Health, Culture, and Society @ Broome

Join the Health Stream for a screening of

SICKO
Monday, 11/26
Meet in the Lobby of Broome at 7:15PM

Discussion to follow with Prof. Rogan Kersh

from the WSJ Heath Blog:

A belief that good things will happen in our lives appears to be hard-wired in our brains, Robert Lee Hotz writes in his WSJ column today.

nullBeing somewhat optimistic is often related to positive behaviors, such as working hard, saving money and taking care of our health. (The images from NYU at right show greater activity in the brain’s rostral anterior cingulate cortex (top) and amygdala (bottom) when subjects imagined positive future events.)

Optimism is so fundamental to us that it probably relates somehow to basic survival. But beware of extreme optimism — that’s more likely to lead to frivolous spending and activities like day trading, he writes.

The exception to the rule, however, appears to be lawyers. Hotz writes:

Surveying law students at the University of Virginia, he found that pessimists got better grades, were more likely to make law review and, upon graduation, received better job offers. There was no scientific reason. “In law,” he said, “pessimism is considered prudence.”

So who were the bigger pessimists? Merck’s lawyers? Or those for the plaintiffs? Sorry, we had to ask.

Health Blog Halloween: Horror Show Doctors
from WSJ.com: Health Blog by Jacob Goldstein

Deranged in the pursuit of knowledge, lusting for power or just stone crazy, the mad scientist is always called “Doctor” — though it’s rarely clear what his specialty might be, or whether he’ll accept your insurance.

This much is clear, though: Intentionally or not, the mad scientist has hitched his brilliance to a dark star, and the inhabitants of planet Earth — or at least a few torch-wielding villages — are in big trouble. The ivory tower types will call him (and yes, it’s basically always a him) a metaphor for science run amok. But to us he’s the bad doctor, the emblem of the Health Blog’s Halloween. Here’s a rogue’s gallery of our favorites.

Dr. Victor Frankenstein created the eponymous fiend. Frankenstein’s been a fan favorite (and cautionary tale for those who would synthesize life) since he first appeared in Mary Shelley’s 19th-Century novel. But maybe nothing about him has been as terrifying as the reported $450 it will cost to get good seats to Mel Brooks’ new Broadway production of Young Frankenstein.

Hannibal Lecter was a psychiatrist who came in for a bit of analysis himself in the scientific literature. This 2002 paper in the American Journal of Psychotherapy says he “relies heavily on schizoid defenses, such as splitting and projective identification, but is unable to avoid psychotic breaks with reality to reenact his early traumas.” Sure. Just make sure you keep that mask on him so he doesn’t bite our face off.

Dr. Henry Jekyll seemed like a nice enough guy, but his alter ego Edward Hyde was another story. Little-known fact: This split-personality fable is also a morality tale about the importance of careful record keeping in pharmaceutical manufacturing. Jekyll had to swallow a potion to keep from turning into Hyde. But when he re-ordered the ingredients for his potion, he found it didn’t work. He concluded the initial supplies were effective because an “unknown impurity.” Doomed to remain Hyde, he took his life.

Doctor Faustus reminds us that — centuries before legions of perky sales reps brought lunch for harried docs — a sole practitioner sold his soul to the devil in exchange for a look at Helen of Troy (along with unlimited knowledge and power). “Was this the face that launch’d a thousand ships, and burnt the topless towers of Ilium?” Faustus asked when he saw the mythical beauty. Yes, doc. Now if you’d just take a look at these data, which show why our drug is better tolerated than the generic alternative…

Doctor Evil said it best: “It’s Dr. Evil. I didn’t spend six years in Evil Medical School to be called ‘mister,’ thank you very much.”

An honorable mention goes to Anton Phibes, with doctorates in music and theology. Phibes, as played by Vincent Price in “The Abominable Dr. Phibes,” turns serial doctor slayer to avenge the poor care he blames for his wife’s death.

We couldn’t possibly pay tribute to all the deserving docs. Which evil doctors (fictional only, please!) did we leave out?

