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.


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

Tuesday, March 27, 2018

Disease also kills: Civil war edition

StrategyPage has a review of a recent book about non combat deaths in the US Civil war....

Willis opens by pointing out that for both sides taken together, combat deaths amounted to perhaps a third of all deaths. He then sets out to explain how the other two-thirds perished.
Naturally disease was by far the biggest killer, causing most of the non-combat deaths, particularly early in the war as volunteers flocked to improvised training camps.
Mostly men of rural origins – even most Northerners – the recruits usually lacked immunity to many commonplace diseases, and died in droves. Dysentery was apparently the biggest killer, acquired from bad food or water, but malaria and pneumonia were up there as well.
Wills also looks at other causes, which seem to have accounted for about a tenth of all deaths. Accidents ranged from drowning to weapons malfunction or misuse, lightning strikes, sun stroke, falls, even snake bites. And there were also some murders, suicides, deaths in duels, executions, and others.
CSPAN has a discussion here. (R rated)


related items:

The Swamp Doctor's adventures in the southwest ebook

Reminiscences of a Southern Hospital, by Its Matron

Monday, March 26, 2018

Bye Bye Guinea worm

SPL/Science Source

NPR report: the Guinea worm is almost completely eradicated:

Guinea worm is a horrific infection. First, a painful blister starts to form on the skin. Then a thin, white worm — up to 3 feet long — emerges from the blister over the course of a few weeks. It is an incredibly painful process and temporarily handicaps a person while he or she waits for the worm to come out of the skin...
People catch Guinea worm by drinking contaminated water. Simply filtering drinking water can stop transmission of the parasite. An infected person can also stop the spread of the parasite by keeping the emerging worm away from water. When the worm touches water, it releases tens of thousands of baby worms and contaminates the whole body of water.

the bad news: There is no drug to kill it. You freeze the breathing hole (or bathe the area in cold water) and the worm starts to come out, and you pull it out slowly until it is out, which takes time.

You can freeze the entire worm, and it will shrink inside. We used ethyl Chloride spray for this. But that can cause a bigger infection, so it is only used if the worm is very small... and these worms are very long.

You can also remove it surgically, but again it would be a big incision and a larger area to get infected.

thanks to Jimmy Carter who was behind the initiative to get rid of the worm.

via Instapundit:

Thursday, March 15, 2018

monkey pox

CDC reports on outbreaks of monkeypox in several African countries.

several reasons for this: deforestation, "bush meat" trade (i.e. eating monkey meat), and because smallpox vaccination gave people protection, but now that Smallpox has been eliminated and the vaccination stopped, people no longer have this immunity.

the mortality is ten percent, but many cases occur in areas with suboptimal health care, so the real extent is not known.

WHO REPORT on December's outbreak in Nigeria.

From 4 September through 9 December, 172 suspected and 61 confirmed cases have been reported in different parts of the country. Laboratory-confirmed cases were reported from fourteen states (out of 36 states)/territory: Akwa Ibom, Abia, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Lagos, Imo, Nasarawa, Rivers and Federal Capital Territory (FCT). Suspected cases were reported from 23 states/territories including: Abia, Adamawa, Akwa Ibom, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Federal Capital Territory (FCT), Imo, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Ondo, Oyo, Nasarawa, Niger, and Rivers.

The majority of cases are male (75%) and aged 21–40 years old (median age = 30 years old). One death has been reported in an immune-compromised patient not receiving anti-retroviral therapy. Clustering of cases has occurred within states, however there is no known evidence of epidemiological linkages across states. Further, genetic sequencing results of the virus isolated within and across states suggest multiple sources of introduction of the virus into the human population. Further epidemiological investigation is ongoing....

 Monkeypox, a rare zoonosis that occurs sporadically in forested areas of Central and West Africa, is an orthopoxvirus that can cause fatal illness. The disease manifestations are similar to human smallpox (eradicated since 1980), however human monkeypox is less severe. The disease is self-limiting with symptoms usually resolving within 14–21 days. Treatment is supportive. This is the first outbreak in Nigeria since 1978. The virus is transmitted through direct contact with blood, bodily fluids and cutaneous/mucosal lesions of an infected animals (rats, squirrels, monkeys, dormice, striped mice, chimpanzees amongst others rodents) Secondary human-to-human transmission is limited but can occur via exposure to respiratory droplets, contact with infected persons or contaminated materials.
the question is why the outbreaks didn't spread to more people. This is probably good news, meaning an epidemic is less likely.

Wednesday, March 14, 2018

yeah. Blame docs for street drug overdoses

I am sick and tired of being told that if we docs had given our patients non narcotics for pain, there would not be an opioid epidemic.

a picture is worth a thousand words:''

the push to relieve pain, even if it mean using narcotics, started in 2000.

Some of those drugs resulted in addiction, but more were used, sometimes in high doses, and allowed people to live pain free.

A lot of the "natural and semi synthetic opioids", i.e. codiene, morphine, etc, are pain killers. Some were of course stolen or diverted/sold and caused overdoses by those not prescribed the medicine. Others caused overdoses to commit suicide, or because the person was mixing drugs or decided to take an extra dose either to relieve pain or (alas too common) to get high..., or (in the elderly) became weak or confused and the drug slowed their respiration enough to cause death. (i.e. accidental overdose).

But the real increase is in heroin or Fentanyl, both drugs bought and sold on the street.

notice the spike since 2010?

That isn't docs: that was street drugs. The drug dealers knew Marijuana was being legalized, so were switching their product. And since they already catered to folks who like to get high, guess what happened?

every thing costs more. duh

Scidaily reports why health care costs have gone up:

the major drivers of high healthcare costs in the U.S. appear to be higher prices for nearly everything -- from physician and hospital services to diagnostic tests to pharmaceuticals -- and administrative complexity.
administrative complexity, as in paper work.

and higher cost for drugs and equipment.

But commonly held beliefs for these differences appear at odds with the evidence, the study found. Key findings included:
Belief: The U.S. uses more healthcare services than peer countries, thus leading to higher costs. Evidence: The U.S. has lower rates of physician visits and days spent in the hospital than other nations.
Belief: The U.S. has too many specialists and not enough primary care physicians. Evidence: The primary care versus specialist mix in the U.S. is roughly the same as that of the average of other countries.
Belief: The U.S. provides too much inpatient hospital care. Evidence: Only 19% of total healthcare spending in the U.S. is spent on inpatient services -- among the lowest proportion of similar countries.
Belief: The U.S. spends too little on social services and this may contribute to higher healthcare costs among certain populations. Evidence: The U.S. does spend a bit less on social services than other countries but is not an outlier.
Belief: The quality of healthcare is much lower in the U.S. than in other countries. Evidence: Overall, quality of care in the U.S. isn't markedly different from that of other countries, and in fact excels in many areas. For example, the U.S. appears to have the best outcomes for those who have heart attacks or strokes, but is below average for avoidable hospitalizations for patients with diabetes and asthma.
so what costs so much?

Administrative costs of care -- activities related to planning, regulating, and managing health systems and services -- accounted for 8% of total healthcare costs, compared with a range of 1%-3% for other countries. 

Per capita spending for pharmaceuticals was $1,443 in the U.S., compared with a range of $466 to $939 in other nations. For several commonly used brand-name pharmaceuticals, the U.S. had substantially higher prices than other countries, often double the next highest price. 
The average salary for a general practice physician in the U.S. was $218,173, while in other countries the salary range was $86,607-$154,126.