"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Prior Authorization Required: I often have to cut through a lot of red tape to get prior authorization for procedures for my patients, but this is ridiculous:
After a lot of red tape, Briana Lane has her skull back in one piece. The 22-year-old woman was injured in an auto accident in January, and doctors temporarily removed nearly half her skull to save her life.
But for nearly four months afterward, the piece of bone lay in a hospital freezer across town — and Lane had to wear a plastic street hockey helmet — because of a standoff with Medicaid and the hospital over who would cover the surgery to make her whole again.
The surgery finally came through after an excruciating wait, during which she suffered extreme pain just bending down and would wake up in the morning to find that her brain had shifted to one side during the night.
"When you think of weird things happening to people you don't think of that," Lane said. "It's like taking out someone's heart — you need that!"
Actually, it's probably not as horrendous as it seems on the surface. The patient didn't have insurance. She was waiting for her application for Medicaid to be processed, and that does take some time. The doctors may have felt they were doing her a favor by waiting to see if her Medicaid coverage would come through. Otherwise, she would have been stuck with a very large bill. The surgery wasn't an emergency, as another uninvolved surgeon notes in the story. But four months does seem over long. posted by Sydney on
5/14/2004 05:41:00 PM
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(Sorry about all the after-te-fact editing. This new blogger system is horrible.) posted by Sydney on
5/14/2004 08:44:00 AM
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Thursday, May 13, 2004
Book Review: We may flatter ourselves that we think therefore we are, but in reality our lives are much more than the sum of our thoughts. Our deeds and others' perceptions of us can be just as important in shaping the totality of who we are.
Such is the theme, anyways, of Wylene Dunbar's My Life with Corpses. S. Oscar, or Oz (she's from Kansas), is the only non-corpse in her immediate family. Her mother was a corpse when she was conceived (how she does not say) and her father was a corpse in the making. Her older sister was also a corpse, having succumbed to "brain fever." This makes for an odd sort of childhood - one devoid of affection or emotion, except for that to be had from animals. But even corpses are not immune to the ravages of time. One day her family rapidly decomposes, and she is forced into the emotional, messy, world of a living foster family. She's rescued by a kindly neighbor who sends her to college where she studies philosophy and soon learns that academia, and the world in general, is filled with corpses.
There are corpses of all manner in this book and it's difficult to keep them all straight. There are corpses who died in accidents or from medical illnesses. There are corpses who died when they lost their dreams. There are corpses who died by turning too far inward, disappearing into their minds as it were. There are corpses who died from emotional isolation. And there are corpses who were sucked into death by the corpses around them.
The really dead and the metaphorically dead walk around with equal aplomb. The parents are a prime example - are they really dead or just emotionally dead? Most often it seems the latter. They both live lives of disappointed expectations and at one point they join a fundamentalist church looking for salvation. But if the dead have no souls, which the narrator goes to great lengths to make clear early in the story, why would they be worried about salvation?
In the end, this is no zombie story, but a philosophical reflection of the many ways we can die without dying. It could just as easily be titled, My Life with Depressives. But that wouldn't be as catchy.
UPDATE: A reader notes:
I think I prefer what Ambrose Bierce said:
Cogito cogito ergo cogito sum -
I think that I think, therefore I think that I am.
Two new studies found that people with high levels of homocysteine have a higher rate of bone fractures.
Homocysteine is an amino acid found in blood. High levels have been linked to an increased risk of heart disease.
Researchers are not sure whether the high homocysteine causes the bones to weaken or just plays a role in the process. They note that more study is needed to determine homocysteine's exact role in bone fractures.
No study has drawn an association between homocysteine levels and bone mineral density. Other studies have found evidence linking high levels of homocysteine to clogged arteries, heart attack, stroke, blood clots and dementia.
Funny thing about all of those ailments - they're all diseases of aging. As is osteoporosis. And guess what? Levels of homocysteine increase as you age. At least that's what both studies found. It's impossible to tell if the elevated homocysteine levels and bone fractures are causation or just association. I'm betting the latter.
