Personal Account of Medical Worker or Student or Patient

The Face Laughs – BONUS POST

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The Bonus Book of the Week is “The Face Laughs While the Brain Cries, The Education of A Doctor” by Stephen L. Hauser, published in 2023.

Born at the dawn of the 1950’s, the author grew up mostly in Bayside, a section of Queens in New York City. He began conducting medical research in the 1970’s, when knowledge and resources were extremely limited. His first drug-study involved 58 multiple-sclerosis patients selected from two hospitals in Boston. He got to know every patient personally.

Around 2010, the author was a small cog in the wheel of a much, much more extensive multiple-sclerosis-drug study that involved 2,500 patients affiliated with more than 300 hospitals on 5 continents. There were data galore from MRI’s, test results from clinicians and blood and spinal fluid, and integrity- monitoring of the whole extravaganza. Nine million pages of information.

Read the book to learn much, much more about the doctor’s experiences with his medical research and the U.S.’s drug-approval process.

ENDNOTE: The author recounted a few medical cases of people who had lost their minds. They turned out to have brain damage from multiple sclerosis.

Regardless of the cause of the inability of the patients to do their jobs– they couldn’t do their jobs competently. When such workers are responsible for leading a sprawling entity, where people’s lives or livelihoods hang in the balance, there can be extracurricular activity because no one is minding the store.

Two particular cautionary tales in the United States come to mind in connection therewith. It is true, no one person, not even the top leader is entirely to blame when things go wrong, but they get blamed because one thing leads to another, due to their impaired brain function.

Authors of personal accounts have documented how Ronald Reagan had reduced brain function in his second term as U.S. president; among them, George Shultz and Lesley Stahl. Peggy Noonan claimed Reagan had a hearing aid that was only sometimes on, so he was blissfully unaware of a lot of events he should have known about. The head of the CIA, Bill Casey was dying of a brain tumor. One subordinate of his, Oliver North, went rogue– played a large role in secretly selling weapons to the Iranians, with the help of Israel and Saudi Arabia!

The other instance involved Bill Paley, who was head of the international corporation, CBS, into the 1980’s. He would come into board meetings with a walker and two nurses by his side. Due to extensive memory loss, he was clueless as to what was going on. Since he wasn’t truly running the company anymore, a rogue department at CBS, having zero experience, decided to try to make movies. That division generated disastrous losses that resulted in layoffs in unrelated departments, causing trauma for all stakeholders associated with CBS.

In both of the above instances, there would have been a lot less trouble had the leader been removed when his incompetence due to reduced brain function became evident. Hint: the 25th Amendment of the U.S. Constitution can be invoked when a president is deemed sufficiently cognitively impaired to warrant his removal.

Brave New Weed

The Book of the Week is “Brave New Weed, Adventures into the Uncharted World of Cannabis” by Joe Dolce, published in 2016. The author interviewed several individuals in various places associated with growing, using and /or selling parts of the marijuana (or cannabis) plant in the medicinal, recreational and entrepreneurial realms, and related his own personal experiences with it. The terms “marijuana” and “cannabis” will be used interchangeably hereinafter, to refer to the whole plant but other terms will be used to refer to specific parts, such as buds.

At the book’s writing, many American states had yet to pass laws decriminalizing or regulating cannabis. Dolce spoke with people who dispensed it for medicinal purposes, legally and illegally. On the latter score, some Americans dispense marijuana to treat medical conditions without proper licensing or credentials. But they aren’t just out to make a buck. They truly care about their patients. They do their homework, experimenting with the chemicals in cannabis, and consulting with others in Israel, Spain, the United Kingdom, Scandinavia, the Netherlands and Czech Republic.

Anecdotally, Dolce was told that cannabis contains double the carcinogen benzopyrene that tobacco does, yet cannabis can be used to allow easier breathing in treating COPD in the short term. He also related that preliminary studies showed that people who were potheads in their youth are turning out to have lower rates of Alzheimer’s disease in their old age, than those who weren’t.

