Search Results for: Medicine

Why One ‘Big Idea’ Won’t Save the World

In the late ’90s, an MIT economics professor named Michael Kremer wanted to find out if school kids in Kenya were better served by being given free textbooks or medicine that would eradicate stomach worms. Reports Michael Hobbes in The New Republic:

The deworming pills made the kids noticeably better off. Absence rates fell by 25 percent, the kids got taller, even their friends and families got healthier. By interrupting the chain of infection, the treatments had reduced worm infections in entire villages. Even more striking, when they tested the same kids nearly a decade later, they had more education and earned higher salaries. The female participants were less likely to be employed in domestic services.

And compared with Kremer’s first trial, deworming was a bargain. Textbooks cost $2 to $3 each. Deworming pills were as little as 49 cents. When Kremer calculated the kids’ bump in lifetime wages compared with the cost of treatment, it was a 60-to-1 ratio.

These findings led to the founding of an NGO called “Deworm the World” which went on to help 40 million children in 27 countries. But there has been little evidence that giving school children deworming pills in other countries have had similar effects. Hobbes writes:

In the 1980s and early ’90s, a series of meta-analyses found that textbooks were actually effective at improving school performance in places where the language issues weren’t as complex. In his own paper reporting the Kenya results, Kremer noted that, in Nicaragua and the Philippines, giving kids textbooks did improve their test scores.

But the point of all this is not to talk shit on Kremer—who has bettered the world more with his career than I ever have with mine—or to dismantle his deworming charity, or to advocate that we should all go back to giving out free textbooks. What I want to talk shit on is the paradigm of the Big Idea—that once we identify the correct one, we can simply unfurl it on the entire developing world like a picnic blanket.

There are villages where deworming will be the most meaningful education project possible. There are others where free textbooks will. In other places, it will be new school buildings, more teachers, lower fees, better transport, tutors, uniforms. There’s probably a village out there where a PlayPump would beat all these approaches combined. The point is, we don’t know what works, where, or why. The only way to find out is to test these models—not just before their initial success but afterward, and constantly.

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Related: Michael Hobbes talks about writing the story on his blog.

Photo: Susana Secretariat

For the Public Good: The Shameful History of Forced Sterilization in the U.S.

Belle Boggs | The New New South | August 2013 | 62 minutes (15,377 words)

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We’re proud to present, for the first time online, “For the Public Good,” Belle Boggs‘s story for The New New South about the shocking history of forced sterilizations that occurred in the United States, and the story of victims in North Carolina, with original video by Olympia Stone.

As Boggs explained to us last year: 

“Last summer I met Willis Lynch, a man who was sterilized by the state of North Carolina more than 65 years earlier, when he was only 14 years old and living in an institution for delinquent children. Willis was one of 7,600 victims of North Carolina’s eugenics program, and one of the more outspoken and persistent advocates for compensation.

“At the time I was struggling with my own inability to conceive, and the debate within my state—how much is the ability to have children worth?—was something I thought about a lot. It’s hard to quantify, the value of people who don’t exist. It gets even more complicated when you factor in public discomfort over a shameful past, and a present-day political climate that marginalizes the poor.”

Thanks to Boggs and The New New South for sharing this story with the Longreads Community, and thanks to Longreads Members for your helping us bring these stories to you. Join us.

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A Birth Story

Meaghan O’Connell | Longreads | Nov. 6, 2014 | 57 minutes (14,248 words)

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It was Monday, June 2nd, and I was wide awake at 6 a.m. Maybe to some of you this hour doesn’t sound remarkable, but for me it was. It was the first day in a lifetime of six in the mornings, and I made the three-hour leap all in one go.

By this point, it was 10 days past my due date, and I had a very specific and recurring fantasy of being moved around town in a hammock flown by a helicopter. I wanted to be airlifted between boroughs.

When I told my fiancé, Dustin, this wish, he was quiet for a second. He had learned to reply to me with caution, but I imagine in this case he just couldn’t help himself.

“Like a whale?” he asked.

I laughed, standing on the curb somewhere. Actually yes, come to think of it: Like a whale.

On the morning of June 2nd I had been waking up “still pregnant” for quite some time—41 weeks and two days to be exact; 289 days. My mom was in town already, at an Airbnb rental a block away. Dustin was done with work. I was chugging raspberry red leaf tea, bouncing on a purple exercise ball whenever I could, shoving evening primrose oil pills up my vagina, paying $40 a pop at community acupuncture sessions I didn’t believe in, and doing something called “The Labor Dance.” The Dance (preferred shorthand) involves rubbing your belly in a clockwise direction—vigorously—and then getting as close to twerking as one can at 41 weeks pregnant.

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The Therapy That’s Helping People Suffering From Food Allergies

— Is it possible to get over a peanut allergy? In Stanford Medicine Magazine, Melanie Thernstrom reports on how oral immunotherapy (OIT) is helping to fix food allergies. Thernstrom’s son Kieran was allergic to eggs and nuts before going through OIT, and now can eat the foods without his parents worrying:

“For everyone who has stayed in the study, the treatment has been 100 percent successful,” says Nadeau. “It turns out that everyone’s immune system is capable of adapting — and surprisingly, it is as true of adults as children.” She and her team now have an eight-year study of OIT — the longest record in the United States — in which they found that everyone who was compliant with the treatment and continued to eat the foods has kept their allergies from returning.

