When I was working in Africa I read a paper that proved that intravenous corticosteroids were of no benefit in cerebral malaria. Soon afterwards I had a patient with that foul disease whom I had treated according to the scientific evidence, but who failed to respond, at least as far as his mental condition was concerned – which, after all, was quite important. To save the body without the mind is of doubtful value.
I gave the patient an injection of corticosteroid and he responded as if by miracle. What was I supposed to conclude? That, according to the evidence, it was mere coincidence? This I could not do: and I have retained a healthy (or is it unhealthy?) skepticism of large, controlled trials ever since. For in the large numbers of patients who take part in such trials there may be patients who react idiosyncratically, that is to say, differently from the rest.
A paper in a recent edition of the New England Journal of Medicine brought back my experience with cerebral malaria. Animal experimentation had shown that progesterone, one of the class of steroids produced naturally by females, protected against the harmful effects of severe brain injury. The paper does not specify what exactly it was necessary to do to experimental animals to reach this conclusion, but it does say that it has been proven in several species. What is not said is often as eloquent as what is said.
There’s no shortage of media representations of childbirth, between television and movies. The scene, which has played out for as long as babies have been “born” on television, is fairly cookie cutter: the woman’s water breaks and there’s a mad dash to the hospital — otherwise the baby will be born in a stalled elevator. The woman screams in pain, begging for drugs, and then out comes a beautiful, usually clean baby who cries immediately before being wrapped and placed in mom’s arms.
As with all mainstream media representations of real-life events, writers and producers take a lot of liberties with the scene and how it plays out in real life. Since having a child myself, I often wonder if anyone on the writing or producing staff has ever been present for the birth of a child, given how diametrically different these moments are in real life.
The way childbirth is portrayed isn’t just inaccurate, but also fuels a false perception in our society of childbirth as scary, dangerous, and often negative. Several aspects of how childbirth plays out on screen also affect how real life couples may process their own experience in the moment. So what can a couple expect out of the birth of their child? What does the media get wrong? This list is just a start:
1. Babies come out pink
One of the scariest moments for any parent who has seen enough babies being born on television is the color their child comes out. While some people may be ready for the goop and slime that coat a baby’s skin, the color of their skin usually comes as a total shock, even if intellectually one has been made aware that often babies don’t come out flesh-colored or pink right out of the womb.
On the series Parenthood, which, unsurprisingly, has seen quite a few births over the course of the last six seasons, the youngest son of the clan, Crosby Braverman, had a daughter with his wife Jasmine. She came out looking like this:
The very first moments a baby comes into the world, before they’ve had an opportunity to get oxygen into their bodies, a baby’s skin tone, regardless of race, is often a deep shade of purple, which can be petrifying if unprepared, which most parents are. Those first fleeting moments are usually forgotten in the haze of new parenthood, but it’s a shame that most first-time parents find themselves scared for their child’s safety and well-being before the cord has even been cut. Better images would go a long way in changing our image of brand new human beings, highlighting what can be normal in healthy childbirth.
The truth, the whole truth, and nothing but the truth: that is what one swears to tell in a court of law. One lies there and then. It is a noble ideal that one swears to, but one that in practice is impossible to live up to. Not only is the truth rarely pure and never simple, as Oscar Wilde said, but it is never whole, even in the most rigorous of scientific papers.
Not that scientific papers are often as rigorous as they could or should be. This is especially so in trials of drugs or procedures, the kind of investigation that is said to be the gold standard of modern medical evidence.
Considering how every doctor learns that the most fundamental principle of medical ethics is primum non nocere, first do no harm, it is strange how little interest doctors often take in the harms that their treatment does. Psychologically, this is not difficult to understand: every doctors wants to think he is doing good, and therefore has a powerful motive for disregarding or underestimating the harm that he does. But in addition, trials of drugs or procedures often fail to mention the harms caused by the drug or procedure that they uncover.
This is the royal road to over-treatment: it encourages doctors to be overoptimistic on their patients’ behalf. It also skews or makes impossible so-called informed consent: for if the harms are unknown even to the doctor, how can he inform the patient of them? The doctor becomes more a propagandist than informant, and the patient cannot give his informed consent because such consent involves weighing up a known against an unknown.
A paper in a recent edition of the British Medical Journal examined a large series of papers to see whether they had fully reported adverse events caused by the drug or procedure under trial. It found that, even where a specific harm was anticipated and looked for, the reporting was inadequate in the great majority of cases.
