I suppose it should come as no surprise that I've been a customer of the campus's psychological services. As the youngest sibling of three, my persona draws from a childhood spent tableside and bedside, ears open to stern, long-winded and often conflicting advice from elders.
I've since been a walking sponge of sorts, drinking in all the counsel and input possible in preparation for an unforeseen day when I'm asked, ""Do you understand yourself?"" So, contextually, it makes sense that later in life, I would find my comfort zone in an easy chair, in front of another adult telling me what things mean and what to do about them.
This month, I will have spent a year away from that chair and the shrink across from it.
So, in therapeutic fashion, this piece is meant to chronicle a trek across years of psychological development (or regression, if you want to be mean about it), and hopefully provide some amount of useful introspection for other furniture-familiar students - and there are many.
In 2004, UCSD Psychological Services served 2,000 students (a figure pulled from an article this newspaper published on issues of staff shortages and budgetary deficiencies).
A year later, a university-commissioned report on students' mental health formalized the problem: UCSD, specifically, had about 11.5 full-time employees at the time, a ratio of one psychologist to every 2,300 students. In some cases, the picture was even darker for other UC campuses, most of them reeling from the same state and administrative budget cuts that racked our campus in 2003-04.
Modern-day politicalization of all things is inevitable, though it is truly sad when such a mindset is applied to health care. A personality becomes a number, and the intangibilities that we enjoy about life become demarcated in a colder, more definable manner. Revelle College then-sophomore Tracy Ho, an interviewee for the previously mentioned Guardian article, was one of many statistics forced to wait weeks for one appointment. Ho was then referred to UCSD Medical Center in Hillcrest, after her on-campus counselor told her there were not enough staff to accommodate her longer-term needs.
I was luckier. My own campus therapist was both earnest and excitable, always pushing mental homework - which included forced conversation, Excel charts scribbled with daily emotive discourses and physical exercise. My give-to-get mentality kept me in the program week after week, but throughout it I realized, ""Man, mental health is hard to sustain.""
It's a hard world out there. The hermit archetype is all but dead; it's impossible to drop all things to wander into the desert alone, Biblical-like.
Today's world is a primitive one, where we are forced into moral fights as we sit and deal with our problems, our spouse's problems, our neighbors' problems, our children's problems - the list is infinite.
I often reflect on my own therapist's investment in me (he extended me past the 12-session limit and continued the meetings until I cut them off), and realized further that other students lack such a luxury. Even a small deterrent - i.e. having to take a weekly bus trip to Hillcrest - is enough to stymie a student from seeking help for mental health issues.
The last of my regular sessions occurred in the campus's newest offices, in a collection of buildings that emanated an unsettling dead-tech, postmodern ambience. It was an unabashedly cold design for an environment meant to fit every warm, welcoming, couch-laying typecast.
By the tail end of my therapy, I concluded that there was something self-serving about paying to talk about yourself - sessions became, for me, something unbecoming and shameful. But because departmental fees are divvied up to make on-campus psychological care free, students can enjoy one more degree of separation from embarrassment, and I can stop prying conversations with the ""hey, it's free"" defense.
But are psych services ""free,"" in the word's strictest sense? Students pay mandatory fees, which have been directed to other campus units in previous years. But this is no whine-fest, stumping for psychological services while cutting down Student Affairs officials (who dole out fee money); this is a sincere reflection on the street-level impact of budget movers and shakers.
I'll be forever indebted to my therapist's devotion, though such an extended experience in therapy is an anomaly for the cash-strapped state and university. But even just one session offered me a memorable epiphany: There is a gaping abyss between self-awareness and self-improvement, and I'm still trying to build a bridge to the latter. The issue of mental health, in all its sensitivity, can be supported by even a simple act, such as enrolling in one session.
A simple slight, however, can be damaging on an equal level, and staffing and funding shortfalls are in no way simple.
What's a cowgirl like you doing with such a small truck?"" asks Jim, the head honcho at the Media Checkout. He smiles at us tying down dolly tracks protruding from the already-overstuffed bed of my truck. It's Friday morning, and this is the last time Devin, Randy and myself (the small Friday crew) will pick up equipment and head out to Temecula before the rest of the cast and crew arrives. I am inwardly ecstatic.
