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It had a progressive one. America enacted the New Deal, which solved a lot of the problems that would have militated for a socialist movement. Addressing those problems in the way that the New Deal did took a lot of steam out of any would-be socialist movement, but without giving actual power to socialists.FDR is regularly labeled ‘socialist’ nowadays, but he wasn’t much of one. He threaded a policy path between that of the lumpen proletariat and the one favored by captains of industry, and did it in a way that kept power firmly in the hands of America’s ruling class, albeit stripping its monopolists of their ability to govern their industries. [1]Several things happened in the USA that didn’t in other places:We were engaged in a cold war, and our anti-socialism folks leveraged that very effectively to conflate socialism with what the Bolsheviks did, even tho the Bolsheviks had overthrown actual socialists and replaced them with a totalitarian system of state-capitalism/wage slavery. Consequently, socialism was associated with totalitarianism and godlessness in the American consciousness.We marginalized our socialists (think: red scares) to the point that it became dangerous to even suggest there might be good ideas here: [The Red Scare in the 1920 - History Learning Site][Red Scare] Associating socialism with external enemies and scapegoating immigrants leveraged the economic pains of the 1920s into effective politics.Our corporate class promoted a strain of Prosperity theology in its effort to roll back the New Deal [Log In - New York Times][How corporate America invented ‘Christian America’ to fight the New Deal].Although there were efforts in the late 1800s to promote socialism in the USA (just as happened around the rest of the industrializing world), their efforts foundered as American workers (already struggling with the economic changes of the industrializing world) proved themselves willing to blame outsiders and newly-freed slaves for their struggles. They were otherwise quite receptive to the ideas of socialism (pooling resources and getting stuff done that way makes a lot of sense), but unwilling to include people they didn’t like as beneficiaries. [The Formative Period of American Capitalism] This allowed would-be socialists to be split politically along race lines, even as the Robber barons captured unprecedented wealth.This last point cannot be overstated: We like our socialism, but we emphatically don’t want it for everyone:Americans with good jobs live in a socialist welfare state more generous, cushioned and expensive to the public than any in Europe. Like a European system, we pool our resources to share the burden of catastrophic expenses, but unlike European models, our approach doesn’t cover everyone. ~[Unspeakable Realities Block Universal Health Coverage In America]Even though they were busy curb-stomping socialists into the political closet (particularly in the context of the post-WWII nuclear arms race), American politicians proposed a number of policies that are basically socialism, but instead funneled them through the private sector (which can deniably discriminate, take rake-offs, and leverage its control of these things as bargaining power with, say, unions) at public expense:President Truman introduced his plan for universal health coverage in 1945. It would have worked much like Social Security, imposing a tax to fund a universal insurance pool. His plan went nowhere.Instead, nine years later Congress laid the foundations of the social welfare system we enjoy today. They rejected Truman’s idea of universal private coverage in favor of a program controlled by employers while publicly funded through tax breaks. This plan gave corporations new leverage in negotiating with unions, handing the companies a publicly-financed benefit they could distribute at their discretion. ~[Unspeakable Realities Block Universal Health Coverage In America]We have lots of sorta-socialist policies, but we’re very careful not to call them that. We socialize the risk of some industries (while allowing private interests to profit from public investment, and where possible the government proxies its programs out through private-sector contracts). We call this arrangement ‘free markets’, but it’s anything but that.Having thoroughly marginalized socialists, our corporate winners exploited their ability to demonize anyone receiving any sort of benefits. Since Reagan, it’s become a partisan (rather than a class-based) practice to shame those who receive benefits particularly by associating them with minorities broadly demonized as ‘lazy’ for abusing the system. But, because we love our tax breaks and other benefits, the ones going to well-off people tend to be hidden, indirect, or otherwise out of sight. (this phenomenon is described as the ‘submerged state’, described in this NYT book review:)Americans often fail to recognize government’s role in society, even if they have experienced it in their own lives. That is because so much of what government does today is largely invisible.Individuals’ political views partly account for their perceptions. In the Cornell poll, a respondent who self-identified as “extremely liberal” was 20 percentage points more likely to acknowledge using a government program than someone who used the same number of programs but was “extremely conservative.” Also, those who believed that the nation spent too much on welfare were less likely to admit that they had used a “government social program,” perhaps because that term had pejorative connotations. ~ [Our Hidden Government Benefits]We spend more on corporate welfare than we do on the other sort, but nothing gets up conservative political dander faster than the idea that the wrong people (immigrants, people of color) might benefit, thus leaving the right people out.Fundamentally, the reasons we don’t have a socialist movement called that is that our socialist tendencies were thoroughly co-opted into the private sector, (where private interests could control who got the benefits, and have their rake-offs as well) and subverted by the bigots and xenophobes among us to ensure the goods don’t go to everyone.Footnotes[1] Wall Street Was America’s First Foe in World War II

