My Perfect World: A Day in the Life of a Child Therapist

By Karen LeVasseur, LCSW, owner and therapist at Calm4Kids Therapy Center, LLC

Imagine a world where you spend all day playing. Perhaps you would shoot hoops or play hockey. Or you might dress up your dolls or blow bubbles. Maybe you would paint a picture or play board games. When you tire of playing and need a break, you could spend time resting in your bean bag chair or relaxing in your very own tent. Sounds perfect right? Luckily for me, this IS my world… the world of a child therapist.

As a Clinical Social Worker I work with children between the ages of 3 and 18, supporting the occasional adult as well. Treatment options vary from client to client with most parents seeking either play therapy or hypnotherapy for their child. Regardless of the modality of treatment used, therapy is fun! When my “friends” come to my playroom they know they are in a safe and peaceful place, where they can try out new things, make mistakes (and be okay with it) overcome obstacles and feel good about themselves. The kids I work with are not treated as damaged or impaired; they simply practice new skills and strategies that help them feel happier and overcome obstacles to success.

What might a typical therapy session look like? Sessions are structured in a way that allows predictability for my young clients; many of whom are diagnosed with ADHD or Autism. We have a brief “Check-in” to talk about the events of the week; engaging in problem solving or goal setting as needed. Next comes “Pick 4” with the child selecting four calming or mindfulness strategies to practice. Then comes the meat of the session where we work on the presenting problem.

In a recent session, with a 3-year-old I will call Sam, we engaged in play therapy to address issues with self-concept. Sam, who is typically a sweet, gentle boy, considered himself a bad boy after becoming physically aggressive with another child at his pre-school who had been hitting, kicking and biting him. He showed signs of anxiety through crying, clinging to mom and refusing to go to school. In the initial session, Sam started a game of “Good Guys, Bad Guys” using my toy Super Heroes (the good guys) and dinosaurs (the bad guys). In the game, the purpose shifted from session to session, with the good guys becoming bad, the bad guys becoming good, everyone fighting etc. One session stands out as the most pivotal moment in his treatment. Sam became very serious and told Superman (the figure I was playing with) that he needed to tell him something. He leaned in and whispered “I’m not always a good guy. Sometimes I fight.” Superman, who is very wise and loves to help kids, told him “When I was a little boy sometimes I got into fights at school. I thought I was a bad boy, but my mommy told me something very important.” I could see the wheels in Sam’s head turning as he waited for Superman to share Supermom’s wisdom. “Everyone makes mistakes with their behavior,” Superman said. “But they are still good kids”. Sam thought about this for a moment, nodded his head, and the game was done. He had “played out” his issue. In play therapy, the act of playing is the child’s language and toys are the child’s words. In the therapeutic setting, children learn to communicate with others, express feelings, modify behavior, develop problem-solving skills and, as in Sam’s case, resolve inner conflicts; all through play. Sam and I have played “Good Guys, Bad Guys” a few more times since, but the focus has changed to the good guys helping the bad guys and everyone ending up as friends.

Play Therapy

Another notable session involved the use of hypnotherapy with an 11-year-old I will call Amy. Our work together has focused mainly on anxiety related to social relationships. When she came in for a recent session, she was visibly upset, describing something that had happened at school that day. One of her longtime friends had given her “the look” at recess, then laughed and ran away. Other girls became involved and when Amy tried to stick up for herself the other girl told her she was over-reacting. This may seem inconsequential to an adult, but in the tween world an event like this is DEVASTATING! We talked through the situation, identifying the worst part of it, which was Amy’s fear that all of the girls would turn against her. We engaged in role-play to explore different ways to handle the situation if it continued the next day. Then we ended the session with hypnosis to strengthen her confidence and imagine handling future drama successfully.  Hypnosis is a wonderful tool to use in therapy as it encourages use of the imagination. According to the American Society for Clinical Hypnosis, mental imagery is very powerful, especially in a state of focused inward attention. The mind is able to use imagery to assist in promoting change in thoughts and behaviors. Ideas or suggestion that are congruent with the child’s needs are given, and in a state of concentrated attention, this can have a powerful effect on the mind. The next session Amy reported communicating with her friend confidently and assertively and working out the problem between them.

