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And the Band Played On…

In Books on May 12, 2010 at 10:18 am

I just finished reading one of the most engaging books I’ve ever read – And the Band Played On: Politics, People, and the AIDS Epidemic by Randy Shilts.  As indicated by the title, this book vividly portrays and honest retrospective evaluation of the history of the AIDS epidemic in America and how multiple parties conscientious negligence of the issue lead to the needless loss of hundreds of thousands of peoples’ lives and further diffusion of the disease that could have been dampered.  Shilts took no prisoners and placed blame on everyone – from the press that chose to ignore the disease until it started plaguing mainstream America, to the scientific community who allowed egos to get in the way of progressive research, to blood banks who didn’t want to lose profit rather than save lives, and to even members of the gay community who ignored warnings to stop dangerous sexual practices to avoid spreading the disease instead favoring sexual liberation, to finally, the US government.

As you can imagine, our lovely governmented failed astronomically with this situation.  In short, Reagan failed with AIDS much how Bush failed with Katrina. Random tangent: Did people really like Reagan? I don’t get it… (imo) Reaganomics failed, (fact) the “war on drugs” initiated by him is a waste of a lot of money and energy that could be better dispensed elsewhere, AND (fact) because of his personal inaction and his administration’s determination to divert necessary funds away from anything pertaining to AIDS hundreds of thousands senselessly died.

As I tore through the pages, I was nearly brought to tears on numerous occassions. One was the stories of the numerous AIDS babies being born that were neglected by the government and hospitals because they refused to believe that this “gay disease” [fyi: AIDS was originally called GRIDS (gay-related immune deficiency) by our government] was anything but a curse on this one population of people. They continued to deny that AIDS was causing the deaths of IV drug users, babies, and hemophiliacs (a class of people heavily reliant on blood transfusions at the time), even after it was the proved cause proved.  I read tear-jerking stories of people going into hospitals, having surgical complications necessitating blood transfusions, and being transfused with HIV-infected blood that could have easily been screened out had Blood Banks been ethical leaders and not money-hungry businessmen. I could continue with the stories, but the point is that day after day for nearly a decade (~1978-88) AIDS and its victims were swept under a rug of indifference woven by our nations’ leaders in health, media, and politics.  It was not until the disease started affecting Hollywood and non-minority heterosexual that the media and the goverment decided it was an important enough issue to address.

I’m not going to lie, by the time I finished reading this book (forewarning, it’s rather thick to get through, but definitely worth it), I was p.o.’ed at our government, yet again.  How many times throughout history do we have to see our government pruposefully neglecting the rights and needs of certain populations within our borders because they are not in the majority, and therefore are apparently less important constituents?!? This theme was clearly repeated in Katrina and even as recently as his ridiculous legalized racial profiling in Arizona. When will the government start treating us all like we’re all citizen of the human race with lives that are valuable, rather than separate and unequal?? For a nation that has a “Christian” founding, declaring statements such as “In God we trust” and “one nation, under God,” and a nation that has yet to see a non-“Christian” Prseident, we have a horrid legacy of treating people as anything less than children of God. I put the word Christian in quotes because I’m a firm believer that there’s a difference between the regilion and the personal relationship with God.  Based on history, I have my doubts about the sincerity of this religious affliation in the lives of our nation’s leaders. I think it’s just one more thing on their resume that qualifies them for the position. [end tangent]

I think I found the book particularly interesting for a few reasons.  First, as boring as I found history in high school, as I age, I am finding increasing value in it.  I’m not sure if it’s just life’s struggles that have pushed me to this point, but I gather so much more from historical accounts now than I did in my teens years. Then again, reading a boring, biased textbook is a lot difference than reading book on a topic of interest to you. Secondly, the fact that all this was developing while I was being born makes it particularly interesting to me.  I remember all the AIDS awareness coomericals and advertisements I saw in my youth, and now…it’s almost as if the disease doesn’t exist. Or, maybe because treatment has been so successful (re: Magic Johnson..I debate whether he really has HIV…or maybe a cure?) that the disease has lost much of its bite and scare of the 80s. Clearly, we know AIDS is here to stay, but people are much less concerned with it now than they were back in the 70s and 80s, when people were popping uup with the disease only to fall down dead just as quickly.  Imagine how scary it had to be back then.

