As if the complexities and vagueness described in the previous six blogposts on Mental Health and Gun Control were not sufficient to muddy the waters of understanding about mental illness and violence almost to make it impossible to come up with sensible objective decision making on the part of governments, law enforcement, attorneys, and judges–to say nothing of run-of-the-mill citizenry–there are still more complicating and thwarting issues. Authors, Jonathan M. Metzl, MD, PhD and Kenneth T. MacLeish, PhD, Mental Illness, Mass Shootings, and the Politics of American Firearms, Am J Public Health. 2015 February; 105(2): 240–249, published online February, 2015 cited previously continued their explanations of the difficulty of arriving at good legislation to deal with mental issues and gun ownership. “Complicating matters further, associations between violence and psychiatric diagnosis shift over time. For instance, schizophrenia—far and away the most common diagnosis linked by the U.S. media to mass shooters—was considered an illness of docility for much of the first half of the 20th century. From the 1920s to the 1950s, psychiatric literature often described schizophrenia as a “mild” form of insanity that affected people’s abilities to “think and feel.” Psychiatric authors frequently assumed that such patients were nonthreatening, and were therefore largely harmless to society.

“Only in the 1960s and 1970s did U.S. society begin to link schizophrenia with violence and guns. Psychiatric journals suddenly described patients whose illness was marked by criminality and aggression. Federal Bureau of Investigation (FBI) most-wanted lists in leading newspapers described gun-toting “schizophrenic killers” on the loose.

“Historical analysis suggests that this transformation resulted, not from increasingly violent actions perpetuated by “the mentally ill,” but from diagnostic frame shifts that incorporated violent behavior into official psychiatric definitions of mental illness… In 1968, the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) recast paranoid schizophrenia as a condition of “hostility,” “aggression,” and “projected anger”, and included text explaining that, ‘the patient’s attitude is frequently hostile and aggressive, and his behavior tends to be consistent with his delusions.’” This resulted in a new and distinctly negative mindset about schizophrenia and the condition’s propensity for violence.

PTSD [posttraumatic stress disorder] is another mental illness which is associated with gun violence with disturbing frequency. From the mid-19th century through the end of World War II, military leaders and doctors promulgated their conviction that combat-related stress afflicted only neurotic or cowardly soldiers. Research about the experience of combat veterans of the Vietnam War resulted in the DSM-III recasting PTSD as a normal mind’s response to exceptional events. Fairly soon, the image of the traumatized soldier became the common sense “knowledge” presumed by the body politic. However, serious real events caused an evolution from sick and cowardly to sympathetic victim, and then PTSD increasingly became associated with violent behavior in the public imagination and understanding. That went on to create the stereotype of the “crazy vet” which persists to the present day. Currently, supposedly sympathetic news coverage drawing attention to veterans’ suffering frequently makes its point by linking posttraumatic stress with violent crime. This generalized mind-set about this particular form of mental illness persists despite the paucity of data linking PTSD diagnosis with violence and criminality. Violence did and does happen, but it is a very infrequent manifestation of the behaviors associated with the disorder.

The result of such evolution in opinions created nearly fixed ideas associated with imagined potential for violence. Even psychiatrists–not just the general public–came to define violent acts as symptomatic of mental illness. Those fixations of opinions came to associate racial, economic, educational, and social stereotypes with a propensity to commit gun violence.

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There is one more myth that is widely held in the general U.S. public—that of the unpredictable and suddenly violent lone gunman. Most serious research shows that “social relationships also predict gun violence. Regression analyses by Papachristos et al. demonstrate that up to 85% of shootings occur within social networks.” [such as gangs, disenfranchised subgroups who feel angry and alienated including minorities, and persons who gravitate to violent ideologies stemming from an “us versus them” theme. “In other words, people are far more likely to be shot by relatives, friends, enemies, or acquaintances than they are by lone violent psychopaths.” To put the killings into statistical perspective, “a report by the police department of New York City found that, in 2013, a person was ‘more likely to die in a plane crash, drown in a bathtub, or perish in an earthquake, than be murdered by a crazed stranger in that city.”

Other researchers have found evidence that “…certain persons with mental illness undoubtedly commit violent acts. Reports argue that mental illness might even be underdiagnosed in people who commit random school shootings.” Statisticians, however, point to a fallacy of viewing numbers—that of “basing gun crime–prevention efforts on the mental health histories of mass shooters risks building “common evidence” from “uncommon things.”, i.e. going from the singular to the general rather than the more logical other way around. “Such an approach thereby loses the opportunity to build common evidence from common things—[such as…medical specialties might catalog as a result of their necessarily robust use of practical, verifiable, and useful information]. A rapid jump to conclusions blaming mental illness as the core cause of gun violence, as found in communities around the country, ignores what is known “about substance abuse, domestic violence, availability of firearms, suicidality, social networks, economic stress, and other factors.”

Conservative commentators such as Anne Coulter take the self-serving NRA proclivity to “blame ‘the mentally ill’ for violence, and even psychiatric journals are more likely to publish articles about mentally ill aggression than about victimhood.” But, in the real world with which law enforcement and the courts must deal when faced with the best factual information is that “persons with mental illness might well have more to fear from ‘us’ than we do from ‘them.’” Blaming persons with mental disorders for gun crime overlooks the threats posed to society by a much larger population and skews the basis for the process of pursuing a logical course for prevention of gun violence and of dealing with the mentally ill.

In terms of predicting whether or not mentally ill persons in general or those more narrowly suspected of being a threat to society, there is “legislation in a number of states now [that] mandates that psychiatrists assess their patients for the potential to commit violent gun crime. New York State law requires mental health professionals to report anyone who “is likely to engage in conduct that would result in serious harm to self or others” to the state’s Division of Criminal Justice Services, which then alerts the local authorities to revoke the person’s firearms license and confiscate his or her weapons. California adopted a 5-year firearms ban for anyone who communicates a violent threat against a ‘reasonably identifiable victim’ to a licensed psychotherapist.” All of this legislation presumes that mental health workers hold a singularly better set of knowledge than do law enforcement, judges, science-based students of the subject, and investigative journalists, and is therefore naïve. Even broader is the one in Tennessee, “passed as a response to mass shootings” [which] requires Tennessee-based mental health professionals to report “threatening patients” to local law enforcement. Of course definitions both medically and legally beg definition.” Supporters of these types of laws argue that they provide important tools for law enforcement officials to identify potentially violent persons.

