James Medlock (@jdcmedlock) | |
Average out-of-pocket spending for a day in the hospital
US: $1,013 Austria: $22 Germany: $11 Sweden: $11 Estonia: $2 Norway: Free Denmark: Free Canada: Free Italy: Free United Kingdom: Free Portugal: Free Spain: Free Israel: Free Iceland: Free Poland: Free |
PHIL 3345. Supporting the philosophical study of bioethics, bio-medical ethics, biotechnology, and the future of life, at Middle Tennessee State University and beyond... "Keep your health, your splendid health. It is better than all the truths under the firmament." William James
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Wednesday, December 18, 2019
A day in the hospital in the USA
Wednesday, December 11, 2019
Terminally Ill at 25 and Fighting Fake News on Vaccines
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the uptake of the HPV vaccine. Then Laura Brennan got involved.
By David Robert Grimes
Dec. 11, 2019
Video by Adam Westbrook
In 2019, measles cases in the U.S. have been on the rise, much of it driven by false claims about the safety of the vaccine.
In the Video Op-Ed above, a cancer researcher, David Robert Grimes, confronts the rising trend of medical misinformation. From herbal remedies for cancer to vaccination horror stories, fake medical news is spreading fast on social media.
The effects can be severe, with anti-vaccination movements partly responsible for the resurgence of measles and other preventable illnesses.
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the number of HPV vaccines administered, given to young girls and boys to prevent cervical cancer. Dr. Grimes tells the story of how, with the help of a remarkable woman named Laura Brennan, they were able to reverse the trend, and what countries like the United States can learn in their fight against medical misinformation.
David Robert Grimes (@drg1985), a cancer researcher and physicist, is author of “The Irrational Ape: Why Flawed Logic Puts Us All at Risk and How Critical Thinking Can Save the World.”
Dec. 11, 2019
In 2019, measles cases in the U.S. have been on the rise, much of it driven by false claims about the safety of the vaccine.
In the Video Op-Ed above, a cancer researcher, David Robert Grimes, confronts the rising trend of medical misinformation. From herbal remedies for cancer to vaccination horror stories, fake medical news is spreading fast on social media.
The effects can be severe, with anti-vaccination movements partly responsible for the resurgence of measles and other preventable illnesses.
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the number of HPV vaccines administered, given to young girls and boys to prevent cervical cancer. Dr. Grimes tells the story of how, with the help of a remarkable woman named Laura Brennan, they were able to reverse the trend, and what countries like the United States can learn in their fight against medical misinformation.
David Robert Grimes (@drg1985), a cancer researcher and physicist, is author of “The Irrational Ape: Why Flawed Logic Puts Us All at Risk and How Critical Thinking Can Save the World.”
Tuesday, December 10, 2019
The difference between ethics and morality
Ethics is a more inclusive matter than morality; it concerns character whereas morality concerns actions. Our actions will mainly of course flow from our character, but the targets of enquiry in ethics (seeking answers to What sort of person shall I be?) and in debates about morality (What is the right thing to do in this case?) are obviously not the same... A.C. Grayling, The History of Philosophy
Monday, December 9, 2019
Notable books
Among the 100 Notable Books of 2019 (as selected by the NYTimes)...
By KATHERINE EBAN.
$28.99. Ecco/HarperCollins.
$28.99. Ecco/HarperCollins.
Nonfiction.
In her stunning exposé, Eban describes an industry rife with corruption and life-threatening misdeeds exacerbated by lax regulation...
By DANIEL OKRENT. $32.00. Scribner.
Nonfiction.
In 1920s America, a mix of nativist sentiment and pseudoscience led to the first major law curtailing immigration. Okrent focuses on eugenics, which argued that letting in people of certain nationalities and races would harm America’s gene pool...
By JULIE YIP-WILLIAMS. $27.00. Random House.
Nonfiction. Memoir.
Written before her death last year from cancer at the age of 42, Yip-Williams’s book is a remarkable woman’s moving exhortation to the living.
==
‘THE UNDYING: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care’ By Anne Boyer (Farrar, Straus & Giroux). Boyer’s extraordinary and furious book is partly a memoir of her illness, diagnosed five years ago; she was 41 when she learned that the lump in her breast was triple-negative cancer, one of the deadliest kinds. But her story, told with searing specificity, is just one narrative thread in a book that reflects on the possibility — or necessity — of finding common cause in individual suffering.
