How hard it is to get prescription drugs

I have a friend who takes a prescription for a seizure
disorder, that if she doesn’t take it every day she could well
die, if she has a seizure at the wrong time. She has a rant about
how any drug without major public health consequences should be
available over-the-counter to anyone who thinks they need it. She
is unusually good at dealing with complex systems, and she still
has problems if she goes on vacation or changes insurance
companies or whatever.

The insulin I take for my diabetes isn’t in quite that life-sustaining
category, but the health care providers I talk to do claim that
it’s pretty important to take it every day. But that’s not what
the people who work in the system for getting me refills when I’m
out seem to think.

Here’s the system.

  1. When I go to the pharmacy, I get a vial with 1000 units of
    insulin.
  2. I inject myself with, currently 45 units of insulin, every
    day. I’m supposed to modify this if necessary, going up if my
    blood sugars are running high, or down if I’m getting low blood
    sugar reactions. The last time I talked to my doctor, I was
    taking only 40 units, but I upped that after getting my
    haemoglobin A1C result from that visit.
  3. When I point out to the pharmacy that 1000 units is not a 30
    day supply, they explain that the shelf life of the insulin is
    only 28 days, so they don’t want to give me 2 of them, so
    they’ll just give me another one a little sooner. Usually this
    works.
  4. However, the prescription is written for 1 year or 12
    refills. 12 refills takes noticeably less than a year.
  5. So last Monday, I called to get a refill and the computer
    told me that I didn’t have any refills left, and it would notify
    my doctor that I needed a new prescription.
  6. This usually works, but this time, whoever processes these
    requests (I think not either a doctor or a nurse, so it’s quite
    possible that this person didn’t even know that Lantus is a form
    of insulin) decided that they couldn’t really need a new
    prescription, because it was under a year since I got the old
    one. This seems to be the real breakdown in the system — if I
    say I need insulin, and the pharmacy says they need a new
    prescription, the system maybe should allow this person to argue
    with the pharmacy, but certainly shouldn’t allow them to just
    ignore the request.
  7. Three days, and about a dozen phone calls later, I talked to
    a nurse, and finally got her to agree to get the doctor to write
    a new prescription.

This has nothing to do with Obamacare, because this problem has
existed in some form for at least a decade. It probably isn’t
really related to government health care, although the Cambridge
Hospital Association, which operates both the pharmacy and the
clinic in this story, is funded in a major way by the city of
Cambridge. My friend with the seizure disorder isn’t using
government-operated healthcare any more than anyone else in this
country.

But I have been hitting this problem for a decade, and every
time I hit it, I mention to my health care provider that the
system seems to be screwed up. Most recently, I told the nurse
who finally got me the prescription, and she said she understood
my concerns, but not that she knew of any way to address them.

So it’s probably time to call or write someone else. You can
consider this a rough draft of that letter.

How I use the library

Since I’m posting quite a lot here about what I’m reading, I
thought I should mention how I go about acquiring it. By far the
largest set of books I read these days come from the ebook lending
system
of the Middlesex Library Network. The next largest set
come from Project Gutenberg and other online free books source.
And I do buy some books, both ebooks and dead tree books, of which
maybe more later.

The ebook site is pretty complicated, so I thought I’d mention
the way I’ve eventually settled on how to use it.

  1. Whenever I get an email notice that
    a book I have on hold is available, I log in and take that book
    out.
  2. I then look at all the books on my wish list, and take out
    any of those that are currently available I want to have.
  3. Then I look at the new
    ebooks
    menu item, which lists all the ebooks they have in
    reverse order of acquisition. I put anything I might want to
    read on my wish list, and anything I’m sure I want to read as soon
    as possible on my hold list.

If I’m feeling insecure about where the next book I read is
coming from, I do steps 2 and 3 even if I can’t do step 1.

News of the week of October 29, 2013

Meeting Report

We played:

Schedule

We will not be meeting on November 5. After that we will
resume our regular meetings November 12.

Our regular meetings are on Tuesdays at 7:45 PM at my place. If
you haven’t already told me you’re coming, let me know by 10 in
the morning of the day of the meeting. If you have told me you’re
coming, and something comes up so that you can’t, please let me
know as soon as is practical.

Recommended Candidates in the Cambridge elections

I got this email from Nancy Ryan, whom I met working on
neighborhood issues. She’s been intimately involved in Cambridge
politics for decades, worked for the city for quite a while as
director of the Cambridge Women’s Commission, and as executive
director of the Massachusetts ACLU.