“The due process clause of the fourteenth amendment guarantees, protects the rights of parents but the fact is that we have to put it in law. You wouldn’t think we have to go here. What we’re seeing in our country today leads us to believe that if we don’t put this stuff into law then we are behind the eight ball and we find ourselves with these kinds of situations. I’m just afraid, down the road, we’re going to see more and more cases like [the Isaiah Rider case].” — Ken Wilson (R-MO)
We’re farther “down the road” than most dare to imagine.
The bill Rep. Wilson introduced states that a parent cannot be charged with medical child abuse for disagreeing with medical advice and choosing treatment of another doctor. Yeah. We’re there.
You might remember the well-publicized ordeal of Justina Pelletier. It seemed like a fluke of injustice, an isolated case. So beyond right, it was easy to assume there’s more to the story. In the Pelletier case, rather than receiving discharge papers, parents were charged with “medical child abuse,” the new term that has replaced Munchausen by proxy (MSbP). Mr. Pelletier was surrounded by agents of the Massachusetts Department of Children and Families (DCF) and hospital security and ushered off the premises. Justina became a ward of the state for 16 months and her health deteriorated.
In a press conference, Reverend Patrick Mahoney, director of the Christian Defense Coalition in Washington, D.C., and spokesperson for the Pelletier family, made a remarkable statement that became a mirror reflecting an unsettling image of a dangerous mindset:
“t’s easier for us to want to believe, or wrap our brains around the fact that a family is mistreating their child, than the alternative to that, and the alternative to that, is what happened in this case and that is, with impunity government agencies and courts have removed a child from the loving care of their parents—and so that’s that obstacle that no one wants to believe that reality.
“That reality” is the last thing parents think of when they have a chronically ill child or have taken a holistic path to health.
Michelle Rider, the 34-year-old registered nurse and single mother of Isaiah Rider, the boy in the above video, told PJ Lifestyle just why we have a hard time accepting this is happening:
We are taught that hospitals are safe, that doctors are safe, and DCFS intervenes when intervention is needed. So when we accept the fact that this is really happening– we are accepting that we are not safe, and our children are not safe.
While President Barack Obama asks the nation if we will accept the “cruelty of ripping children from their parents’ arms,” it’s blatantly apparent to parents like Michelle that he isn’t talking about sick children like Isaiah. Agents of the state — with calculated impunity — take their children.
On the very day a law was introduced in his name, his worst fears came true.
The “New Year’s Resolution” must be one of the most ridiculous of human customs. You identify a problem you’re having, and then you wait until January 1 of the next year to address it, in the spirit of a group-participation event that nobody completes and nobody approaches seriously. You decide that you’re going to quit eating chocolate or stop scratching your feet. You stop until January 5. You’re typical.
In the gym business, New Year’s Resolution business used to be a bigger factor than it is now. Twenty-five years ago, fewer people participated in the fitness industry during the regular course of the year, so more people were free to buy memberships in January they weren’t going to use. Back then, New Year’s business was a significant percentage of the year’s gross, and the leveling off of this spike is really a good thing for everybody. The gym isn’t as crowded with amateurs for the three weeks after their hangovers are gone, and more people are using the gym more of the year.
But if you fall into the category of die-hard NYRers that insist on giving it a shot this year — again — let me suggest a different approach this time: strength training.
Training is the systematic approach a person employs to improve a physical ability. Preparing for a marathon, a football season, or a weightlifting meet are examples of training. They require an analysis of the specifics of the task, an assessment of where you are now in relation to where you want to be, and a plan for getting there. The plan and its constituent components are the training. The constituent components are the workouts, and each workout is important because together they produce an accumulation of increasing physical capacity. The plan that controls and directs the process is what makes training different than what you did last year.
Exercising is what you did last year.
The nurse who caused an Ebola scare that closed many Ohio schools and businesses is demanding a refund from the bridal shop she visited during her trip to Akron last month.
The attorney for Amber Vinson, the Texas nurse who traveled to Ohio after treating an Ebola patient, sent a letter to the owner of Coming Attractions Bridal and Formal shop in Akron requesting a refund of $480 in deposit money that her bridesmaids paid to the store for dresses for Vinson’s upcoming wedding.
The bridal shop closed for several weeks after being notified that Vinson had tested positive for Ebola. Anna Younker, owner of the Akron store, said she paid to have the shop cleaned using ultraviolet light technology. In addition, she lost business during the 21 days her store was closed and had customers cancel orders because of fears of infection.
