January 16th, 2008 by Dr. Val Jones in News
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We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
– The US Declaration of Independence, July 4, 1776
When I was in college I spent my summers working with mentally and physically disabled adults in group homes and camps. Many of the patients had IQs<75, which presented a unique communication challenge. Emotional outbursts were not uncommon as the adults used the only form of communication that seemed to draw attention to an immediate need. I spent a lot of my time trying to predict needs before frustrations bloomed, and after getting to know the peculiarities of each individual, I could generally keep the group in a fairly content state.
Most of the adults were on a long list of medications – some were for epilepsy, others were for heart defects, but many were antipsychotics and sedatives. At the time I didn’t realize exactly what each medicine was for, and wondered why these relatively young men and women needed so many pills.
In retrospect I believe that many of the medicines were a misguided attempt to control behavior. It’s analogous to giving someone, with their hand in a bucket of very hot water, a pain medicine instead of removing their hand from the bucket. And now new research in the Lancet suggests that antipsychotic medications (such as haldol or risperdal) do little or nothing to control aggressive behavior in the mentally disabled (though not psychotic) population.
So why have we been giving mentally disabled individuals antipsychotics for decades? Sadly, we thought that these pills would provide a quick and easy way to conform their behavior to our sensibilities, without having to get to know the reasons for their frustrations. And of course, these people weren’t intellectually sophisticated enough to question the utility of this approach or to decline the use of such medications.
I find it terribly sad that it has taken us this long to realize that giving anti-psychotics to mentally impaired people is not in their best interest. Surely more evidence would have been gathered prior to subjecting “normal” adults to such treatments. In this imperfect world, it does seem that those without a voice are less often heard. It is our responsibility as healthcare professionals to look after their interests and not take the easy way out. Mentally disabled individuals have the right to express themselves, and to be free of unproven and unnecessary drug treatments. Life, liberty, and the pursuit of happiness. Our own Declaration of Independence argues as much.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 11th, 2008 by Dr. Val Jones in Opinion
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Last night I watched the premier of VH1’s new “Celebrity Rehab” reality show with Dr. Drew Pinsky, an M.D. and popular TV and radio personality. Before turning on the TV, I had my own reservations about making a spectacle out of alcohol and drug addiction. But I hoped that the show would help to unglamorize the Hollywood drug culture and dissuade young men and women from idolizing bad behavior. As a physician who helped run a detox unit in New York City, I was also curious to see whether or not this “rehab” resembled real-world drug rehabilitation.
Overall, I was sorely disappointed. The only realistic part of the show involved actor Jeff Conaway (of “Grease” and “Taxi” fame), who was the most impaired and ill of the group. His speech and behaviors were typical of a man so wracked by drug and alcohol addiction that he needed a wheelchair for mobility. It was tragic to see him in such a self-destructive state, and witnessing his condition was a real wake-up call for anyone considering starting down that path. As for the rest of the stars, they seemed to be more interested in getting attention from the camera than turning their lives around and breaking their addictive behaviors.
The good
“Celebrity Rehab” may have some “shock value,” as it offers viewers some footage of individuals whose addictions have destroyed their lives. Although Jeff Conaway’s situation is certainly tragic and unappealing, the other stars still maintain some degree of “coolness” -which may be counterproductive for a young audience.
The bad
Overall, the dialogue is quite dull – which comes as no surprise since the individuals being videotaped were often inebriated or high on cocaine. The desire for true change does not come through in the celebrity stories, as best evidenced by a conversation between Dr. Drew and former professional wrestler Chyna (aka Joan Marie Laurer). Dr. Drew asks Chyna why she has come to “Celebrity Rehab,” and she responds with a shrug and says: “I don’t know.” Not compelling television.
I had the feeling that empathetic counseling is not Dr. Drew’s forte. In his attempt to show tough love mixed with detailed history taking, he comes off as aloof and uncaring. He is neither believable nor inspirational as a change agent. This disconnect makes it hard to believe that “Celebrity Rehab” is going to turn anyone’s life around.
Of course, the plush set, the comfortable celebrity quarters and the trendy clothing bear no resemblance to real drug rehab centers, where facilities are bare-bones and clinical and all patients wear standard uniforms. The lack of case managers, nursing staff and therapists was also notable – as the normal team approach was spun unconvincingly as a one-man Dr. Drew show. And of course, inpatient drug rehabilitation centers in the real world are NEVER co-ed.
