Recently in Medicine and Health Category

Just wonderful - measles outbreak

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From The Bellingham Herald:

22 confirmed cases of measles in Clark County
VANCOUVER, WASH. -- Health officials now say they have 22 confirmed measles cases in Clark County since the start of the year.

And of course:

Clark County Public Health said Monday is also investigating three suspected cases of the infection. Officials say 19 of those infected were not immunized, while the three others are not verified to have had the vaccine.

The anti-vax movement is one of the most horrible things ever perpetrated. The poor children. The guy who started it all - Andrew Wakefield - had his license to practice medicine revoked over this.

Dietary Fiber - more good news

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Dietary Fiber is very good for you. I have been really watching my carbohydrate intake - keeping it to a minimum with the exception of the occasional past binge. Dietary Fiber counterbalances carbs so it is a good thing to have in your diet.

This from British medical journal The Lancet by way of Eureka Alert:

The Lancet: High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases
People who eat higher levels of dietary fibre and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycaemic load and low glycaemic index diets are less clear. Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet.

The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.

In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.

I currrently eat about 10 grams/day - have to figure out a way to increase that. I do eat a lot of whole grains and beans so coming from a good start.

These outbreaks keep gettting bigger and bigger - from Vox:

The Ebola outbreak in Eastern Congo is moving toward a major city. That’s not good.
At least 680 people have been infected with the Ebola virus in the Democratic Republic of Congo. It’s the second-largest Ebola outbreak in history, with 414 deaths so far, and the first Ebola outbreak in an active war zone, DRC’s eastern North Kivu and Ituri provinces.

But it could get worse: Health officials this week are concerned that Ebola appears to be spreading in the direction of Goma, a major population center in DRC.

Just this week, DRC’s health ministry confirmed four cases of the deadly virus in Kayina, a town in North Kivu, where fighting among rebel and militia groups has repeatedly interrupted the painstaking work of health workers who are responding to the outbreak.

Kayina happens to be halfway between Butembo, currently one of the outbreak’s most worrisome hotspots, and Goma, where a million people live.

Victims are contagious for about two days before the symptoms manifest. All it takes is for one victim to fly to the USA on a large airplane and all hell will break loose. We do not have the ability to deal with an outbreak of this scale.

Very scary.

Rethinking Vitamin D

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Not surprised but very interesting. From Outside Magazine (which publishes solid science articles - I like them)

Is Sunscreen the New Margarine?
These are dark days for supplements. Although they are a $30-plus billion market in the United States alone, vitamin A, vitamin C, vitamin E, selenium, beta-carotene, glucosamine, chondroitin, and fish oil have now flopped in study after study.

If there was one supplement that seemed sure to survive the rigorous tests, it was vitamin D. People with low levels of vitamin D in their blood have significantly higher rates of virtually every disease and disorder you can think of: cancer, diabetes, obesity, osteoporosis, heart attack, stroke, depression, cognitive impairment, autoimmune conditions, and more. The vitamin is required for calcium absorption and is thus essential for bone health, but as evidence mounted that lower levels of vitamin D were associated with so many diseases, health experts began suspecting that it was involved in many other biological processes as well.

A bit more:

Yet vitamin D supplementation has failed spectacularly in clinical trials. Five years ago, researchers were already warning that it showed zero benefit, and the evidence has only grown stronger. In November, one of the largest and most rigorous trials of the vitamin ever conducted—in which 25,871 participants received high doses for five years—found no impact on cancer, heart disease, or stroke.

A bit more:

These rebels argue that what made the people with high vitamin D levels so healthy was not the vitamin itself. That was just a marker. Their vitamin D levels were high because they were getting plenty of exposure to the thing that was really responsible for their good health—that big orange ball shining down from above.

A bit more:

It was already well established that rates of high blood pressure, heart disease, stroke, and overall mortality all rise the farther you get from the sunny equator, and they all rise in the darker months. Weller put two and two together and had what he calls his “eureka moment”: Could exposing skin to sunlight lower blood pressure?

Sure enough, when he exposed volunteers to the equivalent of 30 minutes of summer sunlight without sunscreen, their nitric oxide levels went up and their blood pressure went down. Because of its connection to heart disease and strokes, blood pressure is the leading cause of premature death and disease in the world, and the reduction was of a magnitude large enough to prevent millions of deaths on a global level.

And a really interesting study:

Still, Weller kept finding evidence that didn’t fit the official story. Some of the best came from Pelle Lindqvist, a senior research fellow in obstetrics and gynecology at Sweden’s Karolinska Institute, home of the Nobel Prize in Physiology or Medicine. Lindqvist tracked the sunbathing habits of nearly 30,000 women in Sweden over 20 years. Originally, he was studying blood clots, which he found occurred less frequently in women who spent more time in the sun—and less frequently during the summer. Lindqvist looked at diabetes next. Sure enough, the sun worshippers had much lower rates. Melanoma? True, the sun worshippers had a higher incidence of it—but they were eight times less likely to die from it.

So Lindqvist decided to look at overall mortality rates, and the results were shocking. Over the 20 years of the study, sun avoiders were twice as likely to die as sun worshippers.

A bit more:

Meanwhile, that big picture just keeps getting more interesting. Vitamin D now looks like the tip of the solar iceberg. Sunlight triggers the release of a number of other important compounds in the body, not only nitric oxide but also serotonin and endorphins. It reduces the risk of prostate, breast, colorectal, and pancreatic cancers. It improves circadian rhythms. It reduces inflammation and dampens autoimmune responses. It improves virtually every mental condition you can think of. And it’s free.

