Redefining the "irreversible coma"

You come across an accident and the person that tumbled from their motorbike is dead; as defined by the cessation of all vital functions including the heartbeat, brain activity, and breathing. Then technology arrives and shocks the heart back into beating and they bag breath for the biker until he can be hooked up to an artificial ventilator. The body is sustained, but the person is in a coma. This is not a alpha coma or a alcoholic, diabetic, hepatic, myxedema, Kussmaul's, metabolic, or uremic coma. This is an irreversible coma which means that every second after blood stopped flowing to the brain, the brain started shutting down. But is the person dead? It's true that had technology not stepped in the biker would have died. But was it's purpose ever to save the life of the biker or to preserve the body for organ transplant? Since identifying the moment of death may now involve another life, biomedicine has made the effort to precisely define death in order to avoid "false positive errors ... People must never be misdiagnosed as biologically dead when in fact they are alive." (Lock,191) I'm going to take a look into what is the criteria for death and it's changes, how redefining death commodified organs, and what the future holds for those in a irreversible coma or brain-dead.

According to the medical dictionary, there are twelve current indicators that death has occured. These are not mutually exclusive, but are accumulative and are as follows.
#1) no pupil reaction to light
#2) no response of the eyes to caloric (warm or cold) stimulation
#3) no jaw reflex (the jaw will react like the knee if hit with a reflex hammer)
#4) no gag reflex (touching the back of the throat induces vomiting)
#5) no response to pain
#6) no breathing
#7) a body temperature above 86 °F (30 °C), which eliminates the possibility of resuscitation following cold-water drowning
#8) no other cause for the above, such as a head injury
#9) no drugs present in the body that could cause apparent death
#10) all of the above for 12 hours
#11) all of the above for six hours and a flat-line electroencephalogram (brain wave study)
#12) no blood circulating to the brain, as demonstrated by angiography
In the past, there were various identifiers of death depending on where one lived, what religion they had, or what cultural beliefs were in place. In addition, death's value to those that lived was determined by the culture norms. The reason death became specific with the list above is because those in a irreversible coma became not only takers of time, money, and emotions, but also givers. And anywhere that there is taking and giving, by definition, exchange is happening; which is the driver of commodities.


"Without transplant technologies, aside from possible use for experimentation, human organs could have no value other than to the individual in whom they reside, and then only if they remain healthy." (Lock, 48) However, with the arrival of the artificial ventilator and other equipment, the brain-dead have taken on new value - that of their organs. Do the needs of the many out weigh the needs of the one? "Only between 2 and 5 percent of patients in ICUs are eventually declared brain-dead. The organs of brain-dead donors were, from the outset, a scarce resource, and it was evident that the urgent need for organs might threaten the presumption that every effort should be made to preserve human life." (Lock, 65) That effort comes with a cost.
*A heart cost approximately $787,700
*A single lung costs $450,400
*Two lungs cost $657,800
*Heart and lungs $1,123,800
*A liver costs $523,400
*A kidney costs $259,000
*The pancreas costs $275,200
*The intestines costs $1,121,800
"Commodity candidacy" is culturally determined.(pg 46) As long as there are people that want what other has to give, then they are candidates. But how can it be determined what a person in an irreversible coma wants? With media and altruistic adds saying that, "when your life is done, give life to another - sign your donor card." Why wouldn't someone want to do so? They are done using the organs after all. Or are they? What if the coma isn't the end and recovery is possible? Is organ transplantation the best that we have to offer the brain-dead?

There are many who oppose making the person in an "irreversible" coma the definition of dead. The fact that the brain does not cease functioning or the body working as an integrated unit bothers them. "The claim that whole brain death marks the end of unified organic integration of a human being is empirically false," and that, "if the brain-dead is a 'corpse' it certainly has some unusual properties ... brain-dead patients suitably maintained, can breath, circulate blood, digest food, filter wastes, maintain body temperature, generate new functions, and fulfill other functions as well." (Potts, 129-130) The fact that these coma patients require machinery to stay alive is immaterial in defining death. This is because it is not so very different than a man walking on the street with a pace-maker near his heart, or a woman working a job to feed and shelter her body. Sustaining life in the modern world requires machinery in one aspect or another; therefore, a living organism is defined by it's ability to function as a integrated being. And if it's alive then it has identity and rights to live.

