Archives for category: Medicine

“When a disease image is used by Machiavelli, the presumption is that the disease can be cured. ‘Consumption,’ he wrote, in the commencement is easy to cure, and difficult to understand; but when it has neither been discovered in due time, nor treated upon a proper principle, it becomes easy to understand, and difficult to cure.” (from “Illness as Metaphor” by Susan Sontag)

This is sort of an obvious idea, that if you are looking out clearly before everyone else is, what might eventually be a problem, isn’t hard to solve. And when it’s obvious to everyone, it’s very difficult to solve. This is where we are now. I’ve read the same articles everyone else has about PPE and stay at home measures and masks.

And what the hell happened in Michigan this week? Armed people stormed the capital and got in? And were not stopped? (As one friend noted: Is it time to be scared yet?) Everyone apparently went home at the end of the day and no one was hurt or shot. (As another friend noted: This is how you know they were white.)

The problem is obvious if there’s compassion, but how can we show compassion to those who behave in ways that we despise? Those Michigan protesters are frightened, possibly already out of work, financially and domestically at risk, and desperately wanting a return to normal. Because I want doctors and nurses not to be at risk and nursing homes and meat packing plants not to continue to be outbreak vectors, I see this thing one way. But those folks storming the Lansing statehouse? They want to be able to work and get the kids out of the house and fight battles against things they can see, like legislators rather than things they can’t.

Years ago, a woman I respect pointed me to The Five Love Languages, a bit of relationship self-help which I read and found things applicable to my own relationship. (I’m a fiction guy – this is way out of my usual reading, so bear with me.) The writer is a marriage counselor with a heavy Christian leaning and I took from it what spoke to me and let the rest go. The thesis is that each person feels best loved when that love is expressed in one or two of five different ways. And he illustrates this with a couple dozen case studies from his own practice. One such case has stuck with me: A woman comes in for counseling whose husband has been emotionally abusive to her since not long after their wedding. Her attempts to communicate and love in her husband’s language started to bridge the divide between them and they were able to build their relationship together again.

In America’s political divide, from which we find armed men from one side invading the capital where a governor from the other party is trying to keep people safe from our current pandemic, we have to find ways to make the whole thing work. I’m not suggesting that those of us on the left simply need to learn the love languages of those on the right and that will make everything better. In the summer of 2016, I spent some time with some very politically active and astute members of my family. A cousin predicted that we would lose the election because democrats still weren’t speaking to the needs of those in the so-called heartland. I’m not sure if that’s the (only) reason we lost, but I’m not seeing the language coming from Joe Biden that’s going to cross the divide either. Note: I’m also an armchair policy wonk. I want to hear from Biden specifically what he’s going to do to ease the crisis. How he’s going to get PPE and ventilators to all the places that need it, how he’s going to make people the focus of the crisis and not big business, how how how. I’m not getting it yet, but I’m probably not listening in the right places. (And being an ocean away from the US part of this crisis, means I’m not seeing the headlines on a daily basis either.) In politics, policy might be my love language.

And getting back to the opening salvo: the illness and its associated crises are very easy to see now. And as such, very easy to suggest how to attack each portion of the problem. One thing I see that we need is a kind of national compassion that is beyond the skills of the current administration. What I hear is the stoking of division and the coddling of big business at the expense of the working class. This has been what I’ve heard and seen as long as this administration has been in power. The current moment demands unity and unification if we’re going to solve it and most of us live through it.

Karl Marx was being somewhat reductionist when he said that history repeats itself, first and tragedy, then as farce. And I won’t be the first person to suggest that the Corvid-19 tragedy in the US is a repeat of the AIDS crisis of the 1980s. The earlier was (for those of us in the West) a great tragedy, and what’s affecting us now surely isn’t farce – it’s a tragedy on a larger, faster scale. One of the reasons it’s such a tragedy is that many people learned from the AIDS crisis, President Trump just isn’t one of them.

