How Green Is the Color of Money?

Stick Your Damn Hand In It: 20th Birthday of the Exxon Valdez Lie

Greg Palast

March 23, 2009

Twenty years after the Exxon Valdez dumped 11 million gallons of crude oil into Prince William Sound in Alaska, marine life still struggles to recover from the largest oil spill in US history. The oil spill was a result of negligence on the part of Exxon. The Valdez was sailing with faulty radar equipment and lacking other equipment that could have prevented the crash and contained the spill, as required by law. Exxon was not merely negligent: Executives made a deliberate decision to do without the oil spill equipment in order to save money, after they had promised to use it. Exxon blamed the spill on human error caused by a drunken captain, who was actually not even navigating the vessel at the time.

Prince William Sound is in a remote enclosed area that made it especially difficult to contain and clean up the spill. The effects were devastating on the environment, wildlife, and commerce in an area that was already fragile from the ravages of pollution. Some species, including one group of orcas, or killer whales, now face extinction, while another group of orcas is taking longer than expected to recover. Some species that do eventually recover (this may take another 10 years for the orcas) will never be the same due to altered family systems and stunted growth patterns caused by the spill. Air pollution carried across the Pacific Ocean from China and Southeast Asia has exacerbated the situation by causing toxic substances to lodge in the fatty tissue of the whales, resulting in a diminished ability to reproduce. The human toll included bankrupt businesses and individuals, suicide, starvation, and increased alcoholism within the Native Alaskan community of fishing villages. The $5 billion in punitive damages that Exxon was required to pay to the 30,000 Natives and fisherman of Prince William Sound was reduced to half a billion dollars, one-tenth of the original award. The litigation continued for 20 years, promises made to the villages and fisherman were never kept, and about one-third of the fisherman have died waiting for their award to start trickling in from Exxon. Meanwhile, Lee Raymond, who was president of Exxon at the time of the spill, retired in 2006 and received a $400 million retirement bonus.

Exxon Mobil recorded a $45.2 billion profit in 2008, up almost 19% from 2007, setting a new US record and toppling Fortune 500 giant Wal-Mart from its six-year number one spot in the process. This against the backdrop of soaring gas prices of well over $4 per gallon, which left many Americans unable to afford travel for the basic necessities of life, such as commuting to work or buying groceries. Exxon is currently running a PR campaign for green energy alternatives. These television advertisements are heavy with gender and racially diverse scientists and technicians idealistically singing the praises of Exxon’s explorations into eco-friendly fuel innovations. One such ad makes the claim that liquefied natural gas is a clean fuel. The UK Advertising Standards Authority (ASA) adjudicated that the ad was misleading and could not be aired, after some astute viewers notified the authority. Liquefied natural gas causes significant carbon emissions. Some of Exxon’s innovations have merit but fossil fuels remain the basis of Exxon’s business.

Most people have forgotten the Exxon Valdez, but the community and wildlife that have suffered the consequences of Exxon’s negligence and lack of accountability will never be the same. Twenty years later, proudly touting a newer, greener image, Exxon Mobil, with it’s policy of deception, contempt for the environment, and greed, remains essentially the same.

Have we become uncomfortably numb?

Are We Numb to Mass Murder?
Jeff Glor
CBS News
April 5, 2009

In the wake of the mass shooting at the Binghamton, NY American Civic Association where 41-year-old Vietnamese immigrant Jiverly Wong gunned down 13 people who were studying for their citizenship exam before he finally shot himself, the writer of this article asks us, “Are we numb to mass murder?” The writer asserts that this is so, that the public’s reaction has become ritualized, and that people are more concerned with economics than gun control. Furthermore, it doesn't appear that our political leaders are inclined to do much about the problem, aside from offering condolences to the towns and the families that have been traumatized by these events, while hundreds hold vigil for the unfortunate victims.

Everyone still remembers the Columbine shootings 10 years ago, when 15 high school students and teachers were shot down by a fellow student, and Virginia Tech two years ago where the death toll was more than double that of Columbine. There were others before and after that. In the past month 47 people died as a result of six mass shootings. The trend has migrated to Europe as well: Finland had two mass shootings within one year in 2007-2008 and a teenager in Germany shot 15 people in Germany this past March.

These events are tragic, horrifying, and gruesome. And they have become common. But I don’t think people are numb to mass murder—I think they just feel powerless. Honestly, what can anyone do? We can all become paranoid and start mistrusting everyone we see and avoiding public places, but that would put a halt to our lives as we know them. Unless they are actually experiencing the event, people are of necessity going to detach from these events—you could go insane with grief, outrage, and incredulity over the commonality of these events and the fact that the virus has migrated to the rest of the world, as well. People have to go on with their lives. Look at Israel and the Middle East, where a suicide bomber could kill an entire café full of people enjoying an afternoon cappuccino in a matter of minutes: The citizens of these countries continue to live their lives, even though they could die at any moment. They just take precautions. Philosophers state that we should live each day as though it is our last—well, here it is in action. The human spirit can rise about tragedy.

Quite realistically, the economy is a far more immediate danger to survival for most people today than the possibility of being murdered in a mass shooting spree. People are justified in worrying about the economy. They are protecting their families. The chances of losing your investments or your home seem more likely than the chance of getting murdered.

I don’t think tougher gun laws are necessarily the answer. I think we need to focus on stricter enforcement and follow-up of existing laws, with new provisions for mental illness. I don’t want everyone touting a gun, either. But I also don’t want my Constitutional rights curtailed. The right to bear arms was an essential freedom that our Founding Fathers insisted on for the protection of our people against a (despotic) government that misused its power. I don’t want just the army and the police to be allowed to have guns and then private citizens are left without a means to protect themselves against potential abuses of power. I don’t have a gun and I don’t want one but I want to be able to know that I can have one when I need it. I hate guns.

Clearly, our society requires an overhaul of its system of dealing with troubled teenagers and people who exhibit the warning signs of potential violence. It may not be politically correct, but it can save lives. I think there is an element of copycatism involved in these crimes. One crazy person got the idea more than a decade ago and it caught on like wildfire. So, should we stop reporting on these crimes and giving these people their 15 minutes of fame? It might actually stop some of the violence but that’s not a solution, either. I believe it is time for our lawmakers and mental health experts to begin studying this problem in earnest and drafting a workable plan for stopping these crimes of rage.

Personally, I feel a little sadder, a little more frightened each time I hear about one of these slayings because, to me, with each new incident, I feel that the odds of my life being touched by such an event are increasing, that it is coming a little closer to home. I feel a little more worried each time I read about a mass murder. I feel a little less inclined to spend time in public places, a little more watchful of my surroundings. I feel that my freedoms are being replaced by fears. I don't like it but I don’t know what to do about it, other than pray for the victims, pray that the violence stops, and continue with my life.

Memory erasing/enhancing: the possibilities...

A recent New York Times article asks: What would your life be like if you could erase certain memories by tinkering with a single substance in the brain? Imagine being made to forget a chronic fear, a traumatic loss, or even a bad habit. This notion seems like a cheesy Sci-Fi movie; however researchers are on the verge of making memory erasing a reality.

Dr. Todd C. Sacktor and his team of scientists from SUNY Downstate Medical Center have been able to show how a single dose of an experimental drug can, in animals, block the ability of the brain to hold onto specific types of memories.

The positive side to this research includes the fact that the drug blocks the activity of a substance that the brain apparently needs to retain much of its learned information. And if enhanced, the substance could help ward off dementias and other memory problems. With an estimated 100 million Alzheimer's and dementia sufferers worldwide by the year 2050, this appears to be a clearly beneficial target treatment.

This possibility of memory editing has enormous possibilities; yet it also raises huge ethical issues. For example, how will erasing specific memories affect humans? Any such drug could be misused to erase or block memories of bad behavior, even of crimes. It may seem beneficial to erase traumatic memories, but the erasure of other troubling memories, and the healthy dread of them, form the foundation of moral conscience.

