Pondicherry, India Feb 2006

In this short clip we continue our exploration of Doctors Without Health Insurance in the United States of America.  Dr. Aaron Blackledge runs a private practice in San Francisco.  He and his family only carry catastrophic health insurance.  This means that there is a very high deductible on the policy and thus routine health care is generally not covered in any meaningful way.  This kind of insurance only is valuable for major medical problems such as severe trauma, prolonged hospitalizations, or life threatening illnesses.  Dr. Blackledge offers us his views on the value, or lack thereof, of health insurance.  Premiums are high, often unaffordable, inconveniences frequent, paperwork abundant, and services covered few.   If you are uninsured or underinsured, or know someone who is so, or even if you are just someone who cares, feel free to comment.  And stay tuned for a few more doctors without health insurance who will be sharing their varying perspectives on the subject.

Igatpuri, India, Nov 2007

The bacteria in our intestines are very similar to the bacteria in the external world.  It turns out that bacteria not only are responsible for digesting our food and all the debris of the world, they also play key roles in the functioning of our immune systems and global warming.  Dr. Eoin Brodie explains the relationship between the bacteria in our intestines and our environment.  And since our digestion and elimination is so intimately connected with our environment, Mr. Jeff Conant tells us about ecological toilets.

Is it because
I live
in a world of cement,
that my muscles behave like rocks?
Is it because
success
involves the grind of steel gears,
that my will stands like an iron pillar?
If I walked
on the soft earth
with my bare feet,
would my body dance
like the waves upon the rocks?
If success
was as delicate
as a lotus on a pond,
would my will
have the grace and depth
of the great ocean before me?
-jaysi

Medicine under Lock & Key, Pondicherry, India Feb 06

There’s plenty of statistics and articles available on the disastrous health insurance situation in the United States of America.  Health care costs have spiraled out of control, for the most part, making health care unaffordable to the uninsured.  And health insurance itself has become increasingly expensive while covering less of the costs of health care in America.  I could bombard you with the numbers and statistics but I’ll spare you the agony.  That information is strewn about everywhere.  We know that people who are unemployed and under-employed are left without adequate access to health care.  We know that many people who are self-employed are offered health insurance at individual rates that are often unaffordable and impractical.  We rarely think of physicians and other clinicians who are working in the health care professions to be also living without health insurance in America.  Doctor Kelly Eagen shares her experience with going without health insurance for a period of time.  If you are uninsured or underinsured, or know someone who is so, or even if you are just someone who cares, feel free to comment.  And stay tuned for a few more doctors without health insurance who will be sharing their varying perspectives on the subject.

Piazza Venezia Rome, May 2010

Yesterday, Feb 13^th, 2012, after a two-year trial, a panel of three judges in Turin, Italy ruled Jean-Louise de Cartier de Marchienne of Belgium and Stephan Schmidheiny of Switzerland guilty of involuntary manslaughter and has sentenced each of them to 16 years in prison along with millions in compensation.  The Swiss billionaire Schmidheiny, age 64, was a former owner of the Eternit conglomerate that owned four cement factories in Italy using asbestos in their manufacturing processes.  The Belgian baron de Cartier, age 90, was a major shareholder in the firm. They were convicted of causing over 3,000 asbestos related deaths in four Italian villages in the 1980s.

Schmidheiny’s defense team claims Eternit has modernized the Italian plants in the ‘70s and ‘80s to provide the highest safety standards in the industry at the time.  They are planning to appeal the ruling.  Yesterday’s decision paves the way for the second trial against the same defendants to hold them accountable for the more recent asbestos related deaths.

The Italian arm of Eternit went bankrupt in 1986. Not an uncommon practice. Many companies dealing with asbestos file for bankruptcy, generally well before asbestos related compensation claims need to be paid out.  Italy banned asbestos in 1992.

This ruling sends a very strong and important message to owners and shareholders of companies that fail to protect workers and community members from exposure to toxic substances used in their processes and products.  The Eternit trial could set a precedent for international environmental and occupational justice cases.  Companies such as Dow, now owner of the Union Carbide Gas Disaster legacy in Bhopal, India, should be shaking in their boots.

