Self-Evaluation Form October 2012 Context Of The School: Fill & Download for Free

I was very arrogant about my health until recently.At 59, I had never been sick, I’m very fit, and look quite a bit younger than my age. My father is 90 and lives the same lifestyle now as 30 years ago, living in his own home in the Texas Hill Country.I’m a physician and have almost daily occasions to offer health advice, and I have a healthy, thriving practice.I am a fan of Nortin Hadler, MD, who writes extensively on intelligent, informed healthcare, offering facts and studies a healthcare consumer should be aware of before giving or refusing consent to commonly recommended medical screenings and treatments for conditions such as high cholesterol, blood pressure, or glucose; colonoscopy; mammography; PSA screening and more. Lest you think he’s fringy, he’s Professor Emeritus of Medicine at UNC School of Medicine at Chapel Hill, and Harvard and Yale educated. You can see his brilliance and relevance in this PBS interview.For 20 years or so, I’ve seen a wonderful internist yearly, but, would abdicate responsibility for this behavior, saying. “The only reason I have a doctor is I have a wife.”Thank goodness I have a wife.September, the year before last, 2018, I had previsit labs for my annual visit with Rick Earnest, who was Chief Resident during his internal medicine residency at Emory, he’s top notch.My white count was low. Rick’s nurse called and said he wanted another CBC and a folate. White count low; folate normal.Then, I saw Rick in his office and we chatted dispassionately about the neutropenia… WBC was around 2, with 4–12 being normal.He told me he had talked to a local heme/onc that morning and then, he shrugged his shoulders and said, “Looks like you need to see a hematologist…” I agreed.About a month later, I had extensive labs at the local oncology center; met the delightful hematologist, Kavita Nirmal, who recommended a bone marrow biopsy.I knew this was coming and, once again, being very healthy and having no signs or symptoms, I thought serial CBC’s would do.However, after my consult with Kavita, I had no urge to refuse the bone marrow biopsy, and it was done that day.Things moved quickly from there.The next day, Kavita called and said I needed to see a specialist at Baylor. Five minutes later, she called back and said, “You could also go to MD Anderson.”Baylor is two hours, MD Anderson is four.Initially, I balked at accepting an MD Anderson referral, as this meant, in my mind, saying, “This is serious.”Over the next 24–48 hours, I had the strong intuition I should go to MD Anderson.I responded to Kavita’s phone call about my treatment choice in a way I found funny/odd… I said, “I owe it to my family to go to MD Anderson.” I thought, “Wow, Dude, you can’t even take responsibility for your choice to go to MD Anderson.” (It wasn’t a big deal… but, interesting.)My records and actual marrow specimen were Fedexed to MDA; I went there for labs and another bone marrow biopsy; and met with a national leader in leukemia, Naveen Pemmaraju.All this occurred in a very compressed period of time and in a context of general surreality, punctuated by briefs periods of extreme surreality.I had accepted there was something wrong with my bone marrow. I had actually been aware I was neutropenic as far back as August 2016; but, again, arrogant invincibility had me ignore it.In Longview, I was told, based on microscopic evaluation of my marrow, and an estimated 13% blast count, I had myelodysplastic syndrome (MDS), something I was familiar with when a fellow staff psychiatrist told me he had it. It was a significant health scare for him, but that was in the 90’s and he and I were in touch for at least 10 years after that, and to my knowledge, he’s still fine today… (we both moved on from that mental health center years ago).Then, as I was going through the process leading up to seeing Dr. Pemmaraju, a nurse who was checking me in and reviewing my chart, was reading out loud to herself… as I listened, it was all quite routine to me as a health care provider, until the letters “AML” came out of her mouth.They weren’t intended for me; she was just one of those people who reads out loud when they read. Perhaps she thought I knew. Perhaps she didn’t know she was reading out loud. It is a cancer center…I can’t think of an adequate adjective to put in front of “stunned” and “frozen” to adequately express that instant as the biggest WTF! of my life rang out in my mind…“It’s leukemia?! I have leukemia?!!!” My mind was reeling with that shock…It was quite a mental shift, in an instant, unsuspecting, unprepared, from MDS to AML.I suppose it was helpful to have the time to be past that initial reaction later, as I sat in one of Dr. Pemmaraju’s exam rooms, waiting to see him. He burst into the room almost as enthusiastically as Kramer on Seinfeld. He was young, energetic, positive and extremely enthusiastic.There I was, sitting face to face with one of the finest allopathic physicians… a hematologist/oncologist who only treats two types of leukemia and MDS.It was a briefly challenging/confronting situation on a philosophical level.You see, I’ve been writing, Power Without Pills: A Curious Psychiatrist’s Guide to Healing and Growth in the Modern World since Googling John Sarno, MD in February 2006. And, I have talked some trash about modern medicine. Not irresponsibly or inappropriately… but, trash talking nonetheless.I was challenged with substantial, in-my-face cognitive dissonance.I resolved it for myself quickly.I had been throwing the baby out with the bath water.I had been all “mindbody medicine is where it’s at!” and, then and there, I realized I had been going to an extreme.I once heard a man say, “You’re just as half-assed no matter which cheek you got.”So, I decided, “Alright... I like this guy... I trust this guy... I’m going to roll with this, and I’ll handle the mindbody part... and he’ll handle the traditional medicine part…”Both cheeks were suddenly firmly in place.He told me they have a clinical trial, using the CLIA protocol, where they’re getting upwards of 90% complete remission rates in frontline AML.All three drugs are FDA-approved for AML, but no one is using all three together. “We are gonna rock this thing! We are going to crush it together!”, he said, beaming.He told me I’d need some preliminary tests, like an echocardiogram, to qualify for the study... a formality.Then, I would be admitted, given five days of chemo, be in isolation, and have a total of around 28 days inpatient before being discharged to outpatient treatment where I would receive five consolidation rounds of the same three chemotherapy drugs every 28 days.He said I’d be in complete remission by Day 28.That conversation was on the Friday before Thanksgiving. He told me to go home and spend time with family... my wife was there in that initial consult and throughout, but I hadn’t seen my father in Austin in a while... it was a wonderful, deeply meaningful break/visit with close family before I went inpatient… ostensibly 28 days, in isolation.On the eve of Thanksgiving Day, I was admitted to the Leukemia Specialty Care Unit at MDA, at around 7 pm, and began chemotherapy that night.How I’ll be bathing in isolation for the next 3–4 weeks…My wife and father-in-law visit me in the square bubble…This woke me up in the middle of the night, tickling my nose…Going…Gone. My hair didn’t survive.It went exactly as he said; except I had a Day 21 bone marrow biopsy in the hospital. The next day, the attending on the service strode briskly into my room, smiling, and said, “Go home. You don’t need to be here any more.”My blast count had gone from 30% to 4%, complete remission, in 21 days.I said, “Uh… I’m not ready.” (My wife was four hours away and expecting me to be discharged in about a week).I went home the next day, six days early, for good biological behavior.I was in complete remission.There was suspense though. I was told through some magic called flow cytometry, they could give a measure of prognostication, MRD, Measurable Residual Disease. With MRD, they could find traces of leukemia, the presence of abnormal blasts, “down to levels of 1:10,000 to 1:1,000,000 white blood cells (WBCs), compared with 1:20 in morphology-based assessments.”