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Demystifying Medicine One Month at a Time

Category: deaths in the news (page 1 of 4)

ObiTrio

When I was young, I avoided reading obituaries out of superstition that I or a family member might fall ill or die.

When I was pursuing a medical education, my fear lessened and I became fascinated by obituaries–especially the 2nd paragraph, in which the cause of death is mentioned (or speculated upon).

As I’ve matured, I now read them because they are a distinct form of writing–succinct, and in telling about the decedent’s life, amazing true stories of our time here on earth.

OBIT | Theatrical Trailer Exclusive from Green Fuse Films on Vimeo.


Three recent NYT obits caught my eye, because each one had an interesting connection to health care. In chronological order of when they died, here they are:

John Sarno was a physical medicine and rehab specialist at NYU for almost 50 years. He was adored by his patients, particularly those for whom he helped achieve relief from back pain. He authored several books on the topic, suggesting that most if not all of it was caused by unresolved anxiety and rage. He coined the term “tension myositis syndrome” as a catch-all for the most common form of back pain–muscular pain that in most cases is episodic or short-lived. The obituary discusses how his ideas were never accepted into the medical mainstream, despite the facts that his books sold millions of copies just by word-of-mouth, and his own skeptical physician colleagues turned to him for help.

Spencer Johnson started his career as a medical doctor, but decided against a career in clinical medicine. As the obituary states, “…while working in a hospital, he grew frustrated at seeing the same patients return with the same ailments, as if they were not trying to better their lives…” He went to work for a medical device company, becoming its director of communication. Learning how to write succinctly for lay audiences led him to his ultimate success–co-authoring the massive bestseller “Who Moved My Cheese,” a parable about pushing ourselves out of our comfort zones. It has since sold nearly 30 million copies worldwide and has been translated into 44 languages.

I love the quote he gave to a newspaper writer: “Most writers write the book they want to write. You’re much wiser if you write the book people want to read.”

Keith Conners was a psychologist most known for his work in the world of defining and diagnosing Attention Deficit Hyperactivity Disorder (A.D.H.D.). In the first half of the 20th century, hyperactive children with difficulty focusing were said to suffer from “hyperkinesis,” or the lovely moniker “minimal brain disorder.” Conners brought rigor to the field, and created the Conners Rating Scale, a 39-item questionnaire that became the gold standard for diagnosing A.D.H.D. Conners went on to become a critic of what has become a big industry, stating that A.D.H.D. is now diagnosed about three times as much as its actual prevalence. [If you are interested further in this topic, you can hear a podcast of my interview with author Alan Schwarz of “A.D.H.D. Nation” here.]

These doctor/writers all lived interesting and varied lives–I was simply struck by the proximity of their deaths and the loveliness of their obituaries.

RIP: Jake Page (1936-2016)

jake-page-large

Jake Page. Source: Rio Nuevo

I didn’t know Jake Page. Until his death, I wasn’t even aware of him.

But reading his obituary, I see a kindred spirit.

Page was a young editor at Doubleday when he was given responsibility for an imprint called “Natural History Books.” He’d never taken a science course in high school (how is that possible?) or college, and was suddenly in charge of making science books accessible to regular people.

“My job was to edit them so that any idiot could read them,” he told an interviewer. “I was any idiot then for the next seven years.”

He eventually wrote a monthly column for Smithsonian Magazine called “Phenomena, Comment and Notes.”

His style was to report on science by imbuing his writing with humor. “Science, which always seems earnest to the point of stuffiness, is too important to leave only to scientists.”

Amen, I say. The same holds true for medicine.

One other note about Mr. Page: Apparently, he had a good eye. Early in his career, he recommended publishing a series by a British author named J.R.R. Tolkien, only to be rebuffed by his boss.

Recalling his life in publishing, Page recalled, “Most memorably, the editor…shot down my notion that we should publish a fascinating trilogy by an English author, so the whole billion-dollar Hobbit enterprise was taken on by Ballantine.”

Ouch.

RIP: Richard Fine (1940-2015)

I didn’t know him, but was inspired by the life story of Richard Fine, which I came across while reading his obituary in the San Francisco Chronicle.

Dr. Fine grew up in Cincinnati, and was educated at Cornell — first the college in upstate New York, then the medical school in New York City. He moved to California in 1966 for medical training, and never left.

920x920Like Zelig or Forrest Gump, he was seemingly ubiquitous at major historical events around that time: He volunteered to provide medical care at Altamont, where the Hell’s Angels, working as security for the Rolling Stones, killed a concert goer. He served as a physician to members of the Black Panthers, who were unable to get medical care in more traditional venues. He also ran a clinic for American Indians during the siege of Alcatraz from 1969-1971.

In addition to his medical leadership, he was widely known for his casual dress (bowling or mechanic’s shirts) and riding a motorcycle as his main form of conveyance.