When Younker received a letter from Vinson’s attorney, she thought it was an apology for the inconvenience she caused. The Beacon Journal reported:
Instead, Dallas attorney Stephen F. Malouf requested the refund and notified Younker that Vinson has decided to use another bridal store for her nine bridesmaids’ dresses “in order to minimize additional public scrutiny.”
“Would you kindly advise whether this is agreeable to Coming Attractions?” Malouf asked. “If it is not, would you ask your attorney to contact me to discuss this matter?”
“Are you kidding me?” Younker thought as she read the letter.
Younker said she never received a phone call from Vinson or any of her bridesmaids before getting the request from the attorney.
“This is like the icing on the cake for her to ask,” the bridal store owner said. “By canceling completely because she wants to go somewhere else, that’s like a slap in the face to me.”
The store’s policy typically prohibits refunds or order cancellations, but Younker said she makes exceptions in special circumstances.
“I couldn’t believe she didn’t at least call me and have some discussion on why,” Younker said. “Maybe I would have considered it differently.”
In the letter, Malouf acknowledged that “Amber’s Ebola infection brought significant attention to Coming Attractions, not all of it positive.”
Nevertheless, he asked for refunds of $107 for two of the bridesmaids and $132.92 for two other bridesmaids “due to the most unusual circumstances.” He said it would be best if Younker kept the matter “strictly confidential.”
Malouf said he tried to contact Younker before sending the letter. “I’m sorry that the shop is upset,” he said. “This was an effort to help the shop and Amber. Amber feels strongly that the publicity was such it was harming the business and she didn’t want to add any further scrutiny to it. This was a purely innocent request and I’m sorry it wasn’t received in the spirit in which it was sent.”
“If that’s how she feels, I can’t force her to continue to order,” Younker said. “But for me to hand over a refund, it’s not feasible. It doesn’t make sense. I’m out a lot of money.”
In my youth the government encouraged people to eat more eggs and butter and drink more milk for the sake of their health. Perhaps it was the right advice after a prolonged period of war-induced shortage, but no one would offer, or take, the same advice today. Nutritional advice is like the weather and public opinion, which is to say highly changeable.
How quickly things go from being the elixir of life to deadly poison! A recent paper from Sweden in the British Medical Journal suggests that, at least for people aged between 49 and 75, milk now falls into the latter category, especially for women.
Milk was once thought to protect against osteoporosis, the demineralization of bone that often results in fractures. It stood (partially) to reason that it should, for milk contains many of the nutrients necessary for bone growth.
On the other hand, it also stood (partially) to reason that it should do more harm than good, for consumption of milk increases the level of galactose in the blood and galactose has been found to promote ageing in many animals, up to and including mice. If you want an old mouse quickly, inject a young one with galactose.
In other words, there is reason to believe both that the consumption of milk does good and that it does harm. Which is it? This is the question that the Swedish researchers set out to answer.
Low back pain is a condition so common that, intermittently, I suffer from it myself. It comes and goes for no apparent reason, lasting a few days at a time. Nearly 40 years ago I realized that, though I had liked to think of myself as nearly immune from nervous tension, anxiety could cause it.
I was in a far distant country and I had a problem with my return air ticket. At the same time I suffered agonizing low back pain, which I did not connect with the problem of my ticket. When the problem was sorted out, however, my back pain disappeared within two hours.
In general, low back pain is poorly correlated with X-ray and MRI findings. Epidemiological research shows that the self-employed are much less prone to it than employees, and also that those higher in the hierarchy suffer it less than those lower – and not because they do less physical labor. Now comes evidence, in a recent paper from Australia published in the Lancet, that the recommended first treatment usually given for such pain, acetaminophen, also known as paracetamol, is useless, or at least no better than placebo (which is not quite the same thing, of course).
I’d like to thank my PJ colleague David Steinberg for his great work in developing and editing these excellent fitness articles from the indomitable Mark Rippetoe. I was skeptical of Rippetoe’s approach at first — he challenged my routine — but it didn’t take many articles for him to win me over. I’m not running anymore and our recent move from the San Fernando Valley to Inglewood reminded me that it would be useful to have much more strength in my emaciated, workaholic writer’s skeleton frame.
In planning my next year’s Resolutions list, I’ll be formulating my own fitness and strength routine based on Rip’s books and these articles. Anybody want to join me?
