Saturday, November 19, 2016

Trump represents the American Dream (and why that’s a dangerous thing)

            Trump is the American Dream. And no this isn’t a coy metaphor or piece of wordplay that only tangentially hits the point. Trump won this past election because he represents this idyllic of the all-powerful and endlessly wealthy man, and people bought it, hoping for a piece of it themselves. But the reason I can prove Trump is the American Dream is the very reason that makes it dangerous. Our American Dream, as we have come to define it, is rooted in nostalgia and retrospect.

            We look to the ‘good old times,’ ‘how things once were,’ ‘American greats Rockefeller and Carnegie.’ Our perspective is dangerously focused on recreating a past version of America that doesn’t exist anymore. And if you listen to Trump’s xenophobic remarks, it harkens back to racist roots more than a hundred years old – the same anti-immigrant rhetoric that rippled at the turn of the 20th century. Yet outside of the politically correct liberal bastion, this old-school racism appeals to Trumps supporters. Not because his supporters are bigots (necessarily), but because that is how things once were. And in this “Great American History” that we have created in our idealized view of the American Dream, how bad could it be to go back?

            Very bad. Bad on an economic level, and worse on a social.



            The industrial America that we knew after World War II has vanished, and this idea of returning to a great American economy in the same industrial way as before is economically impossible. The middle class is shrinking by the year. The financial mobility that we covet from the Rock n Roll era is now an afterimage our nation’s eye. In truth we have less economic mobility now than the developing nation of Rwanda. And so the Lower class and Upper class continue to grow, and the chasm of immobility continues to drive itself between the tax brackets.

            In the post war economy, the US controlled more than 50% of all of the worlds industry – Europe was in shambles and East Asia hadn’t modernized in the way we know it today. We were a powerhouse of jobs and wealth. The path of the middle American was paved with an American made car and a comfortable living. Today we control single digit percentages of industry today. The industrial jobs we once produced have been replaced by robots and tech companies. And in truth we are a nation in crisis, and the threatened blue collar middle class voted for Trump as a hail mary to get back to the American Dream of yesteryear. The sad truth of the matter is that according to two economists from Harvard, we will not be able to replicate the post-war industry today. Yet our eyes are set backwards.

            Perhaps the more dangerous consequence of this backwards looking approach is the revival of old racism and sexism. We too quickly forgot that ‘colored’ water fountains existed less than 60 years ago, the same “golden” years we look back to for the American Dream. Trump’s ascendance to the presidency has revived a brand of old racism with a new, and deleterious wave of nostalgia.

            As I see it, the American Dream as we now it is dead. But we keeping looking back to before in this idealization of what was. And like sand escaping from a hand, the more your clench the faster the grains slip out. And that’s what I find so dangerous. As we nationally realize the death of the American Dream, we are going to grasp wildly, trying to protect ourselves in a fight or flight way to preserve our way of life. And we’re seeing it already with the division we have driven between ourselves in the course of this election. I say the American Dream is what drives this racism and what drives the shrinking middle class.

            We need to wake up, and begin looking towards the future like post-war Germany and post-war Japan, abandoning this old mentality that only plagues us as we struggle like a house collapsing in on itself.

Sources:

http://www.pewsocialtrends.org/2016/05/11/americas-shrinking-middle-class-a-close-look-at-changes-within-metropolitan-areas/

Saturday, November 12, 2016

Narcotic Negligence: A Nation in Crisis

            Convicted in early November for three counts of criminal mistreatment of a child, Ashley Hutt and Mac McIver were sentenced for injecting their 2, 4 and 6 and year old children with heroin. Impoverished, the poor couple was without health insurance and needed to treat their underfed and diaper-rashed children with the only “medicine” they had.

Though their kids are now healthy and safe in child protective services, the sheer shock of the headline is reviving the far too downplayed opioid epidemic plaguing our nation.

            The epicenter of this narcotic crisis isn’t rooted in illegal drug trade, it rather stems a greater cultural dependence on opioids promulgated through the rising popularity of prescription painkillers. We as a country, like Ashley Hutt, use and abuse narcotics as an easy fix to dull our chronic pains.

How did we get here?

Our first mistake begins with “the war on drugs”. The damage of this movement spurred by H.W. Bush and the ‘drug czars’ is not the spike in drug-related incarceration, but in the larger blindsiding narrative. Marked with an asterisk, in reality the battle was against illegal drugs as a reaction to the crack epidemic of the 1980s. As war has been waged against illegal drugs, other narcotics could quietly burgeon outside of public scrutiny, provided it was legally packaged with an FDA seal of approval.

Our second misstep: In the early 90s powerful opioids were scarcely prescribed, only available to cancer and end-of-life pain management. Big pharmaceutical companies realized cancer and end-of-life patients represented a very small portion of a larger target demographic. They changed their marketing strategies, appealing to a broader audience and spending billions marketing directly to doctors to increase prescription numbers – a choice supported by the FDA, and a decision worth $400 billion dollars annually for pharma.

 Our third miscalculation: The most routine surgeries with quick recovery time like wisdom teeth removal or something as simple as a bad back have become targets for painkiller prescriptions. This has led to an exponentially increasing demand for OxyContin and Vicodin consequently the price of prescription painkillers to cost a fraction of heroin. More so it has established painkillers as the panacea to all our problems.