The terrible, and not fun, facts are that

-The World Health Organization estimates 125 million people are exposed to asbestos on the job each year and 100,000 die from asbestos related diseases.

-The United States has still not completely banned the use of asbestos and American manufacturers continue to rely on asbestos.

-Canada continues to mine asbestos, advocate the use of asbestos, and export it to developing nations.  The Canadian Asbestos Industry has consistently obstructed the attempts to list asbestos as a toxic substance in the Rotterdam Convention and any efforts to create an international ban on the mining and use of asbestos.

The story is not yet over.  The use of asbestos remains rampant in rapidly developing nations.  Stay tuned her for an upcoming interview with Laurie Kazan-Allen of the International Ban Asbestos Secretariat.

The keynote lecture, titled “Darwin, Diet, Disease, and Dollars,” was given by Robert Lustig, MD, who is known for his research on the regulation of body weight by the central nervous system.  The noontime talk, “Raising Happiness and Reducing Stress,” was given by Christine Carter, PhD, a sociologist dedicated to studying the psychology, sociology and neuroscience of well being.  We were delighted to be present with such scientists and advocates for prioritizing health and happiness.

Raw Milk Delivery, Pondicherry, 2006

Many bacteria are not only our friends, they are also essential for our health and well-being. Professor Susan Lynch explains the intricacies and complexities of how the bacteria in our intestines interact with our physiology.  She describes the importance of exposure to the proper bacteria prenatally and in the first year of life.  Simmy Makhijani shares her experience with using bacteria supplements known as probiotics.

bugs ‘r’us

candidaly speaking
there is surely a segmentus filamentus
among us
while clostridium remains
frustratingly difficile,
salmonella entirely enteritica,
and escheria absolutely so coli

by and by bifida
begins a round
to the tune of kumbaya
my bacterium
eubacterium
modulating me
modulating you
lactobacillus joins in
followed by fusobacterium
before you could think about it again
ruminococcus starts singing along
and soon we’ve got
symbiosis, my bacteroides, symbiosis

-jaysi, 2011

Removing Asbestos, LBNL, Fall 2009

I spoke with Dr. TK Joshi in New Delhi through a Skype mediated call on the 9th of August 2011. Dr. Joshi is an occupational medicine physician and founder of the Center for Occupational and Environmental Medicine at the Maulana Azad Medical College in New Delhi. He tells us about his efforts to warn Indian medical professionals and government officials about the dangers of using asbestos. He is working to get India to ban the import and use of asbestos in India. He has faced opposition from other physicians in the Indian Association of Occupational Health and the Canadian asbestos industry. He continues to advocate for placing the health and safety of the people before profits for corporations and governments.

Not Fall Prevention, Poster @ LBNL 2010

Prevention

The word prevent has its roots in Latin; from præ which means “before,” and venire, which means “to come.”  The word originally has the sense of anticipating something in order to hinder its arrival. In general, we can presume that we want to prevent undesirable events from occurring.  Prevention can be classified depending on the stage at which one anticipates or obstructs the occurrence of an event, primary prevention, secondary prevention, tertiary prevention, and quaternary prevention.

Primary Prevention

Washing Up Water, Kolkata 2008

When we hinder a problem from ever getting started or taking root, we call that primary prevention.  We avoid exposure to a situation or an agent that would cause a problem.  An example would be having access to clean water prevents exposure to agents that are spread through contaminated water.  The infectious agents can cause a variety of diseases such as polio, cholera, typhoid, hepatitis A, hepatitis E, cryptosporidium, giardia lambia, rotavirus, helicobacter, mycobacteria, hookworm, schistosomiasis, and others.  Many illnesses can also be caused by chemical contamination of water. This concept is very important because as you can see by this example, having clean water would prevent a number of diseases all at once.  Primary prevention is generally an extremely efficient way of avoiding diseases, trauma, unhappiness, and delaying death.