- Strength vs. Endurance: Why You Are Wasting Your Time in the Gym
- Squats, Presses, and Deadlifts: Why Gyms Don’t Teach the Only Exercises You Need
- The 1 Reason You Aren’t Getting Stronger
- Forget What You’ve Heard: 4 Reasons Why Full Squats Save Your Knees
- Maybe, You Should Gain Weight
- The Deadlift: 3 Reasons Why Just Picking Up Heavy Things Replaces Most of Your Gym
- 3 Reasons Why You Need to Lift the Barbell Over Your Head
- ‘Training’ vs. ‘Exercise’: What’s the Difference?
- Why You Should Not Be Running
- You Only Need These 6 Things For a World-Class Home Gym
- Why Being Sore Doesn’t Mean You’re Getting Stronger
- Strength Training for People My Age
- Bodyfat and Age: Just How Important Is Thin?
- The 3 Most Effective Ways to Waste Time in the Gym
Also don’t miss David’s 3-part video series where he received some first-hand coaching from Rippetoe to put his method into practice, embedded on each of the next 3 pages:
I return to work today after a week recovering from a major procedure. I underwent gastric bypass surgery to treat, among other things, my adult onset type 2 diabetes.
While no surgery occurs without pain, discomfort, disorientation, and some period of recovery, I can say that my experience has been as good as it could have been given the circumstances. My doctors, their staff, the insurance company, and the healthcare provider have all performed professionally and effectively.
That said, as a guy daily occupied with the effect of government upon the human experience, I certainly perceived areas where the healthcare system would undoubtedly improve if less encumbered by government. First, I noted inefficient compartmentalization.
To give you an idea of what I mean, consider the path taken to get this surgery done. First, I needed to see my primary care physician for a referral. Then I needed a consult at a weight loss clinic. Then I spent three months checking off a long list of labs, dietitian visits, psychological evaluation, and preparatory classes and consults. Despite the fact that nearly all this occurred under the umbrella of the same healthcare provider, every single time I saw a different person – even within the same clinic, it was like I was being seen for the very first time. I had to answer the same questions, fill out the same forms, tell the same story, over and over again. I can only imagine how frustrating this is for patients dealing with chronic illness.
To a certain extent, this redundancy can be justified. Some of it no doubt serves patient privacy and security. For instance, asking for my birthdate or address could be a verification check to ensure I am the right patient. However, I have a hard time believing that explains most of the redundancy. Most of it seems to be a product of compartmentalization, a lack of access to information previously disclosed. Other industries model customer service solutions which could easily be applied to healthcare.
When you go to the airport in any major city, you can check in at a kiosk and get your boarding pass without seeing a clerk. You can even check in online ahead of time, from your phone while in transit if necessary. Why can’t we do this in healthcare? I get to an appointment on time, but have to wait ten minutes in line behind other patients with more complex needs, and end up checked in late. There’s no need for that.
There is no new thing under the sun, least of all panic at the approach of an epidemic of a deadly disease. In 1720, the preface to Loimologia, Nathaniel Hodges’ account of the Great Plague of London in 1665, first published in Latin in 1672, referred to the outbreak of plague in Marseilles:
The Alarm we have of late been justly under from a most terrible Destroyer in a neighbouring Kingdom, very naturally calls for all possible Precautions against its Invasion and Progress here…
In fact, though no one was to know it, no epidemic of plague was ever to occur in Western Europe again; and it is doubtful whether the precautions referred to made much difference.
The death rate from the Ebola virus is probably greater than that from bubonic plague, though of course the plague spread much faster and killed far more people in total than Ebola ever has: and at least we, unlike our plague-ridden ancestors, know the causative organism of the Ebola disease, even if we are not certain how the virus first came to infect Mankind.
Dan McGurk from Toledo had one wish for his 30th birthday — that singer Kid Rock would come to his birthday party to help him celebrate.
“Hi, my name’s Dan and I’m the No. 1 Kid Rock fan,” said McGurk, who has Down Syndrome, in a YouTube video that garnered thousands of hits.
In the video, McGurk shows off his bedroom that is filled with Kid Rock gear — t-shirts, albums, a blanket, and walls covered with posters. “Please be there for my 30th birthday. … I hope you’ll come!” McGurk begged in the video.
This week, McGurk’s dream came true. During a celebration at Clarkston Union restaurant in downtown Clarkston, Michigan, Kid Rock surprised the 30 year old, joining the party and singing “Happy Birthday” as the birthday cake was served. The look on McGurk’s face when he sees Kid Rock is priceless. The singer put his arm around the man and hugged him and then sat down to chat with McGurk for a bit.