Still, it won't hurt you to eat plenty of green, leafy, vegetables, which are high in homocysteine, or to take a multivitamin with folic acid, B12 and B6 in it. As long as you don't overdose on them. I just wouldn't go out and have a homocysteine level drawn to predict your risk of having a fracture some time in the future. The older you are, the higher your risk. And the higher your homocysteine level. posted by Sydney on
5/13/2004 04:43:00 PM
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The biggest comparison of the two procedures to date, involving 48 U.S. and Canadian hospitals, found the same rates of survival, tumor recurrence and surgical complications. In addition, patients who had laparoscopic surgery had less pain and less time in the hospital.
Experts predicted the results will end the virtual moratorium on such surgery that began in 1994.
The study appears to be a well-designed one. It compared outcomes among a diversity of hospitals and surgeons. Participating surgeons had to submit a videotape of their performance to ensure that they all knew what they were doing. And the patients in both groups shared the same characteristics - same sex distribution, and the same diversity of types of tumors. There were a few differences in the outcomes, though:
Operating times were significantly longer in the laparoscopic-surgery group than the open-colectomy group (150 minutes vs. 95 minutes, P<0.001). Patients in the open-colectomy group were more likely than those in the laparoscopic-surgery group to undergo concurrent resection of other organs (63 vs. 34 patients, P=0.001); malignant histologic findings were identified in these resected organs in 14 patients in the open-colectomy group, as compared with 6 in the laparoscopic-surgery group. Abdominal-wall adhesions (P=0.002) and bowel adhesions (P=0.001) were reported more frequently among patients in the laparoscopic-surgery group.
The laparoscopic group spent one day less in the hospital and used both intravenous and oral pain medication on average one day less than the open resection patients. There were more complications during surgery for the laparoscopic patients (4%) than the open resection patients (2%). Those complications included things like puncturing the bowel accidently or the spleen. But overall survival and cancer recurrence were about the same in both groups.
So, will this replace open colon resection for colon cancer? Maybe in a few years, when surgeons learn the technique. Although, I've got to think that some of them will be reluctant to give up touching the bowel to look for other tumors that might have been missed pre-operatively. posted by Sydney on
5/13/2004 09:29:00 AM
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Personal Note: I've been so inspired by the "Go Active" adult happy meal, I'm going to start a personal experiment. I'm going to do the same thing I've been telling patients who want to lose weight for years - eat less and exercise more. Starting today, I'm going to keep a record of my calorie intake, shooting for 1200 calories a day, and of my walking - shooting for five miles a day.
I know it works, because I've done it before. It just takes a degree of obsessive-compulsiveness that's hard to maintain. And once you stop being obsessive about counting everything, backsliding is inevitable. It's so easy to convince yourself that you didn't really eat that many calories today, so it's OK to have that extra cookie. Or that you really did do a lot of walking at work so it's not necessary to get on the treadmill or go to aerobics class. We'll see how it goes. (But I'm not going to go on a McDonald'sdiet. It's too expensive. And boring.) posted by Sydney on
5/13/2004 09:09:00 AM
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Wednesday, May 12, 2004
A Low Carb World II: Krispy Kreme, once our family's favorite doughnut maker, says the low carb craze is hurting its business:
Krispy Kreme is not getting fat on sales these days, blaming the low-carb diets for eating into its profits.
"For several months, there has been increasing consumer interest in low-carbohydrate diets, which has adversely impacted several flour-based food categories, including bread, cereal and pasta," according to Krispy Kreme. "This trend had little discernible effect on our business last year. However, recent market data suggests consumer interest in reduced carbohydrate consumption has heightened significantly following the beginning of the year and has accelerated in the last two to three months."
This is a pretty lame excuse. Krispy Kreme has no one to blame but itself for its dismal performance. They've been shutting down their shops and moving their doughnut sales to gas stations and Target stores, where they're sold in prepackaged boxes, like Hostess or Dolly Madison doughnuts. Who wants that?
