John Tierney has been following the retrial of Dr. William Hurwitz, the pain doctor accused of drug trafficking because some of his patients misused or resold medications he prescribed. Today's column focuses on testimony from one of the government's paid experts, Dr. Robin Hamill-Ruth, whose attitudes and actions illustrate just what's at stake for patients.
Dr. Hamill-Ruth, who noted that she never prescribed the highest-strength OxyContin tablet, said some of Dr. Hurwitz's actions were "illegal and immoral" because he prescribed high doses despite warning signs in patient behavior that the opioids were being resold or misused.
Then, during cross-examination by the defense, Dr. Hamill-Ruth was shown records of a patient who had switched to Dr. Hurwitz after being under her care at the University of Virginia Pain Management Center. This patient, Kathleen Lohrey, an occupational therapist living in Charlottesville, Va., complained of migraine headaches so severe that she stayed in bed most days.
Mrs. Lohrey had frequently gone to emergency rooms and had once been taken in handcuffs to a mental-health facility because she was suicidal. In 2001, after five years of headaches and an assortment of doctors, tests, therapies and medicines, she went to Dr. Hamill-Ruth's clinic and said that the only relief she had ever gotten was by taking Percocet and Vicodin, which contain opioids.
Mrs. Lohrey was informed that the clinic's philosophy "includes avoidance of all opioids in chronic headache management," according to the clinic's record. The clinic offered an injection to anesthetize a nerve in her forehead, but noted that "the patient is not eager to pursue this option." Mrs. Lohrey was referred to a psychologist and given a prescription for BuSpar, a drug to treat anxiety, not pain.
"You gave her BuSpar and told her to come back in two and a half months?" Richard Sauber, Dr. Hurwitz's lawyer, asked Dr. Hamill-Ruth. Dr. Hamill-Ruth replied that unfortunately, the clinic was too short-staffed at that point to see Mrs. Lohrey sooner. Under further questioning Dr. Hamill-Ruth said that she was not aware that BuSpar's side effects included headaches.
As someone who suffers from comparatively mild migraines, treatable with Imitrex (which itself can feel awfully hard to obtain when you're waiting for a pharmacy to verify your prescription while feeling an invisible spike plunged through your eye), I can only imagine how desperate Mrs. Lohrey must have been. Read the whole thing. And check out Jacob Sullum's 1997 Reason feature on the subject, which should have won a National Magazine Award (it was a finalist) but was beaten out by a far less memorable, but more establishment, feature on computers in the schools published by my current employer.
Posted by Virginia Postrel on April 24, 2007 • Comments
I've been steadily working my way through the books of Yi-Fu Tuan
, a geographer at the University of Wisconsin and a fine, insightful essayist. Although widely respected and occasionally reviewed, he was aptly described in this 2001 profile in the Chronicle of Higher Education as "the most influential scholar you've never heard of." I can't speak to his scholarly influence, but he's certainly a much more interesting and insightful essayist than his relatively modest fame would suggest. His textured works on the relations between place, identity, and human longings don't get the attention they deserve, perhaps because they're not easily summarized or because they don't fit reviewers' pre-existing political and intellectual categories.
Here are some sample passages from Cosmos & Hearth: A Cosmopolite's Viewpoint, published in 1996.
Consider the expression "cosmopolitan hearth." The emphasis is on "hearth" rather than on "cosmopolitan" in recognition of a fundamental fact about human beings, which is that free spirits--true cosmopolites--whose emotional center or home is a mystical religion or philosophy, an all-consuming art or science, are few in number and always will be. The binding powers of culture are nearly inexorable: note that even the most highly educated people (the Bloomsbury literati, for example) can be as narrowly bound to a particular culture (English country house and afternoon teas), as xenophobic and intolerant of what they don't know, as the provincials and primitive folks they disdain. So we are all more or less hearth-bound. We can, however, make a virtue of necessity. We can learn to appreciate intelligently our culture and landscape.