Rewind to a few years ago: me, terrified of going inside the Media Checkout - I don't know what the equipment is called or what it's for, and the gruff student employees have no time for newbies. ""It's OK to be ignorant,"" says one of my film professors. ""But you must work to bridge that gap of ignorance.""
Skip back to this Friday: I waltz in with my cowboy boots on, I don't have to say my name or what I am here for, because the people at checkout already know. I smile mischievously at the students just beginning, clutching their checkout forms while we stand next to our truck, roped and weighed down with hundreds of pounds of equipment. These are the kind of moments that interest me - moments of aftermath, where scenes drip with that invisible ghost of action that has led up to this moment. You can see the traces of movement, the invisible marks of my hands on the windowpane, Randy's sweat on the truck bed and Devin's fingers tying the rope, all intangibly marking the struggle that preceded this end product. This is, in part, what the world of my film is about: characters living in an aftermath. But this is also a parallel for the process of filmmaking. Film is an end-product, nothing more than two-dimensional ghosts existing in a frame, referencing the moment that existed at one point in time when these images were recorded on tape.
Cut to a few hours later, in Temecula. I hold the camera while Randy and Devin throw logs into the water to simulate the truck crashing in - but the log keeps floating back into frame like an albino alligator. ""We should just drive the truck in the water,"" says Randy. ""Yeah, I guess we could,"" I respond. Ten minutes later, the back tires are spinning out of control, hopelessly stuck in the mud.
Back up five days: Paul is spraying a violent storm of white powder from the fire extinguisher to put out the fire creeping up the side of the wooden shack we're filming. Fast forward one day, Steven is yelling on top of the truck because I've slammed his hand in the closed truck door.
Rewind a few hours and the sound of shattering glass rings in the canyon as Josh does a somersault down the side of a rocky hill.
Fast forward to six days and five guys with hardhats are pushing the Volkswagen van up a hill; it's my crew, my dad and my cousin, acting the role of construction workers, but we are not filming. We can't get the key in the cantankerous ignition, so for every take where the van goes downhill, they must push it back up under the midday sun.
Skip to the last Sunday. ""Dad, what's the best way to cut a glass bottle evenly?"" A moment later my dad is raising an axe up while I hold a glass bottle against cement.
Skip back to a quarter to midnight on President's Day, and we have been rehearsing and setting up lights in an old abandoned house for hours. Everyone has gotten very little sleep in the past two days, and it is starting to show; the camera operator is nodding off, the assistant director has his eyes closed, the actors are falling asleep in between takes. Coffee keeps coming in, but is having no effect. I am shouting and trying to pretend I could go on all night. I pick up a c-stand and it drops limply out of my hand. Every glance I get and word I hear is asking me to utter those three pleasant words … that's a wrap.
A slow fade in to an empty field. It's Saturday a week later, after the last shoot. I am back in Temecula by myself, filming forgotten shots. Holding the camera in one hand, a rock in the other, I am trying to scare some quails so they will fly up in front of the camera. It's so quiet, you can hear the wind in the grass and the distant sound of children playing. The clothesline has fallen down. The plates are all askew inside the van, next to paper shreds gnawed by mice, and outside I can see a tiny piece of purple fabric stuck in a cactus. It's another moment of comedown, of aftermath. No more Devin, no more Randy, no more Paul, Steven, Tricia, Mom, Dad, Tom, Josh, Jake, Norbert, Christie, John, Salomon, Adam. Just me in a field with a camera. Filming is done and now what's left to show for all the action are seven Mini DV tapes, holding all our efforts in their tiny digital ones and zeros, like phantasms trapped on electronic tape. This is film, a 2-D memory.
When the UC Regents meet on March 14, millions of dollars of student money will be in their hands. In Gov. Arnold Schwarzenegger's January budget proposal, he recommended that undergraduate student fees be raised 7 percent for the 2007-08 academic year, with some UC law and business programs facing 10-percent hikes. However, California's nonpartisan fiscal adviser, the Legislative Analyst's Office, urged that fees only be increased 2.4 percent for all programs, arguing that given the absence of an explicit policy on student fee increases, fees should continue to cover the same share of educational costs. The LAO's increase would account for inflation.
It is time for the regents to formulate a fee policy that is more transparent than their current ""compact"" with Schwarzenegger, which stipulates that fees always rise in accordance with California's per-capita income (not inflation rates) in addition to increases (up to 10 percent total) that the board feels the UC system needs.
