Nobody writes about health care practice from the inside out like Atul Gawande, here focusing on an increasingly important part of clinical work: information technology.
A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking—almost double the rate of the general working population.
Something’s gone terribly wrong. Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.
It’s not just the workload, but also what Gawande calls “the Revenge of the Ancillaries” — designing software for collaboration between different health care professionals, from surgeons to administrators, all of whom have competing stakes and preferences in how a product is used and designed, what information it offers and what it demands. And most medical software doesn’t handle these competing demands very well.
I don’t know how many people under the age of 35 know about the Chicago Tylenol murders, but for a few weeks in 1982, it was a national news sensation. Seven people in the Chicago area died after ingesting Tylenol capsules laced with potassium cyanide. Retro Report took a look back at this episode, with a focus on how Johnson & Johnson and other drug companies modified their packaging to prevent in-store tampering.
The company considered renaming Tylenol, a word that incorporates some of the letters from 4- (aceTYLamino) phENOL, a chemical name for acetaminophen, the drug’s active ingredient. But a name change was rejected.
Instead, a mere six weeks after the crisis flared, the company offered a different solution, a new bottle with the sorts of safety elements now familiar (if at times exasperating) to every shopper: cotton wad, foil seal, childproof cap, plastic strip. Capsules began to be replaced with caplets the following year.
Johnson & Johnson was viewed as an exemplar of corporate responsibility, and enjoyed what some people described as the greatest comeback since Lazarus. Nowadays, all sorts of products come in containers deemed tamper-proof, or at least tamper-evident, meaning that consumers can readily tell if a seal has been broken or something else is amiss.
Incredibly, the case is still unsolved…no one knows who did it or why. Thinking about the amount of in-store surveillance that we have, it seems unlikely that such a crime would go unsolved for long today.
When she was 16, she moved with her parents from Vermont to Florida to attend a performing arts high school. Soon after she tried OxyContin for the first time at a high school party, and so began a relationship with opiates that would dominate the rest of her life.
It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie — when they saw her addiction, they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless, and resilient. She could and would talk to anyone, and when you were in her company you wanted to stay. In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders and doctors, who advocated for and believed in her ‘til the end. She was adored as a daughter, sister, niece, cousin, friend and mother, and being loved by Madelyn was a constantly astonishing gift.
This is powerfully straightforward writing by Linsenmeir’s family…my condolences are with them. They devoted a few paragraphs at the end of her obit to address addiction and its place in our society:
If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support.
If you work in one of the many institutions through which addicts often pass — rehabs, hospitals, jails, courts — and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.
Why did it take a grieving relative with a good literary sense to get people to pay attention for a moment and shed a tear when nearly a quarter of a million people have already died in the same way as Maddie as this epidemic grew?
Did readers think this was the first time a beautiful, young, beloved mother from a pastoral state got addicted to Oxy and died from the descent it wrought? And what about the rest of the victims, who weren’t as beautiful and lived in downtrodden cities or the rust belt? They too had mothers who cried for them and blamed themselves.
She died just like my wife’s cousin Meredith died in Bethesda, herself a young mother, but if Maddie was a black guy from the Bronx found dead in his bathroom of an overdose, it wouldn’t matter if the guy’s obituary writer had won the Booker Prize, there wouldn’t be a weepy article in People about it.
Why not?
But if there had been, early enough on, and we acted swiftly, humanely, and accordingly, maybe Maddie would still be here. Make no mistake, no matter who you are or what you look like: Maddie’s bell tolls for someone close to you, and maybe someone you love. Ask the cops and they will tell you: Maddie’s death was nothing special at all. It happens all the time, to people no less loved and needed and human.
If you’re ever called on to perform CPR in an emergency but you don’t have training, the American Heart Association recommends performing “Hands-Only CPR”. There are two easy steps: you call 911 and then you press hard and fast in the center of the person’s chest 100-120 times per minute. As their fact sheet explains, familiar music can help maintain the proper tempo.
Song examples include “Stayin’ Alive” by the Bee Gees, “Crazy in Love” by Beyoncé featuring Jay-Z, “Hips Don’t Lie” by Shakira” or “Walk the Line” by Johnny Cash. People feel more confident performing Hands-Only CPR and are more likely to remember the correct rate when trained to the beat of a familiar song.
