I happened to notice recently a report in a French newspaper of a study just published in the British Medical Journal, a study that had purportedly shown an increased incidence of cardiac death in people who took an antibiotic called clarithromycin. As I had myself taken this drug a couple of times in my life (though not, of course, quite as prescribed, because no one ever takes drugs quite as prescribed), I felt a certain personal interest in the question.
I needn’t have worried because the paper, from Denmark, claimed that the increased risk of cardiac death occurred only while the patient was taking the drug, not afterwards. But the closer I looked at the paper, the more darkness it seemed to shed on what doctors ought to do.
Denmark is a small country with a population of about 5.5 million, but it has the best health records in the world. This means that statisticians are able to churn out comparisons as Danish dairy farmers churn out butter.
By now you’ve probably seen 1,000 ice bucket challenge videos auto-play on your Facebook newsfeed by now. Everyone is doing it — kids, pets, celebrities, politicians, you name it. Yesterday I heard my neighbor do it on our front porch, but as I heard him explain, they didn’t have a bucket, so he used a “very cold” can of Coke instead. I’ve seen a few outtake lists, where instead of people having a bucket of water poured over them, the person pouring instead had the entire bucket full of water dropped onto their heads — it was painful to watch, I can’t imagine how painful it was to experience. The challenge has some haters, namely people annoyed at how many of those taking the challenge aren’t donating, and are instead wasting water. This meme popped up in my newsfeed this morning:
To which I say: Lighten up. The ice bucket challenge has gone viral like no other charitable cause I’ve ever seen, and has netted millions of dollars for ALS charities, over $15 million at last count (compared with less than $50,000 during the same period last year). I have no dog in this argument: I haven’t done the ice bucket challenge personally (please don’t nominate me, I’m poor and really dislike cold water), but I really applaud those participating and donating.
Many people have been misinformed regarding human-to-human transmission of Ebola. The Canadian Health Dept. States that airborne transmission of Ebola is strongly suspected and the CDC admits that Ebola can be transmitted in situations where there is no physical contact between people, i.e.: via airborne inhalation into the lungs or into the eyes where individuals are separated by 3 feet. That helps explain why 81 doctors, nurses and other healthcare workers have died in West Africa to date. These courageous health care providers use careful CDC level barrier precautions such as gowns, gloves and head cover, but it appears they have inadequate respiratory and eye protection. Dr. Michael V. Callahan, an infectious disease specialist at Massachusetts General Hospital who has worked in Africa during Ebola outbreaks said that minimum CDC level precautions “led to the infection of my nurses and physician co-workers who came in contact with body fluids.”
Currently the CDC advises health care workers to use goggles and simple face masks for respiratory and eye protection, and a fitted N-95 mask during aerosol-generating medical procedures. Since so many doctors and nurses are dying in West Africa, it is clear that this level of protection is inadequate. Full face respirators with P-100 replacement filters would provide greater airway and eye protection, and I believe this would save the lives of many doctors, nurses and others who come into close contact with, or in proximity to, Ebola victims.
It is apparent that the primary mode of person-to-person Ebola transmission is through direct contact with the body or bodily fluids of Ebola victims, but it is unwise to ignore the airborne mode. I believe the current evidence supports healthcare workers using a higher level of airway and eye protection than is currently recommended. Since CDC level respiratory/eye precautions for Ebola are inadequate for healthcare workers in West Africa, I assume they will also be inadequate in the United States.
The dream of rejuvenating the aged by the infusion of young blood is much older than anyone living. It is said that the Scythians thought to make themselves strong by drinking the blood of their enemies killed in battle. And Dracula kept himself youthful by drinking the blood first of young maidens visiting Transylvania and later of maidens in England once he had moved there.
Blood is not the only tissue that has been thought to protect and rejuvenate the elderly. In the 1920s a Franco-Russian surgeon named Serge Voronoff transplanted monkey testes into men (some of them eminent, for example Kemal Ataturk) whose virility had declined, and claimed that it worked. He made a fortune but soon became the object of mockery and scorn, dying in prosperous obscurity in Switzerland in 1951.