            Combined, over a few decades we created a culture attune to illegal drugs but completely blind to the potential dangers of prescription drugs, while fueling a legal and inexpensive system that annually fills more than 250 million Schedule I prescriptions for nearly 70% of the US population. While not all patients are addicts, we nevertheless have created a culture that dangerously supports opioid dependence.

Like a hydra gaining heads, this national addiction has grown more dangerous and more multifaceted by the year. It’s no longer a simple issue beyond the 30,000 annual opioid related death, but one of child endangerment, suicide rates and increased heroin abuse. Yet we remain frighteningly numb to a crisis in fever pitch.

            Adults are no longer the only victims of opioids, as a new study by JAMA Pediatrics has accounted for a doubling of opioid related poisonings of children from ages 1 to 14 over the past decade, reaching more than 13,000 last year. The prevalence of Vicodin, Percocet, OxyContin among others, has promoted the accidental hospitalization and death of our nation’s youth. Narcotics now account for more childhood accidents than do traffic collisions.

             Beyond accidental overdoses, the readily available compounds have seen suicides rates double over the past decade in the 14 to 24 age ranges, with triple to quadrupled rates among Caucasians. Whether a consequence of addictive behavior or a lethal drug in easy access, the effect is astonishing.

            Ultimately the addictive behaviors and cravings produced by these drugs often lead to the abuse of harder drugs like heroin. Today, 75% of heroin users say they began by abusing prescription drugs. And in the end it goes to show that our dependence on narcotics isn’t one determined by legality, but an umbrella of addiction and a culture obsessed.

This epidemic poses a problem without a clear solution. Despite their dangerous potential, these opioid drugs serve an important medical purpose for our sickest individuals. Though outright ban would halt the drug flow, it would disservice a significant portion of our most infirm population.


To find any solution we must understand this is an issue of culture, and not the chemicals. Change begins with reversing our need to prescribe a painkiller for any and all maladies; a reformulation within pharmaceutical ethics to cease marketing them as cure-alls; the government to taking ownership of our war on drugs, notwithstanding the legality of the abused substance.

Fighting Bad Energy with Good Energy


            President-elect Donald Trump has declared many policy changes to begin within in first hundred days of his administration, even going so far as to create a ‘contract’ with the American people which he shared via social media – his premier platform. With his selection of Myron Ebell – a prominent climate-change-denier - Trump’s influence is already being felt, even before the January inauguration. A New York Times report cites Mr. Ebell’s opinions on the EPA’s regulatory impact:

In the interview in Paris last year, he said he hoped whoever was elected president would “undo the E.P.A. power plant regs and some of the other regs that are very harmful to our economy.”
            The hard-lined stance on de-regulating one of our most important regulatory agencies prompts massive actions on a state level to keep our nation moving in the 21st century towards healthy energy policies. While on a federal we may shift towards lax regulation, states can still move towards more green and renewable sources, exceeding the bare national requirements. There is no better state to model after than Washington.

            Presently, Washington State receives nearly 70% of its energy from renewable sources, producing energy from a myriad of different technologies, rather than a single source. Hydroelectricity is the prevailing source (accounting for nearly 30% of our entire nation’s hydroelectric power). But wind power also accounts for nearly 10% of the state’s production. Recent investments in biomass and tidal sources have led to a burgeoning of new energy sectors beyond the traditional solar/wind approach of most renewable sources. And although nuclear is not considered a renewable source, it is a green energy in the mind of most environmental sciences – Washington claims home to the only nuclear power for more than 500 miles.

            These sorts of infrastructure by no means appear overnight, but they have created the least expensive energy market in the country and one of the cleanest, while not hampering jobs. Washington is rated the 5th highest for petroleum refining potential (the amount of infrastructure existing for petroleum manufacturing), yet the state is not dependent on oil or natural gas sources. While not all state economies can directly match Washington, the effect on petroleum industries is not as severe as conservatives might infer from a green switchover.

            The beauty of Washington’s green energy is its state driven mentality – the changes experienced over the past decade were largely implemented during the Bush presidency, a time when gas prices were at a national low, and our environmental regulations were considerably tamer than today. Yet at a state level, Washington has been able to achieve a prosperous energy sector – independent of a Presidential mandate. Other states should look to the past decade of legislation in Washington, as we venture into a new presidency that is looking to de-emphasize the way we treat our environment. After all, we all share only one planet – best we can do is treat it well.

Sources:
http://www.nytimes.com/2016/11/12/science/myron-ebell-trump-epa.html?_r=0
http://www.eia.gov/state/?sid=WA

            

Monday, November 7, 2016

The Sound of Silence: A lack of regulation in 21st century media mergers

What does it mean when the most pro-business candidate in the past 50 years slanders the most recent billion dollar merger? There isn’t a clear answer. In the wake of billion dollar mergers in the past decade, the recent $85.4 billion Time Warner-AT&T merger has set a new standard for business consolidation. But the very fact Donald Trump has voiced concern raises more than one red flag.

