Thursday, February 26, 2009
http://www.salon.com/env/mind_reader/2009/02/26/bernie_madoff/print.html
The dark lesson of Bernie Madoff
The financier ripped off his lifelong friends and clients with callous precision. He should be a case study of human cruelty.
By Robert Burton
Feb. 26, 2009 |
At age 90, after 30 years of retirement, Ian Thiermann is back at work for $10 an hour as a supermarket greeter, thanks to being bilked out of his life savings by broker Bernie Madoff, perpetrator of perhaps the biggest investment fraud ever by a single person. It is hard to watch a video clip of Thiermann talking about his shattered life without wincing.
And yet, as Thiermann was gamely trying to accept his diminished financial circumstances by handing out fliers for the weekly specials, Madoff, under house arrest and close scrutiny, was busy mailing $1 million worth of old watches to family and friends.
I suspect we all wonder what, if anything, Madoff feels when directly confronted by those he has utterly destroyed. He cooked the books and perpetually lied to his investors. He pulled off the ongoing deception with an utter insensitivity to others. If shown videos of interviews of his victims, would he wince, laugh or simply shrug dismissively and say, "There's a sucker born every minute." For me, a glimpse into Madoff's brain can shed light on the origins of how we treat each other, and perhaps most important, why we treat each other so poorly.
If there's any single attribute that separates Madoff from the average Wall Street thief, I'd suggest that it's his extraordinary ability to read what others think and desire, and especially to know what will give them the greatest satisfaction. (In technical jargon, this ability to read another's thoughts is referred to as Theory of Mind).
From a neurological perspective, a prime candidate for how we learn how others think is the mirror neuron system. In turn, it's been proposed that this ability to read the mind of another makes it possible for us to experience empathy toward others. We know what they're thinking and feeling and this triggers a similar response in us.
Behavioral neurologist V.S Ramachandran has referred to mirror neurons as "empathy neurons" or "Dalai Lama neurons." He believes this system, by allowing us to understand the intentions and desires of others, is the principal driving force behind "the great leap forward" in human evolution. As a result of such claims, the mirror neuron system has risen to the level of accepted folk psychology. According to U.C. Berkeley psychologist Alison Gopnik, "Mirror neurons have become the 'left brain/right brain' of the 21st century."
But Madoff's behavior raises serious questions about the relationship between mirror neurons and empathy -- and represents a golden opportunity to study the as yet puzzling connection between them.
Over a decade ago, Italian neurophysiologist Giacomo Rizzolatti and his colleagues studied motor control in macaque monkeys by placing electrodes in the region of a monkey's pre-motor cortex responsible for hand movements. To their surprise, they noticed that these neurons fired both when a monkey reached for an object and when the monkey observed someone else (other monkeys and researchers) reach for an object such as a peanut or bit of banana.
The resulting interpretation has been that you recognize the intentions of others by equating their action with what you would do under the same circumstances. These neurons mirror the activity of others and allow you to see the world "from the other person's point of view." Marco Iacoboni, collaborator with Rizzolatti and author of "Mirroring Others," has written that this system is capable of automatically assigning intention to another.
(Although it's not possible to directly isolate and detect mirror neurons in humans, functional studies -- both fMRI and transcranial magnetic stimulation -- strongly suggest that we possess a similar brain system, primarily in the inferior frontal and inferior parietal regions).
To have played his investors as flawlessly as he did for several decades, I'm tempted to say that Madoff knew his investors' minds better than they did -- presumably good evidence for a well-functioning mirror neuron system. But contrary to Ramachandran's view that mirror neurons are synonymous with "empathy neurons," Madoff gets a zero in the empathy department. Just watch Madoff on the news, disdainfully and without any outward appearance of contrition, remorse, guilt or embarrassment, push his way through a crowd of angry onlookers and reporters. Contrast this contempt and disregard for his accusers with his savvy, sophisticated understanding of what his neighbors might expect from him, and we get a sense of the disconnect between understanding the thoughts of others and genuinely sharing their feelings.
Consider this letter that Madoff posted in his apartment building:
Dear neighbors,
Please accept my profound apologies for the terrible inconvenience that I have caused over the past weeks. Ruth and I appreciate the support we have received.
Best regards,
Bernard Madoff
If Madoff's mirror neuron system appears clinically intact, and mirror neurons are key to the development of empathy, what allowed him to muster the callous indifference to ruin so many friends and associates? The obvious candidate would be something awry in the emotional centers and empathy circuitry that allow each of us to feel another's pain and suffering.
In general, there appear to be two distinctly different, albeit overlapping, types of empathy: intellectual empathy, or knowing what someone is feeling; and affective empathy, or experiencing the same feeling as the other person. For example, a life insurance salesman and his wife can attend a funeral of her co-worker. The salesman might understand the mourners are grieving, and yet the sight of their weeping doesn't affect him emotionally; instead he might feel a bit giddy that the mourners would be easy marks for some term insurance policies. His wife, on the other hand, might become overwhelmed with real grief.
One of the best-studied examples of this disconnect between understanding the feelings of others and sharing their feelings is the patient "Elliott," described by neurologist Antonio Damasio in his book "Descartes' Error." Following the removal of a benign brain tumor, Elliot underwent a dramatic personality change. Although his imaging studies showed bilateral damage to his prefrontal cortex, he scored above average on standard intelligence tests, including some designed to detect frontal lobe damage. He responded normally to standard tests of personality, and retained his ability to speak and reason about topics such as politics and economics.
What was strikingly different was his affect. Although he was able to intellectually recognize emotional content, he now was unable to feel these emotions. When shown pictures of gory accidents such as a decapitated car accident victim, or a child drowning, Elliot reported having no emotional response at the same time as he remembered previously having had strong emotional responses to similar photos. His ability to intellectually experience empathy was disconnected from any affective response.
Even the neural substrates of affective empathy aren't neatly organized; they vary according to what emotion is being experienced. If you see a woman in danger and feel fearful for her, your amygdala -- a limbic system structure critical to experiencing fear and trembling -- will light up on fMRI. If you witness quarterback Joe Thiesmann's leg being broken on Monday Night Football, the anterior mid-cingulate cortex and the anterior insula -- two regions that process pain perception -- will go into overdrive.
But do we really need to have prior similar experiences to empathize with others? This is the fundamental argument underlying the theory that the mirror neuron system, by providing the ability to read the thoughts and feelings of others, is essential for empathy.
In a January 2009 study, French neuroscientist Nicolas Danziger wanted to see whether a person could empathize with an unfamiliar emotional state. He studied a group of patients with congenital insensitivity to pain -- a rare condition present at birth and related to genetic changes in sensory nerves. Such patients have never felt physical pain sensations and have no idea what pain feels like. Interested in seeing how these patients would respond to seeing others in pain, Danziger showed them photos of a person getting her finger caught in gardening shears and a video clip of Theismann's leg being broken.
Surprisingly, some of the pain-insensitive patients responded on fMRI similarly to normal controls -- their pain perception regions lit up. Others had the anticipated lack of response. The difference between the two groups correlated with the degree of empathy that was elicited on a standard empathy assessment questionnaire. The authors concluded that those patients who responded had the "empathy trait."
If this study pans out and can be duplicated under a variety of similar circumstances, the inference is profound: Each of us is wired differently for feeling the pain and suffering of others, irrespective of our past personal experience.
So is empathy an inborn trait?
