Wednesday, January 27, 2016

Looks like a nice day to play ball

This image is a clear way of illustrating the difference between equality and equity. Should each of the three fans be given the same box to stand on, or should each be given what they need to be able to see?

But look a little further than the foreground, and the image raises far more questions. Should these three fans be relegated to peering over an outfield wall while the more affluent white fans are welcome in the ballpark? Or is my assumption of the racial makeup in the stands colored by living in Boston?

There is no pretense of equality or equity in what we pay the professional athletes vs. what we pay anyone else in the ballpark. Thousands of people want to come watch these athletes play ball, while nobody wants to watch me edit pdf files. How should pay reflect that? Aside from establishing minimum salaries, how do equality and equity factor into collective bargaining? And since the entire ballpark was built with taxpayer financing, what sort of public access should there be?

Illustrators and designers routinely have their work ripped off, devalued, and undervalued, while content distributors, internet service providers, and hardware and software companies rake in huge amounts of money. Doesn’t distributing an image for free perpetuate that inequity?

Monday, January 18, 2016

Rally for the home team

There are 329 state-funded local cultural councils in Massachusetts. There are between 2 and 4 statewide awards each year for LCCs, so if they are randomly distributed across all of the LCCs, any particular LCC should expect to receive an award roughly once every 110 years.

Next month, Medford is receiving its 4th statewide award in the past 9 years. That’s not random. In fact, it’s unprecedented.

(One of the projects we funded when I was on the LCC also won a statewide Gold Star Award, so we’re getting recognition for actual programs as well.)

Medford has had a good number of very active and talented volunteers. That’s part of it. Medford’s city government decided to support the LCC financially, which many cities and towns do not do. That’s also part of it. Medford’s arts organizations and business organizations formed a productive coalition to make the arts more visible in Medford, and that’s part of it. But it’s all hard to reconcile with a city that let one of the largest capacity live theaters in the Boston area rot for decades, a city that blatantly refused to help find a home for a local arts center, a city that allowed a premier dance center to go permanently dark directly across the street from City Hall, a city that cannot seem to support a single bookstore or a single art gallery.

There will always be contradictions, and perhaps art thrives in the spaces where contradictions thrive. But there’s an exciting story to tell here if the new Medford administration wants to promote Medford as a home for the arts.

Sunday, January 17, 2016

Not running a synagogue

Paul Levy, when he was president and CEO of Beth Israel Deaconess Medical Center in Boston, had a blog called “Running A Hospital.” His blog provided some insights into how a hospital CEO viewed various aspects of running a hospital. Then he resigned, and continued his blog with a name change to “Not Running A Hospital.”

Last year I joined my synagogue’s board and gradually discovered that the board has no serious involvement in running the synagogue. Day to day operations cannot be the charge of a group that only meets once a month, but in principle a board could make policy decisions. I suspect the board I’m on is a vestigial remnant of some past time when the board did make such policy decisions, but over time the role of the board has, um, changed? Withered? Atrophied? Fled to Florida?

Let me be clear: I like rituals, and Judaism is full of rituals. Those rituals provide structure and comfort, and allow layers of meaning to both encrust themselves and reveal themselves over lifetimes of experience. Those rituals allow connections within the world today and to generations past and future. The rituals evolve, participation ebbs and flows, and still they provide a deep continuity.

But monthly board meetings as ritual? Incantations of calling the meeting to order and asking for committee reports don’t do it for me. Please join us as we rise on line 12 of the youth group proposed budget and say together, “Thank you for not needing us to do anything or decide anything.” No, I’m ok with skipping that service.

So being on the board has left me more informed about the various decisions that we’re not making. It has sparked plenty of conversations about how synagogue policies could be different, but few of those conversations have happened with other board members and none have had any hope of implementation. With no expectation of affecting actual policies at present, I might as well focus on organizing my thoughts about how policies could be different and why they should be different. And perhaps at some point in the future, I can be a useful part of a team that is running a synagogue.

