You may not have heard of koro -- a mental syndrome in which a person has an overwhelming belief that his or her genitals are disappearing -- or zar-- a condition that generates dissociative episodes characterized by intense laughter and singing -- but that doesn't mean these are any less universal than, say, anorexia. At least that was the theme of a fascinating article by journalist Ethan Watters about "the Americanization of mental illness," published in the New York Times Magazine in 2010.
One of the primary points Watters makes is that the Western mental-health practitioners behind the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) problematically placed "culture-bound" disorders -- like those mentioned above --in their own section at the back of psychiatry's most definitive diagnostic guide, implying that these syndromes are somehow affected by culture in a way that predominantly Western illnesses are not:
Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world's psyche, and applying it around the world represents simply the brave march of scientific knowledge.
But Watters disagrees with that approach. "In the end," he concludes, "what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations.... [M]ental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions - the idiosyncratic cultural trappings - of the mind that is its host."
The American Psychiatric Association (APA), it seems, is heeding that advice. The organization is unveiling DSM-5, the long-anticipated (14 years, to be exact) new edition of its manual, over the weekend during its annual meeting in San Francisco. And based on preliminary information, the task force that wrote it appears to have been more sensitive to the nuances of patient care across countries.
"Rather than a simple list of culture-bound syndromes," reads one statement on the APA's methodology, "DSM-5 updates criteria to reflect cross-cultural variations in presentations, gives more detailed and structured information about cultural concepts of distress, and includes a clinical interview tool to facilitate comprehensive, person-centered assessments."
What exactly will this look like? Instead of relegating cultural expressions of mental disorders to the back of the book, the manual will incorporate these throughout the text. The example the APA provides is for social anxiety disorder. In the new manual, "fear of 'offending others'" will be included in order to reflect "the Japanese concept in which avoiding harm to others is emphasized rather than harm to oneself."
Another example: A preliminary version of the DSM-5, which the APA released for feedback last year, updated the criteria for dissociative identity disorders so that professionals won't need to diagnose practices like shamanism as a mental illness. In the new manual, practitioners are told that if the so-called "disturbance" is actually "a normal part of a broadly accepted cultural or religious practice," then it does not technically constitute dissociative identity disorder.
Changes such as these are definitely a start. But all the medical anthropologists out there need not worry. With ambiguous words like "broadly accepted" and "normal" peppered in the DSM-5, there's certainly still room for criticism.
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What can an impoverished island nation -- one isolated by the United States and lacking natural resources of its own -- do to secure its influence in the world and earn hard currency? In Cuba's case, the answer lies in its medical corps.
On Monday, Brazilian Foreign Minister Antonio Patriota announced that his country is in negotiations to hire some 6,000 Cuban doctors to come work in rural areas of Brazil. The plan highlights what has become a cornerstone of Cuban foreign policy and its export economy. Since the Cuban revolution in 1959, the country has aggressively exported its doctors around the world -- sometimes for humanitarian reasons, sometimes for cash -- and has garnered a reputation as a provider of health care to the world's neediest countries.
Shortly after the revolution, for instance, Fidel Castro sent physicians to Algeria as a sign of socialist solidarity and to Chile in the aftermath of a devastating earthquake. Since then, Cuba has sent at least 185,000 health workers to more than 100 different countries, according to the New York Times.
But what began as a strategy for exporting revolution has in more recent years turned into a means of ensuring the government's survival. Cuba's largest medical mission is currently in Venezuela, which sends Havana 90,000 barrels of oil per day in exchange for 30,000 Cuban physicians. It's an elegant quid pro quo that secures legitimacy for the Venezuelan government and keeps the Cuban economy afloat.
We hear a lot about Cuban cigars, but tobacco is far from Cuba's most important export. In 2006, 28 percent, or $2.3 billion, of Cuba's total export earnings came from medical services, according to a study by Julie Feinsilver. As a rough measure of comparison, Cuba's cigar exports totaled $215 million in 2011.
So what might Cuba's latest foray into medical diplomacy entail? In return for physicians and other health workers, Brazil is expected to fund infrastructure projects in Cuba and direct a $176 million loan toward Cuban airports. Cuban medical personnel, meanwhile, will fan out to rural areas of Brazil that are typically underserved by doctors.
It's a bitter irony for U.S. policymakers that 50 years after the imposition of the Cuban embargo, the communist regime is circumventing efforts to isolate it by sending, of all things, doctors around the world.
Never mind that the motive isn't always humanitarian.
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Save the Children's "Mother's Index 2013," released less than a week before Mother's Day, generated buzz on Tuesday for its ranking of the best countries in the world to be a mother. Out of the 176 nations on the list -- 46 developed and 130 developing -- the top six are all located in Northern Europe while the bottom 12 are in Africa (Finland placed first, and the Democratic Republic of the Congo came in last). The United States finished in 30th place despite performing well on the index's educational and economic measures. The metrics holding the America back? Maternal mortality rate, under-5 mortality rate, and especially female representation in government, where it ranked 89th (women hold only 18 percent of seats in the U.S. Congress).
It's this last prong of the methodology that we found particularly interesting. Is there really a connection between a higher percentage of females in national government and a mother's quality of life?
According to Save the Children, the answer is yes. The report hypothesizes, "When women have a voice in politics, issues that are important to mothers and their children are more likely to surface on the national agenda and emerge as national priorities."
The organization based this conclusion on a number of factors. First, it compared individual countries to regional peers and nations with similar gross national incomes (GNIs), and found that the strongest performers in terms of mother and child health and well-being (maternal mortality, under-5 mortality, and access to education) also had higher proportions of parliamentary seats held by women. The team also found that when a country performed better in terms of those three health and well-being metrics than its GNI would predict, a differentiating factor was participation of women in government.
