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anonymous

The Dress Promised Me Something the Doctors Couldn't - The New York Times - 0 views

  • The Dress Promised Me Something the Doctors Couldn’t
  • My obsessive online shopping wasn’t really about the clothes.
  • I said to my friend, “I want you to bury me in this dress,” which I found funny because I thought I was dying. And then I thought it wasn’t funny at all.
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  • Even if the doctors couldn’t pin down what was going on with me, I was so alarmed by my symptoms and the doctors’ gravest guesses that I felt anxious about whether or not I would have a future.
  • What was certain is that I was shrinking. Rapidly, uncontrollably.
  • My clothes hung loose at the waist and sloughed off my shoulders as if they belonged to a stranger, so I bought a stranger’s dress. Kate Spade, $348 retail.
  • I found it for $50 at an online designer consignment store while on hold with the hospital; a nurse was checking on the results of my bone marrow biopsy.
  • Online shopping was the sort of thing one might do if she were on hold with her cable company, not awaiting a possible blood cancer diagnosis.
  • I filled my cart with a cobalt dress, a blush silk blouse, a slinky skirt.
  • On paper, the doctors said, it looked like it could be lymphoma. The symptoms were classic: fever, night sweats, weight loss.
  • A biopsy of my enlarged lymph node showed it to be benign.
  • Two weeks earlier, a doctor had taken a surgical drill to my hip and hollowed out my bones with a syringe fit for a large horse. “Painful” was a deficient descriptor.
  • “I just don’t know what else to do,” my doctor said.
  • I sat still while my insides turned over. A cold sweat crept across my face. I closed my eyes, shook my head and returned to my shopping cart. I was not going to dwell.
  • No — I was going to shop. I was going to shop until I could think of nothing else. I punched in my credit card number and bought the Kate Spade.
  • Then I rushed to my closet, threw open the double doors and began rifling through Target impulse buys and ill-fitting hand-me-down
  • we’ll have to keep looking
  • I couldn’t breathe. I couldn’t do illness anymore. I could only do this.
  • I spun around in it, watching the hem rise and fall. Something about it made me feel less like a haggard patient and more like the kind of woman who went to cocktail parties dripping with perfume and family money.
  • Over the next few months, I made it my mission to build a new wardrobe from scratch. The process demanded every moment of my free time, every spare thought
  • We both knew it was impractical. The clothes were expensive and high maintenance, most of them over-the-top fancy for my modest life in nonprofit communications.
  • But they felt vital. I told myself I was overdue for some frivolity, that I deserved to treat myself.
  • For my next doctor’s appointment, I picked out a Valentino pencil skirt that fit snugly against my new, withered body.
  • I hurled the clothes into boxes and garbage bags. They smelled like the hospital, all burned coffee and antiseptic. I didn’t want them. I didn’t even want to look at them. I wanted silk. I wanted velvet.
  • “Can I see you again in six weeks? We can repeat blood work then and come up with a timeline for scans. Does that sound like an OK plan?”
  • “Just that I live here,” I said, gesturing at my body. “I have to live here.”
  • That night I ran my fingers through my hair, and a clump of blond strands fell loose into my palm. “It’s just stress,” I told my cat. I brushed my hands together, letting my hair fall into the trash, and returned to my shopping list.
  • Each one had lived a life before me. Now I held onto them in the dim light of my bedroom like tangible hope.
  • We’re forced to find hope in what we used to mock: God, the afterlife, miracles, hemp oil. Healing, by any means. Healing, against all odds.
  • After every appointment, after every failed attempt to name my illness, I would prop myself in bed, choose new dresses and think of all the places I would wear them.
  • The clothes promised me something the doctors, as they continue to search for a diagnosis, still can’t: an uncomplicated future. And I promised a future to the clothes.
  • This was their life after life. And they deserved that, didn’t they?
  •  
    This is an extremely moving and well written article. It discusses mental reactions and decisions of a woman facing an unrecognized illness.
Javier E

If We Knew Then What We Know Now About Covid, What Would We Have Done Differently? - WSJ - 0 views

