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Well: A Clutter Too Deep for Mere Bins and Shelves
By TARA PARKER-POPE, The New York Times, January 1, 2008
After the holidays, many shoppers load up their carts with storage bins, shelving systems and color-coded containers, all in a resolute quest to get organized for the new year.
The country’s collective desire to clean up is evident in the proliferation of organization-oriented businesses like the Container Store and California Closets. Reality shows like “Mission Organization” on HGTV and “How Clean is Your House?” on Lifetime feed a national obsession to declutter. The magazine Real Simple has even created a $13 special issue on cleaning house.
Getting organized is unquestionably good for both mind and body — reducing risks for falls, helping eliminate germs and making it easier to find things like medicine and exercise gear.
“If you can’t find your sneakers, you aren’t taking a walk,” said Dr. Pamela Peeke, assistant clinical professor of medicine at the University of Maryland and the author of “Fit to Live” (Rodale, 2007), which devotes a section to the link between health and organization. “How are you going to shoot a couple of hoops with your son if you can’t even find the basketball?”
But experts say the problem with all this is that many people are going about it in the wrong way. Too often they approach clutter and disorganization as a space problem that can be solved by acquiring bins and organizers.
Measures like these “are based on the concept that this is a house problem,” said David F. Tolin, director of the anxiety disorders center at the Institute of Living in Hartford and an adjunct associate professor of psychiatry at Yale.
“It isn’t a house problem,” he went on. “It’s a person problem. The person needs to fundamentally change their behavior.”
Excessive clutter and disorganization are often symptoms of a bigger health problem. People who have suffered an emotional trauma or a brain injury often find housecleaning an insurmountable task. Attention deficit disorder, depression, chronic pain and grief can prevent people from getting organized or lead to a buildup of clutter. At its most extreme, chronic disorganization is called hoarding, a condition many experts believe is a mental illness in its own right, although psychiatrists have yet to formally recognize it.
Compulsive hoarding is defined, in part, by clutter that so overtakes living, dining and sleeping spaces that it harms the person’s quality of life. A compulsive hoarder finds it impossible, even painful, to part with possessions. It’s not clear how many people suffer from compulsive hoarding, but estimates start at about 1.5 million Americans.
Dr. Tolin recently studied compulsive hoarders using brain-scan technology. While in the scanner, hoarders looked at various possessions and made decisions about whether to keep them or throw them away. The items were shredded in front of them, so they knew the decision was irreversible. When a hoarder was making decisions about throwing away items, the researchers saw increased activity in the orbitofrontal cortex, a part of the brain involved in decision-making and planning.
“That part of the brain seemed to be stressed to the max,” Dr. Tolin said. By comparison, people who didn’t hoard showed no extra brain activity.
While hoarders are a minority, many psychologists and organization experts say the rest of us can learn from them. The spectrum from cleanliness to messiness includes large numbers of people who are chronically disorganized and suffering either emotionally, physically or socially. Cognitive behavioral therapy may help: a recent study of hoarders showed that six months’ therapy resulted in a marked decline in clutter in the patient’s living space.
Although chronic disorganization is not a medical diagnosis, therapists and doctors sometimes call on professional organizers to help patients. One of them is Lynne Johnson, a professional organizer from Quincy, Mass., who is president of the National Study Group on Chronic Disorganization.
Ms. Johnson explains that some people look at a shelf stacked with coffee mugs and see only mugs. But people with serious disorganization problems might see each one as a unique item — a souvenir from Yellowstone or a treasured gift from Grandma.
Many clients have already accumulated numerous storage bins and other such items in a futile attempt to get organized. Usually the home space is adequate, she says, but the challenge is in teaching them how to group, sort, set priorities and discard.
Ms. Johnson says she often sees a link between her client’s efforts to get organized and weight loss. “I think someone decides, ‘I’m not going to live like this anymore. I’m not going to hold onto my stuff, I’m not going to hold onto my weight,’” she said. “I don’t know that one comes before the other. It’s part of that same life-change decision.”
On its Web site, www.nsgcd.org, the group offers a scale to help people gauge the seriousness of their clutter problem. It also includes a referral tool for finding a professional organizer. But since the hourly fees can range from $60 to $100 or more, it may be worth consulting a new book by Dr. Tolin, “Buried in Treasures” (Oxford, 2007), which offers self-assessments and advice for people with hoarding tendencies.
Dr. Peeke says she often instructs patients trying to lose weight to at least create one clean and uncluttered place in their home. She also suggests keeping a gym bag with workout clothes and sneakers in an uncluttered area to make it easier to exercise. She recalls one patient whose garage was “a solid cube of clutter.” The woman cleaned up her home and also lost about 50 pounds.
“It wasn’t, at the end of the day, about her weight,” Dr. Peeke said. “It was about uncluttering at multiple levels of her life.”
When Hospitals Kept Children From Parents
By HOWARD MARKEL, M.D., The New York Times, January 1, 2008
Early one morning, I visited my daughter’s 5-year-old friend Eddie, who was laid up in the hospital the night after an emergency appendectomy. Understandably, Eddie looked miserable. Just as understandably, so did his parents, who were still in their pajamas in a fold-out cot next to his bed.
At every children’s hospital across the nation, at just about any time of day or night, you are likely to see at least as many parents as patients.
