Even China's moving toward universal health care: "China Health Reform to Give Every Village a Clinic," (AP, April 8, 2009). Of course, they are communist....
Jeffrey Sachs brings to our attention the President's attention to agricultural development in developing areas: "Homegrown Aid," (NYT, April 9, 2009). His comments about the traditional way aid is handled versus his recommendations for how it should be handled are important to note, if we really want our money to make a difference, that is.
4.09.2009
4.07.2009
The Fun (Fight) Begins
The Times signals that the debate over the shape that healthcare reform will take has commenced: "A Public Plan for Health Insurance?" (NYT, April 7, 2009). The bottomline of their perspective is worth considering: if the government launches a public insurance program that one can opt into voluntarily, and more people opt into it than opt into private health care...isn't that a sort of referendum, a sort of voting? In other words, as they say, "If, over time, a vast majority decides the government plan is superior, so be it." I agree. That's democracy in action. It'd be nice if many folks in this country would actually support democracy rather than just pay lip service to it.
Here's Uwe Reinhardt's explanation of it: "A Medicare-like Plan for the Non-Elderly," (Economix, April 6, 2009).
And an important corrective to the tired lines about socialized medicine: "More on Healthcare Rationing," (Economix, April 7, 2009).
Oh, and before I forget, a couple of very interesting pieces about socialism from this past weekend's Journal-Sentinel: "Here, Socialism Meant Honest, Frugal Government," (MJS, April 4, 2009). And, "Obama Isn't a Socialist, and Here's Why," (MJS, April 2, 2009). I like the first piece because it shows what socialism can look like in action in the United States, using real, historical data. Now, obviously there is a spectrum among "socialists," especially since the folks written about in the first article don't look like the folks written about in the second article. But what is at the center of both pieces is a strong, vibrant sense of the public good -- the "goods" that the public holds in common, that cannot simply be held privately because they are common to all persons, which is, of course, a very Catholic idea.
Now this raises all sorts of interesting ethical questions (not to mention movie plots): "Brain Researchers Open Door to Editing Memory," (NYT, April 7, 2009). Yes, this could be used therapeutically....could it be used any other way?
Here's Uwe Reinhardt's explanation of it: "A Medicare-like Plan for the Non-Elderly," (Economix, April 6, 2009).
And an important corrective to the tired lines about socialized medicine: "More on Healthcare Rationing," (Economix, April 7, 2009).
Oh, and before I forget, a couple of very interesting pieces about socialism from this past weekend's Journal-Sentinel: "Here, Socialism Meant Honest, Frugal Government," (MJS, April 4, 2009). And, "Obama Isn't a Socialist, and Here's Why," (MJS, April 2, 2009). I like the first piece because it shows what socialism can look like in action in the United States, using real, historical data. Now, obviously there is a spectrum among "socialists," especially since the folks written about in the first article don't look like the folks written about in the second article. But what is at the center of both pieces is a strong, vibrant sense of the public good -- the "goods" that the public holds in common, that cannot simply be held privately because they are common to all persons, which is, of course, a very Catholic idea.
Now this raises all sorts of interesting ethical questions (not to mention movie plots): "Brain Researchers Open Door to Editing Memory," (NYT, April 7, 2009). Yes, this could be used therapeutically....could it be used any other way?
4.06.2009
Med Students with a Conscience
Here's a truly useful site for most of you: "Health Student Network." The name of the site doesn't exactly convey its purpose, which was summarized when it was sent to me as follows: "This is a news and social network for health students, researchers and professionals. It's just starting. Its niche is global health and development rather than how to pass first year anatomy. We hope that by combining news and comment with social networking, the site may be used by a wide range of health students and practitioners around the world. It may even help to get medical students and student nurses interested in public health and development issues! "
If you know of more sites like this, send them on to me and I'll post them.
If you know of more sites like this, send them on to me and I'll post them.
4.05.2009
Beyond Greed
The Times ran a number of interesting items in their business section today on executive compensation, and they're just worth noting.
First, "Who Moved My Bonus? Executive Pay Makes a U-Turn," (NYT, April 5, 2009). Even down 50%, these pay scales are still obscene.
Second, here's a very nice accounting of executive compensation. It should make your stomach turn: "The Pay at the Top," (NYT, April 5, 2009).
Third, the blame goes a long way: "Executives Took, but the Directors Gave," (NYT, April 5, 2009).
Fourth, a map of the recession as of a month ago, via unemployment: "The Geography of a Recession," (NYT, March 3, 2009).
First, "Who Moved My Bonus? Executive Pay Makes a U-Turn," (NYT, April 5, 2009). Even down 50%, these pay scales are still obscene.
Second, here's a very nice accounting of executive compensation. It should make your stomach turn: "The Pay at the Top," (NYT, April 5, 2009).
Third, the blame goes a long way: "Executives Took, but the Directors Gave," (NYT, April 5, 2009).
Fourth, a map of the recession as of a month ago, via unemployment: "The Geography of a Recession," (NYT, March 3, 2009).
4.04.2009
The Pope May Be Right
I am steadfastly not watching basketball tonight, ergo, I shall post. That, and I have been spurred out of my over-taxed silence by an interesting article just sent me by a former student. I have vented to some on my annoyance with the media's coverage of the Pope's visit to Africa. One might think that the only word he uttered on his multi-day tour was the word "condom." Here, at last, is a more sane perspective: "The Pope May Be Right," (Washington Post, March 29, 2009). Nuance, facts -- they're so refreshing.
Speaking of Africa, and the 'third world' generally, Nicholas Kristof remains on the case, bringing a new issue to the attention of the west: "Pssst. Pneumonia. Pass It On," (NYT, April 4, 2009). Given some of my current research interests, this article was particularly of interest. And relatedly, no great surprise, but to keep it on the radar: "HIV Infection Sharply Raises Risk for TB, Report Says," (NYT, March 30, 2009).
The latest post from Uwe Reinhardt: "Defining 'Health Care Reform," (Economix, March 27 2009). I plan to refrain from posting articles about current proposals for healthcare reform until we actually have something concrete and not just hypothetical. This post is helpful, though, for defining what the parameters of any proposal will have to include.
Something to think about for down the road: "Treating an Illness is One Thing: What About a Patient With Many?" (NYT, March 30, 2009). This is why we need more geriatricians -- a specialty you all should consider. Not only are more and more patients finding themselves in this situation, doesn't it figure that: "Doctors are Opting Out of Medicare," (NYT, April 1, 2009). Just when people need them, the docs turn the other direction. Gotta love contemporary medicine. Especially when it has results like this: "Study Finds Many on Medicare Return to Hospital," (NYT, April 1, 2009).
How will you learn to talk to your patients about dying? Will you avoid it by going into a 'safe' profession like family practice? Is it essential to the medical profession to know how to have these conversations? "At the End of Life, Denial Comes at a Price," (NYT, April 3, 2009).
And last but not least, most timely since my current research projects are on research ethics in developing countries, they've finally settled this Pfizer suit that has been going on since, I think, 1996 (yes, 13 years): "Deal in Pfizer-Nigeria Drug Suits," (BBC, April 3, 2009). More on this topic soon.
Speaking of Africa, and the 'third world' generally, Nicholas Kristof remains on the case, bringing a new issue to the attention of the west: "Pssst. Pneumonia. Pass It On," (NYT, April 4, 2009). Given some of my current research interests, this article was particularly of interest. And relatedly, no great surprise, but to keep it on the radar: "HIV Infection Sharply Raises Risk for TB, Report Says," (NYT, March 30, 2009).
The latest post from Uwe Reinhardt: "Defining 'Health Care Reform," (Economix, March 27 2009). I plan to refrain from posting articles about current proposals for healthcare reform until we actually have something concrete and not just hypothetical. This post is helpful, though, for defining what the parameters of any proposal will have to include.
Something to think about for down the road: "Treating an Illness is One Thing: What About a Patient With Many?" (NYT, March 30, 2009). This is why we need more geriatricians -- a specialty you all should consider. Not only are more and more patients finding themselves in this situation, doesn't it figure that: "Doctors are Opting Out of Medicare," (NYT, April 1, 2009). Just when people need them, the docs turn the other direction. Gotta love contemporary medicine. Especially when it has results like this: "Study Finds Many on Medicare Return to Hospital," (NYT, April 1, 2009).
How will you learn to talk to your patients about dying? Will you avoid it by going into a 'safe' profession like family practice? Is it essential to the medical profession to know how to have these conversations? "At the End of Life, Denial Comes at a Price," (NYT, April 3, 2009).
And last but not least, most timely since my current research projects are on research ethics in developing countries, they've finally settled this Pfizer suit that has been going on since, I think, 1996 (yes, 13 years): "Deal in Pfizer-Nigeria Drug Suits," (BBC, April 3, 2009). More on this topic soon.
3.31.2009
Are We Living in an Exponential Age?
Here's a thought-provoking video: "Did You Know?" Some of this is probably based on somewhat skewed data, but an interesting thought, that we live in "an exponential age." But of course, the exponential growth in these technologies are not distributed with geographic equity. What might it mean to see "exponential growth" in the economic status of poor countries, in the health status of the poor? It seems theoretically possible that that could happen, given some of the data in this video.
And all it would take is 'will.' As this story shows, the work is not rocket science -- it's not hard (conceptually) to figure out: "Surgeon Heals Patients and Their Violent Ways," (CNN, March 30, 2009). It just takes one person who cares to start the engine, to capture a team of people who also care and who can make a real difference in the lives of real people.
Today's final story brings together a previous conversation, on these pages, about reproductive technologies with the recent economic scandals: "Another Despicable Financial Scandal," (Freakonomics, March 30, 2009). How low can one go? But also -- how will this be resolved? Of course, perhaps it points to one of the (many, many, many) problems with the commodification of reproductive technologies that took place in the 1980s and 1990s (alongside the happenings that caused the current economic debacle. Hm....could they be related?).
And all it would take is 'will.' As this story shows, the work is not rocket science -- it's not hard (conceptually) to figure out: "Surgeon Heals Patients and Their Violent Ways," (CNN, March 30, 2009). It just takes one person who cares to start the engine, to capture a team of people who also care and who can make a real difference in the lives of real people.
Today's final story brings together a previous conversation, on these pages, about reproductive technologies with the recent economic scandals: "Another Despicable Financial Scandal," (Freakonomics, March 30, 2009). How low can one go? But also -- how will this be resolved? Of course, perhaps it points to one of the (many, many, many) problems with the commodification of reproductive technologies that took place in the 1980s and 1990s (alongside the happenings that caused the current economic debacle. Hm....could they be related?).
3.29.2009
Doing the Right Thing
Here are two stories about doing the right thing, just in case all the economics gets you down. Granted, these are not pollyanna stories -- not all sunshine. But they're good stories to meditate on.
First, from Minneapolis: apparently it's becoming quite the international city and this is causing issues for healthcare because most of these international folks are immigrants and refugees and have endured really awful life experiences. Yet, they need medicine. So what does a city like Minneapolis do?: "Foreign Ways and War Scars Test Hospital," (NYC, March 29, 2009). Well, maybe not Minneapolis, but at least Hennepin County Medical Center, a hospital with a long-standing reputation as being a really good place. Now we see why.
