Quiz Apr 5

Also see ** below... We'll go over these on Tuesday next week, before beginning final reports.

1. What does Paul Offit find laughable?

2. How much revenue did the rotavirus vaccine and Lipitor generate, respectively?

3. What did a Nashville woman sell for $50?

4. What did Jacobsen v. Massachussetts (1905) uphold?

5. What 20th century political philosopher does Biss's sister mention, in criticizing "Dr.Bob's" counsel of silence?

6. What paradoxical emotional state does Biss say is induced by citizenship in this country?

7. What "cultural obsession of the moment" do some mothers consider a viable substitute for vaccination? OR, what problematic implication of their obsession do some fail to consider?

8. Whose errant article "Deadly Immunity" was retracted, but only in its corrected version?

9. Who said "a scientist is never certain"? OR, Who advocated "negative capability"?

10. What was the bioethicist who said "it's not a matter of if, but when" referring to?

11. Immunologist Polly Matzinger's _____ Model says the immune system is more responsive to entities that do damage than with those that are merely foreign.

12. Who said "we must cultivate our garden," which for Biss implies recognizing immunity as "a garden we tend together"?

DQ:

• Do we have too many childhood vaccines, administered too soon (regardless of however many a child could "theoretically handle")? 110, 113
• Are there any "vaccine profiteers"? 111 Do you agree that medical researchers (as distinct from pharmaceutical companies, or their Boards and stockholders) are not in it for personal profit? 112  Do you think many private practitioners rejected a life of research mainly for personal-financial reasons? What considerations will guide your own medical-vocational choices?
• Are people who want their children to get chicken pox "idiots"? 115
• Should we respect the "conscientious objections" of anti-vaxxers? Does it matter that they "honestly believe" unfounded, unreasonable claims about the hazards of immunization? 119
• We owe the existence of this nation in part to George Washington's campaign of compulsory smallpox  inoculation, but also "owe some of its present character to resistance" to compulsion. 120 Have we achieved a proper balance between individual rights and the common good? Is balance a reasonable goal? Or would you defend tilting one way (individualism) or the other (the "general will")?
•  Is conscience easily confused with any other feeling? 122
• If "the body is such a ready metaphor for the nation," is it best conceived as an independent individual or as part of & dependent on a collective and community?
• "We have sunshine in us!" 132 Should we be more optimistic about our future health prospects?
• Is there anything wrong with understanding immune system as reflecting not only immunology but also environmentalism, alternative health, and New Age msyticism? 133
• "Some prefer to assume health as an identity" 135 and not a fortunate but transient and vulnerable condition. Do you think this attitude leads those who hold it to feel less compassionate towards the sick, or less responsible for participating in behaviors that enhance the health of the whole community? Does it encourage a new and pernicious "social Darwinism"?  137
• What's your response to those who say that AIDS is a punishment for homosexuality, promiscuity, and addiction? 138
• Do you ever feel, when doing research - especially online research - that you've fallen down a rabbit hole? 139 How do you climb out? Is science a wonderland mostly in a good way?
• What's the best way to deal with prevalent misinformation and "sensationalist" misleading headlines that distort science: confront, correct, or ignore? 141 Do you agree that "most published research findings are false"? 142
• Are you optimistic about our "technologies for reproducing information" and our prospects for conquering the "mysterious unknown" of disease?
• Are we still in the same predicament as Defoe's narrator, "left to reckon with improbable theories and pure speculation" and fears of mysterious plague? 148  Was San Francisco c.1989 not that different from London c.1665?
• Can we defuse the "bomb" of antibiotic-resistant bacteria?
• Is Offit's respect for fear of vaccines but not for decisions not to vaccinate coherent? 150
• Does Stoicism seem right for our times? Is "apocalypse" an overstatement? 151 If we're too stoic, will we be vigorous enough in challenging those who do not acknowledge a civic responsibility to participate in measures to secure the entire community's health and safety?
• Is there any rationale for banning gays from giving blood? 157
• Are there "reasons to vaccinate that transcend medicine"? 158
• What does "cultivating our garden" mean to you, in either medical or broader contexts? 162

