Wednesday, June 20, 2018

I Pad neck

from science daily: the latest occupation disease.

"iPad neck," sometimes called "tablet neck," is usually associated with sitting without back support, such as on a bench or on the ground, or slumping over the tablet while it rests in the user's lap.
Other postures significantly associated with pain included using tablets while lying on the side or back.
The condition is more prevalent among young adults than older adults. Women were 2.059 times more likely to experience musculoskeletal symptoms during iPad use than men. Those with a history of neck and shoulder pain reported experiencing more neck and shoulder symptoms during tablet computer use.

The Gosport scandal

My last rant might have sounded paranoid, but the problem is that very sick and dying patients can be "offed" if the doc is overworked (as happened with the deliberate Euthanizing of patients during Katrina) or just because.

The "protocol" for "terminal sedation" has been misued to kill people: but the protocol is actually guidelines to relieve severe pain: the problem is the physicians etc. want the patient to be dead.

( I might add: I was once accused of overdosing a dying patient who was moaning in pain and I had ordered doses of narcotics to be given until he was pain free...there is a small line here, but I should note that several patients who were given huge doses of sedation actually got better once the pain was relieved and the cause of their pain or infection was treated).

this would be kept quiet in the USA, but the UK papers have this about the Gosport scandal:



In 1991, Anita Tubbritt, a staff nurse working nights on an elderly ward at the Gosport War Memorial Hospital in Hampshire, asked to have a quiet word with her local union representative.
Mrs Tubbritt, along with a number of her colleagues, had become concerned over the way medical heroin was being administered to patients, who in their opinion did not require it.
On Wednesday, more than 27 years later, those concerns were finally acknowledged, when an independent inquiry concluded that more than 650 patients’ lives could have been prematurely ended by the “institutionalised regime” of prescribing and administering opioids without medical justification. In arriving at that conclusion, the Right...

that one is behind a pay wall, but here is the UKGuardian article about the scandal.

The independent report found that Dr Jane Barton, a GP working as a clinical assistant at the hospital, routinely overprescribed drugs for her patients in the 1990s.
consultants were aware of her actions but did not intervene. Nurses and pharmacists collaborated in administering high levels of drugs they would have known were not always appropriate.
Some senior nurses in 1991 tried to raise the alarm over using diamorphine – the medical name for heroin – for patients who were not in pain, administered through a syringe-driver pumping out doses that were not adjusted to each patient’s needs.

the whole issue of "assisted suicide" will not only encourage the depressed to think suicide is rational, but it will change the ethics of the medical profession to think that killing is okay, and hey, they will do it to "help" people.

“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love,” Jones said in the introduction to the report.
 “It represents a major crisis when you begin to doubt that the treatment they are being given is in their best interests. It further shatters your confidence when you summon up the courage to complain and then sense that you are being treated as some sort of ‘troublemaker’.

Right now, there is a level of mistrust by minorities against doctors, and this is going to make it a lot harder to practice medicine .

Materialism kills

Social Causes of Rational Suicide in Older Adults,” 
 Neoliberalism changed human relationships within society from a civil sphere that enshrined a commitment to social solidarity and collaboration among fellow citizens to that of a universal market where human beings are pawns in calculations of profits and losses. Rather than emancipation and freedom, the markets created atomization and loneliness... 
The declaration of aging as a disease, pathologizes aging as an entity to be shunned and avoided, in oneself and others.
and who benefits? well, it will cut medical bills. (/s)

 . .Clinicians should also feel empowered to speak up against agism and recognize it in themselves. Acceptance of the idea of rational suicide in older adults is in itself ageist. It implicitly endorses a view that losses associated with aging result in a life that is not worth living.
from the Journal of the American Geriatrics Society.
 via National Review.

it goes beyond this of course: you know, I have always worked with the poor, (mostly AmerIndians but also rural white and Hispanics). This is not a problem with them, because they still hold the idea of family and respect their elders as being a source of wisdom. And despite what outsiders see as "family dysfunction", the family is still there as the first line to help each other.

or as one of our caregivers told a neurologists who pressured the family to remove the feeding tube from an alert but brain damaged relative: That's the difference between you white folks and us Indians: we respect our elder.

