Category Archives: Health and Medicine

Are doctors the problem and can they be the solution?

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This week’s New Yorker has another article by doctor and health care policy expert Atul Gawande. In the article he attempts to probe why medical costs in this country are spiraling out of control, singling-out one particular outlier in Texas:

It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.

McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami–which has much higher labor and living costs–spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. [Link]

By systematically eliminating all the likely suspects (e.g., it’s the lawyers and their malpractice suits that cause health care costs to soar), Gawande comes to a conclusion that many doctors probably already grudgingly realize through experience. It is doctors (not all, just the ones who increasingly advocate for tests that the patient probably does not need) who are driving up health care costs for everyone:

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures. [Link]
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We Are Fatter Than We Think We Are

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An African-American friend of mine on Facebook recently jubilantly posted a link to this article about a recently-discovered problem with the BMI Index, a number widely used to determine body fat levels — whether people are underweight, healthy, overweight, or obese.

The BMI index was calculated with reference to caucasian body types. But people from different ethnic backgrounds have bodies that might be constructed slightly differently, so one BMI might not accurately determine everyone’s body fat level. A more direct measure of body fat can be found through Dual X-Ray Absorptiometry (DXA or DEXA), which measures body fat directly, rather than as an index. Here are the basics:

BMI is a formula that estimates a person’s body fat using only his/her weight and height. The result is then used to determine weight categories: 18.5 and below is considered underweight; 18.6 – 24.9 healthy; 25 – 29 overweight and 30+ obese.

“This scale was created years ago and is based on Caucasian men and women,” says Bray, “It doesn’t take into account differences in body composition between genders, race/ethnicity groups, and across the lifespan.” (link)

The good news for African Americans and bad news for Asian Indians is after the jump: Continue reading →

Isolation: The Prisoner and the Yogi

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In the most recent edition of The New Yorker, Atul Gawande has an absorbing article titled “Hellhole,” in which he reviews the effects of extreme isolation on the human mind. In particular, his article focuses on prisoners in America’s SuperMax facilities that spend upwards of 23 hours a day in solitary confinement. He also uses as examples, prisoners of war/hostages such as Terry Anderson and John McCain (who were isolated as a form of torture). American prisons purportedly use solitary confinement as a last ditch deterrent against the “worst of the worst”: that segment of the prison population which continues to commit crimes inside of the prison, gives the guards a hard time, or has successfully escaped previously. The problem is that the data shows that this approach simply doesn’t work. What’s more, it is as bad as any form of torture in that it irreversibly destroys the human brain:

Craig Haney, a psychology professor at the University of California at Santa Cruz, received rare permission to study a hundred randomly selected inmates at California’s Pelican Bay supermax, and noted a number of phenomena. First, after months or years of complete isolation, many prisoners “begin to lose the ability to initiate behavior of any kind–to organize their own lives around activity and purpose,” he writes. “Chronic apathy, lethargy, depression, and despair often result. . . . In extreme cases, prisoners may literally stop behaving,” becoming essentially catatonic.

Second, almost ninety per cent of these prisoners had difficulties with “irrational anger,” compared with just three per cent of prisoners in the general population. Haney attributed this to the extreme restriction, the totality of control, and the extended absence of any opportunity for happiness or joy. Many prisoners in solitary become consumed with revenge fantasies.

…EEG studies going back to the nineteen-sixties have shown diffuse slowing of brain waves in prisoners after a week or more of solitary confinement. In 1992, fifty-seven prisoners of war, released after an average of six months in detention camps in the former Yugoslavia, were examined using EEG-like tests. The recordings revealed brain abnormalities months afterward; the most severe were found in prisoners who had endured either head trauma sufficient to render them unconscious or, yes, solitary confinement. Without sustained social interaction, the human brain may become as impaired as one that has incurred a traumatic injury. [Link]

I find that last sentence particularly important given our modern culture of incessant Twittering and Facebook updates. If you think the reaction of the brain to social deprivation is bad now, just wait until you see the next generation of prisoners who not only have their friends and family but also their Twitter circle stripped from them. The most disturbing observation that Gawande makes is that none of this is a revelation. On the scientific front, Harry Harlow and his cruel experiments proved in the 1950s what harm isolation causes in monkeys. On the legal front, the U.S. Supreme Court opined in 1890 that solitary was no way to re-habilitate a criminal mind:

Justice Samuel Miller noted… “serious objections” to solitary confinement:

A considerable number of the prisoners fell, after even a short confinement, into a semi-fatuous condition, from which it was next to impossible to arouse them, and others became violently insane; others, still, committed suicide; while those who stood the ordeal better were not generally reformed, and in most cases did not recover sufficient mental activity to be of any subsequent service to the community. [Link]

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Gassy? Bloated? Fatigued? YOU may be suffering from PSSD!