From Times Online


Race row Nobel scientist James Watson scraps tour after being suspended



James Watson: he said last night he was mortified about the furore caused by his comments
Helen Nugent

A Nobel Prize-winning geneticist has cancelled a string of speaking engagements in Britain after being suspended from a prestigious scientific laboratory for claiming that black people are less intelligent than whites.

James Watson is on his way back to the United States to "sort out" his job at the Cold Spring Harbor Laboratory in Long Island, NY. His comments caused a storm of controversy.

The scientist, who won the Nobel prize for his part in discovering the structure of DNA, was quoted in an interview in The Sunday Times saying he was “inherently gloomy about the prospect of Africa” because “all our social policies are based on the fact that their intelligence is the same as ours - whereas all the testing says not really.”

Although Dr Watson tried to quell the row with an apology last night, he was too late to prevent widespread condemnation of his comments.

The Cold Spring Harbor Laboratory board joined a throng of prominent researchers and institutions who said they found the remarks Dr Watson was quoted as saying to be offensive and scientifically incorrect.

In a statement, the laboratory said it had “decided to suspend the administrative responsibilities of Chancellor James D. Watson, Ph.D., pending further deliberation by the Board”.

The board went on: “This action follows the Board’s public statement yesterday disagreeing with the comments attributed to Dr. Watson in the October 14, 2007 edition of The Sunday Times UK.”

The newspaper also quoted Dr Watson, 79, claiming that people should not discriminate on the basis of colour, because “there are many people of colour who are very talented, but don’t promote them when they haven’t succeeded at the lower level.”

Dr Watson shared the 1962 Nobel prize for medicine with Francis Crick and Maurice Hugh Frederick Wilkins for their description of the double helix structure of DNA.

Last night Dr Watson told an audience in London that he was mortified by the public response.

At a book launch at the Royal Society, Dr Watson said: “To all those who have drawn the inference from my words that Africa, as a continent, is somehow genetically inferior, I can only apologise unreservedly.

“That is not what I meant. More importantly, there is no scientific basis for such a belief.”

He went on: “I cannot understand how I could have said what I am quoted as having said. I can certainly understand why people reading those words have reacted in the ways they have.”

Dr Watson has said before that there is a genetic basis for intelligence – something undisputed by other scientists. But experts deny there is any such thing as race on a genetic level.

Scientists expressed their disbelief at Dr Watson’s comments.

"They are wrong, from every point of view, not the least of which is that they are completely inconsistent with the body of research literature in this area,” Dr. Elias Zerhouni, director of the National Institutes of Health in the US, said in a statement.

“Scientific prestige is never a substitute for knowledge. As scientists, we are outraged and saddened when science is used to perpetuate prejudice.”

Another group of Nobel laureates also expressed revulsion.

“The Federation of American Scientists is outraged by the noxious comments made by Dr James Watson that appeared in the Sunday Times Magazine on October 14th,” said the group, founded by Manhattan Project atomic physicists.

Federation of American Scientists President Henry Kelly added: “At a time when the scientific community is feeling threatened by political forces seeking to undermine its credibility, it is tragic that one of the icons of modern science has cast such dishonour on the profession.”

Prior to Dr Watson’s departure, the Science Museum had decided to cancel a talk by the scientist, organised as part of his speaking tour to promote his new book “Avoid Boring People: Lessons From a Life in Science”.

A spokeswoman for Dr Watson’s publisher said: “Dr Watson feels he needs to go home and sort things out.”

from the NYT

8 States Plan to Press Bush on Health Bill
By SARAH KERSHAW

Gov. Eliot Spitzer said yesterday that New York, joined by six other states, would file suit against the Bush administration, challenging stricter eligibility rules for the government health insurance program that covers poor children. Separately, Gov. Jon S. Corzine announced yesterday that New Jersey filed a similar suit against the administration.

The protests from the states come in the wake of President Bush’s threat to veto legislation that would loosen those rules and increase federal funds for the State Children’s Health Insurance Program, or Schip. The bipartisan bill would expand coverage to 10 million children from the 6.6 million covered now.

More than 40 states have urged Washington to act quickly to reauthorize funds for the program, which has been the subject of angry debate in Congress over how much the federal government should contribute.

