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In response to multiple concerns about water quality expressed by residents, EJCAN launched a water quality testing initiative with university-based collaborators from UNC Chapel Hill and Appalachian State University. Threats to water include but are not limited to industrialized agriculture. Industrialized hog feces contain pathogens, heavy metals, and antibiotic-resistant bacteria that growers store in large, open pit lagoons (Grant 1999; Wing et al. 2008; Blanchette 2019; Christenson et al. 2022). When operators spray the waste onto nearby fields, they also release air and waterborne contaminants. Scholars have linked airborne emissions from industrial hog operations to respiratory dysfunction, mood disorders, compromised immune function, anemia, kidney disease, tuberculosis, and low birth weight (Wing et al. 2000; Kravchenko et al. 2018; Guidry et al. 2018). Moreover, the odor is noxious, causing nausea, embarrassment, disorientation, and social loss in cultural continuity as people cease culturally meaningful practices like gardening, going for walks, or gathering outside to share food (Herring 2014; Blanchette 2019). The impacts to water include contamination, harmful algal blooms, fish kills, and eutrophication in rivers and estuaries, especially when hurricanes flood the inner coastal plains with industrialized animal waste (Wing et al. 2000; Wing et al. 2008; NCCN 2021; Emanuel 2018; Christenson et al. 2022). Access to water infrastructure in Sampson County is highly uneven, and residents have been advocating for improved access for more than a decade. 

1) “Repeatedly, I have been surprised by the impact that even lightly sketched case histories can have on readers.”

2) “But even the manifesto conceded that less formal expertise would remain important in the areas of practice that had not been subject to high-level testing. THAT confession covers much of the territory.”

The author conducted his research by personal experience and reference to case examples.

The main point of the article is that doctors need individual stories about patient success stories but that the current medical community has largely done away with this. His argument is that that are needed because of their impact on patients, their use in identifying problems like depression, knowing others have felt the same or have the same condition can give hope, and they can inspire research agendas.

Dr. Kramer refers to various people in various medical cases but redacts their names.

The Journal of the American Medical Association and the medical community as a whole embraced “evidence based medicine” back in the 90s and claimed that individual case stories were inferior, antiquated, and a thing of the past.

Oxford University press and the New England Journal of Medicine started writing case reports embracing stories.

The author addresses public health by making the case that “evidence based medicine” is not always there for every type of case nor is it always infallible. This effects emergency response where there are so many variables and there are no datasets, protocols, or studies for some cases.

1) “Repeatedly, I have been surprised by the impact that even lightly sketched case histories can have on readers.”

2) “But even the manifesto conceded that less formal expertise would remain important in the areas of practice that had not been subject to high-level testing. THAT confession covers much of the territory.”

I looked into how EMS operates in situations that are beyond protocols, standing orders, and medical control. I also looked into how story cases are used by other medical professionals. Further I looked into how “evidence” based approaches are formulated for studies and research.

• "For a variety of reasons, including a heightened awareness of medical error and a focus on cost cutting, we have entered an era in which a narrow, demanding version of evidence-based medicine prevails. "
• "No formal research can offer a 40-year lead-in or a 19-year follow-up. Few studies report on both symptoms and social progress. Research reduces information about many people; vignette retains the texture of life in one of its forms."
• "Beyond its roles as illustration, affirmation, hypothesis-builder and low-level guidance for practice, storytelling can act as a modest counterbalance to a straitened understanding of evidence."
• "We need storytelling, to set us in the clinical moment, remind us of the variety of human experience and enrich our judgment."

The author is a psychiatrist who specializes in clinical depression. He conducted his research for this article with anecdotes and personal experience. He references other studies regarding clinical depression and refers to doctors that used stories and personal experiences to help shape their diagnosis.