When Children With Autism Grow Up

I was 23 and needed a summer job; he was 21 and needed full-time support. He’s one of an estimated half million people diagnosed with autism who are soon becoming adults — and who society is entirely unprepared for.

The heat that afternoon was intense. Weather maps across Iowa were deep red, and warnings flashed across the screen. A high school football player on the other side of the state had died from heat exhaustion the week before. Cornfields wilted and shrank into hills of despondent brown.

I was running late as I parked and shuffled to a dilapidated satellite classroom building. I introduced myself to a teacher sitting at a desk and told him that I was there to meet a 21-year-old man named “Scooter” — a childhood nickname, I’d later learn, that had stuck. (I’ve changed all names and some details to protect him and to comply with privacy laws.) I needed a summer job after my first year of grad school, and he needed staff.

My experience with autism had been limited to movies and anecdotes from friends who worked in “the field” — care industry shorthand for post-institutional residential and community-living nonprofits supporting people with developmental disabilities. (“We’re always looking,” the agency had said, and hired me without any sort of drug screening and a cursory, astonishingly fast background check. The drug screening was my only concern while filling out applications.)

The teacher looked like he was close to retirement age and wore a hearing aid. He asked about my experience working with people diagnosed with autism. “None,” I said, and his face dropped.

“Don’t stand directly in front of him,” the teacher said, “and avoid making eye contact. He might perceive that as a threat. He’s very keyed in on body language. Introduce yourself, but let me take the lead.”

I was led to a corner of the room I hadn’t before seen. It was darker than the rest of the space and a few decibels quieter. In the nook, I saw Scooter. He had a stringy mustache and hair with great curling wings. One of his eyes wandered slightly. He sat behind a crescent-shaped table padlocked to the wall at both ends of the curved top. Scattered in front of him were piles of flashcards, jars of beads, toy cars, unfinished puzzles, crumbs from lunch, and a laminated piece of tagboard with a strip of Velcro down the center. As soon as he saw me, his face tightened into a sort of grimace, baring his teeth, but the rest of his face, his eyes, posture, and hands were unexpressive as he blankly leaned out into the dim classroom.

“Well, hi there,” I said, waving. I began to clam up in all of the pits of my body.

“Well, hi there,” Scooter said, and he let out a deep laugh.

The person I was going to meet that day had been a child in my mind. In front of me was a man. A man only two years younger than me.

The three of us sat at the table while Scooter and his teacher went through flash cards, and Scooter looked at me a few times with a penetrating glare. His expression settled into a sort of skeptical normalcy. I felt like I was being sized up, and I now realize that I was. Scooter has had dozens of staff come and go in his lifetime. He was right to wonder whether I would be sticking around.

As medical phenomena go, autism is a recently identified one, although perhaps not as recent as the current vaccination panic suggests. The term was coined in 1912, and the first person ever diagnosed with autism is now 81 years old. And yet the contemporary situation is an unprecedented one: Though the data we have is under constant scrutiny for its accuracy, methodology, and usefulness, the Centers for Disease Control reports that the current rate of autism diagnosis in the United States is 1 in 68. This is a continuation of a trend identified by the Environmental Protection Agency that started between 1988 and 1992, when the worldwide diagnosis of autism spiked from 6 in 10,000 kids to 24 in 10,000. Scooter, born in 1989, is part of a coming “tsunami” of autistic adults. Signed in August of last year, the Autism CARES Act has devoted $1.3 billion in federal spending to research, which is a drop in the bucket autism currently costs the United States annually. That number only stands to go up. Simply put, we have no plan for any of this.

People diagnosed with autism and other developmental disabilities used to be stuffed into institutions, and the horrors that took place within them are well-known. I’ve read about Achilles tendons being cut to prevent people from running away, teeth being pulled to prevent biting, cattle prods used to electrocute, endless streams of sedatives. While most of that has stopped, with the glaring exception of overmedication, the current system of care is hyperaware of this history.

Ideally, those who work with this part of the population now strive to empower them, to remove labels and barriers and work toward independence. And yet this is the ugly fact, a vestige of the institution era: The chief witnesses to Scooter’s life are not friends and family but scores of paid providers. People like me. We accommodate, teach, and encourage. We support. We never punish. And yet our interests are split between doing genuine good for another human being and getting a paycheck. So we’re also probably looking around for something that pays better than $10 an hour and doesn’t involve regular emotional, and sometimes physical, beatdowns. And that, in turn, affects people like Scooter.

Mac had long hair, had studied English in college, and was a competent thinker and dedicated stoner. When I showed up to work on the first day, he stood by the Smoke Shack, a repurposed bus stop shelter, and was halfway through an American Spirit. His belly and hips were pressed forward. He said, as if informing me, “You’re Bob.”

I grinned and lit a cigarette.

“Smoke that fast. You have to work.”

Mac had known Scooter for five years. Scooter had been living in group homes since he was 11. For the last decade, Scooter would see his family about once a year, if that. He has no friends. Mac explained that my job was to help him transition into the agency’s day program, a place for people to socialize, do activities, and complete sub-minimum-wage work.

We entered what Mac called the Autism Room, or A Room. One man, in his forties, overweight and wearing a Ron Paul T-shirt, was vacuuming while doing a spot-on impression of the vacuum. Another, in his late thirties, was eating a box of raisins and singing his name. A third, approaching 60 and wearing overalls, took off his shoe, jumped out of his rocking chair, bit his shoe, began to cry, and then sat back down. The people supported, like Scooter and the rest of the men, were referred to as “individuals.”

Opposite each was a member of the “staff”: a reformed redneck with trendy sunglasses and a Metallica T-shirt, an aging Gen X’er with a pink poodle haircut and psycho-’50s-housewife-chic miniskirt, and a hipster who talked at length about shoegaze-y post-punk and horrorcore-trance hip-hop. Everyone had a clipboard and documented, ad nauseam, their daily assigned individual, from lunch choices to the size and consistency of their bowel movements.

Scooter was the youngest in the A Room by almost 10 years. He and Mac and I sat in a corner, Scooter in a plush recliner and Mac and I in stiff plastic chairs. Mac tossed the clipboard under his chair and said we would fill most of it out at the end of the shift.

“Hey, man. Um, dude. What’s up with you today, Scooter? Remember, we met at your school?” I asked.

Scooter looked at Mac.

“Don’t ask open-ended questions,” Mac said. “You have to use phrases that he knows and yes-or-no questions. Yo, Scooter. You want to go for a walk on the Key-Wash trail today?”

“Yuh,” Scooter said.

I couldn’t tell if he had said “yeah,” “huh,” or “no.”

“Key-Wash?” I asked. “So are these phrases, like, written down somewhere?”

“No, just pay attention. That’s a ‘yeah.’ Everyone assumes he’s saying ‘no,’ or ‘huh.’ Scooter, do you want to go for a walk on the Key-Wash trail? Yes or no.”

“Yes.” Scooter said.

“Scooter, do you want to go for a walk on the Key-Wash trail? No or yes.”

“No,” Scooter looked puzzled.

“So which one is it?”

“Do you want to go for a walk on the Key-Wash trail?” Scooter said.

“He talks in the second person,” Mac said. “So ‘you’ sometimes means ‘I.’ Also, questions are sometimes questions, but other times they’re statements. It’s part of his echolalia. Give him two choices and he usually picks the first one. Are you getting all of this?”

“Yeah, um, yes,” I said. I wrote “echolalia” on my palm and googled it when I got home.

Mac slathered Scooter with sunscreen and then documented that he had administered the medication “SPF 30 sport sunscreen.”

We piled into a junky minivan and Mac showed me how to fill out the mileage tracking and use the company card for gas. He prompted Scooter to buckle up and told me that we couldn’t take the thing out of park until everyone had their seatbelt on.

After Scooter clicked his buckle, Mac said, “You’re all telphered in and…”

“Telphered in and goin’!” Scooter rocked forward and back in his seat excitedly.

“I have no idea what that means,” Mac said. “Someone taught it to him a long time ago and now it’s just a thing that he says. He’ll say it pretty much every time if you prompt him. Some people go overboard and get him to say off-the-wall shit, but it’s not like he doesn’t have a sense of humor. Scooter,” Mac said. He changed his voice to mimic an announcer: “Nothin’ runs like a…”

“Nothin’ runs like a Deere.”

“Um, wrong one, dude. He does love John Deere, though. Scooter,” he gave a sneaky nod in the rearview mirror. “Try again. Nothin’ runs like a…”

“Stripper,” he said and smiled.

Mac made it a point to tell me that the whole “intellectual age” thing, that Scooter is like a 5-year-old trapped in a 21-year-old’s body, is bullshit. “He understands everything we’re talking about right now,” he said, “so don’t be shitty to him. Treat him like a person.”

Scooter sat in the backseat, watching the slumped cornfields as we whipped past them. We drove over a dam, past a large irrigation reservoir, and arrived at a trailhead. A sign read “Woodpecker.”

“I thought we were going to the Key-Wash trail,” I said.

“I don’t know where the Key-Wash trail is or if it even exists. All trails are the Key-Wash trail.” Mac logged the van’s mileage. “He won’t be upset as long as you guys go for a nice long walk. Where we at, Scooter?”

“The Key-Wash trail,” he said.

