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Archive for the 'Health' Category

Friday, October 3rd, 2014

How Poverty and Income Disparities Influences Doctor-Patient Relations — Dennis Rosen

Dennis Rosen, Vital ConversationsWe conclude our week-long feature on Vital Conversations: Improving Communication Between Doctors and Patients, with an excerpt from the book in which Dennis Rosen explores how socioeconomic disparities affect communication between doctor and patient:

Even when socioeconomic disparities between physician and patient are not glaringly obvious, they can and often do heavily influence the quality of physician-patient communication during the visit as well as its outcomes. Researchers have found that patients from lower socio­economic backgrounds tend to participate less in medical decision making, which … results in lower adherence and higher overall health-care costs. These patients are also generally provided with less information and socioemotional support by their physicians. In contrast, patients from higher socio­economic backgrounds tend to be much more involved in the man­agement of their own care. There are many possible explanations for this, including societal boundaries that limit the scope of communi­cation between people of different social stations and differences in education levels that can impede the ability of physician and patient to find a common language. Whatever the reasons, however, the fact remains that some patients are consistently less engaged by physicians than others, with consequent effects upon their participation in defin­ing the parameters of their care and, ultimately, their adherence with the treatment.

Disparities in socioeconomic status can also have profound effects on how disease is contextualized and understood. In some cases, these can lead to active resistance on the part of patients to public-health disease prevention and treatment efforts. Marilyn Nations of Har­vard and Cristina Monte of the Federal University of Ceara Medi­cal School, Brazil, interviewed the indigent residents of two favelas (shantytowns) that were hit hard by the 1993 cholera epidemic. Their aim was to understand more fully why there had been such a high degree of resistance by the favelados to governmental efforts to control the outbreak, such as water purification and the use of prophylactic antibiotics. Nations and Monte confirmed that in many instances the favelados’ refusal to cooperate with the campaign was a response to a longstanding sense of marginalization and stigmatization, which was potentiated by the use of certain metaphors in the prevention cam­paign that seemed to blame them for becoming sick in the first place. By rejecting the government-sponsored prevention efforts, the fave­lados were also rejecting the stigma of being made responsible for the epidemic.

(more…)

Thursday, October 2nd, 2014

A Doctor, a Rabbi and a Chicken — Dennis Rosen

“Deeply held beliefs .. need not only to be recognized and respected, but also integrated into the therapeutic approach in order for treatment to succeed. It is a lesson that has served me well, and which has helped me to serve so many others over the years.”—Dennis Rosen, MD

Dennis Rosen, Vital ConversationsIn a recent New York Times op-ed entitled A Doctor, a Rabbi and a Chicken, Dennis Rosen, the author of Vital Conversations: Improving Communication Between Doctors and Patients, explores an odd yet pivotal moment in his medical career.

While working in a hospital in Israel, Rosen explained to the son of 75-year-old stroke victim what lay ahead for his father in terms of rehabilitation. The son then asked if a rabbi could enter his father’s hospital room. While such a request might not have been strange, what was different was that when the rabbi walked in the room he was carrying a live chicken and then proceeded to wave it above the patient’s head.

Rosen learned that it was a custom of the local Persian-Jewish community to help heal the sick. In describing the experience, Rosen writes:

I was very impressed by how deftly the son was able to maneuver between two very different belief systems explaining his father’s disease and paths towards possible recovery: biomedical and religious. As evidenced from our repeated discussions about tests and treatment plans for his father, he clearly understood — and valued — what modern medicine could offer. And yet, his belief in Divine mercy and intercession was unshakeable….

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Wednesday, October 1st, 2014

Staying Out of the Hospital — Dennis Rosen

Vital Conversations, Dennis Rosen The following post is by Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients

Hopefully, all of you will live long and healthy lives that will end peacefully in your sleep sometime after seeing your youngest great-grandchild head off to college. Unfortunately, it will be a lot less rosy for most of us. Disease and illness are natural parts of our lives, and as science and technology advance people now live longer—and with more coexisting medical conditions—than ever before. As we get older we tend to consume more medications, and the likelihood of being hospitalized because of an acute health crises increases.

