Physicians Aren’t ‘Burning Out.’ They’re Suffering from Moral Injury

Simon G. Talbot and Wendy Dean at The Boston Globe:

5th October 1917: Supporting troops of the 1st Australian Division walking on a duckboard track near Hooge, in the Ypres Sector. They form a silhouette against the sky as they pass towards the front line to relieve their comrades, whose attack the day before won Broodseinde Ridge and deepened the Australian advance. (Photo by Frank Hurley/Hulton Archive/Getty Images)

Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury.

Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the consequences.

Burnout is a constellation of symptoms that include exhaustion, cynicism, and decreased productivity. More than half of physicians report at least one of these. But the concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work.

more here.



On Rachel Cusk

Lorrie Moore at the NYRB:

Rachel Cusk

The concentrated, flinty nature of Cusk’s mind (a fellow admirer and I often refer to her, in pseudo-jazz-intimacy, simply as “Rachel,” though we have never met her and haven’t the flimsiest intention of trying to do  so) ensures that authorial intelligence is burned into the syntax of every line, despite the cloaked narrator in the foreground. Even if they technically belong to fictional others, the voices, with their stories of familial upheaval, traps, escapes to dubious safety, or dull drift, are chosen and arranged by Cusk as both reflections and arguments concerning life’s dissolutions and reconstructions. What runs through her trilogy is a coolly abstracted consciousness organizing all the stories—one that is alert to the mendacity and (as the trilogy suggests, if they are any good) the cruelty in stories (in a culture that glibly claims to value them). It is like reading the best kind of philosophy—steely, searching, brisk.

more here.

Aristotle’s Way – ancient wisdom as self-help

Sam Leith in The Guardian:

It’s hard to imagine, at this distance, how it must have been to be Aristotle in his own time: cutting-edge rather than foundational. We see him standing at the beginning of western philosophy and surveying something like virgin territory. Did it feel like that at the time? He didn’t know, obviously, that he was an Ancient – at the start of things, as we now see it, rather than, say, at their end. He was interdisciplinary before there were really disciplines to worry about. Look at him, romping across the territory of possible human knowledge like a big dog snapping at butterflies, or Theresa May running through a field of wheat. One moment he invents literary theory. At another he formulates the rules of human persuasion. Whoops: politics. Bang! Catharsis! Hello: musicology. Ethics! Psychology! And while we’re at it who wants to know how a cuttlefish works?

The range and subtlety of his thought are almost inexpressibly thrilling, and it’s a mark against Edith Hall’s mostly lucid trot through what Aristotle can do for us that, in modernising and domesticating him, and making him instrumental in a self-help format, some of that thrill is lost. Mind you, it may be that this wasn’t the book on Aristotle she wanted to write so much as the only one she could publish. The fuse was probably lit for the highbrow self-help boom by Alain de Botton’s How Proust Can Change Your Life in 1997. In the two decades since, the puckish irony of De Botton’s title has burned off like morning dew. “How X Can Change Your Life” is publishing boilerplate these days. That’s not to write off the whole genre. As De Botton and his compadre Roman Krznaric have argued, lots of ancient philosophy was self-help, and the Nicomachean Ethics – with its inquiry into how best to live – certainly answers that description. Though, as Hall makes clear, Aristotle is everywhere preoccupied with the question of how we live in relation to others, rather than offering life lessons as the spiritual equivalent of a selfie-ready workout in the gym.

More here.

The mice with human tumours: Growing pains for a popular cancer model

Cassandra Willyard in Nature:

Lindsey Abel takes an anaesthetized mouse from a plastic container and lays it on the lab bench. With a syringe, she injects a slurry of pink cancer cells under the skin of the animal’s right flank. These cells once belonged to a person with tongue cancer, a former smoker whose disease recurred despite radiation and surgery. The mouse is the second rodent to harbour them, creating a model for cancer known as a patient-derived xenograft (PDX). The tumour that grows inside will provide cells that can be transferred to more mice. Abel has performed this procedure hundreds of time since she joined Randall Kimple’s lab at the University of Wisconsin–Madison. Kimple, a radiation oncologist, uses PDX mice to carry out experiments on human tumours that would be impractical in people, such as testing new drugs and identifying factors that predict a good response to treatment. His lab has created more than 50 PDX mice since 2011. Kimple’s lab is not the only one doing this; PDX mice have exploded in popularity over the past decade and are beginning to supplant other techniques for modelling cancer in research and drug development, such as mice implanted with cancer cell lines. Because the models use fresh human tumour fragments rather than cells grown in a Petri dish, researchers have long hoped that PDXs would model tumour behaviour more accurately, and perhaps even help to guide treatment decisions for patients. They also allow researchers to explore the vast variety of human tumours. PDXFinder, a catalogue launched earlier this year, lists more than 1,900 types of PDX mouse. But there are many more scurrying around in academic and industry labs — as many as 10,000 PDXs have been created, says Nathalie Conte, a bioinformatician at the European Bioinformatics Institute, in Hinxton, UK, who leads PDXFinder.

