Recently in Medicine and Health Category

Just wonderful - Seattle opioid epidemic

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From Seattle station KOMO:

An opioid more deadly than fentanyl found on Seattle streets
Right in the midst of the opioid crisis, another illicit drug has hit the streets of Seattle. Experts say it's more potent and deadly than other opiods.

The DEA says carfentanil is 10,000 times more potent than morphine and 100 times stronger than fentanyl. It was first detected in Seattle in March. Experts insists its usage is "very rare" in the area, but nonetheless, it's surfaced in the city.

The timing couldn't be worse. Two people in Washington state overdose on opioids each day. In King County, at least three teenagers have died from fentanyl overdoses recently.

"I was like, 'Oh crap!' " said Dr. Caleb Banta-Green when he heard that carfentanil was detected in Seattle.

These opioids - fentanyl and carfentynil are not being prescribed by Doctors - that is not the opioid crisis that we have. These are cheap to make and are coming in from overseas - China and North Korea. It is coming in through our port cities as well as through the borders.

I am ambivalent - there are some real personal tragedies but also, many of the fatalities are people who would find some other way to shuffle off this mortal coil if they didn't have these drugs. At least, this will be a painless way to go.

Interesting - Vitamin D

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I take D3 supplements - a small amount in summer and a larger amount in winter. From United Press International:

Vitamin D deficiency linked to muscle weakness in older adults
Vitamin D deficiency is linked with poor muscle health in older adults, a new study finds.

Maintaining muscle health helps seniors maintain their independence, mobility and quality of life. It also lowers their risk of falls and frailty.

Researchers looked at more than 4,100 people, aged 60 and older, in England. About 4 in 10 with vitamin D deficiency had muscle weakness -- twice the level found among those who had adequate vitamin D levels.

Impaired muscle performance was three times more common among those with vitamin D deficiency (25.2 percent) than those with adequate vitamin D (7.9 percent).

Interesting - one of those chemicals that is used (for good) in several places in our body.

Quite obvious really

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I hate to see parents using a screen as an artificial babysitter. Yes, it keeps the kiddos quiet but it is causing some significant damage to their developing brains. From the MIT Technology Review:

Screen time might be physically changing kids’ brains
study published today in JAMA Pediatrics warns that kids’ literacy and language skills suffer with screen use, and MRI scans of their brains appear to back up the findings.

The study: Forty-seven 3- to 5-year-olds took a test to measure their cognitive abilities, and their parents were asked to answer a detailed survey about screen time habits. Questions included: How frequently do they use that screen? What type of content are they viewing? And is there an adult sitting with the child talking about what they’re watching? The answers were scored against a set of screen time guidelines put out by the American Academy of Pediatrics. The kids also had their brains scanned in an MRI machine.

Brain changes: The scans revealed that kids who spent more time in front of screens had what the authors call lower “white matter integrity.” White matter can be roughly thought of as the brain’s internal communications network—its long nerve fibers are sheathed in fatty insulation that allows electrical signals to move from one area of the brain to another without interruption. The integrity of that structure—how well organized the nerve fibers are, and how well developed the myelin sheath is—is associated with cognitive function, and it develops as kids learn language. 

Lead author John Hutton of Cincinnati Children’s Hospital told MIT Technology Review there’s a clear link between higher screen use and lower white matter integrity in the children his team studied. That structural change appears to be reflected in the results of the cognitive test the kids took as well, which showed high screen time associated with lower levels of language and literacy skills. “The effect size is substantial, as these findings also rigorously controlled for multiple comparisons across the brain,” Hutton says.

Sample size was pretty small (less than 70) but the evidence is pretty overwhelming.

Socialized medicine - England

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They just got woke big-time - from the National Health Service:

North Bristol hands red card to racism
North Bristol NHS Trust has today launched a “Red Card to Racism” campaign to protect all staff from any discrimination.

Following a national trend, staff have reported that incidents of racism on wards have increased over the past year so the hospital will be enforcing its zero tolerance policy against abusive behaviour.

This means that any patient abusing staff will be challenged and warned, leading to a sports-style disciplinary yellow card and then final red card in which treatment would be withdrawn as soon as is safe.

Any visitors causing disturbance or behaving in an unacceptable manner will get one verbal warning before being removed.

Talk about the Camel's Nose - you get a yellow card and then a red card and then the Doctors withdraw treatment? Stopping the medical care for which this person was admitted to the hospital. What is next? Checking their social media before you attempt resuscitation?

Here is what gets you a red card:

  • Racist or sexist language, gestures or behaviour.
  • Excessive noise.
  • Abuse of alcohol or drugs.
  • Threatening and offensive language.
  • Malicious allegations.
  • Intentional damage to trust property.

So you are injured or in pain or confused and you blurt out something not in keeping with the protected narrative (all hail the narrative) - they withhold your treatment?

This is socalized medicine and this is why it needs to be killed with fire. We do not want to implement it here.

