Health is much more than not being able to find something wrong. It’s how people feel, it’s a state of mind. And it’s hard to feel good when things are constantly being found wrong with you. But we are moving towards a [notion of] health that means the absence of any abnormalities. That’s not a good definition.-- Dr. H. Gilbert Welch, Wall Street Journal Health Blog Q&A
Diagnoses of every condition, from high cholesterol and high blood pressure to osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades. Yet Americans are living longer than ever. While the medical establishment credits aggressive early disease detection as the cause of improved public heath, it is in fact the reason so many of us are told we are sick. Going against the conventional wisdom that more screening is the best preventive medicine, Dr. H. Gilbert Welch builds a compelling counterargument that what we need is fewer, not more, scans and tests.
Drawing on twenty-five years of medical practice and research on the effects of screening, Welch explains how the cutoffs for "abnormal" test results have been drastically lowered while at the same time technological advances have enabled doctors to detect more and more "abnormalities," many of which will pose no health complications. Now, with genetic and prenatal screening common practice, patients are increasingly being diagnosed not only with disease but with "pre-disease."
Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.
Over the past twenty-five years, the practice of medicine has been subverted by the business of medicine, sacrificing old-style doctoring to fit the values of consumer capitalism. InWhite Coat, Black Hat: Adventures on the Dark Side of Medicine, physician and moral philosopher Carl Elliott traces for the first time the evolutionary path of this new direction in health care, revealing the dangerous underbelly of the beast that has emerged. We're introduced to the often shifty characters who work the production line in Big Pharma: the professional guinea pigs who test-pilot new drugs; the ghostwriters who pen "scientific" articles for drug manufacturers; the PR specialists who manufacture "news" bulletins; the drug reps who will do practically anything to get their numbers up; the "thought leaders" who travel the world to enlighten the medical community about the wonders of the latest release; even, finally, the ethicists who oversee all this from their pharma-funded perches.
Check out Carl Elliott's recent clinical trial expose in Mother Jones, and his piece on Big Pharma's Thought Leaders in the Chronicle Review.
Sonia Sanchez "drenches her words in honey goodness so they sound like the sweetest thang you've ever heard," The Root gushes in this feature interview, where the poet discusses what she's reading and the future of African-American literature.
Chalk the union of one man and one woman up to the good influence of their gay friends: it took a lesbian wedding for Jeremy Adam Smith to understand the importance of marriage.
"Last month my son and I were playing with his friend Oliver (not his real name) when Oliver had a seizure.
It came at me sideways; his scream possessed a rattling amplified quality, as though it were coming through an old speaker, and I saw his little body flex and seize out of the corner of my eye. I knew Oliver had epilepsy (as well as other difficulties) but I confess I needed an agonizingly eternal five seconds to understand what was happening. I was knocked out of my momentary paralysis by Oliver's mom, who leapt over to him and shouted at me to call 911. Even in the moment, some part of my mind murmured to me a reminder that I had been spared watching my child go through what Oliver was going through."
If you are reading this in Massachusetts or Maine, odds are
good you're enjoying a three-day weekend thanks to Patriots' Day, which our
history editor explains involves something historic, but many Bostonians
understand to be the day everyone watches the Boston Marathon. Even if you are
reading outside the region, we hope you enjoy these recent media appearances by
Beacon Press authors et al:
On "The View,"
the ladies talk to the Trebing family about their quest for a donor sibling to
help heal their daughter, a moving true story veteran journalist Beth
Whitehouse tells in her new book The Match.
Sachs joins NPR's
"Talk of the Nation" host Neal Conan to discuss Operation
Babylift and how, in 1975, the U.S. government airlifted nearly 3,000 displaced
children out of wartime Vietnam.
A Beacon Press editor related to the pink bird in the intro of "The Dylan Ratigan Show" recommends this Story Pirates video on financial deregulation. “This,”
she says, “is what I call educational programming.”
Today's post is an excerpt from a new book by Pulitzer Prize-winning Newsday reporter Beth Whitehouse. Her five-part front-page series "The Match," which was the basis for this book, won numerous awards, including the American Association of Sunday and Feature Writers First Place for Narrative Writing, a National Association of Science Writers Award, and a Casey Medal for Meritorious Journalism in Service to Children. Whitehouse is an adjunct professor of journalism at Columbia University.
