Tag Archives: film

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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Money-Driven Medicine, the documentary, available on the web

Maggie Mahar announced today (on her Health Beat blog) that the documentary of her book, Money-Driven Medicine , will be available for free on the web for two weeks.
As Mahar says in her post today, the director and field producer “did a brilliant job of finding doctors and patients who tell riveting stories, while simultaneously exposing many of the less-well-known facts about our broken health care system.”
Here’s the website where you can watch it. I tried, and it works fine. You can make the video full screen. Move backwards and forwards. Watch some now and watch more later. The entire film is 80 minutes long.

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Doctors in the trenches speak out – Part three

maggie-mahar-money-driven-medicineHere’s the third and last installment from the documentary Money-Driven Medicine. The topics this time focus on the financial issues of health care: Insurance premiums, competitive hospitals, the control of medicine by profit-driven corporations, the disconnect between money and health. The first and second installments are in previous posts.

Is it possible for opponents and proponents to find common ground here? Are these issues that could unite concerned citizens of various political persuasions? Could we all agree there’s something profoundly wrong with the existing health care system that needs to be addressed?

One of the most disturbing quotations comes near the end of this post: “The end product of all of this mess and confusion in [medical] technological innovation is going to be a system that cannot be sustained, because it will be so expensive that only the extremely well to do, the elite, will have access to it.”
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Doctors in the trenches speak out – Part two

maggie-mahar-money-driven-medicineHere’s a second installment from the documentary Money-Driven Medicine. The producer, Alex Gibney, is an Oscar-winning filmmaker (Enron: The Smartest Guys in the Room). See the previous post for the first installment.

Bill Moyers: “Money-Driven Medicine is one of the strongest documentaries I have seen in years and could not be more timely. The more people who see and talk about it, the more likely we are to get serious and true health care reform.”
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Doctors in the trenches speak out – Part One

maggie-mahar-money-driven-medicine

I grow weary of the politics of health care reform. Powerful interest groups buy the politicians. The need to get re-elected takes precedence over the national interest. Paul Krugman writes: “Actually turning this country around is going to take years of siege warfare against deeply entrenched interests, defending a deeply dysfunctional political system.”

My sympathies may lean towards one side of the health care reform argument, but I find it distressing to see good people on both sides insult, demean, and provoke one another. I know it’s a dog-eat-dog world out there, but does it really have to be? When Rodney King said “Can we all just get along?” did that resonate with us and become unforgettable because it was so naïve?

I don’t think so. I believe, deep down, the vast majority of Americans would prefer a kinder, gentler nation. What we have now is a spectacle with high entertainment value.
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The Sicko files

Wendell Potter, who was once the head of Public Relations at health insurance giant CIGNA, recently testified before Congress on the nefarious practices of the insurance industry. Last Friday he did an extended interview with Bill Moyers. In the video excerpt below, Moyers and Potter discuss the insurance industry’s comprehensive strategy to discredit Michael Moore’s Sicko.
The insurance industry was extremely nervous about the release of Moore’s film. Their trade association prepared a document full of talking points and tactics for lobbyists and insurance industry staffers. The contents were highly confidential, but not any more. Moyers not only obtained a copy, but has posted the complete document online (PDF). It’s as fascinating as one of those secret tobacco industry memos.

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Health Culture Daily Dose #6

In today’s Dose:

Health care reform
(Congressionional Budget Office numbers; Why Maggie Mahar isn’t worried; Kevin MD, Daniel Callahan)

Foodborne illness
(Cookie dough)

Industrialized agriculture
(Food Inc.)

The risk society
(Jodi Picoult novels)

Health care reform

  • A recent Ezra Klein Klein column in the Washington Post discussed the bad news this week from the Congressional Budget Office. Health care reform will cost $1.6 trillion over 10 years, not the $1 trillion the Senate HELP committee was targeting, and that’s with one-third of the uninsured still without coverage.

[H]ealth reform has just gotten harder. The hope that we could expand the current system while holding costs down appears to have been just that: a hope. … The question now becomes whether we want health-care reform that achieves less of what we say the system needs, or more. Doing less would be cruel to those who have laid their hopes upon health reform. But doing more will be very, very hard.

I have always thought that reform would be very hard. I knew that conservatives and lobbyists would fight with every weapon at their disposal–and that they wouldn’t mind distorting the truth, which is what they have done by making a mountain out of CBO’s preliminary mark-up of the Senate’s rough draft. …
The headlines are correct in one sense: reform is not “inevitable.” This is not a Greek Drama where the final Act is written in the stars. As I have said all along, the battle will be fierce, and, in the end it will not be pretty.
Those who have been gouging the system will have to be gored. Imagine a slaughterhouse with gobs of fat and pools of blood on the floor. But the White House understands that the alternative is to pour billions of tax-payer dollars into a $1.6 trillion dollar medical-industrial complex that, too often, provides profits for the industry, but no benefits for patients. This administration is too smart to let that happen.

This is an excellent post, especially if you enjoy getting into the nitty-gritty of the economics and politics of health care reform. I came away from it with a sense that Obama and his White House advisors are on top of this issue and doing a good job. The post is followed by extensive comments.
Maggie Mahar has a first rate mind. I highly recommend her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much and the recent documentary of the book, produced by Alex Gibney (director of Enron: The Smartest Guys in the Room).

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What’s wrong with our food?

food-incA new movie, Food, Inc., will be in theaters starting June 12. The film documents how industrialized agriculture has changed the food we eat and explores the impact of this change on health, food safety, and the environment. In the movie’s trailer (see below), a woman eyeing vegetables in a grocery store says “Sometimes you look at a vegetable and say, well, we can get two hamburgers for the same price.” That about sums up the problem with the American diet, a problem directly related to a decrease in health (diabetes, heart disease) and an increase in weight (the so-called “obesity epidemic”).

