:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Thursday, July 29, 2004  

Drug reimportation and the DNC

Teamster president James Hoffa on drug reimportation:
"This administration is so pro-trade that they want to import into this
country the T-shirts, the cars and everything from every third-world country
around," Hoffa said. "But when it comes to importing drugs from Canada, they're
against it."

posted by Anjali Taneja | 7/29/2004 11:43:00 AM | (0) comments |

Sunday, July 25, 2004  

Why the elderly rock, and why we shouldn't allow others to screw them over

Alex's post about a conversation he had with a 102 year old man in the hospital made me smile:
You're back in school for a Master's in computer science?
"Well, I figured since computers are the wave of the future, I should know something about 'em."

He lives with his two older sisters. His oldest sister is 107 years old, and "She does all the cooking." The other older sister is 105 years old.

How is your quality of life these days?
"Well, sometimes it can be hard. My sisters still treat me like a baby."
I guess "old" is relative.  I absolutely love working with the elderly, and am hoping that once I'm out there in the "real world" practicing medicine, that much of my patient population will be the elderly.  I find myself fiercely defending them when they're being exploited, in the hospital, in the community, or in policy decisions. 

Graham posted this week about an amazing speech that Senator Mark Dayton (D-MN) gave about the Medicare "reform act, before it was passed.  Check out all of Graham's post, as it eloquently speaks to the problems inherent in the Medicare reform bill.  Senator Dayton's speech is definitely worth reading in its entirety too.  Some teasers -- did you know that Dayton wrote an amendment that would require members of Congress to have the same prescription drug coverage as would be passed for Medicare beneficiaries?
That amendment, which passed the Senate by a vote of 93 to 3, was stripped out of the conference report as, evidently, some Members were promised it would be. That should tell the American people everything they need to know about this bill. It is not good enough for Congress. 

Some Members of Congress are trying to sell this legislation as good for seniors and other Medicare beneficiaries of America, but it is not good enough for them to live under. That is the height of hypocrisy. It is good enough for the senior citizens of this country, it is the best we will vote to provide for them, but, sorry, we will pass on it for ourselves. Why is Congress opting out of this coverage if it is so good? Why is it only half as good as what Members voted to provide themselves and their families and their employees?
And Dayton on the American government not sticking up to pharmaceutical companies for the interests of our own people:
Now, why are the prices so much lower in Canada than they are in this country? It is because the Canadian Government stands up for its citizens and negotiates prices that are lower and will not agree to prices that are exorbitant. And their citizens are the beneficiaries of these prices that are one-third, one-fourth, one-fifth of what they are in the United States--not even close approximations.

