Category Archives: Health & Medicine

Academic medical centers: Education or profits?

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The quality of health care depends on many things, but certainly medical education is uniquely significant. Following four years of medical school, the additional years of internship, residency, and fellowship are not simply a time for acquiring the latest insights into the nature and treatment of disease. This is when fledgling doctors imbibe the values and priorities of the medical profession from the attending physicians who mentor them. If attendings have no time to mentor the doctors they are presumably training, the quality of doctors who emerge from such a system will suffer. And if the priority of an academic medical center is to increase profits rather than care for patients, patients will also suffer, first at the hospitals associated with these centers and later as patients of the doctors who trained there. The decline in the residency system for training doctors is the subject of Kenneth M. Ludmerer’s Let Me Heal: The Opportunity to Preserve Excellence in American Medicine.

From mentorship to profits

Sir William Osler established his ideal of medical training at Johns Hopkins Hospital in the 1890s. The guiding principle was that doctors should learn to care for patients under the close supervision of highly experienced attending physicians. Right up to WWII, the highest priority of teaching hospitals remained education. Faculty members formed intense mentorships with their students, often lasting a lifetime. Lara Goitein, in an essay/review of Let Me Heal, writes: Read more

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US healthcare: Atul Gawande has some good news

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Back in June of 2009, when Congress was just beginning to formulate and debate the Affordable Care Act, Atul Gawande wrote an article on the rising (and exorbitant) cost of US health care. He focused on how waste contributes to cost — not just the usual fraud, high prices, and administrative fees, but unnecessary care: Drugs that are not helpful, operations that do not make patients any better, scans and tests that not only have no benefit, but often lead to harm. Waste accounts for a third of health-care spending. More disturbingly, it can cost people their lives.

Gawande used the town of McAllen, Texas to illustrate his case. McAllen had one of the highest costs in the nation for Medicare — twice as high as El Paso, another Texas border town with similar demographics. And it’s not as if patients in McAllen were receiving better care. Compared to El Paso, patient care was similar or worse.

It turned out that many specialists in McAllen had financial stakes in home-health-care agencies, surgery and imaging centers, and the local for-profit hospital. One local doctor told Gawande: “Medicine has become a pig trough here. … We took a wrong turn when doctors stopped being doctors and became businessmen.” Read more

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Nutritionism and the glycemic index

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Let me begin by quoting a paragraph from Gyorgy Scrinis, a lecturer in food and nutrition politics and policy at the University of Melbourne. This is from a chapter called ‘Nutritionism and Functional Foods,’ which he contributed to the book The Philosophy of Food. Scrinis went on to publish an entire book on this subject, Nutritionism: The science & politics of dietary advice.

Just prior to the following paragraph, Scrinis has been discussing the dietary advice, from the 1960s to the 1990s, that it was better to eat margarine than butter. (Added emphasis in this and the following quotations is mine.)

The “mistake” of inadvertently promoting transfat-laden margarine is one of several mistakes, revisions, and backflips in scientific knowledge and dietary advice over the past century. Other cases include advice regarding dietary cholesterol, eggs, low-fat diets, and vitamin B. Yet these revisions do not seem to have tempered the sustained and confident discourse of precision and control that continues to pervade nutrition science, nor the willingness to translate limited and partial scientific insights into definitive population-wide dietary advice. I refer to this nutritional hubris as the myth of nutritional precision, as it involves an exaggerated representation of scientists’ understanding of the relationship between nutrients, foods, and the body and a failure to acknowledge the limits of the nutrient-level perspective. At the same time, the disagreements and uncertainties that exist within the scientific community with respect to particular nutritional theories tend to be concealed from, or misrepresented to, the lay public.

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Jamais vu and the hippocampus as GPS

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I always thought the main function of the hippocampus was to convert short-term memory into long-term memory. It’s one of the first regions of the brain damaged by Alzheimer’s. If your spouse can’t remember something you discussed 20 minutes ago, you start to worry.

