Category Archives: Arts & Media

What is healthism? (part two)

Apple and stethoscopeIn part one of this post I explained the most common meaning of healthism (an excessive preoccupation with healthy lifestyles and feeling personally responsible for our health) and described an authoritarian sense of the term. Here I discuss healthism as an appeal to moral sentiments and as a source of anxiety. I also note an unusual definition of the term as the desire to be healthy, which leads me to end with a personal disclaimer.

Moral healthism

The directive to be personally responsible for our health – whether it comes from a government health policy, the medical profession, or an advertisement – is often fraught with unacknowledged moral overtones. People who practice healthy lifestyles (daily exercise, a Mediterranean diet) and dutifully follow prevention guidelines (annual cancer screenings, pharmaceuticals to maintain surrogate endpoints for risk reduction) are overtly or implicitly encouraged to feel morally superior to those who do not. This includes the right to feel superior to those who ‘choose’ to be unhealthy – after all, isn’t smoking a morally indefensible choice? The implication is that those who fail to take responsibility for their health are undeserving of our sympathy or assistance (especially financial).

This quality of healthism – like the anti-authority healthism discussed in part one – is possibly more common in the US than elsewhere. It’s unfortunate but true that in the US there’s a tendency to blame the poor and disadvantaged for not being able to pull themselves up by their bootstraps. There is a decided unwillingness to acknowledge that differences in wealth and social class during childhood have lifelong effects on behavior and health. Read more

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The Dreams of the Founders of Family Medicine

Marcus Welby MD on the phoneLaurence Bauer has been an ardent, longtime advocate of family medicine. Among other things, he is Chief Executive Officer of the Family Medicine Education Consortium, a not-for-profit corporation that encourages and supports collaboration among Family Medicine Residency Programs and Departments of Family Medicine.

Larry and I met thanks to our mutual interest in Marcus Welby, MD. The practice of medicine has changed dramatically since Dr. Welby inspired doctors to become practitioners of family medicine. Yet each time I talk to Larry, I’m reminded of today’s dedicated students and physicians who want to practice comprehensive care with the same concern for the whole person that Welby expressed for his patients. This remains a timeless value of the medical profession, and for Larry, it’s important to keep that value alive in an age of narrow subspecialties and corporate medicine.

Family Medicine as a specialty (a three-year residency after medical school that includes the study of internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and geriatrics) emerged in the late 1960s. Those who initially endorsed family medicine wanted to change the direction of medical culture and influence its future. In the words that follow, Larry addresses those early visionaries. I’d like to thank him for allowing me to share his thoughts.

The Dreams of the Founders of Family Medicine

When poetry strays too far from music, it atrophies. When music strays too far from dance, it atrophies – Ezra Pound

As Family Practice emerged from the field of General Practice, it is important to realize that many in and out of medicine told the founders they would not succeed. The cynics believed that the dominant forces in medicine were too entrenched and there were too many societal forces working against the idea of a generalist renaissance in medicine. “Real” medicine of the future aspired to something more worthy. Real medicine involved care of hospitalized patients and was informed by the scientific and technological advances associated with sub-specialty medicine. Anyone could care for the people “out there”. But the founders dreamed big, bold dreams; they were a determined and visionary group. Read more

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Is a liberal arts education good preparation for being a doctor?

Dr. Joel AngI’ve written before about doctors and the arts. In 1980 the cultural historian G. S. Rousseau, citing the techo-scientific nature of modern medicine, claimed that doctors no longer maintained the rich tradition of physicians as humanists. “Until recently, physicians in Western European countries received broad, liberal educations, read languages and literature, studied the arts, were good musicians and amateur painters; by virtue of their financial privilege and class prominence they interacted with statesmen and high-ranking professionals, and continued in these activities through their careers.”

Contemporary evidence contradicts Rousseau’s claim that physicians are no longer practitioners and connoisseurs of the arts. We may not personally encounter a doctor with her cello or recognize one painting en plein air in the little free time doctors have these days, but doctors write books that ascend the best-seller list, and many more write thoughtful, provocative blog posts. The poetry of doctors is published in medical journals and is available online in modest chapbooks. Nearly every major city throughout the world has an orchestra staffed by the medical profession. And the American Physicians Art Association encourages and assists physicians with art organizations and exhibits.

