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Tuesday, July 17, 2007

Mumps jabs Happy Hour


Former Dalhousie Medicine dean Dr Noni MacDonald (right) has proposed a novel way to combat the ongoing mumps outbreak in Halifax and its environs:

"Maybe what you could do is say if you go to the bar between 5 and 7, you could get your beer half price if you get your measles, mumps, rubella immunization updated."
In an editorial she co-wrote in this week's CMAJ, Dr MacDonald warns that the mumps outbreak is a sign that our public health system is struggling. Her prescription? Greater vigilance by healthcare workers, ramped-up immunization and vaccination programmes, and a national immunization registry to identify at-risk populations faster.

"These mumps outbreaks are like the proverbial canary in the coal mine, warning us of the inadequacies in our present approach to infectious disease control," concludes the commentary.

Photo courtesy CMAJ

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Q&A: Why tech journalist just had to try body modification

When I wrote about body modification and home surgery in May, I spoke with fascinating San Francisco journalist Quinn Norton. She has spent innumerable hours researching body mods for Wired magazine.

Dedicated reporter that she is, she even had a body mod done herself last year: a rare earth magnet implanted into her fingertip (see photo, right; more photos here), which she claimed gave her a sixth sense that allowed her to detect electromagnetic fields from a distance. Unfortunately, she had to have it removed not long after she and I spoke. (Check out photos of that surgery here.)

Here's the full transcript of the interview, conducted by chat on April 25, 2007.


National Review of Medicine: Can you tell me a bit about your research into body modification?
Quinn Norton: It's an ongoing effort, looking at issues of control and decision making in the body modification community, as well as the community of medical patients and people who are looking towards the tools of modification to enhance their work or personal life, but wouldn't identify as patients or body modders. The modification community is particularly interesting in its willingness to assume risk, and so sometimes things that wouldn't be tried elsewhere can be 'tested' as it were, and the data and ideas leak out to the rest of society
mainly I’m looking at this idea of enhancements rather than cosmetics - people trying to change their bodies in a way that is not primarily cosmetic to give themselves not only an ability they didn’t have before, but an ability that isn’t within the normal human realm of expectations. Is there an enhancement or a particular piece that caught your interest?

NRM: Your magnet. When you had it implanted by a body mod enthusiast, were you concerned about your safety?

QN: Of course. But i'm also concerned about my safety with a medical professional, though there are more safeguards in place in medicine, I think a responsible patient is always concerned. I checked into the body modification artist's references, and examined the room he had set aside for such procedures. I checked the certificates on his autoclave and watched his procedures carefully. Most of all, I asked if I had concerns - something I do with doctors as well, and has saved me some trouble in normal medical settings a few times.
Many of the high profile modification artists, tattoo and piercers I've seen are much more stringent than any hospital I've been in to be honest. It surprised me to find that when i started to look at this community, but they are under such a constant distrust that I think they are used to dotting every i and crossing every t. But I should make it clear that within the modification community, everyone I've worked with were of very good reputation. There are many irresponsible people in that community as well, and they don't keep their clients safe at all. But there’s little to no mandate for education or inspection for body modification in many states, which is just outlandishly stupid.

NRM: You sound as though your experience was predominantly positive, but you did have an infection not too long after the implant was inserted into your finger, right?

QN: The infection actually wasn't the main problem. The infection was a risk I knew about and made an informed decision - they made sure I understood the risk. It was an issue they hadn’t worked out how to resolve. You can’t autoclave rare earth magnets. They got them as clean as they could with a soak, but there’s always the chance of missing something. Almost no one ever had the infection issue besides me, and it was minor and resolved quickly. The main problem was that the silicone it was in breached, and my body began to react to it. Scar tissue formed around it, and exposure to my blood leached away the iron in the magnet, leaving it at a brittle sphere so the sense went away, and it became much more difficult to remove than anticipated.
Right now I’m scheduling with a hand surgeon to have it removed very soon. I suffered a knee injury, and they want to do an MRI so the magnet has to come out. Well, that would get the magnet out, but not the way I was hoping. These days it's a black bump that is sensitive to being pressed on directly, but doesn't really interfere with the rest of my life. I did find it hurt a lot and swelled up when I went rock climbing, but that's the only thing it stopped me from doing.

NRM: What have your doctors (family doc and hand surgeon) said about the magnet?

QN: Both of them have been fascinated. My regular doctor has gotten quite used to me being a bit on the quirky side. I almost never see him without a student these days :)
When my GP asked why I'd had it done, I told him it was to get a sense for electro magnetic fields, live wires, spinning motors, and the like. He asked me why I'd want that? I was at a loss. I wasn't sure how to explain it, other than to say, why wouldn't you want a completely new sixth sense?
In general the response from doctors has been exactly the same as from the general populus: "why would you want that" or "wow, that sounds neat."

NRM: Has your GP (or your hand surgeon) expressed any ethical discomfort or medical concern?
QN: Actually, no, but I think that's in part because I've made it clear that I researched everything and made informed decisions about it.
I was expecting more ethical concern than I've run into, but I think that might the regional; being in San Francisco I'm not the weirdest thing in town, and the fact that I've done so much research in advance makes me easier to deal with then many of the weirder things,
but I was asked the same question you started off with several times - was I worried about having the modders work on me.

