Thursday, November 26, 2009

Formula Thinking

It happens all the time. But more so in health care than any other place, and we know that doctors are the cream-of-the-crop, the intelligentsia of our days. That doesn't mean that it happens only in a doctor's office. Politicians do it, neighbors do it, even your best friends do it. They are in lock-step with formulaic thinking.

At the doctor's office it goes like this. "Doctor, I have itchy toes, my skin is very dry, and, look here--pointing to the inside of the mouth--my throat is sore. I don't have a fever. I am unable to sleep at night." The doctor then says: "I don't know what your problem is. Your symptoms are very vague." "But doctor, I am not vague. I am telling you, those are my symptoms. I can write those symptoms down for you." The doctor gives up and writes out a prescription for a cortisone cream to be applied three times a day until the tube is empty. Also there is the invariable blood test that is supposed to instill confidence that the doctor knows what he is doing. The whole encounter takes no more than ten minutes. Meanwhile the patient is fully clothed. The doctor does not do as much as look at any part of the body. He trusts the patient to give him all the buzz-words, as if the patient has already figured out what ails him. The doctor expects a set sequence of words that can be fed straight into the doctor's robotic mind, which then spits out the robotic answer. The doctor does not ask questions because that might hold up the doctor's need to see the next patient in the allotted time-frame. The next patient might have a more important ailment or possibly be more interesting.

I've got news. Patients do not know what their problems are most of the time. Patients also don't have the standard terminology that rings a bell up there in the belfry to make the answer simple. A patient goes to the doctor for his extra special brain, and because he has an extra-special ability to analyse his or her own personal bodily complaints.

Formulaic thinking happens in other areas as well. Not long ago I attended a meeting that dealt with the health of Mexican American immigrants. The question was posed why immigrants who arrive in this country are relatively free of medical complaints when they arrive but experience a downturn in their health after about five years. Statistics for this fact exist. In this meeting, the prevailing thought and most of the answers to this phenomenon related to the lack of access to good health care, a general consensus that that population group is more stressed and simply less able to cope with the discrimination, the vagaries of living in a new country and other societal pressures.

It is very likely that all those features are very important. This mind-set that allows some human rights groups to only look at the problems from that one human rights angle, a formulaic angle, does not leave room for other reasons to take a place in thinking about a remedy for the seemingly inevitable course of events: family arrives, everyone is well; family is here in the Bay Area for five years and health deteriorates. This happens even with families who have no financial woes.

It is curious, but the answer for this problem might not be found by examining societal stresses. It might simply be found by looking at an environmental factor. Mexican Americans come from Mexico. Mexico is closer to the equator. Mexicans experience more sun that shines the right amount of Vitamin D producing UV-B rays on them year-round. The move for Mexicans to the Bay Area, where UV-B hits the whole population for only about five months of the year, causes Vitamin D deficiency because most Mexicans living in Mexico would not have had to take Vitamin D pills. They would not know to add them to their grocery list as a necessity.

Black persons may be in the same boat as far as Vitamin D goes. In that population group, there is no obvious reason for why they wind up in jail much more often than the white-skinned population. No doubt, discrimination plays a huge role. But no obvious statistics give a clue that there might be an environmental factor. Most blacks haven't arrived here from a lower degree of latitude within the last five years (although in Minnesota the Somali immigrant population can be statistically assessed and should be). So the question is not even asked why they are suffering more from disabilities. This question should be asked much more forcefully.

I remember that during the O.J. Simpson trial, it was pointed out that O.J. had rickets when he was a child. Did anyone ever mention a connection between Vitamin D deficiency and altered behavior? I don' think so. This connection has not been explored. But it should be. The discoveries about what Vitamin D deficiency does to the human body are very young because an inexpensive Vitamin D test has not been available for more than 10 years.

It is now known that sufficient Vitamin D might prevent depression. I can attest to the fact that large doses of Vitamin D can help a person tremendously in all kinds of ways including depression and mood swings.

Formula thinking is rampant. It is rampant in the media, among politicians and your friends and neighbors. They might even look at you with distant eyes, might turn away and roll them so you might not be offended. There are reasons for certain conditions that are not garnered from the mathematics of an obvious formula.

Monday, November 09, 2009

The first frost

This morning I found the first frost on the roof. My car window had to be defrosted and I am pretty certain that the loquats will not bear fruit next year. I am not surprised.

Nothing surprises me anymore. The predictable nature of things to come almost leaves me with a sense of inevitability. My wild garden helps. I have control over the plants. I water them and they do as well as their nature allows. Watering gives me a sense of power. I could, if I wanted to, let them wilt and wither to wood and straw. I just can't let that happen. I am human. I don't want to leave things untended. That's my nature. Does nature thank me for that? Who knows?