[1][1][1][1]A few nervous days later, at my first outpatient follow up, I was given the news, “You are MRD negative.”A Senior Coordinator of Clinical Studies, Department of Leukemia, MD Anderson Cancer Center, Rabiul Islam, who’s worked there since 2003, gave me that wonderful news, and he added, “I have never seen an MRD negative patient at Day 21.”As I have said, I highly value and practice mindbody medicine; parts of that are a positive mental attitude and faith in the healing propensity of the body and the intelligence of life.And my positivity and faith had been rewarded at every turn (even developing leukemia, which I would not have consciously asked for); but it was never the kind of faith and positivity that produced a reaction to, “You are MRD negative,” of, “Well, of course, I’m MRD negative.”I cried when he told me and it brings tears to my eyes now as I write this. I am deeply grateful.And, along those lines, I have taught mindbody medicine concepts for over 20 years and was pleased to find nothing changed with being diagnosed with an illness that has a 25% five-year survival rate. I found, not surprisingly, I walked the talk. Yet, you don’t know how solidly your ship is moored until there’s a storm.As interesting foreshadowing, for years, as one approach to mindbody medicine, I would discuss the hypothetical situation in which someone was diagnosed with a type of cancer that had their physician say, “The 5-year survival rate is 5%.” I would then say, “I wouldn’t say, ‘Oh, no! Those are terrible odds!’ I would say, ‘What did the 5% do?’’’ (My apologies for the complex, and possibly incorrect sentence structure.)I have had many profound blessings in the powerful life lesson leukemia brought to me.To address the question:The leukemia was caught on a yearly routine blood test before I was symptomatic.I am young and healthy, with no comorbid illnesses, and I really stood out on the Leukemia Specialty Care Unit because of my youth, fitness, and lack of comorbid illness.I got the best cancer treatment in the world, I assert.I’ve had an excellent attitude throughout.I never fought the leukemia. I was never inclined to. At the local cancer center, the narrative was everywhere about fighting cancer; even the wifi password had that rhetoric… yet, I could not abide by that narrative.I’m not suggesting that people not adopt that narrative; it’s fine with me if they do; it’s just not for me. I’m not going to start a “Fight Fighting Cancer!” campaign.I do want people to know there’s more than one narrative to adopt in the face of cancer. Pick according to your gut.I’ve said thousands of times: “What you resist persists.” I would not fight. I would listen.I viewed the leukemia as a messenger, and my job was/is to get the message.I have enjoyed Louise Hay’s work, and was aware of the fact she gave meaning to particular illnesses.I thought, “Leukemia is a childhood disease…” Hmmmmmmm…I had started guided journaling at What is Self Authoring? many months earlier, and had started with the Past module (there are also two for the present and one for the future… starting with the past made the most sense to me…) but, I quickly fell into procrastination…One obvious message was, “I wouldn’t do that if I were you…”, meaning, I got one message as, “Don’t keep putting off deep work.”Now, acute myeloid leukemia is relatively rare with about 20,000 newly diagnosed cases a year. That’s an incidence of 0.006%. It’s rare.But, things would likely be much darker (which sounds weird to write, because I can’t say they’re dark (though I can admit if one looks at the five year survival rate for AML, one would be inclined to say they’re dark… but, that’s a statistic, and part of good mindbody medicine is not being negatively influenced by stats…)) if I hadn’t been getting yearly routine labs.TLDR:Get yearly routine labs like a CBC and complete metabolic panel.The risk/benefit ratio argues for it.Think of it as insurance… you definitely want to have it, even though you don’t want to use it.Extra credit edit:So as to exclude as few readers as possible, I am adding an important point…I have used the word, “blessing” more than once, and said that there is meaning in this life challenge/lesson, thereby asserting/strongly implying it’s not random; we don’t live in a strictly mechanical Universe, in which we humans are machines that break and consequently go to doctors that intervene on our behalf and restore us to health.I was ultimately convinced of that mechanistic worldview until the age of 23. I no longer believe in or inhabit that worldview… but no matter…I’m working on a reply to the gentleman’s comment in which it’s asked what I think caused the leukemia.My reply involves logic I learned from my mother, an adept at logic. She changed her worldview late in life with logic.She told me one day, she had done a thought experiment in which she made a matrix of cells… the particulars will be in the reply when I post it.It is the particular thought exercise that’s relevant here:Let’s say you can’t abide by the notion of an actual blessing, or the idea there’s meaning to be mined in a disease, especially a life-threatening one like leukemia, you can still potentially get the value of that system/belief through this exercise:Let’s construct a matrix of four cells: 2 rows, 2 columns…I’m blessed really/I’m not actually blessedI believe I’m blessed/I reject the possibilityThen stand in each cell and look out at the world as if those conditions are so… what do you see? Is that possibility empowering?You see, it isn’t the truth that I was blessed and it isn’t the truth there is meaning, not randomness, in the leukemia… it’s a powerful place to stand.For the strictly “If I can’t see it in a lab, it doesn’t exist,” Do you want to be empowered, or do you want to be right? Or, if your health isn’t good, do you want to be healthy, or do you want to be right?Consider everyone is a house with four rooms: physical, mental, emotional and spiritual.In the modern world, you risk falling prey to the paradigm, the physical level of reality is all there is… It’s all matter and energy… if you can’t see in the lab it doesn’t exist.That worldview may be true, and obviously, it may not be.If you hold yourself as a house with only one room, physical, which gives rise to the illusion of the other three rooms and that’s not the case, there may be a dear price to pay.EDIT (April 16,2019):I can’t say I’m about to add materially to my answer of the question; however, I can see how the reader might be curious as to what’s up as of today… I don’t remember when I wrote this; I see my last update was February 16th.There have been three excitements and one very sad loss since I last updated. I’ll end with the loss.About six weeks ago, after receiving a unit of red blood cells, an infusion which took about two hours, I drove home and sat on the couch. I started to feel cold and hot at the same time. Cold won out and I got underneath an electric blanket and turned it on. Very shortly I was having hard chills.My instructions from MDA since my December discharge were, “Go to the ER if your temperature hits 101 or more.” I didn’t have to take my temperature. My wife drove me to the ER. It was a Friday afternoon and the ER was packed. Getting into the ER was fun; because I have staff privileges there, but the staff up front and the triage nurse don’t know me from Adam. So, I went in the back doors of the large ER, bald, with an overnight bag slung over my shoulder and said, “I’m Dr. Murphy. I’m in treatment for leukemia and I have a fever.” Most of the dozen or so doctors, nurses, technicians and unit clerks behind the counter stopped what they were doing to stare at me. I stared back at them. Eventually, a nurse broke the deadlock. “17 is open,” she said stepping out to escort me.I was deathly ill. All the routine things… blood cultures, chest xrays, etc. were