Unfortunately, the high cost of health care has resulted in growing pressure to shorten the length of stays in hospital as much as possible. And while there are many good reasons for doing this—reduced expense, lower likelihood of picking up a secondary infection or experiencing a medical error)—there can be significant downsides as well. Among these are the risks patients face when sent home from the hospital before they are well enough to care for themselves or before they understand how it is, exactly, that they are supposed to do so.

Almost one in five Medicare patients discharged from the hospital will be readmitted within the next thirty days. Interestingly, this also corresponds to the percentage of patients who experience an adverse medical event or complication, two thirds of which involve the medications they are taking. This suggests that better pre-discharge patient education needs to take place. And yet, one study of adult patients being discharged from a large academic hospital in New York found that only 28 percent could name all their discharge meds (on average, fewer than four), and that almost two thirds did not understand why they had been prescribed the medications in the first place.

Although this information is supposed to be included in a printed discharge summary, it is often not as clear as it should be, or even that easy to find among the many pages of small-font verbiage. Let’s not forget as well, that many patients are too anxious, in pain, or simply hazy from the meds they’re on to make sense of the discharge summary as carefully as they should. When you add in the fact that more than one third of Medicare patients possess marginal or insufficient health literacy skills, it’s surprising that the rate of adverse medical events following discharge is as low as it is.

(more…)

Tuesday, September 30th, 2014

Interview with Dennis Rosen, author of “Vital Conversations”

Vital Conversations, Dennis RosenThe following is an interview with Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients:

Question: So what is Vital Conversations about?

Dennis Rosen: Vital Conversations is about why good communication between doctors and patients is so important to achieving better—and less expensive—health outcomes. It explores many of the reasons that this communication becomes compromised, such as cultural and socioeconomic differences; stigma and bias; and external meddling in the actual content of the medical visit that takes away from the direct face time between doctors and patients. Vital Conversations concludes with clear suggestions—for both patients and doctors—about ways each can improve the quality of their interactions in order to get more out of them. It also provides suggestions for how the health-care system can prioritize this issue in ways that will serve us all.

Q: I notice you spend a lot of time in Vital Conversations discussing how cultural differences between patient and physician influence the quality of their communication. What made you decide to focus on this?

DR: I’ve spent most of my own life moving among different cultures. I was born in the US, lived in Canada until I was 15, then in Israel for the next 19 years, and have been living in Boston since 2001. I completed my medical education and pediatric residency in Israel, and did additional training as a resident and fellow at Boston Children’s Hospital before becoming an attending physician eight years ago. I have also worked in Haiti and Guatemala several times over the last five years. All of these experiences have given me deep insight into how the ways we perceive and understand what happens to and around us influence our ability to explain it to others, and to understand their explanations in turn. When the underlying concepts are different, this can become very difficult.

Although magnified when working with people from different cultures—and let’s not forget that one quarter of American physicians were trained abroad—it is also true even when both doctor and patient are of the same culture. One issue that I explore in Vital Conversations is the differences between the objective disease, subjective illness as experienced by the patient, and sickness as defined by society. A person with a broken finger has obvious disease, and the illness process she is suffering as a result is likely to be straightforward to the physician. By virtue of this shared understanding, the doctor’s treatment recommendations are likely to be easily understood and carried out by the patient. However, a person who comes to the doctor’s office and is found to have high blood pressure may feel absolutely fine, i.e. have disease without illness. Unless the doctor is able to convince him of the need to take medications to keep the hypertension from leading to heart disease or stroke, he may be inclined to stop taking the medicine at the first sign of side effects, leading to progression of disease.

All throughout the book I’ve included numerous personal stories and vignettes from my career as a physician that illustrate these and other points I make. Even though I wish I could claim otherwise I still don’t always get it right, despite my best attempts to, as the stories make clear. As fascinating and entertaining as the stories themselves are, I think that they really drive home the central message of the book, which is that good communication between doctors and patients is vital for medical care to be effective.