I know that memories of punishments from parents and other authority figures have had a major impact on my decision making and resultant actions. If I had no recollection of the way I felt during punishments, then I would probably be apt to repeat the same mistakes. If somebody erased those types of memories, then it would be like somebody squashing my internal "Jiminy Cricket".

A substance that improves memory would raise larger social concerns in addition to ethical concerns. For example, when scientists find a drug to strengthen memory, will everyone feel compelled to use it? People already use smart drugs and performance enhancers of all kinds; so a substance that actually improved memory could lead to an arms race.

At this point in time, the ethical and social implications of memory erasing/enhancing are just another future dread. However, we can all find comfort in the fact that such drugs may never even make it to human trials. Also, we can always rely on our government to halt any possibilities of future research. I say this because there may actually be positive aspects to this type of drug, such as Alzheimer's treatment, and we know how the government has reacted to promising studies (pre-Obama days)…case in point: will stem cell treatments ever get off the ground?

BW706: Blog #12
Lisa Menard

Humanising Medicine

Currently, I am a medical writer for clinical trials. The human aspect of my job is hard to ignore considering that I am writing about subjects' immunology and safety results. However, a recent New York Times article took me back to my earlier days of working as a medical technologist in a hospital microbiology laboratory; a time when the human aspect was not always present.

As a technologist, I spent many hours processing serum samples through machines, and, at times, feeling like a machine myself. In other respects, I had to force myself to de-humanize the certain samples due to their inherent nature. For example, I would pretend that stool samples were actually mud; however, it was difficult to keep the mental image of mud when that mud also contained corn.

The main point is the fact that the job duties became extremely mechanical in nature. The workload was high, and the manpower was low. Therefore, tasks must have been performed efficiently without extended thought, and it was very easy to forget about the human aspect of the job.

Dr. Yehonatan Turner, a radiologist from Jerusalem, appears to have the same problem in his field, but he thinks that he has come up with a solution.

When Dr. Turner began his residency in radiology, he was frustrated that the CT scans he analyzed revealed nothing about the patients behind them. So to make things personal, he imagined each patient was his father. But then he had another idea; to attach a photograph of the actual patient to each file.

Dr. Turner’s hunch turned into an unusual medical study. Its preliminary findings suggested that when a digital photograph was attached to a patient’s file, radiologists provided longer, more meticulous reports. And they said they felt more connected to the patients, whom they seldom meet face to face.

In the digital age, adding a photo to a file is a simple procedure, and the study’s authors say they hope it becomes a standard procedure; not just for radiologists, but also for pathologists and other doctors who rarely have contact with patients.

However, attaching photos to patient files could prove difficult in the United States. Privacy rules might require patient consent each time a photo was used.

Putting aside any ethical implications concerning privacy, the logistical considerations alone should be enough to thwart any thoughts of this photo system. Who supplies the photo? Would photo costs be covered under health insurance? What is done with the photos after a X-ray is processed? Would healthcare institutions need a separate filing area for all of these photos?

While Dr. Turner's heart seems to be in the right place, I think that his passion for photography and art should remain separate from his radiology career. I mean, where would the photograph madness end? If I were still a medical technologist, would I want to see the face of the patient's stool that I am plating?

I think the answer is that each individual in the medical field should take it upon themselves to find their own human inspiration behind mundane and mechanical tasks. For me, it was my once week expeditions out of the microbiology lab. I volunteered to be the individual to maintain the bloodgas machines in the Intensive Care Unit. If seeing people dying doesn't make you see the human aspect, then you're definitely in the wrong business.

BW706 Blog #11
Lisa Menard

You Mean I Don’t Need a Pap Every Year!

I am flabbergasted and stunned. After reading the article in the New York Times, “DNA Test Outperforms Pap Smear,” I am speechless. And, I’m not just referring to the new development that a new DNA test for the virus that causes cervical cancer will eventually replace the Pap smear. I’m referring to the fact that the article reveals a fact of which I was not aware. “Since 1987, she (Debbie Saslow, director of gynecologic cancer for the American Cancer Society) said, the cancer society and the American College of Obstetricians and Gynecologists have recommended Pap smears only every three years after initial negative ones. In 2002, they recommended the HPV test too, and evidence is mounting that the Pap smear can be dropped.” Dr. Saslow went on to say that, “‘But we haven’t been able to get doctors to go along… The average gynecologist, especially the older ones, says, ‘Women come in for their Pap smear, and that’s how we get them in here to get other care.’ We’re totally overscreening, but when you’ve been telling everyone for 40 years to get an annual Pap smear, it’s hard to change.’”

The article then reveals that this new development, DNA testing for cervical cancer, may only have to be done every 3 years. “Not only could the new test for human papillomavirus, or HPV, save lives; scientists say that women over 30 could drop annual Pap smears and instead have the DNA test just once every 3, 5 or even 10 years, depending on which expert is asked.” However, the significance of this test will depend on the gynecologists’ willingness to administer this test instead of the Pap smear. In the 1950s, when cervical cancer was a leading cause of death for women, the Pap smear was extremely effective. However, today, cervical cancer only accounts for less than 4,000 deaths each year. So, the importance or significance of the Pap smear has lost its validity. The article notes that most countries may have been reluctant to administer the DNA test because of its overwhelming cost. But, “In poor and middle-income countries, where the cancer kills more than 250,000 women a year, cost is a factor, but the test’s maker, Qiagen, with financing from the Gates Foundation, has developed a $5 version and the price could go lower with enough orders, the company said.” In this country, Pap smear results may take several days. But the DNA screen will be read by machines, providing results much quicker. In third-world countries, Pap smears fail because women often can not return and there are fewer available trained gynecologists. A study conducted in India revealed, “…none of the women who were negative on their DNA test died of cervical cancer.” With this test, women over 30 may not need testing but every 5 to 10 years, improving quality of life and reducing deaths due to cervical cancer.

So, if this is true, why would the doctors in the United States not provide this type of information to their patients? I’ve been having unnecessary panic over getting a Pap smear annually, when I could have been getting them every 3 years. Why would the doctors not inform us of this fact? Is it to make more money, and not necessarily to improve our quality of life? I have several sisters, and after speaking with them, they revealed that they were never told this by their gynecologists. Why? Other research revealed that:
* If you are younger than 30 years old, you should get a Pap test every year. If you are age 30 or older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 2 or 3 years. If you are ages 65 to 70 and have had at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests. (http://www.womenshealth.gov/faq/pap-test.cfm#pap04).
* You should have your first Pap smear when you start having sex or by age 18. Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause. (http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html).
* If you are over age 30 or your Pap smears have been negative for 3 years in a row, your doctor may tell you that you only need a Pap smear every 2-3 years. (http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm).

So, I have to continue to wonder about the motivation behind gynecologists’ insistance on annual Pap smears, especially for women over 30 years old. Is it monetary based or quality of life concern? According to the article, the hesitation is not because of high costs of the DNA test. “Dr. Jan Agosti, the Gates Foundation officer overseeing its third world screening, said Qiagen’s new $5 test — which proved itself in a two-year study in China — runs on batteries without water or refrigeration, and takes less than three hours. In countries where women are ‘shyer about pelvic exams,’ she added, it even works ‘acceptably well’ on vaginal swabs they can take themselves.”

You can be sure that I’ll be bringing up this matter with my gynecologist, especially since the dreadful time has come this month. Now, I can’t wait to go to the doctor.

Three Steps Back for Women

Worse Than the Taliban
Jon Boone
The Guardian
March 31, 2009

Afghanistan’s President Karzai reportedly signed a law last month that contradicts the country’s own constitutional provisions for equal rights for women. The new law, which was rapidly passed with little debate, and has not been published, allows for the Shia sect to have its own jurisprudence regarding family law, much to the dismay of some female parliamentarians. This law is also in conflict with international treaties. The new law comes out in time for the upcoming presidential elections in Afghanistan, which are expected to be a close battle this year, as Mr. Karzai has become increasingly unpopular. It is believed that the new legislation curries the votes of Shia Muslims, which comprise about 10% of the Afghani population, as well as the Hazara, who are also Shia, and a powerful minority in Afghanistan. The Hazara represent about 20% of Afghanistan’s population.

