AHC: Eddie Van Halen does vascular surgery before music; different Flexner Report in 1910.

. . . From the time I started medical school until when I went out on my own (USA) was 10 years! (4 school/5 residency/1 subspecialty fellowship). . .
Thank you for your work in helping fellow human beings. I wish to say that at the outset.

Now, in keeping with an alt history website, I am going to push the point.

One medical school autobiography I read was Becoming a Doctor, by Melvin Konner (1987). Now, he was a guy in his mid 30s who had been an anthropology professor before going to medical school, so yes, he has some unique viewpoints. And the book focuses on the beginning of clinical rotations in his third year.

One of the slogans of the school was "see one, do one, teach one." There was a joke that the real slogan was, "see one, screw one, do one." Which got me thinking that the training was broad but shallow.

The students had trouble doing things like a spinal tap and giving "big red" (an anti-cancer drug). In a way, it was inexcusable. Now, I think the person did successfully do the spinal tap, but it wasn't a guarantee. It wasn't something they had practiced ten times like an athlete might. There seemed to be a blithe assumption that "smart" people are going to be physically dexterous, which is not always going to be the case.
 
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The whole approach of the Flexner Report seemed to be higher entrance requirements, more training, but we're going to fully preserve the prerogatives of being a doctor.

And most of the "reforms" since then have been in the same direction.
 
To me it is just amazing that people who would never consider getting in an airliner flown by a self taught pilot with very few flight hours will happily opine that most of medical training is a waste of time. Happy landings...

O by the way the perks of being a doctor include taking lots of emergency callif you are a surgeon of most sorts, and the privilege of operating on folks with bad contagious blood borne disease but being legally prevented from getting tests for the same so you can take precautions if there is contamination. I recall one particular incident, out of many, where I was awakened in the middle of the night to go perform surgery on an escaped prisoner who injured themselves breaking in to a gas station. I drove there through a snowstorm, spent several hours dealing with complicated surgery and was paid zero for the whole episode....
 
. . . I recall one particular incident, out of many, where I was awakened in the middle of the night to go perform surgery on an escaped prisoner who injured themselves breaking in to a gas station. I drove there through a snowstorm, spent several hours dealing with complicated surgery and was paid zero for the whole episode....
You sound like a stand up individual, and of course I wish you had been paid. You sound like the type of person I'd be very happy to have as a neighbor, as a friend, as a co-worker, or simply as a fellow citizen. And I strongly suspect you'd inspire me to raise my own level. All the same, you have a job a lot people are interested in, somewhat similar to a college basketball coach. And just like a coach is going to have amateurs giving their opinions on talk radio, people are going to ask why doctors don't do it this way or do it this other way.

And self taught? No, I have in mind formal training where a vascular surgery candidate practices the same operation three times on soft plastic somewhat similar in feel to human veins. And perhaps even watches tape like an athlete watches tape. And then maybe just takes hold of the heart and does the very beginning step. It seems to me the current system is more self-taught, like Konner's book, maybe watch this operation and then maybe watch this other operation all in, yes, a very higgledy-piggledy manner. And whether the medical student happens to pull it all together is up to them, and not just their dedication, but also their specific skills, including skills of knowing what not to spend too much time on.

A book which gives a somewhat rosier view of medical training is Perri Klass's A Not Entirely Benign Procedure (1987), although there's still a lot of room for improvement.

What I have in mind is perhaps similar to how they used to fly big planes in which you have a pilot, co-pilot, and flight engineer. In this case, the main surgical team is the doctor, the surgeon, and the anesthesiologist, with the surgeon distinct from the doctor, and the doctor in role of pilot to make final decisions if things turn out radically different than expected. We might also loosely draw from the British legal system where there are levels of lawyers with solicitors and barristers.

