyc-public-hospital-nurses-win-historic-contract-pay-parity-and-safe-staffing

"Two years of pay parity wage increases, effective 7/31/23. The awarded payments of $16,006 in year one and $5,551 in year two bring public-sector salaries up to par with NYC private-sector nurse salaries."

 [late note]  https://bronx.news12.com/nyc-health-hospitals-nurses-to-receive-major-pay-bump-following-new-contract  

"The increase will bring salaries for nurses up to par with those at private facilities."

[very happy -- late notes]  https://www.bbc.com/news/business-66445496

"UPS driver pay and benefits deal in US to be worth $170,000 a year, firm says"

 https://fortune.com/2023/08/08/ups-drivers-170000-union-agreement-teamsters-middle-class-bidenomics/  

"UPS drivers’ new $170k per year deal shows that unions (and Joe Biden) may just save the middle class after all"

 IT'S ALL ABOUT UNIONS.

THE ONLY REALISTIC IDEA I HAVE EVER SEEN FOR RE-UNIONIZING AMERICA OVERNIGHT: 

https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/

SS Trust Fund worries? -- just a matter of flip-flopping income streams

 Isn't the Trust Fund question just a matter of flip-flopping income streams?  My understanding is that TF bonds are cashed with income tax.

When the TF runs out, FICA can be raised while income tax is cut -- not exactly the same payers for both taxes; but for most payers no giant burden.

Raising, or eliminating, the FICA cap comes to mind.  Rebuilding labor union density even comes to mind -- flooding FICA income.

Something like a five year, projected outgo, fund could insure Congress never takes too long getting around to resetting FICA tax level.

Trans women and innate behavior in the locker room

However women (and men) relate to natal males is baked in by age six -- end of the sex identification period -- innate behavior.

Caitlin Jenner can partake of all the procedures and hormones she wants to -- she will never become a woman to other women in the locker room or bathroom -- innate behavior.  Same privacy damage wrought.

If we point out to trans folks (being helpful; not being catty) that they don't seem bothered too much when everybody else stays out of the locker room -- maybe they can find some equivalence there that can make feel that the single shower or stall are not so bad after all. 

I'm not worried about who uses the men's room.

https://time.com/4324687/even-in-liberal-communities-transgender-bathroom-laws-worry-parents/
 * * * * * *

As for all these state legislatures outlawing different trans therapies for children: come back in 20 years, after the medical profession has sorted out what combinations of therapies produce -- what different choices and outcomes.  Way too tricky and complicated.

Share US inventory of 65,000 Maverick, fighter launched anti-tank missiles

 Back in the eighties, Armed Forces Journal reported we had procured 65,000 Maverick, fighter plane launched anti-tank missiles -- 500 pounds, 130 pound shaped charge warhead, 4 mile range, imaging infrared sighting, fire and forget.

I wonder how much Mavericks might help Ukraine, while barely putting a dent in our inventory?

Give them some A-10s.  100 A-10s (out of 700 built) and 10,000 Mavericks and nobody will give Ukraine a dirty look again.

Elections, elections: that labor can't lose

Why go through all the ups and downs and in and outs -- yada, yada, yada -- and rounds and rounds of labor organizing?

Let your elected legislators do all the hard work for you.
https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/ 

All you have to do is show up on election days and vote.
 * * * * * *

When are progressives going to wake up to the political possibilities federally mandated cert/recert/decert votes, maybe every four years?

Pushing this issue takes no huge financing -- the central impact on most people's lives comparing to the impact of 1960s anti-segregation impact on minorities alone.

All we need do is talk up the proposal in venues we usually inhabit and watch the political wild fire cross the country.

Should prescribing Zolpidem/Ambien be moved mostly to the realm of psychiatrists?

I have come to believe that prescribing Zolpidem/Ambien ought to be reallocated mostly to the realm of psychiatrists -- because psychiatrists have the training -- and the inclination -- to do the necessary work up and careful follow up -- and primary doctors, more and more clearly in my hearing, definitely do not.

The clear trend in the "physical illness” medical field – I hear about it over and over – is of medical doctors zapping long running prescriptions for Zolpidem without so much as a five minute, intelligent discussion about how much the withdrawal of their sleeping crutch may upset and or even upend patients' whole ways of life.