==
‘THE UNDYING: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care’ By Anne Boyer (Farrar, Straus & Giroux). Boyer’s extraordinary and furious book is partly a memoir of her illness, diagnosed five years ago; she was 41 when she learned that the lump in her breast was triple-negative cancer, one of the deadliest kinds. But her story, told with searing specificity, is just one narrative thread in a book that reflects on the possibility — or necessity — of finding common cause in individual suffering.
Sunday, December 8, 2019
George Church
60 Minutes (@60Minutes) | |
“So you went from George’s skin cells, turned those into stem cells, and turned those into brain cells?”
60 Minutes reports on the wild possibilities brought by genetic engineering, tonight. cbsn.ws/34XvxJf |
The weird world of medical billing.
Where the Frauds Are All Legal
Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.
I have been circling around this conclusion for this past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.
My husband, Andrej, flew over his bicycle’s handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.
The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.
I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services... (continues)
Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.
I have been circling around this conclusion for this past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.
My husband, Andrej, flew over his bicycle’s handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.
The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.
I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services... (continues)
Saturday, December 7, 2019
Can Biology Class Reduce Racism?
COLORADO SPRINGS — Biology textbooks used in American high schools do not go near the sensitive question of whether genetics can explain why African-Americans are overrepresented as football players and why a disproportionate number of American scientists are white or Asian.
But in a study starting this month, a group of biology teachers from across the country will address it head-on. They are testing the idea that the science classroom may be the best place to provide a buffer against the unfounded genetic rationales for human difference that often become the basis for racial intolerance.
At a recent training in Colorado, the dozen teachers who had volunteered to participate in the experiment acknowledged the challenges of inserting the combustible topic of race and ancestry into straightforward lessons on the 19th-century pea-breeding experiments of Gregor Mendel and the basic function of the strands of DNA coiled in every cell.
The new approach represents a major deviation from the usual school genetics fare, which devotes little time to the extent of genetic differences across human populations, or how traits in every species are shaped by a complex mix of genes and environment.
It also challenges a prevailing belief among science educators that questions about race are best left to their counterparts in social studies.
The history of today’s racial categories arose long before the field of genetics and have been used to justify all manner of discriminatory policies. Race, a social concept bound up in culture and family, is not a topic of study in modern human population genetics, which typically uses concepts like “ancestry” or “population” to describe geographic genetic groupings.
But that has not stopped many Americans from believing that genes cause racial groups to have distinct skills, traits and abilities. And among some biology teachers, there has been a growing sense that avoiding any direct mention of race in their genetics curriculum may be backfiring.
“I know it’s threatening,” said Brian Donovan, a science education researcher at the nonprofit BSCS Science Learning who is leading the study. “The thing to remember is that kids are already making sense of race and biology, but with no guidance.”
Human population geneticists have long emphasized that racial disparities found in society do not in themselves indicate corresponding genetic differences. A recent paper by leading researchers in the field invokes statistical models to argue that health disparities between black and white Americans are more readily explained by environmental effects such as racism than the DNA they inherited from ancestors... (continues)
But in a study starting this month, a group of biology teachers from across the country will address it head-on. They are testing the idea that the science classroom may be the best place to provide a buffer against the unfounded genetic rationales for human difference that often become the basis for racial intolerance.
At a recent training in Colorado, the dozen teachers who had volunteered to participate in the experiment acknowledged the challenges of inserting the combustible topic of race and ancestry into straightforward lessons on the 19th-century pea-breeding experiments of Gregor Mendel and the basic function of the strands of DNA coiled in every cell.
The new approach represents a major deviation from the usual school genetics fare, which devotes little time to the extent of genetic differences across human populations, or how traits in every species are shaped by a complex mix of genes and environment.
It also challenges a prevailing belief among science educators that questions about race are best left to their counterparts in social studies.
The history of today’s racial categories arose long before the field of genetics and have been used to justify all manner of discriminatory policies. Race, a social concept bound up in culture and family, is not a topic of study in modern human population genetics, which typically uses concepts like “ancestry” or “population” to describe geographic genetic groupings.
But that has not stopped many Americans from believing that genes cause racial groups to have distinct skills, traits and abilities. And among some biology teachers, there has been a growing sense that avoiding any direct mention of race in their genetics curriculum may be backfiring.
“I know it’s threatening,” said Brian Donovan, a science education researcher at the nonprofit BSCS Science Learning who is leading the study. “The thing to remember is that kids are already making sense of race and biology, but with no guidance.”