Just think, the first real test for HIV antibodies was implemented in 1985 – the same year I was born.  After reading this book, I truly feel blessed to even be alive today.  Who knows what emergency situation could have arisen in my life or in the lives of my parents that would have landed them in the emergency room, possibly receiving infected blood. I could have been born an AIDS baby had circumstances played out differently. From a public health human perspective, it is arguably the most detrimental event to hit our nation.

Clearly, I highly recommend reading this book. It’s thick, but worth the investment of time if you can find it at a used bookstore or on Amazon (I found mine for a few dollars online).  Alternatively, if you’re not a reader, the talented, late Mr. Aaron Spelling directed an HBO movie by the same name, which I’ve heard great things about.

What I still cannot for the life of me wrap my head around is how a disease that started in America as a disease plaguing White homosexual men now hits hardest amongst Black heterosexual females. Riddle me that.

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If You Only Gave Your Heart

In Causes on May 10, 2010 at 2:11 pm

Being the awesome substitute teacher that I am, I use my lovely, sparse free periods to browse the internet for interesting articles, especially those pertaining to health care, so I have something educationally related to pick the kiddies’ brains about. Today, I came across a very interesting article pertaining to a cause that is close to my heart  – organ donation.  CNN Health is my homepage, it makes it easier for me to keep up with the latest health developments.  One of today’s main articles is California, New York mull changes to organ donation laws.   The article details the proposed legislative changes to current organ donation laws. While using two different approaches (in a typical West Coast vs. East Coast style), each is progressive in it’s own right.

California is pushing to be the first state to create a living donor registry, a move lead by Steve Jobs (Apple co-founder who himself was a liver transplant recipient).  This move is backed politically and, personally, I always find it refreshing when wealthy people are aware of their beneficial treatment and make moves to erradicate this preferential treatment.  I find it interesting that there are unofficial registries online.  Seeing how ~75% of people waiting for an organ are waiting for a kidney (an organ we could each live just fine with only one of), this move by Cali has a possibility for making a substantial impact at decreasing the wait list, especially if proved successful and mirrored throughout the nation.  Cali’s approach aims at increasing the amount of organs available for transplant by increasing availability of those from the living.

Conversely, New York aims to increase the amount of organs available for transplant by increasing the availability of harvesting organs from the recently deceased.  In my opinion, New York’s proposal is a bit more radical, and something, while with good intention, probably will rub certain policital groups the wrong way…you know we can never legislate moves that would radically benefit society without stepping on some toes and offending some group who’ll cry “Foul!” at the slightest impingement of their liberty.  Sorry, I just get a bit worked up about how sensitive and cry-babyish Americans have historically been, when slightly cramping their freedom for the increased good of the people leads to protesting cries of injustice (probably has moreso to do with this book I am just finishing up…) Anywho, NY wants to implement the implied consent for donation already in place in many European countries, making it so that everyone is automatically an organ donor by default, unless you opt out. And I know, various cultures have strict views on their bodies and donation of any parts, but guess what?  They can always chose to say no, so I don’t see the big deal. And bet, it will up the amount of available organs for donation, thus decreasing the amount of people dying after sitting on the wait list (nationally about 101,000 people long). I’m all for autonomy, but what are you going to do with your organs when you are dead? It’s not like you’re going to be killed for your organs… Give someone the gift that keeps on giving – life!   A particular part of this bill I appreciate stops relatives from reversing decisions made by their loved ones regarding donating their organs…something I never understand how was previously justified.

Since I can remember being interested in medicine, I recall being told that one of the larger disparities pertains to organ donation. Blacks wait 2-3x longer than Whites to receive organ donations…which means that more often than not, we are dying at a higher rates than other groups due to thie prolonged waiting period.  Now, this is not due to any systematic prejudice within the donation system, but rather reflects a hesitation and an underlying distrust within the Black community regarding the medical community.  We are ~12% of the US population, but only ~3% of organ donors.

