The 2013 Nobel prizes were awarded in October, but as this is the time of year when many of us are surrounded by treats — holiday gifts and celebration goodies — we thought we’d ease a little guilt on holiday consumption and maybe add a little perspective to common New Year’s resolutions.
Why would the sweet treat be linked to winning the most prestigious intellectual award, you ask? In the New England Journal of Medicine, Dr. Franz H. Messerli, a cardiologist at St. Luke’s–Roosevelt Hospital in New York City, writes that cocoa contains flavanols, plant-based compounds that previous studies have linked to the slowing or reversing of age-related cognitive decline. (You can also get flavonols in green tea, red wine and some fruits.) Read more…
This article and comments put the lie to our health care system being among the best, or driven by the free market. It is politically and economically corrupt and untenable. The benefits that drive much of the hysterics against reform elude the many who have no coverage, and the rest of us, who are billed in irrational ways, ignorant of price until the bill is issued to a third party who ignores it and pays something else, are receiving care that is frequently unnecessary and without positive impact.
The 30-50% more of our GDP that we pay in the US system – as compared to our Canadian neighbors to the north and many other countries we have no problem admiring and vacationing in – is money that could go to education, higher salaries, or any number of other productive uses.
Waste and inefficiencies are not of benefit to any but a few. The zeitgeist is rapidly moving towards recognizing the debacle of our current system and doing something about it. Change is being fought and fought hard, but in the end, facts and data will hopefully win out. It may take longer than some would wish, but the facts that were closely held about excesses and irrationality are now being seen and studied by a wide group. And it is no longer unfashionable or “leftist” to consider and advocate for other options.
Last month, to the consternation of a few readers, we blogged about emotional support pets, citing an article in The New York Times which noted pushback against pets riding for free on planes with no systematic standards as to what constitutes emotional support and medical necessity.
Psychiatrist Dinah Miller, who has been in the position of reviewing such use, chimes in to discuss the criteria involved and her thought process:
Like most things, defining the lines of what it is to “need” an animal on a flight and what training should be required for “support” pets won’t be a problem until someone is bitten or distressed, or until a passenger announces they must bring their emotional support snake aboard a flight where someone has a phobia. In the meantime, I’ll contend that I like seeing an occasional cute dog on planes, but this isn’t a psychiatric issue.
The authors of this article argue that technology and change in regulations will effectively address concerns about a looming doctor shortage. Underscoring their assumptions is the novel concept that medicine ought not be immune from innovation at the system and delivery level, in much the same way that other businesses have changed and adapted.
As interesting as the article is, the comments by readers are even more so, both in their content and in the defensive fears that underscore many, accompanied by a cry to preserve the basic status quo while raising reimbursement. The devil of Medicaid is raised by more than one, claiming that treating such patients is simply unaffordable, thus diverting doctors to lucrative concierge practices.
So called mid-level practitioners including PAs (physicians assistants) and nurse practitioners are alternately praised or criticized, based more upon feelings and anecdotes than data.
The basic theme of the naysayers is leave the system alone, increase reimbursement, continue with fee-for-service excesses and basically make an unviable system even worse as a result. The clear lack of consensus based largely upon one’s personal interests or politics underscores virtually every aspect of the health care debate.
Health care in the US is belatedly being thrust into the real world of economics, where those paying get say in what they are willing to buy and willing to spend. This concept is simple in most things, where we open our own wallets. But when it comes to the wallet of employers, fellow citizens and government – those who pay for our healthcare, we have a medical equivalent of “the tragedy of the commons,” an economics theory by Garrett Hardin, according to which “the depletion of a shared resource by individuals, acting independently and rationally according to each one’s self-interest, despite their understanding that depleting the common resource is contrary to the group’s long-term best interests.”
In this case, we individuals are depleting the shared resource of the health care system by acting in our own self-interests to the detriment of all.
I don’t make a habit of sharing views on world events with the company. But the passing of Nelson Mandela has deeply moved me and compels me to write.
I believe that Mandela is the greatest and most impactful statesman and leader in my lifetime to date and I believe in yours. I was born in 1952, a few years after the death of Gandhi, who might have been a rival for this distinction, from whom Mandela learned a great deal, and who by chance or not, spent his formative years in South Africa as well.
His memorial in several days will be a major world event, attended I am sure, by most significant world leaders and many more. I will watch it in his honor and as an observer of a major piece of world history. You should as well. His life deserves study and familiarity by all. Perhaps this note might cause a few of you to learn more about him.