Human population geneticists have long emphasized that racial disparities found in society do not in themselves indicate corresponding genetic differences. A recent paper by leading researchers in the field invokes statistical models to argue that health disparities between black and white Americans are more readily explained by environmental effects such as racism than the DNA they inherited from ancestors... (continues)
Monday, December 2, 2019
Bioethics, Spring 2020
Returning to MTSU, January 2020-
PHIL 3345,
TTh 4:20-5:45 pm, Peck Hall 305
Supporting the philosophical study of bioethics, biomedical ethics, biotechnology, and the future of life, at Middle Tennessee State University and beyond... "Keep your health, your splendid health. It is better than all the truths under the firmament." William James===
Our anchoring theme: the psychological and social dimensions of medicine and the life sciences from birth to death, with a special emphasis this semester on the “biopolitics” of new and emerging biotechnologies such as assisted reproduction, human genetic modification, and DNA forensics.”
Texts 2020 We’ll begin with these texts:Each student will also choose and report on an additional relevant text, thus enabling us to extend our study of the field by “crowd-sourcing” many more of the crucial issues it raises.
- Bioethics: The Basics (Campbell) ”...the word ‘bioethics’ just means the ethics of life…”
- Beyond Bioethics (Obasogie) “Bioethics’ traditional emphasis on individual interests such as doctor-patient relationships, informed consent, and personal autonomy is minimally helpful in confronting the social and political challenges posed by new human biotechnologies…”
For more info contact phil.oliver@mtsu.edu, or visit http://bioethjpo.blogspot.com/
Wednesday, October 23, 2019
Animals' consciousness
NYT Health (@NYTHealth) | |
Carl Safina has long argued that animals have consciousness and emotional lives. The evidence is piling up. nyti.ms/31GFtnY
|
Monday, October 21, 2019
Don't get sick here
I say a lot in this @NewYorker interview but this is the part on health care. 1/2 pic.twitter.com/oFM9snF08e— rob delaney (@robdelaney) October 21, 2019
Wednesday, September 18, 2019
Friday, August 30, 2019
The Message of Measles (to anti-vaxxers)
As public-health officials confront the largest outbreak in the U.S. in decades, they’ve been fighting as much against dangerous ideas as they have against the disease.
By Nick Paumgarten
August 26, 2019
“People seem to think measles is some happy Norman Rockwell rite of passage,” New York’s health commissioner said.
One day in the early sixties, Saul Zucker, a pediatrician and anesthesiologist in the Bronx, was treating the child of a New York assemblyman named Alexander Chananau. Amid the stethoscoping and reflex-hammering of a routine checkup, the two men got to talking about polio, which was still a threat to the nation’s youth, in spite of the discovery, the previous decade, of a vaccine. At the time, some states had laws requiring the vaccination of schoolchildren, but New York was not one of them. In his office, on the Grand Concourse, Zucker urged Chananau to push such a law, and shortly afterward the assemblyman introduced a bill in the legislature. The proposal encountered resistance, especially from Christian Scientists, whose faith teaches that disease is a state of mind. (The city’s health commissioner opposed the bill as well, writing to Chananau, “We do not like to legislate the things which can be obtained without legislation.”) To mollify the dissenters, Chananau and others added a religious exemption; you could forgo vaccination if it violated the principles of your faith. In 1966, the bill passed, 150–2, making New York the first state to have a vaccination law with a religious exemption. By the beginning of this year, forty-six other states had a version of such a provision; it has proved to be an exploitable lever for people who, for reasons that typically have nothing to do with religion, are opposed to vaccination. They are widely, and disdainfully, known as anti-vaxxers... (continues)
By Nick Paumgarten
August 26, 2019
“People seem to think measles is some happy Norman Rockwell rite of passage,” New York’s health commissioner said.
One day in the early sixties, Saul Zucker, a pediatrician and anesthesiologist in the Bronx, was treating the child of a New York assemblyman named Alexander Chananau. Amid the stethoscoping and reflex-hammering of a routine checkup, the two men got to talking about polio, which was still a threat to the nation’s youth, in spite of the discovery, the previous decade, of a vaccine. At the time, some states had laws requiring the vaccination of schoolchildren, but New York was not one of them. In his office, on the Grand Concourse, Zucker urged Chananau to push such a law, and shortly afterward the assemblyman introduced a bill in the legislature. The proposal encountered resistance, especially from Christian Scientists, whose faith teaches that disease is a state of mind. (The city’s health commissioner opposed the bill as well, writing to Chananau, “We do not like to legislate the things which can be obtained without legislation.”) To mollify the dissenters, Chananau and others added a religious exemption; you could forgo vaccination if it violated the principles of your faith. In 1966, the bill passed, 150–2, making New York the first state to have a vaccination law with a religious exemption. By the beginning of this year, forty-six other states had a version of such a provision; it has proved to be an exploitable lever for people who, for reasons that typically have nothing to do with religion, are opposed to vaccination. They are widely, and disdainfully, known as anti-vaxxers... (continues)
Friday, August 16, 2019
Proactive probiotics
"You should start taking probiotics now, before we discover that they don't make a difference."
