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.

Stephen Hawkings: showing disability doesn't mean inability

Prof Hawking's only advice on disability was to focus on what could be achieved.
"My advice to other disabled people would be, concentrate on things your disability doesn't prevent you doing well, and don't regret the things it interferes with. Don't be disabled in spirit, as well as physically," he said in an interview with the New York Times.