The hippocampus also plays an important role in spatial memory and navigation. That’s why you unfortunately hear of Alzheimer’s patients wandering away from home and not being able to find their way back.

A recent JAMA article, Nobel Prize Winners’ Research Relates to Brain Function and Neurodegenerative Diseases, describes the hippocamcus as our inner GPS. Place cells in the hippocampus (discovered in the 1970s) are associated with locations (even if you’re just thinking about a location), and grid cells (discovered in 2005) create triangular grids that function as a positioning system in space.

Together, place and grid cells allow animals to determine their position and to navigate through their surroundings much like an inner GPS.

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RN #3: Health news: Exercise and depression. Aspirin for primary prevention. New stool sample test.

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Reading Notes #3: Some articles of interest I’ve come across while reading NEJM and JAMA. These items all fall into the category of health news.

Bulleted titles in the following list link to the individual items below. Under References I indicate the accessibility of articles: OA means open access, $ indicates a pay wall.

HEALTH NEWS

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Reading Notes #2 (For-profit medicine): Cancer drugs. Expensive doctors. Health care monopolies. Dental care.

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Here are more articles of interest I’ve come across recently while reading NEJM, JAMA, and New Scientist. These items all relate to for-profit medicine.

Bulleted titles in the following list link to the individual items below. Under References I indicate the accessibility of articles: OA means open access, $ indicates a pay wall. Note that emphasis in quotations has been added by me.

FOR-PROFIT MEDICINE

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The patient with a list of questions

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When I want to know more about a medical condition, my first Internet destination is the Mayo Clinic’s website. It seems both reputable and decidedly non-alarmist.

Each condition is organized into a series of information packets: definitions, symptoms, causes, risks. There’s invariably a section called “Preparing for your appointment.” Without fail, it recommends that you make a list of your symptoms. Here’s an example:

Before your appointment, make a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

Once you’ve begun interacting with your doctor, it can be easy to forget something you’d intended to ask.

I was somewhat surprised, then, to learn that some doctors are decidedly irritated when a patient brings a list to an appointment. Dr. Suzanne Koven discusses this in a Perspective piece in NEJM: The Disease of the Little Paper. Read more

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Reading Notes #1: Health care inequities. Overdiagnosis. The Doctor/Patient Relationship

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What follows are items I found interesting in magazines I’ve recently read. Normally I would have tweeted these links, but since I was on vacation from Twitter (see My Twitter vacation), I decided to create a type of blog post called Reading Notes (see Blogging and my Twitter vacation).

The bulleted titles below link to the specific item. There’s more detail on the articles I mention under References. OA indicates open access. $ indicates a pay wall. Note that emphasis in quotations has been added by me. Read more

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Electronic medical records, for-profit medicine, and the doctor-patient relationship

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A complaint one often hears about electronic medical records (EMRs) is that the doctor pays more attention to the computer than the patient during an office visit. Among nations using EMR, is this a characteristically American problem?

I read an illuminating letter to the editor recently that compares the doctor/patient/EMR experience in the US and Canada. The letter was from Dr. Alan B. Astrow, a hematologist/oncologist who practices in Brooklyn, NY. He writes: (emphasis added)

Many American physicians agree that recording patient data electronically has interfered with “a deeply human, partly intuitive and empathetic process,” and has led to inefficient care. Since no one wants to revive illegible paper charts, however, the indictment encourages us to ascribe these harms to the price of progress.

A Canadian physician friend, though, says he uses an electronic record that does not disturb his rapport with patients. He also sees more patients hourly than American counterparts without compromising quality.

Why the difference? American physicians must choose from five levels of service when submitting bills. Of necessity, we tend to include extraneous information to justify higher levels and satisfy potential insurance company audits. Canada has only two levels, so doctors’ notes are short and succinct. Read more

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When health was something we could simply “forget about”

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I came across the following sentence in The Positive Thinkers, a book originally published in 1965. It strikes me as a good example of how the meaning of health has changed. (emphasis added)

Health is ordinarily regarded — when it is “regarded” at all, for ordinarily the point of being healthy is to be able to forget about it — as a means to other things; healthy men are those able to pursue their ends.