When performing CPR, you should push on the chest at a rate of 100 to 120 compressions per minute, which corresponds to the beat of the song examples above.
The playlist includes songs familiar to lifesavers of all generations, from Book of Love by the Monotones to Sweet Home Alabama by Lynyrd Skynyrd to Walk Like an Egyptian by The Bangles to Sorry by Justin Bieber. Stayin’ Alive or Justin Timberlake’s Rock Your Body are probably more appropriate to the situation, but should the need arise, my go-to CPR song is now Crazy in Love. Who knows, Beyoncé might help save someone’s life someday. (via @juliareinstein)
keyword void, or search void, n.: a situation where searching for answers about a keyword returns an absence of authoritative, reliable results, in favor of “content produced by a niche group with a particular agenda.”
An article by Renee DiResta at Wired uses the example of Vitamin K shots, a common treatment given to newborn babies at hospitals, but whose top search results are dominated by anti-vaccination groups.
There’s an asymmetry of passion at work. Which is to say, there’s very little counter-content to surface because it simply doesn’t occur to regular people (or, in this case, actual medical experts) that there’s a need to produce counter-content. Instead, engaging blogs by real moms with adorable children living authentic natural lives rise to the top, stating that doctors are bought by pharma, or simply misinformed, and that the shot is risky and unnecessary. The persuasive writing sounds reasonable, worthy of a second look. And since so much of the information on the first few pages of search results repeats these claims, the message looks like it represents a widely-held point of view. But it doesn’t. It’s wrong, it’s dangerous, and it’s potentially deadly.
I wondered what other examples of keyword voids might be out there, so I searched for it. Unsurprisingly — in retrosepect — you don’t get a lot of relevant results. It’s mostly programming talk, when you literally want a function to return no results.
Science writer Carl Zimmer has a new book on genetics and heredity called She Has Her Mother’s Laugh. The New York Times published an excerpt this week focusing on mosaicism — an unexpected but surprisingly common condition where different cells in the same organism display different DNA (sometimes strikingly, fatally different).
Dr. Walsh and his colleagues have discovered intricate mosaics in the brains of healthy people. In one study, they plucked neurons from the brain of a 17-year-old boy who had died in a car accident. They sequenced the DNA in each neuron and compared it to the DNA in cells from the boy’s liver, heart and lungs.
Every neuron, the researchers found, had hundreds of mutations not found in the other organs. But many of the mutations were shared only by some of the other neurons.
It occurred to Dr. Walsh that he could use the mutations to reconstruct the cell lineages — to learn how they had originated. The researchers used the patterns to draw a sort of genealogy, linking each neuron first to its close cousins and then its more distant relatives.
When they had finished, the scientists found that the cells belonged to five main lineages. The cells in each lineage all inherited the same distinctive mosaic signature.
Even stranger, the scientists found cells in the boy’s heart with the same signature of mutations found in some brain neurons. Other lineages included cells from other organs.
I’ve always been drawn to the idea that each of us are many people, an assembly of mismatched parts, manifesting themselves in different times and contexts. It’s striking to see that reflected, albeit in a refracted way, in our array of possible genomes.
Last month when I posted a video comparing the sizes of various microorganisms, I noted the weirdness of bacteriophages, which are bacteria-killing viruses that look a bit like a 20-sided die stuck on the top of a sci-fi alien’s body.
Bacteriophages are really real and terrifying…if you happen to be a bacteria. Bacteriophages attack by attaching themselves to bacteria, piercing their outer membranes, and then pumping them full of bacteriophage DNA. The phage replicates inside of the bacteria until the bacteria bursts and little baby bacteriophages are exploded out all over the place, ready to attack their own bacteria.
I couldn’t find a good explainer (video or text) about these organisms, but over the weekend, Kurzgesagt rode to the rescue with this video. In the second part of the video, they discuss whether bacteriophages might form the basis of an effective treatment for antibiotic-resistant infections.
Solving unsolved rape and murder cases is generally good, but turning private websites into repositories of criminal evidence police can obtain without a warrant is generally bad. Like, extra bad.