“History suggests, however, that psychiatrists are inefficient gatekeepers in this regard. Data supporting the predictive value of psychiatric diagnosis in matters of gun violence is thin at best.” Psychiatric diagnosis is largely an observational tool, not an extrapolative one, a limitation largely accepted by mental health professionals—a group which is unenthusiastic about being given such responsibility, arguing that a nuanced and complicated subject is overly simplified as a solution. …“There is actually very little literature that provides empirical evidence dealing with psychiatric predictions of dangerousness… and that ‘despite statutory and procedural trends to the contrary, the data available suggest no reason for involving psychiatrists in the dispositional processes of violent offenders under the expectation of [successfully] predictive expertise.’”… Swanson put it even more succinctly: “Psychiatrists using clinical judgment are not much better than chance at predicting which individual patients will do something violent and which will not.…The lack of prognostic specificity is in large part a matter of simple math. Psychiatric diagnosis is–in and of itself–not predictive of violence, and even the overwhelming majority of psychiatric patients who fit the profile of recent U.S. mass shooters—gun-owning, angry, paranoid White men—do not commit crimes.

“In this sense, population-based literature on guns and mental illness suggests that legislatures risk drawing the wrong lessons from mass shootings if their responses focus on asking psychiatrists to predict future events. Though rooted in valid concerns about public safety, legislation that expands mental-health criteria for revoking gun rights puts psychiatrists in potentially untenable positions, not because they are poor judges of character, but because the urgent political and social conditions psychiatrists are asked to diagnose are at times at odds with the capabilities of their diagnostic tools and prognostic technologies.”

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I repeat my intention in this series of blogposts to limit discussion as much as possible to the issues of mental illness and its relationship to gun violence. The previous blogpost ended with an assertion that mental health specialists might well hold the key pre-emptive solutions to the problem. The same authors, Jonathan M. Metzl, MD, PhD and Kenneth T. MacLeish, PhD, Mental Illness, Mass Shootings, and the Politics of American Firearms, Am J Public Health. 2015 February; 105(2): 240–249, published online February, 2015, made it very clear that the problem is not so simply understood; and the solutions are not so simply arrived upon. In fact, they point out that even the data upon which researchers and ultimately legislators must rely to formulate legal controls over the mentally ill to prevent violent outbreaks is hotly debated among experts.

Consider first the assumption that mental illness causes gun violence (and ignore for the purposes of this discussion, the violence perpetrated by hate groups in the name of their ideology, their god, or their spurious assertions of being fighters against violent oppression by outsiders). This decade is hardly the first to focus on mental illness as a cause of gun violence. There has been a multi-decades-long history of debates in psychiatry and law about guns, gun violence, and “mental competence.” As far back as the 1960s, psychiatric articles deliberated ways to assess whether mental patients were “of sound mind enough” to possess firearms. Following the 1999 mass shooting at Columbine High School, a researcher named Breggin decried the toxic combination of mental illness, guns, and psychotropic medications that contributed to the actions of the shooter. After the 2012 shooting at Newtown, another psychiatric researcher, Torrey, reasserted his earlier warnings about “dangerous ‘subgroups’ of persons with mental illness who;” he contended, “were perpetrators of gun crimes.” Speaking to a national television audience, Torrey, claimed that “about half of… mass killings are being done by people with severe mental illness, mostly schizophrenia, and if they were being treated they would have been preventable.”

The same kind of debates have been seen throughout those past decades in legal dialogues as well. The U.S. Supreme Court strongly affirmed a broad right to bear arms in 2008 but endorsed prohibitions on gun ownership “by felons and the mentally ill” because of their special potential for violence.

There is, however, very little population based evidence to support the hypothesis that individuals diagnosed with mental illness are more likely than anyone else to commit gun crimes. “According to [researcher] Appelbaum, less than 3-5% of U.S. crimes of any kind involve people with mental illness…[in fact] the percentages of crimes that involve guns are lower than the national average for persons not diagnosed with mental illness. Databases that track gun homicides, such as the National Center for Health Statistics, similarly show that fewer than 5% of the 120 000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness.” Furthermore, there is an accumulating body of research suggesting that mass shootings are anecdotal distortions of—instead of accurate representations of, the actions of mentally ill people as a defined subgroup. “There were fewer than 200 mass shootings reported in the United States—often defined as crimes in which four or more people are shot in an event, or related series of events—between 1982 and 2012.”

There appears to have been a change in the prevalence of such terrible events beginning in 2009. Reports in research literature and by the media suggest that 160 of these events occurred after that time “and that mass shootings rose particularly in 2013 and 2014.  Statistical analyses after 2009 were based on a different set of standards regarding what constitutes mental illness. “As anthropologists and sociologists of medicine have noted, the time since the early 1980s also marked a consistent broadening of diagnostic categories and an expanding number of persons classifiable as “mentally ill.” Statisticians who study the best means of preventing violence thus “contend that mass shootings occur far too infrequently to allow for the statistical modeling and predictability—factors that lie at the heart of effective public health interventions.” Some researchers argue that mass shootings denote “rare acts of violence” that unfortunately have little predictive or preventive validity when taking into account the finding that there are “32, 000 fatalities and 74, 000 injuries caused on average by gun violence and gun suicide each year in the United States.” The United States is by all evidence, a violent place, and mental illness is just one of the many causes.

Links between mental illness and all types of violence are similarly contentious among researchers and statisticians who study such trends. “Several studies suggest that subgroups of persons with severe or untreated mental illness might be at increased risk for violence in periods surrounding psychotic episodes or psychiatric hospitalizations [more commonly than throughout most of their lives]. Writing in the American Journal of Psychiatry, Keers et al. found that the emergence of ‘persecutory delusions’ [at least] partially explained associations between untreated schizophrenia and violence. [However], at the same time, a number of seminal studies asserting links between violence and mental illness—including a 1990 study by Swanson et al. cited as fact by the New York Times in 2013—have been critiqued for overstating connections between serious mental illness and violent acts.