And second, a story from Haiti. I didn't realize Haiti was on Nicholas Kristof's radar. I'm glad it is: "A Boy Living in a Car," (NYT, March 29, 2009). These composting toilets are one of the most interesting recent inventions I've come across. They certainly could solve a number of problems at once. This story reaffirms the fact that the solution to the global problems related to health and nutrition are not, really, all that complicated.
First, from Minneapolis: apparently it's becoming quite the international city and this is causing issues for healthcare because most of these international folks are immigrants and refugees and have endured really awful life experiences. Yet, they need medicine. So what does a city like Minneapolis do?: "Foreign Ways and War Scars Test Hospital," (NYC, March 29, 2009). Well, maybe not Minneapolis, but at least Hennepin County Medical Center, a hospital with a long-standing reputation as being a really good place. Now we see why.
And second, a story from Haiti. I didn't realize Haiti was on Nicholas Kristof's radar. I'm glad it is: "A Boy Living in a Car," (NYT, March 29, 2009). These composting toilets are one of the most interesting recent inventions I've come across. They certainly could solve a number of problems at once. This story reaffirms the fact that the solution to the global problems related to health and nutrition are not, really, all that complicated.
Healthcare Economics -- It's the big question
Back from St. Louis and another meeting with my colleagues at the Catholic Health Association. This year's "Theology and Ethics" colloquium (attended mostly by people who work in health care) was fascinating. It was about...healthcare economics (my latest obsession!). The main presenters were fabulous. The first was Charles Clark, an economist who teaches at St. John's in NYC, and who has done many interesting things. Here's an economist who...critiqued economics...from the perspective of Catholic social teaching! You don't run into that very often! He was great -- very informative, very straightforward. The second was a healthcare journalist (or healthcare policy and ethics analyst, per her website) Emily Friedmann -- she was phenomenal. Both Clark and Friedman took the notion of "markets" vis a vis health care apart. I encourage you to have a look at their websites and writings.
And, of course, healthcare economics (and the ethics thereof) continues to fill the news. From today:
"Drug Firms Cash Skews Doctor Classes" (MJS, March 29, 2009). Med student beware, in other words! Isn't medical education supposed to be...objective, impartial honest, factual, true....?
Relatedly: "Three Researchers at Harvard are Named in Subpoena," (NYT, March 29, 2009).
And relatedly: "Psychiatric Group Ends Industry-Sponsored Seminars," (NYT, March 25, 2009).
An update today on the Massachussetts experiment in healthcare reform: "A Lesson on Health Care from Massachussetts," (NYT, March 29, 2009).
Here's a topic growing near and dear to my heart -- CRO's and commercial IRB's. More on that soon, but for now, it appears to be timely as well: "An Overseer of Trials in Medicine Draws Fire," (NYT, March 26, 2009).
It'll be interesting to see where this goes: "Bill Would Let Copycats Compete with Biotech Drugs," (NYT, March 26, 2009).
Enough economics. On to something else.
And, of course, healthcare economics (and the ethics thereof) continues to fill the news. From today:
"Drug Firms Cash Skews Doctor Classes" (MJS, March 29, 2009). Med student beware, in other words! Isn't medical education supposed to be...objective, impartial honest, factual, true....?
Relatedly: "Three Researchers at Harvard are Named in Subpoena," (NYT, March 29, 2009).
And relatedly: "Psychiatric Group Ends Industry-Sponsored Seminars," (NYT, March 25, 2009).
An update today on the Massachussetts experiment in healthcare reform: "A Lesson on Health Care from Massachussetts," (NYT, March 29, 2009).
Here's a topic growing near and dear to my heart -- CRO's and commercial IRB's. More on that soon, but for now, it appears to be timely as well: "An Overseer of Trials in Medicine Draws Fire," (NYT, March 26, 2009).
It'll be interesting to see where this goes: "Bill Would Let Copycats Compete with Biotech Drugs," (NYT, March 26, 2009).
Enough economics. On to something else.
3.24.2009
Feast of Oscar Romero, Bishop and Martyr
Twenty-nine years ago today, Archbishop Oscar Arnulfo Romero was assassinated. When he is canonized, today (March 24th) will likely be his feast day. We can celebrate in advance.
One of the many, many things that struck me when I was in El Salvador was how many paintings, pictures, or portraits of Romero I saw, and what's more -- almost every one of them was accompanied by something he said -- and almost every one of them quoted a different saying. Here is a powerful quote:
One of the many, many things that struck me when I was in El Salvador was how many paintings, pictures, or portraits of Romero I saw, and what's more -- almost every one of them was accompanied by something he said -- and almost every one of them quoted a different saying. Here is a powerful quote:
"Even when they call us mad,
when they call us subversives and communists
and all the epithets they put on us,
we know that we only preach
the subversive witness of the Beatitudes,
which have turned everything upside down
to proclaim blessed the poor,
blessed the thirsting for justice,
blessed the suffering."
when they call us subversives and communists
and all the epithets they put on us,
we know that we only preach
the subversive witness of the Beatitudes,
which have turned everything upside down
to proclaim blessed the poor,
blessed the thirsting for justice,
blessed the suffering."
The Beatitudes -- Matthew 25 -- this indeed was the heart of his ministry. What would it mean to take the Beatitudes seriously -- not even the whole of scripture, just this small part? Yes, it probably would turn everything upside down.
Here's another remembrance, from one of our doctoral students in theology: "Remembering Romero."
Here's another remembrance, from one of our doctoral students in theology: "Remembering Romero."
iConfess
Check this out: an iPhone app for confession: "iConfess" (Catholic News Service, March 24, 2009). If only it would upload your confession to a priest and ring you back with your penance (and maybe an indulgence!). Would an online sacrament be the same? [answer, of course: No!]. Either way, download it now!
Here's the March 2009 Issue of the PIH Newsletter. Two items of note: (a) the opening article on women's health -- like, wow, here's one of the first pieces I've read that says 'women's health has to do with more than just uteruses and ovaries.' Finally; and (b) a hilarious article on Farmer, admitting that his high school senior thesis was on why the US should NOT have national healthcare. That's a great story.
"Wisconsin vs. Pfizer" (MJS, March 24, 2009). It never ends -- it really never ends. I wonder how many lawsuits like this are going on right now, across the 50 states. And think about the money being spent just on litigation. It's boggling. And all because the drug companies endlessly attempt to defraud the government.
Here's the March 2009 Issue of the PIH Newsletter. Two items of note: (a) the opening article on women's health -- like, wow, here's one of the first pieces I've read that says 'women's health has to do with more than just uteruses and ovaries.' Finally; and (b) a hilarious article on Farmer, admitting that his high school senior thesis was on why the US should NOT have national healthcare. That's a great story.
"Wisconsin vs. Pfizer" (MJS, March 24, 2009). It never ends -- it really never ends. I wonder how many lawsuits like this are going on right now, across the 50 states. And think about the money being spent just on litigation. It's boggling. And all because the drug companies endlessly attempt to defraud the government.
3.23.2009
Dr. Felon?
Finally, a change of pace from healthcare costs and pharma fraud: a fascinating story from Sweden: "A Quandary in Sweden: Criminals in Med School," (NYT, March 23, 2009). There's a fabulous question: should criminals be excluded from the practice of medicine? [yes, depending on the offense, I'd say]. Why [which is the more interesting question]? The answer to the latter has to do with character, the temptations of medicine, and the nature of the patient-physician relationship [I'd say].
Back to our earlier Lenten theme (since it's still Lent), I post this, mostly because this very morning I realized that I have indeed, once again, been "Flunking Lent" (The Ekklesia Project, March 23, 2009). This is a very nice post.
Back to our earlier Lenten theme (since it's still Lent), I post this, mostly because this very morning I realized that I have indeed, once again, been "Flunking Lent" (The Ekklesia Project, March 23, 2009). This is a very nice post.
3.22.2009
QALYs
I've never entirely understood 'QALYS', which have become a standard term in discussions of healthcare reform. Here's Reinhardt giving a graspable explanation: "Pricing Human Life(-Years)," (Economix, March 20, 2009). While I'm all about efficiency and immunizations/preventive health measures, I remain quite leery about the language of cost-effectiveness.
Here's a good way to justify travel and a vacation: "Going Abroad to Find Affordable Healthcare," (NYT, March 20, 2009). I've always wanted to go to Costa Rica....
On a different note (more along the lines of Dying for Growth, which I'm reading again for class tomorrow), here's an interesting piece: "Envoy Damns US Afghan Drug Effort," (BBC, March 21, 2009). What's interesting about this is (a) Holbrooke is a well-respected diplomat and probably knows what he's talking about and (b) this story supports the claims about the US mis-steps (likely intentional) in Afghanistan made by Mortenson in Three Cups of Tea.
Here's a good way to justify travel and a vacation: "Going Abroad to Find Affordable Healthcare," (NYT, March 20, 2009). I've always wanted to go to Costa Rica....
On a different note (more along the lines of Dying for Growth, which I'm reading again for class tomorrow), here's an interesting piece: "Envoy Damns US Afghan Drug Effort," (BBC, March 21, 2009). What's interesting about this is (a) Holbrooke is a well-respected diplomat and probably knows what he's talking about and (b) this story supports the claims about the US mis-steps (likely intentional) in Afghanistan made by Mortenson in Three Cups of Tea.
3.19.2009
Happiness and Cost-Effectiveness
Bracketing the fact that my mind remains in Central America, here are a few items of interest from the past week or so:
"Happiness and the Working Class," (Economix, March 18, 2009). Intriguing. This analysis suggests that being in the working class isn't so great for your health or your happiness. For another analysis of happiness, see: "Other Potential Causes of Happiness" (Economix, March 13, 2009). See also: "The Happiest States of America" (Economix, March 10, 2009). How would this play in El Salvador? Here's an international analysis: "Money and Happiness," (Economix, March 9, 2009).
Uwe Reinhardt continues his posts on the economics of health care:
"'Cost-Effectiveness Analysis" and U.S. Healthcare" (Economix, March 13, 2009). I'd be interested to hear what Farmer has to say re. this post. Reinhardt responds to some of the comments here.
"Happiness and the Working Class," (Economix, March 18, 2009). Intriguing. This analysis suggests that being in the working class isn't so great for your health or your happiness. For another analysis of happiness, see: "Other Potential Causes of Happiness" (Economix, March 13, 2009). See also: "The Happiest States of America" (Economix, March 10, 2009). How would this play in El Salvador? Here's an international analysis: "Money and Happiness," (Economix, March 9, 2009).
Uwe Reinhardt continues his posts on the economics of health care:
"'Cost-Effectiveness Analysis" and U.S. Healthcare" (Economix, March 13, 2009). I'd be interested to hear what Farmer has to say re. this post. Reinhardt responds to some of the comments here.
3.18.2009
Back...but not...
So...I'm back from El Salvador. And I should post. But what to say? All the medical news in the media seems so unimportant or self-absorbed or problematic. I had a similar experience when I came back from Haiti in 2004, so this is nothing new. But still...it's quite destabilizing....
The trip was astounding -- fabulous and fascinating in every dimension. We worshipped with a base community; visited with NGO's; walked with the base community through some of their ministry; sat in the church where Romeo was assassinated and saw the house where he lived; visited his tomb, and the Cathedral; spent time at the Universidad Centroamericano (UCA), a vibrant and beautiful campus; paid our respects to the place where the six Jesuits were martyred. And more -- that's just the bare outlines. The place we stayed was beautiful and restful; the group of students and faculty was amazing; the activities in the lead up to the historic election this past Sunday (the FMLN candidate did win the presidential election) were fascinating to watch. The entire week was an experience of grace -- of unmerited, unanticipated, and unimagined gift.
