Man, if you replace the word ‘marriage’ with ‘slavery,’ or ‘segregation,’ or ‘denying women the right to vote,’ it’s hard to tell if it was Bush speaking today or one of his historical likenesses:

bq(quote). “The amendment should fully protect slavery, while leaving the state legislatures free to make their own choices in defining legal arrangements other than slavery. America’s a free society which limits the role of government in the lives of our citizens. This commitment of freedom, however, does not require the redefinition of one of our most basic social institutions. Our government should respect every person and protect the institution of slavery. There is no contradiction between these responsibilities.”

And, just to finish off the point, a couple zingers from some pro-slavery arguments from the antebellum era. Sound anything similar to the speech today?:

bq(quote).. Speech to the Virginia legislature, 1832
Thomas R. Dew Defends Slavery

“It has been contended that slavery is unfavorable to a republican spirit; but the whole history of the world proves that this is far from being the case. In the ancient republics of Greece and Rome, where the spirit of liberty glowed with the most intensity, the slaves were more numerous than the freemen. Aristotle and the great men of antiquity believed slavery necessary to keep alive the spirit of freedom…In modern times, too, liberty has always been more ardently desired by slaveholding communities…”

” … and all who are white are equal in spite of the variety of occupation…And it is this spirit of equality which is both the generator and preserver of the genuine spirit of liberty.”

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It probably would have helped me to blog or, more generally, to write when I was feeling down last week (lonely post-Valentine’s Day), but I decided instead to lay in bed all day. I decided after that mess that I was going to start lifting again–if only for the free endorphins I’d get out of it. I’m not expecting any transformation like this guy , but I’d be happy with weighing more than 143 pounds. 145 is my goal. (Baby steps to success. That’s the key.)

I’ve also been active with a number of activities that’re keeping me relatively busy. First, obviously, finals are coming up. I’m taking one early in hopes of making it to the AMSA convention a little earlier. It’s in my hometown, and should be fun. I’m also TAing the Queer Health and Medicine lecture series, so I’ve been tracking down and confirming speakers for class, starting next quarter. Add to that my search for a car (anyone selling cheap?), and you have a full load.

I’m starting a Community Health Partnership with the Ravenswood Family Health Clinic in East Palo Alto–I’m going to be developing a program to reduce their pharmacy costs by trying to easily implement the usage of Patient Assistant Programs. I’ve been reading about best practices from the good folks at MedPiN up in Oakland, but if anyone has specific strategies they’ve used, I’d love to hear them. Almost all the drug companies offer these programs to “help” low-income patients receive medications, but the paperwork changes every couple of months, and it’s generally a big hassle for doctors’ offices and small clinics to maintain administratively. Not only are each company’s forms different, but they all have different means-testing criteria–some only accept 100% of federal poverty income, others are 150%, others are only for citizens, etc.

I’ve recently been selected as the Database and Technology Chair for our two student-run free clinics at Stanford– Arbor Free Clinic and Pacific Free Clinic . I’ll start the job next quarter, and I’m looking forward to it. Gives me an excuse to play on my computer.

I feel like my Spanish, although still slow, broken, and poorly conjugated, it starting to come together. The medical Spanish class once a week for two hours clearly isn’t enough, but I practice with a couple fluent friends in my class, and on Friday I interviewed a patient in Spanish. She was a very kind, very *patient* woman. Spoke very clearly and slowly for my and my classmate (who also speaks some Spanish). She had had a knee replacement and they removed all the cartilage because of her osteoarthritis (that’s the bone type, not the immune response type, called rheumatoid arthritis), so we spoke about that, and eventually her daughter and granddaughter came to visit, and we spoke a bit with them, too. It’s amazing how much of a difference it makes to patient repore to just *try* to speak their native language. Even if it’s broken and awful. I think it implies a sense that you have some greater stake in the patient’s care, and that increases patient trust. That you’ve taken the time to learn *their* language speaks more volumes to them than any number of words you could say, no matter how fluent you are.