The articles of the new law are believed to include provisions that women are required to have their husbands’ permission in order to leave the house, seek work or education, or visit the doctor. Additionally, women are not allowed to refuse sex when demanded by their husbands. The law also gives custody of children to fathers and grandfathers. Some female parliamentarians argue that, although the law is not perfect, it is an improvement over earlier drafts of the law, which included a proposed marriage age of nine for girls (it was raised to 16) and provisions for temporary marriages. According to the ministry of justice, the law still has “technical problems” that must be resolved before it will be published.

The United Nations Development Fund for Women (UNIFEM) have decried the new law but the international community appears to be avoiding the issue, Presdident Obama included, hiding behind the shield of cultural sensitivity. I have to admit I was truly disappointed as I watched Mr. Obama’s response to a reporter’s question regarding the new law at a news conference following the NATO summit in Strasbourg, France this weekend. The president appeared to lose his customary poise and articulate fluidity, as he hesitated, stammered, and fidgeted with his notes. He referred to the law as “abhorrent” but he was clearly discomfited by the question as he requested that the reporter remember the reason for our being in Afghanistan and the culturally sensitive nature of the issue.

Cultural sensitivity is a very important issue, and I understand the delicacy of the situation, but it can also be a cowardly excuse not to address the basic human rights of women…again. Shouldn’t women, who comprise roughly half of humankind, have equal say in the direction that their culture is taking? Yet the abuse, rape, and false imprisonment of women and girls and the disregard for women’s basic rights continues to be systematically sanctioned by societies and governments, to greater or lesser degree. Sexism is the most insidious of injustices because it begins in the family and permeates every aspect of life. Men behave the way they do because they can—it is the world boys’ club sanctioned by religion and tradition.

The rights of women (followed by children and animals) are the last to be acknowledged, codified, and enforced in every society. Women suffer twice in an oppressive society: first at the hands of the law, then at the hands of their husbands and fathers. Human rights in general take a back seat to economics (especially oil). Remember Uganda, Rwanda, Darfour? What about China? The United States (reluctantly) had sanctions against South Africa during Apartheid, where half the population were oppressed—how is this different? (Kudos to us for taking action in Kosovo in the 1990s: they didn’t even have oil!) I’m not declaring war: I am asking for awareness and action on the part of the international community. No society will ever be whole, ours included, until every voice is heard, and has weight, and the rights of the most vulnerable are protected.

Social Darwinism’s Impact on Personalized Medicine

The educational and health complexities in American society cannot be explained by a single theory. However, no one theory continues to have as much of an impact on our social construct than Charles Darwin’s theories of evolution and natural selection. It is doubtful that Charles Darwin himself predicted the impact his assertions would have on our interactions within present-day society as well as the effects propagated throughout the world. Yet, his theories of genetic variations, incorrectly applied, filter into our socio-political and health paradigms and permeate our educational and health infrastructure while politicians and corporations quibble over moral and ethical obligations that drive a wedge between cultures defined more by economics than biological differences.

A central theme of population genetics is that “race is an inherent biological characteristic that accurately reflects human ancestry and the flow of common threads of genetic material in biologically distinct populations over time and geography” (Fine et al., 2005). As such, genetics research has the potential to identify populations at risk of developing particular diseases, thereby providing the opportunity for tailored preventive medicine therapies as well as personalized medicine by use of identified biological markers (Burchard et al., 2003). Although mapping race and genes is not a new phenomenon, modern technology has the propensity to propel these theories into research and, if proven true, actual practice.

Opponents of using the biological notion of race argue that the species Homo sapiens consists of a single population not biologically distinct while citing the Human Genome project that shows humans share 99.9% of their genetic makeup (Fine et al., 2005; Lee 2005). According to this theory, race is not a biologic construct but a social construct with detrimental consequences that sustain arguments for racial profiling. However, racial profiling based on phenotypic and socio-demographic characteristics already exists and is the foundation for disparities in education, health, and health care. It is not in society’s best interest to ignore the impact of biologic variations particularly when the differences adversely impact health and health economics for large portions of the population that suffer from rare biologic anomalies that are unique to specific racial groups: for example, sickle cell anemia and Tay-Sachs disease just to name two.

Arguments for and against biologic notions of race and race-based research are circular with no clear beginning (origin) or end (definitive conclusion). However, the adverse applications of Social-Darwinism and the subsequent racism that stems from its theories continue to plague logical, data-based decision making with respect to health and health care. Genomics and pharmacogenomics technologies have the capacity to propel society beyond petty aggravations of antiquated notions of race and, subsequently thwart health disparities while paving a clear path toward personalized medicine.

However, it is important to assure society that genomics technologies do not go unchecked. One way of ensuring that genomics technology does not exacerbate health disparities is the application of a public health code of ethics (Thomas, et al 2005) routed in the principles of medical ethics while ensuring questions related to the allocation of resources for the overall good of the community are adequately addressed; less society continues to sweep notions of race and health disparities under the proverbial rug of genetic and social equipoise. Such notions are steeped in obsolete ideas of genetically dominant-survivalist-theories that propagate health disparities while leading us further away from superior medical technologies and optimal health.

Note: This blog is based on articles from the 2005 issue of the American Journal of Public Health – Race and Genetics

References

Burchard EG, Ziv E, Coyle N, et al. The importance of race and ethnic background in biomedical research and clinical practice. N Engl J Med. 2003; 348:1170-1175.

Fine MJ, Ibrahim, SA, Thomas, SB. The role of race and genetics in health disparities research. Am J Pub Health. 2005; 95(12): Editorial 2125-2128.

Lee SS. Racializing drug design: Implications for pharmacogenomics for health disparities. Am J Pub Health. 2005; 95(12) 2133-2138.

Thomas JC, Irwin DE, Zuiker ES, and Millian RC. Genomics and the public health code of ethics. Am J Pub Health 2005; 95(12) 2139-2143.

Reaching Out to God at the 11th Hour

One Man’s Ambivalent Retreat from His Racist Past
Helen O’Neill
Associated Press
April 4, 2009

Call it human nature. But why do people wait until it’s almost too late to change?

Elwin Hope Wilson is a 72-year-old man near the end of his life, suffering from the complications of diabetes and a very guilty conscience. Mr. Wilson was a Klu Klux Klansman for much of his life and performed many despicable acts against Black people in South Carolina. He is now seeking forgiveness by reaching out to Black men his age and apologizing in Black churches. He owed a special apology to Congressman John Lewis of Atlanta, who was a civil rights leader during the Freedom Rides 48 years ago, and brutally beaten by Mr. Wilson at a bus station in 1961.

A group of nine Friendship Junior College students, who became known as the Friendship Nine, took the brave stand of ordering food from a "Whites only" lunch counter in Rock Hill, SC on January 31, 1961. They were arrested and took the “jail, no bail” stand that landed them in prison for a month doing hard labor in a chain gang. This policy was subsequently taken up by other Freedom Riders throughout the south. Mr. Wilson never knew the name of the man he had beaten until he read a story about Congressman Lewis’ return to Rock Hill, SC in 2008 for a public apology from the York County Council and presentation of a plaque to the Friendship Nine. That lunch counter now has the names of the nine protesters engraved on its stools, a proud yet sad reminder of their bravery on that fateful day.

Apparently Mr. Wilson was a drinker and just plain old mean to everybody, but he especially hated Blacks (at least he wasn't a hypocrite). He was an embarrassment to his family. His conscience began to tug at him several years ago, most poignantly when he saw the ghost of a Black man in his rocking chair that caused Mr. Wilson to beat his fists in the air. Mr. Wilson is unable to explain his hatred of Blacks or how it originated, and why it ended. His change of heart appeared to be sudden and surprised his family, but it appeared to increase as his health declined. He began to apologize to family members whom he had embarrassed and people he had threatened or harassed. He felt a great burden lifting from his heart.