One piece of evidence comes from observations on the Autism Spectrum Disorder. Thought to have a strong genetic predisposition, patients with autism and Asperger's syndrome commonly are unable to grasp what others are thinking and feeling. Listen to this mother of a toddler with Asperger's syndrome describe his reactions to his 8-month old brother crying whenever he fell down, bumped his head or pinched a finger. "My son asked me the most puzzling questions such as 'Why is that baby crying?' 'Why is he doing that?' and, my favorite, 'Can't we take that noisy baby back to the store and get a new one?'" If genes play a significant role in the Autistic Spectrum patient's lack of empathy, it stands to reason that there might be a similar genetic contribution to the experience of empathy in all of us.
Further support comes from studies on antisocial behavior, both in young children and in adult "psychopaths." (I'm using the unfortunately biased term "psychopath" to denote folks with chronic antisocial behavior who lack remorse for their actions, as opposed to antisocial behavior in which remorse and guilt are present.)
Looking at 3,600 pairs of 7-year-old twins, the British Twins Early Development Study found antisocial behavior in 7-year-olds generally fell into two categories: those with normal degrees of empathy and those described as callous and lacking in empathy. The former group was felt to be primarily environmentally mediated (learned behavior), whereas those lacking in empathy demonstrated that their antisocial behavior (primarily bullying and conduct disorders) strongly ran in families. In a subsequent fMRI study, this non-empathic group was shown to have decreased activation of the amygdala in response to looking at fearful faces. In other words, those who lack proper emotional responses to negative stimuli are more likely to have genetic underpinnings to their disorder.
Perhaps the most compelling predictive data supporting the "bad seed" hypothesis is a 25-year study showing that, as early as the age of 3, there are temperamental and physiological difference between those who show psychopathic tendencies as adults and those who don't. In the early '70s, 1,800 3-year-olds were observed and rated on several psychological scales, including their degree of fearfulness and inhibition. Twenty-five years later they were reexamined. Those with the higher psychopathy rating scores were found to be significantly less fearful and inhibited and more glib, charming and manipulative.
The authors concluded that children with a low level of fearfulness may be more likely to develop antisocial personality as adults. I'm always leery about accepting purely questionnaire-based studies at face value, but being able to predict the bad seeds at age 3 is hard to entirely ignore.
Although it's painfully obvious that we don't know what makes Madoff tick, it is hard not to speculate. If there is such a thing as empathy deficiency, Madoff would be its poster child. Perhaps this was a trait that he shares with his mother, Sylvia Madoff, who was registered as a broker, but in the 1960s was forced to close shop as part of an agreement with the Securities and Exchange Commission not to further investigate her brokerage. (I know it's impossible with our present state of knowledge to sort out nature from nurture, but the above studies on empathy certainly suggest the possibility of there being a primary biological contribution.)
Even if true, a genetic predisposition for lack of empathy cannot possibly excuse Madoff's behavior. We all have genetic predispositions for various personality traits -- it is our struggle against baser biologic urges that distinguishes us from the rest of the animal kingdom. Deferring to biology as explanation or excuse for a behavior is to abandon all notions of what it means to be human.
Madoff can't repay his victims, but we can learn from him. That's why he should be forced to participate in medical studies as part of his sentence. The best cognitive scientists, philosophers, geneticists and sociologists should be allowed to administer to him whatever non-invasive and ethically appropriate clinical studies they can dream up. See if any pattern emerges that is sufficiently reliable to qualify as predictive. Even if our present knowledge is insufficient to draw conclusions, Madoff would make a great set of data points. Perhaps one day he can give something back to society by teaching us about human empathy, and its limitations.
-- By Robert Burton
The dark lesson of Bernie Madoff
The financier ripped off his lifelong friends and clients with callous precision. He should be a case study of human cruelty.
By Robert Burton
Feb. 26, 2009 |
At age 90, after 30 years of retirement, Ian Thiermann is back at work for $10 an hour as a supermarket greeter, thanks to being bilked out of his life savings by broker Bernie Madoff, perpetrator of perhaps the biggest investment fraud ever by a single person. It is hard to watch a video clip of Thiermann talking about his shattered life without wincing.
And yet, as Thiermann was gamely trying to accept his diminished financial circumstances by handing out fliers for the weekly specials, Madoff, under house arrest and close scrutiny, was busy mailing $1 million worth of old watches to family and friends.
I suspect we all wonder what, if anything, Madoff feels when directly confronted by those he has utterly destroyed. He cooked the books and perpetually lied to his investors. He pulled off the ongoing deception with an utter insensitivity to others. If shown videos of interviews of his victims, would he wince, laugh or simply shrug dismissively and say, "There's a sucker born every minute." For me, a glimpse into Madoff's brain can shed light on the origins of how we treat each other, and perhaps most important, why we treat each other so poorly.
If there's any single attribute that separates Madoff from the average Wall Street thief, I'd suggest that it's his extraordinary ability to read what others think and desire, and especially to know what will give them the greatest satisfaction. (In technical jargon, this ability to read another's thoughts is referred to as Theory of Mind).
From a neurological perspective, a prime candidate for how we learn how others think is the mirror neuron system. In turn, it's been proposed that this ability to read the mind of another makes it possible for us to experience empathy toward others. We know what they're thinking and feeling and this triggers a similar response in us.
Behavioral neurologist V.S Ramachandran has referred to mirror neurons as "empathy neurons" or "Dalai Lama neurons." He believes this system, by allowing us to understand the intentions and desires of others, is the principal driving force behind "the great leap forward" in human evolution. As a result of such claims, the mirror neuron system has risen to the level of accepted folk psychology. According to U.C. Berkeley psychologist Alison Gopnik, "Mirror neurons have become the 'left brain/right brain' of the 21st century."
But Madoff's behavior raises serious questions about the relationship between mirror neurons and empathy -- and represents a golden opportunity to study the as yet puzzling connection between them.
Over a decade ago, Italian neurophysiologist Giacomo Rizzolatti and his colleagues studied motor control in macaque monkeys by placing electrodes in the region of a monkey's pre-motor cortex responsible for hand movements. To their surprise, they noticed that these neurons fired both when a monkey reached for an object and when the monkey observed someone else (other monkeys and researchers) reach for an object such as a peanut or bit of banana.
The resulting interpretation has been that you recognize the intentions of others by equating their action with what you would do under the same circumstances. These neurons mirror the activity of others and allow you to see the world "from the other person's point of view." Marco Iacoboni, collaborator with Rizzolatti and author of "Mirroring Others," has written that this system is capable of automatically assigning intention to another.
(Although it's not possible to directly isolate and detect mirror neurons in humans, functional studies -- both fMRI and transcranial magnetic stimulation -- strongly suggest that we possess a similar brain system, primarily in the inferior frontal and inferior parietal regions).
To have played his investors as flawlessly as he did for several decades, I'm tempted to say that Madoff knew his investors' minds better than they did -- presumably good evidence for a well-functioning mirror neuron system. But contrary to Ramachandran's view that mirror neurons are synonymous with "empathy neurons," Madoff gets a zero in the empathy department. Just watch Madoff on the news, disdainfully and without any outward appearance of contrition, remorse, guilt or embarrassment, push his way through a crowd of angry onlookers and reporters. Contrast this contempt and disregard for his accusers with his savvy, sophisticated understanding of what his neighbors might expect from him, and we get a sense of the disconnect between understanding the thoughts of others and genuinely sharing their feelings.
