Michael D. Stein

From a leading public health expert and physician, and in the style of Studs Terkel's Working, comes an eye-opening look at what it's like to have to work physically hard for your money in America . . . A Living is a vivid portrait of the working lives of the patients who visit Dr. Michael Stein, a primary care doctor in urban America. What makes his patients unique is that they, by and large, do demanding manual labor. Very few have the luxury of working remotely, or seated. Inspired by Studs Terkel's classic WORKING, Stein produces an eye-opening look at what it's like to have to work long hours at physical jobs for a paycheck in America. A Living is composed of vignettes, snap shots of people's working lives, the dramas, disappointments and frustrations workers have with their colleagues, family co-workers, and supervisors.And yet it also captures the sense of accomplishment and satisfaction, the opportunities for initiative and self-expression that come from doing intricate work with one's hands. Work gives Stein's patients a sense of identity and a social environment to thrive in. Ultimately, A Living is an extraordinarily powerful and poetic tableaux of working-class America at this moment when manual labor may be the final refuge in the new era of AI.

In the early years of COVID-19, Americans witnessed the intersection of a global pandemic, an economic collapse, and civil unrest that galvanized the country and the world and ushered in an era of unprecedented disruption. Three years later, we can begin to reflect on the experience of the pandemic and ask ourselves how the lessons of that experience can inform a healthier present and future. The Turning Point: Reflections on a Pandemic examines the first years of COVID-19 through the lens of population health, revealing a critical turning point in our engagement with key public health issues. Through a series of short, provocative essays, the authors leverage their experience as prominent public health leaders to untangle the social, economic, environmental, and political forces at work in our response to the pandemic. Combining cutting-edge data with philosophical insights, these bold and revelatory essays encourage us to broaden and sharpen our vision of health and renegotiate policies that can allow health to flourish in extraordinary-and ordinary-times.

How can we care so much about health care yet so little about public health? Before Covid-19, public health programs constituted only 2.5 percent of all US health spending, with the other 97.5 percent going towards the larger health care system. In fact, the United States spends on average $11,000 per citizen per year on health care, but only $286 per person on public health. It seems that Americans value health care, the medical care of individuals, over public health, the well-being of collections of people. In Me vs. Us, primary care doctor and public health advocate Michael Stein takes a hard, insightful look at the larger questions behind American health and health care. He offers eight reasons why our interest in the technologies and delivery of health care supersedes our interest in public health and its focus on the core social, economic, and environmental forces that shape health. Stein documents how public health has continually "lost out" to medicine--from a loss in funding and resources to how we view our personal priorities--and suggests how public health may hold the solutions to our most concerning crises, from pandemics to obesity to climate change. Me vs. Us concludes that individual and public health are inseparable. In the end, Stein argues, we need to recover and sharpen our sense of health based on a reverent appreciation of both perspectives.

This issue of Medical Clinics, guest edited by Drs. Jeffrey H. Samet, Patrick G. O'Connor, and Michael D. Stein, is devoted to Substance Use and Addiction Medicine. Articles in this outstanding issue include: Making Unhealthy Substance Use a Part of Behavioral Health Integration in Primary Care; The Inpatient Addiction Consult Medical Service: Expertise for Hospitalized Patients with Complex Addiction Problems; The Addiction Physician Workforce: Addiction Psychiatry and Addiction Medicine Collaboration in a New Age; Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists; The Role of Non-Traditional Maintenance Treatments: Injectable Opioid Agonist Therapies and Managed Alcohol Programs; Office-Based Addiction Treatment (OBAT) in Primary Care: Models that Work; Alcohol Use Disorder Pharmacotherapy: the Use of FDA and non-FDA Approved Medications; When and How to Treat Possible Cannabis Use Disorder; Clinical Presentations of New Drugs with Abuse Potential; Use of Technology in Addiction Therapy; Sleep Management Among Patients with Substance Use Disorders; Pain Management Among Patients with Substance Use Disorders; E-Cigarettes: A Path to Recovery or a Road to Hell?; Are Adolescent and Young Adults Different When Addressing Substance Use Disorders?; and Smoking Cessation for Those in Recovery from Substance Use Disorders.