Stacy Trebing yanked off the yellow paper hospital gown that covered her shorts and T-shirt, unhooked the surgical mask from behind her ears, and stuffed both items into the garbage pail in the entryway of her daughter's hospital room. She'd been at her three year-old daughter's bedside practically every minute of the past ten days.
She needed a breather.
The next morning, Stacy's daughter would have a bone marrow transplant, a medical procedure that would either cure her or kill her. Every minute since Katie's birth had been leading to this day. Everything Stacy and her husband, Steve, had done, every decision they'd made, had propelled them here.
Including the most controversial of their choices: to create a new human being they had selected as an embryo because he genetically matched a critical portion of his sister's DNA.
That one-year-old baby would be brought into the hospital the following morning to donate the life-changing bone marrow that was the only chance to heal his sister. Christopher Trebing was born to be a member of the Trebing family, but he was also born with a job to do. He would be put under general anesthesia while a doctor inserted needles repeatedly into his hips and siphoned the tissue that could repair Katie's ailing body.
In To Uphold the World: A Call for a New Global Ethic from Ancient India, author Bruce Rich contemplates the rule of the Indian emperor Ashoka over 2,200 years ago, whose philosophy of tolerance, conservation, nonviolence, species protection, and human rights still have much to teach us today. One of the many programs established by Ashoka was a system of universal health care for people and animals which, once established, served the Indian empire for close to a millennium. Rich discusses Ashoka's health care system in this video.
Bruce Rich is a Washington DC based attorney who has served as senior counsel on international finance and development issues for major environmental organizations such as the Environmental Defense Fund and the Natural Resources Defense Council. Rich has published extensively in environmental and policy journals, as well as in newspapers and magazines such as The Financial Times, The Nation and The Ecologist. He is the author of Mortgaging the Earth, a widely acclaimed critique of the World Bank and reflection on the philosophical and historical evolution of the project of economic development in the West. He has been awarded the United Nations Environment Program 'Global 500 Award,' the highest environmental prize of the United Nations, in 1988, and also won the World Hunger Media Award in that year for the best periodical piece on development issues.
Jonathan Metzl discusses schizophrenia, the DSM (The Diagnostic and Statistical Manual of Mental Disorders), and how the disease moved from being thought of as a ailment of housewives to a diagnosis of violent behavior among African-American men.
There is a veritable epidemic of doctor-writers out there. What is going on?
Are doctors suddenly in the kiss-and-tell mode? What about confidentiality? Professionalism? HIPAA?
one of the aforementioned doctor-writers, I look upon this trend with
both awe and trepidation. I suspect that that this flourishing
literary phenomenon relates to the public’s fascination and fear
about all things medical. It also relates to the falling away of
previous, pedestal-like images of doctors and doctoring. Lastly, it may
have occurred to the medical profession-- and this has taken a few
centuries, it seems-- that doctors have profound emotional reactions to
the work we do, and that exploring these reactions may offer benefit to
both patient and doctor.
Whatever the reason, this literary
genre appears to be here to stay, and it is worth considering the
ethical implications. Legally, there doesn't appear to be much beyond
protecting identity and avoiding libel.
Today's post is an excerpt from The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan M. Metzl. Metzl is associate professor of psychiatry and women's studies and director of the Culture, Health, and Medicine Program at the University of Michigan. A 2008 Guggenheim Fellowship recipient, Metzl has written extensively for medical, psychiatry, and popular publications. His books include Prozac on the Couch and Difference and Identity in Medicine.
Reading the medical charts of the patients of Ionia State Hospital for the Criminally Insane, I felt a mixture of responsibility and deep sadness. For better and largely for worse, the Ionia charts documented the lives of the marginalized and the forgotten in novel-like detail, and in ways that made the medical records of today seem impersonal and flat. This was because the charts recorded people in two conflicting ways: in their roles as patients and convicts, as defined by interactions with the state hospital complex and the courts, and in their roles as sons, daughters, fathers, husbands, wives, or loners, as defined by letters, cards, and other texts. The charts also documented in minute detail the tragedy of what it meant to be warehoused in a state asylum at midcentury -- and in particular, in an asylum where short sentences devolved into lifelong incarceration. A number of charts contained yearly notes from patients to their doctors voicing such sentiments as "Doc, I really think I am cured," or "Dear Doctor, I believe I am ready to go home," or "You have no right to keep me here after my sentence is over." These letters stacked thirty deep in some charts, signifying years of pleading and longing and anger, together with thirty years' of responses from clinicians urging, "You are almost there" or "Perhaps next year." Invariably, the last note in each stack was a death certificate from the Ionia coroner.