NYker
Monday, August 12, 2019
Should Patients Be Allowed to Choose — or Refuse — Doctors by Race or Gender?
By Kwame Anthony Appiah
Aug. 6, 2019
I work for a public medical system, and we have an ethics seminar each month. The last one featured an article by a doctor in one of our hospitals. She discussed patients or their families who insist on having medical providers who are some combination of straight, white, male and/or American-born.
Some seminar participants thought patients should be able to choose such a provider in our system because they can do so in the private care system and because we now encourage them to use the private system if they prefer.
I was shocked that any providers considered it ethical to support patients’ openly making health care decisions based on bias. The point was also made that treatment is often provided in emergency settings where a patient’s life is at stake. Many of our treatment options are aimed at small populations of patients, so there may be only one practitioner available. That practitioner may not be male, straight, white or American-born. Patients cannot receive some types of specialty care outside our system, so they do not have the option of shopping around for all types of medical care. Is it truly ethical for patients to demand that their bigotry dictate who treats them? Name Withheld
Is it ethical for patients to want their bigotry to be accommodated? That’s an easy question: no, because expressing bigotry isn’t ethical. The harder question is whether health care professionals ought to accommodate their bigotry.
Everyone knows that doctors must not discriminate on the basis of gender, sexuality, race, religion or national origin when they select or treat patients: It’s an obligation they accepted when they entered the health care profession. (That doesn’t mean they have to take all comers; they can turn away patients for various other reasons.) But should patients be able to choose clinicians on the basis of such attributes? The answer is: It depends.
In an outpatient setting — in private care, as you note — patients can freely discriminate in choosing whom they want to treat them. That may be unethical as a matter of personal conduct, but we don’t want a system that would try to sift through their motives and correct for invidious ones. We’re in the Zocdoc era — something like Tinder M.D. Patient-consumers, in this context, have the prerogatives enjoyed by suitors to make choices that are biased and boneheaded.
The picture changes when we’re in an institutional setting, one in which patients haven’t chosen their health care practitioner. The picture changes when a man with a swastika tattoo, say, announces that he doesn’t want a black nurse touching his newborn in the neonatal intensive care unit. (That’s a real case, from a hospital in Flint, Mich.) He’s not obliged to choose a particular hospital. But once he has, a hospital that accommodates his request and assigns employees on that basis is effectively instituting his bias.
Your own medical system should be careful not to make that mistake. There are more complicated cases, to be sure. What about a woman who, as a survivor of sexual assault, asks to be seen by a female gynecologist? Here, surely, it would be reasonable to try to accommodate her, not least because the choice doesn’t reflect disrespect for male doctors, as refusing to be touched by an African-American nurse does reflect disrespect for black medical staff. Not every form of discrimination is invidious. It’s perfectly appropriate for a patient who speaks Spanish to ask for a doctor who does, too. It’s a very different thing for patients to reject a doctor because she also speaks Spanish.
For health care professionals who work in hospital systems, incidents of patient bias can be wounding. That’s why hospitals should, when possible, try to accommodate staff members who don’t want to be assigned to patients who display bias toward them. A doctor’s primary concern is the best care of her patients, and we rightly hold physicians to a higher bar than we do patients. But a health care system has to attend, as well, to the welfare of its staff members.
Aug. 6, 2019
I work for a public medical system, and we have an ethics seminar each month. The last one featured an article by a doctor in one of our hospitals. She discussed patients or their families who insist on having medical providers who are some combination of straight, white, male and/or American-born.
Some seminar participants thought patients should be able to choose such a provider in our system because they can do so in the private care system and because we now encourage them to use the private system if they prefer.