You are what you eat

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An interesting look at the link between depression and diet - from scientific journal PLOS | ONE:

A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial
There is strong epidemiological evidence that poor diet is associated with depression. The reverse has also been shown, namely that eating a healthy diet rich in fruit, vegetables, fish and lean meat, is associated with reduced risk of depression. To date, only one randomised controlled trial (RCT) has been conducted with elevated depression symptoms being an inclusion criterion, with results showing that a diet intervention can reduce clinical levels of depression. No such RCTs have been performed in young adults. Young adults with elevated levels of depression symptoms and who habitually consume a poor diet were randomly allocated to a brief 3-week diet intervention (Diet Group) or a habitual diet control group (Control Group). The primary and secondary outcome measures assessed at baseline and after the intervention included symptoms of depression (Centre for Epidemiological Studies Depression Scale; CESD-R; and Depression Anxiety and Stress Scale– 21 depression subscale; DASS-21-D), current mood (Profile of Mood States), self-efficacy (New General Self-Efficacy Scale) and memory (Hopkins Verbal Learning Test). Diet compliance was measured via self-report questionnaires and spectrophotometry. One-hundred-and-one individuals were enrolled in the study and randomly assigned to the Diet Group or the Control Group. Upon completion of the study, there was complete data for 38 individuals in each group. There was good compliance with the diet intervention recommendations assessed using self-report and spectrophotometry. The Diet group had significantly lower self-reported depression symptoms than the Control Group on the CESD-R (p = 0.007, Cohen’s d = 0.65) and DASS-21 depression subscale (p = 0.002, Cohen’s d = 0.75) controlling for baseline scores on these scales. Reduced DASS-21 depression subscale scores were maintained on follow up phone call 3 months later (p = .009). These results are the first to show that young adults with elevated depression symptoms can engage in and adhere to a diet intervention, and that this can reduce symptoms of depression. The findings provide justification for future research into the duration of these benefits, the impacts of varying diet composition, and their biological basis.

Looks like they were very thorough. No mention in the abstract as to what the two diets were but the Mediterranean diet is well known for being very healthful.

Woof!

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Not surprising at all - from Circulation: Cardiovascular Quality and Outcomes Journal

Dog ownership associated with longer life, especially among heart attack and stroke survivors
Dog ownership may be associated with longer life and better cardiovascular outcomes, especially for heart attack and stroke survivors who live alone, according to a new study and a separate meta-analysis published in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

“The findings in these two well-done studies and analyses build upon prior studies and the conclusions of the 2013 AHA Scientific Statement ‘Pet Ownership and Cardiovascular Risk’ that dog ownership is associated with reductions in factors that contribute to cardiac risk and to cardiovascular events,” said Glenn N. Levine, M.D., chair of the writing group of the American Heart Association’s scientific statement on pet ownership. “Further, these two studies provide good, quality data indicating dog ownership is associated with reduced cardiac and all-cause mortality. While these non-randomized studies cannot ‘prove’ that adopting or owning a dog directly leads to reduced mortality, these robust findings are certainly at least suggestive of this.”

Makes perfect sense to me. My pups bring me joy. Always been a dog person although cats are a lot of fun (so are llamas, horses, goats, etc...)

Just wonderful - Ebola outbreak

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This time in the Democratic Republic of the Congo - from the World Health Organization:

Ebola virus disease – Democratic Republic of the Congo
The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues this week with 20 new confirmed cases reported in North Kivu and Ituri provinces from 25 September to 1 October 2019, versus 29 in the previous week. This decrease in the number of cases should be interpreted with caution, as operational and security challenges in certain health zones make it difficult to undertake case detection and response functions. With over half (55%) of cases in the past week coming from Mambasa and Mandima Health Zones, there is a clear shift in the hot spots of the outbreak from high density, urban settings, such as Butembo, Katwa, and Beni, to more rural areas with a lower population density. This results in a change in the transmission dynamics, with more community-based transmission and less possible transmission in healthcare facilities. Conversely, this may introduce new issues in terms of accessibility and logistical challenges to reach affected villages, especially as we enter the rainy season.

In Mambasa Health Zone, delays in raising EVD awareness and involving the community and civil society in the response have led to community mistrust. To strengthen the participation of local communities in the response, WHO is working with the community, civil society, and partners in Mambasa Health Zone to engage women’s groups and enhance community-based surveillance. While in Lwemba, within Mandima Health Zone, poor EVD awareness compounded with armed conflict has led to heightened tensions between local communities and Ebola response teams. This has resulted in difficulties in investigating community deaths. Therefore, it is likely that the number of cases and community deaths in this area is under reported.

Emphasis mine - community mistrust? More like tribalism and ignorance. I would take these numbers and multiply them by at least 50. This is spreading out.

Gee - if only we could use DDT

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We had a serious problem with DDT - it was so effective that we were - literally - marinating the planet in it. We need to bring back it's use on a limited and careful basis. Why? Mosquitoes kill more human beings than any other cause of death.

From USA Today:

Deadly EEE: Parts of nation see worst outbreak of brain-swelling, mosquito virus in more than a half-century
Patricia Alice "Pat" Shaw, of East Lyme, Connecticut, loved the outdoors. She walked her dogs three times a day. She often sat by the backyard swimming pool at her home, surrounded by woods.

The walks, the pool, the woods – any of those pleasures may have led to the mosquito bite that killed her weeks later on Sept. 19.

A bit more:

This year, Massachusetts is experiencing its largest EEE outbreak since 1956. The virus is typically spread through bites from infected mosquitoes, which are more likely to be carriers near wetlands or sitting water. While people of any age can die from EEE, the victims this year have primarily been the young or old.

There is no cure for EEE. A vaccine developed by the military exists for the virus, but it is not commercially available because the side effects are considered too severe. Although EEE can be treated, about 80% of survivors are left with some level of permanent neurological damage.

