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This month marks the 30th anniversary of the Americans with Disabilities Act, which is considered the most important civil rights law since the 1960s. Through first-person stories, we look back at the making of this movement, the history of how disability came to be seen as a civil rights issue, and what the disability community is still fighting for 30 years later.

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This month marks the 30th anniversary of the Americans with Disabilities Act, which is considered the most important civil rights law since the 1960s. Through first-person stories, we look back at the making of this movement, the history of how disability came to be seen as a civil rights issue, and what the disability community is still fighting for 30 years later.
If you would like to learn more about the topic: We love to hear from our listeners! Tweet at us @throughlineNPR, send us an , or leave us a voicemail at (872) 588-8805.

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This month marks the 30th anniversary of the Americans with Disabilities Act, which is considered the most important civil rights law since the 1960s. Through first-person stories, we look back at the making of this movement, the history of how disability came to be seen as a civil rights issue, and what the disability community is still fighting for 30 years later.

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What are the connections between healthy bodies, healthy bank accounts and skin colour? Our opening episode travels to Louisville, Kentucky, not to explore whether medical care cures us, but to see why we get sick in the first place, and why patterns of health and illness reflect underlying patterns of class and racial inequities.

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What are the connections between healthy bodies, healthy bank accounts and skin colour? Our opening episode travels to Louisville, Kentucky, not to explore whether medical care cures us, but to see why we get sick in the first...

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What are the connections between healthy bodies, healthy bank accounts and skin colour? Our opening episode travels to Louisville, Kentucky, not to explore whether medical care cures us, but to see why we get sick in the first...

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OC213 - Doulas and Midwives and Women's Health, Oh My! (Guest Edition)

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OC213 - Doulas and Midwives and Women's Health, Oh My! (Guest Edition)

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The Social Breakdown Team is at it again with another really important topic--Women’s Health! On this week’s show Omar and Ellen will be having a discussion with Alexandra, a current University of Hawai’i at Manoa PhD Student, medical sociologist, and a practicing doula! What is a doula? What is midwifery? Join us for the conversation as Alex gives us a brief but important tour of women’s health, mythbusting the differences between being a doula and a midwife, and much more

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Our goal for this podcast is to breakdown the social world one topic at a time. Come join us each week as we tackle a new topic using our sociological imagination!

1. All Episodes

2. SOC213 - Doulas and Midwives and Women's Health, Oh My! (Guest Edition)

The Social Breakdown Team is at it again with another really important topic--Women's Health! On this week's show Omar and Ellen will be having a discussion with Alexandra, a current University of Hawai'i at Manoa PhD Student, medical sociologist, and a practicing doula! What is a doula? What is midwifery? Join us for the conversation as Alex gives us a brief but important tour of women's health, mythbusting the differences between being a doula and a midwife, and much more.

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SOC213 - Doulas and Midwives and Women's Health, Oh My! (Guest Edition)

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The Social Breakdown Team is at it again with another really important topic--Women's Health! On this week's show Omar and Ellen will be having a discussion with Alexandra, a current University of Hawai'i at Manoa PhD Student, medical sociologist, and a practicing doula! What is a doula? What is midwifery?

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the Nocturnists: Stories from the Pandemic: Episode 1: New World

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the Nocturnists: Stories from the Pandemic: Episode 1: New World

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In this first episode of our special podcast series, healthcare workers reflect on the imminent patient surge that we have all been bracing for across the United States. It is the calm before the storm.

You will hear the voices of a trauma nurse in San Francisco, a pediatric emergency medicine doctor in New York City, a Durable Medical Equipment (DME) truck driver in the Southern US, a neonatologist in Pennsylvania, a neurosurgery resident in Los Angeles, an emergency medicine physician in Arizona, and an internal medicine resident in New York City

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In this first episode of our special podcast series, healthcare workers reflect on the imminent patient surge that we have all been bracing for across the United States. It is the calm before the storm.

You will hear the voices of a trauma nurse in San Francisco, a pediatric emergency medicine doctor in New York City, a Durable Medical Equipment (DME) truck driver in the Southern US, a neonatologist in Pennsylvania, a neurosurgery resident in Los Angeles, an emergency medicine physician in Arizona, and an internal medicine resident in New York City.

Illustrations by Lindsay Mound.

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In this first episode of our special podcast series, healthcare workers reflect on the imminent patient surge that we have all been bracing for across the United States. It is the calm before the storm.

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SOC109 - Illness & Morality: A Look at Medical Sociology

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SOC109 - Illness & Morality: A Look at Medical Sociology

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Is health a privilege or is it a right? As a society, how do we come to understand health and its social origins and outcomes? Though medicine has been understood as a social science that dates back to Hippocrates-- the Hippocratic Oath-- medical sociology is not even 70 years old yet! The climb to intellectual legitimacy and sound research is recent. When it comes to matters of stress, food, doctor-patient interactions, racism and sexism, medical sociologists have a lot to say and a lot to do...come join us as The Social Breakdown begins its journey in everything health!

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Our goal for this podcast is to breakdown the social world one topic at a time. Come join us each week as we tackle a new topic using our sociological imagination!

1. All Episodes

2. SOC109 - Illness & Morality: A Look at Medical Sociology

Is health a privilege or is it a right? As a society, how do we come to understand health and its social origins and outcomes? Though medicine has been understood as a social science that dates back to Hippocrates-- the Hippocratic Oath-- medical sociology is not even 70 years old yet! The climb to intellectual legitimacy and sound research is recent. When it comes to matters of stress, food, doctor-patient interactions, racism and sexism, medical sociologists have a lot to say and a lot to do...come join us as The Social Breakdown begins its journey in everything health!

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SOC109 - Illness & Morality: A Look at Medical Sociology

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Is health a privilege or is it a right? As a society, how do we come to understand health and its social origins and outcomes? Though medicine has been understood as a social science that dates back to Hippocrates-- the Hippocratic Oath-- medical sociology is not even 70 years old yet!

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the Nocturnists, Stories from the Pandemic: Episode 2: Arrival

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the Nocturnists, Stories from the Pandemic: Episode 2: Arrival

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In this episode of The Nocturnists: Stories from a Pandemic, you will hear diary entries from healthcare workers from New York, California, Massachusetts, and Indiana, all grappling with the first of the COVID case arrivals in their institutions. You will hear the voices of an internist, a pulmonologist, an emergency medicine intern, a clinical laboratory scientist, and a recently graduated medical student

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In this episode of The Nocturnists: Stories from a Pandemic, you will hear diary entries from healthcare workers from New York, California, Massachusetts, and Indiana, all grappling with the first of the COVID case arrivals in their institutions. You will hear the voices of an internist, a pulmonologist, an emergency medicine intern, a clinical laboratory scientist, and a recently graduated medical student.

Illustrations by Lindsay Mound.

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In this episode of The Nocturnists: Stories from a Pandemic, you will hear diary entries from healthcare workers from New York, California, Massachusetts, and Indiana, all grappling with the first of the COVID case arrivals in their institutions. You will hear the voices of an internist, a pulmonologist, an emergency medicine intern, a clinical laboratory scientist, and a recently graduated medical student.

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More than 40 percent of all coronavirus deaths in America have been linked to nursing homes. How did it happen, and how bad could it get?

Staff writer Olga Khazan joins James Hamblin and Katherine Wells on Social Distance to explain.

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James Hamblin: Was it inevitable that nursing homes would be hit really hard?

Khazan: Actually, no. I talked to a few nursing homes in other countries. In Hong Kong, there were no nursing-home deaths or cases, basically because they were freaked out by SARS. They had a really bad SARS outbreak in Hong Kong in 2003. That caused them to come up with this new plan for nursing homes in case of an outbreak like this. They stocked up on masks. They isolated nursing-home residents in special hospital wards instead of in the nursing homes. They had government-trained infectious-control officers stationed inside the nursing homes.

They really took it seriously, and it worked. Starting in January of this year, they set this plan in motion and it prevented nursing-home deaths. And I think, hearing the Hong Kong example, people might think, Well, you have to have a different government in order to do that, but there was an example in Baltimore. The Maryland Baptist Aged Home did something similar and also prevented any coronavirus deaths.

Hamblin: How did they do that?

Khazan: They basically stopped family visits in early February, which was pretty early. They stopped having the residents do community meals. They stopped having lots of foot traffic into the nursing home-vendors and delivery drivers, people like that. They brought in extra cleaning. They started screening their staff really intensively for their temperature and their symptoms and what they'd been doing outside of work.

Hamblin: It seems like the resources that you would need to do that grow exponentially as the outbreak is bigger and bigger in a community. It might be possible if you've got the virus relatively contained in a certain city to keep your nursing homes safe. But if there's this huge outbreak all around, it's going to be really hard to keep people in the nursing homes safe.

Khazan: Yeah, that's what experts told me. Essentially, if you have a big outbreak outside the nursing home, there's a really high chance you're going to have an outbreak inside the nursing home. Workers will leave work and go to the grocery store. They brush up against someone who has it. They bring it back into the home. When you don't have masks, when you don't have tests ... A lot of experts believe that asymptomatic staffers essentially brought the virus into nursing homes and were never tested, and it kind of spread silently for a while earlier this spring.

The Centers for Medicare and Medicaid Services (CMS) is the agency that regulates nursing homes, and it could have stepped in and given them masks, for example. Guidance from CMS-even on when to use masks-came really late in the game. Hospitals were prioritized, and they got priority for the stockpile of masks. But nursing homes weren't.

They were competing against large hospitals and states trying to get extra [personal-protective-equipment] supplies, paying tons of money for masks that were not actually effective or that were in some cases defective in various ways. In early June, data showed that 250 nursing homes had no masks left, and 800 more were a week away from running out. The federal government left it up to individual nursing homes to protect their residents. And what these nursing homes are saying is: We don't have the money to do that. We're not trained to do this. We don't have a stockpile of masks. And we don't have access to tests. That's where it all broke down.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

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transcript of their conversation.katherine wells

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James Hamblin: Was it inevitable that nursing homes would be hit really hard? Khazan: Actually, no. I talked to a few nursing homes in other countries. In Hong Kong, there were no nursing-home deaths or cases, basically because they were freaked out by SARS. They had a really bad SARS outbreak in Hong Kong in 2003.

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Thanks to the pandemic, the telehealth revolution we’ve been promised for decades has finally arrived. Will it stick? Will it cut costs — and improve outcomes? We ring up two doctors and, of course, an economist to find out.

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Listen and subscribe to our podcast at Apple Podcasts, Stitcher, or elsewhere. Below is a transcript of the episode, edited for readability. For more information on the people and ideas in the episode, see the links at the bottom of this post.
Thanks to the pandemic, the telehealth revolution we've been promised for decades has finally arrived. Will it stick? Will it cut costs - and improve outcomes? We ring up two doctors and, of course, an economist to find out.

* * *

Stephen DUBNER: Okay. If you would just say your name and what you do, please. Rebecca KURTH: My name is Dr. Rebecca Kurth. I'm an associate professor of clinical medicine at the Vagelos College of Physicians and Surgeons at Columbia University. And I'm a general internist in private practice in Manhattan. DUBNER: We should also say you are our family doctor. And I think you're great. So, thank you. KURTH: Thank you for that. DUBNER: It's been an interesting few months. Can you give us a quick overview, really, of what your typical day was like during the Covid peak in New York City and how that compared to a typical day pre-Covid? KURTH: Yes. I do predominantly preventive medicine. I do a lot of checkups and things that are done in a fairly routine fashion. What happened at the end of March is I went from having a few conversations with people who were having fever to having eight to 10 patients a day calling in with symptoms that were concerning. And I would say of my practice of about 1,000 patients, 50 had Covid-related illness. I spent a lot of time basically talking to people on the phone. The last two weeks of March and the first two weeks of April were the peak time here in New York City. DUBNER: And at what point did you stop going into your office to see people and handling this all electronically? KURTH: Well, I never stopped going into my office because I live within walking distance of my office. My office manager and I worked the entire time. It was also easier for me to be in my office in what I felt was my command central when I was handling all the phone calls. I had very quick access to my electronic health records. I was able to use my office as a reassuring background for any video calls that I had with patients. And it just allowed me to kind of stay focused. So, I would do an initial consult, a telemedicine consult, and then I would create my list of phone calls of people who I would call and follow up on over the next day or two or a week or two. DUBNER: I should say we were on your daily call sheet for a while. We had illness in the family during that time, which was pretty concerning, especially because in New York City the big concern was if you go to the hospital, what's going to happen there? And so, we were talking to you every day for, it seemed like typically 20 to 30 minutes. KURTH: So, what happened with Covid, and the hard thing for physicians is that there was so much uncertainty, and there was a sense that there wasn't much we could do other than maybe manage some of the other medications that the patient was taking, or maybe listen and see if on top of a viral infection, they were developing bacterial infections, or pneumonias, or sinus infections, or ear infections. So, every day I felt the follow-up phone calls - they were to reassure the patient, but it was also for me to learn more about the illness and what was happening and then to make micro-interventions to maybe prevent things from getting worse.

Things didn't get worse in my family. In fact, none of Dr. Rebecca Kurth's patients were hospitalized or died. We were fortunate. But many others were not: At the peak, as many as 800 people a day were dying in New York City from Covid-19. The streets had been abandoned. The most common sound was the ambulance siren. By mid-April, the Covid numbers started to decline, but the city was still shut down.

KURTH: What I saw in mid-April is that the Covid calls went way down, but the calls for other types of problems began to increase.

Kurth was faced with a dilemma: Should she reopen her office or find a way to keep treating her patients virtually, practicing what's known as telehealth?

KURTH: I think the thing that made me go immediately to telehealth was the news that Angela Merkel was in quarantine because her doctor had tested positive for the virus. And the idea of a physician or a physician's office being a vector of illness is kind of creepy. That you go to a place to get help and you get sicker.

So, Kurth started seeing non-Covid patients virtually, over Zoom. She felt she got to know them better.

KURTH: I enjoy seeing their homes. And I've met their pets and I've seen the children running in and out of the screens.

Once she began offering a telehealth option, she got very busy.

KURTH: People were wanting telehealth visits for low back pain. They wanted it for shoulder pain. They wanted it for a rash that they had developed. They wanted to simply go over their blood-pressure medications because they hadn't seen me in a few months. And it actually became quite enjoyable. Back pain is actually quite easy to do with a video camera. You can do all of the exam. You can phone in the prescriptions. No labs or x-rays are often needed. DUBNER: Can you give me a quick list of the things that, going forward, cannot and will not be done via telehealth? KURTH: So, earache, you've got to look at the ear. It could be wax. It could be anything. That's a simple thing. Abdominal pain. I did a couple of telehealth, but I certainly knew when I was going to need to get some blood work or other x-rays. Tough ones are fatigue or malaise. You can start the conversation over the phone, but it's hard to complete it. Chest pain and acute stroke symptoms, really need to go to the emergency room. There were two visits during the pandemic that I converted from telehealth to actual office visits because I felt that I was at risk of not getting it right on the phone or by video. And I actually brought the patient into the office with all protective gear because I felt it was essential. And I was safer than an emergency room at that time.

Kurth became convinced that telehealth would outlast the shutdown, at least for certain kinds of care.

KURTH: For me, it's the sick visits that I actually could easily do over the phone because they usually have algorithms. Back pain has an algorithm. A number of things like headache, sleep disturbance, you can actually do those things over the phone because they don't require as much of a physical exam. For annual checkups we could do certainly the screening questions over the phone. So, I would say looking next year, I would expect that 20 to 30 percent might be done over the telephone, and office hours would be more restricted.

Rebecca Kurth is just one doctor, with a pretty standard practice. Multiply her by the more than 200,000 primary-care physicians in the U.S. who've had to shift their practices during Covid-19 and you may be starting to look at a telehealth revolution.

Chad ELLIMOOTTIL: I really think that the old model of bringing patients in for every medical reason is over.

Today on Freakonomics Radio: what does this revolution look like? Who wins and who loses? And what kind of unintended consequences might we see?

ELLIMOOTTIL: You got the questions that stumped me. I was doing so well.

* * *

There are going to be a lot of long-term consequences of Covid-19 - economic and social consequences, how we travel and congregate and educate, on and on. There will also be a lot of long-term medical consequences, beyond the destruction done by the virus itself. For instance, screenings for cancer and other illnesses that didn't happen during the pandemic; childhood vaccinations that didn't happen. On the other hand, the telehealth revolution that we have been promised for decades was finally thrust upon us, by necessity. Some institutions were already well set up for telehealth.

ELLIMOOTTIL: Prior to the pandemic in February, we were doing about 400 visits per month.

That's Chad Ellimoottil. He's a practicing urologist, an assistant professor at the University of Michigan, and also:

ELLIMOOTTIL: And also the director of Telehealth Research Incubator at the University of Michigan.

Which is what?

