Friday, December 27, 2013

Acupuncture as pseudoscience

Instapundit links:

SHOCKER: New Study Exposes Acupuncture As Pseudoscience. I think the reason the Chinese government pushed it so hard under Mao was that it was cheap, not that it was effective. . . .

I might add: I suspect it is related to placebo/hypnosis, which does work in a subpopulation.

Why? Well, when we took a course on hypnosis in medicine, the teacher observed that

ONE: those getting open heart surgery with acupuncture anesthesia were sitting there smiling. Ordinary folks, even if pain free, would be hyperventillating, especially when they sawed the chest open. That suggested a deep trance state rather than pain relief.

Two: one patient asked to be taught self hypnosis for chronic pain and it didn't work for him...and that patient mentioned that acupuncture didn't work either.

A lot of this could be sorted out by using the eye roll test, which correlates with hypnotizability.

And if you have a high score, you are also easily talked into doing things, and easily suggestible.

So I suspect accupuncture will work for these people, (along with placebo and faith healing)...

On the other hand: Acupuncture works on some there might be a "counter irritant" type blockage of the pain signal in acupuncture similar to the reason that moxification/old fashioned mustard plasters etc. work.

Thursday, December 26, 2013

Vaccine deaths in China?

BBC report on possible vaccine related deaths from Hepatitis B vaccine given to infants.

No previous problem with this vaccine: I wonder if it was made wrong...adulterated and counterfeit medicines are a major problem in China (and India) and here, where they can be sold as the real thing.

another question: Does this company make vaccines that are used in other countries?

NYTimes story here.

Investigators have not determined the cause of the deaths or linked them directly to the injections, but the cases come at a time of growing public concern in China about food and drug safety problems.
In recent years, China has been troubled by a series of scandals, including tainted rice and milk and the mysterious appearance of thousands of dead pigs floating in the Huangpu River in Shanghai. China has vowed repeatedly to crack down on food and drug safety violations and has moved to strengthen the powers of health officials.
In the vaccine cases, the government is focusing on the role of Shenzhen Kangtai, a privately run drug maker formed in 1992 with government support and the cooperation of the American pharmaceutical company Merck.

further down, it says the vaccine is to stop the two million cases of Hepatitis B that occur every is a wicked disease, and many doctors caught it in the past (especially surgeons) because of contact with blood...a friend of mine got it from his spouse who caught it from a patient, and ended up with a liver transplant...

Wednesday, December 25, 2013

The really important medical headline of the day

Don't want a hangover? Eat mashed potato before that first drink

Diabetic risk from Neanderthal genes?


this study is in Latin Americans and Mexicans: What is not answered is the ethnicity of those studies. Are they mainly upper class (with mainly Spanish blood) or lower class (metziso, mulatto, or Indian)?

Diabetes is very common in American Indian tribes: especially the Pima and the Objibwe (I worked with the latter).

And if so, how did this migrate to America? what is the percentage of Neanderthal genes in American Indians?

They discovered that the SLC16A11 sequence associated with risk of type 2 diabetes is found in a newly sequenced Neanderthal genome from Denisova Cave in Siberia.
Analyses indicate that the higher risk version of SLC16A11 was introduced into modern humans through interbreeding between early modern humans and Neanderthals.
It is not unusual to find Neanderthal genes. About 2% of the genomes of present-day non-Africans were inherited from this distinctive human group, which lived across Europe and western Asia from about 400,000-300,000 years ago until 30,000 years ago.

One thing about this "gene": it is a tendency to put on weight and develop metabolic syndrome if there is a lot of food...which means that during times of famine you are more likely to live.

bookmarked for later reading.

Wednesday, December 18, 2013

Abortion breast cancer link?

A meta analysis suggested the proposed link between breast cancer and abortion may actually be true: at least in chinese females.



We searched three English databases (PubMed, ScienceDirect, and Wiley) and three Chinese databases (CNKI, WanFang, and VIP) for studies up to December 2012, supplemented by manual searches. Two reviewers independently conducted the literature searching, study selection, and data extraction and quality assessment of included studies. Random effects models were used to estimate the summary odds ratios (ORs) and the 95 % confidence intervals (CIs).


A total of 36 articles (two cohort studies and 34 case–control studies) covering 14 provinces in China were included in this review. Compared to people without any history of IA, an increased risk of breast cancer was observed among females who had at least one IA (OR = 1.44, 95 % CI 1.29–1.59, I 2 = 82.6 %, p < 0.001, n = 34). No significant publication bias was found among the included studies (Egger test, p = 0.176). The risk increased to 1.76 (95 % CI 1.39–2.22) and 1.89 (95 % CI 1.40–2.55) for people who had at least two IAs and at least three IAs, respectively. Subgroup analyses showed similar results to the primary results. Meta-regression analysis of the included studies found that the association between IA and breast cancer risk attenuated with increasing percent of IA in the control group (β = −0.022, p < 0.001).


IA is significantly associated with an increased risk of breast cancer among Chinese females, and the risk of breast cancer increases as the number of IA increases. If IA were to be confirmed as a risk factor for breast cancer, high rates of IA in China may contribute to increasing breast cancer rates.

You can read the  whole thing for 36 dollars. (Sarcasm).

I remain sceptical (I am on record for being sceptical, because if the link was true, then we'd see very high numbers of cases of Breast cancer in past years in countries like Japan or Russia, where multiple abortions was a common way to control births).

Breast cancer is hormone related.

If you have 8 kids and breast feed them for one to two years, you rarely have a period...and your chance of breast cancer is low (as it was in Africa).

In the "good old days", we knew there was a much higher rate of breast cancer in some women: women who were "nulliparous" (no kids) or who had only one or two kids, or who had their first child later in life, or who didn't breast feed them.

welcome to the modern world, where women only have one or two kids, and rarely breastfeed for long (because they have a job outside the home, or are lazy, or it's not the custom anymore).

What else has changed? Uh, birth control pills/shots, anyone?

And what about all those phytoestrogens in the environment, from pesticides to plastics?

And then there is obesity: We used to call Rubenesque women "high estrogen profiles"... some obesity is associated with higher estrogen levels, (something about fat cells and hormones...sorry I'd have to look it up and the internet is unsable right now).