Illustration by Eric Petersen for BuzzFeed News

I was off on my own a few days later. I parked the van in front of Scooter’s house and waited for him to come out the front door. I had a vicious hangover. When he appeared, he was wearing a new pair of shorts and clean white shoes, had shaved his mustache, and sported a fresh crew cut.

“What’s up, Scooter?” I said when he opened the door of the van.

“Where’s Mac?” he asked.

“Just you and me today, dude.” Scooter climbed into the backseat. “You’re looking sharp, man. Nice threads. Where ya headed?”

“To the A Room.” He looked out toward the front door of the house, disconnected from our conversation, and slowly buckled his belt.

“Are ya all telphered in and…”

“Huh?” he said, suddenly engaged.

“Are ya all telphered in and goin’?” I said in my best Scooter impersonation.

“Are ya goin’? You don’t want to go to the A Room today?” he said.

“Which one is it? Going or not going?” I asked.

“Are you goin’ to the A Room?”

“Groovy,” I said. My guts began to angrily rumble.

When we arrived and I parked, Scooter did not get out of the van.

“You don’t want to go to the A Room today,” he said.

I tried being nice, being firm, everything I could imagine. And finally I said, “I can wait all day, dude,” took a few steps from the van, and lit a cigarette. But that was a lie. Twenty minutes later, I said: “Scooter, please. I have to go to the bathroom really bad.”

Scooter sat in the backseat with the door open and said nothing. The sun pulsed down in oppressive waves, cooking whatever foul thing was roiling in my intestines and heating the van to what I hoped was intolerable for Scooter. And then Mac happened to come outside for a smoke.

“How’s it going, fellas?”

“We’re stuck,” I said, “And I’m about to fill my shorts.”

Mac laughed. He poked his head into the van. “Sup, dude.” He pointed at me and then at the building, so I ran in. When I came back out, Scooter’s binder in hand, negotiations were still heated.

“Check it out, dude,” he said, showing Scooter. “We’re going to get out of the van, go rock, go to the bathroom, go for a ride in the van, then go home.”

“You want to stay in the van?” Scooter said.

“Can you move to this seat so we can talk better?” Mac pointed to a seat closer to the door. Scooter did. Over the next half hour, Mac continued to prompt Scooter to complete the next step of getting out of the van. Move to this seat, move to that seat, put your feet near the edge of the door, put one foot on the ground, put your other foot on the ground, grab this handle, and finally out.

The victory, if one could call it that, felt so small that I wanted to stay home the next day and the rest of the summer. It would have been easy for me to leave. But it was a job.

Scooter and I soon spent six hours a day, five days a week together. I eventually didn’t need Mac’s help as often, which I think he respected. We would shred confidential documents from nearby businesses so Scooter could make money, and then head down to the Dairy Queen on payday. I would ask Scooter what he wanted, already knowing that the answer would be a medium chocolate ice cream with sprinkles. I would get a small root beer float. “How about this weather?” I would say, or, “They sure make one hell of a cup of ice cream here” or, “These are the days to remember.” He would just say, “Yuh,” and eat too fast.

“Slow down or you’ll get brain freeze,” I would say.

“Your brain freeze,” he would reply between bites and laugh.

We walked many miles of trails and worked through sorting and matching tasks. A lot of time was spent sitting in silence. When he was unable to regulate the information coming into his brain, I would perform a process called the Wilbarger Protocol. It was intimate. I would move a soft brush on Scooter’s arms, legs, neck, and back. Then he would put his hand in mine and I would grab his fingers one at a time, compressing the joints in toward his palm. Firm but gentle, confident but caring. I would watch his face, look for some tension to drop from it and then linger there, count to 10 in my head, and then move on to the next one. We were an impossible duo, a temp and one of the hardest guys in the agency.

But things got rough by the end of the summer. He started to refuse activities, and then he got aggressive, reaching for other staff members’ faces, toward their groins, pulling people’s hair. He never tried to hurt me. I wasn’t sure why. Maybe he wanted me to stay.

Before long it was my last day and I was checked out. He refused to leave the A Room at all, which just meant less work for me. I was happy to sit in a chair and play with my phone. But then it was time for Scooter to go home.

The dude in the Ron Paul T-shirt vacuumed, and his staff orbited. I called Scooter’s house, and the staff who answered said he’d be there soon but that Scooter’s roommate was going berserk and kicking holes in the walls.

“Are you done?” I said in a low, firm voice.

“Are you done?” he replied, laughing.

“Whatever, dude. I can sit here all day. They’ll give me overtime.”

Scooter said, “Whooossshhh,” and laughed again. The vacuum shrieked.

“Seriously, dude, I just fucking want to go home,” I said in a half whisper and stood up. “Out of the chair, let’s go.”

“Get out of the chair.” He said in a rough voice.

“So what, are we just hanging out here? Just chillin’ one last day? You haven’t had enough of me yet?”

“Oh, I’m just hangin’ out.” He said with a high-pitched, mocking tone. Repeated it for another hour. Whooshed every time I spoke to him.

When we parted, neither of us said good-bye.

Illustration by Eric Petersen for BuzzFeed News

It was about a month before I caught myself sitting alone at the DQ, slurping down a root beer float, or hiking Woodpecker with the hopes that Scooter and I might run into each other. Mac and I had become friends, and he gave me updates on how Scooter was doing while we played disc golf or went out drinking.

Mac showed up one day, pale, wearing a hat.

“Bad haircut?” I jabbed, and then he took the hat off. His scalp had bald patches and open abrasions. Scooter had had an episode and was hospitalized, Mac said. He put his hat back on. We ate Indian food and didn’t talk about it much more.

Scooter has never been diagnosed with post-traumatic stress disorder, but he almost certainly has it. He has alleged that his father sexually abused him, but the claims were unfounded because it was Scooter’s word against his dad’s, which is common. By one estimate, people with intellectual disabilities are four times more likely to be sexually abused than people without.

Scooter’s allegations of abuse come in huge outbursts, and he echoes things that must have been said to him while it was happening. “You are a fucking retard, aren’t you?” and “Does that dick feel good in your ass?” and more that I can’t bring myself to repeat. During post-traumatic episodes, almost all of his frustration eventually manifests as physical violence.

Over the Indian food, my nostalgia turned into guilt, which, in the weeks that followed, turned into outright pain, a longing to be there for him. To help Mac and the other staff and ultimately Scooter. He would listen to me, I was certain. I could help him somehow. That thinking was rooted in the relationship Scooter and I had built together, but also, I now realize, in a sort of compassionate hubris. I can take care of him because he can’t take care of himself, I thought, and got a job part-time at his house.

“It is Bob!” Scooter exclaimed, rushing to me. He looked tired, ragged, the stringy mustache coming back in, the wings starting to curl behind his ears.

“What’s up, Scooter-duder?”

“What’s up, Scooter-duder? Oh, I’m just hangin’ out,” he said and laughed.

“We’re still on that, huh?”

“Yuh.” Scooter said and then reached out for my face with both hands. I ducked out of the way reflexively. Mac appeared out of the bathroom and tapped Scooter on the shoulder.

“We don’t need to be doing that,” he said, and looking at me: “You ready for an adventure?”

Mac and I had to take Scooter to a pre-appointment; he was getting his wisdom teeth removed. Long overdue. Dental work causes so much anxiety for Scooter that in order to do it safely, he needs to be fully anesthetized, and they need to see him before they will put him under.

“Scooter,” Mac said as he drove, “what should we have for lunch after we’re done at the dentist?”

“Do you want to go to McDonald’s?” Scooter said. McDonald’s was more than lunch. It was the ace up our sleeve.

“Sounds like a plan, dude,” Mac said.

Scooter tried to pull the receptionist’s hair when we went to get his paperwork. He tried to pull a little kid’s hair on our way back to the far corner of the waiting room. Nobody looked at him. Everyone stared into their devices. White lab coats occasionally floated through the space.

“Bob,” Mac said, and nodded toward Scooter. He grimaced. Scooter has been in and out of inpatient psychiatric units his whole life, and the lab coats reminded him of that. He moaned and bent over, nearly touching his chest to his knees, and then threw himself into the back of the chair hard. He started reaching over my shoulder toward the person sitting closest to us, a young mother, trying to get at her hair or face.

“Let’s keep our hands to ourselves,” I said in a low, calm voice. Mac was in a vaguely athletic stance, ready to react.

Scooter looked at me, continued to make pained faces and reach.

“Scooter, stop,” I said.

Scooter suddenly stood and fixed his gaze on the woman. His arm was out and he started walking toward her, his face unrecognizably vacant.

I felt my own energy rising and stood right in front of him, puffed myself up to look big and imposing, and I said, “Sit down, now.”

Getting hit in the face doesn’t hurt. Not at first. At first you aren’t sure what happened, but it’s vivid and embodied in retrospect. Scooter slapped me three times and, after a few attempts, boxed my ears, which sent me into a dizzy high. Overcome with a vibration, a warble in my gut of an instinctual magnitude spread to all of my limbs like an electric charge. Fight or flight or keep your fucking cool. Always try to do the lattermost. Finally, he grabbed my beard. Pulled slow, hard. That hurt right away, like a thousand pinpricks. Mac was there, holding Scooter’s hands against my face, trying to keep him from ripping out hair, asking him to let go.

“Scooter,” a nurse said, and he was off, Mac and I flanking him on either side. I glanced back over my shoulder as we walked to the exam room. Everyone in the place stared at us, wan and terrified.