ELLIMOOTTIL: Essentially it's a collaborative that uses resources and expertise at the University of Michigan to catalyze and disseminate telehealth research.

Are there a lot of telehealth incubators?

ELLIMOOTTIL: It's fairly unique. The purpose of it was to specifically look at population-level effects of telehealth.

Before the pandemic, the University of Michigan health-care system - which is huge, by the way - was doing about 400 telehealth visits per month.

ELLIMOOTTIL: And then in April and May, we did about a hundred times that. In April, we had 30,000 visits. And in May, we ended with about 40,000 visits.

Ellimoottil also got hold of data from a large insurance company to show their telehealth activity for the entire state of Michigan.

ELLIMOOTTIL: Prior to the pandemic, there were about 10,000 telehealth encounters per month. And then in March and April, these numbers were 140,000 and 230,000. So, about 20 times as many visits during the pandemic.

The pandemic forced changes that led to a massive spike in telehealth - including regulatory changes, as we'll hear later. But first, let's define what we're talking about when we talk about telehealth. For starters, is there a difference between "telehealth" and "telemedicine"?

ELLIMOOTTIL: So, telehealth, telemedicine, virtual care, and e-health are essentially the same thing for all intents and purposes. Telehealth is typically a little bit more broad than telemedicine. And some organizations may distinguish between the two terms. But nowadays those terms are all used interchangeably.

We'll call it telehealth too. You may be surprised to learn - I certainly was - that the earliest telehealth goes back to the invention of the telephone. In 1879, for instance, the medical journal The Lancet discussed using the phone to reduce unnecessary doctor visits.

ELLIMOOTTIL: It has been around for a long time. In fact, the Medicare program has reimbursed telehealth for about 20 years now.

But take-up rates have been low.

ELLIMOOTTIL: Up until March 2020, less than 1 percent of Medicare patients have ever used a telehealth service.

Ellimoottil's own interest in telehealth came from working as a urologist.

ELLIMOOTTIL: We're seeing patients from all over the state who sometimes travel four hours just to have a 15-minute consultation about their kidney stone. And to be honest, I probably knew the answer about how I was going to manage that patient when I looked at their C.T. scan.

M.D.'s aren't the only people who can deliver telehealth; nurse practitioners, social workers, and clinical psychologists can use it. And the applications are diverse.

ELLIMOOTTIL: Everyone knows about video visits and telephone calls, but there are other modalities of telehealth. One example is called an e-visit.

What's an e-visit?

ELLIMOOTTIL: Essentially an e-visit is a secure message between a health-care provider and a patient. That secure message can come in the form of a patient portal message. It can come in the form of an email. It could come in the form of a picture. A good example would be in dermatology, where you could take a picture of a rash and send it to a dermatologist and the dermatologist can reply without actually having to talk to you, and give you a prescription for it.

There's also an e-consult.

ELLIMOOTTIL: An e-consult, also known as an interprofessional consultation, occurs when a primary-care doctor has a question about their patient and then sends a specialist that question. And then rather than having the patient see that specialist directly, the primary-care doctor and the specialist hash it out, they come up with the solution and that's it.

Telehealth can cut across many specialties. During the pandemic, it's even been used to facilitate assisted dying. And also:

ELLIMOOTTIL: Psychiatry is a very important area. Dermatology is an important area. Stroke care is a very important area. When a patient is diagnosed with the stroke, how quickly they're started on medications impacts their function after that stroke. And so, if a patient is having a stroke in a small, rural hospital and there's no neurologist that's around, you can use video conferencing to get a neurologist in the room to diagnose that patient within seconds and then start that patient on medications within minutes so that they can have the best functional outcome from their stroke. David CUTLER: So, it turns out it's not just telehealth, you can do tele-fill-in-the-blank for anything.

That's David Cutler, a health-care economist at Harvard.

CUTLER: For example, you can have a tele-I.C.U. You've got a rural hospital somewhere with maybe not a full-time I.C.U. physician who really does need backup. And you have a hospital system that then has a central I.C.U. where they look into maybe 10 or 20 different hospitals and their local I.C.U.

Cutler worked in the White House under President Clinton and advised Barack Obama on health-care policy during the 2008 campaign. Being a health-care economist in the U.S. is a bit like being a general in a warzone: everywhere you look, there are crises - and opportunities. You want to cut spending while increasing access for those who need it. To that end, David Cutler is excited about this unplanned surge in telehealth.

CUTLER: It is amazing. We went from essentially no visits for medical care being telehealth to now between 10 and 15 percent of visits for medical care are telehealth. And we did it virtually overnight.

But the telehealth spike didn't happen entirely on its own. Yes, there was an increase in demand from patients who couldn't get to their doctors during the pandemic. And yes, there was a supply of unbusy doctors who had the capacity to treat those patients. But that alone wouldn't have been enough to drive the surge. Chad Ellimootil again:

ELLIMOOTTIL: There were more regulatory changes related to telehealth in the last three months than there have been in the last 20 years.

The Trump administration has leaned into this one, hard. F.C.C. Chairman Ajit Pai has called the telehealth boom the " silver lining of the pandemic."

ELLIMOOTTIL: At the federal level, there were five major changes. No. 1 was patients were allowed to connect from home. So, prior to the pandemic, patients were required to go to a medical facility, and that medical facility needed to be located in a health-professional shortage area.

In other words: you didn't have local access to the medical help you needed but rather than being allowed to get telehealth from your home, you had to visit a local medical facility and connect remotely from there. So, pre-pandemic access to telehealth was often not very convenient.

ELLIMOOTTIL: No. 2 was that patient privacy rules were relaxed. And what that means is that prior to the pandemic, there was a requirement that the software that you use, the equipment that you use, has high levels of security required by the law called HIPAA. And so, during the pandemic, there were some relaxation of these rules just so they can enable patients and providers to ramp up quickly.

So, rather than a dedicated interface or device, patients could use their own phone or computer.

ELLIMOOTTIL: The No. 3 was that payments for telehealth services were essentially made comparable to in-person visits. This is especially true for phone calls, which typically were either not reimbursed by payers like Medicare or were reimbursed at low levels.

No. 3 is the big one, if you think about it. The money. We'll come back to this one.

ELLIMOOTTIL: No. 4 was that there was relaxation of medical licensure rules. What this means is that many state governments and the federal government also said it would be okay to practice across state lines.

This allows flexibility, of course. In the past, some health-care providers fought this idea, arguing their businesses will shrink if patients are allowed to see out-of-state doctors.

ELLIMOOTTIL: And then, finally, the other big change was that practices were essentially given the power to waive co-pays for patients. And that's really important because it incentivizes patients to use these visits versus in-person care.

Okay, so that's a lot of regulatory change in a short time. The kind of change that doesn't typically happen without years of legislative fighting and horse-trading. The biggest change, as I mentioned earlier, concerned how doctors could get paid for practicing telehealth. David Cutler, again:

CUTLER: The key missing ingredient had always been the financial one. It was not the technological one, because as we've learned, it's easy, relatively easy to do. It was not the desire of patients because as we've learned, patients would like to do it this way. It was the financial issue. ELLIMOOTTIL: Insurance coverage for telehealth was fragmented. There were some private payers that were reimbursing for telehealth visits. The Medicare program was not at that time - or there was at least a significant regulatory burden on how a telehealth visit could be conducted. And so, that sort of fragmentation leads to confusion among patients, confusion among providers, which just inherently leads to lower rates of adoption.

Now, keep in mind the U.S. health-care system is incredibly segmented. Some doctors take private insurance; some take Medicare; some take no insurance. So, the money didn't flow evenly. Consider my family doctor, Rebecca Kurth; she doesn't take insurance - which meant no insurance company was reimbursing her for all those Covid calls.

KURTH: April was a brutal month. It was a 75-percent reduction in revenue, even though I was doing eight telemedicine visits a day and probably 10 non-charged phone calls, which were my own neurotic follow-up phone calls. I bill by 10-minute intervals. But you don't bill the same way when you're not fully present in a room with somebody.

Money, probably more than anything else, will likely determine the degree to which telehealth continues after the pandemic. These federal regulations have been changed only temporarily, on account of the crisis.

CUTLER: At the end of this, C.M.S. will have to figure out whether it wants to go back to the way it had it or keep things the way that it changed into.

C.M.S. is the Centers for Medicare and Medicaid Services. It's a federal agency, within the Department of Health and Human Services, and it accounts for 37 percent of U.S. health-care spending, and accordingly plays a huge role in setting costs.

CUTLER: That's a political-economic decision. Congress might get involved as well. My hope is that they will continue to reimburse telehealth. Certainly there haven't been stories about widespread abuse of telehealth that might indicate we've got to be careful here. DUBNER: What kind of abuse would one fear? CUTLER: Anytime that you have someone taking care of a patient or claiming to take care of a patient, you always need to be sure that that actually occurred. There was a good deal of home-health fraud that was about bills that were submitted for home health where people suspected no actual home health care was provided, that it was entirely a scam to submit bills. There is a seamy underside of a lot of medical care like that.

This sort of caution may be justified, Cutler says. But it doesn't fully explain why C.M.S. has been historically disinclined toward reimbursing for telehealth.

CUTLER: I think what happened was there were no doctors yelling and screaming, "You have to create this telemedicine thing because I'm desperate to do it." And so, C.M.S. listens to where the yelling and screaming is. And the yelling and screaming is coming from the specialists who say, "Oh, we've got a new way of treating X, you've got to find a way to reimburse X." And so, there's this tendency to focus on where the hockey puck is and not where it's going. DUBNER: Talk about the other economic decisions being made, including - I'm really curious to know about private insurers. CUTLER: So, private insurers are in a very interesting position. So, on the one hand, the use of medical services has plummeted. Absolutely plummeted. People are not going to the doctor. People are not going to the hospital. There are fewer people showing up with strokes and heart attacks. On the other hand, they had businesses and individuals who were writing them checks who are saying, "I can't pay you now. My business is shuttered. I can't pay you. As an individual, I can't pay you." So, on the revenue side, they were losing a lot as well. Most insurers are in this tricky spot where in the short term they've been making a lot of money because they haven't been paying out. They're now, if you will, extending loans to businesses. And they're wondering, is that care that was deferred going to come back and bite us? So, all those people who didn't go to the doctor for X, are they going to show up in the fall next year? They don't really know about this. If they get very nervous that people are going to have all these elective surgeries, that doctors are going to make up for a couple of months out with a lot of billing, then they're going to return to clamp-down mode. So, they'll say, "We have to get a handle on expenses. We have to impose more drug co-pays. We have to stop this telemedicine thing. We have to do all these things to try and bring our costs under control." If they don't need to do that, if utilization stays low, if people come back and can pay their insurance premiums and so on, then the insurers will be in a much better position to say, "You know, this actually turned out okay, and we're willing to go with this and let's figure out how we work this into routine care. So, on the one hand, that was like a bonanza for private insurers because their business models take in premiums and pay out claims. And if nobody's making claims, then you're taking in premiums and not paying out.

It may end up being harder to take away telehealth reimbursement than it appears. Just because it can be hard to take away anything that people have gotten used to. For now, patients are using it, doctors are being reimbursed, and everybody's already invested time and energy in figuring out how to do it.

ELLIMOOTTIL: And that reluctance and that resistance to change is a big problem in health care. As someone who is working to expand the use of telehealth, just getting providers to do a video conference with a patient that is eight hours away, is hard enough to build that into workflow. Providers and patients across the country were able to see what the value and the benefit of telehealth was during this time, where they really didn't have any other options. DUBNER: It strikes me that telehealth has been the future for a long time, and then suddenly in the course of a month or two, because of Covid-19, it became the present. Really, what I want to know is, is it also the future? In other words, is it going to stick? ELLIMOOTTIL: I think it's going to be sticky to some degree. I think that this spike is probably the highest level that we're going to get to for a while. After the pandemic is over, as health systems start to ramp up in-person care, we're going to see telehealth drop, and it'll drop to some baseline level that was much higher than it was prior to Covid, but it won't be at the levels that it was during the pandemic. DUBNER: If this goes as you would like it to go, what share of in-person medical visits as of 2019, let's say - right before pandemic, what share of those will convert to telehealth visits by, let's say, 2025? ELLIMOOTTIL: I think that the right number is probably about 25 percent. I really think that the old model of bringing patients in for every medical reason is over. And now that there's been that exposure to telehealth, a lot of specialties will be redesigning care.

* * *

A few months ago, before the Covid-19 pandemic, we were working on an episode about the U.S. health-care system. We had two central questions: is the system as messed up as people think it is?

Zack COOPER: Oh, I think absolutely the U.S. health system is as messed up as people think it is, probably more so.

And what are the primary drivers of this mess?

Marty MAKARY: If there are two fundamental drivers of our broken, costly health-care system, I would say it's pricing failures and inappropriate care.

We will finish up that episode eventually. But we, like everyone else, put our pre-pandemic plans on hold. And today, we're focused on one piece of that larger health-care story - the massive boom in telehealth precipitated by the Covid shutdown.

In a typical year, the U.S. spends about 18 percent of its G.D.P., or $3.5 trillion, on health care. That's nearly double the average O.E.C.D. country in terms of G.D.P. percentage; and our outcomes aren't always so good. How might telehealth change this? The health-care economist David Cutler sees three main drivers of those high costs:

CUTLER: The first one is the administrative cost of running the health-care system. In most countries, they just say to the physicians, "Here are the resources that we have, you make do with them." And that's not a very expensive way to do things. In the U.S. we don't say that. We say, "You can have whatever equipment you want, but we're going to question every single time you want to use it." The net effect is we spend an enormous amount of resources adjudicating when is it appropriate to use care or not. That's very, very costly.

Okay, so a huge layer of administrative cost. Health care is hardly the only U.S. industry to pay these costs - higher education comes to mind. What else drives up U.S. health-care costs?

CUTLER: The same provider of care - think about pharmaceutical companies - gets paid more for selling in the U.S. than in other countries. Drugs are more expensive in the U.S. than in other countries. So, by the way, are physician visits for the same thing, more expensive in the U.S. than other countries.

That's connected to our byzantine system of insurance reimbursements, and the fact that many people get their health insurance through their employers, which doesn't happen in other countries. And the third driver of high U.S. health-care costs?

CUTLER: The typical visit to a medical-care institution is more intensive in the U.S. than it is elsewhere. It's likely to involve additional testing, maybe hospitalization. And a lot of that care is not really so essential. It's done because the physician just wants to be sure, sometimes because he or she is afraid of being sued, sometimes because there's an empty hospital bed, so you might as well use it. DUBNER: When you break it down into those three areas, does telehealth - if it were to, let's say, double, triple, quadruple over the next five or 10 years - does that do anything to significantly lower those costs? CUTLER: One thing that it does, which is independent of cost, is it just makes the medical system more convenient for people. One of the big frustrations about medical care in the U.S. is that people have a very, very difficult time using it and accessing it and getting to where you need to and the physician visits and all of that. So, we shouldn't underestimate the poorer outcomes that result from having a system that's difficult to use.

But Cutler also sees promise in the direct lowering of costs. While C.M.S. is currently reimbursing telehealth visits at the same rate as in-person visits, that doesn't necessarily reflect the future reality.

CUTLER: So, the telemedicine visit doesn't need to be as high. My sense is that something like 85 percent of an in-person visit is roughly the cost that's needed, because you don't need the staff and you don't need the office space. ELLIMOOTTIL: I would play a little devil's advocate here and say that it's not necessarily cost savings.

That again is Chad Ellimoottil, the urologist who runs the Telehealth Research Incubator at the University of Michigan.

ELLIMOOTTIL: There are kind of two ways to look at it. One is that it is cost savings because it reduces that in-person clinical footprint. It reduces overhead costs. But on the other hand, it actually can be - you can lose revenue through these visits. And so, there's this concept of payment equity, which means that it's not just is the visit reimbursed at the same level, but it's also about all the additional services that come with in-person care. DUBNER: Do you mean, upselling, essentially? Like I go for my physical and I get asked, "Do you want not only the flu vaccine, but the pneumonia vaccine, too?" that kind of thing? ELLIMOOTTIL: So I don't know if it's so much upselling as it is kind of the services that you receive out of convenience. Let me give you an example in my practice. When we see patients in person for urologic care, we typically start the visit by collecting a urine sample and running a urine-analysis test. And so, that urine-analysis test, I'll take a look at, I'll make sure that there's nothing that I need to address in that. However, does every patient need that particular screening modality? I mean, we do it because they're there and it's quick and it's easy and it helps us with our management, but it may be considered low-value care or a low-value test. Those are the kind of things that practices make money off of, so that the total reimbursement for a patient may actually be lower with telehealth visits than it is with in-person care. DUBNER: But it sounds like the concern from the health-care provider may be that it really strips it down to the essentials, that even if reimbursement is commensurate with in-person reimbursement for certain activities, there are other activities that just won't be happening at all, that you won't be able to charge for. Is that right? ELLIMOOTTIL: That's 100 percent correct.