Some of the Friendship Nine accepted Mr. Wilson’s apologies, while others questioned his motives and declined a meeting. He also receives threats from the KKK for betraying them. But many, Blacks and Whites included, consider Mr. Wilson a hero and have been healed by his actions. Now he is a celebrity, with many demands on his time and his health to appear at churches to speak and tell his story. By his own admission, he is still a curmudgeon but he now understands the impact of his behavior.

I don’t much care about Mr. Wilson’s current state of health. And I don't much care if he goes to heaven or hell. I truly wonder what his attitude would have been if his health hadn’t failed and he was guaranteed another 20 years of quality life. But I do hope that his remorse is heartfelt and that his apologies have helped to heal some hearts that have been victimized by him. I hope that there is closure for some whom he has scarred. People change when they are ready. I suppose that growth and insight can come at any age, and I believe that it does, but I just wish people would get their religion a little earlier in life when it has more meaning. But I am also changing and forgiving him as I write this blog. Better late than never.

What is happiness, really?

I recently purchased a book titled, The Geography of Bliss, in which the author, who spent 10 years as a foreign correspondent for National Public Radio visiting some of the unhappiest places on earth, decided to visit some of the happiest. There is actually a map of the happiest and unhappiest places on earth. Denmark has topped the charts for the past 30 years as the happiest country on earth. The United States is currently ranked number 17 out of 95, up from 23 in 2006 (Zimbabwe and Moldova ranked at the bottom), and number 97 out of 140 in peacefulness.

We as Americans believe that we have such a high standard of living. We have convinced ourselves, rightly so, that we are the greatest nation on earth, but we have so much to learn from other countries that appear to have so much less, yet are ranked higher in happiness. People in other countries have enough. We have excess everywhere we turn: extremes of wealth and poverty, consumerism, obesity, you name it.

I think that our American need to be the best and have the most has created a very unhealthy lifestyle, especially in areas like the Northeast. We spend too many hours working and driving and too little time relating, exercising, and enjoying ourselves. Parents compensate for being absent by spending guilt money on their children. More and more stuff and less and less quality time is the name of the game. We have also lost the fine art of conversation. People don’t have anything to talk about except who worked more hours than whom (which often turns into a p*ssing contest), what they bought, and everyplace they had to drive the kids to. People don’t talk about books they’ve read, or a meal at a special restaurant that they enjoyed, or the beauty of a sunset at their vacation island.

I had a conversation yesterday with a lovely man from Columbia. He described life in his town, where people dress up in the evening to go for a stroll through the square, the streets are closed off for walking on the weekend, and people don’t have a whole lot of money, but seem to really enjoy themselves and their relationships. And they are much healthier. I find that this is sadly lacking in our American lifestyle. People really do have a lot but no one seems to be enjoying any of it very much. Stress levels are very high and satisfaction is low.

But I think the authors might be confusing satisfaction and contentment with happiness. Morley Safer of 60 Minutes did a segment on Danish happiness in 2008 to find out why the Danes are so happy. A Danish research team concluded that, although the Danes do a lot of complaining, they have modest expectations; therefore, they are rarely disappointed. I lived in Denmark for 13 months from 1978-1979 and I can tell you that my stay there was one of the happiest times in my life. As a people the Danes have a very high self-esteem that borders on arrogance. They are very outspoken and not at all politically correct. But they sure are a lot of fun to hang out with. I recently asked a Danish friend what he thought of the researchers’ finding and he told me that, because of their social welfare system, “I know that whatever happens, I cannot fail.”

My friend’s statement pinpointed the contrast between life in the US, which can be one long adrenaline rush, and life in some of the happier, safer places on earth. People come to the United States for challenge, excitement, and the chance for a new life. It’s a crap shoot. We fight for our survival everyday here because failure can put us out in the street, as we have seen with our recent economic crisis. But that is also what makes us so creative, innovative, and competitive. We have to be—it really is a matter of survival.

But our failure right now can be a good thing. I think we have traded our health and happiness for having more stuff. This economic crisis is forcing young people in their 20s to move back home. It’s not the ideal, but families are getting closer. For the first time in decades, people are saving more, buying less. Everyone is getting more conscious of the environment now, too. We are resetting our values. I think this will all lead to healthier lifestyles in general. People are switching to new careers and learning new skills that they never would have considered before. I think we as Americans can adopt a healthier lifestyle, maybe tone it down a bit, but I don’t think we can ever be the happiest nation on earth—that would mean that we have stopped searching, exploring, daring, taking chances. Innovators and dreamers are never satisfied or content, and that is what we are. But we can be healthier while we are pursuing our bliss and that is something that we can achieve.

You Get What You Pay For

The health care insurance crisis is now affecting even those who have health insurance. In the article, “Cancer Debt: The Hidden Costs Behind Insurance,” patients reveal how their insurance coverage did not cover the entire costs for their breast cancer doctor visits and procedures. Even though Susan Braig was insured with a “catastrophic” policy that covered hospitalization, she still has accrued $40,000 in debt after being diagnosed with breast cancer in 2004. Another patient, Nelda Lopez, mentions that although her plastic surgeon was listed under her insurance as being covered, her insurance did not cover the reconstructive work for her double mastectomy.

As noted during a previous blog on the problem with health care insurance, a classmate stated that insurance coverage was not as expensive as people believed, and inexpensive coverage was available for those who could not afford the overwhelming costs of health care insurance. However, based on the information from this article, as with any other expense, you get what you pay for. You pay for cheap insurance, and you get less-than-quality coverage. The article reports that, “…officials at the American Cancer Society say that with the bad economy and people buying cheaper insurance policies, the number is growing.” So, when you buy cheap insurance policies, make sure to read the fine print. Even a “catastrophic” policy that covers hospitalization has limitations, such as high deductibles.

What is the health care insurance industry doing to prevent this from continuing to happen, and to provide citizens with better insurance options? Isn’t the United States government obligated to provide quality health care and insurance coverage to all of its citizens, regardless of race, creed, or socioeconomic status? According to the CDC's National Center for Health Statistics, the number of uninsured persons under the age of 65 in 2007 was 43 million (16%), and the number of uninsured children under the age of 18 in 2007 was 8.9%. It would seem that after reviewing the overwhelming statistics of people who are uninsured, the health care insurance providers would try to develop a better solution, other than cheap insurance with high deductibles. It is obvious from this article that cheaper insurance does not necessarily mean you receive quality health care coverage. The article reveals that, “The cancer society has set up a hotline for people having trouble paying for cancer treatment. Without much advertising, call volume was up 12 percent in January compared to the previous year, and up 37 percent in February.”
According to the CDC, health expenditures in 2006 reached an overwhelming $2.1 trillion, with health expenditures using public funds accounting for 46% of that number. During this economic crisis when unemployment numbers continue to rise, numbers of people are losing their homes, and the market is unreliable, the number of uninsured individuals has dramatically increased. The CDC reports these statistics:
· From January-September 2008, 59.6% of unemployed adults aged 18-64 years and 22.3% of employed adults in this age group had been uninsured for at least part of the past year. Also, 32.2% of unemployed adults aged 18-64 years and 13.5% of employed adults in this age group had been uninsured for more than a year.
· From January-September 2008, 18.9% of persons under 65 years of age with private health insurance were enrolled in a high deductible health plan (HDHP), 5.0% were enrolled in a consumer-directed health plan (CDHP), and 18.0% were in a family with a flexible spending account (FSA) for medical expenses.
· From January-September 2008, 43.3 million persons of all ages (14.5%) were uninsured at the time of the interview, 55.2 million (18.5%) had been uninsured for at least part of the year prior to the interview, and 31.1 million (10.4%) had been uninsured for more than a year at the time of the interview.

With these overwhelming statistics, you have to wonder what numbers will incite worry in the hearts of the CEOs of health care insurance providers? When will it be enough? As I’ve mentioned before, I am one of the uninsured individuals and have pondered actually purchasing a cheap insurance policy, or a “catastrophic” policy as mentioned in the article. However, with the extremely-high deductibles associated with those cheap insurance policies, I have been reluctant to make the purchase. Now, with the information from this article, I am further doubting the quality of these policies. What do you think? Is the high-deductible plan worth it? Or, should I continue to grace the offices of the public-health department, until I’m able to afford a better health care plan? Is it ethical for me to have to make these types of choices about health care, because my salary is in the low- to mid-income bracket? Should my health care choices be judged based on my socioeconomic status?