In their legal challenges, the eight states contend that the new eligibility rules, which went into effect in August and limit coverage to children living at or below 250 percent of the poverty level, will either force out children in the program or leave tens of thousands without coverage who would be eligible.

In August, federal health officials informed states that they could no longer receive federal matching funds for children in families living above 250 percent of the poverty level, except under special conditions that the states say would be almost impossible to meet. Three weeks ago the federal health officials denied a request by New York to insure more children by covering those in families with incomes up to 400 percent of the poverty rate, or $82,600 for a family of four.

“Despite every effort to negotiate in good faith, the Bush administration did nothing but put roadblocks and poison pills in our path,” Governor Spitzer said at a news conference yesterday. “The president was out of touch with the reality on the ground.”

Mr. Spitzer said that Maryland, Illinois and Washington would join New York in the lawsuit, with Arizona, California and New Hampshire filing amicus briefs in the case. He has argued that the new rules violate the intent of the federal law that created the children’s insurance program in 1997.

Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid, which administers Schip, issued a statement saying, “We are confident that our requirements are appropriate and will be sustained in a court of law.”

He added, “Our chief goal with Schip is to ensure that the poorest kids and those with no health insurance are placed at the front of the line.”

An expansion of the national program passed by both the House and Senate would provide $60 billion over the next five years, $35 billion more than current spending. President Bush has proposed adding $5 billion to current spending.

New Jersey, which estimates that 10,000 children will lose health insurance under the new eligibility rules unless the Congressional version prevails, filed its lawsuit yesterday in federal court in Trenton.

Governor Corzine, speaking at a news conference, criticized the White House for both the veto threat and the eligibility rules, saying: “The Bush administration has gone far beyond its regulatory rights. I think there’s going to be major, major pushback.”

New York health officials said that the Congressional version would allow the state to add 70,000 children to the 396,000 currently covered.

Diluting the Benefits of Tea
(NYT, Oct 1)


Tea is getting a lot of good press these days. Many studies have linked regular tea drinking to a lowered risk of cancer, heart disease and hypertension. But where health is concerned, all teas are not created equal.

Many consumers who’ve taken to popular bottled teas and the hot chai served at coffee houses have the mistaken notion that they are low-calorie and good for you, noted Lisa R. Young, a nutritionist at New York University. But a 16-ounce bottle of the popular Arizona Green Tea with Ginseng and Honey, for instance, contains 140 calories and 34 grams of sugar. (By comparison, a similar amount of Coke has 194 calories and 54 grams of sugar.) A grande Tazo chai tea latte at Starbucks packs 240 calories and 41 grams of sugar.

“I see so many educated people who, when I tell them it has calories, look at me and say, ‘It does?’” said Dr. Young. “These are people who wouldn’t get the whole milk cappuccino, but they get the venti chai because it’s only tea.'’

The health benefits of tea have been observed mostly in populations regularly consuming simple brewed teas, usually around three cups per person per day, according to Harvard Women’s Health Watch. Traditionally made tea is loaded with antioxidants that fight heart disease and cancer, the newsletter notes. Instant teas and bottled, decaffeinated preparations contain fewer of the compounds that make unadulterated teas so good for you.

*via the Gothamist.

Recently Williamsburg doc Jay Parkinson unleashed his revolutionary idea onto Brooklyn -- a doctor for the uninsured, medical advice through emails, and the return of the housecall. The word spread fast and now much of the world is looking his way to see if he can change the way healthcare is provided.