(more…)

Friday, July 25th, 2014

“The mind–body dualism has long overstayed its visit” — Concluding Thoughts from Shadow Medicine

“The mind–body dualism has long overstayed its visit. Western science needs to advance beyond the cur­rent reductionist model to some blending of the subjective and social aspects of healing.”—John S. Haller Jr.

Shadow Medicine, John S. Haller Jr.We conclude our week-long feature on Shadow Medicine: The Placebo in Conventional and Alternative Therapies with an excerpt, fittingly enough, from the concluding chapter. In “Reassessment,” Haller examines some of the challenges confronting alternative medicine as it tries to gain greater legitimacy as well as the need to integrate our understanding of what both alternative and conventional medicine offer:

With approximately 80 percent of the world’s population, including half the US population, using some form of [contemporary and alternative medicine] (CAM), the scientific community can no longer view these thera­pies as simply a fringe interest among consumers. However, because CAM therapies diverge sharply from reductionist science, the nature of their evidence and the subjective manner of their production create substantive problems for evidence-based medical knowledge. This suggests a remark­able similarity between CAM therapies and numerous nonspecific theo­ries and practices such as psychotherapy that, although difficult to explain in terms of their modus operandi, have proven beneficial to patients. The current tension between conventional therapies and unconventional ther­apies represents a collision of epistemologies. For the former, disease cau­sation constitutes the ideal form of evidence; for the latter, outcomes are of equal or greater importance. In our postmodern world, multifactorial causation has become more accepted as doctors and medical researchers adopt a more integrative role for unconventional therapies—a road that neither is straight nor accompanied by clear markers.

As the usage of homeopathy, acupuncture, herbals, chiropractic, and other CAM modalities amply demonstrate, their poor performance in clinical trials have caused little or no diminution in their popularity. They remain robust in their claims and ever anxious to expand their therapeu­tic applications. Even with increased consumer interest, however, only a small number of CAM therapies are expected to achieve legitimacy along­side conventional medicine. Unlike biomedicine, which is constantly jus­tifying its existence through replication and evidence-based research, most CAM modalities have yet to prove their efficacy or replicability, standing firmly on a static set of principles and practices that appear to “work,” albeit only marginally better than the placebo. To date, only a few have been able to build a scientific explanation for their efficacy. And for those that have achieved this status, the outcome has not always been to their benefit. The fact that the management of chronic disease constitutes 78 percent of medical expenditures in the United States explains why con­ventional medicine has been so aggressive in fighting CAM and, where possible, co-opting its more effective therapies.

(more…)

Thursday, July 24th, 2014

Conventional vs Alternative Medicine — An Excerpt from Shadow Medicine by John Haller

“In addressing the standoff between the dueling protagonists of conventional and unconventional medicine, the placebo has served as both mediator and judge….” —John S. Haller Jr.

We continue our week-long feature on Shadow Medicine: The Placebo in Conventional and Alternative Therapies by John S. Haller Jr. by presenting an excerpt from the book . In the introduction, Haller examines the debate between proponents of conventional and alternative medicine and the role in which the placebo plays in challenging both positions.

Wednesday, July 23rd, 2014

An Interview with John Haller, author of Shadow Medicine

“The question at hand is not only whether conventional and unconventional therapies can stand on their own self-authenticating authority, but whether it is possible to modify the context of these two opposing camps into something both can benefit from sharing. To date, there is no hard-wired connection, but the bridge between them is nowhere as long, nor is the chasm beneath them as deep as it once appeared.”—John S. Haller Jr.

John Haller, Shadow MedicineThe following is an interview with John S. Haller Jr, author of Shadow Medicine: The Placebo in Conventional and Alternative Therapies. For more on the book, read John Haller’s essay The Medical Challenge:

Q: In Shadow Medicine, you use the term conventional medicine. What do you mean by that?