  • For much of 2020, doctors and public-health officials thought the virus was transmitted through droplets emitted from one person’s mouth and touched or inhaled by another person nearby. We were advised to stay at least 6 feet away from each other to avoid the droplets
  • A small cadre of aerosol scientists had a different theory. They suspected that Covid-19 was transmitted not so much by droplets but by smaller infectious aerosol particles that could travel on air currents way farther than 6 feet and linger in the air for hours. Some of the aerosol particles, they believed, were small enough to penetrate the cloth masks widely used at the time.
  • The group had a hard time getting public-health officials to embrace their theory. For one thing, many of them were engineers, not doctors.
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  • “My first and biggest wish is that we had known early that Covid-19 was airborne,”
  • , “Once you’ve realized that, it informs an entirely different strategy for protection.” Masking, ventilation and air cleaning become key, as well as avoiding high-risk encounters with strangers, he says.
  • Instead of washing our produce and wearing hand-sewn cloth masks, we could have made sure to avoid superspreader events and worn more-effective N95 masks or their equivalent. “We could have made more of an effort to develop and distribute N95s to everyone,” says Dr. Volckens. “We could have had an Operation Warp Speed for masks.”
  • We didn’t realize how important clear, straight talk would be to maintaining public trust. If we had, we could have explained the biological nature of a virus and warned that Covid-19 would change in unpredictable ways.  
  • We didn’t know how difficult it would be to get the basic data needed to make good public-health and medical decisions. If we’d had the data, we could have more effectively allocated scarce resources
  • In the face of a pandemic, he says, the public needs an early basic and blunt lesson in virology
  • and mutates, and since we’ve never seen this particular virus before, we will need to take unprecedented actions and we will make mistakes, he says.
  • Since the public wasn’t prepared, “people weren’t able to pivot when the knowledge changed,”
  • By the time the vaccines became available, public trust had been eroded by myriad contradictory messages—about the usefulness of masks, the ways in which the virus could be spread, and whether the virus would have an end date.
  • , the absence of a single, trusted source of clear information meant that many people gave up on trying to stay current or dismissed the different points of advice as partisan and untrustworthy.
  • “The science is really important, but if you don’t get the trust and communication right, it can only take you so far,”
  • people didn’t know whether it was OK to visit elderly relatives or go to a dinner party.
  • Doctors didn’t know what medicines worked. Governors and mayors didn’t have the information they needed to know whether to require masks. School officials lacked the information needed to know whether it was safe to open schools.
  • Had we known that even a mild case of Covid-19 could result in long Covid and other serious chronic health problems, we might have calculated our own personal risk differently and taken more care.
  • just months before the outbreak of the pandemic, the Council of State and Territorial Epidemiologists released a white paper detailing the urgent need to modernize the nation’s public-health system still reliant on manual data collection methods—paper records, phone calls, spreadsheets and faxes.
  • While the U.K. and Israel were collecting and disseminating Covid case data promptly, in the U.S. the CDC couldn’t. It didn’t have a centralized health-data collection system like those countries did, but rather relied on voluntary reporting by underfunded state and local public-health systems and hospitals.
  • doctors and scientists say they had to depend on information from Israel, the U.K. and South Africa to understand the nature of new variants and the effectiveness of treatments and vaccines. They relied heavily on private data collection efforts such as a dashboard at Johns Hopkins University’s Coronavirus Resource Center that tallied cases, deaths and vaccine rates globally.
  • For much of the pandemic, doctors, epidemiologists, and state and local governments had no way to find out in real time how many people were contracting Covid-19, getting hospitalized and dying
  • To solve the data problem, Dr. Ranney says, we need to build a public-health system that can collect and disseminate data and acts like an electrical grid. The power company sees a storm coming and lines up repair crews.
  • If we’d known how damaging lockdowns would be to mental health, physical health and the economy, we could have taken a more strategic approach to closing businesses and keeping people at home.
  • t many doctors say they were crucial at the start of the pandemic to give doctors and hospitals a chance to figure out how to accommodate and treat the avalanche of very sick patients.
  • The measures reduced deaths, according to many studies—but at a steep cost.
  • The lockdowns didn’t have to be so harmful, some scientists say. They could have been more carefully tailored to protect the most vulnerable, such as those in nursing homes and retirement communities, and to minimize widespread disruption.
  • Lockdowns could, during Covid-19 surges, close places such as bars and restaurants where the virus is most likely to spread, while allowing other businesses to stay open with safety precautions like masking and ventilation in place.  
  • The key isn’t to have the lockdowns last a long time, but that they are deployed earlier,
  • If England’s March 23, 2020, lockdown had begun one week earlier, the measure would have nearly halved the estimated 48,600 deaths in the first wave of England’s pandemic
  • If the lockdown had begun a week later, deaths in the same period would have more than doubled
  • It is possible to avoid lockdowns altogether. Taiwan, South Korea and Hong Kong—all countries experienced at handling disease outbreaks such as SARS in 2003 and MERS—avoided lockdowns by widespread masking, tracking the spread of the virus through testing and contact tracing and quarantining infected individuals.
  • With good data, Dr. Ranney says, she could have better managed staffing and taken steps to alleviate the strain on doctors and nurses by arranging child care for them.
  • Early in the pandemic, public-health officials were clear: The people at increased risk for severe Covid-19 illness were older, immunocompromised, had chronic kidney disease, Type 2 diabetes or serious heart conditions
  • t had the unfortunate effect of giving a false sense of security to people who weren’t in those high-risk categories. Once case rates dropped, vaccines became available and fear of the virus wore off, many people let their guard down, ditching masks, spending time in crowded indoor places.
  • it has become clear that even people with mild cases of Covid-19 can develop long-term serious and debilitating diseases. Long Covid, whose symptoms include months of persistent fatigue, shortness of breath, muscle aches and brain fog, hasn’t been the virus’s only nasty surprise
  • In February 2022, a study found that, for at least a year, people who had Covid-19 had a substantially increased risk of heart disease—even people who were younger and had not been hospitalized
  • respiratory conditions.
  • Some scientists now suspect that Covid-19 might be capable of affecting nearly every organ system in the body. It may play a role in the activation of dormant viruses and latent autoimmune conditions people didn’t know they had
  •  A blood test, he says, would tell people if they are at higher risk of long Covid and whether they should have antivirals on hand to take right away should they contract Covid-19.
  • If the risks of long Covid had been known, would people have reacted differently, especially given the confusion over masks and lockdowns and variants? Perhaps. At the least, many people might not have assumed they were out of the woods just because they didn’t have any of the risk factors.
kortanekev

The question doctors fear most: 'Do you believe in God?' | Ranjana Srivastava | Opinion... - 0 views

  • The question doctors fear most: 'Do you believe in God?
  • I thought of telling him politely that religion was immaterial in a secular public hospital.
  •  
    Very interesting duality here between the most-trusted, (mostly) purely scientific people in society - doctors - and the use of religion many patients bring into this field, in a way, bringing seemingly unimportant speculation when compared to the science of doctors. There is a value of both separately, but what do they do together?  (Evie 12/6/16) 
sissij

There Is No Such Thing as Alternative Medicine | Big Think - 1 views

  • Unfortunately for Hahnemann his philosophy—the less of an active ingredient remains the more powerful a remedy is (once you reach 13c on the homeopathic scale there is no longer any active ingredient left)—is nonsense.
  • This does not stop the irrational stream of unproven (or disproven) therapies arising from the holistic and wellness sphere.
  • Distrust in one doctor should not imply blind faith in another.
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  • Yet a growing suspicion of corporate and political interests in the sixties inspired a new wave of holism that’s gaining strength a half-century later. We’re right to be wary of corporate agendas and political mismanagement when it comes to healthcare.
  • The reality is the most basic advice—move often and diversely; eat a balanced, whole foods diet—is boring in an age of immediate gratification.
  • The alternative is suffering, something many companies and hucksters willfully champion at a time when we can all use less of it.
  •  
    People have been searching for more powerful and more efficient medicines. All sorts of weird ideas pop up as people try out different possibilities. Although people believe in science today, they are still willing to try out different things. Alternative medicine is where people like to spend their money on. When it comes to health, people are likely to be superstitious. Many people don't go to the doctors until the last minute. They tends to rely more on their own senses and perception when it comes to their life. I think it's because going to doctor is like trusting another person with your life, which is very hard for people. Seeking for alternative medicine give people a feeling that they can avoid the doctors. Like the medicine of eternity back in time, the alternative medicine today uses the same flaws in our reasoning. --Sissi (2/28/2017)
grayton downing

In Syria, Doctors Risk Life and Juggle Ethics - NYTimes.com - 1 views

  • Majid, who gave only his first name to protect his safety, collected hair and urine samples, clothing, tree leaves, soil and even a dead bird. He shared it with the Syrian American Medical Society, a humanitarian group that had been delivering such samples to American intelligence officials, as proof of possible chemical attacks.
  • United Nations inspectors have taken the first steps to destroy Syria’s chemical stockpile.
  • Many Syrian doctors have fled; those who remain describe dire conditions where even the most basic care is not available.
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  • Mothers are desperate to have their children vaccinated; patients with chronic conditions like heart disease and diabetes struggle to get medicine; and there is “huge anxiety in the population,”
  • On Aug. 21, the group got word from some of its “silent partner” hospitals of a flood of patients with “neurotoxic symptoms” — roughly 3,600 in a period of three hours, including 355 who died.
  • The debate over whether doctors should expose human rights abuses has long been “one of these inside baseball arguments within the humanitarian community,” said Len Rubenstein, an expert on human rights and medical ethics at Johns Hopkins University. While Doctors Without Borders has a culture of “bearing witness,” he said, not all humanitarian organizations do.
  • The International Committee of the Red Cross, for instance, adheres to a strict code of political neutrality;
katherineharron

'Life or death still possible': 31 days at my dad's virtual bedside - CNN - 0 views

