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Unit1
1
、
Do you agree
that it is sheer neuron overload on the doctor
side that leads to the complaint that doctors do
not listen?
2
、
Describe Mrs.
Osorio's condition.
3
、
What are the
good and bad things about Mrs. Osorio's conditions
that run through the author s mind?
4
、
Describe
the
situation
when
Mrs.
Osorio
might
send
the
authors
delicately
balanced
three-ring
circus
tumbling down.
5
、
Compare
multitasking in human beings and computers.
6
、
Use numbers to
justify that it is the juggling mind that keeps
doctors awake at night.
7
、
What are
possible solutions to the impossible high-wire act
of juggling competing details and panicking
about slipping a critical one?
Unit2
1
、
What does the
author imply by mentioning two choices?
2
、
Describe the
heady days of victory declarations and what
followed ever since.
3
、
Elaborate on
the joined battle.
4
、
Justify “the
realization that world health is
indivisible”.
5
、
Exemplify the
statement that
“Every returning
condition marches to the beat of a different
drum.”
6
、
Vaccination
practices are at the heart of the most infectious
diseases. Use examples to prove it.
7
、
What are the
four areas of focus according to Bob Howard?
8
、
“Old enemies
never die.” Justify it medically.
Unit3
1
、
How was Terry s
life before she was diagnosed with MS?
2
、
What are the
symptoms of MS and autoimmune disease?
3
、
What did Terry
do before she self-experimented?
4
、
What approaches
did Terry mainly use to deal with
neurodegeneration?
5
、
Give one
example to illustrate the correlation between
toxic load and diseases.
6
、
What does the
title “The Seventy Percent Solution”
mean
?
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Unit4
1
、
Give a brief
explanation of the two concepts: complementary
medicine and alternative medicine.
2
、
To what extent
do you agree with the authors opinion on
traditional Chinese medicine as being
“affordable
，
low tech, safe,
and effective
”
？
3
、
Summarize the
clinical uses of acupuncture.
4
、
Do you think
the author is overoptimistic in predicting a wider
future use of
acupuncture
in the U.S
5
、
Explain how
inappropriate uses of herbs may result in
complications.
6
、
Various
approaches to herbal study are mentioned in the
text. Choose one to discuss the advantages and
limitations.
7
、
What are the
difficulties in investigating herbal therapies?
8
、
What are the
factors to consider when we integrate Eastern and
Western medicine
Unit5
1
、
Clarify the
differences between disease and dis-ease.
2
、
Share
your
personal
understanding
about
the
claim
that
health
is
a
multi-dimensional
experience
of
body, mind and spirit.
3
、
Illustrate the
relationship between life on automatic pilot and
4
、
Describe the
time of great confusion we live in.
5
、
Comment on
4
a culture that values
thinking more than feeling and emphasizes reason
over intuitive
awareness and knowing .
6
、
Explain the
process where we change from ^playing
full-
out to play it safe, or play not
to lose”.
7
、
Explain how
wellness can be established
8
、
Make a list of
tips on how to become a fully integrated human
being.
Unit6
1
、
How has the
end-of-life care changed over time?
2
、
What is said
about George?
3
、
What advantages
does a hospital have over a nursing home for end-
of-life care?
4
、
What is the
role of family and friends when the patient is
cared for at home?
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5
、
What needs to
be considered to make comfort care available at
home?
6
、
How has
the meaning of palliative care changed?
7
、
What might be
one of the misconceptions about choosing a
hospice
？
Uint7
1
、
What difficult
situation is the young doctor facing?
2
、
What is
paternalistic decision-making in medicine
3
、
In what way can
patient empowerment be good for the patient?
4
、
Why does the
author say too much physician restraint may not be
that good for the patient?
5
、
What kind of
considerations may have prevented doctors from
making decisions for their patients?
6
、
Do you agree
that doctors should be prepared to make any
decisions together with their patients
Unit8
1
、
How are
research and practice related to each other?