I would add to her list that I’ve talked to people who’ve worked with
Fran Cronin and are enthusiastic about her bid for school committee. I
also think Craig Kelley works hard at communicating with voters, and
said some of the right things about the City Manager selection process,
or lack thereof.

In other words, I respect Nancy and will vote for everyone on her list
based on her recommendation if not anything else. I had independently
concluded that Dennis Carlone should get my number 1 vote. But I
usually continue on down the rankings (although I’m pretty sure my vote
always goes to my first, second, or third choice) quite a lot farther
than she does, so I will be ranking many of the people she doesn’t
mention ahead of other people she doesn’t mention.

Dear Cambridge Neighbors and Friends – Many of you have asked me what
I’m doing about the up-coming election so I’m taking the liberty of
sending my recommendations. Regarding City Council – this is a pivotal
moment in Cambridge. The city seems to be up for sale to large
developers who want to build upscale housing or commercial space in
high and dense buildings. Central Square is particularly a target. The
current City Council members have been inclined to grant up-zoning
petitions even with large protests from residents. There’s no overall
plan and huge development proposals about to be presented to the
Council.  Here are my recommendations and a request – would you
consider forwarding this email to lots of your friends and neighbors?
You can change it up to fit your own priorities but I URGE you to
recommend Dennis Carlone #1.

  1. Dennis Carlone – A 40- year Cambridge resident and first-time
    candidate, an architect and city planner in Cambridge whose motto is
    “Planning for People.” He designed and implemented the East Cambridge
    Riverfront project in collaboration with the neighborhood. Dennis is
    committed to making sure the city has a Master Plan for development,
    traffic and transit that works to make the Cambridge of the future a
    livable, affordable and diverse community. He has refused all campaign
    contributions from developers. He raised his kids here and has a
    broader agenda, but right now it’s his expertise and grounded
    temperament that are sorely missing among our current City Council
    members. There is no one we need more at this time.
  2. Nadeem Mazen – a young innovator and entrepreneur who opened two
    small businesses in Central Square — danger!awesome on Prospect
    Street that serves as a small digital engraving business and a
    training and mentoring center for young people; and Nimblebot.com that
    makes educational media and software for social entrepreneurs and also
    provides access to cutting-edge technology and job training. Nadeem is
    also a strong proponent of a master plan for development and traffic
    management as well as affordable housing. Having spent a few hours
    with him, I believe he can bring new ideas and energy coupled with
    leading edge skills and experience to City government. And he promises
    to stay in office only long enough to encourage and mentor other young
    people to step into his shoes.
  3. Minka vanBeuzekom – completing her first term on the Council, Minka
    has worked hard to bring her environmental experience to bear on many
    aspects of development and green space in Cambridge. She’s also
    diligent – it was Minka who discovered that Forest City had not lived
    up to its 25-year-old  commitments to maintain low- and
    moderate-income housing on its University Park campus during their
    request for a massive up-zoning of their property. Her discovery
    brought the process to a standstill until Forest City made good on
    their promises, saving a large number of peoples’ homes. Minka is the
    only incumbent I can recommend, even though I wish she were a more
    consistent and strong voice. I am trusting that with new members as
    potential collaborators and two years’ experience, she will come into
    her own.
  4. Marc McGovern – a strong advocate for the needs of families and
    children who, as a social worker in a therapeutic school for students
    with a range of emotional and learning problems, he has witnessed
    firsthand the needs of struggling parents and kids. As a School
    Committee member, he was willing to take controversial stands in
    behalf of the schools’ budget and the creation of middle schools
    because of his assessment of their impacts on the families most
    dependent on public schools. Because of his deep roots in this city,
    because of his stated commitment to increase affordable housing and
    early childhood education, I am putting some faith in him.  He will
    face temptations to finance increased services with large, mostly
    upscale housing developments that contain a very few affordable units.

That’s as far as I could go with City Council candidates.

School Committee – I am not deeply involved in the School Committee so
can only offer one strong candidate and some personal experiences or
comments that people have made about others:

#1 Kathleen Kelly – I have known Kathleen as a community activist and
parent and strongly recommend her as a first time candidate. She is a
unique combination of education and experience — a trained social
worker with an MBA who takes the social justice stand that public
education is the great equalizer in our society and has the capacity
to analyze budgets and policy to carry this commitment forward.