What we've been talking about here is the microeconomics of one doctor. Health care is of course much, much broader than that. Consider all the treatment - all the elective surgery and consultations and other procedures - that was deferred during the pandemic. That loss of revenue has already put a lot of providers under an existential threat. It's not a very popular position to express concern for the existential well-being of health-care providers - they're generally seen as already charging too much. But no one wants to see providers disappear, either. So, what's the best way to think about balancing health-care supply, demand, and price?

CUTLER: The biggest source of spending in health care is when people get very sick, so they wind up in the hospital, they're in intensive care, they're in rehab and acute-care facilities, post-acute care facilities. If you want to reduce spending in medical care, get people out of institutions. That is super expensive. Most anything you can do that prevents that will save money.

And here's where telehealth may prove most valuable: using various technologies for preventive care, for health-care monitoring, and other cheap and easy interventions that keep people out of institutions.

CUTLER: One of the shames about prevention is we know how to do it and it's still woefully underdone. Only about half of people with high cholesterol or hypertension are successfully treated. If you can use telehealth to do that, you can both improve people's lives and save money on things like heart attacks and strokes and related conditions. DUBNER: So, the complaint from providers is always - well, the complaint from everyone really - is always that prevention is not monetized, you're not incentivized, and that procedures and treatment are. Can you see a way in which telehealth, and all that includes - apps that have a pulse-ox, smartphones are really, really smart when it comes to health care - can you imagine a way in which telehealth is an avenue for a huge increase in preventive care? CUTLER: Yes, I can. A lot of preventive care involves regular activities on the part of people, but that it's easy to slip up. So, for example, I need to be taking medication regularly for someone who has a particular condition. But if you forget to go to the Walgreens that month or that week, then you don't have it. Maybe actually the right way to care for yourself at home is with telemedicine and C.V.S. or Walgreens. You know, coming in and delivering your diabetes test strips and making sure that your high blood pressure monitor is accurate and so on.

It's a strange feature of our digital revolution. If you consider how much computers and the internet have changed the way we work and socialize and entertain ourselves, it can often seem that health care is back in the 20th century.

CUTLER: The thing about health care that's always struck me is that health care is the most information-intensive industry in the economy, and it uses information technology among the least of any industry. The fax machine seems to exist, at the moment, only for health care. So, I think of telehealth as one part of a system that we know should work differently than it does. And this is an easy entree into doing that. ELLIMOOTTIL: The idea of remote monitoring is being able to collect vitals or collect important data from patients without them actually being there in front of you. That is going to be a big way that certain types of conditions, like congestive heart failure, diabetes, those conditions can be managed where physicians are essentially managing an entire panel of patients just by looking at their data. And that's also where these new concepts like artificial intelligence can come into play, where the big part of remote monitoring is being able to sort through lots and lots of data to be able to come up with clinically-appropriate solutions and red flags for patients. DUBNER: So, here's the big question, Chad. We've talked about uptake and technology and costs and regulations and so on. The big question for me is outcomes generally, health outcomes. ELLIMOOTTIL: There's four areas where we can think about outcomes. One area is access. Second area would be costs. The third area would be quality. And then the fourth area would be patient experience. And so, on the patient-experience side, there's numerous studies that have essentially showed that patient satisfaction rates with these telehealth visits are equal to or better than in-person care. DUBNER: Okay. But you're talking about satisfaction outcomes, essentially, even when you talk about quality. I want to know about medical outcomes. So, in other words, if I feel that there's huge value in seeing my doctor in person because there are things that can be done diagnostically, whether it's physical examination, whether it's a sort of conversation, whatever, or maybe how the data are are gathered, collected, and analyzed. ELLIMOOTTIL: Yes. That's a good question. There's certain things that we know from smaller sized studies, pilot studies, single institution studies, and what we don't know is really the population level effect. And so, let's just go to the chronic disease management of congestive heart failure. That's one area that has been studied very well with a lot of randomized control studies that have found that using remote monitoring, checking patients' weights at home, and adjusting their medications can keep them out of the hospital, can shorten their stay inside hospitals, and can actually decrease mortality as well. And so, that's one area where remote monitoring works well. In diabetes management, remote monitoring has been shown to, in randomized control trials, to be associated with lower rates of hemoglobin, A.1.C.'s. There is some strong data in selected areas. But in terms of, "Will a patient's outcomes from a cancer diagnosis be improved because of early detection?" We don't know the answer to that yet because it just hasn't been used in oncology at a population level where we can actually assess that particular outcome. I want to know what we can tell about, if we were, let's say, the thought experiment, if we were to switch to 100 percent telehealth overnight, what do we see in terms of early cancer diagnosis? What do we see in terms of diabetes and C.O.P.D. diagnosis and monitoring and treatment and so on? What can you tell us about that?

Better medical outcomes are of course reliant on access to health care in the first place. Let's go back to something David Cutler said earlier:

CUTLER: We shouldn't underestimate the poorer outcomes that result from having a system that's difficult to use.

Think about that for a second. Even if you're the kind of person who does have health insurance - and 27 million Americans don't - even if you're the kind of person who does have the time and ability to make a doctor's appointment on a weekday, and wait there as long as the doctor needs you to wait before seeing you, and you also have the time and the ability to come for the follow-up visits or tests - imagine how convenient a telehealth visit might be for you. Now imagine you don't have the ability or the time to access medical care in that standard, old-fashioned way. How much more convenient would a telehealth visit be for you now?
SOURCES
CUTLER: So, if telemedicine becomes part of this whole thing, which is now we want to care for as many patients as possible at home, not by making them go to the doctor's office and not by making them go to inpatient settings, then that could set off a really interesting battle for who controls the patient's house in terms of medical care. DUBNER: So, if I forced you to predict, when the data start being revealed in the fall and beyond, what do you think we will learn about, especially about the insurers' thinking on the economic value of telehealth? CUTLER: My guess is the more fortunate - economically, demographically fortunate - have probably found ways to keep in contact with the medical sector to make sure they're getting their medications, to make sure if anything's going wrong, they're up with it. And that the lower income one has, the less able what it's been to do that. We'll likely see more in the way of missed medications, of missed screenings, and that will then translate into poorer outcomes. DUBNER: So, an exacerbation of the inequality already, basically. CUTLER: Correct. There's a fact about medical innovation which is relevant here. Almost every medical innovation first diffuses to people who are better off and then diffuses to people who are worse off. So, you see that with new drugs, you know, new drugs for H.I.V. first get taken by higher-income people and then they spread to lower-income people and people in lower-income countries. Same is true with antihypertensives, cholesterol drugs and so on. It may very well be that telehealth and its related innovations happen first for people in cities, and rich providers and so on. I'm hopeful that it won't be. But even if it does, that doesn't mean that's where it has to end up. DUBNER: So, assuming the change sticks, at least to some degree, and that telehealth grows - who stands to lose the most? CUTLER: That's an interesting question. It'll depend on a couple of things. One thing that will happen is that the physical space and the office personnel may shrink some. If you're, for example, a landlord renting to medical offices, they may not need as much space. And if you're in the medical-record business or in the office-support business and there's no office to support, then you may be out of a job. So, those would probably be the biggest losers. The winners - some physicians will turn out to be winners because really what they want is actually a more flexible schedule, too. And so, being able to do the telemedicine version may actually work out well. Patients could very well be winners, too. Depending on how much more we spend in primary care relative to what we save, the spending balance could go up or down. My own personal thought as we're talking about it is that over time, technology from telemedicine and other things ought to be able to lower spending. But there's a possibility, certainly in the short run, that it would increase spending. The bad way to say it is never waste a crisis. The good way to say it is people, doctors, patients, health-care systems are now open to more change than they've been in some time. DUBNER: So, let's just pretend for a minute that Joe Biden wins the presidency in November. Let's pretend that you come back into that administration, head of C.E.A., maybe health care, specifically. What's the first move you make or the biggest, best move you make to address "the health-care system"? CUTLER: I'm going to give you two priorities. The first one is you're going to come in, in the middle of a continuing recession - hopefully it's not a depression - where people are going to be without coverage or they're going to have lost the coverage they like, and they'll be searching around for coverage. And so, you're going to have to do something to help people. So that's item one. Item two is that medical care is too expensive, and the expense hinders people from seeking medical care. It hinders businesses from investing in workers. It hinders governments from doing things that governments would like to do. So, I make a full-frontal assault on the cost of medical care. I go after the administrative costs in medical care. I go after wasted resource use. I go after fraud and abuse. I go after higher prescription drug prices than are necessary. I do everything I can not to ration care to people because I don't want to ration care to people, but to get rid of all the waste in medical care. We have a $3.5 trillion medical system and our best guess is that a trillion dollars a year is unnecessary. If I can get any part of that trillion, then I can do whatever the heck I want. DUBNER: And would you consider - whether you pursue some kind of Medicare-for-All option or not - would you consider unbundling health-care insurance from employers? Because that strikes me as in some ways the original sin of the U.S. health-care dilemma. CUTLER: There's an issue as to whether the next president, if it's President Biden, should take a big swing at medical care or should take a medium swing at medical care. A big swing would be something like Medicare-for-All or get rid of private insurance and some combination like that. And a medium swing is patch up the A.C.A. and focus on costs. There are other issues that we need to address, too. At a time where the capital of the president is at its highest, I don't know that I would recommend going all in on the big swing for health care, spending the first year and a half on that and not addressing wage inequality and cities coming apart and racial issues and pandemic and all of that. I don't know that I would say now is the time to do that.
RESOURCES
One part of Cutler's medium swing would be moving away from the fee-for-service system in most primary care:

CUTLER: What we currently do with primary care docs, is we say, "Every time you see the patient, send in a bill and we'll pay you. Every time you have a phone call, send in a bill and we'll pay you. Every time you do this, send in a bill and we'll pay you." If you, as a provider, say, "Hey, you know what? By using email and telemedicine, I can see many more patients," then go ahead and do it. Those kinds of alternative payment models would also help to incentivize telehealth services. KURTH: One of the things I should say about myself is I am a fee-for-service doctor and I've opted out of all insurances. A different payment model would be something like, "I'll tell you what, we're gonna pay you $40 for each person per month, adjusted for how severely ill they are. Then you figure out the best way to care for them. Oh, by the way, we're going to monitor, like, make sure you actually do interact with them. They're getting their medications, they're self reports are good. And so on, so you can't not see them. But you decide the best way to see them."

That, again, is Rebecca Kurth, a professor of medicine at Columbia and my family doctor.

KURTH: One of the brutal things I realized 15-plus years ago was that I worked for the patient and I can't have myself - and this is maybe more than one needs to know - I'm not working for Kaiser, which I think is a wonderful nonprofit health company. I don't work for Cigna, or I don't work for Oxford or United, or I don't work for a commercial insurance company. Yet they put rules on me that may not actually be in the best interest of my patient. And that's a harsh thing to say. And when I work for the patient, it means you have my undivided attention. I will work with your insurance plan to get things covered that need to be covered. But I need to unfetter my brain from thinking about their rules. And when I do that, I become a better doctor because I'm thinking about what does this person need, how can I help this person, what do I think the diagnosis is, how do I best get at the diagnosis without somebody telling me I can't or it's going to take two hours on the phone to get prior authorization. So, I look at myself as somebody who is trying, to the best of my ability, to use my knowledge base and skills to navigate the health of the individual patient. And that makes it easier for me to say, first of all, accept all change that's coming forward if it's in the patient's interest and if I can do a good job with telehealth, I'm going to do it.

* * *

Freakonomics Radio is produced by Stitcher and Dubner Productions. This episode was produced by Zack Lapinski. Our staff also includes Alison Craiglow, Greg Rippin, Matt Hickey, Corinne Wallace, Mary Diduch, and Daphne Chen. Our intern is Emma Tyrrell. We had help this week from James Foster. Our theme song is "Mr. Fortune," by the Hitchhikers; all the other music was composed by Luis Guerra. You can subscribe to Freakonomics Radio on Apple Podcasts, Stitcher, or wherever you get your podcasts.

Here's where you can learn more about the people and ideas in this episode:

Rebecca Kurth, associate professor of clinical medicine at the Vagelos College of Physicians and Surgeons at Columbia University.

Chad Ellimoottil, assistant professor of urology at the University of Michigan.

David Cutler, health-care economist at Harvard University.

Zack Cooper, associate professor of public health and economics at Yale University.

Marty Makary, professor of surgery at Johns Hopkins University.

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Listen and subscribe to our podcast at Apple Podcasts , Stitcher , or elsewhere . Below is a transcript of the episode, edited for readability. For more information on the people and ideas in the episode, see the links at the bottom of this post.

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AMERICA DISSECTED: CORONAVIRUS - Epidemiology is hard to do

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AMERICA DISSECTED: CORONAVIRUS - Epidemiology is hard to do

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Abdul talks about the challenges of doing science in real time during a pandemic and interviews Prof. Kerry Keyes, an epidemiology professor at Columbia’s Mailman School of Public Health about the scientific process, and how people should approach new findings.

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Epidemiology is hard to do | Crooked Media

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BIG NEWS. SHORT PODCAST. SUBSCRIBE TO WHAT A DAY BIG NEWS. SHORT PODCAST. SUBSCRIBE TO WHAT A DAY

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Suicide Rates and Insights from Medical Sociology - Healthcare Triage

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Suicide Rates and Insights from Medical Sociology - Healthcare Triage

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Our guest this month is Dr. Bernice Pescosolido, who is a medical sociologist at Indiana University. Dr. Pescosolido studies the environments, neighborhoods, and connections that contribute to patients’ identities, and looks how this social fabric works or doesn’t work for some people. Particularly, Dr. Pescosolido studies the rising suicide rates in the United States, and tries to track the pathways that have led victims to suicide. She also studies what kind of social factors contribute to how patients come into contact with (or don’t manage to engage with) the medical system.

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Suicide Rates and Insights from Medical Sociology - Healthcare Triage

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the Nocturnists: Being Black in Healthcare Episode 1: Again

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the Nocturnists: Being Black in Healthcare Episode 1: Again

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There is so much to explore about what it means to be Black in healthcare, but for our first episode we wanted to take a moment to sit with the grief of the event that set this whole project into motion: the murder of George Floyd, a Black man, by a white police officer in Minneapolis.

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There is so much to explore about what it means to be Black in healthcare, but for our first episode we wanted to take a moment to sit with the grief of the event that set this whole project into motion: the murder of George Floyd, a Black man, by a white police officer in Minneapolis.

Black Voices in Healthcare was made possible by the California Medical Association, the California Health Care Foundation, and you.

Illustrations by Ashley Floreal.

Original music by Janae E.

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There is so much to explore about what it means to be Black in healthcare, but for our first episode we wanted to take a moment to sit with the grief of the event that set this whole project into motion: the murder of George Floyd, a Black man, by a white police officer in Minneapolis.

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SOC126 - Medicalizing Behavior: Common or "Abnormal"?

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SOC126 - Medicalizing Behavior: Common or "Abnormal"?

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Since 2000, which marked the national Human Genome Project (HGP), society has seen a shift in the process of medicalization, and we are here to talk about it! What is “normal” versus “abnormal” child behavior? How has society continued to explain human behavior in biological, genetic or medical terms? How does the pharmaceutical industry influence this process? Join us for the conversation on this week’s episode!

Also, check out our website (www.thesocialbreakdown) to look at the many sources we cited in today’s episode, along with some other relevant materials you may find interesting!

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Our goal for this podcast is to breakdown the social world one topic at a time. Come join us each week as we tackle a new topic using our sociological imagination!

1. All Episodes

2. SOC126 - Medicalizing Behavior: Common or "Abnormal"?

Since 2000, which marked the national Human Genome Project (HGP), society has seen a shift in the process of medicalization, and we are here to talk about it! What is "normal" versus "abnormal" child behavior? How has society continued to explain human behavior in biological, genetic or medical terms? How does the pharmaceutical industry influence this process? Join us for the conversation on this week's episode!

Also, check out our website ( www.thesocialbreakdown ) to look at the many sources we cited in today's episode, along with some other relevant materials you may find interesting!

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SOC126 - Medicalizing Behavior: Common or "Abnormal"?

# data[].attributes.attachment_link.description
Since 2000, which marked the national Human Genome Project (HGP), society has seen a shift in the process of medicalization, and we are here to talk about it! What is "normal" versus "abnormal" child behavior? How has society continued to explain human behavior in biological, genetic or medical terms? How does the pharmaceutical industry influence this process?

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Episode 8: Touch: The Nocturnists Black Voices in Healthcare

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Episode 8: Touch: The Nocturnists Black Voices in Healthcare

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From the physical exams we conduct to diagnose disease, to the reassuring handshakes before a surgical procedure, human touch is absolutely fundamental to the work we do in healthcare.