Friday, January 15, 2016

Correcting gaps in our synagogue membership categories

Because the congregation must be financially viable to survive as a congregation, it is easy for the leadership to focus on membership as a means of maximizing dues. Because we live in a consumerist society, it is easy for individuals and families to focus on minimizing dues (and an easy way is to avoid becoming a member). This focus on dues distracts us from the important aspects of the congregation: community, education, worship, and tikkun olam. We need to focus on building and supporting a meaningful community, make it clear that membership is an important statement of belonging to our community, and ensure that there are no obstacles to becoming and remaining members of our community.

Our synagogue’s current membership policy as spelled out in the bylaws clearly works for the many individuals and families who are members. Unmarried Jewish adults can be individual members, and families where at least one adult is Jewish and all adults in the family are committed to the goals of the congregation can be family members. This leaves a couple of gaps. If an adult wants to be a member but their spouse does not, that adult has no membership option. If a family includes a Jewish child but no Jewish adult (as can happen through death or divorce), that family has no membership option.

We can correct the first gap (when an adult wants to be a member but their spouse does not) by striking the word “unmarried” from the description of individual membership. We should also make it clear that an individual member is welcome to become a family member at any point when a partner or child would also like to be a member.

We can correct the second gap (when a family includes a Jewish child but no Jewish adult) by changing the definition of family membership to be a family where at least one adult or child is Jewish, rather than requiring at least one Jewish adult. It takes courage for a non-Jewish adult to raise a child in Judaism, and we should provide every support rather than turn them away. We want them to feel welcome in our congregation as a family and be able to participate in congregational life. We want the child to attend Hebrew School and to become Bar or Bat Mitzvah. We should open our doors, not close them.

There are good reasons to require family membership for a child to attend Hebrew School and to become Bar or Bat Mitzvah. It reinforces a model of community participation and belonging and ensures greater financial support for the congregation. But that membership requirement should not be a litmus test that some families are not allowed to pass.

If asked, we would make exceptions to our written rules to accommodate individual requests. But rather than exclude some prospective members and then depend on them being willing to ask for exceptions, we should amend our rules so that we can be as welcoming as possible.

Thursday, January 14, 2016

Cummings Park

I’ve lived directly next door to Cummings Park for over 17 years. Cummings Park is a small city-owned playground (also called a tot lot or pocket park). Over that time, there have been numerous competing groups of park users:

• teenagers drinking and vandalizing the playground structures (primarily at night)
• dog owners using it as a dog park so their dogs can exercise and go to the bathroom
• adults shooting heroin (primarily at night)
• young children using it as a playground

As with any public space, there are many individual occasional uses as well: birthday parties, geocaching, people doing yoga or tai chi, adults reading or chatting, etc. The only problematic uses are the ones that are incompatible with the intended primary use as a playground for young children (dog run, alcohol and drugs, smoking, and vandalism) or are incompatible with the park being directly next door to people’s homes (noise at night, fires, or golf balls).

There are signs saying that most of those problematic uses are not allowed, but the signs are largely ignored because they are never enforced. Even the huge new "NO DOGS ALLOWED" signs at both entrance gates are often ignored because there is no enforcement mechanism.

For the first decade that I lived next door to Cummings Park, it was a constant source of problems and was seldom used by young children. One week about 7 or 8 years ago, the city finally repaired the vandalized structures and removed the graffiti, the police started occasionally reminding people that the park is closed at night, and families started donating toys to the playground. A number of significant changes happened:

• young children and families started using the playground in far greater numbers
• vandalism mostly stopped
• drinking and drug use in the playground was greatly reduced (as measured by the far lower number of empty bottles and empty needles left in the playground)

The donated toys were a huge part of that turn-around. They encourage families to use the playground and extend the play options for young children. They helped Cummings Park become a destination playground for families who live closer to other parks. They were an asset to the two separate family day cares that both use the playground. And even when the playground is not in use by young children, the presence of the donated toys sends a clear signal that the playground is actively used by young children.

Local musician Matt Heaton even wrote a song about the donated toys in Cummings Park, titled “Outside Toys”.

