Althouse | category: medicine



an endless succession of beans and nuts.

"[Gert-Jan] Oskam... said that these stimulation technologies had left him feeling that there was something foreign about the locomotion..."

"... an alien distance between his mind and body. The new interface changed this, he said: 'The stimulation before was controlling me, and now I’m controlling the stimulation.' In the new study, the brain-spine interface, as the researchers called it, took advantage of an artificial intelligence thought decoder to read Mr. Oskam’s intentions — detectable as electrical signals in his brain — and match them to muscle movements. The etiology of natural movement, from thought to intention to action, was preserved. The only addition... was the digital bridge spanning the injured parts of the spine.... 'It raises interesting questions about autonomy, and the source of commands. You’re continuing to blur the philosophical boundary between what’s the brain and what’s the technology.'"

"Organ transplantation is mired in stagnant science and antiquated, imprecise medicine that fails patients and organ donors."

"And I understand the irony of an incredibly successful and fortunate two-time heart transplant recipient making this case, but my longevity also provides me with a unique vantage point. Standing on the edge of death now, I feel compelled to use my experience in the transplant trenches to illuminate and challenge the status quo.... Because a transplant begins with the overwhelming gift of a donor organ that brings you back from the brink of death, the entirety of a patient’s experience from that day forward is cast as a 'miracle.'... But this narrative discourages transplant recipients from talking freely about the real problems we face and the compromising and life-threatening side effects of the medicines we must take. This 'gratitude paradox,' as I’ve come to think of it, can manifest itself throughout the transplant professional communities as well. Without vigorous pushback, hospitals and physicians have been allowed to set an embarrassingly low bar for achievement...."

Writes Amy Silverstein, in "My Transplanted Heart and I Will Die Soon" (NYT).

"Circular, and dark blue, with a Tupperware-style lid, it is precisely the kind of vessel you’d transport a soup or salad in."

"I’ve even sealed it inside a freezer bag, to contain any leaks. Or smells. I walk slowly and with care across Westminster Bridge, because any trip could prove disastrous. As I enter St Thomas’ Hospital and head for the infection department on the fifth floor, I realise the object I’m carrying is still warm, and, despite my preparations, I’m sure I can detect a faint whiff of something ripe, like camembert. It is, in a word, a turd. Freshly laid, and brimming with bacteria, the doctors I’m delivering it to believe such faeces could be the future of medicine. I’ve carried mine across London to be made into capsules – that someone else will ultimately eat...."
Désirée Prossomariti, a research biomedical scientist, takes my sample and opens it inside a biosafety cabinet. Watching her scoop my poop into a series of plastic containers feels uncomfortable: it’s not often we hand over something so intimate, nor so laden with cultural taboos, to a fellow human. Prossomariti reassures me that she views faeces as “just another type of specimen.” 
“A lot of people get grossed out by it, but it is not much worse than blood. Besides,” she adds, “in my personal opinion, it is not the most disgusting thing you can work with.” 
“What is?” I ask. 
“Sputum,” she says. “That’s awful.” 

"When I graduated with a medical degree in 1973, a Black woman in a class of mostly White men, there was a real sense that the days of obsessing over skin color..."

"... and making race-based assumptions about our fellow human beings was finally fading — and, hopefully, soon gone for good. Apparently not. That racial obsession has come rushing back — in academia, politics, business and even in my beloved medical profession. But now it’s coming from the opposite direction...."

"I reject the unscientific accusation that people are defined by their race, not by their individual beliefs and choices. It is little consolation that studies are finding implicit bias training has no effect on its intended targets, and might even make matters worse. Think about the message this mandate sends to Black physicians. It suggests that I should be wary of my White colleagues because, after all, they’re biased against people like me. Sure, they can undergo frequent training, but their bias is always going to be there, beneath the surface, threatening to rear its ugly, racist head.... Since I became a physician, I have seen exactly one instance of racism in health care — and it was from a patient, not a fellow physician. As for my colleagues, I have been consistently impressed with the conscientious, individualized care they have provided to patients of every race and culture... [T]he message to patients is much worse. Black people are, in effect, being told that White physicians are likely to quite literally damage our health...."

She's getting trashed in the comments over there.