Here’s the official description of the film:

In Food, Inc., filmmaker Robert Kenner lifts the veil on our nation’s food industry, exposing the highly mechanized underbelly that has been hidden from the American consumer with the consent of our government’s regulatory agencies, USDA and FDA. Our nation’s food supply is now controlled by a handful of corporations that often put profit ahead of consumer health, the livelihood of the American farmer, the safety of workers and our own environment. We have bigger-breasted chickens, the perfect pork chop, insecticide-resistant soybean seeds, even tomatoes that won’t go bad, but we also have new strains of E. coli–the harmful bacteria that causes illness for an estimated 73,000 Americans annually. We are riddled with widespread obesity, particularly among children, and an epidemic level of diabetes among adults. … Food, Inc. reveals surprising–and often shocking truths–about what we eat, how it’s produced, who we have become as a nation and where we are going from here.

Kenner, the producer/director, and Eric Schlosser, author of Fast Food Nation, started talking about a documentary of Fast Food six or seven years ago. By the time the film was funded, both Kenner and Schlosser were heavily influenced by the ideas of Michael Pollan, author of The Omnivore’s Dilemma and In Defense of Food .

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Gupta vs. Sicko: Are there socially acceptable mistakes?

Among those opposing Obama’s choice of Sanjay Gupta as the next Surgeon General is Adrian Campbell, a Michigan woman who appeared in Michael Moore’s film Sicko. Gupta told his television audience:

In Canada, you can be waiting for a long time. A survey of six industrialized nations found that only Canada was worse than the United States when it came to waiting for a doctor’s appointment for a medical problem.

In the film, Mrs. Campbell takes her daughter to Canada for an ear infection. She feels personally offended by Gupta’s statement. “When Dr. Gupta said that Canada has longer waiting times, I felt like I was being made fun of.”

Michael Moore & Sanjay Gupta on Larry King Live

Michael Moore got some valuable publicity out of this controversy. CNN’s Wolf Blitzer interviewed Moore shortly after Sicko was released. Since the movie was newsworthy, Moore may not have expected an attack. But preceding the interview was a prerecorded “Sicko Reality Check” by Gupta. It was overwhelmingly negative and accused Moore of “fudging the facts.” Moore responded with his characteristic forcefulness. CNN subsequently arranged a debate between Moore and Gupta on Larry King Live. (See Sources below for links to the Blitzer interview and the three segments of the debate.)

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Ich Habe Genug on Thanksgiving

It’s Thanksgiving and I’m feeling ‘Ich habe genug’ (I have enough). I’d like to share some poetry, music, and a film while continuing the ‘death’ theme of my last blog post.

wit
First the film, Wit, starring Emma Thompson and directed by Mike Nichols. It’s the story of Vivian, a woman with ovarian cancer who spends the end of her life in a hospital. Talk about aggressive treatment of the terminally ill. She’s basically a guinea pig for an experimental drug that has no chance of saving her life. The young doctor who oversees her treatment will get a publication out of the case. He’s a resident planning a career in research and has no interest in ever seeing patients again. He’s only there because it’s one of the requirements on the road to becoming an MD

Wit is based on a Pulitzer Prize-winning play. Very minimal. Lots of monologue. Vivian was a professor of English literature and quotes the metaphysical poet John Donne (of “Death be not proud” fame) throughout the film. The contrast between the poetry and the setting is beautifully done. Donne had much to say about death, but he lived in an era when death had a different meaning. Or more precisely, when death had a meaning.

Sounds a bit gloomy, I know, but it’s an excellent film. Watch it with a friend, if you can. It’s very thought provoking. This is exactly the way we don’t want to die. The more we’re aware of what we don’t want, the more we’ll be motivated to change the way things are.

Next, a poem by Jacques Prevert, “Pater Noster.” The poem received some publicity when Meadow Soprano read the first few lines to her Level 1 ICU-docked Dad: “Our father, which art in heaven, stay there. And we shall stay on earth, which is sometimes so pretty.”

Here is the French version. And here’s an English translation.

hospital

Philip Larkin’s poem “The Building” is about a hospital. Here’s the complete poem, and here are the last few lines:

All know they are going to die.
Not yet, perhaps not here, but in the end,
And somewhere like this. That is what it means,
This clean-sliced cliff; a struggle to transcend
The thought of dying, for unless its powers
Outbuild cathedrals nothing contravenes
The coming dark, though crowds each evening try

With wasteful, weak, propitiatory flowers.

I’ve been partial to Larkin ever since I read “This be the verse” at an impressionable age.

And continuing the theme of Genug, here’s the Bach Cantata, “Ich habe genug”.

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Are Americans naive about medicine?

There was a follow-up letter to “The Last Well Person” (see previous post) from a doctor in Spain. He pointed out that the “extinction of well people” was anticipated in the 1920s by the French comedy, Knock, by Jules Romains. Dr. Knock purchased the unprofitable practice of a country physician and proceeded to diagnose everyone in the village with an illness. He prescribed cures commensurate with the patient’s income. (This is really quite considerate compared to the reality of bankruptcy caused by medical costs in the US.)

Just as Dr. Meador used the quotation “A well person is a patient who has not been completely worked up,” Dr. Knock was known to say “The healthy are ill people who are unaware they are ill.” Meador’s response to the letter mentions further explanations for the “The Last Well Person” phenomenon: insurance coverage that requires a specific diagnosis even when there is none, disability insurance, worker’s compensation, Medicare, and television advertisements.
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