 Donald J. Trump has already condemned the deal. Campaigning in Gettysburg, Pa., on Saturday, Mr. Trump said he would block it if he were president, “because it’s too much concentration of power in the hands of too few.”
In some ways this sort of media conglomeration has been seen before, take Comcast’s $30 billion takeover of NBCUniversal or Verizon’s acquisitions of Yahoo and Huffington Post. But in spite of this growing trend in media company deals, this is one we haven’t seen before. The scope at which Time Warner-AT&T will operate exceeds the current regulatory functionality of our government.

Some have cited the $800,000 fine that Comcast received in 2012 as a harbinger of a monopolization in the cable market. Skeptics claimed it would be the first of many lawsuits launched towards the perennially disliked cable company (just look at their annual approval ratings, only Time Warner lies lower). But instead the FCC and FTC have remained remarkably silent over the past four years.

The fright of the merger is not the trail of scandals Time Warner and AT&T have behind them, but the disturbing lack of our regulatory agencies in enforcing the very policies. To many economists, the announcement of the merger came as a left field shock, mostly because the deal resembles that of classical vertical integration pioneered by Rockefeller in the late 19th century. And it was Rockefeller and Carnegie’s vast fortunes that prompted the regulation overhaul of the early 20th century. Yet we seem to be careening back on that path, even with the power of hindsight. 

While the distinction of vertical integration isn’t as clear as Rockefeller’s deliberate monopoly over every step of oil refinement, with the Time Warner-AT&T merger, it is very plain to see that the wireless market of AT&T doesn’t overlap with the cable platform of Time Warner. But combined, the new conglomerate can essentially control – top to bottom – all of the media services the average American requires. This is what distinguishes this merger from other mergers.

Unlike the Comcast-NBC merger which by dollars is the closest comparison, Comcast didn’t seize control of another media platform, but rather one entertainment company, and one television station (and its sister companies). But this deal consolidates a different sort of power, and looms to dominate our telecommunications market.

Most startling is the lack of teeth from the DoJ and our regulatory commissions. These sorts of mergers are never made public without vetting from the Judicial and Executive branches. Months, if not years, were spent analyzing this deal, and yet our laws and our regulators found no major issues.

In the wake of the worst financial meltdown since the Great-Depression, and with the consternation of even Trump, we should seriously reconsider our country’s regulatory policy as big business gets bigger and bigger, with fewer and fewer competitors.

Sources:

http://www.nytimes.com/2016/11/07/business/media/media-merger-success-comcast-and-nbcuniversal-say-yes.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news&_r=0

http://www.nytimes.com/2016/10/23/business/dealbook/regulatory-microscope-lies-ahead-for-att-and-time-warner.html

http://www.nytimes.com/2016/10/23/business/dealbook/att-agrees-to-buy-time-warner-for-more-than-80-billion.html

http://www.theacsi.org/index.php?option=com_content&view=article&id=149&catid=&Itemid=214&c=all&sort=Y2014

Friday, October 28, 2016

The (Hidden) Cost of Film Piracy


            Nearly one quarter of all global internet traffic is involved in the piracy of copyrighted media, as of 2016 according to research reports by the US Bureau of Economic Analysis. That fact by itself is shocking in scope. It’s the sort of lynchpin fact that could easily headline a staunch anti-piracy campaign, which are more in favor now sincethe solely dramatic anti-piracy advertisements of the early 2000s were far fromsuccessful. In fact piracy bandwidth – the total data used by digital piracy – has increased by roughly 50% annually since the premiere of the FBI’s You Wouldn’t Steal A… campaign. Growing at an almost exponential rate, despite shutdowns of The Pirate Bay and MegaShare, it’s clear the hydra that is 21st century piracy is not one to die soon.


(You Wouldn't Steal A... campaign, circa 2002).
            I bring up these statistics for their precise face value, they’re numbers. Numbers evoke a very analytical and very dry part of our brains, and just as usual as they are for objectively quantify a situation, they are just as prone to distract. In the case of piracy, the list of statistics are a long one, just take a look at this infographic prepared by Creative Future – an anti-piracy group based out of Los Angeles:


Source: Creative Future. 2016.

            These numbers evoke issues that are rooted in economics and finances, imports and exports, legal codes and legislation. It becomes drier and drier the more we talk about it. In fact, the US Congress has not updated the Copyright Act of 1976 since a digital amendment was added in 1998, back when transferring a movie online would take almost a week compared to the minutes it can be today. Congress hates debating this issue – especially now that Google has become the single largest lobbying group in Washington DC. Little is expected to change as our digital econoy has irrevocably grown around our lax digital copyright laws.

There is a definite status quo with our piracy, both legally and on a broader cultural spectrum. It is something we have accepted worldwide as part of our 21st century lifestyle – at least 25% of the world certainly agree. And it’s a dangerous one, but not for the numerical reasons that so cloud the issue:

Ruth Vitale (CEO, CreativeFuture) was particularly vocal about its negative consequences. One shocking case study she noted related to Dallas Buyers Club (for which Jared Leto won an Oscar). Jean-Marc VallĂ©e’s 2013 film generated about 7 million theatrical ticket sales. But, it amassed some 21 million illegal downloads, or about three times more than the legal transactions.
[Ms. Vitale later added] “It is sad whenever an artist doesn’t get compensated for their painstaking work. In this example, though, I do like to see an indie film like The Rendezvous and director Amin Matalqa get as much exposure as possible.”
            There’s no doubt that piracy hurts small sleeper hits like Dallas Buyer’s Club or The Rendezvous, and we know that before the numbers are even presented. But there’s a cost that stretches beyond simple box office tickets. For a film like Dallas Buyers Club, most of the crew was paid close to minimum wage, banking on ‘back end points’ or a small percentage of the net profits if the film did well. The film was successful, but never broke past its initial production cost. Many of the filmmakers, as Ruth Vitale can testify, are struggling to find work, and some may exit the film industry all together. Amin Matalqa, after working near a decade on his feature rather apathetically admitted it’s likely his last. And that’s the unseen cost behind the millions of tickets we tend to focus our attention on.