Connections would seem self-evident to intelligent and informed members of the U.S. general population, and affirmed by media reports that assume an obvious distinction between mild versus severe mental illness. The more severe form of mental disease, it goes, connects severity to behavioral unpredictability and especially to lack of self-control. “However, this distinction, too, is called into question by mental health research… A number of the most common psychiatric diagnoses, including depressive, anxiety, and attention-deficit disorders, have no correlation with violence whatsoever. Community studies find that serious mental illness without substance abuse is also ‘statistically unrelated’ to community violence.” The overall accumulation of evidence confirms that the vast majority of people diagnosed with psychiatric disorders do not commit violent acts. Only about 4% of violence in the United States can be attributed to people diagnosed with mental illness. That suggests strongly the mental illness, per se, is not a valid reason to restrict gun ownership on the basis of mental illness alone because the stereotypes of “violent madmen” are at odds with scientific realities. There are researchers who posit the suggestion that “serious mental illnesses such as schizophrenia actually reduce the risk of violence over time, as the illnesses are in many cases marked by social isolation and withdrawal.” Rather, the best evidence indicates that the risk is exponentially greater that individuals diagnosed with serious mental illness will be assaulted by others, rather than the other way around. The extensive surveys of police incident reports collected by Brekke, et al. “demonstrate that, far from posing threats to others, people diagnosed with schizophrenia have victimization rates 65% to 130% higher than those of the general public.”  “Media reports sound similar themes: a 2013 investigation by the Portland Press Herald found that ‘at least half’ of persons shot and killed by police in Maine suffered from diagnosable mental illness.”

A more accurate conclusion to be arrived at from the majority of credible research is that
the issue is the result of a number of risk factors more strongly correlated with the assortment of causes of gun violence than mental illness alone. These risk factors include alcohol and drug abuse which “increase the risk of violent crime by as much as 7-fold, even among persons with no history of mental illness.” There is less evidence against mental illness than there is against persons protected by “recent legislation that allows persons in certain U.S. states to bring loaded handguns into bars and nightclubs. Other factors as important as mental illness include, a history of childhood abuse, binge drinking, and male gender. Much as the NRA and the people who favor a lassie faire approach to gun ownership, “a number of studies suggest that laws and policies that enable firearm access during emotionally charged moments also seem to correlate with gun violence more strongly than does mental illness alone.” That is, the plethora of guns in the general population, thus making access to firearms available to persons susceptible to violence during times of stress, trumps the number of mentally ill with the proclivity to violence.

The NRA and other advocates of free or nearly free opportunity of gun ownership argue along with advocate, Lott, “that… ‘more guns’ lead to ‘less crime,’ [rather than the opposite popular view]. Serious researchers have “found that homicide was more common in areas where household firearms ownership was higher… [and that] states with high rates of gun ownership had disproportionately high numbers of deaths from firearm-related homicides.” For instance, “Webster’s analysis uncovered that the repeal of Missouri’s background check law [not mental illness] led to an additional 49 to 68 murders per year, and the rate of interpersonal conflicts resolved by fatal shootings jumped by 200% after Florida passed ‘stand your ground’ in 2005.” Availability of guns is statistically “a more predictive factor than is psychiatric diagnosis in many of the 19, 000 U.S. completed gun suicides each year.” An uncomfortable fact for the NRA is that “gun-related homicides and suicides fell precipitously, and mass-shootings dropped to zero, when the Australian government passed a series of gun-access restrictions in 1996.”

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Two articles underscore the confusion—some say the schizophrenic attitudes—surrounding gun control targeting the mentally ill: Steven Rosenfeld, The NRA once supported gun control, Salon, Alternet, Monday, Jan 14, 2013 and Lexington, Why the NRA keeps talking about mental illness, rather than guns, Mar 13th 2013. I will quote and paraphrase from those articles.

“The gun lobby’s focus on mental illness as the “true” cause of such massacres. Did they really support a large expansion of officialdom’s right to declare someone mentally unfit, trumping their right to bear arms under the constitution’s second amendment? In Hartford the question provoked some debate. But most demonstrators followed the NRA’s line in opposing any talk of moving to “universal” background checks: jargon for closing the loophole that currently allows private individuals to buy and sell guns without any checks on the criminal or mental-health records of buyers. Almost 40% of gun sales currently fall through that loophole. The message discipline of the National Rifle Association and its congressional allies has been impressive. After an initial period of silence, the NRA came out with a consistent narrative about mass shootings. The problem, said such spokesmen as Wayne LaPierre, the NRA’s executive vice-president, was that criminals and the dangerously ill can get their hands on guns.”

Rosenfeld went on to ask if the NRA had radically changed its iron stiff position on the absolute right to bear arms. He quoted Wayne LaPierre, “We have a mental health system in this country that has completely and totally collapsed.” The executive vice-president of the NRA went on to assert the NRA’s support of FBI-run NICS [instant background checks system used by gun dealers when selling firearms]. That was disingenuous because the NRA’s real objective is found in the loophole that allows private owners to buy and sell firearms at will. In addition, Mr. LaPierre strongly asserted the NRA’s support of laws which would include all persons formally adjudicated as having mental illness into the federal system and went on to deplore “the fact that many states are still putting only a small number of records into the system.” That public statement is the height of disingenuousness because behind the scenes, the NRA has successfully orchestrated measures to thwart the mental health record system thereby effectively emasculating it and allowing the mentally ill to be part of the private citizenry so revered by the NRA who can and should have guns. “The Democratic governor of Connecticut, Dannel Malloy…accused the NRA of a “bait-and-switch”, in which the gun lobby is trying to appear constructive without allowing any gun rules to change.”

Probably of more importance is the fact that the mental health/gun and violence issue is grossly exaggerated. Only a small proportion of violent crimes carried out by the mentally ill. Researchers and mental health care workers point out that “the mental-health system is good at describing behavior patterns but very poor at predicting specific acts by specific people.” …”And you can’t go around locking up all the socially awkward young men.” Looking with the clarity of hindsight, there is one area where mental illness is well known and well documented to be important, and that is suicide by gun. As of 2010, suicide “accounted for 61% of gun-injury deaths in America.” That is hardly germane to the overall problem of the killing of innocents by gun wielding killers or even the more narrow issue of the role of mental illness in such killings.

The confusing issue of the role of mental illness in mass shootings is well presented in an important recent article by Jonathan M. Metzl, MD, PhD and Kenneth T. MacLeish, PhD, Mental Illness, Mass Shootings, and the Politics of American Firearms, Am J Public Health. 2015 February; 105(2): 240–249. Published online 2015 February.