This is a fairly long article - I have been excerpting small chunks. It is well worth reading in full if you are concerned for your health and longevity. Fascinating stuff. Been taking modest Vitamin D supplements for years. Think I will stop now. Already spend a lot of time outdoors without wearing sunscreen so I am fine there.

From Nature Microbiology:

Characterization of a filovirus (Měnglà virus) from Rousettus bats in China
Filoviruses, especially Ebola virus (EBOV) and Marburg virus (MARV), are notoriously pathogenic and capable of causing severe haemorrhagic fever diseases in humans with high lethality. The risk of future outbreaks is exacerbated by the discovery of other bat-borne filoviruses of wide genetic diversity globally. Here we report the characterization of a phylogenetically distinct bat filovirus, named Měnglà virus (MLAV). The coding-complete genome of MLAV shares 32–54% nucleotide sequence identity with known filoviruses. Phylogenetic analysis places this new virus between EBOV and MARV, suggesting the need for a new genus taxon. Importantly, despite the low amino acid sequence identity (22–39%) of the glycoprotein with other filoviruses, MLAV is capable of using the Niemann–Pick C1 (NPC1) as entry receptor. MLAV is also replication-competent with chimeric MLAV mini-genomes containing EBOV or MARV leader and trailer sequences, indicating that these viruses are evolutionally and functionally closely related. Finally, MLAV glycoprotein-typed pseudo-types transduced cell lines derived from humans, monkeys, dogs, hamsters and bats, implying a broad species cell tropism with a high risk of interspecies spillover transmission.

No word as to just how contagious it is - Ebola is a nasty piece of work.

Yikes - Ebola in the US?

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From FOX News:

Nebraska medical facility says it's monitoring American possibly exposed to Ebola
An American who may have been exposed to the lethal disease Ebola while in the Democratic Republic of Congo arrived in Nebraska to be monitored, the medical facility revealed Saturday.

The unidentified individual had been in the country offering medical assistance at the time exposure may have occurred, according to a news release from Nebraska Medicine.

At this point, the person has not demonstrated any symptoms of the virus, but he or she "will be monitored closely,” the facility said.

Ebola is incredibly contagious and people do not show symptoms for a while (average 8-10 days). All the other airplane passengers on the flight this person took. All the people going through the airport terminal. So many other people exposed. Ebola is the stuff of nightmares.

From the Chicago ABC affiliate:

Alcohol, coffee could be key to living longer, study finds
People who drink moderate amounts of alcohol or coffee and are overweight in their 70s live longer lives, according to researchers at UC Irvine Institute for Memory Impairments and Neurological Disorders.

The researchers started a study in 2003 to look at what makes people live past 90.

They say participants in their study who drank moderate amounts of alcohol or coffee lived longer than those who abstained from either drink.

In addition, people who were overweight in their 70s lived longer than people who were normal or underweight in their 70s.

The study group's website is here: The 90+ Study

Waiting until the cheers die down. From Bloomberg:

Democrats Vow Rapid Action After Obamacare Tossed by Judge
Obamacare was struck down by a Texas federal judge in a ruling that casts uncertainty on insurance coverage for millions of U.S. residents, drawing sharp condemnation from some medical professionals and a vow for action by top Democrats.

President Donald Trump termed the ruling “a big big victory by a highly respected judge” and an alternative path to the long-time Republican goal of repeal-and-replace.

“We’ll be able to get great health care,” Trump said Saturday during an unannounced visit to Arlington National Cemetery, where a “Wreaths Across America” holiday wreath-laying event was under way. “We’ll have to sit down with the Democrats to do it, but I’m sure they want to do it also.”

We needed to do something but Obamacare was not the way to do it. Have to pass it before we can see what is in it? What was Nancy smoking so that I can avoid it. A bill that is 33,000 pages long is not an efficient way to go - for anything, let alone something as crucial as health care. All these laws do is just drive up the prices for everyone.

Pharmaceutical price fixing

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Interesting and not unexpected. I have bad skin and use a lot of products from Teva. From the San Francisco Chronicle:

Probe of generic 'cartel' grows to 300 drugs
Executives at more than a dozen generic-drug companies had a form of shorthand to describe how they conducted business, insider lingo worked out over steak dinners, cocktail receptions and rounds of golf.

The "sandbox," according to investigators, was the market for generic prescription drugs, where everyone was expected to play nice.

"Fair share" described dividing up the sales pie to ensure that each company reaped continued profits. "Trashing the market" was used when a competitor ignored these unwritten rules and sold drugs for less than agreed-upon prices.

The terminology reflected more than just the clubbiness of a powerful industry, according to authorities and several lawsuits. Officials from multiple states say these practices were central to illegal price-fixing schemes of massive proportion.

The lawsuit and related cases picked up steam last month when a federal judge ruled that more than 1 million emails, cellphone texts and other documents cited as evidence could be shared among all plaintiffs.

What started as an antitrust lawsuit brought by states over just two drugs in 2016 has exploded into an investigation of alleged price-fixing involving at least 16 companies and 300 drugs, Joseph Nielsen, an assistant attorney general and antitrust investigator in Connecticut who has been a leading force in the probe, said in an interview. His comments in an interview with The Washington Post represent the first public disclosure of the dramatically expanded scale of the investigation.

The unfolding case is rattling an industry that is portrayed in Washington as the white knight of American health care.

"This is most likely the largest cartel in the history of the United States," Nielsen said. He cited the volume of drugs in the schemes, that they took place on American soil and the "total number of companies involved, and individuals."