Essentially, this means that under the compact, the regents can raise student fees up to 10 percent per year with very limited accountability.
It's no secret that the regents and the state of California have been leaning on students to subsidize the university's bills at their discretion.
However, an explicit fee policy from the board that protects student interests in the face of much more powerful political actors would reflect an attitude of respect toward the population that gives the university its leverage as the premier educator of California's future.
Whether it's the rubber costumes and visible zippers in the good ol' days of ""Godzilla"" and ""Creature from the Black Lagoon,"" the cartoonish, computer-generated imagery of modern horror films like ""The Relic"" and ""Anaconda"" or the cliched casts of dashing heroes, brilliant scientists and savvy female reporters, it's hard to take a monster movie seriously. But with his latest romp, acclaimed Korean writer/director Joon-ho Bong doesn't ask us to do so. Instead, he embraces the slapstick action and absurd heroism that most moviemakers try to disguise, resulting in what might be the most fun - and most honest - monster movie ever made.
To give the creature feature a fresh angle, Bong replaces the undefeatable monster with a clumsy animal and the dashing heroes with a family of buffoons. His clear affection for the genre spills into his work, adding an unabashed sincerity and that helps him bridge moments of terrible tragedy with campy comedy - a pairing that has rarely, if ever, been executed so successfully. But the emotional grip of the story never eases either, as one of the monster's victims, a young girl named Hyun-Seo, struggles to survive in the sewers while her family desperately tries to find and rescue her.
The family of half-witted protagonists is comprised of the genial grandfather, who runs a convenience store; his daughter, the bronze-medal-winning Olympic archer; his son, the unemployed grad student; and his other son, the half-retarded father of Hyun-Seo. When she's abducted by the beast, the government is too inept and the community too paranoid to do anything to help, so the endearingly flawed family of underachievers sets out to rescue her themselves.
Bong provides the film with an unflappable sense of humor, even amid the story's most grim moments. Soon after the monster emerges from the Han River and abducts Hyun-Seo, a mass funeral is held. While her family is sprawled on the ground in wailing grief, crying her name to the heavens, wallowing in abject misery and surrounded by the grieving families of countless other victims, the mourning is interrupted by a loudspeaker announcement asking the driver of an illegally parked car to please come to the parking lot. Then, a government official wearing a yellow hazmat suit steps in to announce the quarantine of everyone at the scene - as if things couldn't get any worse. But before the official goes in another word, he slips and falls - probably in a puddle of the tears from the bereaved - right on his ass. It's a strangely comfortable mix of sweltering pity and Marx Brothers humor.
Even the monster slips and stumbles in its pursuit of prey. And as the SUV-sized creature trips over its own feet, onlookers throw beer cans and government soldiers scramble to secure the quarantine, more concerned with containing any potential diseases the monster might carry than capturing or killing the ravaging beast.
There are only three Americans in ""The Host,"" all of whom are quite blunder-prone: the environmentally callous mortician in the opening scene (who creates the beast by dumping hundreds of bottles of formaldehyde into the drain simply because the bottles were dusty), an American sightseer (one of only two people ever to confront the monster) and a cross-eyed U.S. official who wants to perform brain surgery on Hyun-Seo's mentally deficient father because ""maybe that's where the virus is.""
Bong's film is more than a monster flick. It's a spoof on global hysteria and our relentless fear of an ever-approaching apocalypse in one form or another. As the four pathetic protagonists struggle to find the missing girl, they pass through a crazy world of frightened citizens clinging to surgical masks and bumbling government officials more frightened of pathogens than of the monster itself. Every character, flawed to the core, seems to fail in everything they do, but it's impossible to stop rooting for them. At times unbearably heavy - yet incredibly light-hearted too - Bong's satirical monster action/horror/comedy is a rare treat.
This year's A.S. Council deserves credit for taking a cue from the Undergraduate Student Experience and Satisfaction report and making an effort to revive beer gardens. And the accompanying advertising campaign hasn't been too shabby either, with plenty of high-visibility posters and even a Facebook group to get the word out.
The price of success: a 20-minute wait at the door of the last Bear Garden, followed by an hour-long wait in line for your plastic cup of booze. With such a wait, students might as well pick up a minimum-wage job for an hour and spend the money they earn on a pair of pints at Porter's Pub, which has a far wider selection of brews, far fewer rent-a-cops and practically no line.