He challenged the leadership of San Francisco General Hospital to provide care for the poor and uninsured, something we take for granted today but wasn’t at all a given when he was starting out. He was instrumental in helping start both a clinic and a residency program to train young doctors in the principles of social medicine — looking beyond the direct biological causes of illness to social causes, institutional discrimination, and beyond.

As you might imagine, he championed the cause of AIDS victims during the early part of the epidemic when other facilities would find excuses not to care for those infected with HIV. He also was known for improving the care of those jailed in San Francisco, making the case that incarcerated individuals still need care. When Type I diabetics were denied insulin and wound up hospitalized or dead, it made more sense for city supervisors to allow Dr. Fine and his trainees to develop better and more humane care plans for those in jail.

I was touched to read that Dr. Fine’s proteges at UCSF and San Francisco General Hospital were able to name their clinic in his honor. They announced that to him at the debut showing of a documentary film made about him last summer, so he was able to learn of the honor before his death due to cancer.

Whistleblowers

My son and I recently saw the Oscar-winning documentary “Citizen Four” about NSA contractor and leaker Edward Snowden. It’s a riveting film, because it not only covers the topic of unwarranted government surveillance, but it was made in ‘real time,’ as Laura Poitras, the filmmaker, was in Hong Kong filming Snowden and reporter Glenn Greenwald as the first stories broke and Snowden’s identity became known.

Tuskegee-syphilis-experiment-test-subjectsIt’s an interesting coincidence, then, to read the obituary of an almost-whistleblower by the name of Dr. Irwin Schatz. Schatz is remembered for writing a letter to the authors of a medical journal article in 1965 about the infamous “Tuskegee Syphilis Study,” in which black men in the South, primarily Alabama, were followed without treatment for decades to learn about the ‘natural history’ of untreated syphilis. The study was administered by the United States Public Health Service, and is widely remembered and taught as an egregious example of bad medical ethics. If the profession’s dictum is “First, do no harm,” the Tuskegee study caused irreparable harm by not treating an illness for which there was a surefire cure: penicillin.

The obituary contains all of Schatz’ three-line letter, which was sent to the study’s senior author:

“I am utterly astounded by the fact that physicians allow patients with potentially fatal disease to remain untreated when effective therapy is available. I assume you feel that the information which is extracted from observation of this untreated group is worth their sacrifice. If this is the case, then I suggest the United States Public Health Service and those physicians associated with it in this study need to re-evaluate their moral judgments in this regard.”

Unfortunately, when his letter went unanswered, he did not persist. It took the whistleblowing of a Public Health Service investigator named Peter Buxtun to finally bring the study to a close in 1972. Unsurprisingly, it took Buxtun a number of tries to bring the unethical nature of the study to light. He first tried to go through official channels, as early as 1966, but was met with resistance on several occasions. It wasn’t until he leaked the information to a reporter at the Washington Star that the story received enough attention to stop the study. 

Snowden registered his concerns with his superiors, too, before ultimately deciding to go to the media because no one in the hierarchy seemed poised to question the status quo.

I’m Astounded, Too

Senator Chuck Grassley of Iowa, as of this month the Chair of the Senate Judiciary Committee, has led a decade-long crusade to make our nation’s non-profit hospitals more accountable to the public.

GrassleyOfficialPhotoAfter all, the reasoning goes, non-profit hospitals are tax exempt because they provide community benefit. How this standard is defined has been the crux of the issue.

Hospitals always face a share of patients that are uninsured, who are therefore unable to meet the high costs of hospitalization. Depending on their location, some non-profits care for more non-insured patients than others. Of course, the Affordable Care Act (Obamacare) was designed in part to greatly lessen the number of uninsured among us — a win for those patients, and for the hospitals that struggle financially because of non-collected fees. The American Hospital Association (AHA) supported the passage of the Affordable Care Act under the premise that nearly all patients would become paying customers.

Since not all states (>20) have agreed to expand their Medicaid pools in spite of generous new federal funding, there are still millions of uninsured patients straining the finances of hospitals. Businesses (non-profit hospitals included) have a right to collect payment for services rendered. But how aggressive should non-profit hospitals be in pursuit of unpaid fees?

Propublica, a non-profit investigative journalism enterprise, has researched the billing practices of non-profit hospitals in six states. What they found ‘astounded‘ Senator Grassley: aggressive collection practices including lawsuits, wage garnishing, and the placement of liens on personal property. These practices are legal, but skirt the ethical notion of helping our fellow humans. If sick people are rendered health care services but then put into collections, the results can be emotionally, financially, and even physically catastrophic. To me it certainly seems counterproductive to bully members of your community, who more than likely will continue to be customers.

Stay tuned to find out if Sen. Grassley and his committee do anything to rein in these practices. My guess is we’ll see an attempt made to more clearly define the community benefit standard and put limits on what extent hospitals can go to for collecting unpaid bills. One option: taking away a hospital’s non-profit status if it continues engaging in such aggressive collection practices.

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RIP: EB (1931-2015)

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