Will the future hold something more than commodification for those in an irreversible coma? Probably not. Once something organic has achieved the status of commodity, like slavery, history has shown that those in power over it will hardly let it go. Is there a problem with "removing organs from someone whose heart is still beating?" (Lock, 44) Perhaps there is, but as a culture we have yet to oppose powerful exchangers from dictating their desires in the legal, medicinal, and personal realms. Many of us will wait to see what technology has to offer next in defining death, but there is no guarantees that it will ever be right.


Bibliography

Lock, Margaret M. 2002. Twice dead: organ transplants and the reinvention of death. California series in public anthropology, 1. Berkeley: University of California Press.

Potts, Michael, Paul A. Byrne, and Richard G. Nilges. 2000. Beyond brain death: the case against brain based criteria for human death. Philosophy and medicine, v.66. Dordrecht: Kluwer Academic Publishers.

"Death." The Free Dictionary. http://medical-dictionary.thefreedictionary.com/death

"Financing a Transplant." Transplant living. http://www.transplantliving.org/beforethetransplant/finance/costs.aspx

Mind Games

As Nikolas Rose goes into the advances made in "The Decade of the Brain," he quotes Michael Trimble in claiming that, "with our present knowledge the distinction between 'organic' and 'functional' melts away, stripped of its Cartesian dualism." (pg 180) Advances in psychiatry takes on a more biological role in the studies of: brain chemistry, brain functions, experimental modeling systems, investigative techniques, human subjects, and truth technologies. And it is these great discoveries and testing that altered the crazy into just ailing "one located within the brain, metal disorders can sometimes, and somehow, escape from the stigma of madness, and become simply diseases like any others." And once they can be identified they can be treated with psychopharmaceuticals. Were these drugs really meant to treat an individual of a psychiatric illness? Or were these drugs created for profit? and where can a mentally ill person seek help?

Since the United States allows direct-to-consumer advertising, "'disease mongering' has become a key marketing tactic," where "ethical" shifts in tactics would just bring in more marketing expenses. (pg 214-215) So consumers have excepted this educational role because it also gives them insite and a share of responsibility in managing their mental health. "Person's are increasingly demanding control over the medical practices that subject them, seeking multiple forms of expert and nonexpert advice in devising their life strategies, and demanding that medics act as the servants and not the masters of this process." (pg 218) However, they're not, and so it becomes a "mind game" between self study and marketing techniques to convince the consumer that their psychopharmaceutical is what the mentally ailing person needs. Which easily encourages consumers to undergo the consumer-industry relationship. But what about the psychiatrists themselves? Are they objective doctor's or puppets to the drug companies?


The above photo is from the "the Great Scientology Protest against Psychiatry in San Francisco" in 2009. Apparently, the American Psychiatric Association (APA) is the nationwide organization to which most psychiatrists belong. Dr. Loren Mosher, who resigned from the APA, states that, "a large proportion of its income is from drug company advertising in its journals and newspaper. It also receives 'unrestricted educational grants' and convention revenue from drug companies. Drug company sponsored symposia and exhibitions dominate the two major annual psychiatric conventions." She goes on to state that it is her opinion that, "the APA is so dependent on pharmaceutical company support that it can not afford to criticize the overuse and misuse of psychotropic drugs. Perhaps more importantly, the APA is unwilling to mandate education of psychiatrists about the the seriousness of the short and long-term toxicities and withdrawal reactions from the drugs." And it's spreading. These psychopharmaceuticals are not being prescribed to the "crazy" but also to everyone else; children and adult alike. Suddenly, depression, anxiety, excess energy, or not enough energy, are all causes for "treatment" with drugs that are made for profit by doctors that are paid to prescribe them.


