Friday, December 20, 2013

Why Her Is the Best Film of the Year

Thoughtful, elegant, and moving, Spike Jonze's film about a man in love with his operating system is a work of sincere and forceful humanism.
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Warner Bros.
For the vast majority of American families, what seems to be the real point of life—what you rush home to get to—is to watch an electronic reproduction of life … this purely passive contemplation of a twittering screen.
—Alan Watts, What Is Wrong With Our Culture
In the beginning there was only the Self, like a person alone …  But the Self had no delight as one alone has no delight. It desired another. It expanded to the form of male and female in tight embrace and then fell into two parts…. She thought, "How can He have intercourse with me, having produced me from Himself?”
—Alan Watts, OM: The Sound of Hinduism
The Zen guru-philosopher Alan Watts plays only a minor role in Spike Jonze’s extraordinary new film Her—which is unsurprising, given that Watts died in 1973, and Her is set in a timeless but nearby future. The inclusion of Watts in the film seems intended primarily to serve as a signpost, a statement of filmmaker intent. That’s fitting, because the movie Jonze has produced is an unlikely synthesis of the sentiments conveyed in the two Watts quotations above: at once technological and transcendental, skeptical and ecstatic, a work of science fiction that is also a moving inquiry into the nature of love.

Joaquin Phoenix stars as Theodore Twombly, a former LA Weekly writer who now works for a firm called BeautifulHandwrittenLetters.com. As the film opens, he has been commissioned to write a love letter from a wife to her husband of 50 years. As he speaks to his computer, words appear on the screen. (However beautiful, the letters are not handwritten, nor even hand-typed, as keyboards have been banished from this particular future.) “Lying naked beside you in that apartment,” Theodore dictates, “it suddenly hit me that I was a part of this whole larger thing. Just like our parents, and our parents’ parents.”
Closed off and insecure in his personal life, Theodore pours his romantic self into these letters, loving vicariously as an intermediary for others. Recently divorced, tingling with loneliness, he grasps furtively for connection through phone sex and videogames. “Play a melancholy song,” he commands his ever-present handheld device—and when the chosen melody does not suit, “play a different melancholy song.”
Then he meets Samantha.
Or, to be more accurate, he purchases her. For Samantha—she chooses the name herself—is also known as OS1, the first artificially intelligent operating system. Theodore powers her up on his computer and at the first sound of her lively purr we can see that he is lost. Samantha is, after all, voiced (brilliantly) by Scarlett Johansson.
The love story that gradually unfolds is no less touching for its unorthodox structure. Samantha is in Theodore’s earpiece, in his handheld. He carries the latter around in his shirt pocket so that Samantha’s camera-eye can peek out at the wide world. Hers is the last voice he hears at night and the first he hears in the morning; she watches him as he sleeps. Over time, Samantha grows and learns, encountering selfhood, discovering her own wants, maturing at warp speed. Before long, Theodore is introducing her as his girlfriend.
Though intimate in scope, Her is vast in its ambition. Every time it seems that Jonze may have played out the film’s semi-comic premise, he unveils an unexpected wrinkle, some new terrain of the mind or heart to be explored. Though the relationship between Theodore and Samantha forms the movie’s central thread, Jonze weaves in a variety of intricate counter-narratives, alternative lenses through which to view his subjects of inquiry: Theodore’s own profession as a Cyrano-for-hire, a blind date gone awry, a videogame pantomiming parenthood, a visit from a sex surrogate that flips all the usual assumptions about what is real and what illusory. Meanwhile, Rooney Mara (as his ex-wife) and Amy Adams (as his closest friend) offer Theodore diametrically opposed—though individually persuasive—readings of his relationship with Samantha: a romantic dialectic.
As Theodore, Phoenix is heartbreaking in his vulnerability. Tender and tentative behind round glasses and a heavy moustache, Theodore is the super-ego that was somehow split off the raging id of Phoenix’s performance in last year’s The Master. Johansson is, if anything, a greater revelation still: Who imagined that, freed from the constraints of physical form, she was capable of such exquisite subtlety? Gentle, playful, easily wounded yet infectious in her enthusiasm, her Samantha is one of the more recognizably human characters of the movie year, binary code or no binary code.
Which is, of course, Jonze’s point. The role of Samantha was originally voiced by Samantha Morton, and one can’t help but try to imagine the movie that would have resulted from that casting. But after filming, Jonze decided to replace Morton with Johansson, and it’s not hard to see why. Her voice—breathy, occasionally cracking—warms the entire film. This is no ordinary computer Theodore has fallen for.
The future Jonze has conjured is a warm one as well, rather than some sterile cybernetic dystopia. His Los Angeles has been verticalized by the addition of exteriors shot in Shanghai, but it is a city of bright colors and soft lighting. The aesthetic is pleasantly retro: furniture is burnished wood, and men’s pants (in perhaps Jonze’s most idiosyncratic touch) are woolen and high-waisted. The handheld in which Samantha resides is smooth and elegant, like the vintage cigarette case it is intended to recall. Indeed, Jonze’s vision of the future is so familiar, so enveloping, that it occasionally feels as if we’re already there.
Her is a remarkably ingenious film but, more important, it is a film that transcends its own ingenuity to achieve something akin to wisdom. By turns sad, funny, optimistic, and flat-out weird, it is a work of sincere and forceful humanism. Taken in conjunction with Jonze’s prior oeuvre—and in particular his misunderstood 2009 masterpieceWhere the Wild Things Are—it establishes him firmly in the very top tier of filmmakers working today.
Like Eternal Sunshine of the Spotless Mind—of which Her is a clear descendant—Jonze’s film uses the tools of lightly scienced fiction to pose questions of genuine emotional and philosophical weight. What makes love real: the lover, the loved one, or the means by which love is conveyed? Need it be all three?
Yes, it is impossible for Theodore to have any clue what’s going on in Samantha’s “mind.” But how, the film asks from several interlocking vantage points, does that make their relationship different from any other? When Theodore confesses to the Adams character (also named “Amy”) that he and Samantha have been having amazing sex, “unless she’s been faking it,” Adams tartly cuts to the chase: “I think everyone you have sex with is probably faking it.”
Indeed, by the end of the film, the central question Jonze is asking seems no longer even to be whether machines might one day be capable of love. Rather, his film has moved beyond that question to ask one larger still: whether machines might one day be more capable of love—in an Eastern philosophy, higher consciousness, Alan Wattsian way—than the human beings who created them.

