The other sure thing

We’ve touched on death in these pages before. I don’t know that we’ve ever talked about taxes.

I heard a politician talking about tax cuts. That seems to be the central theme of nearly every Republican. We’ve been taught to think of taxes as a bad thing and as cutting them to be the best thing our politicians can do for us.

If cutting them is the best thing they can do, why do they have jobs? Taxes pay their salaries. If we don’t need taxes and don’t need the services provided by them, why do we need legislators? It would seem their first course of action should then be to eliminate their own jobs.

But what are taxes but our shared vision as to how to build a society? We may not all agree on every expenditure – I’d be frightened if we did – but most of us like to have roads to travel on. Those of us who live where it snows like to have the snow removed now and then. Having trash removed comes in handy. Water we can drink? Not a bad idea. Sewage that flows out of pipes away from our houses? Hey, I could use that. Treating that sewage instead of just having pipes that run into the nearest body of water? Another pretty good idea.

It seems those who clamor for tax cuts are not the same who call for defunding the police. Something ironic there. Cutting taxes means defunding something, and taken to the extreme I’ve seen proposed means defunding nearly everything (including schools, Social Security, Medicare, nearly all social services).

But what does “defunding”mean? And what do the police do? (And I don’t mean to say that former Chicago Mayor Richard J. Dailey was correct that “The policeman isn’t there to create disorder; the policeman is there to preserve disorder.”¹) If our interest is public safety, are police departments the best place for all of those dollars? The police likely would be the first to tell you that their job is to respond to crime after it happens. They arrest the alleged perpetrators and work with the DA to develop a case. Their crime prevention role seems to be primarily to convince us that the likelihood of being caught and the repercussions of being convicted outweigh the benefits of committing a crime. (That, and going to elementary schools to scare kids out of smoking weed; though I don’t think that program is still in existence.)

My city alder just wrote a thoughtful post about public safety which included this:

“For once, I would love for our city to have intentional city-wide conversations on what public safety should mean.  I had often wondered if we could ask the question, what would you need to feel safe in the City of Madison -without framing these conversations around police and fire-what people might answer?  This question faces challenges because of competing forces preventing change.  As an elected official, if you explore alternatives to policing, you can be labelled as soft on crime by the police union and others, making electability more difficult.  For most of us, we have grown up with a media landscape or narrative about policing that informs us.  Think of the hundreds of cops shows on TV and at the movies.  For me, I cannot escape the fact that the horrific racial disparities within our local criminal justice system and policing could not exist without the other. 

    With calls to defund or abolish the police, I am left curious that if I woke up tomorrow, and there were no police at all, who would investigate murders, who would respond to sex trafficking, who is going to be the first responder if there is a shooting?  I could foresee a future where we might take long held police duties like traffic enforcement and civilianize these roles.  Imagine if you were speeding and you were pulled over by someone without a gun ( let’s call them  a Civilian Traffic Buddy), knowing that the worse outcome would be a citation (unless you were in the act of a felony) rather than jail or death.”  

My own two cents on that last part. 1) In Great Britain, between 4 and 5% of police officers are armed. Police firearms were “intentionally discharged at persons” four times in the year ended 3/31/2022. ² This number is reported as stable over the past several years.

In contrast, in the US, police have shot and killed an average of 982 people per year over the past six years.³ As a percentage of total population, police kill Black people at a rate 2.5 times greater than that at which they kill White people, and kill Latin@ people at a rate nearly double that of White people.