Is a liberal arts education valuable to physicians?

I have many unanswered questions about doctors as practitioners of the arts. I’d particularly like to know if the long-standing tradition of physicians as humanists has changed over the past half century. Higher education has definitely changed since the mid-20th century. In particular, there’s less emphasis on the value of a liberal arts education. (On this, see the excellent book, Not For Profit: Why Democracy Needs the Humanities, by Martha Nussbaum.) Has this affected physicians, either in their satisfaction with their careers or in their understanding of patients? Read more

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What gets lost in the bureaucratization of medicine

Medical practice as an artIn a recent issue of JAMA, Dr. Michael H. Monroe recalls how medicine has changed in the mere 14 years he’s been practicing. His desk has a drawer on the lower right where – at the start of his practice — he began collecting articles and stories on the medical humanities and the art of medicine. Over time, that drawer has fallen into neglect.

Addressing a mentor who retired shortly after he began his own practice, Dr. Monroe writes: (emphasis added)

A 14-year career of rounding, teaching, and publishing has not the longevity you had at your “retirement,” but it feels like it’s become an increasingly wearying few years. Concerns of coding, billing, documenting, administration, computers, surveys, rules, regulations, and politics have increasingly occupied my mind and space like an intracranial tumor, slowly compressing my right hand drawer. …

Medicine today is science, and business, and law (perhaps not in that order) but not so much art as it seemed to be even when I started. It is a world of statistics, evidence-based medicine, and quality improvement; of increasing things to count, to codify, and to structuralize. I know why we are counting, why it is important, essential even, and we are doing better, say the numbers, and I mark the progress but still can’t shake the feeling that in medicine, things easily counted need to be distrusted. Despite years of study and numbering, after all, we still haven’t settled the role of vitamins, hydrochlorothiazide, mammograms, aspirin, diabetes control, or almost any other topic in medicine including statistical analysis itself. What I have slowly realized and come to reluctantly is how hard it is to prove that anything is true. … Read more

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Why do we feel bad about the way we look?

Laurie Essig’s new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, includes a chapter on how we learn to want cosmetic surgery. She quotes Joan Rivers, from her book Men Are Stupid . . . And They Like Big Boobs: A Woman’s Guide to Beauty Through Plastic Surgery:

My abiding life philosophy is plain: In our appearance-centric society, beauty is a huge factor in everyone’s professional and emotional success—for good or ill, it’s the way things are; accept it or go live under a rock.

Heidi Montag cultural texts promoting cosmetic surgery

Essig comments:

But Rivers is a TV star. TV and movie stars have always utilized the miracles of cosmetic surgery to look good in the two-dimensional spaces they inhabit. How did the rest of us learn to desire a perfectly plastic body? How did ordinary women and men with ordinary lives and ordinary bodies learn that they need plastic? The answer: the plastic ideological complex, a set of cultural texts that are both highly contested and yet tightly on message. It is itself so ubiquitous that it might even be described as hegemonic. In other words, the “need” for cosmetic procedures is impossible to avoid. Through advertising and TV shows, movies and magazines, we learn to want cosmetic intervention in our aging faces and imperfect bodies. This need is now so firmly implanted in our cultural psyche that it has become “common sense” to embrace cosmetic procedures. Why wouldn’t we want to look more beautiful, younger, thinner, more feminine, better? The question is no longer will you have plastic surgery, but when.

Accept plastic beauty or go live under a rock. Rivers isn’t just joking; she’s also doing the serious work of enacting the ideology of plastic, an ideology that we can no longer avoid. Even if we did live under a rock, whenever we crawled out from underneath it, we would be assaulted by images of perfectly plastic beauty on billboards and the sides of buses and on TV and in movies and even the nightly news. And then there are those damn magazine racks, an unavoidable gauntlet of Dos! and Don’ts! that must be passed through each and every time we buy our food.