2
、
What is the
principle of respect for persons?
3
、
What is the
principle of beneficence?
4
、
How is the
principle of beneficence related to Hippocratic
Oath?
5
、
What
concrete examples can be given to illustrate the
principle of justice?
6
、
What is
informed consent and its application?
7
、
What are the
considerations involved in selection of human
subjects in research
？
Unit1
1
、
Some factors
that may lead to the complaint:
·
Neuron overload
·
Patients* high expectations
·
Mistrust and
misunderstanding between the patient and the
doctor
2
、
Mrs. Osorio’s condition:
·
A 56-year-old woman
·
Somewhat overweight
·
Reasonably well-controlled
diabetes and hypertension
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·
Cholesterol on the high
side without any medications for it
·
Not enough exercises she
should take
·
Her bones a
little thin on her last DEXA scan
3
、
Good things:
·
Blood tests done
·
Glucose a
little better
·
Her blood pressure a little
better but not so great Bad things:
·
Cholesterol not so great
·
Her weight a
little up
·
Her bones a little thin on
her last DEXA scan 4
4
、
The
situation:
·
The
author was in a moderate state of panic: juggling
so many thoughts about Mrs. Osorio
’s
conditions and
trying to
resolve them all before the clock ran
down.
·
Mrs.
Osorio made a trivial request, not so important as
compared to her conditions.
·
Mrs.
Osorio
seemed
to
care
only
about
her
“innocent
—
and
completely
justified
—
reques
t
”
：
the
form
signed
by her doctor.
·
The doctor
tried to or at least pretended to pay attention to
the patient while completing documentation.
5
、
Similarities:
·
In computer multitasking, a
microprocessor actually performs only one task at
a time. Like microprocessors,
we human
beings carft actually concentrate on two thoughts
at the same exact time. Multitasking is just an
illusion both in computers and human
beings.
Differences:
·
The
concept of multitasking originated in computer
science.
·
At best, human
beings can juggle only a handful of thoughts in a
multitasking manner, but computers can do
much better.
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·
The more thoughts human
beings juggle, the less human beings are able to
attune fully to any given thought,
but
computers can do much better.
6
、
·
7 medical issues to
consider
·
5 separate
thoughts, at least, for each issue
·
7 x 5 = 35 thoughts
·
10 patients that afternoon
·
35 x 10 = 350 thoughts
·
5 residents under the
authors supervision
·
4
patients seen by each resident
·
10
thoughts, at
least, generated from each patient
·
5 x 4 x 10 = anther 200
thoughts
·
350 + 200 = 550
thoughts to be handled in total
·
If the doctor does a good
job juggling 98% of the time, that still leaves
about 10 thoughts that might get lost
in the process.
7
、
Possible
solutions:
·
Computer-
generated reminders
·
Case
managers
·
Ancillary services
·
The simplest solution: time
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Unit2
1
、
The author
implies:
?
Peoples
inadequate
consciousness
about
the
con
sequence
of
neglecting
the
re-
emerging
infectious
diseases
·
Unjustifiability of peoples
complacency about the prevention and control of
the infectious diseases
·
Unfinished war against
infectious diseases
2
、
Victory
declarations:
·
Surgeon
General William Stewart's hyperbolic statement of
closing
“
the book on
infectious disease
”
.
·
A string of impressive
victories incurred by antibiotics and vaccines
·
The thought that the war
against infectious diseases was almost over What
followed ever since:
·
Appearance of new diseases
such as AIDS and Ebola
·
Comeback of the old
afflictions:
?
Diphtheria in the former
Soviet Union
?
TB in urban centers like
New York City
?
Rising Group A
streptococcal conditions like scarlet fever
·
The fear of a powerful new
flu strain sweeping the world
3
、
Elaborate on
the joined battle:
·
WHO
established
a
new
division
devoted
to
worldwide
surveillance
and
control
of
emerging
disease
in
October 1995.
·
CDC launched a prevention
strategy in 1994.
