Why Movie Stars Marry

A recent study published in the Journal of Human Capital examines movie star marriages in an attempt to identify why people often marry someone with a similar educational background. According to Gustaf Bruze, an economist at the Aarhus School of Business and Social Sciences in Denmark, the answer has less to do with financial or professional considerations, and that just because a couple attended the same school is not necessarily conclusive.

Bruze reviewed information about the top movie stars’ marriages, earnings, and education levels. The analysis showed that the level of formal education may have little to no correlation with success (either financial or the likelihood of winning an industry award).  Notwithstanding, movie stars who marry still tend to have similar educational backgrounds, even though it is unlikely a couple met in school or on a film set as a result of their their education level.

Bruze noted that the findings suggest education is not dependent upon financial or professional  connections. “What it says is that men and women have very strong preferences for nonfinancial partner traits correlated with education. And educational sorting would remain even if the tendency of men and women to work with colleagues of a similar educational background were to disappear or if the role of educational institutions as a meeting place for future husbands and wives were to disappear.”

A Punch Up At A Wedding

Lost Hospital — Ellis Island Hospital, New York Harbor0

Between 1892 and 1954, Ellis Island served as the only entry point into the United States for more than twelve million immigrants. A small island inside New York Harbor located just off the New Jersey coast and the nearby Statute of Liberty, Ellis Island grew over the years from its original 3.3 acres to 27.5 acres in size.

Before 1890, individual states regulated immigration. When the Federal government assumed this responsibility, it constructed and operated a new facility on Ellis Island, opening its doors on January 1, 1892.

For the most part, class and status dictated whether an immigrant was sent to Ellis Island. Travelling across the Atlantic Ocean (the only real viable option at the time), first and second-class passengers were only sent to Ellis Island if they were sick (or had legal issues).  Third class passengers, also known as “steerage”, would almost always be sent to Ellis Island by ferry or barge for a medical examination.

If one’s legal documents were in order and he or she appeared to be in good health, the time spent on Ellis Island would be brief.  Doctors conducted medical examinations by quickly scan all newcomers for obvious physical ailments (sometimes referred to as the “six second physical”).

Fearing danger to the public health, immigrants with contagious diseases were excluded from entry into the United States. As a result, a hospital was needed on Ellis Island to treat the immigrants and protect the public health, and it opened in 1902. The contagious disease hospital was built with 18 wards for specific diseases, and it also included a psychiatric hospital.  Eventually the hospital would grow to include 22 buildings on Ellis Island.

A report by Assistant Surgeon General H.D. Geddings in 1906 stated: “The hospital building is of modern construction, on the block plan, of brick and stone construction, architecturally very handsome, and three stories and an attic in height, with a basement.  The general plan of the building is a central portion for executive and administrative purposes, with wings containing large and small wards.”

The Ellis Island Hospital received heat, light and power from a plant on Ellis Island. The hospital’s kitchen prepared 2,000 meals each day for the immigrants and 300 employees. According to the Commissioner of Immigration, Federic C. Howe, in 1916 Ellis Island would accommodate “as many as 10,000 people temporarily or permanently.”

The Ellis Island Hospital handled all diseases, including measles, mumps, diphtheria, and whooping cough. The hospital also had its own state-of-the-art laboratory, critical at the time to identify cases such as pulmonary tuberculosis. Indeed, the hospital reported only one employee death due to infection with contagious disease (tuberculosis) while working with the immigrants.

According to Dr. Milton Foster in 1915, “The medical inspection of arriving immigrants is made chiefly for two purposes; first, to see that they are strong, well, and bright enough to be able to earn a living and get along in this country; and second, to ascertain that they do not have certain diseases which they might transmit to their new neighbors in America.” While it treated disease and the passing of 3,500 patients, Ellis Island Hospital also delivered 350 babies (receiving immediate citizenship at birth).

The hospital screened immigrants for mental illness as well, usually a process initiated with an “X” chalk marked on the jacket or dress of the immigrant.  According to Dr. Thomas Salmon in 1905: “Justice to the immigrant requires a carefully considered diagnosis; while on the other hand, the interests of this country demand an unremitting search for the insane persons among the hundreds of thousands of immigrants who present themselves annually at our ports of entry.”

