This is the future of health and medicine as envisioned by scientists peering into the next millennium from the brink of 1999. Forty-two international medical journals, led by the Journal of the American Medical Association (JAMA) Journal of the American Medical Association (JAMA) and the British Medical Journal (BMJ), are dedicating their pages this month to a “global theme issue” on new medical technologies and their impact on health care.

Scanning the articles is like hopping a time machine to a better, smarter world — a medical “Futurama” where doctors use “electronic noses” to sniff out ear, nose and throat infections, where “smart” pacemakers monitor a patient’s blood oxygen levels and cardiac wall pressure, adjusting the heart’s pace from moment to moment. And there will be souped-up wheelchairs that can climb stairs and go barrelling through sand and gravel like Humvees.

And, in a bit of news guaranteed to prick up ears everywhere, doctors will grow artificial penises and vaginas and use them to replace worn-out or disfigured parts. Dr. Myron Murdock, director of the Impotence World Association recently told Reuters that within 25 years genetic research will make it possible for scientists to construct male and female genitalia by culturing human cells and growing them over a mold.

In other words, expect the bizarre in medicine’s brave new world. Hospitals are going to change drastically, according to Dr. Charles B. Wilson, a neurosurgery professor and director of the Institute for the Future at the University of California San Francisco. As part of the admission process, Wilson predicts in his BMJ article, patients will be implanted with sensors that automatically perform more than 40 laboratory tests.

Wilson predicts that ceiling vents in hospitals will be equipped with air monitors to scan incoming visitors and sniff out anyone who could transmit an infection to a patient. Intensive care units will disappear, and we’ll see the emergence of “transportable intensive care beds” complete with sensors to monitor patients’ vital signs and deliver ventilation.

And in a scene straight out of “Star Wars,” robots will go tooling around our hospitals like automated candy stripers, running supply services and filling pharmacy orders.

Gazing through the pages of this month’s medical journals, the future looks exciting. But, as Dr. David H. Mark writes in JAMA’s introduction to the global theme issue, “Technological progress, even when it is real progress, often leads to new problems, difficult choices, and unforeseen dilemmas. Clearly, technology is not an unequivocal savior. With it often come difficult social, ethical, and economic choices.”

A prime illustration of the progress-problem dichotomy — and the attendant ethical and economic issues — is the thorny debate over xenotransplantation. The chronic shortage of human organs has compelled some doctors to promote the use of animals — pigs and primates, mainly — as an alternative source for organ transplants. Research is now underway to determine the viability of cross-species transplantation, with scientists looking at the immunological barriers, physiological functions and the risk of infectious diseases.

But opponents are calling for a moratorium on the research, saying that xenotransplantation — “Frankenscience,” some call it — is expensive, unethical and ridiculously dangerous due to the high risk of transmitting animal viruses to humans.

This gulf of dispute has separated supporters and critics since the first animal-to-human experiments at the turn of the century. For a long time, though, the debate raged on a mostly hypothetical level. But with recent advances in genetic manipulation and the development of immunosuppressive drugs, xenotransplantation is looking less like science fiction and more like medicine’s next big thing.

One of the more radical prophecies put forth in Wilson’s article is the idea that animal-to-human transplants will become quite commonplace in the near future — so common, he says with tongue only partly in cheek, that pig farms will sit next to hospitals for easy access. Wilson says, “By 2010, xenotransplantation will be available.”

It shouldn’t be, says Alix Fano, director of the Coalition for Responsible Transplantation and author of the 1998 book “Lethal Laws: Animal Testing, Human Health, and Environmental Policy.” “The risks are way too great,” she says. The FDA has acknowledged the risk, and yet the research goes on. In Fano’s view, “it’s inconsistent for agencies to continue to invest in a technology that could spread disease.”

Dr. Harold Vanderpool, a professor in philosophy of medicine at the Institute for Medical Humanities at the University of Texas Medical Branch in Galveston, serves on the FDA subcommittee on xenotransplantation. Vanderpool, who authored a BMJ article on xenotransplantation for the global theme issue, doesn’t deny the risks.

“The possibility of passing on diseases — many of which we haven’t identified yet — is a real concern,” he says. “The risks are great enough to require vigilant oversight. We have to be somewhat paternalistic about saying when trials can go forward.”

Vanderpool says that scientists are nowhere near ready to begin clinical trials on humans, but he believes the genetic research should continue, with the hope that xenotransplantation can someday be proven safe and effective. He says, “The probable benefits outweigh the probable risks.”

For Fano, “probable” is the key word. “The benefits have never been proven,” she argues. “Since 1906, 83 people have received animal organs and they’ve all died — most within a few hours or days.”

Still, the push for progress goes on. Fano believes that, if you follow the money trail, you can trace that push to the biotech companies who stand to cash in if xenotransplantation develops into a full-fledged industry. It’s a simple case of misplaced priorities, she says. “Is it fair to commit $35 billion a year to xenotransplantation when 50 million American lack basic health care and 50 million more are uninsured?”

Maybe not fair, Wilson says, but medicine must continue its forward march regardless of money issues. “Cost concerns cannot prevent the advance of science,” he says. And if the wealthy have a better chance of reaping the rewards of expensive high-tech medicine, that’s just the inevitable consequence of a society divided into haves and have-nots. “Someone who’s poor is less likely to get a new heart — or a new car. In a perfect world, this wouldn’t be true.”

But the xenotransplantation debate raises questions that go beyond financial nitpicking to the very core of what it means to be a human being. We tend to view the human heart as the locus of personality and soul; of our humanness. And that doesn’t bode well for the spiritual well-being of cross-species transplant recipients.

“How will the recipient feel,” Vanderpool wonders, “when he realizes that inside him beats the heart of a pig? Is he not fully human? A chimera of some kind? The whole notion of humans walking around with animal organs is an idea that most people haven’t come to terms with.”