"I am a 42-year-old St. Louis native, a queer woman, and politically to the left of Bernie Sanders...."

"I have spent my professional life providing counseling to vulnerable populations: children in foster care, sexual minorities, the poor. 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.... 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.... 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...."

"Well, Ann, I did in fact read the whole thing, and a more pustulent agglomeration of rubbish I've never seen. That glossary alone — about half the length — is pure screwballery."

Said Michelle Dulak Thomson in the comments to my post where I'd written: "Here's the [54-page] AMA document. It is fascinating. I read a lot of it, and I suspect that absolutely no one will read the whole thing."

"The American Medical Association put out a 54-page guide on language as a way to address social problems — oops, it suggests instead using the 'equity-focused' term 'social injustice.'"

"The A.M.A. objects to referring to 'vulnerable' groups and 'underrepresented minority' and instead advises alternatives such as 'oppressed' and 'historically minoritized.'... I’m all for being inclusive in our language, and I try to avoid language that is stigmatizing. But I worry that this linguistic campaign has gone too far, for three reasons. First, much of this effort seems to me performative rather than substantive. Instead of a spur to action, it seems a substitute for it.... Second, problems are easier to solve when we use clear, incisive language. The A.M.A. style guide’s recommendations for discussing health are instead a wordy model of obfuscation, cant and sloppy analysis. Third, while this new terminology is meant to be inclusive, it bewilders and alienates millions of Americans. It creates an in-group of educated elites fluent in terms like BIPOC and A.A.P.I. and a larger out-group of baffled and offended voters, expanding the gulf between well-educated liberals and the 62 percent majority of Americans who lack a bachelor’s degree — which is why Republicans like Ron DeSantis have seized upon all things woke."

Writes Nicholas Kristof in "Inclusive or Alienating? The Language Wars Go On" (NYT).

Here's the AMA document. It is fascinating. I read a lot of it, and I suspect that absolutely no one will read the whole thing. Talk about things that are not inclusive: it excludes everyone. But that's the reason for long bureaucratic documents — to create an impression that something complicated has been worked through but to make it impossible to check the work. I mean, it's possible, but no one will do it. 

There are a lot of tables and diagrams, and these jump out as more readable than the rest. I spent some time absorbing this diagram:

Shouldn't the "deep" part be at the bottom? Are they using a pyramid the way the government used the old "food pyramid" — just to represent the size of the particular groups of things? And what's with the yellow arrow pointing upward? What is this gravity-defying process? I spent some time on the narrative/story distinction. "Narrative" and "story" are buzzwords, and you might tune out when you hear them, but this pyramid teaches that a "story" tells of related events — or "experiences" — and a "narrative" is a collection of stories or messages.

So don't confuse "stories" and "messages." A story is an "account" but a "message" is "words, images, and/or sounds that convey and idea or belief." Now, I can't see how an "account" can be anything other than "words, images, and/or sounds," so I presume the "story"/"message" distinction is that a "story" relates news of something that happened and how people felt and thought about it, and a "message" is more inward and abstract, "an idea or belief." 

I see in the fine print that this (helpful?) diagram comes from "Guide to Counter-Narrating the Attacks on Critical Race Theory." I guess the advice to "counter-narrators" is that when you hear your opponent's "message," you then climb the pyramid of story and narrative until you get to the top, "the deep narrative." When you've reached the highest point, you are at the greatest depth. 

I'm just noticing that the pyramid is labeled "The Narrative Ecosystem." Mixed metaphor! Is the locked-in-place stone to be thought of as alive?

I also read some of the various tables. I paused on this one, because of the buzzword "narrative" and because I could see that it was instructing the reader to perceive sets of deeply held beliefs and therefore to be in a position to question them (or is it to be vigilant about not repeating them? ):