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Mutineers, have you been the victim…of strange assumptions and blatant stupidity?

Are you confused? Uneasy? Constipated?

You may be suffering from PSSD. Post-Slumdog Stress Disorder is a very real ailment, with devastating consequences for its sufferers. Victims of PSSD often, on a daily, if not hourly basis, endure flashes of rage, manic ranting, rocking back and forth while twitching slightly in the corner, and a smug proclivity to email links to anti-“Slumdog Millionaire” news stories with the subject line: “HA! Look who agrees with me! LOOK!!”.

If you have been accosted by allegedly well-meaning but clearly oblivious, pink cylons who initiate insensitive conversations about this movie with you, DO SOMETHING. Instead of being harmed by that dangerous trauma trigger, show them this educational video, so that they leave you the fuck alone, then you can go back to being bitter about not going to medical or law school, in peace.


Link courtesy of old skool mutineer Sexy_Gulti_Ho. And yes, that’s his screen name. Continue reading →

Sex selection accompanies immigrants to America

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The San Jose Mercury News has an article highlighting some soon-to-be-published findings by economists at both Columbia University and the University of Texas who were studying Asian immigrant communities. The findings indicate that the practice of sex selection among Asian immigrants does not stop at American shores as many of us would like to believe:

Researchers are finding the first evidence that some Asian immigrant families are using U.S. medical technology to have sons instead of daughters, apparently acting on an age-old cultural prejudice that has led to high ratios of boys to girls in parts of China and India.

The new research, produced by independent teams of economists who arrived at similar conclusions, focused on Indian, Chinese and Korean families who first had girls and then used modern technology to have a son…

For some South Asian couples, having a boy is a “status symbol,” said Deepka Lalwani of Milpitas, the founder and president of Indian Business & Professional Women, a nonprofit business support network. “If a woman has male children, she feels in her family, certainly with her in-laws, that her status will go up because now she is the mother of a male child…”

Such cultural pressures may explain the recent findings. A Columbia University study suggests that Chinese, Indian and Korean immigrants have been using medical technology, most likely including abortion, to assure their later children were boys. And a soon-to-be published analysis of birth records by a University of Texas economist estimates there were 2,000 “missing girls” between 1991 and 2004 among immigrant families from China and India living in the U.S. — children never born because their parents chose to have sons instead. [Link]

Perhaps I’ve just been very naive but I was quite surprised by this finding. Given that the prime reason for preferring sons in Asian countries is that sons serve as a social security net, I just assumed the practice would be swept aside in America given that there are alternate means of obtaining social security and that women here have a greater ability to rise up the socio-economic ladder and support the family. I guess I did not put enough importance in the desire some of these families have to preserve their names through a male heir.

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Too sexy for this job?

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News that Sanjay Gupta has been offered the position of Surgeon General has produced the classic trifecta of Golidlocks responses: Is he too sexy for the job, not sexy enough, or does he have the right amount of smouldering sex appeal to keep pace with Obama, Biden, Daschle and Hillary Clinton?

Too sexy for this job:

My friend Dr. B objects to the idea that SG could be the SG, saying that he lacks the gravitas for the job, and that she would have preferred a more established, less erotically charged nominee in the C. Everett Koop mold.

For those of you too young to remember, despite Koop’s mad pediatric surgical skillz, he was as attractive as Bill Gates on a bad hair day. Nobody, no matter how intense their uniform fetish, ever had an erotic dream about Dr. Koop or Joycelen Elders, and Dr. B thinks that precedent should be maintained.

Similarly, when Dr. Amonymous asks for SG’s policy qualifications, pointing out that “The Surgeon General functions under the direction of the Assistant Secretary for Health and operationally heads the 6,000-member Commissioned Corps of the USPHS, a cadre of health professionals who are on call 24 hours a day, and can be dispatched by the Secretary of HHS or the Assistant Secretary for Health in the event of a public health emergency.” [wiki], it’s clear that what he’s really saying is … “how can I take him seriously when he’s so pretty?”

(Manish has a variant of this argument, claiming not that Gupta is too sexy for the job, but that the job isn’t sexy enough for him, calling it a step down from his current position to one that pays less and has less influence.)

They do have a point since “Gupta was named one of the Sexiest Men of 2003 by People magazine.” [wiki] It’s hard to see what more objective measure of sexiness there might be.

Not sexy enough for this job:

There are those, however, who reject People Magazine’s imprimature as if it were some illegible doctor’s scrawl on a prescription pad, arguing brazenly that Dr. Gupta doesn’t have the intellectual honesty sex appeal necessary for the position.

