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In the summer of 2009  I went on an Abraham Verghese binge and read everything he has published; listened to every radio interview I could find; and combed through the Stanford website to find speaking events. I’ve posted this NY Times article below as an introduction to Dr. Verghese.

If medicine continues to be a commodity rather than a human right, then we–the consumer–should know what choices we have.  Abraham Verghese gives me hope.

From October 11, By DENISE GRADY

STANFORD, Calif. — For a 55-year-old man with a bad back and a bum knee from too much tennis, Dr. Abraham Verghese was amazingly limber as he showed a roomful of doctors-in-training a twisting, dancelike walk he had spied in the hospital corridor the day before.

He challenged them to diagnose it. Hemiplegia? Sensory ataxia? Chorea? Spastic diplegia?

“It would be a shame to have someone with a gait that’s diagnostic, and yet we can’t recognize it,” he said.

It was their introduction to a rollicking workshop on abnormal gaits that soon had them shuffling, staggering and thrashing about, challenging one another.Parkinson’s? Neuropathy? Stroke?

Dr. Verghese (ver-GEESE) is the senior associate chairman for the theory and practice of medicine at Stanford University. He is also the author of two highly acclaimed memoirs, “My Own Country” and “The Tennis Partner,” and a novel, “Cutting for Stone,” which is now a best seller.

At Stanford, he is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.

Art and medicine may seem disparate worlds, but Dr. Verghese insists that for him they are one. Doctors and writers are both collectors of stories, and he says his two careers have the same joy and the same prerequisite: “infinite curiosity about other people.” He cannot help secretly diagnosing ailments in strangers, or wondering about the lives his patients lead outside the hospital.

“People are endlessly mysterious,” he said in an interview in his office at the medical school, where volumes of poetry share the bookshelves with medical texts, family photos and a collection of reflex hammers.

His sources of inspiration include W. Somerset Maugham and Harrison’s Principles of Internal Medicine. In addition to his medical degree, he has one from the writing workshop at the University of Iowa.

He is out to save the physical exam because it seems to be wasting away, he says, in an era of CT, ultrasound, M.R.I., countless lab tests and doctor visits that whip by like speed dates. Who has not felt slighted by a stethoscope applied through the shirt, or a millisecond peek into the throat?

Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.

Medical schools in the United States have let the exam slide, Dr. Verghese says, noting that over time he has encountered more and more interns and residents who do not know how to test a patient’s reflexes or palpate a spleen. He likes to joke that a person could show up at the hospital with a finger missing, and doctors would insist on an M.R.I., a CT scan and an orthopedic consult to confirm it.

Dr. Verghese trained before M.R.I. or CT existed, in Ethiopia and India, where fancy equipment was scarce and good examination skills were a matter of necessity and pride. He still believes a thorough exam can yield vital information and help doctors figure out which tests to order and which to skip — surely a worthwhile goal as the United States struggles to control health care costs, he said.

A proper exam also earns trust, he said, and serves as a ritual that transforms two strangers into doctor and patient.

“Patients know in a heartbeat if they’re getting a clumsy exam,” he said.

He has lectured and written about the erosion of examination skills, and his ideas have resonated with many doctors.

Stanford recruited him in 2007, in large part because of his enthusiasm for teaching the exam. He seized the bully pulpit.

“Coming from here, it’s taken more seriously,” he said.

With colleagues, he developed the Stanford 25, a list of techniques that every doctor should know, like how to listen to the heart or look at blood vessels at the back of the eye. The 25 are not the only exams or even the most important ones, he emphasizes — just a place to start.

Medical School, Interrupted

At times, Dr. Verghese said, he feels almost embarrassed by all the interest in his work, because the exam techniques he is teaching are nothing more than the same ones he learned in Ethiopia and India decades ago.

Two days a week he hides out to write, in a secret office that was part of the deal he made when Stanford recruited him. His name is not even on the door; he left the names of the previous occupants. There is no land line.