“Four assumptions frequently arise in the aftermath of mass shootings in the United States: (1) that mental illness causes gun violence, (2) that psychiatric diagnosis can predict gun crime, (3) that shootings represent the deranged acts of mentally ill loners, and (4) that gun control “won’t prevent” another Newtown (Connecticut school mass shooting). Each of these statements is certainly true in particular [emphasis by the author of this blogpost] instances. Yet, as we show, notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics. These issues become obscured when mass shootings come to stand in for all gun crime, and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat. [and a political football].”

Conservative media commentator Anne Coulter provocatively and stridently proclaimed that “Guns don’t kill people—the mentally ill do,” and National Rifle Association President Wayne LaPierre blamed “delusional killers” for violence in the United States which are at the minimum overstatements and at worst impediments to the solution of even the narrow problem of massacre by mentally ill persons. (To say nothing of the larger issues of attacks by terrorists and sane persons with a violent ideological purpose.) LaPierre called for a “national registry” of persons with mental illness.

Shortly after the Newtown shooting, “a number of states passed bills that required mental health professionals to report “dangerous patients” to local officials, who would then be authorized to confiscate any firearms that these persons might own. “People who have mental health issues should not have guns,” New York Governor Andrew Cuomo told reporters after one such bill passed the New York Senate. “They could hurt themselves, they could hurt other people.’” It is logical to repeat the widespread opinion that “only an insane person would do such horrifying things.”… “Reports suggest that up to 60% of perpetrators of mass shootings in the United States since 1970, displayed symptoms including acute paranoia, delusions, and depression before committing their crimes.” The shooters in the Aurora, Colorado movie theater, of U.S. Congresswoman Gabrielle Giffords in Tucson, Arizona, Columbine High School, and Isla Vista, California, for example, exhibited highly suspicious behavior suggesting an irrational violent propensity. More recently, terrorists of all stripes have taken center stage.

There is strong evidence from psychiatric, psychological, neuroscientific, public health, sociological literature, and even investigative journalism, that there are connections between mental illness and gun violence. “However, notions that mental illness caused any particular shooting, or that advance psychiatric attention might prevent these crimes, are more complicated than they often seem.” The simplistic view of even factual material tends to ignore or to downplay other significant factors such as race and ethnicity, poverty, living in a crime-ridden neighborhood, immersion in socially alienated groups and ideologies, access to firearms, failure of the reporting system, and poor response to reports when they are available. “Anxieties about insanity and gun violence are also imbued with oft-unspoken anxieties about race, politics, and the unequal distribution of violence in U.S. society.”  The authors concluded from their extensive research, that, “At the same time, the literatures we surveyed suggest that these seemingly self-evident assumptions about mass shootings are replete with problematic assumptions, particularly when read against current and historical literatures that address guns, violence, and mental illness more broadly. On the aggregate level, the notion that mental illness causes gun violence stereotypes a vast and diverse population of persons diagnosed with psychiatric conditions and oversimplifies links between violence and mental illness. Notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural issues that become obscured when mass shootings come to stand in for all gun crime and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat.” Furthermore, “linking guns and mental illness in ways that subtly connect “insane” gun crimes with oft-unspoken assumptions about “White” individualism or “Black” communal aggression.” And confuses the issue of what is the best solution for the problem.

“It is understandable that U.S. policymakers, journalists, and the general public look to psychiatry, psychology, neuroscience, and related disciplines as sources of certainty in the face of the often-incomprehensible terror and loss that mass shootings inevitably produce. This is especially the case in the current political moment, when relationships between shootings and mental illness often appear to be the only points upon which otherwise divergent voices in the contentious national gun debate agree.” The researchers went on to add, “Our brief review ultimately suggests, however, that this framework—and its implicit promise of mental health solutions to ostensibly mental health problems—creates an untenable situation in which mental health practitioners increasingly become the persons most empowered to make decisions about gun ownership and most liable for failures to predict gun violence.” While “it is undeniable that persons who have shown violent tendencies should not have access to weapons that could be used to harm themselves or others,” it should come as no revelation that health care professionals are reluctant to shoulder the blame for such complicated and broad societal problems.

Finally, the researchers concluded that there are four central assumptions that are commonly asserted in the aftermath of each new horrific mass shooting and have more than a grain of truth: “ (1) Mental illness causes gun violence, (2) Psychiatric diagnosis can predict gun crime before it happens, (3) U.S. mass shootings teach us to fear mentally ill loners, and, (4) Because of the complex psychiatric histories of mass shooters, gun control “won’t prevent” another Tucson, Aurora, or Newtown. Each of these statements is certainly true in particular instances. Evidence strongly suggests that mass shooters are often mentally ill and socially marginalized. Enhanced psychiatric attention may well prevent particular crimes. And, to be sure, mass shootings often shed light on the need for more investment in mental health support networks or improved state laws and procedures regarding gun access.”

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Continuing make use of the information found in Pacific Standard Magazine, Nov/Dec, 2015: Among the states, while mental health data has remained sparse overall, some states have made it easier for the mentally ill to restore their gun rights than even the federal law would allow. The New York Times noted that in Virginia some people have regained rights to guns by doing nothing more than writing a letter to the state. There are Virginians who got their rights back just weeks or months after being hospitalized for psychiatric care. What are the numbers of Virginians whose gun ownership rights were restored? Unknown because no agency is responsible for keeping track.

Nonetheless, despite the limitations of the mental health database throughout the country, some gun control advocates still see it as better than nothing. Apparently, for some it is a case of beauty in the eye of the beholder. The status of gun control affecting the mentally ill is well described by Ben Wolfgang, in Gun control debate at standstill despite agreement on restrictions for mentally ill, The Washington Times, October 1, 2015. “Across the country, from statehouses to Capitol Hill to federal courtrooms, the debate over whether students should be able to carry firearms on campus, whether the nation needs to rein in gun rights in the name of public safety and how to keep guns out of the hands of the mentally ill continues with little in the way of progress.” He goes on to describe the frustration felt by those who try to come up with a sensible set of laws to deal with the mentally ill. “In 2013, a coalition of senators tried to enact background check measures in the wake of the massacre at Sandy Hook Elementary School in Connecticut. Although the measure garnered a small level of bipartisan support, it ultimately died amid strong opposition from the National Rifle Association and other groups.

