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What Moral Narcissism Looks Like In the Medical World

Wednesday, July 30th, 2014 - by Theodore Dalrymple

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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 editor 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 the airliner of Malaysian Airlines, taking many AIDS doctors and activists from Amsterdam to Melbourne for an international conference on AIDS, was shot down over the 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, photos of whom looking extremely self-congratulatory accompany 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.

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Is Ignorance Really Bliss? What Is the ‘Nocebo’ Effect?

Sunday, July 27th, 2014 - by Theodore Dalrymple

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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?

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3 Things Getting Lupus Taught Me

Saturday, July 26th, 2014 - by Kathy Shaidle

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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.

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VIDEO: Coach Rippetoe Puts PJ Media on Starting Strength (Part One)

Thursday, July 24th, 2014 - by David Steinberg

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 gainAs 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.

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8 Things I Learned Running a Ragnar with No Training

Wednesday, July 23rd, 2014 - by Hannah Sternberg

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.

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One Step Forward, Two Steps Back in the Battle Against Tuberculosis

Tuesday, July 22nd, 2014 - by Theodore Dalrymple

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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.

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50 Is the New Crappy

Thursday, July 17th, 2014 - by Kathy Shaidle

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!)

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Strength Training for People My Age

Tuesday, July 8th, 2014 - by Mark Rippetoe

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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?

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Hobby Lobby, Assisted Suicide, and Slippery Slopes…

Sunday, July 6th, 2014 - by Theodore Dalrymple

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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)?

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The Top 10 Tips for Surviving Summer Airline Travel

Wednesday, July 2nd, 2014 - by Bonnie Ramthun

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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

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When the Risk of Treatment Outweighs the Benefits…

Tuesday, July 1st, 2014 - by Theodore Dalrymple

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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.

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Should You Get Your DNA Tested to See if You’re More Likely to Get Cancer?

Wednesday, June 25th, 2014 - by Theodore Dalrymple

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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.

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Why Being Sore Doesn’t Mean You’re Getting Stronger

Thursday, June 19th, 2014 - by Mark Rippetoe
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A weighted sled has no eccentric component, thus no soreness.

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.

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Will Legal Marijuana Be a Bonanza for Trial Lawyers?

Saturday, June 14th, 2014 - by Theodore Dalrymple

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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.

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Do Medical Experiments on Animals Really Yield Meaningful Results?

Monday, June 9th, 2014 - by Theodore Dalrymple

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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.

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Ebola: The World’s Most Terrifying Disease?

Saturday, May 24th, 2014 - by Theodore Dalrymple

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?

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The #1 Reason We Watch Call the Midwife

Thursday, May 22nd, 2014 - by Susan L.M. Goldberg

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.

Jennifer Worth

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Should Prisoners Receive Better Health Care Than the General Population?

Tuesday, May 20th, 2014 - by Theodore Dalrymple

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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.

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This Christian Ministry Just Went Galt

Sunday, May 18th, 2014 - by Walter Hudson

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Recently, my wife approached me with the unwelcome news that our health insurance plan — which we like — will likely be cancelled next year. Her employer, a healthcare provider, generously provides benefits even for those working part-time. Due to the devastation wrecked upon the industry by Obamacare, they anticipate the need to drop coverage for all employees working less than 60 hours per pay period. My wife works 56. Since my employer’s offering proves virtually worthless, far too expensive for far too little coverage, we will be left effectively uninsured.

We may consider Samaritan Ministries as an alternative to insurance. Resembling the mutual aid societies which were common throughout America before the rise of the welfare state, Samaritan Ministries operates as a “health care sharing” service. Here’s how it works:

Each member commits to sending a set “Share” amount each month. These “Shares” are sent directly through the mail from one household to another, to the members with “Needs”. Samaritan Ministries uses a database that randomly matches Shares to Needs, so that the Sharing is coordinated and Shares go to the appropriate members with Needs.

Born to a world dominated by employee-provided health insurance, we may find the notion of health care sharing bizarre or even suspect. But is it really any more odd than our rapidly corrupting government?

It’s with some irony that a Christian ministry has essentially gone Galt. While Ayn Rand may have balked at the religious context in which Samaritan Ministries operates, she also may have tipped her hat at their defiance of convention.

The service “even satisfies the Federal health care law’s (Affordable Care Act) requirement that you have insurance or pay a penalty-tax (see 26 United States Code Section 5000A, (d), (2), (B)).”