Like Dr. Marion Stone, the main character in “Cutting for Stone,” Dr. Verghese was born in Ethiopia. His parents were teachers from Kerala, a state in southern India. His mother had newspaper articles published there about life in Ethiopia. The family’s expectations were high.

“You were a doctor, engineer, lawyer or a failure,” Dr. Verghese said. He was always drawn to literature, but never imagined he could make living at it.

He left Ethiopia at 15 for two years of premedical studies in Madras, India, and then returned to Addis Ababa for medical school. By then his parents, worried about Ethiopia’s stability, had moved to the United States. But he had no desire to leave.

“I loved that land,” he recalled.

The medical training was rigorous. Students spent a year dissecting a cadaver, and then had to pass grueling essay exams.

“It was almost brutal,” he said. “But it left us changed in some fundamental way, like formatting a disk.”

Medical students in the United States today spend far less time studying anatomy — too little to learn it well, he said, shaking his head.

Civil war broke out in Ethiopia in 1974. Emperor Haile Selassie was deposed, and the military took over. During Dr. Verghese’s third year of medical school, the university was shut down. Soldiers were everywhere. A curfew was imposed, and troops patrolled at night in jeeps with mounted machine guns. Corpses lay in the streets. As a citizen of India, he was a foreigner, and it was time to get out. He joined his parents in Westfield, N.J.

America excited him. But he was a young man used to being on his own, thrust back into a small house with his parents, who urged him to finish his medical studies. He would have to start from scratch, earning a bachelor’s degree and then applying to medical schools, even though he already had more than two years of medical training.

He took a night job as a hospital orderly. He liked earning a paycheck, and he bought a used car, hung out with nurses and orderlies, and dated an American girl.

“I could see my blue-collar life starting to unfold,” he said. “I’d marry a Jersey girl, we’d live in an apartment someplace and take vacations in the Poconos when we could afford it.”

He lost his way during that period, he says, and it made him the black sheep of the family.

A Passionate Return to Training

Then one night at work he had an epiphany. He picked up a book that a medical student had left behind, the Harrison textbook. It’s a medical school classic, the same book he had studied in Ethiopia. He realized how much he had already invested in medicine, and what he would be throwing away if he did not resume his training. He finished medical school in India, and then did his residency in the United States, specializing in internal medicine and infectious disease.

He worked in Tennessee during the early days of the AIDS epidemic, before there were any effective treatments. Before AIDS, he said: “I must have been a conceited ass, full of knowledge. AIDS humbled a whole generation.”

He came to know many of his patients and their families. He visited their homes, attended their deaths and their funerals. One patient, near death, awoke when Dr. Verghese arrived, and opened his shirt to be examined one last time.

“It was like an offering,” Dr. Verghese said, with tears in his eyes. “To preside over the bed of a dying man in his last few hours. I listen, I thump, I don’t even know what I’m listening for. But doing it says: ‘I will never leave you. I will not let you die in pain or alone.’ There’s not a test you can offer that does that.”

His long hours and intense involvement with his patients led to his first book, “My Own Country,” but also drained him and contributed to the failure of his first marriage. Still, it was not a mistake to get so close, he insists.

“I’ve never bought this idea of taking a therapeutic distance,” he said. “If I see a student or house staff cry, I take great faith in that. That’s a great person, they’re going to be a great doctor.”

He met his present wife, Sylvia, in El Paso, where she had started a ministry to help people with AIDS. Their son, Tristan, is 12. Dr. Verghese also has two grown sons, Jacob and Steven, from his first marriage.

The Next Generation

Making hospital rounds with students, Dr. Verghese is in his element. He is impeccably dressed under the white coat, in a crisp dress shirt, pale silk tie and sharply pressed pants. His hair has made its retreat, and what remains is trimmed too close to hide the hearing aids that he has reluctantly begun to wear. He loves being in the wards, he says. It is the only place where his back does not ache.

On a morning in August, he peppered four students with rapid-fire questions, mini-lectures on science and the history of medicine, pointers on presenting cases, and jokes that made them roll their eyes or laugh, or both.