Short answer: Most often ancestry and environment together mould disease risk. Ancestry alone directly confers disease risk less often, specifically so in cases where single gene mutations have outsize effects. Tay–Sachs disease - Wikipedia, Sickle-cell disease - Wikipedia and Cystic fibrosis - Wikipedia are some well-known examples of the latter.Longer answer if interestedWhy It's So Difficult to Scientifically Tease Apart The Role Of Ancestry In Disease CausesHuman ancestry is the outcome of choice that liberally pockmarks both past and present with gratuitous violence and calamities since it's a choice contrived to mediate and enforce differential access to resources. This choice manifests itself as caste, class, ethnicity, linguistic group, race, sect, tribe, etc. They're social, i.e., explicitly political and cultural, not biological categories (1) but they end up influencing biology anyway. Here's how.Human societies tend to practice some form of social stratification or another. Over time, differential access to critical healthful life-sustaining resources such as quality education, health care and nutrition impact health, especially since social stratification-engendered privations tend to be experienced across generations.Thus, health disparity is the outcome of historical inequities a particular social category experiences at the hands of what usually tends to be a long-prevailing hegemony.Persistence of social stratifications across generations thus end up influencing biology by differentially influencing disease risk through the human-created construct of health disparity.The ethically unambiguous and appropriate place for ancestry in biomedicine lies in helping to try to tease apart the relative contributions of health disparity versus genetic predisposition to disease.However, it's well nigh impossible to disentangle genetic predisposition from the many environmental confounders health disparities impose on disease risk. This stymies the effort to accurately parse and pinpoint the role of ancestry in many disease causes.Problem is by tending to examine it devoid of its inherent sociological context, biomedicine artificially insulates ancestry. That leaves its role vulnerable to exploitation by the scientific flavor of the day, which these days is genomics.The genomic era is like the proverbial hammer primed to seek and find nails everywhere so it's become quite the fashion to privilege or attempt to privilege genetic predilection even in the case of multi-factorial diseases. This problem is also grounded in the fact that biomedicine has evolved an inherently siloed approach such that super-specialists, be they molecular biologists, geneticists, epidemiologists, public health researchers, etc., examine a given health issue through the lens of their training often without simultaneously attempting to look beyond, especially at the sociological context of disease. Thus, ancestry in the form of race/ethnicity has been and continues to be used as a proxy for genotype, albeit devoid of sociological context.Official guidelines add to the problem, being inadequate and/or inaccurate and/or too riddled with ambiguity. For example, in the US, when classifying their research subjects, NIH-funded scientists are required to adhere to the racial and ethnic categories specified by the Office of Management and Budget (OMB)'s Directive #15, the so-called NIH Inclusion Policy and Guidelines (see below from 2),'American Indian or Alaska Native, Asian, Black or African American, Hawaiian or Pacific Islander, and White, Hispanic or Latino and Not Hispanic or Latino’At least one survey of 18 NIH-funded scientists (11 men, 7 women) (3) reports these guidelinesAre applied too unquestioningly regardless of their utility or accuracy.Are bureaucratic, one size fits all, catch all, inflexible, an example cited being Barack Obama. Categorize as Black or Caucasian?Are difficult to comply with in geographic areas with few minority residents.Force minority inclusion numbers that yield data lacking sufficient statistical power to provide meaningful results, i.e., difficult to generate representative and therefore generalizable data sets.A study from the UK (4) reports similar flawed approach to study of racial/ethnic contribution to health and disease.Genomic Approaches To Assess Ancestry Remain Inherently FlawedAncestry-informative marker - Wikipedia (AIMs) are inherently misleading and fraught with flawed assumptions (5, 6, 7, 8, 9). So what are AIMs? They're population-specific markers, typically Single-nucleotide polymorphism - Wikipedia (SNPs) that occur at different frequencies in different populations. Since they're shared by all humans, rather than presence or absence, analysis focuses on their frequency.These days TV ads about learning one's ancestry are plentiful. Just send a saliva sample in and get genetic genealogical results back. Too deceptively simple but also flawed to boot.Obviously a test sample is compared to reference samples of Africans, Asians, Europeans, Native Americans, etc.Who are the 'reference populations' for each race or ethnicity? To assign 'purity', ideally they should be groups that have remained immobile, isolated and endogamous for millennia till date since reference samples should represent 'pure' examples of different ethnic/racial categories, the standard against which the test sample would be compared.Obviously such reference populations are an impossibility for much of the world's population.Instead 'small groups of contemporary people' (9) are chosen as representative samples for a particular continent or region or ethnic, linguistic or tribal group.Who is chosen? What are the criteria used to choose one individual and not another to supply the reference sample?How many people from a given population (caste/ethnicity/linguistic group/race/sect/tribe) are sampled to develop a representative reference sample base?How many are necessary? How many sufficient? 