John Haller Jr.: Conventional (or reductionist) medicine identifies statistical baselines against which to measure its therapies, looking to physiological, pathological, biochemical, and molecular processes derived from physical matter and to treatment based on the calculus of probabilities. That is to say, conventional medicine draws its authority from the clinical trials and laws embedded in the natural sciences. At its best, conventional medicine encourages a healthy skepticism and urges various forms of sampling, followed by repeated experimentation to reaffirm a hypothesis. Its identity is thus based on the unambiguous application of normative science whose laws interpret the body as a materialistic system that can be reduced and analyzed according to its component parts.

Q: You seem to suggest, however, that conventional medicine has limits? How so?

JH: While conventional medicine continues to provide the most credible information for justifying a clinical judgment, its ultimate value remains uncertain because much of what happens in a clinical trial fails to capture the myriad of variables that affect the physician/patient encounter. For this and other reasons, the clinical trial remains an imperfect tool.

Calibrating the outcome of a medical procedure or the efficacy of a pharmacologic treatment defies certitude insofar as the organic side of medicine tends to be infused with psychotherapeutic interventions—some intended and, others, hidden. This suggests that conventional medicine has overestimated the value of the clinical trial in resolving the challenges presented in medicine and that more creative efforts are needed that compare “whole treatments.”

Q: How does conventional medicine contrast from complementary and alternative medicine?

JH: Today’s complementary and alternative healers focus their attention on forces or energies that, although undetectable by the tools of science, are thought to be real. Such phrases as “paradigm change,” “probability waves,” “string theory,” “chaos theory,” “new physics,” “ectoplasm,” “chakras,” and “spirit-release therapy” are used to anoint beliefs wholly distinct from empirically-based laboratory science. Challenging the discrete boundaries between objectivity and subjectivity by including consciousness in the reframing of reality, today’s unconventional healers insist that “life forces” can be transmitted or channeled into the patient to mediate physical, mental, or emotional needs. This secularized notion of body, mind, and spirit forms the basis of homeopathy, psychic healing, crystal healing, reiki, light therapy, acupuncture, qigong, aromatherapy, distant healing, transcendental meditation, therapeutic touch, and other paranormal healing systems.

(more…)

Tuesday, July 22nd, 2014

The Medical Challenge — A Post by John S. Haller Jr.

Shadow Medicine, John S. Haller Jr.The following post is by John S. Haller Jr., author of Shadow Medicine: The Placebo in Conventional and Alternative Therapies:

“The placebo has undermined the positivist model of biomedicine by interjecting subjectivity, uncertainty, and ambiguity into the clinical encounter. It suggests that a specific disease or illness does not exist apart from the manner in which the society conceptualizes it and addresses it.”—John S. Haller Jr.

Conventional medicine is founded on the belief that the body is the outcome of material forces. Given this assumption, it looks to physiological, pathological, biochemical, and molecular processes derived from physical matter to diagnose and treat disease. Its basic tool is the randomized clinical trial, guided by the fact that its active pharmaceutical substances “work” (even when the patient is unaware of their administration) and that their effects can be demonstrated, measured, and replicated. As authority figures, conventional physicians not only project a certain level of scientific legitimacy but purport to have legal authority, political privilege, and cultural acceptance—entitlements that also come with obligations that include standardized training, accreditation, licensing, and regulation.

While the randomized clinical trial provides the most credible information for justifying a specific treatment, its ultimate value remains uncertain because much of what happens in a trial fails to capture the myriad of independent and/or related variables that affect the physician/patient encounter. For all its hype, the randomized clinical trial remains an imperfect tool. Although it informs individual clinical expertise, it does not (and should not) replace it. Conventional medicine has overestimated the value of its clinical trial and more creative methods are needed that compare “whole treatments” rather than just the normative components which biomedicine is most acquainted.

In contrast to conventional medicine, complementary and alternative medicine (CAM) defines health in psychological and spiritual terms and emphasizes patient individualization and self-healing. It is founded on a philosophy of organism known as “vitalism” which explains life not by the laws of physics and chemistry but by a principle, force, or spirit-like power that comes from beyond the material world to animate organic matter. Consisting of a mixture of religion, mysticism, cosmic energy, disbelief in Western reductionism, and an increased fascination with Eastern philosophies, CAM encourages a more metaphysical encounter with the world, one that questions the basic assumptions about the nature of reality. In this new setting the patient’s experience becomes intensely personal and compares strikingly to certain types of spiritual awakening. In its intuitive approach to healing, the goal of the healer is to assist the individual in finding harmony with nature.

