From Zimbabwe, Peta Thornycroft (Still) Reporting

DATE October 31, 2007 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Peta Thornycroft talks about her work as a journalist
and living in Zimbabwe
DAVE DAVIES, host:

This is FRESH AIR. I'm Dave Davies, senior writer for The Philadelphia Daily
News filling in for Terry Gross.

For the past several years the world has watched the civic and economic
disintegration of the African nation of Zimbabwe under the rule of dictator
Robert Mugabe. Our guest Peta Thornycroft is one of the few independent
journalists who's watched the events from inside Zimbabwe. Thornycroft was
born and raised in the country when it was the white-ruled nation of Rhodesia.
She continued to report on the country's crisis after foreign journalists were
expelled, renouncing her British citizenship in 2001 to remain in Zimbabwe.
Thornycroft has just received a Lifetime Achievement Award from the
International Women's Media Foundation.

Robert Mugabe was the leader of one of two black rebel groups that took power
from a white supremacist government in 1980. Mugabe soon eliminated his
internal opposition and established himself as Zimbabwe's ruler, though the
country still goes through the formality of elections.

Zimbabwe's current crisis has its root in a sweeping confiscation of
white-owned farms that began in 2000. Mugabe's ruling ZANU-PF party initiated
the campaign in part to punish an opposition movement led by Morgan
Tsvangirai. As the country's agricultural economy collapsed, inflation
soared.

I spoke to Peta Thornycroft last week and asked her why food, fuel and other
necessities have become so scarce in Zimbabwe lately.

Ms. PETA THORNYCROFT: In June the outgoing US ambassador to Zimbabwe,
Christopher Dell, made a statement that Zimbabwe's rampant inflation would
totally collapse the economy by year end. The military, who really run
President Robert Mugabe and run policy, got a real panic. They interpreted
this as a Western plot to effect regime change, that's what they say. And so
they immediately set up a price task force and they froze prices as of June
the 18th. With about 8,000 percent inflation--that's at the official rate--it
meant that within a few days prices for retail goods were 50 percent below the
cost of production. The supermarkets were faced with no local goods. They
would store some imported goods in some of the out market supermarkets, but
really 99.999 percent people can't afford to buy those goods. In the regular
supermarkets throughout the country, the following items are missing: cooking
oil, margarine, butter, sugar, flour, meat--excepting a little bit of
pork--bread and all dairy products. So all the basics essentials for
nutrition were missing. There were some fruit and vegetables.

And it took about three weeks before the black market clicked in. Zimbabwe
has an extremely efficient black market, both for money and for goods that are
in short supply. And so the black market started to get over, but I would say
that 80 percent of the population were excluded from buying on the black
market because they simply couldn't afford it.

DAVIES: So it does sound like an economic collapse. Let me ask, how do you
get food and household goods that you need when you're there?

Ms. THORNYCROFT: Because I earn foreign currency, I take essentials with me
to Zimbabwe. I hardly ever travel with things like clothes. I've always got
bottles of cooking oil and melting margarine in my suitcase and spilling
yogurts in my suitcase and powdered milk and tinned meats and biscuits and
things like that. I take things up with me and then, because I have access to
foreign currency, I hang around and listen as to where there might be some
meat available, where there might be some essentials, and you pare down your
diet. You just cut all essentials out.

DAVIES: Well, let's talk about how we got here. I mean, what President
Mugabe will say is that, you know, a few years back he took the bold step of
redistributing the country's resources from wealthy whites to disenfranchised
blacks, in effect nationalizing industries and taking over farms. Why did
this lead to the collapse of Zimbabwe's economy?

Ms. THORNYCROFT: Commercial agriculture had always produced 40 percent of
foreign currency, and that was produced by agricultural exports grown 95
percent by white commercial farmers because they had the training and the
resources to do it, and they were really good at what they did. And a new
political party arose in September 1999 and fought a referendum in February
2000 in which the farm workers, mobilized to an extent by their employers, who
represented the largest voting block in Zimbabwe, delivered Mugabe his first
political defeat in February 2000 and rejected this new constitution.

And Mugabe then turned on the farmers. There had been
some...(unintelligible). There were requests by people for more land. The
land resettlement program whose independence had not been a great success. So
there was this discontent. There were no jobs in the manufacturing sector,
few jobs in the business sector. Mugabe needed something to give
people--perhaps as all politicians do--and he chose to do it in two ways, to
stop the opposition's support, massive support, from the farm workers and the
white farmers who had the resources to assist the opposition party and to
distribute that land, first of all to landless people, but largely, the main,
best, richest, well endowed first world farms were given to members of his
cabinet, the military, the judges, senior civil servants, the police, anyone
he needed...

