These are lyrics from a band that I'm a little obsessed with. On bad days, this is what I feel like about my hearing.
And I go on
Wondering if I've got a soul and
Counting down the hours 'til it goes
-- Ted Leo and the Pharmacists, "Counting Down the Hours"
Sunday, September 13, 2009
Wednesday, September 9, 2009
Insight and humanity
There's a concept in psychiatry that most of us don't consider often. Insight, defined in my intro to clinical psychiatry book as, "the patient's awareness of his or her mental illness and the ability to connect this disturbance to other problems", is not really the most important important aspect of a patient's mental state from a diagnostic perspective.
But what strikes me is that insight is perhaps the most important factor in determining our emotional reaction to the patient. Consider an older patient with dementia, for example. He is losing his mind, forgetting who his children are, giving them gruff and slightly wary welcomes when they come to visit. Maybe we roll our eyes, shake our heads a little as we repeat what we've been telling him for weeks, that his visitors are his family, and he should be nice and sit and talk with them for awhile.
Now consider the same patient, who, in a moment of insight, realizes that his mind is slipping away past his reach. A lifetime of professional accomplishments and personal connections is blurring into an oblivion that he recognizes as the path towards the end. Our patient has now gone from a sweet old nuisance to a tragedy.
Why? What is it about this one feature that evokes such a an empathetic response? I think it's because insight gets at what makes us human. Ants will never have the insight into their situation aside from an instinct to run when they see large objects moving quickly near them. Insight implies a broader realization, a conceptual understanding of illness and one's relationship to it.
Ancient playwrights knew that insight is the stuff tragedy is made of: the entire, horrible events that lead to Oedipus's putting his eyes out happen before the play starts. Things only turn tragic when Oedipus realizes what has occurred -- when he gains insight.
Although embedded within the endless descriptive terminology that psychiatry uses, insight describes more than a symptom of an illness. It describes an expression of humanity.
But what strikes me is that insight is perhaps the most important factor in determining our emotional reaction to the patient. Consider an older patient with dementia, for example. He is losing his mind, forgetting who his children are, giving them gruff and slightly wary welcomes when they come to visit. Maybe we roll our eyes, shake our heads a little as we repeat what we've been telling him for weeks, that his visitors are his family, and he should be nice and sit and talk with them for awhile.
Now consider the same patient, who, in a moment of insight, realizes that his mind is slipping away past his reach. A lifetime of professional accomplishments and personal connections is blurring into an oblivion that he recognizes as the path towards the end. Our patient has now gone from a sweet old nuisance to a tragedy.
Why? What is it about this one feature that evokes such a an empathetic response? I think it's because insight gets at what makes us human. Ants will never have the insight into their situation aside from an instinct to run when they see large objects moving quickly near them. Insight implies a broader realization, a conceptual understanding of illness and one's relationship to it.
Ancient playwrights knew that insight is the stuff tragedy is made of: the entire, horrible events that lead to Oedipus's putting his eyes out happen before the play starts. Things only turn tragic when Oedipus realizes what has occurred -- when he gains insight.
Although embedded within the endless descriptive terminology that psychiatry uses, insight describes more than a symptom of an illness. It describes an expression of humanity.
Saturday, August 29, 2009
O.I.B.
I have an ongoing mental list of "only in Berkeley" occurrences, that I'm now going to start as an electronic list.
1. At the live broadcast of new president Obama's inauguration speech on the Berkeley campus, the mention of "nonbelievers" gets the biggest cheer of the day. OIB.
2. On an afternoon jog up in the Berkeley hills, on a quiet residential street, I run into a group of Code Pink protesters, apparently camped out in front of the house of a Berkeley professor who has been implicated in some sort of Evil. OIB.
3. The squirrel that has come into the Free Speech Cafe on campus wanders around freely for several minutes, gaining only some raised eyebrows and shrugs, even from the cafe staff. I finally chase it out, because I realize no one else will. OIB.
More to come, I'm sure; never a dull day in the Republic of Berkeley.
1. At the live broadcast of new president Obama's inauguration speech on the Berkeley campus, the mention of "nonbelievers" gets the biggest cheer of the day. OIB.
2. On an afternoon jog up in the Berkeley hills, on a quiet residential street, I run into a group of Code Pink protesters, apparently camped out in front of the house of a Berkeley professor who has been implicated in some sort of Evil. OIB.
3. The squirrel that has come into the Free Speech Cafe on campus wanders around freely for several minutes, gaining only some raised eyebrows and shrugs, even from the cafe staff. I finally chase it out, because I realize no one else will. OIB.
More to come, I'm sure; never a dull day in the Republic of Berkeley.
Tuesday, June 16, 2009
HIV in the porn industry: time for regulation
I know, it seems like a strange cause to take up.