The Krispy Kreme in our town used to be very popular. People would pick up doughnuts there and take them to work as treats for their co-workers. Drug reps used them as doctor-treats. The store even had a drive-thu window, which appeared to be as busy as McDonald's drive-thru. They were hopping on Sunday mornings after church.
But beginning last year a series of corporate decisions doomed the place. First, they cut down on the variety of their doughnuts. (No more vanilla frosting! It wasn't an "official Krispy Kreme recipe.") Then they shut the drive-through window. Then they shut down the store and sold the pre-packaged doughnuts in the gas station across the street. Well, no one goes to the gas station to get doughnuts for their co-workers, and no one goes there after church, either. They go to a new doughnut shop that opened when Krispy Kreme closed. (The owner knew an opportunity when she saw it.)
But, of course, it's easier for Krispy Kreme executives to blame diet fads for their failures than to accept the blame for their bad decisions. posted by Sydney on
5/12/2004 08:01:00 PM
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A Low Carb World: I devoted my lunch hour to blog research today, and went and got an adult happy meal. For those of you who haven't heard of the latest McDonald's innovation, it's a salad in a cardboard box with bottled water and a "stepometer." The box lists the calorie counts of each salad as well as the salad dressings. It also has a picture of Oprah Winfrey's personal trainer on the side (he "wrote" a small booklet -i.e. user manual - that comes with stepometer), and the words "Shopping is Now an Official Sport." Men are not their target market, evidently.
You can choose one of four salads - three with chicken and one with hamburger - Caesar Salad, Bacon Ranch Salad, California Cobb Salad, or the Fiesta Salad (a taco salad.) Choosing crispy chicken over grilled chicken adds one hundred calories to the chicken salads. I opted for the Cobb salad with crispy chicken. Total calories = 370. It came with a creamy vinaigrette dressing with Paul Newman's picture on the package - 120 calories. All for $5.25. I would have been ahead to have a cheeseburger with a small iced tea for 330 calories and a price tag of around two dollars, but I wouldn't have gotten the stepometer.
The "stepometer" is a cheap pedometer, but it works OK. I wore mine at the office this afternoon and discovered I only walked one mile seeing my afternoon patients. According to Oprah's trainer, I should try to get up to five miles a day if I want to see any health benefits.
It wasn't a bad meal, but if you really want a salad, you'd be ahead financially to buy it without the packaging ($3.99 per salad at my McDonald's) and drink your water from the tap. posted by Sydney on
5/12/2004 03:37:00 PM
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Immunization Triumph: The pneumonia vaccine for children seems to have made a dent in invasive pneumococcal infections:
The report found that between 1998 and 2002, annual U.S. incidence rates for invasive pneumococcal disease -- pneumonia and meningitis -- decreased from 19 to 12.1 cases per 100,000 among whites and from 54.9 to 26.5 among blacks.
"Due to these declines, 14,730 fewer cases occurred among whites and 8,780 fewer cases occurred among blacks in the United States in 2002, compared with the average number in two pre-vaccine years, 1998 and 1999," the study said.
That's quite a reduction among minorities. I'm guessing that the decrease in rates would be even more impressive if they broke it down into children who attended daycare and those who didn't, rather than classifying it by race.
It's too bad the vaccine isn't available, although the CDC says it is, but just in short supply. I haven't been able to buy any for the past two months. And neither has our county health department. posted by Sydney on
5/12/2004 08:26:00 AM
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Use It or Lose It: Nightly use of Viagra after a prostatectomy may preserve erectile function in the long run:
For the second study, Frank Sommer and colleagues at the University Medical Center in Cologne, Germany, tested 76 patients who had suffered erectile dysfunction for more than six months.
They found 58.8 percent of the patients who took Viagra every night for a year enjoyed a full return of sexual function, compared with 9.7 percent of those who only took it when they wanted to.