Consider this letter that Madoff posted in his apartment building:
Dear neighbors,
Please accept my profound apologies for the terrible inconvenience that I have caused over the past weeks. Ruth and I appreciate the support we have received.
Best regards,
Bernard Madoff
If Madoff's mirror neuron system appears clinically intact, and mirror neurons are key to the development of empathy, what allowed him to muster the callous indifference to ruin so many friends and associates? The obvious candidate would be something awry in the emotional centers and empathy circuitry that allow each of us to feel another's pain and suffering.
In general, there appear to be two distinctly different, albeit overlapping, types of empathy: intellectual empathy, or knowing what someone is feeling; and affective empathy, or experiencing the same feeling as the other person. For example, a life insurance salesman and his wife can attend a funeral of her co-worker. The salesman might understand the mourners are grieving, and yet the sight of their weeping doesn't affect him emotionally; instead he might feel a bit giddy that the mourners would be easy marks for some term insurance policies. His wife, on the other hand, might become overwhelmed with real grief.
One of the best-studied examples of this disconnect between understanding the feelings of others and sharing their feelings is the patient "Elliott," described by neurologist Antonio Damasio in his book "Descartes' Error." Following the removal of a benign brain tumor, Elliot underwent a dramatic personality change. Although his imaging studies showed bilateral damage to his prefrontal cortex, he scored above average on standard intelligence tests, including some designed to detect frontal lobe damage. He responded normally to standard tests of personality, and retained his ability to speak and reason about topics such as politics and economics.
What was strikingly different was his affect. Although he was able to intellectually recognize emotional content, he now was unable to feel these emotions. When shown pictures of gory accidents such as a decapitated car accident victim, or a child drowning, Elliot reported having no emotional response at the same time as he remembered previously having had strong emotional responses to similar photos. His ability to intellectually experience empathy was disconnected from any affective response.
Even the neural substrates of affective empathy aren't neatly organized; they vary according to what emotion is being experienced. If you see a woman in danger and feel fearful for her, your amygdala -- a limbic system structure critical to experiencing fear and trembling -- will light up on fMRI. If you witness quarterback Joe Thiesmann's leg being broken on Monday Night Football, the anterior mid-cingulate cortex and the anterior insula -- two regions that process pain perception -- will go into overdrive.
But do we really need to have prior similar experiences to empathize with others? This is the fundamental argument underlying the theory that the mirror neuron system, by providing the ability to read the thoughts and feelings of others, is essential for empathy.
In a January 2009 study, French neuroscientist Nicolas Danziger wanted to see whether a person could empathize with an unfamiliar emotional state. He studied a group of patients with congenital insensitivity to pain -- a rare condition present at birth and related to genetic changes in sensory nerves. Such patients have never felt physical pain sensations and have no idea what pain feels like. Interested in seeing how these patients would respond to seeing others in pain, Danziger showed them photos of a person getting her finger caught in gardening shears and a video clip of Theismann's leg being broken.
Surprisingly, some of the pain-insensitive patients responded on fMRI similarly to normal controls -- their pain perception regions lit up. Others had the anticipated lack of response. The difference between the two groups correlated with the degree of empathy that was elicited on a standard empathy assessment questionnaire. The authors concluded that those patients who responded had the "empathy trait."
If this study pans out and can be duplicated under a variety of similar circumstances, the inference is profound: Each of us is wired differently for feeling the pain and suffering of others, irrespective of our past personal experience.
So is empathy an inborn trait?
One piece of evidence comes from observations on the Autism Spectrum Disorder. Thought to have a strong genetic predisposition, patients with autism and Asperger's syndrome commonly are unable to grasp what others are thinking and feeling. Listen to this mother of a toddler with Asperger's syndrome describe his reactions to his 8-month old brother crying whenever he fell down, bumped his head or pinched a finger. "My son asked me the most puzzling questions such as 'Why is that baby crying?' 'Why is he doing that?' and, my favorite, 'Can't we take that noisy baby back to the store and get a new one?'" If genes play a significant role in the Autistic Spectrum patient's lack of empathy, it stands to reason that there might be a similar genetic contribution to the experience of empathy in all of us.
Further support comes from studies on antisocial behavior, both in young children and in adult "psychopaths." (I'm using the unfortunately biased term "psychopath" to denote folks with chronic antisocial behavior who lack remorse for their actions, as opposed to antisocial behavior in which remorse and guilt are present.)
Looking at 3,600 pairs of 7-year-old twins, the British Twins Early Development Study found antisocial behavior in 7-year-olds generally fell into two categories: those with normal degrees of empathy and those described as callous and lacking in empathy. The former group was felt to be primarily environmentally mediated (learned behavior), whereas those lacking in empathy demonstrated that their antisocial behavior (primarily bullying and conduct disorders) strongly ran in families. In a subsequent fMRI study, this non-empathic group was shown to have decreased activation of the amygdala in response to looking at fearful faces. In other words, those who lack proper emotional responses to negative stimuli are more likely to have genetic underpinnings to their disorder.
Perhaps the most compelling predictive data supporting the "bad seed" hypothesis is a 25-year study showing that, as early as the age of 3, there are temperamental and physiological difference between those who show psychopathic tendencies as adults and those who don't. In the early '70s, 1,800 3-year-olds were observed and rated on several psychological scales, including their degree of fearfulness and inhibition. Twenty-five years later they were reexamined. Those with the higher psychopathy rating scores were found to be significantly less fearful and inhibited and more glib, charming and manipulative.
The authors concluded that children with a low level of fearfulness may be more likely to develop antisocial personality as adults. I'm always leery about accepting purely questionnaire-based studies at face value, but being able to predict the bad seeds at age 3 is hard to entirely ignore.
Although it's painfully obvious that we don't know what makes Madoff tick, it is hard not to speculate. If there is such a thing as empathy deficiency, Madoff would be its poster child. Perhaps this was a trait that he shares with his mother, Sylvia Madoff, who was registered as a broker, but in the 1960s was forced to close shop as part of an agreement with the Securities and Exchange Commission not to further investigate her brokerage. (I know it's impossible with our present state of knowledge to sort out nature from nurture, but the above studies on empathy certainly suggest the possibility of there being a primary biological contribution.)
Even if true, a genetic predisposition for lack of empathy cannot possibly excuse Madoff's behavior. We all have genetic predispositions for various personality traits -- it is our struggle against baser biologic urges that distinguishes us from the rest of the animal kingdom. Deferring to biology as explanation or excuse for a behavior is to abandon all notions of what it means to be human.
Madoff can't repay his victims, but we can learn from him. That's why he should be forced to participate in medical studies as part of his sentence. The best cognitive scientists, philosophers, geneticists and sociologists should be allowed to administer to him whatever non-invasive and ethically appropriate clinical studies they can dream up. See if any pattern emerges that is sufficiently reliable to qualify as predictive. Even if our present knowledge is insufficient to draw conclusions, Madoff would make a great set of data points. Perhaps one day he can give something back to society by teaching us about human empathy, and its limitations.
-- By Robert Burton
Wednesday, February 25, 2009
The Night the Professor Became a Nurse
Oncology nurse Theresa Brown, an occasional contributor to the Well blog, writes about her decision to become a nurse.
By Theresa Brown
INSERT DESCRIPTION Theresa Brown, R.N.
“You left teaching English for this?”
I’ve been asked the question so many times by so many people that it no longer surprises me. After all, who in their right mind would give up being an English teacher, an English professor no less who taught writing at Tufts University, to become a nurse?