And in any order:

Richard Harding – is a lifelong resident of Area 4 and a founder of
the Port Action group focused on violence prevention and connecting
formerly incarcerated people with services and resources. He knows and
cares about the young people and families who most need an educational
system that supports all of our children. I have known Richard for a
long time and hope he is re-elected.

Patty Nolan – I can mainly say that Patty asks the difficult questions
and expects accountability from everyone.

Eleche Kadete – I have not meet this young man who graduated from CRLS
and went on to Brandeis, but I read his platform and on the basis of
that, I’ll vote for him. Here’s a link.

Rosemary Cake

I’ve mentioned this cake a couple of times — it’s my go to
recipe these days when I want to bring baked goods somewhere, or
use up lots of eggs or have fresh rosemary sitting around.

I made it last night for the Recorder Society, and
someone asked for the recipe, so here it is.

Rosemary Cake Recipe

From “An Everlasting Meal” by Tamar Adler, who

adapted it from “Cooking by Hand”, by Paul Bertolli.

  • 8 eggs
  • 1½ cups raw sugar (If you’re someone who always reduces
    the sugar, try it this way anyway — you might like this amount.)
  • 1 cups olive oil
  • 4 tablespoons finely chopped fresh rosemary
  • 3 cups flour
  • 2 tablespoons baking powder (this is presumably a typo — I
    use 2 teaspoons.)
  • 1 teaspoon kosher salt

Heat the oven to 325 degrees.

Coat a bundt pan first with butter, then with flour, tapping out the
excess flour. (I use a non-stick angel cake pan, and spray oil.)

Beat the eggs for 30 seconds with a handheld beater. Slowly add the
sugar and continue to beat until the mixture is very foamy and
pale. Still mixing, slowly drizzle in the olive oil. (I use the beater
on the highest speed for the preceding steps.)
Using a spatula,
fold in the rosemary. (I use the beater on the slowest speed for all
the following steps.)

In a separate bowl, whisk together the flour, baking powder, and
salt. Keeping the mixer on low speed, gradually add the dry ingredients
to the egg mixture. Pour the batter into the bundt pan. (I never
bother with a separate bowl or pre-mixing the dry ingredients.
I just add the small ones, in this case salt and baking powser,
first, and figure they’ll get evenly mixed while I’m mixing in
the flour.)

Bake for 45 to 50 minutes, rotating the pan halfway through. The cake is
done when it is golden brown and springs back when touched, or when a
skewer inserted in the center comes out clean. Allow the cake to cool
briefly in the pan and then tip it out onto a rack to continue
cooling. (I don’t bother with the rotating; I use the skewer
method, and it takes my oven a little over an hour to do this.)

This is delicious on its own, or accompanied by freshly whipped
unsweetened cream, or the wonderfully rich, soft Italian cream cheese
called mascarpone. (I’ve always just eaten it on its own.
What people like about it as opposed to other pound-cake style
baked goods is how it isn’t sweet at all.)

Election Worker Training

I spent yesterday afternoon being trained to be a warden in the
Cambridge city elections on November 5. It was an unusually tense
training session — normally you want to choose your seat so that
your nap isn’t interrupted by the snores of the person next to
you, because everybody has done everything before, and if the
training didn’t take then, it isn’t going to happen now.

In Cambridge, the city elections are different from the others
because of proportional
representation.
As a voter, what this means is that instead
of putting X’s next to the names of the people you want to vote
for, you have to rank the candidates in the order you prefer.

As an election worker, this means you do a lot less of the
total process, since the counting takes place in a computer back
at the election commission, instead of in the scanner and the
various tally sheets at the precinct. But you have to do more
voter education, since a remarkable number of the voters have no
idea that they have to do anything different for this
election.

Of course, this city election takes place every two years, but
it seemed like a longer interval than usual this time, because
we’ve had so many more elections than we used to. I’ve done
special elections and primaries for a state senator and a US
senator, and lots of poeple have also done them for state
representatives, and the primary for the US Representative.

Part of the tension yesterday was that the Election
Commissioner was new and hadn’t ever done this particular
training. Actually, he’s someone who’s done the warden and clerk
job before, so to some extent his answers to questions were more
practical than some of the other commissioners. Example:

Q: Can we tell the voters to use a ruler, so that they
won’t be as likely to vote the same number for two
candidates?

A: You can tell them that, but you can’t yell at them
when they decide not to and spoil their ballot.