This series is brought to you by the California Medical Association and the California Health Care Foundation.

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From the physical exams we conduct to diagnose disease, to the reassuring handshakes before a surgical procedure, human touch is absolutely fundamental to the work we do in healthcare.

This series is brought to you by the California Medical Association and the California Health Care Foundation.

Learn more on our website.

Illustrations by Ashley Floreal.

Original music by Janae E.

# data[].attributes.attachment_link.description
From the physical exams we conduct to diagnose disease, to the reassuring handshakes before a surgical procedure, human touch is absolutely fundamental to the work we do in healthcare. This series is brought to you by the California Medical Association and the California Health Care Foundation. Learn more on our website.

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How Society Handles Mental Health Problems

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How Society Handles Mental Health Problems

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Today, we discuss how society handles its mental health problems. Our guest is Neil Gong from the University of Michigan. Neil recently published “Between Tolerant Containment an d Concerted Constraint: Managing Madness for the City and the Privileged Family” in the American Sociological Review.

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Today, we discuss how society handles its mental health problems. Our guest is Neil Gong from the University of Michigan. Neil recently published " Between Tolerant Containment an d Concerted Constraint: Managing Madness for the City and the Privileged Family" in the American Sociological Review.

Photo Credit

By Unknown - Università degli Studi di Milano Centro Apice, Archivio storico, Archivio proprio, serie 7, Carteggio articolato sul titolario, b. 100, fasc. 82., CC BY-SA 4.0, Link

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How Society Handles Mental Health Problems - Sociocast Project

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Today, we discuss how society handles its mental health problems. Our guest is Neil Gong from the University of Michigan. Neil recently published " Between Tolerant Containment an d Concerted Constraint: Managing Madness for the City and the Privileged Family" in the American Sociological Review.

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How Will Society Change in Response to COVID19?

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How Will Society Change in Response to COVID19?

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How did COVID19 happen? Why did we botch its handling? How will society change in response to the virus?

Alison Buttenheim is an Associate Professor of Nursing at the University of Pennsylvania. She specializes in how people make health-related decisions.

Malia Jones is an Assistant Scientist at the Applied Population Laboratory at the University of Wisconsin-Madison. She looks at spatial differences in health outcomes.

Amy Hsin is an Associate Professor of Sociology here at Queens College in the City University of New York. She is an expert on education and immigration, and has worked on New York schools’ closure.

# data[].attributes.attachment_link.readable_text
How did COVID19 happen? Why did we botch its handling? How will society change in response to the virus?

Alison Buttenheim is an Associate Professor of Nursing at the University of Pennsylvania. She specializes in how people make health-related decisions.

Malia Jones is an Assistant Scientist at the Applied Population Laboratory at the University of Wisconsin-Madison. She looks at spatial differences in health outcomes.

Amy Hsin is an Associate Professor of Sociology here at Queens College in the City University of New York. She is an expert on education and immigration, and has worked on New York schools' closure.

Photo Credit

By Jedimentat44 - https://www.flickr.com/photos/jedimentat/49641499342/, CC BY 2.0, Link

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How Will Society Change in Response to COVID19? - The Annex Sociology Podcast

# data[].attributes.attachment_link.description
How did COVID19 happen? Why did we botch its handling? How will society change in response to the virus? Alison Buttenheim is an Associate Professor of Nursing at the University of Pennsylvania. She specializes in how people make health-related decisions. Malia Jones is an Assistant Scientist at the Applied Population Laboratory at the University of Wisconsin-Madison.

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Black Americans were denied access to doctors and hospitals for decades. From the shadows of this exclusion, they pushed to create the nation’s first federal health care programs.

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transcript

Episode 4: How the Bad Blood Started

Hosted by Nikole Hannah-Jones, produced by Annie Brown and Kelly Prime, with help from Clare Toeniskoetter and Austin Mitchell, and edited by Larissa Anderson, Lisa Chow, Wendy Dorr and Lisa Tobin

In the United States, racial health disparities have been as foundational as democracy itself.

nikole hannah-jones

My Uncle Eddie was my favorite uncle. He was my dad's younger brother, not that much older than me, and he was a complete jokester and cutup. He was the one who was always playing some practical joke on you, or who, in some ways, you always felt was taking things too far, because he just thought everything was funny. So for instance, if you fell asleep in his house, he might light a match and stick it between your toes and let it burn down to wake you because he thought it was funny. He called me Bird, which was my nickname. And we liked to listen to music together. We liked to watch TV together. He was never mad. I never remember him ever disciplining me for anything. And in fact, when my father and I would fight when I was a teenager, I would sometimes pack my bag and go stay with him for a couple of days, and he would never kind of sell me out.

When I got into college at the University of Notre Dame, I think the only person prouder than my mom and dad was my Uncle Ed. And when I graduated, my uncle picked out this all-red outfit from head to toe. He had on a red hat and a red shirt and red pants and these red gators, and he was determined that he was going to show everyone how proud he was of me by out-dressing everyone at the graduation, and he certainly did.

So we just were always very close. Whenever I would come home, we would get breakfast together at Morg's and just talk about life. And all he would tell me all the time was how proud he was of me.

Besides being a lot of fun, my Uncle Ed was also one of the hardest-working men that I knew. He worked a lot of jobs doing things like working in animal processing plants. And the last job that he had was roofing, and he did roofing for a lot of years, often coming home at the end of the day kind of grimy, and sometimes with his joints in his hand so swollen that he couldn't even make a fist. He relished working hard. He was proud that he could provide for his family, even without an education. And then about 2009, he started to feel a pretty severe pain in his back. And that pain began to spread from his back down into his legs. And he started to have trouble moving. And there were some mornings where he would have to kind of crawl out of bed. But around that time, my uncle also got laid off from the job where he was doing roofing, and with that layoff, he lost his health insurance. So like many people, he at first avoided going to the doctor altogether, because he didn't have insurance. But then when it got kind of unbearable, he went to the free clinic. Because my uncle did not have health insurance, they would not give him the tests that he probably needed to find out what was going on with his back. They wouldn't give him an X-ray, they wouldn't give him a CAT scan or a PET scan, and instead, they just tried to diagnose based on what he was telling them. And they told him that he probably just needed an alignment in his spine, that that's what was bothering his back. So they sent him to a chiropractor. My uncle would end up going back about five or six times as his back was getting progressively worse, and the final time that he went to the chiropractor, as the doctor was working on his back, they both heard a big pop. That pop concerned everyone, and so the chiropractor told him, as my uncle kind of gets up off the bed and is barely able to stand up, that he better go to the emergency room right away. When he got to the emergency room, that doctor recognized right away that something serious was going on, and actually gave my uncle the X-ray and the CAT scan that he probably had needed months before. And what that doctor saw scared him.

He saw these spots on the scans that he had taken all over my uncle's back and along his spine. And it's at that point where we find out that my uncle has cancer, and that he'd likely had cancer for many, many months, if not longer. And we learned that the cancer is Stage 4, and it has metastasized throughout his entire body. And because of that, the cancer is terminal.

And it is because of that diagnosis that my uncle was finally able to get access to the insurance that he had needed so badly all those months before. And that's because, with this diagnosis of terminal, untreatable cancer, my uncle was able to qualify for federal disability. And federal disability means because your physical health is so poor and you are unable to work, the government will help you and pay for your insurance and your medical treatment. So it took, literally, my uncle getting a death sentence before he was able to get health insurance. That health care gets him out of those free clinics and into an actual cancer clinic in Illinois. And it's there that the doctors give us the news that had they been able to see him months before, he could have had a fighting chance. But it was too late. And so in those next four months, we just saw my uncle's health deteriorate more rapidly than any of us could have imagined, and his body wither to almost nothing. And in the end, the pain of the cancer was so bad that he didn't even want to fight anymore. So at the age of 50, just two weeks after my daughter was born, my uncle passed away.

I remember in those last days, when he was in hospice and I had just had my baby, I called him to give him the news. He was really weak. He could barely talk. But he said, I'm so happy that I'm going to get to see my baby bird.

And so when my daughter was just two weeks old, I had to wrap her up and put her on an airplane as we flew back to Waterloo to bury my uncle.

["1619" theme music by daoud anthony]

nikole hannah-jones

From The New York Times Magazine, I'm Nikole Hannah-Jones. This is "1619."

O.K., Jeneen Interlandi, where do you want to start?

jeneen interlandi

I think we should start in the fall of 1866, with a woman named Rebecca Lee Crumpler. Rebecca Lee Crumpler is a young black woman who was born free and raised in Pennsylvania by her aunt. Her aunt was a medicine woman. She used to go from home to home tending to the sick, and Rebecca liked to tag along and to help her. She liked it so much that she went on to become a nurse, and she was so good at being a nurse that she makes the really unusual decision to go on and become a doctor. So she eventually goes to the New England Female Medical College, which is a college that was specifically built to train women in medicine, and that's really extraordinary. Because around the time she graduates, there's about 54,000 doctors in the country, and only 300 of them are women, and only one of those women is black. And that woman is Rebecca Lee Crumpler. And so about a year after she finishes medical school, the Civil War comes to an end, and she makes another unusual decision, which is to completely uproot her life and to head down to the South.

archived recording (speaker 1)

Do you remember when the Civil War was being fought?

archived recording (speaker 2)

Well, I can't remember much about it, but I remember this much.

jeneen interlandi

Because four million people have just been released from slavery into freedom.

archived recording (speaker 2)

And I thought old master was dead, but he had been off to the war and come back. You know, and old master didn't tell you no one was free.

archived recording (speaker 1)

He didn't tell you that?

archived recording (speaker 2)

No, he didn't tell -

jeneen interlandi

And Crumpler knows that it's going to be a huge challenge to help these people assimilate into society and to address their many basic needs, including health care.

nikole hannah-jones

I spent a lot of time reading the slave narratives. And we're not really taught that emancipation came, and someone would walk on the plantation and say, you are free. But nothing came with that. These were people who just literally were told, you're free to go, but given no resources to go with.

jeneen interlandi

Even just with basic shelter.

jeneen interlandi

They didn't have places to go.

archived recording

I was about 9, 10 years old, maybe more. Stayed right there. We didn't know where to go.

archived recording (fountain hughes)

We had nowhere or nothing. We didn't have nothing. Just like your cattle, we were just turned out.

jeneen interlandi

So they were forced to take up residence in abandoned prisons, former military barracks, empty churches, refugee camps.

jeneen interlandi

They're crammed together in very close living quarters. They don't have the tools necessary to maintain good hygiene.

jeneen interlandi

And as a result of all of this, they're getting sick. But they can't tap into any health care system, because at that time, there really isn't any organized health care system to speak of. Most medical care is provided at home by family members, or by doctors who would actually visit the house. And the only hospitals that exist are much more like institutions for the very poor or for people who get sick and don't have any family members to take care of them. And those facilities were private, and they were run by charitable groups. And when the newly emancipated turned to those facilities for help, they were turned away. They were told no.

And they start dying in really high numbers, so much so that in some towns and cities, their bodies are littering the streets.

This is a massive public health crisis. And so to deal with this crisis, the federal government creates what ends up being the nation's first federal health care program. It's called the Freedmen's Bureau Medical Division. And this is what Rebecca Crumpler is heading south to do. She's going to Virginia to treat the newly emancipated through this new medical program.

nikole hannah-jones

And what does she see when she gets there?

jeneen interlandi

So when she gets to the South and she starts working, she sees that this new program is a complete mess. The hospital she has gone to, just like all of the other hospitals in this program, are completely under-resourced. They don't have enough beds or sheets or linens. They don't have enough medicine. They don't have enough quarantine facilities, and they're in the middle of a smallpox outbreak. And there's this horrible shortage of doctors. There's only about 120 doctors employed by the entire program.

nikole hannah-jones

So you're saying that the federal government at that time was only supplying 100 doctors to serve the entire emancipated population of 4 million people?

jeneen interlandi

Yeah, so this is one of the crazy things about the Freedmen's Bureau Medical Division, which is, it was founded in utter ambivalence. Officials wanted their communities clean enough to prevent diseases that might eventually spread into white communities, but they don't want to provide any free assistance, because they're worried that it's going to create dependency among the black American community. And so what they do is they open these hospitals, and they staff them with a few doctors. But then they close them down at the first sign of progress, and they refuse to send resources that their own doctors, including Crumpler, are requesting. They're saying, can we have additional staff to address the smallpox outbreak? No. Can we have more blankets and more bedding? No. Can we have an extra facility for quarantine so that the diseases don't spread? No. And so unsurprisingly, black people continue to die at very, very high rates.

nikole hannah-jones

In that hospital in Virginia where Rebecca Crumpler has gone, what specifically is standing in the way of hospitals like that getting more support?

jeneen interlandi

Well, one of the things was, as you have all of these people dying from preventable things, a theory emerges.

And the theory goes that this high death rate is actually just nature taking its course. So black people aren't dying for want of basic necessities, they're actually dying because they're biologically inferior to whites and ill-suited for freedom. The argument became that African-Americans specifically were literally going extinct, and that to provide any type of funding or resources to fight that would be wasteful and foolish, because you're just trying to prevent the inevitable. And this theory actually gains pretty wide traction. There's a congressman from Ohio who uses it to argue against the Freedmen's Hospitals in the U.S. House of Representatives. He takes to the House floor, and he says, quote, "No charitable black scheme can wash out the color of the Negro," can "change his inferior nature or save him from his inevitable fate."

nikole hannah-jones

So what you're saying is that this theory of extinction was so mainstream that you could actually hear it being argued on the floor of the House.

jeneen interlandi

Yes, that's correct. And so, because that theory became so mainstream and so kind of generally accepted, the lack of funding and the lack of resources persists, and the Freedmen Hospitals continue to struggle. And the ambivalence is so profound that at a Freedmen's Hospital in North Carolina, when doctors detect smallpox in a couple of their patients, bureau officials are terrified of the disease spreading into the community, but they also don't want to invest the resources to treat it and to prevent that spread. So they put out an order to burn their own hospital down.

nikole hannah-jones

So this is the first example of government-funded health care, and it is an example of something that was set up to fail.

jeneen interlandi

That's exactly right, and as that hospital burns to the ground, there is this feeling that black people have that they're on their own, that the government created this system to help them, but that they didn't really want to help them, and so that they were going to have to take care of themselves.

And Rebecca Lee Crumpler understands this, and she decides to write a book. It's called the "Book of Medical Discourses in Two Parts." And it's not addressed to her colleagues in the white medical community or to segregationists in Congress. It's addressed to the black community, specifically to black mothers and black nurses. And what she tells them in this book is how to take care of themselves, how to prevent diseases like cholera, how to treat basic ailments like hemorrhoids and bronchitis. And what's so profound about this book is that she's telling black Americans, you're not inferior. You're not going extinct. You can take care of yourself. And this is kind of the first example of something that echoes down through the ages, which is black medical professionals taking matters into their own hands. And in the coming decades, they open medical schools, they build hospitals, and they organize themselves to push back against this system that's trying to shut them out completely.

jeneen interlandi

So fast forward -

jeneen interlandi

- to January of 1947 -

jeneen interlandi

- and President Truman's State of the Union address.

jeneen interlandi

It's actually the first State of the Union that's televised, and he opens with this joke about how both chambers of Congress have been taken over by Republicans.

jeneen interlandi

And so one side of the room is much more full than the other side of the room. And as the New York Times reports, you can clearly see his smile when he makes this joke.

A little more than halfway through his speech -

jeneen interlandi

He turns to health care.

jeneen interlandi

What he wants is a government-run health insurance program that everybody pays into ahead of time and that people can draw from when they need it.

jeneen interlandi

What he's essentially talking about is universal health care.

So by the time Truman's giving this address, the nation's health care system has grown up a bit from the days right after the Civil War, but not by much. All of the hospitals that were created through the Freedmen's Bureau have been closed down except for one that's in Washington D.C. And other hospitals have been built, but there's not nearly enough of them, especially in the South. And to make matters worse, the hospitals that do exist are all segregated. In fact, a "separate but equal" clause had actually been written into the law. And what that meant was black patients had to either go to their own black facilities, which were few and far between in a lot of places, or they were relegated to the basement wards of white hospitals, and those wards were small, and they did not provide as good care as you got in the white facilities.

nikole hannah-jones

And there were also lots of rules about who white nurses could serve in these hospitals, because I know I've read Jim Crow laws that said white nurses couldn't serve black patients - particularly black men - and this is also true for doctors, right?

jeneen interlandi

Well, for nurses, specifically, because there was a lot of concerns about keeping white women away from black men. So you maybe had a couple of white doctors that would check on black patients. But again, even the white doctors that would attend to the black patients would do that after they took care of all of their white patients, so it was second-class in every conceivable way. But it's not just black Americans who are not getting enough care. It's many poor white Americans as well. So at that time, most Americans were not insured. And the insurance that did exist was employer-based, which means you had to get a certain type of job where the employer actually offered this benefit, and then you could have it. The problem for black people and for poor white people is that they didn't have those kinds of jobs that offered health insurance, so they had to pay out of pocket. Basically, the whole system is not working, and Truman sees this as one of the most pressing problems the country is facing. And so he decides that national health insurance is the fix.

jeneen interlandi

And this government-sponsored health insurance initially has really widespread support.

jeneen interlandi

But then, days after Truman wins the election, the American Medical Association, which is the largest and arguably the most powerful professional organization for doctors in the country, launches this massive campaign to take it down.