A conspiracy of capital to make us feel bad

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Never Let Me Go: Exploitation of the young by the old

Movies in which life is all the more precious because the main character has a fatal disease are common Hollywood fare. Love Story and Terms of Endearment come to mind. Jenny (Ali MacGraw), in Love Story, appears to have leukemia. Emma (Debra Winger), in Terms of Endearment, has an incurable cancer.

Never Let Me Go, a novel by Kazuo Ishiguro, has been turned into a film that’s a variation on this theme. The director, Mark Romanek, asserts he was making a love story. In the final scene, the surviving character, Kathy H. (Carey Mulligan), says: “Maybe none of us really understands what we’ve lived through, or feels we’ve had enough time.” Romanek comments: “Since our lives are so short, it makes you change perspective about what’s important.”

The movie trailer (below) has a voice-over that says “Love made them human.” But there’s nothing about the characters that suggests they’re anything less than human. They don’t need a love story for that. The premise of the film is so much more than a character’s brief life and death. (If you haven’t seen the film or read the book, insert spoiler alert here.)

Romanek: “I wasn’t making a sci-fi”

The story takes place in the recent past, but Ishiguro has reimagined a few things. Medical breakthroughs have increased the average lifespan to 100 years, creating a huge demand for body parts that can be transplanted from the young and healthy. A segment of the population – their parentage only vaguely alluded to – has been designated from birth to become organ donors.

The reality of the donors’ lives – the truncated future they face – is revealed only gradually to them (and to the viewer) as they mature from child to adult. The film is so visually and acoustically lush – and the plot so concentrated on the love story – that one can easily fail to register moral repulsion at the premise. That would be a lost opportunity in the face of current organ shortages, rationing (kidneys for the young, not the old), and – more important – the immorality of exploitation.

Never let me go
The donors as children at their boarding school, Hailsham
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What the Internet does to the mind and self

Internet addictionOne of the best things I’ve read on the subject of what the Internet does to our mental processing and social interactions is Adam Gopnik’s The information, How the Internet gets inside us. It was published in The New Yorker and is currently not behind a pay-wall.

Gopnik discusses the work of a number of writers, including the books Cognitive Surplus, Is the Internet Changing the Way You Think?, The Shallows, Hamlet’s BlackBerry, Alone Together, and Too Much to Know. He divides the thinking of these writers into three categories: Never-Better, Better-Never, and Ever-Waser.

The Never-Betters believe that we’re on the brink of a new utopia, where information will be free and democratic, news will be made from the bottom up, love will reign, and cookies will bake themselves. The Better-Nevers think that we would have been better off if the whole thing had never happened, that the world that is coming to an end is superior to the one that is taking its place, and that, at a minimum, books and magazines create private space for minds in ways that twenty-second bursts of information don’t. The Ever-Wasers insist that at any moment in modernity something like this is going on, and that a new way of organizing data and connecting users is always thrilling to some and chilling to others—that something like this is going on is exactly what makes it a modern moment.

Gopnik’s writing is inspired, as in the end of this passage:

[T]he Ever Wasers smile condescendingly at the Better-Nevers and say, “Of course, some new machine is always ruining everything. We’ve all been here before.” But the Better-Nevers can say, in return, “What if the Internet is actually doing it?” The hypochondriac frets about this bump or that suspicious freckle and we laugh—but sooner or later one small bump, one jagged-edge freckle, will be the thing for certain. Worlds really do decline. “Oh, they always say that about the barbarians, but every generation has its barbarians, and every generation assimilates them,” one Roman reassured another when the Vandals were at the gates, and next thing you knew there wasn’t a hot bath or a good book for another thousand years.

I found this next observation insightful. It relates to the offensive behavior so common on the Internet. Read more

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Exploiting vanity for a good cause

[N]ew anti-drug campaign may succeed where others have failed, grabbing teens’ attentions by appealing to their vanity….

“The thinking is that this will give kids a tangible image of what can happen if they get involved in using hard drugs,” [Deputy Bret] King says. “We did want to appeal to their sense of vanity.” …

“It’s less abstract than telling someone they’ll get lung cancer many years down the line. This is something you can actually see right now.”