100, 1000, 10000, 100000, …?How are thresholds set to determine how a given result is interpreted to include or exclude a particular population?The answers to these scientifically crucial questions lie hidden behind the legal iron curtain of proprietary information preventing even the bare minimum in terms of rigorous science, namely to independently replicate and thereby verify (9). Thus, the widely advertised genomic categorization of ancestry using AIM touted by various commercial entities is more or less the outcome of a technological Sleight of hand - Wikipedia or two or three or more.Diseases Found To Be More Prevalent in A Particular Race/Ethnicity Are Typically MonogenicTay–Sachs disease - Wikipedia & BRCA1 - Wikipedia mutationsAt least 2 disease-causing/associated genes are more prevalent among Ashkenazi Jews - Wikipedia, infantile form of Tay–Sachs disease - Wikipedia and BRCA1 - Wikipedia mutations associated with higher risk for breast cancer.Tay-Sachs is an autosomal recessive (Dominance (genetics) - Wikipedia) Genetic disorder - Wikipedia caused by a Mutation - Wikipedia in HEXA - Wikipedia gene on Chromosome 15 (human) - Wikipedia where children usually die by the age of 4. Disease is caused by the impaired function of lysosomal enzyme, Hex A.Higher prevalence in these two instances is presumed to owe to the fact that the Jewish population descended from a small number of founders and remained largely endogamous (10).Genetic counseling and prenatal screening are also advised for Cajuns - Wikipedia in Louisiana and French Canadians - Wikipedia since similar mutations have been identified among them.Sickle-cell disease - WikipediaAn adaptation to thwart malaria, sickle cell is more common among those with West African ancestry, specifically those with the globin S (betas) mutation (11).Cystic fibrosis - WikipediaAn autosomal recessive genetic disorder caused by mutations in Cystic fibrosis transmembrane conductance regulator - Wikipedia (CFTR) gene, it's found to be more prevalent among people of European descent (12, 13).More Accurate To Envision Ancestry As A Continuum Rather Than Groups Of Independently Evolving Discrete UnitsAn additional challenge is the fact that ancestry as a social construct is fast becoming less categorical as populations meet and meld as perhaps never before, even while they may have remained geographically isolated for varying lengths of time here and there in previous millennia.Consider USA for example, a country that assesses race in its census.The category 'Other' was first listed in the US 1910 census. Now listed as 'Some Other Race', in the 2010 census it had become the 3rd largest category after 'White' and 'Black' (14, 15).In recent years, 15% of US marriages are between people of different ethnicities and races.One in seven US infants is today born into a ethnically and/or racially mixed family.A particular genomics example perfectly hints at the potentially vast complexity hidden underneath the surface of the race/ethnicity categories commonly used in our times. Complete genomic sequences of two famous European origin American scientists, James Watson - Wikipedia, Craig Venter - Wikipedia, and Seong-Jin Kim, an Asian-origin scientist, showed the former shared fewer (461000) SNPs with each other than they each shared with the Asian (569000 and 481000, respectively) (16, 17), something utterly unlikely to be discerned from physical appearance alone.A genomic analysis of self-identified European Americans (n = 326), African Americans (n = 324) and Hispanics (n = 327) in Manhattan, New York, revealed such substantial ancestral mix in both African Americans and Hispanics, the authors concluded (18, emphasis mine; see figure below from 19).'A pooled analysis of the African Americans and Hispanics from NY demonstrated a broad continuum of ancestral origin making classification by race/ethnicity uninformative’Needless to say, such melding happened or is happening faster in some countries and especially faster in large cosmopolitan cities. Largely the mix of Native American (Amerindian), European (mainly Portugal) and African, Brazil is a country that famously embodies more than anything else racial ambiguity (20).Finally, data also suggests higher genetic diversity within races (85%) rather than between races (15%) (21), which only further undermines the practical value of race/ethnicity in dissecting disease risks and causes at group level. This is especially the case for Africa, the continent with the greatest degree of genetic variation (see below from 22 quoted in 9).'For many regions of the human genome, there are more variants found among people of Africa than found among people in the rest of the world. This is probably because humans have resided in Africa for much longer than we have resided any place else in the world, so our species had time to accumulate genetic changes within the people in Africa.'In other words, race/ethnic categories such as African, Asian, Caucasian, Hispanic, Latino, White poorly predict human biological similarity and diversity. As Cuban geneticist Dr. Beatriz Marcheco put it (23),'The classic mirror reflects skin color; but the DNA mirror reflects our common ancestors'Race/ethnicity are thus becoming less and less relevant as proxies for genotype or rather the discernible truth about ancestry lies more and more between rather than within these commonly accepted social categories.Some Examples Where Misapplication Of Ancestry Obfuscates Rather Than Clarifies Cause For Disease PredispositionHypertension - WikipediaHypertension and its clinical outcomes such as heart disease, stroke and renal failure are so much more prevalent among African Americans that a racial predisposition ascribed back in the 20th century still erroneously prevails as a dogma (19). Erroneous because large studies comparing West African, Caribbean and American Blacks show high prevalence of hypertension among African Americans is an outlier, being lower among other Blacks (24, also see figures below from 19).Low blood pressures in rural West Africa that change little with age.Similar average blood pressures to White North Americans among West Indian