Longer Looks: The Smells To Treat PTSD; Nudging Healthy Choices

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The Miami Herald: Bringing The Smells Of War Home, Via Virtual Reality
On an Orlando college campus, veterans and active duty soldiers suffering from post-traumatic stress disorder inhale the unmistakable smell of burning tires, rotting garbage and Middle Eastern spices as part of a virtual reality treatment for the psychological wounds of war. Participants sit in a chair wearing a head-mounted display and video goggles connected to a computer system and a scent machine that puffs out the odors, recreating their memories of war. ... The Trauma Management Therapy program, now available to South Florida active duty soldiers and veterans with PTSD who volunteer, is part of a clinical study at the University of Central Florida that uses sights, sounds and smell to help ease the episodes of anxiety, sleeplessness and nightmares. With new waves of soldiers returning as American forces withdraw from Iraq and Afghanistan, researchers are hoping the combination of traditional therapy and virtual-reality simulation — with an emphasis on smell — to help decrease post-traumatic symptoms (Audra D.S. Burch, 9/9).

The New York Times: Door To Door In The Heartland, Preaching Healthy Living
Like a missionary, Michael Bailey, a county health worker, spends his days driving his beat-up Nissan around (Okalahoma City's) poorest neighborhood, spreading the word in barber shops and convenience stores about the benefits of healthy diet and exercise. "Look at the kids," he said. "Overweight, huffing and wheezing. Their lives will be miserable if this doesn't change." Mr. Bailey believes that food is slowly killing his community here, and signing people up for a program to prevent heart disease is his way of saving souls. Local governments across the country are creating dozens of such experiments with money from the Obama administration's Affordable Care Act. It is part of a broad national effort set in motion by the law to nudge a health care system geared toward responding to illness to one that tries to stop people from getting sick in the first place. To that end, the law created the $10 billion Prevention and Public Health Fund, the largest-ever federal investment in community prevention (Sabrina Tavernise, 9/10).

The New York Times: How My Mother Disappeared
In 2005, as my mother began the torturous process of disappearing in plain sight, I retreated to my kitchen, trying to reclaim her at the stove. Picking up a pot was not the instant panacea for illness and isolation and despair that I wanted it to be. But it helped. When I turned to my mother’s recipes, I felt grounded in her rules, and they worked every time. I could overcook or undercook the meatloaf, and it still tasted the same. ... A CT scan ... showed that she had suffered ministrokes, transient ischemic attacks. The scar tissue the strokes left in Mom’s brain was anything but mini; because of its location, it was not only impairing her memory but ensnaring her in a state of depression (Alex Witchel, 9/7).

The Atlantic: The Fallacy Of Treating Health Care As An Industry
On September 6 the well-respected Institute of Medicine (IOM) released its report, "Best Care at Lower Cost." Its authors argue that the U.S. health-care system is falling far short of its potential and continuing to rack up unsustainable cost increases. ... The solution, they argue, is for the health care system to adopt practices already in use by other industries. ... One problem with a patchwork approach to reforming healthcare is the danger that we may produce a sort of Frankenstein, a monstrosity made up of parts that look strong when viewed in isolation but turn out not to fit well together. We cannot merely mix up two-thirds of a cup of banking, a quarter cup of manufacturing, and two tablespoons of airline policies and procedures and expect to produce well-integrated patient care. No matter how good each of the individual ingredients that go into preparing a meal are, if the components are not mixed in the appropriate combinations and proportions, the result is more likely to prove stomach churning than appetizing (Dr. Richard Gunderman, 9/10).

Los Angeles Times: The Doctor-Patient Relationship Is Evolving
(This story is part of a series of health care stories in a special section of the Los Angeles Times called The Future Of Healthcare)  
Until now, doctors have pretty much called the shots in the doctor-patient relationship. But change is on the way. Patients, say ahhhhh — it's about to be all about you. The new approach is called patient-centered care, and it's a very good thing, according to Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics in Bedford, Ind. "It will mean better outcomes, more satisfied patients and lower costs," he says. Here are just a few ways your relationship with your doctor may evolve in the not-too-distant future:Your doctor won't be the boss of you. "Physicians are experts on likely outcomes, likely effects and side effects," says Dr. Elliott Fisher, a professor of community and family medicine at Dartmouth's Geisel School of Medicine in Hanover, N.H. "But patients are experts on their preferences"...You and your doctor will spend more time on the Internet. That's because e-visits will replace some traditional kinds of appointments. "It's so easy," says Dr. Redonda Miller, an associate professor at the Johns Hopkins University School of Medicine in Baltimore. "Patients love it — 50% of what we do in the office could by done by email" (Karen Ryan, 9/13).

Journal of the American Medical Association: A Path To Wholeness
My communications with Len and Lorraine allowed me to envision this loving young couple as they embarked on establishing Len's first church in Hardin, Montana, after seminary in 1952. Lorraine was glowing as she was about to give birth to their firstborn, starting their family and new life. A much-dreaded experience befell them on October 13, 1952, when physicians in Billings discovered that Deborah had a life-altering condition at birth: spina bifida. ... In 1952, the expectations and values imposed by social standards and framed through the advice of both nurses and physicians—"You cannot care for this infant." "Do not bond." "Pass her on to an institution for care. You cannot do it." and insisting that Lorraine should "Stop that crying" whenever she was seen expressing emotion—were in marked contrast to those deafening proclamations coming from Deborah's parents: This is our daughter. How can we not care for her and love her? Our very souls have been as one with hers from the moment of intention, to conception, to birth, to death and beyond (Dr. Jay M. Milstein, Lorraine B. Kovar, Leonard J. Kovar and Debora A. Paterniti, 9/11).

The New York Times: The Caregiver
I was driving through Kansas, taking the kids back to college, when my cellphone buzzed. It was my sister-in-law letting me know that Juanita Hawkins had died. An aching sensation — grief — filled my chest and swelled into my throat. Juanita was my mother’s caregiver for more than 35 years. She was at every Passover, every Thanksgiving, for as long as I could remember, sitting at the table, smiling at the jokes, partaking in the closeness of family. They were an unlikely pair: my mother, raised in Chicago by Russian Jewish parents, her high school’s valedictorian and a gifted pianist before multiple sclerosis attacked in her early 20s. And Juanita, a black woman, the second of 10 children from Pine Bluff, Ark. A modest woman who never went to college, married or had children. A committed churchgoer. They had nothing in common, these two, except decades of living together and being bound inextricably by my mother's illness and the rhythms of their daily life (Judith Graham, 9/11).

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