October 6th, 2007 by Dr. Val Jones in News
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Have you ever been singled out in a lecture and picked on? Or maybe at a comedy club? It’s somehow awkward when everyone is looking at you, and you can’t really defend yourself. That happened to me yesterday in a lecture about how email can transform medical practices. My friend Joe Scherger was talking about the beauty of asynchronous communication, and how much time it saves – when out of the blue, he said that Blackberries defeated the whole purpose of emailing, and that people who used them lead unbalanced lives. He then pointed at me and said, “See my friend Val Jones, there? She uses a Blackberry all the time!”
All eyes fixed on me with a sort of half pity, half “tisk, tisk” expression.
“She answers all her emails within minutes… She never unplugs.”
I shrugged and smiled sheepishly. Soon the conversation turned to other subjects, and I resisted the urge to pull my Blackberry out of my bag to check my emails.
Today I heard that Intel instituted email-free Fridays as a means to force their engineers to talk to others face-to-face. Apparently, the company was worried that interpersonal skills were being lost, and that people were not developing normal working relationships because of the artificial distance created by email-only communication.
“Well, at least I’m not alone,” I thought as I read the news story. “This is a serious problem across the country.”
There has been recent debate in the psychiatric community about whether or not video games could be considered an addiction (just as drugs and alcohol can be). Some have proposed that it be added to the DSM-V due out in 2012, others have said that compulsive video game playing is a sign of other underlying pathology (such as depression or social anxiety) but not a true addiction.
But the bottom line is that overuse of the Internet can disrupt a person’s time available for meaningful interpersonal relationships, be they with a spouse, a parent, a relative, or a friend. When your husband is sitting in the same room with you and has to get your attention by IM-ing or emailing you, you know there’s a problem.
And there doesn’t seem to be much of a break in sight – with Facebook, MySpace, Linked-In, YouTube, Pownce, Twitter, GTalk, blogs, podcasts, discussion boards, chat rooms, forums, etc. available as 24-7 forms of entertainment and communication, and companies like Intel trying to forbid this kind of stuff at least 1 day per week, Blackberries are the least of our worries. I wonder if these programs are like junk food for the brain? Will we soon suffer from cerebral obesity?
I’m afraid that I recognize that there is a problem, but I’m not sure what the solution is. “Just say no” to email doesn’t work for me… I like the fast-paced interactivity and connection I get from these activities. Maybe there’s a positive feedback loop at work, though – we spend a lot of time involved in online activities and become more isolated and lonely in our personal lives. In the end we become more and more engaged with the Internet to fill the emotional gap that we’re actually creating by overusing it.
I’ll ask my husband what he thinks… perhaps I’ll send him an email about it tonight.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 15th, 2007 by Dr. Val Jones in True Stories
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Physicians see horrible things, tragic injustices caused by unexpected disease and circumstance. We do what we can to remain compassionate – to be emotionally “present” and yet to keep the professional distance required for our survival and success. It takes courage to set a bone, crack a chest, to do painful procedures to save lives – there must be no hesitation when minutes count.
And I suppose that our saving grace is that the majority of the patients we meet in tragic circumstances are not personally known to us. We appreciate their humanity in a general sense, but are not pierced and incapacitated by a family tie or bond of friendship. We are pained by their suffering – but we can cope.
That is, until we’re confronted with a loved one who is thrust into tragedy. Two days ago, a dear friend and former coworker called me to say that she had been diagnosed with colon cancer that had metastasized to her liver. She had just given birth to her first child at age 41. Her only symptom? Post-partum fatigue.
My friend is a health nut and athlete – she has lived the “gold standard” life from a preventive health perspective. I always wanted to be more like her – eating lots of veggies and running regularly. She has been at her target weight all her life, has the occasional glass of wine, and spends much of her free time in community service projects and charity work. She has no history of cancer in her family – they are all hardworking, clean-living types who enjoy long, productive lives.
So when she told me about her advanced disease I almost fell off my chair. How could this happen to her? She is too young! She doesn’t fit the right description… Why didn’t I catch this sooner? Did she ever give me any hint of a warning symptom?
She told me that after having her baby she just felt really tired and was unable to bounce back as quickly as expected. I was worried about post-partum depression, and she eventually decided to see a family physician about her fatigue. He was unclear as to its root cause, and ordered a broad range of general blood tests – including liver function tests. They turned out to be abnormal, and he inquired as to whether my friend might be a drinker. She denied any such tendencies, so he scheduled an ultrasound. The ultrasonographer noted the appearance of metastatic cancer – she had a CT scan and a colonoscopy to confirm the diagnosis of colon cancer. We were both in shock.
And now as my dear friend faces likely surgeries and chemotherapy, I am witness to her journey – the same one that I’ve observed in strangers – but this time I have no professional defenses. I will watch as her body is wracked by the disease’s treatments, I will understand the individual circumstances behind her bravery, I’ll know and feel everything in a personal way that I can’t control.