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Per Gardner's 7 types of intelligence, why would recruit surgeons other than focusing on spatial intelligence and bodily-kinesthetic intelligence ? ? ? Instead, we focus on the school skills of writing five paragraph essays and reciting back science facts, and from this shrunken candidate pool, people self-select who are interested in surgery and I guess it works out kind of okay. But I can envision different systems.
 
well said elektro, well said. Surgeons have a saying..."there is no condition that cannot be made worse with the wrong operation". My professor of surgery in medical school said "you can teach a monkey to take out an appendix, but if you find a perforated cecal carcinoma instead, then what?" By the way, at least in the USA surgeons are doctors. Having a "doctor" in their looking over the surgeon's shoulder to "manage" if things go wrong, unless that doctor is another surgeon of the same sort, is equivalent to having a race car driver looking over a pilot's shoulder to take charge if something goes wrong - well qualified, but wrong qualifications.
 
Because knowing when to operate is as or more important than how to operate.
You've got me there. :) I'm still going to come back and say that in many cases, it's more feel and texture than a 'logical' power point type of intelligence. And I think it's the ability to wait and see how something develops, perhaps much like a seasoned baseball manager.
 
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. . . My professor of surgery in medical school said "you can teach a monkey to take out an appendix, but if you find a perforated cecal carcinoma instead, then what?" . . .
I say, all the more reason to have someone who has been trained both formally and informally to use and improve their spatial intelligence.

School almost exclusively focuses on the two types of intelligence, "logical-mathematical" and "linguistical," and that is basically it.
 
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Sept. 3, 2009

http://www.nytimes.com/2009/09/04/health/research/04flu-001.html?_r=2

" . . . In children without chronic health problems, it is a warning sign if they seem to recover from the flu but then relapse with a high fever, Dr. [Thomas] Frieden said. The relapse may be bacterial pneumonia, . . . "
And my challenge still stands. Give me one additional fact about influenza more important than this?

I'm mainly thinking of first world countries, but heck, let's roll third world countries into this, too.
 
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Transcript of virual press conference with Gregory Hartl, Spokesperson for H1N1, and Dr Nikki Shindo, Medical Officer, Global Influenza Programme, World Health Organization

12 November 2009

http://www.who.int/csr/disease/swineflu/vpc_transcript_12_november_09_nikki_shindo.pdf

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In a country where the virus is circulating, we have 3 updated recommendations.

1. Firstly, people in at-risk groups need to be treated with antivirals as soon as possible when they have flu symptoms. This includes pregnant women, children under 2 years old, and people with “underlying conditions” such as respiratory problems.

2. Secondly, people who are not from the at-risk group but who have persistent or rapidly worsening symptoms should also be treated with antivirals. These symptoms include difficulty breathing and a high fever that lasts beyond 3 days.

3. Thirdly, people who have already developed pneumonia should be given both antivirals and antibiotics, as we have seen that, in many severe cases of H1N1-caused illness, bacterial infection develops. These medicines, antivirals and antibiotics, if used in a timely manner, can help save lives.
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Yes, these antivirals such as Tamiflu are pretty good medicine. Most helpful if started within 48 hours of symptoms. And of course, probably a good idea to finish the medicine.

And yes, I am aware that the WHO was accused of overhyping 2009 H1N1.
 
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My point being,

that just like compression-only CPR and AEDs,

just like the Heimlich maneuver,

we should endeavor to give away big chunks of medical knowledge. And a situation where someone has a bunch of training and thinks they're smarter than other people (particularly and especially if that's kind of true!) actually gets in the way of communication. It's far better to assume the other person is actually slightly smarter than you are. They just don't happen to know this particular information.
 
This seems very much like a thread with an agenda.
But I haven't even gotten to the bad stuff yet ! ? ! ;)

Like the scene in the movie The Martian where they're talking about how to seriously pare down the weight of the rocket and the one guy says, he hasn't even gotten to the bad stuff yet. And the other guy says, Well, by all means, get to the bad stuff.

