Friday, March 27, 2009

Still in Cleveland: Social Determinants of Health (and the Behavior of the Harvard Faculty)

Last night, the Medical Advisory Board of the National Center for Medical-Legal Partnership
has a very nice dinner,  and today we opened with a tremendous talk by Rob Kahn on the intersection of social determinants of health and genomics.  Rob pointed to our haste of the medical profession to accept genetic determinism is a social, not a scientific phenomenon.  A couple thoughts:
Interesting quote:  “Few tragedies can be more extensive than the stunting of life, few injustices deeper than the denial of an opportunity to strive or even to hope, by a limit imposed from without, but falsely identified as lying within.”- Steven Jay Gould
Rob looked at the relationship of "hardships" and recurrent admissions for asthma.  Turns out that the folks with more hardship (money troubles, housing problems, lack of food) had more admissions, setting up the next question:  if we reduce hardship, can we improve health and create more wellness.  (Of course, there is another SJG quote that may relevant :  “The invalid assumption that correlation implies cause is probably among the two or three most serious and common errors of human reasoning”)  

Another thought:  applying QI methodologies to the medical-legal partnership makes a certain amount of sense, and Rob showed us how to make that happen.  Their electronic medical record has made it possible to look at individual performance in their site-  they are using the EMR to track the referral process.  EMR makes much of this stuff possible;  he presented some very exciting process data that shows how to monitor the process.

Ultimately, however this comes down to the need to find a common metric for the measurement of well-being.  He liked Sen, the Nobel-Prize winning economist and author of Development as Freedom, who defines well-being as living a life of genuine choice.
"Political rights, including freedom of expression and discussion, are not only pivotal in inducing social responses to economic needs, they are also central to the conceptualization of economic needs themselves."

Interesting guy.

Really interesting talk.  Rob did mention mental health, but only in the context of a consultative service that often provides us with little feedback.
Just to get back to Children's Mental Health, the New York Times has an article about Joseph Beiderman and his work with Johnson and Johnson in the past.  The article shows why you should never use irony in talking  to lawyers:
In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard. 
“Full professor,” he answered.
“What’s after that?” asked a lawyer, Fletch Trammell.
“God,” Dr. Biederman responded.
Did you say God?” Mr. Trammell asked. “Yeah,” Dr. Biederman said.
He continues to do our profession no favors.  I really wish that we could get beyond this discussion, but it seems that it will be with us for quite some time.

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