'After only one year, sildenafil taken regularly at bedtime may be able to bring about regression of erectile dysfunction or can be a useful tool for curing erectile dysfunction,' they told the meeting.
Nightly Viagra facilitates spontaneous night-time erections. You may not be able to teach an old dog new tricks, but you can prevent him from forgetting old tricks. posted by Sydney on
5/12/2004 08:18:00 AM
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Pets should be allowed into hospital wards and made available on prescription, psychologists say. They believe the healing power of animals can hasten the recovery of patients.
Dogs, cats, parrots and ferrets can help improve the physical and psychological condition of people suffering from serious illness or recovering from surgery, research has found.
June McNicholas, a psychologist from the University of Warwick, told delegates yesterday at the Royal College of Nursing conference in Harrogate that they should overcome concerns about infection and allow animal-loving patients to bring their pets into hospitals for visiting access.
We alreadydo this in Akron. Although, I've never seen a cat or a ferret in the hospital. Only dogs. (I'd be a little worried about birds. They are a little too free with their waste and can transmit air-borne diseases.) posted by Sydney on
5/12/2004 08:13:00 AM
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Looking for Answers: Senate Republicans put forth some suggestions for covering the uninsured yesterday, but Association Health Plans seem to have lukewarm support:
The panel was divided on another Bush proposal, which would let small businesses band together and buy insurance through their trade associations. The panel listed such 'association health plans' as an option, but did not explicitly endorse them.
Two panel members, Senators Olympia J. Snowe of Maine and Jim Talent of Missouri, said such health plans would allow small businesses to pool their purchasing power and buy coverage at reduced rates, as large employers and unions do.
But Mr. Gregg said he had two concerns about those health plans. They would be largely exempt from state insurance regulation, he said, and they might attract healthier people, driving up costs for those who stay in the traditional insurance market.
The National Association of Insurance Commissioners and the Blue Cross and Blue Shield Association oppose association health plans for the same reasons.
I'm not sure why they would attract healthier people any more than insurance plans provided by large self-insured employers would. As it is now, it's so difficult for small employers to get insurance coverage for their employees, they just about have to discriminate against the unhealthy. A small employer trying to get coverage for their employees is just like an individual looking for insurance. The insurance companies, at least in my area, can choose not to cover an employee based on their risk or they can make the premiums extremely high.
And as far as regulations, the association health plans would be subject to the same federal regulations that large corporation and union health plans are. If it's OK for them, why wouldn't it be OK for small business?
Finally, it's no surprise that the National Association of Insurance Commissioners oppose it. Their job is to regulate the small business and individual insurance market. And Blue Cross/Blue Shield? They've got a large slice of the pie of the small business market in most states. In fact, in a lot of states, they've got a monopoly on it. Wouldn't want to give up those big premiums now, would we? posted by Sydney on
5/12/2004 07:53:00 AM
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Tuesday, May 11, 2004
Scrubbing Away Peanuts: Good news for the peanut sensitive. Ordinary household soaps get rid of the allergen, for the most part:
In the study, researchers applied a teaspoon of peanut butter to the hands of 19 allergy-free volunteers. Hand wipes, liquid soap, bar soap, plain water and a hand sanitizer were tested, with only the sanitizer failing to remove the allergen.
Researchers also compared the performance of plain water, dishwashing liquid, Formula 409 cleaner, Lysol sanitizing wipes and Target-brand household cleaner with bleach in removing peanut butter from a clean table. Only dishwashing liquid failed.
'It's possible that dish soap creates a film over eating surfaces, making it difficult to clean underneath,' Wood said. 'But our results suggest that even if a child licked the table vigorously after it had been cleaned with dish soap, he probably still couldn't get enough allergen to cause a reaction.' posted by Sydney on
5/11/2004 08:34:00 PM
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Put away that extra large coffee mug: Researchers have discovered that small, frequent doses of caffeine keep you awake better than one large cup of java in the morning.
