You’ll likely recognize the name Vonnegut via Kurt Jr., one of the 20th century’s most celebrated American authors. There is another Vonnegut on the current literary scene, Kurt’s son, Mark Vonnegut, M.D. Mark paid tribute to his father’s memory in an engaging audio-visual presentation in 2008 that serves as a backdrop for his new memoir.
Just Like Someone Without Mental Illness, Only More So is a memoir that celebrates the improbable odyssey of an individual with bipolar disorder who battles his mental imbalance well enough to graduate from Harvard Medical School and subsequently serve on their admissions committee. Regarding his curious book title, Dr. Vonnegut shares that when he fielded questions at the end of a talk to a patient support group, he was asked: “What’s the difference between yourself and someone without mental illness.
Book reviewers are sure to seize on the fact that Vonnegut, a self-described bipolar manic-depressive hippie with a B.A. in religion practicing primary care pediatrics, applied to 20 medical schools and was rejected by all of them except Harvard. As compelling as Vonnegut’s journey is, what intrigues me more is his rant about the current state of primary care pediatrics:
“I know that most blood tests, most referrals and
most medications are unnecessary. I don’t want my patients and parents taken advantage of.” On the surface, Dr. Vonnegut’s comment seems logical. In fact, staunch advocacy for one’s patients should be lauded. On top of that, how could you not have a soft spot for a 62 year-old pediatrician seeing the world anew through his 7 year-old son’s eyes?
With all due respect, I have concerns with self-anointed arbiters of truth. It’s because I see the world from the other side of the fence. I see children who come to us having endured years of needless struggle because their pediatrician reassured them that vision evaluations beyond eye chart screenings are overkill. I see parents who have been dissuaded from potentially life-altering services because their pediatrician made counter-productive value judgments about the necessity of optometric vision therapy.
I admire Dr. Vonnegut’s tenacity, but it is not always a virtue to err on the side of caution. Consider this: One of the best gold standard studies ever conducted in eye care was completed in 2008, known as the CITT. This research proved conclusively that office-based optometric vision therapy for a vision problems known as convergence insufficiency was far superior to other forms of treatment. Yet the vast majority of pediatricians still caution their patients that vision therapy is “unproven”. When it is ultimately the child who suffers by the pediatrician remaining in his dogmatic comfort zone regarding vision, perhaps it’s time to reconsider who is taking advantage of the patient.
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Len,
You have again made a very interesting and important point. Dr. Vonnegut’s blanket dismissal of many medical procedures indeed has some merit. However, it does raise the issue of evidence based medicine which is so popular at the moment. For optometry, as you suggest it is really a Catch-22 (written by Heller, not Dr. Vonnegut’s dad). Our profession needs to be in the mainstream, but when we provide evidenced based proof that VT works for CI, the medical establishment implies the Catch -22 logic; that we can’t use it, because we’re really not in the mainstream. Nevertheless, we continue to make great strides as evidenced by the intensity and enthusiasm at the COVD meeting.
Thanks, Irwin. I agree that we have made great strides. It’s prime time to call for an accounting on the Goose:Gander question. No longer can our critics continue the hypocrisy of dismissing what we do as “bogus” or a financially laden ruse, when they don’t hold themselves accountable to the standards we’ve now set in the field. The CITT has changed everything, and it is a huge embarrassment for the way non VT practitioners and non ODs practice eyecare.
I totally agree that it is irresponsible and embarrasing for pediatricians, and unfortunately our own colleagues, to continue to disparage vision therapy in the face of evidence to the contrary. I have seen many children with CI, intermittant exotropia, and many other vision problems who have been prevented from receiving the vision care they need by their other doctors. Knowing what type of life they are facing without this help, they still haunt me.