Medical Topics – Page 4 – education and deconstruction.com

Morphine, Ice Cream, and Tears. (sic) / Chasing My Cure – BONUS POST

The First Bonus Book of the Week is “Morphine, Ice Cream and Tears. (sic) Tales of a City Hospital” by Joseph Sacco, M.D., published in 1989.

The cynical author did his medical internship and residency in New York City in the early 1980’s. He discussed emotional, financial and ethical issues that doctors-in-training encountered in his generation, illustrating his points with real-life cases.

Healthcare workers, not just medical doctors, must of course not only physically, but emotionally contend with the unpleasant sights and smells of a patient’s body fluids. Such fluids frequently end up on their person, unless they choose a specialty that is not so messy. The author remarked that, therefore, a huge number of medical-school students in their third year realize that they would feel most comfortable specializing in radiology. That partly accounts for why nuclear medicine has become so wildly popular in recent decades.

One medical-industry financial issue that has remained largely the same for the last forty years, has been the profit motive. Thus, emergency rooms are still overstaffed with specialists who overtreat patients to maximize profits for themselves and/or their employers, while drug-addicted patients are also selfish: “This patient was too stupid for conscious manipulation but had succeeded to (sic) engage the attention of doctors, nurses, the EMS, the police, his family, and probably a number of others, as well as to spend a good six figures of public money in his care.”

Healthcare is fraught with ethical issues. One is the completion of the death certificate. The author, as an intern, was tasked with such lowly paperwork. He got scolded for improperly filling in the correct words or phrases (there was a list of them) that constituted “acceptable” causes of death. Overworked and sleep-deprived, most interns sought peace more than accuracy, so the primary or secondary cause of death became “cardiopulmonary arrest” repeatedly. This systemic quirk probably put a wrench in death statistics in the United States. Perhaps it has even been manipulated for political purposes. Enough said about that.

During his residency, the author treated female teenage patients for minor ailments. Because he saw so many who were pregnant, of his own volition, he took the opportunity to counsel them about birth control. He felt that the pill was their best option. He “… sent her off with two free packets and a prescription for several months more. Most incredibly, some patients even decided to use them .”

Read the book to learn of the author’s trials and tribulations, and of other ways times have changed for aspiring medical doctors in America.

The second Bonus Book of the Week is “Chasing My Cure, A Doctor’s Race to Turn Hope into Action, A Memoir” by David Fajgenbaum, published in 2019.

The author’s ordeal began in 2010, when he was halfway through medical school. He suffered from a mysterious illness for weeks, with multiple-organ failure, and misguided, incorrect diagnoses of lymphoma, or an infectious or rheumatologic disease. It turned out he had a rare disease whose origins were auto-immune or cancerous.

Later on, through his own actions, he determined the correct categorization. He connected the dots on many fronts, mentioning two traits peculiar to him: when he was a student, his consumption of energy drinks was excessive, and he had inherited a tendency to have an excessive number of blood vessels in various body parts, compared to other people. The former environmental factor, and the latter genetic factor, when they came together, could have played a role in his responding poorly to treatment, and his having to be bombarded with an extremely powerful chemotherapy cocktail approximately every one to two years.

The above are the kinds of factors scientists take into account when attempting to explain why certain patients do better than others with different treatment options. When patients who have a fatal disease are out of options, they aren’t usually as lucky, insightful and resource-rich as Fajgenbaum was. But even he had to overcome numerous obstacles and nearly died on several occasions.

When he initially tried to do research on his fatal ailment, the author was frustrated by scant, old, inaccurate knowledge on it and scattered sources. He likened the medical community’s situation to that of law enforcement prior to 9/11: “..no one talked to one another, no prime database existed, there was no expectation of coordination or data sharing.” Competition for federal funding meant that resources dedicated to all different kinds of medical research varied widely– a matter of money and politics. Even so, this wasn’t due to malicious intent, but merely honest ineptitude– one would hope. Nevertheless, there was a lot of wasted talent, and a lot of misallocated resources (not to mention, unnecessary deaths!).

The above provided an argument for why the author decided to earn an MBA (he had already completed a medical master’s degree) right after graduating medical school, instead of beginning his residency. Acquiring money-oriented, management and leadership knowledge and experience would be more important than practicing medicine. It would allow him to create a medical-research group that he hoped would find a cure for his disease before he died.