done, looking for a possible source of infection.For the next three days I lay in the dark, sleeping as much as I could. They left me alone, which I thought was odd, but appreciated. At MDA I don’t think they would have let me lay in the bed 24/7, and didn’t even when I had RSV (another story).Monday rolled around; nothing had grown in the blood cultures; and, I had started to feel better. About 11 am, having enjoyed a great rapport and relationship with everyone there, I said politely to the nurse, “Um, I’m going to be discharged. I just need to know whether it will be AMA or not.” 10 minutes later I was signing routine discharge orders, and I went home. I felt like crap.In retrospect, the most likely explanation was a non-hemolytic transfusion reaction, something that occurs in about 1 out of every 1,000 RBC infusions. This can occur if WBC’s stow away in a batch of inadequately washed RBCs. They cause a cytokine reaction, the kind of thing that makes you feel awful when you have the flu.Gradually, over the next few days, my energy came back.The second excitement was going back to MDA on a Friday, my chemo rounds always start on Friday, and had labs in the morning to prep to see Dr. P, who would then order the 3-day round of chemo.My WBC was below 1,000, even though, due to circumstances, I was on Day 35 of a cycle. Being in a clinical trial at MDA, there are protocols and guidelines and chemo was off; it couldn’t proceed.Once again, Dr. P predicted the future. He said, “We’ll do a bone marrow biopsy; you’ll still be in remission. You’ll go home. Have a great weekend. Come back Monday morning. We’ll do labs and give you a shot of Neupogen Monday and Tuesday mornings, and we’ll restart your chemo on Wednesday.”That was an exciting weekend; because, while the blast count was likely ready Friday afternoon, no one was there to read it. And, while I mentioned a couple of potentially arrogant sounding behaviors around febrile neutropenia hospitalization; I’m not the type to be inclined to try and get the results before Monday.I was able to think positively throughout most of the weekend. I did allow my mind to think about a recurrence, but not to dwell on that possibility. I wasn’t in denial; I knew the results of the biopsy could be bad news staying alive-wise. But again, I mainly stayed in positivity and continued to visualize my 90th birthday party (my father, Stu’s 90th birthday party is next month) and to affirm, “I am so happy and grateful now that I’ve released the patterns that gave rise to the leukemia.”Monday morning, after having had my labs, I was sitting and waiting in the 8th floor leukemia waiting area, waiting to be called back for an injection of Neupogen, my cell phone rang. It was Dr. Islam. “Your blast count is 2%.”I cried with joy, once again, as I did when he told me, “Your MRD is negative. I have never seen an MRD negative patient at Day 21,” months before.To be continued… fatherhood calls at the moment…there’s more coming… and… 95% of what I write on Quora is via iPhone… somewhat constraining…My two older sisters and I with our father at his 90th birthday party last month, May 2019. He’s a huge inspiration, and not just because that’s his house we’re visiting and he’s had CLL for ten years and has only accepted monitoring of it.I’m coming up on 6 months complete remission. There’s much more to write; and, my commitment is that what I write make a difference for you.And, as promised above, there’s more to the story and I will flesh out what I believe made the difference in the face of a potentially terrifying disease…Today, my hair, like springtime blossoms, is sprouting again… a sign of the life force, irrepressible, pushing up through the cracks in the sidewalk…Here’s to New Life……and again, more to come…Edit: July 4th, 2019Today, the 4th of July, enjoying Life. I’m 60 now… my hair’s sprouting… the sprouting started this Spring after the chemo was finished… I gave that timing meaning… Springtime… new life…I intend to share more about this experience, and yet, I’m not sure this is the place to do that given the original question.So far, it has been a pleasure to have this forum to share my experiences with leukemia and everything related. If you have a suggestion as to a better forum/platform to share my knowledge, experience and hope with regard to leukemia, let me know.EDIT Saturday, July 27, 2019:I had surgery Thursday to have a myringotomy and tympanostomy tube placed in my left ear. It went perfectly.Fluid filled my left middle ear during my last hospitalization (for febrile neutropenia) in April. There were two complications from that hospitalization, I presume from high dose IV vancomycin and cefipime… a sudden and persistent left ear effusion and neuropathy of my distal feet bilaterally.The tube has all but resolved the effusion (it’s present in the morning, but drains within and hour or two). And the neuropathy, which consists mainly of the sensation my socks, no matter what their fabric, are filled with sand in the toes, and there is pain at times, increased initially with hard shoes and jogging. However, the jogging actually seems now to be a force for its resolution.I set a goal of running a 10K by September 29th, a goal RunKeeper helped me to decide on. Thanks to my varsity tennis playing son, Elliot, for that app tip.I had preop labs Tuesday, and coincidentally, two month followup labs for my heme/onc, Kavita Nirmal, on Wednesday. Not surprisingly, they were both very close…WBC 4.1Hgb 16Platelets 157,000It’s all good.EDIT Thursday, September 12, 2019:Reporting in for the curious…My post above starts with the yearly routine labs I had done September of last year, 2018. That’s cool, and relevant to the question.I’ve had two haircuts since my nuked hair decided it was OK to start growing again. Gone is the childhood fear of the barber or stylist getting it too short.I’ve run 5 days a week since July 21st, and I am registered in Texas Oncology’s Celebrate Life Survivor’s 5K on the 28th.There are two big benefits of running 5 days a week.One is the health and fitness benefit which is enough on its own.The other is, who I am for myself today is larger than who I was when I was saying, “I need to start running again,” for SEVEN years. (I was shocked about 4 months ago, in a moment of self-clarity, I caught myself running that line of bullshit past myself, and I stopped and asked myself, “When was the last time I exercised regularly?” …2012. Damn, Dude. You’ve been saying that to yourself for SEVEN years.)About 3 months ago, I started making the bed if I were the last one out. I’d heard Dr. Jordan Peterson recommend this one before solving any of the world’s problems. “Make your bed.”About a month later, during breakfast with my varsity tennis playing son, I downloaded an app, RunKeeper, he’s using to log his many runs.It started pressuring me to run a 10K in a month. I reacted, “I’m 60 years old. I’m not running a 10K in a month… I’ll run one in two months,” and on July 21st, I started running 5 days a week.Another recent shift in who I’m being in the world is manifested by the fact that I’m writing again.UPDATE: September 30, 2019I beat my oncologist in a 5K this weekend! Sorry, Dr. Nirmal. Good run!Not that long ago, my hemoglobin was 7 and I got winded climbing a flight of stairs. Now it’s 17 and I can run a 5 kilometers!UPDATE: October 25, 2019:It just occurred to me it is getting close to the one year mark that I went to MD Anderson for the first time and I don’t think I’ve adequately acknowledged them.To me, and probably by objective measures, MD Anderson is the best cancer treatment center in the world. It must be one of the largest with over 20,000 employees and over 15,000,000 sq ft of space. Yet, it is one of the best run organizations I’ve ever seen of any size. That’s important. But, not as important as the care and concern I saw everywhere. The ethos there is healthy, upbeat, nourishing and inspiring.In particular, I want to acknowledge and thank to a depth appropriate to one given to someone who participates in literally saving a life. Naveen