...'I hate to say it, but most of the population is using caffeine the wrong way by drinking a few mugs of coffee or tea in the morning, or three cups from their Starbucks grande on the way to work,' says study leader James Wyatt of Rush. 'This means that caffeine levels in the brain will be falling as the day goes on. Unfortunately, the physiological process they need to counteract is not a major player until the latter half of the day.
Kerrycare: John Kerry gave a commencement speech to graduating nurses that would have been a perfect platform for elucidating his healthcare plan. But he told them they could check out his website if that's what they wanted. Instead he served some stirring antecdotes and broad platitudes:
A nurse has one of the most difficult jobs in the world. On an average day a nurse has put up with a stubborn bureaucracy, inefficiency in the system and an uncaring administration...sounds a lot like Washington!
Well, at least he didn't mention Vietnam.
I just met with Albert Barker. Albert is sixty-one years old, and he used to work at Custom Engineering right over in Erie. A little while back, Albert had a heart attack. After he recovered and returned to work, Albert's employer told him he couldn't afford to provide insurance anymore. They re-hired him as a temporary worker, and Albert was then forced to pay $290 a month for temporary coverage. Just this month, that coverage ran out.
.....I remember Virginia Noble. Virginia has cut every cost and saved every penny, but she still cannot afford to insure the eleven employees who work in her Des Moines sandwich shop. She wonders how long her small shop can stay competitive, but more importantly, she worries about the health of the eleven people who've helped make it a success. Small business owners like Virginia create the jobs that make America strong, and I'll be a President who does everything I can to make that job easier.
.....This is not acceptable in America.
It's not acceptable to do nothing about total family premiums rising more than $2700 in just four years
It's not acceptable to do nothing while these premiums are rising four times faster than workers' earnings.
And it's not acceptable to do nothing while families lose their savings, workers lose their jobs, and businesses close their doors because of the high cost of health care.
We need a President who knows our health care crisis isn't acceptable and who has a plan to fix it. And that's the kind of President I will be.
It's worth noting that both of his examples highlight people whose health insurance woes stem from the fact that their small business employers can't find affordable health insurance for their employees. It's also worth noting that as the ranking Democrat on the Senate Small Business Committee, Senator John Kerry has the ability - right now - to rectify that problem. He could make health insurance premiums as affordable and competitive for small business owners as they are for large corporations and unions without spending one tax dollar by endorsing Association Health Plans. But Senator Kerry doesn't endorse them. Instead, he's their chief opponent in the Senate. Thanks for caring, Senator Kerry!
Sen. John Kerry would get the federal government more deeply involved. He wants the government to pay for 75 percent of health-care costs over $50,000 for insured employees, thus aiding employers. But employers would have to follow a number of government mandates in order to qualify for this subsidy, such as to 'provide affordable health coverage to all of their workers.'
However, if history is any guide, the government is likely, long-term, to cut back on payments even as it lays more requirements on businesses buying into the plan. This is happening today with Medicare and Medicaid.
Kerry is against Association Health Plans because they would allow insurance companies to avoid expensive state mandates (and thus offer lower-priced coverage). Instead he favors expensive mandates for everyone. Sounds ruinous. posted by Sydney on
5/11/2004 08:04:00 PM
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The Oldest Profession: I didn't blog much about last month's recommendations by the American College of Physicians that all diabetics should be taking those miracle drugs, statins, regardless of their cholesterol levels because I was too busy. But, those guidelines, and the organization that published them, deserve some scrutiny. Here's the media report:
Most diabetics, regardless of their cholesterol levels, should be taking cholesterol-lowering drugs to reduce their risk of a heart attack, the American College of Physicians says.
.....Simply having diabetes makes a man two to four times more likely to have a heart attack or stroke than someone without the disease. Diabetes makes a woman's risk of a heart attack two to six times greater. Researchers say that's because a diabetic's blood is thicker and more prone to clot.
The new guidelines say diabetics should take cholesterol-lowering statins — even if their cholesterol levels are good — if they have any one of the following health problems: high blood pressure, obesity, smoking, or a family history of heart disease.
