www.medhumanities.org

[Diane]

Ian has produced a very nice blog link, Medical Humanities.org (http://www.medhumanities.org/2007/02/index.html) , by Daniel Goldberg (http://www.medhumanities.org/2006/09/welcome_to_a_ne.html) , with entries dating back to Sept. '06.
Truncated excerpt:
Welcome to a Medical Humanities Weblog..

My name is Daniel Goldberg, and I am currently a second-year student in the Ph.D program in medical humanities at University of Texas Medical Branch's Institute for Medical Humanities. I am also an attorney, and after clerking for a judge and practicing for several years, I am currently a Research Professor with the Health Law and Policy Institute at the University of Houston Law Center.

What This Blog Will Not Be:

I am happy to report that I undertake this blog project with the blessing of the faculty at both institutions, but I want to be clear that this MH blog will most certainly not be a record of my own personal experiences and perspectives on my training or academic pursuits. Rather, I envision this weblog being an academic clearinghouse, and hopefully, a network of people and institutions interested in the medical humanities...

What this Blog Will Be (Initially):

T.S. Eliot once remarked that immature poets imitate and mature poets steal. In that spirit, I am quite unashamed of my intention to "steal" the blogging methodology of Professor Larry Solum's excellent Legal Theory blog. Specifically, the bulk of the early posts (from me, at least) will fall into one of three categories:

(1) Literature Review

(2) Medical Humanities Lexicon

(3) Notification of Happenings in the Medical Humanities


Vision for the Future

It is my sincere hope that, in time, this blog will become a product of a network of collaborators rather than a project of mine. I see my role mostly as a facilitator, one who gets this project off of the ground. I want to heartily encourage interested scholars, students, or lay persons to inquire about the possibility of guest blogging, as the quality and utility of this blog depends much more on the discussion and commentary it facilitates in the medical humanities community than on anything I personally bring. (Note: to discourage spammers and robots, comments will be moderated).

Eventually, if there is sufficient interest, this weblog could even host a blog conference or a blog workshop (both of which are becoming increasingly common in the academic blogosphere) on a medical humanities topic, thereby bringing together parties interested in the medical humanities who might not otherwise have occasion to exchange ideas with ease and efficiency.

So, to wrap up this inaugural post, let me be the first to offer a Texas-sized greeting and welcome, and to thank the medical humanities community in advance.

Posted by Daniel Goldberg on September 01, 2006 at 01:12 PM in Metablogging

[ian s]

Diane there is a thread on the blog relating to chronic pain which is interestsing -advocating more physio and less pharmacology but this is tied up with the drugs and addiction i was led to believe?

http://www.bmj.com/cgi/content/full/324/7342/859
This is interesting to me at least as I am doing my next essay on illich --this has relevance due to overmedicalisation of pain and the iatrogenic issues of procedures (e.g your chiro neck thing!)
ian

[Diane]

I think you're referring to Puzzling AHA Statement on Chronic Pain (http://www.medhumanities.org/2007/02/puzzling_aha_st.html) Ian?

[ian s]

http://www.bmj.com/cgi/content/full/324/7342/0/i

along the same lines........

[ian s]

Diane --yes I was .......interesting thoughts ......


Jean Jackson, among others, has extensively documented that the problems of pain management are particularly serious among chronic pain patients, who consistently report the worst, most conflict-ridden relationships with physicians. The AHA recommendation is unlikely to ameliorate this problem.

Kelly, who suffers from chronic pain, sums it up well:

There are many ways to treat chronic pain problems, and how the treatment happens should depend on the individual scenario. While it would have been perfectly fine for the AHA to come out and say "look, there are some serious risks associated with both the Cox-2 and NSAIDs, and here they are, and this is how we'd recommend using them" - well, okay, that's one thing. But that's a far cry from recommending not how to use medication but to treat patients, and from declaring that no chronic pain patient should receive painkillers until after they've jumped through a long and potentially detrimental (without relief) series of hoops.

I cannot disagree with her. Consider that some chronic pain patients at risk for cardiac disease are unlikely to experience much relief from their pain without pharmacological interventions (of course, there are all sorts of pain which respond well or even better to nonpharmacological therapies). The AHA position means that such patients are consigned to suffer through their pain while the physician, who, based on the empirical evidence, is unlikely to manage their pain adequately under the best of circumstances, prescribes all sorts of interventions that do little to ameliorate the patient's pain, while all along there exists some (pharmacological) interventions that may actually be therapeutic. The patient will suffer through this pain until the physician exhausts the nonpharmacological interventions and finally prescribes pharmaceutical therapy.

This strikes me as ethically problematic. Thoughts?