How did your non-conventional idea come about and become a reality?
I don’t really fit in very well to the traditional doctor mold and don’t have a lot of doctor friends. Many of my friends are youngish like myself, involved in the creative industries, and don’t make a hell of a lot of money. They’re often coming to me for medical advice trying to save the absurd amount of time and money it takes to see a doctor when not insured or under-insured. Many of my friends make too much money or are otherwise disqualified from obtaining low-cost health insurance. Most of the time, they would IM, email, or video chat me. I thought it would be a great idea to treat this demographic -- young, uninsured or under-insured, wired, health conscious, and those who are sick of paying too much to wait four hours for a five minute doctor visit. Many people in this age group have acute illnesses and injuries that need timely treatment. Timely doesn’t seem to be in the vocabulary of the modern healthcare system unless you consider paying $2,000 for an ER visit “timely.” I figured I could develop a high quality medical practice based on very accessible low-cost, nearly immediately available house calls, for people who have been priced out of the absurdly expensive traditional health insurance plans. Of course, this type of practice couldn’t survive in a place that wasn’t as densely packed as Brooklyn and lower Manhattan. I’m obviously very mobile and very wired. My schedule is integrated on my website via Google Calendar. My patients can see an open slot, text me with their desired appointment time, and I’ll come see them...even if it’s the next hour. My entire practice, including my electronic medical record, runs on my iPhone. My practice depends on instantaneous communication and mobility.

Aside from offering the uninsured masses healthcare, you also offer housecalls and consulting via IM, email and video conferencing. Do you think you'll run into a lot of electronic patient/doctor scenarios where you'll need to see the patient in person?
Nothing can replace the value of seeing a patient when making a diagnosis. When someone signs up for my service, I make an appointment to come to their house and perform a physical exam, talk with them about their health history, discuss how to use my service, and ways to optimize their health. After this first meeting, I will still almost always visit the patient in person at their home or work. However, there are some diagnoses that are just so obvious I won’t need to go see them. Acne, depression, allergies, and a growing list of other conditions are successfully being managed in a rapidly emerging field called Telemedicine. At the same time, say someone falls on their wrist and thinks it may be broken...most people would go immediately to the ER and get an X-ray. Say it’s not broken...they just spent $2000 on a negative X-ray. If you are my patient, you would call me and describe what happened. I’ll ask you some questions to assess the injury and then send you to a radiologist I know who charges $80 for an X-ray. If it’s not broken, hot damn you just saved $1920. If it is, I’ll be on the phone with orthopedists finding one who can see you in their office to cast your wrist for $400.

I use IM, email, and video conferencing as a supplement to a person’s care to follow up on patients I saw recently and to manage how well a treatment is working. It’s one of the most fulfilling things in the world to wake up in the morning and read an email from a patient I treated yesterday that says she’s feeling so much better.

You've traced your publicity from Noah Kalina's Flickr account to the NY Post in just ten days, did you expect that kind of attention so fast?
I knew I was doing something that had the potential to be revolutionary. One thing that makes me so angry about the healthcare system is a concerted, widespread policy of keeping their prices hidden from the public until you receive your bill a month later for services already rendered. I’ve called a few thousand physicians, radiologists, ERs, and pharmacies to get their prices they charge for certain services and tests. Healthcare prices are absolutely unregulated and the prices vary tremendously. For example, the cost of a brain MRI (same quality facilities mind you) ranges from $500 to $1750. This is absurd. If you are unlucky enough to have chosen the one that charges $1750, you just made a $1250 mistake. I hope that the general public becomes aware of this issue and forces the Industry to be more up-front with their prices. There needs to be more of a free market system in healthcare services and tests. I hope that, through this media exposure, I’m able to raise the issue enough to force the healthcare industry to stop taking advantage of people who are willing to spend anything just to get back on their feet.

But, yes, the offers I’ve gotten from the media and entertainment industry has blown me away. They don’t teach you how to find an entertainment lawyer in medical school.

How many patients do you currently have? Are you feeling a little overwhelmed with the recent response?
I’m feeling more overwhelmed with the media response. Keep in mind, the demographic I’m trying to treat are essentially pretty healthy people. The healthcare industry calls them the invincibles. Young people unfortunately don’t see the value in having their own doctor until they absolutely need medical care. I’m waiting for people to get sick who have heard about me either through the internet or word of mouth to sign up for my service. Once they do experience what it’s like to have such an accessible physician, they’ll understand what they’ve been missing for so long. I promise. Everyone I’ve treated so far thinks it’s the best thing since wheels on luggage.