But for scientists at work at century’s end, Vanderpool says, playing God just comes with the territory. “On all levels of truly innovative scientific advances, human beings are manipulating nature in ways that are surprising and, for some people, alarming. Xenotransplantation will raise a new specter for people who feel it’s unwarranted to cross boundaries in nature with impunity.”

For Wilson, those boundaries fluctuate with the societal climate. “When I was in med school,” he says, “people would die before they’d take blood from a black person.” Our cultural qualms can’t interfere with progress, he says, and in the case of xenotransplantation, “We’ve been given the wisdom to do what is a step forward for humanity. There will always be people who talk about the immorality of progress,” he says. “To get full accord is an unattainable goal.”

The only thing as inevitable and obdurate as the advancement of science may be the debate over the advancement of science.

Vanderpool takes a historical view. When the idea of in vitro fertilization was first introduced to the public, he points out, “There was enormous outrage and controversy, a great wringing of hands. But when Louise Brown [the first test-tube baby] was born in 1978, and she was healthy and normal, the controversy died down. The controversy tends to settle when you see the wonderful human results right before your eyes.”

It’s too early to tell whether we’ll see wonderful human results from xenotransplantation — or smart toilets, or electronic noses, or artificial penises — or if these new technologies will instead strip away some of the mystery of living day to day in the sway of the natural world. Science marches forward now, history steps in later to judge.

“Only the future will tell if this is for the betterment of humankind,” Vanderpool says, “or if it’s destructive.”

The journal eventually led him to the prestigious Iowa Writers’ Workshop, where he began “My Own Country” — a memoir structured as a series of stand-alone vignettes, some told with wrenching acuity from the point of view of his patients. There’s the preacher with gonorrheal sores, the bisexual hillbilly who infects both his wife and her sister with HIV, and two “pillars of the community,” a man and his wife, who visit Verghese from another county in order to keep their condition clandestine. In 1998, Verghese’s second memoir, “The Tennis Partner,” recounts his friendship with an agonized, drug-addicted intern who eventually commits suicide.

Both books link Verghese’s unraveling marriage with his ever-deepening friendship and identification with AIDS patients. Salon Health interviewed Verghese during a tour to promote the paperback edition of “The Tennis Partner,” and asked how a writer celebrated for such startlingly frank prose could also be a physician entrusted with his patients’ deepest confidences.

Physicians are bound to protect patients’ confidentiality, even after death. Yet in both your books you disclose details about their sex lives, drug habits and illnesses. How did you pull this off?

In the mid-1980s, my patients and I lived through an extraordinary experience — AIDS coming to a small, conservative community in rural Tennessee. Many years later I went back and told them I wanted to write a book about it. To my great amazement, to a man and woman they were very willing to cooperate. It became almost their mission to tell their stories. All my patients wanted to appear as they were, with their names unchanged. At the very last minute, in deference to their children, we changed some of the names and some key things that linked them to certain towns. Otherwise it was very much their desire to appear as is.

One could question the ethics of a doctor revealing a patient’s private information. But I didn’t use legal loopholes as a means to tell their stories; either I got permission or the revealing details were so concealed it would be impossible for anyone to know who they were.

So your patients were alive when you started the book?

Most of the people I included in the book were alive or their partners were alive at the time. Now, except for one person, they’re all dead.

Why would your patients want their stories to be told?

It’s like a backlash — you really want to make sure that people know what you went through. Many of my patients are gay. Before you come out you’re forced to live with such fear; you’ve kept quiet for so long you come out with a vengeance.

I think it was that sense with the woman I call Vicky. Before developing HIV, as she tells it, she was a hick living in a trailer, uneducated, angry, overweight and so stressed that she pulled her hair out in clumps. AIDS became an important way of defining who she was. She is now an activist in the HIV community, her hair has grown back and she’s doing extremely well — she’s about to finish nursing school. She was an example of someone who was particularly adamant that I tell her story.

But some of your patients lived and died in agony. I’m thinking of Luther, who lashed out at everyone who tried to help him, including you.

The name Luther is not real. It is possible for someone to object to my using a patient that way, but I had a sense that he was very instructive. I wanted to profile his particular kind of courage, which was manifested in this outrageous, hostile, angry behavior. It was really his way of dealing with the virus.

How was his case instructive?

I wanted to address the issue of anger. Patients easily anger physicians. You have to stop and remind yourself that this is either their disease acting out, or their way of dealing with disease. It took weeks of taking care of Luther to see through the front that he was putting up. In a way it was a particular kind of bravery because he had no family to help him; he was incredibly self-reliant and in the end I was very admiring of him. Perhaps he understood that. I’d like to think he wouldn’t disapprove of what I did.

A couple you call the Johnsons was so adamant about hiding their HIV status that they had to leave the city they lived in to get medical care, which is how you became their physician. It must have been difficult to get consent to write about them.

It was a difficult issue because they had both died by the time I was writing a book. From a legal point of view, you don’t need consent to write about someone who is dead. But this wasn’t a legal issue; it was a moral and ethical issue. Their family was concerned about what I might say. One of their sons actually came and stayed with me in El Paso and told me his side of the story. I showed him parts of the manuscript, but they were the only family that I allowed to see it. They ended up allowing me to excerpt their parents’ journal in “My Own Country.” It was an extraordinary manuscript, which the parents had kept, waiting for the day when their children would know what they had lived through.

How do you reconstruct snippets of dialogue that were spoken so many years earlier?

It s almost an impossible job in nonfiction to get dialogue exactly how it happened. You have to make a leap into your memory. When possible, I visit with my former patients and say “do you remember the day that this and this happened?” And I consult the journal that I write at night.