            We’ve all seen that seemingly more and more superhero movies are being made each year, and hardly anything else reaches the silver screen. That’s not simply Hollywood greed as many a laptop-warrior might decry as he pirates The Dark Knight for the umpteenth time, but a symptom of an industry hemorrhaging money on smaller projects like Dallas Buyers Club. As a consequence, less and less of these smaller movies are being made, relying of the tentpole blockbusters to rake in the years net profits for the studios.

            Through all of this we forget that our arts are the glue that bind us together as a society. Every year there is a movie that fundamentally shapes the way we perceive the world. We have to look just under a century ago to the iconic Birth of a Nation and its distasteful blackface to glimpse into the tense racial divisions that plagued the 20th century. Gone with the Wind brought to light Hattie McDaniel, the first African American actress to garner the Academy Award for Best Supporting Actress – a cultural milestone in our long history of racial injustice. And in 2014 amidst a wave of 21st century discussion of sexuality and gay marriage, The Dallas Buyers Club brought to light issues sexuality through the AIDS epidemic in the most heartbreaking of stories following a homophobe stricken with HIV.

These pictorial stories aren’t just for entertainment, but bring to light cultural issues we are waging everyday as a global community. It’s a price that a dollar sign can’t measure, but the voices of our creative communities cannot be stifled as we try and tackle issues of inner city poverty, racism, and sexism. These stories carry an important weight with a power equal if not greater than the journalists of The New York Times. The fight against piracy isn’t a just a legal one as the FBI banner’s might make you think, but a cultural one.

Support Art. Stop Piracy.

Sources:

http://www.starkinsider.com/2016/10/state-film-industry-tackles-amazonnetflix-piracy-technology-led-disruption.html

Monday, October 17, 2016

Cause of Death: Finding Purpose in Medical Cadavers

            The doctor’s office is a place we are all familiar with (that’s not to say we necessarily enjoy the visit, especially having to reschedule our entire Tuesday afternoon’s to hit that 3:00 PM timeslot). But outside of the slight inconveniences of afternoon traffic or the curse of a perpetually late doctor, our contemporary medical practices are a remarkably pain free. Once invasive procedures can like open heart surgery can now be performed via laparoscopic catheters – the process of inserting a microscopic camera and knife mounted a thin plastic tube through the femoral artery1. Astoundingly the process leaves only two quarter inch scars on the inside of the thigh a stark contrast to the broken ribs and sternum long scar from classical open heart surgery1. These ‘Minimally Invasive Surgeries’ as they are known are less time intensive, have nearly half the recovery time, and most importantly have a significantly increased survival rate relative to more invasive and traditional methods2. Many of the bounding advances in our new age of medicine have the digital age to thank. In the case of minimally invasive heart surgery, the success of the laparoscopic process rests entirely on the development of the compact and high-definition cameras used – most laparoscopes span roughly 5 mm or half the size of your pinky fingernail2.


(Example laparoscopes, 5mm and 10 mm sizes. Source: http://www.veterinarylaparoscopy.com/userimages/laparoscopes1.JPG)
The veritable effects of these new heart procedures can be witnessed in the turnaround of the Seattle area medical community, which in the late 90s began embracing these emerging digital technologies, implementing newer tools and techniques across the greater Western Washington area3. Now thanks to the work of the Virginia Mason Medical Group and the University of Washington Medical School the Pacific Northwest ranks as first in the nation for heart attack, heart failure and stroke treatment, a microcosmic testimony to the medical revolution we are living in today3.
Sixteen short years into the 21st century, we’ve constructed an understanding of the human body never before conceptualized. We have the astounding capability to image, examine and heal the body more efficiently and effectively than over more than eight millennia of recorded medical practice. We now possess ability to detect and decipher even the most fickle of diseases or earliest stages of cancer – thanks to recent developments in digital imaging like positron emission technology. As doctor and author Eric Topol notes in his novel The Creative Destruction of Medicine, the far reaching results of digital technology have spurred overwhelming enthusiasm within the medical community4. Topol’s sweeping interviews investigate a wide range of opinions in virtually every specialty of medicine practiced today, and the consensus is clearly for digital medicine4. And to mirror the novel’s subjective social consensus, more objective scientific studies have been assembled by the National Institute of Health investigating this very advancement5. The findings show digital medicine having a significant impact across medical fields in terms of patient care, quality of treatment, and so on – proof that Seattle’s cardiology boom isn’t so much an outlier, but a trendsetter6. Save for minor arguments relating to the cost of more expensive digital machinery operating expenses7 (which in truth is more a political-funding issue than a medical concern), for doctors and patients alike, there is little reason against modernizing medical practices for a digital age.