Douglas County Sheriff John Hanlin, who is overseeing the investigation of the Oregon campus shooting, was among those opposing the legislation. He sent a letter to Vice President Joseph R. Biden in 2013 after the Sandy Hook shooting, saying he and his deputies would refuse to enforce new gun control restrictions “offending the constitutional rights of my citizens.”

After Newtown, the NRA rolled out its own plan to post armed guards at the nation’s schools, arguing that a “good guy with a gun” is the only way to stop a deranged shooter bent on killing innocent people. That makes sense, but the idea has gone nowhere. On college campuses, lawsuits are being filed challenging restrictions on carrying guns while others are openly defying laws allowing firearms on campus. Ben Carson, a retired neurosurgeon running for president, said that the focus should be entirely on mental health, not on gun laws. That has gone nowhere as well. For one thing, identifying the mentally unstable and preventing them from buying guns has proved to be a complicated and serious challenge throughout the country. For example, Sen. John Cornyn (Rep. Texas) proposed a bill in Congress to strengthen federal background check systems, strengthening mental health treatment programs to treat the mentally ill, and would require court action before barring gun purchases by veterans declared incompetent by the Veterans Affairs Department thus effectively making it easier for seriously mentally ill people to access guns because states and the VA system are not going to be enthusiastic to go through even more rigmarole related to mental health treatment and veterans rights to have guns (incidentally). On a countrywide scale, the NRA once favored having gun dealers turn over sales records to police and creation of a one-day waiting period between buying a gun and physically taking possession of it—two provisions that the NRA opposes today.
Source: Mother Jones

Another article in Mother Jones discussed the problems facing legislators, law enforcement officers, the courts, and mental health workers to determine which if any mentally ill persons should be allowed to carry a firearm. “The specific disqualifications related to mental health are quite narrow. Under federal law, an individual is prohibited from buying or possessing firearms if they have been “adjudicated as a mental defective” or “committed to a mental institution.” A person is “adjudicated as a mental defective” if a court — or other entity having legal authority to make adjudications — has made a determination that an individual, as a result of mental illness: 1) Is a danger to himself or to others; 2) Lacks the mental capacity to contract or manage his own affairs; 3) Is found insane by a court in a criminal case, or incompetent to stand trial, or not guilty by reason of lack of mental responsibility pursuant to the Uniform Code of Military Justice. A person is “committed to a mental institution” if that person has been involuntarily committed to a mental institution by a court or other lawful authority. This expressly excludes voluntary commitment. If a person falls under one of these two categories, they are prohibited from purchasing and possessing firearms for life — although federal law now allows states to establish procedures for such individuals to restore their right to purchase or possess firearms. Many states have done so at the behest of the National Rifle Association, with questionable results.

“There is no guarantee, however, that a formal record of adjudication or involuntary commitment will find its way into the NICS [National Instant Criminal Background Check System] database. Often disqualifying mental health records go unreported by the states. In Colorado, for example, only about 1% of people who have disqualifying mental health histories have been reported to NICS.

“Another problem is that few Americans suffering from serious mental illness ever come into contact with the “system” or receive treatment for their condition(s). According to the National Alliance on Mental Illness (NAMI), approximately 10% of children and adolescents suffer from mental illnesses. Yet only 20% of this group have been diagnosed and are receiving services. Looking at adults, approximately 1 in 17 live with a serious mental disorder such as schizophrenia, major depression, or bipolar disorder. Yet less than one third receive mental health services.”

In the next blogpost in this series, I will discuss efforts to solve the thorny problems of protecting the public from deranged individuals with guns while still protecting their rights under the constitution.

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The mental health issues regarding gun ownership and use are well presented by several authors, and I will quote or paraphrase freely from them to convey their valuable contributions to an even wider audience. In my opinion, the information provided by these authors should be as widely disseminated and as frequently as possible to the general public who are constantly bombarded with the spurious and endlessly repetitive arguments regarding guns from the left and the right.

Joaquin Sapien, writing in, How the NRA Undermined Congress’ Last Push for Gun Control, ProPublica, Jan. 24, 2013, pointed out, “In order to get the support of the NRA, Congress agreed to two concessions that had long been on the agenda of gun rights advocates — concessions that later proved to hamstring the database. The NRA wanted the government to change the way it deemed someone to be “mentally defective,” excluding people, for example, who were no longer under any psychiatric supervision or monitoring. The group also pushed for a way for the mentally ill to regain gun rights if they could prove in court that they’d been rehabilitated. The NRA found allies on both sides of the aisle to champion the concessions.”

The NRA agreed to the support the bill, in exchange for provisions pushing states—as opposed to the federal government–to create gun rights restoration programs, a stance that gave the NRA an opportunity to appear to be supportive of keeping guns out of the hands of truly insane persons, a position they trumpeted. It also gave the NRA and the law makers they control a very convenient loophole to thwart actual implementation, a palatable compromise for the rank and file of the NRA who have bought into the fear of big government taking control of all guns if any gun ownership is compromised in the least.

Since 1968, the law has made its leisurely way through state legislatures and is still not in anything like a majority agreement to make limitations state by state. The effective arguments, largely conveyed behind closed doors, convinced many sympathetic law makers that it would be costly for states to share their data within and without the state’s borders. Sapien explains that, “A state agency would have to monitor the courts, collect the names of people who had been institutionalized, and then send that information to the FBI on a regular basis. So, to help pay for data-sharing, Congress created $375 million in annual federal grants and incentives. But to be eligible for the federal money, the states would have to set-up a gun restoration program approved by the Justice Department. No gun rights restoration program, no money to help pay for sharing data.” And a win-win for the NRA and its heavy-handed concept of who should and who should not own guns (precious few of the latter).

As time as gone on, the federal government has had to resort to try and create legislation to provide both incentives and harsh penalties to force states to put names into the database. For the NRA, the convoluted purpose of that database is eventually to find data that will allow as many people with records of serious mental illness—three months of involuntary hospital confinement for mental illness, for example—to have their rights restored to have gun ownership.