Health is hardly something we’re able to forget about today. We live in a culture where it’s commercially profitable to constantly remind us of widespread, proliferating risks. The conscious, highly intentional pursuit of health is a mark of social status for which we expect to be admired and envied. We “regard” it all the time. Read more

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Medical screening, overdiagnosis, and the motives of for-profit hospitals

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Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal
Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal

[I don’t seem to be able to display that image anymore, but here’s a link to what I’m talking about.]

This superb graphic was created to dramatize what’s happening these days in the UK, where the National Health Service is being ruthlessly privatized. Here in the US, for-profit medicine is so taken-for-granted that we barely notice it. It’s true, we hear a good deal about conflicts of interest involving pharmaceuticals. Doctors get paid — in one way or another — to increase the profits of Big Pharma, a practice that is detrimental to the financial and/or medical interests of their patients. We hear less about scaring healthy patients into using doctors and services that increase hospital profits (also known as fear mongering). So it was nice to see a recent opinion piece in JAMA that discussed precisely this. Read more

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How we came not to care: Oligarchy of the elite

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Side View of Statue of John Harvard by Daniel Chester French

The final post in this series on interrogating inequality is about another possible clue as to why we no longer seem to care about inequality. It’s from the book Excellent Sheep by William Deresiewicz.

The role of elite institutions of higher education

In his book, Deresiewicz argues that elite educational institutions reproduce a class system, exacerbate inequality, retard social mobility, and perpetuate privilege. Not only is the elite class that’s created by these institutions “isolated from the society that it’s supposed to lead.” It runs society for its own exclusive benefit. (emphasis added)

Our educational system, it’s been suggested, is what America developed in lieu of a European-style social welfare state to mitigate inequality. Instead of “handouts,” opportunity. And once upon a time, it worked as advertised. Both the unprecedented expansion of public higher education and the equally unprecedented opening of access to the private sort were instrumental in creating a mass middle class, and a new upper and upper middle class, in the decades after World War II. But now instead of fighting inequality, the system has been captured by it.

I mention this not simply as another possible clue, but because the article (Rebooting Social Science) that prompted me to write this series of posts appeared in Harvard Magazine. That may or may not be relevant to the attitude it expresses towards inequality, an attitude I found troubling. Read more

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How we came not to care: Historical trends

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Continuing my discussion of interrogating inequality, here is another post with a possible clue as to how we came not to care. This one considers a rather wide expanse of history

We have neglected to cultivate a culture that cares

I recently struggled through the book Governmentality: Power and Rule in Modern Society by Mitchell M. Dean. The book is very clearly written — the publisher calls it “exceptionally clear and lucid,” and it is. The book is intended, however, for experts already familiar with Foucault’s writings and lectures, particularly those on governmentality.

I frequently found myself in a fog, but I persisted. I was hoping to find ideas that would explain the changes that produced the contemporary self, including why we have become a society that fails to care about increasing inequality. And I did find a brief reference to this development in a section where Dean asks: “Where do our notions of ‘care’ come from?” Why do we think the state should care for the welfare of its citizens? Read more

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How we came not to care: Rosanvallon

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How did we become a society that passively accepts the injustice and discrimination inherent in inequality? How did we come not to care? It would undoubtedly take me a very long time to adequately address that question, but in this and the next two posts I offer a few small clues.

We are each the stars of our own lives

First up is Pierre Rosanvallon’s recent book The Society of Equals. In a review of the book, Paul Starr mentions what may be an impediment to a society of equals: We see ourselves not simply as individuals, but as unique singularities. (emphasis added in this and the following quotations)

The story that Rosanvallon tells here is that as new forms of knowledge and economic relations have emerged, people have come to think of their situation in less collective ways. Since the 1980s, he writes, capitalism has put “a new emphasis on the creative abilities of individuals,” and jobs increasingly demand that workers invest their personalities in their work. No longer assured of being able to stay at one company, employees have to develop their distinctive qualities—their “brand”—so as to be able to move nimbly from one position to another.

