Janet Golden, PhD, Professor of history, Rutgers University-Camden
Gesundheit, German for “health,” typically is said to someone after they sneeze. The Gesundheit! Institute is a not-for-profit health care organization founded by Dr. Hunter ”Patch” Adams, to create a new model of health care that is linked to community health, welcomes complementary medicine and is infused with fun and play. In the 1998 film Patch Adams, (a trailer is here) Robin Williams showcased some of how he conceived and implemented these principles. Fun, laughter, health care, and healing – how often do you experience those in the same place?
That place may soon be North Philadelphia, where citizens are planning a Patch Adams Free Clinic.They’ve got the site and the plans to make it happen. And now Patch Adams is coming to Philadelphia to give two public talks: Tuesday, July 23, at Drexel University near Center City and Wednesday, July 24, at Mercy Neighborhood Ministries in North Philly. Both are free and open to the public. You don’t even have to wear your red clown nose to be admitted, although I’m pretty sure Dr. Adams would appreciate it if you did.
I interviewed Paul Glover, founding director of the Patch Adams Free Clinic, who is working with neighborhood leaders and activists to transform the five-acre vacant lot into North Philadelphia into the clinic site. They’ve reached out to form partnerships with businesses and organizations, including architects, designers and landscapers, and they’ve met with Philadelphia city planners and environmental officials. Paul tells me they are ready to get the permissions finalized with the city and the neighborhood, and have an option to purchase the land for their “health campus.” Next up is the fundraising needed to purchase the land and then, let the building begin. A six-minute video (embedded below) explains their idea and how it would work.
At its recent annual meeting, American Medical Association (AMA) delegates rejected the advice of their own Committee on Science and Public Health and voted to reclassify obesity as a disease rather than a condition or disease risk factor.
Proponents believe that this reclassification by the nation’s largest physician organization will improve medical providers’ attitudes toward obesity, increase funding for research and treatment and improve patient care. A substantial body of research has found overweight and obesity are associated with many serious health problems including: type 2 diabetes, coronary heart disease, and cancer. Rather than seen as a personal failure, obesity will be seen as a disease resulting in greater attention paid to its medical consequences by the medical profession
Others are concerned this will increase unnecessary and costly pharmacological and surgical treatments and will lead to overtreatment of people based on their Body Mass Index (BMI) rather than objective health indicators. While co-morbidities generally increase with increased BMI, there are many healthy overweight and obese individuals, who in some cases fare better than their lower weight counterparts. For example, in a study looking at cardiovascular risk based on BMI in 5,440 U.S. adults, 23.5 percent of normal-weight adults had cardiovascular abnormalities, while 51.3 percent of overweight adults and 31.7 percent of obese adults were metabolically healthy. Some critics are concerned that the disease label will further stigmatize a group of people who already face pervasive discrimination and will result in physicians overlooking other serious health conditions unrelated to a patient’s weight.
We write about a lot of complex issues here at The Public’s Health. Issues that seem intractable, such as implicit racial bias and poverty. Issues that are ethically challenging, such as organ donation. Issues that have serious implications for future generations, such as climate change and fracking. Such complexity is the domain of public health.
Some public health issues, however, are more straightforward. The relationship between cause and effect is clear, as are the preventive actions that can be taken. This Fourth of July weekend, we revisit one of these issues—swallowing the wire bristles of grill brushes.
On July 4th last year, we posted a story about the dangers of swallowing the bristles of wire brushes that are used to clean grills. The small, but exquisitely sharp, bristles come dislodged from the brushes, rest on the grill’s surface, cling to food, and are ingested—potentially causing serious lacerations in the mouth, throat, and stomach.
June is post-traumatic stress disorder (PTSD) awareness month. Sure, there are months for almost every medical condition imaginable. But this month’s designation, which came about after Congress named June 27th national PTSD awareness day just last year, is a symbolic milestone in the mental health condition’s history and struggle for legitimacy. The cluster of symptoms now known as PTSD—which can include having nightmares and flashbacks about a traumatic event, avoiding things that remind one of the event, feeling emotionally numb, easily startled, or “on edge,” and others—has gone by many different names over the past 150 years.