When you’re keeping your journal of medical events, are you aware of the cases being potential literary fodder?

I don’t think I’ve ever seen a patient with the intention of writing about them in the future. But I am conscious that what I write about them in my journal at night might become the kernel of something I write publicly later.

I heard you wanted to be a journalist, but your parents pushed you into medicine.

That’s true; medicine was considered more respectable. I really wanted to become a journalist before I read “Of Human Bondage.” Somerset Maugham is a tremendously important influence on me, not as a writer but as a physician. I have this theory that there are novels that call people to medicine, at least for my generation. For this generation it might be the show “ER.” But for me it was “Of Human Bondage”. There was a character, Philip, who wanted to pursue art but had this sense that medicine would satisfy all his creative desires. That made me want to become a doctor. My other big hero is William Carlos Williams. He was a legitimate poet before he went into medicine.

So you’re a poet as well?

I love to read poetry but I haven’t written anything that I’m willing to show anybody. William Carlos Williams had a theory that for art to be meaningful it had to emanate from everyday, workaday life. That’s why he went into medicine. He believed in that to the point that when he was in his late 60s he was holding evening clinics and snatching little pieces of time to jot down pithy poems that became so important later.

A lot of doctors say they are too overworked to spend much time reading or writing.

My feeling is that given how privy we are to the intimate details of people’s lives, it’s a surprise that more of us aren’t writing. I think that when you’ve been in practice a number of years, there’s an urge to unburden yourself — not to take somebody’s nasty little story and expose it, but to convey the extraordinary kinds of things you see. To tell about the incredible resources human beings have when they’re very, very stressed. These stories take place every day in hospitals all over the world. To not tell them is to feel an unbearable sense of loss.

Are there parallels between writing and medicine?

Oh yes. The first thing you do as a physician is to take a history, and what is a history but a story? When I’m called in as a consultant in my role as an infectious disease specialist I’m impressed by how many times my expertise isn’t that I bring some extraordinary knowledge that solves the case. It’s that I take that history better, or it means more to me, or I pursue it down further paths than the intern might have, and when I examine the body I’m looking for more clues that the story might be there. It’s like I’m milking the body for more stories. In writing and medicine it’s technique and detail that matter a whole lot more than extraordinary knowledge. I remember hearing the same aphorism at the Iowa Writers’ Workshop as I did in medical school: God is in the details.

Are you saying that writing has made you a better doctor?

I think so. Literature is a beautiful way of keeping the imagination alive, of visiting worlds you would never have time to in your day-to-day life. It keeps you abreast of a wider spectrum of human activities. We have the sense that medical students come to medicine with a great capacity to understand the suffering of patients. And then by the end of the third year they completely lose that ability, partly because we teach them the specialized language of medicine, the jargon, and in the process they lose their compassion, their ability to imagine how others feel. Patients become “the diabetic foot in room 3″ or “the myocardial infarction in room 8.”

My second book, “The Tennis Partner,” is about the phenomenon of physician addiction and suicide, which is in epidemic proportions. Every year it takes two classes of medical students to replace the numbers that have committed suicide. They have no outlet to talk about the carnage they see at the hospital. They deaden themselves to their own feelings and they self-medicate. The way to make better, healthier physicians and improve society is to re-humanize their training. I really think teaching the humanities is a way to keep their emotions alive, not succumb to the tunnel vision that comes with a technical education.

Explain how you develop your patients into characters.

That’s the beauty of nonfiction. You struggle much less to [do so,] because you don’t have to invent. It’s a burden and it’s a blessing. Readers are inherently interested because they know it’s true. For example, if I made up a story about a black quarterback who won the Heisman Trophy and married a beautiful blond woman and then slaughtered her in the driveway and got acquitted, as fiction that would be mundane because it would be unbelievable. But look at how it attracted us as nonfiction.

The issue of confidentiality came up again in “The Tennis Partner”. You revealed that David, the main character, had been fantasizing about an old girlfriend even though he was living with another woman. How did those two women react?

They sat down with me for hours on end and gave me their stories. I gave both of them the chance to read the manuscript and make changes, and in both cases there were things in the manuscript they didn’t know about. It was very tough for them to learn that. They were very cooperative.

Why do you think they were?

Again, I think it was a sense of mission. The flip side of suicide is that it leaves a lingering question in the minds of the people who survived. It’s like a cancer that’s metastasized. The suicide is the cancer and the metastasis is all these people saying, Why? Why? Why? In a way my book was an exploration of Why? It’s helped them put closure on it.

Both books weave the dissolution of your marriage into the narrative.

I never thought I’d be revealing this much about myself. I had this naive idea that I could just write an interesting story about AIDS in a small town in Tennessee and there came a point when the editor said, “You’ve become a character in this book. The reader will feel cheated if he doesn’t know what happens to you when you go home at night to your wife and kids.” So it was forced from me, dragged from me piece by piece.

And your wife?

She wasn’t happy. Nobody wants to appear in a book without his or her permission. I tried not to portray her as malicious because she wasn’t. But if she was telling the story it would have probably been quite different.

Will your next book be a memoir?

I’m a bit leery of plowing my life for material anymore. It’s painful. It’s cathartic, too, but to have a lot of people reading it is scary. But if someone has done me the justice of reading the whole book, they’ve earned the right to learn anything about myself that I’ve chosen to reveal. The narrative voice I’ve found seems to demand that I’m a character, even though I’m always the last one to realize it.

Back at the
house, she’d been hysterical, screaming and grabbing at her husband. One of
the emergency medical technicians had pulled her aside. If you can’t contain yourself, you can’t ride
with us, he’d said. It sounds cold, but it is dangerous and irresponsible to
let a frantic family member loose in a speeding ambulance. Now she
was getting agitated again. “Ma’am,” I said sternly, over the siren, “you
promised. You have got to let me drive.”