One of the first things this reminded me of was Cathy O’Neil’s recent call for a Hippocratic Oath for data scientists. The idea is for data scientists to have some ethical guidelines, and above all to avoid doing harm or violating the rights of the people implicated by the practice of data science. In order to do that, you need to bring in the various stakeholders, properly weigh each of their concerns, and continually work to address them.
It’s always an incomplete process, because as O’Neil notes right away, data science isn’t limited to the acts of professional data scientists; it’s also the province of companies, and algorithms, and automated or self-learning uses of data. So in addition to a Hippocratic Oath (or some version of it), you also need a version of HIPAA (the law that guarantees the secure storage and distribution of health information).
DNA/heredity sites seem like the perfect test case for figuring out the compatibility of these two modes of operating. It seems like largely, they’re being treated either as a simple data regime, a la social media networks, and/or under criminal statutes. But a person’s DNA is, or should be, treated like medical information, with strict limits on its use. There has to be some way to figure out how to weigh all of these things together without compromising people’s rights.
The program offers inmates methadone and buprenorphine (opioids that reduce cravings and ease withdrawal symptoms), as well as naltrexone, which blocks people from getting high.
The data set is small but the results are encouraging: there were fewer overdose deaths of former inmates after the program was implemented in 2016.
In 1995, France made it so any doctor could prescribe buprenorphine without any special licensing or training. Buprenorphine, a first-line treatment for opioid addiction, is a medication that reduces cravings for opioids without becoming addictive itself.
With the change in policy, the majority of buprenorphine prescribers in France became primary-care doctors, rather than addiction specialists or psychiatrists. Suddenly, about 10 times as many addicted patients began receiving medication-assisted treatment, and half the country’s heroin users were being treated. Within four years, overdose deaths had declined by 79 percent.
When she was 16, Charlotte Eades was diagnosed with glioblastoma, an extremely aggressive form of brain cancer. About a year after the diagnosis, she began documenting her illness and her life on her YouTube channel. After Eades died, her family made the video above, a short tribute to her life and video blog.
Annie Onishi is a general surgery resident at Columbia University and Wired asked her to break down scenes from movies and TV shows featuring emergency rooms, operating rooms, and other medical incidents. Spoiler alert: if you seek medical treatment from a TV doctor, you will probably die. Secondary spoiler alert: that adrenaline-shot-to-the-heart scene in Pulp Fiction is not as implausible as you might think, even if some of the details are wrong.
Data artist Josh Begley edited together a 5m30s video of every concussion suffered in an NFL game this year. I was barely able to get through this…I had to pause a couple of times. From an article about the video at The Intercept:
The NFL has done a masterful job at mainstreaming the violence of the game, so that fans and spectators don’t feel too bad about what’s actually happening out there. No single word has protected the NFL from the true costs of this violence more than “concussion.” That word puts a protective barrier between us and what’s really going on out on the field.
It’s not a headache. It’s not “getting your bell rung.” You don’t have a bell. It’s a traumatic brain injury. Every single concussion is a new traumatic brain injury. In addition to the torn ACLs and MCLs, in addition to all of the horrible broken bones, the NFL diagnosed at least 281 traumatic brain injuries this season. And no document has ever quite displayed the horror of it all like “Concussion Protocol,” a film by Josh Begley and Field of Vision.
The backwards slow-mo technique is a bit off-putting at first, but as Greg Dorsainville noted in the video’s thread:
If it was in forwards it would be like any big hits package you see in an espn highlight show where we celebrate the football and hit and not mourn the result of the moment: a human in pain, disorientation, and slowly killing themselves.
Having big second thoughts on watching the Super Bowl this weekend, karma offsets or no. (via @harmancipants)
In a study done by UPenn researchers, first-year medical students who were taught art observation classes at the Philadelphia Museum of Art were more proficient at reading clinical imagery than students who didn’t take the classes.
If you’re unfamiliar or uncomfortable with how art and science can mingle to produce something clinically beneficial, it’s a study premise that might seem far-fetched — but it didn’t seem that way to Gurwin, an ophthalmology resident at Penn, in part because she’d already seen the benefits of art education on a medical career firsthand.
“Having studied fine arts myself and having witnessed its impact on my medical training, I knew art observation training would be a beneficial practice in medical school,” she said. “Observing and describing are skills that are taught very well in fine arts training, and so it seemed promising to utilize their teachings and apply it to medicine.”
