A Short History of Restraint Use.

Leather Restraint

“The great stumbling-block of the American superintendents is their most unfortunate and unhappy resistance to the abolition of mechanical restraint,” said British asylum superintendent John Charles Bucknill in 1876.

In the mid-19th century, after a long history of poor conditions, England started reforming its insane asylums. Cases like that of James Norris, a former seaman who spent ten years shackled to his bed with an iron harness, lead the reformers to push for the near-total abolition of restraint use. The British believed that in a well-run asylum with properly trained physicians on staff, they would rarely be necessary.

Since the first state-run mental hospital in the United States wasn’t established until 1822, Americans didn’t have the same negative history during the British reformation. Rather than seeing restraints as evidence of mistreatment, American physicians believed that restraints were a valuable tool to keep patients safe. They also believed that patients of a democratic nation were less tolerant of authority, and that the American insane were more violent than their British counterparts.

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Cultural Insensitivity.

A 20 minute seizure is considered life threatening. When Lia Lee was four years old, she suffered a seizure that lasted for nearly two hours.

When Lia had first begun to seize, her father, Nao Kao Lee, quickly realized that this seizure was worse than any Lia had before and called his English-speaking nephew over to call an ambulance, delaying Lia’s arrival to the hospital by a critically long 20 minutes.

When journalist Anne Fadiman asked Nao Kao why he had waited for his nephew and then the ambulance to come and get Lia, rather than running the three blocks to the hospital as he had before.

“If you take her in an ambulance, they would pay more attention to her at the hospital,” he replied.

Cultural sensitivity in medicine has become a very vogue topic. But, unless you work in the medical profession, it’s difficult to understand how catastrophic culturally insensitive medicine can be. Luckily, Fadiman successfully portrays the complications surrounding medicine and culture through the Lee family in her book The Spirit Catches You and You Fall Down for all of us who cannot see them first hand.

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Why Do Boys Get All The Circumcision?

Nawal Nour speaking with a Sudanese interpreter (c) Brigham and Women's Hospital

Though infant male circumcision is left to the discretion of parents, female circumcision performed on a minor is completely banned in the United States. This strange kind of sexism was the topic of debate at a Harvard Law School panel discussion today.

Male circumcision has long claimed to be the lesser of the two evils— safer, and with potential health benefits. Unfortunately, those potential health benefits are for people facing an AIDS epidemic, not Americans, and every medical procedure has risks.

“I don’t like seeing the poor little penises bleeding,” said panelist Dr. Nawal Nour, an obstetrician/gynecologist who founded the African Women’s Health Center in Boston. She stopped performing the procedure. Another panelist, Law Professor Sarah Waldeck, said that as a middle-age white woman from the midwest she couldn’t be objective on the issue— in her demographic, circumcision is the norm.

Waldeck’s perspective on male circumcision spoke to her early point about female circumcision— that the cultural aspects have to be taken into account when determining laws if they are going to be effective. Because the people the ban is aimed at view female circumcision as normal, she argued, the law is more likely to provoke backlash than lasting change.

“Getting people to stop circumcising their daughters is as difficult as trying to convince Jewish people to stop circumcising their sons,” Waldeck said. Dr. Nour pointed out that in a traditional Jewish bris, the circumcision is not performed in a hospital, or even by a medical professional.

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How To Mortgage Your Future.

A needle depot in Vancouver, Canada.

Just when The Washington Post reports the demise of needle exchange services in D.C., The New York Times catches up, covering the only safe injection facility in North America. Which is in Canada, of course.

The irony would be better if Vancouver had just started opened this facility, but I mean it when I say that The New York Times is catching up. InSite opened in 2003.

Still, the irony is pretty good.

As the Time’s reports, the Downtown Eastside of Vancouver was once home to the fastest-growing AIDS population in North America.

The city took action, and along with implementing needle exchange programs, they went one step further, opening InSite. People suffering with addiction bring their own drugs to the center, staffed with health care professionals, and shoot up. The facility reduces disease transmission and the risk of death from overdose.

To watch the multimedia piece, click here.

Back in the U.S., D.C. is the HIV/AIDS epidemic epicenter, and the State has responded by delaying funding to it’s needle exchange program. Both the federal and state governments are cutting funding to programs that prevent the spread of HIV, Hepatitis and STDs. I mean, why raise taxes when you can cut frivolous expenses like needle exchange programs and Planned Parenthood?

Unfortunately, cutting these programs isn’t even going to save money. The cost of running the needle exchange program in D.C. for a year is less than the cost of care for a single AIDS patient over a lifetime. Did I mention that the program serves 2,200 people?

But, I guess when even programs for starving babies are getting the axe, it’s not surprising that drug addicts aren’t garnering much sympathy.

A Short History of Thorazine.

Wow. This ad is almost as controversial as the drug it promotes, and that’s a feat. Unlike the other banned ads, this isn’t just showcasing out-dated values— it’s advertising the beginning of a mental health revolution. 

Considered a breakthrough medication, Thorazine secured FDA approval on March 26, 1954 as the first psychiatric medication. Prior to Thorazine’s inception, mental illnesses were treated with psycho- and electroshock therapies and institutionalization. The lobotomy was also popular (its inventor, Egaz Moniz, received the 1941 Nobel Prize in Medicine).

Change came when psychiatry finally crossed paths with the rest of medicine. Following in the footsteps of Paul Ehrlich, a German scientist who discovered a cure for syphilis, researchers all over the world were looking for compounds— “magic bullets”— to cure other diseases that plagued humanity.

Thorazine, generic name Chlorpromazine, was the result of researchers in France trying to find a “magic bullet” for malaria. Instead, they found a sedative thought to be potentially useful in surgery. They also discovered that it produced “a medicinal lobotomy.”

And why do with surgery what you could do with drugs?

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The Great Canadian Foreskin Debate.

While Americans are debating the legality of offering all of their citizens access to health insurance, Canadians are trying to make their (universal) medical care a little more humane.

Specifically, whether or not it is okay to circumcise male infants.

Though female circumcision is usually the trending topic in genital welfare debates, a growing number of parents are choosing not to circumcise their sons, and some are even suggesting the practice be outlawed.

Referred to as “intactivists,” the people calling for a ban are asking if infants should be subjected to a medical procedure when they are too young to consent.  Which begs the question: does it provide any medical benefits?

Male circumcision is currently being promoted in Africa as a means of fighting HIV transmission, and a recent study in the Lancet found that circumcision reduces transmission of HPV, a virus links to genital warts and cervical cancer. At the same time, a 2010 study found that circumcision outside of Sub-Saharan Africa offered little benefit. In addition the both the Canadian Pediatric Society and the American Academy of Pediatrics no longer recommend the procedure because it is not medically necessary.

Whether slightly reduced HPV transmission rates are a benefit to male circumcision may not matter anyway. There are many other less invasive, irreversible ways to control HPV than lopping off part of an infant’s penis.

For those of you brave enough to see how the procedure is done, click here.

To see the discussion, click here.

 

Will They Or Won’t They?

A second federal court judge ruled today that the healthcare law violates the constitution. The problematic provision? It requires all Americans to obtain commercial insurance, the New York Times reports.

It’s the latest development in the melodrama of universal healthcare in United States, a country that can grow organs but can’t decide if basic health insurance is really something everyone should have.

Stay tuned.