Then there is meat and soy, with associated hormone effects.

So is it the abortion, or is it the pollution/hormone contraception/lack of having kids?

Since women who contracept have more abortions, and women with few kids tend to be more affluent and fatter, one does wonder.

I think abortion is murder, and the denial that it affects the mom is a lie. "can a mother forget the child of her womb"? And regret/depression is not because of evil Christian fundamentalists either: Japan's temples have places where moms mourn abortion/stillbirths...and we once had a Russian immigrant hallucinating babies. Max, a good atheistic Russian psychiatrist who had recently immigrated, assured me that such "psychotic depressions" after abortion were common in his homeland...heh. Don't tell that to the PC who are trying to push it around the world (to limit population growth of the wrong races poor people).

So I don't think that a woman who is crass enough to use abortion for birth control will worry about this, and a woman in a trouble pregnancy who is surrounded by folks who all encourage/force her to get rid of it won't be persuaded either.

But it should influence the "do gooders" who are pushing it as public policy.

Sunday, December 15, 2013


just place for later thinking:

You have three choices: GM eggplant, eggplant full of pesticides, or eat the little buggers that infest them.

I should note that commonly the eggplants here are the slim "japanese" type, although we do have the round white ones too.

and the note about  GM soy allergies: uh, that was a common allergy thirty years ago...but didn't get the hysteria like we see the gluten intolerance problem, I suspect it is simply more cases being recognized or treated, since 30 years ago few anti histamines were used. The data doesn't support a huge rise in cases, and notes that many "food allergies" are merely intolerance to certain foods.

The real problems are exaggerated by bad science that gets picked up by the paranoid greens, who attribute every problem to either global warming or GM foods without good studies. So if allergies to peanuts are up, it must be because GM soy beans were introduced about then, never mind the other reasons that might be behind it.

My take: The problem is a small number that may or may not be more common than 30 years agp, and there are many hysterical reactions to mild cases.

and what if there are other causes? For example, all those "low cholesterol" ways of preparing peanuts. From the article above:
Instead, changes in food manufacturing might be to blame. Dry-roasting peanuts, common in the USA, UK and Australia, increases allergenicity compared with boiling or frying peanuts, as is common in China

and true allergies, such as peanut allergies, might indeed be higher, but the problem is that we don't have GM peanuts...and indeed, GM peanuts have been proposed to stop the allergy problem by removing the protein behind the reaction (ditto for soy beans).


Friday, December 13, 2013

You mean laughter is not the best medicine?

From the UKTelegraph:

Health warning: laughter could leave you in stitches

A review of the benefits of laughter in patients by Oxford University has found that far from being the best medicine, it can lead to heart ruptures, asthma attacks and incontinence

Wednesday, December 11, 2013

FYI (you probably don't want to know)

A Brief history of toilet paper from the ancient standard site.

Actually, in Africa, they used leaves (in our rural area the term o use a restroom was "go to the forest")

In the Philippines, most homes still have a nice bowl with a handle to use to ewash, and then you dry using a "butt towel"...
the more sophisticated way is to use a sprayer (similar to the sprayer for washing dishes in many US homes).

water filters

Water purification

I wrote about problems with water in emergencies over on BNN...

linking to how to make an emergency flower pot purifier, similar to the ceramic one we used for years.

But StrategyPage has an article about more sophisticated devices here.

Sunday, December 8, 2013

The Daily mail to the rescue

much of the medical news reported on the NYTimes newfeed is excellent, with nuances and expert opinions.

But for ordinary folks, I used to refer my patients to the national enquirer...the British equivalent of this is the UKMail.

So today's headlines:

Eating Brussel spouts helps fertility

if it's the folic acid content, then maybe a pill would work just as well.

Viagra suppositories might stop menstral cramps.

you know that "bloating" feeling? Well, a good orgasm will make it go away... and viagra, by increasing the blood supply, will help remove the congestion...ditto for men suffering from a similar syndrome.

 Can watching the eye movement when you look at a picture help diagnose your disease?

when we hypnotized people, we check the "eye roll" to see if their neurophysiological ability to be hypnotized. (look up, and slowly close your eyes looking up. If you see a lot of white eye, they are easily hypnotized, easily persuadable, more creative, and more prone to conversion reactions. No white eye, and you have a scientific type who can't be hypnotized).

But in both cases, medicine, fatigue, and nervousness could mess up the results.

finally the good news: Deaths from common cancers are down, due to earlier diagnoses and better treatment.

the cancer picture has changed since I started medical school.

Bowel cancer used to be mainly in the rectal area, and now is rarely there, and more common upstream...lung cancer used to be a men's disease, but now is common in women...breast cancer is found much earlier and usually is cureable when found (ditto for prostate cancer)...and now we rarely see cancer of the stomach, and when we find it, it is usually a lymphoma...

Wednesday, December 4, 2013

Dialysis in older people

NYTimes discusses.

yes, often they have many other diseases that kill them (usually heart disease or stroke or poor circulation to their legs).

But when I read an article that says "Hard Choices", my bullshit antenna goes up, because it means they will be explaining why we should not treat these people.

The object is to let people die to save money

But in general, the evidence supporting a survival advantage in very old patients on dialysis is weak, according to Dr. Thorsteindottir. And there’s growing concern among experts that too many elderly patients with severe kidney disease may be starting dialysis without the potential for significant benefit.
“Concerns about overtreatment are focused on older adults, especially those who are frail or have other severe or life-limiting conditions,” according to the authors of an editorial in The Journal of the American Medical Association last year.

of course, the dirty little secrets it that my patients on "supportive treatment" have a lousy quality of life: So you have to balance the numerous incidents of shortness of breath and cramps and weakness with the inconvenience of dialyzing three times a week for 8 hours.

And yes, I've had people stop dialysis when their bodies simply were deteriorating: There is a point when you are prolonging dying, not prolonging life. But with the government in charge of health care, I suspect that we'll have more articles full of similar propaganda saying don't dialyze grandmom...

epa report on radioactivity in cigarettes


How does radioactive material get into a cigarette?