We got through the rest of the appointment, received pre-op instructions, and kept Scooter from tearing out the nurse’s hair. The whole ordeal felt, at once, bizarre and pointless. Of the vast, innumerable infrastructures of society — dentists’ offices, hospitals, mental health counselors, DMVs, voting stations, restaurants, bars, public parks — I have never been to one that was adequately prepared for someone like Scooter. And if that isn’t enough, the general public responds to him with fear and feels better when he’s out of sight.

An exit sign glowed like a beacon near the exam room. Then we ate McDonald’s; it was terrible.

Illustration by Eric Petersen for BuzzFeed News

A few months later, I was working close to 30 hours a week. Every shift was Scooter and me. That was on top of full-time school, teaching, and writing my graduate thesis — an experimental, heavily fictionalized, and nonsensical book-length essay about working with Scooter. It was unreadable. In all, I spent about 50 hours a week with him or writing about him. And I dreamed about him almost nightly. Most of the time, he didn’t have autism, and we would talk, at length, about my work. Everyone who I’ve told this to in the field has said they’ve had such a dream about someone they support. All this and I was his “preferred staff,” not a friend.

One day, an administrator, I’ll call her Ann, was in the house with Mac when I showed up for my shift. She was, and I suspect still is, the only consistent female presence in Scooter’s life and another paid provider, and she was holding a pair of medical safety scissors.

“We have a job for you,” she said with faux gravitas. “Scooter has really bad dingleberries.” Mac let out wicked, high-pitched laughter.

“Got it,” I said. I had no limits. They didn’t have to ask. I gloved up and took the scissors, went into Scooter’s bedroom, and sat down on the floor while he sat in his rocking chair.

“Dude,” I said, “you and I need to do something.”

“Yuh.”

“It is going to be uncomfortable at first but will make you feel better when we’re done.”

“Yuh.”

“I don’t know how to explain this, so here it goes.” I looked up at him and made prolonged, serious eye contact. “Sometimes, our turds get caught in our butt hair. Guys like you and I, we have a lot of butt hair, so the turds make something called dingleberries. And dingleberries make us feel uncomfortable. So I’m going to take these scissors and cut out the dingleberries. Is that clear? Can you tell me what we’re going to do?”

“Bob’s going to cut your dingleberries.” Scooter spoke these words with an air of knowing.

Scooter got into the shower and I turned it to the temperature I knew he preferred. Ann and Mac hovered outside the door. I rolled up my sleeves and asked him to “bend over,” aware of his history of abuse but unable to think of more neutral phraseology, and he did.

The dingleberries were in a dense clump. Some were the size of walnuts. All of them were dry, hard, and matted in. I started by asking Scooter to wash with a soapy cloth, and then grabbed each one, careful not to pull, and clipped it out. I dropped them into the tub and they made audible thuds. As I continued to trim, I thought about how it must have been to live that way for months if not years, unable to tell anyone he needed help.

Scooter is of the generation that is bringing autism out of the shadow of Rain Man and into the cultural consciousness as a real thing. That damage has been done, however. I once told a woman I was attempting to court that I worked with a guy with autism — that it was hard work, but rewarding. “What’s his gift?” she asked. Savantism is a phenomenon experienced by 1 in 10 people on the spectrum. People like Scooter have to work hard to learn basic skills, and Scooter’s family didn’t have the resources — money, time, education — to teach him.

Intensive early intervention strategies like applied behavior analysis can help teach communication skills and “socially appropriate” behavior. iPads and apps are the new frontier of autism communication systems. After listening to people like Carly Fleischmann and Ido Kedar, we know that people who are unable to speak are still able to think and feel. They can tell us what it is like for them to have autism, but we must be careful not to generalize too much. The spectrum is so immense it is almost useless. As Hans Asperger said, “The autist is only himself.” Or the new adage, “If you know one person with autism, you know one person with autism.” And that person is a whole, complete person, inseparable from their “disorder.”

“You’re doing a good job,” I said, but Scooter didn’t show any discomfort. Mac and Ann giggled. It occurred to me, as I trimmed this man’s pubic hair, that there is no substitute for self-care. Nearly a dozen staff had started and quit in the two years I worked with Scooter. One guy took his first lunch break and never came back.

And I would leave too. A year later I had finished grad school and was set to move out of state. I put in my two weeks with relief. We all worried that Scooter would get agitated and aggressive, that the disruption of his routine would be too much for him to handle. So after talking it over with the other house staff, but not Mac, I decided I wouldn’t say good-bye.

Scooter sat in his rocking chair and I stood in the doorway to his room. It was the beginning of another hot summer. The light coming in through his blinds, brilliant white bands on darkened floorboards.

“Scooter, I’m proud of you,” I said.

“Bob will be back tomorrow?” he asked.

“Not tomorrow,” I said.

“Bob will be back in two weeks?”

Two weeks was an amoebic time frame for Scooter. It meant he would see me later in the vaguest sense — after a vacation or in the parking lot of the Dairy Queen.

I still work in the field, albeit many states away; it’s now my fifth year. I’m in it until I burn out completely. It feels good to have a mission and to dedicate my time to the advancement of others’ well-being. I continue to unlock new chambers of empathy on my very best days and leave work feeling ecstatic clarity. Scooter did that for me first. That’s the selfish edge of altruism. And there’s my paycheck, which helps get me through the door on the bad days. I spend a lot of time thinking about the power dynamic that existed between me and Scooter, how much of an outsider he is. That he lives in a sort of alternate reality, and I’m just a tourist in it. There’s a lot of truth in his status as “other,” but that kind of thinking keeps him on the outside. The reality is that everyone with autism lives in the same ambiguous, fraught, difficult-to-navigate world as the rest of us.

I’ve since been promoted a few times and spend most of my day at a desk, distanced from the hands-on work. Clearing and constantly running into bureaucratic hurdles is exhausting, occasionally infuriating, almost always tedious. My problems are all abstractions. I don’t get hit anymore. I don’t feel all that fear and adrenaline. And I miss it. I miss Scooter and other people I’ve supported. Now I often feel like just another murmur in a strange and hidden system of tax-dollar expenditure.

Scooter is going to live in a group home for the rest of his life. His needs, his desires, his day-to-day life will always be contingent on the presence of staff. Does he need this level of support? Certainly. But how did he end up here, so far away from the availability of solid, meaningful relationships? Because it’s not Scooter’s disability that isolates him; society does. As a newer, much larger, and more visible generation of kids is growing up in the same system, an important question arises: Can this be changed?

During my drive out of state, I would break down into heaving sobs. I had to pull over and confront, for the first time, the fact that I loved Scooter and all of the people I was leaving behind. It can look strange, it can encompass all of our frustration and warmth and indifference in equal measure, because being a person is complicated, but treating everyone with unconditional and irrational kindness is the only thing that makes sense.

In his room, Scooter’s eyebrows were scrunched low. He looked down at his hands folded in his lap. He rocked for a bit, and we remained in silence.

“Bob will be back in two weeks?” he asked again.

“In two weeks. Good-bye.”

“Bob will be back in two weeks?” he asked, and I walked out the door.

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The Invention That Could End Obesity

A Michigan surgeon invented an apparatus that he believes tricks the brain into thinking the stomach is full. His Full Sense Device could be a lifesaver for millions of obese Americans and raises questions about how hunger — our most basic human impulse — even works.

Bonnie Lauria was miserable. She was subsisting on liquids and a handful of foods her stomach could handle. Ever since she’d undergone gastric bypass surgery in the ’80s, foods like meat and bread that went down her throat in a lump would come right back up. “I knew where every bathroom was in every restaurant in the state,” Lauria says from her home in West Branch, Michigan. “It was horrendous.”

During gastric bypass surgery, the stomach is reduced to about the size of a walnut and attached to the middle of the small intestine. Lauria’s complications from the surgery weren’t normal, so she went under the knife a second time. Still, her condition didn’t change. She switched doctors several times, but no one could help. Eventually, someone recommended bariatric surgeon Dr. Randy Baker in Grand Rapids in 2004.

Baker ran some tests and saw that the spot where Lauria’s walnut-size pouch met her small bowel was tightening. Previous doctors had tried to widen the passage so that food could pass through, but the stricture had returned. Complicating Lauria’s condition were those multiple surgeries, which left so much scar tissue that operating again would be too difficult and too dangerous.

Dr. Randal S. Baker. Erin Kirkland / BuzzFeed News

Baker was at a loss. Then he started thinking about esophageal stents. Just like a coronary stent keeps an artery open, an esophageal stent holds the esophagus open and is often used in patients who have difficulty swallowing. What if one of those could prop open the small bowel too?

As far as Baker knew, no one had ever attempted a procedure like that before. But Lauria was out of options, so Baker told her his strategy. She agreed; he inserted the stent and hoped for the best.

“She came back to my office two weeks later and said, ‘Dr. Baker, I’m feeling great. I can eat sloppy Joes!’” Baker says. “Here’s a lady who could only do liquids, and now she can eat solids. And she’s losing weight.”

Lauria didn’t have an explanation; she told Baker she simply wasn’t hungry anymore. Baker wondered if he and other bariatric surgeons had been going at it all wrong. The stent, he theorized, was putting pressure at the top of Lauria’s pouch and sending signals to her brain saying, “I’m full.” It was doing what food does, but without actual food. Which raised some questions: What if we don’t need invasive surgeries that cut away portions of the stomach and rearrange the digestive tract and intestines? What if all we need is a device that puts pressure near the top of the stomach?