To pay for her cancer debt, Susan Braig, “…has started making something she calls ‘prescription jewelry.’ She uses pills, capsules and medical supplies that have been sealed or glued so they're no longer usable. Her goal in making jewelry out of medical gear is ‘to show that health care, like cancer, is a luxury.’” And, Nelda Lopez, “…is still paying off (the$2,100 plastic-surgery bill) one-and-a-half years after the procedure. Meanwhile, she has postponed steps two to four of the reconstructive surgery, which would make her reconstructed breasts look more natural.” When will we all be able to make better health-care choices? Hopefully, one day. I'm still waiting...

Positively Promising Studies versus Promised Positive Study Results: More than Just a Matter of Semantics

Dr. Joseph Biederman, the world’s most prominent advocate of diagnosing bipolar disorder in even the youngest children and of using antipsychotic medicines to treat the disease, is in the middle of two controversies: one relates to conflicts of interest in medicine and the other involves the use of antipsychotic drugs in children.

As reported in a New York Times article, Dr. Biederman earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007, but he failed to report all but about $200,000 of this income to university officials. Just a minor omission on his part, right? I hope you can sense the sarcasm, because I have more for you.

I'm also sure that this hefty paycheck must have been warranted. I mean his studies must have yielded results that benefited the company for which he wrote (Johnson and Johnson) right? You bet your britches I'm right. So what's the problem?

In drug presentations to company executives, one of Biederman's slides referred to a proposed trial in preschool children of risperidone. The trial, the slide stated, “will support the safety and effectiveness of risperidone in this age group.”

Another set of slides in the documents listed a planned trial to compare Risperdal (risperidone) with competitors in managing pediatric bipolar disorder. He stated that the trial “will clarify the competitive advantages of risperidone vs. other neuroleptics.”

Finally, there was also a slide that mentioned a planned study in adolescents of Concerta. In this slide, he stated that the study will “extend to adolescents positive findings with Concerta."

"Will support…"

"Will clarify the competitive advantages…"

"Extend to adolescents positive findings…"

From these examples, you can see that the problem is that Biederman had promised successful studies before the studies even began. I'm not sure who taught Biederman the scientific method, but that person should be fired.

His statements could have been re-worded and included in a hypothesis (e.g., product A is non-inferior to product B), but his statements definitely should not have been included as objectives of the study. An acceptable objective would have sounded more like, "…to evaluate the safety/efficacy of product A compared to product B".

These documents raise questions about how well-designed Dr. Biederman’s trials were in that he promised a result to his funders. Especially when there was so much hidden money involved.

So not only was there a conflict of interest (i.e., payment for promise of positive outcomes), the validity of his studies could have or may actually have put the many patients' lives at risk when taking the products in question.

BW706: Blog #10
Lisa Menard

Why Cats Need Nine Lives

Two Teenagers Charged With Setting Cat on Fire
Sewell Chan
The New York Times
March 19, 2009

Two teenage boys were arrested two weeks ago for pouring lighter fluid on a cat and burning it alive inside an occupied building. The cat was so badly burned that it had to be euthanized. The teenagers face up to 25 years in jail if convicted. One of the teenagers had a previous conviction for beating a man in his bed before demanding money from the victim. This is a very short article about the abuse of a species that has had a very long and colorful history. My blog is not meant to minimize the abuse of any other species.

People who are cruel to animals usually have a callous disrespect for any life: It is known that serial killers characteristically begin their careers by torturing and killing small animals. Twenty-five years is a just punishment for these boys’ crimes, especially in light of the progression to bigger, human targets that their actions are likely to take.

Cruelty against animals is despicable. Crimes against cats are particularly odious because of the hate-related nature of these acts. Cat torture and immolation is a centuries-old “pastime”: The New York Times has articles in its archives dating back to the 1800s describing such acts of violence. Often, such acts were simply dismissed as "boys being boys." Cat burning was a also a form of mass entertainment in 16th century Paris;
and the Danish fastelavn carnival that occurred seven weeks before Easter traditionally included beating a barrel with a black cat inside it to ward off evil. I also found lots of links on UTube pertaining to live cat burnings (links not provided). I didn't open them so I can't tell you if they were real.

There is much superstition surrounding cats and they have long been associated with witches and “crazy cat ladies” (myself being one – or both). Millions of women and cats were burned to death and tortured during the witch trials, here and in Europe. Much has been written about the social, economic, and religious politics of these acts. But karma has its way of working things out: The slaughter of cats (and dogs, to a lesser degree) during the medieval period (1230 to 1700) contributed to the bubonic plague that devastated Europe in the 1600s. The rat population, allowed to multiply unchecked, attacked the grain stores, devouring the grain and dropping infectious fleas that spread the disease. More than 25 million people died during the plague.

There are many misconceptions about cat behavior and the physical and emotional needs of cats, which can lead to such acts of torture and violence and just plain old neglect. People generally believe that cats can fend for themselves and be left alone for long periods. This is not true. Cats are more individualistic than dogs but their basic needs are the same, no matter how differently they may be expressed. They have a strong need for company, affection, food, and shelter. The difference between a cat and a dog is that the cat will demand it on its own terms. Companion animals, both cats and dogs, are not able to fend for themselves once they have become dependent on humans.

I have heard otherwise intelligent human beings and self-proclaimed animal lovers make some of the most outrageous statements, and behave accordingly, regarding cats. Last year, a former neighbor sought my advice regarding a friend who had a situation with her 17 year-old-cat. The woman recently moved in with her boyfriend, who had a two-year-old cat. The two cats did not get along and no measures had been taken to ease the transition for the new housemates—they had simply been thrown together into their new environment and expected to get along. After about two months, hardly enough time to adjust, it was decided that the older cat had to go. My neighbor, who is the most devoted of dog owners, suggested taking the cat to another location and abandoning it, since cats can just fend for themselves. I did mention that the cat was 17-years-old. This neighbor also found it amusing that her Chow dog (a fighting breed), who was often poorly secured, often got into our yard and terrorized our cats. This activity was actually encouraged. The dog did eventually take a nip at a human.

Negligence is a very common form of cruelty. The French writer and pilot, Antoine de Saint-Exupery, wrote in his book, The Little Prince, “You are responsible forever for what you have tamed.” I wholeheartedly agree with his philosophy and I would take it a step further to say that we, as humans, are responsible for taking action against all acts of cruelty, especially those involving the most vulnerable members of our society. A kind neighbor took the initiative to seek medical help for the poor cat. We, as a society, can demand strict punishments for those who abuse and torture animals. By stopping an animal abuser, you may also be saving a human life.

Being Friends With Your Doctor Improves Your Health?

The article, “How Connected Are You to Your Doctor?” reveals that in a study, “…investigators studied over 155,000 patients…about 60 percent of patients studied had the kind of relationship with their specific doctors that could be considered ‘connected.’ But a sizable minority did not. About one in three patients were merely ‘connected’ to an entire practice of physicians but not a single doctor; and just over 5 percent of patients were not ‘connected’ at all.” The study revealed that “patients with the strongest relationships to specific primary care physicians were also more likely to receive recommended tests and preventive care. In fact, this sense of connection with a single doctor had a greater influence on the kind of preventive care received than the patient’s age, sex, race or ethnicity.”

In my experience, I have always found that being friends or more connected with my doctor made me more comfortable talking about personal issues in my life and more open to trying other types of treatments. I have hypertension and being friends with my doctors allowed me to be open to discussing stresses in my life that could have an influence on my blood pressure, like experiencing the grief over my father’s death. Talking about my father’s death and being open about my feelings helped my doctor know the appropriate medicine to prescribe or if medicine was even needed, especially since stress is a major cause of hypertension. When I had insurance, I had a primary care physician.