If you never saw the range of toys donated to Cummings Park, you might not understand the full range of toys that passed through there: shovels and pails, balls, toy trucks and construction vehicles, ride-on toys, walk-behind toys, Cozy Coupes, scooters and tricycles and the occasional bicycle, several play kitchens and plastic slides, little basketball poles, toy lawnmowers, and most recently a plastic gas pump that allowed kids to pretend to be gassing up the various play vehicles.

Here’s a selection of the smaller toys in Cummings Park last year:

Toys eventually wear out, and several park neighbors took responsibility for periodically sorting through the toys and throwing out the broken ones. We also repaired toys when possible, inflated balls and bicycle tires, and worked with the parks department to report wear and damage to the permanent play structures. Mike Nestor at the parks department has been a real ally for years in working with us to keep Cummings Park in good shape to be used by young children and families.

It was, therefore, horrifying to see that the city last week abruptly removed every single donated toy in Cummings Park. This apparently happened around the same time in many or all city playgrounds. There was no warning, no notification, no opportunity for public input, and apparently no recourse. To replace the toys in Cummings Park alone would cost thousands of dollars, and people will be far more reluctant to donate toys when they expect that the city will arbitrarily confiscate them all again at any moment. Cummings Park is now far less appealing and useful for many families who want to use it as a playground. Instead, Cummings Park now looks barren and abandoned, which is exactly the sort of appearance that will lead to an increase in problematic uses of the playground. In a matter of days, it led to a noticeable increase in the use of the playground as an off-leash dog park.

There is widespread frustration, disappointment, and anger about the city’s removal of the toys from Cummings Park on local family-oriented Facebook groups. Here are comments from the last few days:
What happened at Cummings park??? We went there today and it was all cleared out!!! The kids were so sad!
Oh no! Sarah's park!!!!!
My kids loved using the toys at that park 
Oh, my boys will be devastated!!! So sad!
So sad! I think people generally do a good job of getting rid of broken toys. I think it's more of an eyesore NOT seeing them 
That is terrible, I can't believe they did that! 
Oh no my girls are gonna be sad next time we drive by. My oldest had a favorite bike that she always rode on. 
My son uses the toys more than the structures. 
Ours too! Heartbreaking. 
So sad! My daughter loves that park and used pretty much everything! When she was learning to walk she could still play. It's our favorite park. Awwww... 
So sad. Bring the toys back 
My daughter played more with the toys there than the structures. She will be so upset. I hope they bring them back. 
Devastating.... my son adored the toys 
It kept the kids happy. Now what? 
My other question is why, and is it just going to happen again if the community replaces them? I'd love to know who made the decision and how to make that person aware of just how unpopular it is. 
I can't believe they got rid of everything without any kind of notification or explanation, it seemed pretty obvious that the toys are used and enjoyed by the children who play there. It actually is the reason why we choose to go to Cummings park over other parks the majority of the time! My boys loved the diggers, dump trucks, etc they could use with the sand and all of the different vehicles there. Hopefully the city will bring them back. 
My daughter always bee lines for the cozy coupe and usually followed that with a session of digging and dumping sand in or with any kind of bucket or container. Small slides are a hit with the littlest ones too - less daunting than then permanent ones. I'm happy to help with this adventure come spring. We love this park! I'm just hoping it's not in vain. Is there any news on whether this is going to be happening repeatedly?
People have reported that Mike Nestor only wanted broken toys to be removed. It is unclear who in the city made the decision to remove ALL the toys, but it is very clear that it was a bad decision and a serious error. This error should be addressed openly, the city should issue a clear apology to the community for this error, the city should explicitly state that donated toys in good condition are allowed in the playgrounds, and the city should replace the toys.

There are several stakeholders who the city should include in any major decisions about Cummings Park:

1. The immediate neighbors of Cummings Park.

2. Sarah Volpe, who has brought her family day care to Cummings Park every day for many years.

3. Andrea Breen at Medford Family Network, who has run the playgroups in the park program for years, is very familiar with many of the city playgrounds, and knows that Cummings Park is in better condition than many because neighbors help care for it.