Pemmaraju, thank you for saving my life. I am the father of a now 3-year-old, precious boy. I am also the father of two other boys, 19 and 17, who shouldn’t lose their father, either; yet, the biggest save was saving the life of the father of this precious 2-year-old boy.December 13, 2018 - Just discharged from MD Anderson’s Leukemia Specialty Care UnitThis is what I’m talking about, Naveen. This is such a huge gift. Words aren’t adequate to express the depth of my gratitude. Thank you.Rabiul Islam, thank you for your relentless close support and encouragement. You repeatedly went above and beyond calling me on my cell and keeping me informed. And, the moment you told me I was MRD negative is one of the happiest moments of my life. You didn’t have to add, “I have never seen an MRD negative patient at Day 21.” But, you did and that made a deep, profound positive impact. It has been some of the best medicine mentally and emotionally, and probably physically and spiritually. All boats rise with the tide. What a profound gift. Thank you.Michael Andreeff, thank you for who you are personally and professionally. You were my first inpatient physician contact, and it was, interestingly, on Thanksgiving Day. You walked into my room with an entourage of residents and fellows and said, “Who are you, and vot are you efen doing here?” (Sorry, that’s my recollection of your delightful German accent.) I loved our banter. When I told you I was a psychiatrist, you told me, “I vanted to be a psychiatrist, but I vound up being this.” You were part of the development of flow cytometry in the early days in Heidelberg. Flow cytometry told me the leukemia was gone down to a resolution of 1:1,000,000 WBC’s compared to 1:20 resolution possible with a microscope alone. Thank you for the quintessential physician that you are; and, thank you for having me look forward to witty banter every morning at morning rounds. What a delight.Zeev Estrov, thank you for who you are. Two memories stand out. You came into my room the morning after my Day 21 bone marrow biopsy and said, “Go home. You don’t need to be here anymore.” And, after I started to recover from the seeming near death experience from RSV, I perked up for your morning rounds; and, you and your entourage of residents and fellows came in. I had finally had a good night’s sleep and told you so. You turned to your students and said, “That! will tell you more than any lab test.” To me, such a brilliant moment of teaching. In medical school, I remember the lesson of one of my professors, “You treat the patient, not the labs.” You are another star in the MD Anderson firmament.To the staff of the 12th floor Leukemia Specialty Care Unit and to the nurses who inserted my PICC line, I cannot say enough to thank you and express the gratitude I have for my treatment there. It is a difficult thing to be a young man, otherwise healthy, diagnosed with a life threatening disease and facing an uncertain future, knowing it included, at the least, chemotherapy and weeks of isolation. I don’t think I’ve told anyone this because it sounds weird. When Dr. Estrov told me to go home on Day 22, I was disappointed. That’s partly your fault. Good job. I’d say, “Keep it up,” but that would be silly. It’s who you are.To the 8th floor Leukemia Clinic and staff, thank you for always being friendly, upbeat, professional but not dry or stiff, and always being a well-oiled machine. Wow. You and your clinic and lab are part of the reason that the thought occurred to me, “This is the best run organization I’ve ever seen of any size.” Amazing. Thank you.To my individual nurses, inpatient, outpatient and chemo, because all of you were so extraordinary in skill, compassion and presence, I got to be right every time about how great MD Anderson is, every time. Every contact. Thank you.To the nurse who put in my PICC line, when I was the most alone and scared, Wednesday night, alone before Thanksgiving Day, thank you for your flawless insertion of a central line, your calming bedside manner, and thank you for telling me you had multiple myeloma years before and remain disease free. (The only thing that could have made the whole experience better, for the next patient, consider leaving out the part about your PICC line getting infected. :) ) Thank you.There are so many people to thank. Right now I am acknowledging you, MD Anderson. Thank each and every one of you. I am weeping now in gratitude as I get in touch with the magnitude of the gift and how you gave it. Jackson just turned 3. He will thank you one day. For now, I thank you on his behalf.Oh my! There are so many people to thank!To be continued…EDIT: January 7, 2020An interesting “problem” is arising here… the longer I live, the less appropriate the word “recently” in the opening line of this answer is… in December, less than a month ago, I went back to MD Anderson for my first checkup since July. All is well and my MRD continues to be negative over a year after entering remission. Thank you, Dr. Pemmaraju and all of you at MD Anderson.And, as I mentioned above, there are many more to thank. I will address two of you now:To Nortin Hadler, MD, of UNCSOM. Nortin, your startlingly deep compassion and ability to read between the lines of what I was saying moved me to tears. You heard me asking things I didn’t know I was asking. Your clinical acumen and profound compassion were so intense at times it was hard to be with. You encouraged me at a deep level. Not long before I was diagnosed with AML, I wrote you to thank you and tell you how much your work has meant to me as a physician and reader. I didn’t expect a reply, let alone one of such thoughtfulness. Then, during my struggles with leukemia, you shined as a lighthouse of steadfast personal and clinical wisdom. Thank you for hearing what I didn’t even know I was expressing and addressing it.To Steve Derdak, DO. My sister, one of the finest physician’s I know, refers to you as the smartest physician she knows. That’s quite an endorsement. I still remember visiting you when you were in medical school and thumbing through your Harrison’s Principles of Internal Medicine to find it thoroughly highlighted. Years later as an intensivist at Brooke Army Medical Center you brought your vast clinical experience to me personally in a very frightening and challenging time. Thank you for being there. And thank you for your sweet, personal bedside care of Marty at our home during her final days.And thank you Quorans for your views and upvotes. I deeply appreciate it!More to come.Edit: June 21, 2020Went back to MD Anderson a couple weeks ago for a routine followup. Results were all good except MRD.CBC great. Bone marrow aspirate showed 1% blasts (normal is < 5%). All very exciting. 6 days out a notification popped up on my phone that Dr. Pemmaraju wanted a telephone appointment with me.That was not welcome news, and I couldn’t wait until the next day to find out why. I called his PA, Rodney, and learned the news. My Measurable Residual Disease is now positive. I am in morphological remission, but not at the level of resolution provided by amazing technology.Dr. Pemmaraju’s recommendation is 3 rounds of venetoclax and azacitidine (VEN/AZA). Mild chemo… he used the analogy that the previous chemo is like a bomb and the VEN/AZA is like a Predator drone strike.He said my MRD will turn negative again. And he referred me back to the Stem Cell team.No problem seeing the Stem Cell team again for a consult but I was dead set against it.My thinking was why would I sacrifice feeling great for the devastation SCT is?And I’ve already created this narrative of how powerful mind/body medicine can be…It wasn’t an easy choice at all. And at one point in the last 16 days of wrestling with my circumstances I decided to do SCT but from a place of fear. (There’s a powerful distinction between choosing and deciding worth taking a look at.) Then I decided against it.At some point I looked at the scientific research and statistics on it; then I watched some inspirational videos by successful recipients and using the rhetoric