Nasty stuff. A perfect example of why we need to return to using DDT on a controlled basis.

Some bad drugs in Franklin County, Ohio

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Yikes - from CBS News:

Coroner reports 10 overdose deaths in 26-hour period in one Ohio county
The coroner of Ohio's most populous county reported 10 deaths from drug overdoses in a 26-hour period that ended at 10 a.m. Sunday morning. In a statement published on Facebook, Franklin County Coroner Dr. Anahi Ortiz said, "This is an unusually high number for our county in this period of time."

Dr. Ortiz urged residents to carry naloxone — an anti-overdose medication that treats narcotic overdoses immediately. She also cautioned residents about the dangers of fentanyl, a hyper-powerful, synthetic opioid that can easily be mixed with cocaine and methamphetamine and even black market opioid pills.

The reason is not named but the article mentions fentanyl a lot. Most of this is coming from China.

Just wonderful - flu vaccine

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They got it wrong for this year. From Stat:

Flu vaccine selections may be an ominous sign for this winter
It’s never an easy business to predict which flu viruses will make people sick the following winter. And there’s reason to believe two of the four choices made last winter for this upcoming season’s vaccine could be off the mark.

Twice a year influenza experts meet at the World Health Organization to pore over surveillance data provided by countries around the world to try to predict which strains are becoming the most dominant. The Northern Hemisphere strain selection meeting is held in late February; the Southern Hemisphere meeting occurs in late September.

The selections that officials made last week for the next Southern Hemisphere vaccine suggest that two of four viruses in the Northern Hemisphere vaccine that doctors and pharmacies are now pressing people to get may not be optimally protective this winter. Those two are influenza A/H3N2 and the influenza B/Victoria virus.

So basically, of the four strains in this years vaccine, two of them may be wrong. Predicting is a crap-shoot regardless and they have done worse but they have also done better. Thinking of skipping my shot this year.

Forty-four health hoaxes debunked

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Great canonical list at Vice:

The Most Overhyped Wellness Promises, Debunked
Raise your hand if you have a friend who’s tried one of the following in the name of wellness: apple cider vinegargluten-free foodcolonics, or detoxing? How about the friend who avoids microwaves and antiperspirant to protect themselves from “radiation” and “toxins,” respectively? Or the one who swears that the crystals in their bedroom are responsible for all the positive changes they’ve made recently? Yeah, that one. Those ones. This list is for them. And for you, to share with them when you’re at a loss for words.

Behold our ever-growing list of today’s most pervasive wellness lies. Click through on each one for a clear, deeply researched, as-definitive-as-possible explanation, gathered from experts and years of scientific research. You won’t find any thin claims based on small studies or experiments on cells or mice, unless we’re using them to point out how insufficient the research is on a given subject.

In some of these cases, the body of research continues to develop. There may be a time when, say, there’s a probiotic on the market that is proven to improve your mood. But until that time arrives, it’s worth saving your time and money and keeping an eye on the research. Here, in no particular order, we’re setting the record straight on the the most overhyped health and wellness promises out there today.

People believe the strangest things...

Just wonderful - Ebola

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Looks like it is not being contained and is spreading. From the World Health Organization:

Cases of Undiagnosed Febrile Illness – United Republic of Tanzania
The following is a description of the current situation in the United Republic of Tanzania regarding unofficial reports of a number of cases of illness and a summary of WHO efforts to obtain information about this situation.

As specified in Article 9 of the International Health Regulations (IHR), WHO may take into account reports from sources other than notifications from Member States and shall assess these reports according to established epidemiological principles under the IHR.

On 10 September 2019, through its regular event-based surveillance process, WHO was made aware of unofficial reports regarding the death of a person with suspected Ebola Virus disease (EVD) case in Dar es Salaam, United Republic of Tanzania. The identified contacts of the deceased were unofficially reported to be quarantined in various sites in the country. Under the IHR Articles 9 and 10, WHO immediately sent a verification request to the National IHR Focal Point (NFP) of the country.

They are minimizing the extent here - read between the lines. Here is another press release from two weeks ago:

WHO deploys technical team to Tanzania to support investigation of a rumour of unknown illness
The World Health Organization (WHO) is aware of a rumour related to the death of a person due to an unknown illness in the United Republic of Tanzania. We have reached out to Ministry of Health officials for further details and have offered our support.

In line with our responsibility under the International Health Regulations, WHO regularly receives and investigates numerous rumours of public health events.

In this regard, WHO is working with national health authorities and is deploying a technical team to the United Republic of Tanzania to investigate this rumour as a matter of urgency.

WHO will be informing Member States of the outcome of this investigation through their national International Health Regulations focal points.

Their eyes are squeezed shut and they are praying that this will go away. If not that, that they are the last persons to contract this disease. This is big. They know what it is but they are afraid to report on it and its extent.

Yikes - polio

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From Associated Press:

Philippines declares new polio outbreak after 19 years
Philippine health officials declared a polio outbreak in the country on Thursday, nearly two decades after the World Health Organization declared it to be free of the highly contagious and potentially deadly disease.

Health Secretary Francisco Duque III said at a news conference that authorities have confirmed at least one case of polio in a 3-year-old girl in southern Lanao del Sur province and detected the polio virus in sewage in Manila and in waterways in the southern Davao region. Those findings are enough to declare an outbreak of the crippling disease in a previously polio-free country like the Philippines, he said.