(more…)

Monday, July 21st, 2014

Book Giveaway! Win a Free Copy of Shadow Medicine, by John Haller

The Collapse of Western Civilization

This week our featured book is Shadow Medicine: The Placebo in Conventional and Alternative Therapies, by John S. Haller Jr.

In addition to features on our blog, we will also be posting about the book on twitter, and facebook.

We are also offering a FREE copy of Shadow Medicine to a lucky winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, July 25 at 1:00 pm.

“This provocative book is aimed at challenging the research community, and the questions it raises are important for patients and doctors alike.” — Publishers Weekly

Read the introduction to Shadow Medicine:

Friday, June 27th, 2014

Interview with Alfredo Morabia, author of Enigmas of Health and Disease

Enigmas of Health and DiseaseThe following is an interview with Alfredo Morabia, author of Enigmas of Health and Disease: How Epidemiology Helps Unravel Scientific Mysteries. You can also read Morabia’s blog post Michelle Obama and Epidemiology: An Inspiring Example

Question Your book offers a fascinating and frequently surprising history of epidemiology. How does our understanding of this history help us confront contemporary issues relating to medicine and public health?

Alfredo Morabia: If I have to isolate one key lesson of this historical voyage, it is that society’s success in confronting health issues depends on its ability to use epidemiology to identify medical and public health interventions that work. This was the great discovery of the 17th century, and it finally stopped and reversed the inexorable and millenary progression of the great epidemic diseases.

Q: As you looked back at the history, were there particular events or moments that you found particularly surprising and perhaps changed the way you think about epidemiology?

AM: I had always associated the history of epidemiology mostly with the history of public health but this is not true. The history of epidemiology belongs just as much to the history of clinical medicine. Group comparisons were used to assess the efficacy of treatments by clinical doctors throughout the 350 years of existence of epidemiology.

Q: Your book stresses the importance of group comparisons. Why is this so central to epidemiology?

AM: Comparison is the basic tool of science. In epidemiology, by comparing groups of people we can learn whether a specific drug works, whether an exposure is beneficial or deleterious, or whether a screening test can prolong life. Groups are predictable and comparable; individuals are not.

(more…)

Thursday, June 26th, 2014

Michelle Obama and Epidemiology: An Inspiring Example

“American children can learn from someone like Michelle Obama, who decides on the basis of scientific evidence, not on mere speculation.”—Alfredo Morabia

Enigmas of Health and DiseaseThe following post is by Alfredo Morabia, author of Enigmas of Health and Disease: How Epidemiology Helps Unravel Scientific Mysteries

In her May 28th New York Times op-ed, The Campaign for Junk Food, Michelle Obama offers a lesson to Congress and an inspiring example to American children. She explains that before she began advising on policy to reduce child obesity, she first looked to “what works”.

“What works!” because, as Michelle Obama writes, “when we rely on sound science, we can actually begin to turn the tide on childhood obesity.”

Today, Michelle Obama can stand in front of children who may ask her about the importance of fruits and vegetables, less salt, etc. for a healthy diet. She can explain that kids from schools in which lunch menus have slashed sugar, salt, and fat are healthier compared to kids from schools which keep offering junk food; that kids from neighborhoods without nearby grocery stores have poorer eating habits compared to kids from areas with fresh-food retailers; that kids who go to child care centers offering healthier food and more physical activity acquire healthier habits compared to kids who don’t. She can also state that after reducing access to junk food, there is less obesity compared to the situation before the launching of the Let’s Move initiative. It worked!