Physicians from the U.S. Public Health Services were required to rotate through the hospital. The patient load on Ellis Island was challenging. According to Dr. Foster, the volume compared to that of the hospitals in both Boston and Washington, D.C.:

“Take any week in the year and imagine that, during this week, all the people who were sick and needed treatment in [Boston and Washington, D.C.] were to be sent to one hospital.  Assume, also, that this hospital was a real general hospital, in the fullest sense of the word, and that it accepted not only ordinary patients but also the insane and those suffering from contagious diseases. Let us also further suppose that all . . . were inspected and that all those who were suspected of having latent disorders, like tuberculosis or syphilis, were also sent to this hospital for examination and treatment. Grant all of these conditions and you will have a pretty fair idea of the total amount of work performed by the hospital at Ellis Island last year.”

Restrictions on immigration ultimately proved to be the end of Ellis Island Hospital. Additionally, physical screenings were conducted overseas before transatlantic voyage was permitted.

As the number of patients began to decrease, Ellis Island was used by other government agencies such as the FBI (using the island to deport possible foreign spies), the U.S. Army (during World War II for its disabled servicemen as well as German and Italian prisoners of war), and finally the U.S. Coast Guard. In fact, it was the U.S. Coast Guard that ultimately closed the facility in 1954.

Photographs from EllisIsland.orgNewYorkTimes.com, and U.S. DHHS.


Exercising Restraint – The Role of the Neighborhood ER in Treating Mental Illness0

“How do you know I’m mad?” said Alice.  “You must be,” said the cat, “or you wouldn’t have come here.” –Lewis Carroll

The challenges facing the local Emergency Room are as varied and complex as the patients it serves.  From trauma surgery to heart attacks to poisoning and beyond, today’s ER must be prepared for just about any health related issue, ready to quickly and accurately diagnose and treat whatever comes through its doors.  Fortunately, the advent of superior diagnostic technology has made the path between illness and wellness increasingly more linear.  So is the case, at least, with matters of the body.

However, when a patient’s illness is mental in nature, the role of a hospital becomes much more complicated.  What happens when a mentally ill patient gets sick in the outside world and must seek help not in a psychiatric care facility, but the neighborhood Emergency Room?  Unlike a trauma or stroke victim, whose injuries typically present as physical, issues of mental health are much harder to pinpoint, diagnose and treat in a timely fashion, as it is primarily the patient’s judgment that falls under question. Proper medical treatment of a mentally unstable patient requires not just the delivery of emergency medicine, but an understanding of the decidedly nonlinear practices of psychiatric medicine as well.  If that was not enough, it also often involves the ability to navigate additional legal hurdles and a host of ever-evolving ethical considerations unique to the psychiatric patient.

Recent advances have attempted to ensure that acute care hospitals afford psychiatric patients the same caliber of service as those presenting with physical ailments, with some success.  Passed in 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) is a United States Act of Congress that requires every hospital to treat any patient with an emergency condition in such a way that, upon the patient’s release, no further deterioration of the condition is likely.  No hospital may release a patient with an emergency medical condition, physical or mental, without first determining that the patient has been stabilized.  For those who come to the ER with severe mental disabilities, this can create an unusual situation where understanding, patience, and compassion are of great importance.

Though these regulations mean well, the reality they impose often puts hospitals in an awkward position, stretching their already limited resources to include a patient body that brings with it an increased demand for high-level, time-consuming care.  Once admitted to the ER, psychiatric patients often have to wait hours or even days before they are issued a bed within the hospital.  To make matters worse, a disproportionate number of mental patients in the ER also abuse alcohol and / or drugs, making it impossible for doctors to accurately assess the extent of their health until detoxification has been established.  In the interim, beds, services, and staff that would otherwise be used for Emergency Room patients presenting with physical conditions become tied up in the often long wait that comes with getting mental patients situated and provided for prior to diagnosis.  In truth, when it comes to any underlying psychiatric disorder most ERs are only equipped to offer mental patients a hot meal, a place to sleep, and protection, not only from the dangers of living on the streets, but often from themselves.