Gurwin and Binenbaum’s findings, published in the journal Ophthalmology in September: The medical students who’ve dabbled in art just do better.
It’s a glimpse at how non-clinical training can and does make for a better-prepared medical professional. Not only does art observation training improve med students’ abilities to recognize visual cues, it also improves their ability to describe those cues.
The results of this study reminded me of Walter Isaacson’s assertion in his book that Leonardo da Vinci’s greatest skill was his keen observational ability. Not coincidentally, Leonardo was both an artist and a medical researcher who dissected more than 30 human cadavers to study human anatomy. These dissections helped him to represent the human form more realistically in his paintings and drawings.
It’s easier to draw a hand, particularly a hand that appears to be moving (as Leonardo liked to do), if you know that’s going on underneath the skin. Looking carefully and purposefully at art, at anatomy, at the physical world, at people’s actions, at movies; it’s all the same skill that can be applied to anything.
Isaacson argues that Leonardo’s observational powers were not innate and that with sufficient practice, we can all observe as he did. People talk in a precious way about genius, creativity, and curiosity as superpowers that people are born with but noticing is a more humble pursuit. Noticing is something we can all do.
In only 90 seconds with the use of a few props (and some profanity), entertainers Penn & Teller offer a succinct and compelling argument of the benefits of vaccinating our children.
So even if vaccination did cause autism, WHICH IT FUCKING DOESN’T, anti-vaccination would still be bullshit.
Kurzgesagt takes a look at three possible areas of research that may help people live longer and healthier: senescent cells, NAD+, and stem cells. The distinction articulated early on in the video between optimizing for human lifespan versus increasing human healthspan seems particularly important in this search for a cure for aging.
According to a study published in March 2017 in the Journal of the National Cancer Institute, cancer death rates continue to fall across most cancer types. From 2010 to 2014 (the most recent year that statistical data is available), overall death rates decreased by 1.8%.
Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = -1.8% to -1.8%) per year in men, by 1.4% (95% CI = -1.4% to -1.3%) per year in women, and by 1.6% (95% CI = -2.0% to -1.3%) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers.
But the trends are much clearer when you look at progress over a longer time period. As this graph from Axios shows, the five-year survival rates for most common types of cancer have increased quite significantly in the past 30-40 years. Survival rates from all cancers increased by 16% and jumped 26% and almost 29% for non-Hodkin lymphoma and leukemia respectively. If you have prostate or thyroid cancer, you’re almost guaranteed to survive 5 years at this point and the female breast cancer survival rate is up to almost 91%. (via @Atul_Gawande)
Currently, the only way to diagnose chronic traumatic encephalopathy (CTE), a disease caused by repeated head trauma, is by posthumously examining brain tissue for signs of tau protein buildup. But a group from Boston University may have found a way to test for CTE in living patients.
McKee and her team discovered a specific biomarker in the brains of former football players. A biomarker is a measurable substance which is, in this case, found in the brain and identifies an abnormality.
This particular biomarker is called CCL11, and it’s a secreted protein the human body uses to help regulate the immune system and inflammation in the body.
As The Ringer’s Claire McNear writes, if a CTE test is easily available to players, what will that do to football? (Or indeed, what will it do to sports like soccer, boxing, skateboarding, or even skiing?)
“After learning all of this,” the retiring Ferguson wrote of the clarity he gained when he began researching CTE, “I feel a bit betrayed by the people or committees put in place by the league who did not have my best interests at heart.” He should feel betrayed, as should many of his fellow players. As will, certainly, so very many, once they have the ability to see what has happened to them. They may wonder, rightfully, about the people who trained them and paid them, sometimes even as they attempted to shut down research into CTE. They may look at the league’s structure, at the lopsided contracts that rob many players of their leverage, forcing them to choose between getting back on the field or losing a paycheck (and possibly getting cut), and at how the league cycles through players like they’re nothing more than easily broken pieces on a board.
Former New England Patriots player Aaron Hernandez, who was serving a life sentence for murdering a friend and who died in prison from suicide earlier this year, was found to have “a severe form” of CTE, a brain disease linked to repeated head trauma that has also been found in many other former NFL players.
