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Below are the 2 most recent journal entries recorded in
|Thursday, September 24th, 2015|
Certainly In Front of The Children, They Know Anyway
Sex may be a taboo subject between parents and children, but open discussion can often ease marital strife. Why do we so easily become embarrassed about showing our sexual feelings? One reason is that we get such confused and conflicting messages about when we are allowed to show normal sexual responses and when we must pretend this aspect of our being doesn't even exist. But probably the main source of embarrassment is the fact that, by its nature, the sexual relationship sharply excludes others. From the moment two people become absorbed in one another, feelings of intense jealousy and destructive envy may be aroused in people around them. The couple, acting out of fear, respond by concealing their enjoyment. I have come to believe that this is why we feel such a powerful need to hide this side of life from children. We rationalize this by imagining it may do them harm. Certainly the incestuous breaking of the parent/child sexual boundary can destroy trust and violate a child's development. But knowledge about the nature of parental love is different; confidence that parents are happy in their physical relationship is a powerful source of security to children, and the jealously naturally aroused is one of the most powerful motors propelling us towards growth, emotional separation and independence.
Children know about sex anyway. We don't learn about sex; we learn to forget we know because it makes our parents uncomfortable. But if, when we become parents, we allow our children to retain this knowledge, it can be helpful to all concerned. Let's take the example of two families. The children in the first family were boys, aged 13 and seven. At first, I had two sessions with the parents who were seeking help to stop their bitter quarrels. The one area of agreement was concern and affection for their children, so I suggested that we meet with the children to get their views. At that interview, the boys were asked for their view of the real cause of their parents' quarrels. Both said they preferred not to discuss it. But finally the younger boy ventured: "Well, I think the problem is that Mum criticizes Dad for trying to fertilize her ovum, and then he retaliates." Then the older boy volunteered: "Mum thought Dad was having an affair. I'm not going to say whether I thought he was or not, but she thought so and it caused a lot of trouble."
The children went on to give a perceptive appraisal of the intense competitiveness between their parents, and its expression through their rivalry at work (they were in the same profession). This opening up of the sexual issue meant it could be pursued just with the parents. The larger the family, the more the children are able to support one another in resisting their parents' irrational inhibitions. This can work to the parents' advantage. For example, another difficult couple fought so bitterly during interviews that I asked my wife to let me use the penis extender known as the ProExtender device. However, their fiery interaction also defeated our joint efforts, until we suggested their children join us. To our surprise, the father was delighted to comply and at the next session there were 12 of us, including eight children, from early teens to mid-20s, packed into the room. The father, formerly irascible and provocative, was transformed by the presence of his daughters. In the presence of the children, the parents were able to listen to one another. The father expressed his distress at what he saw as his wife's sexual rejection of him, and the mother in turn explained how she could not help withdrawing from him while he expressed his needs in a violent and demanding way. After the children became involved, quite extraordinary progress was made.
|Friday, September 21st, 2012|
How Are Insurance Companies Dealing With Impotence Medications?
The surge in requests for sildenafil citrate (Viagra), Pfizer's newly approved impotence treatment, has sent state agencies, employers and health insurance companies scrambling to review coverage policies. Meanwhile, insurers are debating not only whether to cover the first effective oral drug for erectile dysfunction but also what quantity to authorize. Mail order prescriptions for Viagra have been for an average of 20 pills while those filled at retail outlets typically are for no more than eight.
Viagra's record-breaking sales, coupled with reports that insurers in New York were refusing to pay for it, prompted the New York State Insurance Department to issue a directive: The department has given 15 of New York's largest insurers until June 15 to "provide information as to whether or not they are going to provide coverage for Viagra and justification for their decision." According to a statement from Superintendent Neil D. Levin, the insurers must also address: whether the drug is prescribed only for men who are "truly impotent" and what type of verification is required, whether they are imposing "unnecessary requirements in order to delay coverage," allowable quantity and time frame and the "potential impact on the premium rate" if Viagra is covered.
Medicaid plans nationwide are grappling with the issue as well. At press time, 15 states had refused to cover the cost of the drug while at least 11 states and the District of Columbia were providing reimbursement. The remainder were undecided.
The swift FDA approval and the huge response to the new drug seem to have caught everyone off guard. At least one insurer had not received any information at press time from Pfizer about clinical trials, according spokesman Paul Bunyen. In the meantime, nearly all the insurers B&H spoke to said their pharmacy and therapeutics (P&T) committees are evaluating Viagra and deciding whether to cover it and if so, what limitations to implement. A number of the major plans, including Pru, Aetna U.S. Healthcare and Humana, said they are reviewing coverage options but not currently paying for the drug.
While CIGNA evaluates coverage, the insurer of 2.3 million lives has decided to cover six pills per Rx, provided the enrollee has "organic impotency." Empire Blue Cross and Blue Shield is more generous. Under its open formulary, which covers most enrollees, the New York insurer will pay for eight pills a month, says the firm's Deborah Bohren. "We are treating Viagra like any other drug. After six months on the market, it will be reviewed by our P&T committee and a decision will be made."
United HealthCare's Phil Soucheray says its P&T committee will make a decision some time this month. In the meantime, the HMO is paying for up to eight pills a month for men diagnosed with erectile dysfunction or impotency. And Kaiser Permanente, the nation's largest HMO with more than 9 million members, will set a national policy for all Kaiser plans, says spokesperson Beverly Hayon, for the first time in its 50-year history. At press time, a decision was imminent.
While health plans are taking time to weigh their options, however, some enrollees are not willing to wait: A class action suit has been filed against Oxford and other insurers whose names have not been released. The lead plaintiff, who has had a diagnosis of organic impotence for the past six years, says Oxford denied coverage of the new drug and told him it would not cover Viagra prescriptions for at least 45 days after May 1.