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… begins the headline at the New York Times . It appears that two business trade groups, the Manufacturers Alliance and the National Association of Manufacturers, have come to the conclusion that, big surprise, the manufacturing costs in the US are making it compete with other industrialized nations: Canada, Germany, Britain, South Korea and France, for example.

bq(quote).. Comparing wage compensation to total value added in manufacturing in several countries, the study concluded that the United States was more competitive than Canada, Germany, Britain, South Korea and France. But throw in structural costs – which add 22.4 percent to the cost of doing business in the United States – and American manufacturers’ costs exceed those of counterparts in Canada, Britain and South Korea. Even France, reputedly hostile to business, isn’t far behind.

How is it that the American economic system, thought to be far more friendly to businesses than the European system, has become a competitive disadvantage for American manufacturers? One of the main culprits is health care. And the solution may be something that has traditionally been anathema to corporate chieftains: bigger government.

After corporate income taxes, employee benefits are the second-largest structural cost for American manufacturers, adding 5.8 percent to costs, according to the study. In all major economies, paying for health care means a combination of public and private money. But in the United States, businesses pay a larger chunk than do their European and Asian counterparts.

In Canada, the private sector spends 2.8 percent of gross domestic product on health care; in the United States, the private-sector figure is 7.7 percent. And American private-sector spending falls disproportionately on big employers like manufacturers. Some 97 percent of members of the National Association of Manufacturers provide health care coverage for employees. In 2002 alone, General Motors, which covers 1.2 million Americans, spent $4.5 billion on health care.

p. Coincidence that this point was made here at Gross Anatomy yesterday? I think not.

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Health care costs rose again in 2003 . Slower than 2002, but no where close to resting. We’re now up to $1.7 TRILLION and counting, up 7.8 since last year. And a Brookings Institution health economist said federal taxes would “have to jump by as much as 50 percent” if we keep up the current pace of spending.

But don’t worry. There’s hope in business. As some speakers concluded at a health care costs panel in Palm Beach , business will wake up at some point, realize that they’re simply making a poor economic decision by supporting the current health care system. With each rise in health care costs, the US becomes less and less competitive for work and jobs, as the economy becomes more global. Canada’s big three automakers–Ford, GM, and Daimler-Chrysler– all support Canada’s national health insurance system . Why? Because, simply, it saves them money. More cars are now made in Ontario than in Detroit, and it’s because the auto manufacturers realize it’s much cheaper across the border, and better for their bottom line. Ford now pays more for its employees’ health insurance than it does for its steel for its cars. From the CAW site:

bq(quote).. Workers in the auto industry, and in the many manufacturing and service industries which supply automakers, benefit directly from access to public health care services. Thanks to this system, they are healthier and more productive. Employers in the auto industry, meanwhile, enjoy significant total labour cost savings because most health care services are supplied through public programs (rather than through private insurance plans.)

The public health care system significantly reduces total labour costs for automobile manufacturing firms, compared to the cost of equivalent private insurance services purchased by U.S.-based automakers; these health insurance savings can amount to several dollars per hour of labour worked. Publicly funded health care thus accounts for a significant portion of Canada’s overall labour cost advantage in auto assembly, versus the U.S., which in turn has been a significant factor in maintaining and attracting new auto investment to Canada.

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The role of the doctor: to care for patients. In today’s pharma culture, that means taking a pill. But the billions spent on new drugs, new pills, and new therapies are absolutely, positively, 100% useless if patients cannot afford them. And a University of Michigan study proves the point : diabetes patients with high prescription drug costs simply did not buy their medications. When it’s between paying the heat bill during a Michigan winter or buying your diabetes meds, which are you going to choose?

If tomorrow a pill came out that cured all illness, all disease, but cost $5 million a pop, how effective is it truly? In pharmacology, drugs are noted for their effectiveness (how much of a drug is required to get a certain level of response in a person), but the most effective drug will remain largely ineffective if other factors–financial, cultural, religious, political–impede the population’s access to the drug.