But the popularity of this year's beer gardens - and the lack of disturbances at them - drives home two important points. For one, including booze at on-campus events actually does encourage participation. Administrators should consider this when they decide whether to allow alcohol sales at the RIMAC Annex.
More importantly, the gardens show that with careful planning, UCSD can host wet events and still ensure student safety, assuaging the administration's long-standing and completely understandable concern.
With a year of positive experiences, the door should be open to slowly expand the Bear Gardens, maybe through finding a new venue or streamlining the current one. It wouldn't hurt to bring in bands, either, like at the Thank God It's Fridays of yore. With a little compromise and responsibility on both sides, the UCSD experience can be made far more memorable and special than it is now.
Two Arrested for Body Part Trading at UCLA
The UCLA David Geffen School of Medicine has suspended its program for accepting donated human bodies in the wake of a discovery of illicit body-part trading. An employee of the school and an independent tissue broker are alleged to have used UCLA resources in order to supply body parts for various biotechnology firms and research institutions.
Henry Reid, director of the program, was arrested on March 6 on charges of grand theft.
He is suspected of allowing tissue broker Ernest Nelson to remove and trade the body parts of nearly 500 cadavers from the university over a period of six years, generating a profit of over $700,000.
Reid was coincidentally hired by UCLA in 1997 to correct such problems in handling cadavers. University officials say they are now deciding how to compensate for the university's loss of access to human specimens.
Biotechnology companies and academic institutes use body parts for medical research and training purposes. Though the sale of human body parts is illegal in the United States, firms profit by charging to cover the costs of supplying specimens, which can run up to thousands of dollars for a single human body.
Similar instances have occurred in the past decades at medical facilities at UC Irvine and UCSD.
Attempts to enact stronger state and federal regulation are often hindered by institutions lobbying for ready access to tissue.
UC Irvine Opens Hydrogen Fuel Station
On Feb. 27, UC Irvine celebrated the grand opening of its automobile hydrogen fueling station.
The station is the first in California capable of dispensing hydrogen at 700 bar, or the equivalent of 10,000 pounds per square inch.
In some cases, this nearly doubles a vehicle's driving range.
The station provides the latest in fueling technology, meeting the demands of vehicle development programs directed by automakers Toyota, Nissan, Honda, General Motors and Daimler Chrysler.
""The world looks to California as the testing ground for next-generation automobile technologies,"" UC Irvine's National Fuel Cell Research Center Director Scott Samuelsen said in a press release. ""The shift to a hydrogen economy is … a dramatic and fundamental shift in the way that individuals will operate their vehicles in the future.""
The emissions from a hydrogen fuel cell-powered vehicle contain only water vapor.
Today, hydrogen can be produced from nonpetroleum gas sources, potentially reducing our current reliance on petroleum for the future.
The facility looks similar to a gas station, with stand-alone dispensers delivering pure gaseous hydrogen. According to the California Fuel Cell Partnership, 23 hydrogen stations exist in California, with 14 more planned. Automakers say that they may begin selling fuel cell vehicles by the year 2010.
In the shortest meeting of the year, which lasted just 29 minutes, the A.S. Council moved to Porter's Pub to allow ""Lunafest"" to occupy Price Center Ballroom. Eleanor Roosevelt College Senior Senator Erik Rodriguez-Palacios was the speaker of the council for the meeting, substituting for Earl Warren College Senior Senator and Speaker Michelle Yetter, who opted out of the session because she was sick.
A.S. President Harry Khanna announced he was working with university officials to extend the hours of CLICS. He also proposed that the library be open 24 hours all of 10th week and during finals. Khanna is coordinating with the UCSD Police Department to ensure enough Residential Security Officers are present to accommodate the expected influx of students.
Assistant Vice President of Programming Di Lam announced Head Automatica will perform at this quarter's Thank God It's Over concert. In her report, Lam said the last Bear Garden was a success, despite the ""foamy beer situation.""
Two more Bear Gardens are scheduled for April 13 and June 1.
Assistant Vice President Local Affairs Aida Kuzucan, shouting over noisy diners in the pub, reported that she is working with other organizations in San Diego to pass resolutions against the construction of the Foothill-South Toll Road through San Onofre State Park.