Read the book to learn: how the author broke tradition in thinking about the cause of his illness; how that led to his helping to pioneer a medical-treatment trend that will endure in the future; how his actions have led to sooner diagnoses and saved lives (hint– he marshaled resources to consolidate knowledge, and his team found that “… it’s much more efficient to go directly to patients for [blood] samples, just like we do for patient data in the registry study.”); and to learn about other aspects of healthcare in the United States.

ENDNOTE: The above state of affairs provides yet another argument in favor of a national healthcare system for the United States. Free-market economics is fine for business, but healthcare is super-complicated because it also involves matters of life and death. For more information, see the posts: “full circle” (sic)–eleventh paragraph from the top, and “Here at the New Yorker“– fourth paragraph from the bottom, onward. The best healthcare delivery requires the right balance between cooperation and competition among specific parties. This is why training for both war and healthcare delivery utilizes divestiture socialization. Healthcare delivery works best when there is cooperation within a team and among teams, and disease is the enemy. A capitalistic approach to healthcare necessitates an unhealthy level of competition, as Fajgenbaum learned.

Pertinent Post

“P” post.

Present pandemic’s politics produced:

propaganda

president-promotion

provisions-portioning predicaments

panic

profiteering

paranoia

patronage pigs

pissed, persecuted people

poseurs

puerile politicians (petty power plays)

pained physicians

problematic prescriptions

pressured paramedics

pestered practices

poor populations

plus, predictably:

POPPYCOCK.

The Class

The Book of the Week is “The Class, A Life-Changing Teacher, His World-Changing Kids, and the Most Inventive Classroom in America” by Heather Won Tesoriero, published in 2018. Despite its sensationalist title, this volume provided a fascinating inside look at one program at an elitist school where brainy kids prepared to fiercely compete for big money and prestige on the high-school science-fair circuit.

The cliche of the baking soda/vinegar volcano as a winning project at the science fair ended decades ago. A Greenwich Connecticut school offers a specific course for self-starting kids passionate about science, whose sole purpose is providing resources– experimental equipment, materials and supervising teacher– with which to enter science fairs.

The author related about ten of the kids’ experiences in the form of vignettes– their personally chosen projects and whether they won an award, personal details of their home lives, prom adventures, and college acceptances or rejections, etc., roughly over the course of the 2016-2017 academic year, with backstories.

The supervising teacher of the class, who had previously acquired a couple of decades of scientific experience in private industry, had hand-picked the lucky 48 applicants from different grades who partook of this unique opportunity.

They got access to his guidance and professional scientific devices that even well-funded school districts don’t have. Yet another reason Malcolm Gladwell might brand them “outliers” is that some of the chosen students were younger siblings of ones who had gone before.

Most of the science fairs or prizes thereof are funded by corporations and benefactors with big names, such as Google, Intel, Amazon, Xerox, United Technologies, etc.

A great irony is that the event itself is called a science fair when in reality, there were instances mentioned by the author in which the judging of projects was thought to be unfair by the teacher, contestants or their parents. The reasons that certain entries won awards and others did not, were unexplained.

The real reasons would have to be revealed in litigation–probably beyond the scope of this book. It must be said that the author did not mention any litigation.

Nevertheless, since major business entities are running the show, the projects must certainly be seen in terms of their commercial applications, not just in terms of their potential for societal good, like curing diseases or finding new sources of renewable energy.

For instance, one girl’s project that was passed over for an award involved computational biology. The software she coded was, with 80% accuracy, able to identify the most effective breast cancer drugs. Without question, that project had a very valuable commercial application that would open a Pandora’s box.

In another case, a boy who was competing for an “XPRIZE” was advised by his personal attorney to drop out of that contest. He was exceptional for various reasons, much more advanced than his classmates– already attempting to patent his work, and the kind who has the potential to be a future Nobel-prize winner.

At the other end of the spectrum, the author also wrote about kids who weren’t able to get their acts together, due to honest ineptitude. However, the author also related that, in previous years, there had been mean-spirited activity in the lab. In the documented academic year, there was cyberbullying by students and parents even in the science-fair community (!), borne of jealousy and whiny sour grapes expressed by the non-winners. Sadly, as is well known, the parents can be worse than the kids.