But the real reason for the tension I think was one particular
trainee, who I think is insecure about whether she’s doing the job
right, and has found all the training sessions that are exactly
like all the other training sessions very reassuring, and suddenly
this one started out by saying, “Here are some things you have to
do differently for a city election.”

So she freaked out, and it set off a few other insecure
people. In justice to them, some of the material could have been
organized better. For instance, there are two different problems
that are referred to as “overflow” — one is the actual ballot box
physically overflowing, and the other is the memory card in the
scanner running
out of room. This isn’t a problem in a regular election, because
all it has to store is the tallies of how many votes which
candidate got. For proportional representation, it has to store
each ballot separately, because if your first choice candidate
gets “counted out”, the computer back at the election commission
has to be able to find your second choice candidate. In any case,
there was a set of directions about what happens if the memory
card is in danger of overflowing, and 15 minutes later, a second
set of directions about what happens if the ballot box is in
danger of overflowing, and a completely different number of
ballots.

It was a pity the session got so hung up on these technical
issues, because there is an actual voter education problem I’d
like to discuss in that setting some time. When I was first at
the precinct I work at, there were two checkin inspectors who did
a particularly good job of warning the voters that they needed to
fill in numbers instead of marking X’s. Then suddenly one year,
there were brand new inspectors at that table, and we had a lot
more spoiled ballots. I keep trying to remember what the first
two said, and never do.

The Great Gatsby

I watched
this
movie
last night — it was more enjoyable than I expected.
Mostly the music and the dancing girls, although the acting was
pretty good, too.

I’ve never read the book — my parents owned Tender is
the Night
, and I tried to read it several times and
always got bored, so I never went in for any other F. Scott
Fitzgerald, either. I did see the
version
with Robert Redford
in the 70’s, and remembered it visually
but not for the plot. For instance, I remembered the scene with
Gatsby floating dead in the pool, but not the details of how
or why he died.

This version is a much more lavish production — I don’t
remember there being scantily clothed dancing girls doing
production numbers in every drug store in the other version.

It’s definitely a Hollywood production and not a BBC
historically accurate costume drama. I remember hearing an
interview with a famous actor who had worked in both American TV
and British TV, and he said the difference was how much less
important the actors were in the British version. He’d have
these fittings for costumes, and they’d find a jacket that fit
him pretty well and make notes about how to alter it for his
exact shape, but also for the exact year of the scene he was
wearing it in, as in “We’ll take off these buttons — they
weren’t made until the ’20s and this is 1904.” And the
people who knew about the buttons were treated as well (or
badly) as the actors who wore the suits.

They didn’t do that in this movie. I don’t know enough about
buttons to say when the ones in this movie were made, but I did
get startled when a scene very explicitly billed as 1922 was
playing Rhapsody in Blue as a background to the
fireworks. I looked it up, and sure enough, it wasn’t until
1924 that Gershwin wrote it. It did work really well as the
background to the fireworks. Maybe the Boston Pops Fourth of
July concert could use that instead of or in addition to
Tchaikowsky some year.

I also noticed that the English actress Carey
Mulligan’s
American accent was better than some. It didn’t
sound like any American I’ve ever known, but she did almost
convince me that she might know something I don’t about how a Louisville
debutante born at the turn of the 19th century might have
spoken.

If none of this sounds like I spent a lot of time caring about
what happened to any of the characters in the movie, I didn’t. But I did enjoy
it.


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How many Boston Properties Employees does it take to change a lightbulb?

[Kendall Square Fountain]
Galaxy, Earth, Sphere fountain in Kendall Square, Cambridge, Massachusetts, USA

I like fountains. I live on a street with a world-class
fountain (the Tanner Fountain in front of the Harvard Science
Center) at one end, and what was originally a very good fountain
(“Galaxy: Earth Sphere” by MIT professor Joe Davis) at the
other.

This post is about the Kendall Square end. The original design
had a metal globe in the middle, jets of water spraying on the
globe in summer, steam mists arising around it in winter, and
small globes with different perforation patterns in them
illuminated at night. The globes weren’t as interesting as the
rainbows that form in the mist at the Science center on a sunny
afternoon, but they did change as you walked around them.

This fountain was installed in 1988. For most of the time
since then, it’s been broken.

This
article
explains the repairs that resulted in the water flow
being restored after some number of years in 2010. It mentions
that at that time the steam was still broken. No article I’ve
ever seen mentions that the lightbulbs in the small steel globes
have never been replaced (or maybe are just never turned on).