But the real danger is something no one wanst to admit: That it is minorities who are most vulnerable to be pressured into "non treatment" decisions, or being the victim of removing "futile care" or even the victim of a doctor who "gives them morphine haha" instead of treating their stroke.

(I refer to a visiting doctor who suggested we do this to one of our admissions with a stroke: the attending merely said "we don't do things like that here", but the visitor was a resident from Baltimore, and I wonder how many black old ladies got "morphine, ha ha" without their families knowing what he was doing).

traditional societies and most religions see the elderly as a source of experience and wisdom, and my Objibwe patients put it: suffering as part of the road that the Great spirit wants them to travel, to be endured bravely (This is not just Amerindian: my geeky brothers said the same thing about his cancer).

Indeed, evolutionary scientists now recognize that grandparents were important to the evolution of humanity: because they help raise grandchildren, and they often teach from the wisdom of experience.

ah yes: The subcontext of pushing suicide is the expense of caring for the senile... but hints that this would also treat the handicapped who are now supposedly more common than they were in the past. But were they? This argument goes back to the days of Plato, and anyone living in "S***hole countries" know that a lot of families have one or two of these people being care for in their homes.

but of course, in the modern world, if you are busy caring for Grandmom (or your autistic son, or even your normal 2 year old) it makes it hard for you to be productive and work full time.

But the real underlying reason for this is that the western culture that stresses autonomy and success defines life in money terms. If you aren't successful, you are a failure. And this is one reason that a lot of folks are taking drugs (legal and illegal), to treat their internal angst of a meaningless life.

in contrast, we prevatican II catholics saw suffering to be endured and offered up as a prayer. Indeed, in traditional societies there is the idea that everything that happens to a person is for a reason: we may not know the reason, and like Job we may be angry at God for letting us suffer, but nevertheless there is a reason for us to live despite weakness and needing help.



Tuesday, June 19, 2018

Mosquito control can be done (but it's hard work)

I keep running across articles warning of all these mosquito related disease that are going to kill folks thanks to global warming.

And folks who never heard of the Yellow Fever epidemic that decimated Philadelphia in 1793 think this is a new problem.

no it's not. Malaria, not immorality, probably did more to weaken ancient Rome (not to mention various plagues).

So what can we do to stop Dengue/yellow fever/ malaria/zika virus/ etc. etc.?

uh, maybe kill the mosquitoes?



this has been known for awhile: one reason that the Panama canal was built was because they figured out what was killing all those workmen, and stopped it.

wikipedia article on health measures during the construction of the canal: they note that when the French tried to build a canal, 20 thousand workmen died, so there was a lot of pressure on the US not to let this happen.

The sanitation work included clearing land and establishing quarantine facilities. The most ambitious part of the sanitation program, though, was undoubtedly the effort to eradicate the mosquitoes Aedes aegyptiand Anopheles, the carriers of yellow fever and malaria, respectively, from the canal zone. There was initially considerable resistance to this program, as the "mosquito theory" was still considered controversial and unproven. However, with the support of chief engineer John Frank Stevens, who took over the post on July 26, 1905, Gorgas was finally able to put his ideas into action.
Gorgas divided Panama into 11 districts, and Colón, Panama, into four. In each district, inspectors searched houses and buildings for mosquito larvae. If larvae were found, carpenters were dispatched to the building, and work was done to eliminate objects or places where stagnant water could collect.
Mosquitoes lay their eggs on the surface of standing water, and when the larvae hatch, they live just below the surface, breathing through a siphon in their tails. Therefore, by eliminating standing water where possible and by spreading oil on the surface of any remaining pools, the larvae could be destroyed.
Gorgas also had domestic water systems installed in urban areas around the Canal Zone. These systems eliminated the need for rainwater collection, which had been collected in barrels and was a place for mosquitoes to breed. The United States government also provided $20 million to give workers free medical care and burial services. Gorgas's sanitation department also provided about one ton of prophylactic quinine each year to people in the Canal Zone to combat malaria.[3]
Gorgas organized a major program to drain and fill swamps and wetlands around the Canal Zone. Many miles of ditches were dug, and grass and brush were cut back over wide areas. Oiling was used in a variety of means: workers with spray tanks were sent to spray oil on standing pools, and smaller streams were tackled by placing a dripping oil can over the waterway, which created a film of oil over each still patch of water in the stream. About 700,000 gallons of oil and 124,000 gallons of larvicide were used on the project.
Gorgas also took another step in his efforts to eradicate mosquitoes in Panama: fumigation. He fumigated the residences of Panamanians who had been confirmed to have contracted yellow fever. "Pans of sulfur or pyrethrum were then placed in the rooms, the right quantity of powder was weighed out (two pounds per thousand cubic feet), and the pans were sprinkled with wood-alcohol and set alight" (Cameron 132). When the effectiveness of this procedure was realized, fumigation was extended to all of Panama. Within a year of Stevens's appointment, every building in Panama had been fumigated, using up the entire US supply of sulfur and pyrethrum. In 1906, only one case of yellow fever was reported, and until the end of the Panama Canal's construction, there were zero.