A certain proportion of this disparity is due to religious beliefs, such as those of Jehovah’s Witnesses, who consider it against God’s laws to accept blood transfusions. [actually, I cannot find a document that explicitly states organ transplants are prohibited, but it would logically follow that unless we drain a transplant of all blood, this too would be prohibited by their laws]. But, this only accounts for a relatively small part of this disparity…

As anything else that truly touches me, I try to start my efforts for change close to home, and then work my way outward.  I’ve heard of how distrustful members of the African American are of the health care profession, but I never explicitly heard this mistrust vocalized until a few years ago.  I was visiting a close family friend (a second mother to me) discussing with her how much this issue bothered me and how I was starting with friends and family members to slowly gauge the response of the community to a proposed increase in organ donator status. While she lauded my interest and drive, she flat out stated how she would not join in the effort and preceded to go on a 10 minute monologue about how she honestly felt that having “organ donator” checked on her driver’s license would put a big red bullseye on her back if she was ever in an emergency situation that threatened her life. She legitamately felt that every effort would not be extended to preserve her life in such an event. I could see the fear in her eyes as she spoke these words. I tried to reassure her that no doctor wants their patients dying at their hands, and that they wouldn’t just let people die on their tables so that they could harvest these peoples’ organs for unknown patients X, Y, and Z. As of yet, it’s been to no avail – she flatly refused to believe me.

I’m sure you’ve heard time and time again that much of this mistrust stems from degrading and despicable abuse of the African American community by the medical profession over the 20th century – most notably, the infamous Tuskegee Syphilis Experiments, which ran from 1932 -1972! (Us government apology came in 1997… [insert side eye])  [aside: one of the next books I will read is Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present] To be frank, just thinking of events like Tuskegee boils my blood still, no matter how many years have passed.  But, as angered as I get about this past and near-present mistreatment of my people, other things anger me even more.  It angers and frustrates me to see my community not helping itself out, to see us sitting by an being content with poorer health outcomes.  Frustration is key to igniting change – the past angers me, but there is nothing I can do to change it, thus no frustration…however, I can most certainly change our future. I still have no idea what I want to focus my future practice of medicine on, but this is an effort I plan on becoming intimately involved with throughout my career.  I like the proposed NY legislation – might substantially help decrease the time African Americans spend on transplant waitlists…

p.s. – August 1st is National Minority Donor Awareness Day. I believe this is also the day of my white coat ceremony. Sounds to me like it’s the perfect coincidence

Related Short Reads:

New Articles: Tuskegee’s ghosts: Fear hinders black marrow donation, Blacks’ mistrust of medical system limits organ donations

Academic Articles: Organ donation in the African-American population: a fresh perspective with a simple solution. African-American Reluctance to Donate: Beliefs and Attitudes about Organ Donation and Implications for Policy.

GL on the WL

In applying to med school on May 7, 2010 at 1:24 pm

As crazy as this entire application process has been, there is one thing in particular I am extremely grateful that I have been spared dealing with – The Dreaded Waitlist. I know many friends who have succumbed to the draining process of trying to work their way off the WL – it has the power to jade people and to push them off the edge we tend to tread on during this process. It is known for it’s cruelty and hardening effects…don’t let it get to you!

As much as I was going crazy back in fall, waiting to hear from schools, at least I can say that I knew beyond a shadow of a doubt that I was either 100% in or out of a school. I have the utmost sympathy for those suffering the experience of sitting on waitlists. Hopefully, those waiting have at least one acceptance at a school they like that they know they can fall back on. Even still, it must bite to be so close to being accepted to one of your top choices, and having to wait on baited breath for May 15th to roll around…the date when people must officially commit to one school and withdraw from others, slowly freeing up seats…hoping that your number gets called somewhere between now and Student Orientation. I vividly recall how compulsively I checked my email in the fall, anxiously awaiting (hopefully) good news of interview invites and acceptances, rather than rejections. I’m sure WLers are in that same soggy boat right now.

To those suffering on the WL – Keep the faith! If you really want to attend a certain institution, remain faithful in sending update letters and letters of interest and/or intent. Hopefully, you’ve stayed busy during the process and have some meaningful things to add to your application file – A’s, volunteer work, clinical exposure, research, etc – or can strengthen your argument for your “fit” with the school by  comparing it to other interview days you’ve had and why this school sticks out. If you’ve put in your work in the classroom and during this process, relax and breathe easy – at this point, it is out of your hands. Ignore the probing questions from family, friends, and nosey neighbors asking where you’ll be come August…it’s none of their business anyways! Stay busy, occupied, and productive. For those of you without a solid acceptance, start prepping your AMCAS and secondaries now. Yes, it sucks that you might throw away a few hundred dollars by submitting your AMCAS early, BUT better to invest in securing a better position for the next application cycle than sitting back and seeing what happens, possibly left caught out there without an acceptance AND entering later in the app process. Personally, I think file processing accounts for 30% of successfully gaining admission (no way to prove this, just a hunch), so get your’s in early and ahead of everyone else’s, then withdraw if necessary.