DAVIES: His cronies, in effect, yeah.

Ms. THORNYCROFT: ...in order to maintain the status quo.

DAVIES: Once the farms are confiscated, I mean, it doesn't necessarily follow
that changing ownership would lead to a collapse of production. Why did the
change of ownership of these farms lead to such a widespread economic decline?

Ms. THORNYCROFT: I think, first of all, that Mugabe never intended it to go
as far as it did, actually. It developed a life of its own. Secondly, the
people who took the farms, the white farmers had made it look so easy it, you
know, you drove past their farms, everything was neat and clipped and the
maize was all like the same height. It looked so easy. I think they had no
idea of the difference between growing some corn around a small patch of land
in your communal area and growing, you know, vast acreages of land in a first
world context, where you have to raise money from the banks and do it in a
first world way. And they just did not have that experience. They had not
been trained for it. And they didn't realize that it was a full-time job.
And this is not to say there're not some excellent farmers...

DAVIES: Right.

Ms. THORNYCROFT: ...who did take farmland that Mugabe gave them and are
producing well, but they're in a tiny minority. We suspect that of all the 20
million acres taken for redistribution, less than 10 percent of it has been
productively used.

DAVIES: We're speaking with journalist Peta Thornycroft. She is a citizen of
Zimbabwe and reports on that country for The London Daily Telegraph, The Voice
of America, and other publications.

Let's talk a bit about the political situation. I mean, Mugabe, of course,
was a leader of the guerilla movement, ZANU, one of two which struggled
against the white's minority government and succeeded, and, as he has been in
power since 1980, has increasingly imposed restrictions on opposition. What
is the level of political expression that is allowed in Zimbabwe today? Can
one hold a political meeting? Can one publicly criticize the president?

Ms. THORNYCROFT: You can hold a political meeting if you apply to the police
for permission. And if the police give that permission, and then even if they
do they may break it up.

DAVIES: Mm.

Ms. THORNYCROFT: That is--there's two weekly independent newspapers which
have a tiny circulation in the cities only. They never get out there. The
four radio stations are controlled by the government. The only daily
newspapers are controlled by the government, and even they don't get
distributed in the rural areas because people are too poor to buy them. So
there's virtually no political activity excepting that run and controlled by
Mugabe's ruling ZANU-PF.

DAVIES: And those who stage public protests are greeted often with arrests
or, what, beatings, torture, right?

Ms. THORNYCROFT: Ninety percent of those people who stage demonstrations,
which get smaller and smaller every year, are arrested, and a majority of them
are beaten by police when they're arrested sometimes to within an inch of
their lives and sometimes--one of them's just died from the March beatings.
Yes, you cannot hold demonstrations. People do. They dart into the street
for 35 seconds, get whacked over the head, and they dart back a month later.
And the Women of Zimbabwe Arise, regularly hold meetings. And when the police
come, they sit down, they get taken off to police stations. They do and they
don't get beaten up. There's no civil protest allowed, endured, or even,
really, taking place.

DAVIES: You've written several pieces about this group that you mentioned,
the Women of Zimbabwe Arise. Who are they and just tell us a little bit about
their activities.

Ms. THORNYCROFT: They're a group of civil society activists who want
democracy. They're led by mostly women from second
city...(unintelligible)...that's where it started. And they are pacifists.
They will not ever resort to violence or hit back or even physically protest
if they're being beaten. They just sit there and allow them--rather in the
Gandhi tradition--they just sit there and allow themselves to be beaten and
arrested.

DAVIES: Now, there is a parliament in Zimbabwe, right? And there are
actually opposition members of the parliament, right?

Ms. THORNYCROFT: Mm-hmm.

DAVIES: Just talk a little bit about what the opposition is like. I mean, I
gather that there's a movement which is divided. What are the prospects for
an effective opposition to Mugabe?

Ms. THORNYCROFT: They came so close in 2000 to winning parliamentary
majority. They will tell you that they didn't win those four seats. They
were short of a parliamentary majority because of violence and vote rigging.
I think there was less vote rigging, certainly violence, in 2000. When it
came to the presidential election of 2002, the elections, to an extent, were
just a joke. In 2005, at the general election for parliamentary seats, the
MDC, the Movement for Democratic Change, had tragically split into two
factions. And they'd lost their heart, their organization, their whatever it
was. And they lost a third of their seats in those elections. And they
really count for very little in the public life of Zimbabwe, or any life in
Zimbabwe.

However, they made enough of an impact that they are now engaged in
negotiations with the ruling ZANU-PF, in secret talks facilitated by South
African President Thabo Mbeki, who wants an end--finally, he wants an end to
the crisis in Zimbabwe and he wants the next elections, due in March 2008, to
be undisputed--that's what his words were--undisputed elections.