What happens if the patients stop eating the foods altogether? Nadeau recently published the results of a withdrawal study, where 20 formerly peanut-allergic patients who had completed two years of OIT and were able to eat a full serving (1 tablespoon of peanut butter or 20 peanuts) without any reaction stopped eating peanuts altogether. After three months, more than half (13 out of 20) had regained the allergy to peanuts, although their reactions were no longer as severe. By six months, almost everyone (17 of 20) had regained the allergy.

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Photo: Daniella Segura

‘I Began Refusing Sedation Out of a Work Ethic; I Continued Through Fascination’

Yesterday I saw my appendix. It was pink and tiny, quite hard to see, but how interesting to be introduced to it for the first time. In for a routine colonoscopy (my fourth, on account of a family history), I refused sedation as I always do, and I had the enormous thrill of witnessing parts of myself that I carry around with me every day, but never really know or acknowledge. I chatted with my doctor about many things, including the various justices of the Supreme Court, the details of my procedure, and, not least, the whole question of sedation and anesthesia. He told me that 99 percent of his patients have either sedation or, more often now, general anesthesia, since that is increasingly urged by the hospitals. (In Europe, he said, about 40 percent refuse sedation.) He listed the costs of this trend: financial costs that are by now notorious, lost workdays for both patient and whoever has to drive the patient (whereas a non-sedated patient needs no caretaker and can go right back to work), lost time for nurses and other hospital staff, and, of course, the risks of sedation and the even greater risks of general anesthesia.

And, I’d add, the loss of the wonder of self-discovery. You are only this one body, it’s all you are and ever will be; it won’t be there forever; and why not become familiar with it, when science gives the chance? I began refusing sedation out of a work ethic; I continued through fascination.

What are the countervailing benefits of unconsciousness? Naturally someone benefits from charging the notoriously high fees, and no doubt greed is part of the explanation for why U.S. hospitals increasingly push anesthesia. But what benefits might there be for the patient? There are no pain nerves in the colon, so any discomfort is due to pressure (unless one has done 300 sit-ups the previous day, and thus has inflamed abdominal muscles, a practice I have learned to avoid!) and, of course, to disgust and shame. On a scale of discomfort from 1 to 100, with childbirth way up there, colonoscopy ranks around a 5, much less uncomfortable than a facial peel, and it lasts only 30 minutes. So we must conclude that a great part of what motivates people to choose sedation, imposing great costs on society, on their loved ones, and on themselves, is disgust and shame. The way the nurses talked made it clear to me that patients are terrified that they might fart during the procedure—and of course it is the cleanest fart in town, since the colon has already been thoroughly cleansed.

Martha Nussbaum, in a short essay in the New Republic, on how we view our bodies.

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Photo: UCD School of Medicine, Flickr

The Honey Hunters

Michael Snyder | Lucky Peach | Summer 2014 | 20 minutes (4,960 words)

Lucky PeachOur latest Longreads Exclusive comes from Michael Snyder and Lucky Peach—a trip into the Sundarbans, where groups of honey hunters risk their lives in the forests to follow the ancient practice of collecting honey.
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The Prodigal Prince: Richard Roberts and the Decline of the Oral Roberts Dynasty

Photo by mulmatsherm

Kiera Feldman | This Land Press | September 2014 | 34 minutes (8,559 words)

This Land PressWe’re proud to present a new Longreads Exclusive from Kiera Feldman and This Land Press: How Richard Roberts went from heir to his father’s empire to ostracized from the kingdom. Feldman and This Land Press have both been featured on Longreads many times in the past, and her This Land story “Grace in Broken Arrow” was named the Best of Longreads in 2012.
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The Law Is Human and Flawed

What is lawful is not always identical to what is right. Sometimes it falls to a judge to align the two. Ward’s judgment runs to more than eighty closely typed pages. It is beautifully written, delicate and humane, philosophically astute, ethically sensitive, and scholarly, with a wide range of historical and legal references.

The best of judgments, as I was to discover, are similarly endowed. They form a neglected sub-genre of our literature, read in their entirety by almost no one except law studentsand fellow judges. And in the Family Division particularly, they present a hoard of personal drama and moral complexity. They are on fiction’s terrain, even though they are bound, unlike the fortunate novelist, to a world of real people and must deliver a verdict.

But as we all know, verdicts, indeed the whole system, can also be asininetough, even tragic, for its innocent victims, grimly fascinating for the novelist. For the obvious is true, the law is human and flawed. Just like newspapers or medicine or the internet, it embodies all that is brilliant and awful about humankind.

Ian McEwan, writing in The New Republic about the court cases that inspired his new novel.

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Photo: Law Society of Upper Canada, Flickr

A Family, a Fruit Stand, and Survival on $4.50 a Day

Illustration by Kjell Reigstad

Douglas Haynes | Orion | Summer 2014 | 22 minutes (5,391 words)

OrionThis Longreads Exclusive comes from the latest issue of Orion magazinesubscribe to the magazine or donate for more great stories like this.
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Morning

“It’s like this here every day,” Dayani Baldelomar Bustos tells me as her dark eyes scan the packed alley for an opening. People carrying baskets of produce on their heads press against our backs. Read more…

Awakening

Longreads Pick

The advent of anesthesia fundamentally altered modern medicine, and its technology is often seen as infallible. However tens of thousands of patients each year in the United States alone wake up at some point during surgery. In working to eradicate this phenomenon, doctors have been forced to confront how little we know about anesthesia’s effects on the brain. But their studies have also led to a question just as pertinent to philosophers: What does it mean to be conscious?

Source: The Atlantic
Published: Jan 3, 2013
Length: 31 minutes (7,995 words)