I was shocked that any providers considered it ethical to support patients’ openly making health care decisions based on bias. The point was also made that treatment is often provided in emergency settings where a patient’s life is at stake. Many of our treatment options are aimed at small populations of patients, so there may be only one practitioner available. That practitioner may not be male, straight, white or American-born. Patients cannot receive some types of specialty care outside our system, so they do not have the option of shopping around for all types of medical care. Is it truly ethical for patients to demand that their bigotry dictate who treats them? Name Withheld
Is it ethical for patients to want their bigotry to be accommodated? That’s an easy question: no, because expressing bigotry isn’t ethical. The harder question is whether health care professionals ought to accommodate their bigotry.
Everyone knows that doctors must not discriminate on the basis of gender, sexuality, race, religion or national origin when they select or treat patients: It’s an obligation they accepted when they entered the health care profession. (That doesn’t mean they have to take all comers; they can turn away patients for various other reasons.) But should patients be able to choose clinicians on the basis of such attributes? The answer is: It depends.
In an outpatient setting — in private care, as you note — patients can freely discriminate in choosing whom they want to treat them. That may be unethical as a matter of personal conduct, but we don’t want a system that would try to sift through their motives and correct for invidious ones. We’re in the Zocdoc era — something like Tinder M.D. Patient-consumers, in this context, have the prerogatives enjoyed by suitors to make choices that are biased and boneheaded.
The picture changes when we’re in an institutional setting, one in which patients haven’t chosen their health care practitioner. The picture changes when a man with a swastika tattoo, say, announces that he doesn’t want a black nurse touching his newborn in the neonatal intensive care unit. (That’s a real case, from a hospital in Flint, Mich.) He’s not obliged to choose a particular hospital. But once he has, a hospital that accommodates his request and assigns employees on that basis is effectively instituting his bias.
Your own medical system should be careful not to make that mistake. There are more complicated cases, to be sure. What about a woman who, as a survivor of sexual assault, asks to be seen by a female gynecologist? Here, surely, it would be reasonable to try to accommodate her, not least because the choice doesn’t reflect disrespect for male doctors, as refusing to be touched by an African-American nurse does reflect disrespect for black medical staff. Not every form of discrimination is invidious. It’s perfectly appropriate for a patient who speaks Spanish to ask for a doctor who does, too. It’s a very different thing for patients to reject a doctor because she also speaks Spanish.
For health care professionals who work in hospital systems, incidents of patient bias can be wounding. That’s why hospitals should, when possible, try to accommodate staff members who don’t want to be assigned to patients who display bias toward them. A doctor’s primary concern is the best care of her patients, and we rightly hold physicians to a higher bar than we do patients. But a health care system has to attend, as well, to the welfare of its staff members.
Saturday, August 10, 2019
The Surfer’s Secret to Happiness
They don’t seem to regret all that time they don’t spend actually riding waves.By Ellis Avery
Ms. Avery was a writer. She died in February 2019.
Aug. 10, 2019
In 2013, at the age of 41, I decided to make a career change and become a nurse practitioner. At the time, an advanced case of reactive arthritis often left me unable to walk. The entire time that I was taking prerequisite classes, I was in a mobility scooter, a 35-pound dragonfly of a three-wheeler made by a company called TravelScoot. I also needed a large surgical boot on my foot to help me walk.
I rode that mobility scooter in the sun and through the snow, on the bike path by the Hudson River, from my home in the West Village to the Borough of Manhattan Community College downtown. I rode it through the intestinal maze of the New York City subway system, through tunnels that trapped the heat and cold of the previous day’s weather, up and down elevators that trapped the odor of urine, to New York City College of Technology in Brooklyn. I rode it and rode it and rode it, and wondered if I’d ever walk again.
This isn’t the real me, I wanted to tell the world. This time doesn’t count. When I walk again, that’s when I’ll be real.
Amid the misery, I let myself hope. A physician assistant at my primary-care doctor’s office told me about one of her fellow students, a man with cerebral palsy, who had completed the program and graduated while using a wheelchair. In 2016, I was accepted into a community college nursing program, but then told to come back when I didn’t need a boot, which might mean never.
I continued to ride my scooter and to believe that some school, somewhere, would make a place for me. I didn’t see my future self briskly striding through hospital corridors. I just needed to get through school so that one day I could sit behind a desk at a health center or work in an outpatient clinic. There was plenty of nursing work that could be done just as well in a surgical boot as in a shoe. I could write a prescription, give a vaccine, insert an IUD. I could look a patient in the eye and listen.
