Thursday, May 6, 2010

Service Learning: Blog 2

My first day of service was fun. I met the other volunteers I was going to be working with, and they were all very kind and helpful. Most of them were seniors, and most of them were veterans too. Daniel, one of the other volunteers took me on as trainee so to speak. He took me with him on his runs and showed me where all the different parts of the hospital were, radiology, the laboratory, the ICU, etc. Daniel seemed to be quite the popular guy! He knew most all of the desk workers and lots of the nurses and some of the patients too. He would make sure to include all the details about each part of the hospital, what had changed recently, who worked where and what workers had relatives as patients. I didn't mind listening. He seemed to be very proud about all of his knowledge and the fact that he could remember everything. Which I could understand.
As I would make my way around the hospital, I discovered what a cheerful place it was. Everyone is very polite and nice and asking how each other is doing, making small talk here and there. Even the patients, I noticed a lot of them cracking silly jokes about the equipment they carried or about their wheelchairs. In past experiences, I have found hospitals to have dry atmospheres, where most people are quiet and the most you can get out of a person is a nod or smirk. But at this hospital it was different. I think it may be because the patients at the VA hospital share a common bond because they all served in the military. And that bond creates a family like atmostphere between the patients, staff, and volunteers.
The fact that the patients were talkative made it a lot easier to interact with them and carry on conversation. I have always been uncomfortable around sick people and hesitant because I don't want to hurt them or say the wrong thing. But most of the patients that I escorted were very nice and fun to talk to, and it put me at ease and not as nervous when I was wheeling their huge beds around the tight corners of the hospital. I realized that if you just talk to them like you would any other person, that they really appreciate it and respond well.
Although I was sent on lots of escort runs, there was down time where the volunteers and I would be in the escort room waiting to be sent out. It was fun getting to know the older volunteers. They were all pretty silly. They like to poke fun at one another and tease one another. Which made me laugh because at times they reminded me of little kids. It was nice to see their high spirits. I think that some may stereotype older people as grumpy, unfriendly, or boring. But it was nice to see the high spirted personalities of this group, they seemed to enjoy helping out so much and kind of embrace their oldness.
Working in this environment and doing service learning has helped me to gain insight into the atmostphere of a care-facility. I beleive that learning theories and concepts about communication is ineffective unless it is applied to real world situations. Service learning allows me to see how patients interact and respond to their situation, and in turn I can have that in mind during lecture and bring examples to class discussion. It also allows me to think about further areas of research or study. For instance, in class we studyed social supports and health, and when I was at the hospital, I felt like some of the patients at the hospital were creating a social support, some were related and some were friends, but as I said before, they seem to have a pre-existent bond because of their veteran status. This made me wonder if a hospital would be factored into the social support model in health communication study. Service learning, through its hands-on nature allows for an expansion of inquiry in the study of health communication theories and topics, and goes beyond the preliminary reaches of the classroom.

Wednesday, March 24, 2010

Service Learning: Preliminary Search

At first, I was unsure as to what route I wanted to take with the service-learning project. It was refreshing to know that this class was offering hands on work to supplement the curriculum, so I knew I wanted to make the most of it. I searched a variety of homeless shelters, abortion clinics, and early intervention teen crisis centers. Some of these programs required semester-long training programs, or travel, so I had to follow other routes that would be more accessible and fit within the time constraints for the project. That is what brought me to searching for volunteer oppurtunities at the hospitals in the area. Mercy Hospital and The University of Iowa Hospital both responded by saying they had a steady influx of volunteers in the recent months and were at capacity, which gave me a good feeling because its nice to know that there is a a bigger supply than there is demand for volunteers. The Veterans Affairs hospital, however, responded affirmatively that they needed help at the Iowa City location.
I met with Glenn, the voluntary services director at the hospital, and he introduced me to the patient escort service they sponsor at the hospital. The patient escort service is run by volunteers, and lead by a telecommunications operator who takes calls from various locations in the hospital. The operator is given instruction on a patient, package, message, or specimen, that needs to be transported to a certain location in the hospital, and the operator then assigns a worker to carry out the task. He reassured me that although the layout of the hospital would take some getting used to, the other volunteers and hospital employees are all very helpful and willing to assist with directions.
Although this was a fear of mine, I was mostly worried about transporting the patients! I was imagining nightmares of having a runaway wheelchair or disconnecting an IV, or worse, leaving a patient in the wrong spot. I tried to leave my worries aside, and thought of all the health-related procedures I would be exposed to, and most importantly, the actual patients. All of the patients at the hospital had, at some point in their lives, served in the U.S. military. For that reason I was most excited to hear stories from those times or inquire about their time spent while serving the country. Overall, I was happy with my choice to do service at the hospital and was optimistic that it would be an enlightening and fulfilling experience.