And a bit more:

Among the 16 companies accused are some of the biggest names in generic manufacturing: Mylan, Teva and Dr. Reddy's. Mylan denied wrongdoing in an emailed statement. Sun, Teva and Dr. Reddy's did not respond to requests for comment. In a court filing, Teva said allegations of a price-fixing conspiracy "are entirely conclusory and devoid of any facts."

Mylan does albuterol (asthma med) which has gone from 13¢ to $4.70 per pill. They also manufacture the EpiPen which has gone from $94 to over $700 for the kit of two pens.

I have zero problem with making money. Rigging the market to gouge the customer is another thing. What is especially heinous is that these are generic drugs. The cost of Research and Development has already been borne by the inventor and been recovered by their monopoly patent rights. This is just gouging plain and simple.

Pro Publica is an excellent consumer watchdog site. They are taking a look at Healthcare in the United States and not liking what they find. There have been a lot of revelations regarding the FAANG corporations harvesting consumer data and using it to place targeted advertising and also selling this data to other companies. Looks like the medical business is just as involved. (FAANG - Facebook, Apple, Amazon, Netflix and Google)

They have a couple of articles so I will link to them with clickable headlines - not surprised but really not happy:

More at the site - this is totally legal but it is really morally wrong and unethical.
Big tip 'o the hat to Bayou Renaissance Man for the link -  a great find.

This is my surprised face - Chicken Pox

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From FOX News:

Chickenpox outbreak at North Carolina school with high anti-vaccination rate leaves dozens sick
At least 36 students at a North Carolina school with a heavy anti-vaccine population have been sickened following an outbreak of the chickenpox virus, health officials said.

The outbreak, formally known as varicella, hit Asheville Waldorf School in Ashville, according to a news release from Buncombe County Health & Human Services.

That can lead to Shingles later in life. How widespread is the anti-vax lunacy?

Of the school's 152 students, 110 have not received the chickenpox vaccine, the news outlet reported.

Yikes - do not forget that the initial study linking the MMR vaccine and autism was published in the British medical journal Lancet. It was subsequently retracted and the author had his medical degree stripped away for fraud. From a purely numbers standpoint, his sample size was only 12 children - pathetic size for any statistical calculation. No connection, no correlation. Pure bunkum.

The fires themselves are being gradually contained and there is heavy rain forecast for later this week but the shelters just got really nasty really fast - from the Butte County, CA website:

Norovirus/Gastrointestinal Illness in Butte County Shelters
The Butte County Public Health Department has been using public health measures to stop a gastrointestinal illness (GI) outbreak in all monitored shelters. Since the shelters opened to house Camp Fire evacuees, 145 people have been sick with vomiting and/or diarrhea. As of Wednesday evening, there were 41 people experiencing symptoms at the following shelters:

    • Neighborhood Church: 179 total evacuees at the shelter, 21 currently experiencing illness
    • Oroville Nazarene Church: 352 total evacuees at the shelter, 10 currently experiencing illness
    • Butte County Fairgrounds: 142 total evacuees at the shelter, 9 currently experiencing illness
    • East Avenue Church: 200 total evacuees at the shelter, 1 currently experiencing illness

The number of sick people is increasing every day. Twenty-five people have been to the hospital for medical support. Staff serving the shelters have also been sick. The outbreak has been identified and confirmed by the Butte County public health laboratory to be the Norovirus which is highly contagious. Norovirus spreads through touching surfaces contaminated with the virus, close contact with someone who is infected, or eating contaminated food or drink.

You do not want to catch this disease - it passes within 48 hours or so but you are squirting from both ends and feeling pummeled all during that time. It hurts and in the confines of a contained population, it can spread like wildfire. Outbreaks are common on cruise ships.

Needless to say, prayers are going out to these poor people.

From the wonderful medical website Stat News:

Despite criticism and concerns, FDA approves a new opioid 10 times more powerful than fentanyl
In a highly controversial move, the Food and Drug Administration approved an especially powerful opioid painkiller despite criticism that the medicine could be a “danger” to public health. And in doing so, the agency addressed wider regulatory thinking for endorsing such a medicine amid nationwide angst about overdoses and deaths attributed to opioids.

The drug is called Dsuvia, which is a tablet version of an opioid marketed for intravenous delivery, but is administered under the tongue using a specially developed, single-dose applicator. These “unique features” make the medicine well-suited for the military and therefore was a priority for the Pentagon, a point that factored heavily into the decision, according to FDA Commissioner Scott Gottlieb.

Although an FDA advisory committee last month recommended approval, the agency was urged by critics not to endorse the drug because it is 10 times more powerful than fentanyl, a highly addictive opioid. Among those who opposed approval were four U.S. senators and the FDA advisory panel chair, who could not attend the meeting, but took the rare step of later writing a letter to the agency.

Despite all the nice language, this will find its way to the street in six months.

DOH! - I could have told you that

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From National Public Radio:

When Adolescents Give Up Pot, Their Cognition Quickly Improves
Marijuana, it seems, is not a performance-enhancing drug. That is, at least, not among young people, and not when the activity is learning.

A study published Tuesday in the Journal of Clinical Psychiatry finds that when adolescents stop using marijuana – even for just one week – their verbal learning and memory improves. The study contributes to growing evidence that marijuana use in adolescents is associated with reduced neurocognitive functioning.

More than 14 percent of middle and high school students reported using marijuana within the last month, finds a National Institutes of Health survey conducted in 2017. And marijuana use has increased among high schoolers over the past 10 years, according to the U.S. Department of Health & Human Services.