Clinical Hypnosis

Providing therapy for a child who is struggling is very important. Through the therapeutic relationship my “friends” are able to express themselves without consequence, explore the reasons for their behaviors, learn to shift negative thought patterns and manage their emotions; thus allowing for greater confidence and an increased ability to manage daily stressors. What do I get out of my work? Well, unbelievably I get paid to play all day (Remember that perfect world?) But, more-so, I have the opportunity to connect in a positive way with kids and make a difference in their lives. And that is priceless.

Kids Mental Health Informational Portal

Karen LeVasseur is an LCSW and is owner and operator of Calm4Kids Therapy Center, LLC in Bradley Beach, NJ where she offers hypnotherapy, play therapy, EFT, and mindfulness based psychotherapy for clients ages 3 through adult. Karen also has vast experience as a School Counselor, Elementary School Teacher, School Social Worker and School Anti-Bullying Specialist. Karen’s website and Facebook page offer more information about her practice.

Sources/Citations

Photos from http://www.pixabay.com

Websites: Association for Play Therapy http://www.a4pt.org/

                American Society of Clinical Hypnosis http://www.asch.org

The Good Old Days

by Dr. Edwin Leap, MD, FACEP

I’ve been reminiscing about the ‘good old days’ of medicine.  I think about those times because I remember when medicine was focused on the sick and when practice was challenging & exhausting, but at its heart…fun!  So what changed?  Lots of things.  But two things in particular come to mind: EMR and HIPAA.

First, let’s discuss EMR, or Electronic Medical Records.  Where once we used paper charts or simple dictation to record information on patient care, now hospitals and physicians are increasingly forced into purchasing and using expensive and complex computerized record-keeping systems.  This was a growing trend already, but the Affordable Care Act made it all but mandatory, with rewards for implementation and fines for noncompliance.  Many small hospitals and practices, in fact, struggle to pay for the cost of implementation even as EMR companies make vast amounts of money.

I’ll ‘render unto Caesar’ here.  Paper systems are problematic.  The can be illegible.  On paper, written by hand, it is difficult to document complex medical encounters and procedures.  And thus, the next clinician involved may have trouble understanding what happened before.  (As will the attorneys in malpractice suits.)  Finally, hand-written charts lose charges and are often down-coded in billing when insurers can’t find the information they need, or find enough information to generate a proper bill.  Paper charts aren’t perfect. Likewise, dictated charts, while better, have longer turn-around times.  But both are faster and generally make physicians happier than the monstrosities that are modern electronic medical records systems.  

Indeed, to give credit where credit is due, electronic systems capture lots (and lots, and lots) of data.  And they can be helpful in retrieving information from previous visits.  And some use voice recognition dictation programs.  This kind of real-time dictation can be helpful.

And yet…EMR sucks the fun out of medicine.  Because EMR systems leave clinicians slaves to the keyboard.  The sound of modern medicine is the sound of typing.  And the great anxiety for physicians, and nurses, is the terrible tension between doing the thing we love, which is patient care, and doing the thing our employers mandate, which is hour, upon hour, of mind-numbing data-entry, all the while trying to move patients in a way that provides the best satisfaction scores and the lowest wait times.  

EMR are rarely designed with clinicians in mind. So, while the flow of the log-ins, clicks, drop-down menus, signed orders, time stamps, discharges and all the rest make perfect sense to programmers, billing companies and data-collectors, it’s an electronic nightmare for those of us who simply want to get back to our patients.  (The commonly told joke is that physicians are the highest paid data entry clerks in the country!)

In the end we care for the sick and let the charts pile up.  We then end up with ‘in baskets’ or ‘to do lists’ filled with hundreds of clicks and signatures that we have to do on our own time, after shift, to satisfy the appetite for information that administrators and government agencies desire, even when little of it contributes substantively to the care of the sick, injured and dying before us.  And woe-betide those who are delinquent in completing records!  E-mails and threats will abound until they are completed.

Older physicians and nurses, less computer savvy, sometimes simply leave.  They retire, taking their incredible skills and knowledge with them.  Younger physicians and nurses are frustrated, but have no other option except to press on and type away, longing for the bedside and the people they spent years learning to treat and comfort.

What about HIPAA?  The acronym stands for the Health Information Portability and Accountability Act. Passed in 1996, among the goals of this federal legislation is the protection of the confidentiality of patients’ private medical information.  Like so many things the government touches, it had a noble intent.  But now it is less a law and more of a bludgeon.  