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Paging General Gupta. The country needs you…STAT

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By about 3:30p.m. eastern this afternoon, every South Asian American in the country (and their mother) had already heard that Sanjay Gupta was on the verge of being announced the next Surgeon General of the United States:

President-elect Barack Obama has offered the job of surgeon general to Dr. Sanjay Gupta, the neurosurgeon and correspondent for CNN and CBS, according to two sources with knowledge of the situation.

Gupta has told administration officials that he wants the job, and the final vetting process is under way. He has asked for a few days to figure out the financial and logistical details of moving his family from Atlanta to Washington but is expected to accept the offer.

When reached for comment today, Gupta did not deny the account but declined to comment.

The offer followed a two-hour Chicago meeting in November with Obama, who said that Gupta could be the highest-profile surgeon general in history and would have an expanded role in providing health policy advice, the sources said. Gupta later spoke with Tom Daschle, Obama’s White House health czar and nominee for Health and Human Services secretary, and other advisers to the president-elect. [Link]

The choice of Gupta is very obvious when you think about it. It adds a touch of star power to Obama’s administration, will get lots of kudos (and donations) from the South Asian American community and, perhaps most importantly, adds another health care policy wonk to the dream team to be headed by H&HS Secretary Tom Daschle. You know all those rich Indian doctors that tend to vote Republican? Maybe not anymore.

CNN released a statement saying, “Since first learning that Dr. Gupta was under consideration for the surgeon general position, CNN has made sure that his on-air reporting has been on health and wellness matters and not on health-care policy or any matters involving the new administration…” [Link]

Taking this job, which will result in a large paycut for Gupta, will also set him up very nicely to run for office in Michigan in the future. Through some contacts I heard the rumors a few months back that Gupta at least thought about or was encouraged to run for mayor of Detroit to replace the disgraced Kwame Kilpatrick.

As a college senior I once invited Dr. Gupta to the Midwest Indian American Students’s Conference at the University of Michigan (he is an alumnus). It was before he hit the big time but I remember him being really genuine and laid back. And of course who can forget his exploits with the Devil Docs at the beginning of the war where is switched between reporting for CNN and scrubbing in to brain surgery.

There is another really good potential outcome as a result of this appointment. I know a lot of desi doctors who look a lot younger than they really are. Patients always make comments to them like, “uhhh…are you old enough?” Now these desi doctors can point to Sanjay Gupta who is the top doctor in the land and also looks pretty young and say, “umm, like yeah.”

What I really wanted to do was to end this post with the really funny Gupta/Dobbs CNN ad from a few years back. Can someone find me a working link…STAT?

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Driving substantive health care reform

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While we are busy debating the merits of one potential Obama appointee and fawning over another (ok, I know, I am the only one fawning), there is a third that might end up having the most substantive role of all in Obama’s administration. Neera Tanden, who I first wrote about back in 2004, in all likelihood is about to occupy a position that will greatly influence this nation’s health care policy. First, remember that Tom Daschle will serve a new dual role. He will not only be named as the cabinet level head of Health and Human Services, but will also be director of a new WHITE HOUSE OFFICE OF HEALTH REFORM. This essentially gives him the powers of a Health Czar and indicates that we will see a major legislative push in the direction of comprehensive health care reform. Tanden is a member of the transition team’s health advisors, having come over from Clinton’s campaign. She is a battle-hardened survivor of Hillary-care and knows the lessons learned and can be a great asset to Daschle. Here is an interesting footnote about Tanden’s role at the inception of Hillary’s campaign:

On a cold midmorning in January 2007, Hillary sat in the sunny living room of her house on Whitehaven Street in Washington, a well-to-do enclave off Embassy Row where she lived with her mother and, on occasion, her husband. She was finishing a last round of policy prep with her aides before getting on a plane to Iowa for her first big campaign swing. In a moment of quiet, she looked around the living room and said, to no one in particular, “I so love this house. Why am I doing this?”

Her policy director, Neera Tanden, and her advertising director, Mandy Grunwald, laughed, a little too lightheartedly. Clinton went on. “I’m so comfortable here. Why am I doing this?”

Tanden spoke up. “The White House isn’t so bad,” she said. [Link]

The New York Times had a good article on Tanden way back in 2000 [via Manish]:

How smart is the smart kid in Hillary Clinton’s Senate bid?

From all appearances — including a law degree from Yale — very.

It was Ms. Tanden, signing on with the exploratory committee in July 1999, who moved to New York from the White House and worked with Mrs. Clinton, researching and developing policies. She was 29.

