The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
"The trouble with a free-market approach is that health care is an immensely complicated and expensive industry, in which the individual rarely has much actual market power.
The point of universal coverage is to pool risk, for the maximum benefit of the individual when he or she needs care. And the point of having the government manage this complicated service is not to take freedom away from the individual. The point is the opposite: to give people more freedom.
I wish we were free to assume that our doctors get paid a salary to look after our best interests, not to profit by generating billable tests and procedures."
Excerpts from an amazing op-ed in the NY Times. It pretty well says it all in a pleasant "nordic" way.
When is it ethical to design a health care system that caters to those who can pay?
An old Yiddish proverb runs: "If the rich could pay the poor to die for them, the poor would make a very good living."
Khawar Mann, OBE, a venture capitalist with the Abraaj investment group, travels around Africa scoping out hospitals to buy that seem likely to provide good returns on investments.
Private health care has been an interesting model in the U.S. which lags behind all other developed nations in outcomes. So why is the American system now envisioned as a viable model for Africa? Will this not just serve to widen the "health" gap between the rich and poor?
Mr. Mann says: "“Nairobi is a sweet spot for us. There is a big population that is growing. You have emerging middle incomes. And there is a massive need for health care.” (for those who can afford to pay in cash).
“Delmar Boulevard in St. Louis, Missouri marks a sharp divide between the poor, predominately African American neighborhood to the north and a more affluent, largely white neighborhood to the south. Education and health also follow the “Delmar Divide,” with residents to the north less likely to have a bachelor’s degree and more likely to have heart disease or cancer.” See: Zip Code Predicts Health.
At a recent health care conference in Hawaii, Dr. Dileep Bal, told a packed auditorium of affluent dermatologists that one’s zip-code is a better predictor of health than any of the questions we routinely pose to patients. This got me thinking about how I have missed what should have been in my face in the five decades since I entered medical school. Zip Codes trump most (maybe all) other determinants of health.
There is not as much literature about this subject as one would anticipate given its importance. Here is a pertinent article: “Poverty, wealth, and health care utilization: a geographic assessment” from The Journal of Urban Health. PubMed Abstract, See Free Full Text Online PMC article.
The paper “demonstrates the strong association between low ZIP code income and both higher percentages of disability and greater hospital utilization. And they suggest that, given the large contribution of the poorest neighborhoods to aggregate utilization, it will be difficult to curb the growth of health care spending without addressing the underlying social determinants of health.”
This Zip Code information runs parallel to the effects Adverse Childhood Experiences (ACEs) have on a child’s subsequent physical and mental health and ultimately longevity. They are both significant determinants of one’s health, well-being and success in life.
Note: In researching this topic I came across this quote: Our public health practices ignore this fundamental truth. In America, when it comes to your health, your zip code is more important than your genetic code. Anthony Iton, M.D. J.D., M.P.H. (Commencement address UC Berkeley 2014)
“Are you not giving me any medicine?” her patient asked?
Ms. Shahab was silent for a moment, and then said with a sympathetic gaze, “Medicine for you will not cure your abusive husband.”
"The therapist was born in the isolated Afghan village she still lives in, in 1987 or 1988 — she is not sure. Her father was shot and killed at his mosque shortly before she was born. The reasons for the killing remain unclear, but it shattered their family and forever changed life for Ms. Shahab and her two siblings.
Ms. Shahab and Client (NY Times)
"A marriage was arranged to a man almost 20 years her senior when she was only 13. But the marriage did not stop her from completing her education. She took two of her youngest children with her to school, placing them at the kindergarten as she attended classes."
She is now a therapist in the village, caring for women battered by family and war.
The Reith Lectures were inaugurated in 1948 by the BBC. Bertram Russell gave the first talk.
In 2014, there were four Reith orations by Atul Gawande on The Future of Medicine. They were presented in Boston, London, Edinburgh, and New Delhi. All can be listened to or read. In addition they can be downloaded for free to iTunes and transferred to an iPod for easy listening. O! Brave New World!
Americans are inundated with medical information. It comes from every direction -- the media, the Internet, well-meaning friends and acquaintances, and an ever-proliferating collection of journals. In 'The Smart Patient -- Mistakes We Make About Our Health -- And How to Avoid Them,' Gina Kolata of The New York Times provides guidance in sorting through this welter, helping readers to make better decisions for themselves. Kolata, one of the country's most respected medical journalists, tells why anecdotal evidence should be viewed with skepticism, why large random studies are more trustworthy than observational ones, when a second opinion is a must, and what questions you should ask your doctor and -- equally important -- what ones you need to ask yourself.