My other penny’s worth…2) Alder B above talks about “the worse outcome” of a traffic stop being a citation “(unless you were in the act of a felony)”. That one deserves a closer look. When I worked in a trauma unit, the majority of the people I saw were there for injuries related to alcohol. A 90 day retrospective study of patients at another trauma center found that ⅔ of drivers tested positive for alcohol or other drugs.⁴ When the trauma unit was slow I used to joke about rounding up more business by heading out to the bars, buying a round for the house, and making sure everyone had their keys. The flip side of that (being serious) is that this represents an opportunity for a cultural change that can actually help prevent crime and injury, in other words be a public health measure. In the state of Wisconsin, first offense drunk driving results only in a citation – a traffic ticket. Driving drunk only rises to the level of a felony on one’s fourth conviction.⁵ Of course, it also becomes a felony if you kill someone. What if our culture didn’t glorify drunkenness? (Those of us who are old enough recall when we glorified cigarette smoking and televised athletic events were sponsored by tobacco companies, not just breweries. Culture change is possible.) What if bartenders and friends were encouraged and trained to take away someone’s keys when they were drunk? What if all cars had ignition interlocks to prevent starting by someone who is drunk? The average cost is $50-$150.⁶ Might that cost come down if the devices were produced in greater numbers?

Alder Benford went on to talk about a new city program. If you watch TV drama, this has already been implemented on “Station 19”.

 “By now, most of you have heard of our awesome CARES  team- Community Alternative Response Emergency Services (https://www.cityofmadison.com/fire/emergency-medical-services/community-alternative-response-emergency-services-cares).  As a social worker, I was so excited to learn before I joined the council, that we were on the path to developing a model, like other cities.  A public safety service that could send a skilled paramedic and mental health professional on a 911 call that does not require the police.  As I dream about reimaging public safety, so that all, regardless of our backgrounds, feel safe, I reason that CARES is our first major step as a city to accomplish this goal.  Alders agreed  to fund a tactical expansion of CARES to ensure additional coverage and long-term success.  I am excited about the future of CARES.“

This is another way that tax dollars can go toward public safety and violence prevention. Not all calls to 9-1-1 require a police response. Police response to mental health crisis often results in unnecessary death. To put it more bluntly, it results in the police killing the person they were called to help.⁷

So when people talk of “defunding the police”, the true meaning is often redirecting limited funds to programs more likely to contribute to public health and violence reduction than the current system. It is not an attack on police. It is not anti-authoritarian. It is pro-public safety.

How we make funding decisions comes down to how we set our priorities. If our priority is to catch people after they have done wrong, increasing police funding may well be the answer. If our priority is to change the conditions which lead to crime, transferring some of those funds to other programs which address social inequities may be a more prudent use of dollars.

So while it is possible that “’tis impossible to be sure of any thing but Death and Taxes⁷, how we levy and how we use those taxes is one of the most important discussions we can have.

¹ https://www.chicagomag.com/city-life/January-2020/The-Chicago-Political-Quote-Hall-of-Fame/

² https://www.gov.uk/government/statistics/police-use-of-firearms-statistics-england-and-wales-april-2021-to-march-2022/police-use-of-firearms-statistics-england-and-wales-april-2021-to-march-2022

³ https://www.statista.com/statistics/585152/people-shot-to-death-by-us-police-by-race/

⁴ •Walsh, J. M., Flegel, R., Atkins, R., Cangianelli, L. A., Cooper, C., Welsh, C., & Kerns, T. J. (2005). Drug and alcohol use among drivers admitted to a Level-1 trauma center. Accident Analysis & Prevention, 37(5), 894-901. doi:10.1016/j.aap.2005.04.013

⁵ https://wisconsindot.gov/documents/safety/education/drunk-drv/owi-penchrt.pdf

⁶ https://www.wisconsin-owi.com/blog/2021/01/07/how-much-does-it-cost-208191

⁷ https://www.washingtonpost.com/investigations/interactive/2022/police-shootings-mental-health-calls/

⁸https://ia902807.us.archive.org/0/items/coblerofprestonf00bull/coblerofprestonf00bull.pdf

Note: I attempted to reach my alder for permission to quote from his weekly newsletter. I have not received a response but, as this was a newsletter sent to all constituents, privacy did not seem to be an issue. Since I didn’t get his consent, I ask for forgiveness.

Forgetting where your keys are, or forgetting what your keys are?

One of the definitions of Alzheimer’s Disease is that it is normal to forget where you put your keys. It is not normal to find your keys and not know what they’re for.