Not good - this disease is a killer and if it does not kill you, you will have issues for the rest of your life.

Vaccines are a good thing.

Time for that flu shot

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From NBC News:

This year's flu season may be a bad one. Here's why you need a flu shot
Flu seasons are notoriously unpredictable, but there are already clues that the upcoming season may be especially difficult.

Flu season in the Southern Hemisphere can be an indication of what's to come in the Northern Hemisphere, and the recent flu season in Australia, where winter has just ended, arrived early and with a vengeance. A particularly virulent flu strain, H3N2, dominated.

What's more, a pediatric flu death has already been reported in the U.S. — a 4 year old in California who had underlying health problems.

"We should never forget that the flu still kills," Dr. Cameron Kaiser, a public health officer for Riverside County, California, said in a news release announcing the death.

Cheap insurance. Not a fun illness to have.

An explosion in a lab. Not just any lab. From Russia Today:

Blast & fire hits major virus lab in Russia, where HIV, Ebola & anthrax strains are stored
One of the world’s largest virus research centers, located in Siberia, was reportedly engulfed in flames after a sudden explosion rocked the secretive compound, known for its stores of Ebola, HIV, anthrax and other strains.

Firefighters and rescue services were scrambled on Monday to respond to a fire that broke out in Koltsovo, a scientific hub several kilometers from Novosibirsk. The situation was quickly upgraded from an ordinary emergency to a major incident as the explosion and fire affected Russia’s research center of virology and biotechnology, often referred to as the Vector Institute.

The laboratory is known for having developed vaccines for Ebola and hepatitis, as well as for studying epidemics and genera issues surrounding immunology. During the Cold War, it was thought to be part of now-defunct Soviet biological weapons program, meaning that some of the most dangerous strains – including that of smallpox, Ebola, anthrax and certain plagues – are still being kept inside the Institute’s building.

With that in mind, a local branch of the Emergencies Ministry swiftly responded to the call, sending in 13 fire engines and 38 firefighters, who entered the six-story building minutes after arrival.

Yikes - brave first responders. The Vector Institute is well known in the west now - lots of nasty stuff there.

There is another story at a Russian site but Google Translate no longer accepts URLs to translate a website - it only handles blocks of 5,000 characters at a time. Sad that Google is no longer offering this service as it was really helpful.

Russian news site here.  The Vector Lab home page here.

California is sliding down the tubes. From The Sacramento Bee:

Sacramento trying to kill packs of enormous rats that infested city lot near downtown
The city of Sacramento has started exterminating more than 100 rats that have infested a vacant lot in Sacramento’s River District where the city plans to build a new fire station.

Many homeless encampments typically line the lot, located on Ahern Street between North A and North B streets, causing city officials to worry the rats could also cause a health crisis.

The Centers for Disease Control has a list of rat-borne diseases. Some wonderful ones besides the plague.

Best and brightest - Mumps

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Looks like we are getting some healthy and productive future citizens. From the Centers for Disease Control:

Notes from the Field: Mumps in Detention Facilities that House Detained Migrants — United States, September 2018–August 2019
On October 12, 2018, five confirmed cases of mumps among migrants who had been transferred between two detention facilities were reported by the facilities to the Texas Department of State Health Services (TDSHS). By December 11, eight Texas detention facilities and six facilities in five other states had reported 67 mumps cases to U.S. Immigration and Customs Enforcement (ICE) Health Service Corps (IHSC) or local health departments. On December 12, TDSHS contacted CDC to discuss mumps control in detention facilities and facilitate communication with IHSC. During January 4–17, 2019, six more state health departments reported new cases in detention facilities, which prompted CDC and IHSC to launch a coordinated national outbreak response.

And this disease is spreading to the general population:

Since 2015, approximately 150 mumps outbreaks and 16,000 cases have been reported in the United States, typically in close-contact settings such as universities, schools, and athletic events.

The word you are looking for is: Epidemic. Next up will be bubonic plague and ebola. Not if, when.
Get out of the big cities - the shitholes.

Hansen Disease? You may know it as Leprosy. From the Journal of the American Medical Association:

Characterization and Outcomes of Patients With Hansen Disease Treated at the Los Angeles County Hospital
Although endemic elsewhere, Hansen disease (HD) is a chronic infection caused by Mycobacterium leprae and Mycobacterium lepromatosis that is rarely seen in the United States. Few domestic reports offer long-term follow-up of patients with HD, who sometimes develop significant morbidity owing to delayed recognition of their illness. The Los Angeles County HD clinic, in operation since 1963, offers an archive that allows the description of the disease courses of a large group of patients with HD.

The full article is behind a paywall. All that we need is for the bubonic plague to rear its ugly little rat head and Los Angeles is done for. All the medieval plagues are returning as we stand by with our collective thumbs up our asses.

Vaping in the news

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Proponents claim that it is safe but I have my doubts. They also claim that it is a way to reduce nicotine consumption but everyone I know has increased the concentration over time. From The New York Times:

Cases of Vaping-Related Lung Illness Surge, Health Officials Say
Medical experts and federal health officials on Friday warned the public about the dangers of vaping and discouraged using the devices as the number of people with a severe lung illness linked to vaping has more than doubled to 450 possible cases in 33 states. The number of deaths linked to vaping rose to four from two on Friday.