I shall not go into great detail on all of the above. Let me know if you want to hear more. I'm sure I'll tell the various stories over time. Suffice it to say that it was a transformative trip for me; I have resolved to return to El Salvador annually if possible, to try to build a relationship with the place in a variety of ways. I was powerfully struck by the fact that it had been five years since I had been in Haiti and how the accretions of work and life in the U.S. had made me forget alot of what I had learned there, had insulated me from the ongoing realities of life in most of the rest of the world. The only way to resist that insulation is to return and return and return, to be in the larger reality frequently enough that I can't forget it, frequently enough to keep the reality in which we live in perspective.
The trip was astounding -- fabulous and fascinating in every dimension. We worshipped with a base community; visited with NGO's; walked with the base community through some of their ministry; sat in the church where Romeo was assassinated and saw the house where he lived; visited his tomb, and the Cathedral; spent time at the Universidad Centroamericano (UCA), a vibrant and beautiful campus; paid our respects to the place where the six Jesuits were martyred. And more -- that's just the bare outlines. The place we stayed was beautiful and restful; the group of students and faculty was amazing; the activities in the lead up to the historic election this past Sunday (the FMLN candidate did win the presidential election) were fascinating to watch. The entire week was an experience of grace -- of unmerited, unanticipated, and unimagined gift.
I shall not go into great detail on all of the above. Let me know if you want to hear more. I'm sure I'll tell the various stories over time. Suffice it to say that it was a transformative trip for me; I have resolved to return to El Salvador annually if possible, to try to build a relationship with the place in a variety of ways. I was powerfully struck by the fact that it had been five years since I had been in Haiti and how the accretions of work and life in the U.S. had made me forget alot of what I had learned there, had insulated me from the ongoing realities of life in most of the rest of the world. The only way to resist that insulation is to return and return and return, to be in the larger reality frequently enough that I can't forget it, frequently enough to keep the reality in which we live in perspective.
3.06.2009
Romero and El Salvador: Lenten Reflections
So, I'm off. But before I leave, a few items from Romero and El Salvador to ponder.
Mull this quote from Romero: "A church that suffers no persecution but enjoys the privileges and support of the things of the earth - beware! - is not the true church of Jesus Christ. A preaching that does not point out sin is not the preaching of the gospel. A preaching that makes sinners feel good, so that they are secured in their sinful state, betrays the gospel's call." Per this definition, is the church in the U.S. the true church of Jesus Christ? Does it really preach the gospel?
This year will mark the 20th anniversary of the martyrdom of the six Jesuits assassinated in their house on the campus of the University of Central America in San Salvador. If you don't know much about that story, click here.
Of note, next weekend, March 15th, is the next presidential election in El Salvador. Since El Salvador became a democracy, following the horrific civil war, the right-wing ARENA party has won every election. It is anticipated that the left-wing party, the FLMN, will give them a real challenge this time and might even win for the first time since the peace was signed. It appears that the FLMN candidate is the first candidate from their party that did not participate in guerrilla actions during the war. To catch up on or keep abreast of what's going on in El Salvador, click here.
Mull this quote from Romero: "A church that suffers no persecution but enjoys the privileges and support of the things of the earth - beware! - is not the true church of Jesus Christ. A preaching that does not point out sin is not the preaching of the gospel. A preaching that makes sinners feel good, so that they are secured in their sinful state, betrays the gospel's call." Per this definition, is the church in the U.S. the true church of Jesus Christ? Does it really preach the gospel?
This year will mark the 20th anniversary of the martyrdom of the six Jesuits assassinated in their house on the campus of the University of Central America in San Salvador. If you don't know much about that story, click here.
Of note, next weekend, March 15th, is the next presidential election in El Salvador. Since El Salvador became a democracy, following the horrific civil war, the right-wing ARENA party has won every election. It is anticipated that the left-wing party, the FLMN, will give them a real challenge this time and might even win for the first time since the peace was signed. It appears that the FLMN candidate is the first candidate from their party that did not participate in guerrilla actions during the war. To catch up on or keep abreast of what's going on in El Salvador, click here.
Global Health Corps
Tomorrow morning (way too early!) I leave for El Salvador for a week. I'm going with a delegation from Marquette. It's going to be an awesome trip. So the blog will be on a spring break hiatus for a week. This will give you all a chance to catch up. I'll try to post as much as I can today, to give you alot to work through over your break. ;)
Here's a fabulous new post-graduate opportunity for those of you who might want to defer med school for a year: Global Health Corps. This would be a very, very cool thing to do. If any of you want to apply, let's talk!
Uwe Reinhardt continues his helpful analysis of the health care system in his weekly post: "How Appropriate is Your Medical Care?" (Economix, March 6, 2009). Clearly, there is much inefficiency in the system, which translates into both unnecessarily high costs but also less-than-optimal healthcare for sick people!
Here's a fabulous new post-graduate opportunity for those of you who might want to defer med school for a year: Global Health Corps. This would be a very, very cool thing to do. If any of you want to apply, let's talk!
Uwe Reinhardt continues his helpful analysis of the health care system in his weekly post: "How Appropriate is Your Medical Care?" (Economix, March 6, 2009). Clearly, there is much inefficiency in the system, which translates into both unnecessarily high costs but also less-than-optimal healthcare for sick people!
3.05.2009
Fistulas
A new study suggests that type-1 diabetes (the traditional childhood onset type) might be triggered/caused at least in part by a virus: "Virus Triggers Child Diabetes," (BBC, March 5, 2009). Finding a way to prevent type-1 diabetes, a more burdensome and severe form since it starts in childhood, would be great; could an immunization be developed?
Here's a story from last week on an issue that is a huge problem much the world over but is little talked about: "After a Devastating Birth Injury, Hope," (NYT, February 23, 2009). Such a devastating injury indeed, and so easily preventable. Just spend a few minutes thinking about the personal and social toll this injury takes on these women -- who are usually young (younger than you all even?) when it happens.
It's not often you see the word "sin" in an economics article or in the New York Times (many examples, thereof, but rarely the label): "Sin Cycle: When Greed Isn't Good," (Economix, March 5, 2009). This is a very interesting and thoughtful piece. We should all get on our Netflix the film Wall Street to which this writer refers, and view it now from the perspective of 20+ years later and all the economic turmoil that has ensued since. When Wall Street came out in 1987, it was somewhat controversial, but there was a cultural consensus that the movie was essentially right. As often with these blogs, some of the comments are even more interesting than the post itself. One should take some comfort in the fact that a number of people who comment identify the key problem: that people could even begin to suggest that a vice (greed) could be a good thing. What has happened to a society when vices all of a sudden become seen as good and virtuous? You know you're in big trouble then.
Here's a story from last week on an issue that is a huge problem much the world over but is little talked about: "After a Devastating Birth Injury, Hope," (NYT, February 23, 2009). Such a devastating injury indeed, and so easily preventable. Just spend a few minutes thinking about the personal and social toll this injury takes on these women -- who are usually young (younger than you all even?) when it happens.
It's not often you see the word "sin" in an economics article or in the New York Times (many examples, thereof, but rarely the label): "Sin Cycle: When Greed Isn't Good," (Economix, March 5, 2009). This is a very interesting and thoughtful piece. We should all get on our Netflix the film Wall Street to which this writer refers, and view it now from the perspective of 20+ years later and all the economic turmoil that has ensued since. When Wall Street came out in 1987, it was somewhat controversial, but there was a cultural consensus that the movie was essentially right. As often with these blogs, some of the comments are even more interesting than the post itself. One should take some comfort in the fact that a number of people who comment identify the key problem: that people could even begin to suggest that a vice (greed) could be a good thing. What has happened to a society when vices all of a sudden become seen as good and virtuous? You know you're in big trouble then.
3.04.2009
Back to Lent
It is still Lent -- only the first week! I hope your various Lenten resolves are holding up. Monday, the lectionary had this great passage from Leviticus (19:1-2, 11-18) that I think is worth sharing:
The LORD said to Moses,
"Speak to the whole assembly of the children of Israel and tell them:
Be holy, for I, the LORD, your God, am holy.
"Speak to the whole assembly of the children of Israel and tell them:
Be holy, for I, the LORD, your God, am holy.
"You shall not steal.
You shall not lie or speak falsely to one another.
You shall not swear falsely by my name,
thus profaning the name of your God.
I am the LORD.
"You shall not defraud or rob your neighbor.
You shall not withhold overnight the wages of your day laborer.
You shall not curse the deaf,
or put a stumbling block in front of the blind,
but you shall fear your God.
I am the LORD.
"You shall not act dishonestly in rendering judgment.
Show neither partiality to the weak nor deference to the mighty,
but judge your fellow men justly.
You shall not go about spreading slander among your kin;
nor shall you stand by idly when your neighbor's life is at stake.
I am the LORD.
"You shall not bear hatred for your brother in your heart.
Though you may have to reprove him,
do not incur sin because of him.
Take no revenge and cherish no grudge against your fellow countrymen.
You shall love your neighbor as yourself.
I am the LORD."
Note the structure of this passage. (Yes, it's excerpted, but if you click on the link above, you can read the whole passage.) It starts out by saying: Be holy, because...I, the Lord your God, am holy. In other words: be like me! And then the passage spells out what it means to be holy. And it isn't any individual purity sort of thing. In this part of the passage, to be holy means to: be truthful, act right economically, love, forgive, and be just (in various ways, for all of these). How wild is that? This sort of 'holiness' might be hard, but might also be achievable. And the passage implies that....this is what God is like.
What if medicine...and medical ethics...took this ideal of 'holiness' seriously? What if, in medicine, pharmaceutical research, international health and research, etc., the principles or criteria were: real truthfulness, proper economic action, love, forgiveness, and justice. Zounds, it would sure all be different.
3.03.2009
Good for Dartmouth
Today Dartmouth announces that Jim Yong Kim, one of the original founders of Partners In Health, and key player in their whole story, has agreed to become the next president of Dartmouth College: "Dartmouth Selects its Next President from Harvard," (NYT, March 3, 2009). How fascinating. Why would he want to leave his global health work at Harvard? What will this mean for his role in PIH? Given what he's been able to do for global health, I can't wait to see what he ends up doing with higher education. College presidents could learn alot from the thinking behind PIH. I sure hope this works out for him.
Oh maybe here's why he'd want to leave Harvard...good for Harvard med students, taking their profs to task! I hope you all have this much chutzpah when you're med students: "Harvard Medical School in Ethics Quandary," (NYT, March 3, 2009). Do the right thing. If you see something wrong, don't be afraid to speak up (in the right place, to the right person, at the right time).
I had put this piece aside last week while reading through a backlog of papers and just found it: "Cancer Survivors Struggle to Find Jobs, Study Finds," (NYT, February 17, 2009). It raises the qeustion of what it means to 'cure' a patient; medicine can do its work, but clearly there's still more to the story of recovery from illness, and some people it appears might not make it. And of course these issues are compounded in the US with our problematic structure for health insurance. Worth pondering....