DAVIES: And as you look at the opposition figures, do you see a leader or a
movement that you could see at some point bringing a successful transition to
democracy and a hope for honest and responsible government?

Ms. THORNYCROFT: There are great heroes in both factions of the divided
Movement for Democratic Change. And there are great heroes among civil
society activists in the civil rights movement. So far they're plagued with a
number of things, not least being infiltration by ZANU-PF, who've played a
very clever role in assisting to divide the party. I think this generation of
opposition activists may pass on, you know, and perhaps become elder statesmen
because they're--they seem exhausted at the moment because it's been seven
long years. The efforts to get the two sides together have failed. I'm quite
sure they failed because ZANU-PF managed to rouse opposition to the deal that
had been put together...(unintelligible).

DAVIES: ZANU-PF--just for the audience, ZANU-PF, that's Mugabe's party,
right? Yeah.

Ms. THORNYCROFT: Yes. ZANU-PF is Mugabe's party. So all these
efforts--it's just exhaustion, really, in both parties. And one party has got
access to resources--God knows where it gets its resources, but it's got
access to resources--the other opposition faction hasn't got anything at all.
So I don't even know how they'll get enough money to go to nomination court
and register candidates for the next election.

DAVIES: We're speaking with journalist Peta Thornycroft. She reports from
Zimbabwe for several Western publications and African publications. We'll
talk more after a break. This is FRESH AIR.

(Announcements)

DAVIES: My guest is Peta Thornycroft. She's a freelance journalist living in
Zimbabwe, and one of the few independent journalists reporting from that
country. She's just received a Lifetime Achievement Award from the
International Women's Media Foundation.

Well, I wanted to talk a bit about your life. I mean, you grew up in this
country when it was Rhodesia. Can you just say a little bit about, you know,
your family, what it did for a living, kind of how--your place in Rhodesian
society when you were young?

Ms. THORNYCROFT: I grew up on the border of Zimbabwe and Mozambique in a
very wild part of the country. My family, my mother and the rest of my
family, we lived in the bush. They commuted across terrible roads to town and
ran a small transport business.

DAVIES: Mm-hmm.

Ms. THORNYCROFT: And we had quite a very rural childhood, very happy,
contended, quite poor, rural childhood where we lacked for nothing, really,
apart from more sophisticated material goods. But we had a wonderful
childhood. And we grew up and, you know, this eldest son went into his
father's business and I went away. I was the one who went away, but the rest
of the family, more or less, went into the family business. And then, of
course, there was the war.

DAVIES: You married and moved to South Africa, is that right?

Ms. THORNYCROFT: I did.

DAVIES: Did you always regard Zimbabwe or Rhodesia as your home?

Ms. THORNYCROFT: Yes, I did.

DAVIES: Tell me a little bit about what you love about this country. I mean,
what is it you miss when you're away?

Ms. THORNYCROFT: It's incredibly beautiful. I mean, you've got images
probably in America of Kenya and the Great Plains of Kenya. Everything in
Zimbabwe is better. It's so beautiful. Its natural resources have been well
cared for. The people are so incredibly gentle, which is to their
disadvantage at the moment. It's an incredibly nice place. It was very
advanced in Africa over alternative energy. It had the best educated
population in Africa, and that's thanks to Mugabe. And good foundations, in
fact, laid down by the British so that, unlike South Africa, where there was
unequal education, any blacks who managed to get education had the same
education as whites. So with independent education expanded massively, the
health care expanded massively. It seemed that it was the jewel in Africa
fulfilling its destiny.

And then, unfortunately, in just two years after independence Mugabe started
his tribal and ethnic purge in the south of the country against the
then-opposition. But it is a very moral society. Those morals are breaking
down along with the financial collapse. But it's a very safe society. I am
still, to this day, safer in a high dense area in the Harare than I would be
in Johannesburg.

DAVIES: Mm-hmm.

Ms. THORNYCROFT: I don't ever feel under threat from the ordinary people in
Zimbabwe. I certainly don't think I'll have my throat slit, as I might in
Johannesburg, or be shot. So people have always been engaged, especially in
comparison with South Africa. When you cross the border from South Africa
there's this nation of extraordinary charm and of beauty.

DAVIES: You were arrested in 2002, is that right?

Ms. THORNYCROFT: Mm-hmm.

DAVIES: Tell us what happened. What happened?