Baker set out to test his hypothesis, teaming up with a former product specialist from W.L. Gore (creators of Gore-Tex) and two surgeons at his Grand Rapids practice to create the Full Sense Device — a nitinol wire-mesh funnel coated in silicone that can be inserted through the mouth and placed in less than 10 minutes. Current plans would allow the device to remain for up to six months before removal, though in the future that time may be longer. In the company’s trials, every patient implanted with the device lost weight and continued to lose weight until the device was removed. Baker calls the phenomenon “implied satiety.” At six months, average patients lost 75% of their excess body weight — significantly more and at a faster rate than any bariatric procedure, and all, Baker says, with no “severe adverse side effects.”

The Institute for Health Metrics and Evaluation estimates that 160 million Americans — nearly half — are overweight as indicated by their body mass index, which is calculated from a person’s height and weight. (A BMI between 25 and 29.9 is considered overweight; 30-plus is obese.) Of those people, 24 million are estimated to be morbidly obese, meaning they have a BMI over 40 and are at higher risk for serious, life-threatening illnesses, including heart disease, diabetes, degenerative arthritis, and cancer. Bariatric surgeries can and often do lead to impressive weight loss, yet only 1% of obese Americans opts for the invasive and costly procedure — usually $20,000 to $30,000. (Rex Ryan, Roseanne Barr, Carnie Wilson, Al Roker, Chris Christie, Randy Jackson, and Star Jones are reported to be among the 1%.)

“There are a bunch of things that contribute to that,” says Randy Seeley, an obesity researcher and professor of surgery at the University of Michigan. “One is the ick factor — ‘someone is going to chop up my GI tract.’ Some of it is cost — it’s still not universally covered. Third is stigma. The implication is that it’s the easy way out — you’re cheating somehow by taking that option — which goes to our societal biases about obesity.”

Dr. Baker has come up with a nonsurgical device that he says will enable obese patients to lose substantial weight, and at a fraction of the cost of surgery — in the neighborhood of $5,000 at an outpatient center. A company claiming to have found a simple solution to drastic, easy weight loss is, of course, nothing new; in fact, it’s big business. (See: late-night infomercials.) Some surgeons and researchers are skeptical of Baker’s pressure theory, and at least one patient experienced chronic acid reflux after the device was inserted. But more than 10 years after the eureka moment, Baker is hopeful that doctors in Europe could begin using the Full Sense Device this year and in Canada and Mexico soon after. Americans will have to wait longer; Food and Drug Administration approval is unpredictable and likely still years away. Baker’s concern, though, is that the Full Sense Device might work too well. If it’s effective, easy, and cheap, what’s to stop people from abusing it?

“When this hits the market, there’s not going to be just 10,000 to 15,000 people having it,” says Fred Walburn, president and sole employee of Full Sense Device’s parent company, BFKW. “There’s going to be hundreds of thousands. Millions per year.”

BSIP/UIG Via Getty Images

At Grand Health Partners, the Grand Rapids practice Randy Baker shares with other bariatric surgeons, including his business partners Dr. James Foote and Dr. Paul Kemmeter (the F and K in BFKW), the hallways are extra wide and the doors are oversize. Waiting-room chairs are huge. Even the toilets are bigger and mounted to the floor (not the wall) to better accommodate obese patients. Everything is designed for the comfort of patients who are used to being uncomfortable wherever they go.

On a fall afternoon, Baker shows me into Grand Health Partners’ endoscopy suite, where I watch him put a scope down patients’ throats to investigate postoperative acid reflux and take preoperative biopsies.

In black slacks and a striped button-down, Baker, 50, taps on his iPad while nurses sedate the patients. Despite his 6-foot-5-inch frame, he’s not an imposing figure. With tidy, graying hair and black, wire-rimmed glasses, he has the kind but serious air of a high-school chemistry teacher. When he explains that he discovered something no one else had thought of, he says it with zero dramatic flair. The most animated version of Baker shows up when he explains something, and I respond in a way that communicates an understanding of the concept. “Exactly!” he says.

Each endoscopy is quick — 10, maybe 15 minutes. Patients aren’t in a deep sleep; inserting the scope only requires sedation as opposed to the general anesthesia that is often needed for surgery. Some of these patients will see Baker again in the coming weeks for a 60- to 75-minute sleeve gastrectomy, his preferred bariatric surgery. Such procedures are most often a last resort for morbidly obese patients.

Later that night, as I’m sitting across from Baker at Kitchen 67, a chic Grand Rapids bistro with rows of pulsating screens on the ceiling and iPads in the booths, Baker prays for our meal and our families. He’s the father of nine, an elder at his church, and the board president of Zion Christian School, where he led the charge in revamping the entire curriculum. He and his family used to sing and tour in a Southern gospel group. Baker recommends the burgers, noting that I should feel free to build my own burger instead of choosing one of the restaurant’s signature varieties. “I don’t like categories,” he says.

Once I finish my cheeseburger, Baker takes out his MacBook and queues up a video of a bariatric surgery. An extreme close-up of white-and-red gut gore appears on the screen, followed by a harmonic scalpel that looks like a serrated pincer, which begins squeezing and cutting masses of surprisingly tough, glistening white fat from a pinkish mass that Baker tells me is the stomach — “the second biggest I’ve ever seen.” I glance around the restaurant and ask him if we can turn the screen a bit so as not to ruin someone else’s dinner.

Even though he’s performed thousands of bariatric surgeries, Baker hasn’t lost sight of the harsh, invasive nature of what’s happening in that video. He explains that he spends most of each surgery attempting to gain access to the stomach. Obese patients have so much fat, not to mention an enlarged stomach and liver, that the workspace is cramped. The flimsy spleen is close by, as well. Brush it ever so slightly and it’ll bleed. Plus, there are vessels hidden in the fat. If a surgeon hits a vessel that starts to bleed, it sets off a frantic search to find the source.

“I had a patient who died once from a different surgery because there was an abnormal vessel in an abnormal place, and it started bleeding,” Baker says. As surgeries go, these are relatively safe. Mortality rates for three common procedures — gastric bypass (also called Roux-en-Y), vertical sleeve gastrectomy, and gastric banding — range from 0.14% to 0.03%, which are lower than gallbladder removal or hip-replacement surgery mortality rates.

“This one started to bleed a little bit,” Baker says, pointing to a spot on the screen. “I’m guessing where the bleeding is, but I can’t tell. Can you tell where the bleeding is?” I’m clueless. He closes the computer. “This is the best we have right now,” he says. “When I’m operating on big patients, I’m thinking, This would be a piece of cake if we popped in a Full Sense Device. The biggest highway to the stomach is not through the abdomen. It’s through the mouth!”

Photograph by Erin Kirkland for BuzzFeed News

Though the concept of hunger may seem simple, it isn’t, nor is it understood entirely. Scientists haven’t pinned down exactly how the stomach communicates with the brain. The interaction between gut hormones and the nervous system is key — ghrelin and leptin, for instance, act on neural components of hunger — but there isn’t a complete set of answers for how the gut regulates appetite.

There’s also no consensus as to how or why bariatric surgery often leads to dramatic weight loss and diabetic improvements (or why sometimes it doesn’t). Most bariatric surgeons were taught that the procedures lead to weight loss through restriction and/or malabsorption, and many still hold fast to those two explanations. The restriction theory says that the surgeries lead to weight loss by limiting the amount of food the body can hold. Malabsorption — when something is bypassed to reduce absorption of calories — is also thought to play a role in gastric bypass. But research from the past few years suggests that there are, at the very least, more things going on.

What makes a gastric bypass patient eat less, Baker theorizes, is that it takes less food to put enough pressure on the stomach so that it sends neurological and hormonal signals to the brain saying, “I’m full.”

“People used to think satiety was on or off,” Baker says. “You’re hungry or you’re not hungry.” But Baker says it’s actually a continuum. When there’s nothing in the stomach you have hunger, then you progress to “not hungry,” then levels of fullness, then nausea, then vomiting. “The more pressure you put on,” he says, “the higher you get up that cycle.”

Randy Seeley, the University of Michigan researcher, has a different take. “It’s very clear that restriction and malabsorption have little to do with how surgery works,” says Seeley. His research points instead to the importance of gut bacteria — particularly the hormonal action of bile acids — after surgery.

While Seeley says he’s willing to be convinced by data, he’s no less skeptical of Baker’s pressure theory. There are stretch receptors in the stomach, and the nerves there do respond and generate a signal when you stretch those receptors. But he wonders how much that matters to body weight. “For [Baker] to say that it’s not about restriction is getting outside of a surgeon’s box,” Seeley says. “But to say that it’s pressure, for me, is not changing the box very much.”

Baker agrees that gut bacteria and hormones are important, but thinks the stomach’s upper portion is the gut’s brain, which sets other processes in motion. Still, many questions remain regarding the roles restriction, malabsorption, pressure, hormones, and nerves play in bariatric surgery, and the answers will likely determine whether the Full Sense Device is a legitimate, long-term alternative to weight-loss surgery.

“When we have all those answers, we can put surgeons out of business,” Seeley says.

DEA PICTURE LIBRARY/De Agostini / Getty Images

First came the animal studies. Between 2005 and 2008, BFKW held five studies using beagles, which are less prone to ulcers than pigs and have an esophagus similar in length and width to a human’s.

