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Sociology and Language of Medicine

Gender Differences in Behavioral Skills

by Laura McFarland, MCN Communications Director

A gender difference in behavioral skills, seen as early as kindergarten, is hurting boys’ academic prospects and their earning potential:

In an economy that rewards knowledge, the academic struggles of boys turn into economic struggles. Men’s wages are stagnating. Men are much more likely to be idle — neither working, looking for work nor caring for family — than they once were and much more likely to be idle than women.

My son is six, and though he reads at a middle school level and figured out on his own that if the square root of sixteen is four, the square root of four must be two, it would probably take him two hours to put on his pajamas or brush his teeth if left unattended. Why? Because of the pirates he needs to battle, or the book he can’t put down, or the Legos that come across his line of vision. We talk about how one of my jobs as mommy is to help him learn how to focus on the task at hand.

Frequently I think it must be hard to be a six-year-old boy and constantly be told not to touch something, put that down, leave it alone. He is, after all, amazing. I wouldn’t want him to be anyone other than who he is, and I am just beginning to see how lucky I am to know him. Is what we are teaching him enough? Is he too young for us to worry about his economic future? Articles like this one, “A Link Between Fidgety Boys and a Sputtering Economy” give me pause, to say the least.  

I also have a four-year-old daughter, so part of me is celebrating what I’m reading – wasn’t this the goal, to reach a point where the school system did not reward one group of people based on the behaviors they were allowed solely because of their membership in a group, one which no one else could join? Isn’t it wonderful, the opportunities in store for her?

But clearly we have not reached our goals if people are not learning the skills to be able to support themselves and feed their families. This is true whether we’re talking about education or peace in the Middle East. As author David Leonhardt is wise to note, every group faces their own challenges. And the points he makes are well worth addressing regardless of which group of people he means:  

The problem doesn’t simply involve men trying to overcome the demise of a local factory or teenage boys getting into trouble. It involves children so young that most haven’t even learned the word “gender.” Yet their gender is already starting to cast a long shadow over their lives. 

Sixteen years into the vaccination/autism myth

In 1998 Andrew Wakefield published a paper claiming a link between the measles-mumps-rubella (MMR) vaccination and autism – reporting on a total of eight children who developed symptoms of autism within a month of receiving the vaccine.

In the past sixteen years there have been multiple studies – at least 14 worldwide – and books published debunking the paper, which was initially rejected by four of the six reviewers who were asked to judge it. And yet the myth continues to have tragic effects worldwide as more deaths are reported from outbreaks of preventable these diseases here in the United States and abroad. Why? In part thanks to celebrities like Jenny McCarthy, actress, Playboy centerfold, co-host of The View, and since 2005 anti-vaccine activist. Read more…

A Preview of “Life, Animated” by Ron Suskind

This Sunday’s New York Times Magazine published an except of Life, Animated: A Story of Sidekicks, Heroes, and Autism, by Ron Suskind, a Pulitzer-Prize winning journalist with the Wall Street Journal. And father of Owen, who at age 3 was diagnosed with regressive autism.

The excerpt is beautifully written and moving, and provides a candid, eloquent glimpse into the twenty-year struggle of one family to communicate — through Disney characters, movies, and their themes — with their son. Well worth the read, as are the on-line comments.

Toes are Overrated (and other Post-Plague Observations)

“You’ve got to play the hand you’re dealt,” says Paul Gaylord. This doesn’t sound like a loaded remark, but it is when coming from a man whose hands were, literally, dealt quite a blow; after a bout with bubonic plague he lost eight fingers (and all of his toes, and nearly his life — his recovery came after doctors had discussed with his wife when to remove him from life support after his 27th day in a coma).

MCN processes a lot of reports related to disability claims. As we address questions of causality and medical improvement, it’s important to remember that each claim is not just a report, but that it represents a person, and human suffering, and is also just a very small glimpse into a person’s life. This article is striking in its outlook, and a refreshing reminder not to confuse a misfortune in a life with an unfortunate life. Certainly Gaylord doesn’t.

“I say I’m actually a 1-year-old because I got a second chance at life,” he said. “I can do almost anything I could do before.”

Undoubtedly Gaylord has struggled immeasurably with recovery and adjusting to his new body and all that he had to learn how to do differently. But as the article notes, the Gaylords have a sense of humor about the whole thing, and Debbie Gaylord said her husband has always had a positive outlook about it.

There are numerous studies which show that an injured or sick person’s outlook and attitude are major components not just of how well they will recover but whether they will recover at all. But a study, like a report, is not a human life; and sometimes it is from that individual life that we learn. Certainly there is something to learn from Paul Gaylord and what he has chosen to share with us: that a disability or an illness does not mean that life stops. “Toes are overrated,” Gaylord said. “And I can do a whole lot with just these thumbs.”