Ms. THORNYCROFT: It was after the presidential election, I got a call that
they were beating opposition supporters up in this rural area in this
mountains around this village and destroying their possessions and punishing
them, suspecting they'd voted for the opposition. And I went down to see what
it was. And I was in the process of actually trying to get a comment from one
introduction to a ZANU-PF official for fairness and balance. I was sitting in
a cafe waiting, and they just surrounded me and said, `Who are you?' And I
said, `I'm a journalist' and I identified myself. They weren't satisfied.
They thought I was from the British navy and that I was going to--the British
navy was going to be, you know, invading Zimbabwe from Mozambique. I didn't
actually know that at the time, but they definitely didn't believe I was a
journalist.

DAVIES: Hm.

Ms. THORNYCROFT: They definitely thought I was there for a Western
government to effect regime change.

DAVIES: And how long were you held?

Ms. THORNYCROFT: Only five days.

DAVIES: And were you mistreated?

Ms. THORNYCROFT: No. I mean, it's mistreatment to be in those filthy,
decrepit, inhumane cells which have been declared inhumane even by these
courts. They are inhumane conditions. But I was not mistreated. I wasn't
abused in any way. I heard people being abused in other cells, men being
abused. And there was one policeman there who they've since got rid of who
looked after me. I mean, he was extraordinary. I mean, he said to me at the
beginning, `don't say anything. I'm going to see you right.' Because not all
of the policemen, not all of the soldiers have forgotten their commitment to
democracy and the oaths they took of office to treat people free and fair.
You know?

DAVIES: Hm.

Ms. THORNYCROFT: And he looked after me. But he asked me to make a
statement when I came out, to say that I had been abused, and I said, `I
cannot lie.'

DAVIES: Hm.

Ms. THORNYCROFT: So I tried to say, you know, I talked about the conditions
in the cells, which were absolutely atrocious. I talked about that. And I
was a great deal luckier than blacks being arrested because I was white, I
worked for big newspaper, there was an enormous amount of publicity about it.
I could afford a lawyer, the company bought me a lawyer. I knew VOA, and
people in Washington were looking out for me. But so very many people were
arrested and they've got nothing. I mean, they were just lost, just lost.

DAVIES: And now you're operating in a country where, you know, political
expression is virtually outlawed, where demonstrators are beaten, where
foreign journalists are effectively banned. How do you do your work? Can you
interview someone openly? How do you--can you file your pieces without
censorship?

Ms. THORNYCROFT: I just do it. Because we won, those who've managed through
good luck, mostly, and some planning. Those of us who've survived--and there
are very few, there's a handful--survived to continue telling the tale. In a
way we've won some space. They're used to us. They see us around. But you
get frights and then you leave. You certainly go away for a couple or few
months and hang out in South Africa and then go back.

DAVIES: Well, Peta Thornycroft, thanks so much for speaking with us.

Ms. THORNYCROFT: Thank you.

DAVIES: Peta Thornycroft lives in and reports from Zimbabwe. She's just
received a Lifetime Achievement Award from the International Women's Media
Foundation. I'm Dave Davies, and this is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Dr. James Weinstein talks about alternatives to surgery
for back pain
DAVE DAVIES, host:

This is FRESH AIR. I'm Dave Davies.

So maybe you forget to bend your knees when you lift, or you twist your body
too fast shoveling snow and feel a little pop at the bottom of your back.
You've just joined the not-so-exclusive club of back pain sufferers. Symptoms
can vary from a persistent twinge to excruciating pain, and treatments are as
varied as the symptoms. Should you have surgery? Should you consider more
conservative treatments like physical therapy, or alternatives like
chiropractic care? We thought we'd speak to one of the country's leading back
doctors about the options.

Dr. James Weinstein is chairman of the Department of Orthopedic Surgery at
Dartmouth Medical School and editor of the medical journal Spine. He also
heads the ongoing research project Spine Patient Outcome Research Trial, or
SPORT, which compares the effectiveness of surgical to nonsurgical treatments
for the three most commonly diagnosed back problems. Terry spoke to Weinstein
earlier this month. She asked is his results show whether surgery is
effective for people suffering from disc herniation.

Dr. JAMES WEINSTEIN: We had 1200 patients enrolled, which is a, you know,
the largest study by far. And in that case, what was really impressive,
Terry, was the improvement of the patients who didn't have any surgery. The
surgical patients got better a little faster. But when you look at the
results, the nonoperative patients, their improvement was really much more
than I had anticipated and very significant. I think what that allows for, in
that particular diagnosis, again, is not that surgery or nonsurgical
treatment's the best choice one way or the other, but it allows the patient to
understand there is an option here.

TERRY GROSS, host:

OK. So that's disc herniation. What about stenosis? How effective was
surgery there?