“We ended up having 1% total body weight [loss] per day,” Baker says of the final six-week beagle study. “In the protocols, they said if you get to 20% weight loss, you euthanize the animals. The vets came to us and said, ‘We’re at that 20% rate. Most of the time, animals that lose this weight will become lethargic. These animals are wagging their tails. We’ve never seen anything like this. They’re starving themselves to death, and they’re happy about it.’”

The dogs were actually losing too much weight, so the device was later softened. Also, in a few of the dogs, the device fell out. “The instant they migrated, the dogs were hungry,” Walburn says. (Walburn had quit his job at Gore and moved to Grand Rapids to work full-time on the Full Sense Device.) “They ate every bit of food that was in their cage.”

BFKW’s patient trials have been overseen by Baker, Foote, and Dr. Jorge Trevino, a surgeon in Cancun. The first six-week study in November 2008 was limited to three patients who were fitted with the device and told to go on a liquid diet for one week, then eat normally. They also met with a nutritionist. All three lost significant weight.

Just as the beagles had been, the initial trial patients “were just happy,” Walburn says, explaining what they believe is going on: “Because of the pressure on the top of the stomach, the body does not think you’re dieting. It thinks you’re full. It does not reduce the metabolism like what happens when you go on a diet.” In other words, the body doesn’t think it’s being starved for nutrition.

After making some tweaks, BFKW did a randomized controlled trial, which is the gold standard for clinical trials of drugs and medical devices. The randomized controlled trial was three months long and involved a relatively small sample of 18 patients, six of whom were in the control group and received no treatment. At three months, the control group had 15% excess weight loss compared with 42% in the group that had the device. BFKW then did a “crossover trial,” taking three of the patients from the control group and fitting them with the device.

“We put the device in them, and boom — if you compare that to when they thought they had the device but they didn’t, there’s a clear, statistical difference,” says Baker, who indicates that every patient — about 110 of them at this point — in the company’s various trials has lost weight and continued to lose weight with the device in place.

In a taped interview in Mexico, 41-year-old primary-care physician Manuel Perez explains in Spanish that the stress of studying medicine caused him to gain weight and eventually develop diabetes. His weight peaked around 285 pounds. After injuring his back, he couldn’t exercise much, and going to a nutritionist didn’t help. (“Mexican food is very delicious, so I couldn’t continue with the diet adequately,” he says.) Once fitted with the Full Sense Device in Cancun, Perez says he could control his diet better and he didn’t spend as much money on food. He lost 46 pounds in six weeks, and his diabetes and high blood pressure disappeared. His back pain went away too.

“Before I wanted to fill myself,” Perez says. “Now I eat very little.”

Not everyone’s story is as rosy as Perez’s, though. When I spoke to 49-year-old Cancun patient Luz del Carmen Gabriel, who had her Full Sense Device removed in January, she complained of severe acid reflux and nausea for the four months the device was in place. “It was uncomfortable when I slept,” Gabriel says. “I had to sleep sitting almost.”

Baker says Gabriel’s reflux was directly related to her size. She’s 4 feet 8 inches tall, which means she has a shorter esophagus than the average patient, and right now there’s only one size of the Full Sense Device. In the future, Baker hopes to have several sizes customized to a person’s height.

Gabriel says she wouldn’t necessarily recommend the Full Sense to others because of the reflux she experienced. “I got it bad,” she says. “Other patients didn’t get it at all.” But she’s satisfied with her weight loss from the device, which worked better than the pills and diets she’d tried. She ate “much less,” she says. Last summer Gabriel had a BMI of 32, and now she’s down to a BMI of 24, putting her in the normal, healthy range. She lost nearly 40 pounds, which means, because of her small stature, she achieved more than 100% of her excess body weight loss.

“Of course it was worth it,” she says. “I feel more flexible. I feel more comfortable in my clothes … I feel better when I see myself. I feel good.”

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Baker and his partners are submitting the device for CE mark certification, which would grant approval for use throughout Europe, a process that is typically cheaper and more expedient than the FDA process. Also, the FDA says it requires a device to be both safe and effective, whereas the CE mark focuses only on safety. According to this model, as long as the Full Sense Device is safe, if no one loses weight with it, doctors will stop using it and patients won’t request it.

“We have six or seven centers identified and ready to go in Europe,” Baker says. “These are doctors who have a history of research — top-notch doctors.”

One of those is Shaw Somers, known in the U.K. as the bariatric surgeon on reality TV shows The Food Hospital and Fat Surgeons. Somers met Baker at a surgical conference in Istanbul in August 2013.

“There’s always a dose of skepticism when someone comes out with a claim that something works as well as a major intervention,” Somers says. “Most of the other implantable devices we use and have experience with aren’t as good.” But Somers, who doesn’t have a financial stake in the product or parent company BFKW, believes this one is different. “The Full Sense Device ticks all the right boxes,” he says. “It’s effective, easy to take in and out. There’s nothing out [there] to give it a run for its money.”

Since the U.S. doesn’t allow human trials unless it’s part of the FDA’s approval process, all of the Full Sense patient studies have been conducted in Cancun. Somers expects a call this year to head down to Mexico for training on insertion and removal of the device, and he’ll use that experience to put together a package of care at his own center. Baker and Somers say these “centers of excellence” are key to bringing the Full Sense Device to market. They will be equipped with resources similar to a practice like Baker’s Grand Health Partners, which includes dietitians, exercise physiologists, and behaviorists who specialize in bariatric psychology. The practice has its own store stocked with recommended (and GHP-branded) foods.

“It’s not, ‘Let’s just pile them high and sell them cheap,’” Somers says. “No device will work simply by implanting it without some type of instruction and modification of lifestyle. You need to manage patients in the medium term and longer term. What this industry does not need is a quick fix.”

Baker is fairly optimistic about the timeline and likelihood of FDA approval, especially after the approval in January of EnteroMedics’ Maestro System — the first medical device OK’d to treat obesity since 2007. That surgically implanted device is similar to a pacemaker, sending electrical pulses to the vagus nerve, which plays a role in the stomach’s communication with the brain. Headlines touted the “appetite-zapping implant” and even conspiracy theorist Alex Jones got in on the action, using the approval to decry the “deadly secrets of a hackable fat chip.” But there’s a question of how well the device works: Patients in a yearlong clinical trial did lose weight, but the 156 patients who received the device lost only 8.5% more of their excess weight than the 76 patients who were given a placebo implant.

This isn’t the first time a company has developed a stomach pacemaker. In 2005, the Wall Street Journal reported that “a new wave of implantable stomach devices could transform the way doctors approach obesity,” focusing particularly on the Transcend gastric stimulator, often referred to as a “gastric pacemaker” because, like the Maestro system, it sends electrical pulses to the stomach in hopes of regulating appetite. Medtronic, one of the world’s largest medical-device companies, purchased Transcend’s parent company for $260 million in 2005. But trials didn’t show a significant difference in weight loss between those who had the device implanted and those who did not. Transcend is still available in Europe as a treatment for obesity, but the FDA never approved it.

Despite similar doubts over the efficacy of EnteroMedics’ Maestro system, last summer an advisory panel decided the potential benefits of the device outweighed the risks, and the FDA followed suit with its approval. The high expectations for another questionably effective gastric pacemaker — which will cost between $15,000 and $30,000, about the same price as bariatric surgery — shows just how hungry the FDA, medical-device companies, and the general public are for an obesity-fighting alternative to bariatric surgery. And more endoscopic devices — balloons, fillers, liners — are on the way. One in the pipeline is GI Dynamics’ EndoBarrier, a liner placed at the beginning of the small intestine that was approved in Europe and is undergoing clinical trials in the U.S. In a previous trial, average excess weight loss with the EndoBarrier was 19% after three months — better than Maestro or Transcend, but not as impressive as BFKW’s studies.

Dr. Baker with Fred Walburn, president of BFKW Erin Kirkland / BuzzFeed News

Fred Walburn, president of BFKW, is more cautious than Baker about FDA approval for the Full Sense Device. He estimates the company won’t even begin the FDA process for three or four years. Walburn thinks the Full Sense Device could make the FDA nervous, but for precisely the reason you’d think it shouldn’t make a regulatory agency nervous. “If you’re a regulatory person, and everything you’ve done looks great,” Walburn says, “but there’s some tiny thing we’re missing, we’re not going to miss it in 1,000 patients. There’s gonna be a million people. If we made a mistake in approving it, we’ll get hauled in front of Congress.”

“That’s the big issue,” he says. “If it wasn’t [as] effective, and it would have a smaller market potential, it would be easily approved.”

Mary McGuire Photograph by Erin Kirkland for BuzzFeed News

Around 2009, Mary McGuire was watching TV with her husband when the local news ran a segment about Baker and the Full Sense Device. “I just looked at my husband and said, ‘Oh my gosh. This could be what I’ve been looking for,’” McGuire says. McGuire is 5 feet 5 inches and 291 pounds.

When McGuire was young, her mother would make doughnuts at home. The warm dough coated in cinnamon and powdered sugar was a special treat, though — not something they did all the time. When McGuire was just 7, her mother, a dietitian, died of pancreatic cancer. “Back then, you just kind of dealt with it,” McGuire says. “I never really had anyone to talk to about it.” Her father, now a single parent, would buy himself treats for his brown-bag lunches for his workweek: “He would take a paper bag for the week and have it full of sweets, and he would hide it up in the cupboard,” McGuire remembers. “He thought he was hiding it, but we all knew where it was. I would get home from school before he did, so I would get up on the chair to get into the cupboard and eat some cookies. When I lost my mom, that was my comfort food.”