Researchers who examined the brain determined it was “the most severe case they had ever seen in someone of Aaron’s age,” said a lawyer for Hernandez in announcing the result at a news conference on Thursday. Hernandez was 27.
Hernandez played three seasons in college and only three in the NFL, yet the damage to his brain was similar to “players with a median age of 67 years”. If you’re a young football player in college or the NFL right now, you have to be looking at this situation pretty hard right now.
If Ed Cunningham had not already seen enough, he would be back in a broadcast booth on Saturday afternoon, serving as the color analyst for another top college football game televised on ABC or ESPN. It is the work he has done each fall for nearly 20 years.
But Cunningham, 48, resigned from one of the top jobs in sports broadcasting because of his growing discomfort with the damage being inflicted on the players he was watching each week. The hits kept coming, right in front of him, until Cunningham said he could not, in good conscience, continue his supporting role in football’s multibillion-dollar apparatus.
Another domino falls. Unless there are big changes to the game play, sooner or later football will likely become a marginalized sport in the US.
In the wake of his diagnosis, many of those expressing support for McCain reference his considerable personal strength in his fight against cancer. President Obama said:
John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.
John and I have been friends for 40 years. He’s gotten through so much difficulty with so much grace. He is strong — and he will beat this.
This is the right thing to say to those going through something like this, and hearing this encouragement and having the will & energy to meet this challenge will undoubtably increase McCain’s chances of survival. But what Biden said next is perhaps more relevant:
Incredible progress in cancer research and treatment in just the last year offers new promise and new hope. You can win this fight, John.
As with polio, smallpox, measles, and countless other diseases before it, beating cancer is not something an individual can do. Being afflicted with cancer is the individual’s burden to bear but society’s responsibility to cure. In his excellent biography of cancer from 2011, The Emperor of All Maladies, Siddhartha Mukherjee talks about the progress we’ve made on cancer:
Incremental advances can add up to transformative changes. In 2005, an avalanche of papers cascading through the scientific literature converged on a remarkably consistent message — the national physiognomy of cancer had subtly but fundamentally changed. The mortality for nearly every major form of cancer — lung, breast, colon, and prostate — had continuously dropped for fifteen straight years. There had been no single, drastic turn but rather a steady and powerful attrition: mortality had declined by about 1 percent every year. The rate might sound modest, but its cumulative effect was remarkable: between 1990 and 2005, the cancer-specific death rate had dropped nearly 15 percent, a decline unprecedented in the history of the disease. The empire of cancer was still indubitably vast — more than half a million American men and women died of cancer in 2005 — but it was losing power, fraying at its borders.
What precipitated this steady decline? There was no single answer but rather a multitude. For lung cancer, the driver of decline was primarily prevention — a slow attrition in smoking sparked off by the Doll-Hill and Wynder-Graham studies, fueled by the surgeon general’s report, and brought to its full boil by a combination of political activism (the FTC action on warning labels), inventive litigation (the Banzhaf and Cipollone cases), medical advocacy, and countermarketing (the antitobacco advertisements). For colon and cervical cancer, the declines were almost certainly due to the successes of secondary prevention — cancer screening. Colon cancers were detected at earlier and earlier stages in their evolution, often in the premalignant state, and treated with relatively minor surgeries. Cervical cancer screening using Papanicolaou’s smearing technique was being offered at primary-care centers throughout the nation, and as with colon cancer, premalignant lesions were excised using relatively minor surgeries. For leukemia, lymphoma, and testicular cancer, in contrast, the declining numbers reflected the successes of chemotherapeutic treatment. In childhood ALL, cure rates of 80 percent were routinely being achieved. Hodgkin’s disease was similarly curable, and so, too, were some large-cell aggressive lymphomas. Indeed, for Hodgkin’s disease, testicular cancer, and childhood leukemias, the burning question was not how much chemotherapy was curative, but how little: trials were addressing whether milder and less toxic doses of drugs, scaled back from the original protocols, could achieve equivalent cure rates.