As a result of both cognitive and social change, “everyone implicitly claims the right to be considered a star, an expert, or an artist, that is, to see his or her ideas and judgments taken into account and recognized as valuable.” The demand to be treated as singular does not come just from celebrities. On Facebook and many other online sites millions are saying: here are my opinions, my music, my photos. The yearning for distinction has become democratized.

Rosanvallon does not criticize the society of singularities, with its “right to be considered a star.” Since it’s now a fact of life, we need to figure out how to deal with it. Read more

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Interrogating inequality: Tony Judt

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In a previous post (Interrogating inequality: An annoying article) I discussed an article about a group of interdisciplinary scholars who were “interrogating” the societal consequences of increasing inequality. While the group included individuals with backgrounds in psychology and history, it was dominated by academic scholars who specialized in economics, business, and public policy. (The first three individuals quoted in the article are a professor of business administration, a professor of management practice, and a senior lecturer at Harvard Business School.)

The concluding comments on inequality were offered by a professor of social policy. This particular individual “recently revealed” that he had given up on his long-term research on the social effects of inequality (a project he’d started in the 1960s) because there were no “convincing conclusions.” In other words, research had not been able to provide statistical proof that inequality is in any way harmful to society as a whole. As one of the social scientists put it: (emphasis in original)

The problem is, there is no consensus in the research on the consequences of inequality.

May I suggest that a more significant problem is that social scientists ask the wrong question. As Tony Judt writes (emphasis added): Read more

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Interrogating inequality: Some good news

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The previous post, this post, and the next four were provoked by an article that made two assertions I found troubling: one, that there is no consensus among researchers on the consequences of inequality, and two, that evidence of a “causal relationship” between income inequality and health is unclear. In the last post, I discussed those assertions and quoted Daniel Goldberg on whether health behaviors determine health. To continue …

Ground control, we have causation

Over the past few months, since I first read that annoying article, I keep coming across accounts that offer evidence of the harms that result from inequality (particularly in childhood), as well as actions that doctors and politicians are willing to take to address the problem. We’ve known for some time that there was a correlation between poverty and health. Now we’re finally discovering the mechanisms, the causation. Read more

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Interrogating inequality: An annoying article

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I recently read an article that really annoyed me. It was called “Rebooting Social Science: The interdisciplinary Tobin Project addresses real-world problems.” I began to realize that I wouldn’t see eye to eye with this article when I got to the section that discussed the “real-world problem” of inequality. The section was titled “Interrogating Inequality.” Not “addressing” inequality. Interrogating. Shades of “doubt is our product,” as I’ll explain.

One of the scholars interviewed for this article characterized inequality as “the most contested of contemporary issues.” The evidence cited for said contestation was the lack of agreement on whether inequality contributed to the recent financial crisis. Some claim that it did. Others, however,

dismiss this argument, viewing rising inequality “as little more than a hiccup” or even celebrating it as “a favorable development … in the progress of American capitalism.”

As it turns out, the real issue being “contested” by these “social scientists” (economists, not sociologists) is not whether inequality exists or whether it’s just a hiccup or an inevitability of capitalism. No. (emphasis in the original)

The problem is, there is no consensus in the research on the consequences of inequality.