McGuire, 53, still loves sweets: chocolate, cake, cookies, doughnuts. “If I get bad news about something, I’ll go to food,” she says. “Or happy too. A lot of times it’s boredom. A lot of times it’s stress. Some people pick up a cigarette. I pick up food. It comforts me. It relaxes me.”

Everything else she had tried either didn’t work or helped only temporarily: Weight Watchers, Slim-Fast, South Beach, Overeaters Anonymous, TOPS (Taking Off Pounds Sensibly), and Adipex, an appetite suppressant. Adipex helped her get down to 230, but she slowly gained it all back. None of the diets or portion-control strategies combined with exercise left her feeling satisfied. “I don’t get that full feeling,” she says. “That’s what I’m looking for. I want that sensation.”

McGuire emailed Fred Walburn after watching the TV segment, and ever since she’s been checking the company’s website for updates on the Full Sense Device. She’s convinced it’s the best solution for her. “It’s just so promising,” she says. “It makes sense to me.”

McGuire speaks about the piece of silicone and wire like it’s her destiny and last great hope. She goes to a pain clinic for pinched nerves in both her legs and struggles with high blood pressure, high cholesterol, sleep apnea, and edema. “I told my doctor the other day I feel like a beached whale,” she says. “I don’t want to be this big again. It’s awful. I hate it.”

Despite her desperation, McGuire won’t entertain the notion of bariatric surgery even for a second. A breast cancer survivor, she’s already had to endure more than 20 surgeries. But she can feel the clock ticking. “I know what my future holds if I don’t do something,” she says. “It’s not gonna be good.”

Photograph by Erin Kirkland for BuzzFeed News

Even if the Full Sense Device is approved and becomes an alternative to bariatric surgery, the question remains as to whether it’ll be able to provide lasting weight loss. Dr. Steven Bowers, a surgeon with the Mayo Clinic in Jacksonville, Florida, says the device is interesting, but he puts it in the same group as any other temporary, endoscopic weight-loss device. “It’s not astonishing that you can get the weight off people,” Bowers says. “The tricky part is the weight maintenance afterwards.”

Researcher Randy Seeley has similar concerns. “I’d be willing to bet a lot of money that when you take it out, people will gain the weight back,” Seeley says. “People want to think they’ll be so happy as a lean person that they’ll learn to be lean. And therefore, once they experience what it’s like to be leaner, they’re gonna stay lean. And that just doesn’t happen. There’s a reason why there’s no reunion shows for all the people who’ve been on The Biggest Loser.”

Baker acknowledges there will always be recidivism, but the ability to start over at an obese patient’s optimal weight is significant. And he maintains that no other weight-loss option currently available can match the Full Sense Device. “Nothing we have delivers 100%,” he says. “It is true — if patients want the best chance of keeping the weight off, they need to learn how to exercise and do all these other things right. But that’s true for everything. That’s true for surgery.”

Baker is less concerned about the device working than it working too well. Remember the beagles who were starving themselves to death and happy about it? What if irresponsible doctors allow overeager patients to lose unhealthy amounts of weight? What if this device becomes a new fad diet? “Somebody will abuse it, and I don’t like that,” Baker says. “But how do you deal with that?”

After Baker and his team safely removed the Full Sense Device from 10 more patients this month in Cancun, BFKW achieved “design freeze,” meaning the company is done tweaking (for now) and can move forward with the remainder of CE mark submission. Sometime this year, Shaw Somers and other surgeons from around the world will head to Mexico for training. As Walburn finishes the European approval process, he also has to keep the horse blinders on Baker, who’s already sketching out adjustable and absorbable versions of the device — ones that would potentially allow patients to keep the device in place for more than six months and could be tailored to each patient’s body type, whether morbidly obese or just overweight. “Randy is a chess player,” Walburn says. “He’s thinking two or three moves ahead. I don’t want him to stop, but I have to stay focused. I just tell him, ‘Write it down.’”

Bonnie Lauria hadn’t realized how far Baker had come in bringing his device to market until we spoke. “If it wasn’t for him, I’d still know where all the bathrooms in every restaurant are,” she says. “He saved me a lot of years of suffering.” She also needs help again. It’s been decades since her gastric bypass, and Lauria, now 73, hasn’t been able to keep the extra weight off. Back in 2004, she was allowed to keep her esophageal stent in for only six weeks. “I was happy because I’d started losing weight,” she says. “I’d like to have that stent back, I’ll tell you that. It works.”

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Obama, “Say It To My Face”. If You Do, You are Covered Under Obama’s Plan

By S Daniel Miller, Guest Writer

Obama attacked John McCain in a recent TV interview, saying “Say It To My Face”. What is amusing about Obama’s response is that it is, in and of itself, an attack. Obama has been running a negative attack on McCain from day one. For him to criticize the McCain camp for any negative comment is laughable.

Obama has attacked every facet of the current administration and made every attempt to link McCain and the Bush Administration, no matter how different those policies are and no matter how different they are from the past. Obama started this dirty campaign during the primaries, and now he whines and cries wolf when McCain strikes back.

One of Obama’s best quotes ever.

“I am surprised that, you know, we’ve been seeing some pretty over-the-top attacks coming out of the McCain campaign over the last several days, that he wasn’t willing to say it to my face. But I guess we’ve got one last debate. So presumably, if he ends up feeling that he needs to, he will raise it during the debate.”

Maybe McCain should, but then again why give Obama any chance to defend his radical positions. Should we give his nonsensical attacks equal time to the real issues. The Republicans should take a new tack. The Obama campaign is brilliant at promising America nirvana by spending money they do not have.  With the economy getting flushed down the toilet, neither man has the ability to deliver on any of the promises, so McCain may as well follow Obama’s lying lead and promise planetariums in every house, free real estate for every citizen, new appliances for every home owner.

As an example of the foolishness of the Democratic camp, one should consider heavily the promise of the Obama Health Plan. It is insane. He promises to cover pre-existing conditions, for anyone. In Massachusetts, they instituted the exact same plan last year. IDENTICAL. And after JUST ONE YEAR, premiums on most plans are up 40% in the state as healthy people are forced to pay for the sick. It is just another TAX people!! Welfare for the ill. They are just finding another way to tax you without your knowledge!!

In Massachusetts, and nationally, if Obama gets his way, your best bet is to just pay the tax penalties; they are vastly cheaper than the exorbitant price of insurance that has now exploded to about $20000 to $24000 a year for a decent plan. Then, just pay the doctor out of pocket. It is way cheaper for a person of normal health. And then, if you get sick, sign up!! You can be on the plan by the 1st of the ensuing month. GREAT PLAN!!

Massachusetts is obtuse in pursuing this kind of plan, and Obama is using it as a model. The result will be everyone will be forced to pay ridiculous medical premiums to support people that jump on the train just as they get seriously ill.

I am pregnant, honey, sign up for insurance.

I was just diagnosed with cancer, sign up for insurance.

I just had blood in my stool, sign up for insurance.

Our tax dollars at work.  Democrats need more of them.  Lots more.

McCain Versus Obama, The 2008 Presidential Election Debates, The Hard Questions Demand Answers

Have a question for the two candidates? Publish it here by leaving a comment!

The Hard Questions For McCain

  1. Do you feel that Senator Palin is Ready to assume leadership in the Whitehouse as well as Joe Biden?
  2. How can you institute a tax credit on Health Care without just allowing the insurers to raise prices and consume that tax credit instead of the people that are purchasing the health care?
  3. Isn’t taxing health care over a certain dollar amount discriminatory against those that live in areas with a higher cost of living?
  4. How long will we be in Iraq in your eyes?
  5. You speak of a tax cut, but what form will it take and how will it help America?
  6. What is your primary focus on immigration?
  7. Could you explain your privatization plan on Social Security?
  8. If you are elected President, do you plan to reinstate the draft, and if so, under what circumstances?

The Hard Questions For Obama

  1. How do we reduce our dependency on foreign oil ASAP?
  2. How do you roll back Bush Tax Cuts without raising taxes?  Aren’t raising taxes and rolling back tax cuts the exact same thing?
  3. How can you say you will solve Social Security Problems by taxing people a decade from now, when you know you won’t even be in office by then?  Wouldn’t that just be deferring responsibility to your successor?
  4. How do we bail on Iraq without a clear plan.  Isn’t blaming it on the Iraqis who are getting killed, bombed and intimidated by terrorist factions unfair?
  5. What is your primary focus on immigration?
  6. Your program costs equal the entire national deficit.  How will that be paid for?  If you say it is closing loopholes, what loopholes?  If it is taxing people earning over 250,000 a year, can you show us the math on that?
  7. What is your viewpoint on repealing legislation that directly impacts civil liberties, such as the Patriot Act?

To add your questions, leave comments below, and we will incorporate them into the article!! Contribute and speak your mind!

CBS 60 Minutes Interview of Obama and McCain, “I Am Barrack Obama and I Approve This Message”

So, 60 minutes started off a new season with an interview of the Presidential candidates. Our first reaction was “FANTASTIC!!”. Our second was, “Will CBS be fair?”. The media has gone out of its way to demonstrate its liberal bias this year, and we were hoping CBS would make this a non-biased interview allowing us to get a good feel for the candidates and the issues. We wanted to see if they could take the high road and succeed where so many other news outlets have failed.