But the fact is, being a porn actor puts one at huge risk for STIs including HIV. I wish I had a good and shocking comparison, along the lines of, "being an average porn star for one year is equivalent to riding a motorcycle on a crowded indie speedway without a helmet for a month without stopping", but I don't have any statistics. (And someone should really look into calculating that risk!)
You get the idea, though; being in pornography with the very limited regulation currently in effect is running a huge health risk, and no one should be required to do that to keep his or her job. The recent revelation that a porn actress had tested positive for HIV and possibly infected a costar and her boyfriend prompted the apparently hushed-up fact that several others in the industry have become infected with HIV in the last 5 years. Thousands have tested positive for Gonorrhea and Chlamydia.
The heterosexual porn industry has rejected suggestions that regulation include mandatory condom use, and actors who demand condom use are often not asked back for further work. (Meanwhile, because HIV is so prevalent in the gay community, gay porn studios generally require condom use.) The current regulation around safety in the industry is that actors must arrive on set with the results of an HIV PCR test. However, HIV testing is not flawless, as a cluster of cases in the porn industry in 2004 showed; further, requiring that actors pay for testing on their own, and dismissing anyone who is HIV-positive, is illegal.
As this article (which you can download for free! I love Plos Medicine!) argues, regulation of the porn industry must involve condoms, which will lower risk of STIs and HIV significantly -- and carry the added bonus of normalizing condom use for viewers. The industry apparently thinks that people will stop watching porn if actors are wearing condoms, something that hasn't played out in the gay porn industry. State regulators need to show some backbone and stand up to the industry in order to protect porn actors and their partners.
(On a side note: is this blog getting too soapboxy? I figured that if there was anyone reading this blog, a good use of it might be to write persuasive arguments about issues arising in medicine and public health... but if no one reads it because it's too preachy, it defeats itself.)
But the fact is, being a porn actor puts one at huge risk for STIs including HIV. I wish I had a good and shocking comparison, along the lines of, "being an average porn star for one year is equivalent to riding a motorcycle on a crowded indie speedway without a helmet for a month without stopping", but I don't have any statistics. (And someone should really look into calculating that risk!)
You get the idea, though; being in pornography with the very limited regulation currently in effect is running a huge health risk, and no one should be required to do that to keep his or her job. The recent revelation that a porn actress had tested positive for HIV and possibly infected a costar and her boyfriend prompted the apparently hushed-up fact that several others in the industry have become infected with HIV in the last 5 years. Thousands have tested positive for Gonorrhea and Chlamydia.
The heterosexual porn industry has rejected suggestions that regulation include mandatory condom use, and actors who demand condom use are often not asked back for further work. (Meanwhile, because HIV is so prevalent in the gay community, gay porn studios generally require condom use.) The current regulation around safety in the industry is that actors must arrive on set with the results of an HIV PCR test. However, HIV testing is not flawless, as a cluster of cases in the porn industry in 2004 showed; further, requiring that actors pay for testing on their own, and dismissing anyone who is HIV-positive, is illegal.
As this article (which you can download for free! I love Plos Medicine!) argues, regulation of the porn industry must involve condoms, which will lower risk of STIs and HIV significantly -- and carry the added bonus of normalizing condom use for viewers. The industry apparently thinks that people will stop watching porn if actors are wearing condoms, something that hasn't played out in the gay porn industry. State regulators need to show some backbone and stand up to the industry in order to protect porn actors and their partners.
(On a side note: is this blog getting too soapboxy? I figured that if there was anyone reading this blog, a good use of it might be to write persuasive arguments about issues arising in medicine and public health... but if no one reads it because it's too preachy, it defeats itself.)
Thursday, June 11, 2009
F*@# the AMA
This is making me so angry I can hardly even think. The American Medical Association has a stated mission "to promote the art and science of medicine and the betterment of public health." How an organization with this mission, composed of supposedly human beings who have taken the Hippocratic Oath (or the Lasagna Oath, which we know I love!) to "do no harm" can oppose a system that would improve health coverage to Americans is beyond me.
They say that having a public insurance provider would "restrict patient choice" by driving out private insurers, a logic I'm not even sure I understand. But let's look at the "patient choice" available right now: how many people, even those lucky few with good private coverage, can say they have the choice they'd like in providers? And as this blogger points out, the private insurers enjoy such hegemony over the industry right now that they can raise premiums as they wish, padding the pockets of their wealthy CEOs, thus often driving individuals and businesses into bankruptcy. (Health care costs are the main cost of individual bankruptcy filings in the U.S.) In a free market system, which the AMA seems to tout as king, supply and demand are in communication -- they aren't mediated by HMOs with price-setting behind closed doors in a mysterious, non-transparent process probably influenced by big Pharma and big Insurance.