Monday, December 21, 2009

The Loss of Doctor's Credibility: "Fallout from the Pharma Scandals: The Loss of Doctor's Credibility? Hasting's Center Report

Last year I attended both Food and Drug Administration
(FDA) hearings on children’s depression
and anti-depressants. Despite my twenty-six years
of clinical practice in behavioral-developmental pediatrics,
I was unprepared for the impact these meetings
had on me. Listening to the testimony of families whose
children have committed suicide while taking one of the
new antidepressants—the selective serotonin reuptake inhibitors—
left the doctors at the hearing shaking their
heads, and watching the intricate dance of government,
academia, and industry confirmed my worst fears about
the relationship between doctors and the drug industry.
The meetings were the culmination of a decade-long
pursuit of justice. In the 1994 case of Wesbecker v. Eli
Lilly, the family of a man who went berserk, killed several
people, and eventually killed himself shortly after starting
to take Prozac claimed that Eli Lilly, which manufactures
Prozac, knew of its potential side effects and had
withheld that information from the public. But when a
parade of industry-financed expert witnesses affirmed the
safety of the drug, a jury voted nine to three to acquit Eli
Lilly. The verdict essentially closed the door to successful
legal challenges to Prozac for nearly ten years.
Several trial lawyers, convinced of the potential agitating
effects of the SSRIs
Paxil, Celexa, Lexipro, and Effexor), continued to
pursue the issue, however. They were joined in the mid-
1990s by a British research psychiatrist, David Healy,
whose analysis of studies funded by the drug companies
demonstrated a consistent signal of increased suicidality—
that is, suicidal thinking and behavior. Their persistent
efforts were rewarded when, under the Freedom of
Information Act, they discovered eight previously undisclosed
studies on the SSRIs and childhood depression.
The new studies had all been filed with the FDA
under the Best Pharmaceuticals for Children Act of 2002,
which reflected a congressional effort to motivate drug
companies to study the effects of medications on children.
The effort is important because children’s metabolism
is different and drugs might affect them differently;
but since children present a smaller market for new drugs,
the pharmaceutical industry might not study them without
some prodding. The act rewards the companies that
perform pediatric studies by permitting them an extra six
months of patent protection, which for a drug like Zoloft
represents an additional billion dollars in sales.
However, the law did not require either the companies
or the FDA to publicize or publish the findings. In the
case of the SSRIs, there were seven existing published
studies, of which only three showed that the SSRIs had
any benefits over placebo in the treatment of pediatric
depression. Healy and company found that all of the
eight unpublished studies were negative. When combined
with the available public data, the overall numbers clearly
showed a lack of effectiveness for the SSRIs and a small
but significant increase in rates of suicidality.
These results were first presented to the United Kingdom’s
FDA equivalent, the Medicines and Health Care
Regulatory Agency (MHRA). In August of 2003, the
MHRA banned the use of most SSRIs for the treatment
of childhood depression. The lone exception was Prozac,
which had been the subject of the three positive studies.
In contrast, there was evidence of much foot-dragging
at the FDA, which operates in a very different “drug culture.”
In America, beginning in the early 1990s with
stimulant drugs like Ritalin, the pediatric use of all types
of psychiatric drugs has skyrocketed. For both ideological
and economic reasons, the practices of American child
psychiatrists changed dramatically over the decade, so
that by 2002 nine out of ten children treated by a child
psychiatrist were taking one or more psychiatric drugs. In
comparison, European child psychiatrists, pediatricians,
and family practitioners (who have an important role in
child health care in the United Kingdom) are far more
parsimonious than their American colleagues with the pediatric
use of psychiatric medications.
It was not then until February 2004 that the first FDA
meeting convened. By that time, a mid-level FDA official
had analyzed the combined data and reached the same
conclusion as the British, but his testimony was withheld
on the procedural grounds that the first meeting’s official
purpose was only to set up the guidelines for reanalyzing
both the public and heretofore secret data. Nonetheless,
the public learned of the eight unpublished studies at the
February meeting. Drug company representatives meekly
explained that they were under no legal basis to publicize the