I made a mid-life career change that many people, including a lot of nurses, do not understand, and certainly would not have made themselves. People often ask me if I’m crazy. I’m not, but even I can admit that it’s an unusual choice requiring some explanation.
After having my son, I realized I wanted a job where I was expected to care about people, not grade or judge them. Then I had my twins, and my world turned inside out and upside down with the physical challenges of the pregnancy. The midwives who helped me through the pregnancy left a lasting impression, and when I mentioned my admiration for them, a friend who’s a nurse told me, “You could do that job.”
Soon after that conversation, I decided to go to nursing school. Six years later, when my twins were 8, I got my R.N. But I don’t think even I fully understood my decision until the last night of the very last shift I would ever do as a nursing student.
That night an 11-year-old leukemia patient who had a fever arrived on my floor at a children’s hospital. He and his dad talked and joked with each other, started watching movies on the TV in their room right away, and passed an enormous bag of potato chips back and forth. I got the impression they were trying to convince us, and themselves, that an impromptu hospital stay could be fun if you just had the right attitude.
Some other nurses had warned me that this family was “difficult,” but they seemed O.K. to me. The dad had a bad back and asked repeatedly for more pillows. (I’m not sure why, but pillows are a rare commodity in hospitals. I searched both wings of the floor until I found some for him.) The patient, testing out some preteen behaviors, could be rude, so I teased him about saying “please” and “thank you” as I handed over cartons of apple juice. I described him to the resident as “cheeky,” but I liked him.
Around 4 a.m., I went to check on him. As I walked into his room he looked up at me in the darkness and said, “It feels like I can’t breathe. My chest hurts.” Alarm bells went off in my head, scaring me and drowning out some of my confidence. “Oh, gee, that sounds bad,” I thought to myself. “What am I going to do about that?”
But then I did all the things nurses do: made sure he could breathe, called the resident about his change in status, and quickly left to retrieve the equipment to take a set of vitals.
When I got back to the room, the boy said he needed to go to the bathroom. I helped him walk, but halfway there his knees buckled. He cried out, “I can’t see! I can’t see!” I held him up, then picked him up and somehow got him into the bathroom and onto the toilet. I took his blood pressure twice. It was 70 over 30, much too low, and probably the cause of his temporary blindness. When I checked to make sure he was safe sitting on the toilet by himself he yelled out, “Can’t a man take a crap in peace?”
The doctors were worried that his low blood pressure meant he was going into septic shock and decided he needed the more intense technical support available in the pediatric intensive care unit.
Around 5:30 in the morning, and before the transfer to intensive care, I went to check on him. The room was still dark as night, and I hoped he had fallen back asleep. Instead, he spoke to me. His earlier cheekiness was gone, and I found myself confronted by a very scared 11-year-old boy.
“Why couldn’t I breathe?” he asked. And “Why did my chest hurt?” And “How come I couldn’t see?”
Answers and pieces of answers swirled around in my head. Everything I thought of seemed overly technical, but also just inadequate. I offered him answers, mostly having to do with his low blood pressure, but in my concern for him I wasn’t putting together everything I knew. However, right or wrong, convincing or unconvincing, my responses comforted him. He stopped talking and relaxed back into bed.
Our brief conversation could be categorized as “patient education,” but my patient and I exchanged something more substantial than information when we talked. He found a way to ask, “What’s wrong with me?” and “Am I going to die?” And I told him, “I don’t completely know, but whatever happens I am here with you.” There we were, nurse and patient, talking quietly in a dark room, confronting the vagaries of life and death.
For me this moment finally put to rest any questions I had about why I quit being a professor and became a nurse instead. My patient and I confronted the human condition during our brief talk. I answered his questions, and I met his fear with compassion.
By 8 that morning he went off to the P.I.C.U., and I never saw him again. I ended up overstaying my final shift and missed out on a celebratory breakfast with my friends. I never again worked at the children’s hospital but took a job in adult medical oncology that began once I finished school. I have no idea how things turned out for that boy, but I hope he’s still watching movies and eating potato chips.
In my job now, as with most hospital nursing, I see it all: the struggles with treatment, the confrontation with death, the successes that gladden all our hearts. It’s messy and stressful and I wouldn’t exchange it for a dream classroom full of well-read, hard-working, intellectually curious college students — not in a million years, not ever. For where else can I go to sample daily the richness of life in all its profound chaos.
Oncology nurse Theresa Brown, an occasional contributor to the Well blog, writes about her decision to become a nurse.
By Theresa Brown
INSERT DESCRIPTION Theresa Brown, R.N.
“You left teaching English for this?”
I’ve been asked the question so many times by so many people that it no longer surprises me. After all, who in their right mind would give up being an English teacher, an English professor no less who taught writing at Tufts University, to become a nurse?
I made a mid-life career change that many people, including a lot of nurses, do not understand, and certainly would not have made themselves. People often ask me if I’m crazy. I’m not, but even I can admit that it’s an unusual choice requiring some explanation.
After having my son, I realized I wanted a job where I was expected to care about people, not grade or judge them. Then I had my twins, and my world turned inside out and upside down with the physical challenges of the pregnancy. The midwives who helped me through the pregnancy left a lasting impression, and when I mentioned my admiration for them, a friend who’s a nurse told me, “You could do that job.”
Soon after that conversation, I decided to go to nursing school. Six years later, when my twins were 8, I got my R.N. But I don’t think even I fully understood my decision until the last night of the very last shift I would ever do as a nursing student.
That night an 11-year-old leukemia patient who had a fever arrived on my floor at a children’s hospital. He and his dad talked and joked with each other, started watching movies on the TV in their room right away, and passed an enormous bag of potato chips back and forth. I got the impression they were trying to convince us, and themselves, that an impromptu hospital stay could be fun if you just had the right attitude.
Some other nurses had warned me that this family was “difficult,” but they seemed O.K. to me. The dad had a bad back and asked repeatedly for more pillows. (I’m not sure why, but pillows are a rare commodity in hospitals. I searched both wings of the floor until I found some for him.) The patient, testing out some preteen behaviors, could be rude, so I teased him about saying “please” and “thank you” as I handed over cartons of apple juice. I described him to the resident as “cheeky,” but I liked him.
Around 4 a.m., I went to check on him. As I walked into his room he looked up at me in the darkness and said, “It feels like I can’t breathe. My chest hurts.” Alarm bells went off in my head, scaring me and drowning out some of my confidence. “Oh, gee, that sounds bad,” I thought to myself. “What am I going to do about that?”
But then I did all the things nurses do: made sure he could breathe, called the resident about his change in status, and quickly left to retrieve the equipment to take a set of vitals.
When I got back to the room, the boy said he needed to go to the bathroom. I helped him walk, but halfway there his knees buckled. He cried out, “I can’t see! I can’t see!” I held him up, then picked him up and somehow got him into the bathroom and onto the toilet. I took his blood pressure twice. It was 70 over 30, much too low, and probably the cause of his temporary blindness. When I checked to make sure he was safe sitting on the toilet by himself he yelled out, “Can’t a man take a crap in peace?”
The doctors were worried that his low blood pressure meant he was going into septic shock and decided he needed the more intense technical support available in the pediatric intensive care unit.
Around 5:30 in the morning, and before the transfer to intensive care, I went to check on him. The room was still dark as night, and I hoped he had fallen back asleep. Instead, he spoke to me. His earlier cheekiness was gone, and I found myself confronted by a very scared 11-year-old boy.
