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.
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....
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'sImaginary 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 AccreditationCouncil 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."
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:
YiQi asked me to write something about Outbreak. You might have heard of it. The film takes place in Africa where a dreadful disease could be the next great plague of humankind. There are naughty little monkeys in it....and Dustin Hoffman. I haven't seen it in a while, but to be honest, movies like that always make me cringe becuase 1) That kind of thing probably would never happen and dramatizations are always so sensationalistic, and 2) I'm terrified of the off-chance that it could.
The film, to my knowledge, was the first Hollywood attempt at discussing some tough issues related to national security and where the right for the healthy to survive supercedes that of the sick. Outbreak's timing was pretty important too... it came out about 6 years after the US had its own epidemic of Ebola, now known as Ebola Reston.
I was about 8 at the time, so I don't remember much about the mood of the nation or even how the media publicized the fact that the Ebola virus had been imported into the United States from the Phillipines via cynomolgus macaques and infected 12 people (thank you Tara's Ebola Site). The good news is that the version of Ebola the humans caught did not make them sick.
They say there are no atheists in fox holes and I tend to believe there are no atheist virologists. Say what you like, but the fact that the bengin Ebola Reston and wicked Ebola Zaire are virtually indistinguishable under an electron microscope leads me to believe there are more things on heaven and earth than are dreamt of in our philosophy.
But Ebola's, ahem, fatal flaw is that the virus is exceedingly good at what it does. Ebola replicates too quickly and kills too quickly to have any real staying power. So it comes out every once in a while, takes lives, and goes back into hiding. Even the unfortunate tourist to catch the disease on safari and bring it outside of its natural habitat to Europe or somewhere else in Africa, so far, have not assended to Patient Zero status. They are usually ushered into a cold hospital room, quarantined as much as possible, and most often die.
Let's not forget, while we're talking about this that there are real people faced with the resurgence of this dreadful disease every day. They have lost loved ones to one of the most horrible deaths I can imagine. It's easy to talk about things in such a detached way, living in an industrialized country, as I do, where a victim would have a chance in hell to survive given our excellent acute and infectious disease care.
But Outbreak, and many other films after it, have raised an uncomfortable question about how we, as Americans may be asked to deal with a dreadful plague that could happen at any moment. Now more than ever, as we share airplane rides with patients infected with XDR-TB, clean up cruise ships from norovirus, and pray our spinach is safe from cattle and pig waste, we are keenly aware we may one day need to decide what should be done if an epidemic is serious and pervasive enough to threaten our homeland security.
Most people, when faced with the terrifying threat of your entire body (cells, tissues, organs and all) hemorraghing in one final bloody death shudder--see Richard Preston's Hot Zone--would probably say "Lock them up, kill them! I don't care, just don't let them near me!!"
And if that person clutching at life is your neighbor, your best friend, or your spouse? What then?
Sadly, the United States learned an awful lesson about humanity with the 1918 flu epidemic. Partly becuase Americans had no information about the disease, thanks to gag orders on the press by President Wilson and partly because people were literally dropping dead in the street, many ill people died because their friends and family members literally abandoned them to dehydration and starvation among other things (Thank you John Barry). Mary Mallon, doomed forever to be known as "Typhoid Mary" never understood why she was forced to spend most of her life exiled to an island and publicly shamed for the deaths of her employers. Living in the late 19th and early 20th century, when even the greatest scientists had a limited understanding of typhoid, Mary couldn't comprehend how she could carry a disease that made people sick if she wasn't ill herself. Perhaps if her legacy has taught us anything, it's that the same moral obligations and concerns we have about genocide and slavery apply to how we treat victims of disease.
Is humankind really worth saving if we don't value human life? Is one life or a town of a hundred people worth potentially 10,000 of lives? Is the quick and painless death of an innocent at the hands of a well-meaning government, truly in the best interest of the people?
And if we are ever damned enough to one day look at spreading cases on a map and compare numbers with our vaccine or drug stockpile, we will have to ask ourselves the real questions--the ones where statistics and numbers are no longer a useful tool for calculation. Whose lives should we value? Should we save the weakest first, the children and the elderly? Or should we save the ones who know how to turn the lights back on and protect the public?
Lately, I've been a little addicted to this site, whoissick. It's like trivial pursuit for epidemiologists, with little multicolored wedges (symptoms) that fill in a round based on who reports what symptoms (fever, headache, etc...) in a given combination. If you look up your own zip code, you can find out who in your general vicinity has a tummy ache or runny nose.
From: http://whoissick.org/sickness
It's not GoogleEarth enough yet to help you avoid these people unless they willingly provide their exact location, but at the very least, if you're feeling poorly, you can easily find out if what you've got is going around. Cold comfort if your doctor tells you to drink plenty of fluids and get some rest. On the other hand, it is evidence for a skeptical boss: "Oh yeah, it's definitely contagious--look at all the people in Northdale who've got it!"
Some offices are fantastic about employees working from home when they're sick--others are practically glue factories about it. I've noticed it often depends on the industry. Physicians can't/shouldn't work sick and infect their patients. Many teachers come in sick if they can't get a substitute in time.
HR professionals know that allowing employees to take sick days helps the office avoid epidemics of flus, colds, etc...as well as keep up better morale. I knew someone who was poking around the office in between chest x-rays to check up on his pneumonia.
Do we do this to ourselves? This guy seems to think we enjoy working longer hours and taking less vacation and that we're better for it than the Europeans. I blame the Puritans for this delusional sado-masichism.
It seems while family medical leave is fine and dandy, and legally enforceable, paid sick days are not. According a 2004 report, almost half of the private sector or 59 million Americans have no paid sick leave. And even if a firm offers them, employees aren't using the time off.
It's easy to conjure examples of the single mother with a high school degree, working as a greeter at Wal-Mart or in the food service industry--thanks to Barbara Ehrenreich, we know that cautionary tale all too well. Yet, this disparity strikes at the heart of all Americans who thought they were safe becuase they were fortunate enough to go to college and get a white collar job. Even then, you may be afforded no relief if your kids have the chicken pox or your elderly father has regular appointments with his cardiologist.
This isn't ethical and it isn't good business practice, but it's also a tough argument to make when 45 million Americans (many of whom work full-time jobs) are uninsured and employers are dropping health plans like Britney drops her panties. In times like these, it's almost a moot point that we're even talking about expanding paid sick leave.
Yet we should and here's why:
The Urban Institute, recently found that businesses would save about $8 billion a year if they just let people be sick for seven days of the year. The flu can last longer than that and what about doctor's appointments, or a bad experience with fried rice?
Think for a minute what $8 billion could do if the savings weren't stuffed into the pockets of CEOs. Well, heck, it could just about cover the tab for the State Children's Health Insurance Program for one...
But let's get back to actually being sick and what that means to the average employee/patient.
According to the Institute for Women's Research, avoiding office outbreaks of the flu, alone, can save offices more than 2 days of lost productivity and employees would be spared more than $100 in doctor's visits and prescriptions each.
Obviously, those numbers might differ if you don't have health insurance and can't afford to see the doctor or buy the tamiflu.
So whoissick in America? A lot of people. It's really up to us whether we give them the tools to get better. To me, it's all about who's got a piece of the pie.