“What can alcohol do to the nervous system?” he asked. Damage the cerebellum, said one. Cause seizures, said another. “Come on, I want 10,” Dr. Verghese said, insistent but not bullying.

“What’s the most important part of the stethoscope?” They stared at him. “The part between the earpieces.” They moaned.

Striding down the corridor, he told them about an unusual condition that produces silver-colored stools.

“You’ll be so impressed you’ll want to take them home,” he said.

With a group of third-year medical students, he waited until they had taken their places around a patient’s bed, then asked them to turn their backs and look away.

What had they noticed on the bedside table? A lunch tray? A book? Clues to whether the patient could eat, whether he was alert? Did he look comfortable? Or did he seem to be in pain?

“What if the patient says, ‘Whatever you do, Doc, don’t bump the bed’?” Dr. Verghese asked, bumping the bed with his hip. “Consider peritonitis.”

The patient, a man in his 80s, grinned, enjoying the show, and seemed pleased to let the students practice palpating his spleen and percussing his lungs.

“Name five things that are better outside the body than in,” he asked, not mentioning that the answer appears in his novel: fluids, fetuses, foreign bodies, feces and flatus.

As they headed to the next room, Dr. Verghese told the students: “We’re going to walk these corridors and I’m going to ask you if you notice anything unusual. I’m going to ask you about someone I see along the way. Peek into patients’ rooms as you go by.”

They gathered around the next patient, leaning in close as Dr. Verghese pointed out signs of facial weakness — inability to raise the eyebrows, a lip that rose more on one side than the other when Dr. Verghese asked to see the patient’s teeth, one eye that blinked more often than the other.

In the corridor, he said, “Here’s your question: What about the lady in the next bed?”

As she had watched them walk by, only one of her eyes had moved. Just a few of the students had noticed.

“You can’t show up at the bedside and then turn on your skills,” he said. “You have to keep your game sharp all the time.”

Outside another patient’s room, he had a group of interns and residents palpating their own thighs as he showed them a technique for finding the right place to stick the needle when culturing an abscess.

“Wow!” said one of the group, whose needle had recently missed its mark. “Amazing. This is great.”

Dr. Verghese smiled. “I am here to astound you,” he said.

This article has been revised to reflect the following correction:

Correction: October 13, 2010

An article on Tuesday about Dr. Abraham Verghese, a Stanford medical professor who emphasizes the importance of physical examinations, referred incorrectly to Kerala, in southern India, where his parents came from, and to the prevalence of Christianity there. Kerala is a state, not a region, and although Christianity is prominent in some parts, the state is not predominantly Christian.

This is the number one shared article today. The article was published on Monday.

From the NY Times. By, Roni Caryn Rabin

Does a good massage do more than just relax your muscles? To find out, researchers at Cedars-Sinai Medical Center in Los Angeles recruited 53 healthy adults and randomly assigned 29 of them to a 45-minute session of deep-tissue Swedish massage and the other 24 to a session of light massage.

All of the subjects were fitted with intravenous catheters so blood samples could be taken immediately before the massage and up to an hour afterward.

To their surprise, the researchers, sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, found that a single session of massage caused biological changes.

Volunteers who received Swedish massage experienced significant decreases in levels of the stress hormone cortisol in blood and saliva, and in arginine vasopressin, a hormone that can lead to increases in cortisol. They also had increases in the number of lymphocytes, white blood cells that are part of the immune system.

Volunteers who had the light massage experienced greater increases in oxytocin, a hormone associated with contentment, than the Swedish massage group, and bigger decreases in adrenal corticotropin hormone, which stimulates the adrenal glands to release cortisol.

The study was published online in The Journal of Alternative and Complementary Medicine.

The lead author, Dr. Mark Hyman Rapaport, chairman of psychiatry and behavioral neurosciences at Cedars-Sinai, said the findings were “very, very intriguing and very, very exciting — and I’m a skeptic.”