The tobacco leaves used in making cigarettes contain radioactive material, particularly lead-210 and polonium-210. The radionuclide content of tobacco leaves depends heavily on soil conditions and fertilizer use.
Soils that contain elevated radium lead to high radon gas emanations rising into the growing tobacco crop. Radon rapidly decays into a series of solid, highly radioactive metals (radon decay products). These metals cling to dust particles which in turn are collected by the sticky tobacco leaves. The sticky compound that seeps from the trichomes is not water soluble, so the particles do not wash off in the rain. There they stay, through curing process, cutting, and manufacture into cigarettes.Lead-210 and Polonium-210 can be absorbed into tobacco leaves directly from the soil. But more importantly, fine, sticky hairs (called trichomes) on both sides of tobacco leaves grab airborne radioactive particles.
For example, phosphate fertilizers, favored by the tobacco industry, contain radium and its decay products (including lead-210 and polonium-210). When phosphate fertilizer is spread on tobacco fields year after year, the concentration of lead-210 and polonium-210 in the soil rises.

Polonium, cigarettes and conspiracy theories

DeborahBlum at Wired writes about poisons in her column, and has this one about Yasser Arafat and polonium in cigarettes.
She explains about Polonium's short half life and chemical/radiological characteristics and adds:

All of this — the low level of natural occurrence, the very targeted efficiency of the poison — tell you that it’s highly unlikely for anyone to accidentally receive a lethal dose of polonium-210.
But it is possible to give yourself a nasty little dose — and that’s by becoming a heavy smoker of cigarettes. There’s a detailed description of some of these risks at the website of Lenntech, a company that makes air and water filters. It cites among other things, data from the CDC that “Americans are exposed to more radiation from tobacco smoke than any other source.” It also notes that polonium-210 has been isolated from both the blood and urine of heavy smokers.

another article mentions other toxins in cigarettes.

And when I read the FDA list of hazardous compounds in cigarette smoke and found not only polonium-210 (the radioactive element suspected in Arafat’s death) but two well-known isotopes of uranium  best associated with nuclear reactors (uranium-235 and uranium-238), I thought – wow, how did I miss that?

As it turns out, there’s a real case to be made that I – and really all of us – missed this because the tobacco companies hid the information, that cigarette makers flagged the problem internally by 1960s and studied it in secret. The best evidence for that comes from the companies’  confidential documents, which were released in the 1998 Tobacco Master Settlement Agreement between four major companies – Philip Morris, R.J. Reynolds, Brown & Williamson and Lorillard – and attorney generals from 46 states.
An analysis of those documents by public health researchers at the University of California-Los Angeles was published last year in the journal, Nicotine and Tobacco Research.  As that study (paywall) notes:
The documents show that the industry was well aware of the presence of a radioactive substance in tobacco as early as 1959. Furthermore, the industry was not only cognizant of the potential “cancerous growth” in the lungs of regular smokers but also did quantitative radiobiological calculations to estimate the long-term (25 years) lung radiation absorption dose (rad) of ionizing alpha particles emitted from the cigarette smoke.

1962 L&M advertisement using a “family theme” Photo: The Stanford School Of Medicine
This wasn’t the first study to note the corporate coverup; an earlier report in American Journal of Public Health reached the same conclusion.  Still, let’s call the information an imperfectly kept secret (as so many are). In 1964, for instance, we find scientists from the Harvard School of Public Health reporting that they had discovered hot spots, fizzing with polonium-210, in the lungs of regular smokers.  They published that finding in the highly visible New England Journal of Medicine in 1965, warning that “we believe 210Po may be an important factor in the initiation of bronchial carcinoma in humans”.  It wasn’t, actually, that tobacco companies were entirely successful at hiding the radioactive nature of cigarettes; it was that the rest of us weren’t entirely successful at paying attention.
 but it gets worse, she says:

But, as the UCLA analysis points out, internal documents revealed something else. Not only did cigarette makers know about polonium-210 contamination of their product for decades – they knew how to fix it and chose not to. And to understand that, you need to know why tobacco plants become such little radiation factories.

and here is an article in Scientific American:

Saturday, November 30, 2013

Signing up folks for Obamacare

WSJ link

actually, this might be the only way to get some people to sign up, but it points out to the confusion and complicated health bill.

Ironically, there are some folks among the poor who make a good living finding out all the free stuff to get.

When one of my neighbors left her deadbeat husband a few days after she had major surgery, it was another neighbor who found her a way to get an apartment, foodstamps, money to help pay the electric/heating bill...later, the LDS helped her train and get a job as a secretary...

The first neighbor who knew all the ropes on getting money was not disabled but a widow with two small children trying to live off of her husband's pension. Ironically, her income was too high for Medicaid...

the part about health care that pays for everything is that many folks who really need care just won't keep their appointments, and that many people come in for trivial stuff like mild colds or aches and pains that middle class people treat with Over the counter medicines....

and then you have the druggies...

Friday, November 29, 2013

Kaching: Fat women can't use plan B...

Only MomJones has bothered to notice Plan B doesn't work for the 30 percent of American women who are overweight.

Uh, fellahs: the dirty little secret is that it lowered the number of women expected to get pregnant after intercourse, using rape patients as an example, instead of using sexually active women who had a higher chance of being pregnant.

And pushing it on teenagers is worse: They get sick and don't take the pills right.; And the rate of pregnancy is higher when used several days later (when it aborts the implanting embryo) than when taken within hours (when it stops ovulation).

and the experts pushing it on teenagers don't seem to know that the only thing that works to stop unwanted pregnancy in teenagers is long acting shots: because a lot of teens "forget" to use condoms or take the pill (sometimes because subconsciously they want a baby, sometimes because they are high or drunk, and sometimes, as I would tease my patients, it's hard to put a condom on in the front seat of a car.)

I only give out "Plan b" to rape patients who appear within hours to the ER (When it is contraceptive, not abortion causing) but I know cases where the girls didn't take the second dose because it made them nauseous, or delayed taking it because they were ambivalent. One teenager carried it in her purse and every time her mom threatened to discipline her, she pulled it out and said: "If you ground me I'll abort your grandchild".

the drug companies that push Plan B are making a fortune off of it: It's not a "new" medicine, so it is cheaper to make, but with the new "formulation" they can charge full price of it.