It was Ms. Tanden — with, she wants you to know, her staff of six — who challenged Rick A. Lazio’s first major policy proposal, a tax-reduction plan, in August. In two hours Ms. Tanden prepared a detailed financial response. Finding the facts and figures to defend her candidate’s position is a large part of her work.

Watching Ms. Tanden in action at the Hillary 2000 headquarters on 34th Street is not permitted.

But you can accompany Ms. Tanden, informal, fast-talking, connected to her cell phone as to a body part, across the street to the restaurant she frequents these days, the cafeteria in Macy’s basement. She works 7 days a week, 12 hours a day. Her husband hates her work, Ms. Tanden allows in an unguarded moment. She makes a quick, politic adjustment: he doesn’t hate the work; he hates the way she brings the work home, the stress. [Link]

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If you’re male, you may not want to read this…

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…lest you wish to spend the rest of the day with your legs tightly crossed, doubled-over with sympathy pain and terror (thanks, JTMoney!). Via our news tab: Kir Royale the betta.jpg

A 2cm long fish apparently found it’s (sic) way into the penis of a 14-year-old boy from India in a bizarre medical case.
The patient was admitted to hospital with complaints of pain, dribbling urine and acute urinary retention spanning a 24-hour period. According to the boy, the fish slipped into his penis while he was cleaning his aquarium at home.

Uh…I’ve either had or been around home aquariums since I was a toddler. I have never had a fish slip anywhere, while I was cleaning anything. Hell, I haven’t even had one of these bizarre pedicures.

Professor Vezhaventhan and Professor Jeyaraman, who treated the boy and later wrote a paper on the case, explained: “While he was cleaning the fish tank in his house, he was holding a fish in his hand and went to the toilet for passing urine. When he was passing urine, the fish slipped from his hand and entered his urethra and then he developed all these symptoms.”

Okay, mens. Here’s the part which will have you wincing:

After detecting the fish in the boy’s bladder, Vezhaventhan and Jeyaraman used a technique known as cystourethroscopy to insert a special set of forceps down the patient’s penis. Unfortunately, the fish was just too slippery to grip, so they resorted to using a rigid ureteroscope with a tool attached that is normally used for removing bladder stones.

Yeesh, even I am crossing my legs at this point. One of the most awesome aspects of being female is knowing what a speculum is, whether one is involved with medicine or not, and by awesome, I mean “atrocious”. Owww.

The fish the urologists removed, which Practical Fishkeeping believes to be a small member of the Betta genus, measured 2cm long and 1.5cm wide.

By the way, bettas aren’t just “Siamese Fighting Fish“, even though many people refer to the latter (a.k.a. Betta Splendens) by just its genus name. For those who may be wondering about it, the image enhancing this post is a picture of my dearly departed “Kir Royale“, a betta splendens who traveled to that great pond in the sky, earlier this year.

He was later admitted into counseling to help him overcome any trauma.

Speaking of trauma, aren’t you glad I didn’t play the caption game, with this one? 😉 Continue reading →

A mother’s work is never done

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For one women it seems, the biological work of mothering continues even well after menopause:

A woman said to be 70 years of age has given birth to twins in India’s northern Uttar Pradesh state after taking IVF treatment… The couple were so desperate for a male heir that they spent their life savings and took out a bank loan for IVF.

Omkari Panwar already has two daughters and is a grandmother to five children. “We already have two girls but we wanted a boy so that he could have taken care of our property. This boy and girl are God’s greatest gift to us,” Omkari said. [Link]

That’s right – she got pregnant at age 70 so she could produce a male heir! This boy isn’t even going to be able to take care of its parents in their old age, they’re already there. The sole reason for his conception was so that he could inherit the property.

While I shake my head in confusion at this (why do you care who inherits after you’re dead – you’re dead, right?), is the average American any better? It turns out that they have a strong preference for female children when they adopt:

… there are about 105 boys for every 100 girls in the general population of biological children under the age of 18. Adopted children … [however, have] 89 boys for every 100 girls. What’s more, adopted children under the age of 6 constitute a group where there only are 85 boys for every 100 girls…. the sex ratio of adopted children goes still further off-kilter if you look only at international adoptions… Girls make up about 64 percent of all children adopted by Americans outside the United States. That’s a mere 56 boys for every hundred girls. [Link]

When adopting abroad, Americans have a 2:1 preference for girls over boys. And that’s not a matter of supply, it’s purely demand:

It doesn’t matter if they’re adopting from China, where girls far outnumber boys; from Russia, where the numbers are about even; or from Cambodia, where there is typically a glut of orphan boys and a paucity of girls. Everywhere, demand tends to favor the feminine. [Link]

There are good reasons to tsk over the desi preference for boy children. Should we do the same when it comes to the American preference for girl children when adopting?

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