No consequences? What about childhood trauma, increased rates of disease, shorter lifespans, human dignity? Well, it turns out those things may affect individuals, but what these researchers are looking for are societal consequences. For example, is there a relationship between inequality and economic growth? Evidently, if we cannot detect a decrease in economic growth, there’s no reason to alleviate inequality. And it seems social scientists disagree among themselves about the quality of the evidence on that issue. Read more

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The Journal of Medicine and Philosophy — August 2014

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The August issue of The Journal of Medicine and Philosophy does not have a specific theme. The nine articles address a number of quite interesting issues, among them:

  • How existential psychotherapy can offer powerful insights to patients recovering from severe mental disorders such as psychosis
  • How a preference in athletics for natural talent over artificial enhancements (such as doping) may reflect “unsavory beliefs about ‘nature’s aristocracy’ ”
  • How rich, educated, white males may be just as, if not more, vulnerable to threats posed by physician-assisted suicide and voluntary active euthanasia than members of marginalized groups
  • When the decision is made not to administer artificial hydration and nutrition, can the responsibility for the patient’s death be attributed to the underlying pathology, even when that is not the cause of death
  • The right to procreate: Is it possible for prospective mothers to wrong prospective fathers by bearing their child

Note that the articles in this journal are not open access and that I have added the emphasis in the following extracts and abstracts. Read more

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Journal of the History of Medicine and Allied Sciences – July 2014

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In the July issue of Journal of the History of Medicine and Allied Sciences:

  • A comparison of 19th century public health measures and the contemporary approach to the AIDS pandemic
  • The conflict between the medical profession and religion in their attempts to portray habitual drunkenness
  • The understanding of dementia paralytica in the Netherlands at a time when psychiatry was attempting to establish itself as a medical profession
  • Adelle Davis’ role in creating the ideology of nutritionism.

There’s also a commentary on the Adelle Davis article, an ‘In Memoriam’ for Sherwin B. Nuland, and reviews of ten books (of which I’ve featured here only two).

Thanks to h-madness (a great blog) for bringing my attention to this new issue. Somatosphere (a most excellent blog — highly recommended) often covers this journal, but I haven’t yet seen the July issue there, so I’ll go ahead and post these abstracts. Note that all articles (other than their abstracts/extracts) are behind a paywall. (emphasis added in what follows) Read more

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The Journal of Medicine & Philosophy – June 2014

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The theme of the June issue of Medicine & Philosophy is disagreements among bioethicists. This is an interesting topic in its own right (see the extract from the Introduction to the issue below), plus there are a few articles that especially appealed to me. The discussion of cognitive enhancement appears to argue for a more tolerant attitude toward enhancement drugs based on an attitude of humility, plus toleration and transparency. There’s also an article that points out how we assume the art of clinical medicine is an innate skill and that, as a result, we fail to teach it.

Note that nothing is this journal is open access (and also that I have added the emphasis).

Introduction

Bioethics and Disagreement: Organ Markets, Abortion, Cognitive Enhancement, Double Effect, and Other Key Issues in Bioethics

Victor Saenz

I. BIOETHICS AND DISAGREEMENT

Bioethics was born in the 20th century out of an attempt to cope with rapidly and radically developing medical technologies, especially as they arose around the time of the Second World War. Albert R. Jonsen, one of the founders of bioethics, writes in reminiscence:

New techniques, from antibiotics to transplanted and artificial organs, genetic discoveries, and reproductive manipulations, together with the research that engendered them, presented the public, scientists, doctors, and politicians with questions which had never before been asked. (Jonsen, 2000, 115; cf. Jonsen, 1998)

But more importantly, bioethics arose as well due to major cultural changes that marginalized previous approaches to moral issues in health care and that brought into question medical ethics as an enterprise grounded in the medical profession. Read more

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Drug shortages: “We are talking about people’s lives; this is not a cell phone contract”

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iv-fluidThe shortage of pharmaceutical drugs is a serious problem in the US. The number of drugs in short supply has tripled since 2007. In an article in The New York Times, Sabrina Tavernise reports that the number of drugs in short supply in 2012 was 456.

The types of drugs affected cover a very wide range and include such things as cancer drugs and nitroglycerine used in heart surgeries. The situation is quite disruptive for hospitals, doctors (especially oncologists), and patients.

IV fluid shortage threatens patient care

This year, in addition to drug shortages, there is a nationwide shortage of IV fluid. Intravenous therapy is essential for treating dehydration and electrolyte imbalances, for blood transfusions, and for delivering medications such as those used in chemotherapy. IV fluid is a hospital staple.