There are doctors that "opposition to the escalating overuse of psychiatric medications, the oppressive diagnosing and drugging of children, electroshock, lobotomy, involuntary treatment, and false biological theories," and Dr. Peter Breggin is one of them. On his website he has many articles about legal cases, scientific papers, and drug hazards along with key articles like "Violence and Suicide caused by Antidepressants" and "Mental dysfunction and addiction caused by benzodiazepines". This Harvard trained psychiatrist probably sees the irony when people call him "the conscience of psychiatry".


"Were these drugs really meant to treat an individual of a psychiatric illness?" I had asked. On page 211 of Nikolas book "Politics of life itself: biomedicine, power, and subjectivity in the twenty-first century" he suggests that, "such drugs do not so much seek to normalize a deviant but to correct anomalies, to adjust the individual and restore and maintain his or her capacity to enter the circuits of everyday life." Take Luvox, for example, is a selective serotonin reuptake inhibitor (SSRIs) sometimes prescribed for the treatment of depression associated with bipolar disorder. Although the list of negative side affects is four times as long as the product description, it does help them enter the circuits of everyday life. So it is apparent that there are people that need this psychopharmaceuticals. But if the ruling party is a company who is only interested in earning more money, and have executive-regulation through a form of monetary control over physicians, schools, and hospitals, then how can the profession ever be objective? It can't. And so it will continue on in the form of "contemporary neurochemical selfhood, the blurring of the boundaries between treatment, recovery, manipulation, ..." (pg 223) until some ailments are helped and some are created.


Bibliography

Rose, Nikolas S. 2007. Politics of life itself: biomedicine, power, and subjectivity in the twenty-first century. Princeton: Princeton University Press.

"How Drug Company Money Has Corrupted Psychiatry." Loren R. Mosher, M.D. http://www.antipsychiatry.org/mosher.loren.1.htm

"Photos From the Great Scientology Protest against Psychiatry in San Francisco." San Francisco Citizen. http://sfcitizen.com/blog/2009/05/16/photos-from-the-great-scientology-protest-against-psychiatry-in-san-francisco (May 16th, 2009)

"Psychiatric Drug Facts with Dr. Peter Breggin." http://www.breggin.com (2008)

What makes a Homosexual?

Questions about the homosexual riddled the 19th and 20th centuries. Namely: is homosexuality a crime? is it unnatural? and is it a choice? These questions are viewed from many angles: the religious perspective, the biological perspective, the psychological perspective, the sociological perspective, the heterosexual perspective, and of course the perspective from the homosexual themselves. Some even ask if it is the "fault" of biology? the mother? the father? can we cure it? but few ask why they need to assign "fault" at all. I'm going to review the past theories of homosexuality, what does online sources tell us about homosexuality, and what homosexuals tell us about themselves.

In the effort define homosexuality to prevent the incarceration of homosexual men and women from their "offenses against nature" or rather against Judeo-Christian political control, doctors in the 19th century made it an "urgent medical matter." (pg 40) Jennifer Terry in her book "American Obsession" she initially focuses on the first three theories; naturalists, degenerationists, and psychogenists.

The Naturalists theory, definded by Karl Heinrich Ulrichs in 1864, regarded homosexuality to be an "inborn benign anomaly". That their psyches were hermaphroditic which was produced by two germ layers that are not in harmony. (pg 43-44)

The Degenerationists, defined first by Richard von Krafft-Ebing in 1886, believed that it is a nervous condition that is degenerating the men into "primitives". "Nervous exhaustion thus led to the emergence of a morphologically undifferentiated class of defective individuals who were neither clearly male nor female, and who were hypersexual." (pg.49)

And finally the Psychogenists theory, defined by Sigmund Freud in 1908, is that "homosexuality was a stage in normal childhood development, passed through by all individuals during the course of the Oedipus complex" and is related to the latent homosexuality that arises when a child's "difficulty in adjusting to the psychosexual demands of maturation." (pg 56-61) After 50 years of efforts in defining homosexuality medically, to the theorist, homosexuality was suggested to be inferior and a perversion, linked to narcissism, and threatening to the culture; which was not a large step at all from the Judeo-Christian politics.