According to the article, different practice models, from walk-in clinics (docs-in-the-box) to solo practice models, were originally designed to meet the need of the patient, but has instead met the need of the physicians. In the article, Dr. Steven J. Atlas, the lead author and co-director of primary care quality improvement at Massachusetts General Hospital in Boston, “That business model (walk-in clinics) says we are fulfilling a need, but is it really what patients want, or is it the only thing they can get? You could argue that the way we provide care now is to meet our needs as physicians. We are telling patients what we want to do. What we have to do is flip that around.” Now that I don’t have insurance, I have to go to the health department to see the doctor, and because those doctors see a number of patients daily, it is less likely that they will have good relationships with their patients or be connected with them. I’m sure my doctor wouldn’t remember my name or my recurring diagnoses without my chart in front of her. Also, I’m not open with this doctor like I was with my previous primary care physician who I saw regularly, and I don’t discuss any personal issues because I don’t feel connected with her, which reduces my trust level and comfort level with the doctor. This doctor doesn’t encourage me to share my feelings and my life with her, like my previous primary care physician. I wonder if it’s because of reduced costs, too many patients, and not enough time? So, is it better to schedule as many patients as you can in one day to meet revenue goal, or to leave more time for patient care to improve quality of life?

According to the Spiral Notebook, “In a video-taped study of 171 office visits, doctors who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only an average of two minutes longer. Incidentally, doctors also benefit from the patient-centered approach, researchers note, because they feel more job satisfaction and are less likely to burn out.” A New York Times article on "Doctor and Patient, Now at Odds," reports that “The relationship is the cornerstone of the medical system – nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.” The NY Times blames higher costs and declining reimbursements for the reasons doctors don’t spend more time with patients. The NY Times reveals that “News reports about medical errors and drug industry influence have increased patients’ distrust. And the rise of direct-to-consumer drug advertising and medical Web sites have taught patients to research their own medical issues and made them more skeptical and inquisitive.”

A good relationship with your doctor can improve patient care and quality of life. A Psychcentral article, "Improving the Doctor/Patient Relationship in Medicine," reports that “Physicians who communicate well with their patients and listen more carefully to their complaints score higher in doctor satisfaction scores, have fewer complaints filed against them, and may even help their patients’ health outcomes. Good doctor interpersonal and communication skills, the authors argue, are integral to helping patients get better.” In the article, Dr. Atlas notes that “‘By focusing on new treatments, new technology and instant access, we (doctors) have undermined the patient’s ability to have a longstanding relationship with a doctor, to have a doctor who knows him or her as a human being. If all your primary care doctor does is order tests and make referrals to specialists, he or she will miss the fact that you are stressed out because you lost your job or your health insurance.’”

To have better quality of life and improved patient care, we must be connected with our doctors, so that we can be more open and more comfortable.

P-R-A-C-T-I-C-E…But not on me!

There are times in our lives when, no matter how strong we think we are, we are placed in a vulnerable situation. Such instances may include a simple visit to a doctor's office or more a severe event such as surgery. At these times, we, as patients, are placed in an extremely vulnerable position. We are ill or injured, and we are putting our health in the hands of another.

Well, what happens when you visit a doctor who appears to be "wet behind the ears", or you find out that your surgeon is actually a resident and the attending will not even be in the room? Does this make you feel comfortable in your vulnerable state, or are you wondering if you are actually getting the best care possible?

A recent New York Times article poses this same type of ethical consideration. According to the article, "to become a medical expert it takes practice, practice, practice, and, unfortunately, some error along the way." This conflict is at the heart of medical training; what might be best for making a skilled, independent-thinking doctor may not always be best for the patient.

In the pursuit of patient safety, educators have deliberately prevented residents from acting independently on their own judgment in situations where a patient poses a theoretical risk. The fact is that all physicians in training pose an inherent risk to patients.

Educators should do everything they can to minimize this risk but recognize that it may impair physicians’ self-confidence. However, it is hard to feel confident and independent unless you are given ample opportunity to stand on your own and risk making a mistake.

And how does a physician obtain that confidence? As stated earlier, practice, practice, practice.

This may seem acceptable to the patient during a simple doctor's visit; however, physicians are in a bit of an ethical conundrum in the more serious situations such as surgery. Is the patient really getting the best care possible in this situation?

Atul Gawande, author of Complications: A Surgeon's Notes on an Imperfect Science1, addresses this same conundrum. Gawande introduced surgeons as human with common human traits and faults. He stressed that, as humans, surgeons must practice their skill.
Gawande then went into further detail to discuss the ethics involved with training. As humans, we must follow a code of ethics; and, as humans, surgeons are no exception.

When given the choice, patients would choose an attending physician over a resident. This decision is based on the fact that patients want the best care possible. However, in order to get that care, surgeons must be trained. Therefore, learning is usually "hidden behind drapes".

While Gawande is a surgeon and he understands the importance of this hidden training, he admitted that he has been guilty of acting like a normal human-being. When his daughter was ill, he chose the best care possible instead of the training opportunity for another physician. With this example, he depicted the human side of a surgeon as being a caring father who only wants the best for his daughter. Therefore, with this example, it appears that there is no simple answer to this training issue.

As a patient, I not only perceive physicians to be infallible but I also expect them to be. However, although surgery has become as high-tech as medicine gets, I guess we must retain a recognition for the limitations of both science and human skill….not very easy to do when your life is on the line.

1.) Gawande, A. Complications: A Surgeon's Notes on an Imperfect Science. New York, NY: Picador; 2002.

BW706 Blog #9
By: Lisa Menard

Yes, Doctor, Come On In…

The article, “Having Almost Become Extinct, House Calls Stage A Welcome Recovery,” reports that although doctors making house calls stopped in the 1980s because of lack of insurance coverage, a small group of doctors, nurses, physician assistants, and practitioners are “reviving this once-common practice for keeping Americans healthy and in touch with their doctors.” I say, about time. I miss those days when you could call the doctor late at night and he’d come to your house to check on you, instead of you having to drive to the ER and wait for hours to hear, “Oh, it’s just a cold. Take two aspirin and call me in the morning.” According to the article, “For generations, the home visit was an institution, something a doctor, black bag in hand, just did. In 1930, house calls made up about 40 percent of physician encounters with patients in the United States, according to a recent article in the journal Clinics in Geriatric Medicine. By 1950, that number had dropped to 10 percent. And by 1980, home visits accounted for a mere 1 percent.”

I guess the question here is what are the ethical implications to house visits? How will this affect new regulations, like HIPAA? House calls faded away because of technological advancements, increased non-coverage by private insurance companies, and financial incentives. “As new diagnostic tools and advanced treatments became available in hospitals and clinics, that's where people wanted to go…More doctors chose specialized fields that relied on the technology of hospitals, while those who chose primary care could see easily twice as many patients in offices and clinics as they could traveling from home to home…And then there's the fact that private insurance has rarely fully covered such visits.”

Too, I would suspect that many doctors’ malpractice insurance premiums would drastically increase. With home visits, how will the doctor insure himself against being sued for wrongful deaths and other medical malpractice? Without the supervision of other staff members as well as the necessary tools if something goes wrong while at the home visit, doctors increase their risks for malpractice suits. However, I would think this practice would increase quality of life for the elderly, who have problems making it to doctor’s visits, but need them regularly. According to the article, home visits are increasing quality of life for the “forgotten population,” who don't see a doctor routinely because getting out is so difficult, are “getting much lower-quality care than they should have.” Too, this would also help reduce costs for the elderly by decreasing the amount of co-pays for each clinic visit.

Although the practice of house calls has long been uncommon in the U.S., it is still common practice in other countries, including France, Denmark, Netherlands, and Canada, according to the article. “According to the Clinics article, in Britain, which has a strong tradition of primary care medicine and a national system of subsidized health care, doctors make 10 times as many house calls per 1,000 patients each year as do U.S. doctors.” Though we don’t hear much about doctors making house calls in these times, Medicare modified its billing procedures in 1998 to enable practitioners to easily receive payments for house calls. “Since then, Medicare statistics show a large bump in physician house calls, from 1.5 million in 2000 to almost 2.2 million in 2007.”

