Showing 1 - 10 of 249 annotations tagged with the keyword "Public Health"

Summary:

Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

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Stuck

Larson, Heidi J.

Last Updated: Sep-20-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Medical Anthropology

Summary:

Stuck was published shortly before the Covid pandemic when the American vaccine wars, with all their hostility, misinformation, and political baggage, lay more than a year in the future. In Stuck, Heidi J. Larson, Professor of Anthropology and Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, approaches vaccine rejection as a complex moral and cultural phenomenon, rather than as a simple issue of ignorance or a marginal point-of-view. In a sense, anti-vaccine rumors are the tip of an iceberg, reflecting and perpetuated by deep underlying concerns, like perceived threats to personal or cultural values, distrust of government, misperception of risks and benefits, or a combination of these. The claim that compulsory immunization violates personal freedom is especially prominent today.  

Rumor is a major source of vaccine rejection. The author discusses in detail the case of Andrew Wakefield and his contention that MMR (measles, mumps, rubella) vaccine causes autism. This belief, based on a 1998 paper in The Lancet (later retracted) has been shown to be false by numerous large-scale studies, but is accepted by perhaps millions of people throughout the world.  

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Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Urge: Our History of Addiction, by Carl Erik Fisher, a psychiatrist, is really two books in one.  It is a comprehensive history of addiction from ancient times to the present day.  It is also a memoir of the author’s own struggle with addiction and an attempt “to understand how I went from being a newly minted physician in a psychiatry residency program…to a psychiatric patient” (p.ix).  

Fisher has grown up with two alcoholic parents.  Even as his mother’s drinking “suppresses her blood counts and causes her to miss the chemo sessions I have worked so hard to arrange” (p. 294), she does not stop.  Fisher’s own first drink, in high school, is a revelation.  He blows his interview for his first-choice college when he shows up late and hung over. His intelligence enables him to get by, but eventually the problem catches up with him as he begins to use Adderall and marijuana to counteract the effects of alcohol.  After sleeping through and missing his residency orientation, he is under scrutiny.  Finally, he has a drug-induced manic episode that results in his being tasered by the police, and he is forced into treatment.    

In the historical sequences of the book, we discover that one of the oldest known examples of addiction is found as far back as the Rig Veda (1000 BC).  From there we move through time, learning how Native American populations were devastated by alcohol, how Alcoholics Anonymous achieved prominence, and about the multiple challenges that persist to the present day. 

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The First Wave

Heineman, Matthew

Last Updated: Apr-18-2022
Annotated by:
Bruell , Lucy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

First Wave documents the early days of the COVID-19 pandemic at Long Island Jewish Medical Center (LIJ) in New York from March through June of 2020.  It opens with a graphic scene of a rapid response team trying to save a patient with COVID whose heart has stopped.  Despite their efforts, the patient dies.  After the team pauses for a minute of silence at the bedside, the grueling work of saving lives continues. 

The film follows Dr. Nathalie Dougé, an internist who was born in the Bronx to Haitian parents. Most of her patients are Black, Hispanic or immigrant.  Two patients with COVID are essential workers: Brussels Jabon, a Filipino nurse who undergoes an emergency C-section after she is brought to the emergency room, and Ahmed Ellis, a school safety officer with the NYPD.  Both have young children and supportive families.

Nurses hold up IPads so families can Facetime with the patients.  It’s terrifying and sad for the families to see the patients on screen and not to be present when they are needed the most. It’s emotionally difficult for the healthcare team as well who are the only ones to hold a patient’s hand during these encounters.  One nurse describes the effect of holding the phone while family members have five minutes to Facetime with patients, “You become the family member, and it seems like you’re losing your family.”

The emotional toll of losing so many patients, while fearing that they too may contract the virus and bring it home to their own families, weighs heavily on the healthcare teams.  They are trained to compartmentalize, to separate work from personal life but their empathetic response to their patients follows them home.  “I think about him every night when I go home,” nurse Kelli Wunsch says of Ahmed. “I just want him to do well.”

Scene after scene of teams rushing to resuscitate a patient who has coded are interspersed with more hopeful moments of a reunion between husband and wife, the sound of the song “Here Comes the Sun” when a patient is taken off the ventilator, and the cheerful encouragement of a physical therapist working to help a patient regain enough strength and mobility to be discharged. At times the camera moves outside the confines of the hospital to the outside world:  Dr. Dougé alone at home with her dog celebrating her birthday with friends over zoom, eerily empty streets during the lockdown, and families anxiously awaiting news from the hospital.  We see bodies taken to refrigerated trucks and people cheering the health workers at 7pm from windows across the city.

In May, when protests erupt following George Floyd’s murder, Dr. Dougé, joins the protest with other frontline workers carrying a sign, “Racism is a Public Health Issue” and ”I Can’t Breathe” scrawled on her surgical mask.  Amid the “I Can’t Breathe” cries of the protestors, she relives the myriad times she has heard her patients gasping those words to her just before they are placed on ventilators. 

Both Brussel and Ahmed become stable enough to be taken off the ventilator and released from the hospital to return home to their families.  Despite their recovery from the acute phase of the illness, it is clear their health remains severely compromised.  As the cheers of the staff in the hospital lobby fade, tough work lies ahead for these patients and their families.    

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Fauci

Hoffman, John; Tobias, Janet

Last Updated: Mar-14-2022
Annotated by:
Yin, Ellen
Salman, Akbar

Primary Category: Performing Arts / Film, TV, Video — Secondary Category: Performing Arts /

Genre: Film

Summary:

“The Jesuit philosophy is ‘Men for Others,’” states Dr. Fauci, the titular subject of the documentary Fauci, as he explains how his public school experiences informed his medical career. Indeed, it sets the tone for the rest of a film that traces the beginning of Dr. Fauci’s career as an infectious disease physician through to his role in the creation of PEPFAR, the 2014 Ebola outbreak, and his present day responsibilities in the current pandemic. The documentary bounces primarily between the 1980s HIV/AIDS epidemic and the start of the COVID-19 pandemic in 2020. In both, we see that Dr. Fauci stands as a figure of great controversy, and we are shown his thought process in navigating the court of public opinion.

The film starts off interviewing Dr. Fauci about his childhood in Bensonhurst, Brooklyn where he was exposed to the Jesuit philosophy that would dovetail with his choice to go into public health service when he was drafted into the Vietnam War. Though he began his medical career with aspirations for a private practice on Park Avenue, Dr. Fauci realized that his true calling lay in “trying to figure out diseases that people were dying from” at the National Institute of Allergy and Infectious Diseases where he soon faced one of the greatest public health challenges of the 1980s – piecing together a way to combat a mysterious new disease that was killing more and more Americans. 

This, of course, sounds very familiar to the intended audience of the documentary. It is a parallel that Dr. Fauci himself is well aware of, stating that COVID-19 feels like a “diabolical repeat” of his experiences in the 1980s but that “the difference is [the] divisiveness dominating COVID-19 . . . we’re going to get through it in spite of this divisiveness and this politicization. We’re not going to get through it because of it.” The film leans heavily into this contrast, showcasing the evolving attitudes of many AIDS activists as Dr. Fauci went from “the enemy” to a man sitting in on ACT UP meetings and engaging in a dialogue that would culminate in a historic address at the 1990 International AIDS Conference – an address that highlighted the need for physician-scientists to incorporate the feedback of the individuals they were trying to help and reminded activists of the compassion that physician-scientists have for their patients. 

In the scenes taking place in 2020, we see an explosion of both positive and negative press coverage of Dr. Fauci as the COVID pandemic kicks into high gear. His inconsistencies regarding mask guidance, his direct challenging of President Trump, and his struggle to deal with increasing death threats against himself and his family are put on full display. The documentary does not shy away from showcasing Dr. Fauci’s vulnerability with multiple instances of a tearful Fauci recounting the deterioration of many of his AIDS patients and the “post-traumatic stress” that those experiences induced. These moments of vulnerability are threaded in with images of and commentary from his wife Christine Grady and his daughter Jennifer, a clear attempt to give us a sense of Anthony Fauci the human being and not just Dr. Fauci the public servant. 

As the film draws to a close, Fauci and his wife take a walk through the COVID-19 Memorial on the National Mall in Washington DC. “When you're involved in a race to stop a horrible disease, you always feel like you’re not doing things quickly enough, or well enough,” he reflects. “One of the most mysterious aspects of our universe is how viruses have transformed our civilization . . . And the one thing I can hope for . . . is that emerging infections do not inevitably become pandemics . . . I am optimistic that the lessons that we’ve learned will prevent that from happening.” After watching this documentary, it is an optimism that is easy to share. 

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Dopesick

Strong, Danny

Last Updated: Jan-12-2022
Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: TV Program

Summary:

The eight-part TV miniseries, Dopesick, is a nonfiction, scripted drama inspired by Beth Macy’s nonfiction book of the same title. The creator, Danny Strong, was a writer of all but one episode, director of two, and an executive producer of them all. Beth Macy served as an executive producer and contributed to the writing and updated the reporting. 

In a Kaiser Health News (KHN) panel discussion about the series with Danny Strong, Beth Macy, and three KHN staff members, Strong said his original goal “was to dramatize all this, was to create a clear record of what Purdue Pharma did.” But when Macy joined, his goal expanded “to show the victims and to hopefully redefine the stereotype of addiction...[and] ultimately our goal was to show a path forward.”

The miniseries conforms to these goals. Across the eight episodes, the drama mostly swirls around the direct connections among Purdue Pharma, one physician, one particular patient (and family), one small town in coal mining country, a Drug Enforcement Agency (DEA) investigator, and a U.S. Attorney (Western District of Virginia). In hewing to Strong’s original goal of portraying Purdue Pharma’s responsibility for igniting and fanning addiction to its product OxyContin® (oxycodone HCl), the drama reaches its climax when the company agrees to criminal charges for named executives and a financial settlement in 2007. 

Different episodes touch on other goals about the stigma associated with addiction and access to medication-assisted treatments. While Strong met his goals, he acknowledges the real-life drama didn’t end with the 2007 settlement. He previews what was to come: Purdue Pharma redoubling its sales efforts, the addiction crisis worsening over the subsequent fourteen years, and the continuing efforts to bring Purdue Pharma and its owners (the Sackler family) to their knees.

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Imprimatur

Monaldi, Rita; Sorti, Francesco

Last Updated: Nov-03-2021
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In a future 2040, the church is considering the canonization of Pope Innocent XI. An unusual seventeenth-century manuscript is brought to the attention of the authorities and the bulk of the novel is its transcription in full.  

The manuscript is the diary of an intelligent, but inexperienced young orphan-apprentice who is working in a Roman hostel in September 1683. The Catholic Church is fighting the Ottoman Turks who have besieged Vienna. Tensions with France are high as that country and its king have long asserted their exemption from Church rule.

 A hostel guest dies, and the authorities, suspecting plague, impose a quarantine. The apprentice falls under the influence of another confined guest, Atto Melani, a famous castrato and spy for King Louis XIV of France. Believing that the deceased guest was murdered, they venture out each night into subterranean Rome searching for clues to support their theory and leading them to investigate poisons, panaceas, and political plots. Meanwhile, a physician also confined to the hostel attempts all remedies to prevent plague, while another guest, besotted with astrology, strives to reveal the future, and yet another plays soothing music. 

Like a baroque Agatha Christie novel, plausible suspicion is cast upon every guest until the truth emerges and with it many doubts about the saintliness of Pope Innocent XI. The 2040 writer invites the Holy Office to consider the implications of the manuscript before proceeding with the canonization.

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Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

The Impatient Dr. Lange is a biography of Joseph “Joep” Lange, an HIV/AIDS researcher best known for his work in HIV transmission prevention and treatment, written by Seema Yasmin.  Yasmin is a journalist, doctor, and epidemiologist whose life path was forever altered by a run-in with Dr. Lange at age 17, when he said to her, “If you want to help people, first you need to learn how to take care of them.  Go to medical school.” (p. xiii).  The book’s narrative parallels that of the life of her inspiration, Lange; in addition, Yasmin details the evolution of HIV, how it came to spread around the globe, and a history of antiretrovirals.  

Coming of age professionally in the early 1980s, Joep Lange had a career defined by HIV and the advances to manage it.  Early on, he trained as a physician before pursuing a PhD.  During his PhD, he was a prolific researcher, producing “eleven papers on AIDS in his first years,” including an early case study on the appearance of acute HIV and the way in which the body’s antibody response changes in response to continued infection.  His commitment to rigorous scientific inquiry continued as a professional research scientist.  Most noted for his early trials about the use of antiretrovirals and their role in preventing mother-to-child transmission of HIV, he was intimately involved with much of the science used to treat and prevent HIV today.  Outside of research, he was an ardent advocate of health equity, starting the PharmAccess Initiative, a group initially developed to expand access to antiretrovirals in developing countries.  

Ultimately, the book is about how a life of great potential, drive, and success was tragically cut short.  Shadowing the narrative of the book is the specter of Lange’s unfortunate end on Malaysia Airlines flight MH17, a plane that was mistakenly shot down over the Ukraine by pro-Russian separatists, while he was en route to the twentieth International AIDS Conference in Melbourne.  The penultimate chapter reflects on all that was unfinished - projects on three continents, advising the next generation of PhDs, a novel - and ends with a prescient quote from Lange, in regard to mandatory retirement in the Netherlands at the age of 65:  that even if he had 10-15 more years, he declares “that is still not enough time” (p. 174).

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An Enemy of the People

Ray, Satyajit

Last Updated: Aug-09-2021

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

In this 1989 Bengali-language film, the director and screenwriter Satyajit Ray presents an arresting contemporary reimagining of Henrik Ibsen’s 1882 play, An Enemy of the People. In Chandipur, India, Dr. Ashoke Gupta treats an increasing number of patients with hepatitis and jaundice. After some patients die, Dr. Gupta fears that the town could succumb to an epidemic. A water quality report reveals that bacteria contaminate local sources, and that the pollution lies in the town’s most populous area. Further complicating the crisis is Dr. Gupta’s determination that the holy water distributed at a new Hindu temple is culpable for sickening visitors. Eager to publish the findings in a local newspaper and advocate for the closure of the temple (a major pilgrimage destination) until the contamination is abated, Dr. Gupta must contend with his younger brother, Nisith, and other municipal bureaucrats and journalists who suppress his findings to protect the tourism revenue. The physician struggles to communicate medical information to a population deluded by religious superstition and deceived by avaricious leaders.

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Summary:

Native Ohioan Brian Alexander cares a lot about his state and its many economic problems, especially as they impact healthcare. For this book, he’s an on-the-ground reporter covering the events in and around a hospital in the small town of Bryan from 2018 to 2020. He is also an in-depth interpreter, analyzing the many dilemmas of this small hospital and emphasizing that these represent parallel problems of social justice for all of contemporary American healthcare.  An opening chapter reviews some of the difficult history of this area, including economic collapse, lack of public health, lack of health insurance, and collapse of jobs in supply chains for Detroit.           

While the timeline of the story is short, it has wide breadth in local and national issues. These are illustrated by the stories  of specific people. Marc Tingle, a local contractor has a heart attack; his wife falls ill and is diagnosed with cancer. Medical bills mount up. Marc has a second heart attack and a stent inserted. He, like many others receives “rescue” medicine, not preventive healthcare, due to social or economic issues beyond their control. Similarly, we read about Keith Swihart, overweight and diabetic. He has a foot ulcer that requires surgery and later partial amputation. He has eye problems that progress to near blindness. Valerie Moreno injures her back at work but does not report it to the company, considering herself tough, but she must have spine surgery. After being laid off, she has part-time jobs, money problems, and turns to OxyContin pills. These are dramatic and painful stories.  

Many families make “just enough money to disqualify themselves…from Medicaid, but not enough to afford coverage offered by an employer or via the Affordable Care Act” (p. 242).            

Such patients illustrate a deadly whirlpool of issues: lack of routine medical care, inadequate health insurance, no national health program, a collapsed economy with no good jobs or prospects of advancement, poor nutrition, pervasive poverty, racism, sexism, and more.           

Amidst all this, we follow Phil Ennen, the CEO of this hospital (CHWC--for Community Hospitals and Wellness Centers) in Bryan. He wants to rely on his local, traditional values of “we can fix this,” but now he must confront the threats of national hospital chains, the need to cut staff and services, and the seductive lures of adding for-profit and high-tech services. Eventually, he sees no path forward and accepts the board’s invitation to retire. His replacement will have all the same problems.           

A closing section sees the arrival of Covid-19, a threat to this hospital and, of course, the nation at large. Alexander writes, “the virus seeped into the fault lines created by American pathologies. The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit” (p. 268).  

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