The ugly
Some of the footage was so clearly contrived as to be annoying. Provocative pseudo “conflicts” were created in an attempt to maintain viewer interest. At one point, porn star (and attention-grabbing yet unrealistic 2003 California gubernatorial candidate) Mary Carey makes a fuss about having her dildos confiscated and then asks fellow patient Seth Binzer (lead singer of the rap-rock band Crazy Town) if he’ll have sex with her. This type of interaction really devalues the show and further undermines the credibility of the ongoing rehabilitation. Parents should wonder if exposure to this sort of material is more of a harm than a help to their tweens and teens.
In the final analysis, “Celebrity Rehab” has all the makings of a failure “me-too” reality show, relying on sensationalism to lure viewers. Recycled reality TV celebrities prance about the show in low-cut dresses while Dr. Drew makes uninsightful therapeutic gestures in a rehabilitation setting that’s not designed to truly affect change. I believe that drug and alcohol addiction deserves a more sincere and thoughtful analysis — something that an experienced documentary producer could achieve more effectively. I fear that the screenwriter’s strike will result in even more poor quality reality shows in the near term.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 10th, 2008 by Dr. Val Jones in Uncategorized
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I guess all the enthusiasm from Iowa and New Hampshire have translated themselves into the blogosphere. Not only have I been made a finalist in the Best New Medblog of 2007 award contest, but my alter ego – Mindy Roberts of The Mommy Blog has been nominated for the “Hottest Mommy Blogger” in the Blogger’s Choice awards. Please vote for her when you get a chance. You may remember Mindy from my blog posts about her new book called, “Mommy Confidential: Adventures from the Wonderbelly of Motherhood.” Mindy is a fantastic writer with a terrific sense of humor. I’ve posted excerpts here and here. My favorite one is this:
Will is obsessed with size differentials among animals and the relative strengths and weaknesses of each as they relate to other predators. He wants to know exactly how big everything is so that he can determine how many predators it takes to bring down each type of prey. Among the factors are: height, weight, speed, habitat, how far it can jump, whether it can rear up, whether it can swim, and how sharp the teeth are. Usually he wants to know if, say, 20 wolves can take on 10 tigers, but this morning’s question took the cake. “Daddy, can 10 monkeys take down a zebra?”
Many thanks to Cooper and Emily at The Motherhood who have posted a request for folks to vote for my blog in the blog award contest. It’s so great to be loved by MOMs!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2008 by Dr. Val Jones in Uncategorized
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I’m so excited and honored to have been nominated – and now selected as a finalist – for the “Best New Medblog, 2007” award! Thank you MedGadget team! If you’d like to vote for me, please go to this page. The winners will be selected based purely on quantity of votes. The polls are open until midnight, January 20th.
I’ve also collected the best posts from 2007 below so you can get an overview of what my blog is like – where else can you join a weight loss group, read weekly round ups of the best posts from medical experts, stay in touch with breaking medical news, and have a generally cathartic experience with true health stories?
The Best “Feel Good” Posts
A Baby’s Life Is Saved – a young mother forces a doctor to reconsider his diagnosis, saving her baby’s life.
Do the Right Thing– a young intern fights to save the life of a patient that everyone else has written off.
The Wounds of Childhood– how I might have made a difference for a little girl who was marginalized.
Medicine: Face-to-Face– the story of how I treated a child for the same injury I had at her age: being mauled by a dog.
Informed Consent and the Animal Guessing Game– my reflection on the emotional side of consenting for a procedure.
Thanks to Surgeons– a heartfelt tribute to the surgeon who saved my life.
Fly the Ball– the life and times of a Pakistani doctor who builds a successful career in the US.
The Best Infuriating Posts
The Last Straw: My Road to a Revolution– the true story of a child with cerebral palsy who died because he was denied a wheelchair part by Medicare.
The Benefit of the Doubt– how my friend was labeled as a drug seeker and mistreated in the ER.
VIP Syndrome: A No-Win Situation – the story of how a young man with “connections” demanded and received inappropriate and expensive medical tests, leaving the doctors holding the bag.
The Case of a Predator in the Hospital– how one drug user managed to game the system, wreaking havoc on her fellow patients.