At the same time, the percentage of teens who believe that regular marijuana use poses a great risk to their health has dropped sharply since the mid-2000s. And, legalization of marijuana may play a part in shaping how young people think about the drug. One study noted that after 2012, when marijuana was legalized in Washington state, the number of eighth graders there that believed marijuana posed risks to their health dropped by 14 percent.

The use by youth is worrisome. People that young have no long-range planning skills - they do not think about what might happen 20-30 years later if they begin damaging habits.

Yikes - falsifying medial data

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This guy should face some serious time behind bars - from The New York Times:

Harvard Calls for Retraction of Dozens of Studies by Noted Cardiologist
A prominent cardiologist formerly at Harvard Medical School and Brigham and Women’s Hospital in Boston fabricated or falsified data in 31 published studies that should be retracted, officials at the institutions have concluded.

The cardiologist, Dr. Piero Anversa, produced research suggesting that damaged heart muscle could be regenerated with stem cells, a type of cell that can transform itself into a variety of other cells.

Although other laboratories could not reproduce his findings, the work led to the formation of start-up companies to develop new treatments for heart attacks and stroke, and inspired a clinical trial funded by the National Institutes of Health.

“A couple of papers may be alarming, but 31 additional papers in question is almost unheard-of,” said Benoit Bruneau, associate director of cardiovascular research at the Gladstone Institutes in San Francisco. “It is a lab’s almost entire body of work, and therefore almost an entire field of research, put into question.”

These are people's lives he was messing with. Not like he was just fudging some tree-ring data or something. Odd that his grad students didn't pipe up.

Very cool - President Trump

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He signed a great piece of legislation - from CNBC:

Trump signs ‘right-to-try’ allowing gravely ill patients to bypass FDA for experimental medicines
President Donald Trump signed the controversial “right-to-try” bill into law on Wednesday, which bypasses drug regulators to give gravely ill patients access to experimental medicines.

The legislation allows patients with life-threatening conditions to ask drugmakers for medicines that have cleared some testing but still haven’t been approved by the Food and Drug Administration. Previously, patients would need to ask the FDA for access to experimental treatments.

Trump and Vice President Mike Pence had been major supporters of passing the measure, which proponents say gives patients hope they would not otherwise have. Last week the House of Representatives approved the bill, the same version the Senate passed in August.

Wonderful - if someone is at the end of their rope, they deserve to be able to try experimental medication. I certainly would want this option.

Great news from ABC News:

FDA approves first generic EpiPen
The U.S. Food and Drug Administration has approved the first generic version of the EpiPen and EpiPen Jr auto injector for the emergency treatment of allergic reactions.

The approval is part of the FDA's "longstanding commitment" to providing access to low-cost generic alternatives, FDA Commissioner Scott Gottlieb said in a statement.

"This approval means patients living with severe allergies who require constant access to life-saving epinephrine should have a lower-cost option, as well as another approved product to help protect against potential drug shortages," the commissioner said.

It is unclear how much the generic product -- manufactured by Teva Pharmaceuticals -- will cost. In August 2016, Mylan Pharmaceuticals was criticized for raising the price of a two-pack of EpiPens to $600.

The price of two EpiPens was about $100 in 2009. The brand name version is by far the most popular epinephrine auto-injector on the market.

It will be interesting to follow Mylan's stock prices in the next day or two. A 50ml bottle of Veterinary Epinephrine sells for $24. A standard adult EpiPen dispenses 0.3ml so your $24 will buy about  166 doses at just under 15¢ per dose. The Veterinary grades are just as good as human doses. Someone with a prized racehorse or bull is not going to be putting crap into their animal.

Laser pointers - dangerous

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A cautionary tale. Laser pointers are NOT toys. From the New England Journal of Medicine:

Macular Hole from a Laser Pointer

20180627-eye.jpg

A 9-year-old boy was brought by his parents to our ophthalmology clinic for evaluation of decreased vision in his left eye. Visual acuity in the left eye was 20/100, as compared with 20/20 in the right eye. Funduscopic examination of the left eye revealed a large macular hole with a hypopigmented atrophic area inferiorly (Panel A). Optical coherence tomography confirmed the full-thickness macular hole. Fundus autofluorescence imaging highlighted two spots inferior to the macular hole that corresponded to additional areas of injury (Panel B). The child reported playing with a green laser pointer and repeatedly gazing into the laser beam. Although many national health agencies have warned about the potential eye hazards associated with handheld laser pointers, and the sale of devices with greater than 1 mW of power is restricted in many areas, more powerful laser devices remain accessible, especially through the Internet. Because of the large diameter of the macular hole and the accompanying atrophy in this patient, we favored conservative management rather than surgery. The patient’s vision has remained unchanged during 18 months of follow-up.

Emphasis mine - the damage is permanent. Barring some new development in medicine, the kid is going to have bad vision for the rest of his life. I own some lasers including one very powerful one but they are not used as toys.

Not surprised - the place certainly has its share of idiots. From BoingBoing:

Which American cities have lowest herd immunity due to anti-vaxxers?
Parents of Seattle, Spokane, Portland, Phoenix, Salt Lake City, Provo, Houston, Fort Worth, Austin, Plano, Detroit, Troy, Warren, Kansas City and Pittsburgh: beware.

According to a peer reviewed study of kindergartners whose parents had opted out of vaccination, these cities are the places with the lowest herd immunity to preventable, debilitating (and potentially fatal) diseases.