“Why couldn’t I breathe?” he asked. And “Why did my chest hurt?” And “How come I couldn’t see?”
Answers and pieces of answers swirled around in my head. Everything I thought of seemed overly technical, but also just inadequate. I offered him answers, mostly having to do with his low blood pressure, but in my concern for him I wasn’t putting together everything I knew. However, right or wrong, convincing or unconvincing, my responses comforted him. He stopped talking and relaxed back into bed.
Our brief conversation could be categorized as “patient education,” but my patient and I exchanged something more substantial than information when we talked. He found a way to ask, “What’s wrong with me?” and “Am I going to die?” And I told him, “I don’t completely know, but whatever happens I am here with you.” There we were, nurse and patient, talking quietly in a dark room, confronting the vagaries of life and death.
For me this moment finally put to rest any questions I had about why I quit being a professor and became a nurse instead. My patient and I confronted the human condition during our brief talk. I answered his questions, and I met his fear with compassion.
By 8 that morning he went off to the P.I.C.U., and I never saw him again. I ended up overstaying my final shift and missed out on a celebratory breakfast with my friends. I never again worked at the children’s hospital but took a job in adult medical oncology that began once I finished school. I have no idea how things turned out for that boy, but I hope he’s still watching movies and eating potato chips.
In my job now, as with most hospital nursing, I see it all: the struggles with treatment, the confrontation with death, the successes that gladden all our hearts. It’s messy and stressful and I wouldn’t exchange it for a dream classroom full of well-read, hard-working, intellectually curious college students — not in a million years, not ever. For where else can I go to sample daily the richness of life in all its profound chaos.
Saturday, February 21, 2009
The New York Times
February 21, 2009
Music Review | Leonard Cohen
Pop Music’s Perpetual Old Man, Now 74, Is Back on the Road
By NATE CHINEN
Leonard Cohen kept returning to the stance of a supplicant at the Beacon Theater on Thursday night, dropping to one knee, or both, to intone his wry and ruminative songs. At the same time, he basked in the rapture of the crowd, artfully courting adulation. His mix of humility and sovereignty felt effortless, entirely true to form. And it girded the concert, his first in the United States in 15 years, with a vibrant and effective tension.
Mr. Cohen, 74, left little room for disappointment in a show that lasted just over three hours (with an intermission) and featured more than two dozen songs. The evening doubled as a preview, coming with the eagerly anticipated announcement of a North American tour this spring. (The tour includes a stop at Radio City Music Hall on May 16.) Mr. Cohen began his return to the road last year, with a slew of dates in Europe and his native Canada; one of them yielded “Live in London,” an album and DVD due out next month from Columbia.
The rigors of performing have reinvigorated Mr. Cohen, whose trademark black suit and fedora conveyed a somber chic. He literally skipped offstage at the end of each half, and after each of his several encores. He sashayed back on, with the slyest of grins. And his voice, that grave and inflexible instrument, occasionally escaped its granitelike restraints. On “Chelsea Hotel #2,” one of the best-received songs of the night, he sang with the resonant candor of his younger self, though that moment was brief and bittersweet.
Comforts are fleeting in Mr. Cohen’s songs, and contradictions are eternal. He was unsparing with his song choice, delving early on into “The Future” (“I’ve seen the future, brother/It is murder”) and savoring the sting of “Everybody Knows” (“Everybody knows that you’ve been faithful/Ah, give or take a night or two”). He fleshed out a liturgical cadence on “Who by Fire,” sounding grim; on “Famous Blue Raincoat,” an encore, he struck a complicated but familiar chord of contempt, compassion and self-pity.
Mr. Cohen’s backing ensemble, led by the bassist Roscoe Beck, matched these songs to a warm, gauzy glow, muting all textures. If anything the band was too polished, evoking smooth jazz and the more homogenized strains of world music. (It should be noted that the flamenco-tinged flourishes by Javier Mas, on bandurria and laúd, were more palatable than the ardently cloying solos by Dino Soldo, on saxophones.) When most of the group dropped out for an austere “Suzanne,” with Mr. Cohen on acoustic guitar, the effect was salutary: suddenly there was flow in the music, a feeling of breath and fluctuation.
But Mr. Cohen, like anyone else who isn’t João Gilberto, would have struggled to cast that spell over the course of the concert. He needed the band for atmosphere as well as support. And what he got from his backup singers, Sharon Robinson and the Webb Sisters, was abidingly deep: their airy harmonies offset Mr. Cohen’s sepulchral tone.
Ms. Robinson, a longtime collaborator of Mr. Cohen’s, also sang a solo feature, “Boogie Street,” with authority. The Webb Sisters had their own moment, claiming “If It Be Your Will” as an ethereal Celtic ballad, with Hattie Webb on harp and Charley Webb on acoustic guitar. (This week they released an EP on StratArt, “Comes in Twos,” which contains that arrangement.)
That was one of a handful of songs with philosophical overtones, befitting Mr. Cohen’s experience as a Zen Buddhist monk. The strongest in this vein was “Anthem,” which he prefaced with an allusion to troubled times; a joke about his medications (he mentioned a litany of name-brand antidepressants); and a quip about how he tried a course of religious study, but “cheerfulness kept breaking through.” Then came the song, and its chorus:
Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything
That’s how the light gets in.
Mr. Cohen sang these words with a kind of gracious generosity. Then he introduced everyone onstage, with practiced eloquence. And before dashing into the wings to end the first half he stood for a moment, hat in hand, awash in wild applause.
Leonard Cohen’s Beacon Theater concert will be broadcast at nprmusic.org/music on Thursday. Tickets for his tour go on sale Friday at leonardcohen.com.
February 21, 2009
Music Review | Leonard Cohen
Pop Music’s Perpetual Old Man, Now 74, Is Back on the Road
By NATE CHINEN
Leonard Cohen kept returning to the stance of a supplicant at the Beacon Theater on Thursday night, dropping to one knee, or both, to intone his wry and ruminative songs. At the same time, he basked in the rapture of the crowd, artfully courting adulation. His mix of humility and sovereignty felt effortless, entirely true to form. And it girded the concert, his first in the United States in 15 years, with a vibrant and effective tension.
Mr. Cohen, 74, left little room for disappointment in a show that lasted just over three hours (with an intermission) and featured more than two dozen songs. The evening doubled as a preview, coming with the eagerly anticipated announcement of a North American tour this spring. (The tour includes a stop at Radio City Music Hall on May 16.) Mr. Cohen began his return to the road last year, with a slew of dates in Europe and his native Canada; one of them yielded “Live in London,” an album and DVD due out next month from Columbia.
The rigors of performing have reinvigorated Mr. Cohen, whose trademark black suit and fedora conveyed a somber chic. He literally skipped offstage at the end of each half, and after each of his several encores. He sashayed back on, with the slyest of grins. And his voice, that grave and inflexible instrument, occasionally escaped its granitelike restraints. On “Chelsea Hotel #2,” one of the best-received songs of the night, he sang with the resonant candor of his younger self, though that moment was brief and bittersweet.
Comforts are fleeting in Mr. Cohen’s songs, and contradictions are eternal. He was unsparing with his song choice, delving early on into “The Future” (“I’ve seen the future, brother/It is murder”) and savoring the sting of “Everybody Knows” (“Everybody knows that you’ve been faithful/Ah, give or take a night or two”). He fleshed out a liturgical cadence on “Who by Fire,” sounding grim; on “Famous Blue Raincoat,” an encore, he struck a complicated but familiar chord of contempt, compassion and self-pity.