In July 2017, I was out of the boot and walking again for the first time in years. My spouse and I were thinking about moving to Australia, so I applied to programs there and was admitted to nursing school at the University of Melbourne. After completing my first semester, I decamped to Sydney for a month. There, I lived in an apartment overlooking Bondi Beach, perhaps the most beloved urban surfing destination in the world.
Day after day, I watched the surfers. I daydreamed about taking a surfing lesson, but my hold on walking felt so recent and unlikely, I didn’t chance it. And in other ways, it already felt like I was surfing. I was surfing on the arthritis medication I had starting taking in spring 2016. I was surfing on the steroid shot I’d gotten in April of 2017. I was surfing on the immuno-modulating probiotics with which I was experimenting. Just as if I were a surfer, any little thing could knock me off my board and back into arthritic misery, back into the boot and scooter I had come to know and loathe.
Watching the surfers, I noticed that the time they spent standing on their boards, riding waves — doing what nonsurfers would call surfing — was minimal compared with the time they spent bobbing around in the water next to the board, generally going nowhere. Even the really good surfers spend far more time off the board than on it.
If you added up the seconds that a good surfer actually spent riding the waves, it would amount to only the smallest fraction of an entire life. Yet surfers are surfers all the time. They are surfers while they are working their crap jobs, daydreaming about surfing. They are surfers when they wake up at 4 in the morning. They are surfers when they walk the board down the hill to Bondi Beach. They are surfers when they drink their predawn espressos. They are surfers when they paddle out on their boards. They are surfers when they wait and wait for the right wave. They are surfers when they wipe out, thrashing around blindly in the waves, praying the board doesn’t crack their skulls. They are surfers when they sit by their trucks with their friends after surfing, silently eating their grain-bowl meals.
And the thing about surfers? They don’t seem to regret all that time they don’t spend standing on boards and riding waves. Not only are they surfers all the time, they are, it seems to me, happy all the time.
Could I do that? Could I be happy even when I didn’t know whether I’d be able to walk the next day, or whether I’d be alive a year from now? Could the time I might spend in the humiliating, tedious boot and scooter somehow count as mine? Instead of waiting to be well so I could be myself again, could I be me while sick, too? Could I declare myself a surfer all the time, and seize that happiness?
I thought back to my time in New York, when I was rising at dawn to take courses and intern in doctors’ offices, and struggling both to get around and to relocate the real me: I had seen a new light in the faces of my fellow students and patients, in our shared endeavor to live. The dark mystery of bodily suffering had offered itself to me as a new way to love New York City, and life, all over again. I had accepted it, with joy. Watching the surfers at Bondi Beach, I vowed to do so again when I returned home in the fall, no matter what. nyt
==
Ellis Avery was the author of two novels, a memoir and a book of poetry. She taught fiction writing at Columbia University and the University of California, Berkeley. She died of cancer in February 2019.
Disability is a series of essays, art and opinion by and about people living with disabilities.
Coming soon in print: “About Us: Essays From The New York Times Disability Series,” edited by Peter Catapano and Rosemarie Garland-Thomson, published by Liveright.
Ms. Avery was a writer. She died in February 2019.
Aug. 10, 2019
In 2013, at the age of 41, I decided to make a career change and become a nurse practitioner. At the time, an advanced case of reactive arthritis often left me unable to walk. The entire time that I was taking prerequisite classes, I was in a mobility scooter, a 35-pound dragonfly of a three-wheeler made by a company called TravelScoot. I also needed a large surgical boot on my foot to help me walk.
I rode that mobility scooter in the sun and through the snow, on the bike path by the Hudson River, from my home in the West Village to the Borough of Manhattan Community College downtown. I rode it through the intestinal maze of the New York City subway system, through tunnels that trapped the heat and cold of the previous day’s weather, up and down elevators that trapped the odor of urine, to New York City College of Technology in Brooklyn. I rode it and rode it and rode it, and wondered if I’d ever walk again.
This isn’t the real me, I wanted to tell the world. This time doesn’t count. When I walk again, that’s when I’ll be real.
Amid the misery, I let myself hope. A physician assistant at my primary-care doctor’s office told me about one of her fellow students, a man with cerebral palsy, who had completed the program and graduated while using a wheelchair. In 2016, I was accepted into a community college nursing program, but then told to come back when I didn’t need a boot, which might mean never.
I continued to ride my scooter and to believe that some school, somewhere, would make a place for me. I didn’t see my future self briskly striding through hospital corridors. I just needed to get through school so that one day I could sit behind a desk at a health center or work in an outpatient clinic. There was plenty of nursing work that could be done just as well in a surgical boot as in a shoe. I could write a prescription, give a vaccine, insert an IUD. I could look a patient in the eye and listen.
