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Tuesday, May 5, 2020

#SocialDistancing: alone together

Just saw this reviewed in my current hardcopy Science Magazine (paywalled).
The other public health crisis

As a fledgling physician, Vivek Murthy considered social issues such as loneliness to be outside the domain of doctoring. That all changed when he met a patient named James, whose health concerns appeared to stem from social isolation that started after winning the lottery. In restructuring his life to his new economic standing, James had inadvertently cut himself off from his existing support network, sending his health into a downward spiral. In his book Together, Murthy—who served as the 19th surgeon general of the United States—draws from decades of scientific research and his own experiences with patients like James to show just how damaging loneliness can be.

The timing of the book's release coincides with a global public health crisis, as people around the world adapt to the ongoing COVID-19 pandemic. Murthy's account of the factors driving loneliness and his suggestions to combat isolation are particularly poignant now, as many abide by recommendations to stay home and avoid social contact with others…
Had to buy the Kindle edition. Glad to have done so.
Author’s Note
This is a book about the importance of human connection, the hidden impact of loneliness on our health, and the social power of community. As a physician, I felt compelled to address these issues because of the rising physical and emotional toll of social disconnection that I’ve watched throughout society over the past few decades. What I could not anticipate, however, was the unprecedented test that our global community would face just as this book was going to press.

In the first weeks of 2020, the COVID-19 pandemic turned physical human contact into a potentially mortal threat. The novel coronavirus was on the loose, like an invisible stalker, and any of our fellow human beings could have been its carrier. Almost overnight, it seemed, getting close enough to breathe on another person became synonymous with danger. The public health imperative was clear: to save lives, we’d need to radically increase the space between us.

As I write these words, we are still in the middle of this pandemic. With health workers at risk, hospital equipment in short supply, and death rates from the coronavirus spiking by the day, governments the world over have mandated “social distancing,” closed schools and most businesses, and ordered everyone but essential service workers to stay home. Those first responders, health-care and food-supply workers, and others who must stay on the job to protect us are now putting their lives on the line. They remind us just how much we depend on each other…

This pandemic isn’t the first and won’t be the last time our social connections are tested, but it is rare for the whole world to face such a grave challenge simultaneously. For all our differences, our shared experience is itself a bond. We will have this memory in common for the rest of our lives. And if we learn from this moment to be better together, we won’t just endure this crisis. We will thrive.

March 2020
“This powerful and important book looks at loneliness as a public health issue. Vivek Murthy shows why loneliness evolved in our species, how it can be harmful, why it’s on the rise today, and what we can do about it. By creating better connections with our friends and our communities, we can lead healthier lives and help our friends be healthier.” 

   —Walter Isaacson, New York Times bestselling author 

“Murthy’s book makes a powerful case for the role of community and human connection in medicine. He provides cogent and compassionate insights about how to heal the art of healing.”
   —Siddhartha Mukherjee, the Pulitzer Prize–winning, New York Times bestselling author of The Emperor of All Maladies
We shall see. Amazon reviews were all lauditory. A timely read. Just getting started, stay tuned. I am reminded of another fine book I cited on this blog some time back.

Life with people

Philosopher Jean-Paul Sartre famously wrote, “L’enfer, c’est les autres”—hell is other people. No. Not if you want to live long. One of the keys to a long health span and a long life is social connectedness.

Loneliness is associated with early mortality. It has been implicated in just about every medical problem you can think of, including cardiovascular incidents, personality disorders, psychoses, and cognitive decline. Loneliness can double the likelihood of developing Alzheimer’s disease. It increases the production of stress hormones, which in turn lead to arthritis and diabetes, dementia, and increased suicide attempts. It leads to inflammation, increasing proinflammatory cytokines such as interleukin-6 (IL-6), and it negates the beneficial effects of exercise on neurogenesis, the growth of new neurons. Loneliness is worse for your health than smoking fifteen cigarettes a day. If you are chronically lonely, the risk that you will die in the next seven years goes up by 30 percent.

Loneliness and social isolation are not the same thing. Social isolation refers to having few interactions with people and can be evaluated objectively (for example, how many people you interact with in a week and for how long). Loneliness is entirely subjective—it’s your emotional state. Social isolation can be calculated. Loneliness is felt.

People can feel lonely even when surrounded by others, such as in the middle of a party or inside a large family. Loneliness is a feeling of being detached from meaningful relationships, and that may arise from feeling unacknowledged, from feeling misunderstood, or from a lack of intimacy. Having a spouse sometimes helps, and sometimes not. There are certainly people who enjoy being alone and who do not feel lonely, just as there are people who are constantly in the presence of others, perhaps making small talk, but feeling completely alone. Being unmarried raises the risk of loneliness and a host of health-related problems, but being married doesn’t help in all cases—not all marriages are happy ones.