Currently, in order to protect privacy, patients are yearly advised of their HIPAA rights and expected to sign forms to that effect.  And physicians are constantly beset by log-ins and passwords.  This may seem like no big deal.  Every computer has a log-in screen!  In fact, plenty of applications exist to store all of our various and sundry passwords for our many programs and devices.  However, the average physician will have a log-in and password for the hospital computer system, then for the electronic medical records (EMR) system and a separate set for the radiology system. And if a physician works in more than one facility, the number of log-ins and passwords just keeps climbing.

Our nurses have a similar burden of logging into EMR computers, but also have to access the medication dispensing cabinets which are password protected.  Taken together, it’s very difficult to move patients quickly, chart effectively or maintain a train of thought because we are constantly accessing computers and trying to remember new passwords.  (Biometrics like fingerprint scans and others might help, but we’re not there yet.)

Furthermore, HIPAA terrifies every clinical staffer because they are warned, over and over, that violating privacy is a federal issue.  Even innocently handing the wrong instructions to the wrong patient can be a huge problem.  To make it worse, clinical employees of a hospital can be fired for simply looking up their own labs.  (Their own labs!  In other words, protected from their own prying eyes!)  Their privacy ensured, their job terminated.  

And where we formerly handed lab and x-ray reports to patients so they could take them directly to their physicians, now they must go through the medical records office the next day or later to obtain what is, in fact, their own information.  (Again, protected from their own snooping.)  Or they must have their physician’s office request them with the appropriate release of information signed.   

And when we, the physicians who cared for a critically ill patient, transfer them to another hospital, it’s pointless to check on their progress.  ‘Hello, this is Dr. Leap and I transferred Mrs. Howard, the multi-trauma yesterday after intubating her and placing a chest tube.  Can you tell me how she’s doing?’  ‘All we can say is that she is in the hospital.’  Great.  That’s good quality control, to be sure.

HIPAA has indeed protected privacy (except of course for instances of computer hacking or carelessly placed and lost computers…all too common).  But it has also created a vast industry of programs and consultants, and left clinical and clerical staff slower, and more anxious, than ever.

No, things aren’t what they used to be.  Many issues conspire to make modern medicine difficult; an aging population, complex diseases, rampant addiction, resistant infections, high costs, high expectations and many more.  In the end, however, HIPAA and EMR reflect a common core issue, which is the disconnect between the administrative and political forces that govern medicine (and stand to profit mightily from supervising it) and those who day in, day out, must practice it in the presence of living, bleeding, hurting, dying, fearful human beings whose bodies have no password, and who care less about privacy than survival.

And until that chasm is bridged, it’s unlikely that medicine will ever again be as fun as it was before.  But I can imagine, can’t I, a shift without a computer and a chart without a log-on screen?  Ah, ‘to sleep, perchance to dream…’

Logging off….

   

Edwin Leap, MD, FACEP

Dr. Edwin Leap is a happily married father of four children in the process of becoming adults. He practices emergency medicine in the southern Blue Ridge Mountains.  In addition to his career in medicine, Dr. Leap writes monthly columns for the Greenville News, Emergency Medicine News and The South Carolina Baptist Courier.  He also blogs at www.edwinleap.com/blog.  From faith to family and from culture to medicine, he covers every topic with humor, insight and compassion.

Government Cannot be Run Like a Business

by Michael Makovi, Guest Writer

We sometimes hear that government is inefficient and wasteful because it is not run like a business. The implication is that if only government were run in a more businesslike manner, its performance would not be so unsatisfactory. In a way, this criticism is true, but not in the way its advocates intend it. Government really would be more efficient if it were run like a business. But the only way to achieve this is through privatization and deregulation. By its constitutional nature, government cannot be run like a business.