Oh maybe here's why he'd want to leave Harvard...good for Harvard med students, taking their profs to task! I hope you all have this much chutzpah when you're med students: "Harvard Medical School in Ethics Quandary," (NYT, March 3, 2009). Do the right thing. If you see something wrong, don't be afraid to speak up (in the right place, to the right person, at the right time).
I had put this piece aside last week while reading through a backlog of papers and just found it: "Cancer Survivors Struggle to Find Jobs, Study Finds," (NYT, February 17, 2009). It raises the qeustion of what it means to 'cure' a patient; medicine can do its work, but clearly there's still more to the story of recovery from illness, and some people it appears might not make it. And of course these issues are compounded in the US with our problematic structure for health insurance. Worth pondering....
3.02.2009
GATTACCA
A follow-up from a post a few days ago: "Designer Baby Row over US Clinic," (BBC, March 2, 2009). At least the British have a conscience, for a change. I didn't realize that Italy doesn't allow the creation of surplus embryos. Yet another reason to love Italy. I think it's time for us all to go and rent the movie "GATTACCA" (Ethan Hawke, designer babies, great bioethics movie).
About those healthcare costs...: "Good or Useless, Medical Scans Cost the Same," (NYT, March 2, 2009). Hm....Interpretation?
Nothing like a little pressure to look forward to: "From the Death of Libby Zion, A Life-Changing Case For Doctors in Training," (NYT, March 2, 2009). Maybe I shouldn't post this during exam week....
About those healthcare costs...: "Good or Useless, Medical Scans Cost the Same," (NYT, March 2, 2009). Hm....Interpretation?
Nothing like a little pressure to look forward to: "From the Death of Libby Zion, A Life-Changing Case For Doctors in Training," (NYT, March 2, 2009). Maybe I shouldn't post this during exam week....
3.01.2009
Getting Your Responses Ready....
Over the next year or two, those who believe that universal health care is a moral and economic imperative will need to have ready responses to the nay-sayers who trumpet age-old arguments against "socialized medicine." Nicholas Kristof's op-ed today, gives us a good start: "Franklin Delano Obama," (NYT, March 1, 2009). It's most likely that the only arguments the opponents will buy will be the economic arguments, so memorize those.
Worth reading: "Health Insurers, Poised for Round 2," (NYT, March 1, 2009). If the insurance companies don't completely undercut this new attempt at health care reform, and rightly understand that they might end up making more money if they can insure more people (win-win), reform might just happen. Interesting graphic attached to this article.
And in re. Big Brother in medicine, we must remember that the question is not "Big Brother or not"; the question is "Which Big Brother, and on what basis," as Dr. Pauline Chen makes quite clear: "Does Oversight Threaten the Doctor-Patient Bond?" (NYT, February 26, 2009).
Worth reading: "Health Insurers, Poised for Round 2," (NYT, March 1, 2009). If the insurance companies don't completely undercut this new attempt at health care reform, and rightly understand that they might end up making more money if they can insure more people (win-win), reform might just happen. Interesting graphic attached to this article.
And in re. Big Brother in medicine, we must remember that the question is not "Big Brother or not"; the question is "Which Big Brother, and on what basis," as Dr. Pauline Chen makes quite clear: "Does Oversight Threaten the Doctor-Patient Bond?" (NYT, February 26, 2009).
2.28.2009
The Commons and Our Shared Responsibility
I lead with three posts today on economics, since the current economic situation remains grim and a real player in most of our lives. First, this summary of "How We Got Here" (Freakonomics, February 27, 2009) is worth reading. I have not yet watched the Frontline piece they post, but I have heard from friends that it is quite good.
Second, we have an economist talking about "Taking Responsibility for the Commons," (Economix, February 26, 2009). She not only cites good libertarians and conservatives on her side (Greenspan, Brooks) but makes the very important observation that the opposite of "socialism" is not "capitalism" but "individualism" -- and the growing consensus is that it's precisely "individualism" without responsibility that has gotten us into our current mess.
Third, I was initially going to post this bit of "Assorted Links" because I thought the links looked fun -- the trade deficit site, the blog for the new director of the federal Office of Management and Budget (that should be an interesting blog). But then I clicked on the link that says "Dangerous Loans" -- zounds! Click on the link and then drag the bar across the map. The map you see first will be the percentage of irresponsible (subprime) loans permitted by mortgage lenders in 2000. As you drag the bar across the map, you'll see how different the lay of the land (literally) looked in 2007. This helps to make clear what people mean when they refer to the "failed policies of the last eight years."
With regard to the subprime and housing mess, it's also really important to keep clear on who the main agent of this disaster is. I worked for a mortgage company for a couple of years in graduate school, so I know more about this business than your average theologian. Up until 2000 or so, lenders were not allowed to approve mortgages for people if their payment would exceed 28% of their income (or, if, in combination with their other debt, it would exceed 36% of their income), except in very rare circumstances. Clearly in 2000, those rules changed (deregulation). Mortgage lenders make money primarily off of the fees they generate per new loan, which is based on the size of the loan -- they work on commission. Their incentive is to bring in as many loans as possible and to make them as large as possible. Their first concern is not whether the buyer can afford the mortgage -- their job is to make the sale. Mortgage lenders were as aggressive as they possibly could be during the period outlined on the map, working to convince people that they could take out these irrational mortgages (usually based on adjustable rate mortgages that would start out with an artificially low interest rate for 3-5 years and then the interest rate would automatically adjust (or balloon) to regular market rates). They were persistent, and they were effective because, frankly, most Americans are very ignorant about the basics of economics. The point of this mini-lecture on mortgage lending is to provide an important perspective on the above map: this radical change is not due primarily to poor people taking out loans they couldn't afford or irresponsible people getting in over their head; it's primarily due to deregulation that permitted mortgage lenders to provide financially unsound loans and the incentive structure of the mortgage business. Of course, other factors must be involved (what's up with the western half of the US?!), but these two factors are critical.
So, okay, enough economics for the day. On to health care. Oh, but look, it's economics again! Uwe Reinhardt is also back with more on healthcare economics: "The Mounting Price of Health Care's Status Quo," (Economix, February 27, 2009). He's just so clear and rational, and backs up his arguments with real data. Sigh. I wish the whole public debate would operate like this.
The New York Times has been doing a great job this week of keeping pharma in the cross-hairs. We don't want them to hide behind a little economic debacle. Because (a), clearly they're not hurting: "Big Drug Makers May Seek to Fill Holes in Roster," (NYT, February 25, 2009). Look at those figures! They make the stimulus package look like small potatoes...or at least put it in perspective; (b) they're still lying and hiding data, even when it hurts children and teenagers: "Drug Maker is Accused of Fraud," (NYT, February 26, 2009).
Now here's an interesting idea, courtesy of some smart people at Dartmouth--a label on drugs like the nutrition label on foods so that consumers could rate the effectiveness of a drug over against (at least) a placebo. It'd be nice if they could rate it over against a competitor. If the labels were accurate, you could kind of do that by comparing the labels of two similar drugs: "A Push to Spell Out a Drug's Risks and Benefits," (NYT, February 26, 2009).
This is one thing that happens when we think of health care as a consumer product: "Medicare Spending Still Varies Widely by Region," (NYT, February 26, 2009).
Second, we have an economist talking about "Taking Responsibility for the Commons," (Economix, February 26, 2009). She not only cites good libertarians and conservatives on her side (Greenspan, Brooks) but makes the very important observation that the opposite of "socialism" is not "capitalism" but "individualism" -- and the growing consensus is that it's precisely "individualism" without responsibility that has gotten us into our current mess.
Third, I was initially going to post this bit of "Assorted Links" because I thought the links looked fun -- the trade deficit site, the blog for the new director of the federal Office of Management and Budget (that should be an interesting blog). But then I clicked on the link that says "Dangerous Loans" -- zounds! Click on the link and then drag the bar across the map. The map you see first will be the percentage of irresponsible (subprime) loans permitted by mortgage lenders in 2000. As you drag the bar across the map, you'll see how different the lay of the land (literally) looked in 2007. This helps to make clear what people mean when they refer to the "failed policies of the last eight years."
With regard to the subprime and housing mess, it's also really important to keep clear on who the main agent of this disaster is. I worked for a mortgage company for a couple of years in graduate school, so I know more about this business than your average theologian. Up until 2000 or so, lenders were not allowed to approve mortgages for people if their payment would exceed 28% of their income (or, if, in combination with their other debt, it would exceed 36% of their income), except in very rare circumstances. Clearly in 2000, those rules changed (deregulation). Mortgage lenders make money primarily off of the fees they generate per new loan, which is based on the size of the loan -- they work on commission. Their incentive is to bring in as many loans as possible and to make them as large as possible. Their first concern is not whether the buyer can afford the mortgage -- their job is to make the sale. Mortgage lenders were as aggressive as they possibly could be during the period outlined on the map, working to convince people that they could take out these irrational mortgages (usually based on adjustable rate mortgages that would start out with an artificially low interest rate for 3-5 years and then the interest rate would automatically adjust (or balloon) to regular market rates). They were persistent, and they were effective because, frankly, most Americans are very ignorant about the basics of economics. The point of this mini-lecture on mortgage lending is to provide an important perspective on the above map: this radical change is not due primarily to poor people taking out loans they couldn't afford or irresponsible people getting in over their head; it's primarily due to deregulation that permitted mortgage lenders to provide financially unsound loans and the incentive structure of the mortgage business. Of course, other factors must be involved (what's up with the western half of the US?!), but these two factors are critical.
So, okay, enough economics for the day. On to health care. Oh, but look, it's economics again! Uwe Reinhardt is also back with more on healthcare economics: "The Mounting Price of Health Care's Status Quo," (Economix, February 27, 2009). He's just so clear and rational, and backs up his arguments with real data. Sigh. I wish the whole public debate would operate like this.
The New York Times has been doing a great job this week of keeping pharma in the cross-hairs. We don't want them to hide behind a little economic debacle. Because (a), clearly they're not hurting: "Big Drug Makers May Seek to Fill Holes in Roster," (NYT, February 25, 2009). Look at those figures! They make the stimulus package look like small potatoes...or at least put it in perspective; (b) they're still lying and hiding data, even when it hurts children and teenagers: "Drug Maker is Accused of Fraud," (NYT, February 26, 2009).
Now here's an interesting idea, courtesy of some smart people at Dartmouth--a label on drugs like the nutrition label on foods so that consumers could rate the effectiveness of a drug over against (at least) a placebo. It'd be nice if they could rate it over against a competitor. If the labels were accurate, you could kind of do that by comparing the labels of two similar drugs: "A Push to Spell Out a Drug's Risks and Benefits," (NYT, February 26, 2009).
This is one thing that happens when we think of health care as a consumer product: "Medicare Spending Still Varies Widely by Region," (NYT, February 26, 2009).
2.27.2009
Back to Business as Usual
Now that you are all firmly immersed in Lent, back to medicine and ethics. News in medical ethics is not unlike a soap opera. Go away for a while, come back and--you can pick up right where you left off, same characters, same issues, same drama!
On today's docket is money and death. Following on a couple of articles from last month (that I'll go and dig out), UW-Madison has taken swift action about doctor's side compensation, particularly from the pharma and medical device industry: "Conflict-of-interest Limits on UW Doctors Proposed," (MSJ, February 27, 2009). Of course, this hasn't been approved, just proposed, but at least it's in the works. What do you, as future docs, think of the proposed changes? How cool would it be if Madison could be a leader in creating model programs and reform in this area.