From drugs to mugs

Photos in the anti-drug campaign are from a new documentary, From Drugs to Mugs.

Before and after photos appear in the following promotional video starting at 6:11 minutes. Read more

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Misc Links 12/31/10

Doctors behaving badlyLessons Learned As ‘Doctors Behaving Badly’ Tour Ends (NPR)
States should not deal with doctors who molest patients by setting an age limit on who they can see. Nor should they require that problem doctors practice in prisons and poor neighborhoods.

Real Life Among the Old Old (NYT)
To believe 90 is the new 50 is a fantasy that fails to distinguish between hope and reasonable expectation

FoodPolitics catches up: USDA’s meat labeling (Food Politics)
Meat producers greatly prefer that you remain ignorant of the amount of fat and calories meat contains

Alcohol industry battles among itself over the issue of nutrition labels (Wash Post)
Alcoholic beverages are one of the few things we consume that don’t have a nutrition label. Manufacturers dispute average serving size Read more

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Wikileaks, nerd supremacy, anarchy, dictatorship, and democracy

The information machineJaron Lanier, author of You Are Not a Gadget: A Manifesto, has written a penetrating essay on the Information Age, using WikiLeaks to illustrate how romantic idealism can go wrong.

It’s a long article, published in The Atlantic. Here are some of the best parts. I hope these excerpts either save you some time or prompt you to read the whole thing. (emphasis added)

A free flow of digital information enables two diametrically opposed patterns: low-commitment anarchy on the one hand and absolute secrecy married to total ambition on the other. …

[P]eople are unable to resist becoming organized according to the digital architectures that connect us. The only way out is to change the architecture. …

The Internet as it is, which supports the abilities of Anonymous and Wikileaks, is an outgrowth of a particular design history which was influenced in equal degrees by 1960s romanticism and cold war paranoia. …

The Internet can and must be redesigned to reflect a more moderate and realistically human-centered philosophy. …

The existing Internet design is centered on creating the illusion of no-cost effort. But there is no such thing. It’s an illusion born of the idylls of youth, and leads to a distorted perception of the nature of responsibility. …

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Misc Links 12/22/10

Machine moves a computer punch-cardThe Hazards of Nerd Supremacy: The Case of WikiLeaks (Atlantic)
Substantial, thought-provoking essay by philosopher of the information age, Jaron Lanier

Secrecy May Be Unnecessary for Placebo Effect (WebMD)
Ted Kaptchuk trial involved 80 IBS patients. “There may be significant benefit to the very performance of medical ritual.”

As China’s obsession with plastic surgery grows, so too do the pitfalls (Wash Post)
The first of a growing number of comments from the Western press on the popularity of cosmetic surgery in China, prompted by the death of Wang Bei

Obesity Increases Risk of Death in Severe Vehicle Crashes, Study Shows (Univ of Buffalo)
21% increased risk of death for moderately obese, 56% for morbidly obese. May need to rethink car design for the obese. The normal and underweight are at higher risk than the slightly overweight.

Increase in SIDS on New Year’s Day (Medscape Today)
33% increase in sudden infant death syndrome. Why? Probably the alcohol

The benefits of thinking about our ancestors (Research Digest Blog)
Thinking about our ancestors boosts performance on intelligence tests. We’re reminded that “humans who are genetically similar to us can successfully overcome a multitude of problems and adversities.” Read more

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Misc Links 12/20/10

DonutsA reversal on carbs (LA Times)
The country’s big low-fat message backfired. The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today.

Mental Health Needs Seen Growing at Colleges (NYT)
70s students saw college counselors for existential crisis: Who am I? “Now they’re bringing in life stories involving extensive trauma, a history of serious mental illness, eating disorders, self-injury, alcohol and other drug use.”

Real Cancer Drug Breakthrough Is Astronomical Prices (Forbes)
Cancer drugs are big business. The much-vaunted revolution in cancer therapy is driven by hype and high prices. Excellent piece,

New Puzzle: Why Fewer are Killed in Car Crashes (WSJ)
42% increase in fatal accidents caused by distracted driving, but total road fatalities down 22% in 2009 compared to 2005. Why? The economy (fewer rush hour accidents), technology (side airbags), more responsible teen driving.