[nari]

There seem to be two sorts of doctors around - those who medicate chronic pain people for weeks on end with little effect, and those who don't. The latter probably take the view that the risk of addiction is not worth taking; so the patient ends up on merrygorounds, with little effect, and increasing beliefs that no-one can help them.
It is an ethical dilemma. Every step which sends patients off to yet another facility or PT or gym class tends to confirm in the patients' minds that everyone is trying hard and getting nowhere. So they tend to 'specialise' their pain; it becomes the primary factor which separates them from normal people.

This loss of identity and self-efficacy is not really recognised amongst the primary care persons (doctors). If it is, it is not dealt with satisfactorily.

The problem does not lie with just medicos, of course. It gets to be self-perpetuating amongst all health professionals. Defining where it all starts is as difficult as defining pain states.

Nari

[MedHumanities]

Thanks for the kind words, as well as the links. I should mention that pain and pain management is the topic of my dissertation, so I'm extremely interested in the topic in general. I do not wish to threadjack or self-aggrandize too overtly, as my peers know I am all to prone to wax on pain in general for too long, but I'm happy to discuss any of the issues raised in the post or on pain in general.

Ian, I want to be clear that I did not mean to prioritize complementary and alternative medicine over pharmocologic therapy for chronic pain. Rather, I simply wanted to note that I am not ascribing any false hegemony to such therapy for all chronic pain patients, as there are some kinds of pain which seem to respond better to nonpharmacologic interventions. I just wanted to note that I was aware of that, even though I absolutely believe that opioid analgesics are the exclusive remedy for all sorts of pain problems and are often and ought to often be frontline therapy.

I'm not 100% sure what Ian means by "tied up with drugs and addiction," though there is no doubt such fears are a well-known barrier to adequate pain management. The story gets particularly interesting with the evidence that very few actual pain patients get addicted even with high doses of opiate analgesics. In short, if you're actually in pain, your risk of addiction is statistically insignificant, especially as an inpatient.

Illich on the overmedicalisation of pain is excellent, and I'm currently involved in some prepatory work for my dissertation that involves tracing the history of the reliance on objectification of illness and disease at the fin-de-siecle (the history of medicine is an important part of my work).

Finally, I absolutely agree with nari that "The problem does not lie with just medicos, of course. It gets to be self-perpetuating amongst all health professionals. Defining where it all starts is as difficult as defining pain states."

Actually, one of my theses is that part of the problem lies in our cultural attitudes and beliefs towards pain in general, and that, as a cultural discourse, participants in the discourse are subject to its influence in shaping practices. Often, in the U.S. at least (though there is evidence this is common in much of the "allopathized" world), patients don't even report their pain, and the reasons for this are linked to cultural beliefs and attitudes about the phenomenon of pain in general. Tracing these links, and showing how they inform postmodern pain management and pain policy is my central area of interest.

In any case, thanks for reading the MH Blog.

--Daniel

[ian s]

Daniel, will reply more thoroughly when i have more time . I am dong a Mediclal Humanities course myself and want to do my dissertation in some aspect of pain management or study aspects of Rita Charon and David Morris ideas --so I will pick your brains (if that's ok!)
I hope you too get something from this site.As (mostly) Physiotherapists we are interested in the body and representational anatomy --touch, movement etc not mindless physiclal regimes of loading . There is enormous value in the work of Damasio for instance (see his somatic marker ideas) which rarely if ever get considered in ongoing pain and distress .
I worked in pain management . Its a very tricky no-mans land . Drug dependancy, iatrogenic disability and 'acopia' are extremely common. David Morris summed up much of medical practice in this area .
Another recommendation for a good read is The Suburban Shaman see this review ..very well written .
http://enjoyment.independent.co.uk/books/reviews/article342771.ece

ian

[Jon Newman]

The "in focus" article was part of a presentation at last year's APS meeting during a presentation titled "What does it mean to have a right to pain relief?"

The other article is by one of the presenters (Mark Sullivan.)

[Diane]

Hi Daniel,
Welcome to our humble discussion forum, where we try to locate glimpses into sanity amidst manual therapy chaos. Ian is our resident medical humanities spokesman and the source of many wonderful glimpses into sanity.
You've probably already explored http://www.painonline.com by Kevin McHenry, but if not, you can check him out. Look forward to reading your POV on things.

[MedHumanities]

Again, thanks for the warm welcome and the thoughts.

Ian, I am familiar with Rita Charon and especially David Morris's work on pain. The latter's emphasis on a biocultural model of pain is particularly significant to my work. My only clinical exposure to pain management comes through some of my clinical ethics work, though I am already learning much in practice to supplement my theoretical work. I am eager to hear your experiences and perspectives.