More info on health economics, courtesy of Economix: "A Primer on Health Costs," (Economix, February 25, 2009). They link to a number of informative reports, studies, etc. This sort of real information will be really critical to have over the coming months as the President begins to work in earnest on healthcare reform. The rustle on the street over the past couple of days is that Pharma is not happy with this new initiative (oh, there's a surprise!) and will probably lobby very hard against it (oh, there's another surprise!). Most of you have (or will) read the chapter on transnational corporations in the US in Dying for Growth, and you know how easy it is for them to undermine democracy. Go back and read it again if you have forgotten the specifics. And re-read the necessary parts of Angell. Then you can sit back and watch the machine they describe ramp up and go into its full range of motion.
For example: "Lobbyists Line Up to Torpedo Speech Proposals," (WSJ, February 26, 2009).
If you want to get involved, Move-On is starting a grassroots campaign with this petition. Then forward it to your friends.
Last but not least, here's a story on the of-late quiet question of assisted-suicide: "Four Arrested in Two States in Assisted-Suicide Probe," (CNN, February 26, 2009). I'd love to hear what you think of this.
On today's docket is money and death. Following on a couple of articles from last month (that I'll go and dig out), UW-Madison has taken swift action about doctor's side compensation, particularly from the pharma and medical device industry: "Conflict-of-interest Limits on UW Doctors Proposed," (MSJ, February 27, 2009). Of course, this hasn't been approved, just proposed, but at least it's in the works. What do you, as future docs, think of the proposed changes? How cool would it be if Madison could be a leader in creating model programs and reform in this area.
More info on health economics, courtesy of Economix: "A Primer on Health Costs," (Economix, February 25, 2009). They link to a number of informative reports, studies, etc. This sort of real information will be really critical to have over the coming months as the President begins to work in earnest on healthcare reform. The rustle on the street over the past couple of days is that Pharma is not happy with this new initiative (oh, there's a surprise!) and will probably lobby very hard against it (oh, there's another surprise!). Most of you have (or will) read the chapter on transnational corporations in the US in Dying for Growth, and you know how easy it is for them to undermine democracy. Go back and read it again if you have forgotten the specifics. And re-read the necessary parts of Angell. Then you can sit back and watch the machine they describe ramp up and go into its full range of motion.
For example: "Lobbyists Line Up to Torpedo Speech Proposals," (WSJ, February 26, 2009).
If you want to get involved, Move-On is starting a grassroots campaign with this petition. Then forward it to your friends.
Last but not least, here's a story on the of-late quiet question of assisted-suicide: "Four Arrested in Two States in Assisted-Suicide Probe," (CNN, February 26, 2009). I'd love to hear what you think of this.
2.26.2009
Real Fasting
I know this blog is supposed to be about medical ethics, but hey -- I'm a theologian, so indulge my need to offer a few Lenten thoughts.
First, fasting: yesterday was Ash Wednesday, the kick-off day for Lent and a mandatory day of fasting (along with Good Friday) for Catholics. Much heat is spent discussing the merits of fasting (or lack thereof). The Lenten resource I mentioned yesterday refers to the Liturgy of the Hours, the prayer cycle of the church, formerly used by monks and nuns but now used by lay people too. A schedule of psalms, scripture readings, and short prayers is put together for the entire liturgical year, and anyone can use it as a form of daily prayer. One of the nine "hours" of daily prayer is the Office, which I try to pray in the morning. I like the Office because unlike the other hours, it always includes a passage from a patristic author or pope or saint or church document -- something substantive in addition to psalms and scripture. You can find a pretty good online version of the Liturgy of the Hours here.
In any event, the cycle of readings for Lent is the same every year. The first reading for Ash Wednesday -- in other words, the first reading for Lent -- is from Isaiah 58:1-12. The passage that really struck me yesterday (in light of all the stuff we have read together) was the following:
Now there's a vision of fasting! It has nothing to do with not eating or giving things up. It has to do with overcoming oppression--locally--and practicing the works of mercy (see Matthew 25). Whoa. This is also the passage from which the local daytime shelter for homeless people--Repairers of the Breach--gets its name. How wild is that? From Isaiah, from the reading for Ash Wednesday, the first day of Lent.
So that's one Lenten observation--that every year, the church starts its Lenten prayer cycle with this reading, this vision of fasting. A second highly significant aspect of the Liturgy of the Hours is that the church spends most of Lent reading the entire Exodus story. Today, the Thursday after Ash Wednesday, we started with Exodus 1:1-22, and the church will read through the entire Exodus story (and maybe even the whole book) before Lent is finished. Exodus is a wild book. It is the basis for liberation theology. It is an extremely violent story. It is foundational for Judaism but also in many ways for Judaism. I've spent the last five Lent's or so reading through this story and trying to reflect on it. I guess it's time I got a decent commentary and read along, because there's alot about it that is so culturally-dependent and alot more that's just hard to figure out. But it's also a really cool story if you take the time to read it slowly.
For example, listen carefully to today's passage (if you go and read through it). It begins with the amazing story of reconciliation between Joseph and his family--after a really awful breach! Israel flourishes in Egypt. But...a Pharoah comes to power who did not personally know Joseph, and things take a turn for the worse. He ends up enslaving them. He then turns to the midwives (take note, Denise) and asks them to carry out his really heinous plan of killing all the male babies. But what do we find in this very first chapter of Exodus? We find the women, the midwives, being directly addressed, being the agent of the future of Israel, of using their reason and cunning to outsmart Pharoah, to be subversive, to save lives. They speak -- they are the first people to speak in the entire book of Exodus. In other words, the story kicks off with a group of really strong women. And God blesses them tremendously for what they do. Rock on, midwives!
One final thought. The first reading in the lectionary today (the cycle of scripture passages read at Mass every day) is from Deuteronomy. I post this primarily because this passage is so often misused. This is the passage that contains the phrase "Choose Life," used by many pro-life people. Now, I'm pro-life, but this passage has nothing to do with abortion. It has to do with...idolatry. As you'll see, God via Moses lays out "two ways" (reminiscent of the Didache reading from the Church Fathers, if you read that from yesterday): one is to love and worship God, the other is to "adore and serve other gods." The former is the way of life, the latter is the way of death. God is telling the people of Israel, before they cross into the promised land: you now have the option of worshiping me and following my way or worshipping the many gods followed by the peoples of the lands on the other side of the Jordan. "Choose life -- choose me!" God says. The other way--the way of idolatry, of worshipping false gods--is death.
Many write off the First Commandment (Exodus 20:2-6; note that this is the longest commandment....like God knew that he really needed to spell this one out!) as superfluous these days and only focus on the commandments about sex, money, and death; but it really is the case that all the way through the Old Testament....and then through the New Testament, the real question is about idolatry and who/what do you worship. How might that be the key question....today? I think Shuman and Volck talked about that....for those of you who read that....which relates all of this back to medicine.... :)
First, fasting: yesterday was Ash Wednesday, the kick-off day for Lent and a mandatory day of fasting (along with Good Friday) for Catholics. Much heat is spent discussing the merits of fasting (or lack thereof). The Lenten resource I mentioned yesterday refers to the Liturgy of the Hours, the prayer cycle of the church, formerly used by monks and nuns but now used by lay people too. A schedule of psalms, scripture readings, and short prayers is put together for the entire liturgical year, and anyone can use it as a form of daily prayer. One of the nine "hours" of daily prayer is the Office, which I try to pray in the morning. I like the Office because unlike the other hours, it always includes a passage from a patristic author or pope or saint or church document -- something substantive in addition to psalms and scripture. You can find a pretty good online version of the Liturgy of the Hours here.
In any event, the cycle of readings for Lent is the same every year. The first reading for Ash Wednesday -- in other words, the first reading for Lent -- is from Isaiah 58:1-12. The passage that really struck me yesterday (in light of all the stuff we have read together) was the following:
"Fasting like yours today will never make your voice heard on high.
Is that the sort of fast that pleases me, a truly penitential day for men?
Hanging your head like a reed, lying down on sackcloth and ashes?
Is that what you call fasting, a day acceptable to the Lord?
Is not this the sort of fast that pleases me– it is the Lord who speaks –
to break unjust fetters and undo the thongs of the yoke,
to let the oppressed go free, and break every yoke,
to share your bread with the hungry, and shelter the homeless poor,
to clothe the man you see to be naked and not turn from your own kin?
Then will your light shine like the dawn and your wound be quickly healed over.
Your integrity will go before you and the glory of the Lord behind you.
Cry, and the Lord will answer; call, and he will say, ‘I am here.’
If you do away with the yoke, the clenched fist, the wicked word,
if you give your bread to the hungry, and relief to the oppressed,
your light will rise in the darkness, and your shadows become like noon.
The Lord will always guide you, giving you relief in desert places.
He will give strength to your bones and you shall be like a watered garden,
like a spring of water whose waters never run dry.
You will rebuild the ancient ruins, build up on the old foundations.
You will be called ‘Repairer of the Breach’, ‘Restorer of ruined houses.’"
You will be called ‘Repairer of the Breach’, ‘Restorer of ruined houses.’"
Now there's a vision of fasting! It has nothing to do with not eating or giving things up. It has to do with overcoming oppression--locally--and practicing the works of mercy (see Matthew 25). Whoa. This is also the passage from which the local daytime shelter for homeless people--Repairers of the Breach--gets its name. How wild is that? From Isaiah, from the reading for Ash Wednesday, the first day of Lent.
So that's one Lenten observation--that every year, the church starts its Lenten prayer cycle with this reading, this vision of fasting. A second highly significant aspect of the Liturgy of the Hours is that the church spends most of Lent reading the entire Exodus story. Today, the Thursday after Ash Wednesday, we started with Exodus 1:1-22, and the church will read through the entire Exodus story (and maybe even the whole book) before Lent is finished. Exodus is a wild book. It is the basis for liberation theology. It is an extremely violent story. It is foundational for Judaism but also in many ways for Judaism. I've spent the last five Lent's or so reading through this story and trying to reflect on it. I guess it's time I got a decent commentary and read along, because there's alot about it that is so culturally-dependent and alot more that's just hard to figure out. But it's also a really cool story if you take the time to read it slowly.
For example, listen carefully to today's passage (if you go and read through it). It begins with the amazing story of reconciliation between Joseph and his family--after a really awful breach! Israel flourishes in Egypt. But...a Pharoah comes to power who did not personally know Joseph, and things take a turn for the worse. He ends up enslaving them. He then turns to the midwives (take note, Denise) and asks them to carry out his really heinous plan of killing all the male babies. But what do we find in this very first chapter of Exodus? We find the women, the midwives, being directly addressed, being the agent of the future of Israel, of using their reason and cunning to outsmart Pharoah, to be subversive, to save lives. They speak -- they are the first people to speak in the entire book of Exodus. In other words, the story kicks off with a group of really strong women. And God blesses them tremendously for what they do. Rock on, midwives!