The NRA won even more concessions by the time the proposed legislation reached the Senate. Language was inserted that would allow a person’s application for gun restoration rights to be granted automatically if an agency failed to respond within 365 days of the application and allowed people to have their attorney’s fees reimbursed if they were forced to go to court to restore their rights. That constituted an extremely expensive record keeping and information sharing effort foisted onto already financially strapped states. It came as no surprise to anyone that it was easier for states to let the statute of limitations pass, and applicants gain or regain their gun ownership rights even if they were deemed a danger by their care-givers, neighbors, or local law enforcement. The final bill was signed by President George W. Bush in January, 2008, an action which significantly increased his political (and financial assistance for campaigns) currency with the gun ownership community.

To no one’s great surprise, the NRA called the law “pro-gun legislation” and a victory for gun owners, and to its members, a clarion call for more donations to be certain that the NRA’s good work would continue to be well funded. The sponsors of the bill issued public statements that they support making improvements in the mental health data base; but, as quoted by Sapien, they emphasized that, overall, “we first must ensure our constitutional rights and individual liberties.” (read: the nearly unfettered right to own firearms). The law has serious flaws in implementation—again not unanticipated. Many states do not share all of their mental health records. Actually, as of 2012, only twelve states have cooperated. It is only fair to state that even that poor showing resulted in a huge improvement in the numbers of people whose mental health data became party to the system. Twenty-three states and the District of Columbia have “reported fewer than 100 records. Seventeen states reported fewer than 10 records, and four submitted no data at all…Millions of records identifying seriously mentally ill people and drug abusers as prohibited purchasers are missing from the federal background check database because of lax reporting by state agencies,” Sapien’s research revealed. Others simply can’t afford the expense of gleaning the data from the courts, providing it to the relevant state agency, and then passing it on to the federal government.

Like most such efforts, revealing this type of data is a complicated problem; and it is not fair to blame all states, legislators, and executive branches as being tools of the NRA. Some states cannot because of stiff privacy laws; the influence of the National Association for the Mentally Ill (NAMI) exerts such powerful influence to protect the rights and privacy of mentally ill persons even to the extent of protecting gun ownership rights. A New York Times investigation found that many states have not qualified for federal funding to share their data because they have not as yet established gun rights restoration programs. Ironically, some states have had trouble setting up restoration programs because gun control advocates in those states have protested them.

As strange as it may seem, many states have different interpretations of their understanding about exactly (strict legal parlance) what kind of data must be provided and to whom; and more troublesome overall is the vexing issue of what—precisely—does “mentally ill” and “involuntarily committed” mean in the context of the law and the implications for gun ownership by such persons? That issue will be dealt with in blogpost 3 on the subject.

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After every horrendous massacre in the United States and abroad, there is anguish and anger over guns. The violence creates yet another media opportunity to demand the wholesale prohibition of gun sales and ownership and—at the extreme—an outcry for confiscation of firearms. In addition, there is the inevitable response by gun owners and especially by the National Rifle Association to defend gun possession and use by virtually everyone except outright criminals under the argument that the Second Amendment to the Constitution makes gun ownership a right of Americans. In my opinion both responses are spurious because they are largely driven by politics and money. Both the left and the right benefit with each new outrage: The Democrats get to make their stand known to their constituency and thus collect money for elections. The Republicans get the same money and political upsurge, and the NRA brings in another fifty or so million dollars from its panicky pleas to its members for money to safeguard their gun ownership rights. Jabin Botsford, The Washington Post, October 9, 2013 put it succinctly: “There’s a kind of usual order of national business–a grim ritual that’s been established for the hours and days after a mass shooting. After the final death and injury toll are established, an elected official or candidate–usually a Democrat–will call for stricter gun control. Then, another elected official or contender for public office–usually a Republican–will object to efforts to politicize the tragedy. Victims and their family members step forward to tell their harrowing stories and weigh in on one of the two sides mentioned above. Then, it all just goes away until the next mass shooting.”

For purposes of clarification, I am a political middle-of-the-roader independent with almost equal disdain for both of the major parties and their candidates. I am a member of the NRA, a gun owner, and a hunter; and I agree with the right of ownership of guns by private individuals for self-defense and recreational activities including target shooting and hunting. Furthermore, because I hold the opinion that the people in the NRA fold are—in the vast majority—law abiding, thoroughly decent, and well meaning, and well versed in the safe and sane use of firearms, I agree with the NRA that it would be a good idea to have well armed and well vetted citizen volunteers in place to guard our schools, sports events, and any activity where people gather.

On the other hand, I disagree strongly with the NRA over the organization’s stances that almost any weapon should be legal for law-abiding citizens, that it is a good thing that the 1968 gun laws they engineered allow registration of guns only by manufacturers and licensed distributers while allowing private individuals to buy and sell personal weapons largely unfettered which has left open the free-wheeling sales of very dangerous weaponry to very dangerous people, even convicted felons, in the open market provided by flea markets. According to Michael Corcoran, Ph.D., Mental Health Checks When Purchasing a Gun, Source, Mother Jones, “You don’t need to submit to a background check to buy a gun, of course. Currently, Americans can buy firearms through ‘private sales’ in more than 40 states without undergoing any type of screening at all. The law requires background checks only for guns sold by federally licensed firearm dealers (FFLs), allowing those not ‘engaged in the business’ of dealing firearms to do so without conducting background checks or maintaining any records of sale. How do we know who is ‘engaged in the business’? We don’t (the IRS isn’t looking at anyone’s tax returns to find out), at least until guns start turning up at crime scenes and an investigation is opened by law enforcement. One study estimated that private sales account for 40% of all gun sales in the United States.”

Even law enforcement departments take advantage of that loophole. And the NRA was also successful in getting the law administrated by the separate states—an arena where the NRA is able to work its magic to prevent real change in the gun culture of the United States.

The Gun Control Act of 1968 reauthorized and deepened the FDR-era gun control laws. It added a minimum age for gun buyers, required guns to have serial numbers and expanded people barred from owning guns from felons to include the mentally ill and drug addicts. Only federally licensed dealers and collectors could ship guns over state lines. People buying certain kinds of bullets had to show I.D. But the most stringent proposals—a national registry of all guns (which some states had in colonial times) and mandatory licenses for all gun carriers—were not in it. The NRA blocked these measures, because, in the opinion of the NRA that while part of the law “appears unduly restrictive, the measure as a whole appears to be one that the sportsmen of America can live with.”