Have you really been offered a tv show? Would you think about saying yes to such an offer?
I’ve been offered an ungodly amount. Books, TV series, a full feature romantic comedy from one of my favorite producers who produced some of my favorite movies (who actually personally called me). Yes, I would consider these offers. Especially if I could use some of the money I make from these ventures to make my service even more affordable.

Do you think your press schedule will now offer you less time to treat your patients?
I’m a multi-tasker. All of my press began three days before I “opened” my practice. In reality, “open” means, I enabled the link where people could sign up. As in every type of new business, it takes some time to build a client base. Fortunately, the press I’m getting is happening when my client list is small but growing.

What is the number one/most common ailment you treat?
That has yet to be discovered. But I have some hunches. All I know is that this entire experience in treating patients this way will allow me to save people a hell of a lot of money AND meet some very lovely people who are doing some interesting things with their lives.

What is the general age group and occupation of your patients?
I only see patients age 18-40. Generally, everyone who has contacted me so far has been freelancing creative professionals.

Do you keep certain hours or have a staff?
I do routine house calls with patients on Monday through Friday 8 am to 5 pm. I’ll definitely make some exceptions. It’s not really set in stone. It’s dependent upon the individual case.

Please share your strangest "only in New York" story.
I used to be friends with this guy who was the manager of a popular clothing store in Soho. He was the biggest David Bowie fan and told me how he listened to only Bowie for something like three years straight. He just wanted to immerse himself in Bowie. My friend was walking down the sidewalk in Soho one morning and heard someone whistling a Bowie tune. He turned around and saw David Bowie walking with his daughter on his shoulders whistling his own tune to her. I don’t know why, I just love that story.

Which New Yorker do you most admire?
Unfortunately I have to choose someone who recently died -- Jane Jacobs. The Death and Life of Great American Cities was a huge influence on the New York we know today and quite an influence on the design of my practice. New York can be such an isolating place because most of us just keep to ourselves on the sidewalks of New York. I think the modern forms of communication such as IM, email, and SMS are just as isolating. What if I could use these communication technologies to my advantage as a way to help people with their medical problems; make a meaningful change in a broken healthcare system; and get to know, in a very personal, real way, hundreds to thousands of New Yorkers.

Given the opportunity, how would you change New York?
I would make healthcare more affordable and accessible to young, uninsured or underinsured New Yorkers. I have that opportunity now and that’s what I plan to do. I saw a patient yesterday who was spending $63 a month on her monthly prescription from Walgreens. I knew of a place that was selling it for $42. I saved her over $250 per year because I’ve put the effort into doing the research. One person at a time, I will make sure they get affordable, high-quality healthcare.

Under what circumstance have you thought about leaving New York?
I only thought about leaving New York once. That was two years ago when I finished my residency at St. Vincent’s in the Village to do a residency at Johns Hopkins. Hopkins has a such a great name and is known as the best program in Preventive Medicine. My practice focuses on prevention in order to keep people as healthy as possible for as long as possible. I figured I could suck it up for two years in Baltimore and move back to New York the hour I finished my residency at Hopkins. I love this city. I don’t plan on leaving.

What's your current soundtrack to the city?
Ooooh. Good question. I know not everyone listed is from the city, but I figure that’s alright. They all have some sort of personal connection to NYC in my own mind.

Sonic Youth - Teenage Riot, Brian Eno - On Some Faraway Beach, Elliott Smith - Some Song, Gary Numan - M.E., The Hold Steady - Multitude of Casualties, Iggy Pop - The Passenger, Interpol - Untitled (from their only good record), John Phillips - Let it Bleed, Genevieve, Kiss - God Gave Rock-n-Roll to You, LCD Soundsystem - All My Friends, Liars - Grown Men Don’t Fall in the River Just Like That, Marah - Formula, Cola, Dollar Draft, The Modern Lovers - Dignified and Old, The National - All the Wine, Neutral Milk Hotel - Love You More than Life, The Stooges - I Wanna Be Your Dog, Super Furry Animals - Man Don’t Give a Fuck, TV on the Radio - Staring at the Sun, The Afghan Whigs - 1965, The Velvet Underground - Sunday Morning, Wilco - I Am Trying to Break Your Heart, !!! - Pardon My Freedom

What's the best subway line?
The L? It connects to everything.

