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Medicine

This category contains 16 posts

But for the lottery of birth: Poverty, Racism, and the Permanent Underclass

In Rosa Lee: A Generational Tale of Poverty and Survival, Leon Dash documents the fascinating, disturbing experiences of an extended black urban family struggling to survive the nearly inescapable circumstances of poverty, racism, ignorance, violence and abuse, addiction, and crime in Washington, D.C. during the second half of the twentieth century. Dash, now a professor … Continue reading

Treatment of pediatric hearing loss with cochlear implantation

Lee Ware, Dasha Kenlan, John Penn, Kendra Campbell, Tara Shrout, Keith Albrektson, Jason Chisholm, Daniel Hudson Introduction Cochlear implants, approved for children by the FDA in 1990, are implantable, 2-component devices designed to transmit sound information from the external environment to a patient’s auditory processing circuitry. The external component (placed behind the ear) and internal … Continue reading

The US is far behind peer nations in aligning policies with her public’s health.

The future of public health in the United States is difficult to predict, but the challenges public health has yet to overcome are much more certain. As Keck, Scutchfield, and Holsinger point out in their concluding chapter of Contemporary Public Health, “one of the few constants in public health practice is that change is ongoing … Continue reading

Fast Food Nation: How a Psychopathic Economic System Poisons for Profit.

In Fast Food Nation: The Dark Side of the American Meal, journalist and author Eric Schlosser explores the origin, evolution, ascendance, operation, impact, and exportation of the uniquely American (and extremely toxic) fast food industry. From its birth in the west coast post-war car culture to its capture of food markets around the planet, the fast food industry has succeeded in radically altering the human species’ relationship to food – its meaning, production, distribution, content, form and flavor, cost, acquisition, and consumption. Continue reading

Public Health Accreditation

As Keck, Scutchfield, and Holsinger phrase it, “public health is no longer in the position of being the only major health profession without a process to …. accredit its agencies.” But how and why has public health accreditation arisen, and how might it contribute to improving the public’s health? Continue reading

Health: to reform incentives or re-imagine a paradigm?

If any of mainstream economic theory’s assumptions are true, it is that incentives influence behavior (another is that for-profit firms that are legally mandated to maximize profits [see Ebay v. Newmark] will, in fact, maximize profits). If financial incentives under fee-for-service induce physicians to create demand (by prescribing un-valuable services), then realigning these financial incentives … Continue reading

Who gets sick and why?: the lense of Primordial Prevention

Primordial prevention targets the “causes of the causes” of ill-health and harm – the social and political determinants of health. In the US, these political and social environments are characterized by dramatic class-, gender-, and race-based inequalities in health, wealth, representation, agency, safety, rights, and opportunity. Continue reading

Core Functions of Public Health: Something’s Missing

Advocacy for social justice and health equity is necessary and essential towards fulfilling public health’s mission. Continue reading

Is the US Healthcare System “health care” or a “system”?

To use the word “system” to describe healthcare in the United States is to imply intentionality, coordination, and comprehensiveness, none of which can be appropriately applied here. Continue reading

Benefits and Challenges of PHSSR

Public health services and systems research (PHSSR) is, according to Mays, Halverson, and Riley in Holsinger’s Contemporary Public Health chapter 6, “the field of inquiry that examines the organization, financing, and delivery of public health at local, state, and national levels, and the impact of these services in population health.” Continue reading

Social Justice is the Smart Health Investment

Addressing the social determinants of health and well-being directly at the policy level may be both the most cost-effective and moral path forward. Though inequalities in power and wealth have been central to the critiques of western capitalist societies since the earliest days of the industrial revolution, and though industrial activity’s specific harms to human … Continue reading

Medicare’s Assessment of Brigham and Women’s Performance

Boston’s Brigham and Women’s Hospital (75 Francis Street; a subsidiary of Brigham and Women’s Healthcare) is a major teaching hospital of Harvard Medical School and among the best regarded acute care referral centers in the United States 1. In 1980, three separate hospitals were merged to constitute the present center 2. As of its 2012 … Continue reading

Human Hearing Loss

Hearing loss affects as much as 5% of the global human population and its negative consequences, often exacerbated by cultural bias or distributive injustice, include delayed cognitive and language development, learning deficits and poor academic performance, chronic unemployment and dependency, poverty, elevated risk of harm and poor health. I conducted a review of open access journals and other freely available resources to identify the principal causes of hearing loss; its consequences for individuals, communities, and states; and potential interventions most appropriate for developing and low-resource countries where hearing loss is currently most prevalent and its burdens most egregious. Continue reading