Treating the mentally ill presents a host of challenges to any ER, and includes addressing methods of communication and adherence to proper modes of conduct.  Even with today’s psychiatric advances and new procedures for doctors to employ when treating the mentally disturbed, the concept of patient safety remains at the top of any hospital’s list of priorities.  The very nature of mental illness can force gray issues when it comes to the acceptability of certain of these methods, such as the use of physical restraints on patients. Psychiatric concerns are unique in that they may force a hospital into the unenviable position of having to choose between a patient’s basic right to freedom and the need to protect the patient from himself.

From the hospital’s perspective, the need to balance prevention of self-inflicted patient harm, as well as harm to other patients and hospital staff, with the above-referenced concerns justifies the use of restraint in certain situations.  While a doctor can never legally use restraint as a means to prevent a voluntary patient from leaving the hospital prior to assessment, since every medical patient has the initial right to leave against medical advice, such an alternative does unfortunately continue to serve a purpose when all other options have been exhausted.

Due to the extremity of such a step, the regulations governing how a hospital may restrain a patient who has been assessed as a danger to himself or others are complex.  Again, the safety and well-being of the patient must always be of primary concern.  Though the laws differ by state, most hospitals agree on a set group of principals by which to abide should this step become necessary:

  • Restraints will be used only for adequately justified situations that are medically necessary based on individually assessed patient needs and behavioral risk factors.
  • Restraints will never be used as a means of coercion, discipline, convenience or retaliation by staff.
  • Restraints will not be based solely on prior history of use or history of dangerous behavior.
  • Preventative or alternative strategies will be used to help staff focus on the patient’s well being and will be incorporated into the patient’s plan of care.
  • Medication used to control behavior will be identified on patient’s medical record and included in patient’s plan of care.
  • Informed consent will be obtained prior to administering any psychotherapeutic medication.
  • The patient’s dignity, rights and well-being will be preserved and physical needs will be met while protecting the patient’s health and safety.

These categorizations, while understandably vague at first glance, do provide a much needed structure on which Emergency Room physicians can rely when a patient presents with issues of mental instability and questionable judgment.  Unlike patients dealing with physical ailments, the mentally ill must be treated under their own subset of conditions, taking into consideration the hidden complexities of the human mind.  Though no doctor ever wants to supersede the rights of a patient, on occasion he or she must be both willing and able to step up and accept responsibility for the well-being of another when that person is no longer able to distinguish between what is harmful and what is not.  The ethics put forth by the Hippocratic Oath demand nothing less.


Lost Hospital — Franciscan Skemp, Arcadia, Minnesota

In 1936, the Franciscan Sisters of Our Lady of the Holy Angels in St. Paul opened a six-bed hospital in Arcadia, Minnesota. Originally named St. Joseph’s Hospital, the six-bed facility originally located in a two-story house grew to 25 beds by the end of its first year.

In 1948, a 50-bed hospital (with an additional 25 nursing home beds) was completed. The Arcadia News-Leader described the hospital as “the finest hospital in the state for a city that size.” By 1960 a new wing was added that included a chapel and dining room, and five years later the hospital spent $500,000 on a new surgical wing.

In 1975, a management agreement connected Franciscan Skemp to the hospital, and by 1983 the hospital became part of the Franciscan Health System. The Franciscan Skemp clinic built in 1981 was finally connected to the hospital by a wing in 1995.

In 2011, however, this source of pride for the town of 7,000 came to an end when Franciscan Skemp closed. It was the first time in 75 years that the city was without a hospital. “This hospital was a very important part of our community, and the community showed its support for the hospital for many decades,” said Terry Madden, an Arcadia lawyer and former hospital foundation board member. “People are upset; they feel that Franciscan Skemp is deserting the community.”

Franciscan Skemp made the announcement the hospital would close five mnoths earlier, blaming financial concerns in a town with too few patients and no population growth for the decision. The nursing home, however, remained open. “It’s going to be a sad day Thursday,” said John Nemec, vice president of regional practices for Franciscan Skemp. “It will be more like a funeral atmosphere, but it’s also a day to recognize the good work that was done there.”