And what you have to understand about the A.M.A. is that it's an almost exclusively white organization at that time. Virtually all of its local chapters exclude black doctors completely, and just a few years earlier, the organization had refused to protest the separate but equal clause that legalized hospital segregation. Plus, this is a time when health care costs are rising and private insurance is really taking off. And what the A.M.A. understands is that a national health insurance program is probably going to hurt their profits. And so they've actually been fighting against this idea for years. And now, with Truman's national health insurance program, they take that fight to a whole new level. They've hired a P.R. firm. It's actually the first political consulting firm in the country. And together, they devised this plan to completely torpedo universal health care.

nikole hannah-jones

And what does that fight look like?

jeneen interlandi

What it looks like is all-out war. It's radio ads. It's newspaper ads. It's magazine ads. They're delivering pamphlets and mailers to people's homes. In the end, they send some 100 million pieces of literature all across the country. And what's on that literature and what's in those ads is a campaign slogan. It says, "Keep politics out of medicine." They call Truman's plan socialized medicine. They labeled Truman as a communist - and you have to remember, this is during a time when communism was a real scare - and they terrify people with this idea that if Truman gets his way, government officials are then going to be able to intervene in private medical decisions. And when they do, they're going to destroy the sacred doctor-patient relationship. And that campaign works. Popular support for the bill suddenly plummets. It fails to get through Congress, and the health care system the nation is left with at the end of this fight is still too expensive for most Americans to afford and as segregated as it has ever been.

[music]

nikole hannah-jones

Jeneen, when did all of this start to change?

jeneen interlandi

So it really starts to change with a man named Montague Cobb.

Montague Cobb is this fascinating character. He's a beloved doctor and medical professor at one of the only black medical colleges in the country at that time, Howard University. Over 41 years, he teaches thousands of medical students about anatomy, and he's kind of famous for playing classical music on his violin and reciting poetry for his students while they're dissecting cadavers.

He's already established himself on the national stage. During the fight between Truman and the American Medical Association, Cobb was one of the only doctors to defend Truman's plan and defy the A.M.A.

jeneen interlandi

You know, there's not a lot of recordings of Cobb out there, but there is a documentary from the 1980s called "Step by Step," where Cobb himself talks about this time.

archived recording

Steps were also being taken by Dr. Cobb to end segregation in the medical profession.

archived recording (w. montague cobb)

I think our first point of overt attack was on the theme of old clothes to Sam, the Negroes' hospital dilemma.

archived recording

Cobb used the analogy of whites giving hand-me-down clothes to blacks to illustrate how they also gave blacks hand-me-down hospitals.

archived recording (w. montague cobb)

This one isn't new, but it's better than anything he has or could get.

jeneen interlandi

He's also been outspoken about hospital segregation for years, because he recognized how deadly it could be. There's all these horror stories - they're true stories - of black Americans who are mistreated or denied care at white hospitals and die as a result. There's this one example, from 1931, where a light-skinned black man gets into a car accident, and he's taken to a white hospital. It's Grady Memorial Hospital. This is in Atlanta. And doctors there, they mistake him for a white patient, so they start treating him. And it's only when his family comes to the hospital that they realize he's actually black. So what do they do? They pull him off the examining table and they send him to the black ward across the street, where he later dies.

So these kinds of stories were common knowledge. And Montague Cobb really wanted to change that, so he launches a national conference on hospital desegregation, and he pulls people in from all over the country to come and talk about this issue every year. And he really implores his white colleagues to take the matter seriously and to think about it, but he didn't get very far. Even with all of those efforts, not much changed, and he realized eventually that left to their own devices, white hospitals are going to stay white.

Then, in 1963, he takes the reins of the nation's leading black medical organization. Because remember, the A.M.A. has this history of excluding black doctors. So what black doctors have had to do is create their own professional societies, and the leading one is called the National Medical Association, or the N.M.A. And it's at this moment, when Cobb is in this leadership position, that the fight for universal health insurance that started decades back and the fight for a desegregated health care system that started at the end of the Civil War finally merge into one fight. And that fight is about Medicare.

[music]

archived recording

Ladies and gentlemen, the president of the United States.

archived recording (lyndon b. johnson)

My fellow Americans, we have had many a hard-fought presidential campaigns.

nikole hannah-jones

So what was the role of Medicare in all of this?

jeneen interlandi

Well, the proposal for Medicare is actually born from the ashes of Truman's failed national health insurance program.

jeneen interlandi

After that plan dies in Congress, people who want something like it conclude that they need to think smaller and more incrementally.

jeneen interlandi

So beginning under President Kennedy and continuing under President Johnson, their efforts target what is perhaps the most uncontroversial group anyone can think of -

jeneen interlandi

- old people.

jeneen interlandi

Once again -

jeneen interlandi

- the A.M.A. comes out in full force against the idea.

jeneen interlandi

They use all the same tactics and all the same arguments that they used last time around -

jeneen interlandi

- to convince the American public that this is a terrible idea and that it's going to destroy health care as they know it.

jeneen interlandi

But this time, under Montague Cobb's leadership, the nation's black doctors come out in full force to support Medicare.

jeneen interlandi

They lead protests, they lobby Congress, and they launch their own public relations campaign explaining to the nation that, in fact, this won't destroy medicine. This will make medicine more equitable. And their message is what it's been for a long time: Health care is a human right, and that any program that expands access to health care is the duty of a free and democratic society.

["1619" theme music by daoud anthony]

jeneen interlandi

Meanwhile, the fight for civil rights is escalating all across the country outside of the medical world.

jeneen interlandi

And of course, that effort culminates in the Civil Rights Act of 1964, which says that discriminating on the basis of race is unconstitutional.

jeneen interlandi

And more specifically, it says that the government can pull federal dollars from any facility or entity that does not comply with the law, and that includes hospitals.

jeneen interlandi

But the vast majority of hospitals do nothing. They don't just suddenly desegregate, and it's unclear when - or even if - they're going to face any consequences at all for that. And this is where Medicare comes in, because Medicare is like a new pile of federal money that's dangled in front of hospitals across the country. But in order to get that money, hospitals have to comply with federal law, like the Civil Rights Act. They would have to actually desegregate. So as Congress begins to debate the bill, Montague Cobb knows that this is the moment to both create a national health insurance program and desegregate the nation's hospitals. And when he's called upon to testify, he says that after two decades of arguing and equivocating, it is past time for the nation's leaders to take, quote, "definitive action to expand access to health care."

[music]

jeneen interlandi

And at the end of his testimony, he recites this hymn by George Matheson, and it goes, "O love that will not let me go, I hide my helpless self in thee. I give thee back the life I owe, that in thine ocean depths its flow may richer, fuller be."

And then he tells Congress, "Like this love, the benefits of Medicare cannot be taken away." And he asks them, "Can we deny this small assurance to those on whose shoulders we stand?"

jeneen interlandi

And so Medicare passes, and what happens is within four months of implementation, nearly 3,000 hospitals desegregate. But of course, the health disparities between black Americans and white Americans persist to this day. Black women are three times more likely to die of causes related to pregnancy than white women. Black people with H.I.V. tend to get worse care than white people with the disease.

One study found that black patients with diabetes did worse than white patients, even when they had the same doctor.

Black Americans die at higher rates from many cancers that would have been treatable had they been caught earlier.

[music]

yaa gyasi

My name is Yaa Gyasi, and I'm going to read a short piece I wrote called "Bad Blood."

Upon closer inspection, the leaf her 2-year-old was attempting to put in his mouth in the middle of the playground on that lovely fall day was in fact a used tampon. She snatched it from him and Purelled both of their hands before rushing them back to their apartment on Dean. She put him in the bath and scrubbed, and by the time her husband found them, they were both crying. "We have to leave New York," she said after he put the baby to bed. "Let's move back home." "There are tampons in Alabama," he said, and then, "What's the worst that could happen?" It was the question they'd played out since graduate school, when her hypochondria had been all-consuming. Back then, leaning into her fears, describing them, had given her some comfort, but then they had Booker and suddenly the worst looked so much worse. "He could get an S.T.D., and then we'd be the black parents at the hospital with a baby with an S.T.D., and the pediatrician would call social services, and they would take him away, and we'd end up in jail." "O.K.," he said slowly. "That would be bad, but it's statistically very, very unlikely. Would it make you feel better if we called the doctor?" She shook her head. Her husband only used the word "statistically" when he wanted to avoid using the words "you're crazy." She knew that the doctor would just tell her to trust him, but she also knew that when the worst happens in this country, it often happens to them. She comes by her hypochondria and iatrophobia honestly. When she was growing up in Alabama, people still talked about their grandfathers, fathers and brothers who had died of bad blood. That was the catchall term for syphilis, anemia and just about anything that ailed you. The 600 men who were enrolled in the Tuskegee Study were told they'd get free medical care. Instead, from 1932 to 1972, researchers watched as the men developed lesions on their mouths and genitals. Watched as their lymph nodes swelled, as their hair fell out. Watched as the disease moved into its final stage, leaving the men blind and demented, leaving them to die. All this when they knew a simple penicillin shot would cure them. All this because they wanted to see what would happen. For years afterward, her grandmother refused to go to the hospital. Even at 89, perpetually hunched over in the throes of an endless cough, she'd repeat, "Anything but the doctor." Bad blood begets bad blood. She's more trusting than her grandmother, but she still has her moments. Like many women, she was nervous about giving birth. All the more so because she was doing it in New York City, where black women are 12 times as likely to die in childbirth as white women. And in that very statistic, the indelible impression of Tuskegee. The lingering, niggling feeling that she is never fully safe in a country where doctors and researchers had no qualms about watching dozens of black men die - slowly, brutally - simply because they could. When she held Booker in her arms for the first time and saw her grandmother's nose on his perfect face, love and fear rose up in her. "What's the worst that could happen?" her husband asks, and she can't speak it - the worst. Instead, she tries to turn off the little voice in her head, the one that wants to know: How exactly do you cure bad blood?

[music]

In the United States, racial health disparities have been as foundational as democracy itself.

Hosted by Nikole Hannah-Jones, produced by Annie Brown and Kelly Prime, with help from Clare Toeniskoetter and Austin Mitchell, and edited by Larissa Anderson, Lisa Chow, Wendy Dorr and Lisa Tobin

Listen and subscribe to our podcast from your mobile device:
We'll be back with the next episode of "1619" in October. On today's episode:

Jeneen Interlandi, a member of The New York Times's editorial board and a staff writer for The Times Magazine.

Yaa Gyasi, the author of the novel "Homegoing."

Via Apple Podcasts | Via Google Podcasts | Via Stitcher
Black Americans were denied access to doctors and hospitals for decades. From the shadows of this exclusion, they pushed to create the nation's first federal health care programs.

Image

Protesters marching against hospital segregation and health care inequality in front of the American Medical Association's Chicago headquarters in 1963. Credit... Bettmann, via Getty Images

Background reading:

"One hundred and fifty years after the freed people of the South first petitioned the government for basic medical care, the United States remains the only high-income country in the world where such care is not guaranteed to every citizen," Jeneen Interlandi writes.

The Times Magazine asked 16 writers to bring pivotal moments in African-American history to life. Read Yaa Gyasi's story "Bad Blood" here.

The "1619" audio series is part of The 1619 Project, a major initiative from The Times observing the 400th anniversary of the beginning of American slavery. Read more from the project here.

Tune in, and tell us what you think. Email us at 1619podcast@nytimes.com. Follow Nikole Hannah-Jones on Twitter: @nhannahjones.

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Episode 4: How the Bad Blood Started (Published 2019)

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transcript In the United States, racial health disparities have been as foundational as democracy itself. nikole hannah-jones My Uncle Eddie was my favorite uncle. He was my dad's younger brother, not that much older than me, and he was a complete jokester and cutup.

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Suicide is the second leading cause of death for young people in America. And black youth in particular face increasing suicide rates and challenges in accessing mental health services. Scholar and advocate Kimya Dennis dives into the background behind these suicide statistics, what prevents black youth from getting help, and how mental health providers can address this disconnect.

If you or a loved one are experiencing a mental health crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) any time of day.

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Suicide is the second leading cause of death for young people in America. And black youth in particular face increasing suicide rates and challenges in accessing mental health services. Scholar and advocate Kimya Dennis dives into the background behind these suicide statistics, what prevents black youth from getting help, and how mental health providers can address this disconnect.

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What effect will social isolation and physical distancing have on already marginalized communities during the COVID-19 pandemic? In this episode, we talk to three colleagues from a variety of social sciences to understand the different dimensions of social isolation during the pandemic.

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What effect will social isolation and physical distancing have on already marginalized communities during the COVID-19 pandemic? In this episode, we talk to three colleagues from a variety of social sciences to understand the different dimensions of social isolation during the pandemic.

Dr. Andrea Boyles is an Associate Professor of Criminal Justice, Social and Behavioral Sciences at Lindenwood University. She studies police-citizen relations, neighborhood disadvantage and disorder, and community reliance and collective action. She is the author of two books: Race, Place, and Suburban Policing: Too Close for Comfort and You Can't Stop the Revolution: Community Disorder and Social Ties in Post-Ferguson America.

Dr. Thurka Sangaramoorthy is an Associate Professor of Anthropology at the University of Maryland, College Park. She studies care for those living with HIV, care systems for non-citizen immigrants, and local community expertise in understanding social phenomenon. She is the author of two books: Rapid Ethnographic Assessments: A Practical Approach and Toolkit for Collaborate Community Research and Treating AIDS: Politics of Difference, Paradox of Prevention.

Dr. Jessica Finlay is a Postdoctoral Research Fellow at the University of Michigan. She studies geographies of aging, built environments and service provisions, and vulnerability and resilience among marginalized older adults. She is the author of one book The Whole-Body Microbiome: How to harness Microbes Inside and Out for Lifelong Health and is currently conducting research on the effect of COVID-19 on older adults.

Today's program host is Sarah Patterson from the University of Michigan Population Studies Center. Sarah is a demographer with articles in The Journal of Marriage and Family, The Journal of Aging & Social Policy, Gender & Society, Socius, and Social Science Research. She is also a host of the New Books Network Sociology

Photo Credit

By Muschio Di Quercia - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=82291055

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Social Isolation and Physical Distancing in Time (Boyles, Sangaramoorthy & Finlay) - The Annex Sociology Podcast

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What effect will social isolation and physical distancing have on already marginalized communities during the COVID-19 pandemic? In this episode, we talk to three colleagues from a variety of social sciences to understand the different dimensions of social isolation during the pandemic.

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My Experience Living with a Spinal Cord Injury: Kelly-Blake and Van Linden - Episode 22

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My Experience Living with a Spinal Cord Injury: Kelly-Blake and Van Linden - Episode 22

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In the words of guest Mark Van Linden, “adversity can present itself to anybody at any time.” This episode features a personal narrative of life with a spinal cord injury. Dr. Karen Kelly-Blake, Associate Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine at the Michigan State University College of Human Medicine, is joined by Mark Van Linden, MSA, and president of Adversity Solutions LLC. Mr. Van Linden experienced a spinal cord injury in 2009. In conversation with Dr. Kelly-Blake, Mr. Van Linden candidly shares his story, discussing his life before and after his injury, and addressing not just the physical impact, but the mental, emotional, and relational impact of becoming paralyzed at age 39.

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Audio published by Liz McDaniel on Wednesday, May 6, 2020

In the words of guest Mark Van Linden, "adversity can present itself to anybody at any time." This episode features a personal narrative of life with a spinal cord injury. Dr. Karen Kelly-Blake, Associate Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine at the Michigan State University College of Human Medicine, is joined by Mark Van Linden, MSA, and president of Adversity Solutions LLC. Mr. Van Linden experienced a spinal cord injury in 2009. In conversation with Dr. Kelly-Blake, Mr. Van Linden candidly shares his story, discussing his life before and after his injury, and addressing not just the physical impact, but the mental, emotional, and relational impact of becoming paralyzed at age 39.

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: "While We Walk (2004)" by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. A full episode transcript is available at bioethics.msu.edu.

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My Experience Living with a Spinal Cord Injury: Kelly-Blake and Van Linden - Episode 22

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Audio published by Liz McDaniel on Wednesday, May 6, 2020 In the words of guest Mark Van Linden, "adversity can present itself to anybody at any time." This episode features a personal narrative of life with a spinal cord injury.