Dr. Richard Nesto, chairman of cardiovascular medicine at the Lahey Clinic in Burlington, Mass., told ABCNEWS that a diabetic's arteries are unusually inflamed.
"A cholesterol level in a diabetic patient exists in a person who has chronic inflammation," he said. "That makes this cholesterol much more dangerous to the blood vessel. Furthermore, statins are very good not only at lowering cholesterol but lowering the inflammation."
Basically, I feel the same way this guy does about these recommendations. First of all, the background paper was a meta-analysis, which means it culled through all of the papers ever written about diabetics and statins, pooled all the data, and put them through a statistical mill to come up with a meta-outcome. The trouble is, published papers tend to lean toward favorable outcomes for an intervention. Unfavorable outcomes tend to not get published, making meta-analyses a horrible way to measure the effectiveness of a therapy.
The other problem is that there's no direct comparison of other, cheaper, means of preventing heart disease in diabetics - such as the use of daily aspirin, also a potent anti-inflammatory and clot-preventer.
Why would an organization such as the American College of physicians publish treatment guidelines based on such flimsy evidence? The background paper says that its two authors have no conflict of interest and that they work at the Veterans Administration. The guidelines themselves state that "financial support for ACP guideline development comes exclusively from the ACP operating budget."
But, what they don't tell you is that the authors of the background paper, Doctors Sandeep Vijan and Rodney Hayward, are also faculty members of the University of Michigan, which has a cozy relationship with Pfizer, makers of the popular (and expensive) statin Pravachol. Coincidence? Don't bet on it. The influence may be subtle, but you can bet its there.
And although the American College of Physicians says they don't get specific outside funding for their guidelines, the College is not shy about using industry to fund itself. A few years ago they got together with some of their bedfellows, noting:
Industry plays a large part in the operation of the College, providing approximately 20% of College revenues; the Foundation and College are looking to this meeting for new win-win possibilities with industry.
Looks like they found an excellent win-win possibility with their most recent guideline.
Those South Korean Clones: When South Korean scientists claimed to have successfully cloned a human embryo, it raised a lot of eyebrows because of the unusually large number of donor eggs they were able to obtain for their research. The journal Nature reported recently that they came from graduate students:
After interviewing one of Hwang's Ph.D. female students, Nature reported the student initially told the journal the egg donors included herself and another woman in the lab.
According to Nature, the student called back later and said that she had not donated eggs, blaming her poor English for a misunderstanding.
The journal reported that during the first interview she named the hospital where her donation was carried out and explained that she had been happy to donate eggs because she already has two children.
Lucrative Fields: Life imitates a Robin Cook novel in Moscow:
Four Moscow doctors have been accused of plotting to murder a patient for his kidneys so that they could use them for lucrative and possibly illegal transplantations.
The case has raised fears that doctors across Russia are engaging in such practices.
The four doctors—Irina Lirtsman, Lyubov Pravdenko, Pyotr Pyatnichuk, and Bairma Shagdurnova—all worked in Moscow City Hospital No 20.
Dr Lirtsman was deputy head of the intensive care unit, Dr Pravdenko a doctor in the unit, and the two men were both transplant surgeons.
State of Unpreparedness: Senator Joseph Lieberman says we're woefully unprepared when it comes to bioterrorism:
Two years after Congress passed legislation outlining specific steps for preventing, detecting and responding to terrorist incidents, Lieberman said the Bush administration 'has not come close to complying with the basic requirements and goals' of the measure.
Specifically, he said, key staff positions have gone unfilled, public health laboratories are poorly equipped, mandatory progress reports have not been filed, hospitals do not have the beds or equipment to handle mass casualties, and there remains confusion over the roles and responsibilities of various local, state and federal agencies. And the National Preparedness Plan 'is merely a listing of bioterrorism-related activities' underway, Lieberman wrote to Health and Human Services Secretary Tommy G. Thompson.