  • The attending physician at the intensive care unit had called that morning and asked whether they should include a Do Not Resuscitate order in my dad's chart. They had asked before. I had been indecisive. A successful resuscitation would extend his life. But it might also lead to brain damage.
  • "If it continues in this direction," he told me, "we're talking about a single-digit chance of survival."
  • I suspected that my father had a will and a health care directive inside the house. I put on my mask but couldn't find a clean pair of latex gloves in my duffel bag. It was cold in the backyard. I had a pair of leather gloves. I put those on and entered my childhood home for the first time in weeks. My mother barely registered my presence. She was crying on the couch.
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  • I was relieved -- we wouldn't have to make what felt like an impossible decision -- but then I kept reading. My father had noted that he did not want to be supported by a ventilator or hooked up to a feeding tube for any length of time. He had been connected to both for nearly two weeks.
  • There was grief on her face, but also curiosity. What had finally gotten to her younger son, the one who so rarely showed emotion during his father's hospitalization?
  • I called the hospital and approved the DNR. They told me his status was still dire. I called my dad's closest friends and started preparing them for the worst.
  • My father's lungs showed no signs of progress. The double pneumonia they diagnosed days before was worsening. His kidneys were failing. Dialysis was required but would put a strain on his blood pressure, which was already dangerously low. There was a special form of dialysis designed for delicate situations like this -- continuous veno-venous hemofiltration -- but it wasn't available at Lawrence
  • The morning after I searched for my father's health directive and drafted his obituary, I woke up and tried to turn on my laptop. It wouldn't start. When it eventually booted up, it asked if I wanted to restore an unsaved document. No, I thought, let's see what happens today.
  • It was the same doctor as yesterday, the one who asked about the DNR. "Look, your dad is on a ventilator. That's a form of life support. He's experiencing kidney failure and requires dialysis. His situation is still very acute. He was in good health before the Covid, but his kidney, heart, and lungs are 69 years old. It's tough for them to recover. But the numbers from today are undeniably better than yesterday. There's been an improvement at almost every level. Your dad is a tough guy."
  • One of my close friends, a nurse practitioner, would help me understand all the terminology and its implications. He was treating Covid patients at an ICU upstate. At the end of our calls I'd ask him how he was doing. "We ran out of gowns," he told me one day. "My ICU is out of ventilators -- we're diverting people to Albany," he said another time.
  • "There's a difference between good intentions and good outcomes," I explained to her. She would wave me away and pick up. Inevitably the call would bring her tears. I stewed on the porch. My brother, uncle and I would spend hours trying to ease her mind and pacify her anxiety. Any inquiry or outreach was like sticking a finger in the open wound of her anguish.
  • "He's only improving," I told her, "because of the life-saving care you guys have given him. The whole city is in awe of you. They should have a parade for you down the Canyon of Heroes."
  • The nurses and doctors who took care of my father -- first for four days at NewYork-Presbyterian Lawrence Hospital, then for nearly a month at NewYork-Presbyterian/Columbia -- were always empathetic, straightforward and willing to trust me with complicated details.
  • About a week after writing -- then refusing to recover -- my father's obituary, his condition was continuing to improve.
  • I called my friend, the nurse practitioner, and gave him the latest update. He seemed upset. "You OK, dude?" "A nurse from my hospital died," he explained.
  • I wrote about my dad's volunteer work -- at the Special Olympics, at an organization he founded that helps police families with special needs, and at just about any Italian-American group that needed a lawyer. He was so proud of his Italian-American heritage. He loathed the mafioso caricatures and stereotypes found on TV -- he wrote countless op-eds attacking those -- but he revered the old-school virtues he associated with his Italian-American upbringing: loyalty, humility, hard work, dedication to family.
  • "Yesterday was a stumble, but we're getting back on course," I emailed the group. "We always knew this recovery wasn't going to be a straight line. It's important to remain resilient and optimistic even when there are temporary setbacks."
  • "Oh Lou, I've been waiting for your call. I have such good news. They are planning to extubate him tomorrow. They are going to take your father off the ventilator!" She was practically screaming with excitement. I was speechless.
  • I had been withholding certain information from my family and friends during this whole ordeal. My dad had developed a blood clot two weeks into his hospitalization. Clots are extremely dangerous, of course, but it was small and in a relatively manageable location.
  • I called my brother and told him about the plan to get my father off the ventilator. Since there were a number of contingencies, we debated telling my mother. She was living and dying with every update.
  • My father's breathing was labored on the morning they were planning to extubate. They delayed the procedure a day. That next morning, April 16, a doctor called. I was in the shower and rushed out to answer my cell. He said they were doing the extubation within the hour. What do we want to do if the extubation fails?
  • "It went as well as we could have hoped for," the doctor said. "His vitals are stable and he's breathing well. He's resting now." She explained that my father was disoriented and it probably wasn't a great idea to speak with him that day. Whatever, I thought, I'll speak with him when he gets home. He had been on a ventilator for 28 days.
  • I called the doctor later in the day. She told me my dad seemed distressed. He was trying to speak, but his vocal cords were too swollen. "It's so frustrating," she told me. "I don't know what he wants to tell me."
  • "Each facility has their own Covid rules," she explained. "I'll send you over a list." On the list was the nursing home where my grandfather had died several years before. My father had visited him every day.
  • I called the step-down unit where he had been the past three days. They transferred me to his nurse. "He's doing better, love. We took him off the pressor and his blood pressure is in a good range. His heart rate is good. He's breathing fine. The doctors decided he didn't need to go back to the ICU. He's ok."
  • "I've repeatedly said that recovery isn't a straight line. ... Yesterday we managed the roller coaster ride as a family. My brother, uncle and I were with my mother the entire day. We never lost hope or confidence in my dad's medical care and ultimate recovery. If there's a light at the end of the tunnel, it's a blinking one. Right now, it shines again."
  • I drove back to my mom's house. I scanned the block for my brother's car. He had not arrived. I parked. I have to wait for him and then tell my mother, brother and uncle all at once, right? Should I call my wife first? Should I call my dad's best friend?
  • I called my wife. I called my dad's best friend. I called the guys he grew up with. I called his former colleagues. I began every conversation the same way, "This is that call." I listened to each of them yell and cry and ask if I was serious. Then I said I had to make another call.
  • I wrote about my father's career. How he got his law degree at night school and became a prosecutor at the city, state, and federal level. How he convicted mobsters, drug dealers, and those who abused power.
  • Covid-19 was new and largely unstudied. Maybe one of these seemingly odd treatments would work.
  • He was a Covid patient for 31 days. It was a painful experience, but ultimately unimportant. It doesn't matter how a man dies. It matters how he lives.
Javier E

Lies, Damned Lies, and Medical Science - Magazine - The Atlantic - 0 views

  • How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.
  • even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you
  • studies report average results that typically represent a vast range of individual outcomes.
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  • studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller
  • The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.
  • nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest.
  • Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.
  • Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.
  • The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.
  • even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested
  • even when a research error is outed, it typically persists for years or even decades.
  • much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s
  • Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right
  • His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work
  • while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”
  • “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They’re also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line.
  • What they’re not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.
  • Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding.
  • We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough
  • Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”
Javier E

I Thought I Was Saving Trans Kids. Now I'm Blowing the Whistle. - 0 views

  • Soon after my arrival at the Transgender Center, I was struck by the lack of formal protocols for treatment. The center’s physician co-directors were essentially the sole authority.
  • At first, the patient population was tipped toward what used to be the “traditional” instance of a child with gender dysphoria: a boy, often quite young, who wanted to present as—who wanted to be—a girl. 
  • Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone. 
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  • The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.
  • This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 
  • I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 
  • There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 
  • The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.
  • To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 
  • When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.
  • Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 
  • Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).
  • Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”
  • Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.
  • How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.
  • when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.
  • Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”
  • There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.
  • Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 
  • Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.
  • no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.
  • Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.
  • We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.
  • During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 
  • I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.
  • Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.
  • Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.
  • For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 
  • The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 
  • All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 
Javier E