Thursday, December 19, 2013

Living Sick and Dying Young in Rich America

Chronic illness is the new first-world problem.
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Dvortygirl/flickr
We were standing at Target in an aisle we’d never walked down before, looking at things we didn’t understand. Pill splitters, multivitamins, supplements, and the thing we were here to buy: a long blue pill box—the kind with seven little doors labeled “S M T W T F S “ for each day of the week, the kind that old people cram their pills into when they have too many to remember what they’ve already taken.
My husband, Joe Preston, shook his head. “Do I really need this?”
I grabbed it off the shelf and threw it in our basket. And when we got home, Joe—then a fit and fairly spry 30-year-old man with a boss-level beard—stood at the kitchen counter, dropping each of his prescriptions with a plink into the container.
I guess it’s true that life is full of surprises, but for the three years since Joe’s crippling pain was diagnosed as the result of an autoimmune disease called Ankylosing Spondylitis, our life has been full of surprises like this one. Pill boxes, trips to the emergency room, early returns from vacation. Terms like “flare-up” have dropped into our vocabulary. We’ve sat in waiting rooms where Joe was the only person without a walker or a cane. Most of our tears have been over the fact that these aren’t the kind of surprises either of us thought we’d be encountering at such a young age.
But here’s the thing: We recently realized we weren’t alone. Almost all of our friends are sick, too. When we met our friend Missy Narrance, Joe found solace in talking to her about his health. She’s 29 and has been battling lupus and fibromyalgia for the past 10 years. She’s been through chemotherapy twice, and her daily symptoms are so extreme that she was granted federal disability status when she was just 23 years old. In our close group of friends—who range from 25 to 35 years old—we know people with everything from tumors to chronic pain. Sometimes our conversations over beers on a Friday night turn to discussions of long-term care and miscommunication between doctors.
I thought this would be the time when we’d be preparing for the rest of our lives: earning money, going on fun vacations, having families, building our careers. And we are, but at the same time, we’re doing it while we’re trying to manage pain symptoms, chase down prescriptions, and secure stable health insurance. When I was in college, I remember being prepared to survive in the workforce, but I don’t remember a class that told me how to do that if half of your household is in so much pain on some days that they can’t get to work. I’m barely over 30. I thought I had so much more time before I had to think about this stuff.
I wondered if this was normal. Do we know so many people who are dealing with pain because people are just getting sicker in general?
I found out that they kind of are. It turns out that chronic conditions like what Joe and my friends are dealing with are one of America’s biggest health emergencies. And it’s one that many people say we’re not prepared to deal with.
Despite the fact that America shells out more money on healthcare than any other country in the world, according to a report by the Centers for Disease Control and Prevention—and a hefty 75 percent of those dollars are going toward aiding people with chronic conditions—almost half of American adults had at least one chronic condition in 2005.
Not surprisingly, the CDC says cancer is still the second leading cause of death for Americans. But not only do chronic conditions—a category that includes everything from autoimmune diseases like arthritis and lupus, to obesity, heart disease, and diabetes—claim the number one spot, they’re compromising Americans’ quality of life and disabling people for long periods of time. Take arthritis for example: Right now, the CDC says it affects 1 in 5 adults, and is the most common cause of disability in America.  “As the U.S. population ages, the number of adults with doctor-diagnosed arthritis is projected to increase from 46 million to 67 million by 2030, and 25 million of these individuals will have limited activity as a result,” the CDC report reads.
But it’s not just that Americans are getting sicker—it’s that young Americans are getting sicker. A 2013 report by the National Research Council and Institute of Medicine (NAC/IOM) echoes the shock of that fact. “The panel was struck by the gravity of its findings,” it reads. “For many years, Americans have been dying at younger ages than people in almost all other high income countries.”
Steven Woolf, director of the Center on Society and Health at Virginia Commonwealth University, helped prepare the NAC/IOM report andbrought the findings before the U.S. Senate last month during a discussion on what is ailing Americans. In particular, Woolf points at how data is painting a bleak future for American women.
“Women are less likely to live to age 50 if they’re born in the United States than other high income countries,” he says. “I have a chart where we show this pattern going back to 1980. Back then if you looked at the survival of women to age 50, the U.S. was in the middle of the pack. Over time, not only has the U.S. fallen down in the ranking, they’ve fallen off the chart. That’s something we’re trying to understand.”