**Oliver Sacks, Gratitude

1. What does "Mercury" celebrate? What was Sacks' elemental age when he wrote it?

2. Perfect weather sometimes elicited what exclamation from Sacks?

3. What does nunc dimittis mean?

4. Why were Johnson and Boswell angry with David Hume?

5. Of what did Sacks think he was more conscious, at 80?

6. What was the title of Hume's autobiography?

7. What attitude towards life did Sacks come to share with Hume, after receiving his diagnosis?

8. What did Sacks, contrary to Crick, not see as a problem?

9. What did "celestial splendor" make Sacks think about?

10. To what did Sacks turn, in times of stress?

11. What did Sacks intend to do with his "intermission"?

12. What were Sacks' mother's harsh words that made him hate religious bigotry?


DQ

• How do you see yourself at 80? 
• What do you believe to be "the pleasures of old age," and do you think they compensate for its deficiencies? 
• Do we adequately respect and celebrate age and experience in this culture?
• Oliver Sacks is one clear example of someone who embraced and savored the autumn of life, and continued to be alert, active, and productive. Can you suggest others?
• Sacks survived a near-death calamity at age 41, during which he reviewed reasons for gratitude. Could you do that, in such a situation? 
• Do you ever express overt gratitude for life? Or are you more like Samuel Beckett? 7
• Is gratitude for life a more difficult emotion to sustain, if you live in fear of eternal punishment?
• Will it be enough for you to live on in the memories of friends, or in whatever words of yours get preserved (in books or other written archives)?
• What is an appropriate stance for medical care providers with regard to patients' beliefs about life, death, and an afterlife?
• Do you hope to still be fully engaged in creative work (like Crick) when you die, at whatever age? 10
• Have you known old people who took "the long view" and experienced greater "leisure and freedom" in their last years? What can we do to help more old people have that experience?
• Sacks, like Seneca ("On the Shortness of Life") regrets not a lack of time, but time wasted. How can we learn to make better use of our time?
• Will you still pay attention to politics, as your days become numbered? 19
• Is the future in good hands?
• Do you think of sentient existence as a gift, privilege, and adventure? 20
• What will you do with your remaining time, if you receive a terminal diagnosis offering a few relatively healthful months?
• 
  

Oliver Sacks on Gratitude, the Measure of Living, and the Dignity of Dying

“I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

BY MARIA POPOVA

“Living has yet to be generally recognized as one of the arts,” proclaimed a 1924 guide to the art of living. That one of the greatest scientists of our time should be one of our greatest teacher in that art is nothing short of a blessing for which we can only be grateful — and that’s precisely what Oliver Sacks (July 9, 1933–August 30, 2015), a Copernicus of the mind and a Dante of medicine who turned the case study into a poetic form, became over the course of his long and fully lived life.

In his final months, Dr. Sacks reflected on his unusual existential adventure and his courageous dance with death in a series of lyrical New York Times essays, posthumously published in the slim yet enormously enchanting book Gratitude (public library), edited by his friend and assistant of thirty years, Kate Edgar, and his partner, the writer and photographer Bill Hayes... (continues)

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Eula Biss showed us what conscientious maternal care at the beginning of life looks like. Oliver Sacks, documenting his own final days, takes us to the other end of the journey and shows how a good and worthy life may be capped with a good death. It's no surprise that Atul Gawande, author of Being Mortal, has a featured spot on the jacket. Gawande's message was that we all, and perhaps especially health professionals, need to master the art of living and dying well. Instead we still tend to look away, in denial or disregard, all but insuring death without dignity.

Sacks, in this little book and in his long life, exemplified gratitude, humility, empathy, and compassion - qualities that constitute the very core of dignity, that we value most in our caregivers, and that serve us best in our own personal encounters with mortality. Philosophy was said by its classic practitioners to be the art of learning to live and die. The philosophy of medical practice, we might suppose, should in that light be the art and science of exemplifying and facilitating dignified living and dying.

That may sound a bit morbid, but I take from Gratitude the opposite mood, the "I'm glad I'm not dead" celebratory attitude coupled with a profound recognition that a good life eventually finds its nunc dimittis and its timely dismissal. There's no hint here of self-pity, just deep thankfulness for the privilege of having lived. As Richard Dawkins wrote in one of his own most inspired moments, "we are going to die, and that makes us the lucky ones." (YouT)

I've collected a few examples of salutary long lives, but it must be admitted that far too many older people do not come to their end of days with anything like a feeling of deep gratitude. Maybe the best practice for caregivers is to emulate, project, and replicate the example of an Oliver Sacks.
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Sacks made it into my presentation in Kansas.
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A Tribute to Oliver Sacks on Science Friday:

