Normal docs

Every time I go to the #doctor in #Denmark I'm always shocked at the difference between US #healthcare and EU healthcare in how stressed the doctor looks.

The last three times I went to a doctor in Chicago, every general practitioner I interacted with looked worked to death. Bags under their eyes, too busy to make eye contact with me. Just always typing on the computer and then leaving the room. Truly looked like the worst job on the planet.

Denmark I needed a doctors appointment. My primary doctors office is closed for training, so I got routed to another office. Same day appointment, go in and the doctor looks normal. We have 30 minutes, I use 20 of them, he doesn't seem stressed or worried at all.

I pass by a group of doctors joking in a break room with some coffee and cake. It looks like a normal job. A lot is made of how bad the US system is for patients but you don't realize how horrible it is for doctors until you see doctors allowed to be normal people.

https://c.im/@matdevdug/110428770809815791

“a culture of resistance to change”

"…As my residency progressed, my doubts about my chosen profession only mounted. Time and again, my colleagues and I found ourselves coming into conflict with a culture of resistance to change and innovation. There are some good reasons why medicine is conservative in nature, of course. But at times it seemed as if the whole edifice of modern medicine was so firmly rooted in its traditions that it was unable to change even slightly, even in ways that would potentially save the lives of people for whom we were supposed to be caring. 

By my fifth year, tormented by doubts and frustration, I informed my superiors that I would be leaving that June. My colleagues and mentors thought I was insane; almost nobody leaves residency, certainly not at Hopkins with only two years to go. But there was no dissuading me. Throwing nine years of medical training out the window, or so it seemed, I took a job with McKinsey & Company, the well-known management consulting firm. My wife and I moved across the country to the posh playground of Palo Alto and San Francisco, where I had loved living while at Stanford. It was about as far away from medicine (and Baltimore) as it was possible to get, and I was glad. I felt as if I had wasted a decade of my life. But in the end, this seeming detour ended up reshaping the way I look at medicine—and more importantly, each of my patients…"

— Outlive: The Science and Art of Longevity by Peter Attia MD
https://a.co/0Rr8qnF

Phil.Oliver@mtsu.edu

👣Solvitur ambulando

💭Sapere aude

Degraded personhood

"The Turing test cuts both ways. You can’t tell if a machine has gotten smarter or if you’ve just lowered your own standards of intelligence to such a degree that the machine seems smart. If you can have a conversation with a simulated person presented by an AI program, can you tell how far you’ve let your sense of personhood degrade in order to make the illusion work for you?"

Jaron Lanier, You Are Not a Gadget: A Manifesto [2010]
https://a.co/6Rs2n1i

Dr. Fauci Looks Back: ‘Something Clearly Went Wrong’

In his most extensive interview yet, Anthony Fauci wrestles with the hard lessons of the pandemic — and the decisions that will define his legacy.

It was, perhaps, an impossible job. Make one man the face of public health amid an unprecedented pandemic, in a country as fractious as the United States, and there were bound to be disappointments and frustrations, and they were bound to get personal.

Still, in December, when Elon Musk joked on Twitter that his "pronouns" were "Prosecute/Fauci," it felt like the cresting of a turning tide against the man who had played essentially that role for the first three years of the pandemic. At least 30 state legislatures have passed laws limiting public-health powers in pandemics. This January, the month after Anthony Fauci retired as the four-decade head of the National Institute of Allergy and Infectious Diseases, barely half of Americans said they trusted the country's public-health institutions to manage a future pandemic. The Wall Street Journal named that as his legacy — sowing distrust about public health and vaccines. Earlier in the pandemic, the leftist magazine The Drift mocked Fauci as "Doctor Do-Little," and Representative Matt Gaetz, a Florida Republican, proposed that Fauci had "blood on his hands." Upon the announcement of Fauci's retirement, Gov. Ron DeSantis of Florida, also a Republican, celebrated: "Grab that little elf and chuck him across the Potomac."

Of course, there were mistakes and missteps, including some by Fauci: describing the threat to the country as "minuscule" in February 2020, for instance; or first advising against wearing masks, and moving slowly on aerosol spread; or playing down the risk of what were first called "breakthrough infections" in the summer of 2021. And the broader public-health establishment that Fauci came to embody made other mistakes, too, even if it wasn't always easy to know at the time or identify later who exactly was responsible. Almost certainly, schools stayed closed longer than they needed to. Very conspicuously, American vaccination rates never approached the levels of peer nations — and the problem wasn't just the anti-vaccine right. Quarantine guidance was abruptly shortened in the midst of the Omicron variant, when thresholds of community-spread levels were suddenly redefined as well. There was no effective paid sick leave instituted, and the official end of the pandemic emergency on May 11 imperils the Medicaid coverage of 15 million Americans. But three years on, whether you are focused on Covid's direct carnage or on its collateral damage, it seems irrational to pin the brutality of America's pandemic on policy failures, however much Americans want to put the blame somewhere. Or on someone…

https://www.nytimes.com/interactive/2023/04/24/magazine/dr-fauci-pandemic.html?smid=em-share