In fact, even the most accomplished business person could never run government like a business. If a business person were ever elected or appointed to political office, he or she could not help but execute their office in a typically bureaucratic manner. Only businesses can be operated in a businesslike fashion. There is a fundamental constitutional distinction between government and business, and it is not not the person which makes the office, but it is the office which makes the person. Anyone occupying government office cannot help but behave as a bureaucrat, no matter how accomplished of a business person they might have been previously. The Austrian economist Ludwig von Mises (1881-1973) explained why in a passage worth quoting at length. The following comes from his landmark 1920 article, "Economic Calculation in the Socialist Commonwealth", translated from the original German and reprinted in F. A. Hayek's 1935 collection, Collectivist Economic Planning (https://mises.org/library/collectivist-economic-planning):

A popular slogan affirms that if we think less bureaucratically and more commercially in communal enterprises, they will work just as well as private enterprises. The leading positions must be occupied by merchants, and then income will grow apace. Unfortunately "commercial-mindedness" is not something external, which can be arbitrarily transferred. A merchant's qualities are not the property of a person depending on inborn aptitude, nor are they acquired by studies in a commercial school or by working in a commercial house, or even by having been a business man oneself for some period of time. The entrepreneur's commercial attitude and activity arises from his position in the economic process and is lost with its disappearance. When a successful business man is appointed the manager of a public enterprise, he may still bring with him certain experiences from his previous occupation, and be able to turn them to good account in a routine fashion for some time. Still, with his entry into communal activity he ceases to be a merchant and becomes as much a bureaucrat as any other placeman in the public employ. It is not a knowledge of bookkeeping, of business organization, or of the style of commercial correspondence, or even a dispensation from a commercial high school, which makes the merchant, but his characteristic position in the production process, which allows of the identification of the firm's and his own interests. It is no solution of the problem when Otto Bauer in his most recently published work proposes that the directors of the National Central Bank, on whom leadership in the economic process will be conferred, should be nominated by a Collegium, to which representatives of the teaching staff of the commercial high schools would also belong. Like Plato's philosophers, the directors so appointed may well be the wisest and best of their kind, but they cannot be merchants in their posts as leaders of a socialist society, even if they should have been previously.

Let us parse this passage more closely. "A merchant's qualities are not the property of a person . . . The entrepreneur's commercial attitude and activity arises from his position in the economic process and is lost with its disappearance." It is not the person which makes the office but the office which makes the person. A business person behaves as they do because of the institutional constraints of the position. A business person must satisfy voluntary and willing customers who are free to take their dollars elsewhere. It is the phenomenon of profit and loss which fundamentally shapes the character of the business person's activities. The free-market business enterprise faces no captive market and it can take nothing for granted. Either the firm produces products which willing customers voluntarily purchase, or else it goes bankrupt. The business person behaves as they do because of these institutional constraints, not because of anything peculiar to the person him- or herself. "It is not a knowledge of bookkeeping, of business organization, or of the style of commercial correspondence, or even a dispensation from a commercial high school, which makes the merchant, but his characteristic position in the production process, which allows of the identification of the firm's and his own interests." Therefore, "with his entry into communal activity he ceases to be a merchant and becomes as much a bureaucrat as any other placeman in the public employ."

By contrast, a government bureaucracy possesses a monopoly. Its customers cannot choose whether or not to purchase from the bureau. They have nowhere else to turn. Furthermore, the bureau is subsidized by taxes whether it satisfies customers or not. Compare a car insurance company to the DMV, for example: the insurance company must strive to serve its customers at least as well as its competitors, or else it must compensate for worse service with equivalently lower premiums. If it fails to do so, its customers will all abandon it for its competition. Contrariwise, the DMV has no fear that its "customers" will leave it for another. The citizens have nowhere else to turn to obtain their licenses. And whether the citizens are satisfied or not, the DMV receives its funds from taxation. The DMV is paid whether it does its job or not. Therefore, the DMV has no incentive to operate efficiently or to provide satisfactory customer service. The difference between the insurance firm and the DMV is not that the manager of the one is a better business person than the manager of the other. Rather, the fundamental distinction is the conditions under which each operates. Again, it is not the person which makes the office, but the office which makes the person. Therefore, it will do absolutely no good whatsoever to appoint a proven business person to political office. With the loss of their position in the market system, they lose everything it is that ever made them a business person. "Like Plato's philosophers, the directors so appointed may well be the wisest and best of their kind, but they cannot be merchants in their posts as leaders of a socialist society, even if they should have been previously."