negative studies, which would have been contrary to the fiduciary
interests of their stockholders. Similarly, there was no
legal obligation for the FDA to publicize the studies. The
FDA simply kept them “on file” to meet the requirements of
the Best Pharmaceuticals for Children Act.
The discovery caused astonishment, dismay, and anger
among those attending the hearing, including doctors, press,
and families of suicide victims who had been taking the medications.
Here was a case where the market system, under the
current regulatory guidelines, clearly failed. Profits trumped
children’s health.
At the second FDA meeting, held in September 2004, the
emotions overflowed. “The
blood of my child’s death is on
your hands,” seethed a mother to
the FDA psychiatrists sitting on
the expert advisory panel. Heeding
the pleas of organized American
psychiatry, however, the
panel stopped short of recommending
an outright ban of
SSRIs’ use for pediatric depression,
but they recommended
that the strongest warning, a
“black box,” be added to the labels
of all SSRIs. As the panel
certainly knew, requiring a black
box warning would also mean
that a warning would have to be
added to any advertisement,
which would effectively end direct-
to-consumer advertising for
the drugs on television and in
magazines.
The meetings have had a profound impact on me. My experience
with the drug companies, beginning with the
marketing of Adderall in the mid-1990s for the treatment of
attention deficit hyperactivity disorder, had already made me
skeptical about their claims and cynical about their growing
connections with medical researchers and organized medicine.
Academic medicine, it seemed to me, was being corrupted by
its ballooning dependency on drug company funding. As a
front-line physician having to make daily decisions about
whom to medicate, I find I have lost faith in my academic colleagues
to give me unbiased advice.
But now my cynicism about the pharmaceutical industry
and skepticism about the advice I get from academic medicine
are also shared by the general public. I daily experience this
growing public mistrust. Ever more parents question “the
data” I present, ask more about long-term adverse effects (my
answer most of the time is “No one knows”), and think much
more about non-pharmaceutical alternatives.
To be sure, not all of this uncertainty is bad, and much of
it is long overdue. The public had been misled by the print ads
and commercials showing the smiling faces of “successful”
children taking the medication. But public mistrust of the
drug companies will inevitably extend to physicians themselves.
And why shouldn’t it, in light of drug industry funding
for national physicians’ conferences and their product
“bazaars,” the continual onslaught of drug detail men with insidious
offers of “free” samples of high-priced, brand-name
medications, and offers of free dinners with five hundred dollar
“consultant” fees that make me feel like a prostitute. American
medicine risks returning, ironically, to the era of “patent
medicine,” when hucksterism and medical practice were synonymous.
Unless clear boundaries (legal
and economic) are drawn between
profit-driven companies
and people’s health, doctors will
lose their aura of scientific objectivity,
so hard-won in the first
half of the twentieth century.
First, medicine’s financial links
to the pharmaceutical industry
must be limited. The funding of
medical education must come
from elsewhere, either from the
government or out of doctors’
own pockets. Industry support
of national professional organizations
must end. The practice
of drumming up business with
free samples must end. And new
regulations must be enacted
that, while allowing for some industry
support of research, absolutely
protect and guarantee
scientific interests. New rules for
a central public registry of all clinical trials, from inception to
completion, have been proposed by drug companies and medical
journal editors, but they may be surpassed by more stringent
regulations from Congress. I have wondered whether
something along the lines of “blind” trusts for medical research
could work, if the drug industry was willing.
Finally, direct-to-consumer advertising should be curtailed.
The drug industry’s claims that DTC advertising serves the
goal of patient education ring as hypocritical as those about
doctors’ CME. The United States is only one of two countries
in the industrialized world to permit this practice.
These reforms are not likely to be enacted. But after listening
to the parents’ cries at the FDA hearings, then coming
home to find that patients’ skepticism has filtered down to the
daily encounters in my office, I am certain that if we don’t
mend our ways as a profession, we will dishonor ourselves as
doctors and rightfully lose the public’s trust.