These days, it seems obvious that seriously ill children need their parents beside them during a hospitalization. Yet unlimited parental visiting hours are relatively new in American hospitals. In 1894, Boston Children’s Hospital had only two “visiting days for parents” per week, 11 a.m. to noon on Wednesdays and 3 to 4 p.m. on Sundays (fathers only). At Massachusetts General Hospital in 1910, homesick children who cried too much for their parents were moved to isolation wards so as not to disturb the other patients.
Such draconian prohibitions were the norm at hospitals across the United States. “Order was a word almost sacred in the terminology of the pious gentlemen who wrote the bylaws, raised the funds and sat on the boards of America’s first hospitals,” said Charles E. Rosenberg, a medical historian at Harvard. “They regarded all the hospital’s inmates as moral minors, and most of their regulations were aimed at controlling behavior.”
American hospitals in the 19th century were charitable enterprises devoted to the care of the urban poor, orphans, seamen and immigrants. Consequently, hospital trustees spent a great deal of effort deciding which potential patient was morally worthy of the healing experience they offered. Drunks, criminals, prostitutes and the so-called undeserving poor need not apply.
“Most physicians practicing in this era considered childhood diseases to be caused by unhealthy environments and improper parenting,” said Dr. Hughes Evans, a pediatrician at the University of Alabama. “Removing children from deleterious home environments was considered therapeutic.”
Because many children’s hospitals focused primarily on the correction of orthopedic problems and congenital malformations, pediatric patients often required months of hospitalization. “This made these institutions ideal places to remodel children morally as well as physically,” Dr. Rosenberg said.
Children with infectious diseases, meanwhile, were typically admitted to contagious-disease facilities with even more limited visiting hours.
From the early 1900s to the late 1950s, most American hospitals continued to promulgate strict rules separating children from their parents, cloaking them in the language of science.
“Medical science was reflected through a prism of ethnicity and class,” said David Rosner, a historian of public health at Columbia. “Germs became the surrogates for older class distinctions.
“The vulnerability changed from individual morality to propensity to disease,” he went on, “but the targets of the visiting restrictions — the poor, immigrants, the disenfranchised — remained the same.”
As a result, the working poor were forced to choose between visiting their children and reporting for work, branding them either as bad parents or bad workers. Wealthy parents who could afford private rooms for their children in the same hospitals had unlimited visiting hours.
There were some creative ways around the rules. Dr. Henry M. Seidel, who interned in pediatrics at the Johns Hopkins Hospital in 1946, recalled: “Parent visiting hours were from 7 to 8 p.m. on Wednesdays and 1 to 2 p.m. on Sundays. But we could place ‘very sick’ children on a critical list, giving them unlimited visiting privileges. Many times, we were very loose in how we defined ‘very sick.’”
From the 1960s onward, advances in hospital architecture have radically changed accommodations for family members. As consumers demanded that hospitals shift from open wards to semiprivate and private rooms, it became impossible for the hospital staff to keep an eye on all patients simultaneously.
Such changes meant that parents could pitch in and give their children the nonmedical but essential comfort they need. Nurses, too, led major efforts to develop family-focused care programs at children’s hospitals and health clinics.
In the modern market-driven world of health care, the newest children’s hospitals compete for patient dollars with hotel-grade living spaces for parents, restaurants and other amenities.
The pendulum seems to have completed its swing — to the point where patients like 5-year-old Eddie may feel miserable but not without emotional support. So why did we restrict visiting hours for so long?
“One reason,” said Dr. Seidel, the veteran pediatrician, “might be because we had always done it that way. But I suspect many doctors simply found it convenient and considered parents to be in the way.”
Howard Markel is a professor of pediatrics, psychiatry and the history of medicine at the University of Michigan.
Killing Dogs in Training of Doctors Is to End
By NICHOLAS BAKALAR, The New York Times, January 1, 2008
By next month, all American medical schools will have abandoned a time-honored method of teaching cardiology: operating on dogs to examine their beating hearts, and disposing of them after the lesson.
Case Western Reserve School of Medicine was the last to use the method, but the dean, Dr. Pamela Davis, said it would no longer do so after this month.
On Nov. 19, New York Medical College in Valhalla joined New York’s 11 other medical schools and announced that it would close its dog laboratory.
Among the 126 American medical schools, 11 still sacrifice animals for teaching, according to the Physicians Committee for Responsible Medicine, an advocacy group that tracks the practice. Other than Case, none of them use dogs.
Francis Belloni, a dean at New York Medical College, said his students now used echocardiograms to study heart function, and the subjects were live medical students rather than live dogs. Dr. Belloni said the use of animals was not done lightly and had value, but added that students would “become just as good doctors without it.”
Can They Stay Out of Harm’s Way?
By J. MADELEINE NASH, The New York Times, January 1, 2008
The morning was just starting to heat up when a biologist, Ricardo Costa, set out to look for jaguars on Fazenda San Francisco, a 30,000-acre cattle ranch, rice farm and wildlife reserve in the region of southwest Brazil known as the Pantanal.
Soon, along a fringe of scrubby woodland, Mr. Costa spotted a young male jaguar lazing in sun-flecked shade. “It’s Orelha,” he whispered, pointing out the tear in the animal’s right orelha, or ear.
As Mr. Costa watched from the driver’s seat of a Toyota truck, the animal stretched and yawned, exposing teeth strong enough to crunch through the skull of almost anything. “Wonderful!” he said.