Mises made a similar argument in his 1922 book, Socialism (https://mises.org/library/socialism-economic-and-sociological-analysis) and by now, the reader should be equipped to interpret it without assistance:

If the work of a body of officials appears unsatisfactory, there can be only one explanation: the officials have not had the right training, and future appointments must be made differently. It is therefore proposed that a different training should be required of future candidates. If only the officials of the communal undertaking came with a business training, the undertaking would be more business-like. . . . It is not difficult to expose the fallacies inherent in such notions. The attributes of the business man cannot be divorced from the position of the entrepreneur in the capitalist order. "Business" is not in itself a quality innate in a person; only the qualities of mind and character essential to a business man can be inborn. Still less is it an accomplishment which can be acquired by study, though the knowledge and the accomplishments needed by a business man can be taught and learned. A man does not become a business man by passing some years in commercial training or in a commercial institute, nor by a knowledge of book-keeping and the jargon of commerce, nor by a skill in languages and typing and shorthand. These are things which the clerk requires. But the clerk is not a business man, even though in ordinary speech he may be called a "trained business man."

In summary: if a political candidate ever promises he will run government like a business, do not believe him or her. He or she cannot run government like a business. It is simply impossible. The difference between government and business is the difference between monopoly and competition, between compulsory taxes and voluntarily paid fees. The institutional constraints of the office make all the difference, and the person him- or herself is almost an afterthought. This is not to say that free-market business enterprises are necessarily superior to government bureaus. Perhaps regulation and publicly-owned corporations are necessary. But let us not confuse the matter by believing that the one can be operated on the same basis as the other. Private and public firms operate within totally different contexts and the principles of one cannot be applied to the other. If regulation is necessary, so be it, but let us be frank and admit that insofar as government is necessary, it is precisely because it is not business like and it never can be.

Building a Culture of Caring in Your Classroom

By Karen LeVasseur, LCSW, owner and therapist at Calm4Kids Therapy Center, LLC

Building Character

Having worked as an elementary school teacher for many years I know the importance of building character in your classroom. I learned over the years that time spent on character education, in particular at the beginning of the school year, was time well spent. Think about it. To engage successfully in academic learning, the following skills need to be in place:

- Emotional regulation

- Problem solving

- Communication

- Teamwork

Students don't always come to school with the skills that they need and it is up to the educator to support kids in learning the "how" of getting through their school day. If you have ever read The First Six Weeks of School by Paula Denton and Roxanne Kriete, you will agree that spending time at the beginning of the school year, setting expectations, modeling and practicing socially acceptable behaviors, establishing a routine for identifying and resolving conflict and solving problems as a team will set up your students for success and allow your classroom to run like a well oiled machine. 

Setting Kids Up For Success

I remember one year, when I taught fifth grade. I was excited for the year, having been in fourth grade for many years. I was eager to dive into the fifth grade curriculum and set up a great academic program for my kids. Unfortunately, the twenty five youngsters in my class were not as excited as I was. The school year started off with problem behaviors, arguments, yelling, teasing... It was not the happy school year I had envisioned. About three weeks in, I brought academics to a screeching halt and put a heavy emphasis on character building. During the next month and a half I started holding a morning meeting each day, used the time right after recess for meditation and created an "Acts of Kindness" Wall. Everything we did academically involved practicing team-building and problem solving skills and assertive communication. By the end of October, my students not only knew what to expect and what to do, they also knew how to do it well. My well oiled machine was achieved!

Morning Meeting

Holding a morning meeting is an important part of your classroom culture. Starting each day as a community, interacting positively with one another is a great way to start off the day on the right foot, for students and for the teacher! There are many different activities you can incorporate into your morning meeting. Be creative and add activities that feel right for you and for your kids. Some ideas include:

Class Pledge- Write a pledge that speaks to the core values you want at work in your class. An example is "I pledge allegiance to my class, that I will try my best, to make good choices and try real hard to be responsible like the rest. I care about the others here and I care about me. I want school to be a special place where I learn and want to be!"

Greetings- One year I taught my students to greet one another using both Spanish and American Sign Language. Students would pair off and say/sign "Good morning, how are you?" The student would respond with "Good morning, I am (happy, mad, tired, sick...). How are you?" The kids loved the bilingual challenge!

Circle of Friends- Ask your students to sit in a circle either on the floor or in chairs. Pose a question such as "How will you be successful today?" or pose a challenge such as "Compliment the person next to you on something nice they did yesterday" and have each student respond. Emphasize active listening skills and use a talking stick if needed.