Social isolation can lead to loneliness, of course, and both can increase in old age owing to a variety of factors. People retire and swiftly lose the social contact they had with co-workers. Friends die. Health and mobility problems make it more difficult to leave home. Ageism, present in many modern societies, leaves older adults feeling devalued, unwanted, or invisible. Younger friends and family members become caught up in their own lives and might not take time to visit older people. Government research in the UK found that two hundred thousand older adults had not had a conversation with a friend or relative in more than a month. Clearly that kind of extreme social isolation can lead to loneliness.

Levitin, Daniel J. Successful Aging (pp. 179-180). Penguin Publishing Group. Kindle Edition.


Angrily protesting the governor's emergency stay-at-home order. Just out of photo range above, the requisite "patriotic" Confederate flags, crude swastika placards, and assault weapons replete with playtriot army surplus store garb.


The latest from Hopkins.

Speaking of Hopkins, and "public health" more broadly. From NPR:
Opinion: Always The Bridesmaid, Public Health Rarely Spotlighted Until It's Too Late

The U.S. is in the midst of both a public health crisis and a health care crisis. Yet most people aren't aware these are two distinct things. And the response for each is going to be crucial.

If you're not a health professional of some stripe, you might not realize that the nation's public health system operates, in large part, separately from the system that provides most people's medical care.

Dr. Joshua Sharfstein, a former deputy commissioner for the Food and Drug Administration and now vice dean at the school of public health at Johns Hopkins in Baltimore, distinguishes the health care system from the public health system as "the difference between taking care     of patients with COVID and preventing people from getting COVID in the first place."

In general, the health care system cares for patients individually, while public health is about caring for an entire population. Public health includes many things a population takes for granted, like clean air, clean water, effective sanitation, food that is safe to eat, as well as injury prevention, vaccines and other methods of ensuring the control of contagious and environmental diseases.

In fact, it is public health, not advances in medical care, that has accounted for most of the increases in life expectancy during the past two centuries. Well before the advent of antibiotics and other 20th Century medical interventions, public-health activities around clean water, food safety and safer housing led to enormous gains.

"It's pretty invisible" if the public health system is working well, said Sharfstein, who also once served as Maryland's state health secretary. "It's the dog-that-doesn't-bark agency."
But while public health isn't as flashy as a new drug or medical device or surgical procedure, it can simultaneously affect many more lives at once…

Still, because the public-health system mostly operates in the background, it rarely gets the attention — or funding — it deserves, until there's a crisis.

Public health is "a victim of its own success," said Jonathan Oberlander, a health policy researcher and professor at the University of North Carolina-Chapel Hill.

"People can enjoy clean water and clean air but don't always attribute it to public health," he said. "We pay attention to public health when things go awry. But we tend to pay not a lot of attention in the normal course of events.”

Public health as a scientific field was created largely to address the sort of problem the world is facing today. Sharfstein noted that Baltimore established the nation's first public health department in 1793 to address a yellow fever epidemic. But between emergencies, the public health domain is largely ignored.

"In the U.S., 97 cents of every health dollar goes to medical care," he said. "Three cents goes to public health.”…

Read all of it. Very good.


Finished Dr. Murthy's book. Very enjoyable read. The Science Magazine review sums it up nicely:
…Collectivistic communities—those that emphasize the needs of the group over the needs of individuals—can foster connectedness by providing social institutions that bind people together. But oppressive social norms inherent in many such communities can cause undue stress, and those who do not conform to these norms can be ostracized and left even more isolated than those from individualistic communities. Understanding the profound necessity of connectedness and how we can protect ourselves from isolation in modern society can help us to take deliberate action to cultivate our relationships with others.

For those who are fortunate, the practice of social distancing during the COVID-19 pandemic may provide valuable opportunities to reconnect with family and loved ones quarantined at home. For many others, the situation will be dire. Those living alone will experience increased isolation, and those most at risk, such as the elderly and ill, may be kept in isolation from their loved ones. On a societal level, the public health implications of this widespread disconnect may be severe.

By showcasing research on the impact of loneliness and its social and environmental antecedents, Murthy presents a road map of the various pathways that lead to connection or isolation. Although the path to connectedness may be long and arduous, particularly while social distancing, the direction in which we must head is clear.
Well worth your time.


My current read, just started.
Fun stuff. Clear thinker.

apropos of last year's riff on "Deliberation Science."

More to come...

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