The jaguar, Panthera onca — the largest cat in the Americas and the third largest in the world — still prowls the rangelands of the Pantanal, a 74,000-square-mile mosaic of rivers, forests and seasonally flooded savannas that spill from Brazil into neighboring Bolivia and Paraguay.
From the jaguar’s perspective, this vast, wildlife-rich area probably seems close to a slice of heaven — or, at least it would if the big cats were not routinely hunted down in retaliation for cattle losses.
Mr. Costa, for example, said that he worried about Orelha and his more skittish brother, Grandão. Two years ago, he said, an older, larger male who patrolled the same territory was killed when it ventured onto a neighboring ranch.
And now Fernando Azevedo, the senior scientist with whom Mr. Costa has been working, says he has lost 4 of the 14 jaguars he was starting to study at Fazenda São Bento, about 60 miles from San Francisco.
Once again, it appears, the animals were picked off when they wandered away from a ranch where they are protected, onto adjoining properties. Among the casualties, Dr. Azevedo suspects, were an adult female and her two nearly full-grown cubs. Convincing ranchers and ranch hands to end such killing has become a priority for conservationists in the region.
The importance of the Pantanal was underscored last October when Thomas Kaplan, executive chairman of the foundation Panthera, an emerging force in big cat conservation, finalized the purchase of two large ranches and signed an agreement to buy a third, creating a property that will soon total more than 400,000 acres.
The ranches, which will be run by Panthera, are particularly important because they connect previously isolated wildlife preserves. Now, jaguars will be able to travel safely from one sanctuary to the other.
“With jaguars we have the opportunity to play offense,” said Dr. Kaplan, an entrepreneur and financier who in 2006 founded Panthera. “There are certain areas, like the Pantanal, where the wind is at your back.”
Dr. Kaplan said that Panthera’s plan was to continue running cattle on the ranches while testing a broad range of techniques for reducing livestock-jaguar interactions. The results, he hopes, will encourage others to adopt range management practices that encourage co-existence over conflict.
At stake in the Pantanal, conservationists say, is a significant fraction — perhaps 15 percent — of the world’s remaining population of jaguars.
Cattle ranching and jaguar conservation do not need to be mutually exclusive, said Alan Rabinowitz, executive director of the science and exploration program at the Wildlife Conservation Society, based in the Bronx.
“Cattle open up the landscape,” Dr. Rabinowitz said, and enhance habitat for the jaguar’s wild prey. “If you were to take out the cattle and let large areas revert to scrubby vegetation, you’d have far fewer jaguars in the Pantanal than you do today.”
Jaguars can also provide ranchers with an additional source of income. For example, several ranches in the Pantanal, San Francisco among them, run ecotourism operations that have turned a liability into a valuable asset.
Conservationists say that the next decade will be pivotal for jaguars, in the Pantanal and throughout its range, which runs from northern Argentina to the borderlands shared by Mexico and the United States.
No one knows the precise rate at which the number of jaguars is declining or just how many jaguars there are. But the World Conservation Union pegs the total free-ranging population at fewer than 50,000 adults and classifies the animal as near threatened.
Jaguars may not yet be in such desperate shape as Asian tigers, whose noncaptive breeding population has plummeted below 2,500, or African lions, of which there are perhaps only 20,000 to 30,000 left in the wild. But if conflicts with people and their livestock are not soon resolved, conservationists warn, jaguars could quickly trace a similar trajectory.
At first pass, the conflict between jaguars and ranchers would seem to be intractable. “The cats are where the cows are, and the cows belong to people,” said Almira Hoogesteijn, a research veterinarian at the Center for Research and Advanced Studies of the National Polytechnic Institute in Mexico.
But even though jaguars kill and eat cattle, they do so less often than one might imagine.
A quantitative picture of the dietary habits of jaguars emerged from a study conducted by Dr. Azevedo at San Francisco in 2003 and 2004.
Over the course of nearly two years, Dr. Azevedo and his field assistants collared 11 adult jaguars and tracked their movements. They also methodically collected their scats and examined the carcasses of their prey.
The contents of the scats revealed that the giant rodents known as capybaras were the jaguars’ most common prey, followed by caimans and marsh deer. Of 113 carcasses confirmed as jaguar kills, capybaras made up 35; caimans, 23, and cattle, 32.
Dr. Azevedo, a postdoctoral fellow at the University of São Paulo, then measured the cattle that were killed against a larger background.
In all, 169 cattle deaths occurred at San Francisco during the study period, he and his former thesis adviser, Dennis Murray of Trent University in Canada, reported in the September issue of The Journal of Wildlife Management. Nineteen percent were lost to jaguars. Out of a 5,000-head cattle herd, the jaguar’s take faded even more in significance: it amounted to less than 1 percent.
San Francisco keeps its jaguars in line with a variety of tactics, said the ranch’s owner, Roberto Coelho. Among the strategies is using bulls and older cows with horns to “baby-sit” young, clueless animals and immediately moving cattle away from a paddock whenever depredation occurs.
In addition, Mr. Coelho said, San Francisco’s extensive rice fields are an effective barrier between the cattle paddocks and the property’s riparian forests. Among the important things to understand about jaguars, depredation experts say, is that they like to hang out in wooded areas close to water.