However there is one gross exception to this digital movement: gross anatomy.

As nearly every facet of our medical community moves towards a digital medium, there in suit has been a growing movement towards digitizing medical cadavers, the bodies that make up Gross Anatomy. For all the good that the digital world brings to medicine, it is not a one-size-fits-all improvement that extends to the paramount course that is cadaveric dissection. In fact more damage is being done to the quality of our emerging doctors than is benefited from the digital transition. The anatomical education every medical student receives in gross anatomy – whether a future physician or brain surgeon – is absolutely essential for every healthcare professional, as the body is inherently their specialty in one capacity or another. Today in the pro-digital movement, there is a faction of medical professionals and universities attempting to altogether abolish the practice of cadaver dissections, favoring digital and virtual reality teaching components instead8.
(Virtual Reality Dissections in action.)
On the surface level this anatomical digitization a result of our trend towards our digital medical era. And while this recent technological boom certainly has influenced the burgeoning of digital dissection platforms and virtual reality anatomy, the fundamental shift away from cadaver dissection stems from a much deeper cultural relationship - and fear - of death. But in spite of the cultural taboos, the dissection of human bodies isn’t a simply archaic tradition, but a critically formative experience to young doctors that simply cannot be replaced by a digital model. Notwithstanding of all the positive effects that digital medicine has on our health as a community at large, gross anatomy is the fundamental aspect of medicine that cannot be digitized. To fully understand the complicated relationship we as a society have to medical cadavers today, we must first look to the origins of human dissection itself. In its most primordial state, the first evidence of ‘medicine’ or ‘surgery’ appears circa 7000 – 6500 BCE in trepanned skulls, the iconic craniums with surgically bored holes9. Neolithic shamans of mankind’s earliest societies
(A trepanned skull, the earliest evidence of medical intervention. Source: https://upload.wikimedia.org/wikipedia/commons/thumb/5/52/Crane-trepanation-img_0507_crop.jpg/1024px-Crane-trepanation-img_0507_crop.jpg)
would drill into the skull until the white matter of the brain was visible to the naked eye, with the belief the surgery would release evil spirits afflicting the sick9. Today trepanning represents the first recorded instance of health intervention by fellow man, “medicine” in its simplest terms9. By no accounts is this rudimentary practice a form of dissection, but it serves as a beginning on the timeline of medicine that spans nearly nine millennia from the practice of trepanning to today. The first seven millennia of medicine practices were exclusively dictated by religious or tribal beliefs over any codified understanding of the human body, until approximately two thousand years ago when Aelius Galenus - or Galen as he is more commonly known - released his famous treatises, The Galenic Texts10. These sweeping volumes classified the human body as never before, mapping the muscle systems, identifying major organs and systemizing the four essential humors (black,
yellow, blood, and phlegm)10.
(A classical woodcutting describing the four humors. Source:
https://ridingingodssidecar.files.wordpress.com/2015/12/four-humors-granger.jpg)
Though antiquated by today’s standards, this compendium served as the primary medical text for more than fifteen hundred years, and the basis of nearly all Western medical practices in this time10. The classical practice of bloodletting for instance is directly derived from the humor model proposed by Galen, believing illness to be derived from an imbalance in the humors, thus excess blood was excised from the infirm member’s body as remedy. And yet, despite the text’s hallowed status, Galen never dissected a single human body – from the direct consternation of both Christian and Jewish churches considering the desecration of any human remains to be an excommunicable offense11. Instead Galen completed his anatomical studies upon rhesus monkeys, relying upon their homological similarities to the human skeleton and muscular systems. Never dissecting a body in his time, Galen would never be aware of the inaccuracies between his animal work and the human physiology11.

It wasn’t until 1543, that a Renaissance doctor by the name of Andreas Vesalius that dissection entered the modern medical practice – less than five hundred years ago, a blink in the near nine thousand years of medical practice. Vesalius, an established professor and surgeon of Padua began a series of lectures of live dissections for his disciples, performed on the bodies of deceased criminals, deemed by the church to be beyond reproach and fit for post-mortem examination12. His findings were shocking, and often contradictory to the Galenic teachings that were so prominently disseminated at the time11. For instance, Galenic text asserted that all blood vessels originated in the liver, as opposed to the heart11. Vesalius would compile his work into his magnum opus, De Humani Corporis Fabrica Libri Septem12. Over years of work in dissection, Vesalius and his pupils would compile one of the most extensive anatomical charts of the human body, each system expertly illustrated in his seven part book.

(An Andreas Vesalius illustration. Source: https://nyamcenterforhistory.files.wordpress.com/2014/10/vesalius_fabrica_1543_lambert_181_watermark.jpg)
The combination of precision in and fundamental reconstruction of the Galenic model, Vesalius’ work opened the doors for truly modern medical practices. With an accurate anatomy of the human body, the antiquated Galenic models were discarded and modern surgical practices quickly evolved under the newfound anatomical understanding11. Surgeons could avoid arteries during amputations, and gallstones could be more easily pinpointed, the influence of an accurate anatomical topography was endless11. Mixed with the fancy of the Roman Emperor Charles V, and the advent of the printing press, Vesalius’ work would travel like wildfire across Europe in even into Asia and North Africa12.
 Despite the widespread popularity of De Humani Corporis, acceptance of dissection did not spread with the manuscript. In fact as the documents travelled across country borders, laws were enacted against the sourcing of human bodies for dissection. Several decades after the first publication, turnover within the Catholic Church led to more punitive measures against surgeons dissecting human remains for medical purposes than under the previous pope12. And so as medicine advanced, developing doctors began illegally “body snatching” in order to practice anatomy and surgical techniques on a human specimen11. Without a legal means in nearly every country, the banned practice remained in place consistently through the 20th century. In the United States in particular, body snatching was common practice through the 1960s, until the Anatomical Donation Act was passed allowing for citizens to preemptively sign away their bodies to science13. Though no concrete statistics exist to quantify the extent of the illicit practice, the demand bodies across several thousand medical schools relative to the meager legal channels (dead federal prisoners) suggests a large percentage if not came from graves up to fifty years ago11
Now after half a century of legal cadaver dissection we’ve begun to reverse the process of nearly nine thousand years in the making. Spearheaded by some of the United States’ top medical schools, there is a significant movement to altogether end the use of cadavers from the medical school curriculum. In 2011, Stanford University made wakes within the medical community introducing their ‘virtual dissection table,’ a backlight surgery table that illuminates human cross sections, and at a fingers touch can dissolve from cross section to cross section, progressing through the body14. An eminent figurehead of the medical school community, other schools in the San Francisco Bay area followed suit introducing similar virtual dissection tables to supplant a traditional cadaver lab15. A year later, St. Mary’s Hospital in London proudly became the first major European Hospital to incorporate virtual technology into their curriculum16. In a few short years, Stanford has halted all use of medical cadavers on its campus. And the epidemic is spreading quickly across the US and abroad as these once $300,000 tables are becoming more and more economical for smaller universities to afford15.
It is clear we are now in a transitory period in our use of cadaver labs, and it begs the question, “Are virtual dissections better?” While there are accessory interests, and financial incentives in moving towards a virtual lab, the absolutely essential product in question in the quality of doctor produced. That is a quality that no price tag can measure up to. And by this metric alone, the virtual dissection fails. Seldom does the word “never” appear in scientific literature, there is an inherent danger with speaking in absolutes. Yet in 2008 the ASME concluded this, “We recognize that virtual dissection will never provide the same hands-on experiences as physical dissection”17. And that is the core fault of virtual dissection exposed by an objective study. A physical, hands-on experience cannot be supplanted by clear cut virtual slides. “There is form of somatosensory learning that cannot be formed without physically engaging in the activity.”17. This fundamentally undermines perhaps the most important facet of a doctor’s education, their physical abilities, in a profession that is so inherently tactile. This isn’t to say that virtual reality models are not in some way useful. A recent study has shown that virtual reality models helps increase the ability for gastroenterologists to detect colon polyps at a significantly higher success rate than doctors operating without virtual reality training18. The distinction is this study uses virtual reality as a secondary method to augment medical practice over supplanting physical activity altogether17. Virtual dissections can make for an extremely useful tool to augment the learning of our young medical students, and even as a practice space for our most seasoned doctors, it simply cannot be used in place of the real body.
But the true impact of a course like gross anatomy is less so a matter of book education of dexterity, but as forge to temper the emotional maturity of our up and coming medical professionals. For forty-three years Dr. Snow, Ph.D has led the new medical students of USC Keck through their first human dissection, a process that begins with the back and slowly – over the course of a year – moves eventually to the face. He explains it’s a process adjusting to death, not in the way of accepting a grandparent’s passing, but accepting the death of a complete stranger – a sad but constant part of a job as a doctor15. And for the first class, the students simply acclimate to the chilled body locker. And while the image of forty or so bodies draped in sheets in a ghastly one to most, the student transformation by the end of the term is anything but. In the process of working with the bodies, which is on a near daily basis the students become incredibly close over the months they spend together15. They often name the cadavers (though they are never given their actual names for confidentiality), affectionately giving a personality to the man or woman that so generously donated their body for their benefit. Second year USC medical student Natalie Hartman best summarized her experience with her donor affectionately named ‘Admiral Victor,’ as such, “He was our first real patient. He was the first person to trust you with all of the insecurities and ailments of his body. And that’s a special connection.”19 In an industry founded upon doctor-patient relationships, this is an irreplaceable form of learning and maturation that cannot be forced or coerced on a virtual reality holodeck.
             So why are we still moving away from medical cadavers? In reality, the motive less a scientific one, but an emotional one more than nine thousand years in the making. The same cultural forces that opposed dissection during the time of Galen, and after the rise of Vesalius still echo today. Across regional and temporal lines, the resistance to medical dissection is distilled into a in a common theme: our relationship with death. There is something sacrosanct in the deceased that we all share, with no definite answers, nor explanation of what happens after death, we revere it, and we fear that which cannot fathom. Emotions and fervor trumped scientific and medical reason - it became easier to avoid the controversy by outlawing the practice than by permitting. Even today with the complete legality of medical cadaver sourcing, it still is a somewhat controversial topic, because of the uneasy nature of the subject, and that is something that simply is ingrained into our cultural perception of death. Other accessory arguments can be made toward the money spent sources bodies, and the difficulty there is in the process of acquiring donors. Likewise similar arguments can be made towards the whole digital movement of the medical industry as a whole. But as previously stated, the product is not measured in the dollars saved, but the quality of the doctor, and we cannot afford to short change our future doctors by taking the easy way out. Medical dissection like the Hippocratic Oath are not tradition within medical practice without good reason. They have been preserved over hundreds and thousands of years for their fundamental role in foundationally shaping the quality, expertise and above all caring that our doctors are expected to exemplify. It is just as much emotional as it is an intellectual commitment, and one experience we cannot let subside to the digital wake.

The final stanza of poem written by Warren Yamashita in memory of his cadaver perhaps best summarizes the lasting significance gross anatomy has on its subject:

“I promise, you are the first and last human being I will ever dehumanize.
I’m sorry for stabbing your heart, thank you for convicting mine.”20

An editorial note from the writer:
I choose to begin not at medical cadavers, but with a note about heart surgery in the Seattle area. This wasn’t to hide my thesis pages deep into this article, but to provide some all too important context on the relationship of the digital world to medicine in this complicated issue. Had it not been for a surprise diagnosis in my junior year of high school, I might not be as aware as I am today. In 2011 I was diagnosed with a congenital heart defect that required surgery. In the terrifying process of preparing for heart surgery I was able to witness the effect that these new technological leaps in cardiology – and leap is an understatement – that have been made in the last several years. The surgery I opted, a minimally invasive catheter ablation for had a 92% survival rate at the Seattle Children’s hospital. Had surgery become necessary two or three years earlier, before the necessary laparoscopic camera had been developed, the open heart conditions would have dropped by survival rate to about the flip of a coin.
With an issue like medical cadavers that is a complicated nexus of so many conflicting perspectives, it’s an issue that can quickly become obfuscated with one voice or one viewpoint too strongly represented. Within this argument there is a very serious case to be made towards the preservation of cadaveric dissections, and non-digital methods, especially in consideration of the quality of the doctors we are producing. In many respects this is an issue much less about survival rates, but on the cultural relationship we have with death, and for good reason we as a culture are weary of cutting up our fellow man. This traditionalist view of medical cadavers that I want to avoid from blinding the larger issue at play: that is the ever increasing relationship of medicine and digital technology. For all the ardent support I will put towards the continuation of medical dissection, I cannot ignore the profound and important impact emerging digital technologies, for me, my very life, my family, my hometown of Seattle, and the global community at large.
In a world with so many changing parts, from changing presidencies to changing gas prices, we have a habit of comparing then to now; past to present. While we’ve made so many fundamental strides within medicine, we can’t ignore what has worked in the past to favor a new trend the present, simply because of a false dichotomy we’ve created between old and new. New has its place, be it catheter heart surgery or PET scans, but cadaver dissection has persisted through centuries of hardship and illegality, and not without good reason. Young doctors need the experience; it’s something indelible that simply cannot be faked. Gross anatomy is just as much a part of the Renaissance age of Vesalius as it is now at the USC Keck School of Medicine, Fall Semester 2016. 



End Notes:
1Minimally Invasive Heart Surgery. (2016). Mayo Clinic. May Clinic Tests and Procedures.           Retrieved from: heart medicine: http://www.mayoclinic.org/tests-procedures/minimally-         invasive-heart-surgery/basics/definition/prc-20013701
2Minimally Invasive Heart Surgery. (2009). Brown University. Department of Biomedical Sciences. Retrieved from:   http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/
3Komo News: Seattle. Seattle Hospital Ranks Among Best for Heart Surgeries. Retrieved from:
            http://komonews.com/news/healthworks/seattle-hospital-ranks-among-best-for-heart-         surgeries
4Topol, K. (2012). The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health Care. New York: Knopf. Retrieved from:     https://books.google.com/books?hl=en&lr=&id=I6Bgje2T7Q8C&oi=fnd&pg=PT5&dq=            digital+medicine&ots=ipXFUf8giY&sig=9adCD74kWSulgrnUFB5xHeswuOk#v=onepa            ge&q=digital%20medicine&f=false
5Shaffer, D. (2002). What is Digital Medicine? Stud Health Technol Inform. 2002; 80; 195-204.   Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/12026129
6Elenko, E. (2015). Defining Digital Medicine. Nature Biotechnology. 33, 456–461 (2015)             doi:10.1038/nbt.3222. Retrieved from             http://www.nature.com/nbt/journal/v33/n5/nbt.3222/metrics/index.html
7Terhune, C. (2009). The Dubious Promise of Digital Medicine. Business Week. April 2009.         Retrieved from: http://securehealth.freshdefense.net/content/dubious.pdf
8Reidenberg, J. (2002). The new face of gross anatomy. The Anatomical Record.   doi/10.1002/ar.10076/full
            http://onlinelibrary.wiley.com/doi/10.1002/ar.10076/full
9Arnott, R., ed. (2013). Trepanation. New York: Puffin Books. Retrieved from:             https://books.google.com/books?hl=en&lr=&id=wisNNoceOzoC&oi=fnd&pg=PA223&dq=trepa            nation&ots=NbFJWw89j5&sig=A_RvIu2sJr3VqKEhSwQJ_Ca49YA#v=onepage&q=trepanation            &f=false
10Galen of Pergamum. Encyclopedia Britannica Online. Retrieved from:             https://www.britannica.com/biography/Galen-of-Pergamum
11M. Rosenbloom, Interview, September 6th, 2015.
12Andreas Vesalius. Encyclopedia Britannica Online. Retrieved from:
            https://www.britannica.com/biography/Andreas-Vesalius
13University of Arkansas. (2010). Gross Anatomy: Then and Now. College of Medicine History.   Retrieved from:  http://medicine.uams.edu/about-the-college/college-of-medicine-history/history-      features/gross-            anatomy-then-and-now/
14Stanford University. (2011). Body image: Computerized table lets students do virtual dissection.             Stanford Medicine. Retrieved from: https://med.stanford.edu/news/all-news/2011/05/body-image-            computerized-table-lets-students-do-virtual-dissection.html
15M. Snow. Interview. September 5th, 2015.
16BBC. (2012). Virtual surgery: How to dissect a digital cadaver. Retrieved from:             http://www.bbc.com/news/technology-18173263
17McKenna, A. (2008). The American Society of Mechanical Engineers. Paper No. DETC2008-49783, pp.             359-368; 10 pages  doi:10.1115/DETC2008-49783
            http://proceedings.asmedigitalcollection.asme.org/proceeding.aspx?articleid=1628828
 18Hock, D. (2007). Virtual Dissection CT Colonography: Evaluation of Learning Curves and Reading             Times with and without Computer-aided Detection. RSNA Radiology. DOI:             http://dx.doi.org/10.1148/radiol.2482070895. Retrieved from:             http://pubs.rsna.org/doi/abs/10.1148/radiol.2482070895
19N. Hartman. Interview. September 4th, 2015.
20 W. Yamashita. Personal Correspondence. September 11th, 2015.