My father died of Alzheimer’s Disease (AD, also known as SDAT – Senile Dementia of the Alzheimer’s Type) at age 78. He recognized no one around him. My mom, on the other hand, died at age 93. She not only knew who I was, but knew that, since it was Monday, it was my day off and that was why I could be with her all day. The fact that she was dying went unsaid. She died just as it got dark that evening.

How does one die of Alzheimer’s Disease? Forgetfulness goes beyond just “what are these things for?” to forgetting how to chew and swallow. The immediate cause may be dehydration or malnutrition but the ultimate cause is the disease. My father’s autopsy report mentioned cardiac arrest and multiple organ system failure…duh. He died when his heart stopped beating, not really because it stopped beating. He could have remained alive longer with IV fluids and a feeding tube, but to what end? He had made that decision long before, as have I. If you have not done it yet, write an Advance Directive – a document that specifies what care you want (and don’t want) in the event of a terminal condition. I know – you don’t want to think about that. Death happens to other people. Guess what? It happens to all of us. But you’re not old. Guess what? Not everyone dies of “old age”. Ultimately, there is one terminal condition in life – it is birth.

Alzheimer’s is only definitively diagnosed after death, from examining the brain. In his case, they even left that out until we demanded an addendum to the report. They had examined his brain but neglected to include those findings in the report. With research, we may be able to diagnose the disease short of death; maybe even treat, cure, or prevent it.

An aside: you may notice that “cure” is a rarity in medical science. We tend to “treat” disease by administering medications to control symptoms – medications that often must be taken for life and at great cost. We don’t “cure” a whole lot of diseases. The cynical among us may say that there is little profit in cure and a lot of profit in lifelong treatment.

Prevention of SDAT may well hinge on a lot of the same factors as many diseases – eat well, sleep well, stay physically active, control blood pressure (and have the right genes).

The PBS series Nova produced a documentary on the WRAP (Wisconsin Registry for Alzheimer’s Prevention) study. It is an hour well worth your time. There were damp cheeks in the program, on both sides of the screen.

The project enrolls the children of people diagnosed with AD (and a control group of people without a familial history) and follows them longitudinally. Every few years, participants complete a lengthy questionnaire (with another completed about them by someone who knows them well) and complete a lengthy battery of neurocognitive tests. Additional optional studies include MRI, functional MRI, and PET scans; lumbar punctures; and treadmill testing.

As a test subject, some of this is difficult, as it involves testing to failure. How long a digit span can you recite backward after hearing it once? You get longer and longer spans until you fail. How steeply can you walk up a treadmill at a set speed? You go until you can’t.

Can we see changes in brain structure and function before one develops symptoms of the disease? Does cardiorespiratory fitness delay or prevent onset of disease? Can we see biomarkers of disease in the brain or the cerebrospinal fluid prior to recognizable disease onset? If so, can we address those markers and influence the disease path? These are a few of the questions the study aims to answer.

What’s it to you? Research shows the children of those with AD are more likely to contract it themselves. My father, his brother, sister, and mother all died of AD. On my maternal side, I have questions about a couple of aunts. But you’re not me. According to the Alzheimer’s Association, “1 in 3 seniors dies with Alzheimer’s or another dementia. It kills more than breast cancer and prostate cancer combined.” The longer you live, the greater are your chances of developing Alzheimer’s Disease. If you are a woman or person of color, your risk may be higher than if you are a white male. Per 2022 Alzheimer’s Disease Facts and Figures “Structural racism pervades many aspects of life that may directly or indirectly alter dementia risk.”

Maybe a coast-to-coast bike ride will help prevent Alzheimer’s Disease. That would be icing on the cake. For today, I’ll ride my bike through the snow to the library.

It is snowing. It is the day that US taxes are due. Does that have anything to do with why I am writing this today? It was in 1716 that Christopher Bullock wrote “Tis impossible to be sure of any thing but Death and Taxes” (though for the uber-wealthy, even taxes are not a sure thing).