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The challenge of doctor-patient relations in the internet age

     “Let me do some research and I’ll get back to you,” my patient said. My patient, a 19-year-old student, had already taken time off from school because of her anxiety. I was her psychiatrist, with over two decades of experience treating university students, and had just explained my diagnostic impressions based on a lengthy evaluation. I’d recommended that she try a medicine I expected would help. I’d also laid out the risks and benefits of other treatment options. 

      “Do you have additional questions I can answer?” I asked. I wanted to let her know that’s why I was there, to cull the research, to help make sense of it. “No, I like to go online and look for myself,” she said.

     More and more, I see students turning away from the expertise that a live person can offer and instead turning to the vast and somehow more objective-seeming “expertise” of the digital world.

     In an age when journalism we don’t like can be dismissed as “fake news,” suggesting that the information we do like is most credible, regardless of its source, it’s not hard to understand why young people do this. The medical profession itself, under managed care, has played a role as well, providing less time for doctor-patient interactions and undermining the chances that a personal relationship and trust can develop. Under the guise of efficiency, medical test results are now often released directly to patients, sometimes before or even without the benefit of any interpretation.

     But there’s danger in trusting data over people, as there is in thinking the expertise of all people is equivalent. When it comes to health, digital natives may not be learning how to navigate effectively. And the consequences could be harmful.

    The availability of health data on the internet has its benefits. Online, for example, we can find explanations and solutions for symptoms we might be too embarrassed, or afraid, to discuss with another person, in person. Or, for lifethreatening diseases, we can locate clinical trials our doctors may not be aware of.

     However, there’s also a lot of misleading information, and information that’s simply untrue. The internet is full of people selling things – supplements, treatment regimens that have not been rigorously tested, even prescription medications – and making false promises that have not been scrutinized by regulatory agencies. Sometimes, as in the case of some websites that promote “an anorexic diet” for “aggressive” weight loss, the information can encourage life-threatening behavior.

      Years ago, when we discussed paternalism versus patient autonomy in my medical school ethics class, I came down strongly in favor of autonomy. Who but the patient could best decide what was right for him or her? But years of clinical – and personal – experience have taught me that information in and of itself is insufficient. Judgment is also indispensable, especially in complex situations, and the capacity for good judgment rests within people, not data sets.

(Doris Iarovici is a psychiatrist at Harvard University’s Counseling and

Mental Health Services and the author of Mental Health Issues and the

University Student. www.nytimes.com, 01.03.2018. Adaptado.)

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Worshiping the false idols of wellness

     Before we go further, I’d like to clear something up: wellness is not the same as medicine. Medicine is the science of reducing death and disease, and increasing long and healthy lives. Wellness used to mean a blend of health and happiness. Something that made you feel good or brought joy and was not medically harmful — perhaps a massage or a walk along the beach. But it has become a false antidote to the fear of modern life and death.

    The wellness industry takes medical terminology, such as “inflammation” or “free radicals,” and polishes it to the point of incomprehension. The resulting product is a “Do It Yourself” medicine for longevity that comes with a confidence that science can only aspire to achieve.

     Let’s take the trend of adding a pinch of activated charcoal to your food or drink. While the black color is strikingly unexpected and alluring, it’s sold as a supposed “detox.” Guess what? It has the same efficacy as a spell from the local witch. Maybe it’s a matter of aesthetics. Wellness potions in beautiful jars with untested ingredients of unknown purity are practically packaged for Instagram.

     Medicine and religion have long been deeply intertwined, and it’s only relatively recently that they have separated. The wellness-industrial complex seeks to resurrect that connection. It’s like a medical throwback, as if the idyllic days of health were 5,000 years ago. Ancient cleansing rituals with a modern twist — supplements, useless products and scientifically unsupported tests.

     The dietary supplements that are the backbone of wellness make up a $30 billion a year business despite studies showing they have no value for longevity (only a few vitamins have proven medical benefits, like folic acid before and during pregnancy and vitamin D for older people at risk of falling). Modern medicine wants you to get your micronutrients from your diet, which is inarguably the most natural source.

     Yet the wellness-industrial complex has managed to pervert that narrative and make supplements a necessary tool for nonsensical practices, such as boosting the immune system or fighting the war on inflammation. The resulting fluorescent yellow urine from multivitamins may provide a false sense of efficacy, but it’s a fool’s gold (and the consequence of excessive B2 that couldn’t possibly be absorbed). So what’s the harm of spending money on charcoal for non-existent toxins or vitamins for expensive urine? Here’s what: the placebo effect or “trying something natural” can lead people with serious illnesses to postpone effective medical care. However, I admit that doctors can learn something from wellness. It’s clear that some people are looking for healers, so we must find ways to serve that need that are medically ethical.