Saturday, October 15, 2016

The Rowdy Minority: Will Trump (or Hillary) Supporters Ever Be Satisfied?

In the final weeks of this bloated election season we are catapulting towards a Nov 8th election night that is surely going to alienate a significant portion of the American population by the outcome - and not that previous elections haven’t precipitated in fierce politicking across the aisle. Take for instance Mitch McConnell’s remarks to, “Make Obama a one term president,” following the 2008 election against McCain. But this election is different. In truth it’s not so much an election as it is a war. To voters across the political spectrum, the candidates aren’t the opposition, they are the devil incarnate. There has been so much animosity drudged up by this election it begs the question, will we as a country be remotely satisfied if either Trump or Hillary are elected to office?

The short answer? No. An Op-Ed in The Atlantic took note of the post-election fallout for Trump supporters – assuming a likely Hillary victory:

It leaves Americans that much more segregated and alienated from one another. It’s exactly this kind of cross-cultural suspicion and mistrust that has enabled Trump to come within spitting distance of the presidency. And it’s what threatens to keep his supporters isolated and fuming on the sidelines, long after their champion has forgotten them.
But it goes further. Much further.

Trump’s incendiary remarks have not only lit a fire under his most ardent supporters, but scorched a thick division between the Trump right and the center that not even members of his own party can transgress. If even a quarter of Trump’s ludicrous plans come to fruition, not even his own party can potentially stop it. Even the RNC establishment has blacklisted Trump – pulling funds to the RNC Victory Campaign, one of the largest sources of campaign money to Republican campaigns. In a terrifying way, Trump has aggravated a significant faction of the US population by alienating them from the rest of the country. It’s Us versus Them. “The liberal media says…They wanted that story to drop…I’m not perfect why are they…” Through this mentality Trump has convinced 40-45% of the country to buy only one brand, Trump. And if they lose, where will they go, and will they be satisfied? I doubt it.

Trump is a sore loser, despite his outrageous debate comments towards his, “winning temperament.” Undoubtedly Trump’s post-election media presence will be massive, and all the more inflated by his seemingly inevitable lose. But the damage has already been done, he has become the de facto (and only voice) of such a staggering percentage of the American public, that he can continue to drive this political division long after the election. If you don’t believe me, just look at how effective his Twitter has been in his campaign. Like him or hate him, Trump is a master of social media. The rumblings of a Breitbart-Trump news channel would take this twitter-talk to a national level post-election. 

But the point I’m making isn’t just about Trump. In the unlikely, but ever so possible chance that Trump loses the election, we are back to the same alienated place that pending a Hillary victory. The sad fact of the truth is that the scorched division between the Hillary camp and the Trump camp goes two ways. Should Trump win, undoubtedly it would be rejected by democrats and moderates across the country. Riots, hate speech, you name it. Our attention would be the Sanders, Clinton and any other liberal voice to speak against president Trump. And without a doubt every month of a Trump presidency would be a fight against the liberal establishment. But the bottom line is this action will be just as politically toxic as a Trump victory.

As we move forward from this pivotal election, we as a country need to realize that the wounds we have inflicted across the aisle are not ones that we be magically healed as of November 9th. These are long lasting issues that will alienate half of our country in a way we haven’t seen before. And there isn’t a one size fits all solution to this malady, but it is a problem that cannot be ignored as we go into the 44th President of the United States’ new term.