There is still so much secrecy and false information that is disseminated accidentally and / or intentionally about cannabis, that Americans have had difficulty in learning the truth about it. The author attempted to state facts when he found a reliable source of them. One such fact is that cannabis-related scientific research on mice cannot be perfectly extrapolated to humans because humans are an infinitely more complicated life-form than mice. Israel is one place whose laws have allowed extensive marijuana research on humans.

Dolce tried a concentrated cannabis oil illegally dispensed from an individual in California. It made him so ultra-sensitive to all the stimuli around him– the lights, road, sidewalk, other cars, the sky, the car radio, etc.– he was having trouble driving. On a related note, in 2023, in Boca Raton, Florida near State Road 441, drivers would know they were similarly overstimulated when they saw the wording and graphics of a certain billboard. Without explanation, the billboard disappeared in a few weeks.

On a negative note, the places that grow cannabis-buds are extreme electricity hogs– their bills can run into the thousands of dollars monthly after a Colorado state discount is subtracted. All business is done in cash, and the IRS collects a large amount of tax revenue. Further, high-volume consumers of cannabis lose their ability to dream while sleeping.

Nonetheless, the author’s ideal vision for the future of cannabis is one in which Americans spurn Big Agriculture, Big Tobacco and Big Pharma in favor of toxin-free, contaminant-free, and environmentally-friendly products they can use to relieve their suffering; with the profits of such an industry reinvested in the local community. Good luck with that.

It still remains to be seen what kinds of regulation various states will impose, given their current political climates, and how much of a role the federal government will continue to play– given the nature of political donors and lobbyists, voter-demographics, and propaganda wars.

Read the book to learn about: how hemp is different from marijuana; the best way to store buds to extract optimal medicinal benefit; Colorado’s decriminalization of cannabis that began in 2009 and the legalization of dispensing it that began in January 2014; various dispensing businesses there; marijuana’s different forms including oils, sprays and vaporizers; what transpired when, in 2015, Dolce quit cannabis for sixty days; the lingo, the etiquette, dosing, strains, forms, biological effects, and interesting medical factoids including, “Cannabis is so dose specific that large and small amounts create opposite effects.”

Gynecologist Reflections

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The Book of the Week is “Gynecologist Reflections” by Robert A. Siegel, published in 2017. As is well known, until about the 1970’s, an American medical doctor was a trusted family friend, a generalist. The author started medical school at the dawn of that decade, and ultimately chose obstetrics and gynecology as his specialty. In this poorly edited volume, the author detailed his memorable patient-cases inside America’s changing medical industry amid changing cultural and economic times.

During his training, the author was required to perform abortions; if he didn’t, he’d be fired. Another medical institution wouldn’t accept him and he wouldn’t become a physician. He acknowledged the very emotionally charged, controversial nature of the procedure, and controversial nature of not only when life begins, but when it ends.

The author’s generation of medical interns was still male-dominated. According to the book (which appeared to be credible although it lacked a detailed list of Notes, Sources, References, Bibliography and an index), most of the interns were brainwashed into thinking that working around the clock, saving lives on eight hours of sleep a week, was a macho thing to do. Of course, in the next few decades, American medicine became an increasingly litigious line of work and its trainees rebelled against the abusive hierarchy.

After about a decade, the author was able to make a living as a solo practitioner treating private patients. But his dedication to his work (which often involved emergencies) still left him severely sleep-deprived and very stressed. He admitted to coming quite close to making a medical mistake that would have resulted in a patient’s kidney failure. Fortunately, his assistant asked him a simple question about the task at hand.

In another instance, the doctor bragged about saving the lives of a woman and her later prematurely-delivered baby who were in a serious car accident. He got all the kudos, but explained that the surgical team, the technology and the hospital were just as responsible for the positive outcome.