There is always an air of charlatanry about those who claim to be able to turn the biological clock back (it is easy to find smooth-talking promoters of recaptured youth on the internet, for example), but a recent article in the New England Journal of Medicine suggests that some of the old ideas about the rejuvenating qualities of young blood may not have been quite so far-fetched after all. It is early days to proclaim that eternal youth is around the corner, and personally I am not sure I would want it even if it were, but according to the author a technique known as heterochronic parabiosis has retarded or reversed the aging process in mice. It is, of course, some distance from Mouse to Man.
What stands to reason is not always borne out by facts, for reality is often refractory to human wishes. There was a good illustration of this unfortunate principle in a recent edition of the New England Journal of Medicine.
It has long been known that low concentrations of high-density lipoproteins (HDL) and high concentrations of low-density lipoproteins (LDL) are associated, in a more or less linear fashion, with cardiovascular disease such as strokes and heart attacks. It would seem to stand to reason, therefore, that raising the HDL and lowering the LDL would lead to fewer cardiovascular “events,” as strokes and heart attacks are called.
One way to achieve this wished-for biochemical change is to treat patients at risk of such events with niacin, a B vitamin, in addition to the statins that they are already taking. The largest placebo-controlled trial of niacin ever undertaken, with 25,673 patients who had already had a stroke or heart attack, has shown that the addition of niacin, though it does indeed increase HDL and decrease LDL, has no effect on the rate of heart attack or stroke. Worse still, it gave rise to serious side effects, such as worsening of diabetes and unpleasant gastrointestinal, musculoskeletal and dermatological effects. One of the most unexpected findings of the trial was the excess of infections in people treated by niacin. If anything, the overall death rate in the niacin-treated group was higher than that in the placebo control group, though the difference was not statistically significant (which is not quite the same thing as saying that it was not real). The patients were followed up, on average, for nearly four years and at no time was treatment with niacin superior to that with placebo.
I have been following Mark Rippetoe’s Starting Strength program twice a week now for a few months. I have to say it has worked really well for me.
Since having a heart attack many years ago, I was afraid to do squats and deadlifts with much weight, if at all. However, Mark gave me the confidence to feel that I could indeed, do them again, albeit with some modifications. I have been using lighter weight, mainly just the 45 pound bar for deadlifts and the same for squats. Yeah, it’s light but sometimes I add five pounds on each side if I feel like it. I do three sets of five reps of each of the exercises with rest in-between as Rippetoe suggests. At first, I thought it didn’t seem like this plan would do much but I have noticed subtle changes over the past few weeks.
My lower back rarely hurts and my legs are much stronger. I have been doing overhead presses also that help me keep my posture in line and my upper body no longer hurts from the computer as much as it did. I feel better and can easily squat down now to lift things more readily. The idea of these exercises is to give one more functional ability in his or her daily life and they definitely have done that for me. I am still doing some yoga and other exercise for variety but I think the squats and deadlifts have really been key to helping me achieve the goals that I wanted–less pain and more ability to do tasks in my daily life. Thanks Mark!
Check out some of Mark Rippetoe’s biggest hits at PJ Lifestyle:
All medical journals these days feel the compulsion to be high-minded, but none is as high-minded as the Lancet. It is as if the editors had taken lessons both in moral philosophy and rhetoric from Mr. Pecksniff himself.
Mr. Pecksniff, you may remember, was the preposterous hypocrite in Dickens’ Martin Chuzzlewit, who introduces his daughters, Charity and Mercy, by adding “Not unholy names, I hope?” As Know thyself was inscribed over the entrance to the temple to Apollo at Delphi, and Abandon hope, all ye who enter here over the entrance to Dante’s hell, so Mr Pecksniff’s words, Let us be moral, must be inscribed over the entrance to the offices of the Lancet, figuratively if not literally
In the week before a Malaysian Airlines plane, taking many AIDS doctors and activists from Amsterdam to Melbourne for an international conference on AIDS, was shot down over eastern Ukraine, the Lancet published a statement called the Declaration of Melbourne, a typically sickly and nauseatingly unctuous statement of ethical principles. It began by saying something that, if not a lie exactly, was certainly not a truth:
We gather in Melbourne, the traditional meeting place of the Wurundjeri, Boonerwrung, Taungurong, Djajawurrung and the Wathaurung people, the original and enduring custodians of the lands that make up the Kulin Nation, to assess progress on the global HIV response and its future direction, at the 20th International AIDS Conference, AIDS 2014.