The new science of death: 'There's something happening in the brain that makes no sense... - 0 views

  • Jimo Borjigin, a professor of neurology at the University of Michigan, had been troubled by the question of what happens to us when we die. She had read about the near-death experiences of certain cardiac-arrest survivors who had undergone extraordinary psychic journeys before being resuscitated. Sometimes, these people reported travelling outside of their bodies towards overwhelming sources of light where they were greeted by dead relatives. Others spoke of coming to a new understanding of their lives, or encountering beings of profound goodness
  • Borjigin didn’t believe the content of those stories was true – she didn’t think the souls of dying people actually travelled to an afterworld – but she suspected something very real was happening in those patients’ brains. In her own laboratory, she had discovered that rats undergo a dramatic storm of many neurotransmitters, including serotonin and dopamine, after their hearts stop and their brains lose oxygen. She wondered if humans’ near-death experiences might spring from a similar phenomenon, and if it was occurring even in people who couldn’t be revived
  • when she looked at the scientific literature, she found little enlightenment. “To die is such an essential part of life,” she told me recently. “But we knew almost nothing about the dying brain.” So she decided to go back and figure out what had happened inside the brains of people who died at the University of Michigan neurointensive care unit.
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  • Since the 1960s, advances in resuscitation had helped to revive thousands of people who might otherwise have died. About 10% or 20% of those people brought with them stories of near-death experiences in which they felt their souls or selves departing from their bodies
  • According to several international surveys and studies, one in 10 people claims to have had a near-death experience involving cardiac arrest, or a similar experience in circumstances where they may have come close to death. That’s roughly 800 million souls worldwide who may have dipped a toe in the afterlife.
  • In the 1970s, a small network of cardiologists, psychiatrists, medical sociologists and social psychologists in North America and Europe began investigating whether near-death experiences proved that dying is not the end of being, and that consciousness can exist independently of the brain. The field of near-death studies was born.
  • in 1975, an American medical student named Raymond Moody published a book called Life After Life.
  • Meanwhile, new technologies and techniques were helping doctors revive more and more people who, in earlier periods of history, would have almost certainly been permanently deceased.
  • “We are now at the point where we have both the tools and the means to scientifically answer the age-old question: What happens when we die?” wrote Sam Parnia, an accomplished resuscitation specialist and one of the world’s leading experts on near-death experiences, in 2006. Parnia himself was devising an international study to test whether patients could have conscious awareness even after they were found clinically dead.
  • Borjigin, together with several colleagues, took the first close look at the record of electrical activity in the brain of Patient One after she was taken off life support. What they discovered – in results reported for the first time last year – was almost entirely unexpected, and has the potential to rewrite our understanding of death.
  • “I believe what we found is only the tip of a vast iceberg,” Borjigin told me. “What’s still beneath the surface is a full account of how dying actually takes place. Because there’s something happening in there, in the brain, that makes no sense.”
  • Over the next 30 years, researchers collected thousands of case reports of people who had had near-death experiences
  • Moody was their most important spokesman; he eventually claimed to have had multiple past lives and built a “psychomanteum” in rural Alabama where people could attempt to summon the spirits of the dead by gazing into a dimly lit mirror.
  • near-death studies was already splitting into several schools of belief, whose tensions continue to this day. One influential camp was made up of spiritualists, some of them evangelical Christians, who were convinced that near-death experiences were genuine sojourns in the land of the dead and divine
  • It is no longer unheard of for people to be revived even six hours after being declared clinically dead. In 2011, Japanese doctors reported the case of a young woman who was found in a forest one morning after an overdose stopped her heart the previous night; using advanced technology to circulate blood and oxygen through her body, the doctors were able to revive her more than six hours later, and she was able to walk out of the hospital after three weeks of care
  • The second, and largest, faction of near-death researchers were the parapsychologists, those interested in phenomena that seemed to undermine the scientific orthodoxy that the mind could not exist independently of the brain. These researchers, who were by and large trained scientists following well established research methods, tended to believe that near-death experiences offered evidence that consciousness could persist after the death of the individua
  • Their aim was to find ways to test their theories of consciousness empirically, and to turn near-death studies into a legitimate scientific endeavour.
  • Finally, there emerged the smallest contingent of near-death researchers, who could be labelled the physicalists. These were scientists, many of whom studied the brain, who were committed to a strictly biological account of near-death experiences. Like dreams, the physicalists argued, near-death experiences might reveal psychological truths, but they did so through hallucinatory fictions that emerged from the workings of the body and the brain.
  • Between 1975, when Moody published Life After Life, and 1984, only 17 articles in the PubMed database of scientific publications mentioned near-death experiences. In the following decade, there were 62. In the most recent 10-year span, there were 221.
  • Today, there is a widespread sense throughout the community of near-death researchers that we are on the verge of great discoveries
  • “We really are in a crucial moment where we have to disentangle consciousness from responsiveness, and maybe question every state that we consider unconscious,”
  • “I think in 50 or 100 years time we will have discovered the entity that is consciousness,” he told me. “It will be taken for granted that it wasn’t produced by the brain, and it doesn’t die when you die.”
  • it is in large part because of a revolution in our ability to resuscitate people who have suffered cardiac arrest
  • In his book, Moody distilled the reports of 150 people who had had intense, life-altering experiences in the moments surrounding a cardiac arrest. Although the reports varied, he found that they often shared one or more common features or themes. The narrative arc of the most detailed of those reports – departing the body and travelling through a long tunnel, having an out-of-body experience, encountering spirits and a being of light, one’s whole life flashing before one’s eyes, and returning to the body from some outer limit – became so canonical that the art critic Robert Hughes could refer to it years later as “the familiar kitsch of near-death experience”.
  • Loss of oxygen to the brain and other organs generally follows within seconds or minutes, although the complete cessation of activity in the heart and brain – which is often called “flatlining” or, in the case of the latter, “brain death” – may not occur for many minutes or even hours.
  • That began to change in 1960, when the combination of mouth-to-mouth ventilation, chest compressions and external defibrillation known as cardiopulmonary resuscitation, or CPR, was formalised. Shortly thereafter, a massive campaign was launched to educate clinicians and the public on CPR’s basic techniques, and soon people were being revived in previously unthinkable, if still modest, numbers.
  • scientists learned that, even in its acute final stages, death is not a point, but a process. After cardiac arrest, blood and oxygen stop circulating through the body, cells begin to break down, and normal electrical activity in the brain gets disrupted. But the organs don’t fail irreversibly right away, and the brain doesn’t necessarily cease functioning altogether. There is often still the possibility of a return to life. In some cases, cell death can be stopped or significantly slowed, the heart can be restarted, and brain function can be restored. In other words, the process of death can be reversed.
  • In a medical setting, “clinical death” is said to occur at the moment the heart stops pumping blood, and the pulse stops. This is widely known as cardiac arrest
  • In 2019, a British woman named Audrey Schoeman who was caught in a snowstorm spent six hours in cardiac arrest before doctors brought her back to life with no evident brain damage.
  • That is a key tenet of the parapsychologists’ arguments: if there is consciousness without brain activity, then consciousness must dwell somewhere beyond the brain
  • Some of the parapsychologists speculate that it is a “non-local” force that pervades the universe, like electromagnetism. This force is received by the brain, but is not generated by it, the way a television receives a broadcast.
  • In order for this argument to hold, something else has to be true: near-death experiences have to happen during death, after the brain shuts down
  • To prove this, parapsychologists point to a number of rare but astounding cases known as “veridical” near-death experiences, in which patients seem to report details from the operating room that they might have known only if they had conscious awareness during the time that they were clinically dead.
  • At the very least, Parnia and his colleagues have written, such phenomena are “inexplicable through current neuroscientific models”. Unfortunately for the parapsychologists, however, none of the reports of post-death awareness holds up to strict scientific scrutiny. “There are many claims of this kind, but in my long decades of research into out-of-body and near-death experiences I never met any convincing evidence that this is true,”
  • In other cases, there’s not enough evidence to prove that the experiences reported by cardiac arrest survivors happened when their brains were shut down, as opposed to in the period before or after they supposedly “flatlined”. “So far, there is no sufficiently rigorous, convincing empirical evidence that people can observe their surroundings during a near-death experience,”
  • The parapsychologists tend to push back by arguing that even if each of the cases of veridical near-death experiences leaves room for scientific doubt, surely the accumulation of dozens of these reports must count for something. But that argument can be turned on its head: if there are so many genuine instances of consciousness surviving death, then why should it have so far proven impossible to catch one empirically?
  • The spiritualists and parapsychologists are right to insist that something deeply weird is happening to people when they die, but they are wrong to assume it is happening in the next life rather than this one. At least, that is the implication of what Jimo Borjigin found when she investigated the case of Patient One.
  • Given the levels of activity and connectivity in particular regions of her dying brain, Borjigin believes it’s likely that Patient One had a profound near-death experience with many of its major features: out-of-body sensations, visions of light, feelings of joy or serenity, and moral re-evaluations of one’s life. Of course,
  • “As she died, Patient One’s brain was functioning in a kind of hyperdrive,” Borjigin told me. For about two minutes after her oxygen was cut off, there was an intense synchronisation of her brain waves, a state associated with many cognitive functions, including heightened attention and memory. The synchronisation dampened for about 18 seconds, then intensified again for more than four minutes. It faded for a minute, then came back for a third time.
  • n those same periods of dying, different parts of Patient One’s brain were suddenly in close communication with each other. The most intense connections started immediately after her oxygen stopped, and lasted for nearly four minutes. There was another burst of connectivity more than five minutes and 20 seconds after she was taken off life support. In particular, areas of her brain associated with processing conscious experience – areas that are active when we move through the waking world, and when we have vivid dreams – were communicating with those involved in memory formation. So were parts of the brain associated with empathy. Even as she slipped irre
  • something that looked astonishingly like life was taking place over several minutes in Patient One’s brain.
  • Although a few earlier instances of brain waves had been reported in dying human brains, nothing as detailed and complex as what occurred in Patient One had ever been detected.
  • In the moments after Patient One was taken off oxygen, there was a surge of activity in her dying brain. Areas that had been nearly silent while she was on life support suddenly thrummed with high-frequency electrical signals called gamma waves. In particular, the parts of the brain that scientists consider a “hot zone” for consciousness became dramatically alive. In one section, the signals remained detectable for more than six minutes. In another, they were 11 to 12 times higher than they had been before Patient One’s ventilator was removed.
  • “The brain, contrary to everybody’s belief, is actually super active during cardiac arrest,” Borjigin said. Death may be far more alive than we ever thought possible.
  • “The brain is so resilient, the heart is so resilient, that it takes years of abuse to kill them,” she pointed out. “Why then, without oxygen, can a perfectly healthy person die within 30 minutes, irreversibly?”
  • Evidence is already emerging that even total brain death may someday be reversible. In 2019, scientists at Yale University harvested the brains of pigs that had been decapitated in a commercial slaughterhouse four hours earlier. Then they perfused the brains for six hours with a special cocktail of drugs and synthetic blood. Astoundingly, some of the cells in the brains began to show metabolic activity again, and some of the synapses even began firing.
Javier E