This probably isn’t the first time I’ve mentioned on this blog the travesty of the Reagan administration in not acknowledging the toll AIDS was taking on a couple of communities in the United States, even when it took the life of his friend Rock Hudson. He refused even to name the disease until well into his second term. That the hardest hit communities were the gays and the intravenous drug users might have had something to do with this. I initially wrote that Reagan was handily reelected even with ACT-UP protests in the capital, but ACT-UP wasn’t formed until 1987. As long as the communities were demonized, though, there was no need to worry. It didn’t hurt Reagan that his opponent in ‘84 was the relatively uncharismatic Walter Mondale.

But the fact is that over the first 20 years of the epidemic, 774,467 people in the US were diagnosed with HIV. 448,060 died of its related ailments. (HIV is still the cause of approximately 1 million deaths per year, mostly in sub-Saharan Africa and Asia.)

The disease wasn’t discussed in US political circles, except in reference to the innocent victims. Remember the Ryan White Act? Innocent meaning not gay, not a drug user. Comics used it as a punch line. Sometimes the entertainment industry stepped up (Philadelphia), generally not. But eventually there was movement in the research and the disease became less of a death sentence, at least in the West. Africa? Still a different story. Standard Precautions also evolved out of the AIDS epidemic. Previously there had been precautions associated with whatever diagnosed illness the patient presented with. First Universal Precautions (1986 or so), which referred specifically to blood and blood-related bodily fluids, and then Standard Precautions superseded those with a set of practices for all those who had patient (and especially body fluid) contact and weren’t dependent on the patient presenting symptoms. When I was working in healthcare in the 90s (as a secretary in home health for a major HMO), I had to be familiar with these, even though it wasn’t in my daily routine to practice them.

Read that WHO doc on standard precautions, or this one from the CDC. That’s okay. I’ll wait.

Did you note the bits about cough safety and hand washing? Yeah, those ring bells because we’re coughing into our elbows now and washing our hands eighteen times a day. What about PPE, sterilization, and infection prevention? Yeah. We’ve had rules in place about those things for decades.

Which brings us to the current repetition.

We know just about when this outbreak came to the US. And we’ve listened to the president and his cohort lie, cheat, steal, brag, and generally screw over those most in need: those suffering from this dreadful flu and the health professionals doing their utmost to help those patients. If the AIDS crisis was itself a tragedy, what can we say about the sheer numbers of this pandemic and the madness of the federal response?

In United States of America, from Jan 20 to 2:00am CEST, 15 April 2020, there have been 578,268 confirmed cases of COVID-19 with 23,476 deaths. (https://covid19.who.int/region/amro/country/us)

I’m not really sure how to address this. In less than a week, we will see the number of cases of COVID-19 in the US in three months exceed the number of AIDS cases recorded in 20 years. And we knew how to prevent the outbreak, or at least lessen its effects, and we knew what was needed to safely take care of those suffering. (In fairness, we knew how to do those things relatively early on in the AIDS crisis, too.) And we didn’t. Not only were we as a nation unable to meet this crisis in a unified way, we were undermined from the outset by the avarice of those who should have been setting sane policy.

In Illness as Metaphor, Susan Sontag discusses the different ways in which tuberculosis and cancer were treated by the medical profession and by family members of those suffering those diseases. TB had an odd romance about it, but in both cases, even the mention of the disease was thought to add another burden to the patient. One of several dozen key points she makes is that, ‘All this lying to and by cancer patients is a measure of how much harder it has become in advanced industrial societies to come to terms with death. (Ch. 1)’

This speaks volumes to how much we as a society really want to believe that getting back to normal, opening the markets, and so forth is preferable to addressing the massive numbers of suffering on our doorsteps. I’ll be honest, I’ve only finished two chapters of Illness and haven’t gotten to the second volume, AIDS and Its Metaphors. But I think Sontag will have a lot to say that speaks to our current condition.

The main reason I’m bringing Sontag’s points into this discussion is that we don’t have the time to be either romantic or blithely quiet about COVID-19. We should be studying and learning and financing the science and the health to get to the other side of this. And doing the work to protect one another. But instead we have the anti-science coming out of the White House and folks like the protesters in Michigan demanding society be reopened so they can shop and have their hair done.