No wonder they have "activists" pushing for it's use (including pushing it as over the counter and as mandated to be paid for by Obamacare)

Wednesday, November 27, 2013

The Baby in the freezer

The morality of test tube babies is rarely discussed for fear of hurting people who would do anything to have a baby.

Yet the problems are immense. Discussion here.

the huge numbers of frozen babies in freezers is a very disturbing problem: If you "adopt" one, it implies to parents who let their babies in the freezer that they will eventually be adopted, so you end up with more frozen babies. If you use them for "research" ditto

The dirty little secret is that old, frozen embryos are no good for research, and the longer they are in the freezer, the fewer embryos will survive even if implanted.

If life begins at conception, this is a horrendous idea: that we enslave and allow millions of children to die for the convenience of parents.

Which is why the "experts" have decided that "life" begins at implantation, not conception, as we were taught in medical school: the changed the definition to obscure that this technology takes life.

And of course it allows the morning after pill to be called a contraceptive pill, even though if you take it immediately, it stops ovulation and is contraceptive, if you take it after several hours, it stops the fertilized egg from implanting, but if you take it a few days later, it merely aborts the already growing embryo implanted in the uterus, and indeed causes an abortion.(and now, we find the morning after pill doesn't work in fat women. Heh. Next thing you know they will figure out it does't work very well in teenagers either, who don't take it correctly because it is nauseating).

There are other ethical issues behind the practice: donating eggs is not exactly a risk free practice (although the risk is minimal).

As for "surrogancy", especially when outsourced to poor countries (It's a big industry in India) it has other ethical problems.

like "voluntary" organ donation from the poor in third world countries, it exploits the poor (emotionally, physically and financially, since the middle man gets most of the money).

Ah, but poor women do it and don't care right?

I remember a discussion with a Pinoy taxi driver who said he wouldn't have problem if his girlfriend made money by carrying a surrogate baby...and then the reporter asked the girlfriend, who retorted: I get attached to my cellphone and upset when I lost it. Don't you think it might be hard for me to carry a baby for nine months and give it up?

Monday, November 25, 2013

Kohl take two

CDC reports on Childhood lead exposure in New Mexico due to using Kajal from Afghanistan

In January 2013, the New Mexico Department of Health (NMDOH) received a report from an Albuquerque clinic of a refugee child aged 20 months (patient 1) with an elevated blood lead level (BLL) of 27.0 µg/dL (CDC reference value = 5.0 µg/dL). Medical staff informed NMDOH that the child and family used kajal, a traditional eye cosmetic brought from Afghanistan, their country of origin. Further investigation revealed that patient 1's brother, aged 4 months (patient 2), also had an elevated BLL of 33.5 µg/dL. Laboratory analysis of kajal used by the family showed a lead content of 54%. These two cases highlight the potential for lead poisoning among refugee populations in the United States and call attention to contaminated consumer products as a source of lead exposure.

Sunday, November 24, 2013


I'm reading a book about public health in Eygpt from a UC ebook site (no, I don't have the link: I copy the book and read at my leisure because the on and off internet connection makes streaming etc. a pain).

Kohl was used in Egypt since pre dynastic times to protect the eyes from disease (presumably  trachoma, which is spread by flies. Ever see those photos of starving babies whose eyes are covered with flies? Maybe the poisonous kohl did discourage this from happening).

this has been known since antiquity, but science has confirmed this only recently:

From the NIH:
In trachoma endemic areas, flies are frequently seen clustering around the face and eyes of children where they feed on mucus and discharge (Fig.(Fig.1).1). This association of flies with the faces of infected children has not gone unnoticed, and they have been considered as vectors of trachoma for at least 400 years.1
Fig. 1
Everted upper eyelid of a Gambian child with follicular trachoma and a feeding female bazaar fly (Musca sorbens)
Flies act as mechanical vectors of disease by picking up pathogens from infectious material and transferring them to an uninfected host. Flies have taste receptors on their front feet and when feeding they dip these into the food source as well as their proboscis. Thus, flies may be transferring Chlamydia trachomatis from the eyes of infected children to the eyes of uninfected people, on their feet and proboscis. However, the transmission of trachoma is poorly understood and there are other suggested routes which may be important in different places and at different times. Trying to prove that a particular route is operating, and establishing the relative importance of one route over another, is difficult. Until a recent intervention trial in The Gambia2 there has been little strong evidence to prove that flies actually are important in the transmission of trachoma.

Factoid: Kohl in India is made from a lead compound, but kohl in Egypt is Stibnite, an antimony based compound.

The NIH points out that lead based kohl puts the user at danger of lead poisoning.

 This article from a tourism website notes that both antimony and lead based kohl were used in ancient Egypt.
In ancient Egypt, preparations were a little more extensive. The cosmetic material had to be powdered on a palette and then this powder mixed with a substance, (analysis indicates that these were usually ointments derived from animal fat) to make the powder adhere to the eye.
Eye makeup equipment (palettes, grinders, applicators) has been found among the earliest burials of the pre-dynastic period and seem to have been essential items for the afterlife.
Even the humblest graves consistently contain at least a simple palette. Small containers of galena have been found in tombs alternately stored in leather or canvas pouches, small jars, conch shells or within hollow reeds. What separated rich from poor was not the existence of makeup but the expense and luxury of containers and applicators. Everyone had galena powder however while the poor resorted to sticks to apply it, the wealthy had intricately carved and bejeweled containers of ivory or other precious materials.
That the Egyptians decorated their eyes with great aesthetic care is immediately obvious. Eye cosmetics bestowed beauty and style as well as other gifts, perhaps less immediately apparent to modern eyes.
Galena possesses disinfectant and fly-deterrent properties. It is believed to offer the eyes protection from intense sun. The medical papyri frequently prescribe mesdemet for assorted complaints of the eye.
Eye make up provided psychic protection as well. The Egyptian word for eye-palette seems to derive from their word for "protect." An unadorned and thus unprotected eye was believed vulnerable to the Evil Eye. Outlining the eyes thus became a personal protective amulet drawn right upon the skin; an amulet that once applied could not be lost or misplaced.