Logically, one would think that interruption of a long running, successful treatment for a seriously debilitating “condition" (we don’t use the word “illness" here) should necessitate a careful work up and follow up.

It is not like there seems available any routine Zolpidem substitute, like switching from antibiotic to antibiotic.  Therein lies the patients’ dreaded rub.  Candidate substitutes all seem to introduce serious (yucky feeling) drug hangovers for maybe the first half of patients waking hours.  Alternately, patients can spend all their waking hours in a sleep deprived haze (w/o drug).

I mostly need help getting my last two hours of sleep.  I take a 3-4mg dose cut from a Zolpidem tablet after the first five hours and wake up 2 hours later bright eyed and bushy tailed – zero, ZERO, drug hang over.

Five minutes after I wake up I feel perfectly fit to drive a car.  Logistically perfect.  Doctors will fret that the “hypnotic” is still in your blood stream even if you cannot sense anything like that – causing you to make mistakes even if you feel perfect.

After trying one Zolpidem “substitute" (Mirtazapine) I made one major driving error and had to concentrate hard to avoid two others -- two days after I downed it!  But, intellectually I had no problem knowing I was doing some things very wrong.  Ditto, if I drive on five hours sleep -- I am definitely aware that I am a bit short on patience and judgment.  12 years on Zolpidem; I have never received any “intellectual” message that I am driving incorrectly because of the drug.

So a close look at me, anyway, would seem to obviate extra driving accident concerns.

Even if Zolpidem doubled my accident risk – on the road or slipping and breaking my knee in the kitchen – I prefer that to enduring a drug hangover half the day (from a “substitute”) or to living in a sleep deprived daze all day – every day of my life in my case.  I know; I recently did four miserable months alternating between all day sleepiness and half day gradually shedding the feeling of being hit by a truck.  That half day was what I lived for.  

My OTC “substitute” was Diphenhydramine (Benadryl) – recently reported to bestow the maximum risk of developing dementia.
https://www.medicalnewstoday.com/articles/288546

But, this is the caliber of workup and follow up detail that psychiatrists are primed to ferret out.

Memory loss?  Zolpidem doesn’t make you forget anything you have learned already – or anything new about how things work together.  Less than 1% of users have clinically significant memory loss (whatever that means).

Somebody should do a study of 1000 insomnia patients who have been bumped off Zolpidem (most, probably without discussion) – and 1000 who had their dose halved (probably from 10mg to 5 mg) – to see how deep an effect this may have had on their lives, up close and personal.

But, this is the caliber of follow up that psychiatrists are primed for.  (Did I say that already?)

In one internet conversation, a patient was panicking.  He had previously been out of work for three years because he couldn’t sleep.  Now, after a year and a half on Zolpidem, his doctor was leaving and he was afraid he couldn’t get his prescription renewed (I've been there).  Do you think his doctors realized that they were denying him everything else in his life – job, ability to raise a family, pay for entertainment – to make him safer from slipping and breaking his knee in the kitchen?  Did they think all that through?

I have seen one chart (link below) that shows annual Zolpidem prescriptions have dropped from 45 million to 10 million from 2012 to 2020.  Does that mean that 35 million Americans are now walking around in drug hangovers for hours, or in a sleep deprived hazes all day – in insomnia periods?  Could that be?  (The chart is at the end of a blog post mostly on another topic.)
https://jabberwocking.com/health-update-21/

I am nothing if not grandiose.  I envision the day when everyone can go down a checklist that identifies whether or not they likely have what is known as insomnia – and 50 or 60 million patients are taking Zolpidem.

Zolpidem users: a debilitating surprise awaits at 65

I took Zolpidem (a.k.a., Ambien) for 12 years. Last spring my doctor cut off my prescription without discussion. Around the same time my brother's doctor cut his prescription from 10mg to 5mg without discussion. At same time a fellow employee of my brother had her prescription cut off – without discussion also, I believe. Same time frame, I was refused a prescription for Zolpidem by an online nurse practitioner.

I cannot imagine a sufferer of, say, migraine headaches being treated in such a neglectful way -- in such an unscientific way -- to be left without treatment for a seriously debilitating condition (insomnia) without even a sit-down discussion.