Blacks.Higher blood pressure among urban African Americans from Maywood in Chicago.Obesity, high sodium and low potassium intake, the lifestyle factors known to increase blood pressure matched blood pressure averages among these three groups of Blacks. In other words, abrupt diet and lifestyle changes better explain hypertension rates among African Americans.The specific example of hypertension reveals how difficult it is to assert which is more consequential, nature or environment, simply because it's practically impossible to observe the obverse, people from Africa leading a US lifestyle without experiencing either racial or class inequities.An even larger study of 85000 subjects including Whites from 8 surveys in the US, Canada and Europe, and 3 surveys among Blacks in Africa, the Caribbean and the US, showed preventable causes of hypertension overlap across races and ethnicities (25). Meantime a much smaller (n = 1056) US study (26) on African Americans served as the basis for the US FDA's approval of a hypertension drug, BiDil (Isosorbide dinitrate/hydralazine - Wikipedia), supposedly designed for African Americans (27, 28).Moral? Far from vaunted impartiality, an example of how economics (patents) and politics (tokenism) trump science.The issue of causality is further complicated by the fact that blood pressure regulation is extremely complex and thus unlikely to be explained by genes alone. One of the largest blood pressure GWAS (Genome-wide association study - Wikipedia) examined 200000 subjects and found the 29 genetic markers most strongly associated with blood pressure could only account for 23% of risk for hypertension (29). Since lifetime hypertension risk in the US is ~85%, this means genomics has so far provided little by way of predictive value. Cherry on the cake is blood pressure susceptibility variants are similar among subjects with African, Asian, European and South Asian ancestry (29).DiabetesJudenkrankheit or Jews' disease, as recently as 1904, this is how physicians in the US and Europe tended to perceive diabetes (see below from 30).'THERE IS NO RACE, WHICH is so subject to diabetes as the Jews,” wrote W. H. Thomas in 1904 in the eugenically obsessed language of his day. Thomas, a New York physician, was voicing an almost universally held belief in the United States that of all the “races,” Jews had the greatest likelihood of developing diabetes. At the same time, most members of the medical community considered the prevalence of diabetes among Blacks to be unusually low. In the words of a Johns Hopkins physician in 1898, “Diabetes is a rare disease in the colored race”.'Fast forward 100 or so years and in the US,Diabetes rates have sky-rocketed among African Americans to 2X those in Whites while they've declined among Jews.Today, Pima people - Wikipedia have the highest rate of Diabetes mellitus type 2 - Wikipedia in the world and of course, since they form a homogenous group, unsurprisingly, mapping their genetics has become an intense focus of research interest. Laughable weren't it so soul-crushingly tragic for the following reasons.Before the advent of European American encroachers on their land after the American Civil War, the Pima had a reputation for excellent farming and lived independent, autonomous lives along the Gila river on lands presently known as Arizona (31). They even called themselves Akimel O'Tham or the River People.White settlers directly competing for irrigation rights, the 1877 Desert Land Act which 'required bona fide application of water to the land to obtain title', new dams that re-directed water away from traditional Pima farms (9), all these human-made interventions forced Pima to abandon their age-old ways of life in a matter of a few decades.A health survey in 1902 found a single case of diabetes among the Pima. By the 1930s, this number had increased to >500.With the completed Coolidge Dam not sending enough water their way, their traditional farming essentially going bust, the Pima quickly sank into abject poverty and started dying early.Like a benighted god the US federal government rode to the rescue, providing Pima free government surplus food and what food it is! Refined white flour, processed cheese, lard, candy, chips, refined sugar, grape juice, macaroni when the Pima's original diet consisted of (32 quoted in 9).'...seeds, buds, fruits and joints of various cacti; seeds of the mesquite, ironwood, palo verde, amaranth, salt bush, lambsquarter, horsebean and squash; acorns and other wild nuts; . . . roots and bulbs of the sandroot (wild potato) . . . deer, antelope, ..rabbits, quail, dove, wild ducks, wild turkey.’By the mid-20th century, this ancient diet had been entirely supplanted by boxes and boxes of macaroni and cheese. Where Pima dietary fat intake was 15% in the 1890s, it had increased to an incredible 40% by the 1990s (33).And yet it apparently sounds eminently reasonable and soundly scientific to probe and probe Pima genetics to sincerely try to understand their sky-high rates of diabetes these days (34). An exercise in callousness, ignorance, stupidity or all three.At this point it becomes necessary to ask whether it is really reasonable to highlight ancestry as a mechanistic contributing factor to diabetes when rates can be evidently higher than the norm and drop to average in just 100 years in one group while they increase and increase in two other groups over the same period?A simpler explanation is how abrupt diet and lifestyle changes impact life trajectories and chronic disease risk in the short-term. Plausible proof? Traditional rural dwelling societies practicing 'traditional culture' have vanishingly low rates of diabetes compared to their counterparts newly adapted to 'westernized' diets and lifestyle (see below from 9).Attitudes ranging from the cavalier to sheer ineptitude suggest the prevailing culture of biomedical science is ill-equipped to deal with divisive political topics such as ancestry. Science exists within society, not outside of it and the prevalent untenable allegiance to the implausible notion of striving to be perceived as ahistorical and apolitical ill-serves biomedical science and society alike.And so we're back where we started, namely unable to parse environmental and genetic factors in assigning causes to many, especially multi-factorial diseases. Impasse largely owing to biomedical scientists ignoring sociology when probing the role of ancestry, specifically race/ethnicity, in diseases.Bibliography1. Schwartz, Robert S. "Racial profiling in medical research." New England Journal of Medicine 344.18 (2001): 1392-1393.2. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity3. Knerr, Sarah, Dawn Wayman, and Vence L. Bonham. "Inclusion of racial and ethnic minorities in genetic research: advance the spirit by changing the rules?." The Journal of Law, Medicine & Ethics 39.3 (2011): 502-512. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082969/pdf/nihms-423237.pdf4. Smart, Andrew, et al. "Social inclusivity vs analytical acuity? A qualitative study of UK researchers regarding the inclusion of minority ethnic groups in biobanks." Medical Law International 9.2 (2008): 169-190.5. Fullwiley, Duana. "The molecularization of race: institutionalizing human difference in pharmacogenetics practice." Science as Culture 16.1 (2007): 1-30.6. Fullwiley, Duana. "The Biologistical Construction Of RaceAdmixture'Technology And The New Genetic Medicine." Social studies of science 38.5 (2008): 695-735. http://beck2.med.harvard.edu/week4/fullwiley3.pdf7. TallBear, Kimberly. Native American DNA: Tribal belonging and the false promise of genetic science. 2013.8. Fujimura, Joan H., and Ramya Rajagopalan. "Different differences: The use of'genetic ancestry'versus race in biomedical human genetic research." Social Studies of Science (2010): 0306312710379170. http://www.ssc.wisc.edu/soc/faculty/pages/docs/fujimura/Different%20Differences_SSS_Dec2010.pdf9. Duster, Troy. "A post‐genomic surprise. The molecular reinscription of race in science, law and medicine." The British journal of sociology 66.1 (2015): 1-27. http://geneticsandsociety.org/downloads/Duster_A%20Post-Genomic%20Surprise_2015.pdf10. Burchard, Esteban González, et al. "The importance of race and ethnic background in biomedical research and clinical practice." New England Journal of Medicine 348.12 (2003): 1170-1175. https://www.researchgate.net/profile/Eliseo_Perez-Stable/publication/10847069_The_Importance_of_Race_and_Ethnic_Background_in_Biomedical_Research_and_Clinical_Practice/links/00b49526a8f23ebdf8000000.pdf11. Grosse, Scott D., et al. "Sickle cell disease in Africa: a neglected cause of early childhood mortality." American journal of preventive medicine 41.6 (2011): S398-S405. https://www.researchgate.net/profile/Djesika_Amendah/publication/221717766_Sickle_cell_disease_in_Africa_a_neglected_cause_of_early_childhood_mortality/links/00463532d834a21f73000000.pdf12. Cutting, Garry R., et al. "Analysis of four diverse population groups indicates that a subset of cystic fibrosis mutations occur in common among Caucasians." American journal of human genetics 50.6 (1992): 1185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1682572/pdf/ajhg00077-0040.pdf13. Zvereff, Val V., et al. "Cystic fibrosis carrier screening in a North American population." Genetics in Medicine 16.7 (2013): 539-546.14. Black? White? Asian? More Young Americans Choose All of the Above. The New York Times, Susan Saulny, January 29, 2011. More Young Americans Identify as Mixed Race15. The Rise of the American 'Others'. The Atlantic, Sowmiya Ashok, August 27, 2016. More Americans Are Selecting "Some Other Race" on U.S. Census Forms16. Levy, Samuel, et al. "The diploid genome sequence of an individual human." PLoS Biol 5.10 (2007): e254. http://journals.plos.org/plosbiology/article/file?id=10.1371/journal.pbio.0050254&type=printable17. Ahn, Sung-Min, et al. "The first Korean genome sequence and analysis: full genome sequencing for a socio-ethnic group." Genome research 19.9 (2009): 1622-1629. Full genome sequencing for a socio-ethnic group18. Tayo, Bamidele O., et al. "Genetic background of patients from a university medical center in Manhattan: implications for personalized medicine." PLoS One 6.5 (2011): e19166. http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0019166.PDF19. Cooper, Richard S. "Race in biological and biomedical research." Cold Spring Harbor perspectives in medicine 3.11 (2013): a008573. Race in Biological and Biomedical Research20. Santos, Hadassa C., et al. "A minimum set of ancestry informative markers for determining admixture proportions in a mixed American population: the Brazilian set." European Journal of Human Genetics (2015). http://www.nature.com/ejhg/journal/vaop/ncurrent/pdf/ejhg2015187a.pdf21. Mersha, Tesfaye B., and Tilahun Abebe. "Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities." Human genomics 9.1 (2015): 1. Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities22. Ossorio, Pilar N. "Myth and mystification: The science and race of IQ." Race and the Genetic Revolution: Science, Myth, and Culture (2009).23. Genes Prove Mixed Ancestry of All Cubans: Interview Director, National Medical Genetics Center, Havana24. Cooper, R., et al. "Hypertension prevalence in seven populations of African origin." Am J Public Health 87 (1997): 160-168. http://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.87.2.16025. Cooper, Richard S., et al. "An international comparative study of blood pressure in populations of European vs. African descent." BMC medicine 3.1 (2005): 1. An international comparative study of blood pressure in populations of European vs. African descent26. Taylor, Anne L., et al. "Combination of isosorbide dinitrate and hydralazine in blacks with heart failure." New England Journal of Medicine 351.20 (2004): 2049-2057. http://www.nejm.org/doi/pdf/10.1056/NEJMoa04293427. Roberts, Dorothy. Fatal invention: How science, politics, and big business re-create race in the twenty-first century. The New Press, 2013.28. Kahn, Jonathan. Race in a bottle: The story of BiDil and racialized medicine in a post-genomic age. Columbia University Press, 2013.29. International Consortium for Blood Pressure Genome-Wide Association