from one of those people, switched to viewing SCT as an investment in my future. And I went back to my matrix of 4 cells and considered each possibility it boiled down to which mistake I would rather make…Have a stem cell transplant when I could’ve done well using mind over matter after allorNot have a stem cell transplant when in fact I needed one to prevent death by AML progression?Decision is derived from the root word “cide” or to kill off. In a decision the circumstances and considerations determine the selection… you have a pro list and a con list and the selection is based on which list is longer. The alternative is killed off by the considerations.Choice: To select freely and after consideration.Initially I decided no. Then I decided yes. All of that occurred in a field of fear and suffering.At some point I chose SCT and a feeling of peace came over me.I am at peace with the choice and the outcome.Once again, I think I will fare exceptionally well and I know that isn’t a given.I realize one outcome is death by overwhelming infection, organ failure or graft vs host disease.That is out of my hands. I accept my fate. I choose it.And I am happy to share the journey ahead.Edit: August 3, 2020Day 1 Cycle 2 of venetoclax and azacitidine. Mild chemo. The first cycle of this had few side effects and no hair loss. It was surprisingly hard on my kidneys… the cycle is Monday through Friday every 28 days (if possible) and my creatinine spiked to 1.5 on that Friday. It returned to normal and a nephrology consult concluded it was a reaction to the venetoclax. Dr. P concluded it was an idiosyncratic reaction and doesn’t think it’ll happen again.Edit: November 3, 2020Getting Busulfan at MD Anderson this morning in preparation for a stem cell transplant.I am quite well and continue in morphological remission. My MRD turned positive in June for the first time since December 2018. I’ve accepted MD Anderson’s recommendation for a SCT. It’s been their recommendation all along, but until June insurance wouldn’t pay for it and I didn’t want it. However, confronting a dead canary down here in the mine, two thoughts persuaded me.I have three boys, the youngest is four. In that context I look at this as an investment in the future; and, I’d rather have it and not need it than need it and not have it… I met a wonderful man in his early 70’s, John, in an infusion room last year. Delightful. I got to talk to him at length twice. Delightful man. He looked well to me. However, his chemo had never gotten him into remission and he died very quickly. His death hurt deeply. I grieved his death and I could feel the pain of it much more acutely than my mother’s 8 years ago, something I think odd. Perhaps it was the reminder of my vulnerability.I remain optimistic and grounded in my choice and commitments.Today is the first day the thought, “I am a writer” occurred so consonantly. Perhaps the dawning of the reality of death, not necessarily of its immanence, but of its ultimate reality, shifted my audience from what others think to what I think. I’ve a story to tell. It’s for me and that others may benefit.“The ill person who turns illness into story transforms fate into experience…” —Arthur Frank, from The Wounded StorytellerFootnotes[1] Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party[1] Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party[1] Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party[1] Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party

In advance, this question asked for more specification. What do you mean by most innovative thinker? In relation to his influence in daily life activity or more sophisticated. Innovation is a big and expensive word. Some would say innovation depends one the aim you focus.The question is, what angle of approach you are using to answer, more of an economic or an practical or an artistic of an social political point of view? So my answer is subjective and would not be general.Germany has the biggest population in central Europe and the most powerful economics. Which person has the most influence, who controls the main discussion, to whom they are listening?Certainly, the Chancellor Angela Merkel is the most influential person in Germany, but certainly not the most innovative.I would rather say it depends on what is important and significant for you.The most popular person does not means that this person is always the most influential one."Our best": http://en.wikipedia.org/wiki/Unsere_BestenWho influences the content and structures in a excellent and sustainable way is innovative in my opinion. So the person I mentioned are innovative in this defined matter of fact.The register of twenty is my personal list and have nothing in common with the Cicero report below, the order of the following list is associative and arbitrary.Dr. Ulrike Guérot (b.1964) is one of the most excellent political thinker, scientist and serves the Berlin office of the European Council on Foreign Relations. There, she works and conducts research in the areas of European integration, European institutions and the France-Germany and German-American relations. She coins the term and concept of transnational policy, she is one of the most influential expert about German-France relationship.Peter Sloterdijk (b.1947) is a German philosopher, cultural theorist and author, has triggered numerous debates with his articles and books in Germany.Alexander Kluge (b.1932) is a filmmaker, television producer, novelist and screenwriter as well as a doctorate in law. He was known as one of the most influential representatives of the New German Cinema, which he co-founded and developed in theory and practice. Since 1972 he is working in common withOskar Negt (b.1934) is a philosopher and social theorist in the tradition of critical theory. He is Professor of Sociology at the University Hannover. He studied law and philosophy in the University of Göttingen and the University of Frankfurt am Main as a student of Theodor Adorno, and was an assistant of Jürgen Habermas at the University Hannover. In 1972, Negt with an initiative group of union-oriented parents, teachers and educators Glocksee in Hanover. This should work according to the principle of self-teaching practice and exemplary learning through project work. Negt headed over ten years the scientific monitoring of school.As I say from 1972 he started many years of cooperation with the writer Alexander Kluge numerous joint projects such as the writings of public and Experience (1972) and History and stubbornness (1981) and the book proportions of the Political (1992) emerged. In 2001, the two published the two-volume collection The underrated man. In addition, by 2010, created nearly 50 television dialogues with Kluge.Negt founded in 1994 with the initiative Loccumer critical scientists, who had "the intellectual and political dominance of conservative and neo-liberal ideologies in public life" come together out of concern for its own account. Negt as a scientist connects both subjects the sociology and the philosophy.Jürgen Habermas (b.1929) is one of the most frequently cited philosophers and sociologists of the present. In the philosophical experts who started with work on social philosophy with discourse, action and rationality theoretical contributions, with whom he continued the critical theory on a new basis. For Habermas, communicative form interactions in which rational grounds of validity are raised and recognized, the basis of society.Frank Schirrmacher (b.1959) is one of the most influential German journalist, doctored literature expert and essayist, author and since 1994 co-publisher of the leading newespaper Frankfurter Allgemeine Zeitung.Gabor Steingart (b.1962) is a German journalist and author. From 2001 until June 2007, he led the Berlin office of the German news magazine Der Spiegel in Berlin, and then worked for the mirror office in Washington. From April 2010 to December 2012 Steingart was editor of Handelsblatt. In October 2012, he was appointed to the four-member Board of Handelsblatt publishing group.Germany's leading