Dr. WEINSTEIN: Yes. In the study that we published in the New England
Journal this past spring/summer, that was patients who spinal stenosis with a
slippage of the vertebrae. And in that case the data showed that patients
with surgery did better. It was heartwarming to me to know that in this final
stenosis condition that we actually were making the patients better, and there
was a benefit to treatment.

GROSS: List a little bit about nonsurgical treatments that you've found to be
effective. Let's start with the most basic one, physical therapy. I know you
advocate moving, keeping moving after a back injury. How effective do you
think physical therapy is in healing back problems and preventing recurrences?

Dr. WEINSTEIN: The fact of the matter is most spinal conditions, 85 to 90
percent, get better with essentially no treatment. And if you take physical
therapy as being resuming your normal activities, then I would advocate for
that. A specific exercise program, I think, can be important if you need that
kind of help. But the most important thing is to try to get back to your
normal activities as soon as you can.

And I've given this story before about my wife, who had a serious disc problem
and had severe pain and, you know, treating your family members is always
dangerous, and I hope she won't get mad at me for talking about this. But the
fact of the matter is, I said, `Honey, you need to, you know, get going, do
what you normally do, go running, you know, go off to your job.' And I think
she was about ready to throw me out of the house because she said, `I know
you're supposed to be an expert, but I'm telling you I can't do any of that
and you're crazy.' And I understand that because I see patients tell me that
every day sometimes, but I said, `Honey, please do that. I think you'll feel
better.' So I helped her strap on a little bit of a corset and she went
running, and she came back and she said, `You know, I am a little better.'

But it's really hard to get somebody to do that when they're in so much
discomfort. And I've had the problem myself. I went to a post office one day
and I bent over to get the mail from my post office box and I couldn't stand
up. And I said, well, it serves me right. I'm always telling people to get
going and now I have to do it myself. And, you know, I crawled to my car
holding on to the parking meters to get back to my car, laughing at myself a
little bit that I can't believe this happened. But I'm a runner, too, and I
said I've got to just do it. And I've found over the years that when I've had
people and patients get back to what they do, despite the discomfort, which
can be extraordinary, extraordinary pain and discomfort, that they do get
better faster.

GROSS: I'm with your wife. I think it sounds absolutely insane if you're in
serious back pain to go out running. And not--I mean, not only that, I
thought that a lot of like spinal doctors were kind of down on running because
of all the pressure it puts on the spine.

Dr. WEINSTEIN: Yeah, you know, I'm one of those, I don't know if you call
them crazy runners, and I agree with you that it's hurtful, but hurt doesn't
mean harm. And...

GROSS: But sometimes it means harm, right? I mean...

Dr. WEINSTEIN: Well, it means hurt. It means hurt. But the fact that
you're talking about, you know, not running because you might affect your
joints or your disc, there's really very little evidence for that. In fact,
it's not that compression force that always causes the problem. It's more of
the sheer gliding forces that actually can affect the cartilage and joints.
But really staying physically active and in good shape, you know, it's not
just good for your back, it's good for your heart, it's good for your muscles,
it's good for your bones so you don't get osteoporosis, etc. So yes, it does
hurt. And I've been there and I think I appreciate it and, you know, people
and listeners will say, `Well, you don't have it as bad as I do,' and that's
probably true in many cases. But I do know that hurt doesn't always mean
harm. You're not going to become paralyzed with this spine problem, which
patients fear that, you know, sometimes they're told if you don't take care of
this you could be in a wheelchair or you--that's scaring patients
unnecessarily.

In our studies, we didn't have any patient become paralyzed. No patient lost
function, surgical or nonsurgical. And so those are rare events. When they
occur they're a disaster and they're a tragedy, and we pray that they never
happen. But they're very uncommon.

GROSS: But, you know, in that whole `hurt isn't always harm' that you were
saying, if you have, say, a disc problem where there's a herniation and
something from the disc is pressing on the nerve, if you do certain exercises
or do certain activities, can't that put more pressure on the nerve and
inflame the nerve further, making it more difficult for the nerve to heal?

Dr. WEINSTEIN: Absolutely. And I think that's why you want to work with
your physician to make sure that you're not at risk for that to occur. But,
again, Terry, that's a rare event. I know it seems counterintuitive, and I
know what I'm saying, you know, people would criticize, and I'm open to that
criticism. But we didn't find patients who were in the nonoperative group
with pressure on the nerve actually getting worse. The human body is a
dynamic structure, and it adapts to changes every day in ways that we, you
know, have yet to totally understand. And this is something that needs more
work, needs a better understanding. But I think working with your physician,
they can help guide you through the nonsurgical treatment and tell you if
you're at risk or not at risk. But I would say from our study that risk was
not what it's anticipated to be by most.