I was a boy in the civil rights era, and had one memorable experience when driving with my family from Detroit to Florida, of stopping in a southern town for gas and seeing segregated bathrooms and drinking fountains. I will never forget it. Growing up in Detroit, I was also well aware of the de-facto segregation of much of the community, and the prominence of race in our lives, though it was unofficial rather than the official policy of many areas of the country until the 60’s. I recall my city burning in 1967 during the famous race riots.
The system of apartheid that Mandela confronted in South Africa was profound and all-encompassing for everyone there, regardless of color, but the deprivations were great for the black majority.
I hope that you will take the time to learn about Mandela, in the many tributes, news coverage and articles on him. Here is The New York Times Coverage. And President Obama’s statement was meaningful and moving to me.
I have had the privilege of 3 visits to South Africa in recent years, first with my son when he graduated high school – taking a long drive from Johannesburg to Cape Town, and seeing some great wildlife along the way. Then I returned twice when my daughter and her family lived there for two years until this past June, working as teachers. It is a vibrant and modern country that really changed my stereotypes of Africa. It has been remade socially and economically since the end of Apartheid, largely flowing from the work of Mandela.
He, his party, and the black majority of that country could have easily justified revenge for the deprivations, abuses and deaths flowing from the years of white minority rule. Many would have died in violent retribution or spent decades in prison. The whites would have fled and the country could easily have been more like Zimbabwe, the country next door with a dictator, and a history of oppression and economic failure following its “liberation” from white colonialism. In my trips to South Africa I see a proud place of 50 million or so people, many ethnicities, 10 or so official languages, and a love of human rights. Far from perfect, and in need of more economic gains for the many poor there, it is still the jewel of Africa, a vibrant democracy and an example in so many ways to others who may be cynical about the capacity of people and nations to change.
But where Mandela has made his mark on the world and on me is not only as a statesman and national leader, but in showing individuals that there are different and effective ways to deal with conflict and with one’s enemies that do not involve revenge and violence. His concept of reconciliation through truth and justice (http://en.wikipedia.org/wiki/Truth_and_Reconciliation_Commission_(South_Africa) ) is revolutionary and could and should be studied and imitated in every conflict or potential conflict. He basically embraced his enemies and showed a new path. He has inspired me in small ways to consider and adopt alternatives to anger and revenge in the face of the various mishaps, real or perceived abuses that one faces in life. Adversaries are best treated with respect, and hate – a very costly emotion, should be used sparingly if at all. Hatred destroys the hater more than the person who is the object of hate. When one moves on from difficult or destructive people with neutrality, indifference, or even a form of love and humanity, it elevates us to something better than we were before. Mandela’s legacy has been adopted by families of and victims of violence including murder, who have engaged in reconciliation with the wrongdoer. This is not an act of stupidity or pity, but one of self-respect and preservation for people whose lives could otherwise be destroyed.
His 27 years in prison on Robben Island and the humanity he practiced with his guards and fellow inmates is an inspiration. And the struggles that he, his people and so many others in the world have endured and are enduring as this is written should bring pause to any of us who may complain about our lives.
Thank you Madiba for changing the world. Your passing, while anticipated for some time, will allow the world for a moment or more to think about other possibilities that you have demonstrated are real.
That a professional society would consider expelling a member who treats men is disturbing. There is no suggestion that the doctors in this article are under threat of loss of licensure due to questions of competence or ethical issues. On the contrary, they appear to be exercising their skill and expertise in treating the men in question. Try as I might, I can’t figure out why an esteemed professional board would impose on the practice of medicine. I thought Boards are in place to certify competence in a given specialty, not to tell a trained physician that they may not treat patients and exercise their skills in the service of health?
We should all be concerned about such policies and can imagine all sorts of mischief. Might the psychiatric board see fit to drum out a psychiatrist who sews up a laceration, drawing upon their general medical training? Telling a specialist that they may not treat a man is non-sensical and offensive. Were there a specialty that primarily treats men, punishing members who chose to treat women, there would likely be cries of discrimination and much indignation. Nobody’s interests would appear to be served by this rule. Let’s hope it is changed quickly.
Being able to decide when to have children is central to fulfilling one’s potential. In the year ahead, many women will harness this power for the first time. Melinda Gates discusses funding for family planning in this New York Times Op Ed piece:
In July 2012, I co-hosted a summit meeting on family planning in London. The evidence was clear: The world had been underinvesting in the field for years, with serious consequences for women, their families and their communities. We invited leaders from dozens of countries and key global health organizations and private industry, along with women’s health advocates, to put the needs of women back on the global agenda. It was deeply moving to see older advocates who’d given their lives to this issue pass their passion to a new generation. The participants signed onto a big goal: helping 120 million women who didn’t have access to family planning to get it by 2020.