·
Congress
raised fund from $$6.7 million in 1995 to $$26
million in 1997.
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4
、
The borders are
meaningless to pathogenic microbes, which can
travel from one country to another
remote country in a very short time.
5
、
TB:
·
Prisons and homeless
shelters as ideal places for TB spread
·
Emerging of drug-resistant
strain or even multi-drug-resistant strain
·
A ride on the HIV w^on by
attacking the immunocompromised
Group A strep:
·
A
change in virulence
·
Mutation in the exterior of
the bacterium
Flu:
Constant changes in its coat (surface
antigens) and resultant changes in its level of
virulence
6
、
Examples:
·
Experiment in England is
seeing the waning immunity because of no
vaccination.
·
D
u<
/p>
e
to poor vaccination
efforts, the diphtheria situation in the former
Soviet Union is serious.
'
?
The
vaccination
rates
are
d
ropping
in
some
American
cities,
and
it
will
lead
to
more
diphtheria
and
whooping cough.
7
、
The four areas
of focus:
·
The need for
surveillance
·
Updated
science capable of dealing with discoveries in the
field
·
Appropriate
prevention and control
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·
Strong public health
infrastructure
8
、
The infectious
diseases such as TB, flu, diphtheria and scarlet
fever will never really go away, and the war
against them will never end.
Unit3
1
、
Terry's life
before
·
She loved practicing
Tae Kwon Do
·
She loved the
surge of adrenaline that came with the controlled
combat of tournaments.
·
She
competed nationally, even won bronze medal in the
trials for the Pan American Games.
·
She attended medical
school, practiced as an internal medicine
resident, and became an academic general
internist.
·
She
got married and got a son and a daughter.
2
、
The symptoms of
MS and autoimmune disease:
·
Loss of stamina and
strength
·
Problems with balance
·
Bouts of horrific facial
pain
·
Dips in visual acuity
3
、
Terry did the
following before she self-experimented:
·
She
started injections.
·
She adopted many
pharmacotherapies.
·
She began her own study of
literature:
?
She read articles on
websites such as PubMed.
?
She searched
for articles testing new MS drugs in animal
models.
?
She
turned
to
articles
concerning
neurodegeneration
of
all
types
—
dementia
，
Parkinson's
disease,
Huntington's disease, and Lou Gehrig's
disease.
?
She
relearned basic sciences such as cellular
physiology, biochemistry, and neurophysiology.
4
、
Approaches
Terry mainly used:
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·
Self-experimentation with
various nutrients to slow neurodegeneration based
on literature reports on animal
models
·
Self-experimentation with
neuromuscular electrical stimulation which is not
an approved treatment for MS
·
Online search to identify
the sources of micronutrients and having a new
diet
·
Reduction of food
allergies and toxic load
5
、
Cases mentioned
in the text:
·
Increased
mercury stores in the brains of people with dental
fillings
·
High levels of the
herbicide atrazine in private wells in Iowa
·
The strong association
between pesticide exposure and neurodegeneration
·
The association of single
nucleotide polymorphisms involving metabolism of
sulfur and/or B vitamins
·
Inefficient clearing of
toxins
6
、
With
70%
to
90%
of
the
risk
for
diabetes,
heart
disease,
cancer,
and
autoimmunity
being
due
to
environmental factors other than the
genes, we can take many health problems and the
health care crisis
under our control,
for example, optimizing our nutrition and reducing
our toxic load.
Unit4
1
、
Two concepts:
·
Complementary
medicine refers to the use of conventional
therapies together with alternative treatments
such
as using acupuncture in addition
to usual care to help lessen pain. Complementary
and alternative medicine
is shortened
as CAM.
·
Alternative
medicine
refers
to
healing
treatments
that
are
not
part
of
conventional
therapies
—
like
acupuncture,
massage
therapy,
or
herbal
medicine.
They
are
called
so
because
people
used
to
consider
practices like these outside the
mainstream.
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