economic newspaper.Prof. Wolf Singer (b.1943) is a German neurophysiologist. In 1981 he was appointed member of the Max Planck Society and Director of the Department of Neurophysiology at the Max Planck Institute for Brain Research in Frankfurt am Main.Singer gets through his trenchant comments in interviews, lectures, and popular science essays again and again into the center of public debate. His conclusions from the research in neuroscience in terms of political and legal, psychological, and developmental psychology and educational or anthropological, but also, for example architectural or urban planning issues to such historical and philosophical-ideological nature are often picked up by the press.His theories were discussed particularly controversial for free will. Singer refused to talk of a free will. This he took public in 2004 in a FAZ article expresses its subtitle it in slightly different wording put interconnections are fixed: We should cease to speak of freedom to the main title of the reprinting of an extensive scientific contribution to the professional debate "brain as a subject? (Part I) "made in the German journal for philosophy.Singer urges that the absence of free will would have implications for our concepts of guilt and punishment: When seen in science no one can decide freely, it is not sensible to make people responsible for their actions. Socially unacceptable people would have "locked up" and "specific education programs" - are "subject" - literally so on.Prof. Gerald Hüter (b.1951) is a German neurobiologist and author of much-discussed theories of learning and education. From 1979 to 1989 he conducted research in Göttingen, the Max Planck Institute for Experimental Medicine in the field of brain development disorders. In 1988 he habilitated in the Department of Medicine at the University of Göttingen and received the teaching license of Neurobiology. From 1990 to 1995 he was a fellow in the DFG Heisenberg program and worked in this context in the department of basic neurobiological research.Prof. Christiane Nüsslein-Volhard (b.1942) is a German biologist. It deals with genetics and developmental biology, and since 1985 director of the Department of Genetics at the Max Planck Institute for Developmental Biology in Tübingen. She received the 1995 Nobel Prize in Physiology or Medicine for their research on the genetic control of early embryonic development.Botho Strauß (b.1944) is one of Germans most influential playwrights, novelists and essayists. In his theoretical work, Strauß showed the influence of the ancient classics, Nietzsche, Heidegger as well as Adorno, but his outlook was also radically anti-bourgeois.His work as a writer has been recognized with numerous international awards and his dramas are among the most performed in German-language theatres.Jonathan Meese (b.1970) is a most discussed and influential German painter, sculptor, performance artist and installation artist based in Berlin and Hamburg. Meese's (often multi-media) works include collages, drawings and writing. He also designs theater sets and wrote and starred in a play at the Volksbühne Theater in Berlin.Dr. Gunter Dueck (b.1951) is a German mathematician and author of ideological and philosophical nonfiction. Dueck works since 1 September 2011 as a freelance writer and speaker. He is a corresponding member of the Academy of Sciences at Göttingen. Early 2013 Gunter Dueck took part in the Hello World as a founding partner! Publishing Ltd., which builds the Internet platform BlueForge. BlueForge Wikipedia is a kind of software, evaluated in the software, and comments can also be tried "in the cloud". Dueck published satirical and philosophical books about life, people and managers. The most important part of his philosophy he put in a trilogy with the following volumes down: Omnisophie: About right, true and natural man (2002), Supra Mania: From duty to the people score-Man (2003) and Topothesie: man in animal welfare (2004).Prof. Anke Doberauer (b.1962) is one of the most innovative, contemporary German painter. Since 2003 she is a professor of painting and graphic art at the Academy of Fine Arts in Munich and lives in Marseille and Munich.The painter is mainly known for her large-scale representations of men, the main motive of their life-size photo realistic figure paintings. They show the man as androgynous, narcissistic and very vulnerable, but very covetable beings. One of the early images of men Doberauer developed further visual forms. She portrayed objects, flowers, animals, people and landscapes eventually. These are always painted plein air and often conceived as a multi-part panoramas. Work on the production of the greatest possible presence of color, light and depicted persons led to a painting in the form of wall painting. Meanwhile, panel paintings have the dimensions of wall paintings. Since 2001 monumental panoramas whose foreground is formed as "Repoussoir" were back serving life-size figures. The nearly nine-meter-long work 'Sunset' was installed in a room box.Christoph Schliengensief (b.1960, died in Berlin in 2010) was a German film and theater director, writer and performance artist. Starting as an independent underground filmmaker, Schlingensief later began staging productions for theatres and festivals, which often were accompanied by public controversies. In the final years before his death, he also worked for the Bayreuth Festival and several opera houses, establishing himself as a Regietheater artist.Pina Bausch (b. 1940, died 2009) was a German performer of modern dance, choreographer, dance teacher and ballet director. With her unique style, a blend of movement, sound, and prominent stage sets, and with her elaborate cooperation with performers during the composition of a piece (a style now known as Tanztheater), she became a leading influence in the world of modern dance from the 1970s on.Cornelia Caroline Funke (b.1958) is a multiple award-winning German author of children's fiction. Funke is best known for her Inkheart trilogy, with the English translation of the third book, Inkdeath, released on 6 October 2008. Many of her books have now been translated into English. Her work fits mainly into the fantasy and adventure genres. She currently lives in Beverly Hills, California. Funke has sold over 20 million copies of her books worldwide.Thisbe K. Lindhorst (1962) Dr. Professor of Organic and Bioorganic Chemistry. She is the first woman on a chair of chemistry in Germany, it is internationally connected and in demand worldwide as an expert.Julia Fischer (b.1966) is a German biologist and primate behavior researcher. After a research fellowship at Harvard University and the National Institutes of Health in the United States in 1997, she worked as a postdoctoral fellow at the University of Pennsylvania in Philadelphia. During this time she explored to 1999 as head of the "Baboon camp" in Botswana communication of wild baboons. From 2000 to 2004 she worked at the Max Planck Institute for Evolutionary Anthropology in Leipzig, habilitated there in 2004 and was awarded a Heisenberg fellowship of the German Research Foundation (DFG). Since November 2004, Fischer is Professor of Cognitive Ethology at the Biological Faculty of the Georg-August-University Göttingen and Head of the same research group at the German Primate Center.Momo Ende (b.1974) is one of the most popular and influential literary figures of children's literature in Germany and Europe. It is a story about the concept of time and how it is used by humans in modern societies.http://en.wikipedia.org/wiki/Momo_(novel)The 500 most important intellectuals: The Cicero list reflects the intellectual influence of the German intellectuals. It depicts their interpretation of public power, but does not measure the quality of content. The survey refers to the last ten years. It is based first on the presence of the 160 most important German newspapers and magazines. These are searched electronic databases for reference frequencies. 2 citations are found on the internet. 3 hits in the literature search on Google Scholar are counted. 4 reflect cross-references in biographical archive Munzinger the importance of intellectuals in networking. Active and ex-politicians were not considered.http://www.cicero.de/bilder/die-liste-der-500-wichtigsten-intellektuellen?image=34