The Catholic Apologentics International online has used statistics to endorse their stand that homosexuality in not only unhealthy for the individual, but also for the culture. Below, I've listed a few of statistics reported on their blog.
*One study reports that the average homosexual has between 20 and 106 partners per year. The average heterosexual has 8 partners in a lifetime.
*Many homosexuals don't pay heed to warnings of their lifestyles: "Knowledge of health guidelines was quite high, but this knowledge had no relation to sexual behavior."
*37% of homosexuals engage in sadomasochism, which accounts for many accidental deaths. In San Francisco, classes were held to teach homosexuals how to not kill their partners during sadomasochism.
*41% of homosexuals say they have had sex with strangers in public restrooms, 60% say they have had sex with strangers in bathhouses, and 64% of these encounters have involved the use of illegal drugs.
*Depending on the city, 39-59% of homosexuals are infected with intestinal parasites like worms, flukes and amoebae, which is common in filthy third world countries.
*Captain William Riddle of the Los Angeles Police says, "30,000 sexually abused children in Los Angeles were victims of homosexuals."
*Homosexuals commit more than 33% of all reported child molestations in the United States, which, assuming homosexuals make up 2% of the population, means that 1 in 20 homosexuals is a child molestor, while 1 in 490 heterosexuals is a child molestor.
*73% of all homosexuals have had sex with boys under 19 years of age.
*78% of homosexuals are affected by STDs.
*Homosexuals were responsible for spreading AIDS in the United States, and it takes approximately $300,000 to take care of each AIDS victim. Even today, homosexuals account for well over 50% of the AIDS cases in the United States.
*Homosexuals account for a disproportionate number of hepatitis cases: 70-80% in San Francisco, 29% in Denver, 66% in New York City, 56% in Toronto, 42% in Montreal, and 26% in Melbourne.
*50% of suicides can be attributed to homosexuals.
*The median age of death of homosexuals is 42 (only 9% live past age 65). This drops to 39 if the cause of death is AIDS. The median age of death of a married heterosexual man is 75.
*The median age of death of lesbians is 45 (only 24% live past age 65). The median age of death of a married heterosexual woman is 79.

http://www.youtube.com/watch?v=LYMjXucTFaM

What's also online can be humorous in cartoon form. Where a cartoon that walks through some of the theories with humor.

http://www.youtube.com/watch?v=_Osw05HGe5I

And this link is an 8 minute clip on the Nurture/Nature debate which in an introductory video for psychology classes. In this case there are two twin boys, one likes airplanes and GI Joe's while the other boy likes horses, dolls and stuffed Pokemon. The second young boy is said to have childhood gender nonconformity. A doctor later in the clip indicates that the environment in the womb may be a determining factor and that it might not be the genes or the environment that makes the alteration, but the hormones released to each fetus. Online there are many links with various spins, but a common theme is that society is still trying to determine the "right" or "wrongness" of homosexuality.

Perhaps it is not what is defined by science or culture that is important, but what those that homosexuals think themselves. Natalie Barney considered herself homosexual since she was twelve and wrote in 1899, "I consider myself without shame: albinos aren't reproached for having pink eyes and whitish hair. Why should they hold it against me for being lesbian? It's a question of Nature. My queerness isn't a vice, isn't deliberate, and harms no one." (pg 71) In 1900, she published a book of her love poems to women, which was tracked down and destroyed by her father.