Don’t Believe Everything You Read in a Medical Chart– the story of how a misdiagnosis resulted in a patient being wrongly labeled as a drug seeker.
The Real Dangers of Pain Medicine – a woman who died of opiate induced constipation.
The Best Sad Posts
The Scream– how a cavalier end-of-life decision destroyed a family member.
The Size of Unhappiness– a reflection on America’s obsession with thinness.
Baking Cookies– that’s all I could do as a doctor in Manhattan on 9/11.
Unencumbered by Prognosis– my dear friend handles her diagnosis of stage 4 colon cancer with optimism and grace.
Alzheimer’s Dementia: A Life Lived In Reverse– the story of my grandmother’s dementia and her slow mental decline.
The Best Humorous Posts
Conversations at the Spa– the true story of my recent trip to a high end spa in California.
Kids Say the Darndest Things– these are some pretty good ones.
The Christmas Miracle– a “miraculous” icicle forms on a Christmas tree and pandemonium ensues.
Medical Haiku– some irreverent poems I created a few years ago.
Is that Your Real Skin?– the silly conversations that arise when you’re really pale.
Dudes– a quick look at how men perceive a new hairstyle.
The “Perfect” Wedding– the story of how my hair was transformed into an alien head on my wedding day.
The Best Healthcare Policy Posts
Why I Worry about a Government Sponsored Single Payer System – previous experience with government rulings make me distrustful of population based healthcare savings initiatives.
Pay for Performance: More Red Tape without Improved Quality of Care – the title pretty much sums this post up.
Are Physician Salaries Too High? – compare them to health insurance and corporate executive salaries.
Concierge Medicine for the Masses?– my physician is part of an “off the grid” movement in healthcare.
Rationing Healthcare and the Emperor’s New Clothes – I take a look at some of the funding allocation decisions being made by the government.
End of Life Care: Healthcare’s Big Ticket Item– I explore some of the high costs of end-of-life care and the ethical dilemmas that rationing it creates.
Posts That Make You Go…Hmmm
My First Day as a Doctor– it was a baptism by fire.
The Great Unveiling– who are we deep down inside?
Night Float in the Hospice– what it feels like to care for the dying.
Dying with Dignity– I refused to practice intubation on a deceased patient as his family members waited for news in the next room.
Face Transplants: Ethical Dilemmas– should they be covered by health insurance?
The Man Who Couldn’t Speak– a strange diagnostic dilemma solved by a doting mom.
The Best High Brow Posts
Cancer: Do We Really Understand It?– a wonderful post by guest blogger Avrum Bluming, questioning if we really do know as much as we think we do about this formidable foe.
Hormone Replacement Therapy: A Critical Review– another wonderful post by Dr. Bluming.
Good Science Makes Bad Television– a series on research methodology and why the public should care about it.
The Power of Magical Thinking– describes how to recognize snake oil salesmen.
What You’ll Learn in Pre-Med Classes– a rant about how irrelevant some of the course work is that is required for admission to medical school.
What the Heck is a Rehab Doc?– the history of my medical specialty: PM&R.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 8th, 2008 by Dr. Val Jones in Health Tips
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Washington DC boasts some of the longest escalators in the world.
I’m not sure who decided to build all these extra long escalators
(maybe an escalator manufacturer had some political friends?) but the
very longest one is at a subway station in Bethesda. One evening my
husband and I happened to be getting off at that subway stop to see a
play and were curious to experience this marvel of human engineering.
As we rounded the corner to the beginning of the escalator, we
encountered a very long line of people. I wondered what they had all
lined up for in a dingy subway station – surely no one was giving out
free country club memberships. As my cogs and wheels turned, I realized
that there was one tiny elevator at the very front of the line. As I
inspected the escalator more closely I realized that the stairs were
not moving. Ugh.
I looked at my husband, I looked at the elevator
line, I remembered my weight loss group, and I hiked up my coat and
began the very long journey to the top of the stairs.
Of course,
when it was time to return home after the play the escalator jubilantly
moved us from the top of the stairs to the depths of the subway
station. Murphy’s Law – it was working for the descending phase of the
climb.
If one of your New Year’s resolutions is to lose weight, please
share your small victories here or join a couple of hundred people trying to do the same. Have you resisted
temptation or gone the extra mile to lose weight and get in shape? I’d
love to hear about it!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