“I love that it worked out for me that I was going to be home,” said Kid Rock, who hails from Detroit. “Are you surprised?”
“Yeah! Yeah…yeah!” McGurk said. The two high-fived.
McGurk said that he had seen Kid Rock six times. “I’m the biggest #1 fan of you!”
Kid Rock didn’t come to the party empty-handed. He presented McGurk with a hat, a numbered poster (which he took the time to explain to McGurk), and a custom Kid Rock guitar, which he signed, after receiving permission from McGurk. “I’ll sign it for you if you want me to. You don’t want me to mess it up,” he said.
Before the evening ended, McGurk got Kid Rock to promise to let him hang out with the band the next time they played in Detroit. “He’s smart!” Kid Rock said.
Watch the sweet moment on the next page.
Time is money.
Money is scarce these days, everywhere but D.C. You want to be stronger, so you go to the gym. The best use of your time there is the simple progressive barbell training program we have discussed before, one that drives an upward strength adaptation with a programmed increase in load over a full range of motion using as much of your muscle mass as possible. This approach allows you to lift a gradually increasing amount of weight, thus making you stronger. Stronger means only one thing: you can apply more force with your muscles. The process of getting stronger improves the capacity of every aspect of your physical existence. So, getting stronger in the gym is the best reason to go there.
But it is incredibly easy to waste precious time once you’re inside.
Here are the top three ways:
Long regarded as the first thing you should always do inside the gym, stretching — for most people, and by “most” I mean you, probably — is not only unnecessary, it may be counterproductive.
What a way to start an essay, eh? The most fashionable aspect of modern fitness is the newly rechristened “mobility.” Same thing as “flexibility,” except that it sounds more Californian.
And here I go again, pooping on the most popular thing in the gym. It is a part of every trendy approach to fitness in existence, from CrossFit and “functional training” to Pilates and yoga. In fact, Pilates and yoga are mobility/flexibility/stretching, and that’s about all.
It has been assumed by almost everybody for the past 40 years that every workout should begin with the physical preparation known as “stretching.” Stretching is an attempt to increase the range of motion (ROM) around a joint, like the knee, hip, ankle, shoulder, elbow, or around a group of joints like the spinal column. The common method used is to force the joint into a position of tolerable discomfort and hold it there for a while, thus hopefully increasing the ROM.
More recent approaches to increased flexibility have used techniques that affect the muscles themselves, which actually control the ROM around the joints. Massage, Active Release Therapy, “foam rolling,” and other techniques applied to the muscle bellies themselves are actually much more effective for increasing a tight ROM than stretching. The Hip Bone’s Connected to the Thigh Bone, the Thigh Bone’s Connected to the Knee Bone, etc. So stretching is really all about the muscles, anyway. Every operating room professional knows the truth here: perfect “mobility” is obtained only under general anesthesia.
The assumption is always that your current ROM needs to be increased. Here are some Facts, cheerfully provided without citations, so that you can look them up if you want to:
1. Hypermobility is a medical condition – a Pathology, in fact – that often involves defects in the proteins that form the ligaments, the connective tissues that connect the bones to each other at the joints. The problem with being too flexible is that it results in unstable joints, which can assume positions they are not anatomically designed to occupy. A subsequently injured joint is not healthy: it is injured. This is not good. And here you are, trying to become hypermobile.
2. Tendons and ligaments do not “stretch out.” You cannot make them longer, and it would not improve their function if you could. Their function is to transmit force; in the case of tendons, which connect muscles to bones, the force of muscular contraction is transmitted to the bone it’s attached to, thus moving the bone. Tendons are indeed elastic, in that a sudden dynamic load causes a very small temporary change in length and a subsequent rebound, seen typically in the Achilles tendon complex. But during normal muscle contraction, if the tendon stretched excessively not all of the force would move the bone — some would be lost as the tendon changed length. Like a chain, a tendon pulls the bone with all the force of the contracting muscle because it does not stretch during the contraction.
Ligaments behave likewise. They anchor the joint as it moves, so that the bones which articulate at the joint change their relationship only with respect to their angle. This allows the joint to serve as a fulcrum in a system of levers. When ligaments move enough to allow the joint to change from its normal inter-articular arrangement, it is said to be “dislocated.” You’ve heard of that, right? When tendons and ligaments are stretched excessively, they rupture.