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Social Determinants of Health in Medical Education: Ajegba, Bogdan-Lovis, and Kelly-Blake - Episode 18

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Social Determinants of Health in Medical Education: Ajegba, Bogdan-Lovis, and Kelly-Blake - Episode 18

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This episode focuses on the topic of social determinants of health, or the social and environmental factors that influence our health and access to resources. How can social determinants of health be integrated effectively into medical education? Michigan State University Center for Ethics faculty members Libby Bogdan-Lovis and Dr. Karen Kelly-Blake speak with College of Human Medicine student Brittany Ajegba, who emphasizes the need for standardization when training physicians on social determinants of health. From medical education to clinical encounters, they provide a variety of perspectives on this increasingly important work.

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Audio published by Liz McDaniel on Tuesday, December 3, 2019

This episode focuses on the topic of social determinants of health, or the social and environmental factors that influence our health and access to resources. How can social determinants of health be integrated effectively into medical education? Michigan State University Center for Ethics faculty members Libby Bogdan-Lovis and Dr. Karen Kelly-Blake speak with College of Human Medicine student Brittany Ajegba, who emphasizes the need for standardization when training physicians on social determinants of health. From medical education to clinical encounters, they provide a variety of perspectives on this increasingly important work.

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: "While We Walk (2004)" by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. A full episode transcript is available at bioethics.msu.edu.

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Social Determinants of Health in Medical Education: Ajegba, Bogdan-Lovis, and Kelly-Blake - Episode 18

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Audio published by Liz McDaniel on Tuesday, December 3, 2019 This episode focuses on the topic of social determinants of health, or the social and environmental factors that influence our health and access to resources. How can social determinants of health be integrated effectively into medical education?

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Reflecting on Early Bioethics: Fleck and Tomlinson - Episode 9

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Reflecting on Early Bioethics: Fleck and Tomlinson - Episode 9

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What issues were bioethicists concerned with in the early days of the field? This episode features two senior faculty members from the MSU Center for Ethics and Humanities in the Life Sciences, Director Tom Tomlinson, PhD, and Professor Len Fleck, PhD. Together they discuss and reflect on the accidental ways in which they entered the field of bioethics in the ‘70s and ‘80s, also touching on the creation of the program that became the Center for Ethics around that same time. They discuss the changes they’ve seen around topics such as death and dying, advance directives, and advances in medical technologies. Finally, they speculate on where bioethics may be headed in the future.

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Audio published by Liz McDaniel on Thursday, May 10, 2018

What issues were bioethicists concerned with in the early days of the field? This episode features two senior faculty members from the MSU Center for Ethics and Humanities in the Life Sciences, Director Tom Tomlinson, PhD, and Professor Len Fleck, PhD. Together they discuss and reflect on the accidental ways in which they entered the field of bioethics in the '70s and '80s, also touching on the creation of the program that became the Center for Ethics around that same time. They discuss the changes they've seen around topics such as death and dying, advance directives, and advances in medical technologies. Finally, they speculate on where bioethics may be headed in the future.
This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: "While We Walk (2004)" by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. A full episode transcript is available at bioethics.msu.edu.

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Reflecting on Early Bioethics: Fleck and Tomlinson - Episode 9

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Audio published by Liz McDaniel on Thursday, May 10, 2018 What issues were bioethicists concerned with in the early days of the field? This episode features two senior faculty members from the MSU Center for Ethics and Humanities in the Life Sciences, Director Tom Tomlinson, PhD, and Professor Len Fleck, PhD.

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Racism, the Black Experience, and the Perpetual Fight for Equality (Part 1)

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Racism, the Black Experience, and the Perpetual Fight for Equality (Part 1)

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On Monday, May 25th, 2020, George Floyd, a 46-year old African American man was killed while in police custody in Minneapolis, Minnesota in the United States. This was the straw that broke the camel’s back and has sparked outrage across the country and in other cities across the world. For centuries, the black community has experienced systemic racism and discrimination, particularly at the hand of whites who have been in a historical position of power still to this day. While black men disproportionately experience negative outcomes when interacting with police, black women are also overrepresented in police violence – they are also mothers, sisters, aunts, partners, and friends of these male victims. In Part 1 of our two-part State of the Union Roundtable Series, Linda Holdbrook, Rose Marcelin, and TeNatalie Golding-Walker join us to share their thoughts on racism, prejudice, discrimination, police brutality, and white privilege

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Racism, the Black Experience, and the Perpetual Fight for Equality (Part 1)

On Monday, May 25th, 2020, George Floyd, a 46-year old African American man was killed while in police custody in Minneapolis, Minnesota in the United States. This was the straw that broke the camel's back and has sparked outrage across the country and in other cities across the world. For centuries, the black community has experienced systemic racism and discrimination, particularly at the hand of whites who have been in a historical position of power still to this day. While black men disproportionately experience negative outcomes when interacting with police, black women are also overrepresented in police violence - they are also mothers, sisters, aunts, partners, and friends of these male victims. In Part 1 of our two-part State of the Union Roundtable Series, Linda Holdbrook, Rose Marcelin, and TeNatalie Golding-Walker join us to share their thoughts on racism, prejudice, discrimination, police brutality, and white privilege.

Follow us on Instagram, Twitter, and Facebook. We would love it if you shared your thoughts with us through direct message on your social media platform of choice or by emailing us at ThePublicHealthInsight@gmail.com.

Support the show (https://www.patreon.com/publichealthinsight)

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Racism, the Black Experience, and the Perpetual Fight for Equality (Part 1) - Public Health Insight

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On Monday, May 25th, 2020, George Floyd, a 46-year old African American man was killed while in police custody in Minneapolis, Minnesota in the United States. This was the straw that broke the camel's back and has sparked outrage across the countr...

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Public Health Insight Healthcare Workers' Mental Health in the COVID-19 Warzone

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Public Health Insight Healthcare Workers' Mental Health in the COVID-19 Warzone

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There is a growing concern that front-line healthcare workers from all disciplines in hospitals and other care settings are not being provided with the tools to ensure their safety in the COVID-19 pandemic. The Public Health Insight Team discusses the short and long-term mental health consequences.

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Episode 6 - Healthcare Workers' Mental Health in the COVID-19 Warzone

There is a growing concern that front-line healthcare workers from all disciplines in hospitals and other care settings are not being provided with the tools to ensure their safety in the COVID-19 pandemic. The Public Health Insight Team discusses the short and long-term mental health consequences.

Share your thoughts with us at ThePublicHealthInsight@gmail.com

Icon Made by Freepik from www.flaticon.com

Support the show (https://www.patreon.com/publichealthinsight)

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Episode 6 - Healthcare Workers' Mental Health in the COVID-19 Warzone - Public Health Insight

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There is a growing concern that front-line healthcare workers from all disciplines in hospitals and other care settings are not being provided with the tools to ensure their safety in the COVID-19 pandemic. The Public Health Insight Team discusses the short and long-term mental health consequence...

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What is Social Medicine? | Michael Westerhaus

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What is Social Medicine? | Michael Westerhaus

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Michael Westerhaus (@socmedmjw) teaches the history of social medicine and what social medicine means. He explains the difference between social medicine and public health, the value of storytelling and social position in medicine, the relationship between inequality and health, and addresses if it is right for healthcare practitioners to "get political."

Michael Westerhaus MD is a primary care physician for refugees at the Center for International Health in St. Paul, Minnesota. He is also an assistant professor at the University of Minnesota and an active social medicine educator with SocMed and the Social Medicine Consortium.

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1 | What is Social Medicine? | Michael Westerhaus by Social Medicine On Air

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1 | What is Social Medicine? | Michael Westerhaus by Social Medicine On Air

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Michael Westerhaus (@socmedmjw) teaches the history of social medicine and what social medicine means. He explains the difference between social medicine and public health, the value of storytelling and social position in medicine, the relationship between inequality and health, and addresses if it is right for healthcare practitioners to "get political."

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the Nocturnists, S2 E6. Dying to Tchaikovsky

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the Nocturnists, S2 E6. Dying to Tchaikovsky

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S2 E6. Dying to Tchaikovsky

Family medicine physician Catherine Forest listens to her one of her classical music idols serenade a dying loved one in the hospital.

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Family medicine physician Catherine Forest listens to her one of her classical music idols serenade a dying loved one in the hospital.

According to the internet, the most relaxing song in the world is Weightless by Marconi Union.

To learn more about music and the brain, check out the book Musicophilia: Tales of Music and the Brain by Oliver Sacks.

For more of Catherine's work, check out this essay in Vox.

Illustrations by Lindsay Mound.

Original theme music by Yosef Munro.

Other music comes from Blue Dot Sessions.

Check out our website at thenocturnists.com.

We invite you to support us with a donation here. You can also make small, recurring donations through our Patreon page.

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S2 E6. Dying to Tchaikovsky - the NOCTURNISTS

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Family medicine physician Catherine Forest listens to her one of her classical music idols serenade a dying loved one in the hospital. According to the internet, the most relaxing song in the world is Weightless by Marconi Union. To learn more about music and the brain, check out the book Musicophilia: Tales of Music and the Brain by Oliver Sacks.

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Taking a Closer Look at COVID-19, Health Inequities, and Racism

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Taking a Closer Look at COVID-19, Health Inequities, and Racism

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Chicago public health legend and retired physician Linda Rae Murray, MD, discusses systemic racism and the pandemic's disproportionate effect among African Americans and other people of color with JAMA Medical News Associate Managing Editor Jennifer Abbasi. Dr Murray is an adjunct assistant professor at the University of Illinois at Chicago School of Public Health and a past president of the American Public Health Association

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As COVID-19 dominates the news, Laura Spinney draws historical parallels with other pandemics in history and asks what we might learn from disease outbreaks in the past

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As COVID-19 dominates the news, Laura Spinney asks what we might learn from pandemics in the past

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Disability and mental illness: social versus medical models of understanding

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Disability and mental illness: social versus medical models of understanding

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In this podcast, Professor Andrew Hogan examines the history of the social and medical models of disability and mental illness. The social model characterizes disability as the product of an unaccommodating and oppressive society. In contrast, the medical model supposes that a disability is an individual and medical diagnosis.

Prof. Hogan is assistant professor in the Department of History at Creighton University in Omaha, Nebraska. His research examines evolving clinical perspectives and narratives of disability

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Disability and mental illness: social versus medical models of understanding by CMAJ Podcasts

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In this podcast, Professor Andrew Hogan examines the history of the social and medical models of disability and mental illness. The social model characterizes disability as the product of an unaccommodating and oppressive society. In contrast, the medical model supposes that a disability is an individual and medical diagnosis.

Prof. Hogan is assistant professor in the Department of History at Creighton University in Omaha, Nebraska. His research examines evolving clinical perspectives and narratives of disability.

Full humanities article: www.cmaj.ca/lookup/doi/10.1503/cmaj.181008

Read the transcript: https://www.cmaj.ca/transcript-181008

----------------------------------------------------------------------

Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite aggregator. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.

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Amy Purdy

BENEFITTING ADAPTIVE ACTION SPORTS

Amy Purdy chose to be here. After losing both her legs below the knee at 19 to a form of bacterial meningitis, doctors gave her a 2% chance of survival. A year later she finished third in a snowboarding competition on Mammoth mountain. Amy went on to become one of the top Paralympic snowboarders in the world, competing on Dancing with the Stars, touring with Oprah Winfrey, starting a foundation, and writing a New York Times best-selling book. But after another life-threatening setback, Amy once again found herself knocking down doors to get the help she needed and in doing so, has inspired people everywhere to push through obstacles and make dreams happen.

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Benefitting Adaptive Action Sports Amy Purdy chose to be here. After losing both her legs below the knee at 19 to a form of bacterial meningitis, doctors gave her a 2% chance of survival. A year later she finished third in a snowboarding competition on Mammoth mountain.

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SHORT COAT PODCASTWHEN DOCTORS DO HARM FT. DANIELLE OFRI, MD

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SHORT COAT PODCASTWHEN DOCTORS DO HARM FT. DANIELLE OFRI, MD

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Dr. Danielle Ofri–NYU professor of medicine, Bellevue Hospital internist, and author of great renown–joined us this time to talk about her new book, When We Do Harm: A Doctor Confronts Medical Error.  Examining medical errors is a something all good physicians do–sometimes on a stage in front of their colleagues but often surreptitiously. However, “mistakes were made” simply isn’t acceptable to most patients and lawyers. Meanwhile, the shame felt by practitioners who make mistakes is not only unhelpful but hinders their development and can contribute to burnout and depression.   Because of the consequences of shame are so dire, Dr. Ofri argues in her book that confronting mistakes in a humane, understanding, and open fashion is vital.

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Podcast: Play in new window | Download (Duration: 56:07 - 77.1MB)

Subscribe: Apple Podcasts | Android | Google Podcasts | RSS | More

Hippocrates set a high bar.

Dr. Danielle Ofri-NYU professor of medicine, Bellevue Hospital internist, and author of great renown-joined us this time to talk about her new book, When We Do Harm: A Doctor Confronts Medical Error. Examining medical errors is a something all good physicians do-sometimes on a stage in front of their colleagues but often surreptitiously. However, "mistakes were made" simply isn't acceptable to most patients and lawyers. Meanwhile, the shame felt by practitioners who make mistakes is not only unhelpful but hinders their development and can contribute to burnout and depression. Because of the consequences of shame are so dire, Dr. Ofri argues in her book that confronting mistakes in a humane, understanding, and open fashion is vital.

Not many years ago, a headline grabbed her attention: medical errors are the third-leading cause of death in the United States. How can that be? she wondered. If people were dying at that rate, wouldn't physicians have noticed this earlier? Of course, it turns out that the story of medical error is much more complicated than that headline would lead one to believe, and set Dr. Ofri on the path to this latest book. Join MD/PhD student Aline Sandouk, M4 Marisa Evers, M2 Jessica De Haan, and M4 Anne Nora for this discussion on the sources of error, the causes, and the ways to understand and learn from the inevitable.

We also discuss her and her colleagues' experiences fighting COVID-19 in New York City and learning about the disease in real time.

We Want to Hear From You

How'd we do on this week's show? Did we miss anything in our conversation? Did we anger you? Did we make you smile? Call us at 347-SHORTCT anytime or email theshortcoats@gmail.com. It's always a pleasure to hear from you!

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When Doctors Do Harm ft. Danielle Ofri, MD | The Short Coat

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Podcast: Play in new window | Download (Duration: 56:07 - 77.1MB) Subscribe: Apple Podcasts | Android | Google Podcasts | RSS | More Dr. Danielle Ofri-NYU professor of medicine, Bellevue Hospital internist, and author of great renown-joined us this time to talk about her new book, When We Do Harm: A Doctor Confronts Medical Error .

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SOC313 - To Err is Human: A Look at Medical Error

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SOC313 - To Err is Human: A Look at Medical Error

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Medical error-- defined as unintended or failed plan of actions related to treatments-- is an understudied in medical sociology. Patient harm from medical error can occur at the individual and systemic level however, and it might shock you to learn that it happens more often than not-- it's technically the third leading cause of death in the United States! Listen to our discussion on what societal factors contribute to medical error. Leave us a rating and review if you enjoy our podcast!

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Our goal for this podcast is to breakdown the social world one topic at a time. Come join us each week as we tackle a new topic using our sociological imagination!

1. All Episodes

2. SOC313 - To Err is Human: A Look at Medical Error

Medical error-- defined as unintended or failed plan of actions related to treatments-- is an understudied in medical sociology. Patient harm from medical error can occur at the individual and systemic level however, and it might shock you to learn that it happens more often than not-- it's technically the third leading cause of death in the United States! Listen to our discussion on what societal factors contribute to medical error. Leave us a rating and review if you enjoy our podcast!

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SOC313 - To Err is Human: A Look at Medical Error

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Medical error-- defined as unintended or failed plan of actions related to treatments-- is an understudied in medical sociology. Patient harm from medical error can occur at the individual and systemic level however, and it might shock you to learn that it happens more often than not-- it's technically the third leading cause of death in the United States!

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Join the SB team as we talk about the “myth of mental illness,” a phrase coined by psychiatrist and medical sociologist, Thomas Szasz. Today we will be comparing the ideas of mental health and illness as “problems with living” to the medical model. As sociologists we are not anti-medicine or anti-doctor, but we do feel it necessary to use our perspective breakdown the essence of psychological functioning and how the Diagnostic Statistical Manual of Mental Disorders (DSM) is a gatekeeper. Hope you enjoy this lively conversation, and please subscribe and give us a rating!

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Our goal for this podcast is to breakdown the social world one topic at a time. Come join us each week as we tackle a new topic using our sociological imagination!

