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Thinking about bone fractures brings up an old English children’s rhyme. “Sticks and stones may break my bones, but words will never hurt me.” This ancient phrase has supplied many a verbally abused child with clever words in defense from a bully. I wondered if this old saying had an interesting history, but found nothing about its early beginning on the internet. The first written record of the phrase was in an English book authored in 1830 with the words “golden sticks and stones.” Later in 1862 the words, that are used now, popped up in a U.S. magazine printed by the African Methodist Episcopal Church.
Close to 15 million fractures occur yearly in the U.S. from various causes, mostly from falling and more rarely from sticks and stones. It’s intriguing to examine how a fractured bone heals. When a single bone breaks, there becomes two parts with the rough edges of the fracture held loosely together by muscle and soft tissue. Bleeding into the fracture site is a necessary step for healing since the blood clot that forms around the break initiates inflammation (redness, pain, swelling, and heat). Inflammation tells the body to avoid movement, stimulates new blood vessels to increase blood flow to the area, and calls in white blood cells to fight infection and clean up destroyed tissue and cells. Over the first week or two after the fracture, stem cells are drawn in to help. They turn into cartilage-making cells and replace the blood clot with an early and soft cartilage. This material is sticky and if the bones are not yet reconnected, the gummy and adhesive cartilage helps them re-join and then binds the bones together. This soft callus hardens over the next couple of weeks, stem cells turn into bone making cells, and new bone tissue starts filling in. Given proper nutrition, immobilization of the fracture, and enough time, bones will completely heal, even in very old persons. I believe it is a slow and constant miracle how our bodies are always and everywhere healing, repairing, and even replacing themselves from birth unto death. Back to the children’s rhyme, “sticks and stones . . .” Isn’t it true that sometimes hurtful words cause broken hearts that never mend? Perhaps we should learn from the grace and speed of healing bones and let go of those hurtful words, forgive, reconcile, and heal. Economists often explain high health care costs by comparing the selection of food at the grocery store when someone else is paying. The analogy still works but with a twist. Reported in a recent medical journal, Harvard researchers looked at health care spending here in the U.S. compared to the 10 next highest income countries of the world. They found that, in 2016, we spent almost 18% of our gross domestic product (GDP) on health care. Spending was much less for other countries, ranging from about 9.5% in Switzerland to 12.5% in Australia. That’s a significant difference!
Most surprising was that the problem in the U.S. did NOT appear to be from overutilization (getting too much care) as many have previously thought. Overall, people in the U.S. saw the doctor and were sent to the hospital about as frequently as people from other nations. The quality of the care received was also comparable. The study group also noted that our ratio of primary care doctors to specialists was similar, as were the number of specialist referral rates. The study found that, in the U.S., there was an overuse of expensive image testing and many more specific surgical procedures (60% more CT scans performed than the average of the other countries; 45% more MRIs; 38% more total knee replacements; and 32% more C-sections). Still, these accounted for only a small part of the large difference in spending. This was partly because, in the U.S., we sent people home from the hospital a little sooner than in other countries. The rate of poverty was found to be higher in the U.S. than in other wealthy nations, and only 90% of our people were insured compared to 99-100% in all the other 10 countries. Those are big problems and could partially explain the high cost of health care here. However, the research suggested that higher U.S. health care spending stems mostly from the complexity of our payment system. This has resulted in high U.S. administrative costs (8% GDP vs. 3%), the higher price of hospitalizations, procedures, doctor visits, as well as the price of drugs. For every U.S. dollar equivalent Europeans spent on drugs, we spent $2.50 for the same drugs. For every dollar equivalent Europeans spent on angiograms, we spent $5.25 for the same procedure. Going after overutilization will likely not help much. It’s the price of things that matters the most. It would be like going to your grocery store and finding the cost of milk is more than twice as high as the store on the other side of town, because payment for milk here comes NOT from you, the consumer, but rather after bargaining between your employer, their chosen insurance company, the government, the dairy, and the grocery store. It’s time to simplify! By Richard P. Holm MD
My Grandmother, Axie Jackson Powell, died at 99 having lived a blessed yet tragic life. As a young girl she lost her father and two step-fathers to illness. Her mother, struggling to raise four children alone and out of desperation, put Axie and two of her siblings into an orphanage. Axie grew up separated from her mother. The history of adoption is as old as humankind, with family members commonly raising children orphaned by death, war, or economic destruction. The middle ages introduced the concept of the orphanage when babies were left at the door of monasteries and were then raised within the institution of the church. But much of what the world knows about adoption, and how to protect orphans, actually stems from the orphan trains of the U.S. in the late 1800s. The American Civil War and increased immigration brought about orphanage over-crowding and resulted in huge numbers of homeless children roaming the streets of urban cities on the east coast. A group of religious leaders spearheaded a solution by shipping orphaned children on trains to the rural west. Over the next 70 years, as many as 250,000 orphaned, abandoned, or homeless children were placed on trains and sent to the farms of rural foster families in the west. It was the largest mass relocation of children to ever occur and helped establish the foster care system in America. While many lost children were introduced into families where discipline and love gave them a chance for a reasonable life, some of these children were indentured and exploited, rather than adopted, and were made to become farm laborers and household servants. Because of the orphan train social experiment, laws to protect children from abuse were developed. The best example was the Minnesota adoption law of 1917 which required background checks for families who wished to adopt and careful follow-up after placement. This effort, to ensure the best interest of the child by encouraging and monitoring foster homes and adoption, spread throughout the country and parentless children went to orphanages only when other options failed. Although this societal responsibility to children spread globally, families in the U.S. presently adopt more children than the rest of the world combined. That said, right now there are 110,000 foster children in the U.S. eligible and waiting to be adopted, and every year 23,000 children age out of foster care without having found a permanent family. There are plenty of Axies out there. The gift of “family” by fostering or adopting is a win-win proposition. |
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