Vaccinations are not 100% effective, and some people can't be vaccinated due to illness. The reason vaccination keeps our children of dying or being maimed for life by the diseases that burned through generation after generation is "herd immunity": if all the kids get immunized, then the disease can't find enough people to infect and spread.

The parents need a good whack with a clue-bat - vaccines are not harmful. The guy who first claimed a link between vaccines and autism was in the pay of an insurance company and he had is license to practice medicine revoked. His "paper" was based on a sample size of 12.

Homeopathy in the news

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One word for it - BUNK!  From Ars Technica:

Doctor slammed by med board for selling $5 homeopathic sound waves for Ebola
The California medical board is threatening to revoke the license of Dr. William Edwin Gray III for selling homeopathic sound files over the Internet that he claims—without evidence or reason—can cure a variety of ailments, including life-threatening infections such as Ebola, SARS, swine flu, malaria, typhoid, and cholera.

In an accusation filed with the state (PDF), the medical board writes that Gray is guilty of gross negligence and requested a hearing in which the board would decide whether to possibly revoke or suspend his license.

In an interview with the Los Angeles Times, Gray said he had decided not to contest the board’s allegations, saying it would cost too much money to fight. He added: “Frankly, I think we'd lose anyway.”

Classic case of why this form of treatment should be regulated a lot more tightly - regulated into oblivion. These fools are paying this "doctor" for sounds to cure an infection instead of seeking qualified medical help. Their infections will only get worse until they finally go into sepsis and have to spend expensive time in the hospital. Could have been cured with a simple Doctor's visit and a prescription.

Yikes - Nipah Virus

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Hope it doesn't spread - an excerpt from this article at the Associated Press:

...At least 10 people have died of Nipah since an outbreak began earlier this month in Kerala, health officials say, and two more people are in critical condition. There is no vaccine for the virus, which can cause raging fevers, convulsions and vomiting, and kills up to 75 percent of people who come down with it. The only treatment is supportive care to keep patients comfortable...

A fairly recent development:

Nipah was first identified during a late 1990s outbreak in Malaysia. Later outbreaks have occurred in Bangladesh and India.

An explanation of his plan from David Catron writing at The American Spectator:

Trump’s Excellent Plan to Reduce Drug Prices
Last Friday, President Trump caused consternation among Democrats and their media allies by introducing an eminently sensible blueprint for reducing drug prices. The 50-point “American Patients First” plan addresses four broad challenges: High list prices for drugs, government programs overpaying for drugs, rising out-of-pocket costs for consumers, and foreign governments free-riding off American innovation. The blueprint relies on free market competition and private-sector negotiation rather than regulatory coercion and price controls. And, assuming his plan works as designed, President Trump will have succeeded where his predecessor proved utterly impotent. Consequently, the plan drew immediate criticism from the left.

The most common liberal complaint about the President’s blueprint involves his decision, as the New York Times laments, “not to have the federal government directly negotiate lower drug prices for Medicare.” Trump alarmed conservatives during his presidential campaign by flirting with that exceptionally bad policy idea, but sensibly abandoned it when working with his advisors to formulate a concrete plan. The term “negotiate” has no real meaning in the context of federal dealings with the drug industry. It is nothing more than a pseudonym for price controls. Allowing the government to “negotiate” with drug companies for lower Medicare drug prices would inevitably create shortages of badly needed pharmaceuticals.

Much more at the site - President Trump's plan seems to be effective and well thought out.

Reforming Medicare

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Excellent news - from PBS:

Medicare to require hospitals to post prices online
Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday.

Let the informed customer make their own decisions. A bit more:

Seema Verma, head of the Centers for Medicare and Medicaid Services, said the new requirement for online prices reflects the Trump administration’s ongoing efforts to encourage patients to become better-educated decision makers in their own care.

“We are just beginning on price transparency,” said Verma. “We know that hospitals have this information and we’re asking them to post what they have online.”

Good - this will encourage clinics and hospitals to specialize and this will drive costs down. Clinics that specialize offer better service and cheaper prices. Eye Surgery, Hernias, etc...

Just wonderful - the Flu, round two

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From United Press International:

Second wave of flu season hits U.S.
The winter season ended last month but that doesn't mean the danger of getting the flu is over, even though it is springtime.

Rather than getting a strain of Influenza A, you have a greater chance of getting Influenza B. They carry roughly the same level of severity, having a similar cough, runny or stuffy nose, itchy or watery eyes, sore throat, fatigue and low fever.

They quote data from the Centers for Disease Control:

In the latest results, the CDC said the breakdown was 39.6 percent for Influenza A and 60.3 percent for Influenza B. Among 21,823 specimens tested, 15.4 percent were positive.

"The percentage of respiratory specimens testing positive for influenza in clinical laboratories remains elevated," the CDC said in the report.

A very bad year and it is just getting worse.

Homeopathy explained

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Excellent animation on what it is, why it took off when it did and why it is bunk.

Interesting story along the lines of British sailors contracting scurvy on long voyages. From Atlas Obscura:

How Killer Rice Crippled Tokyo and the Japanese Navy
IN 1877, JAPAN’S MEIJI EMPEROR watched his aunt, the princess Kazu, die of a common malady: kakke. If her condition was typical, her legs would have swollen, and her speech slowed. Numbness and paralysis might have come next, along with twitching and vomiting. Death often resulted from heart failure.