posted by Anjali Taneja | 7/25/2004 11:27:00 AM | (0) comments |

Tuesday, July 20, 2004  

Back on the Hospital Floors -- the patients are happy, but the docs seem divided
Yes, I'm back, in full force, in my last year (11 months and counting) of medical school, after a year away from patient care (working as a fellow for the American Medical Student Association).  I'm doing my 3rd year surgery rotation in my 4th year of medical school because I postponed it to start my AMSA job in time.  I've gained so much respect for the work of surgeons in my first 3 weeks here (at a community hospital in New Jersey), and I'm really digging in and enjoying the experience, even though I'm sure I'm not going to pursue it career-wise (actually because i'm not pursuing it -- I won't have another chance to see all these operations and all the other amazing work that surgeons do).
As I talk to resident physicians in the hospitals, whether surgery residents or internal medicine residents or ob/gyn residents I know from my 3rd year clinical rotations, I'm finding the inter-disciplinary generalizations, ignorant comments, and disparaging comments increasingly intolerable.  To illustrate what I mean, here are some examples of statements that have come up in conversation:
Surgery Resident:  "Ah, you're interested in family medicine -- isn't that field going to become obsolete real soon?" 
Gastroenterologist:  "You know, you've gotta start thinking realistically.  When you have kids of your own, you're going to want to have the best for them.  And pursuing general internal medicine or family medicine won't earn you enough income to provide for them."
Insecure Surgery Resident:  "Many people think surgeons are idiotic people who just want to cut things out of people, and don't know how to think things through.  Well, we're not really like that.  We're.... smarter than other doctors."
Pediatric Neurologist:  "I'd die before I'd send my son to a family physician.  They don't know anything."  (this after hearing of my passionate interest in family medicine and my vision for the future of community health.  i mean, that's just mean).
Department head of Surgery:  (paraphrased from what I remember from two weeks ago) -- Surgery is very different from internal medicine, expect this difference when you do your rotations as medical students.  Surgeons don't think things over and over and over, we don't round on patients for hours on end and waste the day.  Our situations are more often emergencies.  We do things.
My medical student colleague:  "Anesthesiology could be done by a robot.  Only people who are lazy and want to make tons of money go into it."
Surgeon:  "Ah, you're interested in family medicine.  Do you really just want to see runny noses and sports physicals?"
Surgery resident: "Emergency Medicine doctors are just triage nurses.  They see the patient and hand him or her off to us or to internal medicine."
Internal Medicine resident:  "You're too smart for family medicine.  Don't waste your education on it."
Surgery resident:  "Man, those medicine residents, they're no good.  They dont' treat anything.  They create surgery patients for us." 
Anjali in response (couldn't hold back): "No, they treat non-surgical patients" (patients not needing surgery, electively or acutely)
Surgery resident: "No, they create surgery patients for us."
Anjali (raising voice a bit):  "No, they treat non-surgical patients."
Surgery resident (raising voice a bit): "No, they create surgery patients for us."
Then he got paged and we had to continue the puerile back and forth later.  Reminded me of the whole "I know you are but what am I?" back and forth that 8 year olds engage in.  I had to remind myself that I'm a (relatively) mature medical student, and he's a (relatively mature) 3rd year surgical resident, in order to calm down a bit.
The fact that so many physicians "hate" on other physicians' fields really gets to me.  Why can't we all just get along?  But I find myself doing it -- jumping to judgments and generalizations of people in various fields of medicine.  Oftentimes it's a knee-jerk reaction to what other docs say of the field I'm interested in pursuing, and other times it's just plain old judgments.  This growing process is very interesting -- as I become more aware of my own judgments of other fields of medicine, I become less judgmental of them.  (but I reserve my right to look critically at the individual or collective actions of physicians "pan-field" -- I just made up that word).
I was discussing this with a friend the other day, and we brainstormed a few ideas about why doctors may disparage other physicians' fields:  
1.  The desire for acceptance within your field and ownership of what you do can drive you to talk disparagingly about other fields.  In order to be in the "in" group, you've gotta create an "out" group.  A basic sociological and time-tested concept.  This can get to the point where you start thinking your field is really the only important field in medicine (very dangerous).
2.  Insecurity about the field you've chosen causes you to complain about others.
3.  The result of imprinting that occured during medical school or previously.  As you're first exposed to the attitudes of physicians in various different professions, you start to stereotype the whole profession from the few "characters."
4.  It's a status/hierarchy thing, and with status comes arrogance (the culture of medicine places specialists higher up in conventional status, while generalists are generally lower in status -- among physicians).
I'll keep pondering this one.  Add to the list if you'd like, in the "thoughts" section below.  But now, back to being on call overnight at the hospital (and working with some of the most kickass surgery residents this side of the Mississippi River).

posted by Anjali Taneja | 7/20/2004 05:06:00 PM | (0) comments |

Monday, July 19, 2004  

Public Health in DC -- man, it ain't rocket science
Last year, while working at the American Medical Student Association as a fellow, I got involved in a few local DC coalitions on health access, and the stories that I heard about the disparities in health in the DC area were striking.  The public hospital closing issue was of deep interest to me, and I have to thank my friend Joni Eisenberg, a wonderful radio host on WPFW in DC (who allowed me to speak on the radio from time to time -- it was so exciting!), for much of my awareness of the city's health.  Today the Washington Post is carrying a story revealing horror stories about lack of care, treatment, and follow-up for patients referred to a CDC funded, Washington DC Tuberculosis clinic.
I'm really fascinated by the concept of "aligning the silos" of health care and public health in ways that we just absolutely fail at right now as a society.  It would make sense for the health care and public health (and even housing, etc) sectors to seamlessly carry information to each other, seamlessly continue care and seamlessly and efficiently communicate.  But instead of working on that, we're funneling gazillions (for lack of knowledge of what that big ol' number really is) into research for possible biological weapons attacks.  I'm not saying that's not important, but it's taking away money from current public health programs, and also, when we do have public health measures around biological weapons, whose to say they'll be effectively communicated among doctor, patient, and public health agencies?  Victor Freemen, President-Elect of the D.C. Medical Society, put it nicely:
"The issue for the medical society was that if we're not managing the most basic public health function, then we have concerns about the ability to manage more complex issues -- especially in the nation's capital, which is a potential target for chemical and biological events."
Really, it ain't rocket science. (can you tell I like using this statement?)

posted by Anjali Taneja | 7/19/2004 06:04:00 PM | (0) comments |

Monday, July 12, 2004  

Terrorizing the Elections

There's lotsa talk now about allowing a 4 person commission to decide if we should postpone the federal elections this November, in case of a terrorist attack.

