The myth of choice in medicine

By: | April 1, 2011

I’m probably not the only one who has noticed a shift in the way we talk about health care these days. It’s no longer about patients taking the advice of their doctors. It’s about “consumers” making “choices” about care.

We’re shifting away from the old model of medicine, in which doctors guided medical decisions because they knew what was best for us. Nowadays we come to our doctor’s appointments armed with printouts from the Internet, try to understand the true risks and benefits of every procedure, and, supposedly, make our own informed decisions.

But the model of consumers and choice isn’t always a perfect fit for medicine, and the ongoing controversy over the Maine home birth study shows why. This month, the American Journal of Obstetrics and Gynecology will publish a series of six letters critiquing the study, released last year, that claimed to find that babies born at home were more likely to die than those born in hospitals. The journal also published the authors’ responses to the critiques.

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Three Stooges vs. Revelation

By: | March 31, 2011

The Chesapeake Bay was born as the Susquehanna River.  Around 35 million years ago, an asteroid apparently smacked into what is now eastern Virginia and left a 50-mile-wide crater, a sink into which all the rivers – mainly the Susquehanna but also the Potomac and lesser rivers — coming east out of the Appalachians naturally flowed.  Millennia came and went, ice ages came and went, and about 8,000 years ago melting glaciers raised the level of the Atlantic enough that, over the next couple of thousand years, it flooded into that old crater and on up the river valleys and created the Chesapeake Bay.  I’m telling you this story mostly because I like it but please, bear with me, I do have a point.

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A Dictator’s Rule

By: | March 30, 2011

Three weeks ago, a BBC journalist experienced first hand the random brutality of Libyan leader Muammar Gaddafi’s security forces. Chris Cobb-Smith and two colleagues were heading to the town of Zawiya to cover the conflict, when security forces arrested them at a checkpoint and hustled them off to a makeshift prison. There guards repeatedly beat one of Cobb-Smith’s colleagues with a plastic pipe and other implements. The next morning, they drove Cobb-Smith and his associates to another compound and lined them up execution- style along a wall.

One of the guards pointed a submachine gun equipped with a silencer at the terrified men, and ordered them to face the wall. Then, as Cobb-Smith recalled in a recent interview, “he pointed the barrel at each of us. When he got to me at the end of the line, he pulled the trigger twice. The shots went past my ear.”

Cobb-Smith and his colleagues were released a few hours later, badly shaken by these experiences. But many Libyan civilians appear to have been far less fortunate. In May, International Criminal Court prosecutor Luis Moreno-Ocampo will present a report to the United Nations Security Council on alleged war crimes committed by Libyan security forces in the first days of the armed conflict, from February 15th to 26th.

I have become increasingly interested in these grim cases because archaeologists often take part now in the investigations, conducting excavations of mass graves.  Continue reading →

Brooklyn Takes its (Unnecessary) Medicine

By: | March 29, 2011


Last week, my neighborhood health food store ran out of potassium iodide, a compound that can prevent thyroid cancer in people exposed to high doses of radiation. When I called the store, an employee told me demand has been high “ever since the incident in Japan.” I live in Brooklyn, New York, nearly 7,000 miles away from the damaged Fukushima nuclear plant. So what my neighbors plan to do with their potassium iodide is a total mystery. (FYI, if you try to use Google maps to determine the distance from Brooklyn to Fukushima, you will be directed to “kayak across the Pacific Ocean.” No joke.) Continue reading →

Contamination in Goiânia

By: | March 28, 2011

On 24 September, 1987, six year old Leide Ferreira threw up ten minutes after eating her egg sandwich. The next day her parents started throwing up too. Vomiting and diarrhea were followed by strange aches and burns. When Leide’s mother Maria went to the public health clinic in Goiás, the doctor ascribed her symptoms to food poisoning and sent her back home. Leide’s grandmother, who came to help her family, got sick too. Lesions crept over their skin and their hair fell out. The family’s neighbors began to think they had AIDS.

On 28 September, Maria dragged herself back to the doctor’s office and deposited on his desk a small plastic bag filled with iridescent blue powder. This, she said, was the culprit. The doctor dismissed her claims as superstitious nonsense and admitted her to the Tropical Diseases hospital. But another doctor at the clinic called a health physicist to test the mysterious bag. The next day, 112 thousand people found themselves packed into Olympic stadium, queuing at hastily constructed tents to be tested for radiation poisoning.

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New Person of LWON: Sally Adee

By: | March 25, 2011

Please allow me to introduce a new person of LWON . . . Sally Adee, a technology features editor at New Scientist and an all around top-notch human being. I first met Sally in 2006, when we were both starry eyed graduate students at Johns Hopkins University in Baltimore. Back then she was obsessed with nuclear waste. I would say, “I’m having boy troubles. Can we grab a beer and talk?” And she’d say, “Let me tell you about the nuclear waste tanks at Hanford.” And if there’s anything that can make personal problems seem inconsequential, it’s the ghastly radioactive sludge in Hanford’s underground tanks. (If you want to know more, you can find Sally’s 100-page thesis in the library at Johns Hopkins’ Homewood campus.)

These days, Sally has new obsessions — British accents, roller derby, computational neuroscience. But her commitment to producing fine science journalism endures. Sally gets the facts, no matter how much sleuthing it takes. LWON is lucky to have her.

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Image of spent nuclear fuel at Hanford courtesy of the US Department of Energy

Orchids and the Scent of Death

By: | March 25, 2011

As someone who writes about archaeology, I often consider myself to be in the death business. I’ve grown accustomed to the company of skeletons and mummies, wrapped in their linen bandages, curled fetally under ancient house floors, or splayed in a tangle of bodies in a mass grave. Now, like a mortician, I take a kind of professional interest in the processes of death and decay. And this is why I was so intrigued recently by new research out of South Africa on an orchid, Satyrium pumilum. Its flower, reported the researchers, exactly mimics the odor of decomposition, specifically that of a decaying mammalian carcass.

How odd, I thought. Why would any plant do that?    Continue reading →

Dreams of Resilience and Bikini Atoll

By: | March 23, 2011

The late-night radio airwaves—the insomniac’s solace, the new father’s companion—have been heavy with war, disaster and calamity for weeks now. How very different are the sounds of bombing runs over Tripoli from the small coughs and cries through the baby monitor, with which they commingle.

The most extraordinary news of the past two weeks, however, does not have a sound, at least not one that can be captured on the radio. It is the grace, strength and equanimity of the Japanese people under the most challenging conditions. It is a demonstration of what poets and social scientists alike would recognize as resilience—that ineffable quality of somehow remaining unbroken in the face of the unexpected and the catastrophic.

Measuring and enhancing resilience in human communities is a relatively new endeavor—one I plan to write about in the coming weeks—and it is perhaps easier to quantify resilience in the ecological than in the human sphere. It seems appropriate somehow that one of best documented and most dramatic recent examples of ecological resilience comes, like Chernobyl 25 years ago and Fukushima Daiichi today, packaged with all the bright futurism and dark paranoia of the nuclear age. Continue reading →