(Jen Gunter. www.nytimes.com, 01.08.2018. Adaptado.)

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The fantastic appeal of fantasy

The fantasy genre starts where science ends

     Few things can brighten up a dark morning in a Scottish seaside resort during an Atlantic storm. Yet while sheltering in a bookshop from the rain, I had a moment of sunny revelation. Stacked almost as high as my 11-year-old self were copies of The Lord of the Rings, with a cover illustration that promised mystery and magic. That chance discovery started a lifelong love of the fantasy genre1 , both as reader and writer. 

   The fantasy genre has had more and more success, but today we’re in the middle of an unprecedented fantasy boom. Sales continue to rise and it is now the biggest genre in publishing. The more rational the world gets, with super-science all around us, the more we demand the irrational in our fiction.

     Fantasy is not simply a case of swords2 and sorcery3 . Yes, there is that by the shelf. But the genre is as broad as the imagination. The genre starts where science ends.

    “In these modern times, where most of us sit at computers, fantasy books offer a chance to break out of mundane moments,” says Mark Newton, an editor with the genre. “People like to explore themes that go beyond the limited palette that literary fiction claims to offer.” 

     A search for the origins of fantasy will usually have academics muttering about Beowulf or Homer’s The Iliad, but they come from a time when all stories were fantasy: gods and monsters and supernatural artefacts with humanity caught in the middle. The first modern fantasy writer is usually considered to be William Morris, in the late 19th Century. But it was the early 20th Century where fantasy really started to gain status.

     Fantasy fiction has always been about visionary ideas. You can get artful words in plenty of literary fiction, but being able to see beyond the boundaries4 of the world around us — now that’s a special skill.

     I don’t write fantasy fiction simply to provide a trapdoor5 from the real world. For me, the genre is about the reality. But instead of coming up against it, fantasy maps the unconscious aspirations of our modern society through allegory in story- -forms as old as humanity. It’s about turning off the mobile phone and the computer and remembering who we are in the deepest parts of ourselves.

(Mark Chadbourn. www.telegraph.co.uk, 12.04.2008. Adaptado.)

1genre: gênero. Categoria distintiva de composição literária, como romance, poesia etc.

2sword: espada.

3sorcery: feitiçaria.

4boundary: fronteira.

5trapdoor: alçapão

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Modern-day slavery: an explainer

Photograph: Mario Tama/Getty

   About 150 years after most countries banned slavery – Brazil was the last to abolish its participation in the transatlantic slave trade, in 1888 – millions of men, women and children are still enslaved. Contemporary slavery takes many forms, from women forced into prostitution, to child slavery in agriculture supply chains or whole families working for nothing to pay off generational debts. Slavery thrives on every continent and in almost every country. Forced labour, people trafficking, debt bondage and child marriage are all forms of modern-day slavery that affect the world’s most vulnerable people.

  Slavery is prohibited under the 1948 Universal Declaration of Human Rights, which states: “No one shall be held in slavery or servitude: slavery and the slave trade shall be prohibited in all their forms.”

  Definitions of modern-day slavery are mainly taken from the 1956 UN supplementary convention, which says: “debt bondage, serfdom, forced marriage and the delivery of a child for the exploitation of that child are all slavery-like practices and require criminalisation and abolishment”. The 1930 Forced Labour Convention defines forced labour as “all work or service which is exacted from any person under the menace of any penalty and for which the said person has not offered himself voluntarily”. As contemporary systems of slavery have evolved, new definitions, including trafficking and distinguishing child slavery from child labour, have developed. 

  Due to its illegality, data on modern-day slavery is difficult to collate. The UN’s International Labour Organisation (ILO) estimates that about 21 million people are in forced labour at any point in time. The ILO says this estimate includes trafficking and other forms of modern slavery. The only exceptions are trafficking for organ removal, forced marriage and adoption, unless the last two practices result in forced labour. The ILO calculates that 90% of the 21 million are exploited by individuals or companies, while 10% are forced to work by the state, rebel military groups, or in prisons under conditions that violate ILO standards. Sexual exploitation accounts for 22% of slaves.