Life as an Extreme Sport

You’ve Got Potential…

...and everything else, Academics, life and living, The Past Resurrected, Thesis

Here’s where you tell me it’s ridiculous to talk about my potential when I’ve never made an effort to use it. If I had an ounce of real potential, I’d get off my dumdum and do something. Go to school…buy an apprenticeship…or just start incanting on my own. Something. Instead, I’m squnadering my existence. On parties and fine food and umty-tiddly, as Zunctweed says. Doing nothing, day by day.

Do you know what it’s like to have dropped out of life? To have had a hundred chances to be special, but you avoided them all? Or just botched them up because you were a horrid coward, afraid of letting yourself change. You clutch your comfortable excuses, saying, Someday I’ll be brave, it won’t take a lot, just give me one more chance and this time I’ll grab it. But chances come and go. It would be easy to do something, but you don’t. You just don’t. Do you know what that’s like?…

Maybe it’s time. This time it’s time. To see if I’m somebody, or just a middle-aged slut who lies to herself about being gifted.

James Alan Gardner, Trapped

I have one singular bad habit. I procrastinate. It’s an old bad habit, and perhaps more insidious than a simple bad habit, it’s a habit borne of self-defense.

If I don’t lose weight, people will be forced to deal with my brain and not my body, and then the horrors of my early teens won’t be repeated.

If I don’t achieve what I can if I actually make an effort, people won’t then come to expect greatness from me. More importantly, they won’t be disappointed in me, and I’ll never again let anyone down. There is safety in mediocrity and being average, and I am as average and mediocre as I can stand to be.

But it’s not who I want to be, who I dream of being. And I am guilty of the above quote, of thinking that if I just had another chance, if I could just have that moment to prove myself and shine, I would shine. Oh, not shine the way you see me shine, but shine the way I know I can shine.

I would be brilliant. I would be breathtaking and brilliant.

In order to do that, though, I have to stop being afraid. Of consequences, of what will be, of what people will see. Of risk and failure.

The only way to be great is to work hard and take risks, and procrastinating protects me from both. And so I am safe, sheltered, bored and unhappy.

I took risks, once. The last one I took was four years ago, and it blew up in my face. It took me a long time, but I started taking tiny risks again, here and there. Getting in front of a class. Teaching. Applying for scholarships, grants, funds. Each time, I’ve done it, achieved what I set out for, and every single time, I’ve looked for the damned bomb that was going to blow up and ruin all the risk-taking and show everyone not for the fraud I am, but for the fractured, scared soul I am.

I thought graduate school was going to be that bomb. I thought I had finally found my Achillies heel, the thing that was going to neutralize all the risk. And at the seemingly last moment, even that proved untrue.

Which in some ways might be ironic, since now it leads all the potential for explosive failure back to my feet. Not that I failed to win or achieve, but that I will fail to do.

I’m scared of a lot of things. But it’s finally reached thet point where I’m more afraid of not doing anything than I am afraid of failing.

I’m tired of shooting myself in the foot. I’m tired of failing to live up to expectations at the last moment because it’s safer, and I’m disgusted with making excuses for the failure.

It’s time. Not to show you that these visions I have of myself are true, but to show myself.

The Daily – Toward Insuring Immigrants

...and everything else, 2006, Academics, Spring 06, The Daily

Toward insuring immigrants
2006-05-01

The older Asian woman tugs insistently at the young blonde doctor’s coat, pulling her out into the pouring rain, talking in a foreign tongue.

The doctor, a new intern, is confused but following. What she finds shocks her: a young woman by the dumpster, face lacerated and in need of stitches.

The intern tries to convince the young woman to come inside, but in broken English she refuses. She’s afraid. She’s an illegal, as is her mother. There was an accident in the factory, could she please be stitched up?

Time slows and the intern faces her options. Just as fast, time snaps back into place and the intern slowly moves around the hospital, gathering the supplies she’ll need to stitch the laceration in the parking lot.

She gets the young woman, now her patient, to promise she’ll come back to have the stitches removed. The woman promises and disappears. She never comes back.

Chances are good that if you’re a fan of the television show Grey’s Anatomy, this scene is familiar to you. After all, it played out during a first-season episode, with Dr. Izzy Stevens as the young intern treating the illegal Asian immigrant.

Chances are also good that you’re aware that there is a large immigration rally this Monday afternoon.

Smell a coincidence? I didn’t think so.

Immigration — legal and illegal — is a contentious issue in our country. So it only made sense to talk about the issue of illegal immigrants and the strain placed on our medical system.

To be very clear on my position, I support immigration.

I think it should be easier to immigrate to this country. I think that if people honestly believe that if those farm and sweatshop workers just weren’t there Americans would step up and harvest those berries in the burning sun or spend hours a day over a sewing machine for low, low wages, they are, in a word, delusional.

No offense.

Illegal immigration does more than impact the theoretical jobs available for Americans (legal immigrants or those born here).