Studies. "Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk." Nature 478.7367 (2011): 103-109. https://csg.sph.umich.edu/boehnke/pdf/nature478-103.pdf30. Tuchman, Arleen Marcia. "Diabetes and race a historical perspective." American journal of public health 101.1 (2011): 24-33. https://www.researchgate.net/profile/Arleen_Tuchman2/publication/49674566_Diabetes_and_RACE_A_Historical_Perspective/links/54bfde470cf28a63249ff990.pdf31. Dejong, David H. "Abandoned Little by Little:" The 1914 Pima Adjudication Survey, Water Deprivation, and Farming on the Pima Reservation." Agricultural History (2007): 36-69.32. Mark, Albyn K. "Ecological Change in the History of the Papago Indian Population." Master of Arts thesis, University of Arizona (1960).33. Demouy, J., et al. "The Pima Indians: Pathfinders of Health. Bethesda, MD: Nat. Inst." Diabetes Digestive Kidney Diseases (1995).34. Pearson, Ewan R. "Dissecting the etiology of type 2 diabetes in the Pima Indian population." Diabetes 64.12 (2015): 3993-3995. http://diabetes.diabetesjournals.org/content/64/12/3993.full-text.pdfThanks for the R2A, Sergey Yegorov.

I hope this helps you if you haven’t had surgery before and you’re really nervous about it or just want to know what to expect. I wrote it really carefully and in such a way that answers the types of questions that I would have if I hadn’t experienced surgery both as a patient and as a caretaker of a patient. Good luck with your surgery and I hope that you have the outcome you are hoping for! Remember: aftercare is usually really important. Get help complying with it, as necessary.So. At the hospitals I’ve been to, which have all been in Massachusetts and New York, the process is very civilized for scheduled (not emergency) surgery. You’ll have a pre-op meeting before your surgery date where a nurse or a PA will test you (an EKG, for example, if you hadn’t had one in a while) to establish that your general health is good enough to green light you for surgery. They explain how you will prepare for your surgery at home, which usually involves fasting from the night before and not drinking anything the morning of unless it’s a sip of water to take your every day medications. They may give you “prep” that makes you poop non-stop the day before until you’re empty, and they may give you a bottle of liquid “soap” to shower with a few times so that your skin is basically stripped of any grubby little germs that could infect your site once they open you up.If you’re going to have surgery that will affect your gait, they’ll give you a little pamphlet that basically says “hey! pick all of the stuff up off the floor and put it on the counter now because you’re not going to be able to bend over or lift and if you trip and fall, you have to come back to the hospital”. You sign papers attesting that you understand their counsel and know what is expected, on your part, both before and after. At this time, if you don’t already have an end of life directive filed (like a “do not resuscitate” order) they’ll ask for you to make some decisions. You’ll assign a health care proxy—somebody to make medical decisions for you if need be while you are unable to give consent (once they’ve given you anesthesia, for example).On the morning of your surgery, you’ll usually be asked to wear embarrassingly comfortable clothing and arrive far before your procedure. You arrive with whoever is going to “be there for you” that day—a friend, family… hopefully not a guard from the prison. In most cases, this person is also your proxy. The pre-surgical waiting area will probably be packed with a full roster of people getting operated on that day and nurses will be calling names in groups to bring you into the secondary areas appropriate for your specific surgery. Your friend can come with you to this pre-op area. You get into the Johnnie. You get the robe. You get the slipper socks. Your stuff gets put into a plastic bag with your name on it. Somebody takes it away or plunks it under your gurney. Soon, you’re in bed in a big room with a lot of other people from the waiting room, except now you’re all dressed the same way. If you are lucky? You get an awesome heated cotton blanket. Or two.The surgeon comes to meet you. The anesthesiologist comes to meet you. Perhaps another doctor, nurse or physician’s assistant. Generally, they are polite and friendly to try and put you at ease so that you can focus on what they are telling you. They can describe what their plan is for once they get you under and open and will answer any questions you might have. You sign papers, papers and papers. Somebody, usually a nurse or anesthetist assistant but, sometimes, a dedicated cath nurse (the fastest and the best!) will fit you with an IV line in your arm or hand and tape it into place. You’ll get electrodes taped to you. You’ll get a pulse ox monitor clamped to your finger and taped on. These items get hooked into machines that go “beep beep: you’re alive” or “beeeeeeeeeeeeep: you’re dead” and also monitor things like your blood pressure. You get a silly paper shower cap thing to go over your hair. If it’s a long surgery, they will fit you with a catheter to collect your urine, but not until you are unconscious.Most people are nervous—that’s part of why you get to have your friend, family or prison guard there to keep you company. Another reason is to have somebody socially familiar with you at your baseline personality to be able to flag an issue for the surgical team which they otherwise mightn’t detect because they don’t know you. Like: if you’re not speaking at all? They want somebody there to say “Yeah, this is normal. He barely speaks to anybody” or “she’s deaf without her hearing aids in so you should yell, because she’s too polite to complain”.With somebody who knows you there, it’ll be easier for the doctor to communicate with you, efficiently, even if you aren’t a reliable self reporter…you’ll likely overhear examples of this with elderly patients being corrected by their grown children about which medicines they take and when, for example. Lastly, because general anesthesia works a bit differently on each individual, they want you to