There's probably a lot of blame to go around here. You can blame the local and state health departments for not taking the threat seriously. And you can blame the CDC and HHS for not providing the leadership to make them take it seriously. But Lieberman's assessment seems to be on the money, despite Thompson's claims otherwise. There hasn't been any attempt by my local or state public health departments to educate physicians on responding to or recognizing a bioterror threat. Glad to see someone's pointing this out. (Why did the Democrats give up on Lieberman, anyway? He seems to be the only one among them who treats the war on terrorism seriously.) posted by Sydney on
5/10/2004 08:19:00 AM
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SARS Learning Curve: A Chinese pathologist says that SARS may be transmited through sweat and other bodily fluids:
He first noticed during last spring's outbreak that people can be infected by SARS even if they wear protective masks.
'There must be other virus transmission channels,' he told China Daily.
Antibody and gene tests helped prove his hypothesis.
'SARS virus were detected in urinary, excretory and digestive organs of four patients, who were among the early victims of the diseases last spring,' he said.
If true, that would help explain why healthcare workers were disproportionately affected despite taking respiratory precautions. They would have had to bathe and clean patients infected with the virus and would have come into contact with a variety of bodily fluids. Even moreso than household contacts would have. posted by Sydney on
5/10/2004 08:16:00 AM
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Alternate States: There's a movement afoot to stop labeling those who think differently as disabled, but instead to think of them as neurally diverse:
As the number of Americans with brain disorders grows, so has skepticism toward the grab bag of syndromes they are being tagged with, from A.D.D. to Asperger's to bipolar I, II or III.
But in a new kind of disabilities movement, many of those who deviate from the shrinking subset of neurologically 'normal' want tolerance, not just of their diagnoses, but of their behavioral quirks. They say brain differences, like body differences, should be embraced, and argue for an acceptance of 'neurodiversity.'
And as psychiatrists and neurologists uncover an ever-wider variety of brain wiring, the norm, many agree, may increasingly be deviance.
'We want respect for our way of being,' said Camille Clark, an art history graduate student at the University of California at Davis who has Asperger's syndrome, a form of autism often marked by an intense interest in a single subject. 'Some of us will talk too long about washing machines or square numbers, but you don't have to hate us for it.'
And we don't have to medicate their eccentricities away, either, or label them as diseased:
In an effort to rein in the number of diagnoses, the American Psychiatric Association imposed a new criterion in its latest edition of the Diagnostic Statistical Manual: an individual must now suffer from "impairment" to qualify as having one of its 220 psychological disorders. "We're not adequately differentiating normal from pathological if we just use the criteria that are in the syndrome definitions," said Dr. Darrel A. Regier, director of research for the American Psychiatric Association.
...But the most humane approach, some experts argue, may lie in redefining the expanding set of syndromes as differences rather than diagnoses.
"We're doing a service on the one hand by describing many more of these conditions and inviting people to understand themselves better," said Dr. Edward Hallowell, a leading authority on A.D.D. "But when we pathologize it we scare them and make them not want to have any part of it. I think of these as traits, not disorders."
And that's the way we should think of them. For too long we've been labeling everything that doesn't fit a preconceived "norm" as diseased, where the definition of normal is a Lake Wobegon standard of "all the women are strong, all the men are good-looking, and all the children are above average." And where everyone thinks and feels the same.
It's refreshing to see a movement to shift away from the medicalization of differences, especially when it comes to the way the brain works. For people's brains don't work the same, and it would be a very dull world if they did. Some people are visually oriented, others language oriented. Some are pattern oriented, some oriented to the abstract, and some think only in the concrete. Those who are oriented toward visual cues and language have the easiest time of it in the world socially. They understand and are understood better by society at large because our society is more visually and languisticly oriented. While those who think in terms of the abstract have a tougher time understanding others and being understood themselves.