The Bipartisanship Racket (NYT)
No Labels movement is “utterly clueless about why Americans of all labels are angry: the realization that both parties are bought off by special interests who game the system and stack it against the rest of us.”

Kate Middleton’s ‘commoner’ status stirs up Britons’ old class divide (Wash Post)
“I’m not against the middle class as such, but I do query whether she has the background and breeding to be queen one day.” Is this why we left England (or would leave now)? Read more

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Misc Links 12/18/10

The U-bend of lifeThe U-bend of life: Why, beyond middle age, people get happier as they get older (Economist)
Life improves after the stressful middle years. Interesting comments

Can Congress Force You to Be Healthy? (NYT)
A good point or the wrong question? Virginia judge’s ruling could prove irresistible to the Supreme Court

You Gotta Believe: Birthers, truthers, and creationists threaten to take us back to the future (Utne)
One in 20 Americans believes NASA faked the Apollo moon landings. Half the population believes the world was made in six days. Americans take blind faith to disturbing new heights.

Tips on writing from Steven Johnson, ie., an actual successful writer (Oliver Burkeman)
Keep a “slow hunch” file, don’t over-research, cultivate serendipitous connections, set modest goals, and have a glass of wine

Some Measures Of Inequality Are More Equal Than Others (American Scene)
You can grow up in an American home today with a 40-inch flat-screen television and a daily caloric intake so high it’s detrimental to health, but lack access to basic medical and dental care … and leave school functionally illiterate.

Complete list of links

Image: The Economist

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Grey’s Anatomy donates a body to medicine

Grey's Anatomy Meredith Cristina GgeorgeWhile studying anatomy, I once spent a day with a cadaver whose stomach — normally located in the abdomen below the rib cage — had migrated up through the diaphragm and was now located behind the ribs. This was not simply a sliding hiatal hernia, but the rolling kind that occurs only about five percent of the time.

The body belonged to a small Asian woman. Her unusual condition may have been uncomfortable in life, but it had not prevented her from living for a very long time.

I wondered what prompted this woman to donate her complete body for use as a medical cadaver. Perhaps it was her unusual condition. By being a cadaver, she could acquaint thousands of students with the possibility of a rolling hiatal hernia. A description in a textbook is much less memorable than seeing the real thing. Of course with modern imaging technology, one almost doesn’t need to see a real cadaver these days.

I thought of this woman recently while watching an episode of Grey’s Anatomy, an extremely popular TV show that’s more soap opera than medical drama. I watch the show after it’s available on DVD, which is why I’m currently viewing last year’s episodes (season six). This was the season in which the young resident surgeon, George O’Malley (played by T.R. Knight), did not return. Read more

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Once in a lifetime: Marcus Welby and David Bryne

Talking HeadsI can’t resist juxtaposing the end of Dr. Welby’s 1969 speech on general practitioners vs. specialists –

[P]erhaps you’ll remember that one of these after dinner chats was given by a moldy old fig, with overtones of megalomania. And that he almost convinced you to go into general practice. You’ll remember it, and you’ll look at your beautiful wife and your two beautiful cars and your beautiful barbeque pit and for maybe three seconds you’ll be sorry you didn’t take his advice. But then, a beautiful breeze off the ocean will restore you to sanity. And you will have missed a hell of a lot.

— with the Talking Heads song Once in a Lifetime (1980). “You may find yourself behind the wheel of a large automobile. You may find yourself in a beautiful house with a beautiful wife.”

Marcus Welby was not necessarily the inspiration here, of course. Alienation – and the dissatisfaction that comes with a midlife crisis — pervaded the zeitgeist in the seventies.

Whatever happened to alienation, anyway? Perhaps it fell along with the Berlin Wall. Or succumbed to Prozac. Read more

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Marcus Welby vs. the specialists

Marcus Welby MD with young patientIn the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed the group in the past, but tonight they have a general practitioner. After acknowledging this, Welby continues:

Don’t apologize, You’re right. That’s what everyone thinks. Tell me, doctors, are you a specialist or a GP? Or sometimes they say “or just a GP?” But of course we are specialists. And our specialty, like any other, has certain advantages and certain disadvantages. The money is good, but you have to work three times as hard for it. But you people know all about that.