The doctor also recounted a legal case of an acquaintance of his (who was also a doctor). The acquaintance gave verbal instructions, which the mother of the patient (a young child who apparently died through no fault of the doctor’s) failed to follow. He wrote, “You should have seen this lady. She was reeking of alcohol but we weren’t allowed to say that in court…” The initial jury-award unexpectedly, outrageously exceeded his malpractice insurance coverage.

Read the book to learn about: hemorrhages, caesarean sections, hysterectomies, OB-GYN screening tools, etc., plus the sociological aspects of the doctor’s practice, and biographical info on him– including how he almost died at a young age (hint: he led an unhealthy lifestyle to say the least– “Two days before my double by-pass was scheduled, I signed myself out [of the hospital] against medical advice.” Exhibiting arrogance and a feeling of invincibility, no doubt.).

Burn Rate

[Please note: The word “Featured” on the left side above was NOT inserted by this blogger, but apparently was inserted by WordPress, and it cannot be removed. NO post in this blog is sponsored.]

The Book of the Week is “Burn Rate, Launching A Startup and Losing My Mind” by Andy Dunn, published in 2022. Born in February 1979 in the United States, the author won the lottery in that he had family and friends who knew him well enough to recognize that, given his personality, his behavior was anomalous. He was doubly lucky that not only did he get mental-health treatment before he ended up in jail (well, at least on one occasion) or in the cemetery, but also, he could (with assistance from others) afford it.

“… for many, even a ‘chill’ drug like marijuana can stimulate a manic episode.” The author got to college still unaware that bipolar disorder (aka manic-depressive illness) ran in his family; his grandmother had had it. People who actually have the condition suffer under a Damocles sword their whole lives, as their mental state goes through unpredictable cycles, even with medication. Of course, stress exacerbates the highs and lows. The medication has side effects that are meant to dull the emotions, so bipolar patients don’t experience and enjoy life as much as people whose brain chemicals are more stable than theirs.

According to the book (which appeared to be credible although it lacked Notes, Sources, References, or Bibliography and an index), while in college, the author was ingesting alcohol and controlled substances such as ecstasy, magic mushrooms and marijuana on a daily basis, and taking the (radical) acne medication Accutane. Somehow, he graduated anyway, and got his MBA at Stanford. He explained that the professors there educated students in entrepreneurship, if they wanted to go that route. The author did.

After years of interesting ups and downs, in 2016, the author– a lifelong fan of the Chicago Cubs (who had last been World Series winners in 1908)– was afforded the opportunity to see game 7 of the World Series in Cleveland. But first, he had to rush to JFK airport from the streets in the East 50’s in Manhattan, beginning an hour before his plane took off, to get there. His cab driver did 90 MPH. Sympathetic people at the airport made way for him when they heard about his situation.

Read the book to learn of the author’s other trials and tribulations, triumphs and defeats. Speaking of defeats…

This is the song Hillary Clinton is singing now.

IN POST-CLINTON TIME

sung to the tune of “Sunny Afternoon” (Official Audio) with apologies to the Kinks.

My opponents BEAT me the last two times.
Deplorables and BERnie were unkind.
I SOREly miss the Situation Room.
And though I CAN-not be in charge,
I’m not locked up, I’m still at-large.
All I WANT’S in-the Situation Room.

Save me, save me, save me
from bad publicity.
I’ve got lots of enemies.
It’s a VAST right-wing conspiracy.

And I love to hobnob with elites,
brag about my political feats.
I SOREly miss the Situation Room,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time.

Donald Trump’s ruined my rep.
He’s in his safehouse doing ’24 prep,
spewing the usUAL blather and cruelty.
Now I’m here online,
doing the grass-roots, make-work grind.
I SOREly miss the Situation Room.

Help me, help me, help me
revive my ca-reer.
Well, give my Party money
to get me out of here.