Problem Solving Box- Set up a box in the classroom with problem sheets that students can fill out indicating the following: I have a problem with... It is a problem because... I have tried to solve it by.... Each morning pull out one problem sheet and read it to the class. Allow the kids to generate possible solutions to the problem. The person who wrote the sheet can remain anonymous or they can identify themselves. Either way, the child with the problem will leave the circle with many new ideas to try!

Minute to Win It- Put kids into pairs and give them a 60 second challenge to complete together. Use riddles, math problems, rebus puzzles or have them complete a physical or building task like on the tv show. Allow the students to be noisy and have fun while they build teamwork skills!

Calm Kids are Productive Kids

I think one of the best decisions I ever made as a teacher was to add meditation to my schedule. I have used the technique at different times of the day but found that right after recess really helped kids to recharge and refocus, allowing success for the second half of the day. The meditation does not have to be long. Even a few minutes of mindfulness to breath and stillness can calm an active or emotionally labile child allowing them to make good choices with their behavior and with peer interaction. Try some of these techniques. I'm sure you will notice a difference in your students' affect as well as your own!

60 Second Vacation- Have the kids lay on the floor or relax in their seats. Ask them to close their eyes and imagine a place where they feel happy, calm and safe. Guide them in using their senses to explore this place, envisioning themselves doing something to be focused, calm and successful. After about 60 seconds of quiet visualization and deep breathing refocus students on the classroom environment and their job as a student.

A Moment of Stillness- Have kids relax as above and guide them in taking slow, deep breaths (belly breaths) filling up their lungs and expanding their abdomen like a balloon on the in breath, then releasing on the out breath. Once a breathing pattern has been established, ask the kids to continue breathing, remaining as still as possible for a minute of meditation. It is helpful to have them imagine sinking into their chair or melting into the floor. When time is up ask the kids to open their eyes and focus on your face (or a point in the room), taking one more cleansing breath.

Breathing Buddies- Students lay on their back on the floor with a small stuffed animal on their bellies. This is called their breathing buddy who helps them learn to take belly breaths as described above. Model for students how to take a belly breath, saying "On the in breath the belly goes out and on the out breath the belly goes in." Guide students in taking slow, deep belly breaths for a few minutes then collect the buddies and get back to work feeling refreshed!

Meditation for Kids

Meditation For Kids: Parents Turn To Mindfulness Practices To Help Children Stay Calm

Being Kind is Cool!

It is helpful to teach kids the importance of being kind and caring toward others. I helped my students learn this valuable lesson by first identifying acts of kindness in literature, providing roleplay scenarios and by inviting the "Note Fairy" to visit my classroom (she secretly leaves notes for students who she witnessed acting kindly toward others). Once the term "Act of Kindness" was well understood and students were regularly engaging in AoK's I set up an "Acts of Kindness" Wall where students could note the kindness of others or post their note from the Note Fairy to celebrate their own success. Each week a different student was honored on the wall with a brief description of how he/she went above and beyond in helping our classroom be a kind and caring environment. Regular celebration of success really helped to motivate kids to be kind to others and to themselves!

Random Acts of Kindness

Welcome | Random Acts of Kindness
Kindness stories, quotes, ideas, classroom resources and more.

Try some of these ideas and please share the wonderful things you do in your classroom! Be creative, have fun and remember, "What you notice will happen more!" Celebrate your students' successes and help them to build the skills they need to be able to add to the culture of caring you have established in your classroom.

Karen LeVasseur is an LCSW and is owner and operator of Calm4Kids Therapy Center, LLC in Bradley Beach, NJ where she offers hypnotherapy, play therapy, EFT, and mindfulness based psychotherapy for clients ages 3 through adult. Karen also has vast experience as a School Counselor, Elementary School Teacher, School Social Worker and School Anti-Bullying Specialist.

Marijuana's Not-So Scientific Legal Limit

by Liz Sheeley, Guest Writer

States with legalized marijuana are struggling to figure out how much marijuana is too much for drivers.

While Massachusetts has legalized medical marijuana, and is on the cusp of complete legalization next year, the state’s legislature and law enforcement officials are grappling with this problem as well. For alcohol, states have settled on a legal blood alcohol limit ranging from .05 to .08 – roughly the difference between two and three drinks for a 140-lb. person.