Consider the problems that Teresa Bracher has been having on the four ranches she owns in prime jaguar habitat along the Paraguay River, the Pantanal’s main artery. For a time, depredation losses may have approached 8 percent, said Ms. Bracher, a committed conservationist as well as a rancher.
For assistance, Ms. Bracher turned to Peter Crawshaw Jr., a leading Brazilian jaguar expert based at the Pantanal National Park. Dr. Crawshaw suggested a spectrum of nonlethal jaguar deterrents, Ms. Bracher said, and she and her cousin, who runs the cattle operation, have implemented every one.
Among other things, they deployed guard dogs and surrounded their cattle with electrified fencing. They installed bright lights around the paddocks and instituted regular patrols. They even set off noisy fireworks at night, when jaguars are most active.
As a result, depredation has significantly declined. Like many other ranchers in the area, Ms. Bracher is wary of one antipredation measure: substituting water buffaloes for cattle. Water buffaloes easily turn feral, creating a problem as large as the one they are supposed to solve.
But, said Rafael Hoogesteijn, a Venezuelan veterinarian who is an internationally respected depredation expert, a properly managed water buffalo herd can be as close to predator proof as a group of ungulates gets. When a jaguar or puma appears, water buffaloes protectively encircle their young. They will even menace the predator by advancing on it, with the big bulls in the lead.
In a soon-to-be-published study, Dr. Hoogesteijn and his sister, Almira, report on the experience with water buffaloes and cattle at six ranches in Venezuela. On three, they note, jaguars managed to snatch a few calves when the buffaloes were first introduced. Then the herds learned to defend themselves, and the jaguar attacks ceased.
These intimidating herbivores, the Hoogesteijns found, appear to surround cattle in a broad, protective umbra. On the Venezuelan ranches, jaguars preyed upon cattle significantly less often when they were placed in the same paddocks as buffaloes.
“With cattle, you will always have losses,” said Rafael Hoogesteijn, who has agreed to become the supervisor of Panthera’s ranching operations in the Pantanal. “But with buffalo, you can have true co-existence.”
What frustrates conservationists here is that multiple techniques for minimizing the problems caused by jaguars exist, and yet, instead of being a last resort, the first reaction too frequently is to pick up a gun.
This occurs despite the fact that the jaguar is protected in Brazil, as, indeed, it is across most of its range. Enforcement, however, is all but nonexistent.
As Dr. Hoogesteijn and others see it, the current system of incentives is perverse. Ranchers are not penalized for shooting jaguars, but they also are not rewarded for resolving predation problems in an ecologically sensitive way.
Programs that compensate ranchers for their losses might help, some believe. Others note that such programs are costly and, if badly designed, can perpetuate poor range management practices.
A survey of 50 ranchers in the northern Pantanal published two years ago suggested that the people there were deeply conflicted where jaguars are concerned. Well over half of the respondents said that they could not tolerate jaguars on their own ranches, and yet nearly three-quarters thought jaguars should be protected. Thirty-eight percent ranked jaguars as a larger source of economic loss than floods, droughts, rustling and disease.
Ranchers, depredation experts have found, tend to exaggerate their losses to jaguars. In part, that is because jaguars are eager scavengers and so can be observed feeding at carcasses they played no part in killing. But the tendency to exaggerate also stems from ranchers’ often being unaware of the extent to which diseases like leptospirosis and brucellosis rob them of their profits.
These diseases, Dr. Hoogesteijn said, attack the reproductive tract of cows, causing abortions and stillbirths. On one large Venezuelan ranch, he once calculated, the annual loss from problem pregnancies and births probably amounted to 400 of 3,000 “potential calves,” or 10 times the number of real calves known to have been killed by jaguars and pumas.
Nonetheless, problem jaguars do exist. And not a few bear old gunshot injuries that handicap them in stalking and killing wild prey. Some conservationists concede that hunting a problem animal may sometimes be a solution.
But more headway may be made by focusing on the human side of the problem, said Silvio Marchini, a wildlife biologist who worked in the Pantanal before moving to the Amazon. “There’s an assumption that the reason people kill jaguars is because they cause economic damage. But social and cultural attitudes may also be very important.”
As Marcos Moraes, the owner of São Bento, put it, “We need a new generation to come along and change the old ways of thinking.”
In the Pantanal, jaguar hunting is part of a tradition as deeply ingrained as fox hunting once was in the English countryside — except that here, it is not the well-to-do landowners who most enthusiastically join the chase but their hired hands, the Pantaneiro cowboys.
For them, jaguar hunting is a form of bush entertainment, said Sandra Cavalcanti, a jaguar expert who will soon receive her Ph.D. from Utah State University.
There’s also a macho component. “Killing a jaguar is considered a manly thing to do,” Ms. Cavalcanti said.
Later this year, Ms. Cavalcanti, who has joined the staff that Panthera is assembling, hopes to begin addressing this problem by starting a cowboy outreach program, which could include things like medical services, instruction in range management and depredation control.
Jaguars in the Pantanal seem to be on a teeter-totter that could tilt strongly in one direction or the other. Given the stakes, Ms. Cavalcanti said, researchers no longer have the luxury to just study these elegantly patterned beasts. To save them, she said, “we have to act.”
By TARA PARKER-POPE, The New York Times, January 1, 2008
After the holidays, many shoppers load up their carts with storage bins, shelving systems and color-coded containers, all in a resolute quest to get organized for the new year.