I guess the AMA's stance shouldn't surprise anyone, because it seems that it has a long history of opposing plans that help people, including Medicare. I honestly don't think the AMA is an evil cabal of specialists trying to make sure they can easily afford next year's timeshare in the Hamptons, although there's probably some of that too. I think most of it is a subconsious reaction that many Americans have that equates "government-controlled" with "inefficient". What Americans must realize is that health is not a commodity like any other, and that American health and productivity do not benefit when health insurance companies make money. Sure, government can be inefficient; it would be the responsibility of the overseeing agencies to make sure that it is run well and makes use of all the current technologies and strategies for maximizing service output. But the current system of armies of actuarial specialists setting premiums based on risk is far more inefficient. A public system has the potential to make Americans healthier than they've been for decades, at lower costs. Under the current, privatized system, there will always be people slipping through the cracks. Anyone who wants to get as angry as I am should just visit a community free clinic and chat for awhile with its clients.
Physicians for a National Health Program is an organization that advocates for single-payer healthcare -- care provided to all Americans by government agencies, with provision of care managed privately. This is the only way to give Americans real choice in their care, and real coverage for their health problems. Obama's plan doesn't go far enough, but it's a step in the right direction. The AMA's stance is 50 steps back.
They say that having a public insurance provider would "restrict patient choice" by driving out private insurers, a logic I'm not even sure I understand. But let's look at the "patient choice" available right now: how many people, even those lucky few with good private coverage, can say they have the choice they'd like in providers? And as this blogger points out, the private insurers enjoy such hegemony over the industry right now that they can raise premiums as they wish, padding the pockets of their wealthy CEOs, thus often driving individuals and businesses into bankruptcy. (Health care costs are the main cost of individual bankruptcy filings in the U.S.) In a free market system, which the AMA seems to tout as king, supply and demand are in communication -- they aren't mediated by HMOs with price-setting behind closed doors in a mysterious, non-transparent process probably influenced by big Pharma and big Insurance.
I guess the AMA's stance shouldn't surprise anyone, because it seems that it has a long history of opposing plans that help people, including Medicare. I honestly don't think the AMA is an evil cabal of specialists trying to make sure they can easily afford next year's timeshare in the Hamptons, although there's probably some of that too. I think most of it is a subconsious reaction that many Americans have that equates "government-controlled" with "inefficient". What Americans must realize is that health is not a commodity like any other, and that American health and productivity do not benefit when health insurance companies make money. Sure, government can be inefficient; it would be the responsibility of the overseeing agencies to make sure that it is run well and makes use of all the current technologies and strategies for maximizing service output. But the current system of armies of actuarial specialists setting premiums based on risk is far more inefficient. A public system has the potential to make Americans healthier than they've been for decades, at lower costs. Under the current, privatized system, there will always be people slipping through the cracks. Anyone who wants to get as angry as I am should just visit a community free clinic and chat for awhile with its clients.
Physicians for a National Health Program is an organization that advocates for single-payer healthcare -- care provided to all Americans by government agencies, with provision of care managed privately. This is the only way to give Americans real choice in their care, and real coverage for their health problems. Obama's plan doesn't go far enough, but it's a step in the right direction. The AMA's stance is 50 steps back.
Monday, May 18, 2009
Ah, the internet
I'm trying to write up some materials for the project I'm working on, which looks at the role of multiple, concurrent partnerships in the HIV epidemic in Mozambique. I probably should have known better than to Google Image "network concurrent sexual" to find a good illustration of network characteristics when partnerships are concurrent.
Along with some racier stuff (and some things about computer programming...?), I got the picture above, which made me laugh. It's actually from a PSI site, and PSI is one of our main partners on the project. So it really does have to do with what I'm studying. I guess I sympathize with wanting the page to be visually appealing, and yet not having a picture that represents what's being discussed.
But still... this is funny. Some PSI intern is now patting herself on the back for being able to sneak in there a picture of a guy grabbing his lady friend's tuchas.
Monday, May 4, 2009
Disconnected
According to my new ENT, there's a problem with my connexins. These proteins, pictured above, assemble in a pretty flower shape on cell membranes, interacting with connexins on neighboring cells to form gap junctions. Gap junctions turn out to be important to neurochemical signaling. So, specific types of mutations in the genes encoding connexins can lead to deafness and/or hearing loss. I elected not to have any genetic testing done at this point, because it wouldn't change my treatment, but the doctor said that connexin mutations are the most frequent causes of slowly progressive sensorineural hearing loss -- and that these mutations, autosomal recessive alleles, occur at a higher prevalence among Ashkenazic Jews (who, it turns out, are also susceptible to fat metabolism disorders and GI disorders, probably among other things I haven't learned about yet. All those population bottle-necks, I guess?). So it's likely that this is what's wrong with me.
I guess it's nice to know that. It gives it some closure, and gives me a good idea what might be in store in the future. It's also a little weird, though, being someone with a "rare genetic condition", whom I should be seeing on an evening news story rather than, well, the person who is looking out through my eyes. It took me awhile to get used to being "the girl who wears hearing aids"; now I guess I'm also "the girl with the rare genetic disease." I got used to the hearing aids, though, so I'm sure I'll get used to this -- it'll just take some time.
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