Read the book to learn of the triumphs and setbacks, trials and tribulations of the privileged kids and their teacher.

How We Do Harm

The Book of the Week is “How We Do Harm” by Otis Webb Brawley, M.D. with Paul Goldberg, published in 2011. This is yet another lamentation on the sorry state of affairs of the oncology industry in the United States. As is well known, the fear-mongering, lying and profit-seeking never stop in many parts of “the system.”

Brawley prudently wrote, “It’s always about the balance of what I know, what I don’t know, and what I believe.” However, so many medical professionals ignore the second, and offer up as facts, the third. This is where guidelines go awry. Hundreds of organizations globally distribute thousands of guidelines every year; many of them from profit-seekers.

American medical culture changed for the worse in the 1990’s. For, “…commercial interests usurped the language of clinical epidemiology, making it impossible even for an educated person to distinguish a real recommendation based on science from a thinly disguised advertisement for medical services.”

The author served as a medical oncologist, professor, and officer of the American Cancer Society, among other roles in his career. He provided a series of anecdotes on the system’s victims and critical analyses of the fear-mongerers and liars.

One major irony is that people whose top-dollar medical care is supposedly dispensed by “experts” become victims of fear-mongering and lying and get overtreated and die unnecessarily. Whereas, poor people who forgo medical care except to save their lives and end up receiving publicly-funded care– because they can’t afford better– are more likely to survive because the caregivers have their patients’ best interests in mind rather than a desire to make more money.

The American mentality is that more is better– more early detection and treatment must be better than less. Not necessarily true. Often, the screening tests and the treatment are themselves carcinogenic, so more of each actually increases the likelihood of more medical problems.

The author described an FDA-approved (but insufficiently tested) drug launched in the single-digit 2000’s whose makers claimed it strengthened patients and reduced fatigue; it actually caused strokes and heart attacks and even tumors. But it was lucrative! That became apparent at an FDA advisory committee session, where “Billions of dollars in [stock] trades hinge[d] on the words of the [medical] doctors and the scientists…”

American oncology is reminiscent of the Jack Benny joke: A robber approaches a man on the street, points a gun at him and menacingly says, “Your money or your life.” The man becomes pensive for a few seconds. The robber says, “Well??” The man replies, “I’m thinking, I’m thinking.” The joke is that the man can’t spend his money after he’s dead, but he values both money and life equally.

But thinking is the right answer– instead of succumbing to panic instilled by the oncology industry that leads to the loss of both money and life. All of the victims in the author’s anecdotes had panic in common.

Read the book to learn the answer to the question “Does treatment of localized prostate cancer save lives?” (hint– statistically, tens of men might become incontinent and impotent unnecessarily for one life to be “saved”) plus other thought-provoking, awareness-raising issues in American medicine, and how not to get fooled by liars and fear-mongerers.

Deadly Spin

The Book of the Week is “Deadly Spin” by Wendell Potter, published in 2010. This is a book that explains how health insurance companies engage in unethical behavior in the name of profit, that results in needless deaths in the United States.

It follows then, that serving as a top executive at a health insurance company requires sociopathic tendencies, favoring money over people. One reason the insurance companies are so obsessed with their bottom lines (aside from the greed of their top executives) is that they have to answer to Wall Street.

Potter worked for Humana and then CIGNA a combined approximately twenty years as head of their public relations departments. By the late 1980’s, Humana realized it had a conflict in running a for-profit hospital and a managed-care plan simultaneously. The hospital was more than happy to maximize the stays of its most lucrative patients, while the plan’s goal was to minimize costs through preventive health care– promoting wellness.

The author learned to play the game of maximizing his employer’s profits through fighting legislative changes to his industry; and protecting, defending and enhancing his employer’s reputation. For, there was a direct relationship between his employer’s profits and his raises and bonuses. He therefore emotionally detached himself from health insurance plan members, and focused specifically on actuarial tables and legalese to help him project an image of his employer as a reasonable, if not caring participant in patient care.