Favorite headlines: NY Post or Daily News?
The Post is the shittiest newspaper in the entire nation.

Yankees or Mets?
Rangers

Best cheap eat in the city.
Cheap is so damn relative. Cheap (as in stuff your face for $3): Big Enchilada on 12th and University. Cheap (as in good eatin’ for a good price): Itzocan Cafe on 9th Street in the East Village.

Best venue to see music.
Bowery Ballroom. The only thing I hate about summer in NYC is having to see a band at some horrible outdoor venue.

Photo by Noah Kalina.

Smoothie Workshop tonight at 7:30 in the Broome Room. See you then.

Hey HSHers,

For those of you wondering about community service oppurtunities, this the event for you!! Holly, the RA of the Gender and Sexuality Stream and I are working together with FFiR Stephanie Smith-Waterman on the AVON Walk for Breast Cancer. We'd be glad if you could join us- read on for details!

-Dina

The AVON Walk for Breast Cancer

Come Volunteer with us at the North Moore Cheering Station

For the 3rd Year in a row, GLWD and NYu will be celebrating the accomplishements of all the participants at the AVON Walk for Breast Cancer. Join Us!


WHEN: Saturday , October 6th ; Meet at the Broome Street Lobby at 8AM !!!

WHERE: North Moore St. at the Hudson River

WEAR: FREE T-Shirts for All!

WHAT: We will distribute brownies, cheer folks on with clappers and ask participants to sign a commermorative banner!


TO SIGN UP : PLEASE CONTACT Stephanie Smith-Waterman, Faculty-Fellow-in-Residence at ssw228@nyu.edu

August 29, 2007
Frontline Report: Childhood Asthma
For Minority Kids, No Room to Breathe
By ALIYAH BARUCHIN

Among Americans with asthma, minority children are in by far the worst situation. The numbers are striking: in the United States, 20 percent of Puerto Rican children, or one in five, have asthma. Among African-American youngsters, the rate is 13 percent, compared with the national childhood average of 8 percent. In addition, since 1999 asthma-related mortality rates have dropped for Americans as a whole, but not for minority children.

According to the National Center for Health Statistics, African-American and Puerto Rican children are six times as likely as white children to die of asthma. In minority children, “the prevalence of asthma is about 40 percent higher, but the difference in the adverse outcomes is three times, four times higher for hospitalizations,” said Dr. Lara Akinbami, a researcher at the center who tracks childhood asthma. “Given that we have the tools to prevent those things, that does reach the level of a public health crisis.”

Several factors contribute to the disparity. Socioeconomic status is certainly central, particularly in terms of environment. Children in poor inner-city communities are disproportionately exposed to both indoor and outdoor allergens — cockroaches, mice, mold, dust, cigarette smoke, automobile exhaust, soot — that can trigger breathing problems.

“If you look at inner-city children, they’re sensitized to more allergens and exposed to more allergens at higher levels in their homes, allergens that it’s difficult for them to avoid,” said Dr. Andrew Liu of the National Jewish Medical and Research Center in Denver. Dr. Liu is part of the Inner-City Asthma Consortium, a federally sponsored research initiative at 10 medical centers nationwide that looks at the severity of asthma in cities and is testing treatments to block the allergic response.

Chronic lack of access to outpatient health care and the poorer quality of care in inner-city neighborhoods is another crucial factor. Successful asthma care depends on regular medical maintenance, and poor urban children have less reliable access to doctors’ offices and clinics, more often relying on emergency room visits for treatment.

More generally, keeping up with treatment can be daunting for anyone. “Asthma is a very high-maintenance disease,” Dr. Akinbami said. “You can really control it and live without symptoms, but it’s a lot of work. And if you have a lot of other challenges, it’s much harder to really get organized and motivated to do the things that are necessary.”

Patterns of medication use may differ as well. Inner-city children with asthma tend to overuse fast-acting rescue medications like albuterol at the expense of long-acting steroids like Flovent or Pulmicort, mainstays of asthma control. Language and other social barriers often prevent doctors from accurately assessing how asthma patients are using their medicines at home.