Every 5 years the Right Livelihood organization, also known as the alternative Nobel Prize invites past laureates and new nominees to spend the week together discussing the world’s most urgent issues. I was perusing the website and found this speech given in 1986 by Robert Jungk, an activist who wore many hats. He died in 1994.

More than two decades have passed between this speech and our present climate, and yet he is clearly holding out hope that his future will not look like the one we are living now. I encourage you to read the speech in its entirety.

Acceptance Speech by
Robert Jungk
December 8th, 1986
In the talk, dear Jakob von Uexkull, which you gave during the 1984 ceremonies, you spoke of the longing for a very different future than the one we are now creating. It is precisely for such a different future that the previous recipients have been working. But who is “we”? Can we also be equated with the planners and builders of the technocracy? When I reflected I realized that this statement is unfortunately true: through our work, our tax money, our consumption we have-become captive supporters of the system, which pretends to create a wonderful future but in reality destroys all hope of one. We have become wheels in an all perverse machine of destruction, which works against us, our children and their children.

However there is a world wide movement of resistance, which tries to liberate us from this new tyranny. It is growing. Not fast enough, but at a steady pace. It is strong, but by no means strong enough. May be something is lacking. To say NO is essential, but not sufficient, because negation is always dependent on that, which it negates. A good doctor will not only fight a disease. He will try to stimulate the healing forces in the body.

Therefore, if the new movements for real change are going to succeed they will have to turn the “longing for a very different future” into a loud and powerful “YES”. We need radically new concepts, concrete examples of more human relationships between people and just as importantly between people and the earth. These glimpses of another “tomorrow” should be made visible even today.

On one of the walls in my workroom hangs a woodcut. It shows a half naked man, who tries to gather together the glowing debris of an exploded sun to form a new heavenly light. I feel very close to this figure. Because for years I have been collecting bits of bright news: information about hopeful beginnings, encouraging activities, reports about imaginative individuals and groups, who try out new ways and do not give up.

The public does not hear enough of these seeds of a more sensible and hopeful future. Maybe that has to do with the way that the media look at reality. For them “good news is no news”. Sensational events such as crises and catastrophes seem more interesting to them than the attempts to live more simply, to work more meaningfully, to help one another and to create  spiritual wealth rather than accumulating material goods.

Future Research – at least in its first phase – did not listen to these faint signals of a new “Zeitgeist”. What was heard was the voice of the technocrats: more, faster, stronger, higher, bigger. The roots of this violent futurism can be found in the “think tanks” of the American military and industrial establishments. Even before the Second World War ended the RAND Corporation was founded by the US Air force in order to study and prepare future armed conflicts. Shortly thereafter “Stanford Research Institute” came into being in the area known today as “Silicon Valley”. Here plans and products for control of the future world marketwere developed.

Only now do we begin to understand the importance of these first attempts to invent and manipulate the future rather than letting it happen. Continuing in the tradition of Los Alamos and other weapons laboratories they devised blueprints for complex and extremely powerful systems. These differed significantly from the earlier inventions of the industrial age: their impact must be measured in decades, centuries or even thousands of years. Even more horrifying is the fact that the damage they may cause can be irreversible.

So today we have to live with the possibility of a manmade apocalypse. The sudden and final end of our species – alas – has become a realistic vision. The senseless extinction of numerous plants and animals portends maybe our own fate. For short-term economic or political gains we risk damages, which may last a hundred times longer or perhaps forever.

In the late sixties a new kind of futurist emerged. Their guiding star was PEACE not war. They spoke of “old-fashioned” ideas such as human scale, humility, beauty and the inescapable fact, that man and woman belong to nature. It was no coincidence that it was the peace researcher Johan Galtung and the Quaker James Wellesley-Wesley, who organised the first world wide conference on future research in 1967. I am proud of the fact that I was able to work with them at the very beginnings of this new movement.