The emperor had suffered from this same ailment, on-and-off, his whole life. In response, he poured money into research on the illness. It was a matter of survival: for the emperor, his family, and Japan’s ruling class. While most diseases ravage the poor and vulnerable, kakke afflicted the wealthy and powerful, especially city dwellers. This curious fact gave kakke its other name: Edo wazurai, the affliction of Edo (Edo being the old name for Tokyo). But for centuries, the culprit of kakke went unnoticed: fine, polished, white rice.

Gleaming white rice was a status symbol—it was expensive and laborious to husk, hull, polish, and wash. In Japan, the poor ate brown rice, or other carbohydrates such as sweet potatoes or barley. The rich ate polished white rice, often to the exclusion of other foods.

This was a problem. Removing the outer layers of a grain of rice also removes one vital nutrient: thiamine, or vitamin B-1. Without thiamine, animals and humans develop kakke, now known in English as beriberi. But for too long, the cause of the condition remained unknown.

An interesting story - much more at the site. The Doctor who discovered the actual cause became a member of the Royal Family and was named Doctor Barley.

Great news from the CDC

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From United Press International:

Doctors visits for the flu down for second week in a row, CDC says
If the latest government data on doctor visits is any indication, a brutal flu season may be starting to wane.

For the second week in a row, there was a drop in doctor visits for flu-like illness in the United States. And the latest drop was more pronounced than the one before, the U.S. Centers for Disease Control and Prevention reported Friday.

As of Feb. 17, the CDC said that 6.4 percent of patient visits to doctors were for the flu, down from 7.5 percent of patient visits the week before.

But the news was not all good, and it doesn't look like the flu season is over yet.

Flu-linked hospitalization rates continued to rise -- from 67.9 per 100,000 people for the week ending Feb. 10, to 74.5 per 100,000 people for the week ending Feb. 17, the findings showed.

Pediatric flu deaths are also still increasing, with 97 children now dead from the flu so far this season, according to the CDC.

CDC officials have pinpointed one reason why this flu season has been so brutal: the flu vaccine is only 25 percent effective against H3N2 influenza, which is causing most flu cases this year.

This was a bad season - lost a dear friend to the flu. He was only 52 years old.

News you can use - longevity

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From the UC Irvine Institute for Memory Impairments and Neurological Disorders (UCI MIND)

The 90+ Study
The 90+ Study was initiated in 2003 to study the oldest-old, the fastest growing age group in the United States. The 90+ Study is one of the largest studies of the oldest-old in the world. More than 1,600 people have enrolled. Because little is known about people who achieve this milestone, the remarkable increase in the number of oldest-old presents a public health priority to promote the quality as well as the quantity of life.

The 90+ Study participants
Initial participants in The 90+ Study were once members of The Leisure World Cohort Study (LWCS), which was started in 1981. The LWCS mailed surveys to every resident of Leisure World, a large retirement community in Orange County, California (now incorporated as the city of Laguna Woods). Using the 14,000 subjects from the LWCS, researchers from The 90+ Study were able to ask, What allows people to live to age 90 and beyond?

Some of their findings are interesting:

Major findings
Researchers from The 90+ Study have published many scientific papers in premier journals. Some of the major findings are:

    • People who drank moderate amounts of alcohol or coffee lived longer than those who abstained.
    • People who were overweight in their 70s lived longer than normal or underweight people did.

I'm down with that - love a glass of two of red wine in the evening and maybe I'll ease up on getting that last ten pounds off my bodyweight...

Just fscking wonderful

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From the The Government of the Hong Kong Special Administrative Region:

CHP notified of human case of avian influenza A (H7N4) in Mainland
The Centre for Health Protection (CHP) of the Department of Health (DH) today (February 14) received notification from the National Health and Family Planning Commission (NHFPC) that a human case of avian influenza A (H7N4) was confirmed from February 10 to 14, and reminded the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the NHFPC, this is the first case of human infection with avian influenza A (H7N4) in the world. The case involved a 68-year-old female patient living in Liyang in Changzhou of Jiangsu Province who developed symptoms on December 25, 2017. She was admitted to hospital for medical treatment on January 1 and was discharged on January 22. She had contact with live poultry before the onset of symptoms. All her close contacts did not have any symptoms during the medical surveillance period.

According to a report from the Chinese Center for Disease Control and Prevention, upon analysis, the genes of the virus were determined to be of avian origin.

"All novel influenza A infections, including H7N4, are notifiable infectious diseases in Hong Kong," the spokesman for the CHP said.

"Based on the seasonal pattern, the activity of avian influenza viruses is expected to be higher in winter. Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry," the spokesman reminded.

Just what we need - a new strain of flu to watch out for... Lost a dear friend to it earlier this year. RIP Kurt.

Faster please - vaccine

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From The Wall Street Journal:

Experimental Drug Promises to Kill the Flu Virus in a Day
As Americans suffer through the worst influenza outbreak in almost a decade, a Japanese drugmaker says it has developed a pill that can kill the virus within a day. But even if the experimental drug lives up to the claim, it likely won’t be available in the U.S. until next year at the earliest.

A late-stage trial on Japanese and American flu patients found that for the people who took the Shionogi & Co. compound, the median time taken to wipe out the virus was 24 hours. That is much quicker than any other flu drug on the market, including Roche AG’s Tamiflu, which the trial showed took three times longer to achieve the same result. Quickly killing the virus could reduce its contagious effects, Shionogi said.

Also, Shionogi’s experimental drug requires only a single dose, while patients need to take two doses of Tamiflu a day, for five days.

Both Shionogi’s compound and Tamiflu take roughly the same amount of time to entirely contain flu symptoms, but Shionogi says its compound provides immediate relief faster.