She composed herself, hugging her purse, knuckles white over her Bible. We
delivered her husband to the hospital and settled her in the waiting room.
On the way home, the assistant chief looked at me. “You know who that was,
don’t you?” “No,” I replied. “That’s the vigilante woman, the one who shot
the guy in the hand. You know she never goes anywhere without her pistol in that purse.”

I recalled the tone I had taken with her, and gave a little shudder.

Earlier this year, I was at my desk writing when the fire chief knocked at
my door: “You busy?” I asked what he needed. “Remember that guy you took care of last night?” I did. We had been called to an outlying tavern in the wee hours. A man had been making trouble in the bar, and when the police finally arrested him, he began complaining of chest pains. When I tried to take his vital signs and give him oxygen, he was cranky and recalcitrant, so I adopted my stern voice and lectured him into compliance.

The chief told me the man was holed up in a trailer with a shotgun
and a pistol, shooting at people. “The county SWAT team has got him
surrounded,” said the chief. “They’re gonna try to take him in about half
an hour. They want us to come stand by with the ambulance.”

I recalled the tone I had taken with the man the night before, and reprised
the little shudder.

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From so-called “reality programming” to shows like “ER” and “Third Watch” and movies like “Bringing Out the Dead,” big-city rescue services get most of the attention, and they earn it. Their call volume is far higher, their drama more sustained. But when it comes to surreal rescue, it’s tough to beat rural service. For example, last winter a fisherman collapsed and died on the ice. He must have been catching fish pretty regular because when the ambulance crew arrived, another fisherman was standing over the body with his line down the hole previously manned by the deceased. Strange things happen in the city, but out here, deep in the trees or on a plain of white ice, the strangeness presents itself in tableau.

There is no ambulance in our town. Depending on the location of the telephone pole you clip with your pickup, or where you’re standing when the big one hits, an ambulance will be dispatched from a town nine miles to the north or nine miles to the south of our little village. Some of us on the volunteer fire department are basic EMTs and first responders; we’ll set out with a pack of rudimentary medical supplies and do our best to stabilize the situation until the ambulance or medical chopper arrives. Sometimes that means crawling into a tangled car in an attempt to keep an unconscious victim breathing. Sometimes it means simply holding the hand of a sickly grandmother or a suicidal farmer.

The business of “rescue” is often rough and impersonal — you cannot put a tube down someone’s throat and deliver a shock to his heart without engaging in a certain level of assault — but out here, we often get to reassure someone we know, take time to tell them we’ll call their brother, or aunt, or grandson.

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I became an EMT 12 years ago. I had just finished nursing school, and
thought working on the ambulance would be an exciting diversion. I took a
110-hour class through the technical school, passed the National Registry
exam and started pulling 48-hour weekend shifts for a private ambulance
service in a mid-sized city. We had a high call volume, and I got lots of
valuable experience. But when I moved back to my hometown in 1995, the
experiences became more personal. I found myself being reacquainted with
faces I hadn’t seen for 12 years. When you serve as a rural EMT, you meet
your neighbors one crisis at a time.

It’s a rare privilege, really, a way to thread yourself into the fabric of
a place. A few winters back, we were called out for a heart attack. When
my partner and I arrived, we found an old man, his body sunk in the snow.
He had been dead some time. There was nothing to do but wait for the
coroner, and so we stood there, scuffing our feet in the melting drifts,
recalling the man we now recognized from our childhood. “He used to feed me cranberry juice in the summer,” said my partner. For my part, I remember him standing tall behind the wooden counter of the old general store, beside a large candy jar. He lay dead at our feet, but from the perspective of memory, he smiled above us.

We are by no means isolated. A major highway runs right past town. But
our coverage area is large, and extends well out into forest and marshland.
Our clients are a mix of townies, farmers, upper-crusters who own lake
property and a wide range of trailered recluses. Other areas are far more
remote, but we have our pockets of darkness, and we’re often the first to
discover them.

On a night when it is 20 below and our breath freezes on our beards, I
follow our fire chief into a skeletal, slouching farmhouse. The fire we’d been called for has been extinguished, but the air inside the house is toxic with
the odor of scorched carpet and raw fuel oil. A black dog woofs
thunderously from beside a greasy couch. A young woman is cradling a baby. The baby’s lips and nose are soot-stained. A crooked length of copper
tubing snakes over the slanted floor to a small heater the husband has
rigged. He is tattooed and wiry, and has a burn across his forearm. Like
his baby, his face is soot-stained, and he has a hacking cough. The only
light in the room radiates from a garish aquarium and a huge console TV.

We take the family to the rescue van, give the baby and father oxygen and wait for the ambulance. The father worries about what our help is going to
cost. (His concerns are not uncommon. When one of our crews arrived at the cabin of an Illinois tourist recently, his wife met them at the door with a
handful of plastic. “What credit cards do you accept?” she asked. When the
crew told her pre-payment wasn’t necessary, she was flabbergasted. “Where
we’re from, you have to pay before they’ll take you.”)

A practical note: When we respond on behalf of our fire department, there is no direct charge to the patient — the charges are paid by the townships we serve. The ambulance service bills patients directly, but since many of our patients are covered by Medicaid or Medicare, the service receives only partial payments. Most of the remaining costs are subsidized by the townships, but the service “eats” a number of delinquent accounts every year. The bottom line is, if you call the ambulance, it will come, and you will receive care regardless of your ability to pay.

I warm a stethoscope and listen to the baby’s lungs. I hear the air go in and out, and I wonder what this little life will come to. Back in the lopsided house, the aquarium is bubbling, and Jay Leno is giggling with a starlet.