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Most of the time when we talk about minority health disparities , people talk about lack of health care access, cultural barriers, disparities in health insurance coverage, Medicaid coverage, etc. But my Medical Spanish professor brought several examples of even more striking–and simple disparities. We compared some quite simle forms in English and Spanish, and the results were pretty scary.

First we sampled the Stanford Hospital Emergency Room intake form, and found quite a number of cases of poor grammar (literal translations that didn’t make much sense), and a lot of assumptions about people that primarily spoke Spanish–that they didn’t have health insurance, that their jobs or employers were much “simpler.” Bad, but okay, no real health issues there.

More disturbing is a Kaiser Permanente form for “Instructions for Patients With Minor Head Injuries,” typed in English at the top and Spanish at the bottom. Some of the mistakes are pretty frightening. Our class couldn’t believe that Kaiser couldn’t find a *single* fluent bilingual person in all of California that could at possibly translate these correctly. The following are some of the English symptoms of complicating symptoms after a minor head injury, followed by the Spanish (with my rough *but correct* translation in partentheses):

bq(quote).. Severe or persisten headache. Profundo dolor de cabeza. (Deep/profound headache — ignores the “persistent” aspect completely.)
Excessive sleepiness or difficulty in arousing from sleep. Demasiado sueno o dificultad en recordar. (Too much sleepiness or difficulty in remembering – the English version says *nothing* about memory problems.)
… sleep for peiords longer than two hours for the 24 hours following the injury… no duerma mas de 2 horas en un periodo durante 4 horas (No sleeping more than 2 hours in a period of 4 hours – well, that’s pretty damn different, too.)
Unequal pupils. Si las iris estan desparejas. (If the irises are unequal – a poor translation, most people wouldn’t say “desparejas,” and the irises are not the same as the pupils.)
Tylenol (acetaminophen) may be used. Puede usar aspirina. (You can use aspirin – The kicker. Tylenol versus aspirin. How do you mistranslate *that*?)

p. And not to be left out, the English version suggests that if any symptoms appear, the patient should return to the ER immediately *or* call the Emergency Room. In the Spanish version, the patient isn’t given an option of the telephone number.

I’m hoping this isn’t a common practice at Kaiser, and that they just paid some kid to translate these. But I’m surprised that some Spanish-speaking doctor hasn’t raised a concern with the translations.

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According to the beloved Dr. Bill Frist, it’s absolutely impossible to achieve universal coverage in the US (NYT link):

bq(quote).. The Senate majority leader, Bill Frist, said on Friday that “it is impossible” to have all Americans covered by health insurance, but he predicted that Congress would take incremental steps to expand coverage this year.

Dr. Frist, a Tennessee Republican, said his state was “going bankrupt” as a result of trying to achieve universal insurance coverage.

“It is impossible to get everybody covered,” Dr. Frist said at a meeting with journalists. “It’s impossible to get to 100 percent.”

p. Now now, Dr. Frist. Every other democratic, industrialized country has some sort of national health care or national health insurance. They pay a lot less than we do, and have better outcomes. And everyone’s covered. And we seriously can’t achieve it? You’ve got to be kidding.

A great rebuttal from the AMS A health policy listserv from Jeff Huo :

bq(quote).. It seems pretty obvious to me that in a country where employers spent about 200 billion dollars on health care, and Americans spent about as much on soda, wine, and beer, that the money is probably available somewhere, somehow, to close the necessary monetary gap. If you really wanted to.

We built a nuclear bomb from nothing in less than five years; we sent men to the moon in less than ten; it seems hard to believe that we couldn’t find some way, with enough cleverness, to achieve near universal-access to at least basic health care. The only guaranteed defeats are the fights you surrender.