here's a silent film about how to do it from the 1920's
.


of course, nowadays, using insecticides will get the greens hysterical (look at all the African kids who died when DDT was banned to stop birds from dying).

And that part about draining the swamp? Notice swamps are now called "wetlands" and are protected, again for "Green" reasons.

---------------

here in the Philippines, we have a lot of Dengue fever, and the search to eliminate it via vaccine was a failure when they discovered the vaccine led to fewer cases, but more complicated cases.

the actual rate here is down: but since mild cases never see a doctor (poor people can't afford medical care) and since other fevers mimic mild dengue, the case reports are not always accurate: The facgt that the numbers are down is a good sign however, since reporting is going up (and poor people are richer now so can be seen by the doctors).

But the good news? At least in our city, the mayor is putting in sewer pipes to drain the standing water in the streets, and the drains will be covered instead of open ditches.

Thursday, June 14, 2018

we docs often hold "journal clubs" to dissect published articles, and often found flaws in the research: what is worse, the press often hyped these articles, even preliminary data that didn't prove anything.

My favorite was the "Statin" studies, which lowered your rate of heart attack, but not your death rate, since the death rate from cancer (in one study) or violence/suicide/homicide (in a second study) essentially made the death rates the same for both groups.

The cynical docs shrugged and said: I'd rather die of a heart attack.

And then you wonder if there is a relationship between the problems

For example, I just read that antihistamines increase one's chance of Alzheimers. Ah, but do they, or do those with allergies have an immune problem, and this immune problem makes them more prone toward Alzheimer's. And how did they diagnose Alzheimers: with an MRI or by a cognitive test?

You know, there is a study (on nuns) that show those who had low IQ's when they were young were more prone to "alzheimers" disease. Uh, maybe because they tested positve: so their IQ went from 100 to 80, whereas a drop from 140 to 120 might not be noticed.

Ditto for "dietary tests". My favorite is the nurses' diet study: I was once part of this (they figured I was a lady so must be a nurse), but quickly dropped out because heck, who remembers what you eat?

So the study would quickly lose the busy and the careless. But what is worse, it is assumed they are honest. (not putting down what they are supposed to be eating).

A recent dietary study shows the Mediterranean diet study had huge flaws. Well, duh.

from this article:

The authors have now reported that randomization had gone awry for 21% of the participants – 1,588 of the 7,447 people in the trial. About a third each were for one or more of these reasons: When more than one person in a house was recruited, instead of randomizing each, they were all assigned to the same diet; At one site, the randomization table hadn’t been used properly; and At one site, clinics were randomized instead of people.


I always get annoyed with those studies showing "long lived" people in some isolated area: Yugoslavia, a Greek Island, an isolated Indian tribe in South America.

What's left out of the reports? a population analysis to see if there really are more older folks there, and not just the hearty survivors of a population where the weak died off when they were young.

One: the high risk people died as infants.

Two: a lot died of Tb, partly related to malnutrition. So again, those with weaker bodies didn't survive.

Three: especially all those reports from Europe, you forget that they starved in the 1930s and 1940's.

I remember visiting Italy, and there were a lot of old, wrinkled ladies, hobbling along wearing black. Some were only in their 60s, but looked older.

But the little old ladies in our tour were wearing jogging suits and sneakers, and looked younger than their age.

--

in social science, the problem is worse.

Now there is a report that the "Stanford" prison experiment was not spontaneous, but the students playing the "guards" were coached.

Given the politicization of social science, including anthropology, all I can say is: DUH.