I keep using the nominative I, but only because I am telling the story.
The story is not mine. The place is not mine. Our roles — those of the rescuers and the rescued — are not clearly defined. Out here, rescue is less about throwing ropes or stanching blood than assuming a role in a quirky narrative that weaves itself without seams, until one day you look back and it has become history.

Every two years my fellow EMTs and I take a 30-hour refresher course and complete an additional 48 hours of continuing education classes on our own. We are trained, and retrained. But we are never completely prepared.

A man is having a heart attack in the middle of nowhere. When we finally
locate the patient, deep within the stygian woods, he is standing staggered
in the snow, leaning against a tractor, surrounded by a leery knot of men
who reek of bacon grease and banjos. One of the men detaches from the
group, puts his rawhide face in mine and, in a boozy, baccy-stained gust,
announces, “He coded three times. I did mouth-to-mouth.”

It’s a little
strange, out here in the moonless boonies and snot-freezing blackness at the
tail end of some logging trail, to be informed by an alcoholic apparition in
stained coveralls that someone has “coded.” Later I will decide that he
picked up the term from TV, and that after a long day of whiskey-stoked ice
fishing, his buddy hadn’t coded, but simply passed out. I don’t doubt for a
moment, however, that he revived whenever Dr. Deliverance laid on the
lip-lock. The very thought tightens my spine.

We’d been led here from the county road by two guys in a car who signaled our rescue van with their flashers, then we’d careened down a snaky dirt trail paved with nothing but snowpack. We were already 12 miles from town when they led us off the paved road, farther and farther into the forest until the road petered out and we were fishtailing up this twin-track logging trail.
We kept radioing directions to the ambulance — still several minutes out –
right until the logging trail opened into a clearing and our headlights
illumed the banjo boys.

The patient is big and bearded. I try to give him oxygen, but he isn’t
having it. He acts woozy, but his eyes are fierce. When the ambulance
struggles into the clearing, I give a report to the lead EMT, explaining that
the patient had reportedly experienced cardiac arrest, whereupon one of the
coverall contingent, hearing the word “arrest,” rushes me and threatens to
knock my teeth in if I take his friend to jail. The other men form a
protective circle around the patient while I commence a rather hurried
review of medical terminology.

Apparently my explanation penetrates the ethanol fog and paranoia and is deemed satisfactory, as the patient is released back into our care, although not until he has whispered into the ear of his chief defender, who then clasps him by the head, looks deep into his eyes and says, rather mysteriously, “I promise, man, I promise.”

Once on the cot, the patient commences to thrashing and cursing and tearing
his shirt to reveal slack tattoos of an unprofessional sort. The trip back
to the county road is a trial and a test of our goodwill, although the
patient’s determined efforts to wrassle provide us the opportunity to
surreptitiously pat him down for weapons. When we finally emerge from the trees and reach blacktop, we transfer him to a waiting chopper and
gratefully release him to the sky.

I don’t love being fat — far from it. If I could fit in and look normal, I’d
do it. But as Rufus mentions in passing, diets don’t work. After years of
struggle, I refuse to spend my life more obsessed with not eating food than
with eating it. And I’d appreciate it if people like Rufus stopped
worrying about my health risks and minded their own business.

– Linda Miller

Studies have found that when people who are medically defined as “obese” focus on healthy eating and exercise, their health improves, regardless of weight changes. For example: Many “obese” people cancel appointments with health-care providers because they do not want another “weight loss lecture”; they feel ashamed to exercise in public due to the looks they receive; and a constant focus on the fact that they cannot be healthy and overweight often leads to a defeatist mentality, which then leads to unhealthy eating or other health-damaging activities such as smoking and drinking.

The best thing we as a society could do to promote the health of people with larger bodies would be to promote acceptance of different sizes. It would be very interesting to see if in a more accepting world — where fat people were viewed as just as valid and acceptable as thin ones; where fat people worked out comfortably at the gym, were smiled at in the street and were supported by the medical profession in leading healthy lives — the association between weight and many diseases would dramatically decrease. I believe that it would.

One hardly gets the impression that Rufus is concerned about the health of children. If we are, however, what we can do is promote fun physical activity and healthy eating and get images of bigger kids into the media, so that kids grow up feeling good in their bodies. To focus on fatness, with a tone of superiority and mockery (Rufus pointedly describes a girl who is “fat” who is holding hands with a boy as they leave school, as if to say, “How dare she have a boyfriend!”), lays fertile ground for eating disorders, low self-esteem and a lifetime struggle with the scale.

– Lisa Weiner

I have a stepdaughter who is fat. On the one hand she is uncomfortable in her body; on the other, she refuses to take responsibility for it. Her diet is a nutritionist’s
nightmare: rife with sugar and fat, nearly devoid of vegetables or fiber,
full of additives, but lacking in substance. Her hobbies are sedentary
and passive: watching television, reading books, surfing the Internet.
Her private school does not require physical education.
I do what I can, but at 15, she makes her own choices, scorning all
the fresh vegetarian selections I put on the table in favor of (Oscar
Mayer) hot dogs with (Kraft) cheese and (Heinz) ketchup. Homemade
blueberry bran muffins don’t taste right to her desensitized tongue, and
are bypassed for Pop-Tarts.

This Sunday her father and I are participating in a 5K charity walk. I do
not know whether she’ll join us; it’ll be difficult for
her, but a step in the right direction.

– Jamie Tang

Baltimore, Md.

I am horrified to see the teenagers in my neighborhood. Their parents are
busy people who don’t have time to take the young people to sports
activities or spend time cooking meals. They find it easiest to fill their
kitchens with junk food and give the kids money for fast food. As a result
these young people are overweight. One girl is bulimic. Her mother told me she has recently become shy and introverted because she is self-conscious about her weight. She is not old enough to
make decisions about what food to choose; her parents’ role is to educate
her about food.

– Sarah Holland

Herndon, Va.