Q. Can America sentence young non-violent people to military basic training and advanced skilled training instead of a prison sentence?A. Correctional boot camps were the rage in the US in the 1980’s and 1990′s. Meta-analysis conclusively showed no improvement in recidivism, or cost savings. Two papers included were reviews of US experience (vengeful justice) as models/cautionary tales for Australia and the United Kingdom.Correctional boot camps (United Kingdom)What is the focus of the intervention?Boot camps are programmes for juvenile or adult offenders as an alternative to punishments such as prison or probation. They are modelled on military boot camps and involve activities such as drills, ceremony and physical training. Strict daily schedules are followed, and punishments for misbehaviour often involve physical activities like push-ups.Programmes differ based on content and delivery of physical and therapeutic aspects, which could include education, substance abuse treatment and improvement of cognitive skills.This narrative summarises the findings of three systematic reviews. Review 1 was based on 32 studies, Review 2 was based on 44 studies and Review 3 was based on 16 studies.The conclusions on effect size are taken from Review 1 only.All boot camp studies included in the reviews were conducted in the USA.EFFECTHow effective is it?There is some evidence that the intervention has either increased or reduced crime, but overall the intervention has not had a statistically significant effect on crime.In Review 1, while individual studies found both statistically significant positive and negative effects on crime, the overall analysis showed that boot camps had no overall effect on rates of re-offending by participants. This result was consistent across all three reviews.How strong is the evidence?The overall evidence is taken from Review 1 (based on a meta-analysis of 32 studies).The review was sufficiently systematic that most forms of bias that could influence the study conclusions can be ruled out.It had a well-designed search strategy, included unpublished literature and risks of bias by the reviewers were minimised.However, biases remain within the primary studies, including the difficulties of comparing boot camps to one another due to differences in treatments, the use of different outcome measures by researchers, and the problem of drop-out rates and how to take these into consideration when calculating effect sizes.MECHANISMHow does it work?The authors of Review 2 provided the most comprehensive attempt at explaining how boot camps work to reduce reoffending.By ensuring strict discipline and demanding physical exercise and labour, participants are encouraged to behave respectfully and obediently, hopefully making them more likely to comply with rules or laws upon programme completion.Adherence to daily routines and interactions with camp staff should teach participants skills to help them control their behaviour.Prosocial behaviours such as respect are also taught and practiced, with close supervision allowing positive behaviours to be reinforced and negative behaviours punished immediately.Review 3 also mentioned increasing self-esteem and promoting physical fitness as life skills.MODERATORSIn which contexts does it work best?The reviews noted a number of potential moderators, including offender characteristics (age and gender), programme characteristics (focus on rehabilitative or physical elements), treatments (drug treatment, vocational education and aftercare components), whether the programme was voluntary or mandated, and the presence of counselling sessions as part of the programme.None of the three reviews explained why or how these contextual differences might influence the outcome.Review 1 found that participants in boot camps with a strong therapeutic component including treatments such as education, drug treatment and counselling had lower rates of reoffending than those in camps with a stronger focus on physical elements.They also found that juvenile boot camps without a counselling component had a statistically significant negative effect upon re-offending rates of participants.Review 2 found that participants in voluntary boot camps had reduced rates of recidivism compared to mandatory boot camps. Review 2 also discovered that voluntary boot camps for young people significantly reduced the participants’ odds of recidivism (based on only 3 primary studies).While no moderator analysis was conducted on race, review 3 noted that up to 80% of boot camp participants were ethnic minority youths, despite boot camps being originally designed for white, working class participants.IMPLEMENTATIONWhat can be said about implementing this initiative?Boot camps are structured programmes, which generally last between 90 and 180 days.There is a graduation ceremony attended by family and friends for those who successfully complete the programme.Participants are housed in dormitories resembling military barracks, are placed in squads or platoons, and wear uniforms. Programme staff function as drill instructors and are often addressed by military titles. Punishment for misbehaviour is immediate, and usually takes the form of physical activities such as push ups.All three reviews note that studies evaluating boot camps with a strong therapeutic element seemed to have a higher chance of a successful outcome than those with a weaker or no therapeutic focus. Review 3 noted that programmes vary widely in the application and duration of therapeutic elements. Review 2 suggested that aftercare services with therapeutic content are important, and therefore, should not be short term in duration.ECONOMIC CONSIDERATIONSHow much might it cost?While none of the reviews conducted a full cost benefit analysis, some mention of costs was reported in the primary studies.Review 2 cited one study, which found that in 1997, the cost per boot camp participant was $31,752 less per year in California, compared to the cost of incarceration. Another study reported a similar comparison and found that in 2001 boot camps were $78,700 cheaper than prison per participant per year. Review 3 stated that the Alabama boot camp cost a total of between $779,229 and $1,676,880 less than participants being in prison. Three studies within Review 3 found that boot camps were cheaper than prison, while four studies found no difference.General considerations• Boot camps differ substantially in content – some camps focus on physical training and hard labour, while others emphasise delivering therapeutic programming such as academic education, drug treatment or cognitive skills.