Most importantly, you cannot change the length of either a tendon or a ligament with stretching of any type, massage of any type, or therapy of any type. And why would you want to? Tendons and ligaments are force transmission components. They are very very tough, and they cannot be permanently lengthened by non-invasive means. The only connective tissues that you can affect with stretching are the fascias, the thin “silverskin” that covers the muscle bellies. If they become a problem, usually caused by tiny scars called “adhesions” that form between them and their underlying muscle or between adjacent fascias, they can be stretched with the previously-mentioned forms of therapy.
3. Since neither ligaments or tendons are designed to stretch, an increase in flexibility primarily involves the muscles that control the position of the skeletal components they operate. Sometimes, but not that often, the muscles behave in a way that requires you to teach them to lengthen more readily. And the best way to do this is with the aforementioned Full Range of Motion Barbell Exercise. Since full ROM is, by definition, all you need to do, anything beyond that is either a simple waste of time, or a counterproductive waste of time.
4. Stretching does nothing to a.) prevent soreness, b.) alleviate soreness, c.) or improve strength or any other measure of fitness. In fact, the vast majority of the studies done on stretching not only support this summary, but also indicate that stretching prior to either training or performance produces a significant decrease in power production. That’s right: tighter muscles can contract harder and faster, and even you can see the application for this in performance athletics.
The upshot is this: if you are already flexible (okay, “mobile”) enough to operate efficiently within the ROM of your required training and performance movements, you are flexible enough (your “mobility” is sufficient). And you don’t need to stretch. If you want to, go ahead and enjoy yourself, but you are not using your time wisely.
You might have supposed that trust in the medical profession would have risen as medicine became more effective at warding off death and disease, but you would have been mistaken. In fact, precisely the reverse has happened throughout the western world, but particularly in the United States. Half a century ago, nearly three quarters of Americans had confidence in the medical profession qua profession; now only about a third do so.
According to international surveys reported in an article in a recent New England Journal of Medicine, Americans are among the most mistrustful of doctors of any western people. Asked whether, all things considered, doctors in their country could be trusted, 58 percent of Americans answered in the affirmative; by contrast, 83 percent of the Swiss answered positively. Positive answers were returned by 79, 78, and 76 percent of the Danish, Dutch and British respectively. Americans were 24th of 29 nations polled in their trust of doctors. Furthermore, just fewer than half of Americans in the lowest third of the income range thought that doctors in general could be trusted, and younger Americans were also less likely to trust their doctors than older ones.
Curiously enough, though, Americans were among the most satisfied of nations with their last encounter with their doctor. Only the Swiss and Danes were more satisfied than they, and then not by very much (64, 61 and 56 percent respectively). In other countries, then, people were more likely to trust doctors in general than be satisfied by their last visit to the doctor; in America, it was about the same proportion.
What, if anything, does this mean?
One lamentable feature of the contemporary West is the ruthless efficiency of the nanny state. It works overnight. You wake up, slouch over your coffee and corn flakes, and read of the new Bad Thing that must be stopped Right Now. In Britain, the latest activity slated for oblivion is smoking in public parks. Readers, I’m sure, do not need to be reminded that parks are outdoor places; the traditional excuse of “secondhand smoke” does not appear to apply (although it is possible to find “studies” on the dangers of “thirdhand smoke”).
Nevertheless, British officials moved quickly. In September 2013, the mayor of London, alleged conservative Boris Johnson, ordered a “major review of health in the capital,” according to The Independent. The results are already in: Lord Darzi, Britain’s former health minister and the appointed chair of Johnson’s special commission, has said smoking needs to be banned in London’s parks and public squares. There is news that ”councils throughout England are also understood to be analysing how the proposals could be applied locally, paving the way for potentially the biggest crackdown on smoking since the Smoke Free legislation of 2007.”
My PJ colleague Walter Hudson published a compelling argument regarding physician-assisted suicide in response to the ongoing dialogue surrounding terminal cancer patient Brittany Maynard. His is a well-reasoned argument regarding the intersection of theology and politics, written in response to Matt Walsh’s Blaze piece titled “There is Nothing Brave About Suicide.” Both pieces are a reminder that, in the ongoing debate over whether or not Maynard has the right to schedule her own death, little has been said regarding the role the medical profession plays in the battle to “Die with Dignity.” Walsh argues:
None of us get to die on our own terms, because if we did then I’m sure our terms would be a perfect, happy, and healthy life, where pain and death never enter into the picture at all.