Read more:

Wired points out that there is a long history of using arsenic as a pesticide and as a rat killer, and that although China has finally banned it's use, it is probably still being used illegally and could be in your child's apple juice
 Arsenic pesticides didn’t arrive in the United States until the 1860s, when they were used to fight the Colorado potato beetle. Lead arsenate wasn’t introduced until the 1890s when it was used against the gypsy moth. ... In 1919, the Boston Health Department destroyed arsenic contaminated apples because people were getting sick. The follow year, it had to do it again. 


and this is worrisome:

 Rice is an exception to that. Scientists have discovered that the rice plant, because it’s designed to pull silicon out of the soil (it strengthens the grain) does the same with the structurally similar arsenic. Researchers at Dartmouth College’s Toxic Metals Superfund Research program note that rice has been described as a natural arsenic accumulator. Most of this accumulation, of course, is due to naturally occurring arsenic in soil and water.
 this book discusses the ancient use of Kohl in Egypt as a fly repellant. LINK Alas, unlike many of the books published by the Metropolitan museum, it isn't a free download.

Friday, November 22, 2013

Polio in Syria

From strategyPage:

apparently the anti Polio campaign by the Taliban, which has killed half a dozen docs and health care workers in Pakistan/Afghanistan, is now spreading the disease with their jihadis

Syria is going to attempt a widespread polio vaccination campaign because Pakistani Islamic terrorist rebels have apparently introduced polio into Syria. So far this year there have been 13 cases of polio in Syria, after having been absent since the late 1990s. In Pakistan there have been 62 cases of polio so far this year, which was more than all of 2012 (58). In Pakistan polio cases reached a low of 28 in 2005 but then Islamic terrorist opposition to vaccination led to a sharp increase that hit 198 cases in 2011. Since then, Pakistani government and religious leaders have sought to deal with resistance to the vaccination campaign. In Pakistan a third of the polio cases have shown up outside the territories. A Taliban ban on polio vaccinations has left over 250,000 young children vulnerable to the disease and these are most of the ones getting infected. Years of Islamic radical clerics preaching that polio is un-Islamic has caused a growing number of parents (from throughout the country) to refuse the vaccinations, even when there is no Islamic terrorist threat of retaliation. This year about three percent of Pakistani children failed to get the vaccination, either because of Islamic terrorists or parents believing the anti-vaccination propaganda. Polio should have been eliminated entirely by now, as it can only survive in a human host. But there has been resistance from Islamic clergy in some countries, who insist the vaccinations are a Western plot to harm Moslem children. This has enabled polio to survive in some Moslem countries (especially Nigeria, Somalia, and Pakistan). The disease also survives in some very corrupt nations, like Kenya and India, because of the difficulty in getting vaccines to remote areas, tracking down nomad groups, and stopping corrupt officials from plundering the vaccination program (and causing many vaccinations to not happen). Islamic terrorists from Pakistan are believed responsible for a recent outbreak of polio in Syria because an analysis of the DNA of the polio in Syria was similar to polio DNA found in Pakistan.

other news stories add it is spreading to Egypt and polio.

And although some of the lamestream media blame the US for this (because someone revealed a Pakistani doc working for the polio campaign helped to ID Osama ben laden) that is a lie: They were killing polio workers, including the Pakistani doctor who was directing the program, long before Osama was found.

Tuesday, November 19, 2013

Health care cartoon of the day

from the New Yorker

Garbage in Garbage out: problems with guidelines

NYTimes article about the "new" cholesterol guidelines.

This week, cardiologists learned that a new online calculator meant to help them determine a patient’s suitability for cholesterol treatment was flawed, doubling the estimated risk of heart attack or stroke for the average patient. But fixing it would not be easy, because it is based on older data, and heart attack and stroke rates today are much lower than in decades past, meaning that people are at less risk than might be expected from historical extrapolations.

the heart attack and stroke rates have gone down, so the old data is out of date, so they calculate your risk to be too high.
and they don't know the reason behind this change.
and sometimes they calculate it wrong, assuming everything goes on a straight line, when in reality it does not. 

“The model suggests that lowering systolic blood pressure from 130 to 100 is nearly as important as from 180 to 150,” he said. “I doubt there is a cardiologist in the country that believes that.”
not mentioned: if you lower the BP below 130, you end up with fainting patients and broken hips.

actually this is the most disturbing part:
Dr. Blaha and his colleagues discovered the flaws of the calculator based on the Framingham Heart Study a couple of years ago but did not publish their results because they were waiting for the new calculator to appear. They thought any issues with the old calculator would soon be moot. 
uh, fellahs: ever hear of the phrase: "speaking truth to power"?
Scientists are supposed to be dedicated to truth, and not stay quiet because the gov't big shots say something is true.

of course, a lot of us are sceptical and ignored them.
Many doctors never used the Framingham calculator anyway, said Dr. Benjamin Ansell of the University of California, Los Angeles. Instead, they mostly offered statins to people with very high cholesterol levels, ignoring the fact that those who have lower cholesterol levels but other risk factors, like smoking or high blood pressure, often benefited. 
note that last part: it ignores that these lower risk patients might indeed benefit, but that the improved benefit might not be worth the cost and side effects. Which is why I hesitated to give my 80 year old patients treatment for their high cholesterol, and avoided statins in my smoking alcoholics (because it could cause liver disease, not to mention a lot of them didn't take the pills).

and at the very end of the article it notes two things: one, experts don't always get it right, and two, doctors always take these expert's advice with a grain of salt:

Dr. Michael Pignone of the University of North Carolina said it was time to take another look at the new calculator. The guideline committee members are experts, he said, but “getting it right is really hard.”
Dr. Welch went further.
“It should be fixed,” he said. “And before we launch it on the public, we should launch it on the skeptical doctors. This matters to millions of people.”

one of my objections to Obama care is that some gov't bureaucrat will punish docs if they don't obey the guidelines.

Monday, November 18, 2013

Flattened heads: Not just for Indians

Archeology magazine has a photo of a head flattened by using a splint.
 No, it is not an alien skull...

(© Denis Gliksman, Inrap)

ALSACE, FRANCE—In a necropolis containing 38 tombs that were used over a period of more than 4,000 years, archaeologist Philippe Lefranc uncovered the 1,650-year-old remains of a woman whose head had been flattened and deformed during childhood. “The deformation of the skull with the help of bandages (narrow strips of cloth) and small boards is a practice coming from central Asia. It was popularized by the Huns and adopted by many German people,” he said. Such deformed skulls are usually seen in burials containing grave goods associated with the wealthy.