It seriously impacts our hospitals, in two ways.

First, I suspect we have all been in the situation where we’re in the ER because we’ve been sick, or injured; perhaps you were kicked across the room during a slightly rowdy party, breaking your wrist.

But I digress. You sit in that waiting room, and you wait. Depending on what’s wrong, you wait.

Depending on the time of the day, and where you’re located, if you’re a non-emergency case, you can wait for quite a long time.

As many before me have pointed out, waiting often happens because people who don’t have insurance are using the ER as a place to receive basic medical care.

Any hospital in the United States that receives funding from Medicaid is required to treat any patient who appears in the ER.

What this means, practically speaking, is that anyone without insurance tends to end up in the ER to have non-emergency issues treated.

That person’s lack of payment is ultimately passed on to those who can pay. This is the second significant impact illegal immigrants have on our hospitals.

I don’t think this translates into throwing all the illegal immigrants out, locking down the country and building giant walls, and not just because it’s not terribly practical.

What I think this means, at least from a big and cuddly humanist point of view, is that we need to fix the system so illegal immigrants can pay into insurance policies and, even more importantly, not be afraid of accurately reporting address and other information to the hospital itself.

It might be woefully idealistic, but I believe that if we remove the fear of deportation, illegal immigrants will be more inclined toward providing accurate information and working with the hospital to cover medical costs.

The Daily – Pharmacists’ moral acumen

...and everything else, Academics, Spring 06, The Daily

Pharmacists’ moral acumen
2006-04-24

One of the more interesting and underrepresented facts about many women’s health providers — places that are routinely targeted because they provide low- or no-cost birth control for women, as well as access to abortions — is that they often offer other health services, such as flu shots and general health exams.

Sometimes, antibiotics are prescribed.

Most of these clinics don’t have on-site pharmacies, so it is up to the patient to go elsewhere to have the prescription filled.

Or, as was the case with a patient from the Cedar Rivers Clinic, which has facilities in Renton, Tacoma and Yakima, Wash., the prescription is called into a pharmacy for pickup.

Unfortunately, in May 2005, a pharmacist at the Swedish Medical Center outpatient pharmacy took it upon him or herself to decide it was morally unacceptable to receive antibiotics from a clinic that provides access to birth control and abortion, and refused to fill the prescription.

That’s right. A pharmacy refused to fill a prescription based on who prescribed it.

“Well maybe,” you try to rationalize to yourself, “the pharmacist believed that it was an abortion-related complication and they felt complicit?” Ignoring the logic behind that, which basically says that someone deserves an infection, let’s move to another example.

At a Safeway in Yakima, Wash., a pharmacist refused to fill pregnancy-related vitamins for a pregnant woman who was receiving healthcare from Cedar River Clinic. This is a woman who was making an active effort to have a healthy pregnancy.

The Safeway pharmacist reportedly repeatedly quizzed the woman why she needed the pills (seems obvious to you and me, eh?), and then launched into why she was going there.

There.

As if the woman should be castigated for receiving healthcare for her pregnancy.

My friends know that I often play devil’s advocate for pharmacists who decline filling Plan B or chemical abortificant prescriptions on moral grounds.

My reasoning for this is that in some ways you can argue that the filling of these prescriptions does directly force the pharmacist to participate in the providing of a service they morally oppose — what they view, rightly or otherwise, to be abortions.

We do not force doctors to perform abortions on women who want them, and I think it’s reasonable to extend this logic to pharmacists.

But these pharmacy moral-police are overstepping their boundaries when they begin denying prescriptions based on who writes them.

If a pharmacist decides he or she has the moral acumen to decide if someone should or should not have access to antibiotics, what’s next?

Denying someone their AIDS cocktail?

Refusing to fill someone’s prescription for methadone, since maybe they’re lying about having chronic pain and they’re really a heroin user in recovery?

Maybe these morally righteous pharmacists will determine that you shouldn’t have access to any “Class II drugs,” or that you’ll need to provide documentation of your illness before they release the prescription to you.

The potential nightmares can be spun out for a while.

Thankfully, the Washington State Pharmacy Board realizes the potential for abuse, while also recognizing the right of the pharmacist to conscientiously object to some prescriptions, such as Plan B.

Late last week, the board released its first draft of a new rule outlining a pharmacist’s right to refuse prescriptions.

While the exact wording of the rule remains uncertain as it undergoes further revision, so far the indications have been pretty clear: Pharmacists have the right to a conscientious clause only so long as there is another pharmacist on site or closely nearby who can fill the contested prescription.

Which is how it should be. Pharmacists dispense medicine, they don’t practice it.

What I’m Reading Today

...and everything else, Academics, Bioethics

The miscellanious round-up, while I wait for the coffee to infuse my system enough to pack and wander my way towards the airport.

Pfizer Boldly Advertising Celebrex Again – but with a big ol’ warning about the risk of heart attack and/or stroke.