We are going to cover these 60 Minutes interviews, and then give you a summary opinion. We will not comment on the interviews themselves until the end, but we will comment on the format of the show as it progresses.

We hope to get responses, especially if you disagree with our interpretation.

Let’s start. Who gets to go first? This is an important decision and an indication of how fair CBS intended to be. Usually the one to go first has the toughest time in comparison to his competitor. This is so true, in fact, that Hillary Clinton quipped about it in her debates and interviews with Obama, because the media often started with Hillary and allowed Obama to follow up. Hillary recognized being continually placed in this weak political position, and called reporters on it.

CBS revealed its liberal bias by having McCain go first. They wanted an Obama finale. It appears that on every network and in every media outlet but Fox, the media continues to give the advantage to Obama and/or the Democrats in general. CBS was no exception.

CBS once again employed another subtle liberal manipulation at the beginning of McCain’s segment. The background was an open book with the pictures of the two candidates. CBS squarely placed Obama’s picture ABOVE that of McCain. Just showing Obama’s picture directly before McCain’s introduction was insult enough; especially when later introducing Obama, they not only did not show McCain above Obama, they didn’t show McCain at all.

McCain’s Interview:

McCain began, “There is a social contract that Adam Smith talked about between capitalism and the people. That contract has been broken. It has been broken by greed and excess, aided and abetted by a government in Washington that is dominated by special interests and corruption.”

When asked about the economic bail-out, McCain said, “We are going to take over these bad loans. We are going to take over these bonds and we are going to keep you alive, and we are going to have the tax payer help you out, but when the time comes and the economy recovers, then anything that is gained back is going to go to the taxpayers first.”

McCain admitted he has called for the termination of the head of the SEC, Chris Cox. It has been repeatedly believed by many that the SEC was asleep at the switch as the banks and brokerages robbed the nation blind. “Technically, he cannot be fired, but when I am President, when I want someone to resign, they (will) resign”. When asked who would replace Chris Cox, he said he was impressed with Andrew Cuomo, a Democrat that served in the cabinet of President Clinton.

When asked if he felt the Bush administration has failed, he responded without hesitation or partisanship, “I say the Bush administration has failed, the Congress has failed, Democrats and Republicans. I remind you the Democrats have had the majority in the Congress the last two years, so everyone has failed, and the cozy “old-boy” special interests that have prevailed in Washington have harmed the American people, frankly, in the most terrible fashion.”

He was asked if it was smart to cut taxes while the Federal Deficit was breaking all records, reaching 500 billion dollars, McCain responded , “Spending got out of Control. …the size of government increased by 40% in the last seven years. We Republicans presided over the biggest increase in government since the Great Society, Republicans came to power to change Washington, and Washington changed us.”

How would he pay for the tax cuts?

“You can eliminate so many agencies of government that are outmoded. Obviously I would scrub defense spending, obviously, we would look at every institution of government, I would stop these protectionist tariffs, I would stop subsidizing sugar. I think there are areas in defense where we can save a lot of money in cost over-runs”.

“I would move the political office out of the White House and into the Republican National Committee. I think we have to have a White House that is without Politics”.

When told he was referred to by Obama as President Bush’s third term, he responded, “Spending, the conduct of the war in Iraq, climate change, treatment of prisoners and the 9/11 commission…are a number of issues in which I have stood up to my party”.

When asked about the Surge, McCain said “Many Political Pundits said my campaign was over. Senator Obama moved to the left of his party and said we shouldn’t, said the Surge would fail, said it was doomed to failure, and still fails to acknowledge he was wrong about the Surge.”

In your judgement, can you see her (Sarah Palin) as President of the United States. “Absolutely”.

He said he did support NATO membership for Georgia. “It does not mean that we have to go to war with Russia, it does mean that we have to respond, and that this kind of behavior on the part of the Russians is not the kind of behavior we expect of a country that is a member of the world community”.

When asked if he would turn to preemptive war against Iran, he responded “If it is a provable direct threat. Suppose that the Iranians had nuclear weapons and you had a whole lot of other information about Iranian intentions and you could make a case to the American people and the world, I think it is obvious we would have to prevent what we are absolutely certain is a direct threat to the lives of the American people.”

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McCain Versus Obama: Whose Plan Has You Covered On Health Care?

This is a continuing series on the Primary Issues of the Presidential Election 2008. | Read Round One: McCain Versus Obama on the issue of Health care. | Round Two: Their take on the Iraq War. | Round Three: Obama Versus McCain on Free Trade. | Part One of Round Four on Natural Resources and Fossil Fuels, here. | In Part Two, we think the Democrats, Republicans And We All Are Misguided. | Part Three: McCain’s Position. Hypocrites Need Not Apply!! | Part Four: Obama Will Save The World, But the US will Go Broke in the Process | Round five: Is the US the Melting Pot or the Stagnation Pot? The candidate’s position on Immigration | Round Six: On the Issue of Abortion | Round Seven: McCain Versus Obama on Social Security: Obama Needs a Fundraiser, McCain Missing in Action | Part one of Round Eight: McCain Versus Obama on National Security, Obama’s Position | Part two of Round Eight: McCain Versus Obama on National Security, McCain’s Position

UPDATED: October 11, 2008

We originally came to the conclusion that Obama’s plan for health care was vastly better than McCain’s.  We believed that the money given through a tax credit to pay for health care in McCain’s plan would just provide the opportunity for the insurance companies to raise prices, and that a universally available plan that was affordable to everyone was a great idea. To read our original opinion, complete this article to the end to see where we went wrong.

After we submitted our article, one of our readers pointed out to us that a major part of Obama’s plan is to take everyone into the health care plan, even those with pre-existing conditions, and we started to wonder how that would be paid for and by whom?

Obama’s health plan is modeled after the plan instituted last year in our home state.  Massachusetts’ health plan, within just one year, has clearly demonstrated how completely wrong we were.  The state has instituted the exact same plan as Obama promises. Let’s see how well it has worked.

Massachusetts told us how our health care would get more “affordable” if we forced everyone to purchase health care, but then they imposed a subtle and huge tax increase on citizens of the state.  They required that all insurance companies cover all pre-existing conditions, no matter how serious, no matter how long they have existed and no matter how old the patient is.  Take a second to think about that before you read further.  No matter how long a person has been ill, no matter how old they are, no matter what state or federal government program had covered them in the past, they get to jump on the plan with the healthy and young.  DO they pay more because they cost vastly more to cover?  Actually, it is just the reverse.  The state makes it even more painful by subsidizing the elderly and sick, forcing even more of the expense on the healthy and young.

The promise in Massachusetts was that insurance premiums would drop.  Instead, what has happened is policy prices have skyrocketed 40% in a year as the healthy are forced to pay for the unhealthy and elderly, many that had been supported by state health programs.  It is a great deal for the state, the sick and elderly, and a sharp indirect tax increase on the healthy and young.

Many have insurance through their jobs and thought that they were safe.  But the fact is that their plans have soared in price as well and the companies in Massachusetts are being left with hard choices to reduce their health care coverage for their employees, charge significantly higher contributions to help pay for the healthcare or cut jobs to pay for the massively increased costs.  This burden falls particularly hard on small businesses, the type that Obama says he will help.  He says that he will only impose a tax increase on small businesses that earn over $250,000, but almost any small business with more than two employees meets that criteria, so they will raise their taxes and hit them with the sharpest increase in health care costs in our history.

So, what do the Democrats and Obama hope to gain?  To get the healthy to pay for Medicare, Medicaid and other medical problems the US used to fund through entitlements.  It is a huge tax increase that people just cannot see yet.  We are seeing it clearly and painfully in Massachusetts in only one year!!  The cost for a decent plan in Massachusetts has skyrocketed to $20000 to $24000 a year! There are cheaper plans, but they have HUGE deductibles amounting to thousands and sometimes tens of thousands of dollars.

This is a subtle way to shift the cost of Medicare, Medicaid and government programs to business, the healthy and the young. It also gets the insurance companies to collect the hidden tax.  If you decide that you cannot afford it, or if you legitimately cannot afford it, what do they do?  They penalize you on your taxes.  Massachusetts REQUIRES that you have the insurance or they charge you tax penalties.  Exactly what Obama endorses.

The result?  Insurance companies have raised prices 40% in a year because they know you have to buy their coverage.  Deductibles have soared and coverage for well-care such as blood tests are no longer covered by many plans until a huge deductible is satisfied.  Where is that money going?  To pay for the elderly and sick that can jump on the plans at any time.  In fact, the sick and elderly can even to Massachusetts from other states and jump on board.  It is health welfare paid for by Massachusetts victims, er, citizens.

This is the Massachusetts government mindset.  If they cannot directly raise taxes in the obvious way, they run interference and get you to pay the tax another way.  If you do not believe us, just check out the huge increases in insurance rates in Massachusetts following institution of their plan.  Then realize the disaster it would be if applied nation wide.

Massachusetts lied to its citizens telling us that its plan would reduce health care costs.  Instead, our premiums soared 40% in one year!  It is cheaper for many to drop their health care insurance, pay the tax penalties and just jump on board if they get ill.  This makes the premiums even more expensive.  The state collects extra taxes and defers all their expenses to business, the healthy and the young.