GROSS: Now, what do you think of chiropractic and other approaches to spinal
manipulation?

Dr. WEINSTEIN: Well, I think chiropractic is something that really is a
unique specialty: touching a patient and laying hands on a patient is very
important and probably in medicine today, because of the reimbursement
strategies that we study through the institute and other things, we've sort of
changed the strategy of allowing the physician to be the kind of healer that
Normal Rockwell shows in his paintings. But I think we are so rushed that
traditional medicine doesn't do that. I think chiropractic takes the time,
they use manipulative techniques, some of which seem to help people, again,
with apparently low risk.

But I would say in these particular diagnoses that we studied in SPORT,
there's very little information to support chiropractic treatment for the disc
herniation or the spinal stenosis. So for those three diagnoses, I would say
that chiropractic is probably not as helpful as it could be. On the other
hand, it's a nonoperative treatment, and if it's low risk and if it helps
somebody avoid an operation then I think the patient should be informed about
that risk and benefit and make a decision about trying that treatment.

GROSS: Do you have an opinion on Pilates?

Dr. WEINSTEIN: Yeah, I think it's fantastic. I think core body strength is
really important. I think to do Pilates well is incredibly difficult. I
think that you need to work with somebody who's really an expert so you don't
hurt yourself. I see many patients in my clinic who have tried different
treatments by maybe instructors that weren't really capable of actually
working with people of all different ages and different conditions, meaning
their physical condition, and people get injured. So I think you need to work
with people that are--if there's certification in that, I'm not sure, but
people who can help you and guide you through the Pilates or any exercise
program in an effective way without hurting yourself. Again, hurt doesn't
always mean harm, but if you're trying to exercise you'd rather be exercising
and not hurting. And I think core body strength for the spine, which Pilates
focuses on, is really important.

GROSS: What about acupuncture for back problems?

Dr. WEINSTEIN: I think acupuncture's another one of those really interesting
domains where treatments that, you know, certainly has a history much longer
than the United States and the Chinese culture, and working on these various
meridians, to me, it makes sense that you could potentially block the impulses
going to the spinal cord where people actually perceive the initial part of
pain going on up to the brain to actually understand they have pain. And if
you can overcome those impulses through acupuncture, which is the theory, that
you can actually negate the pain perception by providing information in the
spinal cord that actually overwhelms that, then there is some science to that.
And probably modern medicine needs to do more work to understand that at the
very basic level. And for whatever reasons we haven't done that.

DAVIES: Dr. James Weinstein is chairman of the Department of Orthopedics at
the Dartmouth Medical School and editor of the medical journal Spine. We'll
hear more after a break. This is FRESH AIR.

(Announcements)

DAVIES: Let's get back to Terry's interview with Dr. James Weinstein. He's
chairman of the Department of Orthopedics at Dartmouth Medical School.

GROSS: I want to get back to your back pain that you've had. Has it recurred
over the years?

Dr. WEINSTEIN: Yes.

GROSS: What's your diagnosis?

Dr. WEINSTEIN: My diagnosis. I have not had an X-ray or an MRI, so I...

GROSS: Why not? You doctors, you're so strange.

Dr. WEINSTEIN: Yes, we are.

GROSS: Why not?

Dr. WEINSTEIN: I guess I could say I was afraid to see what I would find.
But on the other hand, what I do know from my research and my work over the
last 20 to 30 years is that diagnostic imaging studies don't always
correlate--in fact, rarely correlate with the actual symptoms somebody has.
So you could--one of the issues is, you know, in this country is we're over
using diagnostic testing. And so I'm consciously aware that, if we look for
something we're likely to find it, which then leads you to a pathway of
different treatments, different diagnostic tests that may in fact have no
bearing on your outcome.

My back pain, to me, is sort of what I would call the idiopathic. We don't
really know what's causing it, but I'm guessing as I get a little older my
discs are losing a little bit of water, they're narrowing a little bit. I
probably have a little bit of arthritis in my joints in my back, like I do in
my knees. And that periodically causes pretty significant pain. And there
are days I'm not sure I can actually go through my clinical practice. And I
don't say anything to my patients, but I want to tell them, `You know, I hurt
too and I want to commiserate with you a little bit about your symptoms and my
symptoms and maybe you can help me.' But the fact is that I sit on my chair
gingerly when I talk to them and I try to get up without wincing. But I know
in my mind that within, you know, three, seven, 10 days it's going to get
better and I should just keep doing my running and keep going. And most of
the episodes I've had, Terry, over the years have gotten better.