Fighting Disease Everyday

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Exchange of Copyright for a Creative Commune: The battle over Intellectual Property Rights

Exchange of Copyright for a Creative Commune:
The Battle over Intellectual Property Rights
The concept of property has evolved from a simple claim of possession to a broad term spanning the realms of science, music, medicine, culture, you name it. Intellectual property is a well known term that represents any form of personal creation—such as a film, song, painting, or a piece of literature—that has commercial value. In order to preserve this right to property, congress enacted trademark, copyright, and patent laws to provide documentation for the creators of these ideas, inventions, discoveries, etc. Despite the government’s effort, the lines between give and take, buy and share, copy and reference is one that remains extremely blurred. Industry as a whole has become over-zealous in their claims of ownership, greedy to obtain sole ownership and usage of an innovative product or service. Institutions and Research facilities are demanding more protection on their allocation of informative materials. Musicians, artists, and even cultures have jumped on the bandwagon as well, filing lawsuits against parties using their works without proper permission and consultation. All of these components promote a sense of fear in innovation. United States legislation is moving in the wrong direction veering away from intellectual progression and towards an overhaul of property litigation in the court system Although some arguments pertaining to property infringement are valid, the tug-of-war battle of ‘whose whose’ is all too reminiscent of toddlers in a sandbox fighting over who gets to use the shovel.

Thursday, December 17, 2009

Health Communication Profile

I recently had an epiphany as to where I wanted to go with my life and my career. After working at a day care facility for a year, caring for young children, along with a renewal in the passion I exude for soccer, I have become more aware of the importance of health in the human battle for physical and mental well-being on the individual level. I believe that this state of mind is rare and hard to achieve. So difficult that, in order to attain this level of happiness, people, including myself, turn to alternative means to achieve an illusion of happiness. In some situations, these things are contradictorily harmful to the human body and paradoxically hurt the individual on the personal, physical, mental , social, and behavioral level. Although my thought process is quite vague towards the topic, I wish to explore further these issues.
I disregarded a career path that would lead me to enter the world of consumer corporations. I believe my time would be better spent helping individuals that, due to whatever circumstances may be, do not have access to proper health care and health education. It would be an outlet for me to express my concerns and passions about the importance of health in one’s day to day life.
Upon entering into the school of health, if I am so permitted, I will begin my exploration into the policy, methods, practice, issues and functions of the healthcare world. I also plan to learn the strategies involved in the art of interpersonal communication about healthcare. I believe that along with my skills acquired in my health communication classes, as well as the innovative and creative development gained through my studying of literature, will prepare me for a career in the healthcare industry. Healthcare is the biggest domestic issue in politics today, and I want to play a role, however small that role may be, in the change and reformation in the ethics surrounding the industry of Healthcare.