p53 and Me

Shekinah N.C. Elmore, MD

NEJM May 24, 2018

This is an extraordinary Perspective piece in the New England Journal by a young oncology resident who has the p53  mutation. This is seen in people with Li-Fraumani syndrome.

" A mutation like mine threatens to consume your whole imagination, especially with regards to the future. You start making crazy calculations..."

" Genetic knowledge is power only if both clinician and patient are equipped to move beyond a result and toward action, even if that merely means living well with what we know."

 She feels that people like her need to be studied not just for the data of their genomics but to help build programs for learning to teach people how to live with the uncertainties that their mutations will engender. 

This short essay is has many valuable teaching moments. She says, "I want as many of my days as possible to be untethered to the scans, biopsies and long waiting room sojourns. This is a cry from one who has been there for minimally disruptive medicine.

Trying to Put a Value on the Doctor-Patient Relationship

This is an important article in the NY Times Sunday Magazine (May 20, 2018).

In its push for profits, the U.S. health care system has made it difficult for patients to get personal attention from doctors. But what if hands-on medicine actually saves money — and lives?

The question of what the role of a primary-care physician should be, and how it should be valued, has perhaps never been more urgent. That figure, typically a general practitioner, family doctor or internist, is a patient’s first and often most personal connection to the rest of the health care system. But well-known corporations are betting that Americans would prefer to have health care 'delivered' by a trusted brand rather than a trusted physician."

Kim Tingley's  thoughtful piece is a "keeper' worthy of study.

Photos from a famous 1948 Life magazine article on the life of a country doctor.

Body Ritual among the Nacirema

The anthropologist Clyde Kluckhohn has pointed out that man is distinguished from other living organisms by three characteristics of human activity: the systematic making of tools; the use of abstract language; and religion. Religion is a broad term, embodying not only belief in a supernatural power but also an elaborate web of myth, theology and ritual. Most people like religion in their hearts and in their houses of worship, and they are delighted that modern science has largely emancipated them from irrational ritual and ceremony in medical habits. It is both disturbing and instructive, therefore, to learn that right in the midst of Western civilization there is a tribe of natives that practices daily elaborate rituals filled with mysterious and magical elements designed to sustain the health and well-being of the body. Another distinguished anthropologist, Horace Miner, was able to gain the confidence of these natives, and he has reported on his scientific investigations in an illuminating essay entitled, "Body Ritual among the Nacirema."

See “Miner, “Body Ritual among the Nacirema” The American Anthropologist 1956

Miner’s essay was cited in Barbara Ehrenreich’s book, Natural Causes (2018)

Dermatological PUVA Ritual

High Energy Proton Beam Ritual

Norwegian High Priestess performs Skin Screening Ritual