The country’s collective desire to clean up is evident in the proliferation of organization-oriented businesses like the Container Store and California Closets. Reality shows like “Mission Organization” on HGTV and “How Clean is Your House?” on Lifetime feed a national obsession to declutter. The magazine Real Simple has even created a $13 special issue on cleaning house.
Getting organized is unquestionably good for both mind and body — reducing risks for falls, helping eliminate germs and making it easier to find things like medicine and exercise gear.
“If you can’t find your sneakers, you aren’t taking a walk,” said Dr. Pamela Peeke, assistant clinical professor of medicine at the University of Maryland and the author of “Fit to Live” (Rodale, 2007), which devotes a section to the link between health and organization. “How are you going to shoot a couple of hoops with your son if you can’t even find the basketball?”
But experts say the problem with all this is that many people are going about it in the wrong way. Too often they approach clutter and disorganization as a space problem that can be solved by acquiring bins and organizers.
Measures like these “are based on the concept that this is a house problem,” said David F. Tolin, director of the anxiety disorders center at the Institute of Living in Hartford and an adjunct associate professor of psychiatry at Yale.
“It isn’t a house problem,” he went on. “It’s a person problem. The person needs to fundamentally change their behavior.”
Excessive clutter and disorganization are often symptoms of a bigger health problem. People who have suffered an emotional trauma or a brain injury often find housecleaning an insurmountable task. Attention deficit disorder, depression, chronic pain and grief can prevent people from getting organized or lead to a buildup of clutter. At its most extreme, chronic disorganization is called hoarding, a condition many experts believe is a mental illness in its own right, although psychiatrists have yet to formally recognize it.
Compulsive hoarding is defined, in part, by clutter that so overtakes living, dining and sleeping spaces that it harms the person’s quality of life. A compulsive hoarder finds it impossible, even painful, to part with possessions. It’s not clear how many people suffer from compulsive hoarding, but estimates start at about 1.5 million Americans.
Dr. Tolin recently studied compulsive hoarders using brain-scan technology. While in the scanner, hoarders looked at various possessions and made decisions about whether to keep them or throw them away. The items were shredded in front of them, so they knew the decision was irreversible. When a hoarder was making decisions about throwing away items, the researchers saw increased activity in the orbitofrontal cortex, a part of the brain involved in decision-making and planning.
“That part of the brain seemed to be stressed to the max,” Dr. Tolin said. By comparison, people who didn’t hoard showed no extra brain activity.
While hoarders are a minority, many psychologists and organization experts say the rest of us can learn from them. The spectrum from cleanliness to messiness includes large numbers of people who are chronically disorganized and suffering either emotionally, physically or socially. Cognitive behavioral therapy may help: a recent study of hoarders showed that six months’ therapy resulted in a marked decline in clutter in the patient’s living space.
Although chronic disorganization is not a medical diagnosis, therapists and doctors sometimes call on professional organizers to help patients. One of them is Lynne Johnson, a professional organizer from Quincy, Mass., who is president of the National Study Group on Chronic Disorganization.
Ms. Johnson explains that some people look at a shelf stacked with coffee mugs and see only mugs. But people with serious disorganization problems might see each one as a unique item — a souvenir from Yellowstone or a treasured gift from Grandma.
Many clients have already accumulated numerous storage bins and other such items in a futile attempt to get organized. Usually the home space is adequate, she says, but the challenge is in teaching them how to group, sort, set priorities and discard.
Ms. Johnson says she often sees a link between her client’s efforts to get organized and weight loss. “I think someone decides, ‘I’m not going to live like this anymore. I’m not going to hold onto my stuff, I’m not going to hold onto my weight,’” she said. “I don’t know that one comes before the other. It’s part of that same life-change decision.”
On its Web site, www.nsgcd.org, the group offers a scale to help people gauge the seriousness of their clutter problem. It also includes a referral tool for finding a professional organizer. But since the hourly fees can range from $60 to $100 or more, it may be worth consulting a new book by Dr. Tolin, “Buried in Treasures” (Oxford, 2007), which offers self-assessments and advice for people with hoarding tendencies.
Dr. Peeke says she often instructs patients trying to lose weight to at least create one clean and uncluttered place in their home. She also suggests keeping a gym bag with workout clothes and sneakers in an uncluttered area to make it easier to exercise. She recalls one patient whose garage was “a solid cube of clutter.” The woman cleaned up her home and also lost about 50 pounds.
“It wasn’t, at the end of the day, about her weight,” Dr. Peeke said. “It was about uncluttering at multiple levels of her life.”
When Hospitals Kept Children From Parents
By HOWARD MARKEL, M.D., The New York Times, January 1, 2008
Early one morning, I visited my daughter’s 5-year-old friend Eddie, who was laid up in the hospital the night after an emergency appendectomy. Understandably, Eddie looked miserable. Just as understandably, so did his parents, who were still in their pajamas in a fold-out cot next to his bed.
At every children’s hospital across the nation, at just about any time of day or night, you are likely to see at least as many parents as patients.
These days, it seems obvious that seriously ill children need their parents beside them during a hospitalization. Yet unlimited parental visiting hours are relatively new in American hospitals. In 1894, Boston Children’s Hospital had only two “visiting days for parents” per week, 11 a.m. to noon on Wednesdays and 3 to 4 p.m. on Sundays (fathers only). At Massachusetts General Hospital in 1910, homesick children who cried too much for their parents were moved to isolation wards so as not to disturb the other patients.