‘Cause I love to hobnob with elites,
brag about my political feats.
I sorely miss the Situation Room,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time.

Ah, save me, save me, save me
from bad publicity.
I’ve got lots of enemies.
It’s a VAST right-wing conspiracy.

And I love to hobnob with elites,
brag about my political feats.
I SOREly miss the Situation Room,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time.

The Making of A Woman Surgeon

The Book of the Week is “The Making of A Woman Surgeon” by Elizabeth Morgan, M.D., published in 1980. Her story told how times have changed.

“Female applicants [to Harvard Medical School in 1966] were regarded as either abnormal or silly.” So the author ended up attending Yale Medical School, where there were only seven females in a class of 97 students.

A sterile floor-length gown was required to be worn over one’s street clothes when one entered the surgical intensive care unit. It was a joke because it didn’t prevent infection. Another joke was that the water used by medical personnel in scrubbing up, wasn’t sterile. Besides, their arms’ hair follicles contained bacteria that rose to the surface of the scrub.

In 1972, after surviving all the sexism in addition to the abusive, hierarchical training system to that point, Morgan worked in a veterans hospital, serving the Vietnam war-wounded. She wrote about the tenor of the times, “These were federally subsidized cigarettes sold at cut-rate prices, tax-free, in unlimited quantities to all V.A. patients.”

In May 1973, the author began writing a medical column for Cosmopolitan magazine. The monthly snippet was only 150 to 200 words, but she spent eight to ten hours writing every single one after fact-gathering from a minimum of five sources, and fact-checking, in the library. Then an editor would clarify her facts, if necessary.

Unfortunately, human nature doesn’t change. In the mid-1970’s, Morgan worked alongside a surgeon who made about a million dollars a year performing unnecessary surgeries. His strong suit was that he could boast that no patient ever sued him. Since his patients were in relatively good health prior to surgery, they recovered uneventfully. Clearly, patients who need surgery, are much more likely to have complications afterward, and are much more likely to have worse outcomes. Problems can crop up that are not the surgeon’s fault.

The author specialized in plastic surgery, which includes reconstructive and cosmetic. She preferred to do the former, to help women feel better about themselves, many of whom had had breast-cancer surgery. When she struck out on her own in private practice, there were lots of patients to choose from.

For, there were still plenty of overzealous male breast-cancer surgeons who truly believed that performing aggressive mastectomies was going to cure their patients. Many of those women were traumatized by the assault on their femininity. And they eventually died, anyway.

Read the book to learn of the various personalities of doctors and patients Morgan encountered during her medical training, and the nature of the training in her specialty in her generation.

Do No Harm / Since Yesterday – BONUS POST

The first Bonus Book of the Week is “Do No Harm, Stories of Life, Death, and Brain Surgery” by Henry Marsh, originally published in 2014. In this personal account, the author– a British brain surgeon– described his horribly depressing career. He recounted how he removed brain tumors from, and clipped aneurysms of, his most memorable patients through the decades. Even when a tumor was benign, it would keep growing and inevitably kill the patient unless taken out. Even when a large aneurysm had yet to burst, there was a chance (incalculable, as every patient is different) that it would burst in the patient’s lifetime.

Metaphorically speaking, some people would say that the outgoing president of the United States is a tumor in the nation’s brain. The author wrote, “You can never know for certain from a brain scan exactly how a tumor will behave until you start to remove it. It might be hard or soft, dry or bloody…” Prior to diagnosis, the most common symptom patients experience is headaches– which are uncharacteristic for them in daily life.

In order for a brain surgeon to acquire experience, he needs to actually practice on real patients, and make mistakes. Even when the surgeon does everything right in treating the patient, something could go wrong, anyway. In addition to stressing over his patients, the author had to deal with bureaucracies. But regardless of the healthcare system an industrialized country has (government-run, commercial, or a combination thereof), it’s comprised of: “… government targets, self-serving politicians, tabloid headlines, scandals, deadlines, civil servants, clinical cock-ups, financial crises, patient press-groups, trade unions, litigation, complaints and self-important doctors…”

Read the book to learn of the author’s trials and tribulations in treating patients not only in Britain, but also in Kiev.