PDX models are not perfect, however — and scientists are beginning to recognize their shortcomings and complexities. The tumours can diverge from the original sample, for example, and the models cannot be used to test immunotherapies. Now, biologists are scrutinizing PDX mice and looking for creative ways to cope with the challenges. “Every model is artificial in some way,” says Jeffrey Moscow, head of the investigational drug branch at the National Cancer Institute in Bethesda, Maryland. “The real question is how predictive are these models going to turn out to be.”

More here.

Friday Poem

From the Bridge

I never found the order
I searched for
but always a sinister
and well-planned disorder
that increases in the hands
of those who hold power
while the others
who clamor for
a more kindly world
a world with less hunger
and more hopefulness
die of torture
in the prisons.
Don’t come any closer
there’s a stench of carrion
surrounding me.

By Claribel Alegría

Claribel Alegría was born to Nicaraguan and Salvadoran parents in Estelí, Nicaragua, on May 12, 1924. She moved to the United States in 1943, graduating from George Washington University in 1948. In 1985 she moved back to Nicaragua. Her work was featured in Bill Moyers’ PBS series, “The Language of Life.” Her forty books of poems, fiction, non-fiction, and children’s stories have been translated into more than ten languages.

Thursday, August 9, 2018

There’s Nothing Wrong With Black English

John McWhorter in The Atlantic:

The Nation recently published a poem in which a homeless narrator speaks a complex, nuanced variety of English with a long and interesting history.

The variety of English is Black English, and the poet is Anders Carlson-Wee, a white man. In the wake of the controversy, The Nation’s poetry editors have appended a kind of trigger warning to the poem calling its language “disparaging.” (They also apologized for its “ableist language;” the poem used the word “crippled.”) Carlson-Wee has dutifully, and perhaps wisely, apologized that “treading anywhere close to blackface is horrifying to me” and declared that the poem “didn’t work.”

However, I suspect that many are quietly wondering just what Carlson-Wee did that was so wrong—and they should.

The primary source of offense, in a poem only 14 lines long, is passages such as this, in a work designed to highlight and sympathize with the plight of homeless people: “It’s about who they believe they is. You hardly even there.” The protagonist is referring to the condescending attitudes of white passersby who give her change. Yet Roxane Gay, for example, directs white writers to “know your lane,” and not depict the dialect.

More here.

To see capitalism at its finest, you might have to visit Europe

Evan Horowitz in the Boston Review:

When the European Union slapped Google with a $5 billion antitrust fine recently, President Trump readied his exclamation points, insisting that Europe had “taken advantage of the U.S. but not for long!”

Yet it’s possible this is just what fair, competitive capitalism looks like — and Europe is its real home.

Quietly, gradually, Europe has transformed itself into a capitalist haven, a place where profits and prices are kept in check by fierce competition among businesses, and where anticompetitive schemes are policed by active, independent regulators.

If that flies in the face of stereotype, a lot has changed in recent decades. Europe — once maligned for its intrusive state-controlled companies and harmful limits on hiring and firing — has managed to buck some of the worrisome trends threatening US competitiveness.

More here.

Public Benefit, Incorporated

Lenore Palladino in Boston Review:

The stakeholder model of corporate governance would redesign governance so that all stakeholders in our economy (workers, customers, and the public) have a chance to benefit as corporations create profit. It is simultaneously radical and incremental by promising to remake our economy with some straightforward legal shifts. Though there are plenty of variations, three substantive changes to corporate governance are necessary.