4. Park users, who can be reached through the Cummings Park Medford Facebook group, the Medford Moms Facebook group, the Medford Family Network mailing list, and signs posted in the park itself.

Here is my list of actions the city should take to improve Cummings Park:

1. Establish some practical enforcement mechanism for the park rules, with police enforcement when necessary to remove dogs and to remove people who are using the park at night.

2. Provide a clear way for park neighbors, community members, and park users to report problematic uses of the park at any hour and get a prompt response.

3. Install “no smoking” signs. This is one of the few actual park rules for which there is no sign.

4. Provide better fencing or containment for the basketball mini-court (which is also sometimes used for hockey and lacrosse), or convert that mini-court into a different use more compatible with being just a few feet from a neighboring home.

5. Clear the sidewalks around Cummings Park in the winter when it snow, and clear a single path through the park itself between the two gates (ensuring that the gates can open).

6. Consider installing water for a bubbler and/or the ability to water new plantings.

7. Consider adding a port-a-potty (as exists at Victory Park) in the corner by the intersection, so that little kids don’t have to use the fence line as their toilet. (This may cause more problems than it solves, but it should at least be discussed.)

8. Hire a new landscape contractor who will mow the grass more than once a month in the summer.

9. Establish a maintenance plan and replacement plan for the park structures. The bouncy bridge on the taller play structure has structural connecting links that are almost worn through, and much of the plastic on the climbing structures is now old enough that it is more prone to break and leave sharp edges. The benches under the gazebo are all bent down at the ends, greatly reducing their usable seating area.

10. Establish a maintenance plan and replacement plan for the park trees and landscaping. Many shrubs have died, the tree warden has confirmed that a number of the trees are unhealthy, and new donated plants cannot survive because there is no on-site water access.

11. Establish a community liaison or two for each city park who can help organize needs and wants for the park, and who can help communicate with the appropriate city employees and with residents and park users.

12. Plan to do regular requests on a schedule for graffiti removal by the Middlesex Sherriff’s Graffiti Removal Unit, which costs the city almost nothing to do. This has been a far less frequent problem at Cummings Park since the donated toys started, but it is an ongoing problem at other parks (and around the city).


Monday, January 11, 2016

8 trips to pharmacies in the past 7 days, plus a few phone calls

Things I’ve learned about epinephrine autoinjectors over the past 7 days:

The market leader is EpiPen, made by Mylan. Every drugstore stocks them, every doctor prescribes them.

The biggest competitor was Auvi-Q, made by Sanofi, which had some real advantages. It was a different shape, hurt a bit less to use, and had nifty talking instructions that helped make it more foolproof. It was recalled last October, and is not yet back on the market. Not every pharmacy knows that it was recalled, and you may still run into a pharmacy that insists that it’s the only alternative to EpiPen, insists that it wasn’t recalled, and is stunned to find that it’s not on their shelf. I’m looking at you, local CVS.

An alternative used to be Adrenaclick. It was pulled from the market in 2014, but the Auvi-Q recall notice states that it is still available as an alternative. It isn’t.

What is “available” is a generic epinephrine autoinjector, with no brand name at all. It’s made by the same company that made Adrenaclick, though they seem to use a different company name for the generic to make things simpler. Many pharmacies insist that the generic does not exist. I have a trainer for it in my hand that was mailed to me last week, but it does not exist. It is supposed to be available to pharmacies from their wholesalers, and insurance companies have pricing for it. I have a prescription for it, but I cannot get it filled. The Auvi-Q recall notice does not acknowledge the existence of the generic.

None of these auto-injectors are considered equivalent, even though they all contain identical medication. A prescription for Auvi-Q is therefore currently useless, because the pharmacy cannot substitute EpiPen for Auvi-Q.

A pharmacy might be able to substitute generic epinephrine autoinjector for Adrenaclick, since they are the exact same device. But first the pharmacy would have to acknowledge that generic epinephrine autoinjector exists.