The hospital had an average daily census between four and five patients (1,500 a year), and lost between $1 million and $2 million annually.  According to Nemec: “We saw too few patients at a huge cost at a time when it is important to improve care and lower costs. It boils down that Arcadia did not have enough population to support the hospital. I think people can understand that we can’t run a business without volume.”

Dr. Bert Hodous, a Franciscan Skemp family medicine physician in Arcadia for eight years, explained: “Not one single person in Arcadia has not been touched by the hospital or the nursing home. Our nurses interacted and knew a lot of dimensions of the patients.”

Lost Hospital — Riverside Hospital, Jacksonville, Florida

Riverside Hospital in Jacksonville, Florida once consisted of a 240,000 square-foot acute care hospital with 183 beds and a staff of more than 400.

Today at the site of the former hospital stands a Publix Super Market and Starbucks. This 90-year transformation from wellness to wifi mirrors in many ways the transformation of health care in the United States.

Dr. Carey P. Rogers opened Riverside Hospital in 1911 (known as Rogers Hospital at the time) on Riverside Avenue between Goodwin and Margaret Streets.  By 1918, the Hospital had the first and only multi-purpose specialty medical clinic in Florida.

Over the years, Riverside Hospital catered to its community, keeping up with the changes that came with each decade. By 1968 Riverside Hospital completed a six-story patient tower, and a decade later prepared for further expansion (and at the same time angering community preservationists by razing the original George Clark residence).

By 1982, the original hospital was demolished to make room for an ancillary wing. These structural changes eventually led to a change in ownership when St. Vincent’s Health System bought Riverside Hospital in 1991.  Four years later, St. Vincent’s Health System merged with Baptist Health System, becoming at the time the area’s largest health care provider.

Before the end of the decade, however, the new system announced in 1996 its decision to close Riverside Hospital due to economic reasons. At the time, this was the largest Jacksonville hospital to close.  Shortly thereafter the nursing home across the street and Riverside clinic followed suit.  These ancillary buildings were later replaced by The Villas of St. John’s in 1999 (a 257-unit luxury apartment complex) and other community developments.

By 2000, the location of the former Riverside Hospital was demolished (at a cost of $645,000) to make way for Riverside Market Square, a community retail center.

Studying the Weight of Prayer

For by these he judges the people; He gives food in abundance.”  Job 36:31

According to a recent study from Northwestern University, participation in religious activities may increase the chances for young adults to become obese by as much as 50 percent. The research indicates that religion may lead to obesity rather than obesity serving as an introduction to prayer.

The study followed 2,433 men and women for 18 years. Making the proper adjustments to differences in age, race, sex, education, income, and baseline body mass index, the researchers concluded that young adults with active participation in religion were 50 percent more likely to be obese by middle age. “High frequency” was defined as participating in a religious function at least once a week.

According to Matthew Feinstein, the study’s lead investigator and a fourth-year student at Northwestern University Feinberg School of Medicine: “We don’t know why frequent religious participation is associated with development of obesity, but the upshot is these findings highlight a group that could benefit from targeted efforts at obesity prevention. It’s possible that getting together once a week and associating good works and happiness with eating unhealthy foods could lead to the development of habits that are associated with greater body weight and obesity.”

The study does not suggest an overall unhealthy lifestyle among the devout.  In fact other studies have shown religious people live longer for a multitude of reasons. This study will be presented at the American Heart Association’s Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011 in Atlanta, Georgia.

Toxoplasmosis: Some Facts Behind the Word

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. An estimated 25% of the world’s population carries the infection, but the most common host is the household cat.

Cats are not to blame for spreading the disease, however, as contact with raw meat is a more significant source of human infections world-wide. Animals and humans are infected by eating infected meat, or alternatively by ingesting the feces of a recently-infected cat. Toxoplasmosis is also passed from mother to fetus. Toxoplasmosis can trigger or complicate psychotic symptoms and schizophrenia in patients with such a genetic predisposition.