Now contrast the example of Michelle Obama’s to that of Congressmen fighting the changes she is promoting in the school lunch program. These Congressmen want to see more white potatoes, less fruits and vegetables, more sodium, fewer grains on the menu, and consider pizza sauce a vegetable. How would these Congressmen respond to children asking them: “How do you know that your initiatives will not hurt our health?” The reality is that they cannot answer the question because there is no evidence supporting these decisions. They can only say that they believe otherwise, and claim their right to do so.

(more…)

Wednesday, May 21st, 2014

Why Umami is Good For You and 12 Ways to Add it to Your Diet

Umami: Unlocking the Secrets of the Fifth Taste

In Umami: Unlocking the Secrets of the Fifth Taste, Ole Mouritsen and Klavs Styrbaek explain the health benefits of umami:

Food with umami can often be prepared with significantly less salt, sugar, and fat without sacrificing the delicious taste of the resulting dish. Salt, in particular, is frequently applied too liberally in order to compensate for ingredients that are insipid or unpalatable. In many cases, its use can be reduced by as much as a half by incorporating foodstuffs with umami into the recipe. The fifth taste spurs the appetite, an attribute that can be exploited to advantage in caring for the sick and the elderly, who may have lost interest in eating. At the same time, however, umami promotes satiety, which helps to curb overeating by those who are inclined to overindulge. Either way, adopting a diet that has an abundance of umami may be a way for modem humans to eat in a healthier manner and to adjust their caloric intake to suit the needs of their bodies.

So where can you find umami? Well, the authors also provide a list of 12 easy way to add umami:

Mushroom salt
Cut shiitake or other dark mushrooms into slices and dry them in an oven on low heat. Crush them into a powder and mix it with Maldon sea salt flakes.
Use to season fish, soups, vegetables, and pasta dishes.

Marinated mushrooms
Marinate mushrooms in a little soy sauces or garum
Can be fried or used raw in salads.

Essence of Worcestershire sauce
Concentrated reduction of the sauce kept at the ready in a small bottle with an eyedropper.
Just add a couple of drops to meat that is being fried or to a sauce or a dressing. Rounds out the taste of a pâté or an egg dish.

Highly concentrated chicken bouillon
1 L (4¼ c) chicken stock reduced to 1 dL (½ c) or less.
Use as an essence in gravies that are a little flat or to add depth to a dressing, or drizzle on pasta or salads.

Miso paste
Light or dark paste made from fermented soybeans; available where Asian foods are sold.
Adds a nutty, savory taste to dressings, sauces, marinades, and soups (especially those with shellfish); or use it like butter to coat warm vegetables just before serving.

Anchovy paste
Available in a squeezable tube to keep in the refrigerator.
For all types of vinaigrettes, dressings, marinades, pesto, and pâtés.

(more…)

Friday, January 18th, 2013

Read an Excerpt from our Book of the Week: Jonathan Kahn’s Race in a Bottle

This week, we’ve brought you an interview and author post from Jonathan Kahn, Hamline Law Professor and expert on BiDil, the first race-specified drug approved by the FDA (click here for the story of BiDil). To wrap up our feature of this Book of the Week, we’re letting Kahn’s work speak for itself with an excerpt from his new book, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age.

Read the introduction, “Race and Medicine: Framing [Is] the Problem” (to view in full screen, click on icon in bottom right-hand corner)

Tuesday, June 19th, 2012

Henry J. Aaron on Health Care Reform

The Economists' Voice 2.0In the following excerpt from Henry J. Aaron’s “Systemic Reform of Health Care Delivery and Payment,” which appears in The Economists’ Voice 2.0: The Financial Crisis, Health Care Reform, and More, Aaron examines some of the challenges confronting the implementation of The Affordable Care Act. He concludes by arguing “As things now stand, the future of the ACA is highly uncertain. Yet its success is of critical national importance.”

THE AFFORDABLE CARE ACT (ACA) became law on March 23, 2010, but little of it is yet actively in effect. Not until January 1, 2014, will the Medicaid extensions, the individual mandate to buy insurance, the state-managed health exchanges, and the subsidies to make in­surance affordable take effect. The tax on high- premium plans will not be imposed until 2018. Tight restrictions on the operations of the Independent Medicare Advisory Board will remain until 2018.