Whenever a threat to his former employers’ profits arose, such as the movie “Sicko” or proposed legislation that financially favored patients, his former employers hired a big-name, monster-sized public relations firm, and secretly co-funded and co-founded a political front group, such as “Health Care America” that publicly pretended to favor health care consumers, but truly sought to maximize insurance industry profits. The group was a propaganda machine, and an object lesson in how to lie with statistics.

Other tricks of the trade include: “…rescinding individual policies, denying claims, cheating doctors, pushing new mothers and breast cancer patients out of the hospital prematurely and shifting costs to consumers.”

Read the book to learn additional details of the hegemony of the health insurance companies. One interesting endnote: “Obama opposed any requirement that everyone buy insurance, one of the few points on which he disagreed with Hillary.”

A Memoir According to Kathy Griffin – BONUS POST

The Bonus Book of the Week is “A Memoir According to Kathy Griffin” by Kathy Griffin, published in 2009.

This memoir described the comedian whose shtick consisted of telling humorous, embarrassing stories about members of the entertainment industry. Or, as she characterized herself: “… someone who gets fired, stirs up trouble, and gets debated about on CNN for saying bad things on award shows.” Kudos to her for being an honest, amusing attention whore. She must have brought in sufficient profits for the entertainment industry to tolerate her behavior.

Born in November 1960 in Forest Park, Illinois, the youngest of five children, Griffin grew up in Oak Park, Illinois. At eighteen years old, she moved to Santa Monica, California to be an actress. She apparently had the talent, drive and creativity to get famous.

In the early 2000’s, Griffin performed sufficiently well at the Laugh Factory in Los Angeles to double the length of her show to two hours. This allowed the cocktail waitresses to make sufficient money to pay their rent, “Plus they loved serving the gays, because they were well-dressed, respectful and tipped well.”

Griffin didn’t talk about Anna Nicole Smith right after she died out of respect. As Greg Giraldo would have said, “Too soon, too soon.” Griffin revealed deeply personal information– both of her parents were functional alcoholics, and her oldest brother was a pedophile and substance abuser.

Griffin tried to raise the alarm about her brother, but, as she joked– her parents thought “denial” was a river in Egypt. She admitted to two major errors in her life– poor judgment in both her marriage and in having liposuction. Read the book to learn the details of this and other episodes.

SERIOUS ENDNOTE: Griffin had no qualms about making political statements unrelated to the awards shows she attended. It is therefore not inappropriate to make a political statement unrelated to Griffin’s book, below.

This nation seems to be in denial about the amount of debt load currently carried by not only individuals and businesses, but by the federal government and local governments. It appears that bankruptcies of government entities is the next financial crisis in the offing; the reason why, will be explained shortly.

Within the last thirty or so years alone, the United States has seen greed fests and then busts with regard to junk bonds, savings and loan associations, derivatives, tech stocks, and subprime mortgages, just to name a few. Mortgage-backed securities used to be one of the lowest-risk investments around. Tax-free municipal bonds are presumably still one of the lowest-risk investments around.

BUT one small bond brokerage (and possibly others, too) whose website says it “specialize[s] in tax-free municipal bonds. That’s all we do.” recently changed the language on its customers’ monthly statements. It is forcing them to accept the words, “trading & speculation” (!) for their “Investment objective/Risk tolerance” or else they won’t be able to purchase bonds. It makes itself sound like a penny-stock broker-dealer of the 1980’s that churns accounts. Or a currency broker.

The brokerage is so phobic about covering itself legally that there must be bond issuers who are going to go belly up AFTER THE CURRENT PRESIDENT HAS BEEN REELECTED or has left office, whenever that is. (It might be recalled that Detroit took the plunge in July 2013, after Obama was reelected.) Or its brokers are getting greedy and unscrupulous. Or both. Good luck with that, all.

Mistaken Identity – BONUS POST

The Bonus Book of the Week is “Mistaken Identity” by Don & Susie Van Ryn and Newell, Colleen & Whitney Cerak, with Mark Tabb, published in 2008. This is a long, true story of a cluster-screw-up of honest ineptitude whose negative consequences were mitigated by the virtuous nature of the people involved.

The families of the victims described in this book weren’t vengeful and didn’t look for someone to blame or sue, pursuant to the tragedy. They were forgiving, and saw the positive consequences of it– they widened their social circle and became a good example for others of civil and mature behavior.