A recent JAMA article quotes Erin R. Fox, director of the Drug Information Service at the University of Utah in Salt Lake City: (emphasis added in the following quotations)

“It’s maddeningly frustrating that we don’t have these basics.” … Fox said that although shortages of drugs, particularly sterile injectables, have become common in recent years, it is unheard-of to have a shortage of such a basic supply. …

“Why is the supply chain so fragile that it creates a national crisis? asked Fox. …

“Physicians, nurses, and pharmacists are working together to minimize the harm to patients, but it is really a challenge,” she said.

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Pharma finds creative new ways to be reprehensible

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brand-vs-generic-drugsThe pharmaceutical industry is in the business of making profits. It’s not in the business of improving the health of individuals or populations, nor does it care about the cost of health care, even as those costs spiral out of control in the US.

This is hardly news, I know. The behavior of pharma, along with its reputation, has perhaps sunk lower than that of the tobacco industry. Public disapproval and huge monetary fines for illegal activities have no impact. In its quest for profits, pharma finds creative new ways to sink to ever greater depths.

An article in a recent issue of The New England Journal of Medicine illustrates this. Read more

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For U.S. health care, some are more equal than others

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death-rate-after-surgeryThe Affordable Care Act (ACA, aka Obamacare) will expand insurance coverage to millions of Americans (for example, to individuals with pre-existing conditions). Having insurance, however, does not mean a primary care physician will be willing to take you on as a new patient. There are multiple reasons for this, as discussed in a recent article in JAMA, Implications of new insurance coverage for access to care, cost-sharing, and reimbursement (paywall).

We no longer live in the Marcus Welby days of a medical practice that has only one or two doctors. The “vast majority” of primary care practices, however, have only 11 or fewer physicians (according to JAMA). Many of these practices are already at or near capacity, which means that adding new patients may require additional expenses (staff, office space, equipment). For small practices, the decision to add new patients is first and foremost a business decision: Will the increased income cover my increased expense? Here are some of the things the “vast majority” of providers will be thinking about:

  • The ACA lowers the cost of health insurance for many individuals, in particular, for people with relatively low incomes. These patients, however, will pay more for health care itself due to higher co-pays (that part of the cost not covered by insurance) and higher deductibles (the maximum annual out-of-pocket expense). In the past, the main burden of collecting fees was on insurance companies. Under the ACA, it may be health care providers who are faced with a “collection burden.”

    • Read more

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When healthy eating becomes unhealthy

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healthy-eating-orthorexiaMeghan O’Rourke, poet and author (Halflife: Poems, Once: Poems, The Long Goodbye: A Year of Grieving), has written a wonderful piece for The New Yorker on living with a chronic illness. It’s called What’s Wrong with Me? I had an autoimmune disease. Then the disease had me.

For years O’Rourke experienced symptoms that she tried to attribute to her latest source of stress. Doctors were unable to offer a diagnosis, a situation that tends to suggest the suspicion that the symptoms may be all in your head.

She writes: “I was ill for a long time — at least half a dozen years – before any doctor I saw believed I had a disease.” Eventually, after she received a label for her symptoms (autoimmune thyroiditis or Hashimoto’s disease), she connected to the online community of chronic disease sufferers. There she found not only a great many individuals with similarly frustrating histories, but an abundance of home-grown advice for the relief of symptoms.

A more or less definitive diagnosis for a disease that is only vaguely understood may at least confer some legitimacy on one’s status as a patient (for an historical perspective on diseases that do not fall neatly into diagnostic categories, see Robert Aronowitz, Making Sense of Illness .) The individuals who suffer, however, are still very much on their own when it comes to recovery and the alleviation of symptoms. Thus the home-grown advice.

Orthorexia and healthism

What I’d like to focus on in this post is one small part of O’Rourke’s narrative: her attempts to alleviate her symptoms through a growing obsession with the selection and control of the food she ate. It’s not difficult to find media stories and blog posts that put a positive spin on (what amounts to) an excessive preoccupation with healthy eating. It’s rare, however, to find an experiential account that recognizes the obsessive pursuit of health as itself unhealthy.