Experts Want More Studies of Diet's Role for the Heart - NYTimes.com - 0 views

  • when it comes to diet and heart disease, doctors — and patients — have been going on hunches.
  • Dr. Estruch said he and his colleagues were so buoyed by the success of their study that they were planning another one. They intend to randomly assign people to consume the Mediterranean diet or to exercise while following a similar diet that is lower in calories. The hope is that adding weight loss and exercise will prevent even more heart disease.
  • for now, chaos reigns. The public is bombarded with diet advice, often contradictory and often lacking a rigorous scientific grounding, medical experts said.
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  • “Diets are an extreme case of accepting evidence we want to believe,”
  • That includes doctors, he added, who overlook that the evidence for the low-fat diets they often recommend is the sort “we would never accept in the practice of medicine.”
  • Doctors are in a bind, said Dr. Daniel J. Rader, a heart disease specialist at the University of Pennsylvania. When patients ask what to eat, he said, “you have to give them something.”
  • the best they have are studies that look at intermediate markers of risk, like cholesterol levels. In the end, he said, “most doctors just give dietary platitudes.”
Emily Freilich

The Danger of Telling Poor Kids That College Is the Key to Social Mobility - Andrew Sim... - 1 views

  • She’d been promised that good grades and a ticket to a good college would lead to a good job, one that would guarantee her financial independence and enable her to give back to those hard-working people who had placed their faith in her.
  • When administrators, counselors, and teachers repeat again and again that a college degree will alleviate economic hardship, they don’t mean to suggest that there is no other point to higher education.
  • educators risk distracting them from the others, emphasizing the value of the fruits of their academic labor and skipping past the importance of the labor itself. The message is that intellectual curiosity plays second fiddle to financial security.
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  • My students are understandably preoccupied with money. They don’t have the privilege to not worry about it.
  • . The irony, though, is that many of these students aspire to go to a liberal-arts school but don’t necessarily understand its significance.
  • While the vagueness stems from the lack of models in their communities, it also comes from the lack of imagination with which mentors have addressed their professed college plans. Students hear that being a doctor is great because doctors can make money, enjoy respect, and have a great life. They don’t hear that being a doctor is great because doctors possess the expertise to do great things.
  • schools teaching the children of affluent families prepared those kids to take on leadership roles and nurtured their capacity for confident self-expression and argument.
  • Schools teaching children from low-income families focused on keeping students busy and managing behavior
  • School can either perpetuate inequity through social reproduction or have a transformative effect and help students transcend it.
  • College should be “sold” to all students as an opportunity to experience an intellectual awakening. All students should learn that privilege is connected to the pursuit of passions.
  • People are privileged to follow their hearts in life, to spend their time crafting an identity instead of simply surviving
grayton downing