In late April 2006, two female Taylor College students from Michigan who shared an employer happened to be riding home in the same van in Fort Wayne, Indiana. They didn’t know each other. However, their appearance, build and facial features happened to be largely similar. The van was involved in a tragic accident. Along with other passengers, one of them died, and the other lived but had serious injuries.

In the aftermath, the one who lived remarked, “A lot of what was written in different magazines was wrong, and I think it gave me a different perspective on people and the media that I never had before.”

Read this book (not media stories) to get an accurate picture of what happened to the two families of the accident victims.

In Search of Memory – BONUS POST

The Bonus Book of the Week is “In Search of Memory” by Eric R. Kandel, published in 2006. This book was mostly about neurology and psychoanalysis. The autobiographical parts included descriptions of how and why the author’s family fled Austria for the United States in 1939, and his role in reconciling psychology and biology.

Kandel identified himself as Jewish. He explained that “racial anti-Semitism” is the idea perpetrated by the Catholic Church that the Jews killed Christ and therefore, they are members of “… a race so innately lacking in humanity that they must be genetically different, subhuman.” Such idea was used to justify genocide during the Spanish Inquisition and of course, the Holocaust. Gentiles in Germany, Poland and Austria especially, took up the cudgel of racial anti-Semitism during the Holocaust.

However, what is interesting is, that while the Catholic Church calls the Jews a “race” as a putdown, the Jews think of it as a point of pride.

When American Jews use the term”born Jewish” ironically, most are unaware of the belief that Jews as a group are thought by anti-Semites to have genes in common that bring out their stereotyped, negative traits. By born Jewish, they mean to say, they, like religious Jews, believe that Jews are automatically Jews regardless of their beliefs or observances, because their mothers were Jewish. Not in a derogatory way.

But wait. If people can convert to or from Judaism, it’s not genetic. Hindu people could actually call themselves a “race” because they allow no conversions. That’s the difference. The Hindus were a group of people who did all share the same genes up until the time they started marrying non-Hindus and having children.

By the way, read the book to learn about the progression of the fields of neurology and psychology in the twentieth century.

A Good Fight – BONUS POST

The Bonus Book of the Week is “A Good Fight” by Sarah Brady With Merrill McLoughlin, published in 2002. This is the autobiography of a secondary victim of firearms-violence turned gun-control activist in the United States.

Sarah’s husband, Jim, had just begun to serve as press secretary for President Ronald Reagan. In March 1981, Jim was caught in the crossfire– shot in the head– in the assassination attempt on Reagan. Jim required extensive medical care, having sustained brain damage that resulted in paralysis of his legs and other ongoing quality-of-life complications.

What sparked an interest in gun-control advocacy in Sarah Brady, a lifelong Republican, was an incident during the summer of 1985 involving the cavalier attitude of adults in her husband’s hometown (Centralia, IL) about firearms. People had guns casually lying around, giving children easy (accidental, but deadly) access. Of course, adults, too, who get a gun can kill someone. It is harder if they don’t have a gun.

Reagan’s would-be assassin might have been denied access to his .22 caliber weapon if the-then gun laws had required a background check on him. When he bought it in a pawn shop in Dallas, he gave a fake address and showed an outdated Texas driver’s license.

The 1968 Gun Control Act was rendered useless when gun makers found a loophole in it. Importing of “Saturday night specials” was banned, but importing of their parts wasn’t. So the guns were assembled upon arrival at the factory and sold in this country.

Sarah initially volunteered to help a nonprofit group called Handgun Control, which pushed for ILLEGAL-gun-control legislation. In 1986, it put forth the Brady Bill, which would close the loopholes in the existing laws and require background checks on gun buyers. It did not try to ban anyone from buying or possessing firearms altogether. State laws diverged significantly in working on gun control legislation, due to pressures imposed by the National Rifle Association (NRA) and other groups.

Sarah explicitly wrote that she wasn’t pushing to eliminate the Second Amendment in the U.S. Bill of Rights. She began speech-making at universities, city clubs and civic organizations.