I wrote about this awhile back on my old xanga blog...I linked to South American web articles (e.g. at Palenque) where this was done, but some Canadian west coast Indians also made them flat.

But apparently the Huns also deformed their children's skulls, and so this dead woman's skull was not a congenital abnormality but shaped in childhood.

Painting by Paul Kane, showing a Chinookan child in the process of having its head flattened, and an adult after the process.
photo from Wikipedia link

Sunday, November 17, 2013

Mercury dangers

EnglishHistoricalAuthors blog asks: Was Charles II killed by poisoning (or maybe accidentally poisoned?) Like a lot of folks back then he was interested in making gold from base metals (i.e.alchemy):
Charles became obsessed with ‘fixing mercury’ and often spent whole mornings in his laboratory. Unfortunately, heating mercury in an open crucible releases toxic mercury vapour which can pass across the blood-brain barrier that protects the central nervous system and it is entirely possible that Charles’ alchemy experiments may have contributed to his death.
Charles final illness included slurred speech, convulsions and then fits. At the time his symptoms were put down to a stroke but this is a condition not usually associated with seizures whereas mercury poisoning is. An autopsy of Charles’ brain revealed that the ventricles contained more water than normal – another finding consistent with mercury poisoning.

The Daily Mail (UK) article here.

Mercury, meanwhile, is usually fatal when breathed in as fumes, but less easily absorbed through the gut. ‘In fact, the Margrave of Brandenburg famously drank a large cup of mercury by accident on his wedding night in 1515, and survived unscathed.’ By accident? On his wedding night? It’s possible that the whole story isn’t being told here.
Whereas Charles II, a keen alchemist, was almost certainly killed by acute mercury poisoning. Such was the actual price of trying to turn base metals into gold.

Read more:
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Medscape article on Mercury:

Organic mercury compounds, specifically methylmercury, are concentrated in the food chain. Fish from contaminated waters are the most common culprits. Industrial mercury pollution is often in the inorganic form, but aquatic organisms and vegetation in waterways such as rivers, lakes, and bays convert it to deadly methylmercury. Fish eat contaminated vegetation, and the mercury becomes biomagnified in the fish. Fish protein binds more than 90% of the consumed methylmercury so tightly that even the most vigorous cooking methods (eg, deep-frying, boiling, baking, pan-frying) cannot remove it. (See Etiology.)
Yes: The problem was one reason why when I worked with the Objibwe in northern Minnesota, that we were told not to eat locally caught fish more than twice a week.
From the MN health department:
In Minnesota, mercury is the contaminant in fish that causes the most concern. Air pollution is the major source of mercury that contaminates the fish in Minnesota’s lakes and rivers—see Sources of Mercury Pollution and the Methylmercury Contamination of Fish in Minnesota (PDF: 50KB/2 pages). About 70 percent of the mercury in the air is the result of emissions from coal combustion, mining, incineration of mercury-containing products and other human sources. Over time, fish can accumulate relatively high mercury concentrations. That’s why it’s important to make wise choices about the fish you eat and how often you eat it.

as the UKMail article notes: Mercury poisoning often was a result of being taken for disease, especially syphillis, (one wonders how many of the "mad kings" of the past were made insane by heavy metal poisoning) but more recently pollution is the major danger:

For centuries, mercury was an essential part of many different medicines, such as diuretics, antibacterial agents, antiseptics, and laxatives. In the late 18th century, antisyphilitic agents contained mercury. It was during the 1800s that the phrase "mad as a hatter" was coined, owing to the effects of chronic mercury exposure in the hat-making industry, where the metal was used in the manufacturing process.
One horrible example of mercury poisoning from industrial pollution occured in Minamata Japan, where thousands of people were affected. It was also known as the "Pink" disease
Minamata disease is an example of organic toxicity. In Minamata Bay, a factory discharged inorganic mercury into the water. The mercury was methylated by bacteria and subsequently ingested by fish. Local villagers ate the fish and began to exhibit signs of neurologic damage, such as visual loss, extremity numbness, hearing loss, and ataxia. Babies exposed to the methylmercury in utero were the most severely affected. Furthermore, because mercury was also discovered in the breast milk of the mothers, the babies' exposure continued after birth.

The scandalous delay in getting the cause of the disease pin pointed can be read in this article from the UK Journal "Brain".

and the Medscape article lists the various sources of mercury contamination in the past and in the present day.

This is the part that worries me:
Newer compact, energy-efficient fluorescent lights contain substantial mercury concentrations, making breakages with subsequent release a concerning source of exposure.[16]

Right now, we are replacing all the light bulbs that were destroyed in a recent typhoon, and here in the Philippines, often people just throw garbage into the vacant lots, street or our open air ditches that serve as sewers...for the last few years, we do have garbage collection (which is getting better) but I still worry about all the mercury filled lightbulbs being discarded.

These new lightbulbs don't last very long, but now they are starting to sell LED bulbs, so maybe if they last longer, I'll start replacing the burnt out bulbs with the LED bulbs. (a lot of the cheaper things here in the Philippines are substandard stuff from unless you invest in buying a good brand at a high end shop, you find the item breaks quickly).

Ah, but they have their own problems, according to this ENN article:

A new study from the University of California (UC) Irvine shows that LED bulbs contain lead, arsenic, and a dozen more potentially hazardous substances... Toxins like lead and arsenic are linked to various cancers, brain damage, hypertension, skin rashes, and other illnesses. The copper in LED bulbs, once released, can affect rivers, lakes, and infect fish. 

yes, but without knowing the level of danger, this is merely a "headsup".

Everything has a risk, but one of my nightmares is the thought of mercury contamination of ground water from millions of discarded light bulbs.

Sunday, November 10, 2013

Sleep deprivation


I am old enough to remember when we were told sleep deprivation didn't make us work less efficiently, so it was okay to be on every three days (and a few years before I was an intern/resident it was every two days: Of course, in those days before ICU's, most of the work was drawing blood or starting IV's, not keeping severely sick people alive).