Trust me, patience is nowhere near my strongest virtue, but it is a great virtue to have, and something that I feel this application process can help develop in you, if you allow it. Good luck my WLers!!! I’ll leave you with one of my favorite quotes I’ve found to be true…

Nothing in the world can take the place of Persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan ‘Press On’ has solved and always will solve the problems of the human race. ~ Calvin Coolidge

KFC – Are you Kidding Me?!?

In health, Rants on May 3, 2010 at 10:37 pm

So, I’m sitting here watching the re-run of the Project Runway finale (yes, I love the show!

), and this new, horrid KFC commercial pops up.  They have these guys talking in squeaky, high-pitched voices about how puny regular fast food sandwiches are (because they’re not loaded with calories…) and how they are never full after eating one. Then they transition to their normal, manly voices to talk about the New, KFC Double Down Sandwich.  I guess the notion is cut out the bread and double up on the basics…right. I’m all with the removal of white flour from the American diet, but I’m pretty sure doubling up the amount of greasy, fried food is not the way to go.

Just looking at it makes my stomach churn a bit and my arteries cringe a bit in fear.  Granted, this pic is not the glam shot of the Double Down offered to consumers by KFC marketing, but is more of a raw, butt-naked view of what your money buys you. Here’s the nutritional information straight from it’s homepage: For the “Original Recipe” (re: Fried), 540 Cal, 32g Fat, 1380g Sodium. But have no fear, you can get the “healthier” (re: Grilled) option for 460 Cal, 23g Fat, and 1430g Sodium. I wish there was a smiley for jaw-dropping!

For those of you familiar with the show The Boondocks on Adult Swim (Cartoon Network), at first glimpse, KFC’s sandwich resembles the notorious and comical Luther Burger.  This is a good synopsis from Wiki: “Granddad goes home and prepares some food for his new venture. His first creation is the Luther Burger: “A full pound burger patty covered in cheese. Grilled onions, five strips of bacon, all sandwiched between…two Krispy Kreme donuts.” Huey looks over the menu and informs Granddad that he can’t serve this food to people as it will cause death. Riley tastes the Luther, and falls out of his chair, declaring candidly that “this is what crack must feel like.” He then passes out, waking up briefly a short time later, affirming that the Luther is the “best thing ever.” Granddad leaves him to sleep the itis off and opens the restaurant.”

Something tells me that if I were to ever try to eat the Double Down, I’d find myself in a situation very similar to Riley’s – passed out and near death.  And KFC would do as Granddad did, walk away making money.  I mean, that sandwich has diabetes, HTN, CAD, and a few other things written all over it…just asking for a heart attack!

America, I do not understand – why do we keep doing this to ourselves?!? And who is asking for these things?!? Can we get more truly healthier options for on-the-go? I’d love to see that. I know the demand’s there…where is the supply? Look at Chipotle. Healthy, fresh, organic food that you can grab while out.  Every time I’m there, there’s a line out the wazoo!  Sure, you can consume too many calories there as well, but look at the difference. I’d rather see America eating too many calories from natural, organic, farm-raised products than from junk manufactured in some lab…

I was talking to a good friend in the city the other week and the topic of American “nutrition” (or a lack thereof) came up. She was saying how some British guy was visiting their office and was appalled at the way Americans ate. He flat out asked why our government allows this to occur. That’s right, the government. Even he knows the government has the power to reign in the disgusting habits of our fast food chains, and yet, they don’t.  I do appreciate the efforts undertaken in my local major cities (New York and Philadelphia) mandating that all food places post the calories in each menu option. A knowledgeable consumer is a strong first step towards a healthier America. I hope this movement gains momentum and spreads throughout the enter country. For the #1 country in the world, progress sure is slow…