For example, Rwanda has the highest percentage of female lawmakers in the world (52 percent), and it surpasses other countries with similar levels of national wealth in terms of maternal mortality, under-5 mortality, and years of education. Nepal and Afghanistan, which have made great strides in improving the quality of life of women and children, also have the highest levels of female political representation in South Asia.
It's data Congress might want to take a closer look at.
The suicide rate among Americans ages 35 to 64 rose by roughly 28 percent between 1999 and 2010, according to a Centers for Disease Control and Prevention report released Friday, up from 13.7 to 17.6 deaths per 100,000 people (the suicide rate is much higher for middle-aged men, at 27.3, than for women, at 8.1). The increase, the New York Times noted, is raising concerns that "a generation of baby boomers who have faced years of economic worry and easy access to prescription painkillers may be particularly vulnerable to self-inflicted harm."
The numbers are troubling, but how do they compare to rates in other parts of the world? Suicide data is notoriously hard to compile because it is believed to be vastly underreported -- and the level of reporting varies from country to country, which makes comparing rates across nations an inexact science. But a look at World Health Organization data indicates that the United States falls more or less in the middle of the pack for both male and female suicides, with 17.7 male deaths (38th-most among 105 countries) and 4.5 female deaths (40th) per 100,000 people (the transnational statistics are drawn from varying years).
Men commit suicide more often than women in nearly every nation listed by the WHO report. The only exceptions are China (14.8 women vs. 13.0 men) and the tiny island nation of São Tomé and Príncipe, which reports that no men commit suicide there and that women commit suicide at a rate of only 1.8 per 100,000. That data, though, was is from 1987.
Lithuania, meanwhile, has the highest suicide rate among men, with 61.3 deaths for every 100,000 citizens, followed by Russia (53.9), and one of the largest gender gaps, with the rate for Lithuanian women at 10.3. South Korea has the highest rate for women at 22.1 and more parity between genders, with a rate of 39.9 for men.
In 2008, Reuters took an in-depth look at Lithuania's struggle with suicide, noting that high rates are a particularly painful social issue for the post-Soviet Baltic states despite their economic growth:
Pensioners struggle to survive, healthcare facilities are often poor and cases of tuberculosis, a disease often associated with poverty, are far above the EU average.
Tens of thousands of Latvians and Lithuanians have emigrated to seek higher wages and a better life: others seek a more final way out....
Suicide is particularly prevalent in rural communities where unemployment rose following the dissolution of Soviet era collective farms....
People lack the necessary education and professional skills, or are too old to adapt to new realities, and the state has put too little effort in helping them, experts say. In desperation, many turn to alcohol, fuelling their feelings of hopelessness.
It's a phenomenon that prompted one WikiLeaks cable to dub Lithuania the "suicide capital of Europe."
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Amid the bleak news of the Boston Marathon bombing and its dramatic aftermath, one silver lining has been the success of the first responders in preventing a far more horrific outcome after the explosions. And people are citing an unlikely reason why: the war in Iraq.
In recent days, several articles have pointed to just how instrumental the lessons learned on the battlefield in Iraq and Afghanistan were to mitigating the damage in Boston. Scientific American notes that experiences with IEDs taught medics the importance of responding quickly, since bleeding out was identified as the most common cause of death in these explosions. In an article in Mother Jones, Tim Murphy echoes this idea, explaining the importance in Boston of applying tourniquets -- a lesson learned in Baghdad.
But the spate of deadly bombings from Somalia to Iraq in the days since the Boston bombings made us wonder if the reverse could be true: Could the lessons of Boston apply to bombings in Iraq?
In fact, this debate took place in the pages of the Lancet in 2011. After the medical journal published a statistical analysis of suicide bombings in Iraq that highlighted their disproportionate effect on civilians, Pierre Pasquier and two fellow French scientists wrote the authors a letter suggesting the application of basic care techniques could mitigate these effects, substantially decreasing fatalities.
They pointed to studies showing that in the early years of the war, "around 90% of military combat-related deaths occurred before the casualty reached a medical treatment facility," and went on to say that medics in the military subsequently focused on preventing exsanguination, or blood loss, through the applications of tourniquets in pre-surgical settings, which drastically reduced casualties -- the very lesson that was applied in Boston. They conclude:
Hence, focusing on civilians after bombing, we wonder whether simple tools such as the tourniquet, applied by the man in the street, could be a more efficient approach to improving survival than the hypothetical deployment of "high-quality treatment" facilities.
The study's authors, however, issued an obvious but important reply -- one that offers insight into why the lessons of Boston unfortunately may not be entirely applicable to Iraq:
It is essential to point out that, to whatever degree civilian-administered tourniquets might improve immediate rates of survival from extremity wounds caused by suicide bombs, a tourniquet is a temporary measure that does not replace the adequate health care required by victims for their continued survival. If a civilian-applied tourniquet is required temporarily to stanch severe bleeding from an extremity, to survive in the long term, that civilian will require effective emergency and surgical treatment to the limb once arriving at hospital.
They went on to cite studies about Israeli bombings to explain the complexity of injuries sustained in suicide attacks, pointing out that research shows the "substantial proportions of victims arrive not only with extremity injuries (44%), but also with internal injuries (32%), head injuries (22%), chest injuries (21%), abdominal injuries (16%), and burns (17%). Survival of these wounds would not be affected by tourniquets." Many of these injuries would require surgical and intense post-operation therapy, for which the Iraqi healthcare system does not have adequate capacity.
It's a frustrating reminder of the public health and infrastructural problems that need to be addressed if pre-surgical care in Iraq is to make a significant difference in saving civilian lives, as it did in Boston.
For the umpteenth time, speculation is running rampant about Fidel Castro's health. El Comandante has reportedly suffered a major cerebral hemorrhage and embolic stroke according to Dr. José Marquina, a Venezuelan doctor who told El Nuevo Herald that he has access to "firsthand sources and information."
Castro's public absence since March had given rise to a new round of death rumors that were "quelled" just yesterday when a letter was released congratulating recent medical graduates on the 50 year anniversary of the Havana Medical School.
So basically, Castro "responded" to ill-health humors by writing a letter for a known upcoming historic occasion, while concurrently also having a stroke so severe that he is approaching a neurovegetative state and has been left unable to recognize faces. Word on the street is that Castro is dying in his Havana home where Hugo Chavez visited him on Tuesday to inquire about his health.
As expected, there's been no announcement or verification from the Cuban government.
News of a new "seal flu" has many fearing a repeat of the 2009 swine flu outbreak that infected more than 5.7 million in the United States before peaking as a level 5 on the WHO's 6-point pandemic alert. The H3N8 flu virus was discovered after the mysterious death of nearly 200 harbor seals off the United States' northeastern coast. Describing it as "a combination we haven't seen in disease before," researchers warned that the new strain of influenza A could have severe repercussions for human health.
The real shock of the story may be the public realization that such doe-eyed creatures could cause harm. While mosquitoes and ticks, those pesky harbingers of West Nile, dengue fever, cholera, Lyme disease, and Kyasanur fever (among other assorted viral, fungal, and bacterial pathogens) are universally hated, it's hard to believe the Earth's more cuddly creatures could breed evil. Here's another 13 to ruin your next trip to the petting zoo:
Peacocks are dying in droves in Pakistan's Thar Desert region in an outbreak scientists believe is linked to Newcastle disease. Highly contagious in birds, the viral infection is currently rare in humans. Its unique replication properties make it a potential candidate for agroterrorism, but more positive headway been made in its use as a human cancer treatment.
Found primarily in Latin America, armadillos are better known for their unique defense mechanism than their role as a global disease vector. Beneath their shell, however, these mammals shield leprosy, a rare bacterial infection that attacks the skin and nervous system. Though associated more with the bible than modern medicine, the disease remains active throughout the world -- with armadillos responsible for more than a third of infections in the United States.
The world's largest mammal offers plenty of real estate for influenza A, a viral flu strain with the most potential for interspecies transmission. Luckily, the chances for accidental contact remain slim -- just another reason to skip the whale meat.
Monkeys and apes
Described by malaria researchers as a "reservoir for human disease," monkeys and apes are widely known for harboring emerging zoonotic diseases. The HIV virus originated in African monkeys and strains of malaria, Ebola, and monkeypox virus continue to be created or transmitted by monkey and ape populations -- not to mention the cases of measles, rabies, tuberculosis, salmonellosis, shigellosis, amebiasis, balatidiasis, herpes B, giardiasis and helminthes believed to have appeared first in man's closest relative.
Dogs and cats
While many a dog-lover cheered reports of a feline parasite's negative impact on human dopamine production, man's best friend carries its own risks. Though undulant fever is more commonly associated with other species, human cases of the leptospirosis bacteria, an infection whose effect ranges from flu-like symptoms to liver and kidney failure, encephalitis, and pulmonary involvement, have been reported to originate in dogs.
More commonly associated with rats, plague seems to have chosen prairie dogs as its modern rodent host. One leg of a complex threesome that includes mice and fleas, prairie dog coteries across North America have been struck by a mass outbreak of bubonic and sylvatic plague. In an effort to cull the epidemic, the U.S. Department of Agriculture has implemented a mass fumigation campaign.
While flying foxes are their natural reservoir, the Hendra and Nipah viruses have adapted to survive within horses where they take residence alongside anthrax. Worse, equine encephalitis virus, a pathogen listed as a global priority by the Global Early Warning System for Major Animal Diseases, Including Zoonoses, has spread globally. Transmitted by mosquitos, the virus can be fatal in both horses and humans.
Rabbits and hares
Guinea pigs and hamsters
However popular with the preschool set, guinea pigs and hamsters are still rodents. Next time your kid asks to bring one home remember - these furry beasts are disease vectors of lymphocytic choriomeningitis, leptospirosis, yersiniosis and salmonellosis. Handle with gloves.
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In the aftermath of the U.S. Supreme Court's landmark ruling upholding President Obama's sweeping health care reform package, there have been some rumblings around the Twitterverse about a movement to emigrate to Canada.
As one such Tweeter put it:
#SCOTUS holds up free healthcare for everyone?! Screw this commie country, I'm moving to #Canada #whoswithme.
Apparently Canada's alleged death panels -- frequently featured in right wing rhetoric during the debate surrounding the passage of the health care bill in 2009 -- were not a factor in the decision to relocate.
As a citizen of Canada, I feel it is my duty to clarify some points before a wave of disgruntled anti-Obamacare immigrants arrives at the border
Canada has one of the most comprehensive single-payer public healthcare systems in the world. Everyone is covered, and there is no opt-out option. In the higher tax brackets, we pay nearly 50 percent of earnings in income tax in order to fund health care and other social services.
So, consider yourself warned: If you move to Canada, you will be heavily taxed. Then we will pay for your doctor's appointments. We will heavily subsidize your medications. We will cover your chemotherapy. We will stuff you with poutine and then pay for your coronary bypass.
The poutine, however, is on you, unless you qualify for our welfare system. In which case, we'll cover that too.
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The classic American ‘donut-loving cop' stereotype is not so funny in India. Five overweight police officers collapsed during a short parade in Mumbai earlier this year due to an unfortunate heat and pot-belly combo. City commissioner Arup Patnaik was humiliated and demanded that all policemen trim their waistlines or risk enduring a sort of extreme weight loss boot camp that few police officers pass.
The National Rural Health Mission (NRHM) in Kerala recently conducted a survey and found over 50 percent of police officers were either overweight or obese. Obesity has become one of the leading causes of death even though half of all Indian children suffer from malnourishment, reports VOA. The police chief of the western state of Rajasthan voiced his dismay over obesity in the police force:
"A fat potbellied man in uniform is a sight nobody appreciates."
Just over the border, overweight Nepali officers also face intense scrutiny. Last year, the police force pledged to institute annual health tests alongside personal fitness regimes for every officer in the force of 56,000. Bigyan Raj Sharma, a spokesman for the police force in Kathmandu, threatened overweight police officials, saying:
"Officers who fail will be barred from promotion and transferred to less well-paying posts."
An anti-obesity clinic is in the works for a police hospital in Mumbai and it seems India's officers have no choice but to slim down -- or face the wrath of their mothers. Yes, the new weight-loss campaign includes the wives and mothers of male officers to ensure that they are sticking to their diets by supporting healthier eating habits. Say bye-bye to mango lassis and hello to Atkins.
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Writing in FP earlier this summer, former U.S. ambassador on global HIV/AIDS, Jack Chow, offered a glimpse into China's policy on the epidemic: When it comes to aid money, give a bit, recieve lots and lots. At the time of writing the piece, China's contribution to the global pool of donor money to fight HIV/AIDS, the Global Fund, was $2 million over eight years. Meanwhile, the country won an $1 billion in grants. For a country with $2.5 trillion in foreign currency reserves, this seemed a bit out of whack.
Perhaps they got the message. Because at the replenishment conference that took place earlier this week -- a gathering in which countries, foundations, and other donors pledge their committments for the coming three years -- China upped the ante. From $2 million annually, China's contribution rose to approximately $4.6 million, or $14 million over the next three years. That's still not terribly impressive (especially considering that Nigeria offered a not-dissimilar $10 million for the fund.)
Still, the pressure was clearly on. Prior to the conference, six U.S. senators urged China to give its fair share. The Global Fund itself has also been pushing in this regard, urging the rising powers to slowly transition from recipient to donor. "China, Brazil and India should remain net beneficiaries the Global Fund," Kazatchkine told AFP. "[A]t the same time, they have to be contributors." That was one of President Barack Obama's administration's big goals in the replenishment as well: to get other donors to take up a fair share of the burden, particularly amid difficult financial times.
There were a few other interesting funding committments that stand out from the conference as well. The United States offered $4 billion over three years -- an increase from past funding but still not enough to please activists. Perhaps more interesting, however was the massive $300 million committment from the Bill and Melinda Gates Foundation. That number dwarfs almost all country donors -- including countries known for giving a relatively high proportion of their GDPs to aid, Norway, Denmark and Australia. What a new world it is where the richest foundation in the United States can outspend the world's most generous national donors.
This is extremely disturbing:
U.S. government medical researchers intentionally infected hundreds of people in Guatemala, including institutionalized mental patients, with gonorrhea and syphilis without their knowledge or permission more than 60 years ago.
Many of those infected were encouraged to pass the infection onto others as part of the study.
About one third of those who were infected never got adequate treatment.
Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius offered apologies for the experiments today.
The experiments, which took place from 1946-1948, were discovered by Wellesley Women's Studies professor Susan Reverby in the course of her study on another infamous STD study, the Tuskeegee Syphillis Experiment. You can read her findings here.
If you know anything about the Ebola virus, you're terrified by it. The disease, euphemistically dubbed a haemorrhagic fever, essentially causes one's innards to turn to mush, and blood begins to leak out of a patients eyes, nose, ears -- everywhere. It's only turned up sporadically in remote Africa in humans, but when it does, it has a fatality rate of up to 90 percent.
Think that sounds scary? How about this prospect: that disease engineered as bioweapon. Right. That's what the Department of Defense thought in the wake of the Sept. 11, 2001 attacks. So they have been researching drug therapy treatments ever since.
Yesterday, the U.S. Army Medical Research Institute of Infectious Diseases and a private firm, AVI BioPharma, published the results of studies that show that their treatment does have a helpful effect in monkeys. That's a huge leap, particularly since the reserachers were given clearance to start limited human testing. The partnership won a Defense Department grant of up to $291 million last month for that phase.
It's an interesting reminder of just how many technological advances have come out of such army research -- and who knows, maybe more disease treatments will be down the pipeline. Now, if only they would start researching malaria . . .
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China may be surpassing the United States in energy use and is catching up in the race for the world's biggest economy, but there's one superlative Beijing is trying to avoid: world's fattest country.
Starting this week, the city of Beijing has resumed mandatory daily workplace calisthenics, after a three-year break. Radio broadcast exercise regimens first began in 1951, but were suspended in 2007 so broadcasters could spend more time reporting on the 2008 Summer Olympics, held in Beijing. According to the media blog Danwei, Radio Exercise Set #8 will be broadcast on FM 102.5 every day at 10 a.m. and 3 p.m. Four million workers in the city are participating.
The Guardian interviewed several Beijing residents who supported the move, claiming it will benefit the city's younger workers:
"They are not lazy, they are just too busy. They have a lot of pressure at work and don't have time to exercise otherwise," said retired engineer Yang Jinrong, 55, as she took a break from playing badminton with her husband in a city centre park.
"Of course, the radio exercises will do young people good. Like they say on TV, 'Life lies in movement'," said Li Zhigang, 50, dropping to the ground to demonstrate the lotus yoga position.
Mr Sun, a 30-year-old who works in marketing, said he hoped private sector firms would adopt the drills. "I think this [resumption] is really necessary, because people's living habits are very bad now. They sit in the office the whole day," he said.
"I have my own exercise plan, but I never put it into practice because I am too busy."
Each exercise session is only 8 minutes long, meaning Chinese citizens might still need to hit the gym in order to offset the calories consumed at the country's 3,000 Kentucky Fried Chicken branches (apparently, Yum Brands opens one new KFC in mainland China nearly every day). How do you say Double Down in Mandarin?
That's what Indonesia is arguing:
Indonesia says the United States is abusing health regulations to shut out clove cigarettes, known as kretek and very popular in the southeast Asian country, while allowing U.S. manufacturers to continue to market menthol cigarettes.
U.S. officials say that flavoured tobaccos risk attracting young people to smoking, and that the ban applies to clove cigarettes from all countries and so is not discriminatory.
A meeting of the WTO's dispute settlement body agreed to set up a panel to rule on the dispute, the sources said.
I'm not sure about the trade rules, but the clove ban does seem somewhat inconsequential. Cloves made up less than .01 of the cigarettes smoked in the U.S. in 2008, so arguing that they're a uniquely dangerous gateway for young smokers seems like a tough case to make. On the other hand, with the possible exception of our nation's MFA programs and the staff of Reason magazine, there hasn't been a whole lot of backlash. Menthols, meanwhile, accounted for 28 percent of U.S. consumption, so banning them would presumably have been a much tougher political move domestically.
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Given how stubbornly Kim Jong-Il appears to be weathering his reportedly grave illness, you might think North Korean healthcare is more or less intact -- even the Dear Leader must get a boost from modern medicine. But a chilling report released today by Amnesty International is an all-too-clear reminder that the luxuries (or in this case, just the bare necessities) of royal treatment in Korea are a far cry from the horrors of everyday existence: based on the accounts of 40 North Korean defectors and health professionals, Amnesty investigators reveal just how backward the country's healthcare system truly is.
Drained of the most basic -- and most important -- resources (everything from pills to power), hospitals in North Korea are barely functional. Doctors make their rounds by candlelight, and patients endure major operations without even the mildest anesthesia. And that's only if the ailing can make it to a hospital in the first place: many patients must make many-hour treks to consult with their inept doctors -- appointments that invariably spell further trauma. One interviewee describes his harrowing amputation (anesthesia-free, of course):
Five medical assistants held my arms and legs down to keep me from moving. I was in so much pain that I screamed and eventually fainted from pain," said the man, identified only by his family name, Hwang. "I woke up one week later in a hospital bed.
Under North Korea's official health care program, all citizens are entitled to free medical treatment -- and state officials insist they truly receive it. Yet World Health Organization figures give the country a failing grade: North Korea spends less than one dollar per person per year on health -- a meager sum that makes it the world's worst performer. First-person accounts in the report only confirm this picture. According to one defector and former doctor:
People in North Korea don't bother going to the hospital if they don't have money because everyone knows that you have to pay for service and treatment.
Without the right bribes - cigarettes, alcohol, or just plain cash -- most Koreans don't stand a chance. In short, says the doctor: "If you don't have money, you die.''
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NPR and ProPublica have teamed up to produce a startling report about gaps in the U.S military's diagnosis and treatment of brain injuries. Their investigation calls fresh attention to the plight of so-called "walkie talkies" -- service men and women who by all external indicators appear to be hale and hearty, but who in fact suffer from debilitating mental ailments.
Combat-related brain injuries no longer receive the short shrift they once did: since the start of U.S operations in Afghanistan and Iraq, once unfamiliar terms like post-traumatic stress disorder (PTSD) have entered the lexicons of medical specialists and newspaper readers alike. The ProPublica report, however, reveals that even seemingly straightforward -- and seemingly innocuous -- injuries are all too often slipping under the military's medical radar screen. The most common injuries experienced by U.S soldiers are known as mild traumatic brain injuries -- what some doctors continue to refer to by the name anyone who never got the hang of snow-boarding will recognize: a plain old concussion. (Of course, soldiers typically incur brain damage after weathering the shock of road-side bombs, not the impact of a ski-slope tumble.) You might think that identifying and treating these injuries would, by the standards of army medics facing far more catastrophic cases, be more or less a piece of cake. Unfortunately, Lt. Gen. Eric Schoomaker, the Army's Surgeon General, admitted that one exam used by the military to detect concussions and other brain trauma is about as accurate as "a coin flip."
Even if the exams succeed, accurate testing rarely leads to a responsible follow-up. Often, diagnoses never find their way into a soldier's medical files. If they do, there's no guarantee they won't simply be abandoned -- or, even worse, burned -- in obscure, warzone warehouses:
"The reality is that for the first several years in Iraq everything was burned. If you were trying to dispose of something, you took it out and you put it in a burn pan and you burned it," said [Lt. Col. Mike] Russell, who served two tours in Iraq. "That's how things were done."
(And that's a troubling quote for many reasons.)
Treatment procedure is equally disheartening to read about. There's general consensus among specialists that victims of mild brain injuries should undergo rehabilitative therapy. In reality, it's far more common for patients to be prescribed psychotropic drugs (a response, perhaps, to the intense media coverage of psychological trauma, like PTSD) -- or to be ignored altogether.
The serious consequences of these oversights are driven home by the harrowing stories of victims like Michelle Dyarman, a former reserve soldier whose life was utterly transformed by two roadside bombs and a Humvee accident. After misdiagnosis and mistreatment by military medics, Dyarman's brain doesn't function the way it used to:
Today, the former dean's list student struggles to read a newspaper article. She has pounding headaches. She has trouble remembering the address of the farmhouse where she grew up in the hills of central Pennsylvania...
Dyarman has returned to her civilian job inspecting radiological devices for the state, but colleagues say she turns in reports with lots of blanks; they cover for her.
Meanwhile, she -- and we -- are left to wish the army had offered her the same kind of support.
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Costa Rica, increasingly known as a haven for medical tourism, is putting a stop to one controversial practice:
The health ministry last month ordered the country's largest stem cell clinic to stop offering treatments, arguing there is no evidence that the treatments work or are safe.
"If (stem cell treatment's) efficiency and safety has not been proven, we don't believe it should be used," said Dr. Ileana Herrera, chief of the ministry's research council. "As a health ministry, we must always protect the human being.
The clinic's owner, Arizona entrepreneur Neil Riordan, told Reuters he closed the clinic and admitted the treatments, involving the removal and re-injection of stem cells, had not been approved by the U.S. Food and Drug Administration.
"I think her point was that it is not FDA approved," he said in a telephone interview from Panama.
The ministry said the clinic had a permit to store the adult stem cells, extracted from patients' own fat tissue, bone marrow and donated umbilical cords, but is not authorized to perform the treatment.
Riordan has patients suffering from multiple sclerosis and other forms of paralysis who are coming to his defense, but the evidence that his treatments work is mostly anecdotal. It certainly makes sense that the Costa Rican government doesn't want to be held liable for an unproven treatment, but with patients becoming more comfortable with medical tourism, you can expect similar clinics to open elsewhere.
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Data rockets across South Korea's broadband network at an average clip of 14.58 megabits per second. This makes the country's network the fastest of any in the world. (In comparison, the average American broadband connection chugs along at a sluggish 3.88 megabits per second, almost four times slower than what you'd find in Seoul.)
While South Koreans have been quick to embrace the many benefits fast broadband internet connections provide, increased use of a quicker, more efficient internet has brought with it new problems for South Korean society. Chief among such problems is an addiction to internet video games. According to a Washington Post article, in 2006, approximately 2.4 percent of 9 to 39-year-olds in South Korea suffered from full-blown addiction; another 10.2 percent were classified as borderline addicts.
Apparently the situation has only gotten worse. In 2005, a South Korean man died after a marathon 50-hour video game session, and in March, 2010, a South Korean couple allowed their three-month old baby to starve to death while they were occupied playing an on-line video game. In response, the Korean government has begun experimenting with a teenage video game curfew that will block young gamers' access to 20 different popular on-line role-playing games (RPGs) for 6 hours a day, every day.
Whatever happened to the good old days of underage drinking and loitering?
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The Haitian government estimates approximately 230,000 died in the quake
It estimates a further 300,000 people have sustained injuries
An unknown number of others have died from untreated sepsis, illness, and injury
One million remain homeless
Fifty thousand families have received tent-type emergency shelters
Tents donated by the Cirque du Soleil might soon house the Haitian government
More than 500,000 children are orphans
More than 20,000 children under the age of five are severely malnourished
The Miami-Dade School District has enrolled 1,000 Haitian children
Most of Port-au-Prince's schools are planning to reopen
Doctors have treated more than 100,000 people, performing 2,000 to 4,000 amputations
More than 7,000 babies have been born
Eighty percent of Port-au-Prince remains without power
One thousand planes are waiting for permission to land at Port-au-Prince's airport
Haiti's airport, under the direction of the U.S. Air Force, is landing 100 airplanes a day; prior to the earthquake, it handled three to five
Cruise ships continue to dock in gated zones in northern Haiti
The drive from the Dominican Republic, which formerly took six hours, now takes 18
Economists estimate the earthquake impacted half of Haiti's GDP
International donors have committed at least $3 billion to the rebuilding effort
The United Nations Development Program has started an initiative to pay Haitians $3 a day to clear rubble and help rebuild, to infuse cash into the economy
Nearly half of American families have donated to Haitian disaster relief organizations
The United States has caught the first ship of 78 Haitians attempting to immigrate into the United States illegally -- it sent them back
The United States might cut non-Haiti disaster programs by 40 percent, possibly leading to smaller programs for Congo and Sudan.
The rainy season has just started, soaking Port-au-Prince, collapsing many temporary homes, and increasing risks from water and sewage-borne illnesses
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The first lady argues that the U.S. obesity epidemic is becoming a national security problem:
“A recent study put the health care cost of obesity-related diseases at $147 billion a year,” Mrs. Obama said. “This epidemic also impacts the nation’s security, as obesity is now one of the most common disqualifiers for military service.”
One recent study found that 27 percent of young Americans are too overweight to join the military.
SAUL LOEB/AFP/Getty Images
For those of you who don't subscribe to the bimonthly print edition of Foreign Policy, you're missing a great feature: the FP Quiz. It has eight intriguing questions about how the world works.
The question I'd like to highlight this week is:
After Mexico, which OECD country has the highest rate of teen births?
a) Czech Republic b) Turkey c) United States
Answer after the jump …
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Combating alchohol abuse has always been something of a non-starter in Russian politics. This is, after all, a country whose former president was once found by the Secret Servce thoroughly sauced outside the White House, wearing nothing but his underwear trying to hail a cab so he could get a pizza.
But current President Dmitry Medvedev is trying to change things with a proposal to ban outdoor beer sales in his country, a first step in getting Muscovites to lay off alcohol. He also wants to limit the hours of the day alcohol can be sold.
This week, a bill was submitted to lawmakers that would triple the tax on beer from 3 rubles per liter to 10 rubles per liter by 2012. Wine and spirits would also see a sharp increase.
State prosecutors are also moving to ban liquor sales in airports. Under Russian law, no beverage with alcohol content above 15 percent can be sold in crowded or dangerous places, and prosecutors say this means airports.
Russians drink five gallons of pure ethanol a year, double what is considered dangerous by the WHO. And on average, 30,000 people a year die from alcohol poisoning in the country. Over half of the deaths of the 15 to 54-year-old demographic between 1990 and 2001 are attributed to alcohol.
"I have been astonished to find out that we now drink more than we did in the 1990s, although those were very tough times," Medvedev said.
He is a fan of Soviet Premier Mikhail Gorbachev's anti-alcohol reforms in the 1980s aimed at curbing consumption, even though he acknowledges that the plan had major flaws. Gorbachev destroyed the majority of vineyards and wineries in Georgia, probably the birthplace of wine (This didn't help the growing anti-Russia sentiment in the Southern Caucasus at the time). He also shut down distilleries and breweries. Most notably, the Soviet Union suffered tremendous sugar shortages, because people turned to moon shining. (The Russian word for ‘shine is Samogon) Stores also ran out of window cleaner and aftershave. It is estimated that 13,000-25,000 people died from drinking ill-made moonshine.
Medvedev's plan is much more cautious but many Russians are still wary.
"It's impossible. He doesn't stand a chance," a Russian construction worker told The Los Angeles Times."The Russian man will always be drinking. Russians don't surrender."
ALEXANDER NEMENOV/AFP/Getty Images
Maureen Lewis and Andre Medici of the World Bank respond to "Brazil's Public Option," a Foreign Policy Web piece by Eduardo J. Gómez from Sept. 2.
The article "Brazil's Public Option" from Foreign Policy's Web site captures some of the highlights of the country's public health-care system. But it contains some errors and omits some of its most important lessons.
First, like the rest of Latin America, Brazil is committed to free, universal health care. The government revamped the health-care system when it wrote a new constitution in 1988, at the demise of two decades of military dictatorship. Before 1988, the health-care system was based on two centralized arrangements: a social security-based system tied to formal sector employment, and a public system for everyone else. The Single Unified System (SUS) brought federal financing and provision into a single entity, and decentralized facilities and funding (through transfers) to over 5,500 municipalities. It is hardly comparable to the current movement in the United States to effectively adjust the system and make it more fair.
The problems of public systems (waiting lists, political interference, and deteriorating and outdated infrastructure) are not unique to Brazil. What is different is the adaptability and creativity that has emerged. It is not lack of federal oversight of municipalities that has proved problematic, but the lack of management and capacity, a problem never addressed. As a result the states have taken the lead in revamping and improving the health-care system. State experimentation to deal with the rigidities and poor incentives of public health care include innovative contract mechanisms that have upgraded quality and reduced costs through management contracts that include removal for nonperformance; public sector reforms that rely on performance contracts with line departments; and radically new delivery models in violence-prone slums where normal health-care delivery is no longer viable.
It should also be pointed out that Brazil's large and vibrant private insurance sector isn't new. Even in the 1990s a quarter of Brazil's population purchased private health insurance.
What is missing from the article are the innovations and creativity brought to bear at the state and local level (mostly with federal funds) to improve efficiency and effectiveness, an evolving evaluation culture in service delivery that has spurred prevention and outreach (something lacking in the United States), and the willingness to adapt a public system to new circumstances. These are possibly the best lessons for the United States.
When it comes to using Holocaust metaphors, the power of suggestion is a loaded and delicate thing. Striking the right chord becomes ever more slippery when, for example, you use the most recognizable image of Holocaust evil, Adolf Hitler, to illustrate the recklessness of unprotected sex. But you just about lose any hope of keeping that line clean and clear when you make a Hitler sex video for an AIDS PSA. Which is what a small German AIDS awareness group called, Regenbogen e.V, did.
While the Telegraph says the clip appears to be a "typical advert" at first glance, I imagine most American viewers won't agree. The act of intimacy being portrayed is basically soft-core porn. It shows two very naked hard-bodies engaged in some very steamy sex. (Warning: this video ain't for the kiddies and is probably not safe for work.) The commercial's obvious-to-the-point-of-insult message, that unprotected sex is very, very dangerous, is hammered home with a rather indelicate ... bang. As the couple reaches climax, the man's face is revealed -- it's Hitler. Scary, indeed.
Not surprisingly the ad, released in Britain to coincide with World AIDS day, has created a storm of controversy. A spokesman for the National AIDS Trust, the group that coordinates World AIDS Day in Britain, had this to say:
Of course there are many HIV organisations that run their own campaigns, however I think the advert is incredibly stigmatising to people living with HIV who already face much stigma and discrimination due to ignorance about the virus.
"On top of this it fails to provide any kind of actual prevention message (e.g. use a condom) and may deter people to come forward for testing.
"The advert is also inaccurate because in the UK thanks to treatment HIV is a manageable condition that does not necessary lead to AIDS.
Hans Weishäupl, creative director of das comitee, the group that created the ad for Regenbogen e.V, defended the work:
A lot of people are not aware that Aids is still murdering many people every day. They wanted a campaign which told young people that it is still a threat," he said. "In Germany, Hitler is the ugliest face you can use to show evil."
Provocative it may be, but successful? I doubt it. Would it be a gross and malicious misinterpretation to use this ad to say that people who have unprotected sex, or people with HIV or AIDS, are as evil as Hitler? Absolutely. Is it a stretch to say there are folks out there who will do just that? Nope.
Using the evil führer's personage for good is a tricky business, one that should perhaps be left to the Charlie Chaplins of the world.
The Japanese have been as cautious as any nation in trying to avoid swine flu Even before the first case was diagnosed in May, many Japanese were wearing masks overseas, and after the disease spread to the island, thousands of schools were closed, and testing centers were overwhelmed.
And while the thorough response has done little to halt the disease--three people have died from the virus, and on Wednesday the health minister announced a higher number of cases than expected--even politicians are taking a bold new step to prevent infection: ditching the handshake.
[C]andidate Denny Tamaki is playing it safe. "Shaking hands during an election campaign is key, so this is pretty troubling," Tamaki told the Yomiuri Shimbun.
"It would be bad if I get infected myself and then pass it on to older people with weaker immune systems," said Tamaki, whose home island of Okinawa has been hit hard by the flu.
Meanwhile, students at the British International School in Shanghai are probably glad they set their world handshaking record when they did.
YOSHIKAZU TSUNO/AFP/Getty Images
Spanish Health Minister Trinidad Jimenez launched a new
health campaign with recommendations to guard against the spread of swine
flu by encouraging people to wash hands frequently, avoid sharing glasses and
to refrain from kissing where possible. But just moments before she made her
statement, the minister was caught kissing news conference assistants twice on
the cheek. Though a common social custom, local media wasted no time in
capturing the irony, as weekend papers splashed pictures of Jimenez failing to
practice what she preached. To date, Spain has accredited 11
deaths to the virus, giving it the second highest fatality rate in Europe.
PHILIPPE DESMAZES/AFP/Getty Images
The Globe and Mail's Norman Spector thinks Canadian Prime Minister Stephen Harper missed a chance at the "three amigos" summit to help out Barack Obama and gain some political points that could be used to sway the president on "buy America" provisions:
On health care reform -- a question he knew he would be asked and had obviously prepared -- he ducked instead of helping the President counter Republican disinformation by seconding Mr. Obama’s observation that the Canadian model is not on the table. Most gratingly, with an insipid smile on his face, Mr. Harper referred to provincial jurisdiction over health care — a half-truth, at best, given the constraints set out in federal legislation.
In interview with ABC's Jake Tapper, that Spector also links to, Harper does seem to be bending over backwards not to defend his own country's healthcare system.Given how divorced from reality the U.S. healthcare debate has become, I'm not sure how much Haper really could have helped Obama. It's not as if the assurances of a Canadian Prime Minister -- even a conservative one -- are really going to assuage those who see "Obamacare" as creeping socialism. Ducking the question and staying as far away from the U.S. debate as possible is not exactly a profile in courage, but is probably prudent.
(Hat tip: Matthew Yglesias)
Anxiety over swine-flu infection is mounting, casting a particularly long shadow of caution and concern in Britain. Last week, Sir Liam Donaldson, the UK's chief medical officer, predicted that the country could see as many as 65,000 deaths by this fall, and yesterday newspapers reported that British airlines may ban passengers exhibiting symptoms from traveling. While there have only been 29 reported deaths so far in Britain, it appears the storm of H1N1 is coming early. And now it's jeopardizing a holy journey.
Today, health officials from the Association of British Hujja warned Muslims to reconsider this year's pilgrimage to Mecca, releasing this statement:
British pilgrims have always been at high risk of infections due to the crowded conditions at ceremonies, accommodation sites and on public transport. Therefore pilgrims must follow the guidelines issued by the authorities and they should be vaccinated against the swine flu virus once this vaccine is available at least two weeks before their departure to perform pilgrimage."
The notice came after officials in Saudi Arabia advised all travelers to be vaccinated prior to making the trip, adding that those most vulnerable, "pregnant women, children, chronically ill and elderly people," should simply stay at home this year. Other countries in the Middle East and Africa have issued similar warnings. Egypt did so after a woman, infected during a recent trip to Saudi Arabia, died of swine flu earlier this month -- the first H1N1-related death in the country.
Ramadan begins late next month, and there's no real sign yet how many Muslims planning to make the annual pilgrimage will be affected. Some 25,000 Muslims are expected to come from Britain alone. So far, religious leaders, like Egypt's top cleric, are looking to the World Health Organization for guidance "on whether to issue a fatwa or decree barring all Egyptians from making the pilgrimage."
So far, the death toll worldwide is 700, according to the WHO, representatives of which have said the virus is spreading with "unprecedented speed."
It's enough to make anyone look forward to getting their shots this year.
Official Iranian news agency Fars has reported that two pilgrims recently returned from the Hajj have contracted swine flu. Mecca plays host to about two million Muslims every year including nearly 12,000 from the United States and 25,000 from the United Kingdom, both of whom top the World Health Organization's table of reported swine flu cases. Fears about the rapid spread of the pandemic during the Hajj have prompted swift action from countries across the Middle East, which have as yet reported relatively few cases. Saudi Arabia has already put in place facilities at its major airports to quarantine pilgrims suspected of carrying the H1N1 virus.
Meanwhile in England, the Bishop of Chelmsford has advised that churches remove holy water which, when exposed in stoups, can easily become a source of infection. Revered John Gladwin recommended that parishioners exhibiting flu-like symptoms should stay at home where possible, and priests who must make pastoral visits "wear sterile gloves, an apron and a face mask." He also said those taking holy communion should not drink wine from the chalice if ill, and would still receive the full communion by taking the wafer of bread alone.
Luis Acosta/AFP/Getty images
On Friday, Britons Lady Joan and Sir Edward Downes, a prominent orchestral conductor, committed suicide with barbituates provided by the Dignitas clinic in Switzerland. According to British newspapers, Joan, 74, was suffering from terminal pancreatic cancer and had but weeks to live; Edward, 85, was going blind and deaf and did not want to live without her. The couple had been together for 54 years.
The story has reignited the debate over assisted suicide in Britain -- where every family that makes that horrific trip to Zurich commits a political act.
Indeed, in a brief interview with the Evening Standard, the Downes' son said, "It is a very civilized way to end your life, and I don’t understand why the legal position in this country doesn’t allow it." He also mentioned that he and his sister rang the police themselves to inform them of the deaths.
British police are questioning them, as assisting a suicide is illegal in Britain. But the justice system is unlikely to do anything. At least 117 Britons have committed suicide in Switzerland, where it has been legal to help terminally ill people end their life since 1998. No members of their families have ever been prosecuted. Britain, in essence, turns a blind eye.
I don't have much to say about the validity of assisted suicide laws. But one thing about the story struck me.
It's an expensive way to die -- it costs 4,000 Euros for Dignitas' services, plus the cost of bringing out one's family. And, because it is so expensive, only the wealthy seem to choose to do it. The titled Downeses. Businesspeople. University professors. Doctors.
One can imagine other terminally ill patients, in extraordinary pain and with no quality of life, wishing to end their life in a manner of their choosing, but being unable to do so because of the cost.
Britain's laws, de facto, make it possible for the rich to die via assisted suicide, but impossible for the poor to do so.
It reminds me of one of the common arguments over abortion laws. Women in countries like Portugal (which has restrictive abortion laws) or states like South Dakota (where virtually no clinics provide the service) often need to travel far distances to obtain the service. Which means the rich are able, and the poor aren't.
And access to such services should be determined by law, not class.
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