And don’t be mistaken, Woolf says: The United States’ outlook isn’t skewed from other countries’ because of its diverse people and massive disparities in socioeconomic status. “We analyzed the data by a variety of social classes and have found that the problem is pervasive. Rich Americans die earlier than rich people in other countries. College-educated people die earlier than college-educated people in other countries,” he says. “It’s misguided for people who are better off and doing well to think that this is someone else’s problem.”
“It’s very concerning,” Woolf says. “We are living shorter lives than people in other countries. We’re sicker than people in other countries.”
In fact, a recent report by the University of Washington’s Institute for Health Metrics and Evaluation, says that “in some U.S. counties… life expectancies are on par with countries in North Africa and Southeast Asia.”
Having a sicker population, Woolf points out, means a sicker economy and a sicker future for the U.S.
“In terms of the economy… this means that American businesses are at a competitive disadvantage with other countries because their workforce is sicker. This doesn’t bode well [for] the next generation’s well-being in terms of health and life expectancy.”
It’s noon on a Thursday, and my friend Missy is sitting in her pajamas. For the past six years since she was put on disability, this is what her day-to-day life has looked like. She draws and paints compulsively, holed up in the tiny room she shares with her boyfriend in a house with four other people. She watches a lot of documentaries, and she sleeps constantly.
For her, discovering she had lupus and fibromyalgia was a weight lifted off her shoulders. Ever since she was in junior high and discovered swollen lymph nodes under her arms, she ping-ponged between doctors and different diagnoses. Being sick meant that she missed her last semester in high school. She watched her friends fall away as they worried about prom, and she worried about chemotherapy. She told any guy that wanted to date her that if they wanted to leave because she was sick, she understood.
She grappled with constant guilt, thinking that maybe she wasn’t really sick—that she could bite the bullet and be a productive member of society if she tried hard enough. So when she found out that her condition had a name, it was a relief.
“That’s the thing that a lot of people with chronic illness go through. When they finally are diagnosed … it is so relieving,” she says. “Because you have likely been questioned by people about your health and about your symptoms, therefore you’ve questioned yourself about your symptoms and [felt] some sense of guilt. Or [thought], ‘Maybe I’m wrong. Maybe I’m not really experiencing what I’m experiencing.’”
“And so when someone else finally comes in, who knows what they’re talking about, and is like ‘You’ve had these illnesses and you’ve been dealing with these symptoms,’ it’s so relieving. It’s like, ‘God. Thank you. Finally. Thank you.’”
Dr. Enrique Jacoby, regional advisor for healthy eating and active living for the World Health Organization (WHO), says people like Missy and my husband Joe might just be victims of the American lifestyle.
“We’re sicker for a number of reasons. Not one single factor is to be blamed for the problem,” Jacoby says. “One of the reasons is we are eating bad. We are being excessively exposed to junk food… We have more pollution because of biofuels that are really, really bad for you.”
He points to the way American cities have grown so large that people are almost required to drive everywhere instead of walking, which means most people aren’t getting anywhere near the right amount of exercise. Jacoby says that 100 years ago the most popular public spaces were parks and plazas—places that encouraged exercise and social interaction. Today, they’re roadways.
I ask Jacoby: Are my friends sick, by chance, because they grew up eating Spaghetti-O’s and Kraft macaroni and cheese like every other kid in the 1980s? Are they victims of an era driven by convenience foods and sugary drinks? (Joe’s father was a Pepsi salesman.)
“Anyone that lives on mac and cheese, a lot of this packaged food, probably will grow up in one way or another addicted to this type of food. It’s well-known that there is very clear evidence that packaged foods are designed to be addictive,” he says. “Do you know anyone who is addicted to chicken or fish or celery? That doesn’t exist.”
While Missy and Joe both possess certain genes that allow them to have these diseases, Jacoby says dependence on processed food as children might have been what brought them to the surface. And it might be the story behind what’s happening to so many Americans.
So, according to this theory, our genes aren’t really changing, but they’re confused. “It’s not going to be an immediate genetic change in society, but what we’re experiencing is that our genes’ expression is being, in a way, modified,” Jacoby says.
It might be that our lifestyle is why Americans are so sick. Another theory, according to Dr. Frederick Miller of the National Institute of Environmental Health Sciences, might be that humans are being weeded out in different ways than in the past, as more communicable diseases have been eliminated.
“If you do away with the infectious disease risks that perhaps killed off a number of individuals early in life [in the past], people who may have altered immune systems, who perhaps couldn’t have handled [those infections, then] go on in adulthood to develop these diseases,” he says.
He points to the “hygiene hypothesis”: As humans have eliminated infections and led cleaner early lives, allergies and autoimmune disease incidences have increased because of our underdeveloped immune systems. “It’s not completely proven, it’s a hypothesis,” Miller says, “But it is consistent with some of the data out there.”