Scientists at the Japanese company leveraged their work on a blockbuster anti-HIV drug to create the compound, which works differently from existing flu medicines. It blocks the flu virus from hijacking human cellular machinery, Chief Executive Isao Teshirogi said. Switzerland’s Roche has acquired the international license to distribute Shionogi’s experimental drug.

Not available in the USA as yet but great news nonetheless.

Not a good thing to do for many reasons - from The Atlantic:

The Startling Link Between Sugar and Alzheimer's
In recent years, Alzheimer’s disease has occasionally been referred to as “type 3” diabetes, though that moniker doesn’t make much sense. After all, though they share a problem with insulin, type 1 diabetes is an autoimmune disease, and type 2 diabetes is a chronic disease caused by diet. Instead of another type of diabetes, it’s increasingly looking like Alzheimer’s is another potential side effect of a sugary, Western-style diet.

And the upshot:

A longitudinal study, published Thursday in the journal Diabetologia, followed 5,189 people over 10 years and found that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugar—whether or not their blood-sugar level technically made them diabetic. In other words, the higher the blood sugar, the faster the cognitive decline.

Much more at the site. Trish and I are both eating reduced carb diets and are feeling a lot better for it. Trying to stay under 30 grams/day seems to be the real sweet-spot.

The Flu - three articles

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Just wonderful - flu season

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From Time magazine:

The Flu May Be Spread Just By Breathing, Study Says
For years, you’ve been told to cover your mouth when you cough or sneeze, especially when you’re sick. But a new study finds that it may be possible to spread the flu just by breathing—no coughing or sneezing required.

“People shed a lot of virus all the time, even when they don’t cough,” says Donald Milton, author of the study published in PNAS and a professor of environmental health at the University of Maryland School of Public Health. “As a result, it’s important to realize you can be infectious at any time.”

During the 2012-2013 flu season, Milton and his colleagues studied 142 University of Maryland students with active influenza, attempting to track how and when they expelled virus particles. During a total of 218 30-minute observation sessions, the students sat in a machine that could measure the droplets they shed while breathing, talking, coughing or sneezing. While coughing did expel some flu particles, the researchers discovered that almost half of the aerosol particles collected in the absence of coughing also contained flu matter, suggesting that simply inhaling germ-ridden air could get you sick.

Joyful news - especially since I am summoned for jury duty this coming week. I'll see how I feel and then give them a call on Monday morning to see if I can get out of it.

Scientific American has more:

Warning: A Flu Pandemic Today Could Kill As Many As 80 Million People
If the 1918 flu pandemic broke out today, it would likely kill at least 62 million people, or slightly more than the number that die in a single year from all other causes combined. The estimate stems from a new tally of flu deaths from 1918 to 1920 in different countries, which varied widely. Based on their findings, authors of the study say that 96 percent of the victims of a present-day pandemic would be in the developing world.

The report comes on the heels of fears that the H5N1 flu virus currently circulating among birds in Southeast Asia and Africa may be the precursor to a deadly global outbreak or pandemic. To gauge the potential threat, researchers reviewed the toll of the most severe previous case, which occurred in 1918 when a flu swept the world, claiming at least 20 million lives. "It's the benchmark against which we worry about future flu pandemics," says population health researcher Christopher Murray of the Harvard Initiative for Global Health.

Just great - we have another - and worse strain - waiting to cross over to humans.

News you can use - sneezing

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Makes perfect sense - I always use the inside of my elbow to stifle mine. From the UK Guardian:

Achoo! Why letting out an explosive sneeze is safer than stifling it
In a season where colds are rife, holding your nose and closing your mouth might seem like a considerate alternative to an explosive “Achoo!”. But doctors have warned of the dangers of such a move after a man was found to have ruptured the back of his throat when attempting to stifle a sneeze.

Medics say the incident, which they detail in the British Medical Journal Case Reports, came to light when a 34-year old man arrived in A&E with a change to his voice, a swollen neck, pain when swallowing and a popping sensation in his neck after he pinched his nose to contain an expulsion.

The team took scans of the man’s neck to investigate and discovered bubbles of air in the tissues at the back of the throat, and in the neck from the base of the skull to halfway down the man’s back. 

That, they say, suggested a tear had occurred at the back of the throat as a result of increased pressure from the stifled sneeze, leading to air collecting in his soft tissues. 

“For reasons of propriety and etiquette, one sometimes stops a sneeze. However on unfortunate rare occasions it might lead to potentially serious complications,” said Dr Sudip Das, co-author of the report from the University Hospitals of Leicester NHS Trust.

Propriety and etiquette be damned - use your elbow or a hankerchief. Do not spread it around but also, First Do No Harm.

The 2018 flu season

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It is getting worse - from the medical blog STAT:

Flu season is shaping up as one of the worst in years, officials say
The entire continental United States is experiencing widespread flu right now, the first time in the 13 years of the current tracking system that that has happened, according to the Centers for Disease Control and Prevention.

Officials said that this flu season is shaping up to be one of the worst in recent years.

The rate of flu hospitalizations — the number of people hospitalized with flu per 100,000 — nearly doubled last week compared with the previous week. Last week it was 22.7 per 100,000 people; the week before that rate was 13.7.

I lost a dear friend who was only 52 and in great health. His memorial service was less than a week ago.