When we say there is no room in the budget for Universal Health Care what we’re *really* saying is that we don’t want to make Universal Health Care a priority sufficiently high to fit it into the budget. And if that’s what you believe, then you’re welcome to. But to say that there isn’t, if one thinks hard enough, some way to *make* it happen is not, I think, being honest. There always is if one is willing to try hard and think hard enough –if you’re willing to begin from that first principle, that the vast majority of Americans deserve access to basic health care, and build the rest around it.

We could go over the rest of the constant themes here — universal health care does not necessarily equal single payer and so on. We could point out examples, like Maryland’s Health Care for All plan, of detailed attempts to generate a nuts-and-bolts gritty detailed plan to attempt to achieve near Universal Health Care. But the point is, eventually, we’re right back to where we were a little earlier –you either believe that Universal Health Care is a goal that is to be tried for, or you don’t. If you do, then it is up to us to find a way to make it happen, and to argue the merits of various plans to get there, and the tradeoffs of one plan vs. another plan. If you don’t, you’ll always be able to find a reason, an excuse. You lose every fight you give up.

Bluntly once again, one either looks for solutions or one looks for excuses. If you try hard enough, most times you’ll always be able to find what you’re looking for.

p. What does it say about our political leadership when the Senate majority leader says flat-out that health care for all is 100% impossible? How’s that for compassionate conservatism?

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And I almost forgot, again from Neuro lecture: Mike the Headless Chicken ! (He’s running for President in 2004.)

As the beautiful story goes…

bq(quote).. September 10th, 1945 finds a strapping (but tender) five and a half month old Wyandotte rooster pecking through the dust of Fruita, Colorado. The unsuspecting bird had never looked so delicious as he did that, now famous, day. Clara Olsen was planning on featuring the plump chicken in the evening meal. Husband Lloyd Olsen was sent out, on a very routine mission, to prepare the designated fryer for the pan… A skillful blow was executed and the chicken staggered around like most freshly terminated poultry.

When Olsen found Mike the next morning, sleeping with his “head” under his wing, he decided that if Mike had that much will to live, he would figure out a way to feed and water him. With an eyedropper Mike was given grain and water. It was becoming obvious that Mike was special… It was determined that ax blade had missed the jugular vein and a clot had prevented Mike from bleeding to death. Although most of his head was in a jar, most of his brain stem and one ear was left on his body. Since most of a chicken’s reflex actions are controlled by the brainstem Mike was able to remain quite healthy.

In the 18 MONTHS that Mike lived as “The Headless Wonder Chicken” he grew from a mere 2 1/2 lbs. to nearly 8 lbs. In a Gayle Meyer interview Olsen said Mike was a “robust chicken – a fine specimen of a chicken except for not having a head.” Some longtime Fruita residents, gathered at the Monument Cafe for coffee, also remember Mike – “he was a big fat chicken who didn’t know he didn’t have a head” – “he seemed as happy as any other chicken.”

p. Which just goes to show you: chickens don’t need a brain to live (their brainstem does most of the work), and chickens have no problem getting their heads chopped off. (Sorry, PETA. Don’t hurt me.)

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Completely stolen from today’s lecture on the auditory (hearing) system, I’ve got two little multimedia pieces for readers today:

* First, a little cochlear damage. The cochlea is a spiral-shaped structure in your inner ear (past your eardrum) that lets people hear. It’s got tiny hair cells that move in response to vibrations (sound waves), and, well, to make a long story short, they’re how you hear. But you can lose these hair cells–from old age, from over-exposure to loud sounds, and depending on the pitch of the sounds, you lose hair cells in a certain area of your cochlea. A great picture to illustrate it:

* And for my favorite–like I mentioned above, the hair cells respond to certain frequencies of vibrations. And one type of these hair cells actually contract when they detect a certain frequency. Even faster than our muscles contract. Anyway, a scientist in the UK isolated one of these contractile hair cells (an outer hair cell), and attached a small voltage sensor and speaker to the cell. Ladies and gentlemen, I present, for your viewing and auditory pleasure, please turn up those speakers and give a warm welcome to… THE DANCING HAIR CELL OF LONDON ! (5.2 MB mpeg file).

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