Since you’re about to choose your specialty, you’ve been amassing information about each. Psychiatry, we know, is practiced sitting down. Dermatologists don’t make house calls.

General Practice is performed standing up, sitting down, outdoors, indoors, wherever there’s illness. And that means everywhere. Because, gentlemen, we don’t treat fingers or skin or bones or skulls or lungs. We treat people. Entire human people. … Read more

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We’re all on Prozac now

Doctors with pharma giftsThis entire poem is available online, so I hope JAMA won’t mind if I reproduce it here. The concept might seem simply clever at first, but in fact it’s quite thought provoking.

Side Effects May Include

Now available
over the counter, the phone, or the Internet—
even on the corner—
with or without a subscription.

Clinically proven to
counteract depressed mood,
soothe frazzled nerves,
decrease heart and respiratory rate,
lower the heart from the throat,
warm the heart,
coat the pit in the stomach,
moisten eyes with tears of joy,
motivate individuals to fulfill their potential, and
inspire groups of people to alter the very course of history,
including (but not limited to) putting a man on the moon and
casting off the shackles of racism and political oppression.

Side effects may include
malapropisms,
Freudian slips,
tears of sadness,
things said that can never be taken back,
false hopes,
and, in general, the exact opposite of what’s intended.

So,
talk to your loved one,
your neighbor, your doctor,
to everyone you can, about
Words.

(Words is a registered trademark of Language.)

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The art and science of medicine

Ars longa, vita brevisOne of my posts was featured today on KevinMD, Are physicians today active in the arts?.

While browsing the KevinMD site, I came across a post by “A Country Doctor,” Evidence based medicine at the expense of the art of medicine. My post was on the tradition of doctors as ”humanists” – educated professionals who contribute to the “fine” arts as writers, visual artists, and musicians. There’s a connection, however, between that tradition and the “art” of medicine.

What happens to doctors when the latest scientific methods of clinical decision making — as well as a reimbursement system that determines how medicine is practiced — encourage doctors to be little more than scientific technicians? Will their insight into the humanity and individuality of patients suffer? What happens to the physician’s art of addressing the uniqueness of each patient’s illness?

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Blogging: Time to get over it

The blogging catDr. Lisa Marcucci, a trauma surgeon and Associate Professor of Surgery, recently did an interview with me for her very successful blog Inside Surgery. It was an opportunity for me to think about why I blog, among many other things. I talked much more freely about myself than I ever do on my own blog.

The interview is quite long and will be posted in three parts. Here’s an excerpt from Part 1, where Dr. Marcucci asks about the mission of my blog.

I started blogging because I wanted to understand something that changed medicine and ideas about health in the 1970s. Prior to that time, the policies of the Kennedy and Johnson administrations had assumed the state should be responsible for the health of its citizens. When political and economic thinking became more conservative in the 1970s and 1980s, governments began to promote the idea that individuals were personally responsible for their health and should practice healthy lifestyles.

A large segment of the population – mainly the educated and economically secure – welcomed these ideas. Feeling personally responsible for one’s health and practicing healthy lifestyles gives one the reassuring illusion of control. In particular, it’s a good distraction from the things that are beyond individual control, like salmonella in our peanut butter and the superbug MRSA at the gym.

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The end of privacy

The end of privacyDid you know there’s a Gmail feature – Mail Goggles – that will prompt you to solve simple math problems before you hit send? This “soft paternalism” keeps you from doing something you’d regret later. By default, it’s only active late at night on weekends, “when you’re most likely to need it.” You can adjust the settings, though.