I grieve.

We’ve painted ourselves into a corner with the outbreak of Covid-19 (aka Coronavirus). How much manufacturing previously done in the West is now (not being) done in China and other countries in Asia? We made a decision in the 80s that American manufacturing was too expensive and that we’d do better as industrialists and consumers to move production to Mexico and Asia. This, I suppose, is fine, save that we stopped paying living wages to America’s (former) manufacturing employees and increased their credit lines as a sort of compensation.
That’s three of several dozen problems that have been building up in the US over the last 35 years or so. How we handled American purchasing power is a different part of the discussion. China raised its own game in the years following the pro-democracy demonstrations in 1989. You can’t have democracy but if you’re a Chinese citizen you are entitled to some more of these trappings of capitalism. And it seemed to work. Many Chinese got filthy rich, casinos opened on Chinese real estate, for example, and if you weren’t used to democracy, it did work. Hong Kong? Different question. (Fairport Convention’s Jewel in the Crown seems appropriate.)
Anyhow, US and to a lesser extent, I think, European purchasing power went up, because a lot of Chinese made a lot of stuff very cheaply. So it didn’t matter that real wages in the US haven’t shifted much in 40 years. The decline of unions in post-Reagan America pushed workers into so-called service industries where real wages are kept artificially low much of the time.
Bottom line: We don’t MAKE anything, and as a result we’re in a position where the place that does make all our stuff is on lockdown for we don’t know how long. And creating a manufacturing sector out of whole cloth can’t be done so easily anymore. (It could be done if we were willing to pry a little bit of money and commitment out of the 1%. Not in the cards at the moment.) The same is true in Europe. We have the tools to create that self-sufficient situation, but it means retraining the populous to buy what they need and a lot less of what they want. We’re going to learn mighty soon that the old watch, phone, and TV will last a little longer. (A little less of the planned obsolescence would go a long way.) Clothes and everything else we buy might be more expensive, but part of what we need to do to recover, sustainably, from this crisis is to rebuild the industry and rework how we as people and consumers and industrialists relate to industry.

In a New Yorker book review (16 Feb, 2015), Nathan Heller describes the places of several nordic countries on various happiness indices. He offers some reasons why these peoples measure their own happiness so positively (good schools, free tuition, effectively free health care, an unfrayed safety net, before offering the opinion of Michael Booth, author of The Almost Nearly Perfect People, that the services one receives in exchange for an upper tax rate of over 70% are ‘patchy’.

Heller delves deeper into Booth’s arguments, pointing to alcohol consumption, employment rates, bureaucracy, and cuisine, and ultimately shreds both Booth’s approach (let an expert speak at length, then quote without fact-checking and present everything in a quasi-Innocents Abroad ‘aren’t these foreigners quaint’ fashion) and his conclusions. Finally he moves from discussing Booth’s take on Scandinavia to an assessment of the current changes to the social order in many of these countries as a result of immigration and rising inequality.

While it’s a shame that the welfare state aspect of many such countries is being undercut by US-style “free-market” “improvements” (see the privatisation of the rail system and tuition requirements at formerly free higher education facilities in the UK, for example, not to mention the pillage of the NHS that not even Maggie Thatcher would have dreamed of), these things are not trivial. I’m not the first to suggest that I don’t mind my taxes paying for education even though I don’t have children: I don’t want to live in a society surrounded by the uninformed. The review describes a Swedish couple, the wife of which didn’t pay any tuition to become a neurosurgeon. Fantastic. I’d rather any doctor I see to have gone through medical school on merit and without the worry of how to pay back hundreds of thousands of dollars/euros/etc. in student loans.

The introduction of tuition to previously taxpayer-funded universities is a tradition pioneered by Ronald Reagan when he was governor of California and, as noted, now followed by Cameron and his cronies in the UK. Like the privatisation of the rails and the NHS, it is nothing but a transfer of wealth from the lower and working classes to the bankers and other members of the 1%. Calling it anything but a handover to the City of London is to miss the point.