A new study from Johns Hopkins University provides some clues as to why toxoplasmosis can differ from person to person. The study explains that each of the three different strains sets off a unique response. These findings are published in the March issue of the journal Infection and Immunity.

According to senior investigator Robert Yolken, M.D., a neurovirologist at Johns Hopkins Children’s Center: ”We already know that toxoplasmosis can play a role in some psychiatric disorders, but up until now we didn’t know why. Working with human nerve cells, our study shows the exact alterations triggered by each strain that can eventually manifest themselves as symptoms.”

The researchers injected human nerve cells with the three most common toxoplasma strains. Cells infected with type I had the greatest impact on gene expression, altering more than 1,000 genes (including those linked to brain development and the central nervous system). Cells injected with the less virulent types II and III had low and moderate levels of gene expression (including those genes related to growth and certain hormones).

“While disease course in humans is often more unpredictable than what we see in the controlled setting of a lab, these results give us a fascinating first look into the distinct genetic cascade of reactions that each strain can unlock and may one day serve as the basis for individualized treatment of symptomatic infections,” explained lead investigator Jianchun Xiao, Ph.D., a neurovirologist at the Stanley Division of Developmental Neurovirology at Hopkins.

Most infections with toxoplasma occur early in life following exposure. Infections rarely cause symptoms, but the parasite can remain dormant in the body for years.

Respecting the Right to Health Care0

It has been almost one year since the specter of health care descended upon America and demanded at last to be recognized.  This is no ordinary ghost, however, and while its presence is felt by every U.S. citizen, there is as yet no consensus as to whether it stands as friend or foe.

Known as the Patient Protection and Affordable Care Act (PPACA), or Health Care Reform, its shape is only just beginning to emerge, and medical practitioners and patients alike are waiting to see how they will be affected.  But before America attempts to confront, classify and coexist with our new system, we as a society must first understand the machinery that lies within.

As the structure of our health care system changes, so too must our definition of an individual’s right to coverage. Make no mistake, health care is a business as well as a service, and to function at its best it must strive for efficiency. Today’s hospitals are constantly criticized for their waste of both resources and finances as they work to stem the never-ending tide of sick patients, but what of the patients themselves?  At what point does a nation’s responsibility to assist those who have become sick intersect with a citizen’s obligation to take care of his or her own body?

As the number of elderly and critical patients continues to rise as our population ages, and federal laws tax our nation’s emergency rooms to the breaking point, it is important to search for ways to reduce the burden on America’s hospitals and, ultimately, the system that funds them.  Provision of health care is a two-way street, and for the new reform to function to the best of its abilities, it must be met halfway.

This begs the question: Is health care a right or a privilege?

The first ten amendments to the United States Constitution protect certain freedoms for all citizens including those of religion, speech, and the right to bear arms, while at the same time defending against unreasonable searches and seizures, self-incrimination, and the quartering of troops. These rights exist as a contract between a nation and its inhabitants, granted at birth.

A privilege, on the other hand, must be earned.  For example, to receive a license to operate a motor vehicle one must exhibit a certain level of competence.  Just as easily, this privilege can be lost by a show of negligence or through disregard for the nature of the privilege itself.

Under the Reform Bill, health care – and emergency medical health care in particular – becomes a right, not a privilege.  There is no prerequisite granting entitlement to its benefits save that of U.S. citizenship, and even the highest level of neglect will not bar any claim to services.  Additionally, the right of health care under PPACA transcends sex, race and class.  Notwithstanding any perceived inequities in this nation’s health care system, it declares that no single individual shall have greater entitlement to the right of health care than another.  For this reason alone, health care defies the basic domestic economic principles of capitalism.

But if health care remains a right that one cannot forfeit through abuse, who is responsible for picking up the tab?  In the past, the business of health care in America has often operated outside the parameters of fiscal consideration, and this lack of financial control has threatened its very existence.  At its core, this new system seeks to address these inequities, recognizing that its survival relies on its sustainability.  Early estimates calculate that health care reform can save $1 trillion between 2020 and 2030 by changing the way the system works, as it forces providers to improve quality, eliminate waste, and place greater focus on the prevention of disease rather than simply addressing treatment.  Optimistically, the health care reform bill promises to create the necessary infrastructure to accommodate these changes, relying upon technology and innovation to forge a new system rather than trying to fix one which is beyond repair. Its goals are lofty and laudable, but at what cost?