Also, in a 60's film on humanity and homosexuality, Larz Larson states that the realization of his homosexuality was frightening. That whatever the reason, he was oriented to the masculine. In an effort to explore this discovery he traveled to the french quarter in New Orleans. After 7 days without "experience" he decided that if that environment was what homosexuality was about that he didn't want anything to do with it. He thought it was ugly. But then later, on a weekend trip with a roommate he had a "grand experience". There was alot Larz had to fear in the 1960's for being a homosexual. For an occasional act of intimacy, homosexuals could get five to sixty years in prison; which is a greater sentence than 2nd degree murder, six times that of an abortion, two times that of a bank robbery, and seven hundred and thirty times that of a drunk driver. In the video You Don't Know Dick, a transsexual male stated, "If you perceive me in my female body as male, then I worry about discovery as being female and accused of deceiving. If you perceive me as female ... then it is as if I didn't exist at all."

Even though, it may appear that the "medical writing about homosexuality from the 1860's to 1920's was, oh the whole, speculative and far from scientifically credible" I don't think it should be dismissed altogether unless you are ready to dismiss the "fault" or question in it's entirety. Much more can be said or done on theories to satisfy where they fit in the culture, but the fact remains that they are a part of our culture and not "crazy". Maybe in time those that need an answere, both homosexual and heterosexual alike, will get it. But for now, we need to work together to make our culture a healthy environment for both the heterosexual and the homosexual.


Bibliography

Terry, Jennifer. 1999. An American obsession: science, medicine, and homosexuality in modern society. Chicago: University of Chicago Press.

"Homosexuality: Nature vs. Nurture." Video toolkit for Introductory Psychology. CBS News. http://www.youtube.com/watch?v=_Osw05HGe5I (June 03, 2008)

"Is Homosexuality a Choice." http://www.youtube.com/watch?v=LYMjXucTFaM

"The Statistics on Homosexuality and its Effects." Catholic Apologentics International. http://www.freerepublic.com/focus/f-news/1502263/posts (Oct. 14, 2005)

The Taste of Health

"Let your food be your medicine." - Hippocrates


A restaurant opened up in Wichita, Kansas, called "The Taste of Health". It uses Hippocrates quote, "Let food be your medicine and medicine be your food," as a tag-line for their new age of dinning. The Taste of Health is also attached to The Center For The Improvement Of Human Functioning International, a non-profit medical, research, and educational organization. The visitor to their online site has various ways to investigate their health and what the clinic or restaurant offers. For example, one way online that they promote their services is by having the guest check their thyroid function with the "Necker Cube" to the right. They are told to look at the "X" in the middle of the cube and watch the "Necker Cube" flip-flop, with the front becoming the back, and then the back becoming the front. They say that on average, a person sees the cube flip several times in a minute. Anyone whose flip-flop perception is considerably fast or slow are encouraged to ask a physician to check their thyroid function. This can be a tangible "ah, ha!" to the online visitor and they can continue on to fill out a doctor prescreaning questionnaire for the clinic.


As the online visitor explores their site more they will come to what are called "NutriCircles" as seen above. Then as one is looking at the healthy versus non-healthy version of food, they can see by the lines which is giving them better mineral nutrition versus the one that is nearly "dead food". As Victor Rocine had said that, "If we eat wrongly, No doctor can cure us; if we eat rightly, No doctor is needed." As more Americans are becoming aware that their food matters, what are the requirements for something to be classified as a food or a medicinal treatment? Can food be our healer? and how does the average person regulate what is needed?

http://www.youtube.com/watch?v=de2Cmmlfp1c

This popular idea that the consumer is in control of their own health by eating well is highly visible. At the above link, Dr. Mark Hyman explains on his popular TV UltraWellness his course on "Food as Medicine: Powerful New Drug Could be at the End of Your Fork." He opens by saying that scientists have discovered this powerful drug that cures all chronic illnesses, which he then laughing tells the viewer that it is called "food". Later on in his recording, he mentions where he was told at one convention by chefs that food was all about the flavor and the taste, and not the health aspects. In Judith Farquhar's "Medicinal Meals" book, she also mentions flavor as a language and as an experience. However, the Chinese language for health comes in words such as ku (bitter) with various connotations. The most important being how it helps the body.