Although technological advancements were one reason for the decline in house calls, “Ironically… technology has now made the house call a reasonable alternative to office or hospital visits for certain patients. Doctors still rely on the black bag basics (stethoscope, otoscope, blood pressure cuff, blood-drawing equipment), but now they also come equipped with laptops with electronic medical records and wireless capabilities, portable EKG machines, even bedside X-ray and ultrasound devices that were once found only at a hospital, according to Ernest Brown of Unity Health Care, which mainly serves poor people in the District.” In addition, “Point-of-care testing (where blood, urine and other tests are done at the bedside, with results available in minutes) has become so easy that home-care practitioners can operate very efficiently.”

So, why are more people not taking advantage of this practice? Why are more doctors not making house calls and encouraging this practice among their colleagues? “According to the Clinics article, studies have suggested that house calls may keep people in their homes longer and reduce mortality, particularly in the frail elderly population. That is probably due in part to physicians' being able to identify new or worsening medical problems that, left untreated, could contribute to further disability and even death.” Increased quality of life should be reason enough for physicians’ to begin offering house calls as part of their clinic visits, especially for the elderly who have to see a doctor regularly, but are not able to get out. Not only will this improve quality of care, but it will reduce costs associated with caring for the elderly. The article states that, “Although homebound patients represent only 5 percent of the Medicare population, they consume more than 43 percent of the budget, according to a congressional analysis. An ER visit can be more than 10 times the cost of a typical house call, which Row pegs at $100 to $150.” However, on the other hand, “…the cost-saving benefit of house calls might actually hurt the medical centers that provide them.”

So, the question would be, is it better to increase quality of life by providing house calls or not provide them to maintain quality care at medical centers? Is it better to enhance the life of elderly patients, increasing the length of their lives, or risk decreasing their quality of life for monetary purposes? I know that I’d love it if my mother’s physician provided house calls to her patients, and especially when my father was getting sicker with Alzheimer’s and getting him to office visits became a chore. Many times we had to take him to the ER for non-emergencies that could have been taken care of at home. It would have definitely made life easier. That would have been one less argument and one less frustration.

Do you wear a helmet?

My husband became very interested in snowboarding last year. So he convinced me to go the local ski shop were we purchased him all the gear that he needed. One thing that we did not purchase however was a helmet. I figured my husband was going to be taking it pretty easy and sticking to the bunny slope since this was his first season of snowboarding.

Unfortunately, Natasha Richardson passed away on March 18, 2009 from a traumatic brain injury. Richardson was taking a beginner lesson for skiing when she fell and hit her head on the BUNNY SLOPE with no helmet for protection. At first Richardson felt fine, but later complained of a headache and was rushed to the emergency room where they found bleeding in her brain.

The death of Richardson has once again sparked the idea of whether or not to make it a requirement to wear helmets on the slopes. Some agree that it is important for people to wear helmets and that is should be made a requirement. Studies do show that helmets do help protect the head from significant blunt trauma when in an accident.

However, there are those for example that work at ski resorts that say if helmets were made a requirement, it would significantly make their job more difficult. It would require employees to police the slopes to make sure that people were abiding by the rule.

Jeff Hanle, a spokesperson from Aspen Skiing Company, stated that at their resorts “only children under the age of 12 at the Aspen ski schools are required to wear helmets”.

So the great debate begins… should people be required to wear helmets or not? I believe that everyone should be required to wear helmets and professional athletes should promote the importance of wearing helmets. If seatbelts are required by law, helmets should be as well.

Transplanted Kidneys: Love em', then leave em'

A recent New York Times article tells of a heart-wrenching story of a woman, named Margaret Oliver, who received a lifesaving kidney transplant. The government covered the costs under a special Medicare program for the hundreds of thousands of Americans with kidney failure; the only condition for which Medicare extends coverage to everyone.

Three years later, Medicare stopped paying for the expensive immunosuppressive drugs that Ms. Oliver needed to minimize the risk that her body would reject the organ. This was because the program covers 80 percent of the cost of immunosuppressive drugs, but only for 36 months after the transplant.

This week two senators introduced legislation that would require Medicare to cover the drugs for the life of the transplanted kidney. This legislation is not only beneficial for a transplant recipient's health status; it also provides a significant pharmacoeconomic benefit.

Transplantation generally provides better long-term outcomes and a higher quality-of-life than dialysis; however, patients then need to take immunosuppressive drugs for as long as they have the transplanted kidney. While many organ recipients are able to obtain health insurance through employers or spouses, others, like Ms. Oliver, find themselves with few options in the private insurance marketplace. If they lose the kidney, they have to return to dialysis and return to the organ waiting list. This may be the case with Ms. Oliver because the many months of interrupted treatment significantly weakened her new kidney and increased the chances that she will lose it in the near future.

Now that just doesn't sit right with me. If the immunosuppressive drugs are only covered for three years, then we might as well give in and offer transplants to known alcoholics; there is the same post-transplant liver failure possibility in both instances….so why the heck not?

Okay, well let's say that the government just isn't quite getting the health benefit. So let's put it in terms the government will understand; money.

While a transplant costs more than $100,000, the annual expenses for drugs versus dialysis speak for themselves. Medicare spends, on average, $17,000 a year for the immunosuppressive drugs for a kidney transplant recipient, compared to about $70,000 for a year of dialysis. As far as pharmacoeconomics go, the monetary benefit of extending
immunosuppressive drug coverage should be sufficient rationale for the government to pass the senators' legislation. I mean, isn't money all the government is worried about anyway?

BW706: Blog #8
Lisa Menard

Teen Pregnancy on the Rise...Again

In the article, "Teenage Birth Rate Increase for Second Consecutive Year," it is reported that the, "Nationally, the birth rate among 15-to-19-year-olds rose 1.4 percent from 2006 to 2007, continuing a climb that began a year earlier. The rate jumped 3.4 percent from 2005 to 2006, reversing what had been a 14-year decline." Although the reason for the increase is unknown, they speculate that, ".. it could be a result of growing complacency about AIDS and teen pregnancy, among other factors. The rise may also reflect a broader trend that affects all age groups, because birth rates have also increased among women in their 20s, 30s and 40s and older unmarried women." The article also suggests that the economic downturn may contribute to the rise in teen pregnancies because, "When families are stressed by economic forces, parental communication and supervision may decline, which in turn may have an effect..." So, can we assume then that parental communication and supervision the previous years were better, or is it safe to say that parental communication and supervision has been lacking for years.

Today, unlike in the past, most households are two-income with both parents working long hours and away from home for long periods. A recent poll estimated that 34% of teens and parents blame parental work on the reason they don't spend more time together (http://clinton4.nara.gov/WH/EOP/First_Lady/html/teens/survey.html). And if parents aren't spending time with their teens, then they're not talking to them about sex or other issues. The article, however, doesn't list a decline in parental communication or supervision as an underlying problem to teen pregnancy. Instead, the article notes failed policies and governmental programs. "But opponents said the findings provide new evidence that the approach (abstinence education) is ineffective and that the money should be shifted to programs that include educating young people about contraceptives -- efforts that have been shown to be highly effective." The article also reports that, "...other experts said the two-year data probably represent a trend and fit with other research showing a stall in the long drop in sexual activity among teenagers, as well as a decrease in condom use."

Is it the job of the government to primarily plan programs to reduce teen pregnancy, or does some of the responsible lie with the parents, too? Is it ethically sound to make the government primarily responsible for educating our children and talking to them about issues like sex, drugs, and alcohol? According to the National Campaign to Prevent Teen and Unplanned Pregnancy (NCPTUP), “There are many different solutions to the widespread problems of teen and unplanned pregnancy, at the individual and societal level, and public policy certainly plays a key role.” However, it does not play the primary key role. The NCPTUP reports that, “Teens consistently say that parents most influence their decisions about sex. However, the vast majority of parents (82%) agree that when it comes to talking about sex, they often don’t know what to say, how to say it, or when to start the conversation. Investments should be made to help parents—through a variety of innovative and user-friendly resources—communicate their values on sex, love, and relationships to the next generation.”