Echoes in “Dutch” of a 1994 short story
BY LAURA MILLER

(11/03/99)

In addition to the other problems in Morris’ Reagan biography, there were two
small quotations that caused my little pink ears to perk up. As a fully
qualified journalist, I can state with authority that an “18-point banner”
headline would look extremely odd in a newspaper. A banner headline is one
which stretches across the page. A point — the vertical size of the
letters — is 1/72 inch. An 18-point headline is 18/72 of an inch,
which would look like a slug track running across the top of, say, the New
York Times.

Then there’s the “Jim Raider, Rocketeer” reference. The Rocketeer was a
cartoon character created by Dave Stevens back in the early 1980s. So far as
I know, the name didn’t exist before then, certainly not in popular use.
It appears that one could develop a fine career seeking and listing the
anachronisms, flubs and outright errors in “Dutch.” Beats collecting Beanie
Babies.

– William Peschel

Book page editor, Rock Hill (S.C.) Herald

Hip-hop hooray
BY SIMON RODBERG
(11/03/99)

Simon Rodberg correctly asserts that popular culture is a worthy subject of
academic inquiry. But although Rodberg has stumbled upon a rich, complicated
topic — hip-hop music and its popularity among privileged, white youths –
his analysis is less than rigorous. Instead of addressing rap’s notorious
violence, misogyny and homophobia, or its commercialization (remember, hip-hop music is a multimillion-dollar industry, not the underground phenomenon it once was), Rodberg simplistically insists that hip-hop “battles America’s economic and political structures” without explaining
exactly how Jay-Z’s record sales translate into the economic or political
empowerment of any black or poor person other than Jay-Z.

Rodberg doesn’t even articulate how his love of hip-hop has translated into any
real-world activism on his part. His failure to approach hip-hop with the same level of critical thinking he undoubtedly employed in his directed studies classes only confirms the popular belief that the study of popular culture is more often than not the work of fanatics, not scholars.

– Nikki Montgomery

Tripping on iboga
BY DANIEL PINCHBECK
(11/03/99)

Taking a Bwiti initiation was ill-advised and naive.
Unlike what the article asserts, Bwiti isn’t a group of people, or a
tribe, or the name of followers of a religion. Bwiti’s not a big mystery
in Gabon, either: It’s a belief system, a ceremony and a spirit normally
described as a universal ancestor.

During the Bwiti ceremony, Bwiti reportedly appears and takes you through
your life and explains why you did everything you did. This is supposed to
give you enormous insight into your own behavior and others. Later,
sometimes years later, he allegedly reappears for additional insights.

That said, the people I’ve known who’ve gone through the ceremony
still drank, smoked, acted as addicted as ever and generally displayed no
more wisdom than any other stoner. Others have reported they went through
the thing as a lark, and now realize that they can never get away from Bwiti.

Daniel Pinchbeck’s adventure was a bad, bad idea. Ibogaine is a powerful
drug with properties that should be studied and respected; it’s not a source of
wisdom or kicks. And native religions are better understood before they
are practiced, lest one misunderstand the depth of commitment required or
the long-term costs.

Fortunately for his own safety and health, Pinchbeck’s descriptions
indicate he probably didn’t take near the amount of drugs necessary to do
serious damage, and I’m not convinced his friends in Lambarene took him
through an actual Bwiti ceremony. (Some of his descriptions smack of the
Gabonais’ tendency to goof on Americans and separate them from their
money.) These are good things — it’s important to remember the old
proverb about where angels fear to tread.

– Bill Hatton

Philadelphia

Faith healing
BY JON BOWEN
(11/03/99)

The recent article about faith healing raises the broader issue of
the quality of the evidence in studies purporting to show relationship
between religious activity and beneficial health outcomes. As we
demonstrated in a paper published in the Lancet earlier this year, the
evidence is weak and unconvincing at best. Most of the studies cited by
supporters of this point of view have significant methodological flaws which render their conclusions
unreliable. Regrettably, the Harris paper on the effects of
intercessory prayer is no different. For example, the researchers fail
to comment that even though the intercessors prayed for a quick recovery
for their patients, there was no difference between the prayer and
control groups on length of stay in the coronary care unit (CCU) or in
the hospital. And the scale used in this study to assess clinical
course in the CCU has never been validated.

Even if there were strong and unequivocal evidence of a positive
association between religious activity and health outcomes, bringing
religion into medicine still is ill-advised, since it raises significant
ethical issues, namely the possibility of religious coercion, blaming
the victim for illness and intrusions into private realms of the
patients’ lives.

– Richard P. Sloan, Ph.D.

Director, Behavioral Medicine Program

Columbia-Presbyterian Medical Center

New York

During a time in my life when I considered myself an atheist, my younger
brother had a terrible rock-climbing accident. He was in an induced coma in ICU for two
months. His last rites were read to him three different times. I started praying, and I asked God — that entity I didn’t think I believed in — what he wanted me to do in exchange for saving him. I looked up to see “believe in Jesus” etched on the wall.

I didn’t become a devout Christian on the spot, but I
did stop saying I was an atheist, and I started praying. And my brother got well.
Even the doctors said it was a miracle.
Today, religion does not matter so much to me, but praying does, and I do it a lot.
I pray for others and I pray for myself. I pray at night, at my desk, in the
car, while on walks. It’s not a big ordeal. I just need to do it. I feel like it helps me be a better person.

A friend of mine was recently in the hospital and I put my hands on him and
prayed for him too. I think it’s making a difference. I think he does too.
So others can debunk the idea of prayer to help the sick, but maybe that’s a sign that we should be praying for them too.

– Debra Sherman

Sacramento, Calif.