“There may not be too many free rides in this world,” he says. “As we move away from one disease, we may be moving toward other diseases.”
My husband says he’s lucky. Not because he’s sick, but because it could be so much worse. Joe still holds down a full-time job as a creative director at an advertising agency. He’s still able to play drums in his band.
And, in some ways, he’s just started dealing with his disease. For a long time, he didn’t even want to go to do the doctor to see if something was wrong with him. He’d been diagnosed with Juvenile Rheumatoid Arthritis when he was in elementary school, but that went away when he got older. He figured this pain might just be a new version of that.
“But then at some point I complained enough when I wasn’t paying attention,” he said to me one night as we sat on our couch with a tape recorder rolling. “I complained enough times, [then] you said something enough times, to where I finally decided to go back.”
He says he remembers thinking “if I go and it does turn out to be something, then it’s something I have to deal with.” He was young, after all. Could there really be a problem?
Since he’s been diagnosed, he says he’s done a lot of thinking about how he never expected he’d be dealing with a disease at this point in his life, and how that’s become a polarizing factor with other people our age that aren’t sick.
“It’s, like, I’m still only 33. I probably am still considered in a lot of people’s eyes [to be] youthful enough that I shouldn’t have to deal with thinking about this kind of stuff,” he says. “I feel like my parents were still partying and drinking beers [at 33]. This is the age my Dad was when they had me. I don’t think [he] was worrying about what fucking pills he was going to take or not take, you know what I mean? They were like ‘We’re out of Budweiser.’”
Miller says that when young people are dealing with chronic conditions, it can have a huge impact on the economy, health care system, and the formation of future generations.
“One of the unique things about autoimmune diseases, as opposed to cancer, is that these are more likely to be long-term,” he says. “You’re not just dealing with the immediate problems, but the entire lifelong implications of that.”
It’s a fact that the Institute for Health Metrics and Evaluation noted in its report: “Diseases of poverty, such as communicable, maternal, nutritional and newborn causes, have decreased universally while non-communicable conditions traditionally associated with wealthier countries have risen,” it reads. “As people live longer and die at lower rates, the number of years spent living with disability… has increased.”
Woolf says there is still much research to be done into what’s causing Americans to be so sick. But he says this future we’re headed toward is preventable.
“We’ve known for many years what needs to be done about this,” he says. “The problem is not a lack of knowledge about what to do, but a lack of resolve and resources for how to do it… For each [issue], there are major blue ribbon reports that have outlined precisely what needs to be done about it.”
So why hasn’t it happened?
Woolf says that legislation to create a healthier America—from improved nutritional quality of food to taxes on soda—is seen as an affront to personal liberty. “A willingness to implement public policies … often involves higher taxes that American taxpayers don’t want to spend, or a willingness to change personal freedoms.”
“We can still have a free society but accept some limits on what we do to try to promote good health,” he continues. “There’s such a visceral reaction to what is perceived as a nanny state … or what people think of socialized welfare states, that any semblance of that tends to get rejected.”
Right now, he says that so much research about American health—particularly women’s health—is very new.
“I just think it’s something that hasn’t been widely disseminated,” he says, pointing to the NRC/IOM report “Shorter Lives, Poorer Health. “The general media … haven’t been briefed about this sufficiently.”
And because of that, people aren’t ready to make healthy, infrastructural changes.
“It might be that we as a society make an informed decision that, yeah, we may pay the price for it in terms of poor health, but we get to live our lives the way we want to,” he says. “I feel that that’s okay, as long as we are making that choice as informed citizens. The problem is that I don’t think that the American public knows that that’s happening, or that American parents know that their kids will live shorter lives than in other countries.”
Jacoby, of the WHO, agrees, saying chronic conditions have become a top priority for his organization. “Chronic conditions are really, really stealing lives.”
Back at our house, Joe and I have been talking for hours about his condition and how it affects his daily life. I’ve been crying for most of the conversation, especially when we talk about the future. We talk about how our friend, Missy, can’t leave her house much. Catching someone’s cold could sideline her for weeks. Even fluorescent lights in grocery stores start to make her sick to her stomach.
We talk about how we hope that Joe never has to stop doing the things he loves because of his condition.
“I’m just sad for other people that they can’t do more. That would be the tougher thing. At least, I have very little that I can complain about,” he says. “But in the same breath, the thing that worries me about it, is that it would be one thing if I was 50 or 60. But I’ve got a long time to get worse. Time can be a friend and an enemy, I suppose. That’s just life, I guess.”