Yes, I agree that policies and programs implemented by the government are necessary, but is it not the job of the community and the parents to educate teens on this issue to improve quality of life, not only for the teen, but the child they would have? According to NCPTUP, “A child’s chance of growing up in poverty is nine times greater if the mother gave birth as a teen, if the parents were unmarried when the child was born, and if the mother did not receive a high school diploma than if none of these circumstances are present.” In addition, “Teen childbearing cost taxpayers $9.1 billion nationally in 2004 and the one-third decline in teen childbearing between 1991 and 2004 saved taxpayers $6.7 billion in 2004 alone.” If the numbers reported by NCPTUP that, “three in ten teen girls gets pregnant at least once before the age of 20, resulting in well over 400,000 teen births each year, and the United States still has the highest teen pregnancy and birth rates in the industrialized world,” then that is a number of children living in poverty.

To combat this problem, not only do we need to implement more policies and programs to educate teens, but we also need to educate parents on talking to their kids. It is the job of the government, the community, and the parents to provide assistance to the nationwide problem. If not to reduce the amount of money spent, but to reduce poverty and improve quality of life for teens and babies born into these situations.

From Tragedy to Triumph

Scientist at Work: Alice W. Flaherty
From Bipolar Darkness, the Empathy to Be a Doctor
By Elissa Ely, MD
The New York Times
March 17, 2009

I’m glad to be writing about someone who used a personal tragedy to help others. Dr. Alice W. Flaherty had achieved more as a medical doctor, neuroscientist, and published researcher by the age of 35 than most people accomplish in a lifetime. However, a postpartum crisis of grief following the delivery of stillborn twins triggered the onset of mania that was characterized by hypergraphia, the compulsion to write anything and everything, anywhere and everywhere, including the use of her own body as a manuscript page. Dr. Flaherty was ultimately hospitalized for bipolar disorder. Her experience with mental illness led to a bestselling book, “The Midnight Disease: The Drive to Write, Writer’s Block and the Creative Brain,” and a new, empathetic approach to treating patients that stemmed from her own need for empathy during her illness.

Ten years after the initial onset of mania, Dr. Flaherty is director of the movement disorders fellowship at Massachusetts General Hospital, specializing in deep brain stimulation, and an assistant professor of neurology at Harvard Medical School. She applies her preoccupation with the neuroanatomy of empathy to the treatment of her own patients, always aware of the fact that she is also a patient. She has been able to channel this seeming disability into something greater: the ability to relate to patients from a place of experience, especially depression, that allows them to identify with her. Dr. Flaherty manages her illness with medication, but she still has periods of mania and she still writes on her arms. But she wouldn’t have it any other way. She uses her manic episodes as the driving force for new ideas about treatments and theories of the mind; the subsequent depressions are used to consolidate her thoughts and edit the flood of writing from the manic wave.

Such creativity and brilliance are characteristic of many patients with bipolar disorder: Jim Carrey, Robin Williams, Robert Downey Jr., Tracey Ullman, Sting, Jane Pauley, Winston Churchill, and Virginia Woolf are some names that may be familiar. Robert Downey Jr., one of the “brat pack” of the 1990s, attained notoriety for his well-publicized struggle with drugs and the law, as much as for his brilliant acting. Drug and alcohol abuse, hypersexuality, excessive spending, psychosis, and violence are all characteristics of the manic phase of bipolar disorder. The suicide rate is high. Many don’t achieve the level of insight that Dr. Flaherty has been able to attain in order to transform the mood swings into something constructive. Many patients don’t adhere to their treatment regimens and wind up losing careers, relationships, and even their lives.

Bipolar disorder is so difficult to treat because it often takes years to diagnose accurately. The standard therapies are valproic acid (an anti-seizure medication) or lithium (a mood stabilizer) and adjunctive anti-depressant and atypical anti-psychotic medications. These drugs cause numerous side effects, including weight gain, hyperglycemia, sexual dysfunction, and feelings of dullness. Many patients who have enjoyed the euphoria and high energy of hypomania and mania can’t tolerate the “earthbound” heavy feeling caused by their medications. An acute episode of mania or depression or refractory chronicity that result in hospitalization can take months and even years to rebound from. Not to mention the stigma of having a mental illness. Another physician and well-known spokesperson for mental disorders, Kay Redfield Jamison poignantly described her journey into madness in the autobiography, “An Unquiet Mind.” Dr. Jamison survived numerous suicide attempts before she was finally able to gain control of her disease and reclaim her life. Such is the course of bipolar disorder.

According to Dr. Flaherty, “Neurology and psychiatry should be treating the same organ.” Indeed, some psychiatrists do treat bipolar disorder as a neurological condition. But a mental illness is more than a condition; it is a person’s life. What distinguishes Dr. Flaherty from most caregivers of psychiatric patients is her own patient status. The injection of empathy and identification into the patient-physician relationship can have a more profound effect on the prognosis for that patient than simple adherence to a medication regimen. This type of relationship provides hope to patients. They are able to see a successful, healthy individual who had to transcend many of the barriers that they now face and translate that picture into a possibility for their own lives. Dr. Flaherty is able to empower her patients because she sees things as they would and can adjust her treatments accordingly. Caregivers in any situation have the opportunity to transform lives with a simply shift in perspective in their communication with patients. And it wouldn’t cost anything in terms of time or money.

Donna Proszynski
Blog 5

Homeless Veterans...?

Many argue that war is a necessary evil. It is justified by both aggressors and defenders and even aggressors disguised as defenders. On either side of the argument are soldiers deemed heroes – despite the politics behind a war its citizens are asked to support the troops who stand in harms way to defend their way of life. In the US, the “support our troops” campaign is a fairly recent political stance in America’s policies on war. After the Vietnam War, returning soldiers received a horrifying reception as traumatizing (in some cases more) as combat. The Veteran’s Administration recognized the harmful impact to psychology and invested more money in mental health & hygiene research. Old traumas received face-lifts and expanded medically-accepted definitions in the Diagnostic and Statistical Manual (DSM) of Mental Disorders as well as the International Statistical Classification of Diseases and Related Health Problems (ICD).

The research results for post-traumatic stress disorder (PTSD) for war veterans as well as other war-related psycho-social traumas successfully averted the media’s attention toward the psychological consequences of war. Thus, soldiers from Desert Storm received ceremonial welcome-home celebrations while the VA braced itself for the onslaught of physical disabilities as well as needed mental-health services. Unfortunately, there exists a gap in services such that the VA estimates that approximately one-third of the adult homeless population are veterans – mostly from Vietnam with small portions of the population from Desert Storm. The VA (http://www1.va.gov/homeless/page.cfm?pg=1) acknowledges the relationship between homelessness and military service but cautions against the interpretation that the relationship is causal – that is, military service does not cause homelessness. Instead the VA asserts that family background, access to support from family and friends, and various personal characteristics are stronger indicators of risk for homelessness. “Personal characteristics” is a vague descriptor that could mean anything from physiologic and socio-demographic characteristics to personal preferences. Most likely, though, the term relates to the standard descriptors of gender, race, education, and drug use. As such, the vast majority of homeless veterans are male, single, live far below the poverty level, suffer from mental illness with overlapping substance abuse problems. According to VA statistics, about 56% of veterans are African American or Latino.

Indicators for homelessness are complicated but decipherable. And the risks for homeless veterans can be averted by ensuring that funding is allocated for Veteran’s Affairs medical facilities. That’s obvious. However, what may not be so obvious is the relationship the indicators have to our current health care, educational, and economic quagmire. That is, we have to be persistent about changing our current systems and implementing policies that ensure both security and health so that no one falls in the gaps. Particularly for veterans who are charged with ensuring our security. Thus, support of our troops should not be relegated to a mere slogan for t-shirts and bumper stickers but truly be part of the demand in our current state of reform. NYC should not have to “bolster its efforts to shelter homeless veterans” (www.nytimes.com/2008/12/16/nyregion/16vets.html?_r=1 ) if policies are in place to usurp risk factors for homelessness among veterans and non-veterans to begin with.

Holly Tomlin

BW 706, Blog 5