As a nation, we do not take fitness seriously.  We eat, drink, and smoke too much, and eschew exercise.  And yet, we have clamored for universal health care as though our bodies were temples in need of constant devotion. For health care reform to succeed it needs active cooperation from the very individuals who enjoy its protection, and the truth is that a long term solution may only be possible after the abolition of unrestrained entitlement to care.  Sadly, today’s health care reform relies upon a level of individual engagement its government has no authority to require or enforce.

Establishing parameters that may one day lead to individual loss of this basic right is not presently up for consideration, and certainly was not included in our current reform package.  But it needs to be.  Otherwise, the foundation of health care will erode to such a degree that any chance to preserve it for the people will be Pyrrhic at best.  Inevitably, the success or failure of health care reform will hinge on how well we as a nation come to appreciate this right and respect the obligations that come with it.  America should enjoy its long-awaited coverage, but treat it with the reverence such a monumental step deserves.

Relationships: The Front Line of Health Care0

Chaos is the score upon which reality is written.”

– Henry Miller, American novelist and painter

This article first appeared on the PBS affiliated Website This Emotional Life.

As the Chief Executive Officer of a community hospital in the Los Angeles area, I am a big fan of the television drama “House.”  While it may on occasion stretch the boundaries of medical plausibility, it does an excellent job depicting the often tenuous relationship between doctors, nurses, administrators and patients in a hospital setting.  For seven seasons – nearly as long as I have held my current position – I have been a faithful viewer, but tonight I find myself in unfamiliar territory for a number of reasons.  First, there are zombies in this episode, which strikes me as odd for a show based in reality.  Second, there is an infant in my house, screaming as newborns tend to do.  Finally, there are two plates of fish at the table, and I am eating alone.

Working in a hospital, I have come to accept the fact that very few things surprise me anymore, as the unexpected and strange have long since replaced the usual and customary.  At any given day on the job I might observe the miracle of birth or the tragedy of life cut short, and on occasion even the phenomenon of life brought back from the brink. But regardless of whether art imitates life, work supplants home, or zombies magically appear in a medical TV drama, one thing remains constant – it quickly becomes clear to those involved in any emergency that the likelihood of survival rests on the stability of the relationships that are formed in the environment at hand.

As the onscreen events transition from the macabre to the surreal and the baby heads to his first bath ever, I sit eating my salmon while a small Pekingese dog stands on his hind legs, desperately begging for food.  I think of my young son, dependent on my wife to keep him clean.  I think of the dog, dependent on me to keep him fed. I think of patients dependent on House to keep them alive and House dependent on Dr. Lisa Cuddy et al. to keep him employed. And through it all I remember something else important – I really hate fish. … Read more →

Introducing, the “Diabetes Belt”

According to a new study in the American Journal of Preventive Medicine, the Centers for Disease and Prevention Control (CDC), has identified geographic region now known as the “diabetes belt” in the United States that includes 644 counties across 15 states. While 8.5% of the U.S. population has diabetes, in this new region the number is 12%. The diabetes belt also includes a population that is 32.9% obese (compared to the national average of 26.1%), and 30.6% who do not exercise regularly (compared to a national average of 30.6%).

The diabetes belt includes counties in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia, as well as the entire state of Mississippi. According to Dr. Shubhada Jagasia, associate professor of medicine at Vanderbilt University Medical Center in Tennessee, the counties that make up the diabetes belt are located in regions that used to be primarily agricultural, but are no longer. “People in those states may have continued to consume high-calorie foods, which are appropriate for heavy manual labor as is involved in agriculture, but very inappropriate if people eating that diet are now very sedentary.”

According to the CDC, in the United States almost 26 million people have diabetes, and 79 million people have prediabetes.