"Intelligently" is the word to underline. What does it mean in practice? A modest beginning would be to know the local geography, but this should include lived experience and not just impersonal facts. We need to remember how it is to wake up in the middle of the night to the crash of hail on the roof and feel, because the blanket has migrated up to our shoulders, the chill of exposed feet. Knowing places other than our own is a necessary component of the concept of "cosmopolitan hearth." The unique personality of our small part of the earth is all the more real and precious when we can compare it with other climes, other topographies. Perhaps this is another way of saying that exploration (moving out of the cosmos) enables us to know our own hearth better--indeed, "for the first time." Difference contributes to self-awareness, and that is one reason why high modernism is in favor of difference. But, curiously, awareness of commonality, rather than destroying local distinction, can subtly add to it by giving it greater weight. In a rowboat on Lake Mendota, in Madison, Wisconsin, I look at the moon. The same moon will one night enthrall someone in a rowboat on Lake Como, Italy. I do not feel diminished by sharing the moon with an Italian, nor does Lake Mendota seem less unique.
The next step is to get a firm grip on our own culture--the custom or habit that, stamped on habitat, produces a homeplace. If it is difficult to appraise habitat with the fresh and eager eyes of a visitor, it is more difficult to appraise--or even be aware of--habits, especially those that we repeat daily. I think here not only of such larger acts as getting out of bed, going to the bathroom, preparing and eating breakfast, and so on through the day, but also the infinite number of miniacts within them, such as how one squeezes the toothpaste tube, eats peas, pats the dog, smells the evening air. Miniacts (habits) have their own minihabitats, and these are even more likely to escape our conscious awareness. The recognition that living as such, in all its detail and density, is a terra incognita that eludes scientific probing is an instance of high-modern sensibility. One consequence is the wish to protect the warm core of living, so vulnerable in its inarticulateness, from aggressive rationality and modernism.
Distinct from habits and routines are celebrations and rituals that, although they are recurrent, recur after a sufficient lapse of time to seem new; in any case, they are intended to be occasions of heightened awareness. Such special occasions may be either personal-familial or public. In the first category are births, weddings, funerals; in the second are rituals that punctuate the agri-cultural calendar or memorialize historic events. They are all supported by an appropriate stage, special costumes, decorations, artworks, perhaps music. Each event is thus a large chunk of culture on display. For this reason, when people want to rehabilitate their culture, they often think of resurrecting a traditional festival or ritual. Many communities in the United States, fighting the homogenizing forces of modernization, turn to ethnic roots for significant markers of difference. some communal leaders take this returning to roots with great seriousness, for in their minds it is also a way of regaining a lost sense of collective self and authenticity. Nevertheless, in at least the well-to-do American communities (as distinct from Buber's communities of toil and tribulation), what actually happens is that people at play or engaged in display act our their "pasts" with varying degrees of self-consciousness and irony.
Without modernism, there cannot be high modernism. Modernism provides the necessary security, which includes material sufficiency, social-institutional safety nets such as insurance and government subsidies, and, thanks to science, substantial freedom from the vagaries of nature and almost total exemption from the dread of dark magic, ghosts, witches, and demons. Against this background of security, communities can separately re-create the past. None seeks to resurrect the old insecurities and fears. If an old custom is re-created, it is more likely to be a birthday or wedding than a funeral. As for agricultural rites, late-twentieth-century versions, even if they are correct in every historical-factual detail, cannot recapture the mood of helplessness and dread that drove people to practice animal and even (if one goes back far enough) human sacrifice. Another major difference is this. In the past, festivals and rituals were conducted primarily for local consumption, to establish some sort of harmony between people and nature. By contrast, in the late twentieth century, although festivals continue to promote communality and a sense of place, as much or even more are they set up to attract benign strangers. The local place in our time, far from being indifferent or hostile to the big world, welcomes it. One might say, perhaps a touch cynically, that today's reconstituted festivals are intended to propitiate another kind of god (tourists) and induce another kind of blessing (money).
I should note that in these passages, Tuan uses "high modernism" not as I would--to indicate the mid-century high point of modernist rationalism, exemplified by International Style architecture--but, crediting Anthony Giddens, to signify a scientifically informed universalism that takes account of complexity and local attachments. His work fits comfortably into the dynamist school described in The Future and Its Enemies, making Tuan another example (to answer a common question) of a dynamist who is not a libertarian.