Many prescriptions for medications are for 30 day supplies. That’s a difficult way of looking at EpiPen, since EpiPen is an emergency medication. We need a bunch so we can leave one at home, take one with us, leave one at preschool, etc. Then we don’t need any for a year, unless we use one and have to immediately replace it.

For most medications that are 30 day supplies, Cigna allows you to refill every 23 days. Cigna allows you to buy 2 boxes of EpiPens at one time, and then makes you wait. But unlike with most other medications, Cigna allows you to refill EpiPens every 2 days. Cigna can also do overrides on the refill limits for various reasons.

For most medications that are 30 day supplies, MassHealth allows you to refill every 24 days. MassHealth allows you to buy 2 boxes of EpiPens at one time, and then makes you wait. But unlike with most other medications, MassHealth allows you to refill EpiPens every 3 days. MassHealth cannot do any overrides on refill limits for any reason. Unless maybe they can if a pharmacist calls the DUR office, but probably not.

EpiPen’s price with Cigna is currently around $550 per box. This is up from $300 per box a couple of years ago, and $100 per box a few years before that.

The generic epinephrine autoinjector is under $400 per box. Cigna will happily pay for either EpiPen or the generic without prior authorization. MassHealth requires prior authorization for the generic, but not for EpiPen.

It’s not clear whether EpiPens and the generic are considered separate drugs or the same in terms of setting quantity limits and calendar limits on filling prescriptions. If you just bought two boxes of EpiPens and would have to wait to buy more, would you also have to wait to buy generics? I don’t know what the answer is, nor what the answer should be. I might try to find out tomorrow.

As of early January 2016, EpiPen expiration dates are pretty consistently February 2017 at both Walgreens and CVS around here.

EpiPen is available in 0.15 or 0.3 dose strengths. The smaller one is called EpiPen Jr., and is for kids under 66 pounds. The larger one is for everyone 66 pounds and up. If you have a prescription for the larger one by mistake, Cigna doesn’t mind if you fill it for a 4-year-old. MassHealth, however, rejects it. It’s not clear what would happen if the larger one were not a mistake.

It’s not clear whether the two dose strengths are considered separate drugs or the same in terms of setting quantity limits and calendar limits on filling prescriptions.

Since our pharmacy deductible is combined with our medical deductible this year, and since EpiPen is $550 per box, David’s $2600 annual deductible is now met as of January 11. Whee.

Dentist possibilities

Dentist possibilities (always check recent yelp reviews)

Brookline Dental Team
Dr. Hyejin Kwak, Dr. Seth Bozarth, Dr. Khaled El-Rafie, Dr. Myron Bass

Belmont Dental Group
Dr. James Nager, Dr. John Lapidus

Smiles by Rosie (East Somerville)
Dr. Rosie Wagner
(Michael went to her for the first time in January 2016 to repair a broken bonding on 9. She was very nice and happy to explain exactly what she was doing. Time will tell on how the bonding lasts, of course.)

Dr. Dale Wetmore, Dr.  David Bloom (Back Bay, Boston)
After 15 years going there, office staff refused to provide a quick copy of an x-ray for an emergency repair (saying they had 30 days to provide records).
Dr. Wetmore is conservative about fillings and cavities, Dr. Bloom is much more aggressive. (Dr. Bloom wanted to do fillings on 18 and 19 in Nov 2015, Dr. Wetmore said there was no need in Dec 2015 when he looked.) I trust Dr. Wetmore when he says something needs to be done because he is generally very conservative about that.
Bonding on 9 broke in 2011, broke in Jan 2014, and needed to be reshaped a bit in spring 2015.

Dr. Russell Forman (Cambridge)
recommended by Joshua and Kyla

Dr Fish at Restorative Dental Group in Cambridge
recommended by Josh, who has had good experiences there in general including some crowns
When reading yelp reviews, remember that many people are reviewing either their hygienist experience or billing issues, rather than the dentist.