Forcing society to pay massively increased taxes through their health care organization is NOT the way to address Medicare and Medicaid problems.  It is a way to make the healthy poor.  This plan must be defeated even if Obama gets elected.  It is a tax increase of astronomical proportions.

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John McCain’s RNC Speech Shows No Real Direction

We feel last night Senator McCain had an opportunity to lay out a clear direction for America. We believe he turned mostly to hyperbole and avoided the issues that face America, and because of this, his speech failed. Here are some primary issues from that speech and our replies.

1. We lost their (Americans) trust when instead of freeing ourselves from a dangerous dependence on foreign oil, both parties and Senator Obama passed another corporate welfare bill for oil companies. We lost their trust, when we valued our power over our principles.

Our Response: OK, we need to know what the heck you are talking about Senator. If a bill was passed that was a welfare bill for oil companies, what was it, and how will you have it repealed? That is a big issue, don’t gloss over it.

2. We believe everyone has something to contribute and deserves the opportunity to reach their God-given potential from the boy whose descendants arrived on the Mayflower to the Latina daughter of migrant workers. We’re all God’s children and we’re all Americans.

Our Reponse: Uh, no kidding. You are just paraphrasing the US Constitution. We are figuring the US citizens get that by now. But yet we appear to be doing everything we can to inhibit migration of new immigrants that could help this nation and economy going forward. That Latino daughter likely had parents that came to this country illegally because of the bureaucracy we create to block desirable immigrants from making our shores.

3. We believe in low taxes; spending discipline, and open markets. We believe in rewarding hard work and risk takers and letting people keep the fruits of their labor.

Our Response: OK, but there a policy in there somewhere right? These statements are too broad-based. Open Markets scare Americans because it has led to a huge migration of jobs out of the US and because we continually allow countries like China to export cheap, knock-offs of our products, often patented or name-brand products, to the US. Free trade is one thing. It means we do not charge duties and taxes on imports. But cheating trade is another. And those nations that continually hurt Americans do not deserve carte blanche access to our markets.  Certainly, we want to keep the “fruits of our labor”, but we want to have jobs so there is some fruit!

4. We believe in the values of families, neighborhoods and communities.

Our Response: OK. But this is just filler right Senator?

5. My tax cuts will create jobs. His tax increases will eliminate them

Our Response: Senator. With all due respect, we have kept taxes low or cut them over the past eight years and destroyed our economy. We went from a nation in 2000 with a surplus to once again having a massive deficit. And despite all those tax cuts and Republican efforts, we are facing an economic meltdown as banks and mortgage companies fail.

6. My health care plan will make it easier for more Americans to find and keep good health care insurance. His plan will force small businesses to cut jobs, reduce wages, and force families into a government run health care system where a bureaucrat stands between you and your doctor.

Our Response: We fail to see how a health care system that pools the purchasing power of all Americans can hurt America. So far, the health care insurance companies are raking in unheard of revenues and profits, all the while telling us it is because the expense of health-care has gone up. Yes, it has, primarily because of these institutions that fight, not for health-care, but against paying for it while steadily raising premiums. On a regular basis, these insurance companies reject health-care claims for obscure reasons and make each and every American fight for every visit to their doctor or for every prescription. It is no longer up to your doctor to decide what is appropriate for your personal care; it is up to the insurance companies. That is not health-care. That amounts to insurance bean-counters trying to keep Americans from getting the care they pay for, and it has placed the US well behind curve in terms of quality nation-wide health-care.

In addition, your policy of removing the tax deduction for employer provided health-care benefits replacing it with a $5000 tax credit for family coverage is totally misguided. It penalizes people in higher cost of living areas.  It also rewards only families, implying single people were not worth government’s time (remember, all men/women were created equal, the constitution says nothing about “married only”), and essentially does nothing to address the furious rise in the cost of health insurance.  That is the true issue here.  It comes down to how much we are charged for medical coverage, not the cost of health-care artificially inflated by these insurance companies.

For example, when I get a bill for a test from the hospital, it is three times what the insurance company has told the hospital they would approve.  That is totally unfair to uninsured Americans, to pay many times the cost of the actual service and many times what large insurance companies pay for the same service.  A simple law to ban this practice would assist greatly in the artificially increasing cost of health-care.

7. Cutting the second highest business tax rate in the world will help American companies compete and keep jobs from moving overseas.

Our Response: It is not the tax rate that drives companies out of America, it is the expense of labor. Our cost of living is higher, so we have to pay our workforce more money. You argue for free trade, but fail to protect us from cheap and often illegal knock off imports that damage those companies that support our jobs. If you want to support jobs in America, make it less profitable for companies to locate outside the US, take away their tax breaks and take away the ability of foreign companies to export knock-off products into the US so easily that one can purchase illegal copies of copyrighted software and patented products on the streets of New York 24 hours a day.

8. Doubling the child tax exemption from $3500 to $7000 will improve the lives of millions of American families. Reducing government spending and getting rid of failed programs will let you keep more of your own money to save, spend and invest as you see fit. Opening new markets and preparing workers to compete in the world economy is essential to our future prosperity.

Our Response: Again, you are discriminating against the unmarried man or woman. That does not improve their lives, it makes them pay for the children of others. We are all for reducing government spending, but so far, we haven’t seen a specific policy regarding that. Opening new markets for us internationally is great. The US Market is too open already. Free trade so far is better than “free” for other nations, but is very expensive for America and its labor force.

9. My opponent promises to bring back old jobs by wishing away the global economy. We’re going to help workers who’ve lost a job that won’t come back, find a new one that won’t go away.

Our Response: Words are cheap. This is repetitive nonsense we have heard before. Where are those jobs? We don’t want to wish away the global economy Senator, we want to make it a fair playing field, not just allowing foreign countries to steal from our investors while marketing illegal products in our nation. That is not free trade; that is stupid trade.

10. We will prepare them for the jobs of today. We will use our community colleges to help train people for new opportunities in their communities.

Our Response: Sounds good. But it implies you think that other nations aren’t already training their workforces as well, and as long as you make it more advantageous for them to steal work from America in a so-called global market place, they are doing the training cheaper and delivering cheaper labor, which is killing even trained jobs in America.

If we are going to do that, at least immigrate trained labor from other nations so those people can at least pay American taxes and support Social Security going forward, instead of wasting billions trying to fight off immigration.

11. Senator Obama wants our schools to answer to unions and entrenched bureaucracies. I want schools to answer to parents and students. And when I’m President, they will.

Our Response: More useless verbiage with no plan.

12. We must use all resources and develop all technologies necessary to rescue our economy from the damage caused by rising oil prices and to restore the health of our planet. It’s an ambitious plan, but Americans are ambitious by nature, and we have faced greater challenges. It’s time for us to show the world again how Americans lead.

Our Response: Here we agree with the Senator 100%. We are a “prima donna” nation that thinks we have the right to not use our resources as the rest of the world charges us for theirs. We think that by paying others to do the dirty work, we somehow brush off responsibility on them. We can no longer, with our massive deficit, continue to enrich the nations rich in oil resources. We have our own resources, we must find ways to tap them.

We as a nation cannot be responsible alone for the “health of the planet”. Our population is only 1/3 that of China, and that is only one other nation in the world. You speak of a global economy where the US takes all responsibility for “health of the planet” while you offer those countries taking advantage of cheap resources at the expense of the environment free trade with the US on a totally unfair playing field. We need to drill. We need to build better and more modern energy plants. We need to mine those resources available to us. If we do not, other nations will, we will pay them to do it, and they will not care about what they destroy in the process of taking our money.

We are done listening to speeches like this Senator. We want a plan. We want specifics. This speech was disheartening because it lacked content, it lacked a plan we can buy into, and it is clearly not going to get you elected president no matter how many years you spent in a prison camp.

We have a new idea.  How about making Iraq the 51st US State?  Wow, that is radical.  Anybody with any guts out there?

McCain’s Healthcare Policy Out of Touch With Reality

Senator John McCain has a plan for healthcare that is out of touch with reality because it totally ignores the cost of healthcare, and it does not take into consideration cost of living differences.

McCain’s plan is to offer a $5000 refundable tax credit (what a rebate?) to families to help pay for healthcare. That sounds pretty good until you hear he is including the elimination of the exemption of employer-provided healthcare from income taxes.

Most plans that cover a family cost well in excess of $1000 a month in the US, and sometimes much more in areas that have a higher cost of living. So, if on average, one pays $15000 for healthcare a year and gets a $5000 credit, it would only be marginally different from getting the tax deduction in the first place. Anyone that pays more due to the cost of living would actually pay more taxes because their medical benefit would be taxed as income! This is inherently unfair and could push people towards the Obama camp, especially those in areas with a higher cost of living.

Even some groups that favor better health coverage for their union members are backing away from McCain. The United Mine Workers of America, for example, have endorsed the Democratic ticket specifically for this reason. “Mr. McCain’s plan would impose a tax on health care benefits that have been negotiated into employees’ contracts” said Cecil Roberts, union president.

A more fair plan, if McCain wishes to support commercial health care, is to require an increase in the taxes on profits from those companies providing healthcare. While many people believe that healthcare cost increases have hurt Americans, few have any idea how much they have benefited the US Healthcare Insurance companies such as Unitedhealth Group, Inc. the largest insurer in the US. Unitedhealth Group’s sales have steadily increased while their cost of revenue has dropped. It is good to know someone is benefiting from the high cost of health care, but not if our individual costs for that health care are to be taxed!