We wanted to overcome the deadly crisis of our civilization by developing strategies for survival. Not competition, but cooperation, not exploitation of people and nature, but the care and protection of the creation and its creatures was to be our way into the unknown world of tomorrow. Such a vision lacks the grandiose and macabre fascination of technocratic plans. They don’t have the sensational touch that gets the attention of the media and their consumers, who are out for thrills. And we should not underestimate the seductive power of that risky adventure. Despite all that the alternative culture with its attempts to create a pluralistic decentralized future by choosing a soft path instead of the aggressive technology highway gains momentum. Year by year the number of projects, whose participants think differently, work and live differently, increases. Only last week I attended a conference in Hamburg, where more than 2000 individuals from over 70 self-help organisations met in order to discuss their efforts towards a more livable future.

Among the activities they described were: efforts to regenerate urban slums, the revival of neighborhood democracy, new ways to heal industrial illnesses, the creation of meaningful and useful work, the development of alternative energy by citizen groups, the promotion of female culture, establishing spaces for children’s activities, inspiring cultural creation at all levels and many other positive endeavors.

Such alternative networks, seedbeds of a new culture, have been growing in all industrial nations during the last few decades. Their members are not waiting for the “big day” of sudden change. They are starting here and now to build convincing models of peaceful existence. The effects of their activities can be likened toacupuncture for the social body. Already now they are becoming a sort of antibodies within the afflicted system. If it were not for them paralysis would grip many people of good will, who are close to despair.

These self-help groups not only help themselves, but they give hope to many others. They do not give in to resignation, realising that this would open the road to the destroyers of mankind.

A doubt persists: are these pioneers of a more human and ecological future not too weak? Can they really overcome the enormous power of the entrenched establishment? I would contest that. In times of instability even small inputs of new quality can dramatically alter quantitative superiority. In an epoch of mounting crises people, who can offer possible solutions, have greatly increased chances of influencing the course of events.

Such problem solving takes place in the “future workshops” which have sprung in a number of countries, especially in Germany and Denmark. In these new grassroots groups concerned citizens get together in order to develop their own visions of the future. They want to enter the political process early enough in its initial stages while new ideas are being generated. This way they can become subjects rather than objects, planners rather than victims taking part in the shaping of their destiny.

The people in power are much weaker than they appear and the citizen movements much stronger than they themselves realize. As defenders of the unborn, as protectors of the earth, as pioneers of peaceful relationships they create new beginnings in the middle of the old. We should give them more than our sympathy. They urgently need our active and lasting support.The alternative future is already here. The prize of honour you have given me is an encouragement for us all, who know: OTHER WAYS ARE POSSIBLE. I thank you, we thank you with all our heart.

Who Says We Can’t Change The World is a groundbreaking new report from Other Worlds that introduces nine grassroots alternatives to the current economic and environmental (dis)order, and gives examples of real communities and movements who are living those alternatives every day.

The report touches on alternative education, water struggles, the right to health care (including Community Acupuncture), environmental justice, and solidarity economies, among other topics, and highlights organizing taking place on five continents and in countless communities. There are also lists of resources for more information and contact info for organizations working on similar issues in the US.

GLOBAMA!

In 2009 President Obama invoked the words of Franklin Delanor Roosevelt when he told the American people to “make him” change health care policy. He reminded us that Democratic change requires more than the election of one person to pass law in this country. If we really want to change the way American’s consume oil and energy, then its time to speak out and ask the most visible house in the United States to go solar.  We are the second largest consumers of energy in the world. (China just became the world’s largest consumer of energy–thanks to our buying desires.)

Sign this petition to put solar on the White House.  Solar on the White House is a collective of businesses and organizations petitioning President Obama to put solar panels back on the white house roof. Jimmy Carter first put solar panels on the White House roof in 1979 after the energy crisis of the early 70s. Ronald Reagan promptly removed them for “repairs” a few years later.  If we leave it up to Washington, the lobbyists from the Coal and Oil companies will maintain the status quo with their money and political maneuvering.

Please, speak out today and invoke your Democratic right to demand a viable energy alternative.

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Go solar with your neighbors!

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The Berkeley Ecology center helps you see where you are consuming oil. If you score high in an area and want to change the way you live, the site also points out how you can reduce your impact on the environment.

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