I visited the archive regularly over the next four years. With the help of my research assistant, I analyzed and catalogued hospital administrative records and the charts of nearly six hundred randomly selected patients admitted to the hospital between the late 1920s and the early 1970s, under the agreement that I significantly alter all personal identifying information about patients, as I have done in the case descriptions that appear in this book. Names, dates, and places have been changed, and vignettes represent condensed and extrapolated aggregates drawn from the rich case materials. All doctor-patient dialogue and text in quotation marks is reproduced verbatim. I also visited Ionia on numerous occasions and conducted a series of oral histories with surviving members of the hospital staff, though, perhaps tellingly, I located no surviving patients despite numerous attempts.
What stories boxes tell. Ionia was its own planet, walled off, orbiting, a place where real people worked and lived and died. Then came a series of public scandals, the advent of psychopharmaceuticals, and changes in legal systems and penal codes. Decreased public funding followed, along with encroachment by regional forensic centers. Finally, the transformation. The boxes were but light-years of this implosion, vapor trails, found poems, measurable heat. Disembodied voices that told silent stories of what it meant to be incarcerated, or neglected, or entrenched, or immured.
CNN Newsroom featured a live interview with Sonia Sanchez on Sunday.
The five minute interview focused on the Smithsonian's Freedom's Sisters traveling exhibit, which features Sonia Sanchez and nineteen other 19th and 20th century African-American female activists. The video is embedded here, but if it doesn't appear, you can follow this link.
Public hospitals have a bad rap. They're viewed by many as hospitals of last resort, and most patients with private insurance do anything to avoid them.
As a long-time physician in a public hospital, I'm sensitive to this reputation. I wouldn't work in my hospital if I didn't feel that it delivered excellent health care. I'm certainly aware that private hospitals have amenities that public hospitals can't afford, but many of these are cosmetic issues.
On the cosmetic side, though, public hospitals have come a long way. Bellevue Hospital, where I work, has built a gorgeous ambulatory care building, complete with a soaring atrium that floods the waiting areas with sun and space. The ICUs and emergency wards have been renovated to enviable standards.
But beyond cosmetics, there is an extremely dedicated staff who is committed to providing high-quality care, despite the many financial and logistic challenges that public hospitals face.
I got a call from Kaiser Permanente several days ago informing me that I was due for my yearly mammogram. That call came the day before I saw the headline in the New York Times telling me that having a test every other year is now the recommendation from the U.S. Preventive Services Task Force for a woman my age. Besides, they say, nevermind the breast self-exam, or even the exam by my primary care physician. None of this is going to save my life. Statistically, anyway. And besides, more frequent exams may lead me to extreme anxiety when a lump is found that turns out to be benign (which has happened 2 or 3 times already), and I may be subjected to unnecessary treatment for an early-stage cancer which might have gone away on its own-- unnecessary treatment being more tests, and perhaps radiation and/or chemotherapy, and even surgery. Whoa! What should a woman do?
"Angelina Gomez," the medical assistant hollers out to the crowded waiting room. As always, I cringe when I hear this. It sounds so harsh, so cattle-like. I know that the assistant is actually a gentle and caring person, and I understand that he uses a loud voice so that he can be heard over the general din of a large waiting room.
Nevertheless it feels horrible to me, so demeaning, like we're in the DMV instead of a medical clinic. I want the environment to be more humane, more civilized, and so when I go out to call a patient, I use a much softer voice, with a tone that I hope conveys more respect.
Of course, no one can hear me. Heads turn, ears strain, faces contort as people try to figure out who I am calling. The medical assistant usually gets the right person on the first try. I, on the other hand, end up pacing up and down the waiting room repeating the name. Am I making the environment any better?
If asked what a doctor does, most people would probably come up with the standard description of diagnosing and treating disease, usually while wearing an ill-fitting white coat. Before I entered practice, even during my medical training that probably would have been my answer too.