Before those dates, the law will have to clear four hurdles. The odds that it will emerge unscathed are small. It is important to under­stand those obstacles and to consider how they may change the reform or even prevent it from taking effect. The first hurdle is judicial. Several states are challenging the consti­tutionality of the individual mandate—the requirement that everyone (with a few exceptions) who is not insured at work or covered by a public program must personally buy health insurance. Scholars are divided on whether the Constitution empowers the federal govern­ment to impose such a requirement. The courts will decide….

Should the mandate requiring individuals to carry health insur­ance be declared unconstitutional, much of the rest of the bill would become unsustainable, unless some alternative mechanism to create a sustainable risk pool were to be found. Various alternatives could work. Paul Starr has suggested that people who refuse each year to buy insurance should be barred for an extended period—say, four years—from buying insurance in the regulated market and from qualifying for income-related subsidies. The German health system uses such an arrangement and achieves near-universality. The an­swer to the question whether such a penalty could be adopted in the United States is not obvious. Nor is it clear how well such a penalty would work in the United States. Uninsured Americans would be able, as now, to show up at emergency room doors if they are seri­ously ill, because federal law requires that hospitals provide them ser­vices. The subsidies in the ACA might well tip the balance for most in favor of buying insurance. Such a provision would not have to work perfectly, just well enough to prevent the collapse of the health insurance pool.

Were the individual mandate to be declared unconstitutional, enacting some replacement would doubtless open up the whole bill to amendment. Approval of a time-limited exclusion from subsidized coverage or any other mechanism to maintain a risk pool would re­quire sixty votes in a badly fractured Senate and approval by a major­ity in a House of Representatives now controlled by a party that has pledged to repeal the law. Opponents of the law would be disinclined to agree to provisions that sustain it; at a minimum, their price for accepting such amendments would be high.

(more…)

Thursday, April 5th, 2012

Geoffrey Kabat Breaks the Bad News About the Good News About Chocolate

Geoffrey Kabat, Hyping Health RisksA recent report that got widely disseminated claimed that “that subjects who ate chocolate more frequently had lower body mass index compared to those who consumed it less often, and this was not affected by taking calorie intake or level of physical activity into account.” The notion of chocolate as a new weight-loss strategy obviously has it appeal but what about the science behind this study and the methods applied?

Geoffrey Kabat, author of Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology, questions the basis of the study in a recent op-ed in Forbes, The Bad News About the Good News About Chocolate .

In the piece, Kabat questions and faults the way in which the study was conducted:

This is a cross-sectional study, meaning that the information analyzed was collected at one point in time. Thus, it tells us nothing about weight gain or weight loss or factors contributing to these changes.

Furthermore, the researchers obtained information about the usual consumption of over a hundred foods by means of a “food-frequency questionnaire.” The authors do not tell us how many other food items and other behaviors were correlated, either positively or inversely, with body mass. What about nuts, broccoli, jello, coffee, beer, veal? What about the frequency of other behaviors – going to the movies, sexual intercourse, ice-skating?

(more…)

Wednesday, March 21st, 2012

Interview with Nicoli Nattrass, author of “The AIDS Conspiracy: Science Fights Back”

Nicoli Nattrass, The AIDS Conspiracy: Science Fights BackThe following is an interview with Nicoli Nattrass, author of The AIDS Conspiracy: Science Fights Back

Question: What is AIDS conspiracy theory?

Nicoli Nattrass: The central AIDS conspiracy theory is that HIV was created in a laboratory (perhaps with the help of the CIA) to inflict harm. Ironically, the idea that U.S. scientists invented HIV was initially promoted by the Russian KGB and the East German Stasi in a genuine conspiracy to spread misinformation. There are now many local variants of AIDS conspiracy beliefs–for example, in South Africa a common story is that HIV was created by the apartheid government’s chemical warfare program, with assistance from the United States.

Q: Why does AIDS conspiracy theory matter?