In the mid-19th century, surgeon John Eric Erichsen coined the term railway spine to describe the symptoms he observed among people who survived or witnessed train accidents. American Civil War surgeon Jacob Mendez Da Costa described similar symptoms among soldiers he treated on the battlefield—a condition he called soldier’s heart. Psychoanalysts Pierre Janet and Sigmund Freud documented the hysteria caused by childhood sexual abuse among their female patients. British military psychiatrist Charles Samuel Myers referred to the shell shock experienced by World War I soldiers after they returned from combat.
Time and time again, symptoms of PTSD were observed among people exposed to traumatic events, but were not recognized as “real” given social and political circumstances of the times. Things changed, however, when the forces of the women’s liberation and anti-Vietnam War movements converged and PTSD was added to the Third Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The addition legitimized PTSD as a medical condition and provided a shared language and framework to study and ameliorate the effects of overwhelming human experiences.
By the time we are adults, the role of trees in our lives is largely reduced to providing shade and making us grateful that there are enough of them around to pump oxygen into the air we breathe. Long gone, too, are the days when a good tree to climb was challenging fun – or when we carved the name of someone we loved into its bark.
But don’t fret. There may be good reason to fall in love with trees all over again. Several new studies draw attention to the relationship between tree density and human health. My colleague at the Drexel University School of Public Health, Anneclaire De Roos, analyzes several new studies examining this relationship on her blog, Living With Health Risks. It makes for a very interesting read. Take a look. And hug a tree.
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Janet Golden, PhD
It has been my privilege to serve as one of the historical consultants to Pox and the City, a digital role-playing game for the history of medicine.The game lets players learn about the conquest of smallpox (once known as the “speckled monster”). It was developed with funding from the National Endowment for the Humanities.
Pox and the City just completed beta-testing and got some great reviews from high school students. I interviewed the creator of this project, medical historian Lisa Rosner, who is a professor of historical studies at Richard Stockton College.
What made you want to teach history of medicine through a digital role playing game?
In back-to-back rulings this week, a federal judge decided that two children with end-stage cystic fibrosis—10-year-old Sarah Murnaghan on Wednesdayay and 11-year-old Javier Acosta on Thursday—should be eligible for a lung transplant from the adult donor list, rather than the under-12 list from which they are unlikely to receive new lungs in time. There are too few pediatric transplant donors to meet the demand. The transplants, if successful—if appropriate adult donors are found—would offer them new leases on their still very young lives.
Earlier this week Sarah's parents had appealed directly to U.S. Health and Human Services Secretary Kathleen Sebelius to make an exception for her. When Sebelius refused to intervene, the Murnaghans took their case to court; after U.S. District Court Judge Michael Baylson ruled in their favor, Javier's mother did the same and got a matching decision within hours. The rulings will be revisited at a June 14th hearing. Until then, Sarah and Javier, both at Children's Hospital of Philadelphia, are eligible for lungs from the adult transplant waiting list, increasing the chances that they may receive the life-saving operation.
Bioethicist Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center, said he is concerned about fairness. "It is not clear why everyone now waiting at the bottom of any transplant list would not seek relief in federal court," Caplan told NBC news Wednesday, before Javier's mother filed. "Unless the judge has reason to think the lung distribution rules are simply a product of age discrimination and nothing more—which seems highly unlikely—then this becomes a troubling instance of non-doctors deciding who is the best candidate to receive a lung or other scarce medical resource."
Janet Golden, PhD, Professor of history, Rutgers University-Camden
Let’s have a brief conversation about climate change.
How is climate change related to health?
Here is some of what the World Health Organization has to say: “Climate change affects the social and environmental determinants of health—clean air, safe drinking water, sufficient food and secure shelter.” Global warming leads to excess deaths, and many major killers—diarrheal diseases, malnutrition, and malaria among them—are sensitive to climate and expected to worsen as it changes.