Credit Where It’s Due

January 13, 2009

What will be Bush’s greatest positive legacy? I think PEPFAR is a likely candidate, despite its flaws. I can’t think of any other program initiated by Bush that has helped so many people.

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DC Hurts My Brain

January 6, 2009

Jonah Lehrer (of the Frontal Cortex, author of Proust Was a Neuroscientist) writes How the City Hurts Your Brain in the Boston Globe:

Related research has demonstrated that increased “cognitive load” — like the mental demands of being in a city — makes people more likely to choose chocolate cake instead of fruit salad, or indulge in a unhealthy snack. This is the one-two punch of city life: It subverts our ability to resist temptation even as it surrounds us with it, from fast-food outlets to fancy clothing stores. The end result is too many calories and too much credit card debt.

Don’t worry, there are benefits too.


Good News, Bad News

March 29, 2008

The World Health Organization has announced that polio has been eradicated from Somalia. This was an incredibly difficult task, given Somalia’s endemic violence and instability. And it took a huge effort:

More than 10,000 Somali volunteers and health workers vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times.

However, this has happened before. Polio was eradicated from Somalia back in 2002, only to be reintroduced from Nigeria. The fact that polio was reintroduced from a country on the other side of the continent calls attention to the interrelatedness of disease control efforts in different countries (diseases know no borders) and the tragedies that occur when vaccination efforts clash with local cultures or religions.

But despite its tenuous progress in terms of total eradication, the WHO’s $4 billion polio campaign has made great steps forward:

When WHO and partners began their anti-polio campaign in 1988, the worldwide case count was more than 350,000 annually. The disease’s incidence has since been slashed by more than 99 percent and remains endemic in four countries: Afghanistan, India, Nigeria and Pakistan. Polio cases were also detected last year in Angola, Cameroon, Chad, Congo, Myanmar, Nepal, Niger and Sudan.

So that’s the good (albeit cautiously so) news. The bad news for Somalia:

Somalia’s Government Teeters on Collapse

If you read that and asked “wait, Somalia has a government?” you’re not alone. But it does have a government of sorts:

By its own admission, the Transitional Federal Government of Somalia is on life support. When it took power here in the capital 15 months ago, backed by thousands of Ethiopian troops, it was widely hailed as the best chance in years to end Somalia’s ceaseless cycles of war and suffering.

But now its leaders say that unless they get more help — international peacekeepers, weapons, training and money to pay their soldiers, among other things — this transitional government will fall just like the 13 governments that came before it.

Less than a third of the promised African Union soldiers have arrived, the United Nations has shied away from sending peacekeepers and even the Ethiopians are taking a back seat, often leaving the government’s defense to teenage Somalis with clackety guns who are overwhelmed.


The Draw of Dermatology?

March 20, 2008

This piece in the New York Times focuses on a married couple, both Harvard Medical School students, who are in their fourth year and waiting to find out about their residency placements. Like many medical students around the nation, they’re competing for competitive placements in specialty fields instead of going into less lucrative (and possibly less intellectually stimulating?) fields such as family practice and internal medicine.

And the competition is expensive:

Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.

The article makes me a little sad in general. I had a conversation at CGI U with a med school student who warned me about the “vortex” of med school. Paraphrased: “Everyone’s the same. You get to med school all idealistic, wanting to help people and stuff. Then you spend years and years studying and working, and you see the people ahead of you getting money. You see the doctors with the nice cars and comfortable lives, and you start to wonder when you’re getting yours? And you get into so much debt that you realize you have to practice, and practice well if you want to get out of that hole.”

I’m certainly idealistic about why I want to go to medical school. In fact, the struggle for me is deciding between larger scale health policy work–doing research, designing disease control programs, advocacy, etc.–and traditional clinical work, or how to balance both. I’ve never seen myself as one to get into private practice, or really even treating patients full-time as a traditional clinician. But the vortex sucks many people in.

The problem is ultimately not with the medical students who are drawn to dermatology and plastic surgery for the better pay. Medical students will inevitably be drawn toward the specialties that combine interesting work with the highest pay. From the NYTimes again:

“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.

The market simply isn’t working here. We need more (many more!) primary care physicians. There’s a lot more demand for services there. But people who have the money to pay more for cosmetic treatments and surgery skew the demand away from those who don’t have the money to get adequate treatment for more life-threatening conditions like diabetes and high blood pressure.

I’m not sure what the solution is either. I know it would need to be a large-scale systemic change; merely getting pre-med students to read about Paul Farmer isn’t going to change everyone. Maybe having a single-payer system where doctors are compensated as much or more for basic services as they are for cosmetic services? Or maybe a loan-repayment situation where medical school is even more expensive, but all loans are automatically repaid by the government for those not going into specialties. Who knows. Suggestions?


Focus.

March 11, 2008

Many Doctors, Many Tests, No Rhyme or Reason

All of our investments in high-tech medicine and tons of tests, as well as the drive toward further specialization, aren’t really having an impact on public health indicators like life expectancy and child mortality. But for those who want to go into medicine (like me) the sexy, intellectually-stimulating, cutting-edge, fiscally-rewarding work is in those specialties.

We need to have a different focus.

“In an age of explosive development in the realm of medical technology, it is unnerving to find that the discoveries of Salk, Sabin, and even Pasteur remain irrelevant to much of humanity.” – Paul Farmer

“The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” – Rudolf Virchow


The Language of Abortion

July 5, 2007

Fred Thompson

And again (with a little more detail)

Interesting how this will play out for the uber-conservatives I know who support him.

Here’s one with a (compassionate) quote from Barack Obama, made by a conservative Christian (enjoy the music from Jaws especially):

The amount of in-fighting between Christians on the issue of abortion can be truly vicious. This sort of clip reminds me again and again how Obama’s worldview is closer to my own than to the majority of self-proclaimed Christians I know.

Rudy Giuliani on public funding for abortion (you can bet this one will end up in campaign ads for pro-life Republicans if it hasn’t already!):

And finally, Hillary‘s response on reducing the number of abortions (with some odd sidetracking, like saying ‘the free market has failed’–wtf?, but overall good):


On Domestic Violence

June 28, 2007

It’s everywhere.

The Observant Woman writes on a true story, “Our Disturbing Brush with Domestic Violence.”

A shelter for women that does excellent work I greatly admire is Rose Brooks in the Kansas City area. If more cities had a place like this, it would go a long, long way.