I wish to address Amanda Chandler’s “miraculous” recovery from cancer. It is implied that the prayer she received “swayed the odds” of her having malignant cancer. However, since
the doctors quite clearly gave her a 50/50 chance of it being malignant, the
fact that it was not malignant is completely within those odds. To present this story in such a way as to imply that the results were swayed by prayer goes completely against the
concept of a “50/50 chance.”

– Alex MacFarland

This article indicates a profound misunderstanding of Christian Science. While faith is an important element in healing through prayer, in order to heal consistently, it is
necessary to understand God’s laws and how they apply to healing as
Christ Jesus illustrated. The pediatric study mentioned was presented
by individuals whose work is to oppose any acknowledgement of spiritual
healing. In fact, that “study” ignored massive amounts of data which
refuted their findings. Rather than “dangling their children over the
edge” as the author states, parents are practicing a scientific healing
method that is highly effective, has no harmful side effects, and heals
its patients morally as well as physically.

– Warren Berckmann

Spring Lake, Mich.

How San Francisco ruined itself
BY BILL WYMAN
(11/03/99)

“Ruined”? Who says it is? It’s changed. I’ve
lived in the Bay Area most of my life. As I walk through the
city, I can be sure I’ll encounter a certain amount of selfish, walking
farts of all makes and models, who live to give out bad vibes. Yes,
certain days get ruined by them. But there are also a certain amount of
people who’ll give me a warm smile and say, “How you doing?” Both types are
distributed fairly evenly throughout every town in the world. I
still think San Francisco has a preponderance of the latter. As far as income disparity, that’s a real problem, and it seems to be getting worse in America. But instead of addressing
it by identifying types of people to hate (vainly and incorrectly, I
might add), let’s address it by treating each other more humanely — whether you’re behind the 8-ball or in front of it.

– Andrew John

Bill Wyman complains about the lack of usable public transportation in
San Francisco. He should try living in Minneapolis, where it is faster to walk or
bike anywhere you want to go downtown than it is to take the bus. The only
place you can go by bus relatively quickly is the Mall of America. I
explored San Francisco and the Bay Area for a week this summer and was blown
away by the convenience, price and range of the public transit there. It is quite feasible to not own a car if you live in San Francisco or the East Bay. It’s nearly impossible not to in Minneapolis.

– Manda Lo

What a difference a century makes. In 1899, a sexually enthusiastic woman
would likely have been pathologized as a “nymphomaniac,” and hospitalized for insanity, clitoridectomy or both, and a woman who didn’t achieve a “vaginal orgasm” would be labeled psychosexually immature. In 1999, as our century reaches its climax, we have an international medical and scientific effort to encourage female sexuality, to help the more than 40 percent of American women who report one sexual complaint or another, be it lack of desire, difficulty achieving orgasm or excruciating pain instead of pleasure.

And so, for three glorious autumn days last week I sat in a ballroom with heavy drapes and crystal chandeliers and eavesdropped as people with M.D., Ph.D., M.P.H., R.N., FDA and NIH after their names exchanged data, hypotheses, ideas, beliefs, questions, answers, “Grand Master” lectures, podium presentations, poster displays, prize-winning essays and countless PowerPoint presentations, all on the subject of female sexual dysfunction, or “FSD.”

It was three days of immersion in the desire/arousal/orgasm/resolution cycle, vasocongestion (“that heavy feeling”), hormones and neurotransmitters; vaginas, lubrication and the clitoris (doesn’t rhyme with the name of a Seinfeld date), but none of it was nearly as sexy as five minutes of Barry White.

More than one meeting attendee was heard speculating that if Viagra and its
potential for tapping the other half of the gender market did not exist,
this meeting probably wouldn’t have either. And in fact, several large
pharmaceutical companies provided “unrestricted educational grants” for this meeting. One of the largest, at the “Diamond Level,” came from Pfizer
Pharmaceuticals Inc., the maker of Viagra. As one speaker put it, “Sex
sells. If you didn’t know that before Viagra, you know it now.”

I listened to a stunning blond Swedish researcher describe her
experiments with Seldenafil (Viagra’s real name) on “rat vaginal smooth
muscle.” Another researcher described her Viagra work on the “vaginal
tissue strips” of New Zealand white rabbits; the cute little critters are
“euthanized,” their vaginal tissue is removed and cut into small strips,
hung in chambers and bathed in drug solutions. The point, apparently, is
to understand the mechanism that causes an actual woman’s vagina to “relax” and “dilate,” which is what occurs in sexual arousal, and to determine
whether Viagra and other potential new drugs can help “enhance” that.

I saw pictures of turbocharged vibrators, gizmos for measuring and probing, and women lying on exam tables wearing weird 3-D sense-surround glasses watching Candida Royale erotic videos while a researcher sat at a computer five feet away measuring “pre-stim” and “post-stim” responses.

I saw charts and graphs and color duplex ultrasonograms of blood flow to the clitoris. I saw slides of vaginas turned literally inside-out, hanging
outside the body between the patient’s thighs, in a frightening example of
“uterine prolapse.”

I got a demonstration (on my inner wrist, alas) of a new device called the
EROS-CTD, a battery-powered vacuum device that looks like a computer mouse with a small, clear, plastic suction cup at the end. The device is turned on and the suction cup is applied directly to the clitoris to “cause clitoral
engorgement.” Ah, I thought, finally! A penis pump women can call their
own.

I even heard a few good jokes: (Quick, what’s the difference between a golf
ball and a G-spot?)

By far the oddest thing I saw was a French urologist’s black-and-white
images of a 30-year-old man and a 27-year-old woman who volunteered to have sexual intercourse in an MRI machine. This doctor admitted he had no
“therapeutic goals” for this project; he had simply become inspired by a
15th century DaVinci drawing of sexual intercourse and felt compelled to
create his own “actual anatomical images” of same. He could find only one
radiologist in all of France willing to join him in this endeavor. If
you’ve ever been subjected to an MRI, surely you can understand his report
that the male subject’s “erection was difficult to maintain during the
required imaging period.”