Rachel Maddow this week told of how Wisconsin’s Governor Walker is on a quest to slash funding for his state’s renowned public university system by hundreds of millions of dollars. Same thing. Please the bankers, and your next campaign is funded.

At the same time, Germany is offering free tuition to its universities to anyone who can pass the entrance exams. My sister told me of a couple she knows with two kids, eight and ten, if I recall rightly, who are moving there, though this new plan does not require German residency or citizenship. Language, yes, but if you can get in, Berlin will pay your tuition.

This is the choice we’re after – we can educate and take care of the next generations or we can continue to mess it up. In the US, the war on education has taken a number of forms – one the age-old battle against teachers’ unions and the despicable salaries we pay to those who spend the vast majority of their waking hours either looking after our children or finding ways to make sure they know enough to get to the next level. Another is the fight against teaching science in all its forms, but primarily the teaching of evolution. I share the belief that no questions for which science provides an answer have been better answered by religion. (I’m sure there’s a better quote from someone like Sagan or Tyson, but that’s the gist.) In some regions, I’m distinctly in the minority and 90 years after the Scopes trial, we’re still fighting the same battle.

Yes, I’ve gone from discussing free education to useful education, but surely these things go hand in hand. We had a short period during which we as a culture recognised not only a right to an education, but a responsibility to educate the next generation. It’s possible that period ran only from the GI Bill to (in California) Proposition 13, but with the slashing of tax revenues from a variety of places (Governor Brownback’s Kansas fiasco being a major one), public education takes a big hit.

The upshot of this is that people in states with very high tax rates are still happier and better off by a number of measures than those in the low-tax United States. My guess is that a secure education and worry-free medical care play a very large role in that.

In 1985, the band Coil released a cover of the song Tainted Love. In the booklet for the Scatology CD on which it appears, there was a photo of the two core members, John Balance and Peter Christopherson and text indicating that at publication some relatively small (but shockingly large if you knew them) number of people in the UK had died of AIDS. 184, if I recall correctly.

In the early 1980s, when it was obvious that the vast number of westerners dying of HIV were gay or drug users, the religious right could point at the victims and claim it was divine punishment for sin. What had yet to name itself the Reality-based Community saw this demagoguery for what it was, and fought hard to get some recognition for what was actually happening: a health crisis of vast proportions. The fact that President Reagan would not utter the name of the disease until it was well past time that a concerted effort could have eradicated it. (In a 1982 press conference, White House spokesperson Larry Speakes laughed about it when a reporter asked about the 600 cases then diagnosed.) And now (though we don’t talk about it much), millions of people are still infected with it, with numbers growing primarily in Africa (for a variety of well-researched reasons), but in the west as well.

The BBC yesterday morning indicated that in the latest outbreak of Ebola, 4417 people had died of the disease. Most of them Black and most of them not in the West. The Onion ran a headline to the effect that ‘we’re only fifty white people from a cure for Ebola‘. If only. Papers yesterday ran editorials pointing to slashed medical research budgets in the US being key to our not having an effective and mass-producible treatment for Ebola. Shocking as fuck, that one. As is the fact that the US doesn’t have a surgeon general because the NRA of all groups objected to President Obama’s nomination.

Rachel Maddow reported two nights ago that new cases are coming up in Africa at a rate of 1000 per week and are on track to increase to 10,000 per week in the coming months. And how does the US react to its first case? The family of Thomas Edward Duncan were quarantined in the house where he fell ill for, what, a week? With his sweat and vomit soaked bedding, and no one would step up and take them in. Christian charity finally came in the form of a Dallas county official who secured them rooms in a private home. In all of Texas, *no one* else stood up? Big fucking state to have so many cowards. Would I step up? I don’t know. When Ebola comes to NL, we’ll see if our infrastructure is up to the task. I wish I could say ‘If Ebola’, but given the current spread, I think it’s unlikely to stay in small African countries about which the rich countries couldn’t give two farts.