Mr. Cohen’s backing ensemble, led by the bassist Roscoe Beck, matched these songs to a warm, gauzy glow, muting all textures. If anything the band was too polished, evoking smooth jazz and the more homogenized strains of world music. (It should be noted that the flamenco-tinged flourishes by Javier Mas, on bandurria and laúd, were more palatable than the ardently cloying solos by Dino Soldo, on saxophones.) When most of the group dropped out for an austere “Suzanne,” with Mr. Cohen on acoustic guitar, the effect was salutary: suddenly there was flow in the music, a feeling of breath and fluctuation.
But Mr. Cohen, like anyone else who isn’t João Gilberto, would have struggled to cast that spell over the course of the concert. He needed the band for atmosphere as well as support. And what he got from his backup singers, Sharon Robinson and the Webb Sisters, was abidingly deep: their airy harmonies offset Mr. Cohen’s sepulchral tone.
Ms. Robinson, a longtime collaborator of Mr. Cohen’s, also sang a solo feature, “Boogie Street,” with authority. The Webb Sisters had their own moment, claiming “If It Be Your Will” as an ethereal Celtic ballad, with Hattie Webb on harp and Charley Webb on acoustic guitar. (This week they released an EP on StratArt, “Comes in Twos,” which contains that arrangement.)
That was one of a handful of songs with philosophical overtones, befitting Mr. Cohen’s experience as a Zen Buddhist monk. The strongest in this vein was “Anthem,” which he prefaced with an allusion to troubled times; a joke about his medications (he mentioned a litany of name-brand antidepressants); and a quip about how he tried a course of religious study, but “cheerfulness kept breaking through.” Then came the song, and its chorus:
Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything
That’s how the light gets in.
Mr. Cohen sang these words with a kind of gracious generosity. Then he introduced everyone onstage, with practiced eloquence. And before dashing into the wings to end the first half he stood for a moment, hat in hand, awash in wild applause.
Leonard Cohen’s Beacon Theater concert will be broadcast at nprmusic.org/music on Thursday. Tickets for his tour go on sale Friday at leonardcohen.com.
Wednesday, February 18, 2009
The New York Times
February 18, 2009
Student Expectations Seen as Causing Grade Disputes
By MAX ROOSEVELT
Prof. Marshall Grossman has come to expect complaints whenever he returns graded papers in his English classes at the University of Maryland.
“Many students come in with the conviction that they’ve worked hard and deserve a higher mark,” Professor Grossman said. “Some assert that they have never gotten a grade as low as this before.”
He attributes those complaints to his students’ sense of entitlement.
“I tell my classes that if they just do what they are supposed to do and meet the standard requirements, that they will earn a C,” he said. “That is the default grade. They see the default grade as an A.”
A recent study by researchers at the University of California, Irvine, found that a third of students surveyed said that they expected B’s just for attending lectures, and 40 percent said they deserved a B for completing the required reading.
“I noticed an increased sense of entitlement in my students and wanted to discover what was causing it” said Ellen Greenberger, the lead author of the study, called “Self-Entitled College Students: Contributions of Personality, Parenting, and Motivational Factors,” which appeared last year in The Journal of Youth and Adolescence.
Professor Greenberger said that the sense of entitlement could be related to increased parental pressure, competition among peers and family members and a heightened sense of achievement anxiety.
Aaron M. Brower, the vice provost for teaching and learning at the University of Wisconsin-Madison, offered another theory.
“I think that it stems from their K-12 experiences,” Professor Brower said. “They have become ultra-efficient in test preparation. And this hyper-efficiency has led them to look for a magic formula to get high scores.”
James Hogge, associate dean of the Peabody School of Education at Vanderbilt University, said: “Students often confuse the level of effort with the quality of work. There is a mentality in students that ‘if I work hard, I deserve a high grade.’ “
In line with Dean Hogge’s observation are Professor Greenberger’s test results. Nearly two-thirds of the students surveyed said that if they explained to a professor that they were trying hard, that should be taken into account in their grade.
Jason Greenwood, a senior kinesiology major at the University of Maryland echoed that view.
“I think putting in a lot of effort should merit a high grade,” Mr. Greenwood said. “What else is there really than the effort that you put in?”
“If you put in all the effort you have and get a C, what is the point?” he added. “If someone goes to every class and reads every chapter in the book and does everything the teacher asks of them and more, then they should be getting an A like their effort deserves. If your maximum effort can only be average in a teacher’s mind, then something is wrong.”
Sarah Kinn, a junior English major at the University of Vermont, agreed, saying, “I feel that if I do all of the readings and attend class regularly that I should be able to achieve a grade of at least a B.”
At Vanderbilt, there is an emphasis on what Dean Hogge calls “the locus of control.” The goal is to put the academic burden on the student.
“Instead of getting an A, they make an A,” he said. “Similarly, if they make a lesser grade, it is not the teacher’s fault. Attributing the outcome of a failure to someone else is a common problem.”
Additionally, Dean Hogge said, “professors often try to outline the ‘rules of the game’ in their syllabi,” in an effort to curb haggling over grades.
Professor Brower said professors at Wisconsin emphasized that students must “read for knowledge and write with the goal of exploring ideas.”
This informal mission statement, along with special seminars for freshmen, is intended to help “re-teach students about what education is.”
The seminars are integrated into introductory courses. Examples include the conventional, like a global-warming seminar, and the more obscure, like physics in religion.
The seminars “are meant to help students think differently about their classes and connect them to real life,” Professor Brower said.
He said that if students developed a genuine interest in their field, grades would take a back seat, and holistic and intrinsically motivated learning could take place.
“College students want to be part of a different and better world, but they don’t know how,” he said. “Unless teachers are very intentional with our goals, we play into the system in place.”
February 18, 2009
Student Expectations Seen as Causing Grade Disputes
By MAX ROOSEVELT
Prof. Marshall Grossman has come to expect complaints whenever he returns graded papers in his English classes at the University of Maryland.
“Many students come in with the conviction that they’ve worked hard and deserve a higher mark,” Professor Grossman said. “Some assert that they have never gotten a grade as low as this before.”
He attributes those complaints to his students’ sense of entitlement.
“I tell my classes that if they just do what they are supposed to do and meet the standard requirements, that they will earn a C,” he said. “That is the default grade. They see the default grade as an A.”
A recent study by researchers at the University of California, Irvine, found that a third of students surveyed said that they expected B’s just for attending lectures, and 40 percent said they deserved a B for completing the required reading.
“I noticed an increased sense of entitlement in my students and wanted to discover what was causing it” said Ellen Greenberger, the lead author of the study, called “Self-Entitled College Students: Contributions of Personality, Parenting, and Motivational Factors,” which appeared last year in The Journal of Youth and Adolescence.
Professor Greenberger said that the sense of entitlement could be related to increased parental pressure, competition among peers and family members and a heightened sense of achievement anxiety.
Aaron M. Brower, the vice provost for teaching and learning at the University of Wisconsin-Madison, offered another theory.
“I think that it stems from their K-12 experiences,” Professor Brower said. “They have become ultra-efficient in test preparation. And this hyper-efficiency has led them to look for a magic formula to get high scores.”
James Hogge, associate dean of the Peabody School of Education at Vanderbilt University, said: “Students often confuse the level of effort with the quality of work. There is a mentality in students that ‘if I work hard, I deserve a high grade.’ “
In line with Dean Hogge’s observation are Professor Greenberger’s test results. Nearly two-thirds of the students surveyed said that if they explained to a professor that they were trying hard, that should be taken into account in their grade.