I saw an ad for The Smart Patient in the NY Times and downloaded it to a Kindle. It's also available for the Nook. This is a short book, might take one to two hours to read and there is much for patients, their families and all care givers (including physicians) to ponder over. It's well worth the $2.99 price.
Even as Americans struggle with the changes required by health care reform, an international survey released last week by the Commonwealth Fund, a research organization, shows why change is so necessary.
The report found that by virtually all measures of cost, access to care and ease of dealing with insurance problems, Americans fared poorly compared with people in other advanced countries.
Medical Nemesis: The
Expropriation of Health (1976) by Ivan Illich
(I read this book in 1994 and it has resonated with me ever since. Here is an excerpt from the introduction. My full notes are in the pdf at the end of this post.)
The medical establishment has become a major threat to
health. The disabling impact of
professional control over medicine has reached the proportions of an epidemic.
Thoughtful public discussion of the iatrogenic [“physician
caused”, iatros=physician & genus=birth] pandemic, beginning with an
insistence upon demystification of all medical matters, will not be dangerous
to the commonweal. Indeed, what is
dangerous is a passive public that has come to rely on superficial medical
My argument is that the layman and not the physician has the
potential perspective and effective power to stop the current iatrogenic
During the last generations the medical monopoly over health
care has expanded without checks and has encroached on our liberty with regard
to our own bodies. Society has
transferred to physicians the exclusive right to determine what constitutes
sickness, who is or might become sick, and what shall be done to such
people...The social commitment to provide to all citizens with almost unlimited
outputs from the medical system threatens to destroy the environmental and
cultural conditions needed by people to live a life of constant autonomous
Fairly extensive notes from Medical Nemesis can be found here:
Download Medical Nemesis Illich Illich was a visionary. Few acknowledge his influence; indeed most are not even aware of it.
"Why do some
innovations spread so swiftly and others so slowly? Consider the very different
trajectories of surgical anesthesia and antiseptics, both of which were
discovered in the nineteenth century.
The first public demonstration of anesthesia was in Boston in1846. The idea spread like a contagion, travelling
through letters, meetings, and periodicals. By mid-December, surgeons were
administering ether to patients in Paris and London. By February, anesthesia
had been used in almost all the capitals of Europe, and by June in most regions
of the world. Within seven years,
virtually every hospital in America and Britain had adopted the new discovery.
the other great scourge of surgery. It was the single biggest killer of
surgical patients, claiming as many as half of those who underwent major operations.
Infection was so prevalent that suppuration—the discharge of pus from a
surgical wound—was thought to be a necessary part of healing.
eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis
Pasteur laying out his evidence that spoiling and fermentation were the
consequence of microorganisms. Lister became convinced that the same process
accounted for wound sepsis. During the next few years, he perfected ways to use
carbolic acid for cleansing hands and wounds and destroying any germs that
might enter the operating field. The result was strikingly lower rates of
sepsis and death. You would have thought that, when he published his
observations in a groundbreaking series of reports in The Lancet, in
1867, his antiseptic method would have spread as rapidly as anesthesia.
Far from it. It was a generation before Lister’s
recommendations became routine and the next steps were taken toward the modern
standard of asepsis—that is, entirely excluding germs from the surgical field,
using heat-sterilized instruments and surgical teams clad in sterile gowns and
A major thrust of
this important article deals with how oral rehydration therapy for diarrheal
diseases is only slowly spreading in the countries where it is most
needed. “In the nineteen-sixties,
scientists discovered that sugar helps the gut absorb fluid. Two American
researchers, David Nalin and Richard Cash, were in Dhaka during a cholera
outbreak. They decided to test the scientific findings, giving victims an oral
rehydration solution containing sugar as well as salt.” This cut the death rate from 30% to ~
3%. But 40 years later it is only just
starting to be taught on a large scale.”
It gives one hope – but this simple, inexpensive therapy is just not
sticky enough. Progress has been slow
Gawande’s article has much more of interest
is an important read for anyone interested in global health, public health, and
the spread of medical innovations.