This difference in thinking is astutely portrayed in the novel The Curious Incident of the Dog in the Night-Time by Mark Haddon. The narrator is a fifteen year old autistic boy who is very comfortable in the abstract yet logical world of math but acutely uncomfortable with the more subjective, messy, emotional world of language. His teachers at school don't have to teach him how to interpret or perform complicated math problems, but they do have to teach him how to interpret other people's body language, and what is and what is not socially acceptable. Here's his explanation of what it's like to navigate a languisticly and visually oriented world with a concrete, pattern-oriented mind:
I find people confusing.
This is for two main reasons.
The first main reason is that people do a lot of talking without using any words. Siobhan says that if you raise one eye-brow it can mean lots of different things. It can mean "I want to do sex with you" and it can also mean "I think that what you just said was very stupid."
Siobhan also says that if you close your mouth and breathe out loudly through your nose, it can mean that you are relaxed, or that you are bored, or that you are angry, and it all depends on how much air comes out of your nose and how fast and what shape your mouth is when you do it and how you are sitting and what you said just before and hundreds of other things which are too complicated to work out in a few seconds.
The second main reason is that people often talk using metaphors....The world metaphor means carrying something from one place to another...and it is when you describe something by using a word for something that it isn't....
...I think it should be called a lie because a pig is not like a day and people do not have skeletons in their cupboards. And when I try to make a picture of the phrase in my head it just confuses me because imagining an apple in someone's eye doesn't have anything to do with liking someone a lot and it makes you forget what the person was talking about.
And yet, he has an intuitive grasp of such problems as the infamous Monty Hall problem or how to tell whether or not a number is a prime number. And what's more, when he's feeling overwhelmed by the real world of language and emotion, he finds solace in solving math problems.
Now, let me be frank. I am not a mathetmatically oriented person. I am much more comfortable with the world of language and visual cues than I am with the abstract world of math. When I was a little girl, trying to learn the multiplication tables made me cry. Throughout my education, whenever I came to a mathematical equation in a textbook, I would skip it. It was like a foreign language to me. I could never convert those numbers to an image I could understand. Adding more than one or two digits is still a bit of a challenge for me. But thanks to my choice of a spouse, I now live in a family that is very comfortable in the world of numbers. My kids and my husband have an intuitive grasp of things that I have to work very hard to comprehend. There are times, when they are discussing things like how to always win the game of Nim, when I feel like I'm in a foreign country. And it is those times when I think, this is what it must feel like to be mildly autistic, to live in a world that thinks and expresses itself differently than you do.
But thankfully, the real world is a friendlier place for someone like me. Now, if we can just make it a little friendlier for people like these. posted by Sydney on
5/10/2004 08:02:00 AM
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New "Improved" Blogspot: Blogger did another update this weekend, presumably to "improve" it. All it's done for me is make it more time consuming. The same thing happened the last time they "improved" it. Sorry if there's a paucity of posts, but this new blogger just isn't as user friendly as the original. posted by Sydney on
5/10/2004 07:56:00 AM
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In the Kitchen: I expected to take some heat for this anti-anti-smoking column at Tech Central Station, but I didn't expect to be called immoral:
Smoking is a privilege while clean, breathable air is a right.
Smokers are free to go home and smoke themselves to an early grave but the rest of us, the majority, should not have to suffer from their filthy habit under any circumstances- regardless of whether or not it is a "second hand" health risk.
I am appalled that a health professional such as yourself would come out in favor of an addiction that kills over 400 000 people per year, in a public forum. The feel-good leniency you are advocating from a position of authority in a public forum would result in more fatalities.
This is the worst kind of immorality...
As is often the case with zealots, this reader misses the point of the article and reads into it his own preconceived notions. My point is that the latest jeremiad against smokers - that anyone smoking anywhere in a building can cause a heart attack in someone else - is based on very weak evidence. And yet, thanks to the media it has taken on an air of authority. My fear is that somewhere someone will prosecute a smoker for manslaughter. That would be unjust. And it would be immoral. posted by Sydney on
5/10/2004 07:49:00 AM
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