The Indiana Department of Health announced the third death, and hours later, officials in Minnesota confirmed that a fourth person had died. The Los Angeles County Department of Public Health said Friday that it was investigating a possible fifth death, saying that the fatality was “associated with the use of e-cigarettes.”

“There is clearly an epidemic that begs for an urgent response,” Dr. David C. Christiani of the Harvard T.H. Chan School of Public Health wrote in an editorial published on Friday in The New England Journal of Medicine.

We simply do not have enough history. It took several hundred years of tobacco use to get the laws that we have today. Vaping is going to get much worse before it will get better.

Tried it for a few years a long time ago but never really liked it. From FOX News:

Surgeon General deems cannabis completely unsafe for pregnant women, teens
The Surgeon General says no amount of marijuana is safe for adolescent and pregnant women.

Health and Human Services Secretary Alex Azar joined FOX Business on Thursday to discuss the risks associated with pot use by pregnant women and young people. He said one of the major consequences has to do with brain development.

“A critical factor in brain development is this cannabinoid receptor,” Azar told Stuart Varney on Thursday. “And what happens with marijuana is it actually binds to that cannabinoid receptor. And that's where we get a lot of the pleasure-seeking behaviors that we have.”

And crucially:

Azar said that it can block and slow neural and brain development in young people and in utero babies and lead to impaired IQ, early onset of psychosis, including schizophrenia, and reductions in attention and increased levels of depression.

Nice little shopping list there... Explains a lot about today's society.

Good news - looking at Vaping

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I have zero problem with people vaping but I am really concerned that we do not know what possible dangers there might be with the chemicals used. Glycol is benign as a liquid. We simply do not know enough about its physiological properties as a vapor. Or as a liquid when condensed onto lung tissue. From CNBC:

US health officials investigating 215 possible cases of severe lung disease associated with vaping
U.S. health officials are investigating 215 possible cases of severe lung disease associated with vaping across 25 states, the Centers for Disease Control and Prevention and the Food and Drug Administration said in a joint statement Friday.

The agencies said they need more information to understand whether there’s a relationship between specific products or substances and the reported illnesses. As of now, it does not appear the cases are linked to one particular product, the agencies said, noting that in “many” of the cases, patients reported using THC or CBD, compounds found in cannabis.

“Even though cases appear similar, it is not clear if these cases have a common cause or if they are different diseases with similar presentations, which is why our ongoing investigation is critical,” CDC Director Robert Redfield and acting FDA Commissioner Ned Sharpless said in a joint statement.

Good - I like that they are calling for more information and research. Not an outright ban. More here and here.

He developed a vaccine for Yellow Fever and won the Nobel Prize in Physiology or Medicine in 1951. When asked what he would do with the money -- approximately $32,000 -- that came with his Nobel Prize, Theiler replied that he would buy a case of Scotch and watch the Brooklyn Dodgers play baseball.

Nice biography of a great man here: Max Theiler (1899–1972): Creator of the yellow fever vaccine

Making medical care cheaper

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Two simple things would cut costs substantially. From Market Watch:

The U.S. can slash health-care costs 75% with 2 fundamental changes — and without ‘Medicare for All’
As the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

The first policy—price tags—is a necessary prerequisite for competition and efficiency. Under our current system, it’s nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing. Patients have no way to comparison shop for procedures covered by insurance, and providers are under little pressure to lower costs.

The article cites LASIK eye surgery which is not covered by medical insurance. Because of this, the clinics have to publish their prices and competition has cut the price by quite a lot.

The second item is creating a Health Savings Account - a great idea and is working well for the State of Indiana:

Those changes resulted in 35% lower health-care spending than when the same employees were enrolled in traditional health insurance. Even better, the study found that employees enrolled in the deductible security plan were going in for mammograms, annual check ups, and other forms or preventive medicine at the same rate as when they were enrolled in traditional insurance. Thus, these cost savings are real and not due to people delaying necessary care in order to hoard their HSA balances.

Of course, the lobbyists in DC do not want this so it will never happen. I thought that our elected officials were supposed to listen to their constituents.

A great rant - ZDogg MD

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A great observation into our state of medical care (computers) as well as how we medicalize our social problems.

Here is the website for Epic software. There is a term of art in the computer industry - bloatware.

Hepatitis is spreading - Akron, Ohio

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The epidemic is slowly spreading throughout the USA - from USA Today:

Hepatitis A is breaking out across the country in wake of opioid crisis
AKRON, Ohio — Just before the Fourth of July, Trenton Burrell began feeling run-down and achy. Soon he could barely muster the energy to walk from one room to another. A friend shared an alarming observation: “You’re turning yellow.”

Within days, the 40-year-old landed in the hospital, diagnosed with the highly contagious liver virus hepatitis A, which has infected more than 3,220 people in Ohio and killed at least 15.

Since 2016, the virus has spawned outbreaks in at least 29 states, starting with Michigan and California. It’s sickened more than 23,600 people, sent the majority to the hospital and killed more than 230. All but California’s and Utah’s outbreaks are ongoing, and experts expect to eventually see the virus seep into every state.

Here are some of my earlier posts tracking this medieval scourge: here, herehere, and here. This shit is real and a serious public health problem for urban dwellers. Another reason why I am never going to live in a city again.

