In 2022, Marion Renault wrote a piece for The New Yorker that I think of often. Renault visits the Village Landais in France, a different kind of nursing home. There, she writes, "residents can come and go from their homes as they please, whether through the unlocked door or through a window. They can wake and shower at their leisure; they can shout, pilfer sweets, make tea at 2 a.m., sweep with the broom upside down, and handle sharp knives in the kitchen. … Most nursing homes devote themselves to the narrow and perfectly reasonable goal of keeping residents safe and healthy. The Village Landais contemplates a broader question: What might a good life with Alzheimer's look like?"
It's an inspiring vision, one that has prompted endless media coverage since the first such "dementia village" was founded in the Netherlands. Renault's piece was more measured than some of the more fawning articles and broadcast news packages out there, which uncritically present dementia villages as the future.
But as Kristina Carvalho, a policy analyst at the Boston University School of Public Health, writes in First Opinion this week, much of the coverage is missing something huge: There's so far little evidence that dementia villages work — and there are financial and equity reasons why the hype should be tempered. "We need more research into whether dementia villages are a sustainable and effective form of care that should be uncritically heralded as an easy choice over traditional care," she argues.
This is one of my favorite kinds of First Opinion pieces: It takes a critical look at a popular idea that seems like a no-brainer and, well, adds a little more brains to it. In public health, there is no such thing as a no-brainer, because everything is more complicated than it may seem at first.
Also in First Opinion this week: Utsha G. Khatri, an emergency medicine physician, weighs in on the official end of the fake syndrome "excited delirium" — and its dangerous legacy. As Breast Cancer Awareness Month comes to an end, Vivian Kobusingye Birchall proposes a redesign for the iconic pink ribbon. (I have a strict rule of avoiding any piece explicitly paid to a health awareness day/week/month, but this was such a fresh idea I made a one-time exception. PR people already firing up the pitch machine: Please note that I said one-time exception!) Rebecca Love explains how an outdated reimbursement model is exacerbating the nursing crisis. David Panzirer of the Leona M. and Harry B. Helmsley Charitable Trust argues that it's long past time to bring down insulin costs in low- and middle-income countries. And on the First Opinion Podcast, I spoke with Leonard Rubenstein about protecting health care systems, and workers, in conflict zones.
Recommendation of the week: Tis the spooky season, and one of my favorite horror movies from recent years is "Pure" on Hulu. In this unusual feminist horror movie, a group of teenage girls head to a Christian retreat with their dads to commit to staying pure until marriage — and then things go awry.
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