The second Bonus Book of the Week is “Since Yesterday, The 1930’s in America, September 3, 1929 – September 3, 1939” by Frederick Lewis Allen, originally published in 1939.

“To hear angry Republicans and angry Democrats talking, one would have supposed the contest was between a tyrant determined to destroy private property, ambition, the Constitution, democracy, and civilization itself; and a dupe of Wall Street who would introduce a fascist dictatorship.” Such was the nature of the 1936 presidential election in America.

Clearly, propagandizing hasn’t changed in ninety years. Presidents want to have it both ways: they take credit for all positive economic news, and blame their predecessors for all negative economic news.

At the dawn of the 1930’s when the economy went south, Americans held very strong opinions about their political preferences, heavily influenced by the propaganda they read in newspapers and magazines. Not much has changed, except that now they can force their opinions on the world at the speed of light. Immediately they think they’re experts from watching the idiot box and/or reading the Web; the attitude is, “I’m not an attorney, not a doctor, and not an economist, but I play one on social media, because I can, and because I’m right.”

Other similarities between the Depression Era and recent times include:

Golf was a popular businessman’s game.

Fans of professional sports worshipped their star players, like in baseball, tennis, and golf– Babe Ruth, Bill Tilden, Bobby Jones, etc.

Automation due to new technologies (such as steam, gasoline and electric power, inventions and farm machinery) and urbanization were eliminating jobs in industry, agriculture, and textiles more than offshoring ever would.

Listeners worshipped a pundit on the radio– Father Coughlin– a hate-spewing demagogue from the Detroit suburb of Royal Oak (but he broadcast on only one station, not a national network, so he became nationally known only in his later years in the 1930’s).

All players in the banking industry were financially interdependent so when the system collapsed, they all fell like dominoes. Then-president Hoover established the Reconstruction Finance Corporation in order to bail out only his corporate cronies, as he didn’t believe in stimulus money for individuals.

In summer 1932, Howard Scott and his inscrutable theory of Technocracy was a fad. The author wrote, “Yet in the meantime it had offered an object-lesson in the readiness of the American people for a new messiah and a new credo” just as “Wikinomics” (see the post in this blog) was supposed to be the next big thing.

The political agenda behind COVID has forced Americans to relax online similar to the way the Depression brought on: the five-day (rather than six-day) workweek, construction of sports and recreational areas of all kinds, and provision for transportation to get to them.

Beginning in late 1936 into 1937, in the Midwestern and Northeastern United States, a bunch of rivers overflowed their banks due to humans’ misuse of land; in the third week of September 1938, 682 people died in an unexpected hurricane that destroyed regions unprepared for flooding, in New England and Mid-Atlantic states.

Between 1931 and 1936, there were actually more people leaving the U.S. than coming in, for various reasons, and the U.S. birth rate was slowing.

Ultra-rich Americans who refused to face inconvenient facts were the ones who hated FDR when he was elected president.

Proposals distorted in propaganda that played out in the Depression Era, whose outcomes are yet to be seen in recent times, included:

In the 1930’s, in order to allow men to keep their dignity, the government put them to work instead of giving them handouts. In their first few years of existence, FDR’s alphabet soup of mostly federal (rather than state or local level) jobs and programs was nonpartisan. However, eventually, the Democrats provided maximum funding as election day approached. On the whole, the financial relief worked well, except in Pennsylvania, where there was gross misuse of funds.

FDR’s policies sought to mitigate environmental damage done by people, and prevent future natural disasters with his introduction of the Civilian Conservation Corps, Public Works Administration, and his signing of the Taylor Grazing Act into law. These kinds of measures simply require political backing and money– the sooner a sufficient amount of both are thrown at them, the sooner the problems will be solved!