Next, Thurgood Marshall College Junior Senator Kyle Samia said he wrote a letter to the Marshall writing program, Dimensions of Culture, to disapprove of the direction in which DOC is headed.
""They responded negatively and a little abrasively,"" Samia said.
He announced that DOC administrators are going to be present at the next Marshall College Council meeting to discuss the issue. Samia advised students not to attend, although the council meeting is open to the public.
Marshall Chair Neetu Balram clarified the council's position.
""The concern is that [DOC administrators aren't] expecting such a huge turnout,"" Balram said. ""Things could get very intense and messy.""
She added that the situation could then become counter-productive.
A.S. President Chief of Staff Emma Sandoe announced that a research group of San Diego State University students will survey UCSD student leaders in the coming weeks. The group is working on a project to determine the reasons student leaders choose to take their positions.
She also announced that Revelle College senior Robby Peters was going to declare that he was entering the NBA draft. He recently became the NCAA season leader for the most three-pointers in one game.
On a final note, Khanna described a run-in he had with Chancellor Marye Anne Fox. Fox reportedly called Khanna asking for a five-seat cart, however the council only owns a two-seater.
""We let her down,"" Khanna said in his report to the council.
However, A.S. Executive Assistant Christopher Terry redeemed the council when he borrowed a five-seater for the chancellor from a college resident life office.
Asian Americans are less likely to seek out social support than their European American counterparts, according to a new study conducted by researchers from UC Santa Barbara.
According to assistant professor of psychology and study co-author Heejung S. Kim, Asian Americans do not seek support because of concerns that it affects relationships negatively. Disclosing occurrences like stressful events can make others worry, or even cause the support-seeker appear weak. In contrast, the study found that European Americans view requests for support as a proactive and beneficial method to solve problems.
""Asian Americans seem to be particularly aware and concerned about these implications and therefore are more hesitant to seek social support,"" Kim said in an e-mail.
The research found that Asian Americans still seek implicit help, spending time with family or friends without discussing problems, while still receiving some indirect support from the interactions. European Americans, on the other hand, explicitly deal with emotional issues, and are more likely to talk them over. The emphasis on collectivism in Asian cultures, Kim said, influences Asian Americans to value harmony more than individuals in Western cultures.
Kim stressed that the study's findings are not to be overgeneralized as a complete and total picture of all Asian Americans' relationships.
""Our goal is to identify behaviors that tend to vary systematically across cultures, and bring forward cultural biases that implicitly exist,"" Kim said.
Many UCSD Asian-American students said they saw the findings as representative of their experiences.
""I agree most with the idea of implicit support, that we use our social networks differently just by spending time with our families,"" Revelle College junior Malou Amparo said. ""We have different ways of coping and seeking help; maybe seeing a counselor or something isn't very appealing for some reason. It wouldn't be my first choice.""
Many students hesitate when turning to family for emotional support, some students said, and older generations expect a level of personal control.
""I almost feel as if it would be a sign of weakness if I were to not be self-dependent and be able to deal with things myself,"" Revelle College junior Kimberly Yu said. ""I don't think this was explicitly said to me ever in my life, but I've always felt that way, especially about my academics and my career. I almost don't want to fall into the stereotype, but those are the values that I've gained from my family.""
Sixth College junior Jennifer Wong said that if she were experiencing problems, she would not seek out help from a mental health professional.
""While some of my friends might go to a therapist, my first instinct would not be to go talk to someone about it,"" Wong said.
According to Kim, the study suggests that groups using the culturally appropriate support system had lower stress levels than when they used a support system that didn't match their cultural background. While many students express reservations about talking to older generations, students have an easier time connecting to peers with similar backgrounds.
According to Amparo, she finds support in Kamalayan Kollective, a Filipino organization.
""A lot of the support I feel that I need relates to my Filipino and Asian identity,"" Amparo said.
UCSD Asian Pacific Islander Student Alliance President Brian Kang also said that he finds support among his peers.
""I know that when I was first starting college, I wouldn't ask for help a lot because I didn't really feel comfortable talking to anyone, but in my experiences with APSA, it really brought that out of me,"" Kang said. ""I do try and stress that APSA is family to us. It's like a second home for a lot of the members.""
Skyrocketing health care costs and longer lines at the doctor's office are met with harried physicians more concerned with trying to meet their quota for the day than listening to health problems: This is the future of U.S. health care, according to UC health policy expert Thomas Bodenheimer.
