Your Weekly World News in Public Health

Well, the ceiling's been falling in on me so I haven't been able to update as much as I'd like to, which is even more depressing considering there has been hyperactivity in the world of public health. Here are some highlights:

The Kaiser Family Foundation is every health policy afficionado's bible. It's the first place I look to see if I can find information nicely analyzed and relevant. A couple of weeks ago, they posted KFF's Health'08 site, which details, as much as possible, the health plans of the candidates for the 2008 presidential election. If you don't get information overload just viewing the main page, there's a lot of worthwhile stuff on there.

There isn't a super lot of information available at this point, but I think it is interesting which candidates have come out swinging (John Edwards, Barak Obama) when it comes to health care, and which haven't (Hillary "Once Burned Twice Shy" Clinton, Rudy Guilliani).

In other news, as if avian flu wasn't enough, it looks like we're headed toward a much more prolific West Nile Virus epidemic, so says the New York Times. People tend to freak out nowadays when they hear a mosquito bite could cause a potentially fatal infection. I tend to wonder why West Nile should be so frightening. After all, we've been fighting another, vastly more dangerous kind of mosquito-borne encephalitis for quite a while in the US.

Now, when I was a kid, I vividly remember cleaning out my grandmother's pantry after she died. There were quite a few, very old, and very swollen cans in there--I remember the fruit cans especially were on the point of bursting. At the time I was already morbidly fascinated enough about diseases to know about botulism, and I recall throwing those swollen, seeping cans into the garbage. What I didn't realise is how close I might have come to becoming infected with this disease. So for all you people who have been on Mars this week...for G-d's sake, throw out your cans of Castleberry Chili Sauce.

And you'll never get this in American news outlets, (why I love BBC), but six American medical students have graduated from a special program in Cuba that is free of charge and requires, snidely or no, that the graduates return to their communities to serve the underpriviledged. The program is actually offered to other, more impoverished nations as well. It is kind of ironic that Cuba and the Congressional Black Caucus seem to consider the United States as bad as, oh I don't know, Costa Rica or something.

Oh wait a second... for African-Americans, at least, they're actually right.

And finally, McGruff was right. Just say no to drugs--or a few years later you might be relying on the kindness of strangers when you get older, so says a recent study on how marijuana use increases the risk of psychosis later in life by 40 percent.


iPods--the favorite gadget of Darwin Award Winners

And you thought the dangers of iPods were relegated to listening too loudly or too frequently to Barry Manilow. I've heard of the guy getting hit by a car while texting and listening listening to an iPod, but this is a new one-- iPod induced injury while jogging in a thunderstorm....


Primum non nocere

According to the Agency for Healthcare Research and Quality, medical errors are now one of the leading causes of death in the United States, higher than motor vehicle accidents or breast cancer. A significant contributor to medical errors in hospitals is the medical residency program.

As an editorial in the June 28 issue of the New England Journal of Medicine attests, the 30 hour shifts and 80 hour workweeks medical residents are asked to endure does neither patient nor physician any service.

I remember a study that found that the standard amount of sleep deprivation required of medical residents was as impairing as these doctors having consumed three to four alcoholic drinks.

After many late nights in college and grad school, I have, on many occasions, experienced that loopy, intoxicated feeling that comes with sleeplessness after say, a 16 hour day. I can't imagine what I would be like after nearly twice that long. Probably something like this:

And perhaps it would be Ok for me or these blokes to confuse words or names of things, but if someone I loved were about to go under the knife, I sure as hell wouldn't want a physician to be confused as to a surgical procedure or medication regimen--or laugh uncontrollably as we discuss risks associated with surgery.

Of course, I should give physicians more credit. Every medical resident I've ever come in contact with, regardless of their lack of sleep has always treated me with the greatest respect and dignity possible. And so far, thank goodness, I have never suffered irreparable harm due to a medical error in the emergency room.

But medicine is a highly sophisticated and complicated art, that has significant room for error even under the best circumstances.

Last week, a contributor to Slate magazine published a story on what it was like to be a practice patient for medical students, calling herself a human guinea pig. These students were just beginning to apply the knowledge they have been learning to real people, although these real patients or actors are being paid to be examined and, in some cases, asked to pretend they have a specific illness.

Even for Emily Yoffe, a healthy patient undergoing a standard physical exam, the task required of these students was a complex one. These future doctors were being asked to juggle a patient-physician relationship (albeit a one-visit only deal) that involved the examination of 45 different aspects of the body, and apply to living tissue what they have only seen in textbooks or within bodies donated to science. Yoffe had a few students who well exceeded her expectations and others who floundered miserably.

But I can't help but thinking it's these poor students (with the exception of Dr. I) are the real ones being experimented upon.

Somehow, through the rigors of medical school, these future residents may get used to the fatigue and will undoubtedly save many lives. But why should we torture them so?

Despite the many reforms that have taken place to make the situation a little bit better, medical residency programs seem determined to ignore the problem, almost as ill-advisedly as Moliere's Imaginary Invalid employs several doctors to treat his made-up sicknesses.

One of my best friends, currently in her third year of medical school, says that because all the other doctors before them have had to suffer, things are unlikely to change. I imagine its also very difficult for hospitals with limited funds to afford additional placements to handle the extra work.

The financial constraints on staffing hospitals is probably even more serious in disproportionate share hospitals, or those that serve a much larger proportion of charity or Medicare/Medicaid cases than others in their geographic area.