Perhaps most symbolically, the decline in breast cancer mortality epitomized the cumulative and collaborative nature of these victories — and the importance of attacking cancer using multiple independent prongs. Between 1990 and 2005, breast cancer mortality had dwindled an unprecedented 24 percent. Three interventions had potentially driven down the breast cancer death rate-mammography (screening to catch early breast cancer and thereby prevent invasive breast cancer), surgery, and adjuvant chemotherapy (chemotherapy after surgery to remove remnant cancer cells).
Understanding how to defeat cancer is an instance where America’s fierce insistence on individualism does us a disservice. Individuals with freedom to pursue their own goals are capable of a great deal, but some problems require massive collective coordination and effort. Beating cancer is a team sport; it can only be defeated by a diverse collection of people and institutions working hard toward the same goal. It will take government-funded research, privately funded research, a strong educational system, philanthropy, and government agencies from around the world working together. This effort also requires a system of healthcare that’s available to everybody, not just to those who can afford it. Although cancer is not a contagious disease like measles or smallpox, the diagnosis and treatment of each and every case brings us closer to understanding how to defeat it. We make this effort together, we spend this time, energy, and money, so that 10, 20, or 30 years from now, our children and grandchildren won’t have to suffer like our friends and family do now.
According to a recent interview with Stephens-Davidowitz, right now the data is showing an increase in search queries on how to perform abortions at home and, no surprise, the activity is highest in parts of the country where access to abortion is most difficult.
I’m pretty convinced that the United States has a self-induced abortion crisis right now based on the volume of search inquiries. I was blown away by how frequently people are searching for ways to do abortions themselves now. These searches are concentrated in parts of the country where it’s hard to get an abortion and they rose substantially when it became harder to get an abortion. They’re also, I calculate, missing pregnancies in these states that aren’t showing up in either abortion or birth rates.
That’s pretty disturbing and I think isn’t really being talked about. But I think, based on the data, it’s clearly going on.
Early in my medical training, I learned that it is not the bullet that kills you, but the damage from the bullet. A handgun bullet enters the body in a straight line. Like a knife, it damages the organs and tissues directly in its path, and then it either exits the body or is stopped by bone, tissue or skin.
This is in contrast to bullets from an assault rifle. They are three times the speed of handgun bullets. Once they enter the body, they fragment and explode, pulverizing bones, tearing blood vessels and liquefying organs.
Earlier this year, Jason Fagone wrote a much longer piece on the same topic for HuffPost.
“As a country,” Goldberg said, “we lost our teachable moment.” She started talking about the 2012 murder of 20 schoolchildren and six adults at Sandy Hook Elementary School. Goldberg said that if people had been shown the autopsy photos of the kids, the gun debate would have been transformed. “The fact that not a single one of those kids was able to be transported to a hospital, tells me that they were not just dead, but really really really really dead. Ten-year-old kids, riddled with bullets, dead as doornails.” Her voice rose. She said people have to confront the physical reality of gun violence without the polite filters. “The country won’t be ready for it, but that’s what needs to happen. That’s the only chance at all for this to ever be reversed.”
She dropped back into a softer register. “Nobody gives two shits about the black people in North Philadelphia if nobody gives two craps about the white kids in Sandy Hook. … I thought white little kids getting shot would make people care. Nope. They didn’t care. Anderson Cooper was up there. They set up shop. And then the public outrage fades.”
In retrospect Sandy Hook marked the end of the US gun control debate. Once America decided killing children was bearable, it was over.
Update: Radiologist Heather Sher was on duty at a Florida trauma center when victims from the shooting at Marjory Stoneman Douglas High School were coming in. In this piece for The Atlantic, she explains how drastically different the wounds are from the AR-15 than from other guns.
In a typical handgun injury that I diagnose almost daily, a bullet leaves a laceration through an organ like the liver. To a radiologist, it appears as a linear, thin, grey bullet track through the organ. There may be bleeding and some bullet fragments.
I was looking at a CT scan of one of the victims of the shooting at Marjory Stoneman Douglas High School, who had been brought to the trauma center during my call shift. The organ looked like an overripe melon smashed by a sledgehammer, with extensive bleeding. How could a gunshot wound have caused this much damage?
The reaction in the emergency room was the same. One of the trauma surgeons opened a young victim in the operating room, and found only shreds of the organ that had been hit by a bullet from an AR-15, a semi-automatic rifle which delivers a devastatingly lethal, high-velocity bullet to the victim. There was nothing left to repair, and utterly, devastatingly, nothing that could be done to fix the problem. The injury was fatal.