I am about to join the millions of cancer patients and their families on the other side of the examining room. This time I’m not the doctor, I’m the close friend who rages against a disease that is not fair. And I am ready to fight.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 28th, 2007 by Dr. Val Jones in Health Tips, Medblogger Shout Outs
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I was a bit tired today, thinking about how nice the long weekend will be. A colleague wrote me an email reminder to slow down… he said, “go home and have a nice glass of wine and relax.” I guess research supports drinking in moderation – it’s good for the heart, right?
But then, I noticed this poem in Paul Levy’s blog – and I realized that we docs could all use a little slowing down…
ENCOUNTER ON THE STAIRS
By Warner V. Slack, MD
Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the dayThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 27th, 2007 by Dr. Val Jones in Opinion, Quackery Exposed
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On the recommendation of several members of the blogosphere, I’ve been watching a new British TV Series called “The Enemies of Reason” hosted by Richard Dawkins, a noted atheist and evolutionary biologist at Oxford. The series offers a skeptical review of the claims of alternative medicine practitioners, strung together with Michael Moore-like skill, and designed to showcase the fringiest believers as they concoct wild, pseudoscientific explanations for the mechanism of action of their therapies. It is entertaining and whimsical – though Dawkins himself appears dogmatic and cold as he ultimately builds a case for science as a religion.
Although I agree with Dawkins on many points, I think his approach is somewhat superficial and unnecessarily adversarial. Instead of unmasking kookiness and labeling people as “enemies of reason,” I think it would be more interesting to ask: why are people seeking out pseudoscience? What is the deeper need that scientific medicine is not satisfying? Why are billions spent on alternative therapies? (Please note that the “alternative therapies” that Dawkins evaluates include things like quantum homeopathy, magnetic healing, angelic guidance, and other treatments that don’t have evidence-based underpinnings.)
I think that at the very heart of the matter is that we humans want to feel in control. For millennia we’ve been conjuring up bizarre theories in order to believe that we can influence our destinies and our health. Just take for example the elaborate Egyptian religious myths (health was controlled by one’s ka which required regular food and drink offerings – not to mention all the elaborate embalming rituals to influence a good afterlife). All of these rituals provided the Egyptians with a sense of control over their lives, deaths, and reincarnations. I’m not entirely sure that we humans today are much different in our desire to control our lives. We just manifest it in other ways.
Ironically, science feeds pseudoscience – the more we know, the more definitive we can be about a disease or its prognosis – and the greater the desire to buck against that. And so as we advance in medical understanding, it is not surprising that there is renewed interest in magic as a means of influencing our clinical course as the inalterable progression becomes clearer and clearer. Add to that the fact that the physician-patient relationship has been undermined by a series of unfortunate historical circumstances (the rise of health insurance middle men, decreasing reimbursements, administrative red tape, etc.) and you have a group of dissatisfied patients with chronic diseases that have predictable complications – all seeking alternative outcomes at the hands of any compassionate person who promises to give them some control back. Of course, our “quick fix” culture also gives rise to a preference for simple solutions, rather than complex (though effective) ones. Is there any wonder that snake oil has emerged as a major player in this climate?
Dawkins makes the convincing argument that certain alternative medicine practices rely entirely upon the placebo effect. If this is the case, practitioners of these therapies cannot admit that their remedies are placebos – in so doing they would undermine their potential effects. Therefore, one cannot expect a rational response from them when confronted with evidence that their strategies do not work or are implausible. For the remedies to have a perceived effect, they only need to be believed in by the recipient. The millions of dollars spent by the National Health Service and National Institutes of Health attempting to uncover the mechanism of action of implausible therapies (such as homeopathy) will not influence the millions of faithful believers who turn to such practices for their health. I suppose that once the placebo effect has been scientifically proven, only the skeptics will be convinced by the data.
In the end however, Dawkins’ “war” is not between the evidence based medicine camp and the placebo based medicine group, it’s really an internal battle that each of us faces about our own mortality. The process of coming to terms with health and disease is uniquely personal – some want to be (as Dawkins puts it) coddled, others want the cold hard facts. As for me, all I want is for patients to be able to make informed decisions, not to be misled about therapeutic safety or efficacy, and not to be guided away from known effective treatments and towards known ineffective treatments. I suspect that this is what most people want as well.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 21st, 2007 by Dr. Val Jones in Uncategorized
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I had an interesting dialog with Dr. Bruce Campbell recently. In his blog he described a patient who lost about 60 pounds after losing his sense of taste. The patient had undergone radiation therapy for throat cancer, and in the process lost his ability to taste food. He soon lost interest in eating, and eventually dropped 60 pounds – not from the cancer, but from the side effect of radiation therapy. In this case there was a happy ending (his sense of taste eventually returned and he regained some of his weight) but it made me think about the relationship of flavor to obesity.
Just as I was musing on this very fact, a new research study was published in the journal Neurology. It suggested that unexplained weight loss was an early warning sign of dementia. They speculate that this could be linked to another early sign of dementia: loss of the sense of smell. Of course taste is largely a function of smell, so we can easily understand how people lose interest in eating when they can’t enjoy the flavor of food.
Wouldn’t it be interesting if we could temporarily alter a person’s sense of taste in order to affect weight loss? I doubt I’m the first to think of this… has anyone else heard of such a strategy? Surely this would be a little bit less invasive and dangerous than bariatric surgery.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