NRM: Neither doctor has given you a psychiatric referral?
QN: Even my psychiatrist isn't actually too worried about it. He does say I’m at times an interesting patient :)

NRM: On the topic of psychiatry, I wanted to get your opinion about the people involved in the body modification community. Do you think body modification could be classified as a variety of body dysmorphic disorder, in which people see themselves as flawed and attempt to change themselves to fix their appearances? QN: It’s really not that clear cut. Everyone’s a little body dysmorphic - it keeps us showering and getting haircuts - but that’s not a pathology.
Some people can do extreme modification from a very healthy places, and some people seeking simple cosmetic surgery procedure are doing it out of terrible self loathing.
I’ve certainly run across the spectrum in both situations - I think it’s a mistake to pathologize a particular behavior in this spectrum. You have to look at the person and the context to determine whether this is someone that needs help.
I think one of the most controversial points I make in my talk is about endorphins and cutting
people often use self harm as a psychological crutch: basically pain-> endorphins-> to a bit of dopamine, letting them break the emotional state they're in if someone does this by cutting or pinching their skin, alarm bells go off. Even though this activity isn't necessarily dangerous, physically if they do exactly the same thing by working out, we call that very healthy - even though exercising to pain can often lead to long term damage like destroyed joints.
The effect that's being sought is the same, but the social context is different. One looks like suicide even though it's not, and the other looks like fitness, even through, really, it's not either. I think you have to take people aside and explore why they make those choices if you're going to figure out how healthy they are

NRM: So you’re saying we should differentiate between different kinds of body modification? i.e. implanting RFID [radio frequency identification] chips in your hand as an engineering project on the one hand, and having plastic surgery to give oneself horns as a fashion statement, on the other? The people who are safe and reasonable, and the ones who are ill?

QN: And a vast grey area between, inhabited by most people, body modders or not. :)
This is a very tough question... but that goes to the nature of hacking.
In an area where anyone can (potentially) do anything for whatever reason they dream up, how do you view external factors as descriptive of internal states? If someone is planting an RFID to be the coolest of the local geeks, and keeps pictures online about it, is that still non-cosmetic? I don't know.
The modders themselves divide along lines like 'modern primitives' and 'transhumanists.'
I tend to think most of the time, people place themselves in the proper spots. Transhumanists will be trying to figure out how to become more than human - the engineers. Modern primitivists are often doing it for religious or spiritual transformation.

NRM: The question of ritual scarification versus technological enhancement.
QN: Yep. Though there's more than those two categories, a lot more - those are a couple of the easiest to follow. There's social commentary - people that modify to reject values of society they don't respect. It's not our job to say they're right or wrong, it's history's. If it wasn't for people going to arguably unhealthy extremes to reject society's, I might have no vote and black servants today.

NRM: What do doctors need to know about body mods? Are physicians being too intolerant?
QN: There are a lot of mods I would like to see doctors take over doing or collaborating with the modding community to get them doing them safely. There's bad, dangerous work out there that should be stopped, and the people getting them simply don't have all the information they need to make good decisions. But that's not the same as it being the wrong choice for them personally.

NRM: Can you tell me about a bad case you've seen?
QN: Actually let me back up and tell you a story of something I found kind of disturbing when I was working on a piece about subdermal implants.
Basically subdermals are mild cosmetic surgery, usually done without anesthetic.
When I was talking to modders that pioneered the field, they were doing things like designing their own dermal elevators for putting in these custom shapes in teflon and silicone. The, shall we say, non pioneer types were using things like common butter knives instead of dermal elevators, and trying to derive how to do the implants from pictures off the internet
with some disastrous conclusions, which were also pictured on the internet.
And I asked steve haworth, the very good modification artist who put in my magnet and did many other famous procedures, why plastic surgeons weren't the ones doing this and he told me that the AMA [American Medical Association] said modification towards societal norms were ok, but away was considered unethical. I thought, as a journalist 'well this is the perspective of one side, I shall go ask the other.'
And I did, I interviewed multiple plastic surgeons and asked them about this point - they all basically confirmed what Haworth said.
The same exact procedure, with the same material shaped, say, to change your chin is ethical, but to put a heart on your chest isn't.
I found that a disturbing basis for medical ethics - it shouldn't be so tied to fashion, I think
the practical problem with this ethic is it leaves the people doing the odd shapes out of the medical system, where they have no standards to conform to. I think when plastic surgeons make that kind of decision, they allow simple cosmetic procedures to snowball into health disasters. There's an argument that would disallow all cosmetic procedures, but that's not the choice we've made societally.

NRM: Do you know of any doctors who are involved in body modification?
QN: Yes - kind of. I've been written to by a few doctors, but all of them have asked to remain anonymous.

NRM: Can you paraphrase what they have said?
QN: All on the basic theme that they want to or do do these procedures, and that they don't like the current system, but that they are afraid of legal ramifications and losing their practices. None of them have ever actually gone into details on what they've done, and I haven't pressed. I see this as a hot button, but I also see it as a point of incoherence in the medical stance. if we're worried about the mental condition of people seeking modification, then we should require some minimum psych eval on all people seeking plastic surgery. If we're not, then why restrict what they can get?
Honestly, I support the former quite a bit. I think a woman looking for breast enhancement or a man looking for horns both have good chances that they're trying to solve emotional problem best addressed directly in the mental health system. But sometimes, they just want bigger boobs and horns. And if they want them enough, they're going to get them, so they might as well get them safely.

NRM: Have you had any response on that idea from any medical regulatory bodies?
QN:
No, i don't think I've quite risen to the level of their attention yet. I do imagine I'll have a few more arguments about it in my future, though let me show you what I find to be one of the most interesting, scary and a-shadow-things-to-come documents on the internet:
http://www.bmezine.com/ehs-faq.html

NRM: That is indeed a frightening document.
QN: Combine that with http://business.search.ebay.com/medical-instruments_Healthcare-Lab-Life-Science
and an American healthcare policy driving millions of people out of the system due to insurance, and we have a very interesting future indeed.

Photo: Quinn Norton

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