But there is no clear range for marijuana – there hasn’t been enough research on the drug’s effects to settle on a number, its concentrations vary widely, and everyone responds differently to THC, marijuana’s psychoactive component.

“There have been people who I have seen with 20 or 21 nanograms of THC where you can’t see any impairment, and people with two nanograms who clearly should not be driving,” said Sergeant Don Decker, the Massachusetts State Coordinator for Drug Recognition Experts, a group of law enforcement officers trained to recognize drug impaired driving and evaluate the driver.

Despite these challenges, and a lack of knowledge, marijuana driving laws—so called “drugged driving laws”—have followed the drug’s legalization in Colorado, Washington, Alaska, Oregon and Washington, D.C.

“In many ways, unfortunately, policy has outpaced science and laws are passed before we really know the impact of certain things,” said Dr. Staci Gruber, the Director of the Cognitive and Clinical Neuroimaging Core at McLean Hospital. “We’re trying a little bit to play catch up at this point and I think it’s important to do because [marijuana]’s not going anywhere.”

Marijuana affects each person differently depending on frequency of use, the strain of marijuana and delivery method. Users slowly build up a tolerance to the drug. An experienced user could be fine with a THC concentration in their blood that would impair a non-frequent user.

Genetics also play a role in how two different people are affected by the same level of THC.

And this is a problem for medical marijuana users. Those legal users can’t always get the same product because of stringent laws about growing and distributing marijuana. The strain and potency can vary each time they go to purchase their supply. Gruber said, the state is “still in its infancy with regard to medical marijuana.” She compares this to buying a bottle of Advil – each bottle is going to contain pills of comparable dose. But for medical marijuana, “it’s going to be different wherever you get it, perhaps even by batch.”

Dr. Herbert Hill, a chemistry professor at Washington State University, is developing an in-field breathalyzer for law enforcement to test THC levels of suspected drugged drivers; but he said it is “not ready for the field yet, and still has at least a year to go before the police will be able to test it.”

Law enforcement officers are also using a behavioral test to evaluate drivers, and states like Massachusetts and Colorado are increasing the number of officers who are qualified to assess marijuana impairment in the field. In programs like Decker’s the Drug Recognition Experts (DRE), officers get weeks of specialized training to be able to determine if a subject is under the influence of drugs and what kind of drugs by observing and testing the subject in the field. The DRE test is 12 steps. The officers first administer a breath alcohol test to see if the impaired driver is drunk. If the blood alcohol level doesn’t suggest drunk driving, then the DRE will perform the 12 step test. This includes an in-depth interview, eye examination, the One Leg Stand test, the Finger-to-Nose test, examination of the subject for injection sites, their muscle tone and multiple pulse rates taken throughout the process. Currently there at 108 such experts in MA, and program has just graduated about 30 more. Decker is actively working to increase this number to prepare for the possibility that Massachusetts voters will legalize recreational marijuana next fall.

Bill O’Leary, a Highway Safety Specialist at the National Highway Traffic Safety Administration, said that the problem any state faces when legalizing marijuana can be compared to seatbelt laws. Once marijuana becomes legal, people who said no to it before, just so they didn’t break the, law will now smoke it. Then they will potentially get behind the wheel of a car not understanding when the drug will kick in as well as recurring users.

“I think people will begin to think more clearly about what we mean by ‘impairment,’” said Gruber. “Is it just [this limit] and if you have that, do we just yank you out of your car? I think much more will depend on sobriety testing.” And she said that Massachusetts will turn to states like Colorado and Washington to see what lessons they have learned, “before making any grand decisions.”

Liz Sheeley graduated from Boston College in 2011 with degrees in biology and psychology. After college, she worked as an associate editor for JoVE (the Journal of Visualized Experiments) and as an editorial assistant for Circulation, an American Heart Association journal. She likes to write about the science behind food, health, medicine and how those subjects have an impact on society.

This article originally appeared on the Boston University News Service.

Do Capitalists Manipulate, Deceive, and Cheat? Not as Much as Politicians Do

by Michael Makovi, Guest Writer

Real-world markets, according to Nobel laureate economist Robert Shiller, are all about manipulation and deception.

So he argues in a New York Times article summarizing his new book, coauthored with fellow Nobel laureate economist George Akerlof: Phishing for Phools: The Economics of Manipulation and Deception. According to Shiller, merchants and vendors regularly “phish for” ignorant consumers who they can mislead into acting less in their own interests and more in those of the phishermen.