Such draconian prohibitions were the norm at hospitals across the United States. “Order was a word almost sacred in the terminology of the pious gentlemen who wrote the bylaws, raised the funds and sat on the boards of America’s first hospitals,” said Charles E. Rosenberg, a medical historian at Harvard. “They regarded all the hospital’s inmates as moral minors, and most of their regulations were aimed at controlling behavior.”
American hospitals in the 19th century were charitable enterprises devoted to the care of the urban poor, orphans, seamen and immigrants. Consequently, hospital trustees spent a great deal of effort deciding which potential patient was morally worthy of the healing experience they offered. Drunks, criminals, prostitutes and the so-called undeserving poor need not apply.
“Most physicians practicing in this era considered childhood diseases to be caused by unhealthy environments and improper parenting,” said Dr. Hughes Evans, a pediatrician at the University of Alabama. “Removing children from deleterious home environments was considered therapeutic.”
Because many children’s hospitals focused primarily on the correction of orthopedic problems and congenital malformations, pediatric patients often required months of hospitalization. “This made these institutions ideal places to remodel children morally as well as physically,” Dr. Rosenberg said.
Children with infectious diseases, meanwhile, were typically admitted to contagious-disease facilities with even more limited visiting hours.
From the early 1900s to the late 1950s, most American hospitals continued to promulgate strict rules separating children from their parents, cloaking them in the language of science.
“Medical science was reflected through a prism of ethnicity and class,” said David Rosner, a historian of public health at Columbia. “Germs became the surrogates for older class distinctions.
“The vulnerability changed from individual morality to propensity to disease,” he went on, “but the targets of the visiting restrictions — the poor, immigrants, the disenfranchised — remained the same.”
As a result, the working poor were forced to choose between visiting their children and reporting for work, branding them either as bad parents or bad workers. Wealthy parents who could afford private rooms for their children in the same hospitals had unlimited visiting hours.
There were some creative ways around the rules. Dr. Henry M. Seidel, who interned in pediatrics at the Johns Hopkins Hospital in 1946, recalled: “Parent visiting hours were from 7 to 8 p.m. on Wednesdays and 1 to 2 p.m. on Sundays. But we could place ‘very sick’ children on a critical list, giving them unlimited visiting privileges. Many times, we were very loose in how we defined ‘very sick.’”
From the 1960s onward, advances in hospital architecture have radically changed accommodations for family members. As consumers demanded that hospitals shift from open wards to semiprivate and private rooms, it became impossible for the hospital staff to keep an eye on all patients simultaneously.
Such changes meant that parents could pitch in and give their children the nonmedical but essential comfort they need. Nurses, too, led major efforts to develop family-focused care programs at children’s hospitals and health clinics.
In the modern market-driven world of health care, the newest children’s hospitals compete for patient dollars with hotel-grade living spaces for parents, restaurants and other amenities.
The pendulum seems to have completed its swing — to the point where patients like 5-year-old Eddie may feel miserable but not without emotional support. So why did we restrict visiting hours for so long?
“One reason,” said Dr. Seidel, the veteran pediatrician, “might be because we had always done it that way. But I suspect many doctors simply found it convenient and considered parents to be in the way.”
Howard Markel is a professor of pediatrics, psychiatry and the history of medicine at the University of Michigan.
Killing Dogs in Training of Doctors Is to End
By NICHOLAS BAKALAR, The New York Times, January 1, 2008
By next month, all American medical schools will have abandoned a time-honored method of teaching cardiology: operating on dogs to examine their beating hearts, and disposing of them after the lesson.
Case Western Reserve School of Medicine was the last to use the method, but the dean, Dr. Pamela Davis, said it would no longer do so after this month.
On Nov. 19, New York Medical College in Valhalla joined New York’s 11 other medical schools and announced that it would close its dog laboratory.
Among the 126 American medical schools, 11 still sacrifice animals for teaching, according to the Physicians Committee for Responsible Medicine, an advocacy group that tracks the practice. Other than Case, none of them use dogs.
Francis Belloni, a dean at New York Medical College, said his students now used echocardiograms to study heart function, and the subjects were live medical students rather than live dogs. Dr. Belloni said the use of animals was not done lightly and had value, but added that students would “become just as good doctors without it.”
Can They Stay Out of Harm’s Way?
By J. MADELEINE NASH, The New York Times, January 1, 2008
The morning was just starting to heat up when a biologist, Ricardo Costa, set out to look for jaguars on Fazenda San Francisco, a 30,000-acre cattle ranch, rice farm and wildlife reserve in the region of southwest Brazil known as the Pantanal.
Soon, along a fringe of scrubby woodland, Mr. Costa spotted a young male jaguar lazing in sun-flecked shade. “It’s Orelha,” he whispered, pointing out the tear in the animal’s right orelha, or ear.
As Mr. Costa watched from the driver’s seat of a Toyota truck, the animal stretched and yawned, exposing teeth strong enough to crunch through the skull of almost anything. “Wonderful!” he said.
The jaguar, Panthera onca — the largest cat in the Americas and the third largest in the world — still prowls the rangelands of the Pantanal, a 74,000-square-mile mosaic of rivers, forests and seasonally flooded savannas that spill from Brazil into neighboring Bolivia and Paraguay.