have a witness to the talk you have with your team, in case you can’t remember points in the discussion you’d want to immediately after you wake up…things about how you may feel, initially and what could constitute them deciding to keep an eye on you, overnight, in the recovery room or admitting you to a room on one of the floors instead of just going home. Either would be outside the norm; it’s insurance coverage, nowadays, that pre-determine how long you’ll stay in hospital (more on this later).Somebody (usually a nurse or an anesthetist) will give you ‘a little something’ through the IV to relax you but *not* to knock you out. You will still be conscious the whole time that you are in this first staging area. Eventually, you’ll bid goodbye to whoever came with you that morning, and an orderly will appear to wheel you, your bed and your drip line to the surgical suite. You may have to wait in a hallway for a bit but, by then you really might feel that first stage “cocktail” and not be extremely conscious of time, so it’s not nerve-wracking. They may or may not (depending on factors like the type of and projected length of your surgery as well as known intolerances to certain anesthesia protocols) give you a second “stage” of anesthesia at this time. If this happens, it still will not be the dose that knocks you out.Once you’re wheeled into the theater, itself, you’ll see your team again but, this time, they’ll also have silly hats and also paper masks on like they’re ready to rob a bank. They may check to ask if you’re “all set to go” because by then they’ll have placed a little oxygen mask made out of see-through plastic over your mouth and nose which will inhibit your verbal communication and you’re limited to nodding or shaking you head, thumbs up sign, etc. The mask smells like ozone and, by this time, you *are* relaxed.The anesthetist will address you: these are the doctors who are going to monitor your vital signs all throughout the surgery and make sure that you are in the appropriate level of sedation. They are going to adjust any medicine in your lines, as necessary. If you become distressed, they will be sure that you are intubated to secure an open airway. The anesthetist is your friend in that room, cari g for your whole body, while the surgeon is more like the mechanic, just compartmentalizing their focus on one discrete part of your body.If you didn’t get a second stage of anesthesia yet, they might do it here. Or: they may knock you out straight. They’ll let you know before they do anything. If they give you a second stage in the theater it will only take a minute or so before they give you the thing that will induce unconsciousness. When they push the meds to put you out through the IV, sometimes it stings a bit; in my experience, it’s almost always a sensation of cold—like ice water is entering the veins in your forearm. You are asked to count down backwards from one hundred. You probably won’t make it to 90, even if you try really hard. It’s awesome. I love that part. Especially if you’ve been in too much pain to sleep: it’s a relief.They like for whoever brought you in to stay in a family waiting area during your surgery. The surgeon will often go to them and report how the surgery went and, if you are family, they’ll discus any findings—like if they sent any samples to pathology, for example. Most importantly, they want somebody they can find fast should the surgeon, for some reason, need a proxy to make a medical decision for the patient mid-procedure. Somebody present that the can find fast to sign off on such a decision is easier for them than trying to reach the proxy by phone—-for example. When time is of the essence, the fewer layers of complexity, the better.*Here is an un-solicited piece of advice related to your role as somebody’s emergency contact: if your partner or parent feels very ill and they go in to see the doctor by themselves, just make sure your phone is charged. If you are down as their emergency contact, you may well become their proxy. So, if while they are gone, you happen to get a phone call from a number you don’t recognize? Pick it up. In the rare case your friend’s exam has findings that indicate an emergency surgical procedure, they may be unable to give consent. An example of this would be: if the physician has a sudden reason to use an endoscope, they will likely give a relaxing agent first. If they find something exploding in there, and your friend is semi-drugged, they want to obtain permission to operate from a sober person. If the permission involves a choice between clinical approaches with different degrees of risk, the decision can be an important one.Sometimes during regularly scheduled (not emergency) surgery there is a surprise when they open a patient up and they recognize something visual that’s different than what they expected to see based on previous imaging and they have to change horses mid-stream and perform a surgery other than what was planned or have an on-call surgeon with a different specialty “scrub in”. It’s uncommon. Still, without a proxy, in order to gain consent, your team will have to stop the operation and wait a long time for the anesthesia to wear off so that they can ask the patient, personally, what they want to do. I believe the exception to this case is an emergency intervention-you definitely sign an okay for emergency surgery if it’s required. So, if you start having a heart attack when you go in for a nose-job, they know how to prioritize. They won’t bother with finding your contact.Unless you have a poor reaction to the anesthesia, you will probably come into consciousness very slowly and not feel terribly bad at first. Some people experience side effects when coming out from under—-I know my sister (for one) felt really emotional and sad right after she had her wisdom teeth out. It was purely an effect of the drugs. I only had an with general anesthesia once—a terrible acidic burn in my throat from reflux. I have mentioned this every other time since and the anesthesiologist must understand what to do for that because it’s never happened again.For me, coming out from