This, of course, is the purest 21st century Pecksniffery; and unless the signers of the declaration (who look extremely self-congratulatory in photos accompanying the article) can each and severally explain in what sense the Djajawarrung are the custodians of the lands on which the city of Melbourne is built, I suggest that they be banished to the outback for five years to live as pre-contact Australian Aborigines lived.
One of my first medical publications was on the nocebo effect, the unpleasant symptoms patients may suffer as a result of being made aware of potential side effects of a treatment they are about to receive or a procedure they are to undergo. Thus patients who were having a lumbar puncture were either told or not told they might suffer a headache afterwards; and lo and behold, those who were told that they might get headaches duly got headaches while those who were not told didn’t.
On the whole, as an article in a recent edition of the Journal of the American Medical Association points out, doctors are well aware of the placebo effect, that is to say the good that their treatment may do patients by means of mere suggestion, but have little awareness of the opposite nocebo effect, the harm that their treatment may do their patients by mere suggestion.
The nocebo effect poses an ethical dilemma for doctors, say authors of the article. On the one hand, doctors are supposed to do their patients no harm; on the other, they are supposed to be open and honest with their patients about the potential harms of drugs and other treatments. The dilemma is this: foreknowledge of those harms can harm some patients. Should the need for honesty trump the ethical injunction to do no harm?
When my PJ Media editor suggested that I write about having lupus, I almost said no.
I was diagnosed with SLE in 1991 and have been in remission since around 1995. My book about living with this chronic illness came out two years later. Like most writers, by the time a book comes out, I’m so sick – pun intended – of its topic that I dread having to revisit it.
Having been in remission for almost 20 years, I can honestly make the rather unusual claim that not even the perspective of hindsight has changed my ideas or feelings about what being a pain-wracked invalid was like. Not even a little bit.
I feel like I’m supposed to say the opposite: that looking back, I could have “handled” my disease differently, or learned other, “better” lessons from it, and so forth.
But then, from the very beginning, I didn’t fit the mold of the “disease of the week” TV movie heroine, or some “poster child” for lupus.
Here are some things I learned (or, perhaps more accurately, some pre-conceived ideas I had reinforced) when I was at my very sickest.
Warning: What follows is NOT inspirational. At all.
After spending a few hours with Mark Rippetoe and two members of his coaching team — John Petrizzo and Nicholas D’Agostino — I’ve learned that online strength training information, though often of high quality, takes a distant second to an in-person session from a top-notch coach. And you simply cannot find one at a corporate gym. Maybe you have found one, or thought you had, but my experience from this project has been that years, dollars, and perhaps time spent recovering from injuries could have been saved had I originally sought out the advice considered to be the best by those who train for a living.
For more detail on that, I asked Petrizzo why he was drawn to Rippetoe’s methods and chose to become an affiliated coach:
All through high school and college I read everything I could get my hands on in regards to training for enhanced strength and athletic performance. Starting Strength stood out. I had never seen a comparable level of analysis applied to the barbell lifts in terms of their application and execution. Prior to SS, everything I had read in regards to lifting technique was merely the author’s opinion. I had never read anything that applied a sound biomechanical rationale for every aspect of the movements included in the program, and why they should be coached and taught in the manner they were presented in the book.This was sorely lacking in my formal undergraduate education as an Exercise Science major.
Coach Rippetoe has been writing introductory strength training articles for PJ Media this year. I called him to suggest we do a “video coaching” project, wherein I would follow the advice from his Starting Strength, record each training session, and then send him the video to critique. He didn’t like that idea, explaining that top-level coaching needs to occur in-person.
A few weeks later, Rippetoe, two coaches, and a cameraman were in my lifting partner’s basement gym, showing us everything we’ve been doing wrong all these years.
There’s a reason potential Olympians move to Colorado Springs, and why talented youth tennis players move to Florida. Serious improvement comes from a trained eye watching your every move, giving immediate and correct feedback. This doesn’t happen online, and the trained eyes who can do this at the highest level are few. The difference between Rippetoe, his colleagues, and every other trainer I have worked with? They are meticulous: they always noticed flaws immediately, they gave me the proper fix, and I felt an immediate improvement in performance. If you want improve your strength for any reason — the best being long-term well-being — then you should consider a visit with the best.