In addition to the obvious horrorshow of carnage caused by AR-15-propelled bullets, what gets me is the phrase “a typical handgun injury that I diagnose almost daily”. In other countries, daily gunshot wounds would be an alarming situation in need of immediate response, but the in the US, it’s just a prelude to even greater horrors.
On Monday, August 22, 2016, a surgical team at Johns Hopkins Hospital in Baltimore removed my left kidney. It was then drained of blood, flushed with a preservative solution, placed on ice, and flown to Cincinnati.
Surgeons in Cincinnati then transplanted the kidney into a recipient I’d never met and whose name I didn’t know; we didn’t correspond until this past month. The only thing I knew about him at the time was that he needed my kidney more than I did. It would let him avoid the physically draining experience of dialysis and possibly live an extra nine to 10 years, maybe more.
Why did he do it? Because he thought it was the right thing to do morally.
I’d wanted to give a kidney for years — at least since I first heard it was possible after reading Larissa MacFarquhar’s New Yorker piece on “good Samaritan” kidney donors when I was in college. It just seemed like such a simple and clear way to help someone else, through a procedure that’s very low-risk to me. I studied moral philosophy as an undergrad, and there’s a famous thought experiment about a man who walks by a shallow pond where a child is drowning and does nothing, because leaping in to save the child might muddy his clothes.
As Matthews notes, all you need to do to get started on the road to becoming a living donor is fill out this form.
Vivek Murthy, the surgeon general of the United States, has said many times in recent years that the most prevalent health issue in the country is not cancer or heart disease or obesity. It is isolation.
Oh.
Beginning in the 1980s, Schwartz says, study after study started showing that those who were more socially isolated were much more likely to die during a given period than their socially connected neighbors, even after you corrected for age, gender, and lifestyle choices like exercising and eating right. Loneliness has been linked to an increased risk of cardiovascular disease and stroke and the progression of Alzheimer’s. One study found that it can be as much of a long-term risk factor as smoking.
The research doesn’t get any rosier from there. In 2015, a huge study out of Brigham Young University, using data from 3.5 million people collected over 35 years, found that those who fall into the categories of loneliness, isolation, or even simply living on their own see their risk of premature death rise 26 to 32 percent.
Once at a former deli job, I passed out onto a pizza oven in response to a coworker’s particularly graphic description of a lawn mower injury. Had the oven been on, I would have suffered some pretty drastic burns.
I’m a fainter, though not at the sight of blood. After fainting a couple of times in high school, a doctor chalked it up to low blood pressure — I am the chillest mofo you know, blood pressure-wise — and urged me not to stand up too quickly after lying down. Just this morning, I did not heed that advice and almost toppled over after getting out of bed and stretching my arms above my head.
But my bigger problem, and what made Rotman’s comic resonate with me, is that medical procedures and doctor’s offices also cause me to faint. This wasn’t always the case. When I was younger, I received allergy shots up to three times a week and had no problem going into the clinic to get my shot…I even looked at the thin needle going into my arm every time. Flu shots, dentist visits, doctor’s appointments? No problem. Then when I was 17, I went to the local clinic for a mandatory physical for college. They did a blood draw, which went smoothly, but right afterwards, as I was sitting in a chair in the hallway, I fainted — probably because of my low blood pressure. Weird, but not a big deal.
Fast forward 12-15 years, during which time (because I was young and healthy and dumb and medical care is expensive) I did not visit a doctor’s office1 and somehow I had developed a phobia of needles going into my skin. I found this out when I went to get a flu shot, watched the needle sink into my arm, and promptly passed the fuck out.2 Since then, any time I’ve had to get a shot or blood drawn, I have fainted (or at least felt like I was going to).