Random Acts of Kindness, or Crossing Boundaries?

This interesting column by Abigail Zuger MD, addresses divergent views on patient/professional boundaries. She outlines a challenge but does not answer it: when if ever is it OK to engage in the outside lives of our patients? Perhaps a good way to frame the answer is to be able to ask one’s self as a physician whose interests are being served? If it is truly the patient’s, one may perhaps breathe a sigh of relief and proceed. But how many have the capacity of introspection and self-knowledge to know whose interests are truly being served? And how many physicians’ cloudy thinking about helping their patients by gratifying immediate wishes or needs, are actually mistreating patients by for example, prescribing narcotics inappropriately, thoughtlessly filling out forms endorsing disability or other entitlements upon request, and other actions that cheapen the profession and hurt patients.

Boundary breeches are fraught with hazards. Thus they are generally engaged in by the naive, the scoundrels, or the saints. Sadly, many a scoundrel thinks their actions are that of the saint.

Dogs on a Plane

Last month, to the consternation of a few readers, we blogged about emotional support pets, citing an article in The New York Times which noted pushback against pets riding for free on planes with no systematic standards as to what constitutes emotional support and medical necessity.

Psychiatrist Dinah Miller, who has been in the position of reviewing such use, chimes in to discuss the criteria involved and her thought process:

Like most things, defining the lines of what it is to “need” an animal on a flight and what training should be required for “support” pets won’t be a problem until someone is bitten or distressed, or until a passenger announces they must bring their emotional support snake aboard a flight where someone has a phobia. In the meantime, I’ll contend that I like seeing an occasional cute dog on planes, but this isn’t a psychiatric issue.

When rules get in the way of treating cancer patients, who is served?

That a professional society would consider expelling a member who treats men is disturbing. There is no suggestion that the doctors in this article are under threat of loss of licensure due to questions of competence or ethical issues. On the contrary, they appear to be exercising their skill and expertise in treating the men in question. Try as I might, I can’t figure out why an esteemed professional board would impose on the practice of medicine. I thought Boards are in place to certify competence in a given specialty, not to tell a trained physician that they may not treat patients and exercise their skills in the service of health?

We should all be concerned about such policies and can imagine all sorts of mischief. Might the psychiatric board see fit to drum out a psychiatrist who sews up a laceration, drawing upon their general medical training? Telling a specialist that they may not treat a man is nonsensical and offensive. Were there a specialty that primarily treats men, punishing members who chose to treat women, there would likely be cries of discrimination and much indignation. Nobody’s interests would appear to be served by this rule. Let’s hope it is changed quickly.

Moral Hazards – an Economist Weighs in on Health Policy

Scholarly articles that test behaviors in the real world are fascinating and of potential value if their findings are acted or, or studied further.

This article sites such a study where the impact of co-pays on compliance and on the general issue of compliance when the symptoms of a significant disease are silent or delayed.

We are of mixed mind in considering the implications of social engineering on people’s behavior. On the one hand, adults should take responsibility for doing the right thing, or pay the price when they don’t. On the other hand, paying the price in real terms with respect to poor health decisions, often means that society at large, as well as innocent family members, pay the price of individual ignorance and/or stupidity.

The larger point in this article is that incentives and skin in the game matter with respect to both taking appropriate health measures, as well as avoidance of waste in terms of treatment or diagnostics.

More News in the Global Obesity Crisis

 According to the AMA, obesity is now a disease. Setting aside the particular condition, this decision reminds us that the concept of “disease” is complex, as are the social constructs attached to the disease label.

For example, the disease label may imply responsibility or lack of same by the person who has it. And in fact the person with a disease often attains the label of “patient.” Being a patient implies to many that they are passive recipients of care by the health care system rather than personally responsible for engaging in choices and behaviors that reduce or eliminate the condition. Diseases often carry with them stigma and shame, legal exculpation from responsibility, employer obligation to accommodate, insurer/government obligation to pay for and so on.

Expect this decision to generate considerable debate, emotions, and both intended and unintended consequences. Read more…

A profound article, and must read for all patients and physicians

By Brian L. Grant MD

This article on doing no-thing is the best medical article I have read in some time. Properly applied, this technique would do more to solve our health care crisis than all the PPO discounts, new drugs, payment reforms or other interventions and improvements to our system. Doing no-thing, properly applied would reduce prescriptions of unnecessary harmful drugs, surgery, diagnostics, and more. So much of health care is not necessary. Sometimes this can only be learned in hindsight, but often it is obvious from the start.

Doing nothing is perhaps a bit of a misnomer. The act of listening, empathizing and caring – when active interventions are not of benefit to the patient.

The comments on this article are well worth a read. Some are highly critical of the author and others are most supportive. Read more…