I took Celebrex for a year, maybe more, and have to admit it made my life a lot easier during that time. At the very bottom of the article, Michael Krensavage, a drug industry analyst at Raymond James, says “I would try an ibuprofen first.” Well, thanks Michael K – but I did, and I was taking like 10 ibuprofen a day, which is never good for the liver, and still getting no pain relief. One Celebrex later, and I could move without wanting to cry (this was back when my rotar cuff was torn).

All drugs carry risks and benefits. It’s up to you and your doctor (note: doctor, not pharmacist) to determine what the right drugs are for you.

And lest anyone think last weeks Bones episode The Graft in the Girl, was just more scary science fiction, Stolen body parts linked to patients’ illnesses; several lawsuits claim tissue transplants were infected with viruses and other germs. Four men, one of whom worked for a tissue provider, have been charged with carving up corpses and selling their parts without consent. And oh yeah, they’re diseased and old and damaged parts.

Quite literally the entire plot of the last Bones, down to almost the exact same name of the tissue company. Life, meet art. Art, meet life.

GlaxoSmithKline, Europe’s biggest drugs manufacturer, yesterday defended itself against accusations that it is turning healthy people into patients by “disease mongering” and pushing “lifestyle” treatments for little-known ailments. Charming, ‘cept I don’t believe a word of it. I’m actually having fun collecting a list of all the drug advert commercials I see – I figure it will make a nice column for The Daily.

I particularly love the line “It is easy to trivialise things when you don’t have them. If people did not want the treatments, they would not seek them.” …or, you know, people wouldn’t think about it being an issue if they weren’t told it was one. We spent a while talking about the concept of taught illness in my philosophy of medicine class last quarter. Perhaps I should interview Sara for the article, heh.

Wired has another take on the pill pushers, noting that although Novartis employs some of the most brilliant minds in the pharmaceutical research field, developing impressive leukemia fighting drugs like Gleevec, their fourth most profitable drug is Lamisil.

Lamisil treats toenail fungus. It’s not life threatening. It turns your toenails yellow. And for three months and about $850, you can cure it. And 10 million Americans have, or are trying. And yet, in those numbers, a very small percent have had what you might call a significant reaction to Lamisil – they’ve died.

And yet because of their effective marketing campaign, with Digger the Dermatophyte, a campaign costing them $236 million in three years, Americans are lining up to take a drug that only completely cures 38% of them.

That’s a pretty low cure rate for a mostly invisible (after all, most of us wear closed-toed shoes) fungal problem that does nothing other than making your toe nails yellow.

Can I market a new cure for toenail fungus? I’ll call it… Polimisil. It’s a simple treatment, involving the application of a tinted liquid substance that dries to the toenail, masking the originating colour of the nail. You get approximately 60 treatments per bottle, each treatment lasting about a week. And for this amazing cure, I’ll only charge you $40 a bottle! That’s less than $1 a treatment!

C’mon, you know you want to!

On the other side of the pharmaceutical fence, (wow, I’m just all big pharma lately), Genzyme won FDA permission to sell a new drug to treat Pompe disease, a rare inherited enzyme disfunction. One of the problems with big pharma is that since they are businesses, they have incentive to develop and produce drugs for common problems, like arthritis, so they can make lots and lots of money. Practically speaking, this means that rare diseases, like Pompe, are often overlooked, because there is simply not the client base that would justify the research and development costs.

In doing something right for a change, our government has developed an incentives program for companies developing treatment for these rare illnesses; in fact, that’s what Genzyme specializes in.

Faith Healing and the Body

...and everything else, House MD, Pop Culture

Tonight’s episode of House dealt with the idea of faith healing, something that comes up a lot these days in medical journals. What is the power of prayer? Does faith healing work? Can miracles happen?

I realize it’s a symptom of my interdisciplinary training, and perhaps of being under Phillip’s thumb in particular, but I think a more interesting question is why miracles can’t happen? After all, a miracle is just that which we don’t understand. As has been often remarked, our technically is magic to those who don’t understand how it works, as is often our medicine. The typical example is a cell phone in the rain forest, although I’d argue there’s an awful lot of technology and medicine that might as well be magic for our understanding – there is simply the belief, the faith that it will work, because someone is being told it will work.

How is that so different than hearing a faith healer tell you the same?

Of course, we of the rational, medical type say we have medicine, we can take the time to understand how technology works. But we can’t fully understand how the body works; we keep finding new things, miracles keep being rationalized and understood, filed away into things to learn and knowledge to distill.

If we have learned one thing, it’s that the body is an amazing thing. Who’s to say that the power of the placebo effect, the mind, isn’t enough to help some people? We know, scientifically, medically, that positive thinking does positively affect our health, including to help us recover from illness. Who knows?

We don’t, so it gets filed away as faith healing fakery and fraud. But in ten years, perhaps it will have a Latin name and a textbook. That’s the way knowledge goes, a part of life for both miracle and medicine.