Jason Greenwood, a senior kinesiology major at the University of Maryland echoed that view.
“I think putting in a lot of effort should merit a high grade,” Mr. Greenwood said. “What else is there really than the effort that you put in?”
“If you put in all the effort you have and get a C, what is the point?” he added. “If someone goes to every class and reads every chapter in the book and does everything the teacher asks of them and more, then they should be getting an A like their effort deserves. If your maximum effort can only be average in a teacher’s mind, then something is wrong.”
Sarah Kinn, a junior English major at the University of Vermont, agreed, saying, “I feel that if I do all of the readings and attend class regularly that I should be able to achieve a grade of at least a B.”
At Vanderbilt, there is an emphasis on what Dean Hogge calls “the locus of control.” The goal is to put the academic burden on the student.
“Instead of getting an A, they make an A,” he said. “Similarly, if they make a lesser grade, it is not the teacher’s fault. Attributing the outcome of a failure to someone else is a common problem.”
Additionally, Dean Hogge said, “professors often try to outline the ‘rules of the game’ in their syllabi,” in an effort to curb haggling over grades.
Professor Brower said professors at Wisconsin emphasized that students must “read for knowledge and write with the goal of exploring ideas.”
This informal mission statement, along with special seminars for freshmen, is intended to help “re-teach students about what education is.”
The seminars are integrated into introductory courses. Examples include the conventional, like a global-warming seminar, and the more obscure, like physics in religion.
The seminars “are meant to help students think differently about their classes and connect them to real life,” Professor Brower said.
He said that if students developed a genuine interest in their field, grades would take a back seat, and holistic and intrinsically motivated learning could take place.
“College students want to be part of a different and better world, but they don’t know how,” he said. “Unless teachers are very intentional with our goals, we play into the system in place.”
Friday, February 13, 2009
The New York Times
February 13, 2009
Sensors Help Keep the Elderly at Home
By JOHN LELAND
Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.
Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.
A wireless sensor under Ms. Branch’s bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.
Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.
But the devices, which can be expensive, remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.
Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.
“I lost a very close friend recently,” she said. “She was also diabetic and she fell during the night. She didn’t have the sensors. She went into a coma.”
Without the sensors, Ms. Branch said, “I would probably be dead.”
Stories like Ms. Branch’s show the potential of relatively simple devices to provide comfort and independence to an aging population that is quickly outgrowing the resources of doctors, nurses, hospitals and health care dollars available to it.
The cost for Ms. Branch’s basic system, supplied by a health care provider called New Courtland as part of a publicly financed program, is about $100 a month, far less than a nursing home, where the costs to taxpayers can exceed $200 a day. In the two years Mrs. Branch has had the system, she has fallen three times and been stuck once in the bathtub, each time unable to call for help without it.
“On an individual basis, we’ve demonstrated that they can be very effective,” said Brent Ridge, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York. “But until they’re launched on a wide-scale basis, you just don’t know. Physicians might say, ‘I’m already overstretched, I don’t have time for all this data.’ ”
At a white ranch-style house in Middletown, N.J., Joseph Hayduk, 86, a retired Air Force lieutenant colonel, is greeted by a voice from a small box: “Good morning. It is now time to record your vital signs.” Mr. Hayduk has been using the device since 2006, after his second heart attack, through a program run by Meridian Health.
He stepped on a scale. “Are you experiencing more difficulty breathing today, compared to a usual day?” the voice asked. Mr. Hayduk pressed yes.
“That’s normal for me,” he said.
“Are your ankles more swollen than usual?” the machine asked. In patients with chronic heart failure, swelling or weight gain can indicate that they are retaining fluid. Mr. Hayduk pressed no. After a blood pressure reading, the device signaled that it had relayed the information to Meridian Health.
There, a nurse calls all 18 patients in the program daily, starting with the ones whose data call for urgent attention. One morning, Mr. Hayduk left the house before the nurse’s call. As he sat on his neighbor’s porch, he watched a police car pull up to his house to check on him.
Mr. Hayduk chuckled at the memory, but said that the system had allowed him to stay in his home of 37 years.
“This system’s invaluable to me, not only physically, but psychologically,” he said. “I don’t want to be in assisted living. That’s for people in wheelchairs and walkers.”
Philip Marshall, 85, another Meridian Health patient, uses a system tied to his cellphone to help him remember his medications. Mr. Marshall has high blood pressure and macular degeneration, and takes 10 pills a day. He cannot see a clock or work the buttons on most phones, so he uses a Jitterbug, a phone with big buttons and limited functions.
Drug compliance is one of the biggest problems for the elderly, especially those with memory loss. Until Mr. Marshall got Meridian’s Jitterbug system, his daughter Melanie, 55, said she had to leave work several times a month to help him with his drugs. “I’m answering the phone in meetings,” she said. “He’d forget whether he took a pill or whether he was supposed to take a pill.”
The system, which costs $20 a month, calls him after he is scheduled to take a pill and asks if he has taken it; if not, it asks him why not and sends automated alerts to his daughters.
“I worry a lot,” Mr. Marshall said. “All my life. So this gives me peace of mind.”
He added that knowing that a call was coming had helped him remember to take his medications before the phone rang.
This is the ultimate goal of personal health monitoring — that people who know they are being watched may modify their behavior to better their health. Jeffrey Kaye, director of the aging and Alzheimer’s and memory assessment clinics at Oregon Health and Science University, said one of the most useful health technologies was a cheap pedometer, because carrying one motivated people to walk more.
But Stuti Dang, who directs dementia care for the Miami Veterans Affairs Healthcare System and uses monitoring systems to track the vital signs of 400 patients, said one unforeseen consequence of the system was that “it somehow absolves their kin of the responsibility.”
“The daughter doesn’t have to call every day because she knows if something was wrong with her father, she would receive an alert,” Dr. Dang said, adding: “It’s good for the patient, but there needs to be personal responsibility. As a provider, I don’t want to be responsible for my patient 24 hours a day.”
Raymond Carroll, 59, a retired school administrator, said he went online every day to check on his mother, Viola Carroll, 85, who lives in a building in Queens run by Selfhelp, a nonprofit organization that assists Holocaust survivors. Mr. Carroll checks the temperature of her apartment and calls if it is too hot. Since a system of motion detectors called Quiet Care was installed three years ago, on a grant from Selfhelp, he said he probably called more often but visited less.
Marvin Joss, whose mother, Ray, 89, is also in a Selfhelp building, said the system had helped improve their conversations. “In the past, I tried to spend more time on, ‘How are you feeling?’ ” Mr. Joss said. “I still ask those questions, but now it’s more to an idea of having a conversation, not trying to listen for clues about whether she’s O.K. ”
The future of these technologies, and the terabytes they gather, can involve unprecedented information about the whereabouts and well-being of older people. In a program with Intel, Dr. Kaye is combing motion data for patterns that indicate the onset of dementia, years before the decline shows up on cognitive tests.
But until there is more research — and reimbursement — the technologies’ ultimate impact remains unknown.
“It’s not that we need new technologies,” Dr. Kaye said. “We need to use what we have more creatively. It’s all cool — but is it going to be helpful?”
February 13, 2009
Sensors Help Keep the Elderly at Home
By JOHN LELAND
Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.
Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.
A wireless sensor under Ms. Branch’s bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.
Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.
But the devices, which can be expensive, remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.
Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.
“I lost a very close friend recently,” she said. “She was also diabetic and she fell during the night. She didn’t have the sensors. She went into a coma.”
Without the sensors, Ms. Branch said, “I would probably be dead.”
Stories like Ms. Branch’s show the potential of relatively simple devices to provide comfort and independence to an aging population that is quickly outgrowing the resources of doctors, nurses, hospitals and health care dollars available to it.
The cost for Ms. Branch’s basic system, supplied by a health care provider called New Courtland as part of a publicly financed program, is about $100 a month, far less than a nursing home, where the costs to taxpayers can exceed $200 a day. In the two years Mrs. Branch has had the system, she has fallen three times and been stuck once in the bathtub, each time unable to call for help without it.
“On an individual basis, we’ve demonstrated that they can be very effective,” said Brent Ridge, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York. “But until they’re launched on a wide-scale basis, you just don’t know. Physicians might say, ‘I’m already overstretched, I don’t have time for all this data.’ ”
At a white ranch-style house in Middletown, N.J., Joseph Hayduk, 86, a retired Air Force lieutenant colonel, is greeted by a voice from a small box: “Good morning. It is now time to record your vital signs.” Mr. Hayduk has been using the device since 2006, after his second heart attack, through a program run by Meridian Health.
He stepped on a scale. “Are you experiencing more difficulty breathing today, compared to a usual day?” the voice asked. Mr. Hayduk pressed yes.
“That’s normal for me,” he said.
“Are your ankles more swollen than usual?” the machine asked. In patients with chronic heart failure, swelling or weight gain can indicate that they are retaining fluid. Mr. Hayduk pressed no. After a blood pressure reading, the device signaled that it had relayed the information to Meridian Health.
There, a nurse calls all 18 patients in the program daily, starting with the ones whose data call for urgent attention. One morning, Mr. Hayduk left the house before the nurse’s call. As he sat on his neighbor’s porch, he watched a police car pull up to his house to check on him.
Mr. Hayduk chuckled at the memory, but said that the system had allowed him to stay in his home of 37 years.
“This system’s invaluable to me, not only physically, but psychologically,” he said. “I don’t want to be in assisted living. That’s for people in wheelchairs and walkers.”
Philip Marshall, 85, another Meridian Health patient, uses a system tied to his cellphone to help him remember his medications. Mr. Marshall has high blood pressure and macular degeneration, and takes 10 pills a day. He cannot see a clock or work the buttons on most phones, so he uses a Jitterbug, a phone with big buttons and limited functions.
Drug compliance is one of the biggest problems for the elderly, especially those with memory loss. Until Mr. Marshall got Meridian’s Jitterbug system, his daughter Melanie, 55, said she had to leave work several times a month to help him with his drugs. “I’m answering the phone in meetings,” she said. “He’d forget whether he took a pill or whether he was supposed to take a pill.”
The system, which costs $20 a month, calls him after he is scheduled to take a pill and asks if he has taken it; if not, it asks him why not and sends automated alerts to his daughters.
“I worry a lot,” Mr. Marshall said. “All my life. So this gives me peace of mind.”
He added that knowing that a call was coming had helped him remember to take his medications before the phone rang.
This is the ultimate goal of personal health monitoring — that people who know they are being watched may modify their behavior to better their health. Jeffrey Kaye, director of the aging and Alzheimer’s and memory assessment clinics at Oregon Health and Science University, said one of the most useful health technologies was a cheap pedometer, because carrying one motivated people to walk more.
But Stuti Dang, who directs dementia care for the Miami Veterans Affairs Healthcare System and uses monitoring systems to track the vital signs of 400 patients, said one unforeseen consequence of the system was that “it somehow absolves their kin of the responsibility.”
“The daughter doesn’t have to call every day because she knows if something was wrong with her father, she would receive an alert,” Dr. Dang said, adding: “It’s good for the patient, but there needs to be personal responsibility. As a provider, I don’t want to be responsible for my patient 24 hours a day.”
Raymond Carroll, 59, a retired school administrator, said he went online every day to check on his mother, Viola Carroll, 85, who lives in a building in Queens run by Selfhelp, a nonprofit organization that assists Holocaust survivors. Mr. Carroll checks the temperature of her apartment and calls if it is too hot. Since a system of motion detectors called Quiet Care was installed three years ago, on a grant from Selfhelp, he said he probably called more often but visited less.
Marvin Joss, whose mother, Ray, 89, is also in a Selfhelp building, said the system had helped improve their conversations. “In the past, I tried to spend more time on, ‘How are you feeling?’ ” Mr. Joss said. “I still ask those questions, but now it’s more to an idea of having a conversation, not trying to listen for clues about whether she’s O.K. ”
The future of these technologies, and the terabytes they gather, can involve unprecedented information about the whereabouts and well-being of older people. In a program with Intel, Dr. Kaye is combing motion data for patterns that indicate the onset of dementia, years before the decline shows up on cognitive tests.
But until there is more research — and reimbursement — the technologies’ ultimate impact remains unknown.
“It’s not that we need new technologies,” Dr. Kaye said. “We need to use what we have more creatively. It’s all cool — but is it going to be helpful?”
Friday, February 06, 2009
The New York Times
February 10, 2009
Vital Signs
Behavior: TV Time Linked to Depression in Future
By NICHOLAS BAKALAR
Lengthy television viewing in adolescence may raise the risk for depression in young adulthood, according to a new report.
The study, published in the February issue of The Archives of General Psychiatry, found a rising risk of depressive symptoms with increasing hours spent watching television. There was no association of depression with exposure to computer games, videocassettes or radio.
Researchers used data from a larger analysis of 4,142 adolescents who were not depressed at the start of the study. After seven years of follow-up, more than 7 percent had symptoms of depression. But while about 6 percent of those who watched under three hours a day were depressed, more than 17 percent of those who watched more than nine hours a day had depressive symptoms.
The association was stronger in boys than in girls, and it held after adjusting for age, race, socioeconomic status and educational level.
“We really don’t know what it was specifically about TV exposure that was associated with depression, whether it was a particular kind of programming or some contextual factor such as watching alone or with other people,” said Dr. Brian Primack, the lead author and an assistant professor of medicine at the University of Pittsburgh. “Therefore, I would be uneasy to make any blanket recommendations based on this one study.”
February 10, 2009
Vital Signs
Behavior: TV Time Linked to Depression in Future
By NICHOLAS BAKALAR
Lengthy television viewing in adolescence may raise the risk for depression in young adulthood, according to a new report.
The study, published in the February issue of The Archives of General Psychiatry, found a rising risk of depressive symptoms with increasing hours spent watching television. There was no association of depression with exposure to computer games, videocassettes or radio.
Researchers used data from a larger analysis of 4,142 adolescents who were not depressed at the start of the study. After seven years of follow-up, more than 7 percent had symptoms of depression. But while about 6 percent of those who watched under three hours a day were depressed, more than 17 percent of those who watched more than nine hours a day had depressive symptoms.
The association was stronger in boys than in girls, and it held after adjusting for age, race, socioeconomic status and educational level.
“We really don’t know what it was specifically about TV exposure that was associated with depression, whether it was a particular kind of programming or some contextual factor such as watching alone or with other people,” said Dr. Brian Primack, the lead author and an assistant professor of medicine at the University of Pittsburgh. “Therefore, I would be uneasy to make any blanket recommendations based on this one study.”