Here's a passage that reinforces some of the ideas toward the end of my Atlantic column on chain stores:
"Cosmopolitan hearth" is a contradiction in terms and this fact, perhaps, defines our dilemma--a human dilemma that has always existed but that becomes more evident as we move from traditional to modern, then high modern. The dilemma is captured by the observation, which George Steiner and others have made, that whereas plants have roots, human beings have feet. Feet make us mobile, but of course we also have minds, a far greater source of instability and uprooting. Consider such utterly commonplace experiences: while we are "here," we can always imagine being "there," and while we live in the present, we can recall the past and envisage the future. Stay in the same place, and we will still have moved inexorably, for the place of adulthood is not the place of childhood even if nothing in it has materially changed. Stages of life are sometimes called a "journey," a figure of speech that again vividly captures the condition of human homelessness. A paradox peculiar to our time and to Americans especially is that "searching for roots," which is intended to make us (Americans) feel more rooted, can itself be uprooting, that is, done at the expense of intimate involvement with place. Rather than immersion in the locality where we now live, our mind and emotion are ever ready to shift to other localities and times, across the Atlantic or Pacific, to ancestral lands remote from direct experience. We can be dismissive of what is right before our eyes--the local McDonald's where our young children wolf down their hamburgers, the city cemetery where our parents were recently buried — in favor of some place at the other end of the globe where distant forebears lived, toiled, and danced.
The book concludes with the following:
Singing together, working together against tangible adversaries, melds us into one whole: we become members of the community, embedded in place. By contrast, thinking--especially thinking of the reflective, ironic, quizzical mode, which is a luxury of affluent societies--threatens to isolate us from our immediate group and home. As vulnerable beings who yearn at times for total immersion, to sing in unison (eyes closed) with others of our kind, this sense of isolation--of being a unique individual--can be felt as a deep loss. Thinking, however, yields a twofold gain: although it isolates us from our immediate group it can link us both seriously and playfully to the cosmos--to strangers in other places and times; and it enables us to accept a human condition that we have always been tempted by fear and anxiety to deny, namely, the impermanence of our state wherever we are, our ultimate homelessness. A cosmopolite is one who considers the gain greater than the loss. Having seen something of the splendid spaces, he or she (like Mole [in The Wind in the Willows]) will not want to return, permanently, to the ambiguous safeness of the hearth.
Here's a lecture Tuan gave about his intellectual development. Here are a recent, very brief essay on science and magic and his archive of such "Dear Colleague" letters. In addition to Cosmos & Hearth, I would recommend Escapism and Space and Place: The Perspective of Experience .
Posted by Virginia Postrel on April 23, 2007 • Comments
I'm in Amsterdam, where I spoke this morning at a corporate conference on experience design. My schedule and jet lag haven't allowed much time for tourism, but I did spend a little time museum-hopping yesterday. At the Rijksmuseum, I enjoyed this special exhibit on the work of Jan van der Heyden, a 17th-century artist who specialized in painting views of cities and buildings, the genre of Dutch painting I tend to like best.
What particularly fascinated me about van der Heyden, whose work I didn't know at all, was the way he combined his art with work as an inventor and entrepreneur. His most important invention was a fire-fighting system that combined an engine for pumping water with a long leather fire hose. The pump was an improvement on existing technology, the long hose a new idea that allowed firemen to get water to the heart of a fire rather than simply spraying the facade of a burning building. Van der Heyden not only invented this system but built and sold it, promoting it with a book of prints showing the devastation of urban fires and the advantages of the pump system in fighting them. He's a great example of the mingling of art, commerce, and technology, each complementing the others.
The exhibition, which runs through April 30, includes the prints, including some of Van der Heyden's preliminary sketches, and a later version of his fire engine, which was in operation from 1724 to 1928. One of the prints is shown above; click for a larger version. For more, visit the exhibit's website.
Posted by Virginia Postrel on April 18, 2007 • Comments
In a video line extension of the Atlantic brand, my fellow columnist Corby Kummer, who covers food, demonstrates how to pick a knife. He believes the handle is what makes all the difference and features an knife-making entrepreneur who uses bicycle grips for that purpose (a great example of the innovative power of new combinations, for all Future and Its Enemies fans).