under anesthesia is a slow and gentle becoming aware of my surroundings—sounds first, before the ability to open my eyes. Then eyes need to close again…it’s like that. This is uncanny because we don’t usually wake up in hospital beds but, for me, by the time I can effectively move my body at all, I’ve had enough time to figure out where I am. So, it’s better than having jet lag from international travel, and waking up in a hotel room with no idea where TF you are for a full minute.The post op recovery area (PACU), where you’ll wake up, is another big room with all of your surgery friends whose names were being called that morning, before you went in. You’ll be awake but groggy before your proxy/friend/guard is called to visit you, bedside. Sometimes, the nursing staff will allow only a brief visit at first and then send your buddy out to wait again until you have more of your bearings back. Depending on what surgery you had, you will likely begin to feel some degree of pain while you are still in the post-op recovery room. The nurses there will help manage your pain as it develops, usually through your IV line. If you are scheduled for surgery with aftercare and a two night stay (for example) you’ll get wheeled to your room by an orderly when a bay becomes available.If your insurance code is for a 23 hour stay surgery, the idea is not to admit you to the hospital (a floor); you’ll stay overnight in a quieter corner of the recovery room and be discharged from there if everything goes fine. A complication will probably get you moved to a floor/admitted. If you’ve had day surgery, specifically, this is the graham cracker and apple juice room, baby. Here, the goal is to discharge you as soon as you can meet certain bench marks—usually you have to be able to talk, swallow—even if it’s just ice chips, walk without assistance unless you usually need assistance (like a cane, etc) and pee. These are all signals that you’re awake enough to understand and sign off on the post op directives they give you explaining which scrips you need to get filled and how to take care of the surgical site so that it doesn’t get infected and what symptoms to watch out for because it means you’re having a complication and need to come back into hospital.As mentioned before, different people come out from under anesthesia different ways; some people take longer. The person who has waited for you (and is responsible for getting you home and set up in your regular bed) will have been paged or otherwise fetched from the waiting room by this time and should be present to hear your post-op instructions about how to change the wound dressings, and get any phone numbers for emergency questions, visiting nurses, physical therapy, etc. It is really important that your friend listen closely, ask any questions and make any notes they need to at this time. It’s very possible that you won’t really remember it afterwards because of how anesthesia works on our memory.Usually, you’ll get dressed back into the comfy clothes you came in that morning. If the surgical site makes this impossible you may be the lucky winner of a free Johnnie and robe or paper trousers (like scrubs with a draw string). Your friend will drive you or accompany you on your way home with livery and will (hopefully) help set you up before leaving you alone. This means: picking up your prescriptions for you, feeding your hungry cat, minding your dressing/wound care, and making certain that you have what you need, within reach, at your bedside, such items as you may have brought home from the hospital like a walker, cane or crutches, bandages, your regular medicines, tv remote, etc.The exception to these options is more rare: if your surgery goes poorly or you were in critical care to begin with, you’ll be going to the ICU instead of a regular surgical floor. This is the area they try to keep super-sterile because there are a lot of really sick people inside. There are doctors around all the time. You will likely be poked and prodded more than really allowed to rest as they try different techniques to stabilize your condition.Another alternate outcome is a stint in rehab—either one that’s planned for before surgery or appears necessary after surgery. It’s a midway stop between the hospital where you had your surgery and wherever you call home. Rehab is still a hospital, but it’s not in the same building as where you had your surgery. It will have a less-critical level of care and usually the focus there is on therapies that will help you bridge the gap between your procedure and being able-bodied enough to be able to get up and use the toilet by yourself (for one example).A lot of the risk you undertake with surgery is not going to happen in the operating room, but from post-op complications. If you live alone and require more care than your proxy can offer (we all have jobs) then you MUST NOT leave that hospital without a plan in place for some level of in-home care. They *have to* hook you up with services. They cannot, in good faith, let you leave with no plan. No plan makes it reasonable to expect you will have to be readmitted after a few days of inadequate home care. Unless you fill and take your prescriptions appropriately and clean and monitor your wounds, can get around easily on your own, and have a relatively clean area with fresh laundry and linen…your chance of a fall is high, your chance of infection is high.A second hospital admission and possibly a second surgery is much more expensive than preventative care such as a visiting nurse who can help assess any reason to call the hospital : allergic reactions, infections, worsening of condition. You are entitled to care if you can not appropriately care for yourself after a surgery, have nobody who you can rely on to check in on you, and you are not yet ambulatory enough to visit a drop in clinic for services. Insist on securing aftercare before you go to surgery. What happens between your hospital discharge and your first scheduled post op visit with your doctor is a critical yet enormously under-rated part of the healing process—of which surgery is only the initial stage.