One final thought. The first reading in the lectionary today (the cycle of scripture passages read at Mass every day) is from Deuteronomy. I post this primarily because this passage is so often misused. This is the passage that contains the phrase "Choose Life," used by many pro-life people. Now, I'm pro-life, but this passage has nothing to do with abortion. It has to do with...idolatry. As you'll see, God via Moses lays out "two ways" (reminiscent of the Didache reading from the Church Fathers, if you read that from yesterday): one is to love and worship God, the other is to "adore and serve other gods." The former is the way of life, the latter is the way of death. God is telling the people of Israel, before they cross into the promised land: you now have the option of worshiping me and following my way or worshipping the many gods followed by the peoples of the lands on the other side of the Jordan. "Choose life -- choose me!" God says. The other way--the way of idolatry, of worshipping false gods--is death.
Many write off the First Commandment (Exodus 20:2-6; note that this is the longest commandment....like God knew that he really needed to spell this one out!) as superfluous these days and only focus on the commandments about sex, money, and death; but it really is the case that all the way through the Old Testament....and then through the New Testament, the real question is about idolatry and who/what do you worship. How might that be the key question....today? I think Shuman and Volck talked about that....for those of you who read that....which relates all of this back to medicine.... :)
2.25.2009
Ashes to Ashes...
Ash Wednesday has arrived. Lent has begun. I hope you all find time to pray, fast and give alms during these forty days. A friend sent me this very interesting "Church Fathers Lenten Reading Plan." I post it here to share with you. A great idea, to read through some of the writings of the early church every day as we walk through Lent. Here is a pdf of all the texts on the reading list. None of the texts are very long. Some may require some background -- you can't just dive into them without context. The Didache, for example, the reading for Day 1, is one such text. Here are a couple of background links on that: one for a general reader, another for the more theologically-versed.
For more on Lent (background, theology, practice), click here.
I'll add a story with a somewhat penitential note, reminding us indeed that to dust we shall all return. This morning, London time, it appears that the oldest child of the leader of the opposition party in Britain, David Cameron, died: "Son's Death Recasts Image of British Leader," (NYT, February 25, 2009). I've spent much of this week working on the introduction to the chapter on disabilities for On Moral Medicine, and today I read two essays by men with severely disabled children. The similarities between their essays and Cameron's words here are quite striking. This is certainly a story to remind us how fragile our lives and relationships really are. Take a moment to take stock of the people to whom you are connected--offer a prayer of thanks, mend any rifts, remind them how much you care for them.
For more on Lent (background, theology, practice), click here.
I'll add a story with a somewhat penitential note, reminding us indeed that to dust we shall all return. This morning, London time, it appears that the oldest child of the leader of the opposition party in Britain, David Cameron, died: "Son's Death Recasts Image of British Leader," (NYT, February 25, 2009). I've spent much of this week working on the introduction to the chapter on disabilities for On Moral Medicine, and today I read two essays by men with severely disabled children. The similarities between their essays and Cameron's words here are quite striking. This is certainly a story to remind us how fragile our lives and relationships really are. Take a moment to take stock of the people to whom you are connected--offer a prayer of thanks, mend any rifts, remind them how much you care for them.
2.24.2009
Three Cups of Tea
Sunday when I wrote that you all must read Three Cups of Tea over spring break, I was only about half way through the book. I have now finished it. Who knew it could get even more astounding? Even if you have too many tests and papers and projects and God-knows-what-else, you really should get a copy (through the link above, which donates 7% of the proceeds to this work) and read it. It will be a salve for your soul, a challenge for your conscience, and a roadmap to your own possible future.
As I suggested on Sunday, one of the most stunning aspects of this true story is how ordinary Greg Mortensen (the hero) really is. He's not a genius with two graduate degrees from Harvard (not that I have anything against genius docs with two graduate degrees from Harvard). He spent time in the Army. He turned down a spot at Case Western Reserve medical school and decided to become a nurse, partly so he could spend time mountain climbing. He spent most of his twenties and thirties living the life of a climbing bum. He doesn't start his work, detailed in this book, until he's 35. Up to that point, he's just kind of drifting through life. I'm sure no one would have predicted that he would end up doing the work he's doing.
But he does share alot of characteristics with Farmer (at least as their two stories are told). He had an unconventional childhood (spent the first 12 years of his life in Tanzania with his missionary parents). He clearly doesn't care about possessions and can live on very little money. He has no problem giving money away. He has the gift of being very open to people, whoever they are, wherever he meets them, listening to them, treating them respectfully. He works incredibly hard. He cares passionately about the people he meets in Pakistan and Afghanistant, especially the poor, especially the girls, who really are the poorest of the poor in that context.
His story really is an exemplar of what is at the heart of doing this kind of work: an unfailing willingness to immerse oneself in the "other" context, to honor it, to listen to it, to learn from it, to see the real strength and dignity and humanness of people who live within these impoverished situations, to honor and listen to and learn from them. And the effects of this simple--but enormously difficult--art? Astounding.
The book also offers fascinating insight into Islam, and especially into Pakistan and Afghanistan, from about 1995-2005. Anyone who has a political opinion about the war in Afghanistan, terrorism, Islam--or who is curious about these things--should read this book.
The story is also a story of grace. It's a story of what can happen when (1) you think you've hit a really low point, when you're feeling like a failure and (2) you yet remain open to the grace of God in your life, especially as it comes through contact with other people. Mortensen's relationship with Christianity (his missionary parents notwithstanding) is a bit ambiguous, so there's no mention in this book of his faith or grace (except through the constant presence and invocation of Allah by those he's with and by his devotion to Mother Teresa). But that doesn't mean that one can't read it as a story of what grace really looks like in action. It's hard; it's miraculous; its context is poverty; and it has astounding effects, effects no one could ever have anticipated or imagined.
So, do yourself and your soul a favor and go and buy this book and read it and then pass it along to someone you care about.
Oh, three more things. First, here's the link to the website for his organization CAI. Second, the website mentions something called 'The Girl Effect.' Click on that link and then click on the "fact sheet." Mortensen didn't know about this when he started this project, but he discovered the truth of this discovery very quickly. I believe it's Nobel Prize winning economist Amartya Sen who recognized that the education of girls is really the key to addressing most of the economic ills of the world, especially of the poor. This discovery lies at the basis of microlending, a critical economic initiative worldwide. Much more could be said, but start with the above site.
Third, another really critical aspect of this story is its community-based nature. In this it differs from most government-based aid or development projects. Mortensen raised money in the U.S. to start and then continue this work. And he brought the money (not very much initially) over to Pakistan. But then all that money went into the Pakistani economy--he used Pakistani-made goods (cement, lumber, etc.); he paid Pakistani's to build the schools in their own areas; his teachers are local people. Many (most?) western development projects do not do this. For example, most often, when the U.S. government appropriates funds for a development project in another country, something like 80% of the money allocated returns to the U.S. Its used either to pay U.S. personnel to go over to a country and do work, or it's used to buy U.S. products that will be taken over to the other context. Thus, the money that is being "spent" on all this aid work isn't going into the other economy to strengthen it; it goes right back into our own economy.
Also, he proceeds in his work only after significant local consultation. When he goes over to build the first school (as you'll see), once he gets there with his $12,000 and he's bought all the materials for the school and he's shipped them, arduously, through the country to get to this remote place, the local community to whom he promised this school announces that first, they'd much rather have a bridge built over the river gorge so that they can more easily travel to the local bigger town. Plus, they reason correctly, there'd be no real way to get the supplies for building the school over the river without the bridge. So he builds it. And when he starts expanding his school-building initiative, he first thinks that he'll just go scout out new locations. Very quickly he realizes that a much better way is to let the local area and its leaders decide where the schools are really needed, to work with local communities that come together to donate the land and contribute labor and who will really support the school. This really should be Development Lesson #1, but it is a point seemingly lost on so many development efforts.
As I suggested on Sunday, one of the most stunning aspects of this true story is how ordinary Greg Mortensen (the hero) really is. He's not a genius with two graduate degrees from Harvard (not that I have anything against genius docs with two graduate degrees from Harvard). He spent time in the Army. He turned down a spot at Case Western Reserve medical school and decided to become a nurse, partly so he could spend time mountain climbing. He spent most of his twenties and thirties living the life of a climbing bum. He doesn't start his work, detailed in this book, until he's 35. Up to that point, he's just kind of drifting through life. I'm sure no one would have predicted that he would end up doing the work he's doing.
But he does share alot of characteristics with Farmer (at least as their two stories are told). He had an unconventional childhood (spent the first 12 years of his life in Tanzania with his missionary parents). He clearly doesn't care about possessions and can live on very little money. He has no problem giving money away. He has the gift of being very open to people, whoever they are, wherever he meets them, listening to them, treating them respectfully. He works incredibly hard. He cares passionately about the people he meets in Pakistan and Afghanistant, especially the poor, especially the girls, who really are the poorest of the poor in that context.
His story really is an exemplar of what is at the heart of doing this kind of work: an unfailing willingness to immerse oneself in the "other" context, to honor it, to listen to it, to learn from it, to see the real strength and dignity and humanness of people who live within these impoverished situations, to honor and listen to and learn from them. And the effects of this simple--but enormously difficult--art? Astounding.
The book also offers fascinating insight into Islam, and especially into Pakistan and Afghanistan, from about 1995-2005. Anyone who has a political opinion about the war in Afghanistan, terrorism, Islam--or who is curious about these things--should read this book.
The story is also a story of grace. It's a story of what can happen when (1) you think you've hit a really low point, when you're feeling like a failure and (2) you yet remain open to the grace of God in your life, especially as it comes through contact with other people. Mortensen's relationship with Christianity (his missionary parents notwithstanding) is a bit ambiguous, so there's no mention in this book of his faith or grace (except through the constant presence and invocation of Allah by those he's with and by his devotion to Mother Teresa). But that doesn't mean that one can't read it as a story of what grace really looks like in action. It's hard; it's miraculous; its context is poverty; and it has astounding effects, effects no one could ever have anticipated or imagined.
So, do yourself and your soul a favor and go and buy this book and read it and then pass it along to someone you care about.
Oh, three more things. First, here's the link to the website for his organization CAI. Second, the website mentions something called 'The Girl Effect.' Click on that link and then click on the "fact sheet." Mortensen didn't know about this when he started this project, but he discovered the truth of this discovery very quickly. I believe it's Nobel Prize winning economist Amartya Sen who recognized that the education of girls is really the key to addressing most of the economic ills of the world, especially of the poor. This discovery lies at the basis of microlending, a critical economic initiative worldwide. Much more could be said, but start with the above site.
Third, another really critical aspect of this story is its community-based nature. In this it differs from most government-based aid or development projects. Mortensen raised money in the U.S. to start and then continue this work. And he brought the money (not very much initially) over to Pakistan. But then all that money went into the Pakistani economy--he used Pakistani-made goods (cement, lumber, etc.); he paid Pakistani's to build the schools in their own areas; his teachers are local people. Many (most?) western development projects do not do this. For example, most often, when the U.S. government appropriates funds for a development project in another country, something like 80% of the money allocated returns to the U.S. Its used either to pay U.S. personnel to go over to a country and do work, or it's used to buy U.S. products that will be taken over to the other context. Thus, the money that is being "spent" on all this aid work isn't going into the other economy to strengthen it; it goes right back into our own economy.