Alright, I like the idea of countries ramping up tradition healers, rather than imposing a small number of doctors like kludgeware onto the system. And maybe you could start with diseases and conditions responsible for the largest amount of loss of life among children and branch out from there.

And this would merely be one part of a legitimate third economic system. You'd have a mix of formal and informal economy, and such a system would be largely distinct from both socialism and capitalism.

However, what I have in mind for this thread is how medical training and practice could have developed radically different but arguably just as good if not better in the United States post-1910.
 
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eddie-van-halen-during-musicfest-96-press-conference-at-hollywood-in-picture-id104838212

And returning to Eddie.

He starts building the normal complex resume in surgery in 1974 at age nineteen, with very specific credentials in very specific areas, 1st, 2nd, and 3rd levels.

He works as a practicing surgeon for about three years till mid-to-late 1977. Van Halen really started making it big the beginning of 1978.

Occasionally a radio and TV interviewer will refer to him as a former doctor. Eddie is always quick to correct this. "No, no, no, I was years away from being a doctor. I was a surgeon. I'd like to think I was a solid, first-rate surgeon, but that's I suppose that's for other people to judge. But my resume was a long way from being a doctor, which typically happens when a person's in their thirties or even forties."

Occasionally, Eddie will use an interview as a time to bring up a health related topic, for example the whole business of "good" cholesterol vs. "bad" cholesterol, in the (?) '80s was it? So Eddie might typically say, "Again I'm not a doctor, but these are the questions I might be asking."
 


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Eddie would have been too late for the anti-Nestle activism in the 1970s (some of these pictures are definitely later). But these issues continued into the '80s and more.

PS Of course it's unfair to lay on Eddie that he should save the f#@&ing world! This is a flight of fantasy.
 
A seasoned, older activism convinces Eddie that the whole key is to avoid Swiss citizens defending Nestle as unfairly under attack. Rather, the key is to get Swiss citizens pissed off that Nestle is embarrassing the country.
 
Baby health crisis in Indonesia as formula companies push products

The Guardian, Zoe Williams in Jakarta, 15 February 2013.

https://www.theguardian.com/world/2013/feb/15/babies-health-formula-indonesia-breastfeeding

' . . . Sari Husada, a subsidiary of Danone, has sales reps that build relationships with midwives. Up until 2011, it was purely financial . . . '

' . . . Paperwork seen by the Guardian detailing these contracts specifies the change from cash to gifts. Sometimes they'll get a gift, apparently for personal use, like a television or a laptop, but very often, it's something they need for their practice, such as an oxygen canister, a TENS machine or a nebulizer. . . '

' . . . The Guardian has seen a spreadsheet detailing the number of new mothers contacted, the amount of 0-6 months formula sold, and the proportion of their target this represents. Danone commented: "That may still be happening, that's something we need to address." . . . '

' . . . Sari Husada has legitimate links all the way up the chain. Doctors running seminars for midwives are in its pay. It sponsors professional bodies, conferences and midwifery awards (which are then bestowed by the minister for women's empowerment and the protection of children). . . '
So, don't just criticize the underpaid midwives. This corporate influence goes all the way up the chain.

By the way, the Danone Group is Dannon yogurt, at least here in the United States.
 
https://www.theguardian.com/world/2013/feb/15/babies-health-formula-indonesia-breastfeeding

' . . . A paediatrician in a separate Jakartan clinic, Dr Asti Praborini, said: "Selling formula is like the killing fields, in my opinion. The babies will die of diarrhoea and they will die of malnutrition [emphasis added]." . . . '
I immediately understood diarrhea. These families from poorer areas don't have dependable access to clean water. And diarrhea, what's merely an embarrassment to us in the rich West is literally life and death, esp. to infants and toddlers.

But malnutrition? That one took me a little time to wrap my mind around. And it most emphatically is not just the diarrhea itself. This one you might be a little quicker on the uptake than me.
 
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