In 1988, Handgun Control successfully lobbied to ban (non-metal) handguns able to fool metal detectors at airports. The group received invaluable assistance from Senator Nancy Kassebaum, Republican from Kansas. Sarah mentioned various other politicians, helpful and obstructionist. The vast majority showed her minimum courtesy by returning her telephone calls. Not then-Congressman Dick Cheney from Wyoming. Never.

George H.W. Bush claimed that he “so admired” the work Handgun Control was doing. However, a major campaign donor of his, the NRA, prevented him from acting on that sentiment to support the Brady Bill in any way, shape or form in 1989, when it still had yet to pass Congress.

Sarah delivered a speech at the University of Nevada, Las Vegas. Childish, vicious hecklers with poor impulse control shouted her down, screaming “Liar, liar!!!” Law enforcement officers did nothing to eject them, but had semi-automatic weapons at the ready– in case they got violent. And people wonder why there are so many shooting sprees in the United States.

One small way that shooting sprees could possibly be reduced would be to regulate hate speech and threats on social media. If, pursuant to a legal definition of “hate speech” and “threats” the perpetrators of hate speech and threats could be not only banned, but deemed to be breaking the law (if they mention weaponry in their messages)– then law enforcement would have probable cause to obtain a warrant to search their homes and workplaces for weaponry that is unlicensed or was obtained through dishonest means. Thus, if executed carefully, such a chain of events wouldn’t be a Fourth Amendment violation. It is unclear at this time whether this would be a Federal or State matter.

Read the book to learn why 1994 was a banner year for ILLEGAL-gun-control advocates, about disputes on concealed weapons, about a 1997 ruling of the U.S. Supreme Court, why a background check on American gun buyers in almost half of the states is not really thorough, and much more about Sarah.

Twenty Chickens For A Saddle

The Book of the Week is “Twenty Chickens For A Saddle” by Robyn Scott, published in 2008. This autobiography described people who chose an adventurous lifestyle over one of comfort, safety and convention.

Botswana was a peaceful, well-fed nation, thanks to the government’s policy of designating more than three-quarters of the country as tribal trust land. It was a demilitarized zone where anyone could graze their animals.

In late 1987, the author’s parents decided to move with their two daughters and son from New Zealand to a rural area in Botswana. The author was the oldest, at seven. The father had been a homeopathic doctor but became a physician at five different government-run clinics (only one of which had a telephone; none had electricity and running water), flying to them by light plane on different days. The mother was a home-schooling mom.

The family fixed up a long-abandoned cowshed for their residence. They lived close to the father’s father– a colorful character– and his second wife; some miles away from an abandoned nickel/copper mine. He helped with their education– teaching them Latin names of all sorts of flora and fauna. For the most part, life-threatening dangers and primitive conditions abounded. There were heat, mosquitoes, poisonous snakes, HIV, wild horses and machine parts such as detonators that were supposed to be illegal. The kids did, however, take ballet and tennis lessons in town. And they had a home library. They even had a zipline over their swimming pool with a slide.

While the mother recovered from a medical problem, the author and her younger brother attended a free primary school for a term. Its student body was mostly white people; the government-run school that charged a fee was farther away and was mostly black people. Girls began school at six years old, while boys who had cow-herding to do, started at eight or nine.

The author loved the structure of a classroom, and the competition for gold stars. Her mother inspired a love of learning, but had a free-for-all curriculum and no government supervision whatsoever.

The author joined what would be equivalent to the Brownies in the United States; her brother joined the Cub Scouts. At term’s end, the kids returned to home-schooling. When they reached their early teens, they did self-directed projects for a New Zealand correspondence course in agriculture, architecture and transport. Then they entered boarding school. The author attended a Dominican convent school in Zimbabwe.

The author described the daily trials and tribulations her father encountered in seeing patients, as Botswanans believe in ancestor worship and witchcraft. He had an even tougher time beginning in the early 1990’s, when the AIDS crisis hit the nation.

At that time, the family moved to a nicer property, but it was near the border with South Africa. There was a block association of sorts, which had racist policies– “Newcomers mustn’t offer higher wages to their black servants, or else all the Tuli Block farmers would have to pay the price. Livelihoods might be ruined!” Most of the farmers had large plots of land and hundreds of heads of cattle.

Read the book to learn many more details of the author’s unique experiences and her entrepreneurial endeavors.