And I read the text on "The narrative of individualism":
Individualism is a philosophy and group of ideas, expressed in symbols, practices, and stories that supports a belief that self-sufficient individuals are rational beings that freely make consumer-like choices, independent of political influences, living conditions or historical context. Among these ideas is the concept of meritocracy, a social system in which advancement in society is based on an individual’s capabilities and merits rather than on the basis of family, wealth or social background. Individualism is problematic in obscuring the dynamics of group domination, especially socioeconomic privilege and racism. In health care, this narrative appears as an over-emphasis on changing individuals and individual behavior instead of the institutional and structural causes of disease. 
This narrative acknowledges that class inequities may be unfortunate, but falls short of declaring them unjust, thus obscuring political, structural and social determinants of health inequities. Diseases become the main target rather than the social and economic conditions that produce health inequities. This focus ignores the role of political struggle in the advances that have been made over time. For example, the major advances in life expectancy in the early 20th century resulted from the actions of social movements to eliminate child labor, institute housing and factory codes, and raise living standards, not advances in technology or economic growth. Health promotion in medicine and public health typically means educating people as individuals about their health without acknowledging the influence of living conditions, which are themselves conditioned upon societal, structural inequalities. We argue that much can be gained by shifting this narrative, from the individual to the structural, in order to more fully understand the root causes of health inequities in our society.

But shouldn't doctors focus on the individual? Even if the greatest advancements in health would come from improving economic conditions for large groups of people, what good is it to have doctors preoccupied with these matters? They're not experts, and they have expertise in something tremendously important that is delivered at the individual level.

"Along the walls of the little clinic sat disheveled-looking men, their feet in plastic buckets, while nurses bent over them, speaking softly...."

"[Dr. Jim] O’Connell recognized many of these homeless men.... [H]e’d seen them in the Mass General emergency room, sullen, angry, snarling, resisting all treatment. Here they seemed so docile that they might have been drugged, via foot soaking.... You filled a plastic tub halfway up with Betadine and put the patient’s feet in it.... [Y]ou always addressed the patient by his surname and an honorific — 'Mr. Jones.'... [O'Connell] spent three afternoons and evenings there each week, soaking feet and not doing much else for more than a month. Among the regulars was a very large elderly man usually dressed in three layers of coats, with wary eyes and a salt-and-pepper beard and a great wave of white-and-gray hair that seemed to be in flight.... He was classified as a paranoid schizophrenic, and his chart was thick... [and he] had always refused to take medications or to be admitted to the hospital.... [His feet] were so huge and swollen that O’Connell had to prepare a separate tub for each...."

Writes Tracy Kidder, in "'You Have to Learn to Listen': How a Doctor Cares for Boston’s Homeless/Lessons from Dr. Jim O’Connell’s long crusade to treat the city’s 'rough sleepers'" (NYT).

"[O]ne evening, as O’Connell knelt on the floor filling the tubs, he heard the old man say, 'Hey, I thought you were supposed to be a doctor.... So what the hell you doin’ soakin’ feet?'... About a week later, he put his feet in the buckets and said to O’Connell: 'Hey, Doc. Can you give me something to help me sleep?' He never slept for more than an hour, he said. Within about a month, O’Connell had him taking a variety of medicines for his many ailments. Foot-soaking in a homeless shelter — the biblical connotations were obvious. But for O’Connell, what counted most were the practical lessons...."

Are the "biblical connotations" not "practical"?

"Sam, born during a Texas covid surge in July, 2020, is typical of what some experts are calling an 'immunity gap.'"

"He was cared for at home by his father for his first eighteen months, so he avoided the usual viral infections of infancy. When he started day care this year, his immune system was fairly naïve to infections, except for those covered by his vaccines. So, like many kids his age... he is getting all of them now. Before covid, the cohort of kids under age one would be exposed for the first time each winter. This year, a much larger cohort of kids—not just kids in the first winter of life but also older toddlers like Sam—are getting their first infections. For the millions of children whose important kid work—learning, development, and play—is being interrupted by back-to-back infections, the medical response feels terrifically inadequate...."

From "The Post-COVID 'Immunity Gap' Continues to Pummel Pediatric Wards/While hospitals struggle to find room for young patients, parents have few options for O.T.C. medicines to soothe their sick children" (The New Yorker).

"The American Medical Association put out a 54-page guide on language as a way to address social problems — oops, it suggests instead using the 'equity-focused' term 'social injustice.'""Along the walls of the little clinic sat disheveled-looking men, their feet in plastic buckets, while nurses bent over them, speaking softly...."

Report "Althouse"

Are you sure you want to report this post for ?