Tuesday, May 8, 2018

Brain dead? Moi?

cross posted from my main blog.

Stories like this one will give you a clue why the pro lifers got so hysterical against the UK doctors in the Alfie case awhile back:

from the BBC (video at link).

more here from WFSA:



MOBILE COUNTY, AL (CNN/RNN) – A boy was left brain dead after an accident while playing at a friend's house. After his parents accepted his condition and made the decision to donate his organs, the boy woke up. Trenton McKinley, 13, suffered severe brain trauma two months ago from a dune buggy accident. "I hit the concrete, and the trailer landed on top of my head. After that, I don't remember anything," Trenton told FOX10 News.
For the next several days, Trenton was brain dead and barely breathing, according to reports. "Five kids needed organs that matched him,” said his mother, Jennifer Reindl. “It was unfair to keep bringing him back because it was just damaging his organs even more."
Reindl said Trenton was dead for 15 minutes, and doctors said he would be a vegetable if he survived. Then a day before doctors were scheduled to remove him from life support, Trenton began to show signs of cognition.
Trenton said he believes he was in heaven while he was unconscious. "I was in an open field walking straight,” he said. "There's no other explanation but God. There's no other way. Even doctors said it."

several medical problems with this: was he just in a deep coma, or brain dead? The family understood he was brain dead, but then they say the doctors said he had no chance of recovery so they wanted to pull the plug: which is not the same as being brain dead.

Removing the respirator as "extraordinary" treatment is ethically permitted by the Catholic church, but he was not brain dead.

And if he wasn't brain dead, how could they remove his organs?

The dirty little secret: doctors are now allowed to do "living" donations of organs from the dying who don't meet the criteria for brain death. It is called "non brain dead" organ donation, and that is what seemed to be happening here.

The problem? the lay public doesn't know the difference, so that as more of these cases hit the news, the story of people awakening while their organs are being removed will go from an "urban legend" to reality.

Sigh.

In brain death, the entire brain is dead, including the brain stem. Remove the machines and you die.

in "Higher brain death" that is not true. You have someone who breathes on their own and sometimes even can eat if you carefully feed them.

But in this case (and in Alfie's case), there was no brain death: either the family misunderstood, or the doctors were just trying to remove the extraordinary treatment of a respirator because

a) it's expensive,
b) the family will suffer
c)even if the patient recovers he will be handicapped (aka a "vegetable")

ah, but then you have
d) look at all those wonderful organs that can save the lives of other folks.

and I left out the "but he's dying" argument, which is what these bozos argue: Sorry guys: No, he wasn't dying, but he was in danger of living and that is what the newfangled masters of the universe hate: all those with a poor quality of life becoming a burden on society.

For the elderly, there is a good argument that their many medical problems and low chance of recovery might cause them and the family not to push extraordinary care, but that is not the same as calling someone brain dead so you can harvest their organs:

In effect, this will make people less likely to not sign an organ donor card.

(and the powers that be will then change the law to mandate organ donation if you didn't have a paper saying no).

Many years ago, when bioethicist Arthur Caplan moved from Mn to PA, and he signed up for a local driver's license, he was going to check the "organ donor" box, but the clerk warned him not to do it "because then they'll let you die".

And every move to increase organ donations by moving the criteria to include more people will just make more people suspicious of doctors. (The bioethicists now want to move the diagnosis of brain dead to include "higher brain dead", i.e. you can breathe on your own and live a long time but they can declare you dead because after all you don't meet the criteria for personhood, and if they take your organs, hey, a lot of strong healthy people will live.)

I support organ donation, but because of this last trend I never had an organ donation card on my driver's license.

But since I live in the Philippines, no problem: They often have to pull the respirator after a few days because the families can't afford the bill, but they don't do "body runs" to take the patient to Manila to get the organs out.

and don't give me that argument about "but with modern medicine, many of these people who would have died now live and fill up nursing homes".

Uh no: that argument goes back to the time of Plato, guys, and many of those who thanks to modern medicine nowadays are able to hold jobs in the past would have been kept in a back room and cared for by family (or dropped off at the local monastery).

