Category: Bioethics

If You’ve Got a Pulse, You’re Sick – New York Times

For a nation that spends more than any other on health, the United States certainly doesn’t seem very healthy.

Many cancers are on the rise ”” prostate, breast, skin, thyroid. We’re fatter than ever. As for diabetes, the number of people who say they have it has doubled in the last 10 years. Now a report says that the English ”” those smoking, candy-eating, fish-and-chips lovers ”” are actually healthier than Americans. And they spend half as much on health care.

The American-English comparison, published this month in The Journal of the American Medical Association, analyzed data from people’s own reports of their health and also used some objective measures: a blood test for diabetes, using hemoglobin A1c, and blood tests for proteins associated with heart disease risk, fibrinogen and C-reactive.

Their blunt conclusion?

“Americans are much sicker than the English,” wrote the investigators, led by Dr. Michael Marmot of University College Medical School in London.

…But the lesson for Americans is clear. These days, and especially in the United States, with its screening and testing, “we are labeled,” said Dr. Hadler of North Carolina.

“I call that medicalized,” he added. “And one of my creeds is that you don’t medicalize people unless it is to their advantage. When you medicalize people, they think they’re sick, and in our culture it’s, ‘Do something, Doc. Don’t just stand there.’ ”

Dr. Hadler has written a book about the problems of medicalization, calling it “The Last Well Person: How to Stay Well Despite the Health Care System” (McGill-Queen’s University Press, 2004). The title refers to a story told by Dr. Clifton K. Meador, director of the Meharry-Vanderbilt Alliance, a cooperative program between the medical schools in Nashville.

One day, as Dr. Meador tells it, a doctor-in-training was asked by his professor to define a well person. The resident thought for a moment. A well person, he said, is “someone who has not been completely worked up.”

The medicalization of life is a very interesting concept, and one coming more into play in the philosophy of medicine and bioethics. It’s well worth thinking about how we define illness and health, and whether or not there is ever a perfect state of health one can reach.

The Seattle Times: Health: State may drop HIV encoding

Next month, state health officials likely will finalize a temporary rule that will no longer allow the names of some HIV patients to be encoded for extra security.

Though the change has been protested by advocacy groups, if the state Board of Health does not pass it by June 14, the state will lose as much as $5 million in federal money for a range of services for about 2,000 low-income AIDS patients, including drugs, food, housing and transportation.

Officials at the federal Centers for Disease Control and Prevention (CDC) said last summer that states must keep all HIV patients’ names to allow better tracking of the epidemic.

Mmm. I don’t know how I feel about this. On the one hand, it makes sense, and falls in line with the other new guidelines the CDC is attempting to put in place, testing all people having bloodwork done who’re between the ages of 13-64. And it’s not like Washington would be the only state not encoding the data.

On the other hand, it seems like it’s a gross violation of the privacy patients were guaranteed. Perhaps if the rule were that no new codings were allowed, I would feel comfortable with this, but at the moment, it seems like Washington is being forced by the CDC to engage in a giant game of backsies.

U.S. Plan to Lure Nurses May Hurt Poor Nations – New York Times

There are two really interesting things in this article: that this is a separate provision than the current immigration bill, that is being conveniently overlooked by those arguing against immigrations of all kind (“ignore the brown people – unless they’ll be my nurse!”), and this quote:

“The Filipino people will suffer because the U.S. will get all our trained nurses,” said George Cordero, president of the Philippine Nurse Association. “But what can we do?”

It’s an interesting debate, because it’s not like there’s really much the Phillipine’s can do – they can’t suddenly find the money to pay their nurses much, much more than anyone else’s salaries, just to remain competitive.

And something that most people who’re anti-immigration of all stripes don’t realize is that the reason immigrants here in the United States (legal and otherwise) live in conditions we would consider stacked upon humans is that 1) it’s not unusual compared to where they grew up and 2) they’re sending an awful lot of their money home. Many immigrants have a much stronger tie to their families and communities, and not a strong desire for a lot of the material things that we Americans seem to think is our birthright.

I stop in Ross every few weeks to look for things missing from my wardrobe, and I almost always see the same group of three Ethiopean women there, buying a hundred or more dollars of clothing each trip. One of the women – I’m guessing the only one who spoke enough English to chitchat, since she seems to always do all their talking in English – started talking to me (about something I was wearing), and I asked what I had been wondering: why are they always buying so much clothing. Turns out they’re sending most of it home to their family still in Africa; it’s one of the hottest commodities they can send.

Anyhow. Just musings.

From Reuters.com:

Dr. D.A. Henderson, who helped wipe out smallpox around the world, has a little piece of advice for governments fighting bird flu — don’t use the military or police to enforce public health.

Henderson, who likes to describe how he was vaccinated thousands of times against smallpox to demonstrate the immunization’s safety to wary villagers, says it is much easier to halt epidemics by winning the trust of community leaders and making use of gossipy schoolchildren.

He is critical of parts of the U.S. national pandemic plan that call for the use of quarantine and other imposed types of enforcement should influenza or any other infectious disease bring on a pandemic.

“Never use the police or the military,” Henderson told a meeting organized by the University of Pittsburgh Medical Center’s Center for Biosecurity, where he works.

“Once we brought military or police in, we found many citizens retired to the woods,” Henderson told the meeting on Tuesday.

There are very few people in this world that I love, or trust, well enough that when they say “jump”, I ask without hesitating, “how high”.

DA falls into the unlimited trust category of that personal rule.

Courtesy of AJOB-blog,:

She was going to tatoo “really, must you bang on my chest?” or “Warning, I sue paramedics!” but there were too many letters. Now if only we can persuade the demographic who really need living wills to do something like this. Instead of that little bullseye that has become so popular in the small of the back, how about a little circular advance directive? Guys, instead of that barbed wire around your arms, how about a few words concerning feeding tubes. In fact just weave a little tube around that arm. That’s the ticket.