There were, to be sure, some take-home headlines from this meeting,
including a new, more woman-friendly way of defining FSD. It includes, for
the first time, the requirement that a woman’s sexuality be considered
“dysfunctional” only if it causes her “personal distress.” In other words,
these sexologists are now willing to concede that it is up to the woman
herself — not her partner, not her doctor — to determine whether her lack of desire, lack of arousal, degree of pain or difficulty with orgasm is
sufficiently troublesome to warrant diagnosis and/or treatment. You’ve
come a long way, baby?

There was also a “buzz” about the various Viagra studies on rats, rabbits
and even real women that, while small and preliminary, did seem to suggest some real promise in treating some women with arousal difficulties.
However, FDA approval for Viagra for women seems several placebo-controlled, double-blind studies away.

In a provocative lecture titled “The Sexual Pain Disorders: Is the Pain
Sexual or Is the Sex Painful?” a prominent researcher advocated that pain
and discomfort associated with sexual activities be reconceptualized,
treated not as sexual disorders, but as pain disorders, with the focus on
the pain, not the sex. As he explained, when a back injury keeps a worker
off the job, it’s not treated as a work problem, it’s treated as a pain
problem. Why should pain during sex be any different?

Anthropologist Helen Fisher spoke of the three brain systems for love:
lust, attraction and attachment. There were important presentations as
well about sexuality for women after a breast cancer diagnosis, diabetes or
hypertension; sexuality for women with spinal cord injuries; sex during
pregnancy; sex after menopause; and new ways to think about a woman’s cycle of desire, arousal and satisfaction.

Lesbians and lesbian sexuality were almost invisible at this conference,
with the exception of one presentation about treating “Inhibited and
Discrepant Desire in Lesbian Couples” (aka Lesbian Bed Death), and some
scattered efforts to eliminate the emphasis on sexual intercourse when
talking about what real women actually do. However, for the most part, this
conference placed the heterosexual woman who has intercourse in a stable
partnership front and center.

There was also a good old-fashioned feminist controversy, made all the more
poignant because Boston is hallowed ground: home base for the collective
that publishes the groundbreaking 1970s self-help book for women, “Our
Bodies, Ourselves.”

Even before the conference began, a New York psychologist and sex therapist, Dr. Leonore Tiefer, got scared. She firmly believes this
conference represents a watershed event in the history of women and the
history of sex. She sees only danger in a medical approach to women’s
sexuality, and accuses the medical establishment and pharmaceutical
companies of aggressively trying to define, control and profit from women’s
sexual satisfaction. “We are watching the calculated invention of a new disorder [for women] that serves many financial and professional constituencies — but not necessarily the interests of women,” she says.

Tiefer was outraged that the organizers recruited hundreds of people from
many health-care disciplines to this event, most of whom she says are
“oblivious to the politics of gender,” but invited almost no one who studies
sexuality from a social, cultural or psychological perspective.

From the podium, Tiefer accused her colleagues of “careerism uninformed by
women’s larger social predicaments,” and challenged them to resist “the
temptation to promote simplistic models and solutions for women’s complex
sexuality.” She reminded them that eroticism, personal longings, fear and
the need for intimacy and power are not found in any lab. She implored them not to try to measure and standardize that which is spontaneous.

It was a brave thing Tiefer did — “I would have felt like complete and
total shit if I hadn’t done it,” she says — especially to this crowd, so
giddy in its echo chamber of professional success and stature. Her talk was
politely applauded, but her politics predictably rejected and denounced by
many at this conference, including two angry women who took to the
microphones and called her “reactionary,” “archaic,” “intense,” even (gasp)
“anti-feminist” for wanting to preserve a lower-tech, non-medical approach
to women’s sex lives.

“Women should have choices. Not every woman wants psychotherapy, not every couple wants couples therapy,” was the reaction from Dr. Sandra Leiblum, a leading authority in the field of sex therapy. “Pharmacological options are a choice women should have. It would be like saying women can only have vaginal deliveries without any kind of sedative or epidural for pain.”

I couldn’t help but notice that this meeting was a managed-care efficiency
expert’s wet dream. The program book listed precise times for each event –
for example, “2:01-2:11 p.m.: Decreased Testosterone in Regularly
Menstruating Women With Decreased Libido: A Clinical Observation.” The
longest anybody got to speak, even though he or she may have come thousands of miles to do it, was 20 minutes, and these were the so-called “Grand Master” lectures — so authoritative, apparently, that no questions were allowed afterwards.

There was also a rat-a-tat-tat procession of six-minute presentations with
precisely four minutes of questions no longer than 30 seconds apiece. At one
point, as yet another researcher raced through his latest laboratory
triumph, the woman next to me muttered, “Leave it to men to rush through
sex.”

Here’s what I want to know: How come doctors, who, in my experience, are
constitutionally incapable of ever seeing any patient on time, can run their
conferences like clockwork? I propose a placebo-controlled double-blind
study on that.

But let it not be said that the world’s greatest sexologists are all work
and no play. On Saturday night, those willing to pay $85 apiece (on top of
the $495 registration fee) were treated to a clambake and lobster dinner
aboard a yacht circling Boston Harbor in the moonlight. They told
(preferably dirty) jokes for drink tickets; they chose “You Make Me Feel
Like a Natural Woman” as the FSD theme song; and, through a chain of events that nobody seemed quite able to recall the next morning, about 20 of these high-powered medical men stripped off their shirts, danced bare-chested to Motown oldies and posed for a team photo in a kick line.

Oh, and, in case you were wondering, the answer is: A man will spend 20
minutes looking for his golf ball.