In July 2017, I was out of the boot and walking again for the first time in years. My spouse and I were thinking about moving to Australia, so I applied to programs there and was admitted to nursing school at the University of Melbourne. After completing my first semester, I decamped to Sydney for a month. There, I lived in an apartment overlooking Bondi Beach, perhaps the most beloved urban surfing destination in the world.
Day after day, I watched the surfers. I daydreamed about taking a surfing lesson, but my hold on walking felt so recent and unlikely, I didn’t chance it. And in other ways, it already felt like I was surfing. I was surfing on the arthritis medication I had starting taking in spring 2016. I was surfing on the steroid shot I’d gotten in April of 2017. I was surfing on the immuno-modulating probiotics with which I was experimenting. Just as if I were a surfer, any little thing could knock me off my board and back into arthritic misery, back into the boot and scooter I had come to know and loathe.
Watching the surfers, I noticed that the time they spent standing on their boards, riding waves — doing what nonsurfers would call surfing — was minimal compared with the time they spent bobbing around in the water next to the board, generally going nowhere. Even the really good surfers spend far more time off the board than on it.
If you added up the seconds that a good surfer actually spent riding the waves, it would amount to only the smallest fraction of an entire life. Yet surfers are surfers all the time. They are surfers while they are working their crap jobs, daydreaming about surfing. They are surfers when they wake up at 4 in the morning. They are surfers when they walk the board down the hill to Bondi Beach. They are surfers when they drink their predawn espressos. They are surfers when they paddle out on their boards. They are surfers when they wait and wait for the right wave. They are surfers when they wipe out, thrashing around blindly in the waves, praying the board doesn’t crack their skulls. They are surfers when they sit by their trucks with their friends after surfing, silently eating their grain-bowl meals.
And the thing about surfers? They don’t seem to regret all that time they don’t spend standing on boards and riding waves. Not only are they surfers all the time, they are, it seems to me, happy all the time.
Could I do that? Could I be happy even when I didn’t know whether I’d be able to walk the next day, or whether I’d be alive a year from now? Could the time I might spend in the humiliating, tedious boot and scooter somehow count as mine? Instead of waiting to be well so I could be myself again, could I be me while sick, too? Could I declare myself a surfer all the time, and seize that happiness?
I thought back to my time in New York, when I was rising at dawn to take courses and intern in doctors’ offices, and struggling both to get around and to relocate the real me: I had seen a new light in the faces of my fellow students and patients, in our shared endeavor to live. The dark mystery of bodily suffering had offered itself to me as a new way to love New York City, and life, all over again. I had accepted it, with joy. Watching the surfers at Bondi Beach, I vowed to do so again when I returned home in the fall, no matter what. nyt
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Ellis Avery was the author of two novels, a memoir and a book of poetry. She taught fiction writing at Columbia University and the University of California, Berkeley. She died of cancer in February 2019.
Disability is a series of essays, art and opinion by and about people living with disabilities.
Coming soon in print: “About Us: Essays From The New York Times Disability Series,” edited by Peter Catapano and Rosemarie Garland-Thomson, published by Liveright.
Monday, July 29, 2019
It’s Not Just a Chemical Imbalance
Thinking of my mental illness as preordained missed many of the causes of — and solutions to — my emotional suffering.
By Kelli María Korducki
The antidepressant Prozac came on the market in 1986; coincidentally, it was the year I was born. By the time I saw my first psychiatrist, as an early-2000s teenager, another half-dozenantidepressants belonging to the same class of drugs, selective serotonin reuptake inhibitors, or S.S.R.I.s, had joined it on the market — and in the public consciousness.
The despondent cartoon blob from a memorable series of TV ads for the S.S.R.I. drug Zoloft became a near-instant piece of pop culture iconography after its May 2001 debut. It was commonplace through much of my childhood to find ads for other S.S.R.I.s tucked into the pages of the women’s magazines I’d leaf through at the salon where my mother had her hair cut, outlining criteria for determining whether Paxil “may be right for you.” In my depressed, anxious, eating disordered adolescence, I knew by name the pills that promised to help me.
The mainstreaming of S.S.R.I.s and other psychopharmaceuticals didn’t eradicate stigmas against mental illness, but it certainly normalized a sense of their prevalence. (A 2003 study concluded that child and adolescent psychotropic prescription rates alone had nearly tripled since the late 1980s.) It also shaped the tone of conversation...