Anti-vaccination - unreal

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From the London Daily Mail:

Muslim parents refuse to let their children take part in nationwide flu vaccine drive 'because treatment is not halal'
Muslim parents are reportedly refusing to allow their children to have a nasal flu vaccine because the treatment is not halal.

Concerns were first raised over the spray - Fluenz Tetra - containing pork gelatine last year, but the issue has been highlighted again ahead of a new nationwide drive.

At the time, the Vegetarian Society branded the use of the ingredient in three vaccines as 'disappointing', while the Muslim Council of Britain said the spray would only be permitted if there was no alternative and lives were at risk.

Next month, every healthy child between two and 10 in England will be offered Fluenz Tetra to increase herd immunity.

Christ on a corn dog - these people are not acting on anything factual. They are operating on 9th century tribal superstition. Let them die.

There has been a justifiable push to remove BPA from food-grade plastics. It makes for a much better plastic but it has serious long-term health problems. The industry has substituted BPS and BPFfor the last couple of years but...

From the US National Institutes of Health, Environmental Health Perspectives:

Bisphenol S and F: A Systematic Review and Comparison of the Hormonal Activity of Bisphenol A Substitutes
We identified the body of literature to date, consisting of 32 studies (25 in vitro only, and 7 in vivo. The majority of these studies examined the hormonal activities of BPS and BPF and found their potency to be in the same order of magnitude and of similar action as BPA (estrogenic, antiestrogenic, androgenic, and antiandrogenic) in vitro and in vivo. BPS also has potencies similar to that of estradiol in membrane-mediated pathways, which are important for cellular actions such as proliferation, differentiation, and death. BPS and BPF also showed other effects in vitro and in vivo, such as altered organ weights, reproductive end points, and enzyme expression.

In plain english, from Science Daily:

Exposure to common chemicals in plastics linked to childhood obesity
Bisphenol S (BPS) and bisphenol F (BPF) are manufactured chemicals used in certain kinds of plastic, in the lining of aluminum-canned food and drinks, and in thermal paper from cash-register receipts. These chemicals have been used as a replacement for bisphenol A (BPA), a well-known endocrine-disrupting chemical that harms human health by interfering with the body's hormones.

"This research is significant because exposure to these chemicals is very common in the United States. BPS and BPF use is growing because manufacturers are replacing BPA with these chemicals, so that is contributing to the frequency of exposure," said the study's corresponding author, Melanie Jacobson, Ph.D., M.P.H, of NYU School of Medicine in New York, N.Y. "Although diet and exercise are still understood to the main drivers of obesity, this research suggests that common chemical exposures may also play a role, specifically among children."

Who allowed this substitution to be done? Doesn't seem like there was much testing done...

The crazy that is the liberal

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A clickable headline but you do not need more than just that:

Transgender Woman, 26, Who Was Jailed After Dousing Her Ex-Boyfriend In Bleach Then Trying To Set Him On Fire Is Spared Prison Over Lashing Out At Police Who ‘Didn’t Use The Proper Pronouns’ To Address Her

Surprised that there are not several chapters in DSM-V about liberalism. 100% fruit loops.

Not at all "into" social media. I still keep meaning to delete my faceb**k account (have not yet) but I have not logged into it for many many months. I think it is really sad when parents use tablets as baby sitters for their kids - an easy fix now but serious problems in a couple of years.

Anyway, from the Journal of the American Medical Association:

Association of Screen Time and Depression in Adolescence
Key Points
Question What is the association of various types of screen time and depression in adolescence?

Findings In this cohort study of 3826 adolescents, a within-person association, based on repeated measures, was found between social media and television use with symptoms of depression in adolescence.

Meaning Use of social media and television in adolescents may enhance symptoms of depression and should therefore be taken into account when developing preventive methods.

Abstract
Importance Increases in screen time have been found to be associated with increases in depressive symptoms. However, longitudinal studies are lacking.

Objective To repeatedly measure the association between screen time and depression to test 3 explanatory hypotheses: displacement, upward social comparison, and reinforcing spirals.

Design, Setting, and Participants This secondary analysis used data from a randomized clinical trial assessing the 4-year efficacy of a personality-targeted drug and alcohol prevention intervention. This study assessed screen time and depression throughout 4 years, using an annual survey in a sample of adolescents who entered the seventh grade in 31 schools in the Greater Montreal area. Data were collected from September 2012 to September 2018. Analysis began and ended in December 2018.

Main Outcomes and Measures Independent variables were social media, television, video gaming, and computer use. Symptoms of depression was the outcome, measured using the Brief Symptoms Inventory. Exercise and self-esteem were assessed to test displacement and upward social comparison hypothesis.

More at the site - 3,800 samples over four years is good statistics. I know several people who are glued to their screens and it is not just adolescents that have this problem.

I am a poster child for computers - dropped out of college when the first ones became available - but I have never been "owned" by them. I turn them on. I use them. I shut them off and do something else - read a book, talk with people either in a tavern or on the radio.

Ebola on the move

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Not good - from the London Daily Mail:

Ebola outbreak in the Congo spreads to a new city where one MILLION people live in the epidemic that has killed 1,600
Ebola has spread to the Congolese city of Goma, which has a population of more than a million people, as the virus continues to devastate the region.

The victim is a pastor who had arrived in the city by bus after visiting Butembo, a town around 200miles (320km) north in the centre of the outbreak.