In Syria, Doctors Risk Life and Juggle Ethics - NYTimes.com - 1 views

  • “Doctors are notoriously poor evaluators of chemical warfare injuries if they have never seen them before,”
  • Those reports, he said, were later “cynically manipulated” by American intelligence officials to assert that Iran — not Iraq — was using cyanide. In fact, he continued, there is no evidence that either side was.
  • It’s not our role to collect samples for any government or investigative agency.
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  • In an interview afterward, he said he was able to take samples from two people; the crush of patients was too overwhelming to do more. He worried about preserving them; with electricity working only sporadically, there was no constant refrigeration.
  • “with some degree of varying confidence,” Mr. Hagel said — that the Syrian government had used chemical weapons.
anonymous

Why Doctors Care About Happiness - The New York Times - 1 views

  • Along with a swinging pendulum of medical conditions came a similar array, it seemed, of emotions
  • The correlation of happiness and health — or unhappiness and poor health — has been noted over the centuries. “He who can believe himself well, will be well,”
  • Happy people are more likely to make salutary choices in their life — exercise, eat their veggies, get regular medical care — and so will become more healthy.
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  • health may be the instigator of mood
  • The latest entry in the health and happiness field
  • appears to poke a hole in the accepted dictum that well-being is a driver of good health
  • Small studies have hinted at causality by demonstrating that interventions to increase positive feelings yield improved physiological measurements
  • If a patient has poor health and is also feeling miserable, it’s not enough just to address the medical problem.
  • But the opposite may offer an even more powerful payoff. When doctors notice unhappiness in their patients, they should be probing more carefully for hidden illness
  • I also inquire about obstacles to their happiness, and brainstorm with them on ways to ease some of these
  • The side effect profile and cost surely beat most of our current medications, and, at least for now, you don’t have to get prior authorization from an insurance company.
Javier E

Opinion | America 2022: Where Everyone Has Rights and No One Has Responsibilities - The... - 0 views

  • the deeper issue: How is it that we have morphed into a country where people claim endless “rights” while fewer and fewer believe they have any “responsibilities.”
  • That was really Young’s message for Rogan and Spotify: Sure, you have the right to spread anti-vaccine misinformation, but where’s your sense of responsibility to your fellow citizens, and especially to the nurses and doctors who have to deal with the fallout for your words?
  • “We are losing what could be called our societal immunity,” argued Dov Seidman, founder of the How Institute for Society. þff“Societal immunity is the capacity for people to come together, do hard things and look out for one another in the face of existential threats, like a pandemic, or serious challenges to the cornerstones of their political and economic systems, like the legitimacy of elections or peaceful transfer of power.”
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  • This pervasive claim that “I have my rights” but “I don’t have responsibilities” is unraveling our country today.
  • Third: Unvaccinated people are 20 times more likely to die of Covid than people who are vaccinated and boosted.
  • “When trust in institutions, leaders and each other is high, people — in a crisis — are more willing to sublimate their cherished rights and demonstrate their sense of shared responsibilities toward others, even others they disagree with on important issues and even if it means making sacrifices.”
  • When our trust in each other erodes, though, as is happening in America today, fewer people think they have responsibilities to the other — only rights that protect them from being told by the other what to do.
  • completely ignored the four most important statistical facts about Covid-19 today that highlight our responsibilities — to our fellow citizens and, even more so, to the nurses and doctors risking their lives to take care of us in a pandemic.
  • First, unvaccinated adults 18 years and older are 16 times more likely to be hospitalized for Covid than fully vaccinated adults
  • Second: Adults 65 and older who are not vaccinated are around 50 times more likely to be hospitalized for Covid than those who have received a full vaccine course and a booster.
  • But societal immunity “is a function of trust,”
  • the emotional toll and other work conditions brought on by the pandemic contributed to some two-thirds of nurses giving thought to leaving the profession.
  • many hospitals today are experiencing an unprecedented 20 percent annual turnover rate of nurses — more than double the historical baseline. The more nurses leave, the more those left behind have had to work overtime.
  • Especially when so many dying unvaccinated patients tell their nurses, “I wish I had gotten vaccinated,”
  • none of these statistics were mentioned during that podcast
  • “You can listen to the entire 186-minute lovefest between Rogan and Malone and have no idea that our hospitals are overloaded with Covid cases,” wrote Levy, “and that on the day their conversation transpired, 7,559 people worldwide died of Covid, 1,410 of which were in the United States. The vast majority of them were unvaccinated.”
  • “When Malone uncorks questionable allegations about disastrous vaccine effects and the global cabal of politicians and drugmakers pulling strings, Rogan responds with uh-huhs and wows.”
  • That was Rogan’s right. That was Spotify C.E.O. Daniel Ek’s right.
  • But who was looking out for the doctors and nurses on the pandemic front lines whose only ask is that the politicians and media influencers who are privileged enough to have public platforms — especially one like Rogan with an average of 11 million listeners per episode — use them to reinforce our responsibilities to one another, not just our rights.
  • He could start by offering his listeners a 186-minute episode with intensive care nurses and doctors about what this pandemic of the unvaccinated has done to them.
  • That would be a teaching moment, not only about Covid, but also about putting our responsibilities to one another — and especially to those who care for us — at least on a par with our right to be as dumb and selfish as we want to be.
Javier E

The psychology of hate: How we deny human beings their humanity - Salon.com - 0 views