GROSS: You know, one of the expressions you often use is `hurt doesn't always
mean harm,' and you're referring there to like exercise and movement. Just
because it hurts doesn't mean you're harming yourself. But how do you tell
the difference between good pain and bad pain?

Dr. WEINSTEIN: The bad hurt is when things deteriorate. That's sort of my
message. So in the back area, if you are hurting a lot and your symptoms are
getting worse or your leg pain's getting more severe or you have a change in
sensation, that's a time when, then, the hurt is causing some harm
potentially, and you need to sort of step back, re-evaluate with your
physician and take the next steps. But I think that--you know, I like to
watch sports on the weekend when I have time, and sitting on the couch, you
know, you can get a back ache just from sitting. Sitting causes incredible
pressure on the disc, more than standing. It's a bad position for the spine,
to sit. You need to get up from the couch and watching the game and walk
around, maybe take a walk around the block at halftime or so so you're not
just sitting, which is a bad position for the disc. And so bad hurt occurs
when you've become immobile or you have a condition that you're actually
making worse by something that you're doing. And your body will try to get
you away from that, either getting a muscle reaction or trying to get you to
move into a different position.

GROSS: One of the many hats that you wear is that you're the head of the
Dartmouth Institute for Health Policy and Clinical Practices. When it comes
to spinal problems, what do you think the health care system doesn't get or
doesn't adequately respond to?

Dr. WEINSTEIN: Well, I think it's not unique to spine. The spine is one of
the conditions where there's tremendous variation. So if you live on the East
Coast of the United States, where we live, in New Hampshire, vs. where you
live in Philadelphia or people in California, there's very different rates at
which people have surgical procedures.

Casper, Wyoming, for whatever reason, has the highest rates of back surgery in
the United States. So you might be eight times more likely to have a back
operation just by the fact that you live in Casper, Wyoming. It is puzzling.
And in our work at the institute we see this over and over again, that
geography determines destiny. One of the reasons we started the shared
decision-making center here at Dartmouth was to try to work on the issue of
variation by patients getting involved in those decisions. And where we've
done this in trials and studies, we've seen that the rates of procedures
actually narrows so that the variation or the coefficient or the amount of
variation in a given surgical procedure narrows when you actually get patients
involved in the decision process.

GROSS: You know, we were talking earlier about the effectiveness of different
spinal surgeries. One of the things that has to do with the effectiveness is
how good your surgeon is. What are some of the questions you suggest that you
ask a surgeon before agreeing to be operated on by him or her?

Dr. WEINSTEIN: I think that's a great question, Terry. I think that today
transparency is really important. And the health care profession is being
challenged, I think, to be more transparent in providing information to the
public about the outcomes of their treatment. The idea of talking to your
doctor and knowing how many cases they've done of this particular diagnosis,
what their results are, I think are all fair questions. I think advocating
for having the decision process where you feel like you have the knowledge
about the decisions you're making, that you've been provided that information
in a way that you can understand it and understand the risk and benefits, is
extremely important, whether it's a surgical decision or a medical decision.
Today, I think we have to ask our health care providers, physicians, hospitals
and others to provide us with that kind of information. These are really
important decisions for families to make and they should be made in an
informed choice way.

GROSS: You were telling us earlier, when talking about your own spinal
problems, that you haven't yet gotten an MRI. It was in part because you felt
like you didn't even want to know, and also because MRIs are limited in what
they can tell you because they sometimes mislead you and show you something
being wrong that isn't actually the cause of the symptoms. Do you get anxious
about recurrences? You know, are you the kind of person who worries about
back pain when you get it and worries about getting it again after it's gone
away.

Dr. WEINSTEIN: I don't worry about it because I actually accept that it's
going to happen again. And I think that the listeners shouldn't be afraid,
either. I think that recurrences are very common. Thirty percent of people
have recurrences within the year of their first episode. And again, the fear
of recurrence and that something's gone wrong or you've done something wrong
isn't the case. You can't prevent it. I think what you can do is try to stay
in good condition so that when you get a recurrence that your body's better
able to tolerate it and that you can recover faster. If you don't stay in
good condition and exercise, I think when you get a recurrence it's harder to
recover.

But I think, Terry, that's true with any condition. I think the more that
we're in good physical condition, I think it helps our mind and I think it
helps our body to recover faster. Being in good condition and moving forward
probably helps me to not be so much afraid. And I think the listener
shouldn't be afraid, but they have to have the expectation that it will occur
again. But more often than not, over 90 percent of the time it's going to get
better just as it did the first time.

GROSS: Well, Dr. Weinstein, thank you so much for talking with us.

Dr. WEINSTEIN: Oh, gosh, it's been my pleasure, Terry. Thank you so much.