The Flu - some advice

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Some great advice from Aesop - an Emergency Room Doctor and blogger: RACONTEUR REPORT

PSA: Flu 2018 - Updated
Thirty-six states report influenza activity as "widespread". That would be all the brown ones in the CDC map, above.
Nota bene the number of states with no influenza activity this year is "zero".
The CDC has identified 648 different active influenza virus sub-types this year, to date.

Anecdotally, where I am, approximately 4 out of every 6 persons swabbed for flu for URIs in the ER are coming back with positive results. (My patient pop. average age is markedly older than most of the county.) Just the other night, I admitted three different people over the age of 60 to the hospital, for flu which had debilitated the patients, who subsequently acquired pneumonia as well, the latter affliction being well capable of killing you deader than canned tuna untreated. Breathing underwater has that effect on people.

Flu symptoms are fever, sore throat, cough, body aches, fatigue, muscle aches, and possibly nausea/vomiting.

If you have a fever, you are infectious to others.
If you're treating a fever with Tylenol/ibuprofen/etc., you are infectious to others.
If either of those apply, keep your dumb ass at home, until you're over it. Period.
Anything else deserves a crotch kick.
(A co-worker was patient Zero at my ER, and another colleague gifted me with the crud for two weeks, followed by another four weeks of dreadfully lingering cough. This year's cold has a horrendous URI "tail" of hacking cough that just hangs on.)

Treatment
1) Stay the f*** home. Until it's ALL gone.
2) Get plenty of sleep and rest, but get up and move around, if only to use the bathroom, make a sandwich, pee, poop, or puke. Lying immobile increases your odds for bigger problems.
3) acetaminophen/ibuprofen for fever control and aches.
4) Water, water, water. Anything less than an hourly pee trip, and your pee isn't clear and mostly colorless, you're probably not drinking nearly enough water.
5) Soups, Gatorade, Jell-O, popsicles, etc. are also water.
6) And more water.
7) Caffeine and alcohol are diuretics, and dehydrate you more, and faster. Avoid both.
8) Take any number of "snivel" meds to mitigate symptoms, loosen congestion and mucus, suppress cough, etc.
9) If you find homeopathic voodoo meds that help, use them. They likely can't hurt.
10) Stay the f*** home. Until it's ALL gone.

This year's flu outbreak is in addition to normal viral illnesses (a "cold"), which are similarly rampant, especially from Thanksgiving to Easter, when intergenerational family members gather to share diseases and finger-bang everything they touch and cough on, for everyone from snot-monkey age to grandma and grandpa.

Prevention
1) Keep yourself and your little bastards home when they're sick.
2) Wash your hands.
3) Wash your hands before you eat, drink, or touch your face.
4) Wash your hands.
5) Wash your hands after you poop, pee, cough, or touch anything else in the entire world.
6) Wash your hands.
7) Cover your mouth when you cough.
8) Keep at home all your kids too young and stupid to learn to cover their mouths when they cough.
9) Carry personal disinfectant/sanitizer, and use it vigorously and frequently.
10) Understand that if I catch you or your kids out and about in public, coughing, sneezing, and dribbling your snot-mitts on everything, I may replace or augment my personal disinfectant with OC spray, and I will use it on you. If you can still identify me afterwards, and I'm still in the same area 30 minutes later when your vision clears up, I may express feigned/mock regret over my "mistake" in grabbing the wrong spritzer and using it on you.
11) Or, not.

NB: OC Spray is Oleoresin capsicum - pepper spray. - good words of wisdom...

Three headlines - romaine lettuce

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From Canada's Public Health AgencyOutbreak of E. coli infections linked to romaine lettuce

From the USA's Centers for Disease ControlCDC Investigating Multistate Outbreak of E. coli O157:H7 Infections

From Consumer Reports magazine: Avoid Romaine Lettuce for Now, Consumer Reports Says

Things are pointing to a Canadian source - 59 people ill and two fatalities - washing the lettuce does nothing. Time to switch to iceberg or butter...

The Flu in England

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From the UK Telegraph:

NHS hospitals ordered to cancel all routine operations in January as flu spike and bed shortages lead to A&E crisis
Every hospital in the country has been ordered to cancel all non-urgent surgery until at least February in an unprecedented step by NHS officials.

The instructions on Tuesday night - which will see result in around 50,000 operations being axed - followed claims by senior doctors that patients were being treated in “third world” conditions, as hospital chief executives warned of the worst winter crisis for three decades.

Hospitals are reporting growing chaos, with a spike in winter flu leaving frail patients facing 12-hour waits, and some units running out of corridor space.

The joys of socialized medicine - the system creaks along until something like this epidemic happens and then it collapses. There is no resiliency built into the system. That costs money and they do not have any.

Bad all over - flu

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Kurt died from the flu and he was in really good health. It is bad all around the USA - from the Los Angeles Times:

Severe flu brings medicine shortages, packed ERs and a rising death toll in California
So many people have fallen sick with influenza in California that pharmacies have run out of flu medicines, emergency rooms are packed, and the death toll is rising higher than in previous years.

Health officials said Friday that 27 people younger than 65 have died of the flu in California since October, compared with three at the same time last year. Nationwide and in California, flu activity spiked sharply in late December and continues to grow.

The emergency room at UCLA Medical Center in Santa Monica typically treats about 140 patients a day, but at least one day this week had more than 200 patients — mostly because of the flu, said the ER’s medical director, Dr. Wally Ghurabi.

Wash your hands frequently and stay away from crowds. This season is a bad one. There is a bit of good news from the Centers for Disease Control:

Flu vaccines have been updated to better match circulating viruses

Good news - the initial vaccines didn't cover this year's prevailing strain.

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