"Organ transplantation is mired in stagnant science and antiquated, imprecise medicine that fails patients and organ donors."
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."
Writes Linda Geddes, in "Keep taking the crapsules: how I became a faecal transplant donor" (The Guardian).
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..."
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...."
"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."
"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.'"
Writes Nicholas Kristof in "Inclusive or Alienating? The Language Wars Go On" (NYT).
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).