Bicycling in Assam, 2007

Getting good quality and sufficient sleep and food are other examples of primary prevention practices that can ward off many illnesses.  These practices don’t necessarily avoid exposure to disease causing agents, but they do make one more resilient and resistant to getting ill.  At the risk of employing an overused analogy, rest and nutrition are like keeping one’s bicycle tires inflated, the chain well-oiled, and the brakes in working order.  These things make it easier to maneuver through a busy street and make the uphill and downhill rides much easier.
Living in a peaceful place prevents stress and violence related problems.  Not ever smoking is a perfect example of primary prevention of all tobacco related diseases and deaths.

Washing Up, Kolkata 2008

Hand washing is a fantastic example of primary prevention. This Saturday, 15 October 2011, marks the third annual celebration of Global Handwashing Day. The celebrations will focus on encouraging children all over the world to develop the habit of washing their hands with soap and water after toileting and before and after eating.  Ingraining this habit in children could potentially cut childhood deaths from diarrhea in half and deaths from acute respiratory infections by a quarter. This habit alone has the potential to save more lives than any vaccine or medical intervention.  Apparently some world records have been set already on Global Handwashing Day.  In 2009, almost 53,000 children washed their hands at the same time in different locations of Bangladesh.  In 2010 the celebration in Kenya had 19,352 people washing their hands at the same time in the same place.  That must have been one heck of a sink!! Well done!  Let’s see what happens this year.

Nei Jing in Chinese-Cropped

Nei Jing is an inner vitality.  This vitality protects us from disease and gives us the capacity to heal from an illness.  The word comes from the Chinese language.  Nei means internal; Jing means essence.  It is what allows some of us to be exposed to a virus or a bacteria and not get ill.  If we do fall ill it determines how quickly we recover, with or without treatment.  Nei Jing permits us to withstand various kinds of physical and emotional trauma and still maintain our health and well being.  It is an inner quality that is cultivated by a variety of factors including our genetics, gestation, upbringing, family and friendships, work, creative and recreational pursuits, society, economics, and political and ecological environments.  Nei Jing is what offers us mental and physical resilience.

Lake Mendota, Madison, WI 2007

Well being describes what we feel when we are healthy, happy, and comfortable.  It includes mental, social, and financial health along with physical health.  It is what we need to cope with the normal stresses of ordinary life, to be creative and productive, and to contribute to our families, communities, and society.  It encompasses harmonious interactions not only with other people, but also with our ecological environment.  Although clinicians in various healing traditions can be of assistance in cultivating well being, well being is not available by prescription.

The World Health Organization has developed a well being index which assesses how often a person wakes up feeling refreshed and rested; feels cheerful and in good spirits; feels calm and relaxed; active and vigorous; and interested in the activities of daily living.

Worker Removing Asbestos, LBNL 2009

Here is some good news to share:  The Canadian Medical Association nearly unanimously officially condemned the decision of the Canadian Government and Prime Minister Stephen Harper to block the addition of chrysotile asbestos to the Rotterdam Convention list of hazardous substances.   The Canadian government opposes the addition of the asbestos to the list as that would place limits on the export of asbestos.

There are 52 countries that have restrictions or bans on the use of asbestos.  Canada is one of them.  Yet, Canada is one of the world’s largest exporters of asbestos.  Russia, Kazakhstan, Brazil, and China are the other major exporters.  Exports are sent primarily to developing countries with weak occupational and environmental health and safety regulations.  India and China are the major importers of asbestos.  Earlier this year a trade mission from Quebec visited India with the intent to increase sales of asbestos to India by ten-fold.   The outgoing president of the Canadian Medical Association, Dr. Jeff Turnbull, said in an article in The Montreal Gazette. “Canada should not be in the business of exporting such a dangerous product.”

The American Medical Association supported  the “Ban Asbestos in America Act of 2007”  which would have prohibited the importation, manufacture, and distribution of products containing asbestos, and which included provisions on public education, research and treatment of diseases caused by asbestos exposure.  That bill never became law.