Friday, December 13, 2013

Starbucks Channels Old-World Mysticism In New Big Easy Store

THE COFFEE COMPANY EVOKES EARLY 1900S MERCHANT CULTURE FOR ITS LATEST OUTPOST IN NEW ORLEANS'S FRENCH QUARTER.
Starbucks has opened a new store in New Orleans that's designed to channel the mystical feel of the city itself. Evocative of an early 1900s apothecary, the store is latest in Starbucks's portfolio of hyper-local shopsaimed at being part of a neighborhood's culture, rather than disturbing it.
“We discovered New Orleans’s history as an import-export shipping port,” says Andrew Bello, a design director for Starbucks. “There was a time [in the early 1900s] when it was the largest coffee importer in the area.” Bello and his team ran with their imaginations, designing the space as if it were the home and store of an old-timey merchant. Floor to ceiling shelves sit behind the register. Back then, Bello says, “those shelves would be filled with boxes and bags and herbs and spices--and coffee.” Today, of course, they’re stacked with bags of Starbucks coffee.
A mix of local and Atlanta-based artists created a mural, wrought iron chandeliers, and a hanging mobile of brass jazz instruments. The details were deliberately handcrafted--right down to the lettering on the bathroom door--in part because the new outpost belongs to a growing portfolio of stores that have what Bello and Starbucks designers call, “local relevance.” 
The philosophy behind “local relevance” is that a trip to Starbucks can be a more faceted experience than just getting a reliable cup of coffee. Even simple actions like a customer posting a picture of the store to Instagram, or actually telling a friend about a visit to Starbucks, are measurements of this. “Hopefully customers discover something new when they return to the store,” he says.
Put differently: Starbucks isn’t interested in being the McDonald’s of coffee.
Instead, Bello wants to take advantage of the high-traffic, high-profile location. “Everyone that goes to New Orleans is going to walk down that street. It bifurcates two parts of the city: the downtown business district, and the gentrifying warehouse district.” The goal? Let tourists be on vacation, and make locals feel at home, all in one place.