The Aftermath of a Pandemic Requires as Much Focus as the Start

We rallied the world to invest in emergency relief. Now we must rally the world to invest in recovery. Atul Gawande

https://www.nytimes.com/2023/03/16/opinion/pandemic-recovery-primary-care.html?smid=nytcore-ios-share&referringSource=articleShare
The Aftermath of a Pandemic Requires as Much Focus as the Start

A bioethics professor weighs in on the Last of Us finale

https://www.vox.com/future-perfect/2023/3/17/23641685/last-of-us-finale-hbo-fireflies-bioethics-joel-ellie-arthur-caplan-pedro-pascal

Henrietta Lacks replaces Robt E Lee

https://mastodon.social/@Sheril/109551240176991160

Anthony Fauci: A Message to the Next Generation of Scientists

… At ‌81, I still can clearly recall the first time I drove onto the bucolic N.I.H. campus in Bethesda, M‌‌d., in June of 1968 as a 27-year-old newly minted physician who had just completed residency training in ‌New York City. My motivation and consuming passion at the time were to become the most highly skilled physician I could‌‌, devoted to delivering the best possible care to ‌my patients. ‌This remains integral to my ‌‌identity, but I did not realize ‌‌how unexpected circumstances would profoundly influence the direction of my career and my life. I would soon learn to expect the unexpected.

I share my story, one of love of science and discovery, in hopes of inspiring the next generation to enter health-related careers — and to stay the course, regardless of challenges and surprises that might arise…

https://www.nytimes.com/2022/12/10/opinion/anthony-fauci-retirement.html?smid=nytcore-ios-share&referringSource=articleShare
Anthony Fauci: A Message to the Next Generation of Scientists

We Can Cure Disease by Editing a Person’s DNA. Why Aren’t We?

But for the next few years, devastating genetic ailments and cancer are where CRISPR clinical trials must remain; ethical considerations over the safety of patients being exposed to new technology dictate that. Today's tools are also the cognate of the first iPod — at the time, an exhilarating advance but still low tech compared with present-day smartphones. Everything we learn about how to gene-edit people from this work, coupled with continued CRISPR innovation in the academic and for-profit sector, will provide a foundation for more deeply understanding how to safely edit DNA to treat and potentially prevent dire common diseases.

The invention of CRISPR gene editing gave us remarkable treatment powers, yet no one should do a victory lap. Scientists can rewrite a person's DNA on demand. But now what? Unless things change dramatically, the millions of people CRISPR could save will never benefit from it. We must, and we can, build a world with CRISPR for all.

https://www.nytimes.com/2022/12/09/opinion/crispr-gene-editing-cures.html?smid=nytcore-ios-share&referringSource=articleShare
We Can Cure Disease by Editing a Person's DNA. Why Aren't We?

Prognosis

https://www.instagram.com/p/CktxD7xh5ws/?igshid=MDJmNzVkMjY=

Much Work Remains

	Johns Hopkins Berman Institute of Bioethics ⁦‪@bermaninstitute‬⁩ We Advised Biden on the Pandemic. Much Work Remains to Face the Next Crisis. By Ezekiel J. Emanuel, David Michaels, Rick Bright and Michael T. Osterholm nytimes.com/2022/10/19/opi…   10/21/22, 2:31 PM

The neglected clitoris

Half the World Has a Clitoris. Why Don't Doctors Study It?
https://www.nytimes.com/2022/10/17/health/clitoris-sex-doctors-surgery.html?smid=nytcore-ios-share&referringSource=articleShare

America Is Choosing to Stay Vulnerable to Pandemics - The Atlantic

Recently, after a week in which 2,789 Americans died of COVID-19, President Joe Biden proclaimed that "the pandemic is over." Anthony Fauci described the controversy around the proclamation as a matter of "semantics," but the facts we are living with can speak for themselves. COVID still killsroughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic "over" is like calling a fight "finished" because your opponent is punching you in the ribs instead of the face...

https://www.theatlantic.com/health/archive/2022/09/covid-pandemic-exposes-americas-failing-systems-future-epidemics/671608/

Scientists Knew More About Covid-19 Than We Think. And They Still Do.

"Nobody," Donald Trump claimed in a March 2020 address, "had any idea." He was talking about the Covid virus — which had, seemingly overnight, sparked a global pandemic. In his compelling and terrifying new book, "Breathless: The Scientific Race to Defeat a Deadly Virus," the veteran science journalist David Quammen demonstrates just how much was known — and expected — by infectious disease scientists long before patrons of the Huanan Seafood Wholesale Market fell ill in December 2019 with a pneumonia-like virus.