The Fallibilities of Choice and Competition

Mill’s blacksmith example serves his argument well. But his argument for the sovereignty of free choice and competition in matters of social organization and production fails to account for the poor choices and biased competitive environments that often produce less than ideal results. In fact, socioeconomic prejudice remains as a potent and pernicious social ill long after the worst of codified sexism has been remediated, and the illness has been fueled as much by market forces and competition as by the inaction of government to meaningfully intervene in the disparities of wealth and opportunity that define a still openly classist society. Continue reading

Medical Expertise

As an aspiring physician, medical expertise is something I hope to progressively develop during medical school, internship and residency, fellowship training, and eventually, clinical practice. The knowledge base upon which this expertise will be built has already begun to be established, though the process has often seemed disjointed and the information, to varying degrees, sometimes … Continue reading

Summary of Field’s Yoga: Clinical Research Review

Introduction Tiffany Field, of the Touch Research Institute, University of Miami School of Medicine and the Fielding Graduate University, reviewed recent empirical research of yoga’s impact on psychiatric and neurological conditions, cardiovascular health, immune conditions, and pregnancy. She then assessed yoga’s physiological effects, including decreased heart rate and blood pressure, and proposed mechanisms for its … Continue reading

Neglect

Neglect is “a deficit in attention and awareness of one side of space”, usually the left side, contralateral to right-hemisphere damage (Wikipedia). It is caused by a problem in the brain, usually a lesion or damage from stroke, rather than a problem of sensation. That is, the eyes work fine, but the brain, because of … Continue reading

The 21st Century Physician

The economic and political realities that will define medicine’s practice environment in the United States during the coming decades are difficult to predict. But the competencies and qualities that will define the successful physician are much clearer. 21st century physicians must be habitual life-long learners to stay abreast of translational breakthroughs and technological innovations. They … Continue reading

Medicine’s Professional Organization

The medical profession is organized as a rigidly delineated, legally mandated, and culturally reinforced pyramidal hierarchy within the larger hierarchical health services system. Advancement in the medical hierarchy is achieved in a number of ways. Pre-medical students just beginning their training must combine high academic achievement with competitive scoring on the standardized Medical College Admissions … Continue reading

Atomic Absorption Analysis of Three Dietary Supplements

Whether called alternative, traditional, natural, integrative, or complementary medicine, this largely dietary supplement-based multi-billion dollar industry is associated with claims of extreme efficacy based more on anecdote than evidence. Meanwhile, evidence is mounting that long-term vitamin supplementation may actually be harmful. We wondered whether an industry known for exaggerated claims and pseudo-scientific products was similarly sloppy with its measurements and manufacture.

We chose to take three well known multivitamin supplement brands (One Source, Now, and Equate) to task by measuring the amount of iron, zinc, magnesium, and copper in each using atomic absorption spectrophotometry (AAS) to confirm or expose each brand’s reported values. Of the tools available, AAS was chosen because of its superior accuracy in metal analyte analysis. Continue reading

New Thinking: Medical Hot Spots

Atul Gawande, associate professor of surgery and public health at Harvard and one of our most prolific contemporary physician-writers, adapts his New Yorker piece surveying innovative attempts to lower healthcare costs by better serving those patients with greatest need to a 13 minute PBS FRONTLINE report focused on one such program, the Camden Coalition of … Continue reading

Medicine’s Dilemma of Delivery

I believe in the right to health care, so the decision to participate in a system that insufficiently and inconsistently protects that right – that forces some to choose between needed care and financial ruin and leaves others without even that choice – was, for me, a difficult one. In deliberation, I was reminded that while all endeavors naturally inherit our human imperfections, they can also benefit from our determined, concerted efforts to improve their outcomes. I have observed firsthand, in the clinic and operating room, the awesome, fundamental good routinely delivered to patients in need, and it is something I deeply want to contribute to. The process of making the delivery of that good more humane, accessible, and efficient is, at least in part, dependent on the abilities of we physicians-in-training to see medicine for what it is now, and what it could be, with our vision and hard work, in the future. Continue reading

Amnesia, That Unremembered Country

I found myself, quite unexpectedly, staring down a hospital corridor, its white floor and ceiling and beige walls, now in recollection, bleached at their edges as if glimpsed through a thin cloud’s brief eclipse. Nurses and technicians walked purposefully past on unguessed errands, progressing, with each step, further into the frayed perimeter of my awareness. … Continue reading

Phil Borges’ The Forgotten Crisis

“Short documentary by Phil Borges on the problem of disabling burns in Zambia, where there is only one plastic surgeon serving 11 million people, Interplast partner Dr. Goran Jovic. It tells the story of 7-year-old Mateo, the impact his disabling burns have on his family and how reconstructive surgery really can make a lifetime of … Continue reading

The International Scope of Otolaryngology

I came across this video recently and was blown away, as this reflects exactly my professional interests and ambition. Unfortunately, Google Video doesn’t give any other identifying or supporting information regarding the video authors or their project’s context.