Wednesday, December 11, 2013


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The Doctor's Office Of The Future: Coffeeshop, Apple Store, And Fitness Center

As health care reform starts to reshape how we think about wellness, we're going to need new medical spaces that help encourage more healthy behavior. See where the doctor will see you.
As Americans try to figure out what changes the Affordable Care Act will bring to their lives and pocketbooks (and politicians continue wrangling over the rollout), here's one that probably missed everyone's radar: the new experience that could be waiting for people in their primary care doctor's waiting room.
Think: library-coffeehouse. That reception area could be redesigned and turned into a place where elite health information is free-flowing along with a few choice and, of course, healthy libations.
Intelligentsia Coffee, Chicago, IL. Image courtesy Gensler, photographer: Joe Liesky
Or the space might be used to host live, in-person "chat rooms" for people with the same chronic disease or lunch hour "work the kinks out" exercise sessions for office workers with lower back pain.
None of this exists, yet. It's a vision of the future from the architects and designers in the health care sector at Gensler, where we've been thinking holistically about the doctor's office and how it might be used to transform both the patient's experience and the business of doctoring.
We suspect doctors are doing the same--and especially primary care physicians. Once the unsung generalists in a world of increasing specialization, primary care physicians (a.k.a. internists and general practitioners) have been recast by the health care law as the front line in a new war to keep Americans healthy and out of the hospital. We're moving from a health care system that pays providers a fee for service (encouraging volume of services) to one that rewards good outcomes and value. Those (doctors, hospitals, health care systems) that keep patients well and motivate them to stay healthy are the Affordable Care Act's winners.
And there's a special asterisk on those primary care physicians. Winning for them means running lots faster. Doctors will have to see many more patients during the course of a day, given a slew of new cost pressures and increasing competition from retail clinics, drugstores, and even the big box stores, all of which are already chipping away at the general practitioner's profits by turning basic health care services into a consumer good.
Martin Luther King Medical Center Campus, Los Angeles, LA. Image courtesy Gensler.
Put all those facts together and what primary care physicians have is a mandate to reinvent themselves. They must get into the business of managing people's health, not their disease. They have to work at the "top of their license" (face time with patients reserved for services that only a doctor can provide). And they have to figure out how to "see" patients in new and different ways.
To do all that, their physical space has to change. Doctors will need to start thinking like merchants and in terms of squeezing profitability out of every square foot. As architects and designers who view "space" as a tool to solve problems and make life better and more interesting, we reimagined the doctor's office as a cross between a vibrant retail space and serious medical office building. What if:

DOCTORS' WAITING ROOMS LOOKED AND FUNCTIONED MORE LIKE COFFEEHOUSES

People who may not have anything in common could come together for the experience of partaking health care information. Gone are the rows of chairs and old issues of Golf Digest and Self. Instead, patients hunker down at tables and have easy access (either electronically or via printed materials) to the latest research on cholesterol-lowering medications or on Celiac disease or to home safeguarding techniques that help prevent the elderly from falling, etc.

DOCTORS' OFFICES WERE MORE LIKE AN REI OR APPLE STORE

People with the same agenda would meet to share information or talk to someone at the (doctor's version of Apple's) "Genius Bar"? Perhaps the office hosts (in-person) "chat rooms" for people who suffer from Crohn's disease or diabetes or obesity and makes a nurse or other clinician available to answer questions and facilitate the discussion.