1. All Episodes

2. SOC313 - To Err is Human: A Look at Medical Error

Medical error-- defined as unintended or failed plan of actions related to treatments-- is an understudied in medical sociology. Patient harm from medical error can occur at the individual and systemic level however, and it might shock you to learn that it happens more often than not-- it's technically the third leading cause of death in the United States! Listen to our discussion on what societal factors contribute to medical error. Leave us a rating and review if you enjoy our podcast!

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SOC313 - To Err is Human: A Look at Medical Error

# data[].attributes.attachment_link.description
Medical error-- defined as unintended or failed plan of actions related to treatments-- is an understudied in medical sociology. Patient harm from medical error can occur at the individual and systemic level however, and it might shock you to learn that it happens more often than not-- it's technically the third leading cause of death in the United States!

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Homelessness, Incarceration, and COVID19 America Dissected: Coronavirus

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Homelessness, Incarceration, and COVID19 America Dissected: Coronavirus

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Abdul looks at recent studies on people infected with coronavirus, and then talks about people who are among those most at risk for the disease. He'll talk with Dr. Ashwin Vasan, President of Fountain House, a non-profit supporting people suffering severe mental illness, and Professor John Pfaff who studies mass incarceration to understand how this pandemic affects society’s most vulnerable--and what needs to be done to protect them.

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In This Episode

Abdul looks at recent studies on people infected with coronavirus, and then talks about people who are among those most at risk for the disease. He'll talk with Dr. Ashwin Vasan, President of Fountain House, a non-profit supporting people suffering severe mental illness, and Professor John Pfaff who studies mass incarceration to understand how this pandemic affects society's most vulnerable-and what needs to be done to protect them.

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Homelessness, Incarceration, and COVID19 | Crooked Media

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Abdul looks at recent studies on people infected with coronavirus, and then talks about people who are among those most at risk for the disease. He'll talk with Dr. Ashwin Vasan, President of Fountain House, a non-profit supporting people suffering severe mental illness, and Professor John Pfaff who studies mass incarceration to understand how this pandemic affects society's most vulnerable-and what needs to be done to protect them.

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Abdul walks through the state of a COVID-19 vaccine and speaks with pro-vaccine activist Ethan Lindenberger about how online anti-vaxxers are exploiting COVID19 to stoke misinformation as well as Dr. Ashish Jha, Dean of the School of Public Health at Brown University, about the vaccine development process and how to build public trust for COVID19 vaccinations.

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In This Episode

Abdul walks through the state of a COVID-19 vaccine and speaks with pro-vaccine activist Ethan Lindenberger about how online anti-vaxxers are exploiting COVID19 to stoke misinformation as well as Dr. Ashish Jha, Dean of the School of Public Health at Brown University, about the vaccine development process and how to build public trust for COVID19 vaccinations.

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Abdul walks through the state of a COVID-19 vaccine and speaks with pro-vaccine activist Ethan Lindenberger about how online anti-vaxxers are exploiting COVID19 to stoke misinformation as well as Dr. Ashish Jha, Dean of the School of Public Health at Brown University, about the vaccine development process and how to build public trust for COVID19 vaccinations.

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KHN’s ‘What The Health?’: SCOTUS, Trump Collide Over Transgender Rights

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KHN’s ‘What The Health?’: SCOTUS, Trump Collide Over Transgender Rights

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Transgender people have had a head-spinning week. First, the Trump administration issued long-promised rules rolling back the Obama administration’s protections against discrimination in health care. But just three days later, the Supreme Court, in a 6-3 ruling authored by conservative Justice Neil Gorsuch, said that gay and transgender people are protected by the nation’s core employment anti-discrimination law, Title VII of the Civil Rights Act

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During the pandemic, health care is a top concern for all. So we want to hear from you: What do you like about California Healthline's coverage? How can we improve? Please take our short survey.

Transgender people have had a head-spinning week. First, the Trump administration issued long-promised rules rolling back the Obama administration's protections against discrimination in health care. But just three days later, the Supreme Court, in a 6-3 ruling authored by conservative Justice Neil Gorsuch, said that gay and transgender people are protected by the nation's core employment anti-discrimination law, Title VII of the Civil Rights Act.

Meanwhile, the national divide over how to address the coronavirus pandemic continues to widen, with infections soaring in some conservative states, and a backlash building against public health advice.

This week's panelists are Julie Rovner of KHN, Anna Edney of Bloomberg News, Tami Luhby of CNN and Shefali Luthra of KHN.

Among the takeaways from this week's podcast:

Even though states have begun the process of reopening their economies, the COVID-19 pandemic continues to roil workplaces. Many employers are looking for advice from public health officials on how to operate safely, but it's hard to stick to firm protocols when working with consumers who may have different attitudes about how to stay safe.

People who haven't been able to return to work face a grim prospect as the $600 federal enhancement to unemployment insurance benefits run out. Many Republicans in Congress are not keen to extend the aid because they fear it is keeping some people from returning to their regular jobs. Some workers, on the other hand, are afraid to go back to work for fear of catching the virus themselves or bringing it home to vulnerable family members.

The reopenings are spurring increases in COVID-19 cases. So far, public health experts say, they aren't seeing a spike in disease caused by spread during the national protests against police violence.

The Food and Drug Administration this week revoked its emergency authorization for the use of hydroxychloroquine for hospitalized patients with the coronavirus. Although a doctor can still order the medication for a patient, the announcement put the agency on the side of public health officials who argued that recent studies show the drug has little benefit for coronavirus patients weighed against the potential cardiovascular problems it may cause.

Anti-vaccine advocates are stepping up their campaigns as trials progress toward a COVID vaccine. At the same time, public health experts warn that the rush to get people immunized once a vaccine is developed could have immense consequences if it is found to be ineffective or has side effects.

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Subscribe to California Healthline's free Daily Edition.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: KHN and the AP's " Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response," by Lauren Weber, Anna Maria Barry-Jester and Michelle R. Smith

Tami Luhby: Stateline's " Medicaid Rolls Surge, Adding to Budget Woes," by Michael Ollove

Anna Edney: Bloomberg News' " Why Acting Fast Is the Key to Beating a Second Wave of Covid-19," by Chloe Whiteaker, Adrian Leung and Jeremy Scott Diamond

Shefali Luthra: KHN's " White House Left States On Their Own To Buy Ventilators. Inside Their Mad Scramble," by Rachana Pradhan
To hear all our podcasts, click here. And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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KHN's 'What The Health?': SCOTUS, Trump Collide Over Transgender Rights

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The Trump administration rolled back protections for transgender patients just days before the Supreme Court cemented LGBTQ rights under the Civil Rights Act. So, what now? Meanwhile, coronavirus politics reaches beyond health care settings. Anna Edney of Bloomberg News, Tami Luhby of CNN and Shefali Luthra of KHN join KHN's Julie Rovner to discuss this and more.

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Hospitalist Ann Knapp navigates her own doubts and assumptions when her patient, a ninety-year-old man, states he wants to die -- today.

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Hospitalist Ann Knapp navigates her own doubts and assumptions when her patient, a ninety-year-old man, states he wants to die - today.

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Supplemental: Special Episode Learning the Nocturnists

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Supplemental: Special Episode Learning the Nocturnists

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(not full episode)
Here, we share a tapestry of voices that we stitched together from the 38 audio submissions we received for our first storytelling contest on the theme of "Learning." The entries came from 28 institutions, 14 states, and 3 countries. We plan to announce the contest winner before the end of the month. Thank you to all who submitted!

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Here, we share a tapestry of voices that we stitched together from the 38 audio submissions we received for our first storytelling contest on the theme of "Learning." The entries came from 28 institutions, 14 states, and 3 countries. We plan to announce the contest winner before the end of the month. Thank you to all who submitted!

Illustrations by Lindsay Mound.

Music comes from Blue Dot Sessions.

We invite you to support us with a donation here. You can also make small, recurring donations through our Patreon page.

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Special Episode 2: Learning - the NOCTURNISTS

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Here, we share a tapestry of voices that we stitched together from the 38 audio submissions we received for our first storytelling contest on the theme of "Learning." The entries came from 28 institutions, 14 states, and 3 countries. We plan to announce the contest winner before the end of the month.

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This week tackles what it means to be sick. You’ll hear from diarists from Michigan, Maryland, Ontario/Canada, Massachusetts, and California, including a meds/peds resident, a neuroimmunology fellow, a MICU nurse, two internal medicine residents, a primary care doctor, and an OB/GYN.

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This week tackles what it means to be sick. You'll hear from diarists from Michigan, Maryland, Ontario/Canada, Massachusetts, and California, including a meds/peds resident, a neuroimmunology fellow, a MICU nurse, two internal medicine residents, a primary care doctor, and an OB/GYN.

Illustrations by Lindsay Mound.

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This week tackles what it means to be sick. You'll hear from diarists from Michigan, Maryland, Ontario/Canada, Massachusetts, and California, including a meds/peds resident, a neuroimmunology fellow, a MICU nurse, two internal medicine residents, a primary care doctor, and an OB/GYN.

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the Nocturnists Stories from the Pandemic, Episode 4 Air

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the Nocturnists Stories from the Pandemic, Episode 4 Air

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Episode 4: Air

This week, we continue with audio diaries from healthcare workers around the country discussing ventilator hacks, breathing tubes, search and rescue, and ministries of presence. You will hear from diarists in New York, Colorado, Maryland, Indiana, Atlanta, and California, who include a family physician, a nurse practitioner, a veterinarian, a medical student, a couple of interns, and a hospital chaplain. Featuring a heartfelt rendition of Bill Withers’ Lean on Me.

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This week, we continue with audio diaries from healthcare workers around the country discussing ventilator hacks, breathing tubes, search and rescue, and ministries of presence. You will hear from diarists in New York, Colorado, Maryland, Indiana, Atlanta, and California, who include a family physician, a nurse practitioner, a veterinarian, a medical student, a couple of interns, and a hospital chaplain. Featuring a heartfelt rendition of Bill Withers' Lean on Me.

Illustrations by Lindsay Mound.

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This week, we continue with audio diaries from healthcare workers around the country discussing ventilator hacks, breathing tubes, search and rescue, and ministries of presence. You will hear from diarists in New York, Colorado, Maryland, Indiana, Atlanta, and California, who include a family physician, a nurse practitioner, a veterinarian, a medical student, a couple of interns, and a hospital chaplain.

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the Nocturnists: S2 E2. Compassionate Release

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the Nocturnists: S2 E2. Compassionate Release

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S2 E2. Compassionate Release

Michele DiTomas, a hospice physician who cares for incarcerated men, races against the clock and slashes through bureaucratic tape to help a dying man go home.

Learn more about the U.S. criminal justice system on the ACLU's website.

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Michele DiTomas, a hospice physician who cares for incarcerated men, races against the clock and slashes through bureaucratic tape to help a dying man go home.

Learn more about the U.S. criminal justice system on the ACLU's website.

Illustrations by Lindsay Mound.

Original theme music by Yosef Munro.

Other music comes from Blue Dot Sessions.

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S2 E2. Compassionate Release - the NOCTURNISTS

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Michele DiTomas, a hospice physician who cares for incarcerated men, races against the clock and slashes through bureaucratic tape to help a dying man go home. Learn more about the U.S. criminal justice system on the ACLU's website. Illustrations by Lindsay Mound. Original theme music by Yosef Munro.

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Taiwan’s single-payer system is popular — but it might be in trouble

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Taiwan’s single-payer system is popular — but it might be in trouble

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On the east coast of Taiwan, where a small valley meets sharp, green mountains, lies the township of Xiulin. It has a few narrow streets. Many houses have corrugated roofs and siding.

In this township is a clinic, a building a couple of stories tall with physicians’ offices, X-ray facilities, and a small office for dental care.

Dr. Huei-wen Tien works there. She’s a short woman in her late 50s. Her hair has gone white so she’s dyed it bright pink, and she wears an all-black outfit with black ankle boots. Hermotorcycle helmet has the word “Punk” written on the side, and she rides her moped to visit her patients.

Today, her trips take her just a few minutes into the township, but some days, she drives hours up into the mountains to treat patients living in very remote areas.

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On the east coast of Taiwan, where a small valley meets sharp, green mountains, lies the township of Xiulin. Ithasa few narrow streets. Many houses have corrugated roofs and siding.

In this township is a clinic, a building a couple of stories tall with physicians' offices, X-ray facilities, and a small office for dental care.

Dr. Huei-wen Tien works there.She's a short woman in her late 50s. Her hair has gone white so she's dyed it bright pink, and she wears an all-black outfit with black ankle boots. Hermotorcycle helmet hasthe word "Punk" written on the side, and she rides her moped to visit her patients.

Today, her trips take her just a few minutes into the township, but some days, she drives hours up into the mountains to treat patients living in very remote areas.

In one house, she visits a stroke patient. She checks his blood sugar levels and talks him through some medications.

For the patient, all of this care is free.

Taiwan has a program that looks a lot like the Medicare-for-all proposal being floated by presidential candidates like Sens. Elizabeth Warren and Bernie Sanders. It's called National Health Insurance, and it covers every single person in the country.

is Vox's podcast about how policy shapes people's lives. On this episode, Vox policy reporter Dylan Scott walks us through how Taiwan built their single-payer system and what the US can learn from the program. Dylan Scott went to Taiwan with The Impact's Byrd Pinkerton, as part of Everybody Covered, a project supported by a grant from The Commonwealth Fund. They interviewed patients, doctors, government officials, and a researcher with a charming love story.

Listen to this episode to hear what they discovered:

Dylan learned that the people of Taiwan love their universal health care program that has significantly improved Taiwan's health outcomes.

But he also learned that the entire system could go bankrupt - and soon - if the country doesn't make dramatic changes.
Further listening and reading:
Subscribe to The Impact on Apple Podcasts, Spotify, or your favorite podcast app to automatically get new episodes of the latest season each week.

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Taiwan's single-payer system is popular - but it might be in trouble

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On the east coast of Taiwan, where a small valley meets sharp, green mountains, lies the township of Xiulin. Ithasa few narrow streets. Many houses have corrugated roofs and siding. In this township is a clinic, a building a couple of stories tall with physicians' offices, X-ray facilities, and a small office for dental care.

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Three Roads to Universal Care: The Weeds

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Three Roads to Universal Care: The Weeds

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Dylan Scott and special guest Sarah Kliff join Matt for a close look at health care in Taiwan, Australia, and the Netherlands.

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About This Show

Show Info:

In politics, you're often told not to get lost in the weeds. But we love the weeds! That's where politics becomes policy - the stuff that shapes our lives. Every Tuesday and Friday, Matthew Yglesias is joined by Ezra Klein, Dara Lind, Jane Coaston and other Vox voices to dig into the weeds on important national issues, including healthcare, immigration, housing, and everything else that matters. Produced by Vox and the Vox Media Podcast Network.Read more "

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Listen to The Weeds episodes free, on demand. In politics, you're often told not to get lost in the weeds. But we love the weeds! That's where politics becomes policy - the stuff that shapes our lives.

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Which country has the world’s best health care system?

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Which country has the world’s best health care system?

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On The Ezra Klein Show is about which country has the world’s best health system. But it’s also about how innovation in health care actually works, whether there’s any evidence that private insurers add actual value, whether health care is the best investment to make in improving health (spoiler: no), how do you improve a health system when half of the political system will fight like hell against those improvements, and much more

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I got my start as a blogger. But more specifically, I got my start as a health policy blogger. My first piece of writing I remember people really caring about was a series called "The Health of Nations," in which I checked out books from the college library, downloaded international reports, and profiled the world's leading health systems. It was crude stuff, but it taught me a lot. The way we do health care isn't the only way to do health care. It's not the best way. Or the second best, or the third.

Ezekiel Emanuel is a bioethicist, oncologist, and co-director of the University of Pennsylvania's Health Transformation Institute. He was a top health policy adviser in the Obama administration, he's a senior fellow at the Center for American progress, he makes his own artisanal chocolate, and he's got a new book - Which Country Has the World's Best Health Care? - where he goes into more detail than I ever did, or could, to profile other health systems and rank them against our own.

So this conversation on The Ezra Klein Show is about which country has the world's best health system. But it's also about how innovation in health care actually works, whether there's any evidence that private insurers add actual value, whether health care is the best investment to make in improving health (spoiler: no), how do you improve a health system when half of the political system will fight like hell against those improvements, and much more.

Emanuel has also been doing a lot of work on coronavirus policy, so we spend some time there, discussing the question that's tormenting me now: Are we simply giving up that fight? And is there even a politically viable option to giving up, given how much time the government has wasted and how exhausted the public is?

An edited excerpt from our conversation follows. The full conversation can be heard on

Ezra Klein

Let's do it. Which country has the best health care system?

