Observatory News

SPH Digest: Graduation address by Google.org's Larry Brilliant and more.

Fathers and Sons: Recent M.H.S.A. recipients, the Hoffmans, and From the Archives, the Vaughans

Funds: In honor of Ron Davis and Scott Simonds

George Kaplan Hunts Patterns: In epidemiology, and with the "closer look" lens of photography

Q&A with Karen Peterson: UM SPH's new director of EHS's Human Nutrition program

Letters to the Editor

A Patient’s Quest for Care
Steven Levine’s very useful article from the spring/summer 2008 Findings is so on-point with our current health care concerns. Earlier this year, my 83-year old mother suffered two strokes within a ten-week period. My husband and I wrestled with home-care options, as she required full-time nursing care. Because I’d had guardianship for an aunt who was in a nursing home for several years before she passed away, I was well acquainted with the nursing-care system, and I was determined that my mother get in-home care instead. The culture of nursing care, even where it is fairly competent in dealing with the physical needs of the patients, is so sadly deficient in addressing their emotional needs. The fact that my mother, like Steven Levine, has the means to afford better care, and has family that is intimately involved in that care on a daily basis, has made all the difference.
Deborah Stern
Silver Spring, Maryland

I have always been very impressed with Findings, but the spring/summer 2008 issue was especially good and timely. The story about your faculty member who was in the motorcycle accident really hit home with me, as I have spent five of the last six summers in an arm cast up to my armpit following multiple elbow surgeries. While not identical, because my problems were not caused by an accident, Steven Levine’s story made me think, “Ah, here’s someone who would really understand what I have been through.”
Beth J. Johnson
Ann Arbor, Michigan

Steven Levine’s article truly resonated with me. His moving story provided great insight into the patient perspective on health care and also conveyed the importance of the caregiver’s role. My siblings and I have been caring for sick parents for three years. Late in my mother’s cancer recovery, she became quite ill, and we had to fight the medical care system for her very survival. My father is now ill and has been on life support for several months. And so the struggle continues. My siblings and I must be vigilant about his care almost on a daily basis as he cannot advocate for himself. We are weary, but must continue to persevere. Thankfully, we also have had “Angel Jennifers” along the way.
MaryAnn Rizk-McKenna, MPH ’86
Waterford, Michigan

Even though I had heard Steven Levine’s story before, it was eye-opening to read it again, and it made me thank God for every day I am healthy, my family is healthy, and I have the ability to make life just a little brighter for the people I work with. Steve’s accident may have saved my own life, since I sold my motorcycle shortly after he was hurt. I thought too much about what had happened to him and never got a new one (although I get this itch every spring—thank God for a wife who’s more rational than I am!). Thanks for publishing Steve’s story— it cannot be told too many times.
Axel Bogdan, MS ’93
River Falls, Wisconsin

Alzheimer’s Care
I read with great interest “One Day of Life” in the spring/summer issue of Findings. It takes great courage for a university magazine to broach such an intimate and personal topic in a way befitting general newsstand magazines. Writer Laura Bailey compassionately and sincerely captured the lives of Greg and Lucy Pleva in such a way that I find myself still thinking of them; I wish them well.
Michele Coffill
Grand Rapids, Michigan

I am “one of the millions of people who have a parent or sibling with Alzheimer’s” mentioned in “Genetic Testing for Alzheimer’s” in the spring/summer issue of Findings. I am also one of the people who entered a clinical trial to assess my genetic risk for Alzheimer’s and to evaluate the impact on my well-being, and on decisions I subsequently made, upon learning my APOE allele results. The REVEAL clinical trial I enrolled in at Cornell Weill Medical Center in New York City in April 2005 sounds similar to the NIH–funded research that Scott Roberts at SPH is conducting. My trial included a pre-intake questionnaire, the result of my APOE test, ongoing evaluations to assess the impact of the knowledge, and a final cognitive test in May 2008. I did take actions after learning my risk assessment, such as getting a will, purchasing additional life insurance, taking a daily herbal supplement to potentially reduce my risk, and starting to chronicle the story of my life.

An unanticipated outcome of my participation in the clinical trial is that I began to map out the family history of my mother, who died in 1993 at the age of 72 after suffering from Alzheimer’s disease for 12 years. After learning my genetic risk, I embarked upon a journey to reconnect families that share genetic material but that had had little contact since my mother left her homeland, Chile, to work at the Chilean mission to the United Nations in the 1940s. My dear mother does not know that her disease has reunited our families in New York and Chile.