Neurologist, writer, motorcycle racer, weightlifter, swimmer, and enthusiast of ferns, cycads, cephalopods, and minerals—Oliver Sacks was a modern day Renaissance man. He was endlessly curious about the outer world, and the inner world of the brain, and inspired countless patients, readers, colleagues, and friends. Here we celebrate Sacks with recollections from those who knew him, and hear about his life in his own words, too, in archival Science Friday interviews dating back to 1995.
Orrin Devinsky, a professor of neurology at the NYU School of Medicine, was a friend and colleague of Oliver’s for over 25 years. He recalled discovering Oliver’s case histories in medical school:

I was in medical school. I knew I was quite interested in psychiatry and neurology, but also in some other areas. And I’d never read as compelling case histories. I’d never seen a physician write about patients and bring them to life. And to portray them not just as patients, not just as individuals with deficits or problems. But as people. And there was some essence of humanity that I had never tasted before in my life, or certainly in my brief medical career at the time.
He also spoke about Oliver’s gift as a doctor:

Oliver brought two things together that to my view of the history of medicine were really never brought together. One was the very meticulous study of individual patients. And the second was a humanity. And a humility in approaching those patients. So that whereas people 50, 70 and 90 years ago certainly did meticulous case studies, they didn’t have the humanity. And nowadays, certainly in academic medicine, neither case histories nor humanity is a prominent area.
I think hopefully medical education’s trying to get better at allowing physicians to recognize the importance of seeing the person as a whole and getting into their life. But by the same token the reality of modern medicine is that doctors are looking at relative value units of how many patients they’re seeing in a day. And how many studies are they performing or reading. And how many insurance companies are they calling back. And prescription authorizations, and test authorizations. So the ability of Oliver to go to a patient’s home and observe them in their world, to go to their workplace, and observe them in their world, that’s just a foreign animal in today’s medical world.
Robbin Moran, curator of ferns at the New York Botanical Garden, recalled a fern-hunting trip they took to Oaxaca, Mexico–which Oliver later wrote about in Oaxaca Journal:

He was always taking notes about things. And he would have this notebook that fit in his breast pocket, and he had different colored pens, that I guess he would use, like if he was taking notes about Aztec astronomy or something, he would do it in red, and then something else, like ferns, would be in green. He had it kind of color coded. And I remember going up to him and saying “Hi Oliver,” and he looked at me and had like two different color pens sticking out of his mouth, and these colored pens in his pocket and he was writing furiously. And I began to get a sense of what a compulsive writer he was. And he was really fun to talk to, about anything. And I’m really going to miss him.
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Oliver Sacks on YouTube... Sacks on "A Glorious Accident"
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Richard Powers (author of Generosity) wrote about a fictional character loosely modeled on Oliver Sacks in The Echo Maker:

On a winter night on a remote Nebraska road, 27-year-old Mark Schluter flips his truck in a near-fatal accident. His older sister Karin, his only near kin, returns reluctantly to their hometown to nurse Mark back from a traumatic head injury. But when he emerges from a protracted coma, Mark believes that this woman-who looks, acts, and sounds just like his sister-is really

On a winter night on a remote Nebraska road, 27-year-old Mark Schluter flips his truck in a near-fatal accident. His older sister Karin, his only near kin, returns reluctantly to their hometown to nurse Mark back from a traumatic head injury. But when he emerges from a protracted coma, Mark believes that this woman-who looks, acts, and sounds just like his sister-is really an identical impostor. Shattered by her brother's refusal to recognize her, Karin contacts the cognitive neurologist Gerald Weber, famous for his case histories describing the infinitely bizarre worlds of brain disorder. Weber recognizes Mark as a rare case of Capgras Syndrome, a doubling delusion, and eagerly investigates. What he discovers in Mark slowly undermines even his own sense of being. Meanwhile, Mark, armed only with a note left by an anonymous witness, attempts to learn what happened the night of his inexplicable accident. The truth of that evening will change the lives of all three beyond recognition.

Set against the Platte River's massive spring migrations-one of the greatest spectacles in nature-The Echo Maker is a gripping mystery that explores the improvised human self and the even more precarious brain that splits us from and joins us to the rest of creation.

The Echo Maker is the winner of the 2006 National Book Award for Fiction. Goodreads

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Hospitals have learned to manipulate medical codes — often resulting in mind-boggling bills.

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Surviving an illness and then surviving the trauma of a long stay in intensive care.