We’re breaking the video from that training session into five parts, which we will publish over the next few weeks at PJ Lifestyle. On the following page is the first video: “The Squat, Part One.” Topics covered:
Weight gain: As Rippetoe has previously covered here, the big, strong guy is both self-sufficient and healthier than the waif. You need to eat if you want to get consistently stronger on a strength program — sometimes those plateaus occur from an insufficient diet. What kind of weight gain might someone pursuing greater strength expect?
Foot placement: How far apart, and at what angle?
Back angle: Rippetoe displays, with a simple hands-on test, that a less vertical back angle instantly helps you move more weight.
Eyes on the floor: With another simple test, Rippetoe shows that the typical eyes-forward squat taught by corporate gyms represents weaker positioning.
Bar placement: You are probably placing the bar too high on your back, which can lead to that more vertical back angle. Dropping it down — where it doesn’t feel so comfortable at first — shortens the lever and gives you a mechanical advantage over the high bar position.
I was bored and restless the Wednesday I saw a friend post on Facebook that he knew a Ragnar Relay Race team that needed an extra member. That Friday, I was in a van full of camping equipment on my way into the mountains of West Virginia, wondering what the hell I’d just gotten myself into. I was about to break one of the cardinal rules my mother gave us in childhood: “If you can imagine William Shatner talking about it on Rescue 911, don’t do it.” My only comfort was that if I blogged about it, I might be able to write the trip off on my taxes as a business expense.
By Saturday night I had run 14.8 miles in three parts. I learned a lot about myself and bears that weekend. I also learned about the glory of human endurance, though I still haven’t learned exactly what foam rollers are for. And now, in the name of tax deductiblity, I will share those lessons with you.
Is there ever any good news without bad? Good and bad seem to be inextricably locked in a Hegelian dialectic, or perhaps Manichaean struggle would be a more accurate way of putting it. For example, tuberculosis became the captain of the men of death, the white plague, between the seventeenth and the nineteenth centuries. Then it began its long decline, accelerated by the discovery of the first effective anti-tuberculous drugs. Then, just as large numbers of people became more susceptible to tuberculosis because of the spread of the human immunodeficiency virus, the germ of tuberculosis developed resistance to the most effective drugs against it. It seemed that the disease might once more become what it had been not so very long before. But then, for the first time in 40 years, a new anti-tuberculous drug, bedaquiline, was developed by the pharmaceutical company Janssen. Good news has not retained the upper hand for very long, however. An article in a recent edition of the Lancet suggests that bedaquiline is not the answer to Mankind’s prayers, at least where tuberculosis is concerned.
I just got back from the mammogram I don’t believe in.
In the spring, my doctor handed me an envelope decorated with a cluster of bright balloons and the words “Happy Birthday!”
Alas, this deceptively cheerful package concealed the usual tips on diet and exercise, plus requisition forms for all the annual medical tests I’d be getting from now on.
The mammogram is bad enough. I got my first one before having my doubts about the procedure confirmed, and now I’m stuck in the “Ontario Breast Screening Program” because “free” “health” “care.”
But now I also have to get blood work for cholesterol (how 1970s!), glucose and a bunch of other things, plus an ECG.
The worst part: I need to send little swabs of poo* through the mail. (Although it could be worse: it could be my job to open those envelopes. And a special shout-out to my Facebook friend for sharing her “float a Chinet dessert plate in the toilet” trick.)
It’s all part of the splendor and pageantry of turning 50.
(* As you can see from the video below, which my tax dollars helped pay for, “poo” is the actual scientific term!)
I’m 58. Granted, I’m pretty beat up these days. I’ve had my share of injuries, the result of having lived a rather careless active life outdoors, on horses, motorcycles, bicycles, and the field of competition. People my age who have not spent their years in a chair have an accumulation of aches and pains, most of them earned the hard way. And for us, beat up or not, the best way to stay in the game is to train for strength.
The conventional wisdom is that older people (ah, the term sticks in the craw) need to settle into a routine of walking around in the park when the weather is nice, maybe going to the mall for a brisk stroll in the comfort of the air conditioning, or a nice afternoon on the bicycle, checking out the local retirement communities — at a leisurely pace, of course. For the more adventurous, a round of golf really stretches out the legs. Maybe finish up with a challenging game of Canasta. Your doctor will tell you that this is enough to keep the old ticker ticking away, and should you choose to rev the engine like this every day, you’re doing everything you need to do to maintain the fantastic quality of life enjoyed by old people at the mall.