After watching Fahrenheit 9/11, I was enraged that not one Senator (which is all that it would have taken) could come to the aid of the thousands of disenfranchised voters, and to the aid of the Representatives from the Congressional Black Caucus who called for a senator to sign the request to redo the election. In response to my outrage, a few of my friends tried to rationalize the situation with me and explain that pushing off the elections in 2000 by a few months would have thrown the House of Reps and Senators into a tough situation, etc etc, and that this had never been done before (postponing of the presidential election), so they took the "safe" route. (Remember, Kerry and Edwards were among that bunch...they better EARN black peoples' votes, not just assume they've got 'em in their pockets).

And this is what enrages me even further about this new issue. Back in 2000, the fact that Gore actually won the elections and that thousands were not able to vote (a basic right provided by our very constitution), was not enough to redo the elections. We allowed our leaders to stand in the way of democracy. We can't allow that to happen once again. We had a REAL reason to redo and postpone the elections in 2000, and we didn't pursue it. We'd better have a BETTER reason this time (and the possible threat of a terror attack maybe kinda possibly oh-wait-theres-no-evidence-but-if-we-scare-the-electorate-enough-they'll-vote-for-bush, just aint a good reason).

To sum up, fafblog's post on this issue is telling: "Remember, after all, that in these days it is the darkest enemies of democracy we face, and in the war to defeat them, we cannot let democracy stand in the way."

posted by Anjali Taneja | 7/12/2004 08:55:00 AM | (0) comments |

Friday, July 02, 2004  

Some hypocrises: Kerry is a heretic! and "Love thy Enemies is *so* 33 AD"

Let's burn him at the stake! A Catholic attorney has accused John Kerry -- an abortion-rights supporter -- of yes, heresy. This attorney has claimed that Kerry has brought "most serious scandal to the American public" by receiving Communion despite his support of a woman's right to choose. Some thoughts:

1. Heresy is a charge usually reserved to church officials, not to politicians. Don't we have separation of church and state in this country?

2. "The most serious scandal to the American public"? What about Bush and his cronies leading our nation into an unjustified war? I mean, if we're going to be accusing politicians of heresy, let's take a look at our priorities. The Vatican *IS* opposed to the war.

3. Perhaps the Catholic Church should be less tolerant of its own priests who molest children than politicians who support womens' rights to choose. It doesn't support a zero-tolerance policy for priests who emotionally and sexually abuse kids. The Vatican Pontifical Academy for Life put out a report in February stating that it wouldn't do good to have a zero-tolerance policy. It seems these "experts" have some interesting logic behind their policies:

"The experts said a zero-tolerance policy was mistaken and even dangerous. Most agreed that such a policy can actually increase the chances that offenders might strike again because it removes them from supervision and the only jobs they have known for decades."

Hmm...I won't even comment on that one...

And lastly -- my new favorite blog Fafblog has an entry entitled "Love thy enemy is *so* 33 AD". Yes, I know...the Focus on the Family email to its members telling them what Michael Moore's home address is, is sooooo last week. But hey, I started writing this post last week, and didn't get back to it until today.

I have to end this with a big disclaimer -- I don't claim to know the first thing about the Catholic faith, so if anyone can provide clarity on the above issues, I'm all ears. But at first look, things sound mighty hypocritical.

posted by Anjali Taneja | 7/02/2004 01:02:00 PM | (0) comments |


Mommy, can I have a Taser for my birthday?

Justin Podur's The Killing Train and Zeynep Toufe's Under the Same Sun discuss the horrifying news of taser guns.

"Coming to an electronics store near you: high-voltage stun guns. I couldn't make this up if I tried. Wall Street-darling Taser International, maker of "nonlethal weapons" (that have been shown on at least 40 occasions to contribute to death), said recently it is in talks with electronics chain Sharper Image, among other retailers, to sell "consumer-friendly" stun guns in the U.S. and Canada. For those of us not near a Sharper Image, Taser also plans to sell a "consumer-friendly" version of its 50,000-volt weapon on its Web site -- just a shock and click away."

I just saw the movie Minority Report last night for the first time (yup, i'm catching up with some must-see movies). Boy, that was a great movie. Anyway, I was thankful that it wasn't the year 2050, and we didn't have a department of PreCrime. Oh, but we have a department of pre-emptive strikes, that's for sure.

Reading the posts about the taser guns really hit me hard -- we're already in the business of precrime. And the tasers are doing exactly what they're meant not to do -- actually increasing the amount of violence (because officials who are using it believe that they can punish with it without killing, even though it's caused a whopping number of deaths). I read something a year or two ago about what these tasers do, physically, to inmates in prisons where they're used. Awful.

posted by Anjali Taneja | 7/02/2004 11:29:00 AM | (0) comments |

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