  • The cross-cultural psychologist Gustav Jahoda catalogued how Europeans since the time of the ancient Greeks viewed those living in relatively primitive cultures as lacking a mind in one of two ways: either lacking self-control and emotions, like an animal, or lacking reason and intellect, like a child. So foreign in appearance, language, and manner, “they” did not simply become other people, they became lesser people. More specifically, they were seen as having lesser minds, diminished capacities to either reason or feel.
  • In the early 1990ss, California State Police commonly referred to crimes involving young black men as NHI—No Humans Involved.
  • The essence of dehumanization is, therefore, failing to recognize the fully human mind of another person. Those who fight against dehumanization typically deal with extreme cases that can make it seem like a relatively rare phenomenon. It is not. Subtle versions are all around us.
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  • Even doctors—those whose business is to treat others humanely— can remain disengaged from the minds of their patients, particularly when those patients are easily seen as different from the doctors themselves. Until the early 1990s, for instance, it was routine practice for infants to undergo surgery without anesthesia. Why? Because at the time, doctors did not believe that infants were able to experience pain, a fundamental capacity of the human mind.
  • Your sixth sense functions only when you engage it. When you do not, you may fail to recognize a fully human mind that is right before your eyes.
  • Although it is indeed true that the ability to read the minds of others exists along a spectrum with stable individual differences, I believe that the more useful knowledge comes from understanding the moment-to-moment, situational influences that can lead even the most social person—yes, even you and me—to treat others as mindless animals or objects.
  • None of the cases described in this chapter so far involve people with chronic and stable personality disorders. Instead, they all come from predictable contexts in which people’s sixth sense remained disengaged for one fundamental reason: distance.
  • For psychologists, distance is not just physical space. It is also psychological space, the degree to which you feel closely connected to someone else. You are describing psychological distance when you say that you feel “distant” from your spouse, “out of touch” with your kids’ lives, “worlds apart” from a neighbor’s politics, or “separated” from your employees. You don’t mean that you are physically distant from other people; you mean that you feel psychologically distant from them in some way
  • Distance keeps your sixth sense disengaged for at least two reasons. First, your ability to understand the minds of others can be triggered by your physical senses. When you’re too far away in physical space, those triggers do not get pulled. Second, your ability to understand the minds of others is also engaged by your cognitive inferences. Too far away in psychological space—too different, too foreign, too other—and those triggers, again, do not get pulled
  • This three-part chain—sharing attention, imitating action, and imitation creating experience—shows one way in which your sixth sense works through your physical senses. More important, it also shows how your sixth sense could remain disengaged, leaving you disconnected from the minds of others. Close your eyes, look away, plug your ears, stand too far away to see or hear, or simply focus your attention elsewhere, and your sixth sense may not be triggered.
  • Interviews with U.S. soldiers in World War II found that only 15 to 20 percent were able to discharge their weapons at the enemy in close firefights. Even when they did shoot, soldiers found it hard to hit their human targets. In the U.S. Civil War, muskets were capable of hitting a pie plate at 70 yards and soldiers could typically reload anywhere from 4 to 5 times per minute. Theoretically, a regiment of 200 soldiers firing at a wall of enemy soldiers 100 feet wide should be able to kill 120 on the first volley. And yet the kill rate during the Civil War was closer to 1 to 2 men per minute, with the average distance of engagement being only 30 yards.
  • Modern armies now know that they have to overcome these empathic urges, so soldiers undergo relentless training that desensitizes them to close combat, so that they can do their jobs. Modern technology also allows armies to kill more easily because it enables killing at such a great physical distance. Much of the killing by U.S. soldiers now comes through the hands of drone pilots watching a screen from a trailer in Nevada, with their sixth sense almost completely disengaged.
  • Other people obviously do not need to be standing right in front of you for you to imagine what they are thinking or feeling or planning. You can simply close your eyes and imagine it.
  • The MPFC and a handful of other brain regions undergird the inferential component of your sixth sense. When this network of brain regions is engaged, you are thinking about others’ minds. Failing to engage this region when thinking about other people is then a solid indication that you’re overlooking their minds.
  • Research confirms that the MPFC is engaged more when you’re thinking about yourself, your close friends and family, and others who have beliefs similar to your own. It is activated when you care enough about others to care what they are thinking, and not when you are indifferent to others
  • As people become more and more different from us, or more distant from our immediate social networks, they become less and less likely to engage our MPFC. When we don’t engage this region, others appear relatively mindless, something less than fully human.
  • The mistake that can arise when you fail to engage with the minds of others is that you may come to think of them as relatively mindless. That is, you may come to think that these others have less going on between their ears than, say, you do.
  • It’s not only free will that other minds might seem to lack. This lesser minds effect has many manifestations, including what appears to be a universal tendency to assume that others’ minds are less sophisticated and more superficial than one’s own. Members of distant out-groups, ranging from terrorists to poor hurricane victims to political opponents, are also rated as less able to experience complicated emotions, such as shame, pride, embarassment, and guilt than close members of one’s own group.
grayton downing

F.D.A. Seeks Tighter Control on Prescriptions for Class of Painkillers - NYTimes.com - 0 views

  • The Food and Drug Administration on Thursday recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers.
  • The drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab. Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems.
  • Medical Association and pharmacy organizations, have continued to fight the measure, citing the impact on patients.
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  • “These are very difficult tradeoffs that our society has to make,” said Dr. Woodcock. “The reason we approve these drugs is for people in pain. But we can’t ignore the epidemic on the other side.”
  • In 2011, about 131 million prescriptions for hydrocodone-containing medications were written for some 47 million patients, according to government estimates. That volume of prescriptions amounts to about five billion pills.
  • Schedule II drugs are those drugs with the highest potential for abuse that can be legally prescribed.
  • Along with changing how doctors prescribe these drugs, the classification change will also impose added storage and recordkeeping requirements on druggists. In some states, nurse practitioners and other health care professionals who can currently prescribe hydrocodone-containing drugs may no longer be able to do so.
Javier E

It's Time for a Real Code of Ethics in Teaching - Noah Berlatsky - The Atlantic - 3 views

  • More 5inShare Email Print A defendant in the Atlanta Public Schools case turns herself in at the Fulton County Jail on April 2. (David Goldman/AP) Earlier this week at The Atlantic, Emily Richmond asked whether high-stakes testing caused the Atlanta schools cheating scandal. The answer, I would argue, is yes... just not in the way you might think. Tests don't cause unethical behavior. But they did cause the Atlanta cheating scandal, and they are doing damage to the teaching profession. The argument that tests do not cause unethical behavior is fairly straightforward, and has been articulated by a number of writers. Jonathan Chait quite correctly points out that unethical behavior occurs in virtually all professions -- and that it occurs particularly when there are clear incentives to succeed. Incentivizing any field increases the impetus to cheat. Suppose journalism worked the way teaching traditionally had. You get hired at a newspaper, and your advancement and pay are dictated almost entirely by your years on the job, with almost no chance of either becoming a star or of getting fired for incompetence. Then imagine journalists changed that and instituted the current system, where you can get really successful if your bosses like you or be fired if they don't. You could look around and see scandal after scandal -- phone hacking! Jayson Blair! NBC's exploding truck! Janet Cooke! Stephen Glass! -- that could plausibly be attributed to this frightening new world in which journalists had an incentive to cheat in order to get ahead. It holds true of any field. If Major League Baseball instituted tenure, and maybe used tee-ball rules where you can't keep score and everybody gets a chance to hit, it could stamp out steroid use. Students have been cheating on tests forever -- massive, systematic cheating, you could say. Why? Because they have an incentive to do well. Give teachers and administrators an incentive for their students to do well, and more of them will cheat. For Chait, then, teaching has just been made more like journalism or baseball; it has gone from an incentiveless occupation to one with incentives.
  • Chait refers to violations of journalistic ethics -- like the phone-hacking scandal -- and suggests they are analogous to Major-League steroid use, and that both are similar to teachers (or students) cheating on tests. But is phone hacking "cheating"
  • Phone hacking was, then, not an example of cheating. It was a violation of professional ethics. And those ethics are not arbitrarily imposed, but are intrinsic to the practice of journalism as a profession committed to public service and to truth.
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  • Behaving ethically matters, but how it matters, and what it means, depends strongly on the context in which it occurs.
  • Ethics for teachers is not, apparently, first and foremost about educating their students, or broadening their minds. Rather, ethics for teachers in our current system consists in following the rules. The implicit, linguistic signal being given is that teachers are not like journalists or doctors, committed to a profession and to the moral code needed to achieve their professional goals. Instead, they are like athletes playing games, or (as Chait says) like children taking tests.
  • Using "cheating" as an ethical lens tends to both trivialize and infantilize teacher's work
  • Professions with social respect and social capital, like doctors and lawyers, collaborate in the creation of their own standards. The assumption is that those standards are intrinsic to the profession's goals, and that, therefore, professionals themselves are best equipped to establish and monitor them. Teachers' standards, though, are imposed from outside -- as if teachers are children, or as if teaching is a game.
  • High-stakes testing, then, does leads to cheating. It does not create unethical behavior -- but it does create the particular unethical behavior of "cheating."
  • We have reached a point where we can only talk about the ethics of the profession in terms of cheating or not cheating, as if teachers' main ethical duty is to make sure that scantron bubbles get filled in correctly. Teachers, like journalists, should have a commitment to truth; like doctors, they have a duty of care. Translating those commitments and duties into a bureaucratized measure of cheating-or-not-cheating diminishes ethic
  • For teachers it is, literally, demoralizing. It severs the moral experience of teaching from the moral evaluation of teaching, which makes it almost impossible for good teachers (in all the senses of "good") to stay in the system.
  • We need better ethics for teachers -- ethics that treat them as adults and professionals, not like children playing games.
anonymous