Also, he proceeds in his work only after significant local consultation. When he goes over to build the first school (as you'll see), once he gets there with his $12,000 and he's bought all the materials for the school and he's shipped them, arduously, through the country to get to this remote place, the local community to whom he promised this school announces that first, they'd much rather have a bridge built over the river gorge so that they can more easily travel to the local bigger town. Plus, they reason correctly, there'd be no real way to get the supplies for building the school over the river without the bridge. So he builds it. And when he starts expanding his school-building initiative, he first thinks that he'll just go scout out new locations. Very quickly he realizes that a much better way is to let the local area and its leaders decide where the schools are really needed, to work with local communities that come together to donate the land and contribute labor and who will really support the school. This really should be Development Lesson #1, but it is a point seemingly lost on so many development efforts.
2.22.2009
Reproductive Technologies: Many Questions
I'm finally reading a book Jean recommended to me: Three Cups of Tea by and about Greg Mortensen's work in Pakistan to build schools for girls. Yes, I should have read it two months ago when I got it. Yes, the rest of you should buy it (support this guy's work) and read it over spring break. In some ways, this is an even more interesting book than Mountains Beyond Mountains because Mortensen is far more normal (well, "normal" is not the right word), or at least not as much of a genius as Farmer. I'll post more after I finish it.
In the meantime, today's post is about reproductive technologies. Can I tell you how wierd it is to read something like Mortensen's book--describing life in the Himalayan foothills--and then start reading about reproductive technologies in the US? This alone shows how problematic US reality is.
Anyhow...two items of interest. First, in light of the woman with the octuplets in California, whom the country has for some reason seen fit to completely vilify, even though her behavior is completely consistent with the US mentality, people are finally (finally!) beginning to talk about regulating the reproductive technology industry (yes, it is an industry; let's not pretend otherwise). Of course, they're not actually doing it yet, just talking about it. But for some reason, people seem to think it's odd that only twenty percent of US fertility clinics follow the "guidelines" established by the American College of Reproductive Medicine: "Only about 20 percent of US fertility clinics follow guidelines on embryo numbers," (MJS, February 20, 2009). I'm surprised that almost 20% actually do follow them. As always, pay careful attention to the language used in this article.
But let's be clear on what, exactly, will be regulated. As this article suggests, there are many aspects of reproductive technologies that will be regulated only by "the market": "A Baby, Please. Blond, Freckles--Hold the Colic," (WSJ, February 12, 2009). This article also supports the claim I have made frequently of what we can call the "therapeutic-bait-and-switch": arguments are offered for particular new controversial technologies on the grounds that they will cure children or prevent suffering, and once they gain approval (from the law, the public, or both) then they are immediately targeted to non-therapeutic uses, for that's where the real money is.
Yet...this week the CDC reports a new wrinkle with reproductive technologies, small but possible: "Picture Emerging on Genetic Risks of IVF," (NYT, February 16, 2009). This concern has been around for at least 15 years but has been largely ignored. It'll be interesting to see if this study pushes the question further.
In the meantime, today's post is about reproductive technologies. Can I tell you how wierd it is to read something like Mortensen's book--describing life in the Himalayan foothills--and then start reading about reproductive technologies in the US? This alone shows how problematic US reality is.
Anyhow...two items of interest. First, in light of the woman with the octuplets in California, whom the country has for some reason seen fit to completely vilify, even though her behavior is completely consistent with the US mentality, people are finally (finally!) beginning to talk about regulating the reproductive technology industry (yes, it is an industry; let's not pretend otherwise). Of course, they're not actually doing it yet, just talking about it. But for some reason, people seem to think it's odd that only twenty percent of US fertility clinics follow the "guidelines" established by the American College of Reproductive Medicine: "Only about 20 percent of US fertility clinics follow guidelines on embryo numbers," (MJS, February 20, 2009). I'm surprised that almost 20% actually do follow them. As always, pay careful attention to the language used in this article.
But let's be clear on what, exactly, will be regulated. As this article suggests, there are many aspects of reproductive technologies that will be regulated only by "the market": "A Baby, Please. Blond, Freckles--Hold the Colic," (WSJ, February 12, 2009). This article also supports the claim I have made frequently of what we can call the "therapeutic-bait-and-switch": arguments are offered for particular new controversial technologies on the grounds that they will cure children or prevent suffering, and once they gain approval (from the law, the public, or both) then they are immediately targeted to non-therapeutic uses, for that's where the real money is.
Yet...this week the CDC reports a new wrinkle with reproductive technologies, small but possible: "Picture Emerging on Genetic Risks of IVF," (NYT, February 16, 2009). This concern has been around for at least 15 years but has been largely ignored. It'll be interesting to see if this study pushes the question further.
2.21.2009
Homeless Vets and Inner City Health Care
This morning's post is a bit of a hodge-podge of items mostly related to a conversation I've had with one of you over the past couple of months or something I've posted.
1. One conversation I had last week concerned the deinstitutionalization of the mentally ill and the resulting surge in the homeless population after the 1970s. This story posted yesterday adds yet another dimension. One in three homeless adults has served in the U.S. military. That's an astounding figure! 150,000 US vets are homeless on any given night. It has become pretty clear through many news stories as well as admission of the fact by the Department of Defense over the past year or so, that the U.S. government does a pretty miserable job of helping returning servicemen with the pscyhological aftermath of their combat experiences. This story, with a video, gives some sense of the scope of the issue: "Former Addict Gives Homeless Veterans a Second Chance," (CNN, February 19, 2009). For the text-only story, click here. To think that we could address one-third of the homeless problem in the U.S. by more effectively caring for veterans--that's an astounding prospect.
If I remember correctly, there are something like 500 homeless people in Milwaukee (is that right?). If 1/3 of them are vets--so, 165 or so--what would it take to set up something like this in Milwaukee to address their needs and to address the homeless problem. This would be an interesting venture to set up with an organization like Repairers of the Breach.
2. Two articles about Catholic and/or non-profit hospitals have come my way over the past weeks. Both are testimonies to the good work being done by those who have a commitment to care for the poor in the U.S. They also highlight the fact that simply caring for the health needs of the poor is inadequate, since the 'health' problems they bring are so multifactoral. The first is a story about Mount Sinai Hospital on the west side of Chicago (one of the most destitute parts of the city): "Pursuing Charitable Mission Leaves Hospital Struggling," (WSJ, December 12, 2008). Generally, the Wall Street Journal really has it in for the non-profit, tax-exempt status of Catholic and other non-profit hospitals, so it's nice to see a relatively positive piece (though they do still go after the Catholic system).
The second article is about an initiative by St. John's Health System in Detroit (who I almost went to work for, but instead, I came to Marquette). Last year they announced that they were closing one of their downtown hospitals (while opening a hospital out in the suburbs -- not a good move!). This story redeems them somewhat, and it raises an important question: are hospitals the only or best way for Catholics or Christians or others devoted to the health of the poor to address their health needs? "St. John Health to lay out vision for Healthy Neighborhoods Detroit," (Detroit Free Press, February 17, 2009). I do think what St. John's is attempting to do here--and maybe they're only doing it because they can't find a buyer for their inner-city property in one of the most economically devestated cities in the country--is a model for other cities.
3. We could add this to Reinhardt's analysis of why US health care costs so much. He ends up by taking to task doctor's who charge too much. If we were to factor in this.....: "Doctors Face Pressure to Disclose All Side Pay," (MJS, January 11, 2009). The size of these figures just continues to blow my mind. And there's our friend Marcia Angell! That Reinhardt doesn't even really address the question of pharmaceutical costs in his analysis of healthcare costs is a bit puzzling.
4. I post this just because I think she's right and I wish we could get the collective political will and action together to make it happen: feed children healthier food and help out the local farming sector. What a thought! "No Lunch Left Behind," (NYT, February 19 2009).
1. One conversation I had last week concerned the deinstitutionalization of the mentally ill and the resulting surge in the homeless population after the 1970s. This story posted yesterday adds yet another dimension. One in three homeless adults has served in the U.S. military. That's an astounding figure! 150,000 US vets are homeless on any given night. It has become pretty clear through many news stories as well as admission of the fact by the Department of Defense over the past year or so, that the U.S. government does a pretty miserable job of helping returning servicemen with the pscyhological aftermath of their combat experiences. This story, with a video, gives some sense of the scope of the issue: "Former Addict Gives Homeless Veterans a Second Chance," (CNN, February 19, 2009). For the text-only story, click here. To think that we could address one-third of the homeless problem in the U.S. by more effectively caring for veterans--that's an astounding prospect.
If I remember correctly, there are something like 500 homeless people in Milwaukee (is that right?). If 1/3 of them are vets--so, 165 or so--what would it take to set up something like this in Milwaukee to address their needs and to address the homeless problem. This would be an interesting venture to set up with an organization like Repairers of the Breach.
2. Two articles about Catholic and/or non-profit hospitals have come my way over the past weeks. Both are testimonies to the good work being done by those who have a commitment to care for the poor in the U.S. They also highlight the fact that simply caring for the health needs of the poor is inadequate, since the 'health' problems they bring are so multifactoral. The first is a story about Mount Sinai Hospital on the west side of Chicago (one of the most destitute parts of the city): "Pursuing Charitable Mission Leaves Hospital Struggling," (WSJ, December 12, 2008). Generally, the Wall Street Journal really has it in for the non-profit, tax-exempt status of Catholic and other non-profit hospitals, so it's nice to see a relatively positive piece (though they do still go after the Catholic system).
The second article is about an initiative by St. John's Health System in Detroit (who I almost went to work for, but instead, I came to Marquette). Last year they announced that they were closing one of their downtown hospitals (while opening a hospital out in the suburbs -- not a good move!). This story redeems them somewhat, and it raises an important question: are hospitals the only or best way for Catholics or Christians or others devoted to the health of the poor to address their health needs? "St. John Health to lay out vision for Healthy Neighborhoods Detroit," (Detroit Free Press, February 17, 2009). I do think what St. John's is attempting to do here--and maybe they're only doing it because they can't find a buyer for their inner-city property in one of the most economically devestated cities in the country--is a model for other cities.
3. We could add this to Reinhardt's analysis of why US health care costs so much. He ends up by taking to task doctor's who charge too much. If we were to factor in this.....: "Doctors Face Pressure to Disclose All Side Pay," (MJS, January 11, 2009). The size of these figures just continues to blow my mind. And there's our friend Marcia Angell! That Reinhardt doesn't even really address the question of pharmaceutical costs in his analysis of healthcare costs is a bit puzzling.
4. I post this just because I think she's right and I wish we could get the collective political will and action together to make it happen: feed children healthier food and help out the local farming sector. What a thought! "No Lunch Left Behind," (NYT, February 19 2009).
2.20.2009
More PIH
I have just figured out how to post the monthly PIH newsletters that I receive! I have been saving them, trying to figure out how to convey items you all might find of interest. I now see that they are available in web format; ergo, I can post them. Click on one (or more) of them and subscribe for yourself!
PIH e-Bulletin, August 2008. Three items of particular interest in this issue:
1. Hospitals with windows and other open-air systems have better ventilation than hospitals with mechanical ventilation systems: "Rwanda: Hospital’s Design Keeps Fresh Air in Mind," (NYT, August 18, 2008). A book I'm reading, about which I'll post shortly, also argues that architectural designs that include things like windows (!) can help reduce patients' pain.
2. An article on the relationship between politics, economics, and health in Haiti. "Haiti's Forgotten Emergency," (Lancet, August 2008); does this ring true, Denise?