• Boot camps with an evidence-based therapeutic focus see the largest reductions in recidivism amongst participants.SummaryThere is some evidence that the intervention has either increased or reduced crime, but overall the intervention has not had a statistically significant effect on crime. Those boot camps that have seen the greatest reduction in participant recidivism, especially with juvenile populations, have focused upon therapeutic elements within the programmes.Ratings for Individual ReviewsResourcesReview 1: Wilson, D.B., MacKenzie, D.L., Mitchell, F.N. (2003) 'Effects of correctional boot camps on offending' Campbell Systematic Reviews 2003:1, DOI:10.4073/ csr.2003.1Review 2: Meade, B. and Steiner, B. (2010) 'The total effects of boot camps that house juveniles: A systematic review of the evidence', Journal of Criminal Justice, 38, 841-853Review 3: Riphagen, R. C. (2010) 'Effectiveness of Male Juvenile Boot Camps in the United States: A Critical Review of the Literature', Doctoral Dissertation, Azusa Pacific University.Uploaded 04/06/15Boot camps a poor fit for juvenile justice (Australia)October 24, 2012 2.36pm AEDT Robyn Lincoln Assistant Professor, Criminology, Bond UniversityQueensland unveils tenders for two new boot camp programs for young offenders.The Queensland Attorney-General, Jarrod Bleijie, has authorised a tender process for the operation of two youth boot camps. The camps, aimed at 13 to 17 year olds, are to be trialled in Cairns and on the Gold Coast for a two-year period. The camp in the north of the state is an intensive diversion program for “sentenced” juveniles, while that in the south-east corner is an early intervention scheme for “at risk” youth.As with all matters of justice, Queensland is not alone in proffering boot camps as the “answer to youth crime”. The Brumby Government proposed school-based camps for Victoria in 2010, and both the Northern Territory and Western Australia have flirted with such programs as early as the 1980s.In the wake of calls for the operation of boot camps to solve problems of youth crime, it is instructive to examine what they are, what inspires them and what the research evidence reveals about their outcomes.The shape and size of boot campsThere was a proliferation of boot camps in the USA in the 1980s and 1990s, where millions of dollars were diverted to their operations.They come under the guise of wilderness, bush, work, motivational and challenge camps. Some are attached to schools or prisons and many are geared toward adult offenders, but a significant proportion are aimed at “recalcitrant youth”, some set up specifically for females.While the camp programs vary, the common features of these residential programs are that they are established on militaristic lines with an emphasis on deference to authority, conformity, intimidation, isolation, and concentrated physical training.The tender documents for the proposed Queensland camps appear no different. The program intends to instill “discipline and respect”, ensures “direct consequences for offending” and entails considerable “supervision”.Moral foundationsThe very concept of a boot camp is based on the notion of individual responsibility for crime and anti-social behaviour. It is about failure of parents or families and ultimately of the young people who find themselves in trouble with the law.The principles revolve around shock treatment, power and control, and disciplinarian techniques. To that end they exemplify the “get tough” politicisation of crime, a misplaced view that we have the capacity to correctly identify threat and risk. A misguided belief in the effectiveness of the punitive approaches of past centuries.This is what has been labelled by some as “vengeance justice”. For even though these programs purport to “address the causes of crime”, they are mean-spirited and sheet the blame for crime solely at the individual level.Queensland Attorney-General Jarrod Bleijie addresses the press. AAP/Dave HuntEvaluating boot campsDuring the 1990s in particular and in the USA specifically, a number of studies were conducted into the effectiveness of boot camps. Similar evidence emerged from the UK about a range of “short sharp shock” treatment regimes.All of this empirical work shows quite clearly that there is no benefit to boot camps. Whether the measures are re-offending rates or whether it is centred around cost-effectiveness — there is little to show that boot camps offer a beneficial alternative.Of course given the variety of boot camp philosophies and the practices of their daily regimes some caution needs to be exercised about the research evidence. In addition, trying to conduct any truly robust research is difficult and rarely are quasi-experimental designs used (that is, random allocation of youth to boot camp versus a range of other interventions that are then followed up in the long term).Yet even in studies where there were some differences in outcomes, they were marginal or negligible and could often be sheeted home to the backgrounds of the offenders (age, sex, previous convictions) rather than any militaristic-style intervention they had undergone.Of most significance is that some studies showed that there was potential for greater effectiveness when the boot camp included some kind of “treatment” option which flies in the face of the fundamental philosophy of such camps.In the last decade more sophisticated research has emerged including meta-analyses of multiples studies. However the findings remain, that there were no significant differences on re-offending measures between those who attend a correctional boot camp and those who did not.Even when the “softer” style of boot camps were evaluated there were no differences on recidivism. Similarly studies that have undertaken longer term follow-ups show no benefit. In research where a cost-saving has been identified this was only because offenders spent slightly less time in prison. Finally, one evaluation of a school-based camp again found no differences on re-offending but participants displayed “favourable” views of the program.Does the boot fit?Thus several decades of evaluations of boot camps has demonstrated quite conclusively that they are not effective in reducing recidivism and have marginal impact on cost-savings.The problem with these “shock and awe” tactics is that they are centred around individual responsibility. This shows a fundamental lack of appreciation of the “causes” of crime — demographic changes, deployment of police, reform to criminal codes, urban design, extended surveillance, tougher supervision orders.Most of all it signals a vengeful justice system. Let’s face it, boot camps are founded on fear and terror.Return to the Crime Reduction ToolkitJuvenile Boot Campshttps://www.ncjrs.gov/pdffiles1/nij/197018.pdfConclusions: Correctional practitioners and planners might learn from boot camps’ failure to reduce recidivism or prison populations by considering the following:■ Building reintegration into the community into an inmate’s individual program and reentry plans may improve the likelihood he or she will not commit a new offense.■ Programs that offered substantial discounts in time served to those who completed boot camps and that chose candidates sentenced to serve longer terms were the most successful in reducing prison populations.■ Chances of reducing recidivism increased when boot camp programs lasted longer and offered more intensive treatment and post release supervision, activities that may conflict with the goal of reducing population. Efforts to achieve multiple goals are likely the overall cause of boot camps’ conflicting results.Program designers are urged to determine which options are best for their jurisdictions; for example, they may consider whether to implement more treatment programs or move inmates out of the system more rapidly. These decisions affect costs, as prison bed-space savings go up or down. Other correctional programs are adopting some of the important elements of boot camps—for example, carefully structured programs that reduce idleness—to increase safety and improve conditions of confinement for younger offenders.20 However, in recent years, some jurisdictions facing rising costs have responded by cutting programs.One lesson for policymakers from 10 years of boot camp research is that curtailing programs may lead to increased violence, misconduct, and serious management problems.Boot Camp Justice for Juvenile OffendersAfter the crime rate for those under the age of 17 doubled in a five year period, Camp Stop, a military-style boot camp, was opened. This program aims to deal with juvenile offenders and steer them away from a life of crime. Fourteen-year-old Norton G. explains why he was incarcerated. Sgt. Major Richard Hurt believes boot camp can make a positive difference in kids’ lives. While life is harsh at Camp Stop, it cannot compare with life in Georgia prisons in the 1930s. Scenes from the movie I Am a Fugitive from a Chain Gang, based on a book about Georgia prisons, show how the mistreatment of prisoners led to prison reforms.Criminal Justice and the Juvenilehttp://file:///C:/Users/RAD/Downloads/1978-6398-2-PB%20(1).pdfhttps://www.fdle.state.fl.us/FCJEI/Programs/SLP/Documents/Full-Text/Bobbitt-thomas-paper.aspx