The first change is to disallow corporations from forming for any lawful purpose. Corporations should be required by statute to have as their purpose “creating general public benefit,” which is the language that benefit corporations such as Kickstarter and Patagonia use. Benefit corporations are companies that have chosen to be governed by a new kind of law that requires a public benefit purpose and accountability to stakeholders. Benefit corporation status is permissive—right now, corporations have to choose it. Corporate law should be changed so that all corporations—creatures of the state—must create a general public benefit. This would, at minimum, allow some ability to challenge corporate externalities that have disastrous social consequences.

The second change is to mandate that employees, and perhaps other stakeholders, have elected representatives on the board to balance the interests among those making major decisions of the corporation. The third is to make the fiduciary duties of board members—their obligation to be loyal and to make decisions with the interests of the corporation, not themselves, in mind—applicable to a variety of stakeholders, not merely the shareholders who have been actively trading on the secondary markets.

More here.

One of The Greatest Archeological Mysteries of All Time

Edward Burman at Literary Hub:

In fact, the entire story of the Emperor and his Mausoleum is one of historymystery, and discoveryHistory: the chronicles and annals of Chinese history help us to outline the straightforward historical record: this provides the basic starting point of the story. Mystery: since the emperor’s death there have been several mysteries, including the character of the emperor himself, the deliberately disguised location of the tomb, its real purpose and more recently the uncertain role of the terracotta warriors. Discovery: in the past this was serendipitous, as in the 1974 discovery of the warriors, but today it has become systematic and adopts advanced archaeological and scientific techniques which fill out the history and build on the mystery.

One of the foreigners mentioned above, the French poet, novelist, sinologist, and doctor Victor Segalen, was not the first to photograph the tumulus, but he is the only one to have recorded his “discovery.”

more here.

In Voltaire’s Garden

Isabelle Mayault at the LRB:

UIG538515 Ferney near Geneva, Switzerland, 1786. The chateau where Francois Marie Arouet de Voltaire (1694-1778), French writer and pholosopher, embodiment of the Enlightenment, settled after 1758, viewed from the garden. From The European Magazine, (London, 1786). Engraving.; Universal History Archive/UIG; out of copyright

The château at Ferney recently reopened to the public after three years of restoration and refurbishment. Except for the planes high above the lawns, flying in and out of Geneva airport, not much has changed at the château since Voltaire lived here between 1760 and his death in 1778. It’s easy to imagine him taking an afternoon stroll among the plane trees, Mont Blanc in the background, after a morning in bed dictating his voluminous correspondence to his private secretary. During his twenty years at Ferney, he wrote 6000 letters.

When Voltaire first visited, Ferney was a small village of 130 inhabitants, but it had at least one advantage to a polemicist used to falling out with the authorities: its strategic location just on the French side of the border with the republic of Geneva.

more here.

Serenity and Menace in The Works of Mario Merz

Mika Ross-Southall at the TLS:

Mario Merz, a leading figure of the Italian avant-garde movement Arte Povera, first began to draw in prison, after being arrested in 1945 for his involvement with an anti-Facist group in Turin. He recorded his cell mate’s beard in continuous spirals, often without lifting his pencil off the paper. After his release, he painted leaves, animals and biomorphic shapes in a colourful Expressionist style. It wasn’t until the 1960s, though, that he began creating the three-dimensional works – using everyday objects and materials, such as wood, wool, glass, fruit, umbrellas and newspaper – for which he became famous.

“It is necessary to use anything whatsoever from life in art”, Merz said, “not to reject things because one thinks that life and art are mutually exclusive.” This sentiment is clear in the twelve pieces inspired by the protest movements of 1968, which are currently on show at the Fondazione Merz in Turin.

more here.

Thursday Poem

I am Waiting

I am waiting for my case to come up
and I am waiting
for a rebirth of wonder
and I am waiting for someone
to really discover America
and wail
and I am waiting
for the discovery
of a new symbolic western frontier
and I am waiting
for the American Eagle
to really spread its wings
and straighten up and fly right
and I am waiting
for the Age of Anxiety
to drop dead
and I am waiting
for the war to be fought
which will make the world safe
for anarchy
and I am waiting
for the final withering away
of all governments
and I am perpetually awaiting
a rebirth of wonder

Read more »

How Do the Arts Promote Social Change?