3. And a new open-access online journal Health and Human Rights.
PIH e-Bulletin, November 2008. This one includes in interesting blog post on The Daily Beast by Farmer on the prospects of universal healthcare in the US under the new presidential administration. How interesting that he and his family of eight went without health insurance for most of his childhood. No doubt this has shaped his perspective.
PIH e-Bulletin, January 2009. This one includes a link to a list of recommendations that PIH made to the incoming presidential administration regarding global health.
PIH e-Bulletin, February 2009 (cited earlier today).
PIH e-Bulletin, August 2008. Three items of particular interest in this issue:
1. Hospitals with windows and other open-air systems have better ventilation than hospitals with mechanical ventilation systems: "Rwanda: Hospital’s Design Keeps Fresh Air in Mind," (NYT, August 18, 2008). A book I'm reading, about which I'll post shortly, also argues that architectural designs that include things like windows (!) can help reduce patients' pain.
2. An article on the relationship between politics, economics, and health in Haiti. "Haiti's Forgotten Emergency," (Lancet, August 2008); does this ring true, Denise?
3. And a new open-access online journal Health and Human Rights.
PIH e-Bulletin, November 2008. This one includes in interesting blog post on The Daily Beast by Farmer on the prospects of universal healthcare in the US under the new presidential administration. How interesting that he and his family of eight went without health insurance for most of his childhood. No doubt this has shaped his perspective.
PIH e-Bulletin, January 2009. This one includes a link to a list of recommendations that PIH made to the incoming presidential administration regarding global health.
PIH e-Bulletin, February 2009 (cited earlier today).
Change Haiti Can Believe In
For those needing a dose of Farmer and Partners in Health, in this video posting from PIH, Farmer, Matt Damon and others discussing how changes in U.S. policy could make significant differences in strengthening Haiti as a country: "Change Haiti Can Believe In."
See also the op-ed by the same title that Farmer and attorney Brian Concannon (who works tirelessly for justice in Haiti) published last month in the Boston Globe: "Change Haiti Can Believe In," (Boston Globe, January 25, 2009).
Also, PIH has launched an online Health and Social Justice video network. In their words: "The network features live, scheduled, and on-demand Internet television programs. Video content from PIH and other organizations dedicated to health and social justice will be made available on the PIH website and can be broadcast on any computer with an internet connection." To access it, click here.
See also the op-ed by the same title that Farmer and attorney Brian Concannon (who works tirelessly for justice in Haiti) published last month in the Boston Globe: "Change Haiti Can Believe In," (Boston Globe, January 25, 2009).
Also, PIH has launched an online Health and Social Justice video network. In their words: "The network features live, scheduled, and on-demand Internet television programs. Video content from PIH and other organizations dedicated to health and social justice will be made available on the PIH website and can be broadcast on any computer with an internet connection." To access it, click here.
2.19.2009
Why the US Spends So Much on Health Care: A Primer
Today I am finally posting a series of pieces on health care costs/pricing/etc., that I had been following in November and December.
First, as mentioned to Renee and Denise a week or so ago, here is an interesting piece to get us thinking about exactly how does one do the accounting in healthcare? "A Hidden Cost of Health Care: Patient Time," (Economix, February 9, 2009). At least economists think like this (opportunity costs, etc.).
Second, here's a nine-part series by healthcare economist Uwe Reinhardt on why the US spends so much on healthcare. For the most part, it is VERY clearly written (for non-economists), very informative, and thought-provoking. A few interesting nuggets:
*Reinhardt suggests that it would only cost an extra $125 billion (per year?) over what we spend now to attain truly universal health care in the US. Given the figures we've seen with the recent economic crisis, that number doesn't seem that large anymore. But, on the other hand, if our healthcare costs are deemed high, that would push them even higher? He cites an article in Health Affairs which is probably worth looking up.
*He also goes on to cite figures for excess administrative costs, which if eliminated would be a wash with the 'cost' of universal health care.
*Apparently we can't blame all the old people for raising our health care costs; so much for all those proposals for age-based rationing of healthcare.
*He dismantles all those popular myths about Medicare that you hear on talk-radio.
*He seems to root the problem in unregulated physician autonomy. Fascinating! We'd have to explore exactly what he means by 'cost-effectiveness' here, especially if it effectively ends up meaning that the time physicians spend with patients becomes even more limited than it is now.
*The stuff on hospital pricing is a bit mind-boggling. I'm going to have to read through it again. For now, however, here are the posts:
"Why Does U.S. Health Care Cost So Much? (Part I)" (Economix, November 14, 2008)
"Why Does U.S. Health Care Cost So Much? (Part II: Indefensible Administrative Costs)" (Economix, November 21, 2008).
"Why Does U.S. Health Care Cost So Much? (Part III: An Aging Population Isn't the Reason)" (Economix, December 5, 2008).
"Why Does U.S. Health Care Cost So Much? (Part IV: A Primer on Medicare)" (Economix, December 12, 2008).
"U.S. Health Care Costs Part V: Can Americans Afford Medicare?" (Economix, December 19, 2008).
"U.S. Health Care Costs Part VI: What Price Physician Autonomy?" (Economix, December 26, 2008).
"U.S. Health Care Costs Part VII: Reining in Doctors Who Cost Too Much" (Economix, January 2, 2009)
Reinhardt then turns to hospital financing:
"How Do Hospitals Get Paid? A Primer" (Economix, January 23, 2009).
"A More Rational Approach to Hospital Pricing" (Economix, January 30, 2009).
You can also find all these posts on one page here.
First, as mentioned to Renee and Denise a week or so ago, here is an interesting piece to get us thinking about exactly how does one do the accounting in healthcare? "A Hidden Cost of Health Care: Patient Time," (Economix, February 9, 2009). At least economists think like this (opportunity costs, etc.).
Second, here's a nine-part series by healthcare economist Uwe Reinhardt on why the US spends so much on healthcare. For the most part, it is VERY clearly written (for non-economists), very informative, and thought-provoking. A few interesting nuggets:
*Reinhardt suggests that it would only cost an extra $125 billion (per year?) over what we spend now to attain truly universal health care in the US. Given the figures we've seen with the recent economic crisis, that number doesn't seem that large anymore. But, on the other hand, if our healthcare costs are deemed high, that would push them even higher? He cites an article in Health Affairs which is probably worth looking up.
*He also goes on to cite figures for excess administrative costs, which if eliminated would be a wash with the 'cost' of universal health care.
*Apparently we can't blame all the old people for raising our health care costs; so much for all those proposals for age-based rationing of healthcare.
*He dismantles all those popular myths about Medicare that you hear on talk-radio.
*He seems to root the problem in unregulated physician autonomy. Fascinating! We'd have to explore exactly what he means by 'cost-effectiveness' here, especially if it effectively ends up meaning that the time physicians spend with patients becomes even more limited than it is now.
*The stuff on hospital pricing is a bit mind-boggling. I'm going to have to read through it again. For now, however, here are the posts:
"Why Does U.S. Health Care Cost So Much? (Part I)" (Economix, November 14, 2008)
"Why Does U.S. Health Care Cost So Much? (Part II: Indefensible Administrative Costs)" (Economix, November 21, 2008).
"Why Does U.S. Health Care Cost So Much? (Part III: An Aging Population Isn't the Reason)" (Economix, December 5, 2008).
"Why Does U.S. Health Care Cost So Much? (Part IV: A Primer on Medicare)" (Economix, December 12, 2008).
"U.S. Health Care Costs Part V: Can Americans Afford Medicare?" (Economix, December 19, 2008).
"U.S. Health Care Costs Part VI: What Price Physician Autonomy?" (Economix, December 26, 2008).
"U.S. Health Care Costs Part VII: Reining in Doctors Who Cost Too Much" (Economix, January 2, 2009)
Reinhardt then turns to hospital financing:
"How Do Hospitals Get Paid? A Primer" (Economix, January 23, 2009).
"A More Rational Approach to Hospital Pricing" (Economix, January 30, 2009).
You can also find all these posts on one page here.
2.18.2009
Time to Resuscitate
Finally an article to make me overcome my sloth and again jumpstart this blog. There have been quite a few that have said to me: 'you must post this,' but this one has actually made me do it. I post this in large part because: this could be you. Or it is you. Or it might soon be you. Or it will very shortly be one or more of your friends, if it isn't already. From today's New York Times, "For Uninsured Young Adults, Do-It-Yourself Health Care" (NYT, February 18, 2009). Why, one could ask, are there age-limits for children on parental healthcare policies? I mean, someone would still be paying the premium. Insurance companies could charge more for "adult" children than for "dependent" children. One thing I found fascinating about this article was the "do-it-yourself" healthcare approach adopted by many of these people. People refer to modes of exchange like Craigslist and Ebay as the "alternative economy" -- economic exchange not captured by taxes, GDP, etc. Here we have an "alternative economy of medicine."
The second piece I'm posting tonight I am posting in part to save it to my own archives but also because it raises such an important issue. And it's interestingly coincidental. Tonight I started working on the introduction for the chapter in my forthcoming book (On Moral Medicine, 3rd edition) on research and experimentation. And tonight, we have: "Growth of Clinical Trial Outsourcing Raises Issues," (CNN, February 18, 2009). "Outsourcing" clinical trials -- you have to love that language! It used to be called "offshoring" -- a more accurate description. Why outsource? It's cheaper, there are fewer regulations (to protect the human subjects), and, as we know, poor, brown people in other countries are far more expendable than people in the U.S. Plus they're too poor to litigate if something goes wrong. I posted a number of pieces about research, particularly pharmaceutical research, back when I started this blog. Time to go back and look at those.
Finally, a post for your amusement. This is from the Freakonomics website. I like these guys -- I don't always agree with them, but they post interesting, informative, thought-provoking pieces. Today they posted: "Let the Human-Capital Exodus Begin" (Freakonomics, February 18, 2009). It is such a stupid piece! But what's amusing is how the readers tear them apart in the comments. If nothing else, it's a great exercise in how to spot fallacious logic. Rock on, readers!
Now I'll try to go back and dig out all those interesting news stories I've seen over the past three months and catch up.
The second piece I'm posting tonight I am posting in part to save it to my own archives but also because it raises such an important issue. And it's interestingly coincidental. Tonight I started working on the introduction for the chapter in my forthcoming book (On Moral Medicine, 3rd edition) on research and experimentation. And tonight, we have: "Growth of Clinical Trial Outsourcing Raises Issues," (CNN, February 18, 2009). "Outsourcing" clinical trials -- you have to love that language! It used to be called "offshoring" -- a more accurate description. Why outsource? It's cheaper, there are fewer regulations (to protect the human subjects), and, as we know, poor, brown people in other countries are far more expendable than people in the U.S. Plus they're too poor to litigate if something goes wrong. I posted a number of pieces about research, particularly pharmaceutical research, back when I started this blog. Time to go back and look at those.
Finally, a post for your amusement. This is from the Freakonomics website. I like these guys -- I don't always agree with them, but they post interesting, informative, thought-provoking pieces. Today they posted: "Let the Human-Capital Exodus Begin" (Freakonomics, February 18, 2009). It is such a stupid piece! But what's amusing is how the readers tear them apart in the comments. If nothing else, it's a great exercise in how to spot fallacious logic. Rock on, readers!
Now I'll try to go back and dig out all those interesting news stories I've seen over the past three months and catch up.
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