Shiller claims that the theoretical defense of the free market depends on consumers being rational and well informed — a condition that doesn’t hold true in the real world. Drawing on behavioral economics, he argues that consumers are often possessed with cognitive biases that allow them to be systematically deceived by unsavory merchants. For this reason, Shiller argues, consumers need government regulation to protect their interests. The internal forces of the market are not sufficient.

Deus ex Nirvana

But government regulation is not an infallible deus ex machina. The question is not whether the market fails, but whether the government is more likely than the market itself to correct those failures. Economist Harold Demsetz coined the term “nirvana fallacy” to make this point: it is not enough to find flaws in the real world; one must prove that some feasible alternative is likely to be less flawed. James Buchanan, one of the fathers of public choice economics, compared advocates of government regulation to the judges of a singing contest who, after hearing an imperfect performance from the first contestant, immediately award the second contestant, reasoning that he must be better.

No, the market is not perfect, and consumers are often ignorant and manipulable. But the real question is this: Will government do any better?

Just because the first singer offered a less-than-perfect performance is no proof that the second singer will be any better. Ironically, Nudge author and former member of the Obama administration Cass Sunstein, no friend of economic freedom, accidentally makes this very point in his positive review of Shiller and Akerlof’s book.

According to Sunstein,

Bad government is itself a product of phishing and phoolishness, for “we are prone to vote for the person who makes us the most comfortable,” even when that person’s decisions are effectively bought by special interests.

So yes, people behave irrationally in their capacities as market participants, but they are no more rational in how they cast their votes than in how they spend their dollars.

Buying What You Don’t Want

The difference is that in a market, there are feedback signals, however attenuated. If a vendor cheats his customer by holding back information about his product, at least the customer will learn about the product’s faults after he purchases it, and he will buy from someone else next time. He will likely warn others, too. The consumer may have cognitive biases, but he has the opportunity to learn from his mistakes, prevent others from making them, and correct them in the future. The deceptive merchant will develop a bad reputation, and paying customers are motivated to learn about merchants’ reputations — especially as 21st-century technology develops ever-more-robust reputation markets, accessible through anyone’s smartphone.

By contrast, there are fewer feedback signals in politics and even fewer opportunities to act on that feedback. One vote barely counts, and each voter must vote not for specific policies, but for politicians with a range of policies. Electoral politics doesn’t really offer a choice so much as it imposes a bundle. A vote for a particular candidate implies endorsement of all the policies in that bundle, when the truth is more likely that the voter has selected the least bad option. In the market, customers can easily split their “dollar votes” to purchase only the specific products they want.

In Freedom and the Law, Bruno Leoni notes that we are all doubly unrepresented by politics: we vote for A, but B defeats A in the election. Then, when B is sitting in the legislature, he is outvoted on a bill by C. So in the end, a person is governed by politician C who beat B, who in turn beat the voter’s preferred choice, A.

When Phoolishness Is Rational

In such a situation, it makes sense for voters to be rationally ignorant of the effects of government policies they are helpless to affect. Politicians are free to peddle shoddy products when they know voters have few opportunities to learn from their mistakes — and even fewer opportunities to correct them.

Meanwhile, markets tend to concentrate benefits and costs on the consumers who use a specific product. This internalization of costs and benefits promotes learning and feedback. In a market, a person must bear the consequences of his or her own actions.

In politics, benefits are concentrated on those whom the politician wishes to favor — such as financial donors and special interests whose attention is narrowly focused — while costs are dispersed among those whose attention is elsewhere, including many who focus on producing wealth instead of transferring it.

The combination of rationally ignorant voters and informed and motivated special interests encourages rent seeking. Private benefit and social cost diverge as the political process encourages the creation of new externalities. While markets tend to internalize the costs, politics encourages externalities.

So yes, consumers are often “irrational” and deceived and make mistakes. But, as Sunstein himself tells us, this is true in both politics and markets. The question is, Which institutional environment is more likely to promote learning from mistakes? And which institution — the market or politics — maximizes a person’s ability to correct those mistakes? Shiller and Akerlof have failed to prove that government regulation will detect or correct mistakes better than the market itself can.

This article was written by guest writer Michael Makovi, and was originally published on the Foundation for Economic Education, and can be seen here.