Let's not even mention the fact that physicians, themselves, are putting their health at risk to keep up with this extremely taxing workload. To the extent that some may be even cutting their lives short because of it.

But something has got to give and until it does, the Accreditation Council for Graduate Medical Education is complicit in breaking the very oath that the students they oversee have been sworn to uphold--"First do no harm."


Megaman Music at the Kennedy Center

I might as well admit it publicly--my boyfriend is an avid, practically obsessive video game music fan and he's slowly starting to convert me. After five years, god knows how many tracks of blips, bloops, midi-rips, and Megaman remixes, I'm starting to appreciate the fact that the soundtracks to games I enjoyed during my childhood are experiencing a renaissance under the hands of some very creative, very talented, and very professional musicians.

Everybody knows the classic Super Mario Bros theme a sort of ragtime/calypso homage with a 6/8 back beat to keep the player moving forward. Well, here is just one example of how the hands of artists are making a more than 20 year-old game come to life again for new and old audiences alike.

What's more, the music produced for video games today is also some pretty sophisticated stuff, capable, in many cases, of standing on its own outside of the context in which the games are played. I remember when, I think it was the Outrun game series, developed an option where you could listen to different music as you played. It was only maybe something more jazzy and something neutral, and something metal rock I think--all the same theme.

Flash forward a decade or so, and Grand Theft Auto had several different soundtracks in the form of discreet "radio stations" you could turn on in your car as you played. Each station had pretty extensive song lists and usually funny DJ and commercial segments. GTA was really seminal, in my mind, of breaking through stereotypes of what kind of background music a game had and for good reason, the general public began to sit up and take notice of just how much an elaborate soundtrack can add to the gaming experience.

But don't ask VGM officionados. They'll tell you that although the memorable tunes may have started with Mario and Zelda, the industry has always pushed the boundaries in what people have often thought of as disposable electronica. Their hard work and some intrepid fan loyalty has paid off. Today, masterworks like those in the later versions of the Final Fantasy series, Halo, or Myst, rival something Ennio Morricone or John Williams might write.

And as filmmakers and video game executives become more and more interdependent, I wouldn't be surprised if one day, after it's finally released, Halo, the movie, actually did get an Oscar nod for best score.

And so we come to me being backstage with some some of the most prominent American video game music composers, Jack Wall and Tommy Tallarico during the Video Games Live concert here at the Kennedy Center in our nation's capitol.

The sold-out, two day concert featured the National Symphony Orchestra playing orchestral versions or medleys of some of the most popular video games of all time. Audience members often come in costume for a contest that, at least when I was there, pitted a cardboard, duct-taped, red Tetris block against a blue-spandexed Megaman. Tetris won, and I was just grateful to have my eyesight preserved after Megaman did a few too many revealing poses.

Here's a sample. That's Jack Wall conducting the Los Angeles Philharmonic at the Hollywood Bowl.

During the concert, montages from the video game featured play in sync with the orchestra. This may not only be a good way to reference how the music augments the game playing experience, but also a fabulous way to promote the games, themselves, not to mention keep the highly ADD audience interested.

There are also segments where audience members are selected to come up and play Frogger or Space Invaders, two dinosaurs of the gaming world that are so kid friendly and simple they'd bring a smile to even the coldest censor's heart. It truly is a show for all ages that doesn't seem to forget its roots, although much of the music from games I didn't know (God of War, Medal of Honor, Advent Rising etc...) sounded very similar in format and style. Maybe it was that all of it was orchestral, maybe it was that the sound mixing was so bad.

It was often hard to distinguish the chorus, female soloist, or Tommy playing his electronic guitar for the finale from the orchestra and that was pretty frustrating. It sounded like a lot of good stuff was going on that just went over my head because of the acoustics.

Given you have Tetris blocks and Megamen running around, you can guess that the audience is usually really enthusiastic, which I think shook a few NSO member's nerves as they were trying to play. On the other hand, they all realised it was probably the first time they'd played to an audience of 2500 (each night!) in many years.

As I sat in the backstage area for the NSO, surrounded by autographed photos of illustrious musicians like Yo-Yo Ma, with the Nat's game blaring on the TV in the background, I spoke with some members of the strings section.

While one violinist was a little bit snobby about it, the other musicians seemed to enjoy playing the music and were pretty generous with their praise. You could tell many were truly enjoying themselves on stage as well. One bassist even started head-banging with Tommy during a piece.

It was at this point, that I realised that when I'm old and my children are going to concerts of music that's probably a-tonal to me, old folks homes and elementary school bands will probably be playing video game music, where they once may have played Superman and Love Story themes.

Let's face the facts. Hollywood is becoming less and less profitable, and films are being released as DVDs more and more quickly. Video games are also becoming an increasingly important component to a film's merchandising offering. Steven Spielberg already knows this and has been getting his feet wet with a few select video game projects, most notably Medal of Honor.

Socially, we're bowling alone on our Wiis, texting instead of calling, chatting on AIM instead of hanging out, and logging on to play video games with people all over the world from our living rooms. Who knows if a few years from now, our trend toward self-isolation and personalization of our electronic world will lead to the triumph of the "choose your own adventure" video game over that of the summer blockbusters.

And the music will be there, bigger, better and more influential then ever, thanks to fans/musicians/artists like these: