Podcast • March 1, 2014

“Street Rounds” with Dr. Jim O’Connell

We’re walking from the Massachusetts General Hospital on a crooked path to South Station, meeting people that our eyes and yours might normally never see. These are Friday morning “outdoor rounds” with Doctor Jim O’Connell of Boston Health Care for the Homeless, an esteemed Boston doc giving every one of his needy patients the same claim on his time and skill, treating, touching, and comforting people that the rest of us can manage not to see at all.
Of these eleven

Ten homeless men in “Mousey Park”  in 2000. Only one of these men is still alive today.

We’re on a short Open Source field trip to someplace between Boston Noir and Boston the medical mecca.  We’re walking from the Massachusetts General Hospital on a crooked path to South Station, meeting people that our eyes and yours might normally never see.  These are Friday morning “outdoor rounds” with Doctor Jim O’Connell of Boston Health Care for the Homeless, whose patients are mostly alcoholic men with other mental and bodily afflictions, very sick people who often say they prefer the street to shelter living.  Jim O’Connell has been at this work for 30 years.  He made a habit early on of washing the feet of his patients – as a gesture of his servant-hood – but also as a sort of diagnostic device: what paths have his patients been on?  When you’re looking for models of the doctor – patient relationship, it’s a pleasure to watch an esteemed Boston doc giving every one of his needy patients the same claim on his time and skill, treating, touching, and comforting people that the rest of us can manage not to see at all.  

 

February 20, 2014

Rites of Passage: Docs and Nurses in the Developing World

  A new rite of passage is taking hold among ambitious young doctors entering modern practice in a new century. It can take a year or two after medical school: working far corners of the ...

 

A new rite of passage is taking hold among ambitious young doctors entering modern practice in a new century. It can take a year or two after medical school: working far corners of the poor world, and sometimes later years split back and forth between a community clinic in rural Malawi and a neurology fellowship at Mass General in Boston. The trend is striking: of the new medical doctors coming out of US medical schools in the mid-80s, one in twenty had spent some real time abroad in healthcare.  Ten years ago it was one in 5. Last year it was one in 3.  So more and more doctors, yours and mine, acting locally, will be thinking globally, with many implications.

Our radio conversation is about the lessons that flow both ways.  Some have to do with technology and drugs, but many more with building ground support in community clinics; also with the training of nurses, even with refining the bedside manner and hands-on, make-do skills of American doctors who arrive, as they say, with “sandals on the ground.”  They come back “thinking different” about who needs what kind of doctoring in the States. Consider this, for example: Bill Gates’s foundation report this winter predicts there will be no more poor countries by 2035, that’s two decades out; we’ll just have an awful lot of poor people in middle-income countries.   We know that problem in the US, and we haven’t turned it around.  But there are clues out there in the developing world and lessons coming home with the young doctors: lessons in community care outside the big hospital ERs; lessons in “accompanying” care, lessons in prevention, in doing more with less and getting sharply better outcomes, also in putting moral urgency behind more effective care for everybody.

Guests

  • Ophelia Dahl is the executive director and a co-founder (with Paul Farmer, Jim Kim, the late Tom White, and others) of Partners in Health, the Boston-based non-profit that has taken as its mission to bring great health care to the world’s poorest people and “to serve as an antidote to despair”.
  • Dr. Daniel Palazuelos is PIH’s chief strategist at its site in Chiapas, Mexico, and directs their efforts to ensure the success of their community-health workers, who are charged with the “accompaniment” of patients.
  • Pat Daoust is the chief nursing officer at SEED Global Health, an organization dedicated to training a new generation of health professionals for work in the developing world. Daoust has served as one of the leading figures in HIV/AIDS nursing for decades, first with the AIDS Action Committee, then with the Harvard AIDS Initiative in Botswana and Ethiopia.

Reading List

  • In “Partners in Help,” Paul Farmer gives an ethos of “accompaniment” to those working with the poor and the ill — work tirelessly, with an open mind, and until you’re no longer needed:

There’s an element of mystery, of openness, of trust, in accompaniment. The companion, the accompagnateur, says: “I’ll go with you and support you on your journey wherever it leads; I’ll share your fate for a while. And by ‘a while,’ I don’t mean a little while.” Accompaniment is about sticking with a task until it’s deemed completed, not by the accompagnateur but by the person being accompanied.

  • Slow Ideas,” Atul Gawande’s latest essay in The New Yorker, tells us that the important changes in medicine will depend not on easy technological fixes, but on big and sometimes grueling social change.
  • In “From Haiti to Harvard,” on WBUR’s own Commonhealth blog, Rachel Zimmerman tells of the difficulties that community health workers in Boston face every day — and of the promise they represent for the American medical establishment.
  • Our guest, Dr. Daniel Palazuelos, wrote a short piece about the myths and realities surrounding community health workers abroad.
  • And the 2014 annual letter of the Bill and Melinda Gates Foundation looks forward to the hoped-for end of global poverty as we know it.

Podcast • February 20, 2014

Cuba’s Healthcare Revolution

Cuba’s revolutionary vanguard: US medical students Keasha Guerrier, Kereese Gayle and Akua Brown Three winters ago our Open Source trip to Cuba turned around on an astonishing moment of serendipity. At a bus stop in Havana ...

Cuba’s revolutionary vanguard: US medical students Keasha Guerrier, Kereese Gayle and Akua Brown

Three winters ago our Open Source trip to Cuba turned around on an astonishing moment of serendipity. At a bus stop in Havana my colleague Paul McCarthy heard a laugh he recognized from high school in California. “Only Akua Brown laughs like that,” he blurted. And Akua Brown it was, the friend he hadn’t seen for a decade, now finishing her fourth year at the Latin American Medical School in Havana.

Over the next few days, Akua Brown and her friends poured out their four-year immersion in Cuban life and language, Cuban magic and slang, the Cuban versions of sexism and racism, Cuban boyfriends and families, drums and faith, bureaucracy and student volleyball, and by the way, this strange Cuban thing about toilet seats and toilet paper: the revolution doesn’t seem to believe in either.

But the core of our long conversations is medicine, the Cuban way. This is aggressive, free, hands-on health care that makes house calls, and lingers for the feel of emotions and homelife. Doctors’ training like doctors’ care is free: the payback required of the students here from all over the hemisphere is only that they return to underserved areas of their home countries.

Michael Moore and our friend the Nobel Prize cardiologist Bernard Lown knew the results in Cuba all along. “I have been to Cuba 6 times,” Dr. Lown emailed me, “and learned much about doctoring in Cuba. Their thinking on social determinants of health, on the primacy of public health and the vital role of prevention strategies are unmatched in the world. With spending of less than $200 per person per year for health care, they have achieved health outcomes no different than in the USA where expenditures now exceed $7000 per person annually!”

Keasha Guerrier, a science major from the New York Institute of Technology, knew about Cuban medicine because “my father’s from Haiti, my mom is from Guyana.” But her brother teases her about “blackouts” in Cuba, and she has other relatives and friends who don’t know why she’s there, or ask her to “pick up a box of cigars on the way out.”

Keasha Guerrier

Am I just a pawn in a game the Cuban government is playing? I push back hard against that idea. There are a lot of things that the Cuban government has done that some people might not agree with. But medicine with a community base in training and practice — that is one the things they got right on the nose. They hit the nail on the head. The people who instituted this program saw how it works in Cuba… and they compared Cuba’s situation to countries in Central and South America or third world countries, Africa, Haiti. And they saw how they can make a difference. Here, you do a lot with a little bit… What they are trying to teach us is that you don’t have to be confined to working for a paycheck. But using all the things that you know, you can help a broad base of people. In that respect, I think that the intentions are pure.

Keasha Guerrier in conversation with Chris Lydon over roast chicken with rice and beans at the restaurant El Ajibe in Havana, December 19, 2008

Kereese Gayle grew up in Lousiana and Florida. She was a Spanish major at Georgetown who could see herself coming out of medical school in the US with crushing debts. “My family is Jamaican,” she says, “so we knew about the quality of the Cuban medical system. To this day I know I’m where Im supposed to be.”

Kereese Gayle

We’re here at a very important time in the history of the world. We’re getting the type of education that I think people are looking for. More and more people are thinking very seriously about the idea of universal health care, about the idea of rights for everyone to basic access to health care. I think we’re going to be a huge part of that…

We learn how to diagnose our patients with our hands, our ears, our eyes more so than with technology–X-Rays, CT scans– because you don’t end up doing those kind of really costly labs as often here. So we definitely have that as an advantage… We learn how to interview our patients thoroughly, and how to do a really thorough physical exam and do it well, and be comfortable with that… Doctors here not only do house visits but they go into homes: they have a form that you fill out to check off what risk factors the person has [in their home]. Is their water contained properly? Do they smoke? We get that kind of first hand view. In the United States, you can ask someone if they smoke or if they have a pet and they easily can lie to you. But here, as someone’s primary physician, you can see not only the physical medical aspects but the psychological medical aspects as well. Do you feel tension the minute you walk into the room? Are people in a mentally healthy environment, or do we need to get [them] to a psychologist. There are so many advantages to the system that we can take back and apply to the communities where we live.

Kereese Gayle in conversation with Chris Lydon sipping lemonade at El Ajibe in Havana, December 19, 2008

Akua Brown minored in Spanish at San Francisco State University, and spent most of her first two years in Havana learning the Cuban vernacular and testing her Bay Area ideal of the Revolution.

Akua Brown

The education system here is excellent; there is very little homelessness. Everyone has a right to free health care… up to the most specialized needs. Neurosurgery, open heart surgery, cost nothing to the people. And the fact that a government with so little financial resources is able to do this says that the United States can do so much more… And without the debt that most medical students graduate with, we won’t be afraid to start our own projects and programs without necessarily needing the money to pay back the loans and the things hanging over our heads. Living here for six years, I think we have learned to live a simpler life with bare necessities. I ride the bus, I hitchhike, I buy from the community market. I’m not complaining–home is comfortable, but this is livable.

Akua Brown in conversation with Chris Lydon savoring the coffee at El Ajibe in Havana, December 19, 2008

The practical visions of these blessedly gifted women brought to mind Ralph Waldo Emerson‘s indomitable “world spirit.” Entering the second half-century of both the black freedom movement in the US and the Socialist revolution in Cuba, each with its ups and downs, these very American young women would remind you that grand ideals, the best we have, can prevail. “Things seem to tend downward, to justify despondency, to promote rogues, to defeat the just,” as Emerson wrote at the end of his essay on Montaigne; or the Skeptic. “Although knaves win in every political struggle, although society seems to be delivered over from the hands of one set of criminals into the hands of another set of criminals, as fast as the government is changed, and the march of civilization is a train of felonies,- yet, general ends are somehow answered. We see, now, events forced on which seem to retard or retrograde the civility of ages. But the world-spirit is a good swimmer, and storms and waves cannot drown him…”

January 16, 2014

The Rise of Modern Medicine

In the annals of Boston medicine two historic chapters in the last 50 years were the near conquest of sudden death by heart attack and (not unrelated) the rise of corporate, cathedral hospitals around the practice of heroic scientific medicine with a big arsenal of new drugs, surgical measures, bypasses, catheters and stents. Perhaps the core question is: where’s the better medicine that would make all of us all healthier, even without miracle surgery?
Eugene Braunwald: Heart to Heart

braunwaldIn the annals of Boston medicine two historic chapters in the last 50 years were the near conquest of sudden death by heart attack and (not unrelated) the rise of corporate, cathedral hospitals around the practice of heroic scientific medicine with a big arsenal of new drugs, surgical measures, bypasses, catheters and stents.

All this is the stuff of our guest Dr. Tom Lee’s biography of a giant cardiologist and an expanding industry in Boston. His book is Eugene Braunwald and the Rise of Modern Medicine, a complex and fascinating tale. Don Berwick – a doctor who’s running for governor — is covering the downsides all around this story: overtreatment for some, undertreatment for many, intrusions of finance and breakdowns in the humanity of doctoring, and of course gigantic expense.

We’re talking this hour about Boston’s bluest of blue-chip industries, medicine, in a prosperous maybe triumphant time that may also be the moment for rethinking and reform. Dr. Braunwald and Nobel Prize winner Bernard Lown make cameo appearances — drawn from longer podcast visits with each of them. Perhaps the core question is: where’s the better medicine that would make all of us all healthier, even without miracle surgery?

Podcast • April 30, 2012

Siddhartha Mukherjee: an innovator in the race?

Siddhartha Mukherjee brings authority and a certain kinship to our conversations on historian Tony Judt and his last words — Ill Fares the Land — on the malaise of our times and the abandoned remedy, ...

Siddhartha Mukherjee brings authority and a certain kinship to our conversations on historian Tony Judt and his last words — Ill Fares the Land — on the malaise of our times and the abandoned remedy, which Judt called “social democracy.”

Dr. Mukherjee wrote the enthralling “biography” of cancer, The Emperor of All Maladies, which won the Pulitzer for non-fiction last year. So he is a big-picture diagnostician who looks first to the history of a disease and its treatment to frame his understanding. I think of him first as Tony Judt’s alter-ego in the oncology lab.

But then it turns up in a footnote that Siddhartha Mukherjee knew Tony Judt well for most of 20 years. Indian-born, American trained and twenty years younger than Judt, he was a Judt favorite in a running series of seminars on the full spectrum of medical, social and cultural maladies. They became close friends. “Benign skepticism” in the face of received wisdom was their common working principle. One of their shared methods was a process of sifting through wrong ideas of the problem. They had some persistent differences, too.

You see, Tony is a great eliminator. He arrives at his theory by the process of eliminating nonsense. He finds, as you know, that the answer already exists. You need to reset the clock. The answer existed in our past,” which for Tony Judt embraced the free education and robust public services he grew up on in 1960’s and ’70’s London. Tony’s thought was we could find those mechanisms again. “I thought Tony was spot-on about the malaise in our society, about a collapse in the public conversation… I differ in the sense that I believe less in elimination, more in innovation. I think that the answer does not exist… and in fact the solution is to innovate our way into the answer. Unfortunately I believe that if the country is facing perhaps a moral crisis in the political realm, I think we’re facing an innovation crisis in the scientific realm. And by that I mean that we don’t even know how to train minds — or we’re beginning to forget how to train minds to solve our way out of the problem. That’s what worries me.

So my question is: How would Siddhartha Mukherjee apply his “innovative, oppositionist, disruptive” repairs to the confusion and fear that shadow the public stage in 2012?

We have to innovate our way out of that, too. A good example of this is what I think of as a kind of ‘psychic innovation.’ Take, for instance, the immigration crisis. I think that is a reminder of the need for psychic innovation of that crisis. This is — historically — a nation founded on immigration. The fact that in 2012 that founding force is a crisis in Arizona, say, is a peculiar twist of human history. There must be an innovative way, an entrepreneurial way, to think about immigration and restore the kind of spirit that made it such a positive force in the 18th and 19th Centuries… There must be a political solution that allows this force of young minds desperately trying to get into this country and to convert that torpor that you and I are talking about. It’s an innovation problem. I came here as an outsider, and I continue to be amazed at the quality of social innovation. This country made society plastic. You know, elastic. Why is it that we’re now having a debate about whether we’re suffering from some kind of torpor, when in history you took society and molded it in a different image?

He leaves me with a different puzzle: what would a real innovator sound like in presidential politics? “Everything else is largely irrelevant,” Mukherjee declares. “There are many problems and the solution is to have an incredible engine of innovation. How do we silence all the distractions, and put all our energy into social innovation around health care, around debt, around the economy, so that the conversations become real?”

Photo by Rene + Radka.

Podcast • November 13, 2008

Our Better Angel: Chris Adrian

Click to listen to Chris’s conversation with Chris Adrian. (44 minutes, 20 mb mp3) Chris Adrian: Pain’s Artist, Doctor, Minister The writer Chris Adrian is a medical doctor, a pediatric oncologist, who seems to have ...

Click to listen to Chris’s conversation with Chris Adrian. (44 minutes, 20 mb mp3)

Chris Adrian: Pain’s Artist, Doctor, Minister

The writer Chris Adrian is a medical doctor, a pediatric oncologist, who seems to have known from the beginning that our bodies are not the problem. I think of Beatrice, an attempted suicide, “the jumping lady,” in “The Sum of Our Parts,” one of ten stories in Adrian’s shimmering, glow-in-the-dark collection A Better Angel. Beatrice is comatose, being readied for a liver transplant. But “that part of her which was not her broken body” doesn’t want to live. Her spirit lifts off, finally, “in search of a place without loneliness and desire; without misery and rage, without disappointment; without crushing and impenetrable sadness.”

In Chris Adrian‘s world, the people who jumped out of the twin towers on 9.11 are still falling, some in the strangest of places. In “The Vision of Peter Damien,” for example, they are raining down on a medieval Ohio farm town which may also stand for Iraq. It’s a world where, as he says, “dead people don’t go away.” Out of his own experience and his own obsessions, Chris Adrian’s stories embrace the natural and the supernatural, articulate souls as well as hurting minds and bodies. It was his writing teacher at Iowa, Marilynne Robinson, who turned him toward theology, toward the unexpected pleasure of reading John Calvin, and then to Divinity School at Harvard.

Our long conversation here fortifies the hope that bad times make good books, and that Chris Adrian is as good as they get at making metaphors of this very strange moment. In one of his most widely read stories, “The Changeling,” which ran in Esquire with the title “Promise Breaker”, a single father hacks off his own hand with an ax to address the psychosis of his son Carl, who has taken on himself the pain of the 9.11 dead. “Is it enough?” the father asks. “And I think I mean is it enough to prove to them I love my son, or that I deserve to have him back, that I mean it when I say I promise to take better care of him, that I promise to be a better father, to unroot whatever fault in me threw him into the company of these angry souls who died to make us all citizens of the world…” In Chris Adrian’s cosmos of irremediable pain, father and son can both be seen meeting agony with love. “I am still a fan of happy endings,” as Chris Adrian said to me in conversation. “It was meant to be a happy ending.”

CA: I tend to write about whatever is troubling me most deeply at the moment. That used to mean writing about death, my brother’s death specifically. He died when I was 22, he was 25. A lot of what is in the first two novels has to do with that. But as I got older and became more removed from his death, in time at least, my capacity to be troubled by things that were not quite so personal opened up. And as I started to notice what a sorry state the world was in, and particularly America was in, it started to intrude into fiction in areas that used to be more personal or more private.

 

CL: It seems so brave to introduce not just angels, which are almost cliché, but a spirit reality that’s in endless conversation with us, with individuals but even with countries.  Where does that conviction come from?

CA: I guess it’s a notion that I have demonstrated to myself in my own obsessions and the way that I have engaged in troubling things over the years, that has proven to me that dead people don’t go away after they’re dead. I think that is true for individuals that lose them, and for communities, and for countries and for the world at large. That is something I explored in a relatively ham-handed though satisfying personally way in that the first novel I ever got published [Gob’s Grief] which  was about the civil war but more particularly about a man who loses his brother in the civil war and spends the next ten years trying to build a machine that will bring his brother back to life but also bring back all of the other soldiers who died in the civil war with the idea that the whole world would be transformed if death were abolished.  

 

CL: The godfather of doctor-writers, [Anton] Chekhov, once said, “Medicine is my lawful wife and literature my mistress; when I get tired of one, I spend the night with the other.” Throw in pastoral ministering in your life… how do these things relate to each other?

 

CA: They all, especially the medicine and the writing, because I have been at that longer than the divinity stuff, certainly seem to inform each other. I don’t think that I could do one without the other; I would be a worse writer and a worse physician if I weren’t a writer and a physician both. The things I am privileged to see in my work as a physician drive my work even when it is not about a hospital… I don’t want to say I imagine my patients’ lives, but I think that the habit of trying to imagine the world from someone else’s perspective even if that person is just an imaginary construct you’re using in the course of your work as an artist, makes it easier to make room for how big people are in real life.  It helps you to remember to keep in mind that there is a lot more to the world or the person sitting across from you than what is in that little room.

Chris Adrian in conversation with Chris Lydon, November 11, 2008.

 

 

 

Podcast • October 8, 2008

Bernard Lown’s Prescription for Survival

Bernard Lown: Rx for sudden nuclear death The world-renowned cardiologist Bernard Lown won the Nobel Prize for Peace, (outside his field, so to speak) for putting doctors (starting with the Russian Eugene Chazov, above, who ...

The world-renowned cardiologist Bernard Lown won the Nobel Prize for Peace, (outside his field, so to speak) for putting doctors (starting with the Russian Eugene Chazov, above, who was Leonid Brezhnev’s heart doctor in the 1980s) into the fight against nuclear weapons in a global force called International Physicians for the Prevention of Nuclear War (IPPNW). His professional obsession had been sudden death, one by one, by coronary events. As Dr. Lown says, how could he not try to make a healing connection with the real danger of sudden death, in the hundreds and thousands, maybe millions, by nuclear events? The Nobel recognized in Bernard Lown the doctor-as-citizen to the nth degree, the world citizen, a saint of public health.

Many heart doctors (also Bernie’s mother) have said he should have won another Nobel Prize, for Medicine, for developing the defibrillator — the now implantable (and universal) electrical restart button for the heart. That’s the story of Bernard Lown the researcher and innovator, the doctor-as-scientist to the nth degree, an experimenter and inventor in the family of Thomas Edison.

And then there is Bernard Lown the doctor-as-doctor, the patient’s friend, the hands-on healer to the nth degree. If you haven’t had a touch of Bernie’s doctoring, you’re missing something. The finest interviewer in America is not on radio or television – sorry, Terry Gross; sorry, Ted Koppel. The best interviewer in America is Bernie Lown. He examines you inch by inch. And then he sits there with you in what feels like a sealed room. No interruptions, no distractions of any kind. “Half like a general, half like a bishop,” as Henry James writes about a doctor in The Wings of the Dove. Like Henry James’ doctor, Bernie sets on the desk between the two of you “a great empty cup of attention.” Bernie listens and watches.

“You have a unilateral stare,” he said to me a few years ago.

“Meaning what?” I asked.

“Meaning you lead with your right eye. Your right eye does more of the looking than the left.”

“And what does that tell you,” I wanted to know.

“Not easy to say,” he said. “It could be a sign of aggressiveness.”

A year later, I asked him: “Okay, Bernie, where’s the unilateral stare now – which eye?”

“It’s your right eye,” he said.

“How could you be sure?” I asked.

“I looked,” he said.

“Does that cost extra?” I checked.

“No,” he said, “it’s part of my exam.”

Bernie has written in The Lost Art of Healing that the taking of a patient’s history is the most important diagnostic device ever invented; and that touching – the laying on of a doctor’s hands – is the most effective tool in medicine. He is a doctor on the William Carlos Williams model, who is willing and able to become us, to become the patient, for half an hour, or an hour at a stretch. You leave his office, as Henry James’ Milly Theale did in The Wings of the Dove, feeling that you’ve confessed and been absolved.