Here’s a long article (at NYT) — by a law professor — that discusses the dangers of oversharing and the “behavioral economics of privacy” — the trade-offs we make, consciously or unconsciously, when we decide to reveal or conceal information. (emphasis added)

[A] challenge that, in big and small ways, is confronting millions of people around the globe: how best to live our lives in a world where the Internet records everything and forgets nothing — where every online photo, status update, Twitter post and blog entry by and about us can be stored forever. …

[T]here was the 16-year-old British girl who was fired from her office job for complaining on Facebook, “I’m so totally bored!!”; there was the 66-year-old Canadian psychotherapist who tried to enter the United States but was turned away at the border — and barred permanently from visiting the country — after a border guard’s Internet search found that the therapist had written an article in a philosophy journal describing his experiments 30 years ago with L.S.D. …

The fact that the Internet never seems to forget is threatening, at an almost existential level, our ability to control our identities; to preserve the option of reinventing ourselves and starting anew; to overcome our checkered pasts.

A collective identity crisis

People change. Not just from youthful indiscretion to mature adult, but – ideally – people continue to discover and pursue new interests throughout a lifetime. (emphasis added) Read more

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Check out this medical blog

I have a post today at the blog KevinMD. Check it out.

Dr. Kevin Pho, a primary care physician in New Hampshire, has one of the most successful and popular health and medicine blogs on the web. MedGadget voted it the Best Medical Blog of 2008 and described it as:

an exemplary blog that features timely news and opinion of the latest in medicine, bringing in one of the most devoted audiences and keeping thousands of curious minds satisfied with smart and funny writing. While working on his own blog, Kevin has consistently promoted the rest of the medical blogosphere as a useful and reliable source for medical knowledge and opinion.

Given all that he does – his medical practice, an extremely active blog, writing for the New York Times/USA Today/CNN.com, TV appearances, social media activity – I think Dr. Pho must have a secret source of energy.

I highly recommend his blog. It deserves all the success it has achieved.

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The physician as humanist

Still life with porcelain bowl and plums Ladislaus Rath BergerI have eaten
the plums
that were in
the icebox

and which
you were probably
saving
for breakfast

Forgive me
they were delicious
so sweet
and so cold

— William Carlos Williams

William Carlos Williams is part of an honorable tradition in the history of medicine — the physician/poet. He followed the example set by previous physician/poets, such as John Keats, Friedrich Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and – since the 19th century – photographers.

Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine had overwhelmingly become a science and not an art, he claimed, the interests and accomplishments of physicians had narrowed. (emphasis added)

In our century nothing has influenced the physician’s profile more profoundly than the loss of his or her identity as the last of the humanists. Until recently, physicians in Western European countries received broad, liberal educations, read languages and literature, studied the arts, were good musicians and amateur painters; by virtue of their financial privilege and class prominence they interacted with statesmen and high-ranking professionals, and continued in these activities through their careers. It was not uncommon, for Victorian and Edwardian doctors, for example, to write prolifically throughout their careers: medical memoirs and auto-biographies, biographies of other doctors, social analyses of their own times, imaginative literature of all types.

In twentieth-century America, the pattern has changed; only the most imaginative physicians can hope for this artistic lifestyle as a consequence of the economic constraints and housekeeping demands placed upon the doctor …. [T]he diminution of ‘humanist’ content in the training of physicians has lent an impression – perhaps falsely so but nevertheless pervasively – that medics are technicians, anything but humanists. As a by-product, it has nurtured a myth (already old by the eighteenth-century Enlightenment) that medicine is predominantly a science rather than an art. Both notions require adjustment if physicians hope to return to their earlier enriched, and probably healthier, role.

Rousseau’s comment on constraints (for “housekeeping demands” substitute “dealing with insurance”) is even more true today, especially for primary care physicians. A liberal education that values the humanist tradition is also in danger. See, for example, Martha Nussbaum’s Not For Profit, where she writes that contemporary education favors profitable, market-driven, career-oriented skills and devalues imagination, creativity, and critical thinking – qualities essential to the art and science of medicine.

But Rousseau’s assessment that physicians lack artistic interests is simply not true. Physicians continue to be prolific in their contributions to the ‘humanist’ tradition, most visibly as writers.

A plethora of physician/writers

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The physician as reader of poetry

Dog looking in windowHere’s another wonderful poem from a recent issue of The Journal of the American Medical Association. It’s also about an animal, but with a different mood and tone.