I have been on call and refused to see patients because I was so tired that I was hallucinating and couldn't think straight and went home to bed. UNPROFESSIONAL!

Yeah. I should have gone in and killed someone instead of waking up someone who had had some sleep do the work.

Thursday, November 7, 2013

King Alfred's Piles

I was reading up on King Alfred the Great (a new miniseries on youtube about him on the BBC but also the Cornwell series of books).

A lot of "history" folks wonder why "piles" (aka Hemorrhoids) would cause such a major health concern.

Yet the diet of the Anglo Saxons, may have been low in fiber, and no one who has had hemorrhoids would think that they are not painful.

Modern doctors, who only know modern diseases, wonder if he had Crohns disease, yet if his symptoms were intermittant abdominal pain and diarrhea/constipation, one suggests a chronic amoebiasis or chronic giardia infection might be the cause.

Returning missionaries often were labled as crazy because they developed chronic irritable bowel after treatment for amoebiasis or numerous episodes of diarrhea working overseas, but who tested clear when home.

Been there, done that....had a mild case for five years, then it went away.

Yet parasites can cause low grade chronic debilitating diarrhea.

 This is what killed General Braddock when he went after the French in Pittsburgh, and although the experts posit various problems, the western PA mountains were kept free of people by the iroquois, who used them as hunting grounds, so salmonella/shigella would be less likely...but Giardiasis is spread via Beavers, and there are plenty of them in that area.

So what about Alfred?

No good studies on health problems of the Anglo Saxon era, but given the high death rate at early ages of various kings, one wonders what the autopsies would show.

Alfred spent time in the marshes. Did he get Chronic tertiary malaria, or did the depopulation of the late Roman times and the cool years eliminate the disease? What about worms, and parasites?

another of the complications of constipation is a nasty problem called an anal fissure. This is caused by a break in the bowel mucosa, which causes an abcess that gradually works it's way out the skin....but unless you "deroof" the abcess and let it heal in from the bottom up (no pun intended) it comes back again and again. And when it's acting up, it hurts to poop, so you don't poop, and end up with a lot of abdominal pain.

wikipedia article here.

Tuesday, November 5, 2013

New treatment for wear and tear arthritis?

when they started using the anti cancer drug Methotrexate for rheumatoid arthritis, I was sceptical, until studies showed it was safer than using high dose aspirin/NSAIDs (which cause bleeding ulcers) and cortisone.

By hitting the body's immune system it slows the "auto immune" reaction against one's joints.

But now the UKMail reports that MTX is being used for osteoarthritis too.

this is "wear and tear" arthritis, but more common in some people.
Osteoarthritis: A degenerative joint disease where the cartilage, which cushions the joints, wears away
Osteoarthritis: A degenerative joint disease where the cartilage, which cushions the joints, wears away

The results also suggested that inflammation plays a role in the pain of osteoarthritis, something that hasn't been clear before.
Before she joined the pilot study in 2009, Susan had been in excruciating pain. Just over a year earlier, she'd noticed her knees were clicking when she walked, then the right one gave way completely.
'I didn't hurt myself, but all I could think of was how I was going to manage on the Nile cruise my husband, Stephen, and I were set to go on a month later,' she says.


a lot of my women patients with osteoarthritis have borderline ANA tests (1:40) but not high enough to diagnose Lupus. Wonder if this has anything to do with it. I'll have to check the medical literature and get back to you.

I should add that you have to keep an eye on the blood and liver tests when taking this toxic drug.

Sunday, November 3, 2013

Air pollution in China

I am old enough to remember before the US passed clean air laws, and we had a smog attack. Yuck.

even now, I have to use my inhaler when I travel in Manila and it is cloudy. Most of the pollution there is from automobiles.

In London, smog from small heaters caused the yellowish skies in many Victorian paintings
The sunlight pierces the smoggy sky over London's Houses of Parliament (Image: Christies Images/Corbis)
 Charles Dickens describes the sooty fog:
Fog everywhere. Fog up the river, where it flows among green aits and meadows; fog down the river, where it rolls defiled among the tiers of shipping and the waterside pollutions of a great (and dirty) city. Fog on the Essex marshes, fog on the Kentish heights. Fog creeping into the cabooses of collier-brigs; fog lying out on the yards, and hovering in the rigging of great ships; fog drooping on the gunwales of barges and small boats. Fog in the eyes and throats of ancient Greenwich pensioners, wheezing by the firesides of their wards; fog in the stem and bowl of the afternoon pipe of the wrathful skipper, down in his close cabin; fog cruelly pinching the toes and fingers of his shivering little ’prentice boy on deck. Chance people on the bridges peeping over the parapets into a nether sky of fog, with fog all round them, as if they were up in a balloon, and hanging in the misty clouds.

But it was the Great Smog of 1948, caused by a new coal burning plant, that really made people worry. More HERE from the BBC

and in the US, the Donora smog incident, from a local steel plant, killed many in the US.

So one of the health stories out of China is that they have a major smog problem that is affecting health, because they burn coal (locally mined).

They are trying to import oil to burn instead (now buying it from Iraq instead of Iran) and the problem is succinctly discussed on StrategyPage 

China needs a lot more oil because it is desperate to reduce its use of coal, which is causing more and more air pollution in the north and northeast. The annual “heating season” is in full swing up north and with that comes more coal burning and more air pollution. Foreign analysts have looked at Chinese health and life-expectancy data and concluded that the air pollution problems in northern China have reduced life expectancy up there by at least five years. ...

The pollution is believed to cause over a million premature deaths a year and the censors have been unable to keep Chinese from knowing this, or discussing it. ...

The problem is that coal use has more than quadrupled in the last two decades because of economic growth and increased demand for electricity and more heat. Fewer Chinese are willing to just shiver through the months of cold weather in the north as they have for centuries. They can now afford heat and coal is the cheapest solution

NYTimes story here 
essentially says the same thing I did.

Here in the provinces, burning trash was a big problem (we now have trash collection and a landfill dump to place the trash, which has helped a lot). But even here, when the weather is foggy/humid, I often run the airconditioner at night to keep the dust/humidity down in the bedroom. ( I have an airfilter added to the air intake to collect dust).

Right now, lots of such burning because we were hit by a typhoon two weeks back and lost a lot of roofs, houses, trees, and were without electricity/internet for ten days.