Gene Therapy Creates Replacement Skin to Save a Dying Boy - The New York Times - 1 views

  • The boy in the Nature article had suffered since birth from blisters all over his body, and in 2015 contracted bacterial infections that caused him to lose two-thirds of his skin. His doctors did not know how to treat him, other than keeping him on morphine for the pain.
  • Doctors in the burn unit tried everything: antibiotics, bandages, special nutritional measures, a skin transplant from the boy’s father. Nothing worked.
  • The doctors removed a sample of the boy’s skin — slightly more than half a square inch — and took it to Modena, where they genetically engineered his cells, using a virus to insert the normal form of his mutated gene into his DNA.Then they grew the engineered cells in the laboratory into sheets of skin and transported them back to Germany, where surgeons grafted them onto the boy’s body.In October 2015, they covered his arms and legs with the new skin, and in November, his back. Ultimately, they replaced 80 percent of the child’s skin.
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  • A major concern with any type of gene therapy is that the inserted genetic material could have dangerous side effects, like turning off an essential gene or turning on one that could lead to cancer.
anonymous

Excellence Runs in the Family. Her Novel's Heroine Wants Something Else. - The New York... - 0 views

  • Excellence Runs in the Family. Her Novel’s Heroine Wants Something Else
  • Kaitlyn Greenidge and her sisters achieved success in their respective fields
  • In her historical novel, “Libertie,” she focuses on a Black woman who doesn’t yearn to be the first or only one of anything.
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  • Kaitlyn Greenidge learned about the first Black woman to become a doctor in New York. “I filed it away and thought, if I ever got a chance to write a novel, I would want it to be about this,” she said.
  • Libertie, the rebellious heroine of Kaitlyn Greenidge’s new novel, comes from an extraordinary family, but longs to be ordinary.
  • As a young Black woman growing up in Reconstruction-era Brooklyn, Libertie is expected to follow in the footsteps of her trailblazing mother, a doctor who founded a women’s clinic.
  • “So much of Black history is focused on exceptional people,”
  • I wanted to explore is, what’s the emotional and psychological toll of being an exception, of being exceptional, and also, what about the people who just want to have a regular life and find freedom and achievement in being able to live in peace with their family — which is what Libertie wants?”
  • “If you come from a marginalized community, one of the ways you are marginalized is people telling you that you don’t have any history, or that your history is somehow diminished, or it’s very flat, or it’s not somehow as rich as the dominant history.”
  • “That idea of being the first and the only was a big piece of our experience,”
  • They are engaged in ongoing conversations about their writing, though they draw the line at reading and editing drafts of one another’s work.
  • Libertie
  • The novel has drawn praise from writers like Jacqueline Woodson, Mira Jacob and Garth Greenwell, who wrote in a blurb that Greenidge “adds an indelible new sound to American literature, and confirms her status as one of our most gifted young writers.”
  • raised by a single mother who struggled to support the family on her social worker’s salary,
  • “I’ve always been interested in the histories of things that are lesser known,”
  • “There’s a really powerful lyricism that feels new in this voice,”
  • Greenidge and her sisters developed a reverence for storytelling and history early on, when their parents and grandparents would tell stories about their ancestors and what life was like during the civil rights movement.
  • “That fracture was really formative for me,” she said. “It made me hyper aware of inequality and the doublespeak that goes on in America around the American dream and American exceptionalism, because that was proven to me not to be true.”
  • Greenidge was collecting stories from people whose ancestors had lived there, and tracked down a woman named Ellen Holly, who was the first Black actress to have a lead, recurring role on daytime TV, in “One Life to Live.”
  • Greenidge filed the family’s saga away in her mind, thinking she had the premise for a novel. When she got a writing fellowship, she was able to quit her side jobs and immerse herself in the research the novel required.
  • The resulting story feels both epic and intimate. As she reimagined the lives of the doctor and her daughter, Greenidge wove in other historical figures and events.
  • In one horrific scene, Libertie and her mother tend to Black families who fled Manhattan during the New York City draft riots.
  • Greenidge also drew on her own family history, and her experience of being a new mother.
  • Her daughter, Mavis, was born days after she finished a second draft of the book, and is now 18 months old. She finished revisions while living in a multigenerational household with her own mother and sisters.
  • “Mother-daughter relationships are like the central relationships in my life,”
  • “I cannot think of a greater freedom than raising you,”
anonymous

Pandemic Social Life, One Year In - The New York Times - 0 views

  • One Year Together, Apart
  • The pandemic redefined relationships and self-reliance.
  • In the year since the pandemic began, people learned to be together while apart and navigated the pain of feeling apart while together
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  • Screens, small and large, became crucial links to the rest of the world.
  • In doing so, they rediscovered each other, and experienced the joys of bonding and the suffocation of constant proximity.
  • In some instances, these revelations were not happy ones: lawyers and mediators saw a spike in clients looking to divorce as soon as courts reopened.
  • Engagements and pregnancy announcements seemed to pop up constantly on social media. And there were plenty of weddings.
  • Couples in quarantine learned a lot about their significant others.
  • Inside nursing homes, Covid-19 outbreaks became all too regular, with more than 163,000 residents and workers dying of the virus.
  • In one study, almost one-third of the teens interviewed said they had felt unhappy or depressed.
  • Parents, especially mothers, left the work force quickly and in large numbers in the spring.
  • Those who continued working had to balance the demands of their jobs with domestic chores, child care and online schooling, putting strain on their mental health.
  • Retirees put off plans that had been years in the making, like travel and volunteer work.
  • Young people around the world, cut off from their usual social lives, faced a “mental health pandemic.”
  • Delivery drivers dealt with health risks, theft and assault.
  • Airline workers who weren’t furloughed had to confront passengers who refused to wear masks.
  • hospital staff around the country dealt with the gut-wrenching horrors of a steep surge in cases.
  • Doctors and nurses agonized over putting their families at risk, and dealt with intense burnout and pay cuts.
  • Some said that being characterized as heroes by the public left them little room to express vulnerability.
  • a toll higher than in any other country.
  • The world’s struggle to contain the coronavirus was often compared to a war
  • in this case, the enemy claimed more Americans than World War I, World War II and the Vietnam War combined
  • Grief and loss defined the last year
  • Funerals and final goodbyes took place over video calls, if at all.
  • a sign that people will soon be finding their way back to each other.
  • If you’re wondering what comes after, we are, too.Are you anxious that things will never be the same? Or are you fearful that we’ll return to “the same” much too quickly? Or maybe there is something seemingly small that you will cherish being able to do?
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