"Soothsayer" isn't on Quammen's extensive résumé, but he was among those who had long predicted this kind of catastrophe. In 2012 he provided a field guide to the future, "Spillover," whose subtitle — "Animal Infections and the Next Human Pandemic" — explains exactly what the scientific community had long been expecting.

"This is a book about the science of SARS-CoV-2," he specifies in his new book. "The medical crisis of Covid-19, the heroism of health care workers and other people performing essential services, the unjustly distributed human suffering, and the egregious political malfeasance that made it all worse — those are topics for other books." Instead, he focuses his informed attention on the unsung heroes who dare to wrestle with viruses, those strange entities he calls "the dark angels of evolution." Human beings are part of a sprawling family of interconnected species who can share illness because they all grew up together. It is our common ancestry and related bodily ecology that makes spillover possible between, say, bats and Earth's (currently) dominant mammal.

Covid is, after all, as natural as a wolf cub or David Attenborough, and its thriller-level rate of evolution is part of its danger. "A virus is a parasite, yes," writes Quammen, "a genetic parasite, to be more precise, using the resources of other organisms to replicate its own genome." He demonstrates the sheer weirdness of viruses when he explains how difficult it is to even define them...

https://www.nytimes.com/2022/10/01/books/review/breathless-david-quammen.html?smid=nytcore-ios-share&referringSource=articleShare

Tweet by NPR on Twitter

	NPR ⁦‪@NPR‬⁩ Researchers say diseases that spread between humans and animals, like COVID and monkeypox, will become increasingly commonplace as human expansion into previously uninhabited areas intensify. n.pr/3SlA8xG   9/29/22, 6:06 AM

‘Very Harmful’ Lack of Data Blunts U.S. Response to Outbreaks

'Very Harmful' Lack of Data Blunts U.S. Response to Outbreaks

Major data gaps, the result of decades of underinvestment in public health, have undercut the government response to the coronavirus and now to monkeypox.

https://www.nytimes.com/2022/09/20/us/politics/covid-data-outbreaks.html?smid=nytcore-ios-share&referringSource=articleShare

Her Discovery Changed the World. How Does She Think We Should Use It?

…What about the ethics of all those gene-editing possibilities? That's something you've been talking about for years now, but what would it look like to actually resolve those ethical issues? What is the green light we'd be waiting for that would make us say, "This form of gene editing was not OK yesterday, but it is OK today?" Maybe let's start with, "Where are the ethical boundaries right now for CRISPR technology?" Two come to mind…

3

 But at the same time it could clearly have environmental impacts that might be of concern. That's one aspect. The other is using CRISPR in the human germ line. Meaning making changes in embryos that, if implanted to create a pregnancy, then would create human beings who have edits to their DNA that are not just affecting them but can also be passed on to future generations. Those are two distinct applications, but it's fairly clear why both of those could have profound impacts that could be dangerous. Understanding that, and then thinking about how to proceed as the technology continues to advance, has been incredibly important. Let's take the human-embryo example. Is there a particular event or decision or developments that would suddenly make us say, "Oh, we didn't think it was OK yesterday, but now it seems fine?" No. But it's a complex issue. There would be technical considerations. In other words, even before we ask, "Should we do this?" we have to ask, "Can it be done accurately and safely in a way that creates a change that is desired by the scientist who's doing the work?" Right now that's still not true in human embryos, I would say.

https://www.nytimes.com/interactive/2022/08/15/magazine/jennifer-doudna-crispr-interview.html?smid=nytcore-ios-share&referringSource=articleShare

A huge side benefit of the new climate bill

Air pollution sickens and kills millions every year. Here’s how the new measure will help tackle the problem.

...the law will avert heart attacks, lower emergency room visits of people suffering from respiratory problems and reduce hospital admissions by people with cardiovascular disease...
https://www.nytimes.com/2022/08/12/climate/climate-air-pollution-health.html?smid=em-share

Why Storytelling Is Part of Being a Good Doctor

Doctors are people too.

"…the word 'doctor' comes from the Latin 'to teach.' By writing stories, we as doctors aim to teach others about our patients while learning about ourselves."

https://www.newyorker.com/magazine/2022/07/25/why-storytelling-is-part-of-being-a-good-doctor-all-that-moves-us-jay-wellons

Time for a national public health system

Since the early months of the covid-19 pandemic, it's been clear that the U.S. public health system needs major improvements. Now, a blue-ribbon commission assembled by the Commonwealth Fund has issued a reportwith a rather provocative conclusion: The United States needs a Since the early months of the covid-19 pandemic, it's been clear that the U.S. public health system needs a national public health system.... Leana Wen

https://www.washingtonpost.com/opinions/2022/07/05/is-it-time-national-public-health-system/