It’s a simplistic comment that ignores a very real medical fact: Death can come on your own terms. And that doesn’t have to mean suicide.
My mother was a nurse for 20 years. During that time she worked in a variety of settings, from hospitals, to private practice, to nursing homes. Much like Jennifer Worth, the nurse and author of the Call the Midwife series, my mother practiced at the end of Victorian bedside nursing and the dawn of Medicare. As a result, the abuses she witnessed in the name of insurance claims were grotesque. For instance, if a patient required one teaspoon of medication, an entire bottle would be poured into the sink and charged to that patient’s insurance company. This was just the tip of the iceberg of unethical practices that would become priority in the name of the almighty “billing schedule.”
How informed is informed consent and does it matter much, or as much as medical ethicists say it does? Do doctors have a duty only to make sure that their message is sent, or also a duty to make sure that it is received, and if received that it is retained? The prayer of General Absolution in the Book of Common Prayer refers to those things which we have done and ought not to have done, and those things which we ought to have done and have not done. When it comes to informed consent, there are also those things which patients have heard and ought not to have heard, and those things which they ought to have heard and have not.
This is proven in a recent paper in the British Medical Journal. Patients with stable angina in ten hospitals in the United States were asked what they thought the benefits were of the percutaneous coronary procedures they were about to undergo. The scientific evidence on this matter is more or less universally accepted: such procedures improve angina symptoms but do not increase life expectancy or reduce the rate of heart attacks.
Testicular cancer survivor Thomas Cantley is pushing a giant ball across America to raise awareness for men’s health.
He quit his job and sold his house to push a six-foot ‘testicle’ from Los Angeles to New York City after he was diagnosed with testicular cancer, according to his website.
He’s travelled more than 1,500 miles so far, but the story doesn’t say how much money he’s raised. “Awareness” is a more difficult measure, but there is a giant rolling testicle involved.
Traveling slightly north, we have this potentially related story from Wake Forest:
Researchers at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina, are assessing engineered penises for safety, function and durability. They hope to receive approval from the US Food and Drug Administration and to move to human testing within five years.
Professor Anthony Atala, director of the institute, oversaw the team’s successful engineering of penises for rabbits in 2008. “The rabbit studies were very encouraging,” he said, “but to get approval for humans we need all the safety and quality assurance data, we need to show that the materials aren’t toxic, and we have to spell out the manufacturing process, step by step.”
The penises would be grown using a patient’s own cells to avoid the high risk of immunological rejection after organ transplantation from another individual. Cells taken from the remainder of the patient’s penis would be grown in culture for four to six weeks.
This is great news for men with congenital defects or disfiguring injuries, but I fear what will happen when the porn industry inevitably gets hold of this technology.
Screenwriters are not known for being sticklers for facts. And when it comes to disasters, writes University of Texas Professor David A. McEntire, “many of Hollywood’s portrayals are based on myths and exaggerations….” That’s certainly the case when it comes to disease disaster films. Here are 10 “fun” movies that are of no use whatsoever in terms of helping viewers respond wisely to a pandemic.
10. Panic in the Streets (1950)
“Patient Zero” is carrying the pulmonary version of bubonic plague. A public official (played by Richard Widmark) has 48 hours to find him before the disease spreads throughout the city. Director Elia Kazan delivers a moody, atmospheric, underappreciated film. But if this is how the police, public health officials and reporters will really act during a crisis, well, we’re all doomed.
I didn’t fully appreciate how spiritually free I am as an American woman until I set foot on an El Al plane.
“Do you speak Hebrew?” the fretting woman in front of me asked.
“No, not really.”
“It’s okay, I speak English,” she hurriedly replied, obviously looking for a friendly face. “These Orthodox,” she motioned to the people sitting next to her, “they don’t like sitting next to women.”
“Well, that’s their problem.” My response was pointed, matter-of-fact, American.
She smiled as if a light bulb went off in her head. “You’re right!” Her expression grew cloudy. “But what if I take off my sweater? They won’t like that I expose my shoulders with my tank top.”
Again, I simply replied, “That’s their problem.”
She smiled, empowered. Removing her sweater, she took her seat and stood her ground.
And at that moment I thanked God I was raised in pluralistic America, and realized, oddly enough, that the Holy Land was giving me my first chance to practice the biblical feminism I’ve preached.