Since my participation in the clinical trial, my father has developed Alzheimer’s disease. He is now 85, and I am accompanying him on his journey through the loss of his amazing memory. So, I am now one of many people who have both parents with Alzheimer’s disease. Who knows what the future holds for me? But knowing my risk assessment has helped me choose to live my life fully and embrace each memory that stays with me as a precious gift. The most important outcome of choosing to know my genetic risk is being able to appreciate each moment of my life.
Solange Muller, MPH ’79
New York, New York

SPH Assistant Professor Scott Roberts responds:
Ms. Muller is describing her experience at the Cornell site in the second clinical trial of the REVEAL Study, a series of multicenter trials based at Boston University that examine the impact of genetic risk information for Alzheimer’s disease (I now direct a UM site for the third trial). While her response is not typical, it demonstrates how personal genetic information can serve as a catalyst not only for health behavior changes, but also for exploration of one’s family history. Given concerns about the unintended negative consequences of genetic risk disclosure,
it is nice to hear that in this case, the result was an enriching personal journey instead.

A Nuanced Forum
I am a doctoral student in health management and policy and just wanted to tell you that I think the “Busted” article in the recent Findings (spring/summer 2008) is excellent. It is great to create this forum for faculty to share their more nuanced understandings and interpretations of some of the issues.
Nancy Baum, MHS, Ph.D. candidate, SPH
Ann Arbor, Michigan

I would like to distribute copies of the article “Busted” to my colleagues. There are many statements being bandied about in the press, political arena, and in other forums by “experts.” In “Busted,” the School of Public Health has taken a look at the verifiable evidence and shed light on what can be proven. The article reflects the best tradition of academia: to research and report the facts without concern about unverified intuition or political generalities.
Alan Bloom, MPH ’70
General Counsel, Care 1st Health Plan
Monterey Park, California

Send correspondence about any Findings article to the editor at sph.findings@umich.edu. You will be contacted if your letter is considered for publication.

Editor's Note: Welfare State

I’ve never met Warren Wiscott, but for an hour last summer I stepped into his shoes, and they weren’t very comfortable.

Warren is 75 years old and has a chronic lung condition. He has trouble climbing stairs and can’t walk long distances. His wife, Winona, is 73 and suffers from mild diabetes and hearing loss. Because their monthly expenses ($1,169 for rent, utilities, food, clothing, medicine, hospital bills, and loans) exceed their monthly income ($1,005, from Social Security), they rely on welfare to make ends meet.

They’re not alone. Government estimates put the number of Americans on welfare today at around four million. We all know the myths about who goes on welfare and why, but the truth, says SPH Associate Professor Richard Lichtenstein, is that welfare recipients are mostly adults with physical, mental or emotional barriers to employment—people like Warren and Winona Wiscott—as well as children being raised by a single parent or by grandparents or foster parents.

I learned about Warren and Winona—who are in fact fictional characters—during a welfare simulation workshop given at SPH last June by the Ann Arbor Interfaith Council for Peace and Justice. Lichtenstein invited the council to do the workshop because he wanted students in the school’s Summer Enrichment Program, which focuses on health disparities and poverty, together with the SPH community at large to get a feel for what it’s like to be on welfare and to get a sense of how the experience affects health. It’s a matter of empathy, he told me. “I wanted people to know how impossibly hard life on welfare is. Not only don’t you have enough money, but you’re treated with hostility. The amount of stress that fills the life of a mother on welfare is unimaginable.”

Around 60 SPH students, staff members, and faculty took part in the workshop. At the door we were each given the identity of a welfare recipient—in my case, the fictive Warren Wiscott—along with a packet of information detailing our living situation, income, and expenses. Then the simulation began. For the next hour we all rushed around the room trying to cash checks and pay bills and decide what we could do without (medicine or food?) and whether to pawn the stereo in order to pay down our loans. Volunteers from the Interfaith Council staffed the various stations where these transactions took place.

In their roles as bankers and social workers and housing officials, some volunteers were helpful, but most were brusque, and several went out of their way to slow things down by misspelling names or forgetting to issue receipts.

Every 15 minutes or so a whistle sounded, and we were told another week had passed, and we had to stop what we were doing—usually waiting in line—and go home. Each time we went anywhere we had to pay a dollar in bus fare.

What’s it like to live on welfare? Judging from the hour I spent as Warren Wiscott, debilitating. By the end of the workshop my heart was galloping. We know that stress takes a toll on human health, and the system as I experienced it is clearly very stressful.

I later found out that some of volunteers who’d staffed the workshop had once been on welfare themselves. I imagine it was sobering for them to watch us struggle to cope with a system that is neither efficient nor especially kind. But I can’t speak for them, I can only empathize.

That’s the crucial first step, Lichtenstein says. Public health depends on our ability to empathize with people we don’t know and may never meet, but with whom we build deep and sometimes lasting relationships. It depends on our willingness to step into Warren Wiscott’s shoes, even if it’s only for an hour, and see how they feel.

By Leslie Stainton