From the jaguar’s perspective, this vast, wildlife-rich area probably seems close to a slice of heaven — or, at least it would if the big cats were not routinely hunted down in retaliation for cattle losses.
Mr. Costa, for example, said that he worried about Orelha and his more skittish brother, Grandão. Two years ago, he said, an older, larger male who patrolled the same territory was killed when it ventured onto a neighboring ranch.
And now Fernando Azevedo, the senior scientist with whom Mr. Costa has been working, says he has lost 4 of the 14 jaguars he was starting to study at Fazenda São Bento, about 60 miles from San Francisco.
Once again, it appears, the animals were picked off when they wandered away from a ranch where they are protected, onto adjoining properties. Among the casualties, Dr. Azevedo suspects, were an adult female and her two nearly full-grown cubs. Convincing ranchers and ranch hands to end such killing has become a priority for conservationists in the region.
The importance of the Pantanal was underscored last October when Thomas Kaplan, executive chairman of the foundation Panthera, an emerging force in big cat conservation, finalized the purchase of two large ranches and signed an agreement to buy a third, creating a property that will soon total more than 400,000 acres.
The ranches, which will be run by Panthera, are particularly important because they connect previously isolated wildlife preserves. Now, jaguars will be able to travel safely from one sanctuary to the other.
“With jaguars we have the opportunity to play offense,” said Dr. Kaplan, an entrepreneur and financier who in 2006 founded Panthera. “There are certain areas, like the Pantanal, where the wind is at your back.”
Dr. Kaplan said that Panthera’s plan was to continue running cattle on the ranches while testing a broad range of techniques for reducing livestock-jaguar interactions. The results, he hopes, will encourage others to adopt range management practices that encourage co-existence over conflict.
At stake in the Pantanal, conservationists say, is a significant fraction — perhaps 15 percent — of the world’s remaining population of jaguars.
Cattle ranching and jaguar conservation do not need to be mutually exclusive, said Alan Rabinowitz, executive director of the science and exploration program at the Wildlife Conservation Society, based in the Bronx.
“Cattle open up the landscape,” Dr. Rabinowitz said, and enhance habitat for the jaguar’s wild prey. “If you were to take out the cattle and let large areas revert to scrubby vegetation, you’d have far fewer jaguars in the Pantanal than you do today.”
Jaguars can also provide ranchers with an additional source of income. For example, several ranches in the Pantanal, San Francisco among them, run ecotourism operations that have turned a liability into a valuable asset.
Conservationists say that the next decade will be pivotal for jaguars, in the Pantanal and throughout its range, which runs from northern Argentina to the borderlands shared by Mexico and the United States.
No one knows the precise rate at which the number of jaguars is declining or just how many jaguars there are. But the World Conservation Union pegs the total free-ranging population at fewer than 50,000 adults and classifies the animal as near threatened.
Jaguars may not yet be in such desperate shape as Asian tigers, whose noncaptive breeding population has plummeted below 2,500, or African lions, of which there are perhaps only 20,000 to 30,000 left in the wild. But if conflicts with people and their livestock are not soon resolved, conservationists warn, jaguars could quickly trace a similar trajectory.
At first pass, the conflict between jaguars and ranchers would seem to be intractable. “The cats are where the cows are, and the cows belong to people,” said Almira Hoogesteijn, a research veterinarian at the Center for Research and Advanced Studies of the National Polytechnic Institute in Mexico.
But even though jaguars kill and eat cattle, they do so less often than one might imagine.
A quantitative picture of the dietary habits of jaguars emerged from a study conducted by Dr. Azevedo at San Francisco in 2003 and 2004.
Over the course of nearly two years, Dr. Azevedo and his field assistants collared 11 adult jaguars and tracked their movements. They also methodically collected their scats and examined the carcasses of their prey.
The contents of the scats revealed that the giant rodents known as capybaras were the jaguars’ most common prey, followed by caimans and marsh deer. Of 113 carcasses confirmed as jaguar kills, capybaras made up 35; caimans, 23, and cattle, 32.
Dr. Azevedo, a postdoctoral fellow at the University of São Paulo, then measured the cattle that were killed against a larger background.
In all, 169 cattle deaths occurred at San Francisco during the study period, he and his former thesis adviser, Dennis Murray of Trent University in Canada, reported in the September issue of The Journal of Wildlife Management. Nineteen percent were lost to jaguars. Out of a 5,000-head cattle herd, the jaguar’s take faded even more in significance: it amounted to less than 1 percent.
San Francisco keeps its jaguars in line with a variety of tactics, said the ranch’s owner, Roberto Coelho. Among the strategies is using bulls and older cows with horns to “baby-sit” young, clueless animals and immediately moving cattle away from a paddock whenever depredation occurs.
In addition, Mr. Coelho said, San Francisco’s extensive rice fields are an effective barrier between the cattle paddocks and the property’s riparian forests. Among the important things to understand about jaguars, depredation experts say, is that they like to hang out in wooded areas close to water.
Consider the problems that Teresa Bracher has been having on the four ranches she owns in prime jaguar habitat along the Paraguay River, the Pantanal’s main artery. For a time, depredation losses may have approached 8 percent, said Ms. Bracher, a committed conservationist as well as a rancher.