Genetic factors may also play a role. African-Americans are more likely to have a genetic characteristic that makes them more vulnerable to the adverse effects of overusing rescue medications. And even after controlling for socioeconomic factors, African-American children tend to have higher levels of allergies, which are related to asthma in about 85 percent of cases, than white children. Among Puerto Rican children, the incidence of asthma is equally high both in mainland cities and on the island of Puerto Rico, pointing to a possible genetic predisposition to developing the disease.

But at the moment, genetics is secondary to the pressing need for quality care. Several city-based or regional asthma intervention programs have had significant success in raising awareness among parents and doctors, reducing exposure to allergens in homes and schools, and improving care for children.

From 1997 to 2001 during New York City’s Childhood Asthma Initiative — which ran the memorable “I have asthma, but asthma doesn’t have me” advertising campaign — the rate of childhood hospitalizations for asthma in the city decreased by more than a third. The rates of emergency room visits and hospital stays have decreased sharply in central Connecticut, which has the Easy Breathing program to teach practitioners how to more accurately identify asthma in children and meet National Institutes of Health guidelines for care.

At the end of the day, what makes the statistics about minority children and asthma remarkable is that there is actually no mystery to asthma management. Successful intervention programs are straightforward, fact-based and, in theory, easily replicated.

“Even though we don’t know how to prevent asthma, we really do know how to control the symptoms,” Dr. Akinbami said. “These programs can make a difference, and change the outcomes for these children.”
Published August 30, 2007.

Gaza





Afghanistan

Cases of Cholera Reach Baghdad
By ANDREW E. KRAMER

BAGHDAD, Sept. 20 — The first cases of cholera appeared in Baghdad on Thursday, in a sign the epidemic that has already sickened thousands in northern Iraq is now spreading more widely in a population made vulnerable by war to a normally preventable disease.

The World Health Organization and Iraqi Red Crescent Society reported two cases here and Iraqi television reported another case, in a 7-month-old baby, in Basra, far to the south.

People contract cholera by ingesting water or food contaminated with the feces of an infected person. Roughly one in 20 infected people become severely ill, with profuse diarrhea, vomiting and leg cramps, while others have mild or no symptoms but carry the disease.

While cholera can kill its victims in a matter or hours, it is easily controlled through basic water treatment and sanitation measures. But in a sign of how difficult that may be in Iraq, the director of the Basra health ministry, Dr. Ryadh Abdul Ameer, said Thursday that some waterworks in his city were now entirely without chlorine, which is used to purify, because imports of chlorine dried up this year after insurgents used the chemical in bomb attacks.

“We are suffering from a shortage of chlorine, which is sometimes zero,” Dr. Ameer said in an interview on Al Hurra, an American-financed television network in the Middle East. “Chlorine is essential to disinfect the water.”

The cholera outbreak in Iraq this summer had been centered near Kirkuk and Sulaimaniya, in Kurdistan, where at least 10 people have died. In a report released Sept. 14, the W.H.O. said that cholera had been clinically confirmed in more than 1,055 cases so far in Kurdistan and was suspected in more than 24,500 cases of diarrhea and vomiting. In Baghdad, the W.H.O. representative for Iraq, Dr. Naeema al-Gasseer, said laboratory tests confirmed one 25-year-old woman had contracted the disease; a second case was suspected but not confirmed, she said. A hospital worker in the Sadr City area of eastern Baghdad said one patient there appeared to be sick with cholera. That case also was not confirmed.

Cholera is not uncommon in Iraq, which typically reports around 30 cases a year, public health experts say, with the last major outbreak coming in 1999. While it can be stopped with warnings and basic precautions like boiling water, it has crept south through the tumultuous Diyala region, which has been convulsed in sectarian conflict.

Hospital sources there reported two cases on Thursday, after cholera had earlier turned up on the northern border of Diyala, closer to the Kurdish outbreak.