A classic discussion of the latter is Steven Bratman’s Health Food Junkies: Orthorexia Nervosa – the Health Food Eating Disorder. In O’Rourke’s case, of course, she was not simply eating to be healthy. She was seeking relief from very real and disturbing symptoms. That’s not quite the same thing as orthorexia, although both provide the health food consumer with an opportunity for reflection. Read more

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Neoliberalism, tobacco, and public health (2)

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The occasion for the rambling reflections on neoliberalism in the previous post was three “perspective” articles on tobacco in a recent issue of The New England Journal of Medicine. Two of them concern the FDA’s attempt to place graphic warnings on cigarette packs. The other is on cigarette smoking among the homeless.

The First Amendment

fda-graphic-warning-labels-cigarettes-are-addictivePlacing graphic warnings on cigarette packs was part of the 2009 Family Smoking Prevention and Tobacco Control Act. The tobacco industry sued the FDA (R.J. Reynolds Tobacco Co. v. FDA), claiming the warnings violated the industry’s First Amendment rights. In a case decided last year, the tobacco industry won.

David Orentlicher, in his article The FDA’s Graphic Tobacco Warnings and the First Amendment, writes that the decision is both surprising and not surprising. It’s not surprising “given the Supreme Court’s increased sympathy toward corporations and their First Amendment rights. Regulations of commercial speech often succumb to judicial scrutiny.” It’s surprising because, while the Supreme Court now restricts the government’s power to regulate corporate speech, it has not in the past interfered with the government’s authority when it comes to regulating matters of public health. Evidently, that’s not the case anymore.

The upshot: (emphasis added)

[C]ompanies today are better able to promote their products, and government is less able to promote health than was the case in the past. Ironically, early protection of commercial speech rested in large part on the need to serve consumers’ welfare. In 1976, for example, the Supreme Court struck down a Virginia law that prevented pharmacists from advertising their prices for prescription drugs. The law especially hurt persons of limited means, who were not able to shop around and therefore might not be able to afford their medicines. Today, by contrast, courts are using the First Amendment to the detriment of consumers’ welfare, by invalidating laws that would protect the public health.

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Neoliberalism, tobacco, and public health (1)

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This post became much too long, so I’ve divided it into two parts. The first part is mainly about neoliberalism; the second mainly about graphic warnings on cigarette packs (plus smoking among the homeless). When I read, in a recent NEJM article, “The Supreme Court’s increasing sympathy for corporate speech and decreasing deference to public… Read more

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The general health checkup: Its origins, its future

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What is a general health checkup? It’s when you visit a doctor not because of an ongoing chronic condition or because you’re concerned about new, unexplained physical or mental symptoms, but because you want a general evaluation of your health. The assumption behind such a visit is that if you do this regularly, you may… Read more

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Two children visit their doctors: Social class in the USA

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Rick Santorum, responding to Obama’s statement that “the middle class in America has really taken it on the chin,” said that he would never, ever, stoop to using the word “class.” (Dorothy Wickenden in The New Yorker) Sociologist Annette Lareau has done extensive field work that involves unobtrusively inserting herself (or her field-worker assistants) into… Read more

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What pediatrics can teach us about addressing adult social determinants of health

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Attending to the social determinants of health is especially important for children, since children’s experiences – of poverty, poor nutrition, trauma, abuse, neglect, the prenatal environment – can affect physical and mental health for an entire lifetime. As the authors of a recent commentary in JAMA write: “Pediatrics … continues to evolve clinical practice aimed… Read more

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A new blog on the self

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I’ve started another blog called Basic research on the self. My intention is to write there about the social and cultural history of the self, aided by insights from sociology, anthropology, philosophy and psychology (especially critical psychology). This is a subject that relates to a number of topics I’ve written about here. A while back… Read more

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