Standards, unfortunately, are low. Your doctor often assumes that he’s also your fitness consultant. When you get sick, go to your doctor. When you are deciding what to do to extend your physical usefulness, how about taking a different approach than asking his permission to get up off your ass? How about asking yourself whether your current physical condition is as good as you’d like it to be? If it’s not, what would be the best way to improve it?
The distinction between what the law permits and what the law enjoins is often blurred. An absence of proscription is sometimes mistaken for prescription. The more the law interferes in our lives, the more it becomes the arbiter of our morality. When someone behaves badly, therefore, he is nowadays likely to defend himself by saying that there is no law against what he has done, as if that were a sufficient justification.
The recent Supreme Court decision in the cases of Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell illustrates the difficulties when two or more rights clash irreconcilably. The complex issues involved were the subject of an article in a recent edition of the New England Journal of Medicine. The matter is still far from settled. It seems to me likely that the Supreme Court will one day reverse itself when its philosophical (or ideological) composition has changed.
The two corporations were owned by strongly religious people. Corporations of their size were enjoined by the government to provide their staff with health insurance which would cover contraceptive services. However, some contraceptive methods violated the religious beliefs of the owners of the companies. Did the companies have the right to except these methods from the policies that they offered to their staff (who, incidentally, numbered thousands, many of whom would not be of the same religious belief)?
Vacations can be wonderful experiences, but all too often they start out at an airport, which can be one of the most frustrating, uncomfortable, and stressful places on earth. Here’s the top ten ways to make your airline travel a good experience. Or at least not a nightmare.
10. Pack a small refreshment bag for the end of the flight.
Purchase the wisp toothbrushes that come with toothpaste already installed. Buy a packet of facial wipes. Take a last visit to the bathroom before landing to wash up, brush your teeth, comb your hair and prepare for your day. No matter how tired you are or how long the flight, the refreshment of a small amount of grooming helps energize you and get you ready to face your journey’s destination. Just avoid changing clothes. It never turns out well unless you’re David Spade in Tommy Boy…
In principle medical research is supposed to result in unequivocal guidance to doctors as to how to treat their patients. As often as not, however, the waters are muddied as much as cleared. Two papers in a recent edition of the New England Journal of Medicine about atrial fibrillation and the cause of stroke illustrate this. It has long been known that people with a clinically-detected chaotic heart rhythm called atrial fibrillation (AF) have an increased incidence of stroke by embolism; and likewise that no cause of such stroke can be found in up to 40 percent of patients who suffer from one. Their strokes are called cryptogenic. The two papers addressed the question whether, if you monitor patients with cryptogenic stroke for long enough, some or many of them will turn out to suffer from AF. This is important, because it is generally agreed that, in patients with clinically detected and symptomatic AF, anti-coagulation reduces the subsequent risk of stroke. AF, however, is not an all or none phenomenon. Some people suffer it continuously, but others only occasionally and for only a few seconds at a time. The additional risk of stroke in the latter is unknown, but is an important question because the anticoagulation designed to reduce the risk of stroke is not itself without risk, including that of another kind of stroke, the haemorrhagic kind. In other words, the risk caused by treatment could outweigh its benefits.
If the future were knowable, would we want to know it? When I was young, a fortune teller who predicted several things in my life that subsequently came true predicted my age at death. At the time it seemed an eternity away, so I thought no more of it, but now it is not so very long away at all. If I were more disposed to believe the fortune teller’s prediction than I am, would I use my remaining years more productively or would I be paralyzed with fear?
In a recent edition of the New England Journal of Medicine a question was posed about a 45-year-old man in perfect health (insofar as health can ever be described as perfect) who asked for genetic testing about his susceptibility to cancer, given a fairly strong family history of it. Should he have his genome sequenced?
A geneticist answered that he should not: to have his entire genome sequenced would lead to a great deal of irrelevant and possibly misleading information. But if the family history were of cancers that themselves were of the partially inherited type – more factors than genetics are involved in the development of most cancers – then the man might well consider having the relevant part of his genome, namely that part with a known predisposing connection to the cancers from which his family had suffered, sequenced.