Finally, I take great exception to the actions of the NRA to facilitate the ownership of guns by mentally ill persons. Oh, yes, I am well aware of the NRA’s lip service to the concept that the mentally ill should not have guns; but then they (the NRA) go about quietly undermining the implementation of the laws with the result that mentally ill people have access to guns. That results in killing sprees by deranged individuals on an all too frequent basis.

I recognize that the killings by the mentally ill are not nearly as frequent as those by religiously or ideologically inspired extremists in the name of their various brands of bigotry. Any set of blogposts I might write would fall on deaf ears should I try to tackle the totality of the American gun issues. So, in this set of blogposts, I will endeavor to make the case for changing the mindset of America to protect us at least from dangerous mentally ill persons.

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This blogpost is based in part on material found in Pacific Standard Magazine, Nov/Dec, 2015. We have an educational problem in the United States—actually, multiple problems. One of them is the issue of for profit colleges and universities as an alternative to public schools. The impetus for attendance in for profit schools appears to be inability to get accepted at a college the student can afford. Ten percent of all U.S. students attend for profit schools, and they account for nearly forty-five percent of the students who default on their loans. The average student—the ones lacking rich parents or a sugar-daddy—are caught in an ever worsening grind: debt loans, extra out-of-pocket costs, the need to work balanced against the need to study, the necessity of putting off marriage and having a family, and the difficulty of getting sufficiently high paying jobs after graduation to be able to pay the ongoing interest of the debt. Many will not outlive their interest debt; many others will just walk away with all of the consequences that entails since student loans are not cleared by bankruptcy—non-dischargeable as of 2005.

The federal government comes into the problem in an additional issue: students in for profit schools are suing their colleges and universities in ever increasing numbers alleging that recruitment policies and delivery of promises are unethical, unprofessional, and sometimes frankly illegal. Recruitment is a sales pitch stacked in favor of the school against the student. The school has attorneys, iron-clad contractual requirements, and loose attention to the school’s responsibility to turn out a good educational product at a cost which the traffic can bear—the product being a reasonable expectation of getting a job and being able to pay the costs incurred. Many recruiters become so disenchanted with the process that they report that they feel as if they were in a white-collar criminal enterprise. Some recruiters are in fact encouraged to lie about actual costs and benefits to entice potential students who are finding entrance into publically vetted schools too onerous. For 150 years, for profit schools have been criticized, prosecuted, or shut-down for unfair practices.

Between 1990 and 2010, enrollment in for profit schools increased from 200,000 students to over 2.5 million. The educational industry is big business, and the profits are large enough to capture the attention of very large business corporations. More than half of the enrollees come from families making less than $40,000 a year, the most vulnerable people in our country. Forty percent are Hispanic or Black. Alumni fare poorly. Of those students who started to payback their student loans (as required by contract) in 2011, twenty percent are already in default as of 2015. The median income for this people is just over $20,000 per year. As of 2013, only about thirty percent of those students who entered for profit schools had graduated, and their debts are still accumulating. Only seventeen percent of University of Phoenix students who started in 2008 had graduated after six years of attendance and the necessity to add an additional year or more to their debt load. One of the real problems is that the families and students are desperate to achieve the American goal of obtaining a university degree and are willing to pay whatever it costs to get one. It is difficult for such families to accept that such a dream is not only beyond their reach, but the financial and personal cost may well turn out to be ruinous. The other problem is that the degree may be in a field where there are few or no well-paying jobs, a fact that seems to escape the attention of the colleges and their recruiters.

The injurious climate of the not for profit educational institutions piles societal failure on the already serious problems of high school drop-outs; the numbers of those unfortunate young people amount to seven percent of all young Americans between sixteen and twenty-four years of age. The drop-outs compete with the people who get a flawed education in a capitalism ruled mill for the lowest rung of jobs. And they compete with the people with high school diplomas who fail to obtain a bachelor’s degree (27%). That figure is even worse for people who fail to get a high school diploma but do get a GED (General Educational Development, known by wags as the Good Enough) degree. Only 5% of them go one to earn a bachelor’s. In fact, although 40% of those who pass GED obtain some post-secondary schooling, less than half spend even a year in such efforts. All of them at some time and in some way require assistance from the government, i.e., the already overburdened taxpayers.

The Obama administration is well aware of these problems and is trying to move against the worst offenders, which is proving to be a very considerable up-hill battle. The problem is a tangle of legal, financial, social, definitional, and human problems. One measure is to require compliance by the school with the gainful employment rule for federal assistance to the school, i.e., the institution must produce students whose loan repayment rates are less than twelve percent of their annual income. There are now income-based repayment programs. Federal, state, and local governments, and students and their families, are now instituting multimillion dollar lawsuits against the large for profit educational companies. The outcomes of these and many other educational finance issues will have lasting consequences for our republic. Will our society prosper? Will our economy grow? Will we be able to compete with other countries? Or will we make a long, slow slide into mediocrity?

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This blogpost is based on information found in Pacific Standard Magazine for Nov/Dec. 2015. There are 60,000 wild mustangs in the ten western United States; more than a thousand of them are penned up in BLM corrals near Las Vegas. Nationwide, 45,000 mustangs languish in BLM holding corrals.  Those horses are in competition with 18,000 ranchers whose cattle graze on ±750,000 so-called animal units contained on 155 million acres of land, and no one knows how many domestic animals use the land in aggregate because the BLM considers counts to be futile exercises. The ranchers consider the wild horses as introduced pests comparable to feral pigs, and wild burros—useless and costly. They cannot even be eaten; legal slaughter of horses for human consumption has been banned under U.S. law for the better part of a decade. Animal enthusiasts, particularly horse lovers—including a considerable number of westerners—believe that it is emblematic of American freedom that mustangs should be able to run wild and free, much like the cowboys of the old west. Freedom for the ranchers is the right to have, to feed, and to protect their animals—the cows and sheep—from the predation of deer, elk, and now wild horses. The world would be better off without any of them, some farmers and ranchers feel.

