About Gout

9/10/07

“The actual tragedies of life bear no relation to one’s preconceived ideas. In the event, one is always bewildered by their simplicity, their grandeur of design, and by that element of the bizarre which seems inherent in them.”
-- Jean Cocteau
Les Enfants Terribles, 1929

Imagine falling to the floor in agony and having to crawl to the bathroom. The softest touch, the weight of a bed sheet or fit of the thinnest sock, produces paroxysms of excruciating pain. Shoes? Forget it.

About Gout: Quoting Isaac Asimov’s, The Human Body: structure and Operation (1963), “The amino acid cystine is a normal component of proteins and is the least soluble of the amino acids. Uric acid will also form stones, and here a new are of danger arises. Sometimes uric acid is deposited in the joints of the extremities, particularly of the big toe, to give rise to the extraordinarily painful disease gout. (This word arises from a latin word meaning “drop” because in the Middle Ages there arose the misconception that gout was caused by the gathering of some fluid in the joints, ‘drop by drop.’) Gout seems to have become more prevalent in previous centuries than now, partly because conditions which were once diagnosed as ‘gout’ are now diagnosed as some form of arthritis.”

First diagnosed 2,000 years ago, gout is the “disease of kings,” mostly as a result of its association with overindulgence in alcohol and dietary debauchery.

People with blood related cancers such as leukaemia, lymphoma or myeloma are at risk for developing gout. The symptoms of gout are painful swelling of the joints such as the big toe, ankle or knee. When cells die, they are broken down in the body and make uric acid as a waste product. Normally we clear the uric acid out of our bodies in our urine. But, if you have one of the cancers listed above you probably have a higher level of uric acid in your blood. This is because your bone marrow is producing abnormal cells. As these cells die and are broken down uric acid is released. The already high level of uric acid can sometimes greatly increase when undergoing chemotherapy.


Editorial Comment

Woulda, Shoulda, Coulda!

Re “The New Social Contract,” by David Brooks (Sept. 7, 2007):

The health care system Brooks describes as “coming apart at the seams” is going to require a “distinctly America Social contract.” His argument is, of course, underpinned by a shopworn definition of American exceptionalism that went out the window on 9/11.

Here we go again, we’re somehow different. In saying why we could never adopt a health care system based on a Western European socialist model, Brooks contends that Americans “are more individualistic and pluralistic.” That rugged, individualistic frontier tradition just won’t allow us to “defer to the central government” on health matters. The fact is that pluralism--that social condition whereby numerous ethnic, religious or cultural groups coexist within one nation—is nothing new to Europe. What is odd is Brook’s historical naivete in thinking America is unique in this regard.

A term that pops up again and again in Brook’s essay is should. While Utopian writing has always functioned as a necessary form of social critique, I’m not sure this was his intention. Brooks assumes an economically strong society, where employment and wages should “stimulate private savings and self-insurance.” But that simply isn’t the case in this country at this time. With record mortgage foreclosures, new lows for the dollar, rising unemployment, and unprecedented health care costs, how can the average family’s dwindling savings make self-insurance possible? What do we do with his idea that the new social contract “should foster self--sufficiency”? Well and good to say, but does this sound like what the government is doing in terms of underwriting (a given he takes as an article of faith) this new social contract? In fact, as the 8/21/07 New York Times reported, “The Bush administration, in its 'continuing fight to stop states from expanding the popular Children’s Health Insurance Program,' has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.” This is just one example of where we’re headed. With the economy in freefall, largely because we’ve poured billions and billions into a senseless war while at the same time neglecting a crumbling infrastructure, the upkeep of which would provide countless American jobs; and with the growing public unease about the continuing loss of jobs at every level of the employment strata, it’s no wonder that the American people are concerned about healthcare.

Citing Stewart Butler of the Heritage Foundation, Brooks sees America as a “thick, decentralized” society, in which public sector, non-governmental groups (unions, churches, and community organizations) should participate in health care. What planet is he living on? Union strength is a thing of the past, the strongest religious denominations are more concerned with moral issues than human rights (one of which is the right to basic human health care), and participation in community groups is at an all time low.

Regarding Brooks’s contention that the social condition constitutes a “continuum between the dead, living and unborn,” he writes, “[W]e shouldn’t disrupt the lives of those who are happy with the insurance they have.” Wow! Given that 45 million America citizens have no health insurance Brooks is worried about those of us blessed with the means to pay for medical coverage. If nothing else, history shows that a morally enlightened society is one that provides for the welfare of its lowest class citizens.

A last point that Brooks seems to overlook is that individualism and civic engagement, as cultural values, are difficult to reconcile. The sheer volume of literature (high and low) on self-interest as a much sought after individual value, combined with the contemporary view that civic responsibility is passé, sadly confirms the fact that the “living” nowadays have no concern with either the dead or the unborn. In terms of deferring to the “central government when it comes to making fundamental health care choices” where does this leave us?

Randall L. Tessier
Ann Arbor, Michigan