What’s apparently scaring the doctors off is stats building up about accidents (at home and on the road) for the elderly – reported memory problems (for the great majority, including me nothing especially severe) and reports of strange behaviors (e.g., sleep driving) on Zolpidem. Doctors seem to jump away from these daunting side effects with an almost Pavlovian response – without ever considering that for insomnia there is no other sleep aid that does not have a half or all day after drug cloud to live with.

I DON’T WANT TO BE PROTECTED FROM FALLS IN THE KITCHEN AT THE EXPENSE OF LIVING MY LIFE IN SOME KIND OF HANGOVER MIASMA. That’s the issue our doctors somehow seem to miss wholeheartedly with UNIQUELY hangover free Zolpidem.

I speculate that is because – what I call the physical doctors; as opposed to the psychiatric practitioners -- can't measure insomnia; can't weigh it, can't take its temperature, can't sew it up, wouldn’t know where to sew it back – insomnia doesn’t really exist for them.

IOW, nobody’s knocking to ask them to open their motivational door – not nobody home; nobody even knocking – on a deep motivational level. So they don’t even get around to the purely scientific level that they are so deeply trained on.

There are 38 million Americans on Zolpidem – 85% of all sleep aid prescriptions. [At around 2012 -- down to just above10 million by 2020 -- see post above.]  Are we going to take all of them off their most practical (no hanging on-hangover) and effective sleep aid just when they need it most? For my part I am going to seek a prescription from a psychiatrist. I am very optimistic. I think that with a doctor for whom insomnia is a tangible, palpable, corporeal thing – the argument against being consigned to a life in the miasma to protect against falls in the kitchen – or just losing sleep every night -- will be very compelling.

Notes: I can cut a 10mg tablet in three parts – and take one whatever time of night I can’t sleep. Only had five hours sleep? Take one piece: 25-45-50: 25 minutes to act-45 minute blank brain (unless I want to think about something)-50 minutes to waking, bright eyed and bushy tailed.

If I drive without taking the drug (after five hours sleep) I can feel less concentration and patience. No such lack of clarity if I take the drug as little as two hours earlier. If I were making druggie “mistakes” I would intellectually know it.

Note: My time-fitting (4 hours sleep to go) nights, OTC substitute -- Diphenhydramine: https://healthunlocked.com/redirect?url=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2F288546%23Taking-anticholinergics-for-more-than-3-years-linked-to-higher-dementia-risk

I also wake up from Diphenhydramine feeling like I’ve been hit by a truck. Great.

Insubstantial Due Process -- what Roe never said

 “One of the most curious things about Roe is that, behind its own verbal smokescreen, the substantive judgment on which it rests is nowhere to be found.”  (HLR, Vol 87: 1, p 7 – Laurence Tribe)

Roe enshrined bodily privacy in constitutional theory -- seemingly no one takes exception to that today.  Roe went on to proclaim it takes a "compelling state interest" for a law to override fundamental privacy.

Then Roe fudged.

“One reads this passage several times before becoming convinced that nothing has been inadvertently omitted.”

‘ … the compelling" point is at viability. This is so because the fetus then presumably has the capability of meaningful life outside the mother's womb. State regulation  … after viability thus has both logical and biological justifications.’  

“Truly, this mistakes a 'definition for a syllogism' and offers no reason at all for what the Court has held."  (Ibid. p 4 -- quoting John Hart Ely, YLJ 1973 April; 82: p 924)

The Roe majority took upon itself what would correctly be be seen as a legislative job -- matching the compelling interest standard to the stages of prenatal development -- as opposed to interpreting words of law.  There being no consensus on the worth or rights of fetuses "deeply rooted in this Nation’s history and tradition" -- the Roe majority found itself out in substantive-sorting land all by its lonesome.

But instead of coming back with a substantive delineation of prenatal life (v. privacy) -- Roe served up a fiat trimester policy that gave prochoice nearly everything it wanted.

Roe disguised its baked-in substantive holdings on fetuses by not articulating any one in any part.
 
What will any future Supreme Court be able to say once medical technology enables extracting a fetus temporarily from the womb and then returning it to complete its gestation -- when the cosmic question is legal personhood in the womb?

Coming soon?!