Amanda Moniz in Smithsonian:

The arts are “a space where we can give dignity to others while interrogating our own circumstances,” said Darren Walker, president of the Ford Foundation, at the Smithsonian’s National Museum of American History’s annual symposium, The Power of Giving: Philanthropy’s Impact on American Life. Held this spring, the program explored philanthropy’s impact on and through culture and the arts. As he reflected on the relationship between giving and the arts, Walker said that “throughout our history, we have seen artists and activists work hand in hand. We have seen art inspire and elevate whole movements for change.” As Walker suggests, music, storytelling, drama, and other arts have an emotional impact that motivates giving time and money to causes, while philanthropic appeals help artists attract audiences. To continue the conversation about the arts and giving, here’s a look at three objects that tell stories about how Americans used the arts to promote social change in the 1800s.

In the 1840s, the popular Hutchinson Family Singers from New Hampshire introduced music to the developing antislavery movement. As the sheet music for “The Grave of Bonaparte” suggests, the singers were concerned about freedom in other forms and many places, but they had their biggest impact on the American antislavery movement. Performing before integrated audiences, siblings Judson, John, Asa, and Abby—who were managed by their brother Jesse—helped nurture opposition to slavery among those not exposed to its evils. They also helped build far-flung antislavery networks thanks to their travel and the newspaper coverage of their events. Moreover, the success of their antislavery songs showed that the cause had commercial appeal. Works such as the novel Uncle Tom’s Cabin would cater to that appeal–and help further develop antislavery sentiment. In addition to their contributions to reform causes, the group shaped American musical identity. At a time when Americans favored European musicians, the Hutchinson Family Singers spurred new interest in American music.

More here.

How Termites Shape the Natural World

Lisa Morgonelli in Scientific American:

After I came back from Australia, I wondered about a large bauxite mine that I’d heard of, where termites had rehabilitated the land. I wondered if there was more to the story than the fact that they fertilized the soil and recycled the grasses. There seemed to be a gap between bugs dropping a few extra nitrogen molecules in their poo and the creation of a whole forest. What were they doing down there? I started going through my files, looking for people working on landscapes. This led me to the work of a mathematician named Corina Tarnita and an ecologist named Rob Pringle. When I contacted her, Corina had just moved to Princeton from Harvard and, with Rob, had set about using mathematical modeling to figure out what termites were doing in dry landscapes in Kenya. As it happened, I had interviewed Rob back in 2010, when he and a team published a paper on the role of termites in the African savanna ecosystems that are home to elephants and giraffes.

I took the train to Princeton to meet them in early 2014. By that time I’d been following termites for six years, and I’d pretty much given up on two ideas that motivated me early on: understanding the relation between local changes and global effects—that concept of global to local that dogs complexity theorists—and the development of technology that could potentially “save the world.” But through mathematical models, Corina and Rob and their teams eventually delivered a version of those things. And it was purely a bonus that they might have even solved the mystery of the fairy circles.

More here.

Wednesday, August 8, 2018

Amitava Kumar’s Notebooks

Amitava Kumar in Granta:

What you see below are images from my notebooks, recently posted on my Instagram. Clippings, quotes, sketches. These notebooks represent the many years I have lived with the dream of a book that turned into Immigrant, Montana. When I went to Yaddo on a writing residency one summer, it was the notebooks that I looked through each morning and night – these notebooks are a visual reminder of all the bits and pieces I was thinking about when writing this novel.

What these pictures do not show is a page from a narrow, reporter’s notebook that I used to have when finishing graduate school. Sitting in an Amtrak railcar many years ago, on my way to a Modern Language Association meeting in New York, where I’d be interviewed and eventually be given my first job teaching in an English department, I wrote the following line: ‘The red-bottomed monkeys climbed down the branches of the tamarind tree to peel the oranges left unattended on Lotan Mamaji’s house.’ I was recalling a childhood memory involving a monkey, a gun and my infant cousin still in her crib. This first sentence later turned into a short-story – I workshopped it in a small writing group, my first, which included a twenty-one-year-old Cheryl Strayed – and then, years later, it became the opening episode in my new novel.

The picture on the top left is of Philip Roth. There’s a story there.

More here.