This is not a complete answer, however. Two obvious questions arise: is additional risk clinically as well as statistically significant, and if the risk is known can anything practicable and tolerable be done to reduce it? There is no point in avoiding a risk if to do so makes your life a misery in other respects. You can avoid the risk altogether of a road traffic accident or being mugged on the street by never leaving your house, but few people would recommend such drastic avoidance.
Training with weights produces muscle soreness. Many people don’t like to be sore, and that’s why they won’t train for strength. Running also makes you sore, but not as bad and not all over the body, like weights, so running is more popular. Other people have noticed that riding a bike doesn’t produce sore muscles, so they ride a bike for exercise instead of lifting weights or running. But to some people — and this may come as a surprise to most of you — getting sore becomes the whole point of exercise. They wear their soreness like a badge of honor, and regard sore muscles as the price they must pay for continued self-improvement.
Here are some facts.
Delayed-Onset Muscle Soreness (DOMS) is a phenomenon associated with certain types of muscular work. It can occur as the result of exercise or manual labor, and is a perfectly natural consequence of unaccustomed physical exertion. There are a couple of different theories about its actual cause at the cellular level, which are beyond the scope of this article. Suffice it to say that DOMS has nothing to do with lactic acid production during exercise, and that it is an inflammatory response to certain types of muscular work which therefore responds to NSAIDs like naproxen, ibuprofen, and aspirin.
Pressure to control the consumption of tobacco has grown in tandem with the pressure to liberalize the consumption of marijuana. Perhaps this is not a paradox in the most literal sense, but it is certainly very striking. The yin of prohibition, it seems, always goes along with the yang of permission.
An article in a recent edition of the New England Journal of Medicine discusses the forthcoming tussle between what it calls Big Marijuana – the commercial interests, analogous to Big Tobacco, that will inevitably grow if marijuana ever becomes as accepted as tobacco once was – and the public health authorities. For while the smoking of marijuana does not yet cause anything like as many health problems as tobacco or alcohol, it would do so if its use were as general as the use of tobacco or alcohol. A little statistic that was published some time ago in the Lancet caught my eye: the French police attribute 3 percent of fatal road accidents to intoxication with cannabis and 30 percent to intoxication with alcohol. If, as seems likely, ten times as many Frenchmen drive drunk as drive stoned, marijuana is as dangerous as alcohol where driving is concerned.
The authors of the article point out that commercial growers and marketers of marijuana are likely, given the chance, to resort to all the techniques and obfuscations employed by the tobacco companies. They will minimize the harms done by marijuana while trying to increase the concentration of the very substance in their product that does the harm. The concentration of tetrahydrocannabinol (THC) in modern cannabis plants is already much higher than it was when hippiedom first struck the western world; Uruguay, where the cultivation and sale of cannabis has recently been legalized, is attempting to control the strains of cannabis that can be sold, with what success remains to be seen.
As long as men have experimented upon animals to gain knowledge of physiology or pathology there have been others who have decried the practice. Among them was Doctor Johnson, who said of vivisection that “if the knowledge of physiology has been somewhat increased [by it], he surely buys knowledge dear, who learns the use of lacteals at the expense of his humanity.”
Doctor Johnson argued that the cure of not a single medical condition had been discovered by the use of animal experimentation, and even if that is no longer the case there are nevertheless those who maintain that the benefits of animal research are small by comparison with their cost in the suffering of sentient beings that such research entails.
Two authors in a recent edition of the British Medical Journal, one of them an eminent epidemiologist and the other a sociologist, attempt to answer the question of whether or not animal research is a boon to medicine. Their conclusion is that it is much less so than is commonly supposed, and in some cases it is actually harmful. Since the only possible moral defense of vivisection is that it promotes medical advance, it should be stopped if it does not.
The authors point out that, according to a survey of medical scientists who perform animal experimentation, more are motivated by a desire to advance knowledge or careers than by a desire to help suffering humanity, and are actually rather indifferent to the practical use or otherwise of their work.
This is perhaps just as well, at least for their own peace of mind, because the practical value to patients of most animal experimentation is nil. This is for more than one reason.