Quoting from a 1978 pharmacy textbook, Judith expands on the five flavors and their medicinal effects. For example, "Pungent has the function of spreading and disseminating, moving qi, moving blood, or nourishing with moisture... Sweet has the function of replenishing and supplementing, regulating the activity in the Middle Jiao, and moderating acuteness... Sour has the functions of contracting and constricting... Bitter has the function of draining and drying... Salty has the function of softening hardness, dispersing lumps, and draining downward..." (pg 65) Although these flavors may not please the palate like the chef's argued for, they do carry complex medicinal properties. "There's no doubt, I think, that for a medicine to do anything very complicated it must assault the sufferer with a strong and complex flavor."(pg 63) But medicinal foods and herbs are more than just flavor, in China they are also specific.

At the China Medical University Hospital a Chinese herbal pharmacy is situated in Mei-De medical center.







The Chinese herbal pharmacy is physically divided into pharmaceutical room, medicament room, decoction room, data management room and patient-awaiting room. It takes years of education for these doctors to learn the craft of customizing food and herbal medications. So how is it possible to for average person to know what to eat for optimal health? In Jean Retzinger's article she states, "the fact that the number of Americans actively engaged in and knowledgeable about food production has declined precipitously." (pg 151)

Assuming we as consumers know what to eat for health, we are also susceptible to advertisements that claim that their product will not only make us healthy, but beautiful too. This "gastro-porn" depends on imagery, innuendo, and our raised desire to eat healthy. What they don't tell you is how the healthy salad or herbal plants came about, if they used pesticides, or even retain any of their beneficial properties. For example, "More than 313,000 farm-workers in the United States may suffer pesticide-related illnesses annually." (pg 171) If it's not good for the farm worker, how is it good for the consumer? Are we Ivan Pavlovian's salivating dogs after gastro-porn, or informed consumers that aim to cure their chronic disease with the food at the end of the fork? Can optimal health really be achieved without the well educated doctor leading the patient through the herbal, pharmaceuticals, and nutrition? I like to think we, the lay people, can find the avenue to health through our diet. But we will need to be proactive in finding credible sources of information and food that is not contaminated or useless.

"Books on the medicinal uses of food and the alimentary uses of medicines are of several main types: traditionalist works that link medicinal foods to a long history of "life nurturance" (yang sheng) and preventive medicine, cuisine-oriented works that emphasize elegant presentation along with the special powers of ingredients combined in certain ways." (pg 51) These books seem like a great place to start one's personal journey to healthy or medicinal eating. How a consumer applies the knowledge is up to them. A goal I had placed for myself was to learn how to shop and prepare one healthy meal each week. I'm very busy between raising my daughter, being a full-time student, and running my home; so one a week was not too much for me to take on. However, after only a month I noticed the benefits of even just the addition of four new, easy, and healthy meals that I could prepare. The second place to start would be with an naturpathic doctor to help diagnose and treat any medical conditions that require immediate attention or that might be hard for the consumer to know what to eat. Regardless of the path chosen by the consumer, the facts remain that food can provide a medicinal effect and the average person can venture into self regulation and do so wisely with the help of resources: doctors, herbalists, nutritionists, and printed self study material. The more informed they become, the better their skill will be at eating for health and less for faulty "gastro-porn".



Bibliography

Farquhar, Judith. 2002. Appetites: food and sex in postsocialist China. Body, commodity, text. Durham, NC: Duke University Press.

LeBesco, Kathleen, and Peter Naccarato. 2008. Edible ideologies: representing food and meaning. Albany: State University of New York Press.

"Welcome to The Taste of Health Restaurant." http://www.brightspot.org/toh/index.shtml

“Food as Medicine: Powerful New Drug Could be at the End of Your Fork.” http://www.youtube.com/watch?v=de2Cmmlfp1c