There’s also no mention that the fountain is turned off at
night and on weekends these days. During the day, it is often running at less
than full strength, so that the water streams don’t actually hit
the globe.

My guess is that Boston Properties, which is responsible for
maintaining the fountain, got significant zoning concessions in
return for providing “amenities” to the neighborhood. In my
opinion, it should get no more development permissions until it
has restored this amenity, and is providing it for residents as well
as employees.


[Science Center Fountain]
Tanner Fountain in Front of Harvard University’s Science Center

Zealot, by Reza Aslan

I might not have noticed this book if Fox News
hadn’t done an interview
with the author that was widely reported as a failed attempt at a
hatchet job.

I enjoyed the book a lot. This
review
in the New York Times, by Dale B. Martin, who is the
Woolsey professor of religious studies at Yale University,
suggests that there’s current scholarship that casts some doubt on
ideas that Aslan presents as facts. But he doesn’t suggest any
books about such scholarship that are as readable as this one.

What makes this especially readable is that the notes are
separate from the texts — Aslan is a college professor, but he
obviously knows that books written by professors for other
professors don’t make the best seller lists. So he writes what he
considers the best guess about the history, and then for each
chapter has a notes section that lists the books he used, and
suggests further reading. (This is the references to other
contemporary writers; the biblical texts are referenced by chapter
and verse in context in the usual way.)

The best part of the book is the description of the politics
and economics of first century Palestine. Anyone’s guesses about
exactly what role the early Christians played in that mess are
clearly open to question, but in this century we really know a lot about how the
Romans, Greeks, Jews and other groups related to each other that
makes the stories in the New Testament make a lot more sense.

I especially liked the description of James the brother of
Jesus. (Aslan does not believe that brother meant half-brother or
cousin. I think I doubted that when the nuns said it in seventh
grade, too.) Here’s the first paragraph of that chapter:

They called James, the brother of Jesus, “James the Just.” In Jerusalem, the city he had made his home after his brother’s death, James was recognized by all for his unsurpassed piety and his tireless defense of the poor. He himself owned nothing, not even the clothes he wore—simple garments made of linen, not wool. He drank no wine and ate no meat. He took no baths. No razor ever touched his head, nor did he smear himself with scented oils. It was said he spent so much time bent in worship, beseeching God’s forgiveness for the people, that his knees grew hard as a camel’s.

His thesis is that Christianity would have become a
very different religion if the Hebrew faction led by James hadn’t been wiped
out by the Roman destruction of Jerusalem in 65 C.E, leaving the
Greek faction led by Paul in charge by default. Martin
claims that this description of the early church is
oversimplified, but doesn’t claim that you won’t get the current
complicated view by reading the books in the notes section to that
chapter.

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News of the week of October 22, 2013

Meeting Report

We played:

Schedule

We will be meeting as usual on Tuesdays at 7:45 PM at my place.

Tuesday, November 5, is an election day, and I will be working
until 9 or so, so either someone should volunteer to open up and
start the rehearsal, or we can skip that day.

New Format

What I said last
week
about wanting to know on Tuesday morning how many people
would be here on Tuesday evening doesn’t seem to have worked, so I
will be more specific this week.

One of the ways this group works, when it does, is that I go to
the computer after breakfast on Tuesday morning and transcribe a
piece of music I hope will be suitable for the group that night.
It used to be quite rare that the piece I picked was unsuitable in
the sense that it had the wrong number of parts for the group, but
it has become increasingly common that I transcribe something that
we can’t play because I don’t know who’s coming. And there’s a
very nice 5 part piece I transcribed last Spring that still hasn’t
really had a reading.

So what I want in the future is that everybody who usually
comes, tells me by 10 on Tuesday morning whether they’re coming
that night. And everybody who doesn’t usually come, if they
decide to come on a given Tuesday, you should tell me by 10 in the
morning that you’re doing that.

And if you frequently miss more than half the meeting, you
should tell me whether that’s likely for that meeting.

And whatever you have or haven’t told me, you should feel some
obligation to honor that commitment. I don’t want to go so far as
saying you aren’t welcome if I didn’t know at 10 AM that you were
coming, or that if a serious illness comes on between 10 AM and 8
PM you should come anyway, but casual or postponable distractions
should be avoided.

So that’s a pretty mild form of not being a drop in group, but
as of this week, we are no longer purely a drop in group.