Longer looks: Alzheimer's and a marriage; racism in medicine; abortion restrictions in Texas

Sep 5 2014

Each week KHN's Shefali Luthra finds interesting reads from around the Web.

Vox: Eight Facts That Explain What's Wrong With American Health Care
The US, which has a mostly private health-care system, manages to spend more on its public health-care system than countries where the health-care system is almost entirely public. America's government spends more, as a percentage of the economy, on public health care than Canada, the United Kingdom, Japan or Australia. And then it spends even more than that on private health care. The reason that we spend so much money isn't because we go to the doctor a ton. On average, Americans actually see the doctor less than people in other countries. The reason that American health care is expensive is all about the price: when we go to the doctor, it costs more than when, say, someone in Canada goes to the doctor (Sarah Kliff, 9/2).

The New Yorker: The Antidote
The silent sniper fire of overdoses from pills and heroin that has been picking people off one at a time in increasing numbers all over the country for almost twenty years has hit Staten Island harder than anyplace else in the city. For a number of reasons, this borough of four hundred and seventy thousand-plus people offers unusually good entry routes for the opioid epidemic. ... The opioid epidemic may seem to be a crisis that simply happened, but actual people set it in motion, and other actual people make it worse and keep it going. The cartel leaders and the smugglers and the dealers belong to the second category. In the first category must be included the former management of Purdue Pharma, three of whom pleaded guilty to a non-felony misbranding charge (Ian Frazier, 9/8).

The Atlantic: A Shave, A Haircut, And A Blood Pressure Test
The barbershop has always been more than a place to get a trim and a shave for African American men. It's a place to talk sports, debate politics, and swap stories. Now it may also be a site for early medical intervention for high blood pressure. Dr. Ronald Victor, the director of Cedars-Sinai Center for Hypertension in Los Angeles, recently received an $8.5 million grant from the National Institutes of Health to test if early barbershop intervention can produce significantly better blood pressure control in African American men. High blood pressure disproportionately affects African Americans (Marissa Gluck, 9/2).

The Atlantic: How Racism Creeps Into Medicine
Today, doctors examine our lungs using spirometers that are "race corrected." Normal values for lung health are reduced for patients that doctors identify as black. Not only might this practice mask economic or environmental explanations for lower lung capacity, but the logic of innate, racial difference is built into things like disability estimates, pre-employment physicals, and clinical diagnoses that rely on the spirometer. Race has become a biologically distinct, scientifically valid category despite the unnatural and social process of its creation. In her recent book "Breathing Race into the Machine," Lundy Braun, a professor of Africana studies and medical science at Brown University, reveals the political and social influences that constantly shape science and technology (Hamza Shaban, 8/29).

FiveThirtyEight: It's Really Hard To Measure The Effects Of Abortion Restrictions In Texas
Nineteen of [Texas'] 41 clinics have already shut down after the first wave of tough new standards went into effect last November. ... After the first wave of closures, researchers at the University of Texas's Policy Evaluation Project surveyed the state's remaining abortion providers and reported that the abortion rate (the number of abortions per 1,000 women ages 15 to 44) had already fallen by 13 percent compared to the previous year. But what's behind that 13 percent number? Are women making illicit attempts to end their pregnancies, carrying them to term, or leaving the state to find an abortion elsewhere? To what extent is the abortion rate being influenced by factors that have nothing to do with the clinic closures? The answer is more complicated than the political debate suggests (Amelia Thomson-Deveaux, 8/28).

Pacific Standard: The Rise Of Biblical Counseling
From the perspective of most mental health professionals, biblical counseling is at best a murky phenomenon. Among many conservative evangelical and fundamentalist Christians, though, it is central. Since the mid-1960s, when Presbyterian pastor Jay Adams first laid out its principles, biblical counseling has become dominant in conservative Christian denominations that follow Reformed (or Calvinist) theology. ... For millions of Americans suffering from anxiety, depression, bulimia, anorexia, bipolar or obsessive-compulsive disorder, or even schizophrenia, biblical counseling is the sole form of treatment they are likely to receive (Kathryn Joyce, 9/2).

The New York Times: A Marriage To Remember 
My mother, Pam White, has had a full life. In her 67 years, she has raised three happy children, enjoyed a rewarding career as a social worker and been a devoted partner to my father, Ed. But, as she puts it, "There's just one little glitch." In 2009, at age 61, she was told she had early-onset Alzheimer's disease. After my mother's diagnosis, I moved back into my parents' house near Boston to help care for her. As my mother started to share her nascent experience with Alzheimer's with me, I began filming our intimate conversations. ... One of the most striking things that Alzheimer's has revealed is the strength of my parents' marriage, even as it alters their relationship forever. This process has been both painful and beautiful to watch (video) (Banker White, 8/25).

The New York Times: In Sickness And In Health
My patients tend to be older, and some couples seem to live their lives going from one medical problem to the next. Just as we're able to get a man's leukemia under control, his wife has hip surgery. Or a woman with lymphoma finally enters a remission, and her husband has a heart attack. It's as if one waits patiently until the other's health issues stabilize. ... People make sacrifices for each other when it comes to health, just as they do with family and careers. When both partners develop cancer, it is no exception (Dr. Mikkael A. Sekeres, 8/28). 

Aeon Magazine: Full Disclosure
The boxes in the living room contained the secrets of [psychiatrist Douglas McGlashan] Kelley's psychological assessments and interviews – the keys to the personalities of the men who ran the Third Reich, ... [the papers] ended up with a son who gave me access to them more than 60 years past [the Nuremberg trials'] end. ... From this treasure trove of long-hidden material I wrote The Nazi and the Psychiatrist (2013). A few months ago, at the end of a presentation I gave about the book at the Mayo Medical School in Rochester, Minnesota, a woman in the audience – the school's staff attorney, I later learned – rose to speak. She posed a question that has left me wondering ever since: "How do you justify making public the medical records and private information of the people you write about?" (Jack El-Hai, 9/1).