In February 1938, FDR floated a proposal to make seventy years the mandatory retirement age of all federal judges– including U.S. Supreme Court justices– and increase the number of justices from nine to fifteen. That unpopular proposal hurt FDR’s reputation.

In 1935, FDR introduced economic change to the country by instituting the Social Security system, financial assistance only for Americans 65 and older. In 1965, LBJ introduced economic change to the country by instituting the Medicare and Medicaid systems, healthcare funding for only those Americans who are poor and / or 65 and older.

In the future, the United States government might be introducing a better overall system of healthcare funding for all Americans of all ages and income levels (which is obviously much more complex than any system that has ever been created before in this country, so it’s not going to be perfect the first time around). In order to pay for the improved system, the government will likely have to raise taxes on the rich.

Along these lines, economics 101 says a nation’s economy is strongest when it has a healthy, well-educated workforce.

Whether deliberately or not, the political agenda revolving around COVID has rewarded education-software makers by closing schools across the country. So ironically, by allowing the software makers to get richer (because, presumably, their higher taxes will be paying for the improved healthcare-funding system), the software makers are dictating education policy. So in the long run, the nation will have a healthy, poorly educated workforce!

Anyway, read the book to learn much more about the tenor of the times in 1930’s America, culturally, politically and economically.

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.

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.

The View From the Vue

The Book of the Week is “The View From the Vue” by Larry Karp, originally published in 1977. This is the personal account of a medical intern at Bellevue Hospital in New York City in the 1960’s. The place had a reputation for treating poor, mentally ill patients, as well as the medical facility to which lazy doctors from other facilities transferred poor patients.

The author related a series of anecdotes of the kinds of patients who frequented the hospital and the experience he received in diagnosing their sometimes then-rare ailments, such as abdominal pregnancy, and common ailments– J-O Rat Paste and lead poisonings. He also related a few interesting factoids of that bygone era, like “In these days, the name cards on the foot of each bed were color-coded according to the religion of the patient. Blue was the Jewish color.”

Read the book to learn of how his wife was allowed to assist him in his work as an unpaid intern of sorts (a situation that would never exist these days), and what transpired when he developed sleep-deprivation syndrome.

God’s Hotel

The Book of the Week is “God’s Hotel” by Victoria Sweet, published in 2012. This is a medical doctor’s account of the radical changes that occurred at a county-funded hospital, formerly an almshouse in the San Francisco area that treated mostly disabled and elderly patients who were indigent.

The author describes the series of consequences stemming from an ever-increasing annual budget, a power struggle, office and mayoral politics, and bureaucratic shenanigans. There was a tug-of-war over turning the hospital into a psychiatric facility.

Florence Nightingale summed up the field of medicine in a nutshell when she said there have to be checks and balances in connection with practicing medicine, doing nursing, and handling administration. If doctoring becomes too powerful, patients get overtreated; if administration becomes to powerful, too little doctoring is done. When there is excessive nursing (emotionally and spiritually caring for patients), medical progress suffers.

Over the course of several years, a Justice Department investigation and a special relationship with the mayor’s office prompted the hospital’s executives to increase the administrative staff even as the number of patients fell. The additional staff was required to generate assessments, policies and procedures. When an incident resulted in the death of a demented patient and the media gave the facility bad publicity, the executives pointed to budget cuts that caused the understaffing that led to a compromise in safety. The hospital then hired a PR firm, an in-house director of government and community relations, and an assistant medical director to help with all the new paperwork, decisions and questions. Quietly, even more draconian budget cuts were being made to the hospital. Yet there was still enough money to hire the mayor’s communications consultant.

Read the book to learn how misdiagnosis and home care (rather than hospital care) make healthcare significantly more expensive, and of the controversies surrounding the push for progress on one side, and preservation of personal patient care on the other.