In the middle is the United States Bureau of Land Management (BLM), and both sides feel free to appeal to the government to persuade for or against the horses. The issue is a powerful one between conservationists and livestock producers. It is estimated that there were over 2,000,000 wild horses in 1900, and the numbers were reduced to around 17,000 total in 1971 when the government passed laws to keep the wild horses from extinction. The BLM controls ranchers’ use of government owned land by granting allotments of land for defined numbers of domestic animals and taking into account environmental factors such as the numbers of wild animals, the plentitude or scarcity of feed in the grazing area, and climatic factors such as drought or heavy snows which are not entirely predictable. The allotments are a bargain from a business point of view, but the ranchers resent that they are not able to get more land to raise more cattle and sheep because the useless horses have to be factored in.

In Fiscal Year 2014, the BLM was allocated $79.9 million for its rangeland management program. Of that figure, the agency spent $34.3 million (43 percent) on livestock grazing administration.  The other funds covered such activities as weed management, rangeland monitoring (not related to grazing administration), planning, water development, vegetation restoration, and habitat improvement.  In 2014, the BLM collected $12.1 million in grazing fees. The receipts from these annual fees, in accordance with legislative requirements, are shared with state and local governments.

To accommodate the horses, ranchers have to build corrals, thus raising the costs of production while they are not able to pass on all of those additional costs to consumers. Environmentalists and conservationists do not accept the complaints and assertions of the ranchers citing the fact that horses move about as much as do elk and do no more damage than they do. On the contrary, the horse lovers assert, cattle, and especially sheep, cause almost irreparable damage to the land and the ecosystem. Why not just raise cows in feed yards and be done with the nostalgia of riding the range in the old west? The conservationists point out that the grazing land does not belong to the ranchers; they are given the privilege of grazing their stock on land that belongs to all of the people of the country.

What should be done? This question is asked by citizen of the West. I do not know the answer; neither does the BLM. Any decision they make will infuriate large numbers of people, and politicians and bureaucrats are allergic to giving offense. So, the horses stay in limbo; the ranchers and the conservations gnash their teeth; and the federal government dithers as it always does when faced with such questions. Everyone is urged to be patient. At this point in time, that is about all that anyone can do.

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The Seattle Stateside Dispatch stated that hundreds of billions of dollars were wasted in fraud including physicians referring patients to their own facilities. The U.S. Government Accounting Office [GAO] reported that, in 2003, there were identified 114 unauthorized entities selling bogus insurance to 15,000 employers which–after massive legal processes–left $252 million in unpaid claims as a result of frauds. It 2005, U.S. sales of counterfeit drugs were $39 billion. Estimated bogus drug sales were $75 billion in 2010, and the cost rises annually. Counterfeit versions are often deficient in the important ingredients, and worse, actually dangerous. Every year those numbers increase at an alarming rate.

There is a mistaken belief that healthcare fraud is a victimless crime. On the contrary, that type of fraud is the second largest white-collar crime in the United States. Everyone in the U.S. is affected. Fraud causes insurance premiums and taxes to rise across the board; victims are put through unnecessary or unsafe procedures; and many become victims of identity theft and find that their insurance information has been used to submit false claims.

Pharmaceutical fraud whistleblowers have exposed a vast amount of pharmaceutical criminal activity. Several hundred pharmaceutical fraud cases covering more than 500 drugs are currently under investigation by the U.S. Department of Justice under the False Claims Act. Settlement of the first sixteen pharmaceutical fraud cases–including kickbacks, Medicaid rebate fraud, and best price violations–brought by whistleblowers has returned over $10 billion to the U.S.. Federal law prohibits the fraud of pharmaceutical kickbacks because it colors the judgment of the physician, i.e. the physician will prescribe a prescription drug based not on what is best for the patient, but based upon what prescription drug product most increases the physician’s bottom line. Other examples of kickbacks include: offering pharmaceutical kickbacks to physicians in the form of phony drug studies–the “research” performed has no legitimate value, and is merely a pretext for payments for referrals; phony speaker fees paid for by honoraria–some pharmaceutical companies have used “honorarium” fees or “speaker” fees for physician marketing. They are ostensibly compensation to physicians for agreeing to speak at a true educational event; phony grants–pharmaceutical sales representatives have been allowed by certain companies to give “grants” to physicians, physician groups, and other healthcare providers, ostensibly for an educational program or research program; phony investigator meetings–in some pharmaceutical companies, investigator meetings are ostensibly called for physicians to talk about potential non-indicated uses of drugs. Sales representatives are allowed and instructed to spend lavishly on all physicians, both the speakers and invitees. It has been typical for investigator meetings to last only two hours, yet pharmaceutical companies paid for the physicians’ airfare, hotel, golf, spa treatments, etc. at luxury hotels around the country; advisory board and other meetings–these meetings are typically for the ostensible purpose of getting input/feedback from physicians on drug performance, how they treat disease states, etc. During advisory board meetings, honoraria, lavish entertainment and expenses for physicians are paid for by the pharmaceutical companies.

Clinical trial fraud is another source of ill-gotten gains for pharmaceutical companies and unscrupulous providers and of unwarranted cost to insurance companies and consumers. Clinical trials sponsored by pharmaceutical companies often do not produce the same results as those conducted by the government and other public entities acting objectively. For example, in an analysis published in the American Journal of Psychiatry, it was found that in every publicly available trial funded by the companies that compared five new antipsychotic drugs against each other, the results of 9 out of 10 studies concluded that the best drug was the one manufactured by the pharmaceutical company sponsoring the study.

GMP [Current Good Manufacturing Practice Guidelines] fraud is a practice that frustrates the scientific process, jeopardizes the integrity of the drug product, and creates fraudulent extra costs along with decreased efficacy and safety of drugs. GMP regulations stem from Congressional concern over the danger that impure and otherwise adulterated drugs may escape detection under a system predicated only on seizure of drugs shown to be in fact adulterated. Violations of the GMP regulations have been the basis for qui tam–False Claims Act–lawsuits. The costly and dangerous violations include: off-label marketing; best price fraud; CME fraud–the use of Continuing Medical Education by pharmaceutical companies as a means to influence and induce physicians improperly to prescribe their products, usually newer and more expensive, but not necessarily better medications–unapproved drugs; long term care pharmacy fraud—fraudulent practices in which drugs are adulterated or repackaged in violation of the False Claims Act; and PBM [Pharmacy Benefit Managers] fraud—illegal relationships between pharmaceutical companies and PBMs violate the False Claims Act.

In the next, and final blogpost in this series, fraud perpetrated against the U.S. federal government—and therefore against We the People—will be examined in greater depth.

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