This forum seems a great resource and I look forward to dialogue with y'all.

--dsg

[Jon Newman]

Check out this entry (http://www.medhumanities.org/2007/04/article_on_heal.html) on the MHB (not to be confused with The Google or The Internets)

Theory, unification? A ubiquitous issue.

[MedHumanities]

Agreed, Jon. As an interdisciplinary student, I'm fascinated by attempts to delineate fields of inquiry. Thanks for reading!

[ian s]

http://plato.stanford.edu/entries/pain/

interesting ideas re pain and philosophy.

I have just come back from a week on my Medical Humanities course . Lots of ideas to mull over as usual . However , studying some 'outside' issues is i feel relevant to understanding some of the issues in these threads . Off the top of my head ......look at the fragmentation and differentiation of the professions involved in doing roughly the same thing . How is it if a scientific model is being adopted we 'see' things so differently .....Philosophy and History offers a lot here ......We see things through the lens of prior conditioning and the language we construct shapes the way we see things . I was thinking of terms like subluxation and the mechnical notions in general as deep memes which shape our behaviour . Words and symbols shape the way we are --the symbolic representation becomes the 'truth' seldom is language seen as a construct? (there is an interesting paper on this regarding pain and construcionism ---pdf sent to bernard)
I had a very challenging lecture on power in the healing professions relatedf to Foucault which made me think of the industry of medicine and the opinions of Illich ,(who's projections re medicalisation are becoming more and more important I believe)

[bernard]

pdf sent to bernard
Here it is.

[ian s]

http://www.bmj.com/cgi/content/full/314/7077/0/i

i liked this paper .....

[ian s]

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1122935

good book review and something I agree entirely with .......I am sceptical of the reliance of science for providing answers to all of lifes problems (many of which end up in therapists clinics/depts) see the last quote in this review.
ian

[ian s]

http://www.soilandhealth.org/03sov/0303critic/030313illich/Illich.toc.htm

if you haven't heard of ivan illich this will give you something to go on --
a review of his landmark book here (it has a controversial chapter on pain which is excellent )
http://www.bmj.com/cgi/content/full/324/7342/923?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=medical+nemesis&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

[Jon Newman]

Another thought provoking entry (http://www.medhumanities.org/2007/05/question.html)

Comments (on his blog) are being solicited if you're so inclined. Feel free to post them here too.

In large part I find myself in agreement with Daniel. I'll give it some more thought and see if I can figure out how to post a comment (there.)

[MedHumanities]

Hey Jon,

Posting a comment should be easy! If you are disinclined to do so, just shoot me an email at "mhweblog" at Google's email service, and I'll post it for you. My friend Kevin obviously does not agree with me, but I really can't stand the triumphalist narrative. Its effect is partly why so many disabled persons speak of a process of "coming out," in which the individual ceases to stigmatize themselves for their impairment, but embraces their embodied self, impairments and well. Homer David Avila didn't overcome the cancer that robbed him of his leg (and then his life), IMO. He simply kept dancing.

But I'm eager to hear any and all perspectives, either on the blog or here.

[Jon Newman]

Hi Daniel,

I'm actually in the process of posting. You're blog is a bit easier to post at than some others.

To an extent you have already answered a question I'm asking but I'll post it anyway.

[Jon Newman]

Hi Daniel,

Is there a delay between posting a comment and it appearing on your blog? If not, I'll have to try again. It may be that the computer I'm on is overly protective. I had this problem with another blog.

[Jon Newman]

I've since learned from Daniel that the posts there have to be approved before appearing due to spamming. Thanks for the update and response to my post there.

[ian s]

http://www.bmj.com/cgi/content/full/335/7612/184

this is an excellent paper --not sure if this is the place for it ?

[Diane]

I found this little post on narrative (http://www.medhumanities.org/2007/11/narrative-matte.html) this morning, in Daniel's blog. I went though the links and read the entire piece called "Dad's Legacy", about dealing with aging parents (something I haven't quite had to deal with yet, as my remaining parent is almost 84 and in good health). It's simple, evocative, restores my faith that there are real people behind that doctor persona medical people are forced to squeeze themselves into. Thanks for this Daniel.

Also, just reading through the titles in that journal I caught a little glimpse of how gargantuan medical struggles are, how ours (PT) pale by comparison (even though they feel quite real to us).

[Jon Newman]

Daniel Goldberg is thinking about doing a podcast. If anyone here has ideas or preferences for podcast format leave a comment for him here. (http://www.medhumanities.org/2007/12/on-podcasting.html)