NN: AIDS conspiracy beliefs matter because they reflect and reinforce broader suspicions toward medical science. AIDS conspiracy believers in the United States and South Africa are less likely to use condoms, less likely to test for HIV, and less likely to take antiretroviral treatment. Why did you write the book? I was concerned about the way that AIDS conspiracy theories had been promoted at the highest levels in South Africa, and continue to resonate today. The book is the product of my exploration of how these ideas travel and take root, why they resonate socially, and what can be done to fight them. (more…)

Thursday, March 15th, 2012

Nicoli Nattrass on the AIDS Conspiracy

Nicoli Nattrass, The AIDS Conspiracy: Science Fights Back

In the opening to her book The AIDS Conspiracy: Science Fights Back, Nicoli Nattrass discusses how she became interested in AIDS conspiracy theories.

The Conspiratorial Move Against HIV Science and Its Consequences

Most people do not believe conspiracy theories about the acquired immune deficiency syndrome (AIDS). But suspicions that the human immunodeficiency virus (HIV) may have been created in a laboratory, and that the pharmaceutical industry invented AIDS as a means of selling toxic drugs, persist on both sides of the Atlantic. During the 2008 US presidential campaign, Barack Obama had to deal with politically embarrassing revelations that his pastor, Jeremiah Wright, believed the government had created HIV to harm blacks. Four years earlier, the Nobel Prize–winning Kenyan ecologist Wangari Maathai stunned the world with her casual observation that HIV had been “created by a scientist for biological warfare.” Most tragically, conspiracy theories about HIV were promoted in the early 2000s by then South African president Thabo Mbeki and his health minister Manto Tshabalala-Msimang—with devastating consequences for AIDS policy.

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Wednesday, March 14th, 2012

Nicoli Nattrass on The Specter of Denialism

Nattrass, The AIDS Conspiracy

In a recent op-ed for The Scientist, Nicoli Nattrass, author of The AIDS Conspiracy: Science Fights Back , describes the harm that has been done by AIDS denialists in South Africa and elsewhere.

Nattrass argues that a small group of AIDS denialists have kept alive the myth that antiretroviral treatment (ART) is harmful and that HIV science has been corrupted by commercial interests. Even though these claims have been disproved by science, they have hindered the battle to stop and treat AIDS. South African President Thabo Mbeki, debated the issue of the effectiveness of ART, holding up treatment and leading to the unnecessary death of 330,000 South Africans.

Nattrass also discusses the contested work of University of California virologist Peter Duesberg, another Denialists as well as activist Christine Maggiore, seen as a key icon for the Denialist movement: “Maggiore campaigned against the use of ART to prevent mothers passing HIV to their babies, Despite her 3-year-old daughter’s succumbing to AIDS, Maggiore remained staunchly opposed to HIV science and ART. She opted for alternative therapies and died at the age of 52, from AIDS-related infections.”

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Tuesday, March 13th, 2012

Nicoli Nattrass discusses AIDS Denialism and AIDS in South Africa

In the following interview, Nicoli Nattrass, author of The AIDS Conspiracy: Science Fights Back, discusses the issue of AIDS denialism as well as her work on AIDS in South Africa:

Monday, March 12th, 2012

Book Giveaway!: The AIDS Conspiracy: Science Fights Back, by Nicoli Nattrass

This week our featured book is The AIDS Conspiracy: Science Fights Back, by Nicoli Nattrass. (To browse the book.)

Throughout the week we will highlight aspects of the book and we are also offering a FREE copy of the book to one winner.

To enter our book giveaway, simply e-mail pl2164@columbia.edu with your name and address (U.S. and Canadian mailing addresses only, unfortunately). We will randomly select one winner on Friday at 1:00 pm. Good luck and spread the word!

Praise for The AIDS Conspiracy: Science Fights Back:

“Nicoli Nattrass does a wonderful job uncovering the dangerous consequences of following fringe ideas in health and medicine. Her new book puts medical myths and misinformation square in front of us, and she tells the story with such passion, we dare not look away.” — Seth C. Kalichman, Ph.D., University of Connecticut, author of Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy