Reading matériel

Things have gotten busy at work -- hence the lack of new content. But I have been doing a lot of reading, and would love to point you all towards some of the more interesting things I've come across in the past few days:


A fascinating study conducted by the Kaiser Family Foundation, in conjunction with NPR and the Harvard School of Public Health, takes an in-depth look at the impact of heath care costs and the economy in two of the most important swing states in the upcoming election: Florida and Ohio. I highly recommend you click through to take a look at the analysis of the surveys and at the NPR news coverage, providing insights into the way health care costs currently affect people's daily life decisions in these battleground states.

An article in The New Republic written by a health policy junkie by the name of Don McCanne, MD on the importance and inevitability of stand-alone single payer health care system in the US.

And finally, two articles of note from this week's New England Journal of Medicine:

The first is about "Nontraditional Medical Students" (this includes myself!!) and the future of medicine, written by the young and exciting physician/author, Sandeep Jauhar, who is currently the director of the Heart Failure Program at Long Island Jewish Medical Center.

The second is about the current state of premedical education in the United States, and was written by the dean of medical education at Harvard Medical School.

Hope you find some of these pieces interesting, and I'll hopefully be able to holler back at y'all with some new content before the weekend is out.

First I have to finish up this document outlining the tentative purview of the Executive Quality Council for the hospital. Maybe I'll even share some of the work I've been doing here with you guys as it gets closer to completion.

People Smarter Than I

Julie Solomon, author of the new book Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God, and Diversity on Steroids, has been doing some guest posting over at the Freakonomics Blog on the New York Times website. She is an excellent journalist and is interested in many of the same health related issues that I spend my time thinking about. Here is a great excerpt from her first guest post entitled, Common Sense Health Care:

Our market economy approach to medicine has to change. There is “a fundamental illogic to trying to contain costs in a market-based system,” writes Dr. Marcia Angell in a thoughtful article about health reform in the April 21 issue of The American Prospect.

Dr. Angell, a senior lecturer at Harvard Medical School and a former editor-in-chief of The New England Journal of Medicine, was called “an unlikely muckraker” by The New York Times in 2004, when she published a powerful expose of the drug companies.
Her position on health reform appeals not to corporate interests but to common sense and the desire for good medical care, making it appear radical:

“The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever care he or she needs regardless of age and medical condition,” she writes. “There would no longer be a private insurance industry, which adds little of value yet skims a substantial fraction of the health-care dollar right off the top.

“Employers, too, would no longer be involved in health care,” she continues. “Care would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses.”

Brilliant (and ballsy) stuff, right? Thanks to my darling poet 2.0 Ms. Fjeld for tipping me off to these posts. I'll be back with another installment of my open letter to Edward shortly. Happy Friday, and I hope everyone has a wonderful weekend. Holler.

post and run

This is the same old story about TB and HIV in Africa, this time in the the world's foremost medical journal. Never has a broken record approach been so important. This week's New England Journal article is entitled "Tuberculosis in Africa — Combating an HIV-Driven Crisis" (click for full text).

Tomorrow I'm off to Florida and then the Bahamas to see family and friends. I must admit, I'm very excited for SPRING BREAK!! I'll even have a better sense of the med school landscape when I return. I'm reluctant to let my parents open those admissions envelopes, but I imagine that's what will happen. I'll be sure holler on the flip side.

Just a quick one

I'm absolutely overwhelmed with work today. But while looking through my folder of TB/HIV papers I've compiled over the course of the year, I came across this unrelated article I had downloaded from from the August 9 edition of the New England Journal of Medicine. It's not the type of thing that NEJM normally publishes, but it is every bit as interesting. The story that Dr. Quiñones-Hinojosa's tells is clearly the exception (and it's important not to lose sight of this fact), but it's a very powerful one nonetheless. I have actually had the privilege to meet several doctors and nurses here in Durban who triumphed over similar disadvantages during the era immediately following the fall of Apartheid. Their stories are always deeply moving and inspiring; maybe I'll get around to writing them down some day. I know the article below is a bit long to read in this blog format, but it's really worth the time.

Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Alfredo Quiñones-Hinojosa, M.D.

"You will spend the rest of your life working in the fields," my cousin told me when I arrived in the United States in the mid-1980s. This fate indeed appeared likely: a 19-year-old illegal migrant farm worker, I had no English language skills and no dependable means of support. I had grown up in a small Mexican farming community, where I began working at my father's gas station at the age of 5. Our family was poor, and we were subject to the diseases of poverty: my earliest memory is of my infant sister's death from diarrhea when I was 3 years old. But my parents worked long hours and had always made enough money to feed us, until an economic crisis hit our country in the 1970s. Then they could no longer support the family, and although I trained to be a teacher, I could not put enough food on the table either.

Desperate for a livable income, I packed my few belongings and, with $65 in my pocket, crossed the U.S. border illegally. The first time I hopped the fence into California, I was caught and sent back to Mexico, but I tried again and succeeded. I am not condoning illegal immigration; honestly, at the time, the law was far from the front of my mind. I was merely responding to the dream of a better life, the hope of escaping poverty so that one day I could return home triumphant. Reality, however, posed a stark contrast to the dream. I spent long days in the fields picking fruits and vegetables, sleeping under leaky camper shells, eating anything I could get, with hands bloodied from pulling weeds — the very same hands that today perform brain surgery.

My days as a farm worker taught me a great deal about economics, politics, and society. I learned that being illegal and poor in a foreign country could be more painful than any poverty I had previously experienced. I learned that our society sometimes treats us differently depending on the places we have been and the education we have obtained. When my cousin told me I would never escape that life of poverty, I became determined to prove him wrong. I took night jobs as a janitor and subsequently as a welder that allowed me to attend a community college where I could learn English.

In 1989, while I was working for a railroad company as a welder and high-pressure valve specialist, I had an accident that caused me to reevaluate my life once again. I fell into a tank car that was used to carry liquefied petroleum gas. My father was working at the same company. Hearing a coworker's cry for help, he tried to get into the tank; fortunately, someone stopped him. It was my brother-in-law, Ramon, who climbed in and saved my life. He was taken out of the tank unconscious but regained consciousness quickly. By the time I was rescued, my heart rate had slowed almost to zero, but I was resuscitated in time. When I awoke, I saw a person dressed all in white and was flooded with a sense of security, confidence, and protection, knowing that a doctor was taking care of me. Although it was clear to me that our poverty and inability to speak English usually translated into suboptimal health care for my community, the moment I saw this physician at my bedside, I felt I had reached terra firma, that I had a guardian.

After community college, I was accepted at the University of California, Berkeley, where a combination of excellent mentorship, scholarships, and my own passion for math and science led me to research in the neurosciences. One of my mentors there convinced me, despite my skepticism, that I could go anywhere I wanted for medical school. Thanks to such support and encouragement, I eventually went to Harvard Medical School. As I pursued my own education, I became increasingly aware of the need and responsibility we have to educate our country's poor.

It is no secret that minority communities have the highest dropout rates and the lowest educational achievement levels in the country. The pathway to higher education and professional training programs is not "primed" for minority students. In 1994, when I started medical school, members of minority groups made up about 18% of the U.S. population but accounted for only 3.7% of the faculty in U.S. medical schools. I was very fortunate to find outstanding minority role models, but though their quality was high, their numbers were low.

Given my background, perhaps it is not surprising that I did not discover the field of neurosurgery until I was a medical student. I vividly remember when, in my third year of medical school, I first witnessed neurosurgeons peeling back the dura and exposing a real, live, throbbing human brain. I recall feeling absolute awe and humility — and an immediate and deep recognition of the intimacy between a patient and a doctor.

That year, one of my professors strongly encouraged me to go into primary care, arguing that it was the best way for me to serve my Hispanic immigrant community. Although I had initially intended to return to Mexico triumphant, I had since fallen in love with this country, and I soon found myself immersed in and committed to the betterment of U.S. society. With my sights set on neurosurgery after medical school, I followed my heart and instincts and have tried to contribute to my community and the larger society in my own way. I see a career in academic medicine as an opportunity not only to improve our understanding and treatment of human diseases but also to provide leadership within medicine and support to future scientists, medical students, and physician scientists from minority and nonminority groups alike.

My grandmother was the medicine woman in the small town in rural Mexico where I grew up. As I have gotten older, I have come to recognize the crucial role she played not only in instilling in me the value of healing but also in determining the fate and future of others. She was my first role model, and throughout my life I have depended on the help of my mentors in pursuing my dreams. Like many other illegal immigrants, I arrived in the United States able only to contemplate those dreams — I was not at that point on solid ground. From the fields of the San Joaquin Valley in California to the field of neurosurgery, it has been quite a journey. Today, as a neurosurgeon and researcher, I am taking part in the larger journey of medicine, both caring for patients and conducting clinical and translational research on brain cancer that I hope will lead to innovative ways of fighting devastating disease. And as a citizen of the United States, I am also participating in the great journey of this country. For immigrants like me, this voyage still means the pursuit of a better life — and the opportunity to give back to society.

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Source Information

Dr. Quiñones-Hinojosa is an assistant professor of neurosurgery and oncology and director of the brain-tumor stem-cell laboratory at Johns Hopkins School of Medicine, Baltimore, and director of the brain-tumor program at the Johns Hopkins Bayview campus.