Medical school student Sasan Massachi (right), wants to pursue a career in oncology, while Kevin Burnham is undecided. Students are increasingly choosing specialized fields over primary care.
A drastic decrease in the number of primary care physicians over the past decade prompted the attention of Bodenheimer, a UC San Francisco professor of family and community medicine whose background includes not only an M.D. but also a master's degree in public health.
In a perspective piece published last month in the Annals of Internal Medicine, Bodenheimer and two other doctors blamed the income gap between specialty and primary care physicians for the decline. While the incomes of primary care physicians are by no means meager, the discrepancy in comparison to specialists has become large enough to ""discourage medical school graduates from choosing primary care careers,"" Bodenheimer wrote in the article.
The article said that the percentage of medical school graduates in the United States choosing primary care has dropped from 14 percent in 2000 to 8 percent in 2005, a figure that has been dwindling since the mid-1990s. Studies have indicated that patients under consistent primary care have lower health care costs, making the decline a serious situation, especially with the number of people affected by chronic diseases on the rise. The American College of Physicians has expressed a need to take action to prevent what they call an ""impending collapse"" of primary care.
At UCSD alone, the number of students choosing primary care as a career has dropped to roughly 10 percent of the graduating class over the past 20 years, according to Rusty Kallenberg, head of the division of family medicine at UCSD. Kallenberg said he believes one of the main factors fueling students' decisions to specialize is the looming debt, averaging $130,000 to $200,000, after leaving medical school.
However, patients put themselves in potential danger when they see several specialists but no primary care physician, because the specialists often lack knowledge of the patient's overall health, he said.
""[If it is] no one's job to coordinate everything, [it is] not good news for patients,"" Kallenberg said.
The Resource-Based Relative Value Scale, implemented by Medicare in 1992 with the intent of reducing the disparity costs between office visits and procedures, has become the mechanism fueling the income divide, according to Bodenheimer. Instead of paying for face time with the doctor, the difference in the relative value unit, or RVU, of a visit is based on the work that is done.
A colonoscopy costs more than a normal office visit because the intensity of the work - mitigated by factors of skill, effort, judgment and stress - is seen as greater for p rocedures, as opposed to doctors' cognitive efforts. Over the years, the volume of procedures performed by specialists has increased more rapidly than office visits, contributing to the higher salaries of specialists.
In addition, several studies have shown that private insurers favor specialist procedures over primary care. A 2002 study revealed that, on average, private insurers pay 120 percent of Medicare's fee for procedures over 104 percent for office visits, allowing specialists to negotiate higher rates than primary care physicians.
Bodenheimer's report also highlighted the somewhat biased process of updating RVU values. The American Medical Association and other specialist societies created the Relative Value Scale Update Committee, which is designed to recommend RVU updates every five years. Of the 29 members of the committee, 23 are from specialist societies, and only 15 percent of the voting members represent primary care.
The paper alleges that specialist-heavy membership, along with specialist society influence in the committee, has led to the avoidance of increasing evaluation and management RVUs - the meat and potatoes of primary care physician income.
Revelle College junior Matt Wiepking is one of many premed students on campus. Originally, Wiepking had his sights set on being a general practitioner or pediatrician, but has since been considering specialist fields like radiology.
""There is obviously a financial factor, but a lot of it is lifestyle, patients and decisions you get to make,"" Weipking said.
He said he believes that more than the money, students may be more interested in the immediate, tangible benefits from specialty fields. In being able to see a change in the patient's condition, Weipking said students may feel more useful.
After watching doctors and spending many volunteer hours in hospitals, Weipking said he does not necessarily agree with current method of charging patients.
""I think there is a definite lean on doing the tests, but that stems from fear of malpractice,"" Weipking said. ""A lot of unnecessary procedures done [are] not a good way to practice medicine. [It's] not helping patients.""
Bodenheimer suggested in his report that experts seek out alternate payment models that work to suit each area's approach to treating patients. In the short term, he recommended that Medicare and private insurers identify ways to modify their reimbursement approaches while primary care tries to bolster its ranks.
""Do we need surgeons if you get hit by a bus?"" Kallenberg said. ""Of course, but we also need vibrant primary care to prevent disease from unhelpful behavior.""