He had been preaching at a church where he would have touched worshippers 'including the sick', the country's health ministry said on Sunday.

Authorities have urged people to remain calm after the government said the chances of the virus spreading were 'low'.

Yikes - the pastor had come from Goma which means that not only the pastor but there is the Goma parishioner. Depending on how long the pastor was there, he could have been contagious which means that the other passengers on that bus may well be infected.

This is a very nasty plague and it is spreading.

ZDoggMD is the online name of Dr. Zubin Damania whose YouTube videos are fun and informative. In this one, he talks about the Dunning-Kruger effect. We see this a lot with our elected officials and in other bureaucratic life.

Be sure to check out his other videos - great stuff and well presented.

From Nature Biotechnology:

Engineered toxin–intein antimicrobials can selectively target and kill antibiotic-resistant bacteria in mixed populations
Targeted killing of pathogenic bacteria without harming beneficial members of host microbiota holds promise as a strategy to cure disease and limit both antimicrobial-related dysbiosis and development of antimicrobial resistance. We engineer toxins that are split by inteins and deliver them by conjugation into a mixed population of bacteria. Our toxin–intein antimicrobial is only activated in bacteria that harbor specific transcription factors. We apply our antimicrobial to specifically target and kill antibiotic-resistant Vibrio cholerae present in mixed populations. We find that 100% of antibiotic-resistant V. cholerae receiving the plasmid are killed. Escape mutants were extremely rare. We show that conjugation and specific killing of targeted bacteria occurs in the microbiota of zebrafish and crustacean larvae, which are natural hosts for Vibrio spp. Toxins split with inteins could form the basis of precision antimicrobials to target pathogens that are antibiotic resistant.

Antibiotic-resistant bacteria is getting to be a real problem. Our arsenal is shrinking. Had MRSA a number of years ago - not fun.

Just wonderful - ebola

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And it starts. From Reuters:

WHO likely to declare Ebola an international emergency: experts
The World Health Organization (WHO) should and is likely to declare an international emergency over the Ebola epidemic in the Democratic Republic of Congo that has now spread to Uganda, experts said as a WHO advisory panel met on Friday.

Nasty disease.

About time - measles

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From Buzzfeed:

New York Ended Its Religious Exemption For Vaccines After The Worst Measles Outbreaks In Decades
New York will no longer allow parents to refuse vaccinations for their children because of religious reasons after the state became the center of the worst measles outbreak in decades.

The state legislature approved a bill Thursday that will require all children attending school or daycare to receive vaccinations, unless they could not be safely vaccinated because of a medical issue. Gov. Andrew Cuomo immediately signed it into law.

“I understand freedom of religion. We all do. We respect it. I’ve heard the anti-vaxxers’ theory, but I believe both are overwhelmed by the public health risk,” Cuomo told reporters Wednesday.

The state has recorded 854 cases of measles since September in outbreaks centered in Orthodox Jewish communities in New York City and Rockland County. Health officials in both areas have called the outbreaks a crisis that risks the safety of the public — particularly infants, pregnant women, elderly people, and those with compromised immune systems, such as patients with cancer.

Great news. You can sustain a small population of unvaxinated people when the majority of people are protected - this is called herd immunity When it tips beyond the 5% to 7% threshold for measles, the disease will spread. It was eliminated in 2000 but the influx of illegal immigrants are bringing a host of old-world pests into our civil population. Waiting for Ebola to surface.

Just wonderful - Ebola

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It has made its way from the Congo to Uganda - from the World Health Organization:

Confirmation of case of ebola virus disease in Uganda
The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.

This was published yesterday - segue to today. From NBC News:

New Ebola cases in Uganda raise fears of further spread
Uganda announced two more cases of Ebola on Wednesday - a grandmother and a three-year-old boy, confirming that a deadly outbreak has spread for the first time beyond the Democratic Republic of Congo.

And more:

A five-year-old boy who had crossed into Uganda from Congo died late on Tuesday, said Uganda's health minister, Jane Ruth Aceng, and his family were now being monitored in isolation.

So that means that he was in the late stages of infection, highly contageous while not displaying any symptoms.

The two new victims were the boy's brother and grandmother, the Ugandan health ministry said. His grandfather had recently died of Ebola.

"This epidemic is in a truly frightening phase and shows no sign of stopping," said Jeremy Farrar, an infectious disease specialist and director of the Wellcome Trust global health charity, which is involved in fighting Ebola.

All it takes is for one person to fly to Mexico, get hauled across the border and bussed into a sanctuary city. Two weeks later, it explodes.

From San Antonio, Texas station KENS5:

'Parle vous français?' City searches for French speakers as hundreds of Congolese asylum-seekers head to SA
Roughly 350 migrants from the Congo are expected to arrive in San Antonio in the coming days leaving the city scrambling for French-speaking volunteers.

"We didn't get a heads up," Interim Assistant City Manager Dr. Collen Bridger told KEN 5 on Thursday.

Bridger said the Congolese migrants began to arrive in town on Tuesday. They told Migrant Resource Center workers, they traveled with a group of about 350 migrants through Ecuador to the southern border.

I still want to know who is funding this? We are talking at least $10K per person to get them from the Congo over to Ecuador and then over land, through Mexico and to our border. A bit more:

The city opened up the Frank Garrett Center to house the Congolese migrants for the weekend, but after that, they're not sure where they'll house them especially since they don't know how long some of them will be here.