Ted Nordhaus Is Wrong: We Are Exceeding Earth’s Carrying Capacity

Richard Heinberg in Undark:

IN HIS ARTICLE, “The Earth’s Carrying Capacity for Human Life is Not Fixed,” Ted Nordhaus, co-founder of the Breakthrough Institute, a California-based energy and environment think tank, seeks to enlist readers in his optimistic vision of the future. It’s a future in which there are many more people on the planet and each enjoys a high standard of living, while environmental impacts are reduced. It’s a cheery vision.

If only it were plausible.

Nordhaus’s argument hinges on dismissing the longstanding biological concept of “carrying capacity” — the number of organisms an environment can support without becoming degraded. “Applied to ecology, the concept [of carrying capacity] is problematic,” Nordhaus writes, arguing in a nutshell that the planet’s ability to support human civilization can be, one presumes, infinitely tweaked through a combination of social and physical engineering.

Few actual ecologists, however, would agree.

More here.

The Death of the Author and the End of Empathy

Heather Mac Donald in Quillette:

In 2015, President Obama described the Nation as “more than a magazine—it’s a crucible of ideas.” If it was ever entitled to this descriptor, it isn’t anymore. Academic identity politics may be importing an obsession with phantom victimhood into the business world and the media, but The Nation’s editors are now taking aim at language itself, reducing the complexity of human communication to a primitive understanding of words.

In late July, the magazine’s poetry editors issued a groveling apology for a poem they had published earlier that month. “How-To,” by Anders Carlson-Wee, was an ironic critique of social hierarchies, couched as a manual for successful panhandling: “If you got hiv, say aids. If you a girl,/say you’re pregnant,” the poem opened. It went on to suggest begging gambits for other presumed outsider groups, including the handicapped: “If you’re crippled don’t/flaunt it. Let em think they’re good enough/Christians to notice.” The poem, in its entirety, reads as follows:

If you got hiv, say aids. If you a girl,
say you’re pregnant—nobody gonna lower
themselves to listen for the kick. People
passing fast. Splay your legs, cock a knee
funny. It’s the littlest shames they’re likely
to comprehend. Don’t say homeless, they know
you is. What they don’t know is what opens
a wallet, what stops em from counting
what they drop. If you’re young say younger.
Old say older. If you’re crippled don’t
flaunt it. Let em think they’re good enough
Christians to notice. Don’t say you pray,
say you sin. It’s about who they believe
they is. You hardly even there.

The word ‘crippled’ and Carlson-Wee’s use of black street dialect set off reader hysteria. Editors Stephanie Burt and Carmen Giménez Smith penitently announced that the poem contained “disparaging and ableist language that has given offense and caused harm to members of several communities.” (This maudlin invocation of ‘harm’ in response to speech is the fastest growing academic export into the non-academic world.) “We made a serious mistake [and] are sorry for the pain we have caused to the many communities affected by this poem,” Burt and Giménez Smith continued. They had originally read the poem, they said, as a “profane, over-the-top attack on the ways in which members of many groups are asked, or required, to perform the work of marginalization.” No more, however: “We can no longer read the poem that way.”

More here.

René Magritte still has the power to surprise

Sophie Haigney in More Intelligent Life:

It is sometimes said that Surrealist paintings are disappointing up close; perhaps we see them so often in reproduction that by the time we see the real ones in a museum they’ve lost some of their strangeness. René Magritte’s paintings could fall into that trap. His bowler hats, apples, puffy clouds and pipes have popped up on coffee mugs, tote bags and dorm-room posters for decades. Not to mention album covers: Jeff Beck used Magritte’s “The Listening Room” on the cover of his 1969 LP “Beck-Ola”. Is Magritte too ubiquitous to be uncanny? No, is the takeaway from “The Fifth Season”, an exhibition at the San Francisco Museum of Modern Art (SFMOMA). Displaying lesser-known work alongside some of his best-loved paintings, it shows that Magritte still has the power to surprise.

In 1943 Magritte was living in Nazi-occupied Belgium. He was relatively well-known in artistic circles, though he was far from a household name. He had spent three years in Paris, where he was close with a group of painters which included André Breton, the leader of the Surrealist movement. He had developed his signature style: elegant canvases that challenged our ways of seeing. But the second world war had thrown him into a deep existential crisis. As he wrote to Breton: “The confusion and panic that Surrealism wanted to create in order to bring everything into question were achieved much better by the Nazi idiots than by us.” When everyday life had become horrifically surreal, why bother exploring the anxieties of the ordinary?

More here.