Would you consider a health care sharing service like Samaritan Ministries? How might the business model be applied to other needs?

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You Only Need These 6 Things For a World-Class Home Gym

Thursday, May 15th, 2014 - by Mark Rippetoe

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Not everybody who wants to train for strength can fit a gym membership into their lifestyle. Scheduling problems, the cost, travel problems from home or work, the absence of an adequately equipped facility in the market, or simply the dislike of a commercial gym environment motivates many people to invest in a home gym.

A serviceable home gym for barbell training need not be a gigantic investment, and in fact should be very simple. A bar, some plates, a rack of some type to facilitate the squat and the pressing exercises, a simple flat bench for the bench press, and a platform for deadlifts are all that is absolutely required. For power cleans and snatches, a few bumper plates are quite useful but not absolutely necessary.

The equipment is simple, and need not be expensive, but there are a few tricks.

1. The Bar

This is the wrong place to save money. Of all the pieces in the gym, the quality of the bar is the most critical. The plates just hang there, the platform just lays there, but the bar is your connection to the force against which you lift — gravity.

Saving money is a good idea. Generic drugs are cheaper than the name-brand products, and they are essentially the same product. This is not true of Olympic barbells. In most cases, you get exactly what you pay for. Unless you get lucky — and these days of rapid expansion in the interest in barbell training, such luck is hard to come by — and find a good used bar cheap, expect to pay around $300 for a good bar.

Why? Because steel is expensive, competent manufacturing is expensive, and warehouse space costs money. A cheap bar will bend, and a badly bent bar is junk. A bar within about 3mm of perfectly straight is useable as a straight bar, while a bar bent more than 4-5mm out of straight is considered bent. When loaded with plates, a badly bent bar will rotate to a position of stability — it will “right” itself, with the ends of the bar pointing down and the bend in the middle pointing up. This is fine for a squat, if you have marked the bar so that you can take it out of the rack in this stable position. But if you unrack the bar for a squat, press, or bench press, or pull it from the floor in its unstable configuration, the bar will spin in your hands or on your back to right itself. This is not good, and can cause safety problems during the lift.

Most commercial gyms have a few bars, and usually all of them are bent, because they bought cheap junky bars not knowing any better or not caring about it. Bars get bent in commercial gyms by being dropped on benches, or inside the rack by jackasses that aren’t invested in the equipment. Even expensive bars will bend when 315 pounds is dropped across a bench. But cheap bars will bend if left loaded in the rack overnight.

You can check a bar for straightness by placing it on the floor and spinning it in the middle with your foot (if the revolving sleeves aren’t frozen, which is also bad). If it wobbles, it’s not straight. Or, you can see the wobble when you rotate it in the rack — the end of the bar will describe a circle in the air larger than the diameter of the sleeve, and the middle of the bar will move back and forth, the greatest deviation being at the point of the bend. One of the advantages of a home gym is that you get to work with a straight bar every time you train.

Bars are available in several diameters. The Olympic weightlifting federations specify a 28mm bar, while the International Powerlifting Federation wants the diameter to be between 28 and 29mm. The standard bar length is a little over seven feet, has “2-inch”/50mm diameter sleeves for loading the plates on, and weighs 20kg/44.1lbs. The thicker the bar, the stiffer the bar, so Olympic lifters doing the faster snatch and clean & jerk like the whippiness of a 28mm bar, and powerlifters need a stiffer bar because they handle heavier weights more slowly. Olympic lifting uses a 25mm bar for the women’s division (smaller hands need a smaller bar), and a competitive lifter will need one of these. For home gym purposes, a 28.5mm or 29mm bar will be the most durable and provide the best service over time.

Never buy a 32mm bar. They are either junk, or a specialty squat bar that a home gym doesn’t need. Usually they are junk. Scrap metal.

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Why a Doctor Would Be Relieved When a New Study Fails To Reduce Deaths

Tuesday, May 13th, 2014 - by Theodore Dalrymple

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Sometimes the New England Journal of Medicine reads like a journal of failed bright ideas. I do not remember ever having read of so many failed trials of treatment as I have recently, but perhaps that is a sign of increasing scientific honesty. After all, it is as important to know what does not work as what does, especially when what does not work is very expensive to administer.

Septic shock is a condition of dangerously low blood pressure brought about by serious infection. About 750,000 cases a year are treated in the United States alone, with a death rate above 20 percent, that is to say at least 150,000 people die of it each year. This is a number well worth reducing.