And our part time maid is always hitting on me to buy LPG gas to cook with: Her son ends up with bronchitis/allergies when she runs out, so it is cheaper to give her money for gas than treat her son.

burning wood to cook with is a major reason for asthma in the poor countries, and in places like Africa is a major cause of deforestation.

Even in the USA, wood stoves to heat with can add to the foggy morning air, and the mold on the wood stored in the houses can cause asthma/allergies 

Thursday, October 10, 2013

Danger for those going to Mecca

LATimes story about the worry that MERS, the new "SARS" or respiratory illness that can be fatal, may be spread throughout the world when pilgrims come home from the Haj.
Severe coughs or flu-like symptoms could be a sign of infection with the Middle East Respiratory Syndrome Coronavirus, or MERS-CoV, as the virus is known — and an indication that the infection, thus far detected only in the Middle East and Europe, had spread to the U.S.
Or such symptoms could be nothing significant, just the typical illnesses pilgrims pick up every year during the crowded hajj.
ignore the ignorant comments: The Saudis are quite strict when it comes to the pilgrims and considering the numbers who go there, the deaths are few.

If I remember correctly, some people who attended a Catholic meeting spread SARS...
and catching illnesses in closed airplanes is a major problem for anyone.
we had our forehead temperatures scanned when we traveled by air back then, and our clinic was warned to check for SARS for anyone who had traveled from Asia or Canada.
but SARS was easily spread person to person, including some cases that seemed to be airborne rather than close contact.

MERS is not spread person to person, although there are one or two reports that indicate that a person might have caught it from another, and there have been two nurses in Saudi, one a Filipino who died, who contracted the disease, probably from a patient.

and small pox has been spread when a Somali patient gave it to a few others a decade or more ago.

Wednesday, October 9, 2013

Smelly testing

Improbable research reports on a test for Alzheimer's using peanut butter. 

“Results. The mean odor detection distance of AD patients’ left nostril (5.1 cm), and not their right (17.4 cm), was significantly less (F(3,90) = 22.28, p &lt; 0.0001) than the other groups…. “Conclusion. This non-invasive and inexpensive left–right nostril odor detection test appears to be a sensitive and specific test for probable AD.”

actually, losing smell sensitivity is a traditonal way to test for early dementia, including HIV related dementia. This is why testing for smell is part of the neurological exam.  Usually we tested by opening a small bottle full of coffee grounds, but this webpage suggests using soap for some reason.

On the other hand, as this BMJ article notes: Hardly anyone does it nowadays in routine exams.


When was the last time you asked a patient about their sense of smell? When did you last perform any test of smell identification? Probably never is the answer to both questions. And if you ever did, I expect it was an afterthought and you had to send the clinic nurse scurrying off for an orange or some coffee grains, or worse still you dug out those prehistoric smell bottles that are more appropriate for reviving the dead than assessing the rhinencephalon (the smell brain). Ammonia is useful for cleaning metal. Tinct. asafoetida – the smell of flatus – is an important ingredient of one of the Pentagon’s most repugnant smells ‘US Government Standard Bathroom Malodor’, which causes volunteers to scream and curse within a few seconds...

Loss of smell is called anosmia, and the reason we rarely do the testing is that there are so many reasons for it that testing doesn't give you a lot of information.
LINK from webMD:

Nasal congestion from a cold, allergy, sinus infection, or poor air quality is the most common cause of anosmia. Other anosmia causes include:
  • Nasal polyps -- small noncancerous growths in the nose and sinuses that block the nasal passage.
  • Injury to the nose and smell nerves from surgery or head trauma.
  • Exposure to toxic chemicals, such as pesticides or solvents.
  • Certain medications, including antibiotics, antidepressants, anti-inflammatory medication, heart medications, and others.
  • Cocaine abuse.
  • Old age. Like vision and hearing, your sense of smell can become weaker as you age. In fact, one's sense of smell is most keen between the ages of 30 and 60 and begins to decline after age 60.
  • Certain medical conditions, such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, nutritional deficiencies, congenital conditions, and hormonal disturbances.
  • Radiation treatment of head and neck cancers.

In other words, the person is more likely to suffer from a cold than Alzheimer's disease...

Thursday, October 3, 2013

WTF stories to docs

Drudge has a  headline saying one Democrat said he hasn't read the 10 000 pages of regulations, but presumably docs will have to do so or risk a raid from the FBI?

So the AMA (which emails me but I don't belong to them anymore) has a email telling you these stories:

Add "" to your address book to ensure delivery. Trouble viewing? Read this edition online.

Hello Nancy
Wednesday, Oct. 2, 2013
Special Feature
Health policy decision-makers to discuss how new models can cut costs, improve care
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This Week's News
Senators call for one-year EHR meaningful use extensionSenators call for one-year EHR meaningful use extension
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Get ready for ICD-10; code set compliance deadline one year awayGet ready for ICD-10; code set compliance deadline one year away
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yes, we now have to be "educated" in the new health system. Never mind spending time trying to learn about diseases. We now need the equivalent of a speed reading course, a course in the language of "bureaucratese", and of course know all the signs and symptoms of not obeying big brother.

Then there is the abusurdity of the opiod regulations. Put a lable on the bottle, so that when the druggies steal our dying patient's medicines that they know they are addictive and dangerous.

Like other things from Obama's minions (and in this I point out the lopsided statistics of gun crime as the elephant in the living room), this ignores the real problem: a society that loves to get high. I mean, hey, when the biggest TV show on line is about a meth dealer, it's not like we try to portray people as evil, is it? (Or maybe the program did: a lot of moral people thought it did, but then a lot of good "christian" women liked 50 shades of grey: but here I stand with Janet Evanovich, who said she saw it as a lopsided relationship of abuse being romanticized.)

Luckily, I am retired, and too fuzzy minded and out of practice enough not to care. The only people I see are employees etc. with viruses.

Speaking of viruses: I just saw one of our (part time) drivers and his family all with flu like symptoms and fever. I saw an employee last week who also lived on a farm with the same thing. Sounds like an influenza epidemic. I'll have to check the news and my cousin Dr. Angie to see if there is a flu epidemic, or if something else is going on.