DAVIES: Dr. James Weinstein is chairman of the Department of Orthopedics at
Dartmouth Medical School.

Coming up, music from the upcoming Bob Dylan biopic. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Profile: Ken Tucker reviews the new soundtrack album for Bob
Dylan's biopic "I'm Not There."
DAVE DAVIES, host:

The new Todd Haynes film about the life of Bob Dylan "I'm Not There" doesn't
open until November 21, but the two-disc soundtrack album featuring 34 Dylan
songs covered by an array of artists, from Ramblin' Jack Elliott to Sonic
Youth is already released. Rock critic Ken Tucker has a review.

(Soundbite of "I'm Not There" by Sonic Youth)

(Unintelligible)...she's all too tight
In my neighborhood she cries
Both day and night
It's a milestone, but she's down on her luck
(Unintelligible)

(End of soundbite)

KEN TUCKER reporting:

That's Sonic Youth singing the title song from Todd Haynes' new Bob Dylan
biopic. The movie, as you may have heard, uses six different actors,
including Cate Blanchett and Richard Gere, playing Dylan at various times in
his life. In a parallel manner, the soundtrack album is loaded with Dylan as
diffused through many sensibilities. Sonic Youth, the quintessential New York
noise band, uses its gnarled guitar sound and muzzy vocals to give the title
song, which began this review, a lot of power.

And listen to the way Jim James, lead singer of the band My Morning Jacket,
offers a soaring version of "Goin' to Acapulco."

(Soundbite of "Goin' to Acapulco" by My Morning Jacket)

I'm going down to Rose Marie's, She never does me wrong She puts it to me
plain as day And gives it to me for a song

It's a wicked life but what the hell The stars ain't falling down I'm standing
outside the Taj Mahal I don't see no one around

Goin' to Acapulco Goin' on the run Goin' down to see fat gut Goin' to have
some fun Yeah Goin' down...

(End of soundbite)

TUCKER: Jim James never phrases it like Dylan, but he has a ghostly howl
that's like a modern blues man singing folk music. He's unexpectedly perfect.

To be sure, most cover albums throughout the course of rock history have been
almost always awful. It's particularly tricky to cover Dylan well given his
distinctive voice and copious verbal content. Over the years, the best Dylan
covers have come from unlikely sources. Bryan Ferry's 1973 grand pop operatic
version of "A Hard Rain's A-Gonna Fall," Manfred Mann's Earth Band, which in
the early '70s usually included at least one terrific, idiosyncratic Dylan
cover on every album. A significant number of covers on "I'm Not There" don't
work either. Take this obtuse, pedestrian interpretation of "All Along the
Watchtower" by Eddie Vedder.

(Soundbite of "All Along The Watchtower" by Eddie Vedder)

There must be some kind of way out of here, Said the joker to the thief There
is too much confusion, I can't get no relief Businessmen, they drink my wine
Plowmen dig my earth None of them along the line Know what any of it is worth

(End of soundbite)

TUCKER: Eddie Vedder sings as though he has a trademark stamped on his vocal
chords, `all music copyright Pearl Jam.' He doesn't give himself over to the
song the way, for example, Cat Power does on "Stuck Inside of Mobile." She
sings it the way Cate Blanchett portrays Dylan in the movie, with a female
sensibility that reveals new possibilities in Dylan's personality and music.

(Soundbite of "Stuck Inside of Mobile with the Memphis Blues Again" by Cat
Power)

Oh, the ragman draws circles Up and down the block I'd ask him what the matter
was But I know he don't talk And the ladies treat me kindly And furnish me
with tape But deep inside my heart, I know I can't escape

Oh, Mama, can this really be the end? To be stuck inside of Mobile with the
Memphis blues again Well...

(End of soundtrack)

TUCKER: Like director Todd Haynes' movie, the "I'm Not There" soundtrack
skips all around Dylan's history, coming to rest finally with the title song,
a previously unreleased track recorded by Dylan and The Band in 1967. The
allure of the title song is irresistible, since it suggests Dylan's constantly
shifting forms and images. It turns inside out Gertrude Stein's phrase "there
is no there there." Dylan is here everywhere, even when he's insisting he's
not.

(Soundbite of "I'm Not There" by Bob Dylan)

(Unintelligible)...she's all too tight In my neighborhood she cries Both day
and night It's a milestone, but she's down on her luck (Unintelligible)

I believe where she's stopping...(unintelligible) I believe that she's
looking...

(End of soundbite)

DAVIES: Ken Tucker is editor at large at "Entertainment Weekly."

(Credits)

DAVIES: For Terry Gross, I'm Dave Davies.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.