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.
Hans Rosling, a Swedish physician became a pop-star statistician by converting dry numbers into dynamic graphics that challenged preconceptions about global health and gloomy prospects for population growth. He died on February 7th at 68 of pancreatic cancer.
The topic of Global Health and Social Determinants of Health has interested us greatly. It is covered in detail in Michael Marmot’s dense book, The Health Gap (that few will wade into). Rosling’s work makes this information palatable and easily understandable.
Rosling, his wife and daughter founded Gapminder, an independent Swedish foundation with no political, religious or economic affiliations in 2007. Gapminder is a fact tank, not a think tank. It fights devastating misconceptions about global development.
"Do you want the closest thing to a wonder drug? Try exercise."
In this excellent article by Aaron Carroll in the New York Times Journal of Medicine, June 21, 2016 one will find a valuable introduction of this topic. Unfortunately, no references are given but they can probably be retrieved at PubMed.
Studies have shown that exercise is as good as drugs for conditions as diverse as:
Many people will be surprised lo learn how little exercise they need to do to achieve the results. The recommendations are 150 minutes per week of moderate intensity physical activity for adults or about 30 minutes per workday. Walking at 3 to 4 miles per hour qualifies.
from health enews
This form of therapy has been shown to be effective and it's cheap. Warning: it can be addictive!
Aaron Carroll's essay is a great introduction to this simple therapeutic modality. He draws heavily from a British Medical Journal editorial: “Exercise: not a miracle cure, just good medicine.” BMJ 2015; 350:1416. Download Exercise BMJ editorial "A study of representative samples of clinical practices in the United States found that the proportion of physicians recommending exercise to all patients fell from 14% in 1995 to 11% and 2007."
Physical activity remains the best buy for public health.
In spite of the Affordable Care Act there are many people in our country without health insurance. "The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the ACA’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans."
The states with the lowest percentage of uninsured tend to be the ones that have expanded Medicaid coverage. However, it can be difficult for Medicaid patients to obtain health care, especially from specialists. See: Cherry Picking in the Aina.
It's hard to believe there are still so many health care unequalities.
“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)
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. Modern version of Hippocratic Oath
In this inspiring 90-minute documentary, filmmaker David Grubin takes his camera across America to focus on the challenges and triumphs in our country’s health care delivery system. The four segments that comprise Rx: The Quiet Revolution introduce us to a diverse group of doctors, nurses, and health care professionals who are transforming the way we receive our medical care: lowering costs by placing the patient at the center of their practice.
Rx: The Quiet Revolution shows us what’s happening from Maine to Mississippi, California to Alaska. You will see physicians, nurses and other healthcare professionals placing the patient at the center of their practice — transforming the way medical care is delivered while lowering costs and improving outcomes.
Filmmaker David Grubin brings you these compelling stories:
In Maine, we meet Dr. David Loxterkamp, who practices family medicine with a team of doctors working to treat patients with chronic illnesses.
In Mississippi, a state with more diabetes cases than any other, Grubin finds a rural health clinic fighting diabetes with the aid of an electronic communications device that provides greater access to medical care, helping patients take responsibility for managing this devastating chronic disease.
In San Francisco, Grubin visits a health care facility for seniors called On Lok, dedicated to making it possible for frail, elderly Americans in need of nursing home care to live with dignity in their own homes.
In Alaska, the documentary follows Native Alaskans who own and operate their own health system, caring for 65,000 people across 107,000 square miles. In spite of the number of patients and the vast distances between them, they are determined to foster an empathetic relationship between patients and their health care providers.
At 90 minutes, this may seem a daunting investment in time, but Rx: The Quiet Revolution will speak to you in powerful and compelling ways.
Our Hilo correspondent, Rob Shapiro, brought an important NPR story to our attention. Reading it may save a loved one's, or your own, life!
It seems that every time researchers estimate how often a medical
mistake contributes to a hospital patient's death, the numbers come out
In 1999, the Institute of Medicine published the famous
"To Err Is Human" report, which dropped a bombshell on the medical
community by reporting that up to 98,000 people a year die because of
mistakes in hospitals. The number was initially disputed, but is now
widely accepted by doctors and hospital officials — and quoted
ubiquitously in the media.
In 2010, the Office of Inspector
General for the Department of Health and Human Services said that bad
hospital care contributed to the deaths of 180,000 patients in Medicare
alone in a given year.
Now comes a of the Journal of Patient Safety that says the numbers may be much higher — between each year who go to the hospital for care suffer some type of preventable harm that contributes to their death.
"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.