But my years in the trenches of real medicine have altered that definition greatly. I do spend time doing the things I learned in medical school like diagnosing disease and writing prescriptions, but that turns out to be only a part of the job, often a very small part.
Much of the time I find myself acting as sounding board. Recently I saw one my regular patients, a woman whose main medical issue is hypertension. But for most of our visit she spoke, often tearfully, of the strain of raising grandchildren since her daughter died of HIV. We never really got to her hypertension, and I certainly didn't have any easy answers for her difficult life situation, but this seemed to be the only time and place that she could devote to her own issues.
A good portion of my time is spent being a teacher. So much of medicine involves education-- talking about what a disease means, which medication side effects are important to watch for, how to plan a healthy diet, which screening tests are important, what a particular diagnostic test entails, what the various lab results mean, and so on.
Today's post, in honor of National Midwifery Week, is from Patricia Harman, author of The Blue Cotton Gown: A Midwife's Memoir. Harman got her start as a lay-midwife on the rural communes where she lived in the '60s and '70s, going on to become a nurse-midwife on the faculty of Ohio State University, Case Western Reserve University, and West Virginia University. She lives and works near Morgantown, West Virginia, and has three sons.
As I travel around the country speaking and signing copies of The Blue Cotton Gown: A Midwife's Memoir, I spend more time talking about midwifery than I do about the book. This makes me smile; I didn’t set out to be an ambassador for the profession, but I couldn't be more pleased.
I am surprised that most people don’t know that, worldwide, roughly 70% of babies are born into the hands of midwives; they don’t know that in the US the numbers are growing, almost 10%, up from 3% ten years ago. I’m surprised when they don’t know that midwives are legal in all 50 states and that most practice in the hospital in collaboration with physicians. I'm surprised that they don't realize that there are two kinds of midwives: the nurse-midwife is an advanced practice provider, usually with a
Masters degree, who can do deliveries in the hospital, a birthing center or at home, prescribe medication, and is also trained to do gynecology. The direct entry midwife trains by apprenticeship and delivers, usually at home. I was both kinds.
Today's post is from David W. Moore, author of The Opinion Makers: An Insider Exposes the Truth Behind the Polls (out in hardcover now, paperback with a new afterword available this fall). Moore is a senior fellow of the Carsey Institute at the University of New Hampshire, and he is a former senior editor of the Gallup Poll, where he worked for thirteen years. He frequently contributes to Huffington Post, and blogs at SkepticalPollster.com, where this post also appeared.
A recent series of polls brings to mind a bobblehead doll, whose head wags from side to side and from front to back in a random fashion. That disconnected movement seems to be a visual representation of what the polls have been saying about the general public and its views of President Obama's efforts to reform the health care system.
Before the president's nationally televised speech to a joint session of Congress earlier this month, for example, several polls announced that either a majority or plurality of Americans disapproved of the president's performance on health care. They didn't tell us if the people were dissatisfied because he was trying to do too much, or because he wasn't trying to do enough. All we got was the dismal information about how the public felt let down by the president.
Then, on the Friday after Obama's speech, a CBS poll declared that the public had rallied in favor of the president. A majority of the public now approved of his handling of health care by a 14-point margin, compared to a week earlier when a plurality disapproved by a 7-point margin. That represented a 21-point swing in opinion, which is no mean feat for one speech. (For all poll results, see pollingreport.com.)
Today's post is from Jennifer Culkin, author of A Final Arc of Sky: A Memoir of Critical Care. Culkin, winner of a 2008 Rona Jaffe Foundation Award, is a writer and longtime neonatal, pediatric, and adult critical care nurse. Her work has appeared in many literary magazines, including the Georgia Review and Utne Reader, and in the anthologies Stories with Grace and The Jack Straw Writers Anthology 2006.
I'm so confused. To judge by two current television series about nurses, TNT’s HawthoRNe and Showtime's Nurse Jackie, are we nurses angels or 'hos? Self-righteous, micromanaging do-gooders in lab coats, or adulterous, vigilante prescription-drug addicts in scrubs? Granted, Jackie comes off as intelligent and realistic. Her black humor feels right. But how does she find time for lunch at a restaurant, let alone the sort of restaurant that has wine glasses on the table? And how, during the course of her shift, does she manage a roll in the hay with a hospital pharmacist? There are days I don't have time for a drink of water. I want to work where she works!