"The plan was 350 of them would travel from San Antonio to Portland. When we reached out to Portland Maine they said, 'Please don't send us any more. We're already stretched way beyond our capacity," Bridger said.

"So we're working with them [the migrants] now to identify other cities throughout the United States where they can go and begin their asylum seeking process."

Yikes - Portland is close to Seattle and the rest of the Pacific Northwest - two very dense population centers with large rapid transit systems. You can be without symptoms for as long as two weeks but still be highly contagious. This is a serious health problem and nothing is being done. Every person who comes into unprotected contact with these illegals stands a chance of contracting ebola. 50% fatal even with the best of care and there are only 35 hospitals able to do this.

From the Wall Street Journal:

U.S. Measles Outbreaks Hit Highest Level in More Than 25 Years
The number of measles cases in the U.S. this year has hit the highest level in more than 25 years, the Centers for Disease Control and Prevention reported Thursday, warning that the virus may no longer be considered to have been eliminated in this country if the large outbreaks continue through the fall.

The CDC said 971 cases have been reported so far in 2019, including 91 cases in the past week and a half. The tally means in just five months the outbreaks have surpassed the previous high of 963 cases set 25 years ago, in 1994.

We had it licked and then stupid parents started believing the narrative and not vaccinating their children:

“The measles elimination goal, first announced in 1963 and accomplished in 2000, was a monumental task,” the CDC said. Before use of the vaccine became widespread, an estimated 3 to 4 million people got measles each year in the U.S., the agency said. Of them, 400 to 500 people died, and 48,000 were hospitalized.

Not vaccinating your kid is child abuse plain and simple.

It is not an opioid problem

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It is a general drug abuse/mental health problem and needs to be treated as such. From United Press International:

Opioid overdose victims die with other substances in their system
A large number of people who overdose from opioid use have other substances in their systems when they die, new findings show.

About 82 percent of deaths that involved opioids included other substances like cocaine, methamphetamine and other stimulants, according to findings published in the July issue of Drug and Alcohol Dependence.

"As a provider, these findings indicate a pressing need to address and treat not just opioid use disorder, but other substances that patients are misusing," lead author Joshua Barocas, an infectious disease physician at Boston Medical Center and study lead author, said in a news release.

Synthetic opioids like Fentanyl are cheap and easy to make so they are the product of choice for the cartels. Heroin is expensive to grow and process so the move to the synthetics was a no-brainer. Another thing to do would be to police the border and build the wall - that is where 90% of the bad shit is coming from.

I was wondering - Energy Drinks

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Could very well be bad for you - from The American Heart Association:

Energy drinks may increase risk of heart function abnormalities and blood pressure changes
Study Highlights:

    • Three to four hours after drinking 32 ounces of energy drinks, the heart’s electrical activity was abnormal compared to drinking a placebo drink.
    • Two different commercially available energy drinks produced the same results, suggesting that energy drinks as a class should be consumed with caution.

Drinking 32 ounces of an energy drink in a short timespan may increase blood pressure and the risk of electrical disturbances in the heart, which affect heart rhythm, according to a small study published in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

The study enrolled 34 healthy volunteers between the ages of 18 and 40 years. Participants were randomly assigned to drink 32 ounces of one of two commercially available caffeinated energy drinks or a placebo drink on three separate days. The drinks were consumed within a 60-minute period but no faster than one 16-ounce bottle in 30 minutes.

Researchers measured the electrical activity of the volunteers’ hearts by electrocardiogram, which records the way a heart is beating. They also recorded participant’s blood pressure. All measurements were taken at the study’s start and every 30 minutes for 4 hours after drink consumption.

Very small sample size but the results were overwhelming:

In participants who consumed either type of energy drink, researchers found that the QT interval was 6 milliseconds or 7.7 milliseconds higher at 4 hours compared to placebo drinkers. The QT interval is a measurement of the time it takes ventricles in the heart (the lower chambers) to prepare to generate a beat again. If this time interval is either too short or too long, it can cause the heart to beat abnormally. The resulting arrhythmia can be life-threatening.

The results of the study confirm previous findings and suggest that the QT interval changes are generally sustained over the four-hour monitoring period rather than being a short-lasting effect after consuming 32-ounces of an energy drink.

Researchers also found a statistically significant 4 to 5 mm Hg increase in systolic and diastolic blood pressure in participants who consumed the energy drinks.

Everyone showed the QT change and it persisted for at least four hours. I tried Red Bull a couple of times when it first came out but I did not like the way I felt. Do not use them - a Latte in the morning works much better for me...

Ebola in the news

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A collection of links from MetaFilter:

"Violent attacks are winning, and infections are unchecked."
Ebola is out of control in the Democratic Republic of the Congo, in the second-worst outbreak in history. The WHO says the national and regional risk levels are very high, and with the number of new cases increasing in recent weeks, the UN is strengthening its response. Neighbouring countries are considering using an experimental vaccine which has shown impressive results in the DRC itself, but the challenge there is dispensing it: health workers are met with mistrust, and work in constant fear of armed attack, with some having to lie about being doctors in order to treat people.

This really worries me - again, very glad to not be living in a city. You can be highly contagious for weeks before showing symptoms. All it takes is one traveler on a crowded airplane.

November 2019

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