It’s called “Why My Wife Should Let Me Have a Dog” and the poet is Gary Stein. Only the first 150 words are available to non-subscribers, but one can appreciate the poem even in its truncated version.

Why My Wife Should Let Me Have a Dog

If I had a dog his soft fur would not foliate
the sofa or trigger asthma attacks
in my dear wife, ending with a hospital trip,
an adrenaline shot and those inhaler tubes
littering the house.

His rich brown eyes will convey profound
intelligence and sensitivity to the subtlest
shifts in my mood. Those eyes will never
get infected and fill with viscous yellow pus
we must wipe with Q-Tips and cure with
sticky ointment, awkward for us both.

My dog will lie by my feet while I read
the Sunday Times he fetched from the lawn
and delivered dry from his slobber-free
mouth, and he’ll wait for his walk
until I complete the crossword.

And when we walk he’ll heel until I hurl
a tennis ball. Watch him streak across
the grassy field, catch it on first bounce
and, with gleeful tail, surrender the prize to me
for another . . .

The rest of the poem continues to suggest the narrow line between comforting pleasures and the all-too-easily-imagined darker side of life. The last two stanzas begin “And when I have my heart attack …” and “While waiting for the ambulance ….” The poem concludes:

… this beast …
a gift as perfect as our children who,
when we play tennis, won’t serve as hard
as they can and will blow some shots
to let me think that by some necessary miracle
I’ve survived and will win in the end.

For the complete poem, consult the June 23/30 issue of JAMA, available in almost every public library.

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The physician as poet

SquirrelEach issue of The Journal of the American Medical Association includes a poem, usually written by a physician. I found this one, by Laurie Rosenblatt, MD, especially moving.

There is harm

because there is this innocent animal,
the body;

because a baby’s unguarded gaze,
and the open regard
of animals both hold patience
with the world,
with mineral fact. Impenetrable

consciousness
arising from, locked into flesh. So

the body’s harm

astonishes,
for instance when met in the eyes
of the squirrel, run over, still
alive
beside the road,

eyes near bursting
meeting your own
and holding
something—

   a plea?
Because there is
absence

of words, no telling
what is wanted, what
will help:
the question, “What is right to do?”

if anything,

and a need
to be
out from under this

responsibility,
my god, such need.

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Cultural differences: Emoticons

And what’s the significance of the need to tilt your head to read western QWERTY emoticons, but the eastern ones are looking straight at you? Not what I’d expect culturally. But perhaps the difference here is that the western versions require fewer keystrokes – we’re in more of a hurry.

The Geographic points out that emoticons date back to 1881, when the American magazine Puck published “Typographical Art” for melancholy, indifference, astonishment, and joy. Emotions a bit more subtle than the ubiquitous smiley face, no? Read more

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What musical instruments convey about social class

Here’s an interesting observation on the associations between musical instruments and social class. It’s from Paul Fussell’s Class: A Guide Through the American Status System (emphasis and paragraph breaks added). There seems no place where hierarchical status-orderings aren’t discoverable. Take musical instruments. In a symphony orchestra the customary ranking of sections recognizes the difficulty and… Read more

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Padded bikini bras for seven-year-olds

Source: Fox News A UK clothing chain, popular discount retailer Primark, reacted swiftly to criticism of its padded bikini bras designed for girls as young as seven. The product has been withdrawn, and Primark announced it would donate any profits from the inappropriately sexualizing items to a children’s charity. The bikinis were selling for £4… Read more

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Asbestos, anyone?

I live in a building constructed in the 1950s, with asbestos in the ceilings. As is true for some schools, it’s safer to leave it alone than to disturb it and put all those fibers into the air. Hat tip to a relatively new blog, Medicina – Videos, consejos [advice], material de lectura relacionado a… Read more

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Estranged species

I find these drawings by Jason Whitman, with their accompanying statements, strangely moving. The words are so tender. The animals express their complaints and their wonder about living in a post-modern world. I’ve gotten to a point where I don’t think we should talk anymore. I’ve gotten to point where there is no point. I… Read more

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