I also make it a daily priority to get at least some light exercise, whether a walk or a jog or a bicycle commute. I maintain a regular yoga practice, try to eat a balanced diet and get enough sleep, read constantly, and work to nurture social connections and build community. All of these, I’ve learned, I can do to maintain my emotional and psychological well-being, and the key word here is “maintain.” It’s about process, not prognosis...
(continues)
By Kelli María Korducki
The antidepressant Prozac came on the market in 1986; coincidentally, it was the year I was born. By the time I saw my first psychiatrist, as an early-2000s teenager, another half-dozenantidepressants belonging to the same class of drugs, selective serotonin reuptake inhibitors, or S.S.R.I.s, had joined it on the market — and in the public consciousness.
The despondent cartoon blob from a memorable series of TV ads for the S.S.R.I. drug Zoloft became a near-instant piece of pop culture iconography after its May 2001 debut. It was commonplace through much of my childhood to find ads for other S.S.R.I.s tucked into the pages of the women’s magazines I’d leaf through at the salon where my mother had her hair cut, outlining criteria for determining whether Paxil “may be right for you.” In my depressed, anxious, eating disordered adolescence, I knew by name the pills that promised to help me.
The mainstreaming of S.S.R.I.s and other psychopharmaceuticals didn’t eradicate stigmas against mental illness, but it certainly normalized a sense of their prevalence. (A 2003 study concluded that child and adolescent psychotropic prescription rates alone had nearly tripled since the late 1980s.) It also shaped the tone of conversation...
I also make it a daily priority to get at least some light exercise, whether a walk or a jog or a bicycle commute. I maintain a regular yoga practice, try to eat a balanced diet and get enough sleep, read constantly, and work to nurture social connections and build community. All of these, I’ve learned, I can do to maintain my emotional and psychological well-being, and the key word here is “maintain.” It’s about process, not prognosis...
(continues)
Wednesday, July 3, 2019
Medical intelligence-Sam Harris & Eric Topol
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Why we need to fight misinformation about vaccines
Ethan Lindenberger never got vaccinated as a kid. So one day, he went on Reddit and asked a simple question: "Where do I go to get vaccinated?" The post went viral, landing Lindenberger in the middle of a heated debate about vaccination and, ultimately, in front of a US Senate committee. Less than a year later, the high school senior reports back on his unexpected time in the spotlight and a new movement he's leading to fight misinformation and advocate for scientific truth.
To start, I want to share with you guys something about my hometown of Norwalk, Ohio. Now, as this video stated, I am from Norwalk, which is an extremely small town, about 15,000 people. And really, in Norwalk, if you want to do something fun, you go to Walmart or drive half an hour to something more interesting. And for Norwalk, I've lived there for my entire life, I'm a senior at the local public high school, and you know, it's something to where I really enjoy my small town. And I'm just a normal kid, you know, I lead debate clubs, I volunteer at my church.
And back in November of 2018, I made a small Reddit post asking for advice on an issue that I was encountering that I needed some clarification on. And this issue, as was stated in the introduction, was something towards vaccinations and how I was not immunized against various diseases, including polio and measles, as well as influenza, HPV, hepatitis -- the standard vaccine someone my age would receive. Now, this question I asked was simple and pretty strange, because, you know, I wanted to get vaccinated. That's kind of weird, but it happened, and then this turned into a public story, because I wanted to get vaccinated. So that was kind of strange, and then it blew up more, and I was doing interviews and talking to more people, and again, I'm a normal kid, I'm not a scientist, I don't lead a non-profit, I am a pretty casual person, I'm wearing a hoodie.
Because of this question and this story, because I wanted to get vaccinated and this interesting situation I was in, I saw that I quickly was in this public setting of an extremely important controversy and discussion taking place. Now, I saw that the stories and headlines were pretty accurate for most part, you know, "After defying anti-vax mom, Ohio teen expresses why he got vaccinated." Pretty accurate, pretty true. And, as stated, I testified in front of a Senate committee, so there, they said, "This teen who self-vaccinated just ripped his mom's anti-vaxer beliefs in front of Congress." OK, I didn't really do that, but that's fine. And certain news outlets took it a little further. "'God knows how I'm still alive': Teenager, 18, finally gets vaccinated and attacks his anti-vax parents."
So I did not attack my parents, that's not accurate at all... (continues)
This talk was presented at an official TED conference, and was featured by our editors on the home page.