For assistance, Ms. Bracher turned to Peter Crawshaw Jr., a leading Brazilian jaguar expert based at the Pantanal National Park. Dr. Crawshaw suggested a spectrum of nonlethal jaguar deterrents, Ms. Bracher said, and she and her cousin, who runs the cattle operation, have implemented every one.
Among other things, they deployed guard dogs and surrounded their cattle with electrified fencing. They installed bright lights around the paddocks and instituted regular patrols. They even set off noisy fireworks at night, when jaguars are most active.
As a result, depredation has significantly declined. Like many other ranchers in the area, Ms. Bracher is wary of one antipredation measure: substituting water buffaloes for cattle. Water buffaloes easily turn feral, creating a problem as large as the one they are supposed to solve.
But, said Rafael Hoogesteijn, a Venezuelan veterinarian who is an internationally respected depredation expert, a properly managed water buffalo herd can be as close to predator proof as a group of ungulates gets. When a jaguar or puma appears, water buffaloes protectively encircle their young. They will even menace the predator by advancing on it, with the big bulls in the lead.
In a soon-to-be-published study, Dr. Hoogesteijn and his sister, Almira, report on the experience with water buffaloes and cattle at six ranches in Venezuela. On three, they note, jaguars managed to snatch a few calves when the buffaloes were first introduced. Then the herds learned to defend themselves, and the jaguar attacks ceased.
These intimidating herbivores, the Hoogesteijns found, appear to surround cattle in a broad, protective umbra. On the Venezuelan ranches, jaguars preyed upon cattle significantly less often when they were placed in the same paddocks as buffaloes.
“With cattle, you will always have losses,” said Rafael Hoogesteijn, who has agreed to become the supervisor of Panthera’s ranching operations in the Pantanal. “But with buffalo, you can have true co-existence.”
What frustrates conservationists here is that multiple techniques for minimizing the problems caused by jaguars exist, and yet, instead of being a last resort, the first reaction too frequently is to pick up a gun.
This occurs despite the fact that the jaguar is protected in Brazil, as, indeed, it is across most of its range. Enforcement, however, is all but nonexistent.
As Dr. Hoogesteijn and others see it, the current system of incentives is perverse. Ranchers are not penalized for shooting jaguars, but they also are not rewarded for resolving predation problems in an ecologically sensitive way.
Programs that compensate ranchers for their losses might help, some believe. Others note that such programs are costly and, if badly designed, can perpetuate poor range management practices.
A survey of 50 ranchers in the northern Pantanal published two years ago suggested that the people there were deeply conflicted where jaguars are concerned. Well over half of the respondents said that they could not tolerate jaguars on their own ranches, and yet nearly three-quarters thought jaguars should be protected. Thirty-eight percent ranked jaguars as a larger source of economic loss than floods, droughts, rustling and disease.
Ranchers, depredation experts have found, tend to exaggerate their losses to jaguars. In part, that is because jaguars are eager scavengers and so can be observed feeding at carcasses they played no part in killing. But the tendency to exaggerate also stems from ranchers’ often being unaware of the extent to which diseases like leptospirosis and brucellosis rob them of their profits.
These diseases, Dr. Hoogesteijn said, attack the reproductive tract of cows, causing abortions and stillbirths. On one large Venezuelan ranch, he once calculated, the annual loss from problem pregnancies and births probably amounted to 400 of 3,000 “potential calves,” or 10 times the number of real calves known to have been killed by jaguars and pumas.
Nonetheless, problem jaguars do exist. And not a few bear old gunshot injuries that handicap them in stalking and killing wild prey. Some conservationists concede that hunting a problem animal may sometimes be a solution.
But more headway may be made by focusing on the human side of the problem, said Silvio Marchini, a wildlife biologist who worked in the Pantanal before moving to the Amazon. “There’s an assumption that the reason people kill jaguars is because they cause economic damage. But social and cultural attitudes may also be very important.”
As Marcos Moraes, the owner of São Bento, put it, “We need a new generation to come along and change the old ways of thinking.”
In the Pantanal, jaguar hunting is part of a tradition as deeply ingrained as fox hunting once was in the English countryside — except that here, it is not the well-to-do landowners who most enthusiastically join the chase but their hired hands, the Pantaneiro cowboys.
For them, jaguar hunting is a form of bush entertainment, said Sandra Cavalcanti, a jaguar expert who will soon receive her Ph.D. from Utah State University.
There’s also a macho component. “Killing a jaguar is considered a manly thing to do,” Ms. Cavalcanti said.
Later this year, Ms. Cavalcanti, who has joined the staff that Panthera is assembling, hopes to begin addressing this problem by starting a cowboy outreach program, which could include things like medical services, instruction in range management and depredation control.
Jaguars in the Pantanal seem to be on a teeter-totter that could tilt strongly in one direction or the other. Given the stakes, Ms. Cavalcanti said, researchers no longer have the luxury to just study these elegantly patterned beasts. To save them, she said, “we have to act.”
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Date: 2008-01-02 12:29 am (UTC)Uh, no mention of how people end up with so much stuff because we're encouraged to buy buy BUY every single day, and that material accumulation ends up being tied to feelings of self worth?
We're actually on a one thing in, one thing out trip right now. You could call it the third law of accumulation: every Christmas gift or other accumulated item has an equal and opposite item that is eliminated from our home.