Except I'm not into narcotics, and certainly wouldn't use (Snort! Now there's a nice touch... and it's so lovingly filmed) them at work. Thirty years ago, when I was young and clueless, I sometimes had a glass of wine with lunch at noon before a shift that began at 3 PM. Now I'd never do that, and neither would the vast majority of nurses I know. My patients, like other consumers, have a right to expect that I'll save the wine for my time off. That I'll care for them unimpaired.
And then there is Christina HawthoRNe. I suppose it's a good thing that the public sees there IS such a thing as a chief nursing officer, that nursing is an independent profession with its own management hierarchy and that the CNO is a high-level administrator with her share of clout in the organization. But despite 30 years as a critical-care nurse, I have yet to see one charging around so ostentatiously, setting everyone straight: other hospital administrators, the Emergency Department nurses, her own daughter, a patient and his MD father. The disappointing bottom line is, Christina isn't any more realistic than... a TV doctor.
Today's post is from David W. Moore, author of The Opinion Makers: An Insider Exposes the Truth Behind the Polls (out in hardcover now, paperback with a new afterword available this fall). Moore is a senior fellow of the Carsey Institute at the University of New Hampshire. A former senior editor of the Gallup Poll, where he worked for thirteen years, Moore also served as professor of political science at UNH and is the founder and former director of the UNH Survey Center.
A recent ABC/Washington Post poll reported slipping support for President Obama's efforts to reform health care. In April of this year, polls showed 57 percent approval to 29 percent disapproval of the way the president is handling health care, compared to a 49 percent to 44 percent ratio in mid-July. That's an 8-point decline in approval and a 15-point increase in disapproval.
The same poll also showed that, by a 55 percent to 43 percent margin, Americans support a health care reform plan that is roughly what the president is requesting.
What's going on? If Americans support the president's health care plan, and it is now that he is pushing the Congress to pass legislation enacting reform, why is the president's popularity on this issue declining?
The public's growing disenchantment is especially surprising, because last April the president was hardly focused on health care at all, his attention mostly on getting a stimulus bill passed through Congress. Yet, if we believe the polls, his approval on health care was higher when he was not fully engaged in getting health care legislation passed (which the public wants) than when he is fully engaged!
Today's post is from Patricia Harman, author of The Blue Cotton Gown: A Midwife's Memoir. Harman got her start as a lay-midwife on the rural communes where she lived in the '60s and '70s, going on to become a nurse-midwife on the faculty of Ohio State University, Case Western Reserve University, and West Virginia University. She lives and works near Morgantown, West Virginia, and has three sons. In the interest of privacy, the names and some identifying details of the women she discusses in this post have been changed.
West Virginia has a reputation for being nearly the worst for everything in the US, except for the beautiful scenery. We Mountaineers have the 4th highest poverty rate in the United States: 16.9%, equal with Alabama and just slightly better than Kentucky, Mississippi, New Mexico and Louisiana.
therefore, astounded when NBC Nightly Newsfeatured our hometown,
Morgantown, WV (poverty level 27.7%), as having the lowest unemployment rate
(2.7%) in the nation in this past December's survey. (The rate has since risen,
but we're still
among the lowest in the country.) As a nurse-midwife and women's
healthcare provider in a private clinic, I see life through the eyes of my
patients. If we're doing well, it must be catastrophic everywhere else.
Molly McDonald sits on the guest chair in my exam room. She's a 28- year-old housekeeper at the hospital. There are tears in her green eyes. "I don't know what's going on," she tells me. "Ever since I went back to work, I can't quit crying. I love my job, don't get me wrong and I'm grateful to have one, especially since Leonard got laid off at the sawmill… New home building has slowed and they ain't selling much lumber."
"How old are your kids?" I ask sympathetically.
"Just four months and three. Leonard's at home with them now but he's drinking and in my face all the time, complaining that I don't give him much love. But I'm just so tired…" The patient trails off and stares at the white cupboards over the sink. "I'm just so tired of holding the family together."
I can't fix Molly's family or get Leonard his job back, so I give her a hug and a prescription for anti-depressants.