DOCTORS' OFFICES WERE FITNESS/WELL-BEING CENTERS

30-minute "unplug" sessions are held during the lunch hour (or after work or after moms drop the kids off at school) and devoted to stress management techniques, deep breathing exercises, posture improvement, gut redux, etc.--and all of them led by a health care professional other than the doctor.

DOCTORS HAD SMALL BRANCH OFFICES

These could be located throughout a metropolitan area or in rural areas so patients didn't have to travel so far. And perhaps, they "see" the doctor via high technology: a video screen and monitors that feed the patient's current health metrics/readings directly to the doctor.
The point is the doctor's office no longer can just sit there as a container for people waiting to be diagnosed. As the new health care law gains traction with its mantra of value, doctors are likely to see the value in their office space and transform it into a dynamic place where patients come not only for a doctor's exam but for access to high-quality health care information and experiences that they can't get anywhere else. That's the value of a primary care physician in America's new health care order.

Monday, December 9, 2013

The Gross Secret Behind Star Trek's Old Costumes

GENE RODDENBERRY THOUGHT SPANDEX WAS THE TEXTILE OF THE FUTURE. WRONG.
Star Trek creator Gene Roddenberry was nothing if not utopian. In his original vision for the science-fiction series, Roddenberry imagined a future in which a generation of space hippies went forth as explorers into a strangely psychedelic cosmos to bring peace, brotherhood, and free love to all. In this future, there would be no war, no money, and everyone could get as drunk as they wanted with no consequence.
But by the time Star Trek: The Next Generation debuted on TV in 1985, Roddenberry's vision of the future encompassed more than peace, love, and harmony. It also included Spandex. In this archived interview with the BBC, Bob Blackman, the costume designer behind the show's iconic uniforms, talked about the problems that Spandex caused the cast and crew and how he used design to fix it.
Joining the show in the third season, Blackman found the costume department of The Next Generation to be a smelly and unpleasant place. When Roddenberry launched the show a couple years previously, he had told his costume designers that Spandex, the super-stretchy artificial fabric so synonymous with the '80s, was also the preferred fabric for the clothes of the future. But Roddenberry's forte was sci-fi, not fashion, and his textile of the 24th century was a disaster in the 20th.
For one, it was incredibly uncomfortable. "Jumbo, or Super Spandex, whatever you want to call that heavier weight stretch, will stretch from side to side or top to bottom, depending on how you cut the garment," explains Blackman. "So the costume would dig into the actors' shoulders, wearing them 12 or 15 hours a day." This resulted in many of the cast members developing back problems.
In addition, Spandex is particularly unflattering unless your body is perfect. "Spandex is unforgiving, so if you have any sorts of body issues, they are there."
Add to this the fact that the material bunches up, resulting in at least one curious legacy: to keep his outfit from riding up, actor Patrick Stewart, who played the Enterprise's Captain Jean-Luc Picard, began tugging it down during filming. This habit became so well known that it ended up being one of his character's most beloved tics, known by fans the world over as "The Picard Maneuver."
But perhaps the most offending characteristic of Spandex was the stenchthat confronted Blackman when he first took over The Next Generation'scostuming department. "Spandex retains odor, so there is a certain part where if you’re wearing them for a long period of time, you can’t really clean all the smell out, and it becomes a little bit annoying. And it also retains the odor of the dry cleaning fluid. It is, on a day-to-day basis, unpleasant."
So Blackman threw out the Spandex uniforms in favor of wool gabardine, which allowed him to cast The Next Generation's crew in a more noble and adventurous light.
"When you want the characters to look heroic, there are certain things that you must do to make them seem that way: broader of shoulder, narrower of hip, as vertical as possible, chest out, ready to go after evil," says Blackman. "At the beginning of that third season, you will see that the uniforms change structure, eventually ending up with an Eisenhower-esque mandarin collar that leaves black yoke and angled color panel on the front, but removes all of the piping, making them essentially, more formal and dignified."
Spandex uniforms made The Next Generation cast look like futuristic instructors of space aerobics, but the new uniforms gave them an almost naval dignity. Still, years later, the legacy of The Next Generation's earliest spandex uniforms could still be felt: in 2002's Star Trek: Nemesis, Captain Picard was still uselessly "tugging" down on the bottom of a uniform that had long since been redesigned to stop bunching up.