Best of all: months later I realized that under Bernard Lown’s care, my tachycardia was gone.

Our conversation here is about 87-year-old Benard Lown’s new memoir, Prescription for Survival, about the nuclear obsession that led to his Nobel. I urged him to begin with the revelatory freak happenstance, at a press conference on the eve of the Nobel ceremony, when a Russian journalist had a heart attack and both Lown and his opposite number, Evgeny Chazov, heart doctor to Brezhnev and the Politburo, jumped to the rescue. Lown’s impromptu speech in that moment is a capsule of his life:

We have just witnessed what doctoring is about. When faced with a dire emergency of sudden cardiac arrest, doctors do not inquire whether the patient was a good person or a criminal. We do not delay treatment to learn the politics or character of the victim. We respond not as ideologues, nor as Russians nor Americans, but as doctors. The only thing that matters is saving a human life. We work with colleagues, whater their political persuasion, whether capitalist or Communist. This very culture permeates IPPNW. The world is threatened with sudden nuclear death. We work with doctors whatever their political convictions to save our endangered home. You have just witnessed IPPNW in action.

The patient and the planet survived a while.

June 16, 2006

The Good Death

The Doctor has to be comfortable with accepting that death is not their own failure, but that death is a natural event, and that medical care can help people die with dignity and comfort. Christine ...

The Doctor has to be comfortable with accepting that death is not their own failure, but that death is a natural event, and that medical care can help people die with dignity and comfort.

Christine Cassel
What should the leading cause of death be? We’re all going to die. Someday. (Barring some incredible advances in medicine that confer virtual immortality on everyone.) How should that happen?

We frequently hear about how such-and-such — heart disease, cancer, obesity, accidents, AIDS — is the leading cause of death among a subgroup of the population, or the population as a whole. And that inspires us to donate money to searching for a cure for whatever that thing is, and it inspires us to change our behavior to reduce our risk for whatever that cause is.

And those are good things. Deaths from most of these things still come too early. And I doubt anyone really wants to die from painful cancers or AIDS or Alzheimer’s.

But if we’re all going to die, all things being equal, what should the leading cause of death be? Heart disease in old age? Cancer? Suicide, especially of the death-with-dignity variety? In short, what’s the ultimate goal of modern medicine, short of immortality?

Scarequotes, from Suggest a Show June, 2006

There are only two certainties in life: taxes, and we all know the other one. Advances in medical sciences are staving off the inevitable but once it comes the toll on the individual and on society can be huge. In this program we’ll discuss how to die. Does the most comfortable and painless death coincide with what is least costly to society? What toll will the ageing boomer population take on the US? How do you think about your own death? In this hour we’ll address the ethical, economic and philisophical components of what it means to die.

Arthur Caplan

Director of University of Pennsylvania’s Center for Bioethics

Christine K. Cassel, MD

President and CEO of the American Board of Internal Medicine. Leading expert in geriatric medicine and end of life care.

Charlie Wheelan

Author, The Naked Economist, and he teaches public policy at The Harris School at the University of Chicago

 

Curt Tucker

Curt Tucker is a therapist, blogger and gallery owner. You heard his story at the end of this show.
Extra Credit Reading
Marilyn J. Field and Christine K. Cassel, ed., Approaching Death: Improving Care at the End of Life, The National Academies Press, 1997.

Hospice Guy, The Wharton School Weighs in on Hospice Care, Hospice Blog, June 6, 2006.

Christine K. Cassel and Katherine M. Foley, Principles for Care of Patients at the End of Life, December 1999.

Joao Pedro de Magalhaes, Should We Cure Aging? A Rebuttal of Myths About Immortality, Senescence, 2004.

Joao Pedro de Magalhaes, The Grandparents of Tomorrow: Winning the War Against Aging, Senescence, 2004.

Nurse Mia, Death Maiden.

Muriel R. Glick, The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies, Harvard University Press, March 2006.