--------------------
addendum: BMJ article on the controversy, "Does it matter if the patient is not dead"and if you dig into the article you find the usual suspects pushing the criteria for taking organs and making the patient dead:

Truog and Robinson acknowledge that many patients currently diagnosed “brain dead” do not, in fact, meet the American legal requirements governing that practice. They note that many retain demonstrable brain function—and that this knowledge, which should be a challenge to those certifying death on the basis that there is no such activity—is set aside as not “significant”.1
so they are arguing against removing the organs of those meeting the criteria too?

No, actually they are arguing that since some of those who are used to donate the organs weren't really brain dead (due to misdiagnosis) so why not just move the line and just take the organs from non dead people.

. Truog and Robinson, like others before them,propose the abandonment of all obfuscation where requests for transplantable organs are concerned. They accept that “brain dead” individuals are alive. The issue then becomes: “Given that brain dead individuals are not dead, is it morally acceptable to remove their organs for transplantation?” Truog and Robinson answer “yes,” and “propose that the ethics of organ donation be based on the ethical principles of non-maleficence and respect for persons rather than on brain death and the dead donor rule”. They “propose that sometimes the harm of dying is sufficiently small that patients should be allowed to voluntarily accept that harm if it makes organ donation possible”.

italics mine.

It would be permissible to use as donors at least two classes of patients who had given prior consent: the “permanently unconscious” and the “imminently dying”.1 Ultimately, it would be up to “society” to determine the minimal threshold of lively existence below which donation would be permitted.
They suggest that organ donation from the “permanently unconscious” be limited to patients declared “brain dead” by current standards, because of uncertainty about the “capacity for consciousness” in patients in a persistent vegetative state or in anencephalic newborns.

actually, the reason is because in the early 1990s, the AMA and others put forth an argument to use anencephalic babies as organ donors, and there was a huge public outcry against it.

The time has not yet come, but give them time.

the authors of this BMJ article oppose these two bozos, and argue:

Truog and Robinson’s proposals that unpaired vital organs be removed from “brain dead” and other classes of patients can be seen as the endorsement of killing people for their organs. One difficulty with this is that once utilitarian considerations are used to justify killing ventilator dependent patients who are dying, those same considerations could also be used to justify killing non-ventilator/dependent patients or patients who are not dying.
Another major problem with doctors being involved in killing patients is that such a practice by medical professionals fundamentally distorts the nature of medicine itself.
Edmund Pellegrino and David Thomasma have developed the idea that medicine is primarily a relationship between a sick or injured person needing help and the physician or other health care provider who is trained to provide such help...
The fundamental moral problem with killing patients (as opposed to allowing them to die) is that such a practice distorts the very nature of the doctor/patient relationship, since it involves a dangerous use of medical power.

but expect a lot more pro euthanasia propaganda in the press who is eagerly pushing it, while lamenting that those dang "christians" lack compasssion (and wondering why minorities who remember Tuskegee don't sign "do not resusitate" orders or donate organs).

Thursday, April 12, 2018

marijuana in workers: why so many unemployed?

 Legalizing marijuana analysis by the CDC.

remember, marijuana, unlike alcohol, has a long halflife, and they worry about safety issues in users. But the data is unclear, partly because the test for using Marijuana is not very good (long half life might show positive for subclinical amounts, and technical difficulties in doing the test will miss a lot of cases), and also because many accidents that reported marijuana positive people showed that the person also had other drugs in their system.

you mean druggies will take anything to feel good? Duh.

14% of workers have smoked it recently according to the survey.

Not a big deal if it is your waiter, but what about if they are your nurse in the hospital, or if they drive a truck or schoolbus, or are working at a construction site?

but maybe they shouldn't worry too much because of this snippet deep in the article:

Of those respondents, 10,169 (54.5%) indicated that they were employed or had been out of work for less than 1 year.

Uh, do you mean 46% weren't working? well, maybe it was this high because it was a telephone survery, but we don't know anything about their drug use in this survey.

but that high percentage calls to question the low unemployment in Colorado statistics that pro drug sites have trumpeted all over the place.

the trouble with "unemployment" statistics is that they tend to use numbers from those collecting unemployment compensation and seeking a job, so miss those who are not looking for work, are too sick or old to work, who are not working in the marketplace but caring for children etc. in the home, or who are too lazy/high/drunk to find and keep a job.

theAtlantic: The rise of invisible unemployment.

the EpochTimes: America's hidden unemployment crisis