If a Martian were to land on earth to study humanity, one of the things that would no doubt surprise him about our race is the pleasure it takes in contemplating its own extinction by various catastrophic means: the crash into earth of a giant asteroid, climate change or the spread of new, virulent and untreatable diseases, especially caused by viruses that emerged from the African jungle.
Of all the viruses to have emerged of late, Ebola is the most frightening. It comes in several varieties of different virulence, with (according to a recent article in the New England Journal of Medicine) death rates from a “low” 40 percent to over 70 percent. Among monkeys the death rate can be 100 percent.
Before Ebola there was Marburg, so named because it was first recognized among laboratory workers in Marburg, Germany. This virus is spread from fruit bats to monkeys to humans, and I happened to be in Rhodesia (as it was then still called) when there was an epidemic there of the disease and 33 percent of the patients died. I remember the reaction in the hospital between panic and pride that it should be in the eye of a world-publicized storm. The question on everyone’s mind was whether it could spread on a large scale from Africa to Europe and North America. Could the virus escape its ecological niche?
This past Sunday, American audiences finally had their chance to wave goodbye to Nurse Jenny Lee, the lead character in the famed Masterpiece series Call the Midwife. However sad it may be, the departure of the show’s Hollywood-bound lead actress Jessica Raine was, ironically, in no way a traumatic one.
Most American shows die when their lead actor disappears. Dan Stevens’ untimely departure from Downton Abbey still enrages fans over a year later. Yet, while Nurse Jenny Lee will be a much missed character, fans are far from outraged at her departure. Perhaps this is because Call the Midwife was never just about Jennifer (Lee) Worth, but about the many lives she encountered and a profession that is finally being given the credit it so sorely deserves. But there is more to the massive success of what began as a 6-episode BBC show about nursing in mid-century London’s bombed-out East End than giving credit where credit is due.
In an era of roughshod marketing tactics and semiotic overload, Call the Midwife, with its pure, heartfelt approach to the vicissitudes of life, is therapeutic television. We are a desensitized audience: No one cries when a pregnant mother is stabbed to death on Game of Thrones. Yet, everyone, including the burly guys on set, shed a tear at every birth on Call the Midwife. We are treated to an East End rife with chamber pots, not sexy chamber maids, and yet audiences are drawn to the show in droves. We love the midwives, even when they are dressed in habits and wimples; they are the ideal face of medicine, mother, and God in an era when we’ve been taught to doubt all three. Like a nurse checking our pulse, Call the Midwife reminds us that we are human after all, and perhaps not as sick as we’ve been led to believe.
And yet, while TV execs struggle with sex and violence in the name of Tweet power, they remain blind to Call the Midwife’s axiom for success: There is powerful endurance in simple truth. Call the Midwife will survive without the character of Jenny Lee because the show has embraced Jennifer Worth’s own mystical sense of timelessness. It is the stuff that fueled her memoirs of both London’s East End and her time as a nurse caring for the dying. Brilliantly captured in the season finale, this sense of the eternal in both life and death is what makes Call the Midwife a healing balm of a show and transcendental television in its finest form. Forget bloody battles and wild, nameless sex. Call the Midwife empowers its audience with the strength to face, not escape, life’s pressures, and the faith to believe that while “weeping may happen for a night, joy breaks forth in the morning.”
Now and then in life, love catches you unawares, illuminating the dark corners of your mind, and filling them with radiance. Once in a while you are faced with a beauty and a joy that takes your soul, all unprepared, by assault.
I remember the written response of the senior doctor in the prison in which I worked to an editorial in the British Medical Journal lamenting the difference between health care in prison and health care in the “community.” Yes, he replied, where else in the country but in prison could everyone get to see a doctor within an hour of complaining of something?
I thought of this as I read an article recently in the New England Journal of Medicine about Hepatitis C infection and the American correctional system.
About 3 million Americans are infected with the Hepatitis C virus, mainly because of having shared needles in intravenous drug abuse, but also through transfusions before blood was screened for the virus. Those who are tattooed have two or three times the average rate of infection.
Ten-to-fifteen percent of cases of untreated infection (among males) will go on to get cirrhosis of the liver, and of them an increasing proportion will develop liver cancer as the years go by. Hepatitis C infection is now the largest single cause of the need for liver transplants.