The Iraqi deputy health minister, Dr. Adel Mohsin, said that he knew of only one confirmed case of cholera in Baghdad, and that was in a patient who lived in an outlying district near Diyala Province, called Diyala Bridge, rather than within the city.

Cholera is caused by an infection of the intestines from contaminated water. Dr. Said Hakki, the director of the Iraqi Red Crescent, said earlier that health officials expected the disease to break out in Baghdad by late September or early October. If it is widespread, the security situation could make it extremely difficult to send in health workers to protect the population.

At a briefing Thursday, Lt. Gen. Raymond T. Odierno, the second-ranking commander in Iraq, and an Iraqi commander, Lt. Gen. Qanbar Abud, who is in charge of Baghdad operations for the Iraqi Army, said violence in the capital had dropped off sharply this year during the buildup of American troops. Civilian casualties in Baghdad dropped to 12 per day from 32 per day, he said.

Also on Thursday, the BBC sent a memo to its employees around the world stating that because of a threat received by the BBC’s Baghdad bureau, the network would temporarily move the newsgathering staff out of that bureau to unspecified locations.

“We’ve been made aware of a specific threat to the international staff in the Baghdad bureau,” said the memo, sent by Jon Williams, the BBC’s World News editor.

The memo said that the BBC’s coverage of Iraq would continue with “a significantly reduced team” while the security threat was assessed. No other details were given, but the memo from Mr. Williams said there had been a meeting with Iraqi and Western staff members in Baghdad, “and we have reassured them that this is a temporary move and that their safety is our only concern.”

Reporting was contributed by Ahmad Fadam, Sahar Najeeb, Ali Fahim, Mudhafar Fadhil and other Iraqi employees of The New York Times.

Sunday, September 23: I'll be going to a 10 a.m. Kundalini yoga class directly across the street from the dorms. Please email me by Saturday late afternoon if you would like to join, and we can plan on a time to meet. I'll also be wandering around Soho for a bit after class. Let me know if you might want to wander with me and find a cup of tea around 11:30ish.

Saturday, September 29: NEW YORK UNIVERSITY, “The Pencil Lets You Say What the Mouth Does Not” Saturday at 4 o’clock. 19 West 4th Street (the corner of Mercer and West 4th). Room 102. Co-sponsored by The International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses and the NYU Postdoctoral Program. 212-533-5687 for more info.

Monday, October 1: STREAM EVENT: Smoothie Making Workshop (& perhaps a poem or two) in the Broome Room. 7:30.

Tuesday, October 9: "Dead Mums Don't Cry": Averting Maternal Death and Disability in Africa. 7:00 - 9:00pm. NYU Cantor Film Center. Theater 101. 36 East 8th Street, NYC. Please RSVP online for this event by visiting http://www.nyu.edu/mph/events/.

Wednesday, October 10: STREAM EVENT: "Hotel Cassiopeia;" 6 p.m. at BAM in Brooklyn. We have a limited number of tickets to this show so please let me know if you'd like to come.

Monday, October 29: STREAM EVENT: Felice Aull to speak in the Broome Room. 7:30.

Tuesday October 30 – THE PHILOCTETES CENTER, “Poetry in the Therapeutic Context” Roundtable with Michael Braziller and Madge McKeithen. 247 East 82 Street 3rd Floor, New York, New York Tuesday from 7-9. 646-422-0544

Here's a rough list of HSH programs this semester. We will be adding more programs as we go along, so make sure to check back for updates.


September 20--Perry Klass at Smilow Multipurpose Room, 5-7 (NYU Medical)

October 1--Poetry Workshop/Roundtable at Broome Street, 7:30

October 10--Hotel Cassiopeia @ BAM, 6:00

October 29--Felice Aull to speak at Broome Street, 7:30

November 14--De-stress Yoga/Alternative Medicine, meet at Broome Street

November 26--Madge McKeithen to speak at Broome Street, 7:30

December 12--Final Meal @ Spring Street Natural

rom the NYT, 8.12.07



August 12, 2007

Editorial

World’s Best Medical Care?
Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.

Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.

Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.

Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.

Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.

Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.

Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.

Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.

Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.

That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.

Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.

Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.

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With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.