Ezekiel Emanuel

I know this is an evasive answer, but the honest truth is it depends what your criteria are and what you actually care about. If you're a health policy wonk, a lot of what you'll care about is: Do you get universal coverage and how expensive is it? Do you have some mechanism to control the total expenditures in the country? By that criteria, we don't do well but other countries do well.

A lot of people care about: Do I have choice of doctor and hospital unlimited choice? By that criteria, places like Germany or Switzerland or France are at the top. Other people don't want to have co-pays at the point of care and no deductibles. There you see that Britain and Canada and, at least for public hospitals, Australia are good. Some people want low drug prices. For that, you've got Norway, Taiwan, Australia. Some people want no waiting times. Well, obviously, Canada, Norway, Britain are not on your list but Switzerland and Germany are very high on your list.

It really depends what the criteria or set of criteria are.

Ezra Klein

Because I read the book, I was ready for your evasive answer here. Which system would you want to buy into? Given your preferences, whatever they may be.

Ezekiel Emanuel

Probably the Netherlands, if you're forcing me to choose. I think that they have a very good combination: you get to choose your private insurer, you get to choose your primary care doctor. And their primary care doctors are really gatekeepers to a higher level of care. They're also innovative. So I think they've got a very good system. But there are lots of other alternatives I'd be more than happy with.

Ezra Klein

My sense of the Netherlands is it's what would happen if you made Obamacare exchanges a nationwide system and subsidized them properly. Is that basically right?

Ezekiel Emanuel

Yeah, it's either the exchanges or it's Medicare Advantage made national. But yes, it's making an exchange national and then providing high levels of subsidies for people to buy in. That's why health policy wonks like me like it.

Ezra Klein

Which system would you want to be poor in?

Ezekiel Emanuel

I think Britain or Norway. If you're poor, those are very good subsidized systems. You can also get away pretty well if you're poor in Australia. I'd say a place that's not so great is Switzerland, which has private insurance and the subsidies are good but not great.

Ezra Klein

What system would you want to be in 15 years from now?

Ezekiel Emanuel

I think one of the important points is long-term care. And 15 years from now, I will be 77 and worrying about long-term care.

The Germans and the Dutch are the two that we looked at that have dedicated financing for long-term care, and both are emphasizing aging in place (aging in your own home or your relatives' home). Unlike every other country we looked at, they have secured the financing for long-term care.

I think most other countries, whether the United States or Britain or Australia, and especially China, are really muddling through. And the consequence is a very large burden on people who have relatives who are aging. If you really care about your children not having to care for you when you age, having this dedicated financing mechanism is more important.

Ezra Klein

I'll be honest that I had an ulterior motive on that question. You write in the book that "in the next decade or two, the US will again become one of the best systems in the world," which was a sentence that genuinely surprised me.

If you made me take the bet, I would take a hard under on that. But make the case. Why should I believe that 15 years from now the US will be not the second to worst system that your team looked at behind China?

Ezekiel Emanuel

Because I think we have a lot of innovation happening in our system. We have a lot of innovation not focused on drugs and devices or new surgical procedures or new imaging tests - we have that, too. But I think we have a lot of innovation and experimentation going on with how to pay for care differently and how to deliver care differently. I think we have some very successful models on chronic care coordination and are beginning to sort out some important advances related to mental health care. The real challenge for the US is to get those things generalized and adapted.

Now, there are many things that can torpedo that progress. We have a lot of interests that would be challenged - hospitals being one of them. I would just note that a lot of hospitals are seeing decreases in occupancy and probably some of them need to close and shift to outpatient care. I think we've seen a lot of that happening because of Covid. And I think it will continue to happen.

Ezra Klein

If we wanted to increase life expectancy or some other indicator of healthy well-being over the next 10 years, should that be a conversation about our health insurance and health care system? Or should it be a conversation about something else?

Ezekiel Emanuel

Health care adds 10, 20, on a good day, 30 percent to health outcomes and longevity; other things - education, employment, housing, nutrition, exercise, not smoking, driving safely - add a lot more.

The highest return investment that the United States can make is in early childhood interventions, especially for children born into poverty, which is now 40 to 50 percent of the American birth cohort. So one of the immediate things I would do is make it a requirement for Medicaid. To get Medicaid, you have to provide early childhood interventions for at least two years to every child born on Medicaid. And once they're born on Medicaid, they have to get that benefit for two years, whether they go off of Medicaid or not. Those early childhood interventions, as Jim Heckman at the University of Chicago has shown, returned $7 to $15 per kid. So that's one intervention I would do.

I would also make child care veritably free. That experiment has been tried in Montreal. It actually pays for itself very quickly. That is a huge second investment I would make. A third investment I would make is to make pre-K universal, required, and free. So you can see all of my investments are investing in kids.
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Which country has the world's best health care system?

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I got my start as a blogger. But more specifically, I got my start as a health policy blogger. My first piece of writing I remember people really caring about was a series called "The Health of Nations," in which I checked out books from the college library, downloaded international reports, and profiled the world's leading health systems. It was crude stuff, but it taught me a lot.

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Rwanda's health service evolution – podcast

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Rwanda's health service evolution – podcast

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Rwanda's advances in healthcare come under the spotlight in this month's global development podcast. We look at key areas of improvement and discuss whether other developing countries can learn from the evolution of the Rwandan health service.

Ruth Evans speaks to the country's health minister, Agnes Binagwaho, and Paul Farmer, professor of global health at Harvard University in the US. She also visits Kigali, the Rwandan capital, where she interviews staff and healthcare recipients.

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Rwanda's advances in healthcare come under the spotlight in this month's global development podcast. We look at key areas of improvement and discuss whether other developing countries can learn from the evolution of the Rwandan health service.

Ruth Evans speaks to the country's health minister, Agnes Binagwaho, and Paul Farmer, professor of global health at Harvard University in the US. She also visits Kigali, the Rwandan capital, where she interviews staff and healthcare recipients.

Health is a key pillar of the Rwandan government's Vision 2020 strategy for economic development and poverty reduction. The country spends only $55 (£35) a person on health annually, slightly less than its neighbours, and in 2010 it had just 625 doctors serving approximately 12 million people. Yet it has managed to notch up some remarkable advances.

Medical insurance is a central element of the healthcare system. Two recipients explain how it works, who benefits and how much it costs.

Evans meets two of the country's 45,000 community health workers, who are trained to take care of primary healthcare tasks. There are three such staff in each village and they are elected by local people.

We explore how the treatment of HIV and Aids has improved dramatically in Rwanda. According to the United Nations programme UNAids, there were an estimated 210,000 people in the country living with HIV and Aids in 2012. Sabin Nsanzimana, who works at the Bio Medical Centre, explains how Rwanda has managed to expand the use of expensive antiretroviral therapy (ART).

Standard ART consists of the combination of at least three antiretroviral (ARV) drugs to suppress the HIV virus and stop the progression of HIV disease. In December 2002, an estimated 870 of the tens of thousands of Rwandans with advanced HIV were receiving ART, mostly through private clinics. That number subsequently increased significantly following the introduction of voluntary counselling as well as the testing and provision of ARVs.

Rwanda has also implemented a human papilloma virus vaccination programme to combat cervical cancer, as Maurice Gatera, head of the immunisation programme, explains. The country has so far innocculated more than 80% of teenage girls against the virus, according to the Centres for Disease Control and Prevention, the national public health institute of the United States. By comparison, only a third of girls aged 13-17 in the US have been fully vaccinated.

Translator: Sadiki Businge

* The reporting trip to Rwanda was facilitated by an international development reporting grant from the European Journalism Centre

The Guardian is editorially independent. And we want to keep our journalism open and accessible to all. But we increasingly need our readers to fund our work.

Support The Guardian

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Rwanda's health service evolution - podcast

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Rwanda's advances in healthcare come under the spotlight in this month's global development podcast. We look at key areas of improvement and discuss whether other developing countries can learn from the evolution of the Rwandan health service. Ruth Evans speaks to the country's health minister, Agnes Binagwaho, and Paul Farmer, professor of global health at Harvard University in the US.

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This is a documentary about the mental health institutionalization of youth.  It was completed as part of the social justice program at Hamline University in Saint Paul, Minnesota.  It explores mental health institutions in the context of Irving Goffman's 'total institution' and looks at parallels between the institutionalization of youth in mental hospitals and the prison system.  One part historical, one part sociological, one part personal - former patients share their experiences.  Based on personal experience, we asked as our premise - if you are sending someone somewhere to get healthy, why would you send them to a prison?  In this film we offer a critical look at the institutionalization of minors.

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Afflicted How Vulnerability Can Heal Medical Education and Practice

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Afflicted How Vulnerability Can Heal Medical Education and Practice

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In Afflicted: How Vulnerability Can Heal Medical Education and Practice (The MIT Press), Nicole Piemonte examines the preoccupation in medicine with cure over care, arguing that the traditional focus on biological intervention keeps medicine from addressing the complex realities of patient suffering. Although many have pointed to the lack of compassion and empathy in medical practice, few have considered the deeper philosophical, psychological, and ontological reasons for it. Piemonte fills that gap, examining why it is that clinicians and medical trainees largely evade issues of vulnerability and mortality and, doing so, offer patients compromised care. She argues that contemporary medical pedagogy and epistemology are not only shaped by the human tendency to flee from the reality of death and suffering but also perpetuate it. The root of the problem, she writes, is the educational and institutional culture that promotes reductionist understandings of care, illness, and suffering but avoids any authentic confrontation with human suffering and the fear and self-doubt that can come with that confrontation. Through a philosophical analysis of the patient-practitioner encounter, Piemonte argues that the doctor, in escaping from authentic engagement with a patient who is suffering, in fact “escapes from herself.” Piemonte explores the epistemology and pedagogy of medicine, examines its focus on calculative or technical thinking, and considers how “clinical detachment” diminishes physicians. She suggests ways that educators might cultivate the capacity for authentic patient care and proposes specific curricular changes to help students expand their moral imaginations. Nicole Piemonte is Assistant Dean for Medical Education and Assistant Professor at Creighton School of Medicine, Phoenix Regional Campus

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NIcole Piemonte

Aug 7, 2020

How Vulnerability Can Heal Medical Education and Practice

MIT Press 2018

InAfflicted: How Vulnerability Can Heal Medical Education and Practice (The MIT Press), Nicole Piemonte examines the preoccupation in medicine with cure over care, arguing that the traditional focus on biological intervention keeps medicine from addressing the complex realities of patient suffering. Although many have pointed to the lack of compassion and empathy in medical practice, few have considered the deeper philosophical, psychological, and ontological reasons for it. Piemonte fills that gap, examining why it is that clinicians and medical trainees largely evade issues of vulnerability and mortality and, doing so, offer patients compromised care. She argues that contemporary medical pedagogy and epistemology are not only shaped by the human tendency to flee from the reality of death and suffering but also perpetuate it. The root of the problem, she writes, is the educational and institutional culture that promotes reductionist understandings of care, illness, and suffering but avoids any authentic confrontation with human suffering and the fear and self-doubt that can come with that confrontation. Through a philosophical analysis of the patient-practitioner encounter, Piemonte argues that the doctor, in escaping from authentic engagement with a patient who is suffering, in fact "escapes from herself." Piemonte explores the epistemology and pedagogy of medicine, examines its focus on calculative or technical thinking, and considers how "clinical detachment" diminishes physicians. She suggests ways that educators might cultivate the capacity for authentic patient care and proposes specific curricular changes to help students expand their moral imaginations. Nicole Piemonte  is Assistant Dean for Medical Education and Assistant Professor at Creighton School of Medicine, Phoenix Regional CampusClaire Clark is a medical educator, historian of medicine, and associate professor in the University of Kentucky's College of Medicine. She teaches and writes about health behavior in historical context.

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Claire Clark

Claire Clark is a medical educator, historian of medicine, and associate professor in the University of Kentucky's College of Medicine. She teaches and writes about health behavior in historical context.

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Nicole Piemonte, "Afflicted: How Vulnerability Can Heal Medical...

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NIcole Piemonte Aug 7, 2020 InAfflicted: How Vulnerability Can Heal Medical Education and Practice (The MIT Press), Nicole Piemonte examines the preoccupation in medicine with cure over care, arguing that the traditional focus on biological intervention keeps medicine from addressing the complex realities of patient suffering.

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Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology

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Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology

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There are three statues in the United States honoring Dr. James Marion Sims, a 19th-century physician dubbed the father of modern gynecology. Invisible in his shadow are the enslaved women whom he experimented on. Today, they are unknown and unnamed except for three: Anarcha, Lucy, and Betsey. This week, we talk with historian Vanessa Gamble and poet Bettina Judd as we grapple with the troubling history of medical experimentation on African Americans.
The Hidden Brain Podcast is hosted by Shankar Vedantam and produced by Kara McGuirk-Alison, Maggie Penman and Max Nesterak. To subscribe to our newsletter, click here. You can also f This story was updated to include the names of professors Vanessa Gamble and Bettina Judd, who are featured in this episode. ollow us on Twitter @hiddenbrain,@karamcguirk,@maggiepenman and@maxnesterak, and listen for Hidden Brain stories every week on your local public radio station.

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Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology

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subscribe to Hidden Brain podcast There are three statues in the United States honoring Dr. James Marion Sims, a 19th-century physician dubbed the father of modern gynecology. Invisible in his shadow are the enslaved women whom he experimented on. Today, they are unknown and unnamed except for three: Anarcha, Lucy, and Betsey.

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Strengthening Public Health Systems in Developing Countries Episode 13*

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Strengthening Public Health Systems in Developing Countries Episode 13*

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Natural disasters and infectious disease outbreaks can disproportionately affect communities in developing countries with vulnerable public health infrastructure and health systems. The Team discusses the investment and innovation that may be required to successfully repurpose and scale-up efficient elements of existing public health systems in low-resource settings.

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Strengthening Public Health Systems in Developing Countries

Natural disasters and infectious disease outbreaks can disproportionately affect communities in developing countries with vulnerable public health infrastructure and health systems. The Public Health Insight Team discusses the investment and innovation that may be required to successfully repurpose and scale-up efficient elements of existing public health systems in low-resource settings.

Share your thoughts with us at ThePublicHealthInsight@gmail.com.

Icon made by Freepik from www.flaticon.com

Support the show (https://www.patreon.com/publichealthinsight)

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Strengthening Public Health Systems in Developing Countries - Public Health Insight

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Natural disasters and infectious disease outbreaks can disproportionately affect communities in developing countries with vulnerable public health infrastructure and health systems. The Public Health Insight Team discusses the investment and innovation that may be required to successfully repurpose and scale-up efficient elements of existing public health systems in low-resource settings.Share your thoughts with us at ThePublicHealthInsight@gmail.com.Icon made by Freepik from www.flaticon.com

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KHN’s ‘What the Health?’ Replay: What’s at Stake When High Court Hears ACA Case

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KHN’s ‘What the Health?’ Replay: What’s at Stake When High Court Hears ACA Case

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The “What the Health?” panelists are taking a break for two weeks. But since the Supreme Court recently scheduled arguments in the case challenging the constitutionality of the Affordable Care Act, it seemed like a good opportunity to replay an episode from March, when the law turned 10.

As the “What the Health?” panelists point out in this episode, that’s a milestone that many considered unlikely. The past decade for the health law has been filled with controversy and several near-death experiences. But the law also brought health coverage to millions of Americans and laid the groundwork for a shift to a health system that pays for quality rather than quantity.

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The "What the Health?" panelists are taking a break for two weeks. But since the Supreme Court recently scheduled arguments in the case challenging the constitutionality of the Affordable Care Act, it seemed like a good opportunity to replay an episode from March, when the law turned 10.

As the "What the Health?" panelists point out in this episode, that's a milestone that many considered unlikely. The past decade for the health law has been filled with controversy and several near-death experiences. But the law also brought health coverage to millions of Americans and laid the groundwork for a shift to a health system that pays for quality rather than quantity.

Yet the future of the law remains in doubt. Many progressive Democrats would like to scrap it in favor of a "Medicare for All" system that would be fully financed by the federal government. Republicans would still like to repeal or substantially alter it. And GOP officials have brought the case asking the Supreme Court to invalidate the entire law. Those arguments will be heard on Nov. 10.

This special episode, which first aired March 19, also includes a discussion between "What the Health?" host Julie Rovner and Kathleen Sebelius, who was secretary of Health and Human Services during the development, passage and implementation of the health law. KHN published a transcript of that interview.

Rovner, Joanne Kenen of Politico and Mary Agnes Carey of KHN, who have all covered the law from the start, discuss the ACA's past, present and future.
To hear all our podcasts, click here. And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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KHN's 'What the Health?' Replay: What's at Stake When High Court Hears ACA Case

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The Supreme Court recently announced its schedule for hearing arguments in a case brought by Republican state officials seeking to overturn the Affordable Care Act. The "What the Health?" podcast is on vacation, but it seemed like a good opportunity to replay an episode from March looking at the federal health law on its 10th anniversary.