Israel is a Western nation in that women have equal rights by law. Israel is also a confluence of religious and ethnic cultural attitudes, not all of which are friendly to women. Two days into our trip to Jerusalem, a family member who also happens to be a retired journalist explained the latest story to hit the nightly news. A man accused of spousal abuse was released to return home. Later that evening, police found his wife had been shot dead. The husband confessed to the murder. Apparently, domestic violence and death is a relatively small but significant problem in Israel. When I asked my former journalist why, he pointed to the influence of Middle Eastern (both Arabic and radical Islamic) patriarchal culture as the primary source.
Yet, even religious Jews in Israel (and around the world), despite their insular nature, are far from immune to sexual abuse. Sex scandals among the Haredim (ultra-Orthodox) show up frequently on the evening news. In this case it’s not the Arab/Muslim influence, but perverted behaviors that arise from rabbinic abuse of biblical teachings. How do you expect a man to relate to a woman sexually when he’s not even allowed to look her in the eye?
We live in the age of acronym. To read a medical journal is sometimes like trying to decipher a code; once, when I was a judge in a competition of medical poetry, I read a poem composed entirely of figures and acronyms:
RTA [road traffic accident]
ETA [expected time of arrival] 13.20 hrs
CGS [Glasgow Coma Scale] 3…
The last line of the poem, inevitably, was:
Sometimes one has the impression that the acronym has been devised before the thing that it is attached to has been decided. In a recent paper in the New England Journal of Medicine, for example, I came across the acronym SWEDEHEART. It stood for the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies. If the web system come before the acronym, however, you could see why the latter was necessary, the former being longer than the average tin-pot dictator’s list of honorific titles.
The paper in which the acronym occurred was yet another in which a common medical practice was shown to be valueless, or very nearly so. It turns out yet again that doctors do things not because they do the patients any good, but because they can do them.
When Hamlet tells Claudius that Polonius, whom he has just killed, is at dinner being eaten rather than eating, Claudius is puzzled. Hamlet explains that the worms are eating Polonius, and Claudius, still puzzled, asks Hamlet what he means by this
Nothing [replied Hamlet] but to show how a king may go a progress through the guts of a beggar.
In other words, we all come to the same end.
I thought of this passage when I read a paper about the death of Richard III in a recent edition of the Lancet. His remains were found recently buried under a car park in Leicester, a dismal provincial town in England, one of many ruined by planned modernization. The car park had once been a priory.
A long historical battle has raged over Richard’s real nature, whether he was hero or villain as per Shakespeare (few people think he might have been something in between the two). Certainly his remains, now more than 500 years old, have not been treated with undue respect: a team of forensic pathologists and archaeologists have examined them minutely for clues as to how he died at the battle of Bosworth Field in 1485.
Apple’s HealthKit — coming this week to iOS 8 for iPhone, iPad, iPod Touch, and next year to Apple Watch — is becoming much more than a simple fitness tracker:
Stanford University Hospital doctors said they are working with Apple to let physicians track blood sugar levels for children with diabetes. Duke University is developing a pilot to track blood pressure, weight and other measurements for patients with cancer or heart disease.
The goal is to improve the accuracy and speed of reporting data, which often is done by phone and fax now. Potentially doctors would be able to warn patients of an impending problem. The pilot programs will be rolled out in the coming weeks.
Apple last week mentioned the trials in a news release announcing the latest version of its operating system for phones and tablets, iOS 8, but this is the first time any details have been made public. Apple declined to comment for this article.
Apple almost never comments. The company’s former PR chief, Katie Cotton, elevated not saying anything to an art form. But that’s another story.
Mu question after reading this story is, just how many sensors are they packing into Apple Watch, and what do they plan to pack into future iterations?
The question is important because public health emergencies allow governments to ignore the usual restrictions or restraints upon their actions. In public health emergencies, governments can override property rights and abrogate all kinds of civil liberties such as freedom of movement. They can .r our goods and tells us where to go and where to stay. They do so only for our own good: health being the highest good, of course.
A recent edition of the New England Journal of Medicine discusses the issue in the context of the declaration of a public health emergency in Massachusetts by the governor of that state, Deval Patrick.
In most people’s minds, no doubt, a public health emergency would be something like the Black Death, the epidemic of plague that wiped out a third of Europe’s population in the fourteenth century. A natural disaster of large proportions might also count, not only because of the death and injury caused directly by the disaster, but by the epidemics which often follow such disasters.
What, then, was the public health emergency that “obliged” Patrick to declare that it existed and that he could and should take uncontrolled administrative measures to halt it?