That’s bad enough, but the problem became psychosomatic. Any trip to a doctor’s office will now trigger a faint feeling, even if I’m not the patient. Every time I take my kids to the pediatrician, there’s a possibility I’ll end up on the floor. When my wife was pregnant with our first kid, I nearly fainted at one of her ultrasound appointments and the ultrasound tech plopped me down in a nearby chair and handed me a glucose drink, telling me that becoming a father is a lot to handle for some men. (I think I nodded weakly, not even able to muster a “yeah, it’s not that”.) It’s gotten to the point where even *thinking* about it makes me feel weird. My palms have been sweaty and I’ve felt lightheaded the entire time I’ve been writing this post. The same thing happens when I tell people about it in person. It’s ridiculous and I feel stupid about it, even though it’s a stark reminder how much your subconscious thoughts can affect your body (and how little control we have over ourselves sometimes).
As Rotman did, I have been attempting exposure therapy with some success. When I went in for a physical a few months ago, I told the nurse that I might faint during the blood draw. She had me lay down on the table and just before she came over with the kit, I popped my headphones in and put on some relaxing music (Tycho I think). I broke out in a sweat and the procedure took much longer than it should have — she had to stick me *twice* because she didn’t get enough the first time — but I got through it without passing out. Progress to build on, I hope!
Aside from a trip to the emergency room from — you guessed it! — a fainting incident when I was 24. Came to on the floor of the bathroom having slammed my mouth on the edge of the counter. It was exactly as painful as it sounds and it totally fucked up my grill.↩
And wow, did the nurse look alarmed when I came to a few seconds later. They all look alarmed, even when I tell them ahead of time that I might faint. One of the last times, the nurse said, “I didn’t think you were actually serious.” (That fainting experience was the weirdest one I’ve ever had. According to the nurse, I was out for about 6-8 seconds but had a whole experience in my head that lasted for at least a half hour. I wasn’t near death, but it felt very real and I can definitely see how some people would interpret that as an out-of-body or religious experience.)↩
The Wellcome Image Awards 2017 recognize the best images related to healthcare and biomedical science taken during the past year.
The Wellcome Image Awards are Wellcome’s most eye-catching celebration of science, medicine and life. Now in their 20th year, the Awards recognise the creators of informative, striking and technically excellent images that communicate significant aspects of healthcare and biomedical science. Those featured are selected from all of the new images acquired by Wellcome Images during the preceding year. The judges are experts from medical science and science communication.
From top to bottom, there’s Mark R. Smith’s photo of a baby Hawaiian bobtail squid, neural stem cells growing on a synthetic gel photographed by Collin Edington and Iris Lee, and Scott Echols’ image of a pigeon’s blood vessel network. (via digg)
Before the Roe v. Wade Supreme Court decision in 1973, most women seeking abortions in the US had to get them illegally. Illegal abortions were often unsafe & painful, and many women died, were injured, or were sexually assaulted by the men performing the procedures. In this video, three women who had abortions before 1973 and a woman who worked at a Brooklyn hospital in that era described their experiences.
“He said, ‘I’m not going to give you any anesthetic’ and he said ‘If you scream, they will hear you.’”
That’s how Connie described the illegal abortion she received in 1953 when she was 16 years old. Now a retired teacher, mother and grandmother, Connie said that after she received the abortion, the man who performed the procedure proceeded to sexually assault her as she lay bleeding on the table.
Bill: If we could show you only one number that proves how life has changed for the poorest, it would be 122 million — the number of children’s lives saved since 1990.
Melinda: Every September, the UN announces the number of children under five who died the previous year. Every year, this number breaks my heart and gives me hope. It’s tragic that so many children are dying, but every year more children live.
Bill: More children survived in 2015 than in 2014. More survived in 2014 than in 2013, and so on. If you add it all up, 122 million children under age five have been saved over the past 25 years. These are children who would have died if mortality rates had stayed where they were in 1990.
Bill calls saving children’s lives “the best deal in philanthropy”. Melinda continues:
Melinda: And if you want to know the best deal within the deal — it’s vaccines. Coverage for the basic package of childhood vaccines is now the highest it’s ever been, at 86 percent. And the gap between the richest and the poorest countries is the lowest it’s ever been. Vaccines are the biggest reason for the drop in childhood deaths.
Melinda: They’re an incredible investment. The pentavalent vaccine, which protects against five deadly infections in a single shot, now costs under a dollar.
Bill: And for every dollar spent on childhood immunizations, you get $44 in economic benefits. That includes saving the money that families lose when a child is sick and a parent can’t work.
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