More than a decade ago the results of a trial were published in which it was shown that aggressive treatment according to a pre-arrange protocol could reduce the death rate from septic shock by about a half. In those days (medicine 10 years ago seems that of a bygone era), the death rate in septic shock was much higher than it is today, which may in part explain the success of that trial compared with the failure of a more recent trial published recently in the NEJM. 

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3 Tips for Falling Asleep at Night

Thursday, May 1st, 2014 - by P. David Hornik

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Getting to sleep at night has never been one of my talents. As a kid, fears kept me awake. As a teenager, I found the night the most intense time and didn’t understand why one was supposed to sleep during it. As an adult… if it wasn’t one thing that kept me awake at night, it was another.

Just recently I’ve been on a new regimen, and it’s actually working. There are three things I’ve been doing differently, and I’ve been sleeping with little or no trouble most nights. As for why I made these three changes, it did not come from any conscious decision but, apparently, from something on a subconscious level, some push for greater purity, a byproduct of which has been successful sleep.

I should add that if exercise is not one of the three things, it’s not because I don’t practice it but because I’ve already been practicing it for decades. I find it indispensable to decent mental and physical functioning. No, by itself it did not solve my sleep problem; but without it I wouldn’t have slept at all.

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The #1 Strategy for Happiness

Wednesday, April 30th, 2014 - by Susan L.M. Goldberg

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“You need to have a good mood. Good family, good children, good work, and then you’ll be happy,” he added. “You need to be a sociable person. I love and respect all people. After what happened to me, I don’t only value my own life  more, but I deeply value the lives of all human beings. It’s very important to have good company and good friends. I view everything with optimism, it’s very  important.”

The observation seems simple enough, until you realize that they are the words of a Holocaust survivor. Over at Times of Israel, Margareta Ackerman details:

As a grandchild of a survivor, I’ve always had a  special interest in Holocaust studies. I have read many memoirs and attended  numerous classes on the subject. But, from the very first class in a small  Israeli school in the suburbs of Afula, to the courses I attended in a large  North American university — I had always felt that something I had learned from  my Grandfather was missing from these lectures.

For years, I had trouble pinning down that missing  piece. It frightens me that my grandfather’s gift may have been lost all  together: No one would have known that there once lived a man named Srulik  Ackerman, who challenged our understanding of human nature, and with that, could  bring hope in even the darkest of times.

…after just a few minutes with my Grandpa you  would see the mystery that had perplexed me for so many years. The first thing  that would strike you would be his wide, welcoming smile. Grandpa smiled and  laughed more than anyone I knew. He took every opportunity to tell jokes and  bring joy to others. Without a doubt, Grandpa was the happiest person that I had  ever met.

How was that possible? I spent two years writing his  memoir, hoping to discover his secret. But, even after the book was complete, I  still had no idea what gave him such unparalleled resilience.

So, I decided to ask him directly. “How do stay happy  on a daily basis?” I asked during one of our conversations.

Do yourself and your kids a favor: Get to know a Holocaust survivor so you, too, and your children can understand how a human being can survive and thrive in the face of death. There aren’t many survivors left, but there are countless resources through which you can interact with their thoughts and experiences. Tomorrow, the United States Holocaust Museum is sponsoring a Google+ Hangout with Holocaust survivors specifically geared towards school-aged children. Take advantage of this opportunity to get to know the real “secret” to happiness.

And don’t forget to thank them for sharing it.

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Parents Begin Hormone Therapy on 9-Year-Old ‘Transgender’ Boy

Tuesday, April 29th, 2014 - by Rhonda Robinson

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“It just comes down to love. I mean, if you love your child then you should do anything in the world for your child. And it’s as simple and as pure as that.”

This is not parental love. This is misguided, tragic indulgence. It’s as simple and pure as that. Parental love prepares a child for adulthood–momentary happiness has little to do with it.

Parental love sees beyond what a child currently wants, or thinks he wants, and gives him what he needs. What this child needs is unconditional love and a chance for his brain to mature and his body to fully develop.

It’s far beyond the comprehension of a child to see himself as an adult. To a child of nine, eighteen is a lifetime away. Neither Keat nor his parents can fathom what his life will be like as an adult. The physical and mental consequences of a chemically altered body through puberty cannot be fully understood and weighed.

What